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Objective The purpose of this study was to evaluate the degree of skin thickening of patients with systemic sclerosis (SSc) by high-frequecy ultrasound,as well as the value of ultrasound.Methods Thirty-one patients with SSc and 31 age-matched and sex-matched healthy control subjects were enrolled.Skin thickness,modified Rodnan skin score (mRss),disease activity index (DA1) and other clinical parameters within and between groups were compared using SPSS 21 software.Student's t test,x2 test or nonparametric testing was performed to compare between groups.The Pearson or Spearman methods were used to test correlation.Sensitivity and specificity of skin thickness detection by high-frequecy ultrasound were evaluated by using receiver operating characteristic (ROC) curve analysis.Results Total thickness of skin (TST) of patientswith SSc were positively correlated to the total mRss (r=0.416,P=0.020) and DAI (r=0.436,P=0.014).The skin thickness of patients with mRss 0,1,2 was higher than CNT [1.45(0.60),1.70(0.30) mm,1.60 (0.30) mm vs 1.30 (0.35) mm,Z=-3.242,-6.577,-5.090,P＜0.01].The cut-off value of TST used as the evaluation of skin change was 7.4 mm by ROC curve analysis,and the sensitivity and specificity of them was 77.40％ and 87.10％ respectively,and patients with thickened skin were more likely to suffer interstitial lung disease (ILD) (16 vs 1,x2=26.004,P=0.014),higher mRss [10(6) vs 4(5),Z=-2.499,P=0.031],DAI [(5.2±2.4) vs (2.3±1.7),t=-3.104,P＜0.01)] and CRP [(8.60 (10.48) mg/L vs 3.52 (4.93) mg/L,Z=-2.276,P=0.038].Conclusion US combined with mRss are helpful to evaluate the changes of skin and disease activity of patients in SSc.US can identify the early and subclinical skin involvement that may precede mRss,providing a more reliable tool for diagnosis,treat efficacy and prediction of organ damage.
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Objective To explore how leptin affects RA,especially those with joint erosion.Methods The study recruited 48 consecutive patients with RA (14 patients with knee joint effusion) and 23 age and sex matched healthy people.RA patients were grouped into low and moderate activity group [2.6＜28-joint disease activity score (DAS28) ≤5.1,n =5] and high activity group (DAS28 ＞5.1,n =43) according DAS28-ESR;Meanwhile,they were grouped into bone erosive group (n=20) and non-erosive group (n=28) according to X-ray of both hands.Demographic data of RA patients were recorded.ELISA was applied to assess leptin and a disintegrin and metalloproteinase with thrombospondin-like motifs (ADAMTS4) in serum and synovial fluid of RA group.Sharp/van der Heijde scores were used to assess bone erosion and joint space narrowing.Leptin and ADAMTS4 from serum and synovial fluid were compared between different groups using t test,Rank sum test,Chi-square test and Analysis of Variance,and we did Pearson and Spearman's Corre-lation analyses between these values and clinical features,lab indicators and radiological scores.Moreover,we did single factor and logistic regression analyses,which facilitated screening risk factors of joint destruction.Results Serum leptin in RA group was significantly higher than that of the control group [8.06(6.24) ng/ml vs 4.62(7.13),Z=-2.113,P=0.035],and leptin was positively correlated with Shar/van der Heijde score (r=0.347,P=0.016).Serum leptin in erosive RA patients was higher than that of the non-erosive patients (Z=-2.070,P=0.038),and there was a positive correlation between leptin and ADAMTS4 only in synovial fluid of RA patients with erosion (r=0.900,P=0.037).It was found in logistic regression results that RA patients with more tender joint counts and elevated leptin were more likely to develop bone erosion [OR=1.229,95％CI (1.007,1.500),P=0.043;OR=1.159,95％CI (1.015,1.324),P=0.030].Conclusion Leptin participates RA joint destruction probably by modulating expression of ADAMTS4.Leptin and tender joint count are independent risk factors for RA with joint destruction.
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Systemic sclerosis is an autoimmune disease characterized by skin thickening and tightness.Digestive system is the most commonly damaged system secondary to skin,and as to unspecific clinical manifestations,this complication is often ignored in the early,the prognosis and quality of life of patients will be affected.This article overviews the recent research developments on pathology,clinical features,management of systemic sclerosis with digestive system involvement,to draw attention to early diagnosis and treatment of this condition for the improvement of the prognosis.
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Objective To study clinical manifestations, risk factors and prognosis of patients with systemic lupus erythematosus (SLE) complicated with digital gangrene. Methods Data of 2684 inpatients with SLE admired to Peking Union Medical College Hospital during December 1997 to August 2007, including demographic information, clinical features, laboratory findings, as well as therapeutic regimens, were retrospectively analyzed, and 18 of those complicated with digital gangrene were identified and followed up. Results Average age at onset in patients of SLE complicated with digital gangrene was(33±12)years, with an average duration of disease course of (99±60 ) months.Longer course duration ( ≥ 4 yrs), Raynaud's phenomenon, elevated serum C-reactive protein (CRP) and positive anti-SSA antibody all were associated with occurrence of digital gangrene in patients of SLE, with P values of 0.012, 0.004, 0.037 and 0.087 respectively, and odds ratios of 1.03 (95% CI 1.01～1.05 ), 39.05 (95% CI 3.31～460.13 ), 17.99 (95%(CI 1.19～271.29) and 7.01 (95% CI 0.75～65.12), respectively. Fifteen of 18 SLE patients complicated with digital gangrene started treatment with predisone ≥1 mg˙kg-1 ˙d-1, and eighteen all were treated with cyclophosphamide, though eight cases failed and ultimately received digital amputation. Prompt corticosteroid treatment (predisone ≥ 1 mg˙kg-1˙d-1 within three weeks after occurrence) could decrease risk for amputation, with P =0.081 and OR =0.135 (95% CI 0.01～1.28). Conclusions Longer duration of disease course, Raynaud's phenomenon, elevated serum CRP and positive anti-SSA antibody all are independent predictors of SLE complicated with digital gangrene. Early and aggressive treatment can prevent occurrence of gangrene from its progression and improve its prognosis.
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Objective To investigate radionuclide imaging pattern with ~ 99m Tc-MDP in rat arthritis induced by collagen, and the significance of the imaging in the early diagnosis of arthritis. Methods 70 male Wistar rats were divided into normal (n=28) and model group (n=42), both groups were respectively subdivided into 7 groups according to time of treatment. Collagen induced arthritis (CIA) model was reproduced by subcutaneous injection of collagen and adjuvant. For imaging, rats were injected with ~ 99m Tc-MDP through tail vein. The technique of Radome of Interesting (ROI) was used in knee and whole bone, and R value was calculated. The concentration of radionuclide was observed and compared with arthritis index (AI), paw thickness, pathological changes and ?-ray examination. Results Rats in model group showed higher concentration of radionuclide in the knee joint (P
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Objective To reproduce a rat model of collagen-induced arthritis with anemia,and to probe the effects of thalidomide on hemoglobin of these rats.Methods 128 male Wistar rats were randomly divided into 5 groups:Ⅰ(normal control group,n=24),Ⅱ(model group,n=26),Ⅲ(model group with high dosage of thalidomide,n=26,200mg?kg-1?d-1),Ⅳ(model group with low dosage of thalidomide,n=26,100 mg?kg-1?d-1)andⅤ(model group with methotrexate(MTX),n=26,2.7mg?kg-1?w-1).Every group was divided into 6 sub-groups(14,21,28,35,42 and 60d)according to different time points.The rat models with collagen-induced arthritis and anemia were reproduced by multiple subcutaneous injections at intervals of emulsion of collagen Ⅱ and Freund's complete adjuvant.Different kinds of treatment were given to the rats of different groups beginning on the 12th day after the first injection.The levels of hemoglobin in rats of group Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ were determined,and serological characteristics,morphologic changes,and serum iron content,total iron binding capacity,and pathological changes in bone marrow in rats of group Ⅰ and Ⅱ were observed.Results On the 28th day after the first injection,anemia appeared in rats of group Ⅱ,in which the hemoglobin level was lower significantly compared with that of group Ⅰ(P