Clinical value of SLE-DAS in evaluating disease activity of systemic lupus erythematosus / 中华风湿病学杂志

Objective:To evaluate the diagnostic performance and clinical significance of SLE-DAS in the disease activity of SLE patients in China.Methods:The clinical data of 134 patients with SLE were collected. The disease activity was evaluated by SLE-DAS, SLEDAI-2000, BILAG-2004 and PGA scoring tools. Pearson test and Spearman test were used to analyze the correlation. The receiver operating characteristic curve (ROC curve) was used to evaluate SLE-DAS, and Kappa consistency test was adapted to assess the consistency of the two scoring methods.Results:One hundred and thirty-four patients with SLE, including 7 males and 127 females, aged 13-77 years, with an average of (35±13) years were included. Among them, renal involvement was 38.1%, skin mucosal involvement was 11.2%, musculoskeletal involvement was 8.2%, blood system involvement was 13.4%, heart and lung involvement was 2.2%, neuropsychiatric involvement was 1.5%, and multisystem involvement was 3.0%. SLE-DAS was positively correlated with CRP, ESR, anti-dsDNA antibody, urinary protein (24 h) level, SLEDAI-2000, BILAG-2004 and PGA ( r=0.25, 0.34, 0.47, 0.77, 0.93, 0.94, 0.95, P<0.01); SLE-DAS was negatively correlated with PLT, Hb, C3 and C4 ( r=-0.29, -0.43, -0.41, -0.32, P<0.01). When SLEDAI-2000>5 was used as a cut point for analyzing SLE-DAS, the results showed that the area under the curve (AUC) 95% CI of SLE-DAS was 0.961 (0.927,0.995), the Yoden index was 0.845. When the cut-off value was set up to 4.65( P<0.001), the sensitivity was 98.11%, the specificity was 86.42%, and the accuracy was 91.04%. Kappa consistency test showed that kappa value was 0.819( P<0.001). Conclusions:SLE-DAS can be used to evaluate the disease activity of SLE patients and can be used as the evidence to guide treatment plan in clinical practice.

Clinical evaluation of lacrimal gland parameters in patients with thyroid-associated ophthalmopathy using orbital magnetic resonance imagining / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the lacrimal gland parameters and their correlation with clinical examination in patients with thyroid-associated ophthalmopathy(TAO)using orbital magnetic resonance imaging(MRI).METHODS: A total of 38 patients(76 eyes)with TAO were selected as case group, and 26 patients(52 eyes)who matched the gender and age with case group and volunteered to accept examination were selected as normal control group. Patients in case group were categorized into active TAO group and inactive TAO group according to the modified clinical activity score(CAS). The exophthalmos was evaluated on T1WI after obtaining the MRI images, the longest lacrimal gland length, width, and the biggest area in axial and coronal images were evaluated on T2WI, and the maximum T2 value and mean T2 value of the lacrimal gland were recorded.RESULTS: There were no significant differences in age, gender and exophthalmos between active TAO and inactive TAO(P&#x0026;#x003E;0.05). The area of lacrimal gland was higher in active TAO than that in inactive TAO, and was higher in inactive TAO than that in control group in coronal and axial section(all P&#x0026;#x003C;0.01). The length of lacrimal gland in coronal and axial section was higher in the active TAO than that in the inactive TAO and the control group(all P&#x0026;#x003C;0.05). The width of lacrimal gland in coronal and axial section was higher in active TAO and inactive TAO than that in the control group(all P&#x0026;#x003C;0.05). The maximum T2 value in the active TAO was higher than that in the inactive TAO and control group, and the inactive TAO was higher than that in the control group(all P&#x0026;#x003C;0.05). The average T2 value in the active TAO was higher than that in the inactive TAO and control group(all P&#x0026;#x003C;0.05). CAS was positively correlated with lacrimal gland area in axial, coronal section and maximum T2 value(all P&#x0026;#x003C;0.01).CONCLUSION: The lacrimal gland is significantly enlarged in patients with TAO, especially in active TAO. The lacrimal gland area in axial, coronal section and maximum T2 value could be potentially utilized as valuable radiographic biomarkers for the activity of TAO.

Evaluation of nasal mucociliary clearance by saccharine test in rheumatoid arthritis

Abstract Objective: We aimed to reveal whether there is nasal involvement by examining the Nasal Mucociliary Clearance (NMC) and the relationship between this activity and disease severity in Rheumatoid Arthritis (RA) patients. Methods: In this prospective study, NMC time, disease activity (Disease Activity Score 28) and blood parameters of RA patients (n = 87) were investigated and compared with the healthy control group (n = 50). In addition, the relationship between DAS 28 and NMC was investigated. Results: The mean NMC of the RA group was 9.51 ± 3.54 min, the mean NMC of the control group was 8.69 ± 2.85 min, and there was no significant difference between the two groups. There was no correlation between NMC and disease duration, and DAS 28. The mean NMC of the RA patients with Anti Cyclic Citrulled Peptide (Anti-CCP) positive was significantly higher than the negative ones. Conclusion: Although there was no significant difference in NMC values between the RA and control group, the NMC of the Anti-CCP positive patients was higher. Level of evidence: Level 2.

Study of Pulmonary Function and Chest Radiographic Abnormalities in Patients with Rheumatoid Arthritis

Background: Interstitial lung disease (ILD) is one of the important contributors for morbidity and mortality in rheumatoid arthritis (RA) patients. There is paucity of reliable published data on burden of lung disease in RA patients from Andhra Pradesh, India. Materials and methods: This was an observational study in which 88 patients were evaluated. History and clinical features, including disease-severity score, imaging, and pulmonary function tests were recorded. The data were subjected to statistical analysis. Results: The mean age was 49.4 � 10.3 years. Females outnumbered males. Disease duration was less than 2 years in 60.2% of subjects. Respiratory complaints were noted in 12 patients. Seropositivity was noted in 59% of patients. Based on Disease Activity Score 28, high disease activity was seen in 70.5%, moderate activity in 25%, remission in 3.4%, and low activity in 1.1%. Chest radiography showed abnormalities in 4.5%. Pulmonary function tests revealed abnormalities in 23.9% of patients. High disease activity, duration of disease, and seropositivity were not significantly associated with respiratory abnormalities in our study. Conclusion: Patients with RA should be evaluated for pulmonary involvement during their routine follow-up, which can be helpful in early detection and intervention of ILD and therefore reducing morbidity and mortality.

A double-arm, randomized, and controlled trial to compare the efficacy and safety of bepotastine with levocetirizine in patients of chronic spontaneous urticaria

Background: Second generation antihistamines are first line therapy for chronic spontaneous urticaria (CSU). Sedation has been always a concern as a side effect of antihistamine for both patients and treating dermatologist. It is always better to prefer non-sedative antihistamine for CSU. Bepotastine is such promising non-sedative agent. Aim and Objectives: The objective of the study was to compare the efficacy and safety of bepotastine and levocetirizine in patients of CSU. Materials and Methods: This is a double arm, open label, randomized, and controlled study. Out of 99 patients, 50 patients belonged to Group A while 49 belonged to Group B. Subjects in Group A received bepotastine 10 mg twice daily while subjects in Group B received levocetirizine 5 mg once daily for 8 weeks. Patients were evaluated at baseline, day 14, day 28, and day 56 using Urticaria Activity Score (UAS) and Urticaria Control Test (UCT) for efficacy; and visual analog scale (VAS) for safety, that is, sedation. Results: The fall in mean UAS scores was statistically significant at day 14, day 28, and day 56 for both Groups A and B (P < 0.05) on intragroup comparison. While comparing the overall improvement between the two groups, there was no significant difference in UAS and UCT score at day 14, day 28, and day 56 between Group A and Group B, respectively (P > 0.05). At day 56, there was significant difference in mean VAS of Group A and B. Only one patient in Group B developed headache. Conclusion: Thus, both levocetirizine and bepotastine are equally effective for the treatment of CSU. Bepotastine has less sedative potential than levocetirizine.

Application of four-grade functional activity score in early pain management of patients after radical mastectomy / 中国实用护理杂志

Objective:To investigate the application of four-grade functional activity score (FAS) in early pain management of patients after radical mastectomy, so as to provide theory basis for the early management of cancer pain.Methods:Ninety-six patients underwent radical mastectomy in Sichuan Maternal and Child Health Hospital from April 2019 to June 2020 were enrolled, and divided into two groups by random number table methods, each with 48 cases. The control group received routine nursing combined with Numerical Rating Scale (NRS), based on this, the study group received FAS. Then the pain degree, first activity time of out-of-bed, surgical wound recovery time, drainage tube placement time, hospital stay length, quality of life (FACT-B), upper limb function, and incidence of complications were compared between the two groups.Results:NRS score at the initial event, first activity time of out-of-bed, surgical wound recovery time, drainage time, hospital stay length were (3.42 ± 1.54) points, (8.52 ± 1.20) h, (7.42 ± 2.43) d, (6.25 ± 2.13) h, (7.58 ± 2.31) d in the study group, and (5.76 ± 1.43) points, (12.42 ± 1.42) h, (10.12 ± 2.52) d, (10.08 ± 2.42) h, (10.16 ± 3.44) d in the control group, there were significant differences between the two groups ( t values were 4.31-14.53, all P<0.05). The incidence of complications was 6.25% (3/48) in the study group, and 16.67% (8/48) in the control group, there was significant difference between the two groups ( χ2=6.56, P<0.05). The total score of FACT-B, joint activity at 1 month after operation, effective cough and turning times with 1 d after operation were (84.48 ± 11.75) points, (28.75 ± 2.58)°, (6.64 ± 2.35) times, (6.10 ± 1.45) times in the study group, and (75.26 ± 11.88) points, (15.38 ± 4.76)°, (3.43 ± 1.25) times, (4.35 ± 1.13) times in the control group, there were significant differences between the two groups ( t values were 3.82-17.11, all P<0.05). There was significant difference in the muscle strength of grade between the two groups ( Z=1.21, P<0.05). Conclusions:FAS in the early pain management of patients after radical mastectomy can shorten the first activity time of out-of-bed and hospital stay length, relieve pain, promote muscle and joint function exercise, reduce the incidence of complications, and improve the quality of life.

Comparison between DAS28-ESR and DAS28- CRPus for patients with rheumatoid arthritis: application in a population of southern Brazil

Abstract The Disease Activity Score 28 (DAS28) shows discrepancies when using erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) scores to assess rheumatoid arthritis (RA). This study aimed to verify the agreement between the DAS28-CRP and DAS28-ESR scores in patients with RA from the south of Brazil. A unicentric cross-sectional study was performed (n = 56). The diagnosis of the patients followed the American College of Rheumatology/ European League Against Rheumatism criteria, and their DAS28 were calculated. The DAS28- ESR score was higher than the DAS28-CRP (DAS28-ESR mean 4.8±1.6; DAS28-CRP mean 4.3±1.4) for 83.9% of the patients. The DAS28-CRP and DAS28-ESR scores showed a very strong correlation (Pearson's coefficient = 0.922; P<0.0001, 95% CI +0.87 to +0.95, statistical power 100%). Spearman's correlation coefficient (0.49; P=0.0001, 95% CI +0.25 to +0.67, statistical power 47.54%) showed a moderate correlation between the unique components of the DAS28 formulas. There was agreement between the tests in only 36 of the patients (64.29%). Among the discordant categories, DAS28-ESR overestimated the classification in 16 patients (28.5%). The Kappa coefficient between the categories was 0.465 (SE 0.084, 95% CI +0.301 to +0.630), showing a moderate degree of agreement between the instruments. Although the DAS28-ESR and DAS28-CRP were highly correlated, they differed significantly in terms of patient categorization and should not be used interchangeably

Meta-analysis of the efficacy of Rituximab in thyroid associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the efficacy of rituximab in thyroid associated ophthalmopathy by using a Meta-analysis of the literature. <p>METHODS: Databases such as CNKI, Wanfang, Weipu, China Biomedical, PubMed, Web of Science, OVID, Cochrane Library, and ClinicalTrial.gov were searched. From the establishment of the database to December 31, 2019 on rituximab clinical studies on the treatment of thyroid associated ophthalmopathy. The clinical activity score of thyroid associated ophthalmopathy before and after treatment was used as the main judgment index of curative effect. The retrieved clinical studies were analyzed using RevMan 5.3 statistical software. <p>RESULTS: Six studies were included, two were randomized controlled trials, and four were cohort studies. Meta analysis showed that the application of rituximab in the treatment of moderate to severe thyroid associated ophthalmopathy can significantly reduce the clinical activity score of patients, and has statistical significance \〖<i>SMD</i>=-5.04, 95% <i>CI</i>(-7.08 to -3.01), <i>P</i><0.00001\〗. <p>CONCLUSION: Rituximab can significantly reduce the clinical activity score of patients with moderate to severe thyroid associated ophthalmopathy, and has a good effect on disease control.

A Clinical Study To Evaluate The Combined Effect Of Virechana Karma, Ardraka Khanda And Amruta Rajanyadi Kashaya In The Management Of Sheetapitta Vis-à-vis Chronic Urticaria

Sheetapitta is a clinical condition caused due to vitiation of Tridosha mainly by the contact of Sheetalavayu. It is characterized by Varati Damstravat Shotha (wheals), Kandu (itching), Daha (burning sensation), Toda (pricking pain), Jwara (fever) and Chardi (vomiting). Sheetapitta analogous to urticaria of western medicine. Urticaria is a vascular reaction pattern characterized by transient, erythematous and edematous wheals or papules of varying sizes and shapes which are usually pruritic. Episodes lasting more than 6 weeks are regarded as chronic urticaria. Present study is a single group open clinical trial with pre and post-test design with a sample size of 33 subjects. The diagnosis was based on the signs and symptoms of Sheetapitta vis-à-vis chronic urticaria and the assessment was based on Urticaria Activity Score which includes wheals and itch as its parameter. Subjects were administered with Virechana Karma followed by Ardraka Khandawith Amruta Rajanyadi Kashaya as Anupana for 30 days after Virechana Karma. The result obtained after the completion of intervention showed statistically highly significant with the P value 0.001 and also overall clinical improvement showed significant result in reducing the signs and symptoms of Sheetapitta vis-à-vis chronic urticaria. Sheetapitta being Tridoshajanya, Virechana Karma helped in Tridosha Nirharana (expelling dosha). Ardraka Khanda being Agnideepaka (appetiser), Sheeta Pittahara (disease pacifying action) and Rasayana (rejuvinator) followed by Amruta Rajanyadi Kashaya which is Kapha-Pitta Hara, Dahahara (reducing burning sensation) and Kanduhara (anti-itch) properties pacified the signs and symptoms of Sheetapitta. In combination of both Virechana Karma and Ardraka Khanda with Amruta- Rajanyadi Kashaya, majority of the subjects attained pacification of urticarial wheals and itching.

Evaluation Of Effectiveness And Safety Of Oral Bepotastine In The Management Of Chronic Urticaria

Introduction: Nearly 20% of the total population suffer from urticaria for a minimum of one episode during the entire lifetime.Second-generation antihistamines are preferred in majority cases of urticaria.Objective: The present survey was undertaken in pursuit of analyzing the effectiveness and safety of bepotastine in thetreatment of chronic urticaria (CU).Materials and Methods: This was a retrospective questionnaire-based survey. Doctors were identified from four directionalzones of the country, and each was given prevalidated questionnaire booklets. Clinical response was evaluated by urticariaactivity score (UAS) at baseline (D0), day 14 (D14), and day 28 (D28). All the adverse effects were monitored for severity.Specifically, sedation was closely monitored for its occurrence and severity.Results: A total of 50 doctors completed the survey involving 226 patients. The mean UAS score at D0/baseline was 3.47which reduced to 1.71 at D14 and 0.73 at D28. 78 patients were having UAS score in the range of 1–2, 89 patients in 3–4, and59 patients in the range of 5–6 at D0. 59 patients were encountered in Grade 5–6 at D0, which reduced to 45 patients at D14and 29 patients at D28, while 89 patients in score range 3–4 at D0 reduced to 68 at D14 and 38 at D28. Sedation was reportedin only 15 patients (6.6%) that too majority had mild sedation, rated in sedation scale range of 0–5.Conclusion: The present survey indicates that bepotastine is efficacious and safe in the management of CU.

Elevated serum rheumatoid factor, anti-citrullinated protein antibodies and active rheumatoid arthritis disease are not associated with chronic periodontitis

@#Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease of the joints with the involvement of other systems. Previous studies have demonstrated its association with chronic periodontitis (CP), a chronic inflammatory disease of tooth-supporting tissues. Positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in RA patients have been found to be associated with CP. The aim of this study is to determine the prevalence of CP in RA patients, and to investigate the association of ACPA, RF status and RA disease activity with CP and non-CP RA patients. Materials and Methods: A comparative cross-sectional study involving 98 RA patients was conducted at Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia. Clinical oral examination was carried out to determine the CP status of RA patients. RF, ACPA and erythrocyte sedimentation rate (ESR) were measured, and the 28-joint Disease Activity Score (DAS-28) was assessed. Results: Forty-five patients (45.9%) were found to have CP (95% CI: 0.36-0.56). No significant difference was observed in the prevalence of positive RF (p=0.989) or ACPA (p=0.431) in CP and non-CP RA patients. There was also no significant association between active RA disease (DAS-28 score ≥3.2) and RF positivity in CP (p=0.927) and non-CP (p=0.431) RA patients as well as ACPA positivity in CP (p=0.780) and non-CP (p=0.611) RA patients. Conclusion: In our cohort of RA patients, we did not find significant associations between elevated RF, ACPA, or active RA disease with the presence of CP. There were also no significant associations between elevated RF or ACPA with active RA disease.

Red Blood Cell Distribution Width Can Predict Vasculitis Activity and Poor Prognosis in Granulomatosis with Polyangiitis

PURPOSE: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. RESULTS: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). CONCLUSION: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.

The value of magnetic resonance imaging dynamic enhancement technique in evaluating the activity of hip joint lesions in ankylosing spondylitis / 中华风湿病学杂志

Objective To evaluate the value of 3.0 T dynamic contrast-enhanced magnetic resonance imaging(MRI) in the diagnosis of hip joint lesions in patients with ankylosing spondylitis (AS).Methods Fifty-two AS patients with hip involvement were diagnosed in Department of Rheumatology in our hospital from January 2013 to December 2016.All patients underwent AS disease activity ankylosing spondylitis disease activity score (ASDAS)-C-reactive protein (CRP) score evaluation of hip joint acti-vity and hip joint disease activity was evaluated by doctors.According to ASDAS-CRP score,patients were divided into active disease 34 cases and remission for 18 cases.All patients underwent double hip MRI plain scan,dynamic enhanced scan and post-processing analysis after the diagnosis.Six regions of interest were selected in the abnormal synovial area around the hip joint.The time signal TIC curve was generated automatically,the shape of the curve was described and the early intensification rate of the third,fourth phase was measured.The early intensification rates of the active disease group and the remission group were analyzed statistically.Two independent samples t test was used for analysis,and P＜0.05 was regarded as statistically significant.The early intensification rate of the third,fourth phase were compared with the ASDAS-CRP score,the evaluation of hip joint activity in patients and the evaluation of hip joint activity were carried out by doctors taking care of the patients.Results The TIC curve of the active group was rising fast,followed by platform or fast rising.The curve of the remission group was slow rising.The inten-sification rate of the third,fourth phase [(116±9)％,(146±12)％ respectively] in the active phase group was higher than that of the remission group [(23±5)％,(43±14)％],and the difference was statistically significant (t=2.447,3.054;P＜0.05).The rate of synovial enhancement of the third,fourth phases was positively correlated with the ASDAS-CRP score (r=0.802,0.836,P=0.01),and the correlation was poor with evaluation of hip joint activity by patients (r=0.352,0.458;the P=0.02,0.01respectively),and the correlation was goodwith the evaluation of hip joint activity by doctors (r=0.652,0.717;P=0.01).Conclusion The shape and early enhancement rate of magnetic reson-ance dynamic enhanced TIC curve is valuable in assessing the disease activity of hip joint lesions in AS patients.

Acupuncture combined with western medicine on rheumatoid arthritis and effects on blood stasis / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy of acupuncture combined with western medicine in the treatment of rheumatoid arthritis (RA) and its effect on blood stasis, and to explore ways to improve the clinical curative effect.</p><p><b>METHODS</b>A total of 56 patients of RA were randomly divided into an observation group and a control group, 28 cases in each one. ① ibuprofen sustained-release tablets, 2 times a day, each time 0.3 g; ② methotrexate tablets (MTX), once a week, each time 10 mg ③ folic acid tablets, once a week, each time 5 mg were given in the control group, 30 days as one course, a total of 3 courses were required. In the observation group, acupuncture was adopted on the basis of the treatment as the control group. The main acupoints were Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) combined with local points. The treatment was given once every day for continuous 6 days a week, the treatment for 30 days as one course, a total of 3 courses were required. The serological indexs were evaluated before and after treatment, including the rheumatoid factor (RF), hypersensitive C-reactive protein (hs-CRP), erythrocyte sedirnentation rate (ESR), platelet (PLT), fibrinogen (FBG) and D-dimer (D-D), the changes of disease activity score (DAS-28), symptom grade quantitative score, blood stasis syndrome symptom (the joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin) score were observed.</p><p><b>RESULTS</b>① The scores of RF, hs-CRP, ESR, PLT, D-D, FBG, DAS-28 and symptom grade quantitative were significantly improved in the two groups compared with those before treatment (all <0.05), and the scores of hs-CRP, ESR, DAS-28 and symptom grading in the observation group were more better than those in the control group (all <0.05). ② The total score of joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin and blood stasis syndrome in both groups were decreased after treatment (all <0.05), the joint tingling, tongue, lip color and subcutaneous ecchymosis were improved obviously in the observation group than those in the control group (all <0.05). ③ The total effective rate in the observation group was 85.7% (24/28), which was better than 75.0% (21/28) in the control group (<0.05).</p><p><b>CONCLUSION</b>Acupuncture combined with western medicine can not only improve the clinical efficacy of RA patients but also improve the blood stasis.</p>

Disease Characteristics and Change in Arthritis Activity according to Treatment in Hepatitis B Surface Antigen-positive Rheumatoid Arthritis Patients: a Retrospective Chart Review Study

BACKGROUND: Rheumatoid arthritis (RA) treatment may differ according to hepatitis B state and consequently may bring about different arthritis outcomes. However, whether hepatitis B affects treatment outcome remains unclear. We investigated differences in change in arthritis activity between RA patients according to concomitant hepatitis B virus infection. METHODS: A retrospective medical chart review was performed by two rheumatologic fellows using single center data, from January 2000 to March 2015. Among RA patients older than 18 years, patients with comorbidities that could affect RA treatment aside from hepatitis B were excluded. Using 1:3 propensity score matching, 40 hepatitis B virus surface antigen (HBsAg)-positive patients and 112 HBsAg-negative patients were included in the study. Data were collected longitudinally using standardized electronic forms. The longitudinal relationship between HBsAg-positivity and RA activity was analyzed using generalized estimating equations. RESULTS: RA activity showed time-dependent improvement. Reductions of swollen joint count over time were significantly larger in the HBsAg-negative group. However, changes in disease activity score in 28 joints with three variables (DAS28-3), tender joint count, erythrocyte sedimentation rate and C-reactive protein level did not differ between the groups. There were no differences in alanine aminotransferase level. HBsAg-positive patients were less likely to receive methotrexate (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.04–0.19; P < 0.001) and more likely to receive sulfasalazine (OR, 3.67; 95% CI, 1.94–6.95; P < 0.001). CONCLUSION: RA medication use varied according to HBsAg-positivity. However, improvement in RA activity was not significantly affected by concomitant hepatitis B infection.

Productivity Loss of Rheumatoid Arthritis Patients according to the Their Stages of the Disease Activity Score

OBJECTIVE: Productivity loss was compared by 3-stage of disease activity and associations between higher disease activity and high productivity loss were identified. METHODS: Data were extracted from Rheumatoid Arthritis (RA) Patient-reported Outcomes Research, which enrolled 2,000 RA patients (>20-year) on disease-modifying-antirheumatic-drugs (DMARDs) (≥6-month) from December 2012 to June 2013. This included 1,457 RA patients with the disease activity score (DAS-28-ESR) in their medical charts. Productivity loss in time and indirect cost was estimated using The World Health Organization Health and Work Performance Questionnaire (HPQ). Baseline characteristics and productivity loss outcomes were compared according to DAS-28-ESR groups. RESULTS: 84.4% were females, 54.2% had low DAS-28-ESR ( 5.1). Patients with moderate to high DAS-28-ESR had higher lost productivity time (LPT) and monthly costs of LPT than those with low DAS-28-ESR (time in hours: 110.0±58.4 vs. 132.4±57.2 vs. 71.5±52.0, p < 0.0001; monthly costs of LPT in 1,000 Korean won: 1,097±607 vs. 1,302±554 vs. 741±531, p < 0.0001). Multiple regression analyses revealed significant associations with high LPT in high (adjusted odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.18∼6.87) and moderate DAS-28-ESR (adjusted OR=1.88, 95% CI: 1.41∼2.52) compared to low DAS-28-ESR. In addition, positive associations with high monthly costs of LPT were observed in high (adjusted OR=3.45, 95% CI: 1.98∼5.99) and moderate DAS-28-ESR (adjusted OR=1.93, 95% CI: 1.43∼2.54) compared to low DAS-28-ESR. CONCLUSION: Timely therapeutic strategies should be taken into consideration given that the RA patients with moderate to high DAS-28-ESR showed strong associations with high productivity loss for effective management of RA.

Quantitative study on grading activity of Crohn disease with CT enterography / 中华放射学杂志

Objective@#To explore the feasibility and the value of CT enterography (CTE) in the quantitative evaluation of Crohn's disease (CD).@*Methods@#Retrospectively analyzed 49 patients diagnosed as CD by clinical, enteroscopy, pathology, and imaging from April 2016 to June 2017 in Zhongnan Hospital of Wuhan University. All patients underwent routine enteroscopy and standardized CTE. The interval between the two examinations was less than 2 weeks. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured at intervals. The ESR ranged from 2.0 to 97.0 mm/1 h, with an average of (30.6±26.5) mm/1 h, CRP from 0.3 to 143.3 mg/L, and a median of 27.7 mg/L. CD patients were classified into inactive, mild and moderate-severe according to Crohn's disease simplified endoscopic activity score(SES-CD) after enteroscopy. CTE evaluated the site of lesion, the thickness and enhanced patterns of the most severe lesions of the bowel wall, mural enhanced CT value in the portal vein phase, ΔCT value, stenosis, perienteric inflammation, mesenteric hypervascularity (comb sign), enlarged lymph nodes, abdominal abscesses, fistulas, etc. The Chi-square test was used to compare the differences of enhanced patterns among different groups. ANOVA (Analysis of Variance) was used to compare the differences in bowel wall thickness, plain CT values, mural enhanced CT value in the portal vein phase and ΔCT values among different groups. The correlation between CTE parameters and SES-CD or laboratory data was analyzed by Pearson (normal distribution data) or Spearman (skewed distribution data).@*Results@#SES-CD ranged from 1 to 15, with an average of 5.1±2.6. Among 49 cases, 13 were inactive, 19 were mild, and 17 were moderate-severe. There were 25 cases of intestinal obstruction or stenosis, including 24 cases in the active group and 1 case in the non-active group, and the difference was statistically significant (χ2=13.3, P<0.01). The short diameter of lymph nodes was more than 10 mm in 7 patients, all of them were active patients; 32 cases were mesenteric hypervascularity, manifested as "comb sign" , among them, 28 cases were active and 4 cases were non-active, and the difference was statistically significant (χ2=9.3, P<0.01). Perienteric inflammation was manifested in 30 cases, including 27 cases in the active group and 3 cases in the non-active group, and the difference was statistically significant (χ2=10.8, P<0.01). The enhanced patterns of thickened bowel wall in the non-active was dominated by C and D types, while A and B types was mainly in the active group, and the difference was statistically significant (P<0.05); There were significant differences in bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values between different groups (P<0.05), however, the difference of plain CT values between different groups was not significant (P>0.05). Bowel wall thickness, mural enhanced CT value in the portal vein phase and ΔCT values were all moderately correlated with SES-CD (r were 0.564, 0.585, 0.533, respectively; P all <0.01). Bowel wall thickness was positively correlated with ESR and CRP(r were 0.542, 0.452, respectively; P all <0.01). Mural enhanced CT value in the portal vein phase and ΔCT values were not correlated with ESR or CRP (P>0.05).@*Conclusion@#The bowel wall thickness, mural enhanced CT value in the portal vein phase and the ΔCT value can be used to accurately assess the activity of CD lesions.

Relación entre el Nivel de Vitamina D y Urticaria Crónica Espontánea

Antecedentes: Se ha incrementado la evidencia que demuestra la conexión entre la diferencia/insuficiencia de Vitamina D con aumento de la incidencia, severidad y actividad de trastornos inmunes-inflamatorios. La urticaria crónica es un trastorno de la piel caracterizado por ronchas recurrentes durante más de 6 semanas, y se divide en espontánea o inducible por estímulos físicos. El objetivo principal del siguiente trabajo fue estudiar la relación que pueden tener los niveles de Vitamina D en suero de pacientes con diagnóstico de urticaria crónica espontánea (UCE) que asisten al Servicio de Alergia e Inmunología del Hospital Nacional de Clínicas y compararlos con un grupo control de pacientes sin urticaria. Material y Métodos: Es un estudio descriptivo, prospectivo en donde se estudiaron 27 pacientes con diagnóstico de urticaria crónica espontánea. Luego de confeccionar Historia Clínica compatible con el diagnóstico, se les otorgó un test (UAS7) para evaluar la gravedad de la enfermedad, se realizaron prubeas cutáneas con aeroalergénos y alimentos, se realizó test intradérmico de suero autólogo, laboratorio que incluía además el hemograma, el perfil tiroideo y hepático, serología para virus (Hepatitis B y C, VDRL y HIV), se dosaron niveles de Ig A, G, M, E, y de Vitamina D (D2+D3) a todos los pacientes para luego analizar los resultados y comparar con un grupo control de 16 adultos sanos. Resultados: Hubo diferencias significativas entre los valores séricos de Vitamina D del grupo con urticaria crónica con respecto al control p<0,0001. Conclusión: Este estudio encontró que los pacientes con UCE tienen valores séricos disminuidos de Vitamina D. Son necesarios más estudios acerca del rol de la Vitamina D en la patogénesis de la Urticaria Crónica.

Evidence demostrates the connection between vitamin D deficiency/insufficiency with increased incidence, severity and activity of immune-inflammatory disorders. Chronic urticaria is a skin disorder characterized by recurring hives for mores than 6 weeks, and is divided into spontaneous or inducible by physical stimuli. The main objective of this study was to study the relationship that serum vitamin D levels may have in patients diagnosed with Spontaneous Chronic Urticaria (SCU) who attend the Allergy and Immunology Service of the National Hospital of Clinics and compare them with a control group of patients without urticaria. Materla and Methods: This is a prospective descriptive study in which 27 patients with chronic urticaria spontaneously diagnosed were studied. After making clinical history compatible with the diagnosis, they were given a test (UAS7) to evaluate the severity of the disease. In adition to the hemogram, the thyroid and hepatic profile, serology for virus (Hepatitis B, C, VDRL and VIH), serum levels of immunoglobulins A, G, M, E and vitamin D (D2+D3) to all patients and then analyzed the results and compared with a control group of 16 healthy adults. Results: There were significant differences between serum vitamin D levels in the group with chronic urticaria compared to the control group (p<0,0001) Conclusion: This study found that patients with SCU have decreased serum vitamin D values. More studies are needed about the role of vitamin D in the pathogenesis of UC.

Efficacy of prolonged interval of tumor necrosis factor-α inhibitor treatment in patients with spondyloarthritis: a pilot study / 中华风湿病学杂志

Objective To investigate whether prolonged the interval of tumor necrosis factor (TNF)-α inhibitors (TNF-i) injection could continuously improve inflammatory biomarkers and imaging changes of sacroiliac joint and spine in spondyloarthritis (SpA).Methods A total of 154 SpA patients were included and 95 of them received TNF-α inhibitor therapy.TNF-i used in this study included etanercept,infliximab and adalimumab.The dose of etanercept was gradually reduced from 50 mg per week to every two weeks,every three weeks and then per month.The infusion of Infliximab was reduced from 4 mg/kg at 0,2,6 week to every 8 weeks,every 12 weeks and then every 16 weeks.The interval of Adalimumub injection was changed from 40 mg every two weeks to 3 weeks to 4 weeks and then to two months.The levels of inflammatory parameters,bath ankylosing spondylitis disease activity index (BASDAI),bath ankylosing spondylitis functional index (BASFI),ankylosing spondylitis disease activity score (ASDAS),spondyloarthritis research consortium of canada (SPARCC) scores of sacroiliac joint and fat metaplasia,bone erosion,sclerosis and ankylosis changes on magnetic resonance imaging (MRI) were investigated every 3 to 6 months.Radiograhs of spine were assessed by modified stoke ankylosing spondylitis spinal score (mSASSS) scores at baseline and 2 years.Analyses were performed by Paired t-test,Wilcoxon test,Mann-Whitney U test,Kruskal-Wallis and Chi-square test.Results After 3 months of treatment,erythrocyte sedimentation rate (ESR),c reactive protein (CRP),immunoglobulin A (IgA),BASDAI,BASFI,ASDAS and SPARCC scores were significantly lower than those of the baseline [13.00(6.00,31.00) mm/1 h vs 3.00 (2.00,6.00) mm/1 h,Z=-5.61;7.39(2.52,17.90) mg/L vs 1.88(1.21,3.75) mg/L,Z=-5.57;2.89(2.52,17.90) g/L vs 2.27(1.60,2.85) g/L,Z=-4.69;(2.57±1.43) vs (1.17±0.92),t=9.81;17.50(5.00,27.00) vs 4.00(0,11.00),Z=-6.69;2.62(2.02,3.52) vs 1.22(0.92,1.59),Z=-6.96;25.00(10.00,37.00) vs 12.00 (6.00,20.25),Z=-6.68;all P＜0.05].Compared to 3-6 months,SPARCC scores were significantly reduced during 2-3 years in the TNF-i group [12.00 (6.00,20.25) vs 7.00 (3.25,14.75),P=0.02].There were no significant progresses in fat metaplaisa,bone erosions,sclerosis or ankylosis during the follow-up period (61％,57％,x2=0.07,P=1.00;53％,43％,x2=0.40,P=0.75;31％,57％,x2=3.02,P=0.11;14％,7％,x2=0.43,P=0.66).The mSASSS scores were not different between TNF-i group and TNF-i group after 2 years of treatment [2.50 (0,8.00) vs 3.00 (0,8.00),Z=-0.30,P=0.76].Conclusion Prolonged the interval of TNF-i treatment could continuously improve bone marrow edema in SPA,whereas structural damages of sacroiliac joints and spine are not deteriorated.

Clinical Features of Dry Eye in Thyroid-Associated Ophthalmopathy According to Disease Activity

PURPOSE: To evaluate the clinical features of dry eye in thyroid-associated ophthalmopathy (TAO) according to disease activity and analyze the related factors. METHODS: This study included 157 patients diagnosed with TAO and dry eye between March 2009 and March 2015. According to the clinical activity score (CAS), TAO patients were divided into inactive (CAS < 3) and active (CAS ≥ 3) groups. Clinical features included age, sex, visual acuity, proptosis, palpebral fissure width, orbital computed tomography (CT) findings, thyroid hormones, and ocular surface parameters including tear film break-up time (TFBUT), Schirmer tests, keratoepitheliopathy scores, and ocular surface disease index (OSDI) were obtained and compared between the groups. In addition, correlations between clinical features and ocular surface parameters were analyzed in both groups. RESULTS: In the inactive and active TAO groups, CAS was 1.24 ± 0.69 and 4.23 ± 1.13, respectively (p = 0.001). Thyrotropin-binding inhibitory immunoglobulin was significantly higher in the active TAO group than in the inactive TAO group (p = 0.048). On orbital CT, extraocular muscle hypertrophy was more common in the active TAO group than the inactive TAO group (p = 0.020). No significant difference was found in age, sex, visual acuity, free T4, and thyroid-stimulating hormone between the two groups. During analysis of the tear film and ocular surface parameters, TFBUT (p = 0.006) was shorter and OSDI score (p = 0.028) was higher in the active TAO group than the inactive TAO group. TFBUT was negatively correlated with proptosis (r = -0.432, p = 0.001; r = -0.308, p = 0.032) and palpebral fissure width (r = -0.367 p = 0.012; r = -0.312, p = 0.031) in both groups. OSDI was positively correlated with proptosis in the active TAO group (r = 0.301, p = 0.033). CONCLUSIONS: TFBUT was shorter and OSDI score higher in dry eye patients with active TAO than in patients with inactive TAO. The TFBUT was negatively correlated with proptosis and palpebral fissure width in both groups.