老年类风湿关节炎

２６例６０刚以后发病的老年在风湿关节炎（ＥＲＡ）和３０例６０岁以前成年发病的老年类风湿关节炎（ＮＥＲＡ）的显著不同表现为男性居多，急性发病较多，肩和膝大关节作为首发关节较多，手和足浮肿较常见，并较少累及跖趾关节。在ＥＲＡ组，皮下结节和类风湿因子滴度密切相关，类风湿因子出现与病程长短无关，以及１例并发多发性骨髓瘤。血小板、血沉、Ｃ－反应蛋白和类风湿因子增高的阳性率在两组间无统计学差异。５６例中，除１     

老年类风湿关节炎患者43例临床分析

目的 探讨老年期发病的类风湿关节炎的临床特点。方法 对43例60岁以后发病的老年患者的临床特点进行分析，并与59例年青发病患者进行比较。结果 老年组男性发病多，急性起病较多；肩和膝等大关节作为首发关节者在老年组(37．2％)高于青中年组(11．8％)；老年组患者关节症状及关节功能障碍均重于青中年组患者，且并发心、肺疾患和骨关节炎者明显增多。结论 老年组在发病形式、首发受累关节均与青中年患者不同，且关节症状严重程度与青中年组患者显著不同，老年人并发症多于青中年人。     

银屑病关节炎老年发病的临床及实验室表现

作者前瞻性比较了ＰｓＡ老年发病 (ＥＯＰｓＡ)及ＰｓＡ年轻发病 (ＹＯＰｓＡ)时的表现及 2年后的结局 ,阐明年龄对ＰｓＡ的类型是否有影响。病人和方法　 66例ＰｓＡ患者病程小于 1年 ,类风湿因子阴性 ,1 6例年龄大于 60岁 (Ｅ组 ) ,5 0例年龄小于 60岁 (Ｙ组 ) ,分别在入院时和 2年后进行临床、实验室和放射学分析。临床分析包括活动关节炎数、指关节炎和凹陷性水肿的检查。实验室检查包括ＥＳＲ、Ｃ反应蛋白 (ＣＲＰ)、ＨＬＡ Ｂ2 7。有 1 0例Ｅ组和 2 4例Ｙ组患者出现膝关节积液 ,用ＥＬＩＳＡ法检测其滑液白介素 (ＩＬ) 1 β、ＩＬ 6…     

老年类风湿关节炎患者生活质量及相关因素

类风湿关节炎(RA)是关节发生慢性进行性破坏的一种自身免疫性疾病,主要变现为滑膜炎[1],并伴多系统受累病变.RA的初发症状出现在60岁以后,称为老年性RA(ERA).我国的RA的患病率为0.33％ ～0.36％,而ERA约占总数10％～33％.ERA反复发病,严重影响老年人的生活质量.本文对ERA患者和非ERA(NERA)患者的临床症状和相关的实验室检查结果进行对比分析,以便于提高ERA的早期诊断.     

老年类风湿关节炎患者血清MMP-13、sICAM-1、IL-10的检测

目的探讨老年类风湿关节炎患者血清基质金属蛋白酶(MMP)-13、可溶性细胞黏附分子(s ICAM)-1和白细胞介素(IL)-10检测的临床意义。方法选择2013年9月至2014年9月来该院治疗的类风湿关节炎老年患者48例为观察组,同期选择48例健康人员作为对照组。观察两组人员血清MMP-13、s ICAM-1、IL-10的情况。结果观察组血清MMP-13、s ICAM-1、IL-10水平高于对照组(P<0.01或P<0.05)。类风湿关节炎患者活动期组也均高于对照组和缓解期组(P<0.01或P<0.05)。类风湿关节炎患者MMP-13、s ICAM-1、IL-10水平与血沉(ESR)、高敏C-反应蛋白(hsCRP)呈显著正相关(P<0.05),与病程相关性较小(P>0.05)。结论血清MMP-13、s ICAM-1、IL-10水平与类风湿关节炎的发病及病情进展有关,可作为类风湿关节病情判断的指标,具有较高的临床应用价值。     

老年发病的类风湿关节炎的诊治进展

类风湿关节炎是一个原因不明的慢性炎症性疾病 ,主要病变部位在关节滑膜 ,也可累及关节外的其他器官和系统。它可发生在任何年龄 ,发病高峰年龄为 30～ 5 0岁。其患病率随年龄的增加而增加 ,随着人口老龄化 ,老年类风湿关节炎越来越受到人们的关注。通常人们把 6 5岁以上的类风湿关节炎病人称为老年类风湿关节炎 ,这其中又分两种情况 :一种是 6 5岁以后发病的类风湿关节炎 ,称为老年发病的类风湿关节炎 (ｅｌｄｅｒｌｙ ｏｎｓｅｔｒｈｅｕｍａｔｏｉｄａｒｔｈｒｉｔｉｓ ,ＥＯＲＡ) ,另一种是 6 5岁以前发病 ,携带疾病步入≥ 6 5岁即非老…     

玻璃酸钠关节腔内注射配合蜡疗和超激光治疗老年膝关节骨性关节炎60例

目前治疗膝关节骨性关节炎的方法较多,如药物、物理治疗、手术(包括关节置换)等,都取得了不同程度的效果.我院康复医学科应用玻璃酸钠关节腔内注射配合蜡疗、激光治疗老年膝关节骨性关节炎,使患者膝关节功能明显得到改善. 1资料与方法 1.1 一般资料 将2007年6月至2010年6月我院收治的120例老年膝关节骨性关节炎患者随机分为两组.对照组:60例,年龄在60 ～ 86岁,平均(67.4±9.13)岁,其中男22例,女38例;病程(1.61±1.27)年;关节功能Ⅰ级19例、Ⅱ级28例、Ⅲ级13例.治疗组:60例,年龄60 ～ 89岁,平均(68.2±10.26)岁;其中男25例,女35例;病程(1.73 ±1.19)年;关节功能Ⅰ级17例、Ⅱ级31例、Ⅲ级12例.两组从年龄、性别、病程、关节功能分级上均无统计学意义,具有可比性(P＞0.05).1.2 病例选择①诊断标准:诊断采用美国风湿病学会制定的膝关节骨性关节炎诊断标准及关节功能分级[2].②排除标准:有严重心、肝、肾等重要脏器病变及血液系统疾患和其他恶性病变的患者;石蜡、药物过敏者.     

老年类风湿关节炎45例临床特点

类风湿关节炎(RA)可发生在任何年龄,发病高峰年龄为30～50岁。初发症状发生在≥60岁的RA称为老年类风湿关节炎(EORA)〔1〕。本文对EORA的临床特点进行分析,并与<60岁初次发病的非EORA(NEORA)患者进行比较〔2,3〕。     

老年发病的类风湿关节炎患者的临床特征和治疗现状分析

目的 探讨老年发病的类风湿关节炎(EORA)的临床特征和治疗现状。方法 分析28例EORA、20例非老年发病的类风湿性关节炎(NEORA)和60例中青年类风湿关节炎(MRA)三组患者临床特征和常用的实验室检查项目以及治疗方案的差异。结果 EORA组男女发病的性别构成比为1：1．15，以急起为主(与MRA组比较)，且EORA组首发以大关节受累为主、总计受累关节数较少、血清IgM浓度升高(与MRA组、NEORA组比较)，但是NEORA组与其余两组相比的X线分期病变更严重。治疗方面，MRA组由于关节疼痛而主动住院治疗的住院率比其他两组高，但是EORA组与NEORA组之间比较无差别，风湿专科的治疗与非风湿专科的治疗相比有差别，但与年龄及合并症关系不大。结论 EORA有其自身的特征，而且正规治疗知识的普及在患者和医务工作者中都非常必要。     

类风湿关节炎血清植物性食物过敏原特异性IgG和IgE检测

目的检测类风湿关节炎患者4种植物性食物过敏原Ig G和Ig E水平,探讨类风湿关节炎与食物过敏的相关性。方法收集2013年9月至2014年5月深圳市第六人民医院50例类风湿关节炎患者和45例健康人血清,采用酶联吸附法检测血清花生、大豆、榛子、小麦4种食物过敏原特异性Ig G和Ig E水平。结果类风湿关节炎组与正常组血清花生、大豆特异性Ig G比较差异有统计学意义(1.31±0.36 vs.1.08±0.35;1.22±0.33 vs.1.07±0.32;均P0.01);血清榛子、小麦特异性Ig G,血清花生、大豆、榛子、小麦特异性Ig E比较差异无统计学意义(P0.05)。老年性类风湿关节炎组(年龄≥60岁)与非老年类风湿关节炎组(年龄60岁)血清花生、大豆、榛子、小麦食物过敏原特异性Ig G、Ig E比较差异无统计学意义。结论类风湿关节炎与食物过敏有相关性,食物过敏与类风湿关节炎发病年龄无明显相关性。     

Temporomandibular involvement in juvenile idiopathic arthritis

OBJECTIVE: To study occurrence as well as clinical signs and symptoms of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) in a population representing all subtypes of JIA. METHODS: Ninety-seven consecutive children with JIA underwent orthodontic evaluation including an orthopantomogram (OPG). Further evaluation included patient characteristics, disease onset, course, and medical treatment. RESULTS: Forty-five percent of all children had TMJ involvement. Frequencies according to JIA subtypes: systemic 67%, oligoarticular (persistent and extended) 39%, rheumatoid factor (RF) negative polyarticular 59%, RF positive polyarticular 33%, enthesitis related arthritis 13%, psoriatic arthritis 33%, and other arthritis 50%. In children with a polyarticular course, irrespective of their disease onset, TMJ involvement was more frequent (55% vs 31% in oligoarticular course). In children with disease onset at a young age and/or an extended course of the disease, TMJ involvement was also more frequent. Pain during jaw excursion, absence of translation, asymmetry during maximal opening and protrusion, as well as crepitation during evaluation are predictors for TMJ involvement with a good specificity but a low sensitivity. Not all patients with TMJ involvement have clinical signs. CONCLUSION: Because of the high prevalence and discrepancy between clinical signs and presence of arthritis of the TMJ, regular orthodontic evaluation and OPG is recommended to recognize TMJ involvement and enable early intervention.     

HLA B27 typing in 511 children with juvenile idiopathic arthritis from India

The enthesitis-related arthritis (ERA) category of juvenile idiopathic arthritis (JIA) is the most common category in India. HLA B27 has a high prevalence in ERA, and ILAR classification includes it in exclusion criteria for other categories, but due to its cost, it is not routinely done. We undertook this study to assess the prevalence of HLA B27 in ERA and other groups of juvenile arthritis in India. Consecutive patients of JIA ERA and select patients from other categories were recruited from a single tertiary care hospital over a span of 3 years. HLA B27 was tested using PCR. Five hundred and eleven children were studied: 312 had ERA, and 199 had other categories (29 oligoarthritis, 107 polyarthritis, 44 systemic onset JIA, 9 psoriatic arthritis and 10 undifferentiated). The prevalence of HLA B27 was highest in the ERA group (87 %) and correlated with the presence of sacroiliitis. Prevalence was 10.3 % in oligoarthritis, 16 % in polyarticular rheumatoid factor (RF)-positive arthritis, 26 % in RF-negative polyarticular arthritis, 66 % in psoriatic arthritis and 40 % in the unclassified and 0 % in systemic onset category. Twenty-seven children had a change in category of JIA as per ILAR owing to HLA B27 testing positive, most commonly in the RF-negative polyarthritis group. Only six of these had clinical features suggestive of Spondyloarthropathy. There is high prevalence of HLA B27 in ERA. Though HLA B27 testing helps in correct classification, a minority of these patients have features suggestive of spondyloarthropathy like back pain, enthesitis or sacroiliitis.     

Clinical features, autoantibodies and HLA-DR antigens in rheumatoid arthritis

HLA-DR4 was associated with seropositive but not seronegative disease in 105 Caucasians with rheumatoid arthritis (RA). There were no clinical or radiological differences between DR4 positive and negative RA groups, although 7 of 8 patients with early disease onset (less than 30 yr) were DR4 positive. High rheumatoid factor (RF) titers were more frequent in DR4 negative RA. A plot of the frequency distribution of RF titers in DR4 negative disease showed a bimodal distribution with seronegative and high titer groups. HLA-DR3 was not associated with high RF titers but was associated with high titers of antinuclear antibodies.     

HLA antigens in palindromic rheumatism, nonerosive rheumatoid arthritis and classical rheumatoid arthritis

The frequency of HLA antigens has been investigated in patients with definite rheumatoid arthritis (RA) who lacked characteristic erosive radiographic changes that we called nonerosive rheumatoid arthritis ( NERA ). The frequency of HLA-DR4 in patients with NERA was significantly lower than that in classical, erosive RA. A normal frequency of HLA antigens was also found in patients with palindromic rheumatism (PR). Those of the PR patients who however, developed RA during followup, carried HLA-DR4. The patients with PR, NERA and RA who had familial RA demonstrated increased frequency of HLA-DR4.     

Elderly-onset rheumatoid arthritis

Elderly-onset rheumatoid arthritis (EORA), defined as rheumatoid arthritis (RA) with onset at age 60 years or over, differs slightly at presentation from younger-onset RA (YORA) by a more equal gender distribution, a higher frequency of acute onset with systemic features, more frequent involvement of the shoulder, and higher disease activity. Longitudinal studies have showed more disease activity, radiographic damage, and functional decline in patients with EORA than in those with YORA. These differences were only found in seropositive patients. Seropositive EORA was reported to be associated with HLA-DR4, in contrast to seronegative EORA. Possible heterogeneity in the pathogenesis of seronegative EORA is supported by the recognition of subsets that overlap with the clinical manifestations of other syndromes such as polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema. In addition, crystal-induced arthritis and inflammatory osteoarthritis may be difficult to distinguish from EORA. The efficacy and toxicity of second-line drugs is similar in both age groups, but in the elderly caution is needed with the use of nonsteroidal antiinflammatory drugs and prednisone.     

Prognostic factors for the development of rheumatoid arthritis and other connective tissue diseases in patients with palindromic rheumatism

OBJECTIVE: Palindromic rheumatism is characterized by attacks of acute arthritis of short duration. In the long term, a substantial proportion of patients will develop rheumatoid arthritis (RA) or other connective tissue diseases, but the determinants of subsequent chronic disease have not been adequately established. We identify clinical prognostic factors for the development of RA and other connective tissue diseases in patients with palindromic rheumatism in a retrospective cohort study. METHODS: The medical records of 4900 patients with arthritis referred from 1986 to 1996 to 3 rheumatologists at an academic center were reviewed. One hundred sixty patients were diagnosed as having palindromic rheumatism. After review, 127 complied with diagnostic criteria for palindromic rheumatism. Disease duration was estimated as time of first attack until the last consultation, or the development of RA or other connective tissue disease. Survival analysis including Cox regression was used to identify clinical variables associated with the risk of developing RA or other connective tissue disease, adjusting for varying disease duration. RESULTS: Sixty-five percent of the patients were female. Age at onset was 40+/-12 years. Mean disease duration was 6+/-6 years, and mean followup by the rheumatologists was 40+/-45 months. Joints more frequently affected were wrist, knee, and metacarpophalangeal. Forty-three patients (34%) subsequently developed a connective tissue disease including 36 (28%) RA, 3 (2%) systemic lupus erythematosus, and 4 (3%) other connective tissue diseases. In the final Cox regression model the hazard ratio for development of a connective tissue disease in the presence of a positive rheumatoid factor (RF) was 2.9 (p = 0.002), for proximal interphalangeal (PIP) joint involvement 2.4 (p = 0.02), for wrist involvement 2.5 (p = 0.05), for female sex 2.2 (p = 0.05), and for age at onset 1.03 (per year) (p = 0.001). Female patients with positive RF and involvement of the hands had an 8-fold risk of developing disease, compared with patients with one or fewer of these features. CONCLUSION: Positive RF and early involvement of the wrist and PIP joints predict the subsequent development of RA or other connective tissue disease in patients with palindromic rheumatism, and identify a group of patients at increased risk.     

Older age onset rheumatoid arthritis with or without osteoarthritis.

The clinical features of a group of 79 patients with older age onset rheumatoid arthritis (ORA) were compared with those of a group of 414 patients with younger age onset rheumatoid arthritis. The ORA group contained approximately equal numbers of men and women, were less rheumatoid factor positive, had a raised erythrocyte sedimentation rate, lower HLA-DR4 positivity, and a tendency towards larger joint involvement at the onset of the disease. These features have been reported by many authors except for the lower DR4 positivity. Of these features, the lower prevalence of rheumatoid factor positivity and the tendency towards larger joint involvement at the onset were characteristic of a subset of patients with ORA who had had osteoarthritis before the onset of rheumatoid arthritis. It is suggested that osteoarthritic large joints may be susceptible to the occurrence of rheumatoid synovitis at the onset of the disease, but that the osteoarthritis inducing factor may be negatively related to the progression of rheumatoid arthritis.     

Anti-cyclic citrullinated peptide antibodies as a discriminating marker between rheumatoid arthritis and chronic hepatitis C-related polyarthropathy

Articular involvement is a frequent extrahepatic manifestation of hepatitis C virus (HCV) infection. The distinction between HCV-related polyarthropathy and true RA may be very difficult, especially with recent onset RA before articular damage and erosions develop. The objective of the study is to assess the diagnostic utility of anti-CCP antibodies and compare it with that of rheumatoid factor (RF) in distinguishing between rheumatoid arthritis (RA) and HCV-related polyarthropathy. Anti-cyclic citrullinated peptide (CCP) antibodies and RF were determined in the sera of 30 patients with RA and 22 patients with HCV-related polyarthropathy. Anti-CCP antibodies were positive in 83.3% of patients with RA and in 4.5% in patients with HCV and polyarthropathy. RF was positive in 90% of RA patients and in 81.1% of HCV patients with polyarthropathy. The anti-CCP antibodies showed higher specificity for RA compared with RF (95.4 vs. 18.2%). However, the sensitivity of anti-CCP was comparable to that of RF (83.3 vs. 90%). In conclusions, anti-CCP antibodies are reliable laboratory markers to differentiate between RA and HCV-related polyarthropathy.     

Interleukin-33 as a marker of disease activity in rheumatoid factor positive polyarticular juvenile idiopathic arthritis

Objective: To investigate clinical usefulness of serum interleukin (IL)-33 levels as an indicator of disease activity in juvenile idiopathic arthritis (JIA).

Methods: We measured serum levels of IL-33 in 39 patients with JIA, including 7 patients with rheumatoid factor positive poly-JIA (RF?+?poly-JIA), 8 patients with RF negative poly-JIA (RF-poly-JIA), 20 patients with oligoarticular JIA (Oligo-JIA), 4 patients with enthesitis-related arthritis (ERA) and 30 age-matched healthy controls. Furthermore, we determined their correlation with measures of disease activity.

Results: Serum IL-33 levels in patients with RF?+?poly-JIA were significantly elevated compared to those in patients with RF-poly-JIA, oligo-JIA and HC. Serum IL-33 levels in patients with RF-poly-JIA, oligo-JIA and ERA were not elevated compared to those in HC. Serum IL-33 levels in RF?+?poly-JIA patients normalized in remission phase. Serum IL-33 levels correlated positively with RF in patients with RF?+?poly-JIA.

Conclusions: These results indicate that serum IL-33 levels in RF?+?poly-JIA patients correlated with disease activity, suggesting a potential role of IL-33 as a promising indicator of disease activity.