Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.@*METHODS@#We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.@*RESULTS@#A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803-55.938; P < 0.001).@*CONCLUSION@#As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.

Relationships between serum expression levels of CCL21 and CCL19 in rheumatoid arthritis and interstitial lung disease / 中国免疫学杂志

Objective:To investigate the relationships between the expression levels of chemokines CCL19 and CCL21 in serum of patients with RA and interstitial lung disease,as well as the correlation between the chemokines and the clinical parameters.Methods:Patients hospitalized in the First Hospital of China Medical University from May 2016 to March 2017 were enrolled.Serum levels of CCL21 and CCL19 in the 62 patients with RA,among them,34 cases without pulmonary interstitial lesions while 28 cases with lung interstitial diseases,18 cases ⅡP and 20 health control were detected with enzyme-linked immunosorbent assay (ELISA).One-way ANOVA,LSD-t test,Kruskal-Wallis test,Pearson and Spearman correlation analysis were used for statistical analysis.Results:The levels of CCL21 and CCL19 were both higher in the RA patients than the health controls(P＜0.05;P＜0.01),The concentrations of CCL21 in serum of the RA patients with ILD were higher than thoes without ILD,higher than the health controls (P＜0.05;P＜0.01),serum levels of CCL21 in the ⅡP patients were higher than the health controls (P＜0.01),too.The serum levels of CCL21 in men were higher than women(P＜0.05).Serum CCL21 levels were negatively correlated with albumin and BMI(r=-0.280,P＜0.05;r =-0.605,P＜0.05).Levels of CCL19 were negatively correlated with the levels of C4 (r =-0.326,P＜0.05),and positively correlated with the levels of D-Dimer(r =0.592,P＜0.05).Conclusion:Chemokines CCL21 and CCL19 are highly expressed in serum of patients with RA,they may be involved in the pathogenesis of RA.Furthermore,CCL21 may has a correlation with the lung interstitial lesion in RA.

Clinical study of total glucosides of paeony in patients with systemic lupus erythematosus / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the therapeutic efficacy and adverse reaction of total glucosides of paeony (TGP, extracted from Paeonia lactiflora Pall.) in patients with systemic lupus erythematosus (SLE).</p><p><b>METHODS</b>Clinical data of patients with SLE were analyzed. Those who orally took TGP continuously for five years or more were taken as TGP1 group (29 cases). Those who orally took TGP continuously or intermittently for more than one year but less than five years were taken as TGP2 group (47 cases). Twenty patients matched with the TGP1 group and the TGP2 group in age, affected duration, urine protein, and SLE disease activity index (SLEDAI) were selected as the control group. The average daily dose of prednisone, total cyclophosphamide (CTX) dose, urine protein, SLEDAI score, recurrent case, and episodes of infection were compared among the three groups after five-year treatment.</p><p><b>RESULTS</b>The average daily dose of prednisone, total CTX dose, and SLEDAI score were obviously lower in the TGP1 group than in the control group (P<0.01). The average daily dose of prednisone, total CTX dose, and SLEDAI score were obviously lower in the TGP1 group than in the TGP2 group, Significant difference was shown (P <0. 05). The average daily dose of prednisone and total CTX dose were lower in the TGP2 group than in the control group (P<0.05, P<0.01). There was no statistical difference in the urine protein among the three groups. As for the recurrence, one case occurred in the TGP1 group, nine in the TGP2 group, and seven in the control group. As for episodes of infection, there were three cases in the TGP1 group, seventeen in the TGP2 group, and eighteen in the control group during the five years. No adverse reaction correlated to TGP was found in the three groups.</p><p><b>CONCLUSIONS</b>TGP had definite therapeutic efficacy in treatment of patients with SLE. It could reduce the average daily dose of prednisone and the total CTX dose, lower the recurrent cases and episodes of infection, especially for the medication of more than five years.</p>

Clinical observation of Shuxuetong Injection in treating patients with active rheumatoid arthritis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the efficacy and adverse reaction of Shuxuetong Injection (SXTI, the extracted liquor from Pheretima and Hirudo) in treating patients with active rheumatoid arthritis (RA).</p><p><b>METHODS</b>Ninety-seven patients with active RA assigned in the SXTI group were treated with high or low dose SXTI (6 mL/d or 8 mL/d) combined with conventional therapy and the 30 in the control group treated with conventional therapy alone. Thompson index, Ritchie index, time of morning stiffness (TMS), erythrocyte sedimentation rate (ESR) and plasma fibrinogen (Fib) in patients were determined before treatment (T0), by the end of the 1st (T1), second (T2) and 4th (T3) week of treatment, respectively, as well as the SXTI associated adverse reaction monitored.</p><p><b>RESULTS</b>Marked improvement of all indexes, including Thompson index, Ritche index, TMS, ESR and Fib, was shown in the SXTI groups at T1 (P < 0.01), but in the control group, it only appeared at T3 (P < 0.01). Compared with the control group, TMS, ESR and Fib at T1, Thompson index and Ritche index at T2 in the SXTI groups were significantly improved (P < 0.01), especially significant in the high dose group (P < 0.01). However, hands edema appeared in 2 patients, foot edema in 1 and fullness sensation of head in 1 in the high dose SXTI group. The dose was forced to redue to 6 mL/d, and then all the symptoms were improved.</p><p><b>CONCLUSION</b>SXTI shows good efficacy with less adverse reaction in treating patients with active RA, and better efficacy was obtained at the dose of 8 mL/d.</p>

Clinical observation on effect of total glucosides of paeony in treating patients with non-systemic involved Sjögren syndrome / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and adverse reaction of total glucosides of paeony (TGP) in treating patients with non-systemic involved Sjögren syndrom (NSI-SS).</p><p><b>METHODS</b>Retrospective study was conducted on 27 patients with NSI-SS who received TGP treatment for over two years as the TGP group, and 20 patients received hydroxychloroquine sulfate (HCQs) for over two years in the HCQs group for positive control. Salivary flow, Schirmer's test and serum gamma-globulin at different time points, i.e. before treatment, and at the end of 1st, 3rd, 6th, 12th and 24th month respectively, were compared between groups, and adverse reactions associated with TGP and HCQ were also observed.</p><p><b>RESULTS</b>In the TGP group, saliva secretion was significantly increased and serum gamma-globulin decreased significantly from the 6th month (P <0.01), Schirmer's test improved significantly after 12 months (P< 0.01). While in the HCQs group serum gamma-globulin was significantly decreased from the 3rd month (P <0.01), saliva secretion and Schirmer's test improved significantly after six months (P<0.01). However, the 3 indexes determined at the end of the 3rd month were insignificantly different from those before treatment. Mild diarrhea occurred in 4 cases in the TGP group, they were improved two weeks later, but one case with severe diarrhea was dropped. While in the HCQs group, 2 patients were dropped, one for the raising of alanine aminotransferase at the 6th month and the other for decreased vision at the 9th month.</p><p><b>CONCLUSION</b>Efficacy of TGP is equivalent to that of HCQs in treating NSI-SS, but with higher safety and the effect initiating time being about 6 - 12 months.</p>

The mechanisms of As_2O_3 in treating rheumatoid arthritis / 中华风湿病学杂志

Objective To explore the possible mechanisms of Arsenic Trioxide in treating rheumatoid arthritis(RA)by observing the changes of HE staining and NF-KB expression as well as the apoptosis of syn- oviocytes in adjuvant-induced arthritis rats.Methods After the animal model was set up on Wistar rats sue- cessfully,they were randomly divided into AA model group and arsenic trioxide treatment group.The treat- ment group were injected with 4 mg'kg~(-1)9?d~(-1)arsenic trioxid fluid for 7 days.All of the rats were killed 3 days after the complete of injections.The joint specimens were exposed,fixed,decalcified,wrapped and cut into slices.All slices were examined by HE stain and immunohistological evaluation.Results HE staining showed that when compared with the normal control group,the layers of synoviocytes of the AA group were increased to 6-8,and the arrangement of synoviocytes was disordered and heavy inflammatory cell infiltration were found in the AA group.In the arsenic trioxide treatment group,the layers of synoviocytes increased to 3～4,and medi- um amount of inflammatory cell infiltration were found.The intensity of synovial NF-kB(p65)positive stain in AA model group was significantly higher than that in the normal control group.The synovial expression and ac- tivation of NF-kB in the treatment group were decreased markedly,and did not return to normal level.The average gray scale calculation showed that there were significant differences between the three groups(P

Expression of JAK/STAT signal pathway in collagen-induced rat rheumatoid arthritis / 中华风湿病学杂志

Objective To explore the dynamic change and meaning of JAK/STAT signal path in the invasive course of collagen-induced arthritis(CIA).Methods Forty-eight rats were divided into 6 groups ran- domly,eight rats served as the control group,the rest were for the development of CIA models.Rats were sac- rificed at the 2nd,3rd,4th,5th and 6th week after the initial immunity respectively.Then HE staining,im- munohistochemistry and immunoblotting were used to detect the pathological changes of synovium in different st ages and the expression of p-STAT1 and p-STAT3.Results On the second week after initial immunity,the rats had arthritis,and the inflammation achieved its peak at the 4th week,then gradually relieved,and a few joints developed rigidity,synovium hyperplasia and inflammatory cell infiltration could be seen at the second week of initial immunity,and pannus could be seen at the 4th week as well as cartilage destroy at the 6th week by HE staining.In the invasive course of CIA,STAT1 and STAT3 were all in activated state detected by im- munohistochemistry and immunoblotting,which were significantly different from those of control group and they had a positive correlation with arthritis index,the Pearson's value of them were 0.798 and 0.873 respectively. However,there was some difference on time.STAT3 kept at activated state and had positive correlation with pathology score of synovium,and the Pearson's value was 0.622.On the contrary,the activation of STAT1 was obviously delayed and only confined to the middle and advanced stage of the disease.Conclusion JAK/STAT signal pathway participates the pathological course of CIA,and blocking the different point of JAK/STAT path- way'activation process may reach the goal of reversing the RA's pathological course.