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Objective To analyze and discuss the expression of serum polymyositis‐scleroderma(PM‐Scl) antibody and its clinical significance in patients with systemic scleroderma(SSc) .Methods 315 hospitalized patients diagnosed with scleroderma by typical clinical manifestations or skin pathology from 2009 to 2012 were enrolled in the study .All patients were grouped into PM‐Scl antibody positive(PM‐Scl + ) group(90 cases) ,Scl‐70 antibody positive(Scl‐70+ ) group(70 cases) ,anti‐centromere antibody positive( ACA+ ) group(75 cases) and antibody negative group(80 cases) according to autoantibody spectrum .The severity of skin and visceral damage among all the groups were analyzed and compared .Results Patients in PM‐Scl+ group were characterized with different clinical manifestations .Compared with the other 3 groups ,the incidence of myositis in PM‐Scl+ group was significantly higher( all P< 0 .05) ;patients in Scl‐70+ group had higher incidence of visceral organ damage than PM‐Scl+ group(all P < 0 .05) .The incidence of skin lesions ,Raynaud′s phenomenon and capillary expansion in ACA+ group were higher than that of PM‐Scl+ ,while the incidence of interstitial lung disease ,heart disease and kidney disease were lower(all P< 0 .05) .Conclusion It is helpful for clinicists′ further understanding of common autoantibodies in Ssc patients and making correct assessment of the disease through analyzing the expression of PM‐Scl antibody .
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Objective To compare the clinical response with etoricoxib 60 mg once daily with diclofenac sodium tablet 75 mg two times daily in the treatment of osteoarthritis of the knee or hip joint.Methods A 4-week multicenter,randomized,double-blinded and active comparator-controlled clinical trial was performed during January 2005 and June 2005 in 6 medical centers in China.Eligible patients (≥40 years old Chinese patients with osteoarthritis of the knee and hip) were randomized (1:1 ratio) to receive etoricoxib 60 mg once daily (n=90),or diclofenac sodium 75 mg twice daily (n=90).Primary efficacy end point is the change of WOMAC (Western Ontario and McMaster Universities osteoarthritis index) pain subscale from baseline to 4 weeks; non-inferiority bounds were pre-defined [if the upper bound of 95％ confidence interval (CI) for the difference is less than 10 mm on a 100-mm VAS WOMAC pain subscale] for the comparison of the change between the two groups.The secondary efficacy endpoints include WOMAC physical function subscale,WOMAC stiffness subscale,patient's global assessment of response to therapy (PGART),investigator's global assessment of disease status (IGADS),discontinuation due to lack of efficacy and rescue paracetamol tablet count.Safety was assessed by physical examination,adverse experience reported,and laboratory safety data.Results C6mpared to baseline,the changes of WOMAC pain subscale after 4 weeks treatment were statistically significant (P＜0.01) in both groups (etoricoxib group:51±16 vs 21± 19; diclofenac sodium group:53±16 vs 22±19).There was no difference in the change of WOMAC pain subscale between the two groups.The change in WOMAC stiffness subscale,WOMAC physical function subscale,PGART and IGADS in both groups were statistically significant (P＜0.01),but there was no difference between treatment groups according to the pre-defined non-inferiority criteria.No drug related serious adverse events were observed during the study.The difference in drug-related adverse event incidence between the two groups was not statistically significant.Etoricoxib and diclofenac sodium were generally safe and well tolerated.Conclusion Etoricoxib 60 mg administered once daily is efficacious and shows clinical efficacy notinferior to that of diclofenac sodium 75 mg administered twice daily for the treatment of osteoarthritis.Etoricoxib 60 mg administered once daily for 4 weeks is generally safe and well tolerated.
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Objective To analyze the expression of IFIT4,PRKR and investigate the clinical and immunology features of different types of liver involvement in patients with systemic lupus erythematosus (SLE).Methods Clinical data of 62 cases of SLE with liver damage and 62 cases of SLE without liver damage were collected.Peripheral venous blood samples were obtained and total RNA were extracted and transcribed into cDNA.Sybr green dye based real-time quantitative PCR method was used to compare the expression levels of IFIT4,PRKR in patients with SLE.Clinical parameters were analyzed by ANOVA,Chi-square test,Pearson's or Spearman's test.Results ① The increase of γ-GT or ALP was correlated with rash and oral ulcer (x2=5.625,P=0.018),lupus nephritis (x2=5.631,P=0.019),anemia,thrombocytopenia (99±21,P=0.028; 81±45,P=0.004,),CRP (33±43,P=0.004).The positive rate of nRNP (x2=4.862,P=0.027 ) and SSA (x2=8.087,P=0.004) was higher in patients with liver damage than other groups; ② The positive rate of anti-Rib antibody in SLE with liver damage was significantly higher than SLE without liver damage (x2=19.542,P=0.000); ③ There was no difference in the expression of IFIT4 among these groups,but higher expression of PRKR was detected in the group of patients with increased γ-glutamyl transpeptidase (γ-GT) or ALP(F=3.54,P=0.018).Conclusion The different types of liver damage in SLE patients have different clinical and immunology characteristics.The expression of PRKR is higher in patients with increased γ-GT or ALP.
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Objective To investigate the expression of the genes correlated with interferon induced genes virus (MX1, OAS1, IFI44) in the peripheral blood leukocytes of patients with systemic lupus erythematosus (SLE), and to evaluate the relationships between the expression levels of these genes and diseaseactivity. Methods The clinical data of 100 SLE patients, 40 non-SLE patients with rheumatic diseases, and 40 normal controls were collected. Peripheral blood samples were collected. Total RNA was extracted and transcribed into cDNA. SYBR green dye based real-time quantitative PCR method was used to compare the expression levels (indicated as △CT value) of MX1, OAS1 and IFI44 in patients with SLE and those in the controls. Comparisons between groups were performed with ANOVA and Spearman correlations. Results ①The △CT value of MX1, OAS1 and IFI44 expression level of the SLE patients (3.4±1.8, 4.2±1.5, 8.8±2.2)was significantly higher than those of the non-SLE patients (2.4±0.4, 3.4±0.7, 5.4±2.1 ) and normal controls (2.3±1.1, 2.6±0.7, 5.2±2.0). ② The △CT value of OAS1 and IFI44 expression level of the SLE patients in severe disease was significantly higher than those of the SLE patients in mild disease and the SLE patients with stable disease. ③The ACT value of OASI and IFI44 were correlated with the SLEDAI scores (r=0.038,0.380). ④ The △CT values of MX1, OAS1 and IFI44 expression level of the SLE patients with arthritis were significantly higher than those of SLE patients without arthritis. ⑤ The △CT value of IFI44 expression level of the SLE patients with lupus nephritis (3.2±2.1,2.2±1.1) was significantly higher than that of the SLE patients without lupus nephritis. ⑥ There was correlations among these genes in SLE patients (P＜0.05). Conclusion The value of MX1, OAS1 and FFF44 expression level of SLE patients is up-regulated. The real time expression levels of OAS1, IFI44 genes are associated with SLE disease activity and there are close correlation among these genes with interferon induce virus-relationed genes (MX1, OAS1, IFI44) in SLE patients.
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ObjectiveTo evaluate the clinical and radiological efficacy of TNFR Ⅱ -Fc combined with methotrexate( MTX ) in treatment of patients with moderate and severe rheumatoid arthritis.MethodsThree hundred and ninty-six RA patients were randomized into the combined treatment group,the TNFR Ⅱ -Fc only group and MTX only group.All patients were treated for 24 weeks.ACR-N,ACR20,ACR50,ACR70,DAS28-ESR and Sharp score of both hands were measured for efficacy,and the side-effects were analyzed by one-way ANOVA.Results After 24-week therapy,the ACR-N of the combined treatment group [( 12.79±9.24)％-year] was significantly improved than that of the TNFR Ⅱ-Fc only group [(9.56±11.16)％-year,P＜0.05] and that of the MTX only group[(5.08±11.10)％-year,P＜0.05],and the TNFR Ⅱ-Fc group was significantly improved than that of the MTX group(P＜0.05).The ACR20 response rate of the combined group(80.4％) was significantly higher than that of the TNFR Ⅱ -Fc group(71.1％,P＜0.05) and the MTX group(56.7％,P＜0.01 ).The ACRS0 response rate of the combined group(53.6％) was significantly higher than that of the MTX group(30.8％,P＜0.01 ).The ACR70 response rate of the combined group was 27.7％,which was significantly different from that of the TNFR Ⅱ -Fc group (15.8％) and MTX group (7.7％,P＜0.05or P＜0.01 ).DAS28-ESR in the combination group was significantly reduced than those of the TNFR Ⅱ -Fc group and MTX group,and the DAS28-ESR of the TNFR Ⅱ -Fc group was significantly reduced than MTX group.The average total Sharp score of both hands,which demonstrated the radiographic changes,was significantly reduced in the combination group than the MTX group(P=0.03).The total adverse events in the combined group(40.9％) was significantly high than that of the MTX group(28.8％,P＜0.05).Conclusion TNFR Ⅱ -Fc combined with MTX can effectively control the activity of RA and radiological progress.
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Objective To investigate the expression of interferon-induced protein 44 (IFI44) gene in the leukocytes of the peripheral blood samples from patients with systemic lupus erythematosus (SLE), and to evaluate the relationship between the expression level and disease activity. Methods Mononuclear cells in the peripheral blood samples from 100 SLE patients were compared with those of 40 disease controls and 40 healthy donors (HD) and the expression of the IFI44 was evaluated by quantitative real-time PCR.Comparisons between groups were performed with ANOVA, and the correlation analysis between the level of expression was higher in SLE patients than disease controls and healthy donors (26.8±5.3, 7.4±2.7, 5.2±2.0,respectively) (P=0.0012, P=0.005), but no difference was found between disease controls and healthy donors. Mild disease activity and the SLE patients with stable disease (63.1±22.4, 28.0±7.2, 9.2±1.8, respectively)and 24 hours urine protein level (r=0.42, P=0.000). Conclusion IFI44 is demonstrated to be highly expressed in SLE patients. The level of IFI44 may be a promising candidate biomarker for identifying SLE activity.
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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.
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BACKGROUND: It is always the key issue of rheumatoid arthritis(RA) to treat articular gall. A kind of medicine with favorable therapeutic effects and safety is urgently needed in the clinics. 99Tc-methylene diphosphonate 99(Tc-MDP) receives generalized attentions on its therapeutic effects and safety since its application into RA therapy.OBJECTIVE: To explore the characters of 99Tc-MDP in the amelioration of articular dysfunction in RA patients.DESIGN: A before-and-after controlled study by employing patients as subjects.SETTING: Department of rheumatism and immunology of an affiliated hospital of a university.PARTICIPANTS: Totally 67 patients with RA at active phase including 11males and 56 females aged between 29 and 71 years old with the course of disease between 9 and 78 months and admitted by the Department of Rheumatism of Huaxi Hospital Affiliated to Sichuan University were in accordance with the RA diagnostic criteria established by American Rheumatism Association(ARA) in 1987. Serious heart,liver or kidney dysfunction,active gastrointestinal pathological changes, hematology and endocrinology diseases,allergic complexion,and women during pregnancy or breast-feeding period were eliminated.METHODS: Clinical indicators including articular edema index, articular pain,grip,morning stiffness duration,rest pain,erythrocyte sedimentation rate (ESR) and C reactive protein(CRP) were compared before and after therapy in 67 cases received 99Tc-MDP treatment. Integrated evaluation was performed after the completion of therapy. Effective meant 30% of improvement in symptoms and physical signs,and reduction in ESR and CRP. Side effects were observed and recorded simultaneously. Data were statistically analyzed.RESULTS: After 99Tc-MDP treatment,RA condition significantly improved,as well as each clinical indicator including articular edema index,articular pain index,morning stiffness duration,rest pain,ESR and CRP(P<0.05) . The total clinical effective rate of this medicine was 81% and the incidence of side effects was small and mild.CONCLUSION: 99Tc-MDP can ameliorate the articular dysfunction of RApatients,which is a safe medicine with strong effect.
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Objective To investigate the efficacy and safety of Technetium 99m Tc methylenediphos-phonate injection (Yunke) and various combination therapy on rheumatoid arthritis.Methods All 137 patients enrolled in trial group.Among them 67 patients received Technetium 99m Tc methylenediphosphonate alone,42 patients received combination therapy with methotrexate and mobik and 28 patients received calcium orally meanwhile.Clinical manifestations and lab markers were observed carefully.Results The conditions of 67 patients receiving Technetium 99m Tc methylenediphosphonate alone were improved,42 patients received combination therapy had better effect and 28 patients in middle and old-age taking calcium orally simultaneously showed superiority in remission of rest pain and descent of ESR.Conclusion Technetium 99m Tc methylenediphosphonate is an effective and safe drug in the treatment of rheumatoid arthritis.Results is suggest calcium be taken in the same time.
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Objective To study the significance of antikeratin antibodies(AKA) in rheumatoid arthritis(RA). Method Serum samples of 98 patients with RA and 70 rheumatic disease controls were tested by indirect immunofluorescence assay.The diagnostic specificity and sensitivity of AKA were compared with rheumatoid factor(RF). The features of clinical manifestation and lab findings were compared in patients with RA who were positive for AKA with ones who were negative.Results The positive rate of AKA in RA patients was significantly higher than that in rheumatic disease controls.AKA showed a diagnostic specificity of 97.1%, higher than RF.RA patients who were positive for AKA had more active disease as assessed based on clinical, laboratory tests,and radiological variables, as compared with AKA negative patients. Conclusion AKA showes high disease specificity and has prognostic significance in patients with RA.
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Objective To summarize the various acute abdomen manifestation of systemic lupus erythematosus (SLE) and their diagnosis and treatment.Methods Twenty SLE patients with AA were analysed and 35 year′s literature was reviewed.Results Most AA were of active SLE (70%),others were of non SLE related disease (30%).Cause of these cases was diversified,which often lead to misdiagnosis.Making correct diagnosis as early as possible was the key point to improve the patient′s survival rate.Conclusion SLE with AA indicates a critical condition.Investigating the cause of AA and working out appropriate treatment measures are most important.
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Objective To explore the diagnostic significance of anti-cyclic citrullinated peptide antibody(anti-CCP)and the role it plays in the articular erosion in patients with rheumatoid arthritis(RA).Methods The diagnostic significance of anti-CCP?AKA and RF were evaluated respectively.Seventy-five RA patients were devided into group1(limited radiographic damage group)and group2(severe radiographic damage group).The distribution of anti-CCP,AKA and RF in patients of the two groups were investigated.A univariate analysis was used to determine whether anti-CCP?AKA?RF?ANA?ESR?CRP or cutaneous nodules plays a role on articular erosion in RA.To determine which has the best predictive value for severe radiographic da-mage,all variables were entered into a logistic regression model.Results The sensitivity and specificity of an-ti-CCP?AKA and RF were49%,94%;50%,93%;79%,67%respectively.When any two markers were combined,the specificity would be raised.The positive rate of these three markers were much higher in group2than that in group1.Anti-CCP had the highest OR(6.71)for articular erosion in RA.Logistic regression analysis showed a strong correlation between anti-CCP,AKA,CRP or cutaneous nodules and less favourable disease outcomes.Cut.aneous nodules had the strongest correlation with severe radiographic damage.Conclusion Anti-CCP is a satisfactory marker for RA.Diagnostic accuracy appears to be raised when anti-CCP combined with AKA and RF.Anti-CCP has a strong correlation with severe radiographic damage.To investigate multiple risk factors of articular erosion will be helpful to pridict the outcome of RA.