ABSTRACT
Although the development of the 2009 SpA classification criteria by Assessment of SpondyloArthritis international Society (ASAS) represents an important step towards a better definition of the early disease stage particularly in axial spondyloarthritis (axSpA), the specificity of the criteria has been criticized these days. As the commonest zoonotic infection worldwide, human brucellosis can mimic a large number of diseases, including SpA. This study was performed to determine the frequency of rheumatologic manifestations in patients with brucellosis and the chance of misdiagnosing them as having axSpA in central China. The results showed that clinical manifestations of axSpA could be observed in brucellosis. Over half of patients had back pain, and one fifth of the patients with back pain were less than 45 years old at onset and had the symptom for more than 3 months. Two young males were falsely classified as suffering from axSpA according to the ASAS criteria, and one with MRI proved sacroiliitis was once given Etanercept for treatment. Therefore, differential diagnosis including human brucellosis should always be kept in mind when applying the ASAS criteria, even in traditionally non-endemic areas.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antirheumatic Agents , Therapeutic Uses , Back Pain , Brucellosis , Diagnosis , Drug Therapy , China , Diagnosis, Differential , Diagnostic Errors , Etanercept , Therapeutic Uses , Inappropriate Prescribing , Practice Guidelines as Topic , Rheumatologists , Ethics , Sacroiliitis , Spondylarthritis , Diagnosis , Drug TherapyABSTRACT
Systemic lupus erythematosus-related acute pancreatitis (SLEAP) has a poor prognosis with a high mortality. We described the clinical features of SLEAP, and discussed the feasibility of plasma exchange (PE) combined with glucocorticosteroids (GC) in short-term prognosis and possible mechanism in reducing serum inflammatory cytokine IL-6 and removing serum lipids. A retrospective study was performed by an independent rheumatologist. Medical records of SLEAP from March 2010 to December 2014 were retrieved from Tongji Hospital information system, and patients were divided into two groups according to whether PE therapy was adopted. Sixteen patients treated with PE in combination with GC were classified as group A, and the other 10 patients who were treated with merely GC were classified as group B. Patients' clinical remission rate and average daily GC dosage after two-week therapy were compared between the two groups. Patients' serum inflammatory cytokines and lipid concentration were compared between baseline and after two-week treatment in both groups. Pearson correlation test was performed to determine association between serum cytokines and Ranson score. SLEDAI score in group A patients at baseline (14.8±3.1) showed no statistical difference from that in group B (14.1±3.3). At baseline serum IL-6 levels had no significant difference between group A [13.14 (11.12, 16.57) mg/L] and group B [14.63 (11.37, 16.37) mg/L]; after two-week therapy IL-6 decreased significantly in group A [9.16 (7.93, 10.75)mg/L] while it did not show decreasing trend in group B [13.62 (9.29,17.63) mg/L]. Serum lipid concentration after two-week therapy in group A [(TC=5.02±0.53, TG=1.46±0.44) mmol/L] decreased significantly compared to baseline [(TC=6.11±0.50, TG=2.14±1.03) mmol/L], while similar tendency was not observed in group B. The remission rate after two-week therapy was higher in group A (70.0%) than in group B (25.0%). Acute pancreatitis (AP) was one of the clinical manifestations of active SLE. PE combined with GC could reduce serum IL-6 level, and remove serum lipid to improve short-term prognosis. Therefore, it might be a safe and effective way in treating SLEAP and was worth continuing to explore its feasibility.
Subject(s)
Female , Humans , Male , Middle Aged , China , Glucocorticoids , Interleukin-6 , Blood , Lipids , Blood , Lupus Erythematosus, Systemic , Genetics , Pathology , Therapeutics , Pancreatitis , Blood , Pathology , Therapeutics , Plasma Exchange , Methods , PrognosisABSTRACT
Intraperitoneal glucose tolerance test was performed in the streptozotocin- and high fat-induced diabetic rats and normal rats.The results of RT-PCR and Western blot showed that the expression of 11?- hydroxysleroid dehydrogenase type 1 (11?-HSD1) was higher in the diabetic rats than that in control and was correlated with fasting plasma glucose,insulin and AUC-I/G with respective correlation coefficient (r) of 0.870, - 0.799,- 0.850,suggesting that increased expression of 11?-HSD1 appears to damage?-cell function through magnifying the local effect of glucocorticoids.