ABSTRACT
Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.
ABSTRACT
In recent years, osteoporosis (OP) has become one of the main diseases affecting the health of middle-aged and elderly people in China, and the prevalence of OP has increased significantly. The clinical diagnosis and treatment guidelines for this disease are also constantly updated. The overall principles speciallyemphasise that doctors and patients need to work together to negotiate the details of the diagnosis and treatment guidelines, in order to improve the OP clinical diagnosis and treatment rate. Therefore, patients′ knowledge of the disease, understanding of clinical guidelines, and cooperation with doctors to implement diagnosis and treatment plans are very important. In this study, from the most concerned issues of the patients, we established the OP patient practice guideline working group. 14 recommendations, as the OP patient practice guidelines, are proposed in accordance with the relevant principles of the "World Health Organization guidelines development manual" and the international normative process.
ABSTRACT
In recent years, the clinical guidelines for the diagnosis and treatment of rheumatoid arthritis (RA) have been constantly updated. Among the general principles, it is particularly emphasized that, in order to improve the ratio of treat to target(T2T) of RA, doctors and patients should work together to negotiate the details of the guidelines. Therefore, it is important for patients to further understand the disease and clinical guidelines of RA, and to better cooperate with doctors. This study was based on the most concerned issues of RA patients and international standard procedure of guideline study, we organized the working group and introduce the following 16 recommendations constituting the RA patients′ practice guidelines.
ABSTRACT
Hyperuricemia/gout is a common metabolic disease in China, which is a serious threat to people′s health. In clinical practice, the standardization of prevention and diagnosis and the rate of treat-to-target need to be improved. There is still a lack of education for the patients about the understanding of clinical guidelines, the disease knowledge and the importance of cooperating with doctors to carry out diagnosis and treatment. From the most concerned issues of the patients, we established the hyperuricemia/gout patient practice guideline working group with multidisciplinary physicians and patients. Seventeen opinions, as the hyperuricemia/gout patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process, aiming to improve the patients compliance, improve the level of health management of the disease.
ABSTRACT
In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.
ABSTRACT
Gout is a crystal associated arthritis caused by monosodium urate (MSU) accumulating in joint, and it belongs to metabolic rheumatic disease. In China, gout is common but it is insufficient for education of standardized diagnosis and treatment for gout. Based on the evidence and guidelines from China and other countries, Chinese gout Collaborative Research Group developed standardization of diagnosis and treatment of gout in China. The purpose is to standardize the methods for diagnosis of gout, treatment opportunity and strategies in order to reduce misdiagnosis, missed diagnosis and irreversible damage.
ABSTRACT
Objective To investigate Smoothened (Smo) expression in endothelial cells of synovial tissues in active rheumatoid arthritis (RA),and the expression of Sonic Hedgehog (Shh) signaling pathwayassociated factors after TNF-α treatment in EA.hy926 cells,and the effects of specific inhibitor of Smo (cyclopamine) on the apoptosis of EA.hy926 cells.Methods The Smo expression in endothelial cells in synovial tissue from 4 RA patients and 4 patients with traumatic or meniscal injury (with no arthritis,act as control group) were detected by immunohistochemistry assay.EA.hy926 cells were treated with different concentrations of TNF-α or TNF-α together with different concentrations of cyclopamine,and Shh,Ptch1,Smo,Gli1 mRNA expression levels were detected by real time-PCR.EA.hy926 cells were co-cultured with three different concentrations of cyclopamine for 24 hours before the addition of TNF-α and ActinomycinD (ActD).The cell survival rate was detected using CCK-8,and the population of apoptotic cells was detected using a flow cytometry.T-test and one-way ANOVA were used for statistical analysis.Results The positive expression rate of Smo in endothelial cells of synovial tissue in RA group was (81±23)％,which was higher than that in the control group (20±17)％ (P＜0.05).After being treated with TNF-α,the expressions of Shh and Smo mRNA in EA.hy926 cells increased,while the expression of Gli1 mRNA decreased (P＜0.05),and the expression of Ptch1 mRNA did not change significantly (P＞0.05).The expressions of Shh,Smo and Gli1 mRNA were down-regulated (P＜0.05).EA.hy926 cells treated with different concentrations of cyclopamine (2,4 and 8 μmol/L) showed a significant decrease in cell viability,in cell survival rates (57±6)％,(44±8)％ and (32±5)％ compared with that of TNF-α/ActD group (64±6)％ (P＜0.05),and cell apoptosis rates [(12.4±3.3)％,(14.5±2.7)％ (15.7±2.4)％] compared with that of TNF-α/ActD group (7.1±1.3)％ (P＜0.05).Conclusion Shh pathway is activated in endothelial cells of synovial tissue in active RA.The apoptosis in endothelial cells is promoted after cyclopamine treatment.Shh pathway may play an important role in the antiapoptotic regulatory mechanism of endothelial cells.
ABSTRACT
ObjectiveTo study the effect and safety of flurbiprofen cataplasm on osteoarthritis pain in Chinese patients.MethodsOne hundred and eighty-three patients were divided into flurbiprofen cataplasm group,indometacin cataplasm group and Qizheng-xiaotong plaster group randomly.The score of pain,stiffness and physical function were analyzed with WOMAC scale and adverse reactions were also assessed.KruskalWallis H test,Nemenyi test and CMH tese were used.ResultsAfter treatment,the VAS value of the three groups decreased significantly and the VAS difference value of the flurbiprofen cataplasm group changed the most significantly(the changes of VAS value in flat walking,up and down stairs,nighttime,rest and weightbearing were 31±21,35±20,24±19,20±18 and 37±20 respectively).Meanwhile,the value of stiffness and physical function decreased significantly.In terms of safety,flurbiprofen cataplasm group and the indome-tacin cataplasm group were better than Qizheng-xiaotong plaster group.But in sense of constriction,the flurbiprofen cataplasm group was better than the indometacin eataplasm group.ConclusionFlurbiprofen Cataplasm,with its favorable analgesic effect,is suitable for general clinical use.It can reduce stiffness,improvephysical function,and has good safety profile.
ABSTRACT
Objective To evaluate the efficacy and safety of two forms of preparations of dexamethasone palmitate in the treatment of rheumatoid arthritis (RA).Methods A multicenter,double-blind,randomized,parallel-group clinical trial was carried out according to good clinical practice (GCP).A total of 237cases of RA patients with mild to moderate knee swelling were randomly divided into the treatment group (n=118 ) or the control group (n=119) and were treated with two kinds of dexamethasone palmitate 8 mg injection respectively.The primary efficacy endpoints were the circumference of the knee joint at the upper and the lower edge after the intra-articular injection.The secondary efficacy endpoints were joint tenderness index and patients general assessment.The adveme events were recorded.Analysis of covariance,t test or Wilcoxon test,x2 test or Fisher exact test were used for statistical analysis.Results The upper edges of the treatment group and the control group after treatment were (37.2±3.3) cm and (36.4±3.9) cm respectively,and the lower edges of the two groups were (34.4±2.9) cm and (33.9±3.4) cm respectively.They were all significantly smaller than the edges before treatment [(38.1± 3.3) cm and (37.3±4.0) cm of the upper edges,(35.1±3.0)cm and (34.6±3.6) cm of the lower edges respectively ) (P＜0.O1)].After treatment,the joint tenderness index were improved (P＜0.01).A total ratio of great improvement and improvement of patients general assessment of the two group patients were 67.5％ (79/117) and 74.8％ (86/115) respectively.No statistical significant difference was found in all primary and secondary efficacy endpoints between the two groups (P＞0.05).During the clinical trial,the incidence of adverse events related to the treatment of two groups were 4.2％ and 6.8％,without any significant difference (P＞0.05).Conclusion New preparation of dexamethasone palmitate has the same efficacy and safety as the imported producted in the treatment of RA.The circumference of the knee joints at the upper and the lower edge may be used to assess the effects of intra-articular injections.
ABSTRACT
Objective To investigate the effects of the leflunomide active metabolite (A771726) on the expression of phorbol-12-myristate-13-acetate (PMA) -induced CD147, matrix metallo-proteinase (MMP)-2 and MMP-9 on THP-1 cells. Methods THP-1 cells were cultured in RPMI-1640 medium supplemented with 10％ fetal bovine serum. For all experiments, THP-1 cells were cultured at an initial density of 5×105/ml. Before A771726 treatment, cells were cultured with serum-free RPMI-1640 medium for 12 h, THP-1cells were co-cultured with PMA at three different concentrations of A771726 (5, 15 , 45 μg/ml) for 24 h.The mRNA expression of CD147, MMP-2 and MMP-9 was measured by real-time PCR. CD147 expression on the cells were evaluated by flow cytometric analysis. The activity of MMP-2 and MMP-9 were evaluated by gelatin zymography. Statistical differences among the groups were tested by one-way ANOVA or KruskalWallis test. Results The expression of CD147, MMP-2 and MMP-9 were upgraded by the PMA. The expression of CD147 on THP-1 cells was inhibited significantly by A771726 in a dose-dependent pattern (P＜0.01). The mean fluorescence intensity (MFI) of CD147 in positive control group was 109.5±3.8, the MFI in A771726 (5, 15, 45 μg/ml) group were 73.3±2.5, 64.5±2.3, 40.9±2.7, respectively. The expression of MMP-2, MMP-9 mRNA and the activity of MMP-2, MMP-9 in the supernatant was inhibited significantly by A771726 (P＜0.01). The expression of CD147 mRNA was not inhibited significantly by A771726 (P＞0.05).Conclusion Leflunomide active metabolite (A771726) can inhibit the expression of PMA-induced CD147,MMP-2 and MMP-9 on THP-1 Cells.
ABSTRACT
Objective To validate the discriminatory capacity of the new ankylosing spondylitis disease activity scores (ASDAS) in Chinese ankylosing spondylitis (AS) patients, and assess its clinical value. Method One hundred and twenty-nine patients with AS was included in the study, in which 87 were par-ticipat clinical trials with Etanercept (n=87) and 42 were participants of clinical trails with. The disease activity and treatment effecticacy were assessed by ASDAS, BASDAI and patient global assessment. Discriminatory ability of all the measures was analyzed as standardized mean difference (SMD) and (-score. Pearson's correlation, two indepen -dent samples t test and simple linear regression model were used for statistical analysis. Result The four ASDAS scores correlated well with patient global assessment (r=0.56～0.74), ESR (r=0.50～0.80) and CRP (r=0.50～0.69) both at baseline and the changes form baseline to 6 weeks after treatment. The four ASDAS outperformed BASDAI, patient global assessment, ESR and CRP in differentiating patients with different levels of disease activity and patients with different levels of change. There was little difference in performance between the four ASDAS versions. Conclusion The four ASDAS are highly discriminatory in evaluating the disease activity and the efficacy of drugs in Chinese AS patients, showing a significant value in clinical practice.
ABSTRACT
Objective To consecutively understand the national clinical testing status and to reassure the quality-control of autoantibody detection. Methods Letter or telephone notification were conducted to the participating hospitals or departments. Autoantibodies for quality control survey included anti-nuclear anti-body (ANA), anti-double-stranded DNA (anti-dsDNA), anti-extractable nuclear antigens (A-ENA), anti-mitochondria antibody (AMA)/anti-smooth muscle antibody (ASMA), and anti-citrulline antibody (anti-CCP). Each had 3 control samples, and altogether 15 samples for testing. Sample distribution and data analysis were double-blinded. Results One hundred and two hospitals/departments participated in the national quality-control survey. The accurate rate for this survey was 70%, 88%, 93%, 85%, 79% respectively for ANA, anti-dsDNA, AMA, ASMA and anti-CCP. Anti-ENAs were further divided into anti-RNP, Sm, SSA, SSB and Scl-70 subgroups, and the accurate rate was 88%, 77%, 92%, 93% and 87% respectively. Conclu-sion Compared to the previous 4 national surveys, the accurate rates of ANA, anti-dsDNA, anti-ENAs, AMA in our country's autoantibody testing is improved, and the detection rate of ASMA and anti-CCP antibody is also increased. More hospitals and testing items can test these autoantibodies, which implies that autoantibody testing status has been improving in our country.
ABSTRACT
Objective To evaluate the color Doppler ultrasonographic findings of active ankylosing sacroiliitis.Methods Thirty three patients (66 sacroiliac joints in total) with active ankylosing sacroiliitis identified by MRI and twenty eight healthy volunteers (56 sacroiliac joints) underwent color Doppler ultrasound examinations of sacroiliac joints.Degree of blood flow within and around the sacroiliac joints was evaluated by semi-quantitative scale (0 - 4 grade).For arteries, resistive index was also measured.Statistical analyses were performed to compare blood flow demonstration rate, blood flow signal scale distribution,degree of blow flow and RI value between the two groups.Results Higher blood flow demonstration rate was found in patients with active ankylosing sacroiliitis(60/66,90.1%) than control group (25/56,44.6%)( P = 0.000).The scale distribution and degree of blow flow between these two groups were statistically different (all P = 0.000) ,with mainly 2～3 grade for the patients and 0～1 grade for the control.Mean value of RI in the patients was 0.57 ± 0.07, which was lower than the control (0.66 ± 0.04, P = 0.000).Conclusions Patients with active ankylosing sacroiliitis tend to have higher degree of blood flow in sacroiliac joints and lower RI values of artery.Color Doppler ultrasound may help to evaluate the activity of ankylosing sacroiliitis.
ABSTRACT
Objective To observe the effect of infliximab combination therapy on the expression of CD147 on the peripheral CD14+ monocytes of active rheumatoid arthritis (RA) patients. Methods Thirty active RA patients who were refractory to MTX treatment were randomized into three groups (group A, B, C) with the proportion of 3:1:1. Group A and B received four or three infusions of infliximab (3 mg/kg), group C received four infusions of placebo. All three groups were added to a stable background of MTX. The mean fluorescence intensity (MFI) of CD147 expression on the peripheral CD14+ monocytes of RA patients and normal healthy controls were detected by flow cytometry analysis. Clinical and laboratory parameters were assessed before each infusion. One-way ANOVA, Kruskal-Wallis the MFI of CD147 expression at week 18 (P<0.05). Marked differences were observed between the infliximab + MTX group and the placebo + MTX group on the change of the MFI of CD147 expression from baseline to week 18 (P<0.05).Conclusion CD147 expression on the peripheral CD14+ monocytes of active RA patients is increased, and combination therapy of infliximab and MTX can inhibit the expression.
ABSTRACT
Objective To compare the clinical efficacy of ibuprofen arginate,a new nonsteroidal antiinflammatory drug,with that of ibuprofen,in patients with rheumatoid arthritis or knee osteoarthritis and to evaluate the safety and tolerability of ibuprofen argihate.Methods This is a muhicenter,random,open,active comparator-controlled,parallel clinical trail in which 171 patients with rheumatoid arthritis or knee osteoarthritis were enrolled.Patients were randomized to 2 groups:400 mg of ibuprofen arginate three times daily and 400 mg of ibuprofen three times daily respectively.Clinical efficacy and safety were evaluated after 4-week treatment.Results Ibuprofen arginate,at dosages of 400 mg three times daily,had shown significant efficacy in relieving pain,tenderness and swelling of joints and there was no significant difference when compared to that of ibuprofen.There was no difference in clinical adverse effects between the two groups and no serious adverse effects were repofled.But ibuprofen arginate could initiate effectiveness more rapidly than ibuprofen in both rheumatoid arthritisand osteoarthritis patients.Conclusion Ibuprofen arginate has the same clinical efficacy and safety profiles as itmprofen in treating rheumatoid arthritis and osteoarthritis.However,its onset is more rapid than ibuprofen.
ABSTRACT
Objective To investigate the autophagy and the expression of its related genes in the peripheral blood mononuclear cells (PBMCs) of active systemic lupus erythematosus (SLE) patients.Methods Patients with newly onset or recently-diagnosed SLE (n=20) were enrolled.RA patients (n=10) and healthy blood donors (n=10) were used as controls.PBMCs from all subjects were immediately isolated by Ficoll-Hypaque density gradient centrifugation.And then monocytes were removed by wall sticking method.The morphology was observed using transmission electron microscopy (TEM).Messenger RNA (mRNA) expression of Beclin 1 and microtubule-associated protein 1-light chain 3 (MAPLC3) were determined by reverse transcription polymerase chain reaction (RT-PCR) and real-time quantitative RT-PCR respectively.Results TEM showed autophagic phenomenon in PBMCs from active SLE.On the mRNA level,expression of Beclin 1 and LC3 was significantly increased in fresh isolated SLE cells as compared with RA or healthy donor's PBMCs.Conclusion Based on these results,we can conclude that autophagy occurs in active SLE and the expression of its related genes is significantly higher in active SLE than in RA or normal controls.The enhanced autophagy may indicate its role in the pathogenesis of SLE.
ABSTRACT
BACKGROUND: Rheumatoid factor (RF) is a kind of autoantibody which is routinely used as a factor in patients with rheumatoid arthritis (RA) to evaluate disease activity and severity.But in clinical practice, it occurs frequently that RF values do not decrease according to clinical improvement in RA patients. OBJECTIVE: To investigate the association between rheumatoid factor (RF) and activity or disease severity of RA.DESIGN, TIME AND SETTING: A randomized cross-sectional study was performed in the Department of Rheumatology and Immunology, the Third Affiliated Hospital of Sun Yat-sen University during September 2006 and September 2007.PARTICIPANTS: Seventy-six patients,65 females and 11 males,mean age of (44±13) years,with RA diagnosed according to the American College of Rheumatology (ACR) criteria for RA were included in this study. METHODS: Seventy-six patients with active RA were randomly recruited and assessed for functional status,radiographic change,joint pain,morning stiffness, tender joint count (TJC), tender joint score (TJS), swollen joint count (SJC), swollen joint score (SJS), Health Assessment Questionnaire (HAQ), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP),RF,and hemoglobin. The method of Pearson correlation or Spearman rank correlation was performed for assessing the association between RF and these indices separately, normally distributed data for Pearson correlation, nonnormally distributed data for Spearman rank correlation. MAIN OUTCOME MEASURES: Correlation of RF with above mentioned factors. RESULTS: None of the correlation coefficients between RF and indices including age,disease duration, functional status,radiographic change,joint pain, morning stiffness, TJC,TJS,SJC,SJS,HAQ,ESR,CRP,hemoglobin were significant (P＞0.05). CONCLUSION: No associations between RF and activity or severity of RA are studied.
ABSTRACT
Objective To evaluate the efficacy and safety profile of a recombinant human tumor necrosis factor receptor: Fc fusion protein in ankylosing spondylitis (AS). Methods This was a multicenter,randomized, double-blind, placebo-controlled trial in the first 6 weeks and then followed by an open-labeled trial in the next 6 weeks. One hundred and forty-three patients of active AS were randomly assigned to receive 25 mg twice-weekly subcutaneous injections of rhTNFR:Fc or placebo for 6 weeks. The primary endpoint was proportion of ASAS20 responders at week 6. The secondary endpoints were the proportion of subjects achieving a BASDAI 20%, BASDAI 50% and BASDAI 70% improvement at week 6. Other secondary endpoints, related to reducing signs and symptoms of AS and improving range of motion and physical function, were evaluated.Results Treatment with rhTNFR:Fc resulted in significant improvement. At 6 weeks, 68% of the 71 patients in the rhTNFR: Fc group had a treatment response, as compared with 28% of those in the placebo group(P＜0.01). Improvements over base-line values for other measures of disease activity were significantly greater in the rhTNFR:Fc group, rhTNFR:Fc was well tolerated, The most frequently treatment related adverse event was injection site reaction. Conclusion rhTNFR:Fc has demonstrated consistent evidence of efficacy and is well tolerated in the treatment of active AS.
ABSTRACT
Objective To study the relationship between DNA methylation inhibitor and histone deacetylase inhibitor (HDACI) with HLA-B27 gene expression. Methods Hela-HLA-B27 promoter stable cell line was developed as the first step and followed by detecting the effect of DNA methylation inhibitor(5-Aza-CdR) and HDACI. The synergetic effect of HDACI and cytokines as well as the effect of anti-TNF-α antibody, anti-IFN-β antibody, anti-IFN-γ antibody and Infiximab on HLA-B27 promoter activity were tested by measuring luciferase value. Then HLA-B27 mRNA expression level in CCL6-B27 genomic DNA stable cell line was measured by real-time PCR. Results Sodium butyrate(NaB) and valproic acid(VPA)could significantly up-regulate HLA-B27 promoter activity at 24 h (24.0±1.7) times, ( 17.4±2.2 ) times respectively,(P＜0.05). The synergetic effect between VPA with TNF-α, IFN-α, IFN-β, IFN-γ and PMA on HLA-B27 promoter activity was found. None of the antibody could inhibit the effect of HDACI. It also showed that NaB,TSA, VPA and 5-Aza-CdR could significantly increase HLA-B27 mRNA expression in CCL6-B27 stable cell line. Conclusion DNA methylation and HDACI can up-regulate HLA-B27 gene expression level.
ABSTRACT
Objective To study T lymphocyte subsets and expression of costimulatory molecule CD154 on T-cells in peripheral blood from patients with ankylosing spondylitis and their changes after treated with Enbrel. Methods Sixty-six patients with AS(39 active and 27 inactive, 35 axial and peripheral joint involvement and 31 axial involvement only), 30 patients with rheumatoid arthritis(RA), 30 healthy volunteers were analyzed. The expression of CD154 on CD3+ T cell as well as T-cells subsets were evaluated using flow cytometry respectively. The changes of the expression of costimulatory molecule CD154 in 39 active AS patients(Enbrel treatment or placebo treatment) were observed in a randomized, double-blind, placebothan that of healthy volunteers, and CD154 expression on CD3+ T cells in peripheral blood in AS patients was on CD3+ T cells in the peripheral blood of active AS or AS patients with peripheral joint involvement were significantly higher than those in inactive or axial involvement only AS patients(P＜0.05), and CD154 on CD3+ placebo, in AS patients group, there was significant reduction in CD154 expression on CD3+ T cells in Enbrel group at week 6(P＜0.05), there was no significant difference between Enbrel group and healthy volunteers at week 6(P＞0.05). Conclusion T lymphocyte subsets are significantly abnormal and CD154 is overexpressed on T-cells in peripheral blood of patients with AS. A six-week course of treatment with Enbrel in active AS can induce a down-regulation of the expression of CD154 on T cells.