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Objective To investigate the clinical,serological and imaging features of antisynthetase syndrome (ASS) patients with different positive anti-aminoacyl-tRNA synthase (ARS) antibodies.Methods The demographic characteristics,major clinical data,serological parameters,high resolution CT (HRCT) imaging features and pulmonary function characteristics in 60 cases of ASS [including 42 cases with positive anti-histidine tRNA synthetase (Jo-1) antibody,and 7 cases with positive anti-threonyl tRNA synthetase (PL-7) antibody,5 cases with positive anti-alanyl tRNA synthetase (PL-12) antibody,3 cases with positive anti-glycyl tRNA synthetase (E J) antibody and 3 cases with positive anti-leucyl tRNA synthetase (OJ) antibody] were collected.The differences in ASS patients with different positive ARS antibodies were analyzed by the x2 test and Fisher exact test.Results ① The ASS with different positive ARS antibodies was common in patients with DM/PM,[60％ (36/60),28％ (17/60)],and also appeared in patients with other connective tissue diseases,such as RA(5％,3/60),SS(3％,2/60),SLE(2％,1/60),etc.With ASS diagnosed,ILD complicated with myositis was the most common clinical features (63％,38/60).Typical clinical triad syndrome (myositis,ILD and arthritis) in 52％(31/60) patients,and myositis complicated with ILD,and mechanics hands accounted for 38％ (23/60) respectively.Some patients were complicated with isolated arthritis (25％,15/60),myositis (23％,14/60) and ILD (13％,8/60).The typical triad syndrome (myositis,ILD and arthritis) only accounted for 5％(3/60).The incidence of Jo-1,EJ and OJ antibodies [71％(30/42),100％(3/3),100％(3/3)] was significantly higher than that of PL-12 antibody (20％,1/5).There was a statistically significant difference (x2=5.263,P＜0.05;x2=4.8,P＜ 0.05;x2=4.8,P＜0.05).② The positive rate of ANA was 98％(59/60).Furthermore,the fluorescence staining model of anti-OJ antibody ANA was spotted,and the other subtypes were cytosolic.The positive rate of anti-SSA-52 antibody was 45％(27/60),and there was no statistical difference between the subtypes (P＞0.05).③ The ILD incidence of different positive antibodies had no significant difference in 82％ (49/60) ASS patients with ILD.The lung function in patients with ASS-ILD showed restrictive ventilation and diffused dysfunction.Grid shadow (76％,37/49) and grind glass (35％,17/49) were the most common signs of HRCT.Nonspecific interstitial pneumonia (NSIP) (78％,38/49) was the most common subtype of ILD.The incidence of traction bronchiectasis in ASS patients with PL-12 antibody (75％,3/4) was higher than that in ASS patients with Jo-1 antibody (22％,8/36).The incidence of pleural effusion in ASS patients with OJ antibody (100％,2/2) was significantly higher than that in ASS patients with Jo-1 antibody (17％,6/36).The incidence of pericardial effusion in ASS patients with PL-7 antibody (75％,3/4) was significantly higher than that in ASS patients with Jo-1 antibody (19.4％,7/36).All the differences were statistically significant (x2=5.26,P＜0.05).The ASS-ILD lung function indicated restrictive ventilatory function and diffusion dysfunction.④ There was no significant difference in clinical data,serological indicators,ILD imaging findings,interstitial lung types and lung function between Jo-1 antibody and non-Jo-1 antibody ASS patients (P＞0.05).Conclusion The ASS with different positive ARS antibodies is very common in patients with DM/PM,and is also observed in patients with other connective tissue diseases.ILD and myositis are the most common clinical features of ASS,followed by the typical triad syndrome (myositis,ILD and arthritis).Myositis is commonly observed in ASS patients with Jo-1,EJ and OJ antibodies,while is rarely observed in ASS patients with PL-12 antibody.The diagnosis of ASS should be alert to the onset of isolated arthritis or ILD.Anti-SSA-52 antibody may be related to ASS.NSIP is the most common HRCT pattern in ASS-ILD patients.There are some differences in signs among various subtypes,indicating that the difference of fibrosis in the lung and inflammatory reactions in the body being correlated with the ASS specificities.
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Objective To evaluate the value of high-frequency color Doppler ultrasound in the examination of pathological changes in the peripheral joints of patients with early rheumatoid arthritis (RA).Methods Peripheral joints of 30 consecutive patients with early rheumatoid arthritis (disease duration ＜1year) and 15 healthy volunteers were assessed with ultrasound searching for joint effusion,synovial hypertrophy,tendon lesion and bone erosions.The joints examined including bilateral elbows,wrists,knees,ankles,metacarpophalangeal joints (MCP),proximal interphalangeal joints (PIP) and metatar-sophalangeal joints (MTP).Data were analyzed with t-test and kappa test.Results Joint effusion and/or synovial hypertrophy were found in 471 joints (41.3％).Four hundred and four (35.4％) joints had joint effusion,359(31.5％) had synovial hypertrophy.Power Doppler signals were found in 128 (35.7％) joints with synovial hypertrophy.Periarticular tendon lesions were found in 90(25％) joints of all wrists,ankles and the 2nd to 5th metacarpophalangeal joints.Bone erosions were detected in 27 (2.4％) joints.The most likely involved joint in all peripheral jints was wrist which had the highest positive rate of effusion,synovial hypertrophy,bone erosion and power Doppler signals in the synovial membrane.Other joints which were easily involved with synovitis were knee,ankle,elbow,MTP,MCP and PIP.The positive rate of synovitis was highest in the MTP of all small joints exception the wrist.Synovitis present most frequently in the 2nd MCP of all MCPs,the 3rd PIP of all PIPs and the 2nd MTP of all MTPs.The kappa coefficient between clinical examination and ultrasound in the detection of peripheral joints synovitis was 0.21,showing very poor agreement.Conclusion High-frequency color Doppler ultrasound exa.mination is an effective method in assessing the pathological changes of peripheral joints of patients with early rheumatoid arthritis.It may improve the early diagnosis of RA and useful in assessing disease activity comprehensively.
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Objective To study the roles of apoptosis and expression of the related genes in minor labial salivary gland of patients with primary Sjogren′s syndrome (pSS). Methods Biopsies of minor submucosal labial salivary gland (SG) were obtained from 30 patients with pSS and 10 control individuals. The in situ end labeling and immunohistochemical staining were used to detect the apoptotic cells and the expression of Fas, FasL and Bcl-2. Results The percentage of apoptotic acinar and ductal epithelial cells (AEC and DEC) in labial salivary glands of patients with pSS was significantly higher than that of control respectively, but the percentage of apoptotic infiltrating mononuclear cells (IMC) showed no significant difference compared with that of control, pSS AEC and DEC showed increased expression of Fas/FasL and decreased expression of Bcl-2, whereas pSS IMC showed increased expression of Fas, Fas/FasL and Bcl-2. There was significant positive correlation between the percentage of apoptotic cells and the cells expressing Fas and FasL in pSS AEC DEC and IMC, respectively, and there was significant negative correlation between the percentage of the apoptotic cells and that of cells expressing Bcl-2 in pSS DEC and IMC, but there wasn′t correlation between the percentage of the apoptotic cells and that of cells expressing Bcl-2 in pSS AEC. Conclusions The apoptotic cells increased in the epithelial cells and decreased in IMC of the labial salivary glands may be one of the mechanisms leading to the glandular destruction found in pSS. In pSS labial salivary glands, the expression of Fas and FasL may promote apoptosis, while the expression of Bcl-2 may inhibit apoptosis. The increased expression of Bcl-2 in pSS IMC indicates that IMC may be able to escape apoptosis, resulting in inflammatory cell foci.