A Cross-Sectional Survey of Physicians' Knowledge and Awareness of Chronic Pain Associated with Rheumatoid Arthritis in Rheumatology Departments in Zhejiang Province, China.

Objective: To assess physicians' knowledge and awareness of chronic pain associated with rheumatoid arthritis (RA) in Rheumatology departments throughout Zhejiang province to improve chronic pain relief in RA patients. Methods: A cross-sectional questionnaire survey was conducted onsite and online among rheumatologists in tertiary and secondary hospitals across Zhejiang province, China. The questionnaire inquired about rheumatoid arthritis-related pain cognition, pain assessment, pain management protocols, and medication choice. Results: Among the 150 questionnaires included, 98 were from tertiary hospitals, and 52 were from secondary hospitals. There was no difference in rheumatologists' perceptions of chronic pain in RA patients between tertiary and secondary hospitals. About 55.1% of rheumatologists from tertiary hospitals and 44.2% of rheumatologists from secondary hospitals utilized unstandardized pain assessment scales. About 46.9% of rheumatologists in tertiary hospitals and 36.5% of rheumatologists in secondary hospitals favored the numerical rating scale (NRS). About 87.8% of rheumatologists in tertiary hospitals and 71.7% of rheumatologists in secondary hospitals conducted pain assessment within 4 hours of admission. About 66.3% of rheumatologists working in tertiary hospitals and 32.7% of rheumatologists practicing in secondary hospitals believed their hospitals had pain departments. For RA patients who complained of pain for the first time, secondarily, or repeatedly, 48%, 26%, and 36.7% of rheumatologists preferred nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and opioid analgesics, respectively. For RA patients with mild, moderate, or severe pain, 74%, 6%, and 16% of rheumatologists preferred NSAIDs, glucocorticoids, and opioid analgesics, respectively. Conclusion: The assessment and treatment of chronic pain associated with RA are not standardized. For management, more rheumatologists preferred NSAIDs and glucocorticoids.

Clinical Features and Risk Factors of Fever in Acute Gouty Arthritis.

Objectives: This study aimed to investigate the clinical characteristics and risk factors of fever in hospitalised patients with acute gouty arthritis (AGA). Methods: The clinical data of 167 hospitalised patients with AGA who met the inclusion criteria were retrospectively analysed. The demographic, clinical, and medication data of patients with and without fever were compared, and risk factors associated with fever were identified via logistic regression analysis. Results: The incidence of fever in hospitalised patients with AGA was 31.1%, with low-grade fever being predominant. Visual analogue scale (VAS) scores, white blood cell counts, neutrophil proportion, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were higher in the fever group than in the non-fever group (P < 0.05 for all). In addition, the incidence rates of arthritis of single knee and polyarthritis were higher in patients in the fever group (P < 0.05). The proportion of patients who received betamethasone injection and combination therapy were higher in the fever group (P < 0.05). However, no significant differences were observed in age; sex; uric acid (UA) levels; and the incidence rate of hypertension, diabetes mellitus, cardiovascular disease, and renal function abnormalities between the two groups. Logistic regression analysis revealed that arthritis of single knee, polyarthritis, age of ≥65 years, CRP levels, and VAS scores were risk factors for concomitant AGA and fever. Among these factors, CRP levels and VAS scores were identified as independent risk factors (odds ratio [OR], 1.014 and 1.686, respectively; 95% confidence interval [CI], 1.004-1.025 and 1.115-2.549, respectively; P < 0.05 for both). Conclusion: The incidence of fever is high in hospitalised patients with AGA. Elderly patients, patients with arthritis affecting only one knee, and those with polyarthritis are predisposed to fever. In addition, the risk of developing fever increases with increasing VAS scores and CRP levels, and patients presenting with fever require enhanced anti-inflammatory and analgesic therapy.

Hypocomplementemia in Primary Sjogren's Syndrome: A Retrospective Study of 120 Treatment-Naive Chinese Patients.

OBJECTIVE: To determine the prevalence of hypocomplementemia in primary Sjogren's syndrome (pSS) patients and compare the clinical characteristics of patients with and without hypocomplementemia. METHODS: A retrospective study was conducted in 120 treatment-naive Chinese patients that met the 2012 American College of Rheumatology Classification Criteria for pSS and were followed up for 3 to 24 months. Based on the complement results, patients were divided into four groups: only low C3, only low C4, both low C3 and C4 (double low), normal group. The data on patient demographics, clinical manifestations, laboratory results, disease activity and pharmacologic therapy were collected and compared among the four groups. RESULTS: The prevalence of only low C3, only low C4, both low C3 and C4 in pSS patients was 21.7%, 16.7%, and 10%, respectively. The mean age of the four groups was significantly different. Unlike rampant caries and parotitis, the prevalence of dry eyes and dry mouth differed among the four groups. The proportion of patients with anemia, leukocytopenia, lymphadenopathy, hematological involvement and fatigue was significantly higher in the double low group and lower in the normal complement group. The proportion of patients with increased serum IgG was higher in the only low C4 group than in the other groups. Logistic regression revealed that hypocomplementemia was an independent risk factor for lymphadenopathy and leukopenia. The double low group had a significant history of exposure to glucocorticoids and cyclophosphamide, compared with other groups. CONCLUSION: Our study found that the clinical characteristics of pSS patients with hypocomplementemia differed from those without hypocomplementemia. Hypocomplementemia in pSS was associated with hematological involvement, hyper-IgG, lymphadenopathy, and fatigue, contributing to more significant exposure to glucocorticoid and cyclophosphamide.

LILRA3 is related to monocyte-derived dendritic cell maturation and activation.

OBJECTIVES: Previously we reported functional leukocyte immunoglobulin-like receptor A3 (LILRA3) leads to susceptibility and sub-phenotypes of several autoimmune diseases. LILRA3 levels in blood serum and CD14+ monocytes enhanced in systemic lupus erythematosus and resulted in disease severity. However, the mechanism of LILRA3 in the pathogenesis of autoimmunity remains elusive. This study aims to explore the potential impact of LILRA3 on the differentiation, maturation, and function of monocyte-derived DCs (MoDCs). MATERIALS AND METHODS: The human monocytic cell line (THP-1) was cultured to derive MoDCs in vitro. We performed plasmid transfection to examine the impact of LILRA3 on monocyte differentiation. Surface markers on MoDCs were measured using FACS. To assess the function of mature MoDCs, IL-12p70, IFN-γ and IL-4 levels were detected after the mixed leucocyte response by enzyme-linked immunosorbent assay. Western blot assay was employed in this study to determine the signaling pathways in MoDCs activation. RESULTS: LILRA3 promotes MoDCs maturation, our results showed significant up-regulation of CD40, CD80, CD86, CD209, and HLA-DR and increased production of pro-inflammatory cytokine IL-12. LILRA3-treated MoDCs exhibited a robust proliferation of allogeneic CD4+ T cells and induced naïve CD4+ T cell polarization into the Th1 phenotype. Furthermore, the preceding activation of MoDCs maturation and LILRA3 function might be attributed to p38 MAPK and STAT1 signaling pathway's aberrant activation. CONCLUSION: This is the first study to report that LILRA3 played a critical role in promoting MoDCs maturation and directing MoDCs to modulate Th1 cell differentiation, which may have a role in the pathogenesis of autoimmune diseases.

Myopathy is a Risk Factor for Poor Prognosis of Patients with Systemic Sclerosis: A retrospective cohort study.

To compare clinical characteristics and identify long-term outcomes of Chinese patients with systemic sclerosis (SSc) with and without muscle involvement.We retrospectively investigated the medical records, laboratory results, and computed tomography images of 204 consecutive SSc patients. Kaplan-Meier analysis was performed to determine survival rates. Patients were allocated into groups with and without myopathy.The prevalence of myopathy was 21.6%. The myopathy group was more likely to develop diffuse cutaneous involvement (90.9% vs 56%, P = .006), interstitial lung disease (90% vs 56%, P < .001), digestive system involvement (56.7% vs 29.3%, P = .001), pulmonary hypertension (29.5% vs 10.5%, P = .004), and pericardial effusion (25% vs. 10%, P = .019). Patients with myopathy had lower single-breath diffusing capacity of the lung for carbon oxide (46.5 ±â€Š11.1 vs 57.1 ±â€Š13.4, P < .001).Further, the myopathy group has similar results in interstitial lung disease associated higher resolution computed tomography score (186.8 ±â€Š64.5 vs 152.3 ±â€Š45.5, P = .037), Valentini score for disease activity (3.4 ±â€Š0.9 vs 2.0 ±â€Š0.9, P < .001) and modified Rodnan total skin score (19.4 ±â€Š6.1 vs 15.1 ±â€Š7.7, P = .002), compared with non-myopathy group. Kaplan-Meier survival analysis revealed decreased overall survival rate of the myopathy group (P = .028).SSc Patients with myopathy had more severe clinical manifestations and higher disease activity compared with those without, which affected survival rates and indicated worse prognosis.

The expression and clinical significance of different forms of LILRA3 in systemic lupus erythematosus.

OBJECTIVE: Our previous study has shown that functional leukocyte immunoglobulin-like receptors A3 (LILRA3) contributes to susceptibility and subphenotypes of systemic lupus erythematosus (SLE). However, the mechanism remains unclear. We aimed to evaluate the role of LILRA3 in SLE. METHODS: One hundred twenty-six SLE patients and 48 healthy controls were recruited in this study. Functional studies were performed using intracellular flow cytometry and ELISA. RESULTS: Both LILRA3 levels in serum and CD14+ monocytes were significantly elevated in SLE patients compared with healthy controls. Elevated LILRA3 level was found positively correlated with SLEDAI. Furthermore, more elevated LILRA3 levels were found in patients with higher SLEDAI, presence of lupus nephritis, and thrombocytopenia. CONCLUSIONS: Both LILRA3 levels in serum and CD14+ monocytes significantly increased in SLE and positively correlated with disease activity and severity. The upregulation of LILRA3 expression may serve as a biomarker of disease activity and severity of SLE. KEY POINTS: • LILRA3 contributes to susceptibility and subphenotypes of SLE; LILRA3 is elevated in SLE patients. • Increased LILRA3 correlated with disease activity and severity. • LILRA3 may serve as a biomarker of disease activity and severity of SLE.

Sclerostin rather than Dickkopf-1 is associated with mSASSS but not with disease activity score in patients with ankylosing spondylitis.

OBJECTIVE: To determine the serum levels of Dickkopf-1 (DKK-1) and sclerostin, as well as their correlations with the structural damage assessed by modified stoke ankylosing spondylitis spine score (mSASSS) and the disease activity evaluated by ankylosing spondylitis disease activity score (ASDAS) in patients with ankylosing spondylitis (AS). METHODS: Eighty-eight AS patients, 26 rheumatoid arthritis (RA) patients, and 26 age- and gender-matched healthy controls (HC) were collected from rheumatic clinic of the Second Affiliated Hospital of Zhejiang University, School of Medicine, between March 2015 and July 2015. Demographic data, parameters of ASDAS, and image evaluations of spine (i.e., mSASSS) were collected. The serum levels of DKK-1 and sclerostin were measured using commercially available ELISA kits. RESULTS: Both DKK-1 and sclerostin were significantly higher in the AS patients than in the controls (1855 ± 84.58 vs. 1406 ± 99.76 pg/ml and 106 ± 6.75 vs. 62.78 ± 6.39 pmol/l, respectively, P < 0.05). The correlation analysis suggested a negative correlation between serum sclerostin and mSASSS (P = 0.019, r2 = 0.062). DKK-1 had a trend of positive correlation with mSASSS, but was not statistically significant (P > 0.05). There was no association between the serum levels of DKK-1 or sclerostin and disease activity assessed by ASDAS (P > 0.05). DKK-1 and sclerostin had a negative correlation (P = 0.013, r2 = 0.07). CONCLUSION: In the present study, the expressions of serum DKK-1 and sclerostin were independent of disease activity. Sclerostin was negatively correlated with the mSASSS, which suggests that sclerostin may be a potential marker indicating the spine ossification process in AS. The specific mechanism remains to be investigated.

[Expression of leukocyte immunoglobulin-like receptor A3 in CD14+ monocytes of patients with rheumatoid arthritis].

OBJECTIVE: To investigate the expression of leukocyte immunoglobulin-like receptor A3 (LILRA3) in CD14+ monocytes of patients with rheumatoid arthritis (RA). METHODS: Fifty three RA patients admitted in the Second Affiliated Hospital of Zhejiang University School of Medicine from February 2017 to August 2017, and 21 healthy subjects were enrolled in the study. The expression of LILRA3 in CD14+ monocyte subset was determined by flow cytometry, and its correlations with clinical features, laboratory examination results, antibodies and disease activity were analyzed. RESULTS: LILRA3 percentage in the CD14+ monocyte subset of RA patients was higher than that in the healthy controls (P<0.01). The percentage of LILRA3 was positively correlated with number of tenderness joints, number of swollen joints and erythrocyte sedimentation rate (r=0.280, 0.371, 0.341, P <0.05 or <0.01), but was not correlated with the age, course of disease, Sharp score, C reactive protein, blood routine index and immunoglobulin (all P>0.05). In addition, the percentages of LILRA3 in the monocytes of rheumatoid factor (RF)-positive or anti-cyclic citrullinated peptide (CCP) antibody-positive patients were significantly higher than those of the RF-or anti-CCP antibody-negative patients (all P < 0.05); and the percentage of LILRA3 in patients with DAS28>5.1 was higher than that in patients with DAS28 ≤ 5.1 (P<0.05). CONCLUSIONS: The expression of LILRA3 is up-regulated in CD14+ monocyte subset isolated from RA patients, and it is correlated with disease activity.