Preventive interventions in individuals at risk for Rheumatoid Arthritis: State of the art and perspectives

During the last decade, the outlook for patients with rheumatoid arthritis (RA) has improved greatly, especially for patients with autoantibody-positive RA. To further improve long-term disease outcomes, the field has turned to investigating the efficacy of treatment initiated in the pre-arthritic phase of RA, based on the adage “the sooner the better.” In this review, the concept of prevention is evaluated and different risk stages are being examined for their pre-test risks of RA development. These risks affect the post-test risk of biomarkers used at these stages and, consequently, the accuracy with which the risk of RA can be estimated. Furthermore, through their effect on accurate risk stratification, these pre-test risks ultimately also associate with the likelihood of false-negative trial results (the so-called “clinicostatistical tragedy”). Outcome measures to assess preventive effects are evaluated and relate to either the occurrence of disease itself or to the severity of risk factors for RA development. Results of recently completed prevention studies are discussed in the light of these theoretical considerations. The results vary, but clear prevention of RA has not been demonstrated. While some treatments (e.g. methotrexate) persistently reduced symptom severity, physical disability, and the severity of imaging joint inflammation, other treatments were not reported to produce long-lasting effects (hydroxychloroquine, rituximab, atorvastatin). The review concludes with future perspectives regarding the design of new prevention studies and considerations and requirements before findings can be implemented in daily practice in individuals at risk of RA attending rheumatology practices.     

基于《中华医典》文献挖掘的膝痹用药规律研究

目的 通过对《中华医典》中治疗膝痹的相关文献进行挖掘分析，探索膝痹用药及组方规律，为膝痹的临床治疗提供文献依据。方法 检索《中华医典》中治疗膝痹的中药方剂，经数据筛选处理后，利用“古今医案云平台”软件进行药物使用频数、四气、五味、归经、功效及关联关系等分析。结果 对筛选出的107首处方进行分析，共涉及中药214味，功效多以强筋骨为主，四气以温为主，五味中辛味最多，归经多见脾经、肝经、肾经，高频次组合为防风配伍牛膝，甘草配伍川芎、当归。结论 在膝痹的中药治疗中，以补肝肾、强筋骨为主，同时要兼顾祛风除湿、逐瘀通经等，标本同治，虚实兼顾。     

Arthralgia induced by endocrine therapy with or without cyclin-dependent kinase 4/6 inhibitors in breast cancer: A systematic review and meta-analysis

Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) have been approved for breast cancer (BC) treatment. Several trials suggested that arthralgia was reduced in patients treated with ET plus CDK4/6i compared with that in those with ET-alone. We aimed to compare arthralgia rates in BC patients treated with/without CDK4/6i. We reviewed randomized controlled phase II/III trials investigating CDK4/6i with ET in hormone receptor-positive and epidermal growth factor 2-negative BC. Publications were retrieved from PubMed from January 2014 to April 2021. We compared arthralgia rates between patients who were administered ET plus CDK4/6i (CDK4/6i group) and those treated with ET-alone (control group). We reviewed 12 trials that reported data on adverse effects for arthralgia. These trials included 17,440 patients (9255 in the CDK4/6i group and 8185 in the control group). The arthralgia rate in the CDK4/6i group was significantly lower than that in the control group (27.6% vs. 34.8%, p < .001), especially in early BC (28.8% vs. 37.3%, p < .001). These suggested that the arthralgia rate in patients treated with ET plus CDK4/6i was lower than that in patients treated with ET-alone and that CDK4/6i may decrease the arthralgia rate in BC patients treated with ET, especially in early BC.     

不同历史时期中医胸痹的定义和病机认识变迁

胸痹是以胸膺部疼痛、痹阻不通为主要特点的疾病，自胸痹病名创始以来，各时代医家都对其定义和病机有不同见解。通过梳理历代医书古籍，探讨名医学术思想，以追溯胸痹的学术源流。古代胸痹的内涵范围较广，涵盖了冠心病等心系疾病和其他胸膺部疾病。古籍中胸痹的因机理论亦颇为丰富，不仅有张机提出“阳微阴弦”的重要理论影响后世，还有各医家从风、寒、饮食、痰、瘀、清阳等角度阐述胸痹成因，为现代治疗胸膺部疾病提供更夯实的理论基础和更广泛的治疗思路。     

王耀光教授治疗痛风性关节炎临床经验总结

文章从病因病机、临床治疗调护等多方面总结王耀光教授治疗痛风性关节炎经验。王耀光教授指出痛风性关节炎临床分为急性期和缓解期，其病性为本虚标实之证，急性期以标实为主，辨证当属“热痹”范畴，多由湿热、痰浊、瘀血合而流注肢体关节为病。缓解期以本虚为主，多属脾肾亏虚，兼夹瘀毒之证，但究其致病之根应属于“浊毒”，故泄浊解毒之法应贯穿治疗始终，急性期以清热解毒、利湿止痛为主，以桂枝芍药知母汤为主方加减，并根据患者病性偏胜的不同，加用化痰泄浊或活血化瘀之品，又根据中医取类比象之法，于处方中加入祛风通络之青风藤、海风藤、忍冬藤等藤类药物，取其伸筋通络止痛之功，并内外合治应用痛风止痛方外洗缓解患者症状；缓解期以补脾益肾，化瘀解毒为主，以玉屏风加味合宣痹降浊方治疗，反复发作者加用“虫蚁搜剔”之法，配合间断饮用土茯苓水巩固善后，临床疗效显著。