ABSTRACT
Objective To identify the clinical features and risk factors of early rheumatoid arthritis (RA)-associated osteoporosis in premenopausal women. Methods A total of 76 premenopausal women with early RA were randomly selected in the Department of Kidney and Rheumatology in the hospital. A total of 84 health cases were randomly selected in our hospital as controls. Bone mineral density (BMD) was determined using dual energy X-ray absorptiometry (DEX). Bone metabolism (CTX, PINP) and inflammatory cytokines (IL-17, IL-6, TNF-α) were examined with quantitative enzyme-linked immune-sorbent assay (ELISA). Quantitative data were expressed as x ±s deviation and the data were compared between groups using non- parametric test (Z value). Multi-group comparison was performed with variance analysis. Qualitative data were compared with Fisher's test. Logistic regression was used to investigate the risk factors. Results ①Compared with the control group, BMD in the premenopausal women with early RA group [neck: (0.802 ±0.193) g/cm2, GT zone: (0.923±0.033) g/cm2, L1: (0.862±0.011) g/cm2] was significantly decreased [(0.981±0.032) g/cm2, (0.771 ±0.023) g/cm2, (0.912 ±0.012) g/cm2, F=14.401, 19.860, 6.560, respectively, both P<0.05). The prevalence of osteoporosis in this group was 7%(5/76), which was higher than controls 1%(1/84). ② According to values of Bone meta-bolism [(CTX: (0.37±0.21) ng/ml] and inflammatory cytokines, TNF-α: (9.8±4.1) pg/ml, IL-6: (33.6±5.7) pg/ml and IL-17: (129±24) pg/ml were markedly increased in premenopausal women in early RA group [(0.24 ±0.09) ng/ml, (6.7 ±1.9) pg/ml, (1.5 ±0.4) pg/ml, (45 ±7) pg/ml, Z=2.722, 5.932, 7.501, 4.370, respectively, both P<0.05]. ③ The premenopausal women with early RA group with osteoporosis were signifi- cantly difference with controls in BMI [(9±3) kg/m2 vs (16±3) kg/m2], bone density of neck [(0.85±0.20) ng/ml vs (0.88±0.14) g/cm2], L2 [(0.75±0.23) g/cm2 vs (0.88±0.14) g/cm2], L3 [(0.87±0.07) g/cm2 vs (0.93±0.14) g/cm2], L4 [(0.92±0.12) g/cm2 vs (0.94±0.16) g/cm2], serum ESR [47.8(22.0, 76.0) mm/1 h vs 18.8(8.7, 35.2) mm/1 h] and DAS28-CRP (5.3 ±1.2 vs 3.8 ±1.2) F=0.68, 14.632, 26.114, 20.931, 36.582, Z=3.21, 6.58, respectively, both P<0.05. ④ Logistic regression showed that IL-6 (Wald χ2=5.78, P=0.021), PINP (Wald χ2=5.12, P=0.031), CTX (Wald χ2=9.17, P=0.003), ESR (Wald χ2=9.24, P=0.011), DAS28-CRP (Wald χ2=17.28, P=0.001) were significantly positively correlated with osteoporosis. Moreover, ordered unconditional Logistic regression analysis of the variables (IL-6, PINP, CTX, ESR, DSA28) described above showed that DAS 28-CRP score [OR=1.58, 95%CI: (1.10, 2.20)] was the most important risk factor for osteoporosis in premenopausal women with early RA. Conclusion The incidence of osteoporosis is high in premenopausal women with early RA than healthy cases. DAS 28-CRP score is the important risk factor for premenopausal women with early RA- associated osteoporosis. Measures relieve symptoms of RA can help to prevent and treatment osteoporosis.
ABSTRACT
Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.