[Clinical significance of arthritis treatment guidelines revealed by outpatients prescriptions].

OBJECTIVE: To investigate the current status of osteoarthritis medications of outpatients for arthritis treatment guidelines, and provide references for the promotion and popularization of traditional Chinese and western medicine in treatment of arthritis. METHODS: The outpatient prescriptions for the treatment of osteoarthritis from all the rheumatology and orthopedics specialists from 2007 February to May in Peking University People's Hospital were chosen and analyzed statistically. RESULTS: There were a total of 2 145 osteoarthritis prescription in this study, including 8 categories: joint lubricants, non-steroid anti-inflammatory drugs (NSAIDs), local anesthetics, cartilage protective agent, adrenal corticosteroids, vitamin AD, analgesic drugs and traditional Chinese medicine. The Chinese medicines were among the drugs with the most species amounted up to 35. The most common route of medication was oral administration (73.2%), which was used more in the department of rheumatology and immunology than in orthopedics. And in oral drugs, the biggest consumption was NSAIDs, accounting for 29.9%. There was no significantly difference between the rheumatology and orthopedic specialists when using non-specific cyclooxygenase (COX) inhibitors. But orthopedic specialists prescribed more COX-1 specific inhibitor than rheumatology specialists. CONCLUSION: Recently the arthritis treatment guidelines have been issued one after another. Many experts have already accepted the treatment of pain. However, in the implementation, the large differences still exist. The use of the Chinese medicine is still very chaotic; there are no clear-cut norms to be followed. Therefore, the implementation of the arthritis treatment guidelines and treatments of arthritis by traditional Chinese medicine are urgent to be standardized.

LTB4 can stimulate human osteoclast differentiation dependent of RANKL.

Our previous study showed that Leukotriene B4 can directly stimulate osteoclast differentiation independent of RANKL. In order to determine whether Leukotriene B4 could indirectly stimulate human osteoclast differentiation through increasing RANKL expression of rheumatoid arthritis fibroblast-like synoviocytes, we utilize the coculture model of rheumatoid arthritis fibroblast-like synoviocytes and monocyte, which were stimulated in the presence of 2.5 ng/ml M-CSF in the control group, 2.5 ng/ml M-CSF+10(-8)M LTB4 in the experimental group a, and 2.5 ng/ml M-CSF+10(-8)M LTB4+100 ng/ml OPG in the experimental group b. After culture for 3 weeks, the number of multinucleated TRAP staining positive osteoclast-like cells stained with TRAP was counted to evaluate the differentiation effect in each group. There was almost no osteoclast-like cell in the control group and the experimental group b. There were many osteoclast-like cells in the experimental group a. These results indicated that Leukotriene B4 is capable of inducing osteoclast differentiation by a RANKL-dependent mechanism.

Research on coagulation of unwashed shed blood after total knee replacement in Chinese patients.

To evaluate quality of unwashed but filtered wound shed blood through ConstaVac blood conservation system (Stryker Company) after total knee replacement, we selected 30 patients who underwent total knee replacement consecutively from July 2003 to July 2004 and received retransfusion of wound shed blood. Pre- and postoperative coagulative factors of peripheral vein blood and wound shed blood were measured, such as fibrinogen, AT-III, D-dimer, plasminogen, and PT, APTT were also measured. No clinical evidence of coagulation and DIC appeared in these patients. There is significant change of coagulative factors in unwashed but filtered wound shed blood and it may cause a potential risk of coagulopathy to retransfuse wound shed blood, but retransfusion of unwashed but filtered shed blood appeared to be relative safe clinically.

[Quantification of expression of leukotriene B4 inducing tumor necrosis factor-alpha and interleukin-1beta at mRNA level in synovial membrane cells of rheumatoid arthritis by real-time quantitative PCR].

OBJECTIVE: To investigate quantification of expression of LTB4 inducing IL-1beta and TNF-alpha at mRNA level in synovial membrane cells of rheumatoid arthritis. METHODS: Primary cultured synovial cells from RA patients were treated with exogenous LTB4, MK-886 (inhibitor of 5-lipoxygenase activating protein) and Bestatin(inhibitor of leukotriene A4 hydrolase) in the presence of LIT respectively, expressions of TNF-alpha and IL-1beta were detected at mRNA level by Real-time Quantitative PCR. RESULTS: Expressions of basic TNF-alpha (TNF-alpha/GAPDH) and IL-beta (IL-beta/GAPDH) at mRNA level in primary cultured synovial cells were 0.02 +/- 0.00 and 0.16 +/- 0.01 respectively. LTB4 (10(-9) mol/L-10(-8) mol/L) was shown to induce dose-dependent increase of mRNA expression of TNF-alpha. (7-15 times) and IL-1beta (1 time) , endogenous product of LTB4 by LIT significantly increased mRNA expressions of TNF-alpha (145 times) and IL-1beta (12 times) respectively. LIT-treated synoviocytes with addition of MK-886 (5-LOX exciting protein FLAP inhibitor) (1-10 micromol/L) were inhibited to secrete LTB4 dose-dependently, following the markedly down-regulated expressions of TNF-alpha (15%-66%) and IL-1beta (41%-71%) at mRNA level . Bestatin(100 mg/L) could also remarkably diminish LTB4-induced mRNA expressions of TNF-alpha(86%) and IL-1beta (79%). CONCLUSION: LTB4 of synovial membrance cells in rheumatoid arthritis could induce expressions of TNF-alpha and IL-1beta at mRNA level, and their expression at mRNA level had been quantified successfully. It is a beneficial help to quantify all kinds of cytokines in methodology.

LTB4 can directly stimulate human osteoclast formation from PBMC independent of RANKL.

Leukotriene B4, as a kind of 5-lipoxygenase metabolite of arachidonic acid, is known to influence osteoclast formation and bone resorption. In order to determine whether Leukotriene B4 could directly stimulate human osteoclast differentiation and activation independent of RANKL (ODF), three different concentrations of Leukotriene B4 (10(-9)M, 10(-8)M, 10(-7)M) were added to the culture of CD14+ monocyte fraction of peripheral blood mononuclear cell (PBMC) in the presence of macrophage colony-stimulating factor (M-CSF). Under these conditions, Leukotriene B4 could induce multinucleated cells, which were positive for Tartrate-resistant acidic phosphatase (TRAP) staining and capable of bone resorption. Addition of osteoprotegerin (OPG) to PBMC cultures does not abrogate osteoclast formation induced by LTB4. Osteoclastogenesis induced by Leukotriene B4 were dose-dependently increased and weaker than that of RANKL. These results indicated that Leukotriene B4, elevated in many inflammatory diseases, is directly capable of inducing osteoclast formation by a RANKL-independent mechanism.