Disease-related social and family life: people coping with rheumatoid arthritis in Estonia

Objective: The aim of the article is to investigate the most severe problems aggravating the quality of life of people with rheumatism and to outline the role of support and assistance people with rheumatism receive from their family members/acquaintances in order to cope with their daily life. Methods: The article is based on the data and findings of the national sociological survey ‘Chronic Rheumatic Patients 2006’ carried out by the Rheumatic Association of Tallinn in the years 2005–2006 with the support from the Ministry of Social Affairs of Estonia. Data were collected via a questionnaire from 808 respondents. Results: The respondents indicated their state of health and shortage of money as their most severe problems, followed by dysfunctional family relations, poor living conditions, loneliness, etc. The problems are more severe for the respondents who live alone and have been coping with illness for over 10 years. The assistance received from relatives/acquaintances to cope with daily life is more varied and thorough than that received from children. Assistance is mostly received occasionally. On average, every tenth respondent does not have anyone to turn to for assistance. Conclusion: Severe problems and stress symptoms display a cumulative effect–the occurrence of one aspect often triggers others. To break this vicious circle, people with rheumatism need assistance and support from the state as well as from their immediate environment.     

Disease activity and severity in patients with rheumatoid arthritis: relations to socioeconomic inequality

The aim of this study was to investigate possible differences in measures on disease process, joint damage, health status and self-efficacy between patients with rheumatoid arthritis (RA) living in an affluent and in a less affluent area in the same city. We analyzed data collected on patients enrolled in a community-based register of patients with RA in Oslo, Norway. 246 patients were examined by questionnaire in 1994 and 133 patients were examined clinically in 1997. Measures on disease process, joint damage, health status and self-efficacy were compared between patients from two residential areas. There was no significant difference regarding joint counts, patients' or investigator's evaluation of disease severity, blood test results and number of joint replacements. Significant differences were observed for disability and for various dimensions of health measured by the arthritis impact measurement scales and the short form-36: patients in the less affluent area reported poorer health status. Patients in this area also showed significantly lower scores on the arthritis self-efficacy scale. Patients with RA in two socioeconomically different areas in Oslo thus were found to be equal regarding disease process and joint damage measures. However, in the measures reflecting physical and psychosocial health status, patients in the less affluent area seemed to be more seriously ill. They also showed less confidence in their ability to influence the disease. Even in a welfare society with universal access to health care the impact of a well-defined chronic disease seems to be closely linked to the patient's socioeconomic situation.     

Atherogenic lipid profiles and its management in patients with rheumatoid arthritis

Cardiovascular morbidity and mortality are enhanced in rheumatoid arthritis, which might be due to an increased prevalence of cardiovascular risk factors such as dyslipidemia. The dyslipidemia observed in RA appears to be dependent on disease activity, ie, a higher disease activity is associated with lower total cholesterol levels and even more depressed high density lipoprotein levels, leading to a higher (ie, unfavorable) atherogenic index. It appears that this dyslipidemia is already present long before the clinical onset of rheumatoid arthritis. Antirheumatic drug treatment with disease modifying antirheumatic drugs as well TNF-blocking agents has, in general, favorable, albeit moderate, effects on the lipid profile. Therefore, it is unlikely that the observed beneficial effects of antirheumatic drug treatment on cardiovascular morbidity and cardiovascular mortality in rheumatoid arthritis is mediated through effects on the lipid metabolism. Management of dyslipidemia in rheumatoid arthritis should be part of a general cardiovascular risk management. Hence, in addition to the assessment of the lipid profile, other cardiovascular risk factors should be determined and appropriate treatment installed when indicated. Lower treatment thresholds should be considered in view of the enhanced cardiovascular risk in rheumatoid arthritis and guidelines should be developed based on epidemiological data.     

Change and status in quality of life in patients with rheumatoid arthritis

Current status in quality of life and deterioration retrospectively attributed to the disease by patients with reheumatoid arthritis (RA) were examined. The study group included 169 female and 53 male patients with probable (n=70), definite (n=127) and classical RA (n=25). In a cross-sectional postal survey the participants self-rated their quality of life according to a generic self-assessment package tailored in part for this study. Shortened parallel ratings by significant others were also performed. The impact of RA on quality of life was pervasive. Heaviest intrusion emerged within the physical life sphere and the behavioural and activity domain, followed by the impact on global life satisfaction and habits. Material, psychological and social life domains were less disrupted. In spite of the pervasive discomfort attributed to the illness, quality of life status was mostly rated as being rather good to good. There was a consistent pattern: the better off currently, the less disturbance from the disease perceived. Higher age and longer duration of RA were significantly correlated to a lower status. In addition, individuals still working rated a higher quality of life and less intrusion of the disease. Self-ratings were corroborated by ratings of significant others. While there was an agreement on the level of the negative impact of the disease, the patients rated their current situation more positively than did significant others. The dual assessment of quality of life status and change appears reasonable and informative as regards rheumatoid arthritis.This work was supported by grants from the Löttinger foundation Västervik, Sweden.     

类风湿关节炎危险因素的病例对照研究

目的　探索影响类风湿关节炎 (RA)发病的危险因素。方法　以 12 0例确诊的类风湿关节炎患者为病例组 ,以同地区 12 0名健康者按性别、年龄 (± 3岁 )进行 1∶1配对进行病例对照调查。结果　单因素分析结果发现 ,RA与环境、个体、感染因素以及女性相关因素等关系密切 ;男性RA患病的危险因素明显少于女性 (女性相关因素除外 ) ,进行逐步Logistic回归分析 ,结果得到进一步证实。结论　RA与多种因素相关。口味偏淡、性格开朗为男女RA发病的共同相关因素 ;女性RA发病的危险因素多于男性。     

老年类风湿关节炎患者护理中的综合服务的应用分析

目的 分析综合服务在老年类风湿关节炎患者护理中临床应用效果。方法 抽取本院2017年4月—2018年4月间收治的老年类风湿关节炎患者84例为研究对象,将其随机分为甲、乙组各42例。甲组采取常规护理方法,乙组在甲组护理基础上采取综合护理服务。结果 乙组护理后的晨僵时间短于甲组(P<0.05);乙组护理后的疼痛、焦虑、睡眠质量评分均低于甲组(P<0.05);乙组生活质量评分均高于甲组(P<0.05);乙组的护理满意率95.24%高于甲组的护理满意率90.95%(P<0.05)。结论 对老年类风湿关节炎患者采取综合服务,有效改善了患者的晨僵、疼痛、焦虑、睡眠情况,并提高了生活质量及护理满意度,值得广泛应用于临床。     

热带地区痛风与类风湿性关节炎患者生化指标比较

目的 比较热带地区痛风及类风湿性关节炎患者的生化指标差异。方法 2014年1月-2016年12月间在某院住院治疗的海南痛风患者816例及类风湿性关节炎患者316例,对其部分生化指标进行比较分析,利用统计学软件SPSS19.0对组间数据进行分析。结果 两组患者鳞状上皮细胞、非鳞状上皮细胞、尿粘液、尿蛋白、尿液酸碱度、血清尿酸、钙、钾、磷、氯、钠都存在组间统计学差异（P<0.05）。其中痛风组中尿蛋白的检出率为43.1%,为类风湿性关节炎组的检出率（23.4%）的1.84倍。尿酸在男性痛风组中的浓度为（446±141.1）μmol/L,在男性风湿性关节炎患者中的浓度为（315.44±156.55）μmol/L;在女性痛风患者中的浓度为（382.7±123）μmol/L,在女性类风湿性关节炎患者中为（223±94.7）μmol/L;钙浓度在痛风组和风湿组中分别为（2.03±0.19） mmol/L和（1.99±0.18）mmol/L,差异有统计学意义（P<0.01）。结论 临床生化指标差异不能作为2种病症的鉴别诊断依据。     

早期类风湿关节炎患者自身抗体与放射学破坏的相关性研究

目的　探讨抗Sa抗体和抗角蛋白抗体 (AKA)对早期类风湿关节炎 (RA)放射学破坏的临床意义。方法　检测 4 2例早期RA患者的抗Sa抗体和AKA ,结合手、足X线片的病情分期和改进的Sharp评分分析。结果　初诊时及随诊 2年后抗Sa抗体、AKA阳性组X线分期较阴性组高。随诊 2年后抗Sa抗体、AKA阳性组Sharp评分较阴性组为高。随诊 2年后与初诊时相比较 ,抗Sa抗体、AKA阳性组X线分期、Sharp评分明显增高 ,抗Sa抗体阴性组增高。两种抗体同时阳性患者随诊 2年后Sharp评分明显增高。结论　抗Sa抗体、AKA可作为早期RA患者放射学破坏的预测指标。     

MMP-12在类风湿关节炎中和骨性关节炎中的研究

目的　基质金属蛋白酶 (matrixmetalloproteinase ,MMPs)是分解细胞外基质的重要因子。人类金属弹性蛋白酶(humanmetallolastase ,MMP - 12 )是MMPs的一种。现已证实由巨噬细胞分泌MMP - 12的异常表达与许多疾病有关 ,如类风湿性关节炎 (rheumatoidarthritis,RA)、骨性关节炎 (osteoarthritis,OA)等。试验的目的是研究RA和OA病变中MMP - 12在滑膜组织中的表达。方法　滑膜组织取自临床确诊的 2 2例RA及 2 9例OA患者 (均为膝或髋关节置换手术患者 ) ,用免疫组织化学方法进行分析。结果　免疫组化染色显示 ,表达MMP - 12的细胞主要为滑膜层细胞 ,且大部分为炎性巨噬细胞。结论　来源于巨噬细胞的MMP - 12在RA病变发展 ,如关节破坏过程中起重要作用 ,抑制MMP - 12高活性可能会为治疗RA提供一种新的途径     

正清风痛宁联合甲氨蝶呤治疗老年类风湿关节炎的临床研究

目的 观察正清风痛宁联合甲氨蝶呤(MTX)治疗老年类风湿关节炎(elderly onset rheumatoidarthritis,EORA)疗效及安全性.方法 应用临床实验研究方法,按入院顺序采用区组随机分组法将病例分成实验组与对照组,实验组采用正清风痛宁联合甲氨蝶呤方案治疗,对照组采用单纯甲氨蝶呤方案治疗.治疗24周观察2组患者关节压痛指数、关节肿胀指数、晨僵持续时间、血沉(ESR)、(C-反应蛋白,C-reactive protein,CRP),与治疗前比较DAS28评分,将DAS28评分做为疾病活动度及疗效指标进行评估.检测血小板计数(PLT)、血小板压积(PCT)、血小板平均体积(MPV),同时观察2组不良反应发生率.结果 治疗24周后实验组与对照组晨僵时间、关节压痛数、关节肿胀数、红细胞沉降率、C-反应蛋白、疾病活动度评分(DAS28)均较治疗前好转,差异有统计学意义(P＜0.05);实验组上述指标改善情况均优于对照组,差异亦有统计学意义(P＜0.05).治疗后两组临床疗效比较差异有统计学意义(P＜0.05).两组患者血小板参数水平均降低,但实验组降低水平较对照组显著(P＜0.05).不良反应发生率两组比较差异无统计学意义(P＞0.05).结论 正清风痛宁联合MTX在治疗老年RA,较单纯用MTX更能有效改善症状,控制病情,降低患者异常升高的血小板,从而减少老年RA患者心血管疾病的发生,而不良反应的发生率并未增加,值得临床借鉴应用.     

类风湿关节炎患者外周血维生素D水平的调查分析

目的研究类风湿关节炎(RA)患者外周血25羟维生素D3[25-(OH)D3]水平与疾病的相关性。方法 ELISA法检测72例绝经后女性RA患者(RA组)和58例健康的绝经后女性志愿者(对照组)外周血25-(OH)D3的水平,并采用疾病活动性评分(DAS28)评估RA患者疾病活动性,比较两组间25-(OH)D3水平的差异及25-(OH)D3与RA活动性之间的关系。结果与对照组相比,RA患者外周血25-(OH)D3水平明显降低(P<0.05),且25-(OH)D3水平与DAS28呈负相关。结论维生素D在类风湿关节炎疾病诊治过程中,可能起到防治及病情评估的双重作用。     

类风湿伴肺间质改变患者血中Ⅲ型前胶原变化的研究

用放免法检测 30例类风湿关节炎伴或不伴肺间质病变的患者血中Ⅲ型前胶原含量 ,并以 15例正常人为对照。结果显示 ,类风湿关节炎患者 ,血中Ⅲ型前胶原明显高于正常对照组 ,且类风湿关节炎伴肺间质改变患者的血中Ⅲ型前胶原含量也高于类风湿关节炎无肺间质改变者。提示 ,类风湿关节炎患者易合并肺间质病变 ,且Ⅲ型前胶原水平变化对反映其是否合并肺间质病变具有一定敏感性。     

类风湿关节炎达标治疗相关影响因素的临床研究

目的 调查类风湿关节炎患者（rheumatoid arthritis,RA）达标治疗情况,分析其影响因素,进一步提高RA达标治疗率。方法 选择300例RA患者,详细记录所有患者临床资料,并根据28关节疾病活动性（disease activity score in 28 joints,DAS28）评分分为达标组和未达标组。结果 RA患者中,达标率为36.7%;达标组和未达标组比较：达标组比未达标组患者平均年龄轻、文化程度高、关节肿胀数/关节压痛数少、疼痛程度评分/患者总体评估/医师总体评估（physician global assessment,PGA）低;达标组持续使用致病情缓解抗风湿病药（disease-modifying anti-rheumatic drugs,DMARDs）单药或联合治疗时间≥3个月所占比例高于未达标组;达标患者类风湿因子、红细胞沉降率、C反应蛋白、关节功能分级、生活质量得分低于未达标患者;Logistic回归分析显示：关节功能分级、C反应蛋白、PGA是RA达标治疗独立影响因素。结论 RA患者达标治疗率仍较低,DMARDs正规治疗对达标治疗具有重要作用,关节功能、C反应蛋白、PGA为RA达标治疗独立影响因素。     

Maternal exposure to paternal HLA does not explain the postpartum increase in rheumatoid arthritis

The postpartum period, particularly after the first pregnancy, represents a time of increased risk for the development of rheumatoid arthritis (RA). The present study was undertaken to investigate whether this increase in risk may be due to maternal exposure to fetally inherited paternal HLA-DR antigens that were either 1) similar to their own or 2) had an increased likelihood of being one of the two specific types, HLA-DR1 and DR4, implicated in the etiology of RA. We recruited 94 families where the mother had developed RA within 12 months of a pregnancy, and HLA typed the mother, father, and relevant child of each family. Mothers were not more likely to share HLA-DR genes with their partners than would be expected, and children whose parents shared one HLA-DR gene were not more likely to inherit the shared gene from their father as opposed to the non-shared gene. Further, those children whose fathers were heterozygous for HLA-DR1 or DR4 were not more likely to inherit these genes as opposed to the non-DR1/DR4 gene. In conclusion, maternal exposure during pregnancy to either fetally inherited paternal HLA-DR1 and DR4 genes or to paternal DR genes similar to their own does not appear to contribute to postpartum maternal susceptibility of RA. © 1996 Wiley-Liss, Inc.     

抗环瓜氨酸肽抗体检测在类风湿关节炎诊断中的应用

目的：探讨抗环瓜氨酸肽（抗-CCP）抗体对类风湿关节炎（RA）的临床应用价值,并比较与类风湿因子（RF）之间的相关性以及在临床诊断上的意义。方法：对75例RA患者血清标本和77例对照者的血清标本用酶联免疫吸附试验（ELISA）进行抗-CCP抗体检测,并测定RF,分析RF与抗-CCP抗体的相关性。结果：75例RA患者中,抗-CCP抗体阳性率为56%（42/75）,非RA对照组的阳性率为5.2%（4/77）,两者有显著差别。抗-CCP抗体对RA诊断的敏感度为56%,特异性为94.8%;阳性和阴性似然比分别为16.08和0.16。抗-CCP抗体和类风湿因子（RF）具有相关性。结论：抗-CCP抗体对RA诊断具有良好的敏感度和特异性,将是协助诊断RA的一个新的实验指标。     

Nutritional management of rheumatoid arthritis: a review of the evidence

Rheumatoid arthritis (RA) is a debilitating disease and is associated with increased risk of cardiovascular disease and osteoporosis. Poor nutrient status in RA patients has been reported and some drug therapies, such as nonsteroidal anti‐inflammatory drugs (NSAIDs), prescribed to alleviate RA symptoms, may increase the requirement for some nutrients and reduce their absorption. This paper reviews the scientific evidence for the role of diet and nutrient supplementation in the management of RA, by alleviating symptoms, decreasing progression of the disease or by reducing the reliance on, or combating the side‐effects of, NSAIDs. Supplementation with long‐chain n‐3 polyunsaturated fatty acids (PUFA) consistently demonstrates an improvement in symptoms and a reduction in NSAID usage. Evidence relating to other fatty acids, antioxidants, zinc, iron, folate, other B vitamins, calcium, vitamin D and fluoride are also considered. The present evidence suggests that RA patients should consume a balanced diet rich in long‐chain n‐3 PUFA and antioxidants. More randomized long‐term studies are needed to provide evidence for the benefits of specific nutritional supplementation and to determine optimum intake, particularly for n‐3 PUFA and antioxidants.     

GPI、抗-CCP和RF联合检测对诊断类风湿性关节炎的临床意义

目的研究葡萄糖-6-磷酸异构酶(GPI)、环瓜氨酸多肽抗体(抗-CCP)和类风湿因子(RF)联合检测对诊断类风湿性关节炎的临床意义。方法选择2012年1月—2016年12月在本院进行诊治的类风湿性关节炎患者120例为A组,其他自身免疫性疾病患者(包括骨关节病、系统性红斑狼疮、原发性干燥综合征、系统性硬化症以及混合性结缔组织病)100例为B组,以及同期在本院进行体检的健康者100例为C组。采用酶联免疫吸附法检测GPI和抗-CCP,采用免疫比浊法对血清RF进行测定。比较3组研究对象GPI、抗-CCP、RF及联合检测的阳性率以及GPI、抗-CCP、RF与联合检测对类风湿性关节炎的特异度、敏感度、阴性预测值以及阳性预测值。结果 A组GPI、抗-CCP、RF及联合检测的阳性率均明显高于B组以及C组(P0.05);GPI、抗-CCP、RF联合检测对类风湿性关节炎的诊断特异度、敏感度、阴性预测值以及阳性预测值均明显高于单独检测(P0.05)。结论 GPI、抗-CCP和RF在类风湿性关节炎中具有较高的阳性表达率,三者联合检测可以提高对类风湿性关节的检出率。     

河南漯河地区中老年人群类风湿关节炎危险因素及其患病情况分析

目的 了解贵州省黔南地区20～79岁农村居民类风湿关节炎患病现状及其危险因素,为采取相应干预措施提供参考依据。 方法 于2017年1月 — 2018年10月,采用整群随机抽样方法抽取黔南地区118 587名20～79岁农村居民进行问卷调查、常规检查、影像学检查和实验室检查,采用SAS 9.1软件进行统计学分析。 结果 贵州黔南地区居民类风湿关节炎患病1 097例,患病率为0.925 %,标化患病率为0.917 %。多因素非条件logistic回归分析结果显示,女性（OR = 5.512,95 % CI = 1.348～6.129）、年龄40～79岁、水族（OR = 4.812,95 % CI = 1.215～5.786）、毛南族（OR = 2.896,95 % CI = 1.223～4.195）、苗族（OR = 1.886,95 % CI = 1.136～3.603）、吸烟（OR = 3.108,95 % CI = 1.165～4.382）、口味偏重清淡（OR = 3.072,95 % CI = 1.207～4.506）、抑郁（OR = 2.798,95 % CI = 1.164～3.681）、居住环境潮湿（OR = 4.491,95 % CI = 1.275～5.765）、住在石板房（OR = 3.867,95 % CI = 1.218～5.963）、劳动强度Ⅲ级（OR = 2.817,95 % CI = 1.133～3.132）和Ⅳ级（OR = 3.927,95 % CI =1.226～4.929）、类风湿家族史（OR = 3.732,95 % CI = 1.137～5.214）、既往结核病史（OR = 2.084,95 % CI = 1.212～3.479）、既往腮腺炎史（OR = 2.014,95 % CI = 1.206～3.335）、外伤史（OR = 1.997,95 % CI = 1.136～3.421）、初潮年龄 ≥ 17岁（OR = 2.342,95 % CI = 1.215～4.667）是贵州黔南地区20～79岁农村居民类风湿关节炎患病的危险因素。布依族（OR = 0.397,95 % CI = 0.332～0.995）、其他民族（OR = 0.678,95 % CI = 0.462～0.997）、饮茶（OR = 0.487,95 % CI = 0.125 ～0.765）是贵州黔南地区20～79岁农村居民类风湿关节炎患病的保护因素。 结论 贵州黔南地区农村居民类风湿关节炎患病率较高,应针对该地区农村居民类风湿关节炎患病的危险因素进行干预。