Diurnal differences in acute gout attacks: A clinical study of male gout patients / 北京大学学报(医学版)

OBJECTIVE@#To observe the diurnal difference of acute gout attacks in men, and provide reference for accurate clinical prevention and treatment.@*METHODS@#Using a single-center, cross-sectional study design, the patients diagnosed with gout in the outpatient department of Rheumatology and Immuno-logy of PLA Joint Logistic Support Force No.980 Hospital from October 2021 to April 2022 were selected. The information about the patient's current/last acute gout attacks (less than 2 weeks from visit), date and time of attacks, joint symptoms and signs, medication use, and relevant biochemical tests on the day of visit was recorded. The diurnal time difference of acute gout attacks in male patients was analyzed, and univariate comparison and multivariate Logistic regression analyses were conducted to compare the diurnal difference of acute gout attacks with clinical characteristics and biochemical indicators.@*RESULTS@#A total of 100 male gout patients were included, and 100 acute attacks were recorded. Diurnal distribution of acute gout attacks: morning (6:00~11:59, 18, 18%), afternoon (12:00~17:59, 11, 11%), the first half of the night (18:00~23:59, 22, 22%), the second half of the night (0:00~05:59, 49, 49%); During the day (included morning and afternoon, 29, 29%) and at night (included the first half of the night and the second half of the night, 71, 71%). The rate of acute gout attack was significantly higher at night than in the day (about 2.5 ∶1). No matter the first or recurrent gout, no matter the duration of the disease, the number of acute gout attacks had the difference of less in the day and more in the night. Serum urate (SU) level was higher in the patients with nocturnal attack than in those with daytime attack (P=0.044). Comorbidities were significantly different in the day-night ratio of the number of acute gout attack (P=0.028). Multiple Logistic regression analysis showed that SU level (OR=1.005, 95%CI: 1.001-1.009) and comorbidities (OR=3.812, 95%CI: 1.443-10.144) were the correlative factors of nocturnal acute gout attacks.@*CONCLUSION@#No matter the first or recurrent gout, no matter the duration of the disease, it has a diurnal variation characterized by multiple attacks at night, increased SU level and comorbidities are correlative factors for nocturnal acute attack of gout.

Mechanism of Xiaoyaosan in Preventing and Treating Hepatic Injury Caused by Tripterygium Glycosides / 中国实验方剂学杂志

Objective:To observe the preventive and therapeutic effects of 5-week administration with Xiaoyaosan on rat liver injury caused by tripterygium Glycosides. Method:Thirty-one SD rats were randomly divided into 4 groups， namely normal group， tripterygium glycosides group， tripterygium glycosides+Xiaoyaosan group （treatment group）， and tripterygium glycosides+Xiaoyaosan for 1 week in advance group （prevention group）. Tripterygium glycosides （37.5 mg·kg-1） was administered intragastrically， and Xiaoyaosan （water decoction， 19.270 g·kg-1） was administered intrastrically. First， the rats of prevention group were intragastrically administrated with Xiaoyaosan at 8：00-9：00 am， and the rats of other groups were given an equal volume of normal saline. After 1 week， the rats of tripterygium glycosides group were administered intragastrically with tripterygium glycosides suspension at 8：00-9：00 am. The rats of the treatment group and the prevention group were intragastrically administrated with Xiaoyaosan at 8：00-9：00 am， and then tripterygium glycosides suspension 2 hours later. All the drugs were given once a day for 5 weeks. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of liver， enzyme-linked immunosorbent assay （ELISA） was used to detect serum interleukin-1β （IL-1β）， interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）， chemical method was used to detect the content changes of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， glutathione peroxidase （GSH-Px）， superoxide dismu-tase （SOD）， trace malondiamine aldehyde （MDA）. Immunohist-ochemical staining was used to observe the expressions of IL-6， IL-1β and TNF-α in liver tissue. Result:Compared with the normal group， the tripterygium glycosides group showed inflammatory cell infiltration， hepatocyte edema， hepatic sinuses squeezing and narrowing， liver plate widening， and liver cell necrosis， the contents of serum IL-1β， IL-6， TNF-α， ALT， AST and MDA were significantly increased（P<0.01）， but the contents of GSH-Px and SOD were decreased significantly （P<0.05， P<0.01）， while the positive expressions of IL-6， TNF-α， IL-1β in liver tissue were significantly increased （P<0.01）. Compared with tripterygium glycosides group， rats in the treatment group and the prevention group had less inflammatory cells infiltration and reduced edema in the liver tissue， and disorders in some cell， the contents of serum IL-1β， IL-6， TNF-α， ALT， AST， MDA were significantly decreased （P<0.01）， the contents of GSH-Px and SOD were significantly increased （P<0.05）， and the positive expressions of IL-6， TNF-α， IL-1β in liver tissues were significantly decreased （P<0.01）， with a better efficacy in the prevention group. Conclusion:Xiaoyaosan can obviously alleviate the long-term liver toxicity caused by tripterygium polyglycoside to a certain extent， with a better prophylactic effect.

Anti-cyclic citrullinated peptide antibody predicts the development of rheumatoid arthritis in patients with undifferentiated arthritis / 中华医学杂志(英文版)

BACKGROUND@#Clinical outcomes of undifferentiated arthritis (UA) are diverse, and only 40% of patients with UA develop rheumatoid arthritis (RA) after 3 years. Discovering predictive markers at disease onset for further intervention is critical. Therefore, our objective was to analyze the clinical outcomes of UA and ascertain the predictors for RA development.@*METHODS@#We performed a prospective, multi-center study from January 2013 to October 2016 among Chinese patients diagnosed with UA in 22 tertiary-care hospitals. Clinical and serological parameters were obtained at recruitment. Follow-up was undertaken in all patients every 12 weeks for 2 years. Predictive factors of disease progression were identified using multivariate Cox proportional hazards regression.@*RESULTS@#A total of 234 patients were recruited in this study, and 17 (7.3%) patients failed to follow up during the study. Among the 217 patients who completed the study, 83 (38.2%) patients went into remission. UA patients who developed RA had a higher rheumatoid factor (RF)-positivity (42.9% vs. 16.8%, χ = 8.228, P = 0.008), anti-cyclic citrullinated peptide (CCP) antibody-positivity (66.7% vs. 10.7%, χ = 43.897, P < 0.001), and double-positivity rate of RF and anti-CCP antibody (38.1% vs. 4.1%, χ = 32.131, P < 0.001) than those who did not. Anti-CCP antibody but not RF was an independent predictor for RA development (hazard ratio 18.017, 95% confidence interval: 5.803-55.938; P < 0.001).@*CONCLUSION@#As an independent predictor of RA, anti-CCP antibody should be tested at disease onset in all patients with UA.

Research Progress on Mechanism of Active Components of Traditional Chinese Medicine in Treating Rheumatoid Arthritis Based on Signaling Pathway / 中国实验方剂学杂志

Objective: Rheumatoid arthritis (RA) is one of the most common inflammatory arthropathy diseases, characterized by synovium hyperplasia and progressive destruction of articular cartilage, which is significantly associated with dysfunction and shortening of life span. Drug therapy is the main intervention for RA, but the glucocorticoid and immunosuppressant have many shortcomings in treatment, such as great side effect, slow onset and poor efficacy, while biological agents are too expensive. RA belongs to the category of "arthralgia syndrome" in traditional Chinese medicine (TCM). TCM treatment for RA has a well-established history and multiple advantages such as good curative effect and less side effects, but its mechanism needs to be further studied. Signaling pathway is involved in the pathogenesis and progression of RA, so it is one of the main targets in research on the pathogenesis of RA and related pharmacological research of therapeutic drugs. In recent years, a large number of studies have been carried out on the regulation effect of active components of TCM on RA signaling pathways. These signaling pathways include Wnt signaling pathway, Janus tyrosine kinase (JAK)-signal transducers and transcription activator (STAT) signaling pathway, mitogen-activated protein kinase (MAPKs) signaling pathway, phosphoinositide-3-kinase (PI3K)/serine/protein kinase B (Akt) signaling pathway, nuclear factor-kappa B (NF-κB) signaling pathway, Toll like receptor (TLRs) signaling pathway, receptor activator of the nuclear factor kappa B ligand (RANKL)/receptor activator of the nuclear factor kappa B (RANK)/Osteoprotegerin (OPG) signaling pathway and so on. By reviewing the research results in recent years, we hope to provide ideas and reference for the basic research, development of new drugs and clinical treatment of RA.

Clinical effect analysis of ankylosing spondylitis treated by Chinese medical syndrome differentiation / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect and safety of Bushen Qiangji Decoction (BQD) and Qingre Qiangji Decoction (QQD) in treating ankylosing spondylitis (AS) patients, and to verify the clinical utility of AS syndrome differentiation and treatment scheme [Shen-deficiency induced stasis obstruction syndrome (SDISOS) and dampness-heat obstruction syndrome (DHOS) being two basic syndrome types, Shen invigorating blood activating method (SIBAM) and heat clearing dampness resolving method (HCDRM) being two basic treatment methods].</p><p><b>METHODS</b>Totally 354 AS patients of SDISOS and DHOS were randomly assigned to the treatment group and the control group using a multi-center randomized, positive drug parallel-controlled clinical trail. Patients in treatment group were treated by BQD or QQD according to syndrome typing, while those in the control group took Sulfasalazine enteric-coated tablet (SECT), 24 weeks as one therapeutic course. After treatment, the clinical efficacy was evaluated by using ASAS20 standard (set by Asessment in Ankylosing Spondylitis working group), Chinese medical efficacy evaluation standards, and BASDAI, BASFI, BASMI, night-pain index, spinal pain index, PGA, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).</p><p><b>RESULTS</b>After 24 weeks of treatment by BQD or QQD, ASAS20 standard rate was 86.75% in the treatment group, and the total effective rate of Chinese medical syndrome was 85.47%. They could significantly reduce patients' integrals of Chinese medical syndrome, BASDAI, BASFI, BASMI, night-pain index, spinal pain index, and PGA (all P < 0.01).</p><p><b>CONCLUSIONS</b>QQD and BQD got confirmable clinical effects in treating AS, providing strong evidence of evidence-based medicine for syndrome differentiation and treatment of AS.</p>

Protective mechanism on the vascular pathological process in diabetes mellitus rats by Rheum officeinale / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the protective mechanism of officeihale on the vascular pathological process in diabetes mellitus (DM) rats.</p><p><b>METHOD</b>After the DM rat model was established, 24 DM rats were randomly divided into model group (12 DM rats) and Rheum officeinale group (12 DM rats). Rheum officeinale was orally given in 10 g kg(-1) per day, and the other two groups were given equal pure water. 8 weeks later, blood samples were collected to determine the level of nitric oxide (NO) and endothelin-1 (ET-1). Thoracic aortic rings was prepared to observe the inhibiting effect of Ach with different concentration on contraction caused by NE. Another part of aorta was made to observe the expression of ICAM-1 and VCAM-1 by method of SP immunohistochemistry staining,</p><p><b>RESULT</b>Rheum officeinale group obviously decreased the level of ET-1 and increased the NO compared with model group (P <0.05). The expression of ICAM-1 and VCAM-1 could be obviously inhibited in Rheum officeinale group compared with model group. (P <0.05).</p><p><b>CONCLUSION</b>Rheum officeinale could decrease the level of ET-1 with increased the NO in diabetes rats, and inhibit the expression of ICAM-1 and VCAM-1, which may be mechanisms of protecting the endothelium of vessel in diabetes rats.</p>