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OBJECTIVE:At present,there are many reports on the related factors associated with the incidence of cervical spine instability in patients with rheumatoid arthritis,but there are problems such as small sample size and many confounding factors,and the research results of various studies on the same related factors are also different.This article analyzed the factors related to cervical spine instability in patients with rheumatoid arthritis by means of a systematic review. METHODS:Articles related to cervical spine instability in patients with rheumatoid arthritis were collected by searching both Chinese and English databases until March 2023.The outcome of cervical spine instability in patients with rheumatoid arthritis was used as the grouping criterion to abstract basic information,baseline patient characteristics,laboratory-related tests,medication use,and other relevant risk factors.Meta-analysis was done using Stata 14.0 software. RESULTS:(1)Sixteen relevant studies,all of moderate or above quality,were included,including seven studies with case-control studies and nine with cross-sectional studies.The overall incidence of cervical spine instability in patients with rheumatoid arthritis was 43.08%.(2)Meta-analysis showed:Related risk factors included female(OR=0.60,95%CI:0.44-0.82,P=0.002);age at disease onset(SMD=-0.52,95%CI:-0.86 to-0.18,P=0.003);duration of disease(SMD=0.58,95%CI:0.14-1.02,P=0.01);body mass index(OR=0.74,95%CI:0.63-0.88,P=0.001);rheumatoid factors positive univariate analysis subgroup(OR=1.33,95%CI:1.02 to 1.72,P=0.04),C-reactive protein(SMD=0.26,95%CI:0.16-0.35,P=0.00),erythrocyte sedimentation rate(SMD=0.15,95%CI:0.002-0.29,P=0.047),anti-cyclic-citrullinated peptide antibodies(OR=1.73,95%CI:1.19-2.51,P=0.004),28-joint Disease Activity Score(SMD=0.20,95%CI:0.04-0.37,P=0.02),destruction of peripheral joints(OR=2.48,95%CI:1.60-3.85,P=0.00),and corticosteroids(OR=1.91,95%CI:1.54-2.37,P=0.00)were strongly associated with the development of rheumatoid arthritis-cervical spine instability.Female and corticosteroid use were independently associated with the occurrence of rheumatoid arthritis-cervical spine instability. CONCLUSION:Based on clinical evidence from 16 observational studies,the overall incidence of rheumatoid arthritis-cervical spine instability was 43.08%.However,the incidence of cervical spine instability in rheumatoid arthritis patients varied greatly among different studies.Gender(female)and the use of corticosteroids were confirmed as independent correlation factors for the onset of cervical spine instability in patients with rheumatoid arthritis.The results of this study still provide some guidance for early clinical recognition,diagnosis,and prevention of rheumatoid arthritis-cervical spine instability.
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<p><b>OBJECTIVE</b>To evaluate the clinical therapeutic effects and safety on rheumatoid arthritis (RA) treated with acupuncture at the points detected with thermosensitive moxibustion in medicine combined with western medication.</p><p><b>METHODS</b>A total of 168 RA patients in compliance with the inclusive criteria were collected and randomized into an observation group and a control group, 84 cases in each one. In the control group, in reference to the updated guideline of new drugs by the European League Against Rheumatism (EULAR) in 2013, the medication scheme was formulated for oral administration, methotrexate tablet 7.5 mg, once a week; salazosulfapyridine enteric-coated tablets, 100 mg, twice a day; hydroxychloroquine sulfate tablets, 20 mg, twice a day; and meloxicam tablets, 15 mg, once a day. In the observation group, besides the treatment as the control group, the acupuncture therapy at the points detected with thermosensitive moxibustion in medicine was given. The mild moxibustion was applied near to the affected joint with the moxa material of herbal medicine to detect the sensitization points. Afterwards, the acupuncture technique of medicine was given on those points, without any manipulation applied. The needles were retained for 30 min, once daily. The treatment for 2 weeks was as one course, continuously for 2 courses. The indexes were observed before and after treatment in the two groups including gripping power, the time of morning stiffness, the swollen joint count 28 (SJC 28), the tender joint count 28 (TJC 28), the disease activity score 28 (DAS 28), the score of patient global assessment of disease activity (PtGA) and the score of provider global assessment of disease activity (PhGA), as well as rheumatoid factors (RF), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and anti-cyclic peptide containing citrulline (A-CCP). The clinical therapeutic effects were evaluated in the two groups.</p><p><b>RESULTS</b>After 4-week treatment, a total of 163 patients accomplished the clinical trial, 81 cases in the observation group and 82 cases in the control group. The results of gripping power, the time of morning stiffness, SJC 28, TJC 28, PtGA, PhGA, DAS 28, RF, CRP, ESR and A-CCP were all improved as compared with those before treatment (all <0.05). In 4 weeks of treatment, the results of gripping power, the time of morning stiffness, SJC 28, TJC 28, PtGA, PhGA, DAS 28, as well as CRP and ESR in the observation group were better than those in the control group (all <0.05). The results of RF and A-CCP were not different significantly between the two groups (both >0.05). The total effective rate was 85.19% (69/81) in the observation group, higher than 70.73% (58/82) in the control group (<0.05).</p><p><b>CONCLUSION</b>The acupuncture therapy at the points detected with thermosensitive moxibustion in medicine achieves the satisfactory clinical effects with few adverse effects.</p>
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Humanos , Puntos de Acupuntura , Terapia por Acupuntura , Artritis Reumatoide , Terapéutica , Moxibustión , Resultado del TratamientoRESUMEN
Objective To investigate the diagnostic and prognostic value of immunoglobulin (Ig)G isotype rheumatoid factors (IgG-RF) in rheumatoid arthritis (RA).Methods Five hundred patients with RA were enrolled randomly.IgG-RF antibody was detected by enzyme-linked immunosorbent assay (ELISA).The correlations between serum IgG-RF antibody and clinical features,disease activities,laboratory of RA patients were evaluated.The comparison of continuous variables was performed by using the Student t-test or Mann-Whitney U test in accordance with normality testing.Chi-square test was performed for categorical variables.A value of P less than 0.05 was considered statistically significant.Results ① IgG-RF was positive in 41.0％ (205/500) of RA patients.In patients with anti-citrullinated protein/peptide autoanti-bodies (ACPA) negative,RF negative or the seronegative patients (both ACPA and RF were negative),the positive rate of IgG-RF was 22.4％(24/107),13.2％(17/129) and 9.1％(5/55),respectively.② Compared with patients with negative IgG-RF,patients with positive IgG-RF had higher rates of joint deformity [(58.5％(120/205) vs 39.3％(116/295),x2=17.918] and bone erosion [(75.6％(118/156) vs 60.3％(140/232),x2=9.796] (P＜0.01,respectively).③ The patients with positive IgG-RF had higher rates of elevated ESR(86.3％ vs 67.8％,x2=22.426),IgG(29.9％ vs 20.0％,x2=6.310),compared to patients with negative IgG-RF (P＜0.05,respectively),and levels of ESR [(59±35) mm/1 h vs (47±32) mm/1 h,t=3.989] and CRP [(390±450) mg/L vs (290±340) mg/L,t=3.004] was higher in IgG-RF positive group than the negative (P＜0.01,respectivelys).④ Compared with the IgG-RF negative patients,the positive group had higher smoking rates (22.9％ vs 12.5％,x2=9.227),higher current smoking rates (16.6％ vs 7.1％,x2=11.119) and higher smoking index [(107±238) vs (49±161),t=3.199](P＜0.05,respectively).Conclusion IgG-RF had its clinical values in RA diagnosis.IgG-RF is significantly associated with joint deformity,bone erosions and smoking.
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Objective To investigate the role of rheumatoid factor(RF) ,C‐reactive protein(CRP) ,erythrocyte sedimentation rate (ESR) in the diagnosis of rheumatoid arthritis(RA) .Methods 74 RA patients and 90 patients with symptoms similar to RA were recruited in the study randomly .Blood samples were detected for the levels of RF ,CRP ,ESR .The results were compared between two groups .Receiver operating characteristic curve(ROC) was used to access the diagnostic efficiency .Results The levels of RF , CRP ,ESR of RA group were (271 .4 ± 560 .9)IU/mL ,(28 .7 ± 35 .6)mg/L ,(60 .9 ± 40 .1)mm/h ,respectively ,and were higher than those of control group which were (56 .8 ± 189 .3)IU/mL ,(15 .4 ± 24 .7)mg/L ,(45 .1 ± 33 .1)mm/h respectively .ROC analysis re‐vealed that the AUC of RF ,CRP ,ESR and combined detection of the 3 factors were 0 .784 ,0 .666 ,0 .615 ,0 .757 ,respectively with statistical significance(P<0 .05) .Conclusion RF ,CRP ,ESR are useful in the diagnosis of RA ,and RF has the highest diagnostic ef f iciency .
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Context: Rheumatoid arthritis (RA) has a heterogeneous course, spanning from mild forms tending to remission and reacting well to treatment, to aggressive forms resistant to classical therapeutic measures. Reliable predictive parameters of the disease course in RA are needed. Raised levels of Rheumatoid Factors (RFs) are associated with RA and that this RF is found in IgM, IgA and IgG classes (isotypes). Aims: To figure out the value of RF isotypes titers as predictors for RA processes and outcomes. Materials and Methods: Fifty three RA patients were enrolled in this study. The patients were diagnosed based on ACR criteria. Blood sample was taken from each patient at time of attending; sera were separated immediately and kept frozen at -70oC until used. Disease Activity Score (DAS) was calculated using DAS28-3 formula. Radiographs were read by expert radiologists. Sandwich Enzyme-linked Immunosorbent Assay (ELISA) was used for the separate quantitative detection of RF of the IgG, IgM and IgA classes in serum. Statistical Analysis Used: Chi-square, Pearson's correlation coefficient and ROC statistical analyses was performed using SPSS version 15.0. Results: Among the 53 RA patients who were enrolled in this study, there were statistically significant positive correlations between the presence of radiological joint changes with serum levels of IgG-RF, IgM-RF and IgA-RF as measured by calculation of area under curve (0.772, 0.703 and 0.769, respectively). However, no correlation could be found between those RF isotypes with any of other disease processes and outcomes. Conclusions: These results may indicate the importance of the titers of those isotypes as good predictors of erosive RA and may reflect a causal relationship between their titers and joint damage during the course of RA.
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OBJECTIVE: Serologic support is important for the diagnosis of rheumatoid arthritis (RA). Anti-cyclic citrullinated peptide (anti-CCP) has relatively low sensitivity despite of high specificity for the diagnosis of RA. Anti-mutated citrullinated vimentin (anti-MCV) is an indirect solid phase enzyme immunoassay for the quantitative measeurement of IgG class autoantibodies against MCV, a novel serologic marker for an aid in the diagnosis of RA. We investigated a diagnostic value of anti-MCV in comparison with those of anti-CCP, and rheumatoid factors (IgM, IgG, and IgA RFs) in RA patients. METHODS: Cohorts of 48 patients with RA and 50 patients with osteoarthritis (OA) were enrolled. All patients underwent standard examinations, including anti-MCV, anti-CCP, IgM RF, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). We measured IgG RF and IgA RF titers in 21 RA and 50 OA patients. The sensitivities and specificities of anti-MCV, anti-CCP, RFs were determined. Correlations with these markers, ESR and CRP were analyzed. RESULTS: The sensitivity of anti-MCV, anti-CCP, and IgM RF were 89.6%, 89.6%, and 77.1%, respectively. The specificities of them were 96.0%, 96.0%, and 88%, respectively. Combination of two tests such as anti-MCV or anti-CCP positivity increased the sensitivity up to 93.8%. None of these markers showed significant correlation with ESR and CRP. Anti-MCV correlated with anti-CCP (r=0.596, p<0.01) and IgM RF (r=0.301, p=0.038). CONCLUSION: Anti-MCV and anti-CCP showed high sensitivity and specificity for the diagnosis of RA. Combination of these markers increased the sensitivity without significant decrease in the specificity, suggesting they may be promising serologic markers for RA.
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Humanos , Artritis Reumatoide , Autoanticuerpos , Sedimentación Sanguínea , Proteína C-Reactiva , Estudios de Cohortes , Diagnóstico , Técnicas para Inmunoenzimas , Inmunoglobulina A , Inmunoglobulina G , Inmunoglobulina M , Osteoartritis , Factor Reumatoide , Sensibilidad y Especificidad , VimentinaRESUMEN
Objective To determine the diagnostic value of anti-mutated citrullinated vimentin(anti- MCV)antibodies for rheumatoid arthritis(RA).Methods The anti-MCV were determined in 136 patients with RA,80 non-RA patients and 19 normal peoples.The diagnostic value of anti-MCV was assessed and compared with anti-CCP,AKA and RF.Results The sensitivity and specificity of anti-MCV in the 136 RA patients was 95.6% and 80.8% respectively,there was significanl difference between the test group and the control group(P