类风湿关节炎与动脉硬化关系探讨

目的 探讨类风湿关节炎(RA)患者免疫机制与动脉硬化之间的关系.方法 比较不同程度类风湿患者治疗前后血脂、炎性标志物及颈动脉内膜厚度(IMT)的变化,并与正常人进行对照.结果 RA组与对照组相比,低密度脂蛋白(LDL)、总胆固醇(TC)偏高,高密度脂蛋白(HDL)水平低,且随着RA活动性增加,差别越来越明显(P＜0.05)；C反应蛋白(CRP)、血细胞沉降率(ESR)、类风湿因子(RF)作为炎性标志物,与风湿活动密切相关,完全可以反映病情轻重及控制程度(P＜0.05)；颈动脉内膜厚度比较,两者差别不明显(P＞0.05).结论 RA的病程及活动性和动脉粥样硬化的进展相关,即炎症程度越重,动脉粥样硬化病变程度越重.     

脱亚胺基重组鼠聚微丝蛋白抗体在类风湿关节炎活动性评价中的意义

目的 探讨脱亚胺基重组鼠聚微丝蛋白抗体(ArFA)在类风湿关节炎(RA)病情活动性判断中的意义.方法 采用酶联免疫吸附试验(ELISA)分别测定61例活动性RA患者和48例非活动性RA患者血清中ArFA,并检测红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP),记录关节压痛数、肿胀数、晨僵时间等RA病情活动性评价指标,同时比较20例RA患者治疗前后ArFA的水平变化.结果 RA活动组的ArFA抗体水平较非活动组高[(130±35)U/L与(66±25)U/L,P=0.004],治疗后ArFA水平较治疗前有明显下降(79.8 U/ml与118.2 U/ml,P=O.000).结论 ArFA可以反映RA病情的活动性,可作为RA临床活动评价指标之一.     

99mTc-亚甲基二膦酸盐在类风湿关节炎的疗效及其对炎性细胞因子的抑制作用

目的探讨99m锝-亚甲基二膦酸盐注射液(99mTc-MDP)对类风湿关节炎(rheumatoidarthritis,RA)临床表现及实验室炎性指标的抑制作用及其机制.方法以前瞻性随机开放研究,观察99mTc-MDP治疗前后RA患者临床表现、急性炎症指标以及白细胞介素(IL)-1 β、肿瘤坏死因子(TNF)-α的变化.结果经99mTc-MDP治疗后,RA患者的晨僵时间、握力、压痛和肿胀关节数、关节压痛和肿胀指数、休息痛及医生对病情的估计等临床指标均有显著改善(P＜0.01或0.05),血沉(ESR)、C反应蛋白(CRP)、血小板计数等炎症指标明显下降(P＜0.01或0.05).同时,血清中IL-1 β、TNF-α等细胞因子水平均显著降低(P＜0.05).结论99mTc-MDP对RA的短期疗效显著,并可改善实验室活动性指标.     

类风湿关节炎患者中断慢作用药物治疗原因分析

目的 调查类风湿关节炎(RA)患者中断慢作用药物治疗的原因，以提高RA患者的治疗质量。方法 4年中前瞻性随访了门诊及住院RA患者224例，记录人口统计学资料、临床资料、停用慢作用药物的主观原因；比较停药与未停药患者存在的差异，探讨影响治疗的因素。结果①4年中48％的患者停用了慢作用药物；②停药原因依次为药物副作用、自觉无效、不了解药物、无药物、患其他疾病及妊娠。③停药患者中低经济收入、低教育程度、关节压痛数及类风湿因子(RF)水平与未停药者差异有显著性。结论RA患者中断慢作用药物治疗发生率较高，应引起重视，产生的原因是医疗和患者双方面的。     

中老年人群类风湿关节炎合并心血管疾病的相关因素分析

目的 探讨类风湿关节炎患者合并心血管疾病可能的危险因素.方法 回顾性分析唐山市工人医院179例均符合美国风湿学会标准的类风湿关节炎患者的患病情况和心血管疾病危险因素,探讨类风湿关节炎合并心血管疾病的危险因素.结果 单因素分析提示类风湿关节炎合并心血管疾病发生的风险与年龄、类风湿关节炎病程、内膜中膜厚度、DAS28评分、关节外脏器受累数、类风湿因子、血小板计数、C反应蛋白和总胆固醇水平有关(P＜0.05);多因素分析提示类风湿关节炎合并心血管疾病发生的风险与DAS28病情活动性评分(OR=2.403)、关节外脏器受累数(OR=1.197)、类风湿因子(OR =2.510)、血小板计数(OR=1.166)、C反应蛋白(OR=1.700)和总胆固醇(OR=1.351)有关,与其他传统心血管疾病危险因素无关.结论 类风湿关节炎增加了心血管疾病发生的风险,为治疗和预防心血管疾病方面提供部分依据.     

血清高迁移率族蛋白1水平与类风湿关节炎临床指标的相关性

目的通过检测活动性类风湿关节炎(rheumatoid arthritis,RA)患者血清高迁移率族蛋白1(high mobility group box protein 1,HMGB1)表达水平,探讨HMGB1与RA患者疾病活动性、自身抗体及临床指标的相关性。方法采用双抗体夹心酶联免疫吸附试验测定67例活动性RA患者和21位健康对照者血清HMGB1水平。收集RA患者的同期临床资料并测定相关实验室指标:疼痛视觉模拟评分(visual analog scale,VAS)、疲乏VAS、肿胀关节数、压痛关节数、患者对疾病总体状况的VAS(patient′s global assessment,PGA)、健康评估问卷(health assessment questionnaire,HAQ)、疾病活动评分28(dise aseactivity score28,DAS28)、血沉、C-反应蛋白、类风湿因子-IgM、抗环瓜氨酸肽抗体等,分析以上指标与血清HMGB1的相关性。结果活动性RA组血清HMGB1中位数为8.7ng/ml,四分位间距为16.59ng/ml;健康对照组血清HMGB1中位数为3.47ng/ml,四分位间距为7.43ng/ml,活动性RA组血清HMGB1表达水平显著高于健康对照组,两组间比较差异有统计学意义(P0.01)。活动性RA患者血清HMGB1表达水平与类风湿因子呈正相关(P0.01),与疼痛VAS评分、疲乏VAS评分、肿胀关节数、压痛关节数、PGA、HAQ、DAS28评分及血沉、C-反应蛋白、抗环瓜氨酸肽抗体无相关性(P0.05)。结论活动性RA患者血清HMGB1表达水平较健康对照组显著升高,但可能与疾病活动无关。     

类风湿关节炎合并肺间质病变的发病相关因素

目的分析类风湿关节炎(RA)合并肺间质病变(ILD)的临床及实验室特点,探讨其发病相关因素。方法分析76例RA患者的临床资料,分为单纯RA组(n=40)和RA-ILD组(n=36),比较两组患者的一般情况、临床表现以及实验室指标。结果两组在年龄、关节肿痛数目、血管炎及发热阳性率、CRP、RF、IgM、白细胞计数比较差异具有统计学意义(P<0.05)。结论年龄大,RF高滴度表达,RA病情重,伴有关节外表现的RA患者易合并ILD,应尽早行高分辨CT等检查早期诊断及治疗。     

活动性类风湿关节炎患者生活质量及影响因素分析

目的 探讨活动性类风湿关节炎(RA)患者的健康相关生活质量及其影响因素.方法 采用健康测量量表SF-36对127例活动件RA患者的生活质量进行评价,与非活动性RA患者及健康对照者进行比较,并探讨晨僵时间、疼痛目视模拟测试表(VAS)评分、疲乏VAS评分、患者对自身健康状况的总体评价(PGA)、医生总体评价、压痛关节数(TJC)、压痛关节指数(TJI)、肿胀关节数(SJC)、肿胀关节指数(SJI)、疾病活动指数28(DAS28)、健康评估问卷(HAQ)等临床评价指标与生活质量的相关性.结果 活动性RA患者SF-36量表各维度评分均明显低于健康对照者(P<0.01);与非活动性RA患者相比,除总体健康(GH)外,活动性RA患者其他各维度评分均明显低于非活动性RA患者(P<0.01).疲乏VAS评分、PGA、医生总体评价、HAQ、DAS28是与SF-36量表各维度相关最为密切的临床参数,这些临床参数与各个维度的评分均相关(r=-0.189～-0.673).疼痛VAS评分与除情感职能(RE)外的各维度评分呈低～中度相关(r=-0.201～-0.547);TJI与除GH、RE外的各维度相关(r=-0.189～-0.466),TJC与除GH、社会功能(SF)、RE外的各维度相关(r=-0.179～-0.416),红细胞沉降率与3个维度相关(r=-0.180～-0.266).结论 活动性RA患者的生活质量明显下降,疾病活动、功能状态与患者的生活质量密切相关.     

活动性类风湿关节炎患者生活质量及影响因素分析

目的 探讨活动性类风湿关节炎(RA)患者的健康相关生活质量及其影响因素.方法 采用健康测量量表SF-36对127例活动件RA患者的生活质量进行评价,与非活动性RA患者及健康对照者进行比较,并探讨晨僵时间、疼痛目视模拟测试表(VAS)评分、疲乏VAS评分、患者对自身健康状况的总体评价(PGA)、医生总体评价、压痛关节数(TJC)、压痛关节指数(TJI)、肿胀关节数(SJC)、肿胀关节指数(SJI)、疾病活动指数28(DAS28)、健康评估问卷(HAQ)等临床评价指标与生活质量的相关性.结果 活动性RA患者SF-36量表各维度评分均明显低于健康对照者(P<0.01);与非活动性RA患者相比,除总体健康(GH)外,活动性RA患者其他各维度评分均明显低于非活动性RA患者(P<0.01).疲乏VAS评分、PGA、医生总体评价、HAQ、DAS28是与SF-36量表各维度相关最为密切的临床参数,这些临床参数与各个维度的评分均相关(r=-0.189～-0.673).疼痛VAS评分与除情感职能(RE)外的各维度评分呈低～中度相关(r=-0.201～-0.547);TJI与除GH、RE外的各维度相关(r=-0.189～-0.466),TJC与除GH、社会功能(SF)、RE外的各维度相关(r=-0.179～-0.416),红细胞沉降率与3个维度相关(r=-0.180～-0.266).结论 活动性RA患者的生活质量明显下降,疾病活动、功能状态与患者的生活质量密切相关.     

活动性类风湿关节炎患者生活质量及影响因素分析

目的 探讨活动性类风湿关节炎(RA)患者的健康相关生活质量及其影响因素.方法 采用健康测量量表SF-36对127例活动件RA患者的生活质量进行评价,与非活动性RA患者及健康对照者进行比较,并探讨晨僵时间、疼痛目视模拟测试表(VAS)评分、疲乏VAS评分、患者对自身健康状况的总体评价(PGA)、医生总体评价、压痛关节数(TJC)、压痛关节指数(TJI)、肿胀关节数(SJC)、肿胀关节指数(SJI)、疾病活动指数28(DAS28)、健康评估问卷(HAQ)等临床评价指标与生活质量的相关性.结果 活动性RA患者SF-36量表各维度评分均明显低于健康对照者(P<0.01);与非活动性RA患者相比,除总体健康(GH)外,活动性RA患者其他各维度评分均明显低于非活动性RA患者(P<0.01).疲乏VAS评分、PGA、医生总体评价、HAQ、DAS28是与SF-36量表各维度相关最为密切的临床参数,这些临床参数与各个维度的评分均相关(r=-0.189～-0.673).疼痛VAS评分与除情感职能(RE)外的各维度评分呈低～中度相关(r=-0.201～-0.547);TJI与除GH、RE外的各维度相关(r=-0.189～-0.466),TJC与除GH、社会功能(SF)、RE外的各维度相关(r=-0.179～-0.416),红细胞沉降率与3个维度相关(r=-0.180～-0.266).结论 活动性RA患者的生活质量明显下降,疾病活动、功能状态与患者的生活质量密切相关.     

Erythroid abnormalities in rheumatoid arthritis: the role of erythropoietin.

Erythroid alterations were studied in 136 patients with rheumatoid arthritis (RA). Anemia was present in 75 cases. A definite diagnosis was determined in 65. The most frequent anemia was that of chronic disease (ACD) (43 cases); 14 patients with ACD presented with moderate to severe anemia. Prevalence of deficiencies were also high (15 cases had iron deficiency anemia, IDA). Serum erythropoietin levels were different in patients with RA compared with a healthy control group (p < 0.00001). Serum erythropoietin was increased in ACD (49 +/- 28.8 U/l) with respect to both RA (38.6 +/- 12.7 U/l, p = 0.0036) and controls (18.2 +/- 7.6 U/l, p < 0.00001). Although hemoglobin (Hb) was similar in ACD and IDA, serum erythropoietin in ACD was lower than in IDA (p = 0.01). There was a negative relationship between Hb and serum erythropoietin in ACD (r = -0.42, p = 0.005). In conclusion, almost 50% of patients with RA have anemia and ACD is the most frequent. As serum erythropoietin in ACD is blunted, patients with moderate to severe ACD are possible candidates for erythropoietin treatment.     

Anemia and renal function in patients with rheumatoid arthritis

OBJECTIVE: Treatments are now available that can improve the anemia of chronic illnesses such as rheumatoid arthritis (RA). Despite recognition that anemia is common in RA and that renal function may be impaired and affect hemoglobin levels, there are almost no quantitative comparative data regarding the prevalence of anemia or decreased renal function in RA. METHODS: We studied a prospectively acquired clinical database of 2,120 patients with RA who had 26,221 hemoglobin determinations, and a control population of 7,124 patients with noninflammatory rheumatic disorders (NIRD) who had 12,086 determinations. RESULTS: Using the World Health Organization definition, anemia occurred in 31.5% of patients with RA, and followed a U-shaped distribution that had minimal prevalence around 60 years of age. Anemia prevalence in men was 30.4% and in women 32.0%. Anemia occurred in 11.1% at hemoglobin < 11 g/dl and 3.4% at hemoglobin < 10 g/dl. After erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) was the strongest predictor of anemia, followed by estimated creatinine clearance. Adjusted for age and sex, estimated creatinine clearance was 9.8 (95% CI 7.5 to 12.1) ml/min lower in patients with RA than in those with NIRD. CONCLUSION: Anemia occurs in 31.5% of RA patients, 3 times the rate in the general population. However, severe chronic anemia (hemoglobin < 10 g/dl) is rare (3.4%). In addition, renal function is impaired in patients with RA compared with NIRD. Renal function has a small effect on the anemia of RA, and ESR and CRP have slightly greater effects.     

Antipolymer antibody is not associated with fibromyalgia in Korean female patients

To examine the levels of antipolymer antibody (APA) in Korean female patients with fibromyalgia (FM) and to determine whether the levels of APA correlate with FM severity. Serum samples from patients with FM (n = 69), patients with rheumatoid arthritis (RA) (n = 71), and controls (n = 75) were assayed for APA. All of the subjects were female, and the controls were age-matched healthy volunteers. FM tender point counts and scores were examined, and FM patients were asked to complete a Korean version of the Fibromyalgia Impact Questionnaire (FIQ), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). APA-positive samples were detected in five (7.2%) of the 69 FM patients, seven (9.9%) of the 71 RA patients, and four (5.3%) of the 75 controls. The prevalence of seropositivity and the level of APA in FM patients did not differ from those in RA patients and controls. The proportion positive for APA was not higher for FM patients with severe symptoms than for FM patients with mild symptoms. There was a negative association between the APA level and age. The APA level in FM patients was not correlated with age at diagnosis, age at symptom onset, disease duration, education, tender point counts and scores, FIQ, STAI, or BDI. The prevalence of APA in Korean FM patients was quite low. Owing to the low prevalence of APA in this study, the APA assay did not distinguish FM patients with severe symptoms from those with mild symptoms.     

Tumor necrosis factor alpha, its soluble receptor I, and -308 gene promoter polymorphism in patients with rheumatoid arthritis with or without amyloidosis: implications for the pathogenesis of nephropathy and anemia of chronic disease in reactive amyloidosis

OBJECTIVE: To study tumor necrosis factor alpha (TNFalpha) -308 gene promoter polymorphism and circulating levels of TNFalpha and soluble TNF receptor type I (sTNFRI) in rheumatoid arthritis (RA) patients with and without reactive amyloidosis. METHODS: In a retrospective study, we examined 55 RA patients with biopsy-proven reactive amyloidosis and 55 control RA patients without amyloidosis (matched for age, sex, rheumatoid factor titer, and RA duration). Inflammatory activity was assessed by measuring the erythrocyte sedimentation rate and C-reactive protein level. TNFalpha gene promoter polymorphism was studied using polymerase chain reaction-restriction fragment length polymorphism assay. Cytokine and receptor levels were measured by enzyme-linked immunoassays. RESULTS: Patients with RA and amyloidosis had significantly higher TNFalpha and sTNFRI levels than did the control RA patients. The increased circulating levels of TNFalpha correlated with interleukin-18 levels, but not with the serum amyloid A protein levels or with TNFalpha -308 gene promoter polymorphism (reported to be associated with high TNFalpha levels and certain disease susceptibilities). In the patients with RA and amyloidosis, those with anemia had significantly higher TNFalpha and sTNFRI levels than did those without anemia, and circulating TNFalpha and sTNFRI levels correlated negatively with hemoglobin concentrations. In the patients with RA and amyloidosis, those with nephropathy had significantly higher TNFalpha and sTNFRI levels than did those without nephropathy; in patients with isolated proteinuria (but no creatinine elevation) the TNFalpha level was also significantly increased, indicating that the TNFalpha elevation was not merely a consequence of impaired renal function. CONCLUSION: This study shows that circulating levels of TNFalpha and sTNFRI are significantly increased in RA patients with amyloidosis as compared with control RA patients without amyloidosis and that the increased levels may be implicated in the pathogenesis of certain disease manifestations, including anemia of chronic disease and renal pathology in reactive amyloidosis.     

Evolution of the prevalence and characteristics of anemia in inflammatory bowel diseases between 1993 and 2003

INTRODUCTION: Anemia has been considered as an overlooked complication of inflammatory bowel disease. Studies dating back to the 80ties and the 90ties have shown 30% of anemia among inflammatory bowel disease (IBD) patients. More recently, the broader use of immunosuppressive drug and infliximab allowing better mucosal healing as well as a more aggressive treatment of anemia, including the use of safer form of IV iron, may have influenced the prevalence of anemia among IBD patients. Our aim was to asses the prevalence and characteristics of anemia among two cohorts of IBD patients at 10 years interval and to look for associated clinical or demographic factors. METHODS: Using the IBD patients register of one senior gastroenterologist, we identified IBD patients he had consecutively seen and who had blood test at the outpatient clinic during the years 1993 and 2003. Demographic and clinical characteristics, treatment for Crohn's disease, blood test results and treatment of anemia were recorded and compared between these two cohorts. Anemia was defined as an hemoglobin level lower than the normal value of the laboratory of our hospital. RESULTS: 80 and 90 patients were identified in 1993 and 2003, respectively. There was no significant difference between the two cohorts, according to age, gender, disease type, duration or location. There were 27/80 (33.8%) and 15/90 (16.7%) anemic patients in 1993 and 2003, respectively (P = 0.013). The prevalence of severe anemia (hemoglobin level < 10.5 g/100 ml) was similar in the two cohorts (6.3% and 5.6%). Characteristics of the anemia were similar in the two cohorts with a majority of iron deficiency anemia and inflammatory anemia. Ferritin and CRP levels were not significantly different in the two cohorts. The only significant difference was a more frequent use of immunosuppressive treatment and infliximab in 2003 than in 1993 (33.3% vs. 13.8% ; P = 0.0038, RR: 0.41, 0.22-0.77) CONCLUSIONS: Prevalence of mild to moderate anemia has significantly decreased in our population over the last 10 years. The only difference detected between the two cohorts was the increased use of immunosuppressive drug (mainly azathioprine).     

Serum immunoreactive erythropoietin in rheumatoid arthritis: impaired response to anemia

Serum immunoreactive erythropoietin (EP) levels were measured in 116 patients with rheumatoid arthritis (RA) and 20 control patients with iron deficiency anemia. Serum EP levels were significantly higher in the 46 anemic RA patients than in the 70 nonanemic RA patients (mean ± 1 SD 31.0 ± 19.8 mU/ml versus 16.8 ± 12.4 mU/ml; P < 0.0001). Furthermore, although a significant inverse correlation between the serum EP level and the hemoglobin value was present in the anemic RA patients (r = −0.57, P < 0.0001), the regression coefficient describing the relationship between serum EP and hemoglobin was significantly lower for the anemic RA patients than for patients with iron deficiency anemia (F = 6.01, P < 0.025).     

Mild anemia is frequent and associated with micro‐ and macroangiopathies in patients with type 2 diabetes mellitus

Aims/Introduction: The present study investigated the frequency of mild anemia, which is not an indication of intensive therapy using drugs, in Japanese patients with type 2 diabetes mellitus and the association of mild anemia with diabetic complications. Materials and Methods: This is a cross‐sectional study of 1189 patients with type 2 diabetes mellitus. Anemia was defined as a hemoglobin level <13.5 g/dL in men and <12.0 g/dL in women. The patients with anemia were divided into two groups: (i) grade 1 anemia with a hemoglobin level ≥11.0 g/dL; and (ii) grade 2 anemia with a hemoglobin level <11.0 g/dL. Results: The prevalence of anemia increased with the progression of the stage of diabetic nephropathy and chronic kidney disease. The frequencies of diabetic micro‐ and macroangiopathies increased with the progression of anemia among 798 patients without anemia, 300 with grade 1 anemia and 91 with grade 2 anemia. Both grade 1 and grade 2 anemia were associated with diabetic micro‐ and macroangiopathies. They remained independently associated with diabetic retinopathy, coronary heart disease and peripheral arterial disease after adjustment by age, sex, body mass index, use of angiotensin II receptor blocker, estimated glomerular filtration rate and stage of diabetic nephropathy. Conclusions: Mild anemia is frequent and associated with micro‐ and macroangiopathies in patients with type 2 diabetes mellitus. It is important to carry out intensive examinations for the detection of diabetic micro‐ and macroangiopathies in addition to evaluating the causes of anemia when mild anemia is found in patients with diabetes mellitus. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00060.x, 2010)     

Prolactin deficiency in rheumatoid arthritis.

Prolactin and growth hormone were determined from the sera of 48 patients with rheumatoid arthritis (RA) and 23 controls by radioimmunoassay and by the Nb2 lymphoma proliferation bioassay. A highly significant deficiency was found in the bioactivity of circulating prolactin (PRL) in patients with RA, whereas immunoactive PRL was near normal. Only age matched male patients showed significantly lower serum PRL levels by radioimmunoassay. Patients with RA with anemia and high reticulocyte counts had bioactivity of PRL elevated and those with anemia and low reticulocyte counts had a decreased bioactivity of PRL when compared to patients without anemia. Prolactin isolated from the sera of 5 patients with RA showed decreased bioactivity in comparison with PRL separated from 5 sex matched controls. Serum factors capable of enhancing or inhibiting the response of Nb2 cells to ovine PRL were also discovered. Our results indicate that RA is associated with PRL deficiency.     

HLA-D region genes and rheumatoid arthritis (RA): importance of DR and DQ genes in conferring susceptibility to RA.

The distribution of HLA-D region antigens was studied in three groups (I, IIa, and IIb) of patients with rheumatoid arthritis (RA): group I comprised 43 patients with mild, non-progressive RA, controlled by non-steroidal anti-inflammatory drugs without progression or erosions; group II comprised 94 patients with severe disease, who had earlier been treated with non-steroidal anti-inflammatory drugs and all had incomplete response requiring treatment with gold (sodium aurothiomalate). Of these, 46 patients (group IIa) responded to gold and the disease was well controlled, and the remaining 48 patients (group IIb) did not respond to gold and developed gold induced toxic reactions, including thrombocytopenia or proteinuria, or both. HLA-D region antigens were defined by serological and molecular (Southern blot analysis and oligonucleotide typing) techniques. The results show that DR4 was significantly increased in all three groups of patients. The prevalence of DR1, or DR1 in DR4 negative patients, and DR3 and DR4 associated DQw7 specificities, however, showed differences in these three groups of patients. The prevalence of DR1 and of DR1 in DR4 negative patients was increased only in patients with mild (group I) RA, but not in patients with severe (groups IIa and IIb) disease. On the other hand, the prevalence of DR4 associated DQw7 was significantly increased in patients with severe disease, but not in patients with mild RA. In addition, DR3 was significantly increased only in patients with severe disease who developed gold induced toxic reactions (group IIb). These data suggest that the HLA-D region genes which cause susceptibility to mild RA may be different from those causing susceptibility to severe RA. The results suggest that both DR and DQ (A, B) genes may be important in conferring susceptibility to RA: DR in mild disease and DQ in severe RA.     

Serum hyaluronic acid levels do not explain morning stiffness in patients with fibromyalgia

To investigate the serum levels of hyaluronic acid (HA) in Korean female patients with fibromyalgia (FM) and correlate these levels with variables of disease severity including morning stiffness, we measured HA serum levels in 69 FM patients, 72 rheumatoid arthritis (RA) patients, and 71 healthy controls by enzyme-linked binding protein assay. The serum levels of HA in FM patients did not differ from those in the age-matched controls, whereas HA levels were significantly higher in RA patients than in FM patients and controls (both P < 0.001). With a cut-off value of 75 ng/mL, the prevalence of seropositivity was higher in RA patients (59.7%) than in FM patients (26.1%) or controls (14.1%; both P < 0.001). There were no differences in seropositivity between FM patients and controls, or between FM patients with severe symptoms and those with mild symptoms. The HA levels in FM patients were significantly correlated with age, age at diagnosis, age at symptom development, disease duration, symptom duration, and level of education. There were no correlations between HA levels and morning stiffness, tender point counts and scores, or Fibromyalgia Impact Questionnaire, State–Trait Anxiety Inventory, and Beck Depression Inventory scores. In our patients, the serum HA levels were not increased and did not reflect disease severity. These results suggest that serum HA is not a useful laboratory marker for diagnosis and assessment of FM.