Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR) / 中华医学杂志(英文版)

BACKGROUND@#The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.@*METHODS@#Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.@*RESULTS@#In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0-18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59-3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01-1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01-1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use.@*CONCLUSIONS@#Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

Association of skin lesion severity with clinical features of psoriatic arthritis / 中华内科杂志

Objective:To investigate the relationship between psoriasis severity and clinical features in psoriatic arthritis (PsA).Methods:Patients were recruited from the Chinese REgistry of Psoriatic ARthritis (CREPAR) between December 2018 and June 2021, and data were collected including the baseline demographic characteristics, various clinical manifestations (including arthritis, nail disease, comorbidities), laboratory tests[including erythrocyte sedimentation rate(ESR), C-reactive protein (CRP)], health assessment questionnaire (HAQ). Body surface area (BSA) and psoriasis area and severity index (PASI) were selected for the tools of assessment of cutaneous psoriasis. Patients were divided to two groups, including the severe psoriasis group (BSA>10%) and the non-severe psoriasis group (BSA≤10%). Disease assessment included ankylosing spondylitis disease activity score (ASDAS), disease activity score 28 (DAS28) and disease activity in psoriatic arthritis (DAPSA).Results:1 074 eligible patients with PsA were recruited, and 106 (9.9%) had severe psoriasis. Compared with non-severe psoriasis group, the severe psoriasis group had more peripheral joint involvement (including patients with ever or current peripheral arthritis, 94.3% vs. 85.6%), more polyarticular joint involvement (including patients with current peripheral arthritis, 74.0% vs. 58.2%), more axial joint involvement (51.4% vs. 39.9%), more nail disease (72.6% vs. 61.4%), more frequency of smoking (20.2% vs. 18.7%), and higher proportion of hypertension (23.4% vs. 14.4%). In addition, the severe psoriasis group had higher level of ESR [33(10, 70) mm/1h vs. 20(9, 38) mm/1h] and CRP [18.6(5.0, 60.8) mg/L vs. 7.0(2.4, 18.1) mg/L], higher values of DAS28-ESR (4.5±1.7 vs. 3.7±1.5), DAS28-CRP (4.2±1.5 vs. 3.4±1.4), ASDAS-ESR (3.5±1.4 vs. 2.6±1.2), and ASDAS-CRP(3.4±1.6 vs. 2.5±1.2), higher scores of HAQ [0.6(0.1, 1.0) vs. 0.3(0.0, 0.8)].Conclusion:Patients with PsA with severe psoriasis bore a heavier disease burden. Therefore, clinicians were supposed to pay more attention to them. In addition to skin lesions, they should also focus on examination of other clinical manifestations, such as joints and nails.

Clinical characteristics and risk factors in 118 patients with systemic lupus erythematosus and osteonecrosis / 中华内科杂志

Objective:To investigate the clinical characteristics and risk factors for osteonecrosis (ON) in patients with systemic lupus erythematosus (SLE).Methods:This is a case-control study. A total of 118 patients diagnosed with SLE complicated with ON (study group) were retrospectively analyzed between 2014 and 2019. Gender, age, and course matched 118 SLE patients without ON were selected as controls. Clinical manifestations, laboratory findings, medical history, and treatments were recorded and analyzed.Results:Among 118 patients, the male to female ratio was 20 to 98 with a median age of 27 years and course of disease 1-168 months. Compared with the control group, the study group presented a longer cumulative duration of glucocorticoid therapy [36.5 (0-168) months vs. 19.0(0-168) months on average, P<0.05], a higher incidence of osteoporosis (29.7% vs. 4.2%, P<0.001), a higher frequency of immune-suppressive therapy (83.9% vs. 64.4%, P=0.035), more organs involveed [median 2 (0-5) vs. 1 (0-4)], and a higher SLE disease activity index (SLEDAI) (14.22±7.40 vs. 11.63±6.11, P<0.05) in univariate logistic regression. The control group had a higher rate of positive Coombs test (39.8% vs. 7.6%, P<0.05). No statistical difference on methylprednisolone (MP) pulse therapy ( P>0.05) was observed. Multivariate logistic regression suggested that SLEDAI ( OR= 1.070, 95% CI 1.026-1.116, P<0.005), osteoporosis ( OR=10.668, 95% CI 3.911-29.103, P<0.001) and a positive Coombs test( OR=0.492, 95% CI 0.266-0.910, P<0.05) were related to the development of ON in SLE patients. Conclusion:A higher disease activity and the presence of osteoporosis are associated with an increased risk of ON in patients with SLE, and positive Coombs test seems a protective factor of ON.

Clinical analysis and literature review of adult onset Still's disease with interstitial lung diseases / 中华风湿病学杂志

Objective@#To analyze the clinical characteristics of patients with adult onset Still's disease (AOSD) with interstitial lung diseases (ILD), and review the literature.@*Methods@#The medical records of inpatients with AOSD and ILD from January 2000 to October 2017 were retrospectively analyzed, and pa-pers were searched and summarized with the key words "adult onset Still's disease" and "interstitial lung diseases". Kolmogorov-Smirnov test was used to test if variables met normal distribution. Measurement data which was normally distributed was described as Mean±SD. Measurement data which was not normally distributed was described as median and interquartile range.@*Results@#Among the 15 patients included in the study, six were male, and nine were female, and the mean age was (50±12) years. All of the 15 patients had fever, and the average temperature was (39.4±0.4) ℃. Eleven patients had rash, and 12 patients had arthralgia, seven patients presented with cough, and eight patients presented with short of breath. The high resolution computed tomography of the chest presented as ground glass opacity in nine patients, grid shadow in three patients and consolidation in three patients. All the 15 patients received glucocorticoids, and 10 patients received immunosuppressants at the same time. One patient was lost to follow up, four patients died (three patients died of respiratory failure and one patient died of myocardial infarction), 10 patients improved.@*Conclusion@#Patients with AOSD can also have ILD, which should be alerted by clinicians. Early treatment with glucocorticoids and immunosuppressants if infection is excluded may bring good prognosis, and it is easy to relapse when glucocorticoids is tapered off.

Clinical analysis and literature review of adult onset Still's disease with interstitial lung diseases / 中华风湿病学杂志

Objective To analyze the clinical characteristics of patients with adult onset Still's disease (AOSD) with interstitial lung diseases (ILD),and review the literature.Methods The medical records of inpatients with AOSD and ILD from January 2000 to October 2017 were retrospectively analyzed,and papers were searched and summarized with the key words "adult onset Still's disease" and "interstitial lung diseases".Kolmogorov-Smirnov test was used to test if variables met normal distribution.Measurement data which was normally distributed was described as Mean ±SD.Measurement data which was not normally distributed was described as median and interquartile range.Results Among the 15 patients included in the study,six were male,and nine were female,and the mean age was (50±12) years.All of the 15 patients had fever,and the average temperature was (39.4±0.4) ℃.Eleven patients had rash,and 12 patients had arthralgia,seven patients presented with cough,and eight patients presented with short of breath.The high resolution computed tomography of the chest presented as ground glass opacity in nine patients,grid shadow in three patients and consolidation in three patients.All the 15 patients received glucocorticoids,and 10 patients received immunosuppressants at the same time.One patient was lost to follow up,four patients died (three patients died of respiratory failure and one patient died of myocardial infarction),10 patients improved.Conclusion Patients with AOSD can also have ILD,which should be alerted by clinicians.Early treatment with glucocorticoids and immunosuppressants if infection is excluded may bring good prognosis,and it is easy to relapse when glucocorticoids is tapered off.

Clinical analysis of 25 cases of Beh?et′s disease complicated with pulmonary hypertension / 中华全科医师杂志

Objective To understand the clinical features of Behcet′s Disease( BD) with pulmonary hypertension( PH) .Methods The etiology, clinical features, treatment and prognosis of 25 patients with Bahcet′s disease ( BD) complicated with pulmonary hypertension ( PH) admitted in Peking Union Medical College Hospital from January 2000 to August 2015 were retrospectively reviewed.Results Total 912 BD patients were hospitalized during the same period, among whom 25 cases were complicated with PH accounting for 3%.There were 15 males (60%) and 10 females (40%), with the mean age of (33 ±12) years (range 19 to 66 years).The median interval from the diagnosis of BD to the onset of PH was 1 year (range 0 to 40 years).The most common cause of PH was heart valve disease (n=10, 40%), followed by pulmonary arterial stenosis or occlusion (n=6, 24%), pulmonary arterial aneurysm with thrombus (n=1, 4%), pulmonary thrombosis (n=1, 4%), cardiomyopathy (n=1, 4%);there were no causes identified in 6 cases (24%).Pulmonary arterial pressures estimated by echocardiography were 40 to 117 mmHg (1 mmHg=0.133 kPa) with a mean pressure of (60 ±22) mmHg.When the PH developed, elevated erythrocyte sedimentation rate ( ESR ) and increased hypersensitive C-reactive protein ( hs-CRP ) were founded in 48% ( 11/23 ) and 82% ( 14/17 ) of patients, respectively.After treated with glucocorticoid (96%,24/25), immunosuppressive agents(92%, 23/25), anticoagulation or thrombolysis(36%,9/25) and specific targeted vasodilator(32%,8/25), the levels of ESR and hs-CRP declined in 91% (10/11) and 71%(10/14) of patients, respectively; and pulmonary arterial systolic pressure declined in 50% of cases (8/16).Among 9 patients followed for 2 to 96 months, 4 died, 1 aggravated, 2 kept stable and 1 improved.Conclusion PH is an uncommon complication in disease.Heart valve disease, pulmonary artery involvement are the major causes of PH.The therapeutic effect and prognosis are poor.

Clinical analysis of 6 patients with drug-induced lupus / 中华内科杂志

Objective To improve the understanding of drug-induced lupus (DIL) and the differences from systemic lupus erythematosus (SLE).Methods Clinical manifestation and treatment of patients with definite DIL were retrospectively analyzed.Results Six patients with DIL were enrolled in this study,including 4 females and 2 males.Two patients were diagnosed after receiving interferon,one after soluble tumor necrosis factor receptor fusion protein,one after propylthiouracil,one after penicillamine,and one after levofloxacin.High titer of antinuclear antibody was identified in all six patients,including 3 with positive anti-dsDNA antibody.One patient had positive anti-Sm antibody.One patient had positive anti-RNP antibody.One patient had anti-nucleosome antibody.One patient had anti-histone antibody.One patient had antimitochondrial antibodies-M2,and one patient had anticardiolipin antibodies.Conclusion Patients with DIL are not as severe as those with SLE.After cessation of suspected drugs and administration of standard treatment,the clinical outcome of DIL is satisfying.

Clinical analysis of 46 cases with systemic lupus-associated pancreatitis / 中华全科医师杂志

Objective To determine the clinical features of systemic lupus erythematosus (SLE) patients with pancreatitis.Methods The medical records of 46 patients with pancreatitis among 5 233 SLE patients admitted into Peking Union Medical College Hospital from January 1983 to January 2012 were reviewed for retrospective analyses of clinical manifestations,laboratory tests,radiological findings,treatments and prognosis.Results The prevalence of pancreatitis was 0.88％ (46/5 233) in SLE patients.There were 7 males and 39 females with an average age of (33 ± 13) yeats.Acute pancreatitis (n =40) occurred more frequently than chronic pancreatitis (n =6).It appeared mostly in active course of SLE with an involvement of more organs.Hypertriglyceridemia was found in 81.0％ (17/21) lupus-associated acute pancreatitis patients.The average level of triglycerides in severe acute pancreatitis was higher than that in mild acute pancreatitis (P =0.023).The mortality rate of lupus-associated acute pancreatitis was 37.5％ (15/40).Most patients received high-dose glucocorticoid and immunosuppressants.Acute pancreatitis appeared in only 5 patients during the course of steroids pulse therapy and most symptoms were mild.Concomitant infections were correlated with poor prognosis (P ＜ 0.01).The most common manifestations of lupus-associated chronic pancreatitis were abdominal pain,jaundice and pancreatic enlargement.Autoimmune pancreatitis could be the initial manifestation of lupus.Conclusions Pancreatitis with SLE includes acute and chronic pancreatitis.Among them,acute pancreatitis is more common and severe and it usually occurs in patients with active SLE with a high mortality.Hypertriglyceridemia may induce and aggravate lupus-associated acute pancreatitis.Early aggressive management with high-dose steroids and immunosuppressants is recommended.Concomitant infection is a risk factor of poor prognosis.

Pulmonary artery hypertension of adult onset of Still's disease: 3 cases report with literature review / 中华风湿病学杂志

Objective To improve the rheumatologists'understanding of pulmonary artery hypertension (PAH) of adult onset Still's disease (AOSD).Methods Three cases of (AOSD) with (PAH) were reported and the related literatures were reviewed.Results All patients were female.The average age was 29 years old.As the cases showed,the clinical manifestations of AOSD were all before the appearance of PAH symptoms and the interval could be 5 months to 9 years.From the ultrasonic cardiogram estimation,the PASP of these patients was (80±21) mm Hg (1 mm Hg=0.133 kPa) on average.The common characteristics included the severity of AOSD,recurrence after high dose of corticosteroid and various immunosuppressive agents aggressively.In addition,PAH was developed rapidly,and we found that patients were die 1 year later after disease onset.Studies showed that all of their death were related to circulation failure caused by right heart failure combined with obstructive shock.And infection was considered as an important predisposing factor of the obstructive shock.Conclusion From the findings above,we can conclude that ASOD complicated with PAH is rare,and it always develops rapidly.Furthermore,the state of disease is very serious and at the same time,the prognosis remains poor.Rheumatologists should aware this rare condition.

Incidence of cardiovascular damage in ankylosing spondylitis patients and the related risk factors / 中华风湿病学杂志

Objective To survey the incidence of cardiovascular damage in ankylosing spondylitis (AS) patients and explore the related risk factors.And to establish the risk prediction models for the future.Methods The electrocardiogram (ECG) and cardiac ultrasonography (UCG) of 122 AS patients (group A)in the department of rheumatology of Peking Union Medical College Hospital from 2001 to 2011 were analyzed.Fifty-nine AS patients with abnormal ECG and/or UCG findings consisted of the study group (group A1),the other 63 AS patients without cardiovascular damage were the control group (group A2).We selected 100healthy controls (group B).All healthy controls had ECG and UCG tests.The ECG and UCG findings of the group A1 were analyzed,the clinical manifestations and laboratory results were compared between group A1and A2.A univariate analysis and multivariate Logistic regression analysis were carried out to determine the risk factors related to cardiovascular damage in AS.Results The prevalence rate of cardiovascular damage in AS patients was 48.4％ (59/122).While the prevalence of ECG and or UCG abnormality in healthy controls was 12.0％ (12/100),the difference between the two groups was statistically significant (P＜0.05).In group A1,the main findings in ECG were abnormal sinus node function,high voltage in left ventricle and ST-T changes,other findings were atrioventricular block,branch bundle block and premature beats.In group A1,the main findings in UCG were valvular diseases and arterial root widening,other abnormal findings were pericardial effusion,left ventricular diastolic dysfunction and mild pulmonary hypertension.The level of ESR,CRP,RBC,HGB,blood glucose,the number of peripheral joint involvement,the severity of sacroiliac arthritis and the age were significantly different between group A1 and A2 (P＜0.05).Multivariate Logistic regression analysis showed that age and CRP were risk factors for cardiovascular damage in AS patients.Conclusion The prevalence of cardiovascular damage in ankylosing spondylitis is relatively high.Age and CRP are the risk factors contributing to cardiovascular damage in AS patients.

Establishment and evaluation of classification criteria for early rheumatoid arthritis / 中华风湿病学杂志

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.

Clinical characteristics of cerebral tuberculosis in patients with systemic lupus erythematosus: an analysis of 10 cases / 中华风湿病学杂志

ObjectiveTo analyze the clinical characteristics of systemic lupus erythematosus (SLE) patients with cerebral tuberculosis.MethodsTen SLE patients with cerebral tuberculosis admitted to Peking Union Medical College Hospital(PUMCH) from January 1995 to October 2010 were retrospectively analyzed.ResultsThe median duration from onset of SLE to cerebral tuberculosis was 1.5 years(range from 0.6 to 30 years).All patients had received higher doses of steroid therapy (equal to prednisolone l mg· kg-1·d-1 ),and 3 of them had received methylprednisolone pulse therapy.Nine patients had taken immunosuppressant.When cerebral tuberculosis was diagnosed,the most common features were fever and headache,followed by nausea/vomiting and focal neurological signs.Nine patients were complicated with extra-cerebral infections.The cerebrospinal fluid(CSF) pressures was(247±66) cm H2O(range from 180 to 350 cm H2O),which was higher than normal.The mean CSF protein level was(1.4±0.7) g/L (0.15～0.45 g/L),which was normal or increased.Image examinations were helpful for the diagnosis of cerebral tuberculosis in SLE patients.Pointenhanced or ring-enhanced lesions were found in enhanced magnetic resonance imaging( MRI ) of brain in all patients who had donethis test (8 patients).After treated with targeted antibiotics and specific adjuvant therapies,the symptoms had relieved in 7 patients,however,I patient died,and 2 patients were lost during the follow-up.ConclusionWhen SLE patients with stable disease have unexplained fever,headache,and focal neurological signs,cerebral tuberculosis should be considered.Enhanced MRI of brain and chest X ray are helpful for the diagnosis of infectious cerebral lesions and should be performed promptly.Extracerebral tuberculosis infections can provide clues forthe identification of the causativeagents.Anti-tuberculosis treatment should be initiated as soon as the diagnosis is confirmed,and early treatment can markedly improve the outcomes.

Clinical study on IgG4-related autoimmune pancreatitis / 中华风湿病学杂志

Objective To investigate the clinical features of IgG4-related autoimmune pancreatitis (IgG4-related AIP).Methods A prospective cohort study on IgG4 related disease (IgG4-RD) was carried out in Peking Union Medical College Hospital during December 2010 to June 2012,a total of 50 patients were recruited,including 14 IgG4-related AIP patients.The clinical manifestations,laboratory tests results,radiographic findings,histopatholo-gical lesions and response to treatment were analyzed.Results Fourteen AIP patients accounted for 28％ of IgG4-RD,of whom 9 cases were male,5 females,with the mean age of (55±10) (range 41-71) years.Painless obstructive jaundice was the major manifestation of AIP.All patients had extra-pancreatic organ involvement,including salivary glands enlargement (10 cases),lymph nodes swollen (7 cases),and bile duct tree (6 cases),lung (6 cases),kidney (2 cases),lacriminal gland (2 cases),retroperitoneal tissue (1 case),mesentery (1 case),and prostate (1 case) involvement.Serum levels of IgG4 subclass in all patients were significantly increased,with mean concentration of (11 ±10) (range 1.4-35.2) g/L.Radiographic findings showed diffuse (13 cases) or focal (1 case) pancreatic enlargement with irregular narrowing of the pancreatic duct (4 cases).Histopathological examinations were performed in 12 patients,which revealed massive infiltration with lymphocytes and IgG4 positive plasma cells with remarkable tissue fibrosis.Response to glucocorticosteroid or combined steroid and immunosuppressants were good.Conclusion IgG4-related AIP is a subtype of chronic pancreatitis,which is characterized by specific clinical spectrum,serological markers,radiographic and histopathological features.Glucocorticosteroid is the first choice,which can significantly improve the clinical and imaging abnormalities.

Malignancy-associated dermatomyositis with polyradiculoneuropathy:a case report with literature review / 中华风湿病学杂志

Objective To investigate the difference and treatment strategy of malignancy-associated dermatomyositis and other para-neoplastic neurological syndromes (PNS).Methods The clinical characteristics of a patient with malignancy-associated dermatomyositis and poly radiculoneuropathy was reported and the relevant literature was reviewed.Results Patients with dermatomyositis had increased risk of malignancies,and should routinely screened.Dermatomyositis and polyradiculoneuropathy was clinically similar,but could rarely be seen in the same malignant patient.Malignancy -associated dermatomyositis and PNS had similar pathogenesis.The treatment strategy of both was similar.Malignancy specific treatment should be initiated and immune suppressive agents should be prescribed concurrently.Conclusion Rheumatolgists should aware the association between dermatomyositis and potential underlying malignancies.Multiple para-neoplastic syndromes could be seen in the same patient,but the diagnosis should be considered as one.

The clinical analysis of 35 patients with cutaneous sarcoidosis / 中华内科杂志

Objective To investigate clinical features of cutaneous sarcoidosis. Methods A retrospective analysis was carried out based on the clinic data of 35 patients with cutaneous sarcoidosis who were hospitalized in Peking Union Medical College Hospital during 1980-2009. They were divided into two groups, the group without systemic involvement (skin group )and the group with systemic involvement ( systemic group). Results ( 1 ) The ratio of men and women with cutaneous sarcoidosis was 1: 3. 38, and the average incident age was (47. 5 ± 10. 0) years old. The average incident age of skin group and systemic group were (41.8 ± 12.5 ) years old and ( 50. 5 ± 7. 1 ) years old, respectively. (2) The most common skin manifestation was subcutaneous nodule, followed by maculopapule and erythema nodosa. The most common involved sites were limbs. (3) The common involved systems extra-skin included the lung, joints and lymph nodes. The involvement rate of lung in cutaneous sarcoidosis of our present data was lower than those of foreign reports. However, the involvement rates of joints, lymph nodes, kidney, muscles and nervous system showed higher in our data. (4) The incidences of fatigue and weight loss in systemic group were higher than those in skin group ( P ＜ 0. 05 ). The indexes of erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor in systemic group were higher than those in skin group ( P ＜ 0. 05 ). More patients in systemic group were treated with corticosteroid than that in skin group ( 95.7% vs 66.7%, P ＜ 0. 05 ).Conclusions Subcutaneous nodules are the most common and the involvement rate of lung is lower in cutaneous sarcoidosis of our present data. Compared to the patients without systemic involvement, the average incident age of systemic ones is older, the indexes of inflammation markers and the usage of corticosteroid are higher.

A study of T cell recombination excision circles levels in peripheral blood mononuclear cells of systemic lupus erythematosus patients / 中华内科杂志

Objective To compare the T cell receptor recombination excision cycle (TREC) levels in peripheral blood mononuclear cells (PBMC) of systemic lupus erythematosus (SLE) patients with normal age- and gender- matched controls. To investigate the correlations between TREC levels of SLE patients and their clinical features. Methods We studied TREC levels in peripheral blood mononuclear cells (PBMC) of 21 SLE patients and 22 normal age- and sex- matched controls. TREC concentration was determined by real-time quantitative polymerase chain reaction (real-time qPCR) as the number of TREC copies/1000 PBMCs. The clinical features of the SLE patients such as systemic lupus erythematosus disease activity index (SLEDAI) , ESR, C reaction protein (CRP) , ANA, anti-dsDNA and complement levels and organ involvement were recorded and assessed. Results SLE patients had lower TREC levels [ (9.6 ± 7.5 )copies/1000 PBMC] than controls[ (16.1 ±11.1) copies/1000 PBMC,P = 0.033]. There was an inverse correlation between age and TREC levels in controls (r =- 0. 614, P = 0. 002) but not in SLE patients.There was an inverse correlation between SLEDAI and TREC levels in SLE patients(r =-0. 656, P =0. 001) and TREC levels seemed to have relations to skin lesions ( r = - 0. 620, P = 0. 003 ). No other clinical association was observed between TREC levels and clinical and laboratory SLE manifestations.Conclusion SLE patients had lower TREC levels than normal controls and there is a tendency that TREC level is reversely correlated with disease activity. The decrease PBMC TREC level is indicative of a low proportion of recent thymic emigrant (RTE) in SLE and could be caused by decreased RTE output and/or by increased peripheral T cell proliferation in this disease. The under-representation of RTE in the peripheral T cell pool may play a role in the immune tolerance abnormalities observed in SLE.

Clinical analysis of 30 patients with systemic lupus erythematosus complicated with central nervous system infectious / 中华风湿病学杂志

Objective To investigate the characteristics of clinical manifestations,treatment and prognosis of patients with systemic lupus erythematosus (SLE) complicated with central nervous system (CNS) infoction.Methods The medical records of 30 patients with SLE complicated with CNS infeetion were retrospectively reviewed.Results In the cohort of 3039 SLE patients admitted during last 20-year8,30 patients (1%) were identified with CNS infection.The mean age of patients with CNS infection was (34±11) years.Twenty-seven (90%) out of the 30 patients were fomale.Patients could be divided into 3 groups based on the offending microorganisms:mycobacterium tuberculosis (TB),non-TB bacterial and fungal infection groups respectively.TB infection was identified in 11 patients (37%),non-TB bacterial infections could be confirmed in 11 (37%),and fungal infection in 8 (26%).The most common presentations of CNS infeetion were fever,headache,and conscious level changes.There was no difierence among the three groups in morta-lity rate.Conclusion The clinical presentations of SLE patients complicated with CNS are generally atypical.Tubereulosis meningitis is the most prevalent CNS infection in patients with SLE.CSF analysis should be done as soon as possible for establishing early diagnosis.A lOW sernm albumin level,low C3 level and a low intracranial pressure predicts for unfavorable outcomes.

A multicenter,random,open,parallel controlled study on the efficacy and safety of ibuprofen arginate in treating rheumatoid arthritis and knee osteoarthritis / 中华风湿病学杂志

Objective To compare the clinical efficacy of ibuprofen arginate,a new nonsteroidal antiinflammatory drug,with that of ibuprofen,in patients with rheumatoid arthritis or knee osteoarthritis and to evaluate the safety and tolerability of ibuprofen argihate.Methods This is a muhicenter,random,open,active comparator-controlled,parallel clinical trail in which 171 patients with rheumatoid arthritis or knee osteoarthritis were enrolled.Patients were randomized to 2 groups:400 mg of ibuprofen arginate three times daily and 400 mg of ibuprofen three times daily respectively.Clinical efficacy and safety were evaluated after 4-week treatment.Results Ibuprofen arginate,at dosages of 400 mg three times daily,had shown significant efficacy in relieving pain,tenderness and swelling of joints and there was no significant difference when compared to that of ibuprofen.There was no difference in clinical adverse effects between the two groups and no serious adverse effects were repofled.But ibuprofen arginate could initiate effectiveness more rapidly than ibuprofen in both rheumatoid arthritisand osteoarthritis patients.Conclusion Ibuprofen arginate has the same clinical efficacy and safety profiles as itmprofen in treating rheumatoid arthritis and osteoarthritis.However,its onset is more rapid than ibuprofen.

A meta-analysis of thymoma-associated systemic lupus erythematoms from 1975-2008 worldwide / 中华内科杂志

0.05),Conclusion The possibihty of thymoma should be considered among those late-onset SLE patients.The glucocorticoid-based immunosuppressive therapy is effective for thymoma-associated SLE.To treat SLE is not an indication for thymectomy.

New onset or exacerbation of psoriatic skin lesions in patients with arthritides treated with tumor necrosis factor alpha antagonists / 中华风湿病学杂志

Objective To investigate the efficacy of tumor necrosis factor alpha (TNF-α) antagonists therapy and the possible eauses of new onset or exacerbation of psoriatic skin lesion in patients with arthritides treated with TNF-α atagonists therapy. Methods One patient with definite psoriatie arthritis and one patient with definite ankylosing spondylitis, who were treated with TNF-α antagonist therapy developed an unexpected exacerbation or new onset of psoriatic skin lesion, were investigated in this study. Furthermore, the literatures associated with psoriasis induced by anti-TNF-α therapy were reviewed. Results The patient with psoriatic arthritis experienced exacerbation of psoriatic skin lesion and the skin lesions subsided after discontinuation ofetanereept therapy. The skin lesions recurred with re-introduction of etanereept, which improved after withd-rawal of etanercept therapy. The patient with ankylosing spondylitis unexpectedly developed psoriasis vulgaris after receiving etanercept therapy. The skin lesion waxed and waned followed the administration or discon-tinuation of etanercept therapy. The same settings were reported in patients with rheumatoid arthritis receiving different types of anti-TNF-α therapy. Conclusion Blockage of TNF-α is highly effective in arthritides. Ho-wever, some patients with arthritides can unexpectedly develop either a new onset or exacerbation of psoriatic skin lesions after initiation of TNF-α antagonist therapy. The skin lesions subside after discontinuation of the TNF-α antagonist therapy, but the causes remain unclear.