Full dose, half dose, or discontinuation of etanercept biosimilar in early axial spondyloarthritis patients: a real-world study in China.

INTRODUCTION: To investigate the effect of dose maintenance, reduction, or discontinuation of the etanercept biosimilar Yisaipu (YSP) on early axial spondyloarthritis (axSpA) patients in remission with YSP 50 mg once weekly (QW). MATERIAL AND METHODS: Patients were enrolled in three groups: full dose (YSP50), half dose (YSP25), and discontinuation (YSP0). Patients were assessed by the same rheumatologist every 8 weeks for 48 weeks. The primary endpoint was the proportion of non-failure patients in each group. If a flare occurred during the study period, the patient resumed YSP 50 mg QW or was switched to another tumor necrosis factor inhibitor. RESULTS: A total of 144 patients were included and each group included 48 patients. The proportion of non-failure patients was significantly greater in the YSP50 group than in the YSP0 group at 48 weeks (91.7% vs. 72.9%, p = 0.032). The difference in the other two comparisons was not statistically significant (YSP50 vs. YSP25 group, p = 0.522; YSP25 vs. YSP0 group, p = 0.132). The median time to flare did not differ significantly between the three groups (p > 0.05). Most patients who flared regained remission rapidly after resuming YSP 50 mg QW or starting adalimumab 40 mg every other week. CONCLUSIONS: For patients with early axSpA in remission on YSP for more than 12 weeks, continuation of YSP at full dose was superior to discontinuation of YSP, but not superior to halving the dose.

Vitexin compound 1, a novel extraction from a Chinese herb, suppresses melanoma cell growth through DNA damage by increasing ROS levels.

BACKGROUND: Vitex negundo L (Verbenaceae) is an aromatic shrub that is abundant in Asian countries. A series of compounds from Vitex negundo have been used in traditional Chinese medicine for the treatment of various diseases. Cutaneous melanoma is one of the most aggressive malignancies. A significant feature of melanoma is its resistance to traditional chemotherapy and radiotherapy; therefore, there is an urgent need to develop novel treatments for melanoma. METHODS: We first examined the effects of VB1 (vitexin compound 1) on cell viability by CCK-8 (cell counting kit) and Colony Formation Assay; And then, we analyzed the apoptosis and cell cycle by flow cytometry, verified apoptosis by Immunoblotting. The in vivo effect of VB1 was evaluated in xenograft mouse model. Potential mechanisms of VB1's antitumor effects were explored by RNA sequencing and the key differential expression genes were validated by real-time quantitative PCR. Finally, the intracellular reactive oxygen species (ROS) level was detected by flow cytometry, and the DNA damage was revealed by Immunofluorescence and Immunoblotting. RESULTS: In this study, we show that VB1, which is a compound purified from the seed of the Chinese herb Vitex negundo, blocks melanoma cells growth in vitro and in vivo, arrests the cell cycle in G2/M phase and induces apoptosis in melanoma cell lines, whereas the effects are not significantly observed in normal cells. To study the details of VB1, we analyzed the alteration of gene expression profiles after treatment with VB1 in melanoma cells. The findings showed that VB1 can affect various pathways, including p53, apoptosis and the cell cycle pathway, in a variety of melanoma cell lines. Furthermore, we confirmed that VB1 restored the P53 pathway protein level, and then we demonstrated that VB1 significantly induced the accumulation of ROS, which resulted in DNA damage in melanoma cell lines. Interestingly, our results showed that VB1 also increased the ROS levels in BRAFi (BRAF inhibitor)-resistant melanoma cells, leading to DNA cytotoxicity, which caused G2/M phase arrest and apoptosis. CONCLUSIONS: Taken together, our findings indicate that vitexin compound 1 might be a promising therapeutic Chinese medicine for melanoma treatment regardless of BRAFi resistance.

Mechanisms underlying the wound healing potential of propolis based on its in vitro antioxidant activity.

BACKGROUND: Propolis is a resinous substance collected by honeybees, Apis mellifera, from various plant sources. Having various pharmacological and biological activities, it has been used in folk medicine and complementary therapies since ancient times. PURPOSE: To evaluate the effects and underlying mechanism of the protective effects of the ethanol extract of Chinese propolis (EECP) on L929 cells injured by hydrogen peroxide (H2O2). STUDY DESIGN: The wound healing activities of EECP in L929 cells with H2O2-induced damage were investigated. METHODS: The main components of EECP were analyzed by RP-HPLC, and the free radical scavenging capacity and reducing power were also measured. The effects of EECP on the expression of antioxidant-related genes in fibroblast L929 cells were determined using qRT-PCR and western blotting. RESULTS: EECP had significant protective effects against cell death induced by H2O2 and significantly inhibited the decline of collagen mRNA expression caused by H2O2 in L929 cells. CONCLUSION: EECP induced the expression of antioxidant-related genes, such as HO-1, GCLM, and GCLC, which has great implications for the potential of propolis to alleviate oxidative stress in wound tissues. The protective effects of propolis have great implications for using propolis as a wound healing regent.

Does the choice of tariff matter?: A comparison of EQ-5D-5L utility scores using Chinese, UK, and Japanese tariffs on patients with psoriasis vulgaris in Central South China.

There is an increasing trend globally to develop country-specific tariffs that can theoretically better reflect population's preferences on health states for preference-based health-related quality-of-life instruments, also known as multiattribute utility instruments. This study focused on the most recently developed 5-level version of EuroQol-5 Dimension (EQ-5D) questionnaire, 1 of the world's most well-known multiattribute utility instruments, and aimed to empirically explore the agreements and known-group validities of applying the country-specific tariff versus tariffs developed from other countries using a sample of psoriasis vulgaris patients in Mainland China.A convenience sampling framework was adopted to recruit patients diagnosed with psoriasis vulgaris from Xiangya Hospital, Central South University, China, between May 2014 and February 2015. The 5-level EuroQol-5 dimensions (EQ-5D-5L) utilities were scored by using the Chinese, Japanese, and UK tariffs. Health state utilities were compared using a range of nonparametric test. The intraclass correlation coefficients and Bland-Altman plots were used to examine the agreements among the 3 EQ-5D-5L scores. Health state utility decrements between known groups were investigated using both effect size and a regression analysis.In all, 350 patients (aged 16 years or older) were recruited. There were significant differences among the 3 national tariff sets. Overall, 3 tariffs showed excellent agreements (intraclass correlation coefficient >0.90); however, the wide limits of agreement from the Bland-Altman plots suggest that these tariffs cannot be used interchangeably. The EQ-5D-5L scores using the Chinese-specific tariff showed the best known-group validity than the other 2 tariffs in this Chinese patient sample. The evidence from this study supports the choice of the country-specific tariff to be used in Mainland China.

[Clinical characteristics of urticaria in children versus adults].

OBJECTIVE: To study the clinical characteristics of urticaria in children versus adults, and to provide reference for the etiological analysis, disease evaluation, and treatment of urticaria in children. METHODS: The clinical data of 2 411 patients with urticaria who visited the Department of Dermatology at Xiangya Hospital of Central South University from January 2013 to May 2017 were collected to study their socio-demographic characteristics. The clinical characteristics of urticaria were compared between the 68 children and 672 adults of the 740 patients with complete follow-up data. RESULTS: Among the 411 pediatric patients, 314 (76.4%) had acute urticaria; among the 2 000 adult patients, 896 (44.8%) had chronic spontaneous urticaria. The causes of acute urticaria in children included infection (41%, 16/39). The accompanying symptoms of acute urticaria in children mainly included abdominal pain and diarrhea (44%, 17/39), while those in adults mainly included chest distress and shortness of breath (32%, 11/34). Compared with the adult patients, the pediatric patients had significantly lower chronic urticaria activity scores before and after treatment (P<0.05), a significantly higher rate of response to second-generation antihistamines (82.1% vs 62.2%; P<0.05), and a significantly higher proportion of individuals with a personal and family history of urticaria (P<0.05). CONCLUSIONS: Acute urticaria is more commonly seen than chronic urticaria in children with urticaria, and the main accompanying symptoms are abdominal pain and diarrhea, which are different from adults with urticaria. Chronic urticaria has a better treatment outcome in children than in adults. The most frequently seen cause of acute urticaria is infection in children. Atopic children may be susceptible to urticaria.

Evidence of Apis cerana Sacbrood virus Infection in Apis mellifera.

Sacbrood virus(SBV) is one of the most destructive viruses in the Asian honeybee Apis cerana but is much less destructive in Apis mellifera In previous studies, SBV isolates infecting A. cerana(AcSBV) and SBV isolates infecting A. mellifera(AmSBV) were identified as different serotypes, suggesting a species barrier in SBV infection. In order to investigate this species isolation, we examined the presence of SBV infection in 318A. mellifera colonies and 64A. cerana colonies, and we identified the genotypes of SBV isolates. We also performed artificial infection experiments under both laboratory and field conditions. The results showed that 38A. mellifera colonies and 37A. cerana colonies were positive for SBV infection. Phylogenetic analysis based on RNA-dependent RNA polymerase (RdRp) gene sequences indicated that A. cerana isolates and most A. mellifera isolates formed two distinct clades but two strains isolated fromA. mellifera were clustered with theA. cerana isolates. In the artificial-infection experiments, AcSBV negative-strand RNA could be detected in both adult bees and larvae ofA. mellifera, although there were no obvious signs of the disease, demonstrating the replication of AcSBV inA. mellifera Our results suggest that AcSBV is able to infectA. melliferacolonies with low prevalence (0.63% in this study) and pathogenicity. This work will help explain the different susceptibilities ofA. cerana and A. melliferato sacbrood disease and is potentially useful for guiding beekeeping practices.

[Advance in studies on antioxidant activity of propolis and its molecular mechanism].

Propolis is an adhesive substance mixed with plant resins collected by honeybees (Apis mellifera) and secretions from their mandibular gland and wax gland, with wide pharmacological activity and healthcare functions. Its antioxidant activity has long been regarded as one of the most important biological activities of propolis. This article summarizes studies on the antioxidant activity of propolis extracts from different geographic origins and with different extraction methods, as well as several important monomer active ingredients in propolis, and concludes the potential molecular mechanism of antioxidant activity of propolis and its monomer ingredients, with the aim of providing ideas for further studies on pharmacological activity of propolis, as well as reference for in-depth development of propolis products.

[The clinical characteristics of 26 cases of amyopathic dermatomyositis].

OBJECTIVE: To analyze the clinical characteristics of amyopathic dermatomyositis (ADM). METHODS: Twenty six patients diagnosed as ADM from January 2006 to January 2010 in PLA General Hospital were retrospectively analyzed. The clinical manifestation, laboratory findings, imaging manifestations, treatment and prognosis of the 26 patients were recorded. RESULTS: There were 18 females and 8 males with age of 30-68 years. Overall disease course after diagnosis was 2-18 months. All patients had Gottron rash and interstitial pneumonia. Fifteen patients had history of pulmonary infections. Three patients had comorbidity of tumor. Creatine phosphokinase, creatine phosphokinase isoenzyme, glutamic-oxaloacetic transaminase and lactate dehydrogenase were normal in all 26 patients. Four patients had positive anti-Jo-1 antibodies. Antinuclear antibodies were positive in nine patients. Electromyogram was slightly abnormal in 5 patients. Muscle biopsy was abnormal in 19 patients. Twenty patients had improved after receiving corticosteroids and immunosuppressive agents. Six patients died. CONCLUSIONS: It has been estimated that ADM represents approximately 20% of all cases of dermatomyositis. It seems that patients with ADM have greater incidence of lung involvement and combined cancer. ADM patients need to be treated positively to improve the prognosis.

[Relationship between sleep quality and nocturnal pain in ankylosing spondylitis].

OBJECTIVE: To evaluate the relationship between sleep quality and nocturnal pain in ankylosing spondylitis (AS) patients. METHODS: A total of 157 AS patients were recruited. Pittsburgh sleeping quality index (PSQI) and visual analogue scale (VAS) were used to assess sleep quality and nocturnal pain respectively. Disease activity was assessed by Bath ankylosing spondylitis disease activity index (BASDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). RESULTS: The mean PSQI and nocturnal pain score was 6.6 ± 3.6 and 3.7 ± 3.0 respectively. Fifty-five of them had poor sleep. Quality of sleep was positively correlated with nocturnal pain (P < 0.01). Elevated ESR/CRP was found in 47.1% (74/157) of them. Patients with elevated ESR/CRP had significantly a higher level of BASDAI than those with normal ESR/CRP (P < 0.01). Logistic regression analysis revealed that nocturnal pain was most powerful risk factor of sleep disturbances (P < 0.05). In hierarchical multiple regression analysis, the quality of sleep variable contributed significantly to the variance in nocturnal pain scores, adding an additional 18.2% to the overall R-square beyond that accounted by demographic and disease-related variables (inclusion of ESR and CRP) (R(2) = 0.175). CONCLUSION: Sleep quality has close relationship with nocturnal pain. And sleep disturbances should be considered in the management of AS.

[Inhibitory effect of human umbilical cord-derived mesenchymal stem cells on interleukin-17 production in peripheral blood T cells from spondyloarthritis patients].

In this study, the inhibitory effect of human umbilical cord-derived mesenchymal stem cells (hUCMSC) on interleukin-17 (IL-17) production in peripheral blood T cells from patients with spondyloarthritis (SpA) were investigated, in order to explore the therapeutic potential of hUCMSC in the SpA. Peripheral blood mononuclear cells (PBMNC) were isolated from patients with SpA (n = 12) and healthy subjects (n = 6). PBMNC were cultured in vitro with hUCMSC or alone. The expression of IL-17 in CD4(+) T cells or γ/δ T cells were determined in each subject group by flow cytometry. IL-17 concentrations in PBMNC culture supernatants were measured by ELISA. The results indicated that the proportion of IL-17-producing CD4(+) T cells and IL-17-producing γ/δ T cells of SpA patients were 4.5 folds and 5 folds of healthy controls [CD3(+)CD4(+)IL-17(+) cells (3.42 ± 0.82)% vs (0.75 ± 0.25)%, P < 0.01; CD3(+)γδTCR(+)IL-17(+) cells (0.30 ± 0.10)% vs (0.06 ± 0.02)%, P < 0.01]. After co-culture of PBMNC in patients with hUCMSC, the increased proportions of CD3(+)CD4(+)IL-17(+) cells and CD3(+)γδTCR(+)IL-17(+) cells in SpA patients were inhibited significantly by hUCMSC [CD3(+)CD4(+)IL-17(+) cells (3.42 ± 0.82)% vs (1.81 ± 0.59)% (P < 0.01); CD3(+)γδTCR(+)IL-17(+) cells (0.30 ± 0.10)% vs (0.16 ± 0.06)% (P < 0.01]. In response to phytohemagglutinin (PHA, 1 µg/ml), PBMNC from SpA patients secreted more IL-17 than that from healthy control [(573.95 ± 171.68) pg/ml vs (115.53 ± 40.41) pg/ml (P < 0.01)]. In the presence of hUCMSC, PBMNC of SpA patients produced less amount of IL-17 [(573.95 ± 171.68) pg/ml vs (443.20 ± 147.94) pg/ml, (P < 0.01)]. It is concluded that the IL-17 production in peripheral blood T cells from SpA patients can be inhibited by hUCMSC, which have therapeutic potential for SpA.

[A clinical analysis of 509 cases of sacroiliitis].

OBJECTIVE: To study the clinical features of sacroiliitis and differential diagnosis. METHODS: Totally 509 patients with chief complaints of back pain and diagnosed as sacroiliitis from January 2007 to January in Chinese PLA General Hospital were enrolled. The clinical manifestations, laboratory examinations, imaging and pathological data of the 509 patients were retrospectively analyzed. RESULTS: There were totally 406 male patients and 103 female patients. Among all 509 patients, 436 were diagnosed as ankylosing spondylitis (AS)/ spondyloarthropathy (SpA) , including 385 men. Thirty-six cases were diagnosed as sclerosing osteitis. Ten cases were diagnosed as sacroiliac joint degeneration. Ten cases were diagnosed as pyogenic sacroiliitis or sacroiliac joint tuberculosis. Four cases were diagnosed as diffuse idiopathic bone hypertrophy. Four cases were diagnosed as palmoplantar pustulosis arthritis. Four cases were diagnosed as metabolic bone disease. One case was diagnosed as sacroiliac joint gout. Four cases were diagnosed as neoplastic disease. HLA-B27 positive rate was 86.9% in AS/SpA. Erythrocyte sedimentation rate and C-reactive protein were increased mildly-to-moderately in AS/SpA patients. Erythrocyte sedimentation rate and C-reactive protein increased obviously in sacroiliac joint infection and tumor diseases. Imaging characteristics were sacroiliac joint bone destruction. Magnetic resonance imaging showed sacroiliac joint bone marrow edema, but range was not beyond anatomical structure in AS/SpA. CONCLUSIONS: Based on disease distribution of sacroiliitis, AS/SpA is predominant while non-ankylosing spondylitis is not uncommon. Differential diagnoses of sacroiliitis should be considered to avoid malpractice, especially in patients with negative HLA-B27.

[The diagnostic significance of nailfold video-capillaroscopy in systemic sclerosis].

OBJECTIVE: To observe nailfold capillary changes in a cohort of connective tissue disease (CTD) with Raynaud's phenomenon (RP) and to explore the diagnostic value of nailfold video-capillaroscopy (NVC) in systemic sclerosis (SSc). METHODS: Sixty CTD patients with RP divided into SSc group (n = 36) and non-SSc group (n = 24) were referred to an experienced operator for NVC. RESULTS: The patients had decreased capillary loops in SSc group with the capillary diameter more enlarged in SSc group than non-SSc group. The number of patients in SSc group with giant capillaries was 14, while 3 in non-SSc group. There were 23 patients with haemorrhages in SSc group and 9 in non-SSc group. The number of patients with severe effusion was 15 in SSc group, while 2 in non-SSc group. By using the ROC curves, indexes with AUC at least 0.7 of the input capillary diameter, the output capillary diameter, the middle capillary diameter, blood color and effusion for the diagnostic cutoff points were 18.5 µm, 24.5 µm, 19.5µm, deep red and severe effusion. With at least 2 out of the top 3 indexes, the diagnostic sensitivity and specificity of SSc were higher. CONCLUSIONS: CTD Patients with RP of SSc have less capillary loops, more enlarged capillaries, more giant capillaries, more severe effusion and more haemorrhages than non-SSc patients. The characteristics of nailfold capillary changes in SSc patients with RP can be helpful for the diagnosis and the differential diagnosis of SSc.

[The efficacy of etanercept in enthesitis in ankylosing spondylitis and an evaluation method for enthesitis].

OBJECTIVE: To evaluate the efficacy of etanercept in the treatment of active ankylosing spondylitis (AS) with enthesitis and explore an easy and accurate scoring method. METHODS: We designed this 12-week double-blind, placebo-controlled, randomized clinical study in active AS patients. The first part was a 6-week placebo-controlled period that patients received etanercept or placebo, followed by a 6-week open-label period that all patients received etanercept. At week 0, 2, 4, 6, 8, 10, 12, the scores of enthesitis were recorded. The primary efficacy endpoint was the Mander Index in the two groups. We compared the Maastricht AS Enthesis Score (MASES) index, Spondyloarthritis Research Consortium of Canada (SPARCC) index, Berlin index and San Francisco index with the Mander Index. RESULTS: A total of 127 patients were included with 92 in the etanercept group and 35 in the placebo group. In etanercept group there were 25, 41, 47 patients without enthesitis at week 2, 4, 6 separately. At week 12, more than 70% patients' enthesitis in two groups turned negative. The primary endpoint, as the Mander Index at week 6, was achieved by 0(0, 2) score in the etanercept group compared with 1(0, 3) score in the placebo group (P = 0.0286). Among the four Indexes, the San Francisco Index was the one most correlated with the Mander Index. CONCLUSION: Etanercept can improve the symptoms of enthesitis fast and significantly. In clinics, the San Francisco Index is easier to operate and more accurate for assessment.

[Delayed hypersensitivity to infliximab retreatment in two patients and literature review].

OBJECTIVE: To improve the understanding of severe anaphylactic reactions to infliximab retreatment. METHODS: Delayed hypersensitivity to infliximab in two patients with ankylosing spondylitis who had previously received infliximab and resumed after discontinuation over 4 years were reported and the related literatures were reviewed. RESULTS: Two patients (1 male, 1 female) who were diagnosed with ankylosing spondylitis for more than 10 years, both individuals had received infliximab treatment during a clinical trial approximately 4 - 5 years prior to further therapy.On day 6 after subsequent infusion, one patient had pruritic skin rash covering her whole body, followed by clustered, dyspnea, hypotension and anaphylactic shock, she was successfully treated with epinephrine and glucocorticoid. Another patient experienced a skin rash and itching 9 days after reinfusion, he was successfully treated with antihistaminics. CONCLUSION: A distant infliximab retreatment is associated with high rates of reinfusion reactions, including fever, urticaria, myalgia, arthralgia, even hypotension, dyspnea, laryngeal edema and anaphylactic shock. We recommend careful monitoring of those patients who receive infliximab retreatment, particularly after a lengthy interval.

Idiopathic retroperitoneal fibrosis (RPF): clinical features of 61 cases and literature review.

The objective of this study is to describe the clinical characteristics of patients with idiopathic retroperitoneal fibrosis (RPF). A retrospective analysis of patients diagnosed with idiopathic RPF in Chinese People's Liberation Army General Hospital was conducted. Sixty-one patients with idiopathic RPF were identified. Male to female ratio was 3.7: 1. The mean age was 55.7 years. One patient had polymyositis and two patients had a family history of idiopathic RPF. Back pain and abdominal pain are the most common symptoms. Forty-seven patients (77.1%) had retroperitoneal soft tissue shadow or ureteral obstruction on computed tomography or magnetic resonance imaging. Thirty-eight patients (62.3%) had histological diagnosis of idiopathic RPF. Thirty-four patients (55.7%) received surgical interventions. Five patients (8.2%) had palliative percutaneous nephrostomy. Ten patients (16.4%) received medical treatment alone including corticosteroids, immunosuppressants, and tamoxifen. Four patients (6.6%) received corticosteroids after surgical intervention. Two patients (3.3%) required renal dialysis. There were two cases of death. Surgery and medical treatments are effective for idiopathic RPF. In conclusion, long-term low dose corticosteroids and immunosuppressants may prevent relapse of idiopathic RPF.

[Epidemiological investigation of back pain and spondyloarthritis in Shougang resident communities].

OBJECTIVE: To investigate the epidemiological features of back pain, spondyloarthritis (SpA) and ankylosing spondylitis (AS) in Beijing Shougang district. METHODS: Set up Chinese version of questionnaire about incidence of spondyloarthropathy. Employees and retired ones were drawn out from sub-factory units by non-randomized sampling.15 357 subjects were investigated, of which 12 125 questionnaires were taken. Suspected cases were then screened with sacroiliac joint X ray and HLA-B(27) testing. 2009 assessment in ankylosing spondylitis (ASAS) criteria were used for diagnosing SpA. RESULTS: Back pain is common with total incidence of 42.7%, and the most common pattern is mechanical pain. The incidence of SpA is 0.58% and that of AS is 0.36%, while only 28.9% AS patients had been diagnosed before and received treatment. CONCLUSION: The AS incidence in Shougang district is similar with the epidemiological data got from other districts of China. And knowledge of SpA and AS is needed in China.

[The efficacy and safety of long-term thalidomide in the treatment of ankylosing spondylitis].

OBJECTIVE: To investigate the long term efficacy and safety of thalidomide in the treatment of refractory ankylosing spondylitis. METHODS: A total of 232 patients with refractory ankylosing spondylitis were recruited into open study using thalidomide at a dose of 150 mg/d, bath ankylosing spondylitis disease activity index (BASDAI), spinal pain score and thalidomide related side effects were observed regularly. RESULTS: From the third month, BASDAI and spine pain score decreased significantly when compared with those of the base line (P<0.05). Such improvement became more obvious as time went on. A total of 148 patients (63.8%) got >50% improvement in BASDAI and spine pain score, and 76 cases (32.8%) reported absence of spine pain. The major side effects were drowsiness, constipation, dry mouth, dizziness and dandruff. Thirty two patients (13.8%) withdrew from the study because of adverse events. Most of the adverse effects disappeared as thalidomide was stopped. CONCLUSION: Long term thalidomide is effective and safe for treating resistant ankylosing spondylitis and it has cumulative effect as duration prolongs.

[The clinical characters of 30 patients with enteropathic arthritis and literature review].

OBJECTIVE: To better understand the clinical characters of enteropathic arthritis patients. METHODS: The clinical, laboratory and X-rays data of 30 enteropathic arthritis in-patients were analyzed. RESULTS: Among the 30 patients, 14 were male, 16 were female. Average age at onset of gastroenteric manifestations was 16 - 48 (32.2 +/- 11.0) years old. The course of disease was 1 month - 20 (5.9 +/- 3.4) years. Average age at onset of arthritis was 15 - 52 (43.4 +/- 6.8) years old. The average interval between onset of diarrhea and arthritis was 0 - 13 (4.2 +/- 4.0) years. Peripheral arthritis was founded in 26 (87%) patients, and only 4 felt low back pain at onset. During the disease course, peripheral arthritis in 14 (54%) patients was similar to rheumatoid arthritis. The history of low back pain or buttock pain was recorded in 22 (73%) patients. Extra-articular features including fever occurred in 24 patients, enthesitis in 6, iritis or conjunctivitis in 4, dactylitis in 1 were observed. HLA-B(27) was positive in 36% (9/25) patients. Sacroiliitis in X-ray or CT was observed in 59% patients. CONCLUSION: The clinical manifestations of enteropathic arthritis are characterized by pauciarticular arthritis or symmetric polyarthritis or(and) sacroiliitis, a wide spectrum of extra-articular features, presence of HLA-B(27) and familial history of spondyloarthropathies. As other spondyloarthropathies, the sacroiliitis in enteropathic arthritis was also associated with HLA-B(27).

[A randomized, single-blind, parallel, controlled clinical study on single intra-articular injection of etanercept in treatment of inflammatory knee arthritis].

OBJECTIVE: To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis. METHODS: This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. RESULTS: Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ± 11.1 (P < 0.0001), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5 (P = 0.0015). A mean (34.9 ± 38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while (17.9 ± 24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P = 0.0467). Adverse events were observed in eight patients (19.0%) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. CONCLUSIONS: Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.