[Clinical features and prognosis of patients with lupus nephritis].

OBJECTIVE: To explore the clinical features and prognosis of patients with lupus nephritis (LN) in a large multicenter lupus cohort of Jiangsu Province. METHODS: Medical records of 2 078 systemic lupus erythematosus (SLE) inpatients from 15 hospitals at the first admission from 1999 to 2012 were reviewed and classified into two groups with LN or without. The clinical features between two groups were compared with Mann-Whitney U or Chi-square test and potentially associated factors tested by Cox regression. RESULTS: A total of 883 (42.5%) hospitalized lupus patients were diagnosed as LN. And the median age at disease onset of LN patients was lower than that of those without LN [(30 ± 11) vs (32 ± 12) years, P < 0.01]. Cardiopulmonary involvement, neuropsychiatric disorder, gastrointestinal dysfunction, hematologic disease, ophthalmopathy, SLEDAI score > 9 at admission and SLE disease activity index (SLEDAI) score > 9 at discharge were more often seen in patients with LN compared to those without LN (31.5%, 7.9%, 13.9%, 69.0%, 1.5%, 77.4%, 29.8% vs 18.8%, 5.1%, 6.8%, 63.1%, 0.3%, 43.1%, 8.1%, all P < 0.01). The mortality rates at 1 or 5 years after first admission were both significantly higher in LN patients than those without LN (7.2%, 15.0% vs 3.1%, 6.3%, P < 0.01). Independent predictors for mortality in patients with LN were neuropsychiatric involvement[hazard ratio (HR) 2.46], SLEDAI score > 9 at discharge (HR 2.34), increased serum creatinine (HR 2.21) and elevated alanine aminotransferase and (or) aspartate transaminase (HR 2.09) whereas glucocorticosteroid therapy (HR 0.18) was a protective factor. CONCLUSION: LN is one common complication of SLE patients during an early stage. And LN patients are more prone to present other vital organ involvement, higher disease activity and worse treatment outcomes. When accompanied with neuropsychiatric involvement, increased serum creatinine or elevated transaminase, worse prognosis is expected. Glucocorticosteroid treatment may offer some benefits.

[Clinical analysis of six cases with juvenile primary fibromyalgia syndrome].

OBJECTIVE: To study the clinical features of juvenile primary fibromyalgia syndrome (FMS) and to evaluate outcome after treatment. METHODS: Six patients with juvenile primary FMS were registered in department of rheumatology and their clinical data were assessed, including degree of pain (visual analog scale, VAS), fatigue, depression, anxiety, sleep disturbances, arthrodynia, subjective joint swelling, abdominal pain, irritable bowel symptoms, urinary urgency, dysmenorrhea, morning stiffness, paresthesias, illness changes with weather, feeling worse with exercise, laboratory examination and outcome of treatment. RESULTS: Abdominal pain was the first symptom in 5 of the cases with juvenile primary FMS, diffuse aching and left knee pain were the first symptoms in one patient. All the 6 patients were misdiagnosed prior to their rheumatological evaluation. Diffuse aching, fatigue, sleep disturbances, illness changes with weather and feeling worse with exercise existed in all the 6 patients (100%), the mean pain score was 8.8 and the mean initial tender points (TP) count was 13.7. Arthrodynia, subjective joint swelling, abdominal pain, irritable bowel symptoms and urinary urgency existed in 5 of the 6 patients (83%). Dysmenorrhea existed in 4 (67%), depression in 3 (50%), morning stiffness in 2 (33%), paresthesias in 2 (33%) and anxiety in 2 (33%), respectively. The results of laboratory examination were normal and the outcomes of treatment were good. CONCLUSION: Juvenile primary FMS may not be a rare disease and the clinicians should pay more attention to it for avoiding misdiagnosis.