[Associated factors of different fatigue dimensions in elderly patients with rheumatoid arthritis].

Objective: To investigate the associated factors of different dimensions of fatigue in elderly patients with rheumatoid arthritis (RA). Methods: A cross-sectional analysis was performed in the elderly outpatients with RA (age ≥ 60 years) in the First Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2019. Fatigue was measured by Multidimensional Fatigue Inventory-20 (MFI-20) and 36-item Short Form Health Survey-Vitality (SF-36-VT). Physical fatigue and mental fatigue were subsequently measured by MFI-20 subscales. Results: A total of 104 patients were included. Male-to-female ratio was 1∶3.3. The average age was (68±6) years. The MFI-20 score and SF-36-VT score were 60±14 and 64±20, respectively. The score of physical fatigue measured by MFI-20 was 14±3, and mental fatigue scored 10±4 (P<0.001). Arthralgia, disease activity, disability, insomnia, depression and anxiety were correlated with fatigue assessed by MFI-20 (correlated coefficient: 0.48-0.62). Multivariable regression analysis showed that arthralgia and depression were associated with physical fatigue (Standardized regression coefficients were 0.44 and 0.38, respectively). Insomnia, depression and anxiety were associated factors of mental fatigue (Standardized regression coefficients were 0.20, 0.32 and 0.24, respectively). Conclusions: Elderly patients with RA experiencehigh level of fatigue, mainly presenting as physical fatigue. Arthralgia and depression mainly affect physical fatigue, and arthralgia is a critical factor. Insomnia, depression and anxiety are associated with mental fatigue.

[Clinical study of maternal and infant outcomes in patients with lupus nephritis complicated with pregnancy].

Objective: To investigate the outcomes and associated factors for adverse pregnancy outcomes (APO) in pregnant patients with lupus nephritis (LN). Methods: The clinical data of 139 LN pregnant patients from from 2009 to 2017 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. Results: Totally, 105 LN were diagnosed before pregnancy and 34 were newly diagnosed during pregnancy. One or more APO occurred in 71.2% of patients with LN and 40 (28.8%) were without any APO. Thirty-six (25.9%) of pregnancies resulted in fetal loss. A total of 54 pregnancies were preterm birth with 20 at gestational age <34 weeks, 13 were intrauterine growth retardation (IUGR), 3 were fetal distress, and 8 were neonatal lupus, pregnancy induced hypertension occurred in 18 cases, of which, 2 cases were gestational hypertension and 16 were preeclampsia. There was no eclampsia occurred.In multivariate analysis, predictors of APO included active lupus during pregnancy (OR=8.9, 95%CI: 3.7-21.7, P<0.001), rash (OR=7.3, 95%CI: 2.2-24.5, P=0.001), cylindruria (OR=5.3, 95%CI: 1.6-17.0, P=0.005) and antiphospholipid syndrome (OR=11.4, 95%CI: 1.5-88.3, P=0.02) were risk factors for pregnancy loss. Variables that were independently predictive of preterm birth included anticardiolipin antibody positive (OR=8.8, 95%CI: 1.5-51.5, P=0.02) and active lupus during pregnancy (OR=7.9, 95%CI: 2.3-24.5, P=0.001). Conclusions: Pregnancies in LN are still at high risk of APO in terms of pregnancy loss and preterm birth. Stable disease can help to reduce the risk of APO.

[Pregnancy outcome of planning pregnancies in patients with SLE].

Objectives: To investigate the pregnancy outcomes in systemic lupus erythematosus (SLE) patients with planning pregnancy.And to evaluate the value of fetal umbilical artery Doppler. Methods: A total of 130 SLE patients with planning pregnancy were prospectively recruited from January 2013 to January 2017 at the First Affiliated Hospital of Sun Yat-sen University. Results: Thirty eight (29.2%) patients had active lupus, 30 with mild activity, 5 with moderate activity and 3 with severe activity.Active disease in the first, second and third trimesters occurred in 6, 11 and 21 cases respectively.Lupus nephritis (76.3%) and hematological system involvement (39.5%) were the most common manifestation.Seven cases had pre-eclampsia during pregnancy.One or more adverse outcomes occurred in 40 patients, including 28 with premature, 12 with pregnancy loss, 9 with intrauterine growth restriction, and 8 with fetal distress.All of the pulsatility index, resistance index and S/D value of patients with adverse outcomes were higher than that of patients without adverse outcomes (P<0.05). Conclusions: In SLE patients with planning pregnancy, disease flares were infrequent, and outcomes were favorable. Fetal umbilical artery Doppler can be used as a noninvasive monitoring method for SLE patients at late pregnancy.

[Clinical features and adverse pregnancy outcomes of new onset systemic lupus erythematosus during pregnancy].

Objective: To investigate the clinical characteristics and adverse pregnancy outcomes in pregnant women with new onset systemic lupus erythematosus (SLE) during pregnancy. Methods: The clinical data of 263 pregnancies with SLE in the First Affiliated Hospital of Zhongshan University from 2001 to 2015 were collected and analyzed retrospectively. Results: Of all the 263 pregnancies, 188 were diagnosed before pregnancy and 75 were newly diagnosed during pregnancy. Among the 75 new onset SLE, 27, 31, 14 and 3 cases were diagnosed during first trimester, second trimester, third trimester and puerperium, respectively. Active lupus was noted in 81.3% of the patients with new onset SLE. The main clinical manifestations of new onset SLE were lupus nephritis (57.3%) and thrombocytopenia (38.7%). SLEPDAI scores as well as the prevalence of lupus nephritis, and thrombocytopenia in patients with new onset SLE was higher than those in the previously diagnosed ones (P<0.05). Among the 75 new onset SLE pregnancies, adverse pregnancy outcomesoccurred in 53 patients, including 34 with pregnancy loss, 15with premature, 8with intrauterine growth restriction, 5with fetal distress and5 with neonatal lupus. Compared with patients withnon-newonset SLE, patients with newonset SLEhad a higher prevalence of adverse pregnancy outcomes (56.4% vs 70.7%, P<0.05), and pregnancy loss (21.8% vs 45.3%, P<0.01) but less live birth (78.2% vs 54.7%, P<0.05). Conclusion: Most of the patients with new onset SLE occurred during the first and second trimester. The most common clinical features of new onset SLE were lupus nephritis and thrombocytopenia. Patients with new onset SLE were more prone to active lupus, lupus nephritis and thrombocytopenia, as well as more adverse pregnancy outcomes and pregnancy loss.

Duration of feeding linseed diet influences expression of inflammation-related genes and growth performance of growing-finishing barrows.

The aim of the study was to investigate the effects of dietary linseed (rich in n-3 PUFA) on expression of inflammation-related genes and on growth performance of growing-finishing barrows. Two isoenergetic and isonitrogenous diets were formulated, one as the basal diet and the other containing 10% linseed. Twenty-four Landrace x Yorkshire barrows weighing 35 +/- 3.7 kg were randomly assigned to 1 of 4 treatment groups, with 6 pigs per group. During the entire experimental period of 90 d, these 4 groups of pigs were first fed the basal diet and then fed the linseed diet for 0, 30, 60, and 90 d before slaughter, respectively. Pig growth; messenger RNA (mRNA) expression of peroxisome proliferator-activated receptor-gamma (PPARgamma), IL-1beta0, IL-6, and tumor necrosis factor-alpha (TNF-alpha); and plasma concentrations of the 3 proinflammatory cytokines were measured and analyzed. Average daily feed intake did not differ among treatment groups (P > 0.05), but ADG (P < 0.05) and G:F (P < 0.01) responded quadratically to the duration of linseed diet feeding, and pigs in the 60-d treatment group had the greatest ADG and G:F. The mRNA expression of PPARgamma in loin muscle and spleen increased linearly (P < 0.01) with the duration of linseed diet feeding, whereas its expression in adipose tissue was not affected (P = 0.095). Tumor necrosis factor-alpha and IL-6 mRNA expression in muscle, adipose, and spleen, as well as serum concentration of TNF-alpha, decreased linearly (P < 0.01) with the duration of linseed diet feeding. Peroxisome proliferator-activated receptor-gamma mRNA abundance was negatively correlated with IL-1beta, IL-6, and TNF-alpha mRNA abundance both in muscle (R(2) = 0.63, P < 0.001) and in spleen (R(2) = 0.69, P < 0.001), and PPARgamma mRNA expression in spleen (R(2) = 0.59, P < 0.01) and muscle (R(2) = 0.52, P < 0.05) was negatively correlated with serum TNF-alpha concentration. There were also significant quadratic relations between ADG and expression of PPARgamma (P < 0.05) and splenic TNF-alpha (P < 0.05). These data suggest that intake of n-3 PUFA from the linseed diet led to significant decreases in the expression of proinflammatory cytokine genes, which may stimulate growth in growing-finishing barrows, at least in part, through a PPARgamma-dependent mechanism.