Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China / 中华医学杂志(英文版)

BACKGROUND@#Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income.@*METHODS@#This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients' treatment satisfaction.@*RESULTS@#When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P 50% subgroup (all P 50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032).@*CONCLUSION@#Higher disease severity and higher financial burden were associated with lower patient satisfaction.

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.

Logistic regression analysis of damp-heat and cold-damp impeding syndrome of rheumatoid arthritis: a perspective in Chinese medicine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate a method for quantitative differential diagnosis of damp-heat and cold-damp impeding syndrome of rheumatoid arthritis (RA) in Chinese medicine (CM).</p><p><b>METHODS</b>Laboratory parameters were collected from 306 patients with RA. The clinical symptoms and laboratory parameters were compared between patients with these two syndromes (158 with RA of damp-heat impeding syndrome, and 148 with RA of cold-damp impeding syndrome), and a regression equation was established to facilitate discrimination of the two RA syndromes.</p><p><b>RESULTS</b>There were significant differences in disease activity score in 28 joints [DAS28 (4)], erythrocyte sedimentation rate (ESR), white blood cell count (WBC), C-reactive protein (CRP), platelet count (PLT), albumin (ALB) and globulin (GLB) between the two syndrome of RA (P<0.05). Logistic regression analysis showed that the parameters ESR, WBC, CRP, joint pyrexia, joint cold, thirst, sweating, aversion to wind and cold, and cold extremities were statistically useful to discriminate damp-heat from cold-damp impeding syndrome. The regression equation was as follows: P=1/{1+exp[-(3.0-0.021X (1)-0.196X (2)-0.163X (3)-1.559X (4)+1.504X (5)-0.927X (6)-1.039X (7)+1.070X (8)+1.330X (9))]}. The independent variables X (1)-X (9) were ESR, WBC, CRP, hot joint, cold joint, thirst, sweating, aversion to wind and cold, and cold limbs. A P value > 0.5 signified cold-damp impeding syndrome, and a P value < 0.5 signified damp-heat impeding syndrome. The accuracy was 90.2%.</p><p><b>CONCLUSION</b>The regression equation may be useful for discriminating damp-heat from cold-damp impeding syndrome of RA.</p>

Effect of methotrexate in treating patients with rheumatoid arthritis of different Chinese medical syndrome patterns / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study whether the effects of methotrexate were different in treating patients with rheumatoid arthritis (RA) of different Chinese medical syndrome patterns.</p><p><b>METHODS</b>Retrospective analysis was conducted in 312 RA patients treated with methotrexate, the Chinese medical syndrome patterns in them were differentiated into the cold-dampness blocking collateral type (SA), the heat-dampness blocking collateral type (SB), the phlegm blood-stasis intermingling type (SC), and the heat-cold complex type (SD). Parameters including numbers of joint with tenderness (Njt) and that with arthroncus (Nja); patient's morning stiffness duration (MSD), scores estimated by visual analog scale (VAS) and health assessment questionnaire (HAQ); as well as laboratory indices involving rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), etc. were recorded before and after treatment and statistically analyzed.</p><p><b>RESULTS</b>After treatment, improvements were shown in all patients in terms of Njt, Nja, MSD, VAS scores and ESR, showing significant difference as compared with those before treatment (P < 0.05); and the improvements among patients with different Chinese medical syndrome types were different in degree, the best curative effect was shown in patients of SB type (chi2 = 45.3, P < 0.05).</p><p><b>CONCLUSIONS</b>Referring to Chinese medical syndrome patterns, the curative effect of methotrexate on patients with Heat-Dampness blocking collateral pattern is better than on those of other pattern.</p>

The objectivity research on 322 rheumatoid arthritis patients of dampness-heat impeding and cold-dampness impeding Chinese medical syndrome types / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To analyze the Chinese medical syndrome typing laws in rheumatoid arthritis (RA) patients of the dampness-heat impeding syndrome and the cold-dampness impeding syndrome.</p><p><b>METHODS</b>Clinical data and serum of 322 inpatients and outpatients were collected to perform DAS28 score. Laboratory indices including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin (ALB), globulin (GLB), and blood routines (white blood cell, red blood cell, and platelet) were tested by conventional methods, and the serum levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta were detected by ELISA. The difference of each index was analyzed between RA patients of the dampness-heat impeding syndrome and the cold-dampness impeding syndrome.</p><p><b>RESULTS</b>The levels of DAS28 scores, ESR, CRP, white blood cell count, and platelet of RA patients of the dampness-heat impeding syndrome were significantly higher than those of the cold-dampness impeding syndrome (P <0.01). The serum level of GLB of RA patients of the dampness-heat impeding syndrome was obviously higher than that of the cold-dampness impeding syndrome (P <0.01), while the serum ALB level of RA patients of the dampness-heat impeding syndrome was obviously lower than that of the cold-dampness impeding syndrome (P<0.01). Compared with the dampness-heat impeding syndrome, ROC curve results showed the area under the curve (AUC) were ranked from large to small as DAS28 score > ESR >CRP >GLB > PLT >WBC (P<0.01). Compared with the cold-dampness impeding syndrome, only ALB was of diagnostic value for cold-dampness impeding syndrome and the AUC was 0.636 (P = 0.000).</p><p><b>CONCLUSION</b>DAS28 score, ESR, CRP, PLT, WBC, GLB, and ALB could be used as objective index in identifying the differences between the dampness-heat impeding syndrome and the cold-dampness impeding syndrome in RA patients.</p>

TCM differentiation and treatment of fibromyalgia syndromes based on meridian science / 中国针灸

Fibromyalgia syndrome (FS) is a rheumatic and immunologic disease and the disease incidence is ranked at the third in the rheumatic diseases, characterized by whole-body myalgia, and with mental and nervous symptoms and signs. At present, there is no ideal therapy for it. Based on TCM theories, this article tries to analyze the pathogenesis of FS from the angle of meridian and collateral science, and according to location of pain of the patient, TCM syndrome differentiation for corresponding channels and collaterals is made and FS possible relation with dysfunction of qi is raised, which is used to guide the treatment, so as to provide a better physical treatment way.

Clinical analysis of 682 patients with severe acute respiratory syndrome / 第三军医大学学报

Objective To study the epidemiological and clinical characteristics of patients with severe acute respiratory syndrome(SARA). Methods Clinical data from 682 patients with SARS were retrospectively analyzed. Results The patients ranged from 13 to 76 years old, 387 male and 295 female. A total of 356 patients (52.2) had a history of close contact with diagnosed SARS patients, and 113 (25.1%) had been to hospital ever. The most common symptom was fever (99.3%), followed by cough (44.4%), shortness of breath (12.2% ), diarrhea (8.9%). 596 patients (87.4%) had normal or decreased white blood cell counts. Serum ALT and CPK levels were elevated in 112 patients (16.4%)and 17 patients (2.5%) respectively. Infiltrates on chest radiography were seen in all patients, with 69.8% involved both lungs. Six patients (0.9%) died of SARS. Conclusion SARS is infectious. Hospital is an important place where SARS transmits. Fever, cough and infiltrative changes on chest radiography are mainly symptoms and signs.