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Background: Rheumatoid arthritis (RA) is a common disease that causes substantial morbidity in most patients and premature mortality in many. All the drugs used in the treatment of rheumatoid arthritis show significant toxicity and hence it is important to monitor the drugs for adverse drug reaction. This study will estimate the prescribing pattern and bring out the possible adverse drug reactions in patients with rheumatoid arthritis.Methods: This study included 200 patients with rheumatoid arthritis who fulfilled the study criteria were observed for three months. Their prescriptions were collected and analysed. The symptoms of adverse drug reaction were documented through questionnaire. The causality assessment was done by WHO-UMC assessment scale and severity by using modified Hartwig-Seigel severity assessment scale.Results: This study showed most of the patients were female (86%). Majority of them were in age group of 51-60 years. Average number of drugs per prescription was 10.57. Out of 200 patients, 2% were on single DMARD and 50.5% were on two DMARDs. 40% and 7.5% were taking three and four DMARDs respectively. A total of 450 adverse drug reactions were reported, out of which 68.4% due to steroid,12.5% due to DMARDs and 19.1 due to use of NSAIDs, DMARDs and glucocortisteroids. Chloroquine maculopathy occurred in 3 patients and elevated liver enzymes due to methotrexate in 3 patients, which necessitated DMARD withdrawal. Most patients had 1-3 ADRs. 6% of ADRs were severe and 54% belongs to probable category of causality assessment.Conclusions: Treatment of rheumatoid arthritis is mainly based on DMARDs, glucocorticosteroids and NSAIDs. So, occurrence of ADR is much common. Proper monitoring of therapy and timely modification of drugs and lifestyle can reduce the ADR occurrence.
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Primary nephrotic syndrome( PNS) is a common kidney disease in children. Glucocorticoste-roid( GC) is recognized as the first-line drug,and most children are sensitive to it. However,the problems of fre-quent relapses and steroid-dependence still have not been solved. In recent years,a number of randomized con-trolled studies have been conducted on the dosage of GC medications,the efficacy and safety of immunosuppres-sive agents,some of which try to figure out how to effectively reduce relapse and the rate of hormone-depend-ence. This review summarizes the progress in the treatment of steroid-sensitive,steroid-dependent,and frequently relapsing nephrotic syndrome.
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Objective:To explore the clinical effect of mycophenolate mofetil combined with glucocorticosteroid on the children with anaphylatic purpura nephritis.Methods:70 cases of children treated and diagnosed as anaphylatic purpura nephritis in our hospital from March,2012 to September,2015 were enrolled in this study.They were randomly divided into the observation group and the control group.Conventional therapy was applied to both groups,the observation group was treated by mycophenolate mofetil combined with prednisone,the control group was given cyclophosphamide combined with prednisone.The total effective rate,disappearence time of clinical symptoms,biochemical indicators,immune function as well as the incidence of adverse reactions were compared between the two groups.Results:The total effective rate of observation group was 94.29％,which was 85.17％ in the control group,no statistical difference was found between two groups(P＞0.05).After therapy,the disappearence time of albuminuria,hematuria in observation group showed no significant difference compared with those of the control group,the level of 24 h urine protein quantitation and CD19+ of both groups were significantly decreased,and the level of CD19+ of observation group was significantly lower than that of the control group (P ＜0.05),the level of albumin,total protein and CD3+,CD3+CD4+ of both groups were significantly increased,and the level of CD3+,CD3+CD4+of observation group were significantly higher than those of the control group (P＜0.05).The incidence of adverse reactions in observation group was significantly lower than that of the control group (P ＜0.05).Conclusion:Mycophenolate mofetil combined with glucocorticosteroid was more effective and safe on the children with anaphylatic purpura nephritis than that of cyclophosphamide combined with prednisone.
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Objective To explore the clinical efficacy and safety of cyclosporin A combined with glucocorti-costeroid in the treatment of juvenile uveitis.Methods 66 juvenile uveitis patients(93 eyes)were selected.Accord-ing to the conditions,the patients were treated by oral administration of cyclosporin A,2-5mg·kg -1 ·d -1 ,twice per day,combined with prednisone,0.5-1mg·kg -1 ·d -1 ,taken in the morning.After 4-6 months treatment,the inflam-mation control and visual acuity improvement were observed,and before and after treatment liver and kidney function, blood glucose,blood pressure,white blood cell counts were checked.Adverse reactions in patients were recorded with regular follow-up.Results After 4-6 months treatment,heal inflammation 78 eyes,accounted for 83.87%;improved 9 eyes,accounted for 9.68%;no respond in 6 eyes,accounted for 6.45%;the total effective rate was 93.55%.Visual acuity was obviously improved in 50 eyes,improved in 27 eyes and no response in 16 eyes;the total effective rate was 82.79%;56 eyes were removed from residual standard.In the stage of therapy,6 patients had liver and kidney dys-function,6 patients had blood abnormalities,and 3 patients had low blood sugar,all were controlled by symptomatic treatment in the normal range,and no systemic progression.Conclusion Cyclosporin A combined with glucocortico-steroid applied in juvenile uveitis improved the results with obvious clinical effect and fewer systemic side effect.
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Objective]Based on 346 cases of PNS patients using glucocorticoids observed during treatment, the main symptoms, syndrome differentiation of syndrome type of traditional Chinese medicine(TCM) by induction, and discusses its the evolution regularity of TCM Syndromes.[Methods]Develop a unified observation table, then clinicians recorded symptoms, signs, tongue picture and type of pulse to log on to observe truthfully and un-mistakbly table, after the end of observation, comprehensive analysis by the four examination methods, using a unified standards for TCM syndrome type determination. Discussion after glucocorticoids treatment of patients with PNS TCM syndrome objective laws of evolution.[Result]First ,TCM syndrome evolution:the results show that:before hormone treatment, Qi deficiency of spleen and kidney and Yang deficiency of spleen and kidney have become the most important type of syndrome;hormone use initial stages 1~4 weeks, Qi deficiency of spleen and kidney, deficiency of Qi and Yin, when the hormone used for 5~8 weeks. Yin deficiency of liver and kidney and deficiency of Qi and Yin occupied the main position; during the hormone withdrawal stage, the deficiency of Qi and Yin increased significantly; in the hormone maintain stage it was mostly deficiency of Yin and Yang and Yang deficiency of spleen and kidney. As for demonstration, in hormone therapy before a lot of patients suffering from retention of water and turbid damp;After the treatment of 1~4 weeks it was mostly humid heat ,turbid damp and blood stasis;the accompanying symptoms were mostly humid heat, blood stasis and pathogenic factor of wind after the treatment of 5-8 weeks ;Miscellaneous accompanying symptoms were very conspicuous except retention of water in the treatment of hormone withdrawal stage; In the hormone maintaining stage, the highest proportion of blood stasis compared with others. The use of hormone therapy, humid heat and blood stasis were more prominent than others. Second, after the hormone treatment(1~8weeks) the relationship between efficacy and TCM syndromes: A total of 130 patients enrolled, the 96 patients with Yin deficiency syndrome, the rest of the patients had no deficiency of Yin syndrome. The results indicated that Yin deficiency syndrome group serum albumin and 24-hour urinary protein excretion efficacy than those without Yin deficiency syndrome group, with statistical significance.[Conclusion] Glucocorticoids should belong to pure Yang medicine in traditional Chinese medicine, the body under the action of pure Yang drugs are prone to Yin deficiency symptoms, suggests that the higher the sensitivity to drugs, the clinical remission rate is also higher. This can be applied in clinical glucocorticoids and observe the change of the patients with syndrome, early in the patients' sensitivity to the glucocorticoids.
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It is difficult to interpret the infection after glucocorticosteroid treatment because glucocorticosteroid will lead to increased peripheral blood neutrophils.Procalcitonin (PCT) is a major biomarker,which can be used as the basis for early diagnosis of severe bacterial infections.The level of PCT is not inhibited by glucocorticosteroid.PCT can be used to interpret infection as systemic use of glucocorticosteroid
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High-dose intravenous gamma globulin (2 g/kg) combined with oral aspirin is currently considered as standard strategy for Kawasaki disease (KD) in initial treatment.However,there are still 15％-25％ of KD patients with no response to the treatment,thus leading to persistent fever,or even further damage of the coronary arteries.International literature have also mentioned other methods of treatment,such as corticosteroids,TNF-α blockade,lyclosporin,IL-1 receptor blockade,methotrexate,anti-CD20 rituximab,plasma exchange.But fixed standard for non-reactive gamma globulin require for further treatment.
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Objective To investigate the therapeutic effect of 4-1BB monoclonal antibodies (4-1BBmAb) and glucocorticosteroid and the affect of the expression of CD4+CD25+T lymphocytes on the mouse hepatitis induced by ConA.Methods Mouse model of hepatic injury was induced by the application of ConA and checked by hepatic function tests and hepatic pathology.Mter the animal models were constructed,the mice in the group of therapeutic alliance were treated with glucocorticosteroid and 4-1BBmAb.In contrast,mice in the control group were treated with 4-1BBmAb or glucocorticosteroid alone.The groups were then compared.After blood was collected respectively from the control group,the model group and the therapy group,flow cytometry was used to examine CD4+CD25+T lymphocytes.Chi-square test and t-test were used for statistical analysis.Results Compared with the control group,the conditions of the mice were improved after being disposed with 4-1BBmAb.The conditions became even better when 4-1BBmAb were used combined with glucocorticosteroid.ALT and AST of the control group were (140±22) U/L and (131±16) U/L respectively,that of 4-1BBmAb group were (98±14) U/L and (89±11) U/L respectively.The ALT and AST of the glucocorticosteroid treatment group were (76±11) U/L and (71±10) U/L respectively,ALT was (61±8) U/L and AST was (55±7) U/L in the combination treatment group.Differences among groups was statistically significant (P＜0.01).The expression of CD4+CD25+T lymphocytes was (3.0±0.8)％ in the control group,(8.5±2.9)％ in the gluco-corticosteroid treatment group,(8.4±3.5)％ in the 4-1BBmAb treatment group and was (11.2±3.5)％ in the combination treatment group.The difference was significant among the groups (P＜0.05).Conclusion 4-1BB-mAb have therapeutic effect for hepatic injury.The effectiveness will become even more evident when 4-1BB monoclonal antibodies are used together with glucocorticosteroid.During the course of treatment,4-1BBmAb and glucocorticosteroid can impact the expressions of CD4+CD25+T lymphocytes and this is the mechanism for the effectiveness in treating immune-mediated hepatic injury.
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Objective To screen for biomarkers in urine from patients with steroid-resistant nephrotic syndrome (SRNS) using surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) Proteinchip technology. Methods Urine samples from 9 SRNS patients, 32 steroid-sensitive nephrotie syndrome (SSNS) patients and 45 normal controls were analyzed using UA gold chip. Proteomic spectra were generated by mass spectrometry. Results Four differentially expressed biomarkers were identified with relative molecular weight of 6 703, 7 212, 11 820, 14 356. It was found that these protein peaks with relative molecular weigh of 7 212, 11 820, 14 356 were highly expressed in SRNS and 6 703 were lowly expressed in SRNS. The diagnostic cast that is constructed with these four protein to differentiate SRNS from SSNS with sensitivity of 88.89% and specificity of 93.75%. Conclusions SELDI-TOF-MS Proteinchip technology is a non-invasive, quick, easy, and convenient, and high-throughput analyzing method capable of screening several biomarkers from the urines of SRNS patients and has better clinical value.
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To investigate the effect of the Ginkgo Biloba Extract (GBE) on the asthma and examine its possible mechanisms, 75 asthma patients were divided into 4 groups and the patients were respectively treated with fluticasone propionate for 2 weeks or 4 weeks, or treated with fluticasone propionate plus GBE for 2 weeks or 4 weeks. Fifteen healthy volunteers served as healthy controls. Sputum inhalation with inhaling hypertonic saline (4%-5%) was performed. Lung ventilatory function and forced expiratory volume in one second (FEV1) were measured. The numbers of different cells in induced sputum were calculated. The expression of PKCα in the cells was immunocytochemically detected and the percentages of positive cells in different cells were counted. Interleukin-5 (IL-5) in sputum supernatants was detected with enzyme-linked immunosorbent assay. The percentage of eosinophils, lymphocytes, PKCα positive inflammatory cells and the concentration of IL-5 in asthmatic patients were higher than those in the controls (P＜0.05), and the eosinophils, lymphocytes,positive expression of PKCα and the level of IL-5 were significantly decreased in asthmatic patients after they were treated with fluticasone propionate or fluticasone propionate plus GBE. However,they were still significantly higher than those of the controls. Compared to the group treated with glucocorticosteroid for 2 weeks, no significant decrease was found in the percentage of eosinophils,lymphocytes, PKCα positive inflammatory cells and the IL-5 in the supernatant of induced sputum.Compared with the group treated with glucocorticosteroid for 2 or 4 weeks, significant decrease in the same parameters was observed in the group treated with fluticasone propionate and GBE for 4 weeks. The IL-5 level in the supernatant of induced sputum was positively correlated with the percentage of PKCα-positive inflammatory cells and the percentage of eosinophils in the induced sputum in asthma patient groups respectively (n=150, r= 0.83, P＜0.01; n=150, r=0.76, P＜0.01). The FEV1 was negatively correlated with the percentage of PKCα-positive inflammatory cells and the IL-5 levels in supernatant of induced sputum in asthma patients respectively (n=150, r=-0.77,P＜0.01; n=150, r= -0.64, P＜0.01). It is concluded that GBE could significantly decrease the infiltration of inflammatory cells such as eosinophils and lymphocytes in the asthmatic airway and relieve the airway inflammation. GBE may decrease the activation of the PKCα in the inflammatory cells and thereby decrease the IL-5 level in induced sputum. GBE may be used as a complement to the glucocorticosteroid therapy for asthma.
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BACKGROUNDS: Although glucocorticoids are one of the most potent anti-inflammatory agents, they have limited effect on cysteinyl leukotriene biosynthesis. In addition, the response to inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABA) combination therapy in moderate to severe persistent asthmatics varies. Additional therapy with leukotriene receptor antagonists (LTRA) in patients with moderate to severe asthma suboptimally controlled with ICS and LABA combination therapy would be complementary to asthma control. METHODS: One hundred and ninety eight asthmatics entered a 2 month, open-label descriptive study. Patients suffering from persistent asthma and suboptimally controlled on a combination therapy of fluticasone/salmeterol or budesonide/ formoterol were given montelukast 10 mg daily as an add-on therapy. The level of asthma control was assessed using the Asthma Control Questionnaire (ACQ) including FEV(1) % predicted at the baseline and after a 2-month treatment with montelukast. A global evaluation of the treatment was also made by the patients and physicians. RESULTS: The mean ACQ score decreased significantly on montelukast (11.5+/-5.4 at baseline vs. 6.7+/-5.0), with a significant improvement in all individual symptom scores (p<0.01). The FEV(1) % predicted values did not show any significant change. 59.9% of patients and 59.4% of physicians reported global improvement in their asthma (kappa=0.85). CONCLUSION: These results suggest that the addition of montelukast in patients with persistent asthma that is suboptimally contolled by combination therapy of ICS and LABA might confer complementary effects on asthma control.
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Humans , Adrenal Cortex Hormones , Anti-Inflammatory Agents , Asthma , Glucocorticoids , Leukotriene Antagonists , Surveys and Questionnaires , Formoterol FumarateABSTRACT
BACKGROUND AND OBJECTIVES: Airway epithelial cells contribute to the pathogenesis of air disease by their interaction with inhalant pathogenic extracts. Airborne fungi interact with nasal epithelial cell and enhance the production of inflammatory cytokines. Glucocorticosteroids (GCs) have been used therapeutically for nasal polyps and allergic disease with potent anti-inflammatory effects. The purpose of this study was to investigate the inhibitory effect of GCs on fungi induced nasal epithelial cell activation. MATERIALS AND METHODS: The epithelial cells of nasal polyps were obtained from patients and stimulated with Alternaria. To evaluate the anti-inflammatory effects of GCs, Alternaria was pretreated with GCs (triamcinolone, dexamethasone, and budesonide) and cultured with epithelial cells. Interleukin-8 (IL-8) and granulocyte-macrophage colony stimulating factor (GM-CSF) were measured to determine the activation of epithelial cells. Reverse transcriptase-polymerase chain reaction (RT-PCR) test for protease-activated receptors (PARs) mRNA expression in nasal epithelial cells were performed. RESULTS: Alternaria enhanced the production of IL-8 and GM-CSF from nasal epithelial cells. GCs inhibited the activation of nasal epithelial cells, but the PAR2 and PAR3 mRNA expression were not suppressed by GCs. CONCLUSION: These data suggest that GCs inhibit the production of chemical mediators by Alternaria, but anti-inflammatory effect of GCs are not associated with PARs.
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Humans , Adrenal Cortex Hormones , Alternaria , Colony-Stimulating Factors , Cytokines , Dexamethasone , Epithelial Cells , Fungi , Granulocyte-Macrophage Colony-Stimulating Factor , Interleukin-8 , Nasal Polyps , Receptors, Proteinase-Activated , RNA, MessengerABSTRACT
Objective To study the change of the level of serum leptin in children with primary nephritic syndrome(PNS)treated with glucocorticosteroid.Methods Totally 30 PNS patients and 26 healthy children in whom were a matchable age,sex and body mass index(BMI)with the PNS patients were recruited in this study.The PNS patients were treated with prednisone in middle-term or long-term coure of treatment.Serum leptin and BMI of PNS patients were abserved before treatment,after 2,6 months treatment and in the end.The se-rum total cholesteroc(TC)and triglyeride(TG)were abserved in PNS patients after 2,6 months treatment and in the end.Results The se-rum leptin level was(2.75?2.29)?g/L in the PNS patient before treatment and control group was(2.65?2.22)?g/L.There was not significantly different between the PNS patient and control group.The level of serum leptin after 2 months treatment was(9.29?7.19)?g/L and BMI was(18.12?1.90)kg/m2.They were higher than that in control group,6 months treatment and in the end(Pa
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In order to provide an experimental evidence for clinical utility, we undertook a series of experimental studies of glucocorticosteroid to treat closed head injury and gun shot brain wound, For studies of closed injury in rats, there were four groups as follows: Group 1: methyl prednisone 30mg/kg (MPG); Group 2: dexamethasone 5 mg/kg (HDMG): Group 3: dexamethasone0.5mg/kg (LDMG); and Group 4: normal saline as a control group (CG) For study of gun shot wound of brain, The dogs were divided into three groups, Grup 1 (wound group, n=8); Group 2 (treated group, n=7) and group 3 (control group, n=7). After injury, the vital signs were observed, the water content of the brain and Even' s blue level were measured and the brain were examined under optical and electronic microscopy, All results proved that secondary traumatic edema in the animals used high dose glucocotricosteroid were much more slight
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Objective:To report the clinical characteristics and diagnoses of diabetic demyelinating neuropathy.Methods:Five cases were systematically studied based on the clinical observations and data from aided examination.Results:All the five patients with diabetes mellitus were more than 50 years old.The clinical manifestations included predominantly motor symmetric weakness,proximal and distal,associated with areflexia and a relapsing or a chronic progressive course.The five cases were indistinguishable from idiopathic chronic inflammatory demyelinating polyneuropathy(I-CIDP) in clinical picture and electrophysiology.They responded to glucocorticosteroid treatment,plasma exchange and intravenous immunoglobulin.Conclusion:Diabetic demyelinating polyneuropathy is one of several types of diabetic peripheral neuropathies.