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Objective:To study the efficacy and drug-related adverse reactions of long-term appli-cation of biological anti-rheumatic drugs (bDMARDs) to patients with ankylosing spondylitis (AS), and provide reference for clinical diagnosis and treatment.Methods:We retrospectively analyzed the clinical data of AS patients who were followed-up for more than 5 years in the Department of Rheumatology and Immunology of Peking University Shenzhen Hospital. The patients treated with bDMARDs alone or combined with traditional antirheumatic drugs were included as the treatment group, while those who did not receive biological or non-biological antirheumatic therapy were included as the control group. The data collected included clinical sym-ptoms, inflammatory biomarkers, imaging results, drug applications and drug-related adverse reactions, etc. The counting data were tested by χ2 test, the measurement data in normal distribution was tested by t test, and the measurement data that not normally distributed was tested by Mann-Whitney U test. Paired test was used for statistical processing before and after treatment. Results:We collected the data of 114 eligible patients, including 64 in the treatment group and 50 in the control group. There were no significant differences in baseline data between the 2 groups, including mean follow-up time, course of disease, age, sex ratio, HLA-B27 positive rate, morning stiffness duration, night pain, peripheral arthritis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging. After 5 years, patients in the treatment group had shorter morning stiffness [(3±7) min vs (26±37) min, t=4.827, P<0.01], lower nighttime pain rates [(3/64, 4.8%) vs (29/50,58.0%), χ2=38.329, P<0.01], lower ESR level [(14±14) mm/1 h vs (20±18) mm/1 h, t=2.102, P=0.038], lower CRP level [(7±8) mg/L vs (14±19) mg/L, t=2.431, P=0.017], and lower progression rate of sacroiliac arthritis [(18/64, 28.1%) vs (35/50, 70.0%), χ2=19.786, P<0.01], than the control group. The main drug-related adverse reactions in the treatment groupincluded reversible leucopenia, elevated transaminase level, redness and swelling at the injection site. Conclusion:Biologics treatment for more than 3 consecutive years can effectively control the clinical symptoms of most AS patients, reduce inflammatory indicators and delay the imaging progression of the sacroiliac joint. Without treatment, the imaging progress of the sacroiliac joint in AS patients could be 70% after 5 years.
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Objective:To observe the long-term effects of conventional disease modifying anti-rheumatic drugs (cDMARDs) in the treatment of ankylosing spondylitis (AS) and drug-related adverse reactions, and provide reference to clinical treatment and assessment.Methods:Retrospective analysis was performed for AS patients with more than 10 years follow-up records in the Department of Rheumatology and Immunology, Peking University Shenzhen Hospital. The AS patients enrolled were treated with cDMARDs, non-steroid anti-inflammatory Drugs (NSAIDs), and glucocorticoidsonl only. The treatment group was treated continuously for at least 3 years, and the control group was untreated or treated for less than 3 months. Clinical symptoms, inflammatory indicators, imaging results and drug-related adverse reactions of all patients were collected for statistical analysis. The counting data were tested by χ2 test, the measurement data in normal distribution was tested by t test, and the measurement data that not normally distributed was tested by mann-whitney U test. Paired test was used for statistical processing before and after treatment. Results:A total of 166 eligible patients were included, including 111 in the treatment group and 55 in the control group. There were no statistical significant differences between the treatment group and the control group at baseline including the mean follow-up time, symptomatic disease course, age, sex ratio, human lymphocyte antigen (HLA)-B27 positive rate, duration of morning stiffness, pain at night, peripheral arthritis, ESR, CRP and imaging data. After 10 years, the treat-ment group had shorter morning stiffness[(8±18) vs (22±34), U=2 228, P=0.008], less nocturnal pain [(2/1.9%) vs (19/36.5%), χ2=37.037, P<0.01], lower ESR level [(14±13) vs (20±19), t=2.249, P=0.026], lower CRP level [(6±6) vs (10±11), t=2.154, P=0.033], lower incidence of peripheral arthritis [(23/20.7%) vs(25/45.5%), χ2=10.946, P=0.001] and lower sacroiliac arthritis progression rate [(28/25.2% ) vs (46/83.6%), χ2=50.922, P<0.01], and lower spinal progression rate [(8/7.2%) vs (51/92.7%), χ2=117.407, P<0.01] compared with the control group. The differences between the two groups was statistically significant. The main medications and drug proportions in the treatment group were as follows: sulfasalazine (100%), methotrexate (86.5%), NSAIDs (98.2%), glucocorticoid (78.4%) and thalidomide (62.2%). The main drug-related adverse reactions that occurred during the treatment included dizziness, abnormal menstruation, and reversible liver dysfunction. Conclusion:The combination of cDMARDs can effectively control the clinical symptoms of most AS patients, reduce inflammation indicators, delay the progression of sacroiliac joint and spinal damage, and have no serious drug-related adverse reactions. Almost all of the untreated AS patients have radiographic progression of the sacroiliac joint and spine.
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Objective To observe the clinical characteristics of ankylosing spondylitis (AS) patients with hyperuricemia (HUA), and to understand the correlation between AS and HUA, so as to improve the understanding of AS patients with HUA. Methods A retrospective analysis was carried out in patients with the diagnosis with AS from November 2012 to August 2016. Patients were divided into two groups based on complicated with and without HUA. The clinical manifestations, inflammatory indicators, imaging manifest-ations, treatment and outcomes of the two groups were statistically analyzed, and the follow-up results of some patients with HUA were analyzed. The chi-square test was used for the counting data. The measurement data in line with the normal distribution were tested by t test, and the measurement data in non-normal distribution were tested by Mann-Whitney U test. Results Three hundred and sixty-two patients with AS were collected, consisting of 288 males (79.6％) and 74 females (20.4％), aged from 14 to 72 years, a course of disease was 3 months to 40 years. There were 87 cases (24.0％) with hyperuricemia, 77 cases were male (88.5％, 21.3％of all AS patients), and 10 were female (11.5％, 2.8％ of all AS patients). Shorter morning stiffness time [(13 ±31) min and (22 ±48) min, Z=-2.231, P=0.026], lower IgM level [(1.4 ±1.3) g/L and (3.0 ±4.3) g/L, Z=-2.040, P=0.041], and lower erythrocyte sedimentation rate [(25±17) mm/1 h and (33±22) mm/1 h, t=-2.617, P=0.007] in the HUA group when compared with patients without HUA. The difference between the two groups was statistically significant. Four cases (4.6％) had gout arthritis in the group with HUA, all were male, blood uric acid level all>420 μmol/L. There were 7 cases (8.0％) of urolithiasis in the group with HUA, and 24 cases (8.7％) of urolithiasis in the group without HUA, but there was no statistically significant difference in the incidence of urolithiasis between the two groups. None developed hypertensive disease, heart disease, nephropathy, or diabetis. Conclusion The incidence of hyperuricemia is high in AS, and with lower disease activity, and fewer complications.
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Objective To investigate the clinical features of systemic sclerosis( SSc)patients with pulmonary hypertension(PAH)ane its treatment approach ane prognosis. Methods The clinical information of 16 SSc patients with PAH(PAH group)were recoreee. Seventy-four SSc without PAH were servee as no-PAH group. Patients in PAH group were given the basic therapy inclueing oxygen therapy,anticoagulants,careiac, eiuretic,anti-rheumatic,pulmonary vasoeilator therapy. Results The rate of antinuclear antiboey in PAH ane non-PAH group were 87. 5%(14 / 16)ane 75. 7%(56 / 74),ane the eifference was statistically significant(P= 0. 508). Serum albumin,erythrocyte seeimentation rate at 1 h in PAH group were(32. 6 ± 4. 6)g/ L ane (48. 4 ± 29. 4)mm/ 1 h. The rate of acral lesion proteinuria,hematuria,ECG abnormal rate were 62. 5%(10 / 16),62. 5%(10 / 16),43. 8%(7 / 16),62. 5%(10 / 16)respectively in PAH group. Serum albumin, erythrocyte seeimentation rate at 1 h in PAH group were(35. 6 ± 5. 0)g/ L ane(31. 3 ± 26. 3)mm/ 1 h in non-PAH group. The rate of acral lesions,proteinuria,hematuria,ECG abnormal rate were 31. 1%(23 / 74),27. 0%(20 / 74),12. 2%(9 / 74),9. 5%( 7 / 74 ) respectively in non-PAH group. The eifferences were significant between in terms of all above ineices(P = 0. 033,0. 041,0. 018,0. 006,0. 003,0. 000). During follow-up,the eisease was in stable in 74 case of non-PAH. Among 16 case with PAH,1 mile case was lost,1 case with severe PAH eiee of severe pneumonia,pulmonary hypertension,right ventricular failure,respiratory failure,3 mile patient with PAH were with eevelopment of primary eisease ane the rest 11 cases of PAH patients were with lower interstitial lung eisease than that of the previous eetectee by chest HRCT. Oppler echocareiography measurement of pulmonary artery systolic pressure was(48. 9 ± 2. 4)mmHg before treatment ane then reeucee to(31. 5 ± 4. 5)mmHg in rest 11 cases(t = 22. 27;P = 0. 001)measuree by Doppler echocareiography. Careiac function was improvee euring followee up ane no other aeverse reactions were seen. Conclusion SSc patients merge multiple PAH show it associate with other organ eamage,ane has a poor prognosis. Early careiac Doppler ultrasoune shoule be performee in oreer to get early eiagnosis ane treatment. Treatment approaches shoule be targetee at the primary eisease ane incentives such as pulmonary besiee oxygen therapy,eiuretics,careiac ane anticoagulant erugs in oreer to improve prognosis.
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Objective To investigate the clinical manifestations of cytomegalovirus (CMV) infection in patients with systemic lupus erythematosus (SLE). Methods Data of the consecutive cases of SLE complicated with active CMV infection including clinical manifestations, SLEDAI score, dosage of corticosteroid and immunosuppressants used for treatment,radiological and laboratory examinations were collected and analyzed.Results Among 2221 consecutive patients of SLE, 5.4%(121 cases) were diagnosed to be complicated with active CMV infection. Fever was the most common symptom, followed by serious liver function damage,respiratory symptoms,hematological abnormalities, myocarditis, and encephalopathy, accounted for 81%(98cases), 6.6%(8 cases), 4.1%(5 cases), 3.3%(4 cases), 0.8%(1 case), and 0.8%(1 case)respectively; in addition, 22 (18.2%) cases had no symptom. SLEDAI was higher than 15 in 47.1% cases, and 10-14 in 28.1% cases. 81% of patients were treated with corticosteroid, and 55.4% were treated with immunosuppressants. Ganciclovir was given once the diagnosis of active CMV infection was established. In most of the patients, active CMV infection had been controlled within 14-28 days, except 4 died and 6 gave up the therapy. Conclusion SLE with active CMV infection is common,especially in patients who are treated with corticosteroid and/or immunosuppressants. Clinical manifestations of SLE complicated with active CMV infection are generally nonspecific.In patients with unexplained fever,or liver damage,or lung disease,or active SLE patients who have no symptom but are refractory to the treatment, CMV infection should be suspected and the relevant laboratory tests should be ordered for early diagnosis and treatment.
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Objective To investigate the expression of transforming growth factor beta (TGF-β) and Smad signaling in ankylosing spondylitis (AS) and to explore their roles in the pathogenesis. Methods Fiftythree patients with AS were included in the study. In these 53 cases, 30 patients were performed computed tomography-guided needle biopsy in sacroiliac joint. Serum TGF-β_1 was determined by enzyme-linked immunosorbent assay (ELISA). Immunohistological studies were performed with the streptavidin-peroxidase conjugated methods to assess the expression of TGF-β_1, p-smad3 and Smad7 in sacroiliac joint tissue sample.One-way ANOVA, two independent samples t test and kolmogoorov-Simimov test were used to do statistical analysis. Results In 53 cases patients with AS, 20 cases were with high level Erythro-cyte sedimentation rate(ESR) and C-reactive protein (CRP), while those of the other 33 cases were normal. Serum average TGF-β_1level [ (15.9±5.6) ng/ml ], in patients with high level ESR/CRP [(5.4±5.8) ng/ml ] was significantly increased as compared to the controls and patients with normal ESR/CRP [(4.1±3.6) ng/ml] (P<0.05). There was no expression of TGF-β_1 could be detected in the pannus and bone marrow in SI joints tissue of 30 cases with AS, while decreased level of smad7 expression was detected. In addition, p-smad3 expression was found in the nuclear. Conclusion TGF-β_1 signaling may play an important role in the inflammatory erosion and cartilage fibrosis of sacrojlitis in AS.