幼年特发性关节炎的诊断

幼年特发性关节炎临床表现具有多样性。本文从患儿临床体征和分类,检测早期自身抗体及应用敏感的影像学检测手段等多方面论述早期JIA的诊断,以提高对JIA的诊断水平,及时给予患儿有效治疗,改善患儿病情,提高患儿学习、生活的质量。     

Intranasal Delivery of PEGylated Salmon Calcitonins: Hypocalcemic Effects in Rats

To evaluate the hypocalcemic effect of polyethylene gtycol-conjugated salmon calcitonins (PEG-sCT) in rats, mono-PEGylated sCTs (mono-PEG-sCTs) and unmodified sCT were administered via the intranasal route and serum calcium levels were measured by colorimetric assay using o-cresolphthalein. Mono-PEG-sCTs were prepared with different sizes of succinimidyl succinate monomethoxy PEG molecules (PEG_2K, PEG_5K, PEG_12K) and characterized by HPLC and MALDI-TOF mass spectrometry. Nasal instillation of mono-PEG_2K-sCT at a dose of 2 IU/kg resulted in sustained reduction in serum calcium levels over 8 hr, with a maximum reduction (% max_d) of 13% after 6 hr of application. Whereas unmodified sCT showed a transient decrease in serum calcium levels with the maximum reduction (5%) observed after 30 min of administration. The overall reductions in serum calcium levels expressed as the net change in AUC relative to control in 8 hr were 11.9 ± 0.2, 4.6 ± 0.7, and 2.6 ± 0.7% for mono-PEG_2K-, mono-PEG_5K-, and mono-PEG_12K-sCT, respectively, compared to 3.2 ± 0.6% for unmodified sCT. The relative bioavailability of nasally administered 2 IU/kg of mono-PEG_2K-sCT was approximately 4-fold higher than nasally administrated unmodified sCT, and the absolute bioavailability was approximately 91% of intravenously injected sCT in 8 hr. It can be concluded that the intranasal absorption of mono-PEG-sCTs was inversely related to the molecular weights of the PEG attached. Of the PEGylated sCTs examined, mono-PEG_2K-sCT showed the most pronounced hypocalcemic effect. Therefore the intranasal application would probably be an alternative route of administration for mono-PEG-sCTs in achieving sustained calcium-lowering effects.     

Management of Juvenile Idiopathic Arthritis in ABO-incompatible Kidney Transplantation: A Case Report

Biologic agents are a beneficial therapy for juvenile idiopathic arthritis (JIA). However, there is a lack of evidence with regard to management of these agents for JIA patients who undergo kidney transplantation (KTx). A 36-year-old woman with JIA who was treated with tocilizumab targeting interleukin-6 (IL-6) receptor underwent ABO-incompatible kidney transplantation (ABOi KTx). To prevent over-immunosuppression, tocilizumab was discontinued before ABOi KTx. Rituximab, tacrolimus, mycophenolate mofetil, everolimus, and methylprednisolone were used for immunosuppression. Clinical remission of joint pain was maintained for over 3 years despite complete discontinuation of tocilizumab. Both serum IL-6 and soluble IL-6 receptor levels were markedly decreased, suggesting that multitargeted immunosuppression for ABOi KTx induced long-term clinical remission of JIA through inhibition of the IL-6 pathway. However, levels of C-reactive protein (CRP) and matrix metalloproteinase-3 (MMP-3) gradually increased thereafter and abatacept was initiated to prevent joint deterioration. These levels decreased without any adverse events. The patient's renal graft function was well maintained.     

Assessment of Spine Bone Mineral Density in Juvenile Idiopathic Arthritis: Impact of Scan Projection

Although children with juvenile idiopathic arthritis (JIA) are at risk for vertebral fractures, recent conventional posterior-anterior (PA) spine dual-energy X-ray absorptiometry studies reported minimal areal bone mineral density (aBMD, g/cm²) deficits. Width-adjusted BMD (WA-BMD, g/cm³) represents the bone mineral content (BMC) from the lateral projection, excluding the dense cortical spinous processes, divided by the estimated vertebral body volume based on paired PA-lateral bone dimensions. Therefore, WA-BMD may be more sensitive to JIA effects on the predominantly trabecular vertebral body. Age- and sex-specific Z-scores for spine aBMD and WA-BMD were generated in 84 JIA subjects compared with healthy controls, aged 5–21 yr. JIA was associated with lower mean WA-BMD Z-scores (−0.78, 95% CI: −1.03, −0.53; p < 0.001) and aBMD Z-scores (−0.26, 95% CI: −0.49, −0.02; p < 0.05), compared with controls. WA-BMD Z-scores were significantly lower than aBMD Z-scores in JIA (p < 0.001). A significant JIA by age interaction (p < 0.001) indicated that the magnitude of the difference between WA-BMD and aBMD Z-scores was greater in younger subjects. In conclusion, WA-BMD may be more sensitive to disease effects in children because it selectively measures the trabecular-rich vertebral body and is independent of growth-related changes in BMC of the dense spinous processes.     

Effects of Salmon Calcitonin on Synthesis and Mineralization of Collagen in Rats

The effects of salmon calcitonin (CT) on collagen metabolism and mineral deposition in fractures and intact femora, and on collagen metabolism in healing skin wounds and intact skin have been studied in young male rats. Serum calcium and serum phosphorus were reduced 3 h after the daily subcutaneous CT injection (3 MRC-U/kg body weight), whereas a rebound increase in the serum levels of both minerals was observed at 24 hours after the injection.

CT had an early transient inhibitory influence on the collagen synthesis, and this resulted in a reduced total content of collagen in bones and skin specimens from treated rats compared to controls. the concentration of collagen in bone and skin was, however, increased in treated animals compared to controls after prolonged CT administration.     

Intrapulmonary Drug Delivery of Salmon Calcitonin

SUMMARY Calcitonin (CT) and other bone-active peptides have been restrained in clinical use by the need for parenteral administration. Although nasal and other transmucosal routes can be used for CT treatment, bioavailability and bioactivity of the peptide thus delivered are limited. We have evaluated the intrapulmonary route (IP) for the delivery of salmon calcitonin (SCT) in normal subjects. SCT was administered with a dry powder delivery inhaler. For comparison, each subject also received intramuscular (IM) SCT. Inhaled SCT produced significant hypocalcemia in all subjects as did injected SCT, and the peptide could be readily measured in serum by immunoassay. Compared by dose, IP SCT had 66% of the bioactivity and 28% of the bioavailability of IM SCT. This intrapulmonary route of administration should enhance the clinical acceptability of SCT and could also be applicable to other bone-active peptides. Received: 16 December 1996 / Accepted: 25 April 1997     

Suppression of Bone Resorption in Early Postmenopausal Women by Intranasal Salmon Calcitonin in Relation to Dosage and Basal Bone Turnover

In the present study, we assessed the ability of increasing doses of intranasal calcitonin to suppress urinary deoxypyridinoline cross-link (DPD), a specific biochemical marker of bone resorption, in early postmenopausal women. Subjects consisted of 30 healthy Thai women within 5 years of postmenopause, randomly assigned to 50, 100, or 200 IU of intranasal calcitonin 5 days/week for 3 months. Calcium supplementation by calcium carbonate capsules at 750 mg of elemental calcium per day was given to all subjects. Twenty four-hour urine for DPD and creatinine assays was collected at baseline, 1 month, and 3 months after treatment. All DPD values were corrected with urinary creatinine before analyses. Data were expressed as mean ± SEM. DPD decreased significantly 1 month after intranasal calcitonin treatment (P < 0.01). However, at 3 months, DPD increased when compared with the values at 1 month (P < 0.01), suggesting that there may be a reduction in the suppression of bone resorption after prolonged calcitonin therapy. Using a stepwise multiple regression model to address whether dosage and DPD at baseline influence the response to intranasal calcitonin, it was found that DPD suppression after intranasal calcitonin was not related to dosage but was strongly associated with baseline DPD (P < 0.0001). Suppression of bone resorption in early postmenopausal women by intranasal calcitonin is determined more by the state of bone turnover at baseline than the dosage of calcitonin. Received: 10 March 1997 / Accepted: 14 November 1997     

英夫利西单抗靶向治疗幼年特发性关节炎患儿的护理

对7例幼年特发性关节炎(JIA)患儿采用英夫利西单抗(类克)靶向治疗,同时实施心理护理、用药护理、康复锻炼及健康指导.结果 治疗2～4个月总有效率达85.7%.提示类克治疗JIA效果好,优质护理是良好疗效的保证.     

英夫利西单抗靶向治疗幼年特发性关节炎患儿的护理

对7例幼年特发性关节炎（JIA）患儿采用英夫利西单抗（类克）靶向治疗,同时实施心理护理、用药护理、康复锻炼及健康指导。结果治疗2～4个月总有效率达85．7%。提示类克治疗JIA效果好,优质护理是良好疗效的保证。     

An Observational Study of Patient-rated Outcome After Atlantoaxial Fusion in Patients With Rheumatoid Arthritis and Osteoarthritis

Background  

Fusion is used to address several types of abnormality of the atlantoaxial segment. Traditionally, outcome has been assessed by achieving solid bony union. Recently, however, patient-rated outcome instruments have been increasingly used, although these may be influenced by concomitant comorbidity.     

3例全身型幼年特发性关节炎患儿感染水痘临床特征并文献复习

目的:了解全身型幼年特发性关节炎(So-JIA)患儿感染水痘-带状疱疹病毒(VZV)特征和转归,探讨糖皮质激素、甲氨蝶呤等抗风湿病药对水痘治疗的影响。方法:回顾性分析2014年8月至2017年8月在郑州儿童医院就诊的3例So-JIA感染VZV患儿的临床资料并文献复习。结果:3例患儿平均年龄为4.33岁,平均于So-JIA病程的10.6个月感染VZV。3例患儿均表现为典型斑疹、丘疹、疱疹和结痂样改变,其中2例伴有发热。3例患儿感染VZV后1~2周内血清白细胞介素(IL)-2表达水平下降,而IL-10水平明显升高,随着病毒被清除,IL-2/IL-10比值升高。而IL-6、铁蛋白、红细胞沉降率(ESR)、白细胞计数(WBC)及C-反应蛋白(CRP)等炎性指标持续下降或正常。感染VZV时,2例患儿口服激素和甲氨蝶呤治疗,1例仅口服甲氨蝶呤治疗。3例患儿均给予停用激素,静脉滴注阿昔洛韦抗病毒治疗,平均6.3 d痊愈。结论:So-JIA患儿合并VZV感染,及时给予治疗,多预后良好,且可使难治性So-JIA病情短暂缓解。     

The Classic: On Juvenile Arthritis Deformans

This Classic Article is a reprint of the original work by G. Perthes, On juvenile arthritis deformans. An accompanying biographical sketch of G. Perthes is available at DOI  10.1007/s11999-012-2432-2. The Classic Article is © 1910 and is reprinted from Über Arthritis deformans juvenilis. Deutsch Zeitschr Chir. 1910;107:111–159.     

Equivalence of Nasal Spray and Subcutaneous Formulations of Salmon Calcitonin

The aim of this study was to assess the efficacy and safety of nasal spray and subcutaneous formulations of salmon calcitonin. Two-hundred-four patients, 27 males and 177 females, aged 72 years on average, with a recent, painful, vertebral crush fracture were given either 50 IU/day of subcutaneous salmon calcitonin (SCSCT, 102 patients) or 200 IU/day of intranasal salmon calcitonin (INSCT, 102 patients) for 30 consecutive days, according to a double-blind, double-placebo design. The two-sided 95% confidence interval of the difference between the two formulations for the pain on D30 assessed by Huskisson's Visual Analogue Scale (VAS) [−5.3 mm, 7.9 mm] was included in the [−10 mm, 10 mm] reference interval. Equivalence of the two formulations, was demonstrated. At the end of the study, the 95% confidence intervals of VAS of both treatment groups were included in the [0 mm, 30 mm] interval, which is considered to be clinically pertinent. Relief was obtained in less than 10 days for more than 50% of patients. The urinary hydroxyproline/creatinine and calcium/creatinine ratios remained constant between D1 and D30 with both formulations. General safety was comparable between the two formulations. Local safety of INSCT was similar to that of its placebo. Received: 13 August 1996 / Accepted: 31 December 1996