Cholesterol granuloma as a rare differential in bone erosion of the orbit: A case report

Objective@#We report a case of orbitofrontal cholesterol granuloma as a rare differential diagnosis of orbital erosion in the diploe of the frontal bone. @*Methods@#This is a case report. @*Results@#A 50-year-old man presented with right eye proptosis. Computed tomography (CT) scan of the orbit showed a fairly delineated homogeneous mass centered in the diploe of the right frontal bone with calcification and rugged erosion of the frontal bone and with expansion into the right superotemporal orbit. The patient was initially diagnosed with malignant lacrimal gland tumor on the right. He underwent orbitotomy with excision of the mass. Histopathologic studies of the excised mass revealed a cholesterol granuloma.@*Conclusion@#Cholesterol granulomas of the frontal bone in the superotemporal orbit are rare benign lesions that present with bone destruction and can be mistaken for lacrimal gland malignancies. Surgical excision has a high success rate with low incidence of recurrence.

Correlation between memory B cells and bone erosion in rheumatoid arthritis / 中华风湿病学杂志

Objective:To explore the distribution characteristics of memory B cells and its relationship with bone erosion in patients with rheumatoid arthritis (RA), and to further understand the mechanism of B cells in the pathogenesis of RA.Methods:B cell subsets in peripheral blood of 200 RA patients and 50 healthy individuals were detected by flow cytometry. According to the surface markers CD19, CD27 and lgD, B cells were divided into CD19 +CD27 +lgD - switched memory B cells, CD19 +CD27 +lgD + non-switched memory B cells, CD19 +CD27 -lgD - double-negative memory B cells and CD19 +CD27 -lgD + naive B cells. B cells in RA patients with various disease activity score, course of disease and treatment were analyzed. Patients were divided into four groups according to the results of joint ultrasonography, including patients without bone erosion, patients with hand bone erosion, patients with knee bone erosion and patients with hand and knee bone erosion. The relationship between the distribution of B cell subsets, autoantibodies and RA bone erosion were analyzed. Differences between the groups were analyzed by independent-samples t test, Mann-Whitney U test and χ2 test. The analysis of variance, Kruskal-Wallis analysis were used for multi-group comparison, Spearman correlation analysis was also used for correlation analysis. Results:①RA patients showed significantly decreased non-switched memory B cells [(9.5±6.7)% vs (12.1±4.7)%, t=2.46, P=0.015] and increased double negative memory B cells [(3.8±2.5)% vs(2.7±1.3)%, t=-4.74, P<0.001] in comparison to healthy individuals. The percentage of non-switched memory B cells were decreased in RA patients with moderate disease activity [(8.4±4.7 )% vs (12.4±7.5)%, t=3.13, P=0.001] and high disease activity [(7.8±7.6)% vs (12.4±7.5)%, t=3.00, P=0.003] in comparison to those in RA patients who achieved remission. Meanwhile, the na?ve B cells [(70.3±15.0)% vs (63.9±14.6)%, t=-2.15, P=0.034] were increased in RA patients with moderate disease activity. No difference was found in RA patients with different disease courses. Total B cells [(4.8±2.9)% vs (7.2±4.1)%, t=-3.24, P=0.001], non-switched memory B cells (7.6±4.3)% vs (10.0±7.1)%, t=-2.63, P=0.010) in RA patients who received prednisone treatment were decreased, while double-negative memory B cells (4.9±3.0)% vs (3.6±2.3)%, t=-2.79, P=0.006] were increased compared with those in RA patients without prednisone treatment. Non-switched memory B cells was decreased in RA patients with hand and knee erosion compared with RA patients without erosion [6.8%(2.5%, 9.5%) vs 9.7%(5.5%, 17.5%), Z=-2.12, P=0.034]. Double negative memory B cells in subgroup with keen erosion [3.3%(2.7%, 5.0%) vs 2.6%(1.9%, 3.8%), Z=-2.09, P=0.036]as well as with hand and knee erosion [3.9%(2.3%, 5.6%) vs 2.6%(1.9%, 3.8%), Z=-2.41, P=0.016] were higher than those in patients without erosion. In addition, higher serum RF level was found in subgroup RA patients with hand and knee erosion compared with subgroup of RA patients without erosion [141.0 (38.0, 874.0) U/ml vs 53.5 (10.0, 106.0)U/ml, Z=-2.07, P=0.039]. Meanwhile, the positive rate of ACPA in RA patients with bone erosion of hand was significantly higher than that of RA patients without bone erosion [81%(52/64) vs 64%(38/59), χ2=4.44, P=0.043). Conclusions:The results suggest that the increase of double negative memory B cells, the decrease of non-switched memory B cells and higher level of autoantibodies may closely relate to bone erosion of RA, which may be one of the pathogenesis of disability in RA.

Anti-inflammatory effects of aucubin in cellular and animal models of rheumatoid arthritis / 中国天然药物

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. It is known that aucubin (AU) exerts anti-inflammatory activity, but its effects and mechanisms in RA are unclear. This study investigated the anti-inflammatory effects and mechanisms of AU in vivo and in vitro. Human fibroblast-like synoviocyte cells from patients with RA (HFLS-RA), RAW264.7 cells, and MC3T3-E1 cells were used to evaluate the effects of AU on migration, invasion, apoptosis, osteoclast differentiation and production. Immunofluorescence was used to observe nuclear translocation of nuclear factor (NF)-κB, the double luciferase reporter gene method was used to observe NF-κB-p65 activity in AU-treated MC3T3-E1 cells. RT-qPCR was used to measure expression of bone metabolism and inflammation-related genes, and western blot was used to measure bone metabolism and NF-κB protein expression levels. Collagen-induced arthritis (CIA) rat model was used for pharmacodynamics study. Arthritis indexes were measured in the ankle and knee, histological staining and Micro-computed tomography were performed on the ankle joints. Also, inflammatory factor gene expression and the levels of NF-κB-related proteins were detected as in vitro. AU effectively inhibited HFLS-RA cell migration and invasion, promoted apoptosis, and inhibited RAW264.7 cell differentiation into osteoclasts, as well as inhibited NF-κB-p65 activity in MC3T3-E1 cells. Notably, AU significantly reduced the gene expression levels of three cell-related inflammatory factors and bone metabolism factors, effectively inhibited the expression of p-Iκκα β, p-IκBα, and p-p65 proteins. In vivo, AU relieved joint inflammation, reduced related inflammatory factors, and inhibited NF-κB signaling. It could be used to treat RA-related synovial inflammation and bone destruction through the NF-κB pathway.

Effect of chemokines CXCL9 and CXCL10 on bone erosion in patients with rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To detect the serum level of soluble chemokines CXCL9 and CXCL10 in patients with rheumatoid arthritis (RA), and to analyze their correlation with bone erosion, as well as the clinical significance in RA.@*METHODS@#In the study, 105 cases of RA patients, 90 osteoarthritis (OA) patients and 25 healthy controls in Peking University People's Hospital were included. All the clinical information of the patients was collected, and the serum CXCL9 and CXCL10 levels of both patients and healthy controls were measured by enzyme-linked immune sorbent assay (ELISA). CXCL9 and CXCL10 levels among different groups were compared. The correlation between serum levels with clinical/laboratory parameters and the occurrence of bone erosion in RA were analyzed. Independent sample t test, Chi square test, Mann-Whitney U test, Spearman's rank correlation and Logistic regression were used for statistical analysis.@*RESULTS@#The levels of CXCL9 and CXCL10 were significantly higher in the RA patients [250.02 (126.98, 484.29) ng/L, 108.43 (55.16, 197.17) ng/L] than in the OA patients [165.05 (75.89, 266.37) ng/L, 69.00 (33.25, 104.74) ng/L] and the health controls [79.47 (38.22, 140.63) ng/L, 55.44 (18.76, 95.86) ng/L] (all P < 0.01). Spearman's correlation analysis showed that the level of serum CXCL9 was positively correlated with swollen joints (SJC), rheumatoid factor (RF) and disease activity score 28 (DAS28) (r=0.302, 0.285, 0.289; P=0.009, 0.015, 0.013). The level of serum CXCL10 was positively correlated with tender joints (TJC), SJC, C-reactive protein (CRP), immunoglobulin (Ig) A, IgM, RF, anti-cyclic citrullinated peptide antibody (ACPA), and DAS28 (r=0.339, 0.402, 0.269, 0.266, 0.345, 0.570, 0.540, 0.364; P=0.010, 0.002, 0.043, 0.045, 0.009, < 0.001, < 0.001, 0.006). Serum CXCL9 and CXCL10 levels in the RA patients with bone erosion were extremely higher than those without bone erosion [306.84 (234.02, 460.55) ng/L vs. 149.90 (75.88, 257.72) ng/L, 153.74 (89.50, 209.59) ng/L vs. 54.53 (26.30, 83.69) ng/L, respectively] (all P < 0.01). Logistic regression analysis showed that disease duration, DAS28 and serum level of CXCL9 were correlated with bone erosion in the RA patients (P < 0.05).@*CONCLUSION@#Serum levels of CXCL9 and CXCL10 were remarkably elevated in patients with RA, and correlated with disease activities and occurrence of bone erosion. Chemokines CXCL9 and CXCL10 might be involved in the pathogenesis and bone destruction in RA.

Nodal metastasis of cervix carcinoma- As a probable cause of bone erosion

Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and Design: Retrospective study. Materials and Methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix

Study to Determine the Incus Bone Erosion Ratio on Mastoid Exploration in Cases of Chronic Suppurative Otitis Media with Middle Ear Cholesteatoma

Aim: To evaluate the frequency of incus bone erosion during mastoid exploration in chronic suppurative otitis media with cholesteatoma of the middle ear. Study design: A cross-sectional descriptive study. Place and duration: In the ENT Department of Services Hospital Lahore for the one-year duration from January 2018 to January 2019. Methods: 70 chronic suppurative otitis media patients with the middle ear cholesteatoma were prospectively evaluated and selected with a non-probability purposive sampling technique. The operation was performed on 70 patients under general anaesthesia in the operating room. A standard questionnaire was prepared and history, examination, laboratory data, and treatment were recorded for each patient. Results: One of the usual common diseases of the ear, nose and throat is chronic suppurative otitis media. Previously this disease was called atticoantral type was considered usually unsafe, is mostly caused by marginal perforation with cholesteatoma, the distinguishing feature of this condition and is taken as a complicating element. A total of 70 patients with chronic suppurative otitis media with middle ear cholesteatoma were included in the study. Forty-five (64.28%) are men and 25 (35.71%) are women. 2: 1 was the M: F ratio. There were 10 patients in the first age group from 1 to 10 years 10 (14.28%), in the second age group patients from 11 to 20 years 35 (50%), in the third age group 21-30 years 12 (17.14%), in the fourth age group, 31 to 40 years of age 5 (7.14%), in the fifth age group, 41 to 50 years age 5 (7.14%), and in the sixth age group, 3 patients were >50 years (4.28%). The mean ± standard deviation in the age group was 21.2 ± 11.9 years. The mastoidectomy was performed in 64 patients (91.42%) and a modified radical mastoidectomy was performed in 6 patients (8.57%). Bone erosion due to suppurative otitis media with middle ear cholesteatoma was absent in 59 patients (84.28%) and 11 patients (15.71%) without bone erosion.

Solitary orbital myofibroma in a child: A rare case report with literature review

Myofibroma is a rare benign mesenchymal tumor of uncertain histogenesis. A six-year-old boy presented with a unilateral lower eyelid mass of six weeks' duration. MRI revealed a circumscribed mass in the inferolateral orbit with bony erosion. A systemic examination was unremarkable. Excision with histopathology revealed a partially infiltrative spindle cell tumor with bland nuclear morphology expressing smooth muscle actin and muscle-specific actin, compatible with myofibroma. Solitary myofibroma is a rare childhood orbital tumor and may clinico-radiologically closely mimic a malignancy. Histopathology and immunohistochemistry can help reach a definitive diagnosis. Systemic evaluation and close follow up are crucial in such cases.

Expression and clinical significance of interleukin-22 in patients with rheumatoid arthritis / 中国免疫学杂志

Objective:To explore the expression of IL-22 in the patients with rheumatoid arthritis,and to define the clinical sig-nificance of IL-22 cells for RA. Methods: A total of 50 RA patients, 15 OA patients and 15 healthy controls were enrolled. The proportion of Th22 cells in peripheral blood and synovial fluid( SF) of RA patients was detected by flow cytometry;the levels of IL-22 in serum and synovial fluid of RA patients were detected by ELISA. The clinical parameters of disease activity were assessed including ESR,RF,CRP,DAS28,anti CCP and the degree of bone erosions determined by X-rays. Pearson correlation analysis,t test and Kruskal-Wallis H test were used for statistical analysis. Results:The proportion of Th22 cells in RA patients was higher than that of OA patients (t=2. 290 ,P=0. 021) and healthy controls(t=2. 524,P=0. 015). IL-22 levels in RA patients were higher than that of OA patients (t=2. 560,P=0. 014) and healthy controls(t=2. 768,P=0. 009). IL-22 in the RF positive group were higher than that of RF negative group(t=2. 322,P=0. 035). IL-22 in the anti-CCP antibody positive group were higher than that of anti-CCP antibody negative group (t=2. 504,P=0. 015). The levels of IL-22 were correlated positively with ESR,RF,DAS28(r=0. 312,0. 314,0. 332,P χ20.05(3),P<0. 05). Serum IL-22 levels in the RA patients with joint effusion were higher than that of without(t=2. 587,P=0. 012). The levels of IL-22 in SF were higher than that in serum(t=2. 668,P=0. 011),and had no correlation with the proportion of Th22 cells in SF. Conclusion: The expression of IL-22 in serum and joint effusion of RA patients increase. The level of IL-22 may be useful marker for assessment of disease activity and finding of bone erosions. Therapeutic targeting of IL-22 may be valuable for the intervention of RA.

Value of anti-mutated citrullinated vimentin antibody and anti-cyclic citrullinated peptide antibody in the prediction of bone erosion and disease activity of rheumatoid arthritis / 中华风湿病学杂志

Objective To investigate the relationship between anti mutated citrullinated vimentin (MCV) antibody, anti-cyclic citrullinated peptide (CCP) antibody with disease activity and bone erosion in patients with rheumatoid arthritis (RA), so as to provide evidence for clinical diagnosis and treatment. Methods The anti-CCP antibody and anti-MCV antibody were detected using the enzyme-linked immune adsorption method (ELISA) for 634 patients with RA. At the same time, the clinical and laboratory data were collected, and the X-ray images of hands or feet were taken. Disease activity score (DAS)28 score was calculated, and all patients were divided into high disease activity group, moderatedisease activity group, low disease activity group and stable disease group on the basis of the DAS28 score. We analyzed the relationship between the degree of anti MCV, anti CCP antibodies, and disease activity of patients by Spearman correlation. And anti CCP, anti MCV antibodies, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) of these patients were compared at different period of bone erosion and disease activity by the Wilcoxon rank sum test and nemenyi. Results ① Positive correlation could be detected between anti-MCV antibody and ESR, CRP, number of tender joint, DAS28 score (r=0.115, P=0.004; r=0.120, P=0.003; r=0.124, P=0.002; r=0.085, P=0.032), and anti CCP antibody had no correlation with these index. The anti MCV antibodies in high disease activity group [694 (156, 1 000)] U/ml, and moderate activity group [911 (190, 1 000)] U/ml were higher than that of the low disease activity [248(150, 731)] U/ml or stable group [275(62, 928)] U/ml (U=2.29, P=0.023;U=2.25, P=0.024; U=2.45, P=0.014; U=2.4, P=0.018), and anti CCP antibody in the moderate disease activity group [499(180, 1 370)] U/ml was higher than low disease activity group [297(83, 574)] U/ml and stable group [187(67, 1 153)] U/ml (U=2.53, P=0.012; U=2.22, P=0.026). ②The anti MCV, anti CCP antibody in the bone erosion group were higher than those without bone erosion group (U=4.64, P<0.01;U=2.69, P=0.007). The anti MCV antibodies in stage Ⅱ[722(259, 1 000)] U/ml and Ⅲ group [714 (216, 1 000)] U/ml was significantly higher than that in stage Ⅰ [316(98, 1 000)] U/ml(U=3.46, P<0.01; U=4.28, P<0.01). The anti CCP antibody level in stage Ⅱ [394(180, 1 000)] U/ml and Ⅲ[391(181,1305)] U/ml was higher compared with stage Ⅰ[277 (98,898)] U/ml (U=1.99, P=0.046; U=2.92, P=0.004), and that in phase Ⅲ was higher than Ⅳ [218(71, 911)] U/ml (U=2.06, P=0.041). Conclusion Compared with anti-CCP antibody, anti-MCV antibody is closely related with disease activity, and has a better predictive value for bone erosion. Patients with higher ESR and CRP are more susceptible to bone erosion.

Long-term Treatment with Anti-platelet Agents for Collagen-induced Arthritis Improves Radiological Findings

OBJECTIVES: The objectives of this study were to evaluate the long-term effect of anti-platelet treatment on the radiological progression of collagen-induced arthritis in rats. METHODS: Female Lewis rats with collagen-induced arthritis were divided into three experimental groups: saline, aspirin monotherapy (n = 12), and aspirin–clopidogrel dual therapy (n = 12). Drugs were administered daily and continued up to 70 days after the induction of arthritis. The clinical arthritis index (weight, morphology score, and paw thickness) and radiological scores were evaluated. RESULTS: The clinical arthritis index peaked on day 20, while the radiological scores peaked on day 35. No intergroup difference was observed in the clinical arthritis index throughout the experiment. The aspirin–clopidogrel dual therapy group had a significantly higher mean radiological score than the other groups (p = 0.045) on day 35. Further treatments resulted in significantly improved radiological findings in the aspirin monotherapy and aspirin–clopidogrel dual therapy groups on day 70 but no significant improvement in the saline group. CONCLUSION: Anti-platelet agent treatment improved radiological findings on day 70. These observations emphasize the importance of a future long-term study of the effects of anti-platelet agent treatment on arthritis.

Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis

The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman's rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.

Tenosynovial Giant Cell Tumor Showing Severe Bone Erosion in the Finger: Case Report and Review of the Imaging Findings and Their Significance

We report a case of tenosynovial giant cell tumor with severe bone erosion in the right fifth finger of a 46-year-old man. Throughout this case review, we describe the imaging findings of tenosynovial giant cell tumor with severe bone erosion and review the literatures regarding osseous lesions caused by tenosynovial giant cell tumor and their significance related to the differential diagnosis and patient treatment.

Extradural Dermoid Cyst Located in the Lateral Sphenoid Ridge

Dermoid cysts are rare congenital tumors that occur primarily at the midline at a characteristic intradural location. However, dermoid cysts located at extradural and lateral regions have been rarely reported until now. In the present study, the authors demonstrate the unusual instance of an intracranial extradural dermoid cyst at the lateral sphenoid ridge. A 53-year-old woman admitted because of progressive headache and dizziness. The patient had no neurologic deficits, and magnetic resonance imaging with no contrast enhancement revealed a mass at the right sphenoid ridge. The mass was accompanied with sphenoid bone erosion visible on computed tomography. The patient underwent right pterional craniotomy, and the tumor including the capsule was totally resected. Presence of a dermoid cyst was confirmed with histopathological examination. The patient had no complications during the postoperative period. This study suggests that dermoid cyst should be considered for differential diagnosis of extradural and lateral intracranial masses.

Value of ultrasound on the early bone erosion of finger joint in patients with rbeumatoid arthritis / 中国医师进修杂志

Objective To explore the value of ultrasound on the early bone erosion of finger joint in patients with rheumatoid arthritis (RA).Methods Sixty-three cases of RA patients (patients group) with 486 finger joints was examined by high-frequency ultrasound,X-ray films and MRI,and compared with 20 controls (control group).Results The ultrasound results were significant difference between two groups (P＜0.01).The positive rate was 84.2％(409/486) in high-frequency ultrasound,and 56.2％(273/486) in X-ray films,there was significant difference between the two (P ＜ 0.05 ).The positive rate by high-frequency ultrasound was 63.8％ (136/213) in X-ray check-negative patients,and 68.1％ (145/213) by MRI.The results of the MRI contrast sensitivity of 97.6％,specificity of 75％,accuracy of 96.5％ by high-frequency ultrasound.Conclusion The high-frequency ultrasound on the X-ray check-negative patients with rheumatoid hand early joint bone erosion have some diagnostic value.

The diagnostic value of gluocose-6-phosphate isomerase in patient with rheumatoid arthritis / 中华风湿病学杂志

Objective To investigate the diagnostic value of gluocose-6-phosphate isomerase (G6PI) detected by an enzy-me linked immunosorbent assay (ELISA) in patients with rheumatoid arthritis (RA). Methods The G6PI was detected by ELISA in serum samples from 106 patients with RA, 53 non-RA controls with various rheumatic diseases, and healthy individuals. The level of rheumatoid factor (RF), anti-CCP antibodies and AKA were also assessed in RA patients. The correlation analysis beween G6PI and anti-CCP, IgM-RF. G6PI, anti-CCP, IgM-RF and AKA were carried out between patients with erosion and with non-erosion diseases . Results ① G6PI serum level of patients with RA was (1.61 ±1.20) μg/ml, and was (0.11 ±0.17) in patients with other rheumatic diseases, and (0.06±0.07) μg/ml in healthy individuals. There was statistical significant difference between RA patients and patients with other rheumatic diseases (P<0.05). Receiver operator curve analysis (ROC) showed an opitium cut off level for C6PI at 0.225 μl/ml. The sensitivity of G6PI was 0.868, the specificity was 0.853 in RA. C6PI was associated with RF, but was not associated with anti -CCP. C6PI ws not associated with disease activity index by Spearman' s correlation analysis. The association between above parameters with bone erosion was not detected, however. Conclusion C6PI is abnormally increased in some RA so it may be a new diagnostic marker for RA. G6PI has a reasonable sensitivity (86.8%) and with high specificity(85.3%) to RA and it is valuable for RA diagnosis. C6PI is associated with RF, but not completely overlaps. C6PI is not associated with diseases activity. No association is found between G6PI and bone erosions.

Ultrasonographic Assessment in Rheumatoid Arthritis / 대한류마티스학회지

The administration of disease-modifying antirheumatic drugs (DMARDs) in the early period of rheumatoid arthritis (RA) is critical for protecting against joint damage and inducing remission. Physicians need to identify patients at risk of progression to RA at the early stages of arthritis. Musculoskeletal ultrasonography (MSUS) allows the direct visualization of synovitis and bone erosion in the early phase, and may be useful for differentiating early rheumatoid arthritis from other inflammatory arthritis. Power Doppler sonography is a promising tool for assessing the disease activity and monitoring the effects of DMARDs. This article reviews the current status and recent advances in MSUS imaging in RA.

Artrite reumatóide / Rheumatoid arthritis

A artrite reumatóide (AR) é uma doença crônica, sistêmica, auto-imune, de etiologia desconhecida, que envolve, predominantemente, as pequenas articulações das mãos e dos pés. Punhos, articulações metacarpofalangeanas, interfalangeanas proximais e metatarsofalangeanas são as articulações mais envolvidas. A patogênese é complexa e multifatorial, com participação de fatores genéticos, ambientais e hormonais. A realização do diagnóstico o mais rápido possível e o estabelecimento imediato de terapia adequada nas fases mais iniciais da doença são de fundamental importância para o prognóstico do paciente. O diagnóstico da AR é realizado através da avaliação das manifestações clínicas, achados laboratoriais e de imagem. O paciente apresenta, na maioria das vezes, um quadro de poliartrite tendendo a evoluir para deformidades articulares, com importante perda funcional devido à característica crônica e progressiva da doença. O fator reumatóide (FR) se encontra positivo em 70% a 80% dos pacientes com AR. Corresponde a um auto-anticorpo, geralmente classe IgM, dirigido contra a porção Fc da imunoglobulina IgG. Quando presente em títulos elevados, a doença é, geralmente, mais agressiva e tem maiores chances de apresentar manifestações extra-articulares. O início da terapêutica o mais rápido possível é baseado em dados de estudos clínicos, que demonstraram o benefício no curso evolutivo, prevenindo o dano articular, a perda da função e a redução da dor. O principal objetivo do tratamento é o de atingir a remissão. A base do tratamento da AR é a utilização das drogas modificadoras do curso da doença (DMCD), associadas a antiinflamatórios não hormonais (AINH) e antiinflamatórios hormonais (AIH). Os agentes biológicos são novas drogas que têm indicação nos pacientes que não responderam adequadamente ao uso dos DMCD.

Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis: relation with disease activity and bone erosion / 中华风湿病学杂志

Objective To compare the correlation between anti-cyclic citrulinated peptide antibody (anti-CCP), rheumatoid factor (RF) and disease activity, functional capacity, bone erosion of rheumatoid arthritis (RA). Methods The correlation between anti-CCP, RF and disease activity score 28 (DAS28),health assessment questionnaire(HAQ) and bone erosion was assessed. Results Among the 218 RA patients,76% were anti-CCP-positive and 71% were RF-positive. The mean DAS28 score of RA patients with anti-CCP-positive and RF-positive was significantly higher than patients without anti-CCP and RF. The serum an-ti-CCP levels and RF levels showed a significant correlation with DAS28 score. However, the HAQ scores, ESR and CRP levels showed no significant difference between anti-CCP-positive and anti-CCP-negafive patients, RF-positive and RF-negative patients. Among anti-CCP-positive RA patients, the number of patients with erosive disease was significantly higher than patients without anti-CCP. However, the number of patients with erosive disease was not significantly different between RF-positive and RF-negative patients. Conclusion Anti-CCP and RF arc associated with disease activity. Anti-CCP is associated with bone erosion. No association is found between RF and bone erosion.

Peripheral ameloblastoma: A case report / 대한구강악안면방사선학회지

Peripheral ameloblastoma is an extremely rare odontogenic soft tissue tumor with histologic characteristics similar to those of the intraosseous ameloblastoma. It appears in the gingiva and oral mucosa. And it usually does not show any bone involvement on radiographs, except for saucer shaped erosion of underlying alveolar bone. Recurrence is considered uncommon. We report a case of peripheral ameloblastoma with bone involvement. Histologically it presented with follicles and nest of tumor cells with palisading pattern. And radiographs showed the typical saucer shaped alveolar bone erosion at the distal area of right mandibular third molar. At 6-month follow-up after operation, no local recurrence was noted.

The protective effect on joint destruction of ~99Tc-MDP and its effect on tumor necrosis factor alpha in rat collagen-induced arthritis / 中华风湿病学杂志

Objective To determine the effects of~(99)Tc-MDP on joint inflammation and bone destruc- tion in collagen-induced arthritis(CIA)rats model and its effect on tumor necrosis factor alpha(TNF-?). Methods CIA was induced by immunization of male SD rats with an emulsion of collagen.~(99)Tc-MDP or placebo was intravenous infused to rats for 20 days.Joint inflammation was assessed by arthritis index.Lesions of bone were assessed based on the histological changes in ankle joints,radiographic analysis in hind paw with Larsen score.Systemic TNF-?level was measured by radioimmune assay.Results~(99)Tc-MDP suppressed joint swelling(P