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Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation of the joints with high risk of disability. In recent years, remarkable progress has been made towards the diagnosis and treatment of RA, and the international RA guidelines have been also kept updated. Nevertheless, there are many challenges in China, especially inadequate number of rheumatologists and insufficient experience in the diagnosis and treatment of RA. Therefore, Chinese Rheumatology Association drafted the standardized diagnosis and treatment of RA based on the available evidence, so as to improve the management of RA patients in China.
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Objective:To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus (SLE).Methods:A severe SLE patient with lupus myocarditis, neuropsychiatric lupus, thrombotic microangiopathy (TMA) and other multiple system involvement was reported and discussed.Results:A young female patient developed albuminuria 5 months ago, edema of both lower limbs 3 months ago, change of consciousness 1 month ago and two convulsions attack 2 days ago. She experienced life threatening manifestations such as neuropsychiatric lupus, myocardial involvement of lupus, and TMA. During the course, her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion:Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.
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Rheumatic diseases are a kind of chronic inflammatory diseases mainly involving joints and surrounding tissues. Most patients with rheumatic diseases need long-term treatment, which is difficult to be avoided during pregnancy. Treatment efficacy, as well as maternal and fetal safety should be taken into account in the medical decision. Based on the domestic and foreign guidelines, consensus, diagnosis and treatment experience, Chinese Rheumatology Association developed the standardization of medication use in patients with rheumatic diseases preparing and during pregnancy, aiming on the application and precautions of commonly used medicines for rheumatic diseases in preparing pregnancy, pregnancy and lactation.
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Primary biliary cholangitis is a chronic autoimmune cholestatic disease with a progressive course. This disease is not rare in China, but standardized diagnosis and treatment for primary biliary cholangitis are insufficient. Based on the evidence and guidelines from China and other countries, Rheumatology Branch of Chinese Medical Association developed the recommendations of diagnosis and treatment for primary biliary cholangitis in China. The aim is to help clinicians recognize clinical characters, therapeutic selection and prognosis judgement of primary biliary cholangitis, which will contribute to make diagnosis in time, to select treatment properly and to manage follow-up scientifically.
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Objective:To investigate the clinical characteristics, prognosis, and risk factors for poor prognosis of neuropsychiatric systemic lupus erythematosus (NPSLE) .Methods:Patients who were diagnosed as NPSLE between January 2009 to January 2019 in Peking University First Hospital were included. Patients with neuro-psychiatric symptoms caused by other reasons such as infection and metabolic disorders were excluded. Patients were retrospectively followed up by telephone or medical records. Continuous variables were compared by student t test or Wilcoxon rank sum test. Quantitative variables were compared by chi-square test. Survival was analyzed by Kaplan-Meier curve. Predictive factors of prognosis was estimated by using Cox regression analysis. Results:One hundred and nine NPSLE patients were included. Thirteen (11.9%) were male and 96 (88.1%) were female with a median age of 33 years old. Central nervous system involvement was predominant (89/109, 81.7%) . The most common types were headache, cerebrovascular disease and epilepsy. Cranial neuropathy was the most common type at the initial onset of systemic lupus erythematosus (SLE) , while cerebrovascular disease was more common when SLE relapsed. Patients who demonstrated NPSLE at the initiation of SLE had shorter survival time than those who got NPSLE when SLE relapsed [ (32±26) months vs (197±79) months, t=2.834, P=0.037]. Among the 105 patients with complete followed up data, the follow up time was 118.0 (1.4, 525.7) months and 53.1 (0.4, 363.0) months from the onset of SLE and NPSLE, respectively. The mortality rate was 14.3% (15/105) . The survival rates of 1-5 years were 96.2%, 94.3%, 91.0%, 89.9% and 88.3%, respectively. The survival time was (180±138) months and (33±32) months, t=3.861 , P<0.01) from the onset of SLE and NPSLE, respectively. The major causes of death were infection, NSPLE and cardiovascular disease. Cerebrovascular disease was the independent risk factor for death [ RR=3.413, 95% CI (1.049, 11.102) , P=0.041]. Conclusion:Cranial neuropathy is the most common type at the initial onset of SLE, while cerebrovascular disease is more common when SLE relapsed. Patients who had NPSLE at the initiation of SLE have shorter survival time than those who got NPSLE when SLE relapsed. Cerebrovascular disease is the independent risk factor of death of NPSLE patients.
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Objective:To analyze the characteristics of various clinical parameter reflecting the di-sease activity of patients with rheumatoid arthritis (RA) and explore their objectivity and different clinical values.Methods:The clinical data and ultrasonic data of 28 joints of RA patients diagnosed between 2014 and 2018 were collected. The characteristics of clinical indicators were analyzed, and their correlation with total grey scale (GS)/power Doppler (PD) scores of 28 joints was explored. Semi-quantitative score (0-3 points) of GS and PD for synovial hyperplasia was performed on 28 joints of selected patients by ultrasound. Total GS/PD scores include 28 joints. The characteristics of clinical parameters were analyzed, and their correlation with total GS/PD scores of 28 joints was explored. The normal distribution data was represented by mean SD, while the non-normal distribution data was represented by median (interquad interval, IQR). Correlation analysis was performed using 95% Spearman nonparametric correlation coefficient. All statistical tests were bilateral, with a significance of P<0.01. Results:163 RA patients were enrolled. 85% of them were female, with an average age of (52.0±13.0) years and a median course of disease 34(24, 45) months. The disease activity score in 28 joints C-reactive protein (DAS28-CRP), simplified disease activity index (SDAI) and clinical disease activity index (CDAI) were 4.2(2.4, 5.4), 17.9 (5.7, 33.3) and 16.0 (5.0, 28.5), respectively. There was discordance between tender joint count (TJC) and swollen joint count (SJC) in some patients. Eighty-nine (54.6%) patients had higher TJC than SJC, while 19(11.7%) patients had fewer TJC than SJC. The accordance between physician's global assessment (PGA) and evaluator Sglobalassessmentofdiseaseactivity (EGA) was observed in only 61 cases (37.4%). Eighty-nine patients (54.6%) had a higher PGA than EGA. Overall, all the parameters [TJC, SJC, PGA, PGA, erythrocyte sedimentation rate (ESR) and CRP] were positively correlated with the total GS/PD scores ( r>0.50, P<0.01). Composite disease activity scores, DAS28, SDAI and CDAI, were also significantly correlated with total GS/PD scores ( r>0.59, P<0.01). But compared with TJC, the correlation between SJC and GS/PD was better ( r=0.59/0.60, P<0.01; r=0.50/0.51, P<0.01). Similarly, compared with GPA, the correlation between EGA and GS/PD was better ( r=0.66/0.67, P<0.01; r=0.55/0.58, P<0.01). Conclusion:The composite disease activity scores and all their components are significantly correlated with ultrasonic synovitis. Compared with TJC and PGA, SJC, EGA, CRP and ESR show a higher correlation with joint ultrasonic synovitis, and are more objective and meaningful in the evaluation of RA disease activity.
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Objective:To investigate the frequency of metabolic syndrome (MS) in patients with psoriatic arthritis (PsA) and further analyze the correlation of MS and its components with clinical features of PsA.Methods:Data including demographics, clinical manifestations, laboratory tests, MS-associated features (height, weight, waist circumference, blood pressure, serum lipid spectrum, and so on) and history of complications (hypertension, diabetes mellitus, atherosclerosis, coronary heart disease, and cerebral vascular disease) were collected from PsA patients in our hospital from Jan 2017 to Sep 2019. The frequency of MS in PsA patients was calculated and the association between PsA clinical manifestations and MS as well as its components was investigated.Results:One hundred and sixty-two PsA patients who fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) were recruited. Hypertension was identified in 36 (22.2%) patients, diabetes mellitus in 28(17.2%) patients, coronary heart disease in 11(6.7%) patients, and cerebral vascular disease in 7 (4.3%) patients. Based on the criteria of the International Diabetes Federation (IDF), 58(35.8%) patients were diagnosed as MS. Compared with MS-free patients, patients with MS, hypertension or diabetes mellitus were older [(54±10 vs 44±13; 56±11 vs 45±12; 54±11 vs 44±13, respectively, t=5.058 , 4.450, 5.150, P<0.01 for all], with higher disease activity [DAPSA scores 16.75(11.25, 26.7) vs 8.8(4.8, 16.4), 16.3(9.6, 27.8) vs 10.0 (5.1, 18.0), 14.4 (9, 25.7) vs 9.5 (5, 17.7), Z=4.539 , 3.046, 3.063, P<0.01]. There was a positive correlation between the sum of components of MS and DAPSA score ( r=0.27 , P<0.01), but multiple linear regression showed no correlation between each component with DAPSA score ( P>0.05) except for hypertension ( P<0.01, standard coefficient=0.334) and elevated fasting blood glucose ( P=0.023, standard coefficient=0.247). PsA patients with hypertension had higher ESR [16.5 (9.5, 34.25) mm/1 h vs 10 (5, 24.5) mm/1 h, Z=2.127, P=0.012]. CRP level was higher in patients with dyslipidemia [5.6(2.1, 17.8) mg/L vs 3.7(1.5, 6.5) mg/L, Z=2.543, P<0.01]. Prevalence of inflammatory back pain was also higher in dyslipidemia patients (41.3% vs 22.4%, χ2=5.901, P=0.016). DAPSA score was higher in dyslipidemia patients (14.1 vs9.9, P=0.031). Conclusion:MS and its components are not rare comorbidities in PsA patients. PsA patients with MS tend to be older with higher disease activity, which calls for more attention.
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Objective:Anti-cyclic citrullinated peptide (CCP) antibody is an important biomarker as-sociated with the diagnosis and prognosis of rheumatoid arthritis (RA). Different studies showed inconsistency in the relationship between anti-CCP antibody titers and RA disease activity. Therefore, we investigated the association between anti-CCP antibody with the possibility of achieving treatment target and flare.Methods:The enrolled RA patients must be anti-CCP antibody positive at baseline, and had at least one test result of anti-CCP antibody during follow-up at least one year after the baseline. The patients were divided into declined group and non-declined group according to the decrease of anti-CCP antibody titer over 10% or not during follow-up from the baseline. Single factor comparison, Pearson correlation, Spearman correlation and Kendall correlation analysis were used.Results:A total of 124 patients were included in this study. Sixty-five and 59 patients were in anti-CCP antibody declined and non-declined groups, respectively. At the end of the follow-up, the proportion of patients who achieved clinical remission or low disease activity were 78%(51/65) and 68% (40/59)in the declined and the non-declined groups, respectively ( P=0.181). The changes of Disease Activity Score with 28 joint (DAS28)-C-reaction protein (CRP), DAS28-erythrocyte sedimentation rate (ESR), tender joint count (TJC) and CRP in the declined group were significantly greater than those of the non-declined group ( P values <0.05). There was no positive correlation between anti-CCP antibody titer and several disease activity indicators at baseline ( r values <0.3, P values >0.05). The changes of anti-CCP antibody titers during the follow-up were also not correlated with changes in disease activity (but r values <0.3, P values <0.05). Meanwhile, both the baseline anti-CCP antibody titers and the changes of the anti-CCP antibody titers during follow-up were neither correlated with whether the patient achieved clinical remission or low disease activity at the end of the follow-up nor whether relapse happened. Conclusion:There is no significant correlation between anti-CCP antibody levels at baseline and disease activity, achievement of treatment target, or recurrence after treatment. The value of anti-CCP antibody in assessing disease activity, predicting treatment response, and predicting relapse needs to be confirmed in further large-scale prospective studies.
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Immunotherapy has recently led to a paradigm shift in cancer therapy, in which immune checkpoint inhibitors (ICIs) are the most successful agents approved for multiple advanced malignancies. However, given the nature of the non-specific activation of effector T cells, ICIs are remarkably associated with a substantial risk of immune-related adverse events (irAEs) in almost all organs or systems. Up to 90% of patients who received ICIs combination therapy experienced irAEs, of which majority were low-grade toxicity. Cytotoxic lymphocyte antigen-4 and programmed cell death protein-1/programmed cell death ligand 1 inhibitors usually display distinct features of irAEs. In this review, the mechanisms of action of ICIs and how they may cause irAEs are described. Some unsolved challenges, however really engrossing issues, such as the association between irAEs and cancer treatment response, tumor response to irAEs therapy, and ICIs in challenging populations, are comprehensively summarized.
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Humans , Antineoplastic Agents/adverse effects , Immune Checkpoint Inhibitors , Immunotherapy/adverse effects , Neoplasms/drug therapyABSTRACT
Objective:To explore the clinical and serological evolution of patients with positive antiphospholipid antibodies (aPL), and the factors and therapeutic implications associated with aPL negativization.Methods:Patients with a persistent serological positive aPL according to established criteria between 1997 and 2018 were included. The Lupus anticoagulant (LA), anti-cardiolipid antibody (aCL) and anti-β 2 glycoproteinⅠ (anti-β 2GPⅠ) were tested following the International Society on Thrombosis and Haemostasis guidelines. The patients were classified as aPL negativization if the following aPL tests became negative, on two or more occasions at least 12 weeks apart. Titer more than 40 RU/ml was defined as moderate to high titer for anti-aCL and anti-β 2GPⅠ. For patients receiving warfarin, the results of LA were counted only when international normalized ratio (INR)<1.5. Results:There were 93 patients finally involved. 25% of them were primary APS and 63% were conco-mitant with systemic lupus erythematosus (SLE). After a mean follow-up of 45.0 (45.0) months, the percentage of aPL negativization was 11%(9/83), 26%(18/69), 24%(13/53) for LA, aCL and anti-β 2GP Ⅰ respectively. Multivariate analysis confirmed that double positive of dilute russell's viper venom time (dRVVT) and silica clotting time (SCT) was the only independent protective factor for LA negativization [ OR=0.055, 95% CI (0.006, 0.545); P=0.013]. SLE, moderate to high titer of aCL and number of baseline aPL positivity were independently associated with aCL negativization [ OR=18.2; 95% CI (1.45, 228); P=0.025, for SLE; OR=0.217; 95% CI (0.053, 0.888); P=0.034, for moderate to high titer of aCL; OR=0.198; 95% CI(0.057, 0.689); P=0.011, for number of baseline aPL positivity]. Moderate to high titer of anti-β 2GPⅠ and number of baseline aPL positivity were independent protective factors for anti-β 2GPⅠnegativization [ OR=0.168; 95% CI (0.032, 0.872); P=0.034, for moderate to high titer of anti-β 2GPⅠ; OR=0.243; 95% CI (0.073, 0.813); P=0.022, for number of baseline aPL positivity]. There were no factors related with aPL negativization among 40 triple aPL positive patients. We didn't find any relationship between aPL persistent positivity and further thrombosis/pregnancy morbidity due to limited events. Conclusion:aPLs negativization is common and frequent for aCL. The number of positive antibodies and higher antibody load are associated with persistently positive serology. Patients with SLE are easier to get aCL negativization. Double positive of dRVVT and SCT was a protective factor for LA negativization.
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Objective:The aim of this study was to compare the efficacy and safety of iguratimod (IGU) or leflnomide (LEF) in combination with methotrexate (MTX) in patients with active rheumatoid arthritis (RA).Methods:This was a multicenter, randomized, double-blinded, double dummy and controlled clinical trial. Patients with moderate or high active RA were randomized in a 1∶1 ratio to receive IGU+MTX (Group A) or LEF+MTX (Group B) treatment. The efficacy and safety were assessed at week 12, 24 and 52, respectively. The primary endpoint was the American Colleague of Rheumatology 20 (ACR20) response rates at the 52th week. Pearson chi square test and two-way Analysis of Variance (ANOVA) were used to compare the improve- ment of ACR20 and DAS28 at 52 weeks. Pearson chi square test or Fisher exact probability test were used to compare the ACR 20 and ACR70 rate between the two groups after treatment. The measurement data of the two groups were compared by independent sample t-test or nonparametric test. Results:A total of 240 RA patients were enrolled in the present study. As a result, 84.1% and 81.0% of patients achieved ACR20 criteria at the 52th week in Group A and Group B, respectively ( χ2=0.35, P=0.56). And the ACR50/70 response rates, disease activity score 28 (DAS28), simplified disease activity index (SDAI) and the absolute decrease of DAS28 from baseline were not statistically different between the two groups at week 12, 24 and 52. The rates of adverse events were lower in Group A than those in Group B (60.0% vs 79.0%, P<0.01). The elevations of glutamic pyruvic transaminase/glutamic oxalacetic transaminase levels, concomitant use of hepatinica and white blood cell decrease were more common in Group B ( P<0.05). Conclusion:IGU in combination with MTX is an efficacious and safe treatment regimen, which is comparable in efficacy in control active RA but superior in safety to LEF combined with MTX.
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Objective:To investigate the proportion of patients with clinical remission and sustained remission in Chinses patients with rheumatoid arthritis (RA).Methods:We retrospectively reviewed the medical records of RA patients in our center from January 1, 2011 to December 31, 2016. Disease activity scores and remission status at each visit were assessed by the disease activity score in 28 joints (DAS28), the simplified disease activity index (SDAI), the clinical disease activity index (CDAI), and the American Ccollege of Rheumatology/European league Against Rheumatism (ACR/EULAR) Boolean criteria. Patients were considered in sustained remission if they maintained remission during consecutive visits for 6 months. Kaplan-Meier method was applied to plot cumulative possibility of achieving remission and calculate the median time to first clinical remission. Cox multivariate regression analysis was used to analyze the relative factors of sustained remission.Results:A total of 648 patients were included in the present study. During the median follow-up of 24 months, around 70% of patients reached clinical remission at least once (DAS28: 78.7%, SDAI: 70.8%, CDAI: 68.4%, Boolean criteria: 68.7%). Specifically, the cumulative probability of achieving remission at 3-, 6- and 12- month was 10.6%-24.4%, 25.3%-43.5% and 51.8%-65.2% respectively, depending on instruments applied. The median time to first remission was 7.2 (DAS28), 10.1(SDAI), 11.7(CDAI), 11.4(Boolean criteria) months. Regarding the sustained remission, nearly half of patients experienced SR defined by DAS28(52.2%), CDAI(46.6%), SDAI(45.1%), and Boolean definitions (43.7%) respectively. Among those patients in sustained remission, the median time of persistence remission during study period was 16.0 months (DAS28-ESR), 15.4 months (CDAI), 14.9 months (SDAI) and 15.0 months (Boolean criteria). Among patients achieving sustained remission, the percentage was 18.7% and 81.3% for DMARD monotherapy and combination therapy, respectively. Additionally, 22.3% of patients received low-dose glucocorticoids treatment concomitantly and over half of them successfully tapered or discontinued the glucocorticoids during the period of sustained remission.Conclusion:In daily practice, clinical remission is a realistic target in the setting of treat-to-target strategy, and over half of patients achieveclinical remission in the first year of follow-up. Among those patients who achieve clinical remission, around half of them reach sustained remission over the subsequent follow-up period. The median time of persistent remission in patients achieving remission is about 15 months.
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Objective To investigate the early remission rate of rheumatoid arthritis (RA) and identify the potential predictive factors in Chinese population. Methods For this study, medical records of RA patients during January 1, 2009 to December 31, 2016 were retrospectively reviewed. Disease activity scores at visits were measured by (disease activity score uses 28 joint counts (DAS28)-erythrocyte sedimentation rate (ESR) and remission status was determined subsequently. Early remission was defined as the time interval between first visit and clinical remission for less than 6 months. Logistic regression analysis was applied to identify predictive factors for early remission. Results Seven hundred and seventy nine patients in total were included into the present study. Overall, 317 (40.7％) patients achieved early remission and the median time to early remission was 2.8 (1.8, 1.4) months. Comparison of characteristics between RA patients with and without early remission, male gender (26.5％ vs 16.5％, x2=11.631, P=0.001), treatment-na?ve (64.7％ vs 53.5％, x2=9.692, P=0.002), early RA (50.4％ vs 40.9％, x2=7.656, P=0.01), as well as initial use of hydroxy-chloroquine (44.8％ vs 34.0％, x2=9.293, P=0.003) was significantly higher in patients with early remission. Conversely early remission was less frequent in patients with late onset [(49±16) vs (47±16), t=2.925, P=0.003], long disease duration [24(6, 96) vs 14 (4,72), Z=3.126, P=0.003] high level of all baseline individual com-ponents of disease activity [(TJC, SJC, PGA, EGA, ESR, C-reactive protein (CRP)] and DAS28-ESR [(4.33± 1.21) vs (4.92 ±1.38), t=6.118, P<0.01], as well as initial treated with glucocorti-coids (44.6％ vs 36.0％, x2=5.780, P<0.05). No significant differences were observed in terms of serological features, initial used of MTX, LEF, SSZ, as well as DAMRDs combination. Further logistic regression analyses identified that male [OR=1.70, 95％CI (1.16, 2.47)], treatment-na?ve [OR=1.64, 95％CI (1.20, 2.24)], and treatment with hydroxy-chloroquine initially [OR=1.87, 95％CI(1.37, 2.56)] as independent factors associated with early remission. In contrast, late disease onset [OR=0.99, 95％CI(0.98, 1.00)], high baseline DAS28-ESR [OR=0.70, 95％CI(0.62, 0.79)] were independently associated with decreased possibility of early remission ( P<0.05). Conclusion Early remission is uncommon in clinical practice. Male, treatment-na?ve, and initial hydroxychloroquine treatment increases the probability of early remission, while advanced age, higher baseline DAS28-ESR decreases the chance of early remission.
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Objective To establish a prokaryotic expression system of interstitial lung disease associated autoantigen human bactericidal/permeability-increasing fold-containing B1 (BPIFB1), providing tools for the study on its function in immune responese. Methods The coding region of BPIFB1 gene was amplified with specific primers from recombinant pGEM-C20ORF114 plasmid and cloned into the pET28a-MBP-His and pGEX-5X-1 vectors. The recombinant pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST plasmids were transfected into Top10 cells. The positive clones were selected and sequenced. The correct clones of pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST were transfected into prokaryotic expression strain Rosetta (DE3) and induced by Isopropyl β-D-Thiogalactoside (IPTG). The expression of recombinant BPIFB1 fusion protein was analyzed by SDS-PAGE and Western blotting, and purified by urea modified and renaturation and affinity chromatography of nickel NTA-resin. Results The polymerase chain reaction (PCR) produced specific product with the molecular weight equivalent to that of BPIFB1. The recombinant pET-BPIFB1-MBP-His and pGEX-BPIFB1-GST plasmids were cloned by double restriction enzyme digestion and ligation and confirmed by sequencing. The SDS-PAGE result showed that both BPIFB1-MBP and BPIFB1-GST fusion proteins were mainly expressed in the form of inclusion bodies. The Western blotting result revealed that the recombinant BPIFB1-MBP-His protein could be recognized by Anti-6 ×His antibody. The purified soluble BPIFB1-MBP fusion protein was obtained by urea denaturation, affinity chromatography of nickel NTA-resin and then renaturation after purification. Conclusion The BPIFB1 prokaryotic expression system is established by construct recombinant plasmid pET-BPIFB1-MBP-His, and an approach of renaturation after nickel resin affinity purification in denatured condition.
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Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients.Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis,compared with gout patients without nephrolithiasis.The clinical parameters,urine analysis and lipid levels were analyzed.Patients were divided into groups based on serum lipid levels.The groups were compared based on demographic data and stone composition.Correlations were analyzed between serum lipid,urinary pH and uric acid stones.Moreover,the risk factors of uric acid stones were determined by logistic regression analysis.Analysis of variance,t-test,chi-square test,Spearman's test and Logistic regression were used for statistical analysis.Results ① A total of 144 gout patients were included in study,48 patients with urolithiasis and 96 patients without urolithiasis.② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9,2.1) mmol/L vs 2.2(1.4,3.2) mmol/L,Z=2.38,P=0.01],total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L,t=5.3,P=0.006];low density lipoprotein cholesterol (LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L,t=4.2,P=0.005].③ Compared to oxalate stone formers,uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L,t=4.9,P=0.001),TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L,t=1.8,P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L,t=3.5,P=0.045],while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L,t=-4.0,P=0.002].④ Percentage of uric acid stones in high TG group was higher than normal TG group [85％(17/20 vs 46.4％(13/28),x2=7.4,P=0.007],in addition,the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1％(23/28) vs 35.0％(7/20),x2=11.1,P=0.001].⑤ Uric acid stones were significantly correlated with high TG,low LDL and urinary pH(r=0.522,0.47,-0.212,respectively).Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38,95％CI(1.41,13.7);P=0.01] and lower HDL level [OR=0.01,95％CI(0.01,0.43);P=0.01].Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients.Specific alterations in patient's lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk.
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Objective To explore the risk factors of urinary stone formation in primary gout patients by urinary chemical,serum and urinary biochemical features analysis.Methods All the patients diagnosed as primary gout at Peking University First Hospital from 2009 to 2015 were included in the study.All patients were diagnosed with or without urolithiasis by ultrasound or computed tomography.Their clinical features,baseline urinary metabolic panels and stone composition were analyzed and compared between the two group of patients.Moreover,the risk factors of uric acid stone formation were determined by comparing different composition of stone formation group.Analysis of variance,t-test,chi-square test,spearman's test and logistic regression were used for statistical analysis.Results One hundred and forty-four male gout patients were enrolled in the study among these patients,48 were with urolithiasis and 96 patients were without urolithiasis.Most (136,94.4％) patients were under excretion of uric acid.Among 48 gout patients with uric acid urolithiasis,30 (62.5％) patients who had pure uric acid stones,and 18 (37.5％) had stones composed of mixed uric acid and oxalic acid.Compared with mixed stone group,the mean age was significantly lower in pure uric acid stone group [(46±13) years vs (60±15) years,t=4.1,P＜0.05];and disease duration was shorter [(42±11)months vs (71±22) months,t=-0.2,P＜0.01].The 24-hour urinary uric acid were significantly higher in the uric acid stone group [(5 205±3 524) μmol/d vs (2 132±1 326) μmol/d,t=3.6,P＜0.05].Also,the mean of both Ccr and Cua were higher [(119±61) ml/min vs (75±39) ml/min,t=3.6,P＜0.05;(6.3±3.6) ml/min vs (3.2±2.0)ml/min,t=l.4,P＜0.05].Urinary pH was negatively correlated with uric acid stone in primary gouty patients (r=-0.212,P＜0.01);The total excretion of urinary uric acid was positively correlated with uric acid stones formation (r=0.633,P＜0.05).High urinary uric acid excretion and Ccr were independent risk factors for uric acid stone formation in primary gout patients.Conclusion Urine pH is negatively correlated with uric acid stone formation.Urinary analysis of 24-hour uric acid and Ccr are risk factors for pure uric acid urolithiasis in primary gout patients.
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Objective To explore the risk factors of urate deposition on ultrasound in patients with gout.Methods All the gout patients who visited our center between February 2015 and February 2017 and underwent ultrasound examination of bilateral knees,ankles and first metatarsophalangeal joints (MTP1) were enrolled.Subgroup analysis was done depending on whether double contour sign (DCS) or tophus was found on ultrasound.Main statistical analysis methods were t test,chi-square test and logistic regression model.Results One hundred and twenty-six patients were included.DCS was found in 50(39.7％) patients and tophus was found in 48 (38.1％) patients.The serum uric acid (SU) level of the DCS positive group was signi-ficantly higher than the DCS negative group [(602±79) μmol/L vs (538±101) μmol/L,t=3.998,P=0.044].The hyperuicemia duration of the two groups were (186±87) months and (130±77) months,which was significantly different (t=3.330,P=0.002).The hyperuicemia duration of the tophus positive group was significantly higher than tophus negative group [(175±102) months vs (138±96) months,t=2.003,P=0.045].The SU level and hyperuicemia duration were independent risk factors of positive DCS in gout patients [OR =1.006,95％ CI (1.002,1.01 1);OR=1.028,95％CI (1.013,1.042)].The hyperuicemia duration was independent risk factor of positive tophus in gout patients [OR=1.004,95％CI (1.000,1.007)].Receiver operating characteristic curve (ROC) curve showed gout patient whose hyperuricemia duration was longer than 94months and SU level was higher than 505.5 μmol/L were more likely to have positive DCS in joints;meanwhile,patient whose hyperuricemia duration was longer than 137 months were more likely to have positive tophus in joints.Conclusion Gout patients who have positive DCS and tophus on ultrasound have longer hyperuicemia duration.Positive DCS is also related with patients' higher serum levels.The hyperuicemia duration is an independent risk factor of urate deposition on ultrasound in patients with gout.
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Objective To investigate the expression of histone deacetylase 8 (HDAC8) in the labial gland of patients with Sj?gren's syndrome (SS), and whether it is related to the abnormal activation of B cells of SS patients. Methods The expression of HDAC8 was detected by immunohistochemistry in the labial glands from SS patients (n=10) and non-SS patients (n=4). The subtype of lymphocytes which expressed HDAC8 was determined by double staining immunofluorescence. Person correlation analyses were performed to evaluate the relation between the proportion of HDAC8 positive cells and the level of immunoglobulins in SS patients. Results The expression of HDAC8 in the labial gland from SS patients was significantly higher than that in the non-SS patients.The proportion of HDAC8 positive cells in lymphocytic foci was higher than that in scattered interstitial lymphocytes [(0.76±0.05) vs (0.40±0.03), t=18.5, P<0.01]. IF showed that HDAC8 was expressed in CD20+B cells, and CD138+plasma cells in labial gland from SS group,but not CD4+T cells. The ratio of HDAC8+cell in infiltrating lymphocytic loci was not related to the level of IgG or IgA of SS patients. Conclusion HDAC8 is expressed in CD20+B cells and CD138+plasma cells in labial gland from SS patients. These data suggests that HDAC8 may be involved in abnormally activated B cells and plasma cells in SS patients.
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Objective To investigate the features and discrepancies of the ultrasound findings of shoulders in patients with rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR).Methods Patients with RA and PMR who complained of pain,swelling or limited mobility of shoulder were enrolled for bilateral ultrasound assessment.Inflammatory lesions including long head biceps (LHB) tenosynovitis,subacromial-subdeltoid (SASD) bursitis,tendinosis of supraspinatus (SS) tendon effusion/synovitis in glenohumeral (GH) and acromioclavicular (AC) joints,as well as structural damages including SS tear,bone erosions and osteophytes on humeral head and AC joints were evaluated.Comparison of frequency of ultrasound features between the two groups was analyzed byx2 test.Results A total of 458 shoulders from 192 RA and 37 PMR patients were assessed by ultrasound.In RA patients,the most prevalent inflammatory findings were LHB tenosynovitis (31.3％),followed by SASD bursitis (25％),SS tendinosis (11.5％),AC and GH effusion/synovitis (10.4％ and 5.7％,respectively).LHB tenosynovitis was the most frequent finding in PMR patients (37.8％),followed by SS tendinosis (27％),SASD bursitis (24.3％),AC and GH effusion/synovitis (2.7％ and 0,respectively).Partial or complete tear of SS tendon was found in 9.9％ RA and 8.1％ PMR patients,respectively.SS tendinosis was more frequently presented in PMR than RA patients (x2=6.255,P＜0.05),while GH effusion/synovitis was more common in RA group (x2=3.983,P＜0.05).Bone erosions and osteophytes were common in both groups.SASD bursitis and SS tendinosis appeared to be more unilateral (77.1％ and 77.3％,respectively),while GH effusion/synovitis tended to be bilateral (63.6％) in RA patients.Conclusion Intra-articular inflammatory involvement (GH effusion/synovitis) is more frequent in RA,while peri-articular inflammatory involvement (SS tendinosis) is more frequent in patients with PMR.SASD bursitis and SS tendinosis appears to be unilateral,while GH effusion/synovitis tends to be bilateral in RA patients.
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Objective To develop the optimal simplified combination of joints for ultrasonographic assessment of joint inflammation of wrists and hands in patients with rheumatoid arthritis (RA).Methods US examination was performed using grey-scale (GSUS) and power Dop.pler (PDUS) semi-quantitative scoring systems with scores 0-3 in 22 joints of 705 RA patients,including all proximal interphalangeal (PIP),metacarpophalangeal (MCP),and bilateral wrist joints.Continuous variables were presented as mean and standard deviation if normally distributed,and dichotomous variables were presented as frequencies.T test and Wilcoxon signed test were applied for statistical analysis.All correlations among US variables were assessed using Spearman's rank correlation test.Candidate joint set was selected by multiple stepwise linear regression analysis.Results Through multiple linear stepwise regression analysis,the standard coefficient of wrist,MCP5,MCP2 and MCP3 joints under GSUS was higher than other joints.And the adjusted R2 of the model composed of wrist,MCP5,MCP2 and MCP3 joints was greater than 0.9.Among the sum GS and PD scores of various selected joint combinations,total score-8 (GS vs PD),including bilateral wrist,MCP2,MCP3,MCP5 joints,not only showed highest sensitivity and negative predictive value (97.3 5％ vs 97.20％;92.67％ vs 97.21％,respectively),but also had the highest correlation with the total score-22 (GS,PD) (r=0.989,0.972,P＜0.01).Conclusion Total score-8,including bilateral wrist,MCP2,MCP3,MCP5 joints,is simple and efficient enough for monitoring active synovitis of wrists and hands in patients with RA in daily practice.