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1.
Levent Ozgonenel Esra Cetin Sule Tutun Pinar Tonbaklar Hale Aral Guvenc Guvenen 《Clinical rheumatology》2010,29(5):473-477
Vascular endothelial growth factor (VEGF) is known to be involved in the pathogenesis of rheumatoid arthritis (RA). In order
to elucidate the association between VEGF levels and RA disease activity, VEGF concentrations were measured in RA patients
at different phases and severity levels. Thirty-eight healthy subjects and 40 patients with RA were prospectively included
in the study. Subjects were further categorized into four subgroups (high, moderate, low, or remission) using the disease
activity score-28 (DAS28) scoring system. VEGF levels were significantly higher in patients than controls (p < 0.001). VEGF levels differed significantly in controls, early and late-phase RA patients (p = 0.002). A significant difference was found between controls and patients with high RA disease activity scores (p < 0.0001). VEGF levels were not correlated with age (r = −0.016; p = 0.921) or sex (r = 0.209; p = 0.921). VEGF values were correlated with erythrocyte sedimentation rate (r = 0.445; p = 0.004), but was not correlated with serum rheumatoid factor levels (r = −0.130; p = 0.424) in the patient group. In conclusion, higher VEGF levels are associated with late phase and high disease activity
in RA, independent of age and sex. 相似文献
2.
Oelzner P Franke S Lehmann G Eidner T Müller A Wolf G Hein G 《Clinical rheumatology》2007,26(12):2127-2135
The aim of our study was to investigate determinants of bone mineral density (BMD) measured by dual X-ray absorptiometry at
the lumbar spine (BMD-LS) and at the femoral neck (BMD-FN) in patients with rheumatoid arthritis (RA) with special respect
to bone resorbing proinflammatory cytokines and their physiological antagonists. In 142 RA patients the following parameters
were measured in parallel with BMD: serum levels of soluble receptor activator of nuclear factor kappa-B-ligand (sRANKL),
osteoprotegerin (OPG), interleukin (IL)-6, soluble glycoprotein 130 (sgp130), 25-hydroxyvitamin D3 (25OHD3), 1,25-dihydroxyvitamin D3 (1,25[OH]2D3), intact parathyroid hormone, osteocalcin, ionized calcium, renal excretion of pyridinolin and deoxypyridinolin, C-reactive
protein, and erythrocyte sedimentation rate (ESR). No significant differences of sRANKL, OPG, IL-6, and spg130 were found
between patients with osteoporosis (47.9% of patients), osteopenia (36.6%), and normal BMD (15.5%). However, total sRANKL
was significantly higher in postmenopausal women with osteoporosis at FN than in those without (p < 0.05) and showed a negative correlation with BMD-LS in patients older than 60 years (p = 0.01). BMD-LS and BMD-FN (p < 0.001) and total sRANKL (p < 0.01) were negatively related with the age of the patients. Only IL-6 (positive correlation, p < 0.001) and 1,25(OH)2D3 (negative correlation, p < 0.001) but not sRANKL, OPG, and sgp130 were related to disease activity. Using multiple linear regression analysis, menopause
was identified as the crucial negative determinant of BMD-LS (R
2 = 0.94, p = 0.001), whereas cumulative glucocorticoid dose (β = −0.80, p = 0.001) and ESR (β = −0.44, p = 0.016) were the negative determinants of BMD-FN (R
2 = 0.86, p = 0.001). The results indicate that influences of age and gender must be considered in investigations on the relationship
between BMD and sRANKL in RA and that high serum levels of sRANKL seems to be associated with osteoporosis only in subgroups
of RA patients. 相似文献
3.
Serelis J Kontogianni MD Katsiougiannis S Bletsa M Tektonidou MG Skopouli FN 《Clinical rheumatology》2008,27(6):795-797
The aim of this study was to investigate the effect of anti-tumor necrosis factor alpha (anti-TNF) treatment on body composition
and serum adiponectin levels of women with rheumatoid arthritis (RA). Nineteen women with RA starting anti-TNF treatment were
included in the study. Disease activity, body composition, lumbar spine bone mineral density (BMD) and serum adiponectin concentrations
were measured at baseline and after 1 year of follow-up. No important changes on body composition and lumbar spine BMD were
observed, while the serum levels of adiponectin levels increased after 1 year of anti-TNF treatment (p = 0.02). Anti-TNF treatment in women with RA does not have any significant effect on body composition; however, it is associated
with increase in adiponectin levels which may ameliorate the systemic inflammatory response state associated with RA. 相似文献
4.
Senel S Kisacik B Ugan Y Kasifoglu T Tunc E Cobankara V 《Clinical rheumatology》2011,30(10):1369-1372
We aimed to evaluate the efficacy and safety of long-term use of etanercept therapy in patients with spondyloarthropathy (SpA)
and rheumatoid arthritis (RA) on hemodialysis (HD). Selected RA or SpA patients treated with etanercept under HD were retrospectively
evaluated. Etanercept-related adverse events were closely recorded for all patients. At the follow-up, erythrocyte sedimentation
rate and C-reactive protein levels were monitored. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for SpA patients
and Disease Activity Score (DAS28) for RA patients were measured at every 3 or 6 months. In total five end-stage renal disease
(ESRD) patients were enrolled to the study. The causes of ESRD in the study subjects were amyloidosis (n = 2), analgesic nephropathy (n = 2), and nephrolithiasis (n = 1). Three were diagnosed as SpA and two were RA. All patients used etanercept. The median age was 39 years (range 22–72 years).
The median disease duration was 12 years (range 2–20 years). The median follow-up after etanercept therapy was 18 months (range
5–33 months). DAS28 score decreased after the treatment and did not increase during follow-up in RA patients. BASDAI score
decreased after the treatment during follow-up in three patients with SpA. At the follow-up, only one patient was diagnosed
with septic arthritis. As a result of our study, etanercept treatment in RA and SpA patients on HD seems to be safe, well
tolerated, and effective in most of the patients. Above all, due to impaired host defense in patients with ESRD, enhanced
risk of infections should be kept in mind during follow-up period and larger trials are needed to prove the safety of etanercept
in HD patients. 相似文献
5.
de Souza MC de Ávila Fernandes E Jones A Lombardi I Natour J 《Clinical rheumatology》2011,30(6):831-836
Rheumatoid arthritis (RA) is characterized by inflammation of the synovial membrane, which can lead to deformities and functional
disability. Unlike the dorsal and lumbar spine, the cervical spine is often affected by RA. The objective of this paper is
to assess cervical pain and function in patients with RA and correlate these variables with overall function, quality of life,
and radiographic findings on the cervical spine. One hundred individuals aged 18 to 65 years were divided into study group
(50 patients with rheumatoid arthritis) and control group (50 healthy individuals, paired for gender and age). Patients with
prior surgery, prior trauma or other symptomatic cervical spine condition were excluded. The visual analogue pain scale (VAS),
Neck Pain and Disability Scale (NPDS), SF-36, HAQ and X-rays were used for evaluation purposes. Mean disease duration was
11.1 years. The cervical VAS was 2.4 cm and 1.3 cm for the study and control groups, respectively (p = 0.074). Statistical differences were found in NPDS scores, mean = 26.7 and 6.9, and HAQ scores, mean = 1.1 and 0.1, for
the study and control groups, respectively (p < 0.001). SF-36 scores were statistically worse in the study group, except for the vitality, social aspects and mental health
subscales. There was a positive correlation between the NPDS and VAS (r = 0.54) and between the NPDS and HAQ (r = 0.67). There was a negative correlation between the NPDS and SF-36 functional capacity domain (r = −0.53) and physical limitation domain (r = −0.58). The radiographic findings revealed more prevalent anterior atlanto-axial subluxation (p = 0.030), listhesis in neutral posture (p = 0.037), listhesis in extension (p = 0.007), degenerative alteration of C4–C5 segment (p = 0.023), size of C2 spinal canal (p = 0.002) and C3 spinal canal (p = 0.029) in the study group. Patients with RA have poorer cervical function than healthy individuals, although there is no
difference in cervical pain. 相似文献
6.
We and others have previously shown that IL-17 is elevated in the synovial fluid of patients with reactive arthritis (ReA)/undifferentiated
spondyloarthropathy (uSpA) having acute synovitis. Major source for IL-17 is Th17 cells, which differentiate from Th0 cells
under the influence of TGF-β and IL-6, IL1-β and are maintained by IL-21 and 23. There is a paucity of data on these cytokines
in ReA/uSpA. Thus, we measured the levels of Th-17 differentiating and maintaining cytokines in synovial fluid of patients
with ReA and uSpA. Fifty patients with ReA/uSpA (ReA 24, uSpA 26), 19 patients with rheumatoid arthritis (RA) and 11 patients
with osteoarthritis (OA) were included in the study. Synovial fluid (SF) were collected from knee joint and stored at −80°C
until analysis. Cytokines were assayed using ELISA in SF specimens. The median IL-17A levels were significantly elevated in
ReA (48.3 pg/ml) and uSpA (32.5 pg/ml) as compared to non-inflammatory OA controls (<7.8 pg/ml; p < 0.0001), while comparable to RA (57.9 pg/ml). Further, IL-6 median values were higher in ReA (25.2 ng/ml) and uSpA (13.6 ng/ml)
as compared to OA (0.76 ng/ml; p < 0.0001), and comparable to RA (15.8 ng/ml). The median levels of IL-1β, IL-21 levels were elevated in ReA, uSpA and RA
as compared to OA but were not statistically significant. TGF-β levels in ReA and uSpA were similar to OA but lower than in
RA (4340 pg/ml; p < 0.05). IL-23 was not detectable in any synovial fluid sample. However, levels of these cytokines did not correlate with
disease activity parameters. Significant positive correlation was observed between IL-17 and IL-1β (r = 0.38, p < 0.005), IL-17 and IL-6 (r = 0.659, p < 0.0001), and IL-1β and IL-6 (r = 0.391, p < 0.0001) in ReA and uSpA group. Inflammatory synovitis in ReA/uSpA is mediated by pro-inflammatory cytokines like IL-17,
IL-6, IL-1β, and IL-21. However, IL-23 was not detectable in SF. Good correlation between IL-17, IL-6, and IL 1β suggest that
either they are co-regulated or they regulate each other. 相似文献
7.
Chen-Liang Chou Min-Jung Wu Chia-Li Yu Ming-Chi Lu Song-Chou Hsieh Tsai-Hung Wu Chung-Tei Chou Chang-Youh Tsai 《Clinical rheumatology》2010,29(8):875-881
Anti-agalactosyl IgG antibody (anti-Gal(0) IgG) has been regarded as a useful serological marker for rheumatoid arthritis
(RA). It is unknown whether it is also elevated in serum and implicated in the pathogenesis of joint inflammation in seronegative
spondyloarthropathy (SpA) such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Sera were collected from 43 patients
with AS or PsA with axial joint involvement, 22 patients with RA, and 25 healthy normal individuals for the detection of anti-Gal(0)
IgG with a cup-type lectin enzyme immunoassay (Eitest CA.RF). The disease activity of the AS/PsA was evaluated by Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), the
serum C-reactive protein (CRP) and IgA were measured by nephelometry, and erythrocyte sedimentation rate (ESR) was measured
by Westergren’s method. The median titers of anti-Gal(0) IgG were significantly elevated in patients with RA (167.85, 15.73∼797.58 AU/mL)
and AS/PsA (186.15, 34.71∼651.19 AU/mL), compared to those of the normal controls (13.04, 12.00∼202.43 AU/mL). The titers
of the anti-Gal(0) IgG in patients with AS/PsA were correlated to the BASDAI scores (r
2 = 0.422, SEE = 1.443, p < 0.001) and serum CRP (r
2 = 0.345, SEE = 2.434, p < 0.001) but not to IgA (r
2 = 0.0259, SEE = 126.30, p < 0.001) or ESR (r
2 = 0.171, SEE = 31.053, p = 0.0059). Collectively, the anti-Gal(0) IgG is elevated and vaguely correlated with the disease activity of AS/PsA although
its titers in these patients were erratic. The result of the present investigation has suggested that anti-Gal(0) IgG may
be more ubiquitously present in inflammatory arthritides including RA or SpA. 相似文献
8.
Anti-cyclic citrullinated peptide antibody (CCP-AB) are used for diagnosis of rheumatoid arthritis (RA). It is still unknown
if the extent of CCP-AB levels is useful to assess the disease activity or the individual follow-up as an individual activity
parameter. We investigated 40 patients with a known RA who were positive for CCP-AB. Correlation between disease activity
(DAS 28) and the amount of levels of CCP-AB in all patients over time as well as the individual follow-up were analysed. A
weak correlation between CCP-AB and DAS 28 [r = 0.19; p = 0.001] was found. The individual correlation between CCP-AB titre and DAS 28 ranged between r = −1 and r = 1, so a strong positive and also a strong negative correlation was seen in single patients. In patients with erosive RA
the correlation was significantly more positive than in patients with non-erosive RA. Because the correlation between CCP-AB
levels and parameters of disease activity measured by DAS 28 is very low, we conclude for monitoring the disease activity
to use simply and established parameters like morning stiffness, HAQ or ESR. The individual follow-up of the levels of CCP-AB
is by the moment not useful for monitoring the disease activity. 相似文献
9.
DeLea SL Chavez-Chiang NR Poole JL Norton HE Sibbitt WL Bankhurst AD 《Clinical rheumatology》2011,30(6):805-813
Scleroderma is associated with intractable hand pain from vasospasm, digital ischemia, tenosynovitis, and nerve entrapment.
This study investigated the effect of hydrodissection of the carpal tunnel followed by corticosteroid injection for the painful
scleroderma hand. Twenty-six consecutive subjects [12 with painful scleroderma hand and 14 with rheumatoid arthritis and carpal
tunnel syndrome (RA/CTS)] underwent sonographically observed carpal tunnel hydrodissection with 3 ml of 1% lidocaine administered
with a 25-gauge 1-in. needle on a 3-ml RPD mechanical syringe (reciprocating procedure device). After hydrodissection, a syringe
exchange was performed, and 80 mg of triamcinolone acetonide was injected. Baseline pain, procedural pain, pain at outcome,
responders, therapeutic duration, and reinjection interval were determined. Hydrodissection and injection with corticosteroid
significantly reduced pain scores by 67% in scleroderma (p < 0.001) and by 47% in RA/CT (p < 0.001). Scleroderma and RA/CTS were similar in outcome measures: injection pain (p = 0.47), pain scores at outcome (p = 0.13), responders (scleroderma, 83.3%; RA/CTS, 57.1%, p = 0.15), pain at 6 months (p = 0.15), and therapeutic duration (p = 0.07). Scleroderma patients responded better in time to next injection (scleroderma, 8.5 ± 3.0 months; RA/CTS, 5.2 ± 3.1
months, p = 0.03). Reduced Raynaud’s attacks and healing of digital ulcers occurred in 83% of subjects. There were no complications.
Hydrodissection with lidocaine followed by injection of triamcinolone reduces pain and vasomotor changes in the scleroderma
hand. The mechanism may be a combination of hydrodissection-mediated mechanical freeing of entrapped arteries, nerves, and
tendinous structures and corticosteroid-induced reduction of inflammatory vasospasm. 相似文献
10.
Campbell RC Batley M Hammond A Ibrahim F Kingsley G Scott DL 《Clinical rheumatology》2012,31(4):717-722
We investigate a range of clinical factors and anti-rheumatic treatments, for their degree of association with rheumatoid
arthritis (RA) fatigue in 557 patients. A range of clinical measures concerning disability, pain and disease activity together
with drug history were recorded as part of routine clinical visits. Fatigue was measured using the Functional Assessment of
Chronic Illness Therapy (FACIT-F) questionnaire. Spearman's correlation (p < 0.05) evaluated FACIT-F against the other clinical measures. Mean FACIT-F was compared between the treatment groups. Multivariate
linear regression analysis investigated association between the clinical measures and FACIT-F in more detail. Correlation
(p < 0.05) with FACIT-F was the strongest for Health Assessment Questionnaire (HAQ) (r = −0.68), patient global (r = −0.64) and pain (r = −0.62) visual analogue scores. In multivariate models, DAS28, HAQ and pain explained variability in fatigue the best (R
2 = 0.54). Further analyses, looking at the sub components of DAS28, show that fatigue is mainly associated with tender joint
counts and pain rather than swollen joint counts or erythrocyte sedimentation rate. RA fatigue levels were not significantly
different between patients on no treatment, disease modifying anti-rheumatic drugs or biologics. Fatigue in established RA
is not specifically influenced by the type of treatment used but is associated with tender joint counts, pain and disability.
This finding is in contrast to recent trials in early RA that suggest biologics are better than traditional disease modifying
anti-rheumatic drugs for fatigue. This difference in result may be because the origins of fatigue are not the same in early
compared with established RA. 相似文献
11.
Catherine L. HILL Christopher G. SCHULTZ Rodney WU Barry E. CHATTERTON Leslie G. CLELAND 《International journal of rheumatic diseases》2010,13(3):230-234
Aims: The earliest radiological change in rheumatoid arthritis (RA) is periarticular osteopenia, which occurs prior to the appearance of erosions and clinically apparent deformities. The aim of the study was to measure periarticular bone mineral density (BMD) in the hands of patients with early RA, using dual energy X‐ray absorptiomentry (DEXA) and to correlate this with markers of disease activity and radiological progression. Methods: The study population (n = 50) of patients with RA of < 3 years duration underwent measurement of BMD of the non‐dominant hand, femoral neck and lumbar spine and clinical assessment at baseline, 6 and 12 months. Hand radiographs were performed at baseline and 12 months. Thirty age‐ and sex‐matched controls also underwent measurement of BMD of the non‐dominant hand, femoral neck and lumbar spine. Results: Hand BMD correlated strongly with sex, height, weight and lumbar and femoral neck BMD in both RA subjects and controls. Baseline hand BMD in RA subjects correlated with baseline serum C‐reactive protein (r = ?0.36, P = 0.01) and 12‐month radiographic score (r = 0.36, P = 0.02). There were small non‐significant decreases in hand, femoral neck and lumbar spine BMD over the 12‐month period. Conclusion: Hand BMD measurement using DEXA is a reproducible, well‐tolerated procedure that warrants further investigation as a component of routine assessment in early RA. 相似文献
12.
M. A. Crilly A. G. Macdonald D. J. Williams V. Kumar H. J. Clark 《Clinical rheumatology》2010,29(10):1113-1119
The onset of rheumatoid arthritis (RA) can be associated with constitutional symptoms. Systemic inflammation may be a common
factor behind such symptoms and the subsequent development of arterial disease. The aim of this study was to determine if
a relationship exists between constitutional symptoms and arterial stiffness. We recruited 103 ambulatory RA patients (85
female) without overt arterial disease aged between 40 and 65 years attending hospital clinics. A research nurse measured
arterial stiffness (heart rate standardised augmentation index, AIX) using the ‘SphygmoCor’ device, fasting lipids and erythrocyte
sedimentation rate (ESR). Assessment included patient recall of constitutional symptoms at arthritis onset (aching muscles,
tiredness, generalised weakness, low mood/depression, fever, loss of weight, loss of appetite) and a detailed medical record
review. Regression analysis was used to adjust mean differences in AIX in the presence/absence of constitutional symptoms
for current age, sex, arthritis duration, age arthritis onset, study ESR, ever smoked, mean arterial blood pressure (BP),
treated hypertension and cholesterol. Mean age was 54 years (age arthritis onset 42 years), brachial BP 125/82 mmHg, cholesterol
5.4 mmol/L, ever smoked 59%, median RA duration 9 years, median ESR 16 mm/h and mean AIX 31.7 (SD 7.8). Unadjusted mean difference
in AIX was −0.7 (95%CI −4.5 to 3.1; p = 0.72) in the presence of constitutional symptoms and the adjusted mean difference was −0.1 (−3.2 to 2.9; p = 0.93). No individual symptoms were significantly associated with increased arterial stiffness. In conclusion, we found
no convincing association between constitutional symptoms at the onset of arthritis and subsequent arterial stiffness. 相似文献
13.
S. Illsinger T. Lücke B. Vaske K.-H. Schmidt B. Bohnhorst A. M. Das 《Journal of inherited metabolic disease》2009,32(1):102-108
Summary To further substantiate gestational age-related changes in oxalate excretion, we studied urinary oxalate excretion in 66 preterm
infants born at 23.4–34.7 weeks of gestation. Spot urine of 66 preterm infants was analysed by ion chromatography as soon
as they were completely orally fed with enriched breast milk and/or special preterm milk formula (days 7 to 57 of postnatal
life). Infants with evidence of renal, gastrointestinal, muscular or metabolic disease were not included. Newborns on parenteral
nutrition were excluded. Oxalate/creatinine ratios (Ox/Cr) decreased with gestational age (three age groups: group 1, 23 0/7–28
0/7; group 2, 28 1/7–32 0/7; and group 3, 32 1/7–35 0/7 weeks of gestation). The mean Ox/Cr was highest in group 1 (398.2 mmol/mol
± 116.8; n = 21). Differences between groups 1 + 3 were statistically significant; p = 0.001; those between groups 1 + 2 and between groups 2 + 3 were not. Ox/Cr correlated inversely with gestational and maturational
age (r = −0.41, p = 0.001; r = −0.33, p = 0.007) and positively with postnatal age (r = 0.32, p = 0.008). It correlated inversely with birth weight as well as actual weight at sample collection (r = −0.46 and −0.44, p < 0.001). Ox/Cr was significantly linked to energy and carbohydrate intake (r = 0.3 and 0.4, p = 0.03 and 0.001). These results were independent of sex. In the present study we show that urinary oxalate excretion in
preterm infants depends on gestational age.
Competing interests: None declared
The authors B. Bohnhorst and A. M. Das contributed equally. 相似文献
14.
Generalised bone mineral density (BMD) reduction often occurs in established rheumatoid arthritis (RA); however, in early
RA, there is a disagreement with regard to BMD in the femoral neck and lumbar spine, and there is no available information
for the whole body. Therefore, the aims of this study were to investigate the BMD, frequency of osteoporosis and the risk
factors for BMD reduction in Vietnamese women with early RA. BMD in the femoral neck, lumbar spine L1–4 and whole body was
measured in 105 women with early RA (disease duration ≤3 years) and 105 age-matched healthy women (26–73 years) using a dual
energy X-ray absorptiometry. Femoral neck and whole body BMD in women with RA were lower (p < 0.05) than controls, while lumbar spine BMD was similar between two groups. The frequency of osteoporosis in the femoral
neck, lumbar spine and whole body in women with RA aged ≥50 were higher (p < 0.05) than controls: 41.8% versus 29.5%, 42.2% versus 37.7% and 37.1% versus 28%, respectively. There were associations
between the frequencies of osteoporosis at all sites with postmenopausal status, glucocorticoid use, rheumatoid factor positivity
and disease activity with lumbar spine BMD and disease disability with femoral neck and whole body BMD. In conclusion, women
with early RA had significantly lower femoral neck and whole body BMD, but had similar lumbar spine BMD compared with controls.
The frequency of osteoporosis at all sites was significantly higher in women with RA than controls, suggesting that assessment
of BMD should be considered in women with early RA. 相似文献
15.
The aim of this study was to evaluate serum and synovial levels of IL-17A by ELISA in rheumatoid arthritis (RA) and find out
the correlations between IL-17A levels and various clinical, laboratory parameters and RA disease activity and severity indices.
Group I consists of 30 adult active RA patients fulfilling the ARA 1987 revised criteria, with knee effusion and receiving
basic therapy, and with a mean age of 41.47 ± 11.49 years and mean disease duration of 9.5 ± 4.16 years. Group II consisted
of 13 healthy volunteers, age- and sex-matched, with a mean age of 39.08 ± 14.19 years. RA patients showed significantly higher
mean serum IL-17A levels than controls (11.25 ± 9.67 vs. 0.6 ± 1.4 pg/mL, respectively, p = 0.0002). Synovial IL-17A levels showed a significant positive correlation with serum IL-17A levels (r = 0.5 and p = 0.005). RA patients with negative rheumatoid factor (RF) had non-significantly higher mean serum IL-17A levels (12 ± 9.86 pg/mL)
compared to those with positive RF (10.82 ± 9.81 pg/mL); however, the mean synovial IL-17A levels were nearly the same. Significant
positive correlations were found between both serum and synovial IL-17A levels and DAS-28 scores (r = 0.556, 0.392 and p = 0.001, 0.032, respectively). RA patients with class III functional status showed significantly higher mean serum IL-17A
levels (17.53 ± 13.43 pg/mL) than classes I and II (8.97 ± 6.97 pg/mL, p = 0.009). These led us to conclude that the elevated serum and synovial IL-17A levels in RA patients parallel the degree
of disease activity and severity. This may highlight the usefulness of IL-17 (especially serum level) as a possible marker
for more aggressive joint involvement and damage. 相似文献
16.
C. S. Andreassen J. Jakobsen S. Ringgaard N. Ejskjaer H. Andersen 《Diabetologia》2009,52(6):1182-1191
Aims/hypothesis The aim of the study was to determine the loss of muscle volume in the lower leg and foot in long-term diabetic patients in
relation to the presence of neuropathy.
Methods We re-examined 26 type 1 diabetic patients who had participated in magnetic resonance imaging (MRI) studies on muscle volume
in the lower leg and foot 9 to 12 years earlier. Re-examination involved MRI, isokinetic dynamometry, clinical examination,
electrophysiological studies and quantitative sensory examinations.
Results Annual loss of muscle volume of ankle dorsal and plantar flexors was 4.5 (5.5–3.9)% (median [range]) and 5.0 (7.0–4.2)% in
neuropathic patients, 1.9 (3.2–1.0)% and 1.8 (2.6–1.3)% in non-neuropathic patients, and 1.7 (2.8–0.8)% and 1.8 (2.4–0.8)%
in controls, respectively (p < 0.01). Annual change of volume and strength correlated for ankle dorsal flexors (r
s = 0.73, p < 0.01) and for ankle plantar flexors (r
s = 0.63, p < 0.05) in diabetic patients. In addition, annual change of muscle volume for dorsal and plantar flexors was related to the
combined score of all measures of neuropathy (r
s = −0.68, p < 0.02 and r
s = −0.73, p < 0.01, respectively). Foot muscle volume declined annually by 3.0 (3.4–1.0)% in neuropathic patients and by 1.1 (4.0–0.2)%
in non-neuropathic patients, both values being significantly different from controls (0.2 [−2.5 to 2.4]%). Loss of foot muscle
volume was related to severity of neuropathy assessed at clinical evaluation (r
s = −0.6, p < 0.05).
Conclusions/interpretation Muscular atrophy in long-term diabetic neuropathy occurs early in the feet, progresses steadily in the lower legs, relates
to severity of neuropathy and leads to weakness at the ankle.
An erratum to this article can be found at 相似文献
17.
Bone loss in patients with rheumatoid arthritis (RA) varies at different skeletal sites. The aim of the study was to evaluate
whether bone mineral density (BMD) of the forearm is significantly different in patients with RA and controls and may correlate
to BMD or other parameters of inflammation or bone resorption. We included 421 patients (357 women: mean age 58.4 ± 12.87 years
and 64 men: mean age 56.11 ± 12.80 years) with RA in the study. BMD values of the ultradistal forearm (0.381 ± 0.052 g/cm2) and middistal forearm (0.519 ± 0.091 g/cm2) were significantly (p < 0.01) lower in women with RA than controls (0.395 ± 0.043 and 0.535 ± 0.052 g/cm2, respectively). In contrast, there was no difference in bone density at the lumbar spine (women 0.921 ± 0.l570 g/cm2, men 0.941 ± 0.144 g/cm2) or hip (women 08.11 ± 0.140 g/cm2, men 0.895 ± 0.143 g/cm2) in patients with RA in comparison to controls (lumbar spine: women 0.930 ± 0.146 g/cm2; men 0.960 ± 0.146 g/cm2; hip: women 0.820 ± 0.122 g/cm2; men 0.899 ± 0.144/cm2). Patients with increased inflammatory activity (elevated C-reactive protein) presented with significantly lower BMD of the
hip (0.7533 ± 0.144 versus 0.825 ± 0.138 g/cm2) and ultradistal forearm (0.366 ± 0.09 versus 0.390 ± 0.07 g/cm2). This was not the case for the lumbar spine. BMD of the forearm is precise and, in contrast to BMD of the lumbar spine,
significantly lower in patients with RA. It is related to inflammatory activity, grip strength, and treatment with glucocorticoids
in patients with RA. 相似文献
18.
The aim of this study was to investigate whether moderate physical training can improve the bone mineral density (BMD) in
women with idiopathic osteoporosis. Ten pre-menopausal women aged 24–44 years diagnosed with idiopathic osteoporosis were
included in the study. The physical training program consisted of three fast 30-min walks plus one or two sessions of 1-h
training per week during 1 year at a training centre separate from the hospital. All patients were given supplements of vitamin
D and calcium. Bone mineral density was measured in the femoral neck area and the lumbar spine by dual energy X-ray absorptiometry.
The measurements were performed at baseline and after 12 months of training and compared with the measurements at the time
of diagnosis, 1–3 years before the study. Eight women fulfilled the 12-month training period, and their mean (SD) BMD at start
was 0.88 (0.08) g/cm2 in the spine and 0.76 (0.13) g/cm2 in the femoral neck. The mean spine BMD increase was 0.031 g/cm2 (3.5%) after 1 year of training, which was significant (Wilcoxon’s non-parametric test, p = 0.018). The mean increment in BMD in the femoral neck was insignificant, 0.007 g/cm2 (0.9%) after the intervention (p = 0.74). However, the bone loss during the 1- to 3-year period from diagnosis to study start was, on average, 0.045 g/cm2 or 5.0% in the femoral neck (p = 0.042), thus indicating a positive indirect effect of the intervention. There is no evidence-based therapy for women with
idiopathic osteoporosis. It is therefore of importance to elucidate the impact of moderate physical activity in this group
of patients. A 1-year training program was sufficient to induce a small but significant change in the spine BMD. 相似文献
19.
Disease-modifying antirheumatic drugs (DMARDs) improve the disability and slow the progression of the joint damage in rheumatoid
arthritis (RA). However, a large proportion of patients experience inefficacy by the end of 2 years. This loss of efficacy
may be due to expression of multidrug resistance (MDR) proteins on lymphocytes. The objective is to study the expression of
MDR protein on the peripheral blood lymphocytes in patients with RA and correlate it with the disease status and response
to treatment. Twenty-eight patients were enrolled. Expression of MDR-1 by flow cytometry was carried out on lymphocytes at
baseline and after 4 months of therapy. This expression was correlated with disease activity scores (DAS 28). There were 25
females with mean age of 48.13 years and median disease duration of 48 months. Eighteen patients were DMARD naive and ten
were refractory to DMARD (methotrexate). The percentage of cells expressing MDR-1 in the DMARD-naive (p < 0.O5) and DMARD-refractory (p < 0.05) groups were significantly higher than the healthy controls at the baseline. The relative fluorescence intensity was
significantly higher in the DMARD-refractory group (p < 0.05) as compared to the DMARD-naive group. After 4 months of therapy, there was significant improvement in the D value (p < 0.01) in the DMARD-naive group (treated with methotrexate only) and DMARD-refractory group (p < 0.05). A significant correlation (r = 0.563) between the DAS 28 scores and the D value (p = 0.003) was observed. Expression of MDR-1 in RA correlated with disease activity status and improved with DMARD therapy.
It is not related to the refractoriness to therapy with methotrexate. 相似文献
20.
Chun-Hsiung Chen Hung-An Chen Hsien-Tzung Liao Chin-Hsiu Liu Chang-Youh Tsai Chung-Tei Chou 《Clinical rheumatology》2010,29(10):1155-1161
The objective of the study was to investigate the role of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin
(OPG) in ankylosing spondylitis (AS). Serum levels of soluble RANKL (sRANKL) and OPG were measured in 42 AS patients and 26
healthy controls. We evaluated the AS patient's disease activity, functional ability, global assessment, and physical mobility
and tested markers of systemic inflammation, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Serum
levels of sRANKL [mean (SD), 4.75 (1.88) vs. 3.70 (1.14) pmol/l, p = 0.015] and OPG [mean (SD), 5.18 (1.19) vs. 4.52 (0.85) pmol/l, p = 0.026] were significantly higher in the 42 AS patients than the 26 healthy controls. Interestingly, serum OPG levels correlated
significantly with ESR (r = 0.417, p = 0.007), CRP (r = 0.524, p < 0.001), tragus-to-wall distance (r = 0.556, p < 0.001), fingertip-to-floor distance (r = 0.423, p = 0.007), and occiput-to-wall distance (r = 0.465, p = 0.002) and correlated inversely with modified Schober index (r = −0.525, p = 0.001), cervical rotation (r = −0.403, p = 0.022), lateral lumbar flexion (r = −0.587, p < 0.001), and chest expansion (r = −0.553, p < 0.001). Moreover, in the AS patients with higher (≥4.925 pmol/l, n = 21) serum OPG levels, there were significant increases in the tragus-to-wall distance (p = 0.007), fingertip-to-floor distance (p = 0.023), and CRP levels (p = 0.014) and decreased in the modified Schober index (p = 0.012), lateral lumbar flexion (p = 0.019), and chest expansion (p = 0.005). Serum levels of sRANKL and OPG are increased in the AS patients and may participate in the disease process of AS.
Production of OPG has association with poor physical mobility and may reflect systemic inflammation in AS. 相似文献