Alveolitis during Chrysotherapy for Rheumatoid Arthritis

ABSTRACT. A patient who developed dry cough and increasing breathlessness during chrysotherapy for seropositive rheumatoid arthritis is presented. Chest radiograms were repeatedly normal, but there was a moderate decrease in pulmonary diffusing capacity. Transbron-chial lung biopsy showed alveolitis. No cellular immunity to gold salts could be demonstrated in vitro. Pulmonary function improved after withdrawal of gold, indicating that chrysotherapy rather than systemic rheumatoid disease was the cause of the alveolitis.     

类风湿关节炎蛋白质组学研究进展

蛋白质组学技术通过在蛋白质水平上对机体进行研究以阐述疾病的发生、发展及转归。将蛋白质组学技术应用于类风湿关节炎(RA)的研究,多项研究均证实钙连蛋白A(MRP-8)等蛋白质与RA滑膜局部炎性反应有关,可能参与RA发病。应用表面增强激光解析电离飞行时间质谱技术结合决策树统计方法可建立RA的疾病诊断预测模型。     

类风湿性关节炎的心血管损害

类风湿性关节炎合并心脏损害并非少见,包括心包炎、心肌病/心肌炎、心脏淀粉样变性、瓣膜病、冠状动脉血管炎、心律失常以及充血性心力衰竭和缺血性心脏病,尤其是后二者明显增加了类风湿性关节炎的死亡率。心脏病学家应该和风湿病学家共同努力,降低类风湿性关节炎合并心血管疾病的死亡率。     

Biochemical Markers of Bone Turnover in Rheumatoid Arthritis

ABSTRACT. Bone turnover was determined in 125 patients with rheumatoid arthritis (RA). Bone Gla protein (BGP) and alkaline phosphatase (AP) were used as markers of bone formation. Fasting urinary calcium relative to creatinine (FU Ca/Cr) and fasting urinary hydroxyproline relative to creatinine (FU Hpr/Cr) were used as markers of bone resorption. These variables were compared to the values of two groups of normal controls in order to elucidate the pathophysiology of the osteopenia occurring in patients with RA. When the patients were divided into groups according to treatment (gold salts, penicillamine, or glucocorticoids), serum AP was highly significantly increased in all three groups, whereas serum BGP was below the normal mean. FU Ca/Cr and FU Hpr/Cr were moderately decreased in the groups treated with gold salts or penicillamine, but increased in the glucocorticoid-treated group. When divided according to sex and menopausal state and glucocorticoid treatment versus non-glucocorticoid treatment, there was a balance between bone formation and bone resorption parameters in all groups, except glucocorticoid-treated men and premenopausal women who had increased values of bone resorption parameters.     

利妥昔单抗用于类风湿关节炎的治疗

利妥昔单抗是针对B淋巴细胞表面CD20分子的人，鼠单克隆抗体的嵌合体，最近研究提示利妥昔单抗能够有效治疗类风湿关节炎。利妥昔单抗能够有效减少类风湿因子阳性类风湿关节炎患者的临床症状和体征，而且具有较好的安全性。本文对利妥昔单抗的作用机制及在RA中的应用等问题进行简要综述。     

类风湿关节炎的血清多肽差异

目的筛选风湿性关节炎患者血清中与疾病相关的差异性表达多肽,尝试建立类风湿关节炎(rheu-matoid arthritis,RA)的多肽鉴别诊断模型。方法以RA患者作为实验组,将活动期系统性红斑狼疮(systemic lupus erythematosus,SLE)患者作为疾病对照组,健康志愿者作为正常对照组,应用弱阳离子交换磁珠分离纯化血清样本,MALDI-TOF-MS获取样本生物学信息,用ClinProt2.1软件进行统计学分析,用遗传算法建立分类预测模型。结果成功筛选出一系列差异表达多肽,建立了具有高预测能力和交叉验证能力的诊断预测模型。验证该分类模型后,显示对RA组的识别率达100%,交叉验证能力达87.88%。结论将蛋白质组学技术应用于RA发病机制研究,从多肽指纹图谱新角度进行疾病分析,为更好地理解RA的发病机制、指导RA治疗及其预后提供依据。     

Rheumatoid Arthritis Accompanying Diffuse Panbronchiolitis

A 58-year-old woman with rheumatoid arthritis (RA) visited our hospital complaining of a persistent cough and sputum for the past year. She had a high cold hemagglutinin titer and chronic sinusitis. Chest computed tomography revealed bilateral diffuse centrilobular nodules, bronchiectasis, and bronchial wall thickening. A surgical lung biopsy was performed that confirmed diffuse panbronchiolitis (DPB) because of the lymphocytic and plasmacytic infiltrates in the respiratory bronchioles. Her condition improved after the administration of clarithromycin. Several cases of RA complicating DPB have previously been reported, but only in Japan. We need to consider DPB as a bronchiolitis types accompanying RA among Japanese patients.     

A Gastrointestinal Endoscopic Study on Secondary Amyloidosis Complicating Rheumatoid Arthritis

Abstract: Biopsy specimens endoscopically obtained from the stomach, duodenum, sigmoid colon and rectum of 58 patients with rheumotoid arthritis (RA) were examined for amyloid deposition by light microscopy. Six cases (10.3%) were diagnosed as being amyloidosis. In cases with more than moderate amyloid deposition, amyloid was most notable in the lamina propria mucosae. In cases with slight amyloid deposition, amyloid was seen in the blood vessel walls of the lamina muscularis mucosae and tela submucosa. On the whole, amyloid deposition was most marked in the duodenum. Endoscopically, whitish, irregular, partially nodular thickening of mucosa was characteristic in the sites with severe amyloid deposition. A fine granular appearance was observed in the sites with moderate amyloid deposition. No particular abnormal findings were noticed in the sites with slight amyloid deposition. Erosions, redness and a tendency for easy mucosal bleeding appeared frequently in the sites with more than moderate amyloid deposition. The endoscopic abnormal findings were most remarkable in the duodenum, and mildest in the recto-sigmoid colon. It was suggested that these abnormal findings were correlated with the degree of amyloid deposition especially in the lamina propria mucosae. All the amyloidosis cases were in advanced anatomical stages of RA. The degree of anemia was more severe, and total protein, albumin and total cholesterol values were lower in the amyloidosis cases than in non-amyloidosis cases. It is clear that when endoscopic examinations of RA patients are done to rule out amyloidosis, a biopsy should be taken from a depth including the submucosa even if the endoscopic finding is normal.     

白细胞介素-6阻断剂在类风湿关节炎的治疗应用

类风湿关节炎(rheumatoid arthritis,RA)是一种系统性炎症性自身免疫性疾病。免疫系统的失调在其发病中起着重要作用,因而抑制炎症反应是治疗RA的重要手段。白细胞介素6(interleukin-6,IL-6)是多功能细胞因子,与RA的发病有着密切联系。阻断IL-6信号传导通路是RA治疗的一个新策略。托珠单抗(Tocilizumab)是人源化IL-6受体单克隆抗体,一系列随机双盲安慰剂对照临床试验已显示其对于RA患者的疗效和安全性。这一药物可能会为RA的治疗带来新的曙光。     

A Randomized Double‐Blind Sham‐Controlled Trial of the Prosorba Column for Treatment of Refractory Rheumatoid Arthritis

Abstract: The Prosorba column has been studied as a novel therapy for rheumatoid arthritis in several clinical settings over the last 5 years. In this article, we summarize the pivotal clinical trial study supporting the safety and efficacy of the Prosorba column as it is applied to treatment of rheumatoid arthritis. The Prosorba column is a medical device that contains purified staphylococcal protein A covalently bound to a silica matrix. This device is used to treat patient plasma in conjunction with a plasmapheresis machine. In this ex vivo treatment, blood is withdrawn from the patient, cells are separated from plasma in the machine, and the plasma is passed through the Prosorba column. The plasma then is recombined with the cells and returned to the patient. The Prosorba column was approved for the treatment of idiopathic thrombocytopenic purpura in 1987 and, in 2 open‐label trials 1 , 2 , showed promising evidence of efficacy in rheumatoid arthritis. A subsequent Phase 3 pivotal trial demonstrated statistical superiority of Prosorba treatments to sham column apheresis 3 . Analysis of the pivotal trial of patients who completed all treatments indicated that 41.7% of the Prosorba treated patients met American College of Rheumatology defined response criteria as compared to 15.6% of the sham treated patients. This difference was significant at a level of p ≤ 0.02.     

A Rare Case of Rheumatoid Arthritis with Tocilizumab-induced Intestinal Mucosal Injury

Intestinal mucosal injury that develops as a complication of tocilizumab (TCZ) is usually associated with diverticulosis. We herein report a rare case of TCZ-induced intestinal mucosal injury in the absence of diverticulosis. A 74-year-old woman suffering from rheumatoid arthritis started taking TCZ. Six months later, she complained of hematochezia and abdominal pain. Colonoscopy revealed multiple ulcers spreading from the cecum to the transverse colon but no diverticulosis. These lesions were cured at three months after the discontinuation of TCZ. We should consider TCZ as a risk factor for intestinal mucosal injury, even if patients have no history of intestinal disease associated with diverticulosis.     

自身抗体阴性类风湿关节炎的临床及实验室特点

目的探讨自身抗体阴性类风湿关节炎(rheumatoid arthritis,RA)患者的临床及实验室特点。方法分析11例自身抗体阴性RA患者的临床和实验室特点并监测其自身抗体的变化。结果自身抗体阴性RA患者在全部RA中占6.1%,3个月后有27.3%的自身抗体阴性RA患者的自身抗体转为阳性,6个月后有45.5%的自身抗体阴性RA患者的自身抗体转为阳性。结论自身抗体阴性RA患者较为常见,短期内部分患者的自身抗体可转为阳性,临床上应密切监测RA患者的自身抗体变化。     

巨噬细胞移动抑制因子一类风湿关节炎治疗新靶点

巨噬细胞移动抑制因子（macrophage migration inhibitory factor,MIF）作为炎症反应的上游因子,可诱导各种细胞表达多种炎症因子,具有免疫调节、影响细胞凋亡以及和糖皮质激素相互作用等特性。近年来,研究发现MIF广泛参与类风湿关节炎（rheumatoid arthritis,RA）的发病过程。本文对MIF及其与RA发病机制的可能关系进行简要综述。     

第1、2代抗环瓜氨酸肽抗体对类风湿关节炎诊断价值的比较

目的比较第1代与第2代抗环瓜氨酸肽（anti-cyclic citrutlinated pepfide,CCP1,CCP2）抗体对类风湿关节炎（rheumatoid arthritis,RA）的诊断价值。方法对129份RA、153份其他风湿性疾病和94份健康对照血清进行检测。类风湿因子（rheumatoid factor,RF）检测采用乳胶间接凝集法,抗CCP1和抗CCP2抗体检测采用酶联免疫吸附法。结果对RA的诊断敏感性,抗CCP2抗体高于RF和抗CCP1抗体,分别为67．4％、46．5％和46．5％,差异有显著性意义（P=0．001）;抗CCP1和抗CCP2抗体对RA的诊断特异性均为94．7％,而RF的诊断特异性仅为77．7％,差异亦有显著性意义（P〈0．001）。结论抗CCP2抗体对RA诊断有较好的敏感性和较高的特异性。