中国风湿性疾病流行情况的调查研究

目的：研究风湿性疾病在中国的流行情况。方法：研究由于国际抗风湿联盟合作开始，以后向纵深发展。结果：风湿性症状人群中常见，例如膝痛北京郊区农民中占２４１％（男）及３５８％（女）。因风湿性疾病不得不停止工作的，北京郊区占３０％，汕头郊区占５０％，类风湿关节炎及强直性脊柱炎患病率，分别为０３２％～０３８％和０１１％～０２６％。类风湿关节炎ＤＲ４中的ＤＲＢ１０４０５频率增高（６１９％比２１１％），且与类风湿因子阳性率高，骨侵蚀重关联。强直性脊柱炎９５％ＨＬＡＢ２７阳性。原发性干燥综合征患病率０７７％（哥本哈根标准）或０３３％（圣地亚哥标准），中国患者多为ＤＲＢ１０８０３、ＤＱＡ１０１０３、ＤＱＢ１０６０１。结论：膝骨关节炎老年人４９％有之，但在青壮年中亦不少见。系统性红斑狼疮以查血抗核抗体为首要的筛选工具的调查正在进行中。     

应用PCR技术检测HLA—B27

应用多聚酶链反应（ＰＣＲ）技术检测了８１例广东地区汉族健康人群和４８例类风湿关节炎病人的ＨＬＡ－Ｂ２７的频率分布，阳性率分别为４．９３％和６．２５％。同时对血清学方法检测ＨＬＡ－Ｂ２７为阳性的８５例和阴性的１６例强直性脊柱炎病人的标本应用ＰＣＲ技术进行检测，发现血清学方法检测为阳生的标本中８４例为阳性，符合率为９８．７％；阴性标本中６例为阳性，误判率为３７．４％。通过引进一对内对照引物，避免假阴性     

强直性脊柱炎患者外周血单个核细胞HLA—B27抗原的纯化

目的 纯化强直性脊柱炎患者外周血单个核细胞表面的ＨＬＡ－Ｂ２７抗原。方法 ＨＬＡ－Ｂ２７单抗（ＦＤ７０５）亲和层析法。结果 纯化的抗原蛋白经ＳＤＳ－ＰＡＧＲ显 示为单一条带，经分析其相对分子量为５６４００。结论 经此法可成功纯化强直性脊柱炎患者外周血单个核细胞ＨＬＡ－Ｂ２７抗原。     

HLA—DRB1等位基因与我国北方类风湿关节炎的关系

为了观察ＨＬＡ－ＤＲＢ１等位基因在类风湿关节炎（ＲＡ）临床及发病中的作用，对８６例ＲＡ患者和１０６名正常对照的ＨＬＡ－ＤＲＢ１等位基因进行分型。用序列特异性引物体外基因扩增法测定ＨＬＡ－ＤＲ特异性，用序列特异性寡核苷酸探针进行ＨＬＡ－ＤＲ４亚型的测定。并根据ＨＬＡ－ＤＲＢ１等位基因的分型结果分析ＲＡ的临床表现和血清学特点及其与ＲＡ患者预后的关系。结果表明：同对照组相比，ＲＡ患者中ＨＬＡ－ＤＲ４基因频率明显增高（４８．８％比１７．９％，Ｐ＜０．００１），而ＨＬＡ－ＤＲ５基因频率降低（１６．３％比２７．４％，Ｐ＝０．０６）。ＤＲ４阳性ＲＡ中主要的ＤＲ４亚型为ＨＬＡ－ＤＲＢ１＊０４０５（６１．９％比２１．１％，Ｐ＜０．０１）。在ＤＲ４阳性和ＤＲ４阴性两组患者中，其发病年龄、病程和关节外表现无明显差异，但ＤＲ４阳性组的类风湿因子阳性率高于ＤＲ４阴性组（Ｐ＜０．０５），并且ＤＲ４阳性的ＲＡ患者腕和（或）指关节Ｘ线片分期明显重于ＤＲ４阴性者（Ｐ＜０．０５）。本研究结果表明，我国北方ＲＡ患者和ＨＬＡ－ＤＲ４基因明显相关，其主要亚型为ＨＬＡ－ＤＲＢ１＊０４０５。ＲＡ患者ＨＬＡ－ＤＲ４基因的检测可作为一项有用的预后判断指标。     

抗肺炎克雷白杆菌亚单位抗体与强直性脊柱炎

以免疫印迹法（Ｗｅｓｔｅｒｎｂｌｏｔｔｉｎｇ）测定２６例强直性脊柱炎（ＡＳ）患者和７例类风湿关节炎（ＲＡ）病人及正常人抗肺炎克雷白杆菌（ＫＰ）抗体阳性血清中抗ＫＰ亚单位抗体。结果表明，ＡＳ患者血清抗ＫＰ亚单位抗体阳性区带条数为６．６±１．９条，ＲＡ患者和正常人为３．６±１．３条（Ｐ＜０．０５）。ＡＳ患者血清抗ＫＰ亚单位抗体以６４６００，４８２００以及３６０００抗体占多数，阳性率分别为８０．７％，６１．５％和６５．４％；ＲＡ患者和正常人血清则以抗３６０００和３００００亚单位抗体占多数，阳性率分别为７５％和５０％。抗ＨＬＡ－Ｂ＿（２７）单价血清和兔抗人工合成１８肽（含与ＨＬＡ－Ｂ＿（２７）相同氨基酸序列片段）抗血清能与ＫＰ抗原中的６４６００和４８２００两个亚单位分子起交叉反应，提示这两个亚单位分子与ＨＬＡ－Ｂ＿（２７）有共同的抗原成分，推测ＫＰ感染可能通过与ＨＬＡ－Ｂ＿（２７）的分子模拟在ＡＳ的发病中起作用。     

大动脉炎易感性与HLA-DRB基因相关性研究

目的 探讨大动脉炎易感性与ＨＬＡ－ＤＲＢ等位基因频率的相关性。方法 以８４例汉族大动脉炎患和１０２例健康汉族人（对照组）为研究对象,采用ＰＣＲ－ＳＳＰ及ＰＣＲ－ＲＦＬＰ方法进行ＨＬＡ－ＤＲＢ等位基因分型,比较其等位基因频率在大动脉炎患与对照组之间的差异。结果 ＨＬＡ－ＤＲ４、ＤＲ７等位基因频率在大动脉炎组显高于对照组（３８．１％比１５．７％,Ｐ〈０．０１,ＲＲ＝２．４３;４７．６％比１０．８     

强直性脊柱炎合并类风湿关节炎

目的：分析强直性脊柱炎（ＡＳ）合并类风湿关节炎（ＲＡ）患者的临床特点。方法：自１９８８年－１９９７年我科临床中共诊断ＡＳ合并ＲＡ患者２０例，通过与单纯ＡＳ（６５例）和ＲＡ（４６例）比较其特点。结果：通过比较发现ＡＳ合并ＲＡ患者病情活动指标高，骨质损害重。类风湿因子（ＲＦ）阳性率为６０％（１２／３０），ＨＬＡ－Ｂ２７例抗原阳性率为５８．９％（１１／１９），二者同时阳性率为５１．２％（８／１９），明显     

汉族类风湿关节炎患者HLA—DR和—DQ基因分型研究

为探讨ＨＬＡ－ＤＲ和－ＤＱ等位基因与我国汉族类风湿关节炎（ＲＡ）的相关性，采用聚合酶链反应－限制性内切酶片段长度多态性分析（ＰＣＲ－ＲＦＬＰ）方法对汉族人群中３５例ＲＡ患者和１００名健康人的ＤＲ和ＤＱ位点进行ＤＮＡ定型分析。结果发现，ＤＲ４频率在正常人为２４．０％，在ＲＡ患者为５１．４％（Ｐ＜０．０１，ＲＲ＝３．３０）；ＤＲ４亚型位点分析发现２组均以ＤＲＢ１＊０４０５占多数，但ＤＲＢ１＊０４０５频率在ＲＡ组为３１．４％，高于正常人的１０．０％（Ｐ＜０．０１）。ＤＱ４频率在全部ＲＡ患者为３７．１％，在ＤＲ＋４ＲＡ患者为７２．２％，均高于全部正常人的１０．０％（Ｐ＜０．０１）和ＤＲ＋４正常人的４１．６％（Ｐ＝０．０３７６）；ＤＲ＋４－ＤＱ＋４ＲＡ患者的病情重于ＤＲ－４患者。结果提示，ＤＲ４、主要是ＤＲＢ１＊０４０５与ＲＡ相关，ＤＱ４可增加ＤＲ４对ＲＡ的易感性，ＤＲ＋４－ＤＱ＋４单倍型是ＲＡ病情严重程度的标志。     

LMP2与LMP7基因多态性及强直性脊柱炎并发虹睫炎易感性关？…

目的 研究ＬＭＰ基因多态性与强直性脊柱炎并发虹睫炎发病的关系。方法 应用ＰＣＲ对正常人和病人进行ＨＬＡ－Ｂ２７检测以及ＬＭＰ２和ＬＭＰ７扩增。ＣｆｏＩ进行限制性酶切图谱分析。结果 强直性脊柱炎有虹睫炎（ＡＳ＋ＡＡＵ）病史以及单纯虹睫炎（ＡＡＵ）患者ＬＭＰ２基因ＢＢ纯合型较正常人以及强直性脊柱炎（ＡＳ）患者明显增高（Ｐ〈０．０５）。ＡＳ＋ＡＡＵ患者ＬＭＰ２基因ＢＢ纯合型较正常人以及强直性脊柱炎（ＡＳ     

HLA-B27阴性与阳性强直性脊柱炎的对比研究

了解ＨＬＡ－Ｂ２７在强直性脊柱炎发病及病情活动中的作用。方法；对比分析５１例ＨＬＡ－Ｂ２７阴性，ＡＳ患者和１０２例病程相同的ＨＬＡ－Ｂ２７阳性ＡＳ患者的临床表现及实验室检查结果。结果；Ｂ２７组与Ｂ２７组最明显的差异是前者以女性多见，平均发病年龄偏晚，且临床上较少出现全身症状，外周关节炎及严重的髋关节病变，但合并炎风湿关节炎明显多于阳性组，家族聚集现象，虹膜睫状体炎和脊柱的Ｘ线片改变在两组无差异。     

Prevalence rates of spondyloarthropathies, rheumatoid arthritis, and other rheumatic disorders in an Alaskan Inupiat Eskimo population

We reviewed rheumatic diseases in an Inupiat Eskimo population and found a high frequency of seronegative spondyloarthritides. Most cases of juvenile arthritis, which occurred with particularly high incidence in male children (47.4/100,000), appeared to belong in the spondyloarthropathic category. Both Reiter's disease and undifferentiated spondyloarthropathy were common disorders in adults. The prevalence of ankylosing spondylitis (0.2%) was less than expected in a population with a high percentage of HLA-B27 positive individuals. The prevalence rates of rheumatoid arthritis (1.0%), gout (0.3%), and other rheumatic diseases were similar to those of the United States population in general.     

The prevalences of some rheumatic diseases in western Turkey: Havsa study

To study the prevalence major rheumatic diseases in western Turkey. This survey was conducted in Havsa which have a total population of 18,771. Physicians and interns visited every household, interviewed face to face a questionnaire about the symptoms of rheumatic disorders. The individuals replied positively to any question were examined at the nearest health center. Those have no objective findings related to any rheumatic diseases were excluded. People could not be clinically diagnosed were asked to come to the hospital for further evaluation. A total 17,835 of 18,771 residents participated. We estimated the prevalence of Behçet’s Disease (BD) as 0.019%; ankylosing spondylitis: 0.120%; rheumatoid arthritis: 0.321%; knee osteoarthritis (OA): 5.351%; hand OA: 1.110%; hand and knee OA: 1.958%; total OA: 8.420%; primary Raynaud’s: 1.192%; psoriasis: 0.424 %; psoriatic arthritis: 0.050%; rheumatic fever: 0.318%; rheumatic heart disease: 0.200%; inflammatory bowel disease: 0.023%; lupus: 0.059%; gout: 0.018%; systemic sclerosis: 0.022%; juvenile rheumatoid arthritis: 0.032%; temporal arteritis: 0.020%, and familial Mediterranean fever (FMF) as 0.006%. Figures were adjusted for age-sex of the general Turkish population. The prevalence’s of BD and FMF are considerably lower in Havsa as compared to other regions in Turkey.     

Prevalence of rheumatic diseases and disability in China

The objective of this study was to provide a single source for the best available estimates of the national prevalence of common rheumatic disorders and rheumatic disability by reviewing the epidemiological surveys conducted in China. Relevant publications were retrieved by search engines in both the English and the Chinese language web sites. Only community-based surveys conducted in China were included. A pooled prevalence with 95% confidence interval was calculated. Forty-one surveys met the inclusion criteria. Prevalence of rheumatic pain varied from 11.6 to 46.4%, with significantly higher rate in northern China in comparison to the southern part. Prevalence of rheumatic disability, however, did not increase with higher latitude. Limitation to daily life and work was 1–2 and 3–6%, of general population, respectively. The pooled prevalence of rheumatoid arthritis, ankylosing spondylitis, and undifferentiated spondylarthropathy is 0.37, 0.22 and 0.57%, respectively. The estimated prevalence is 37.7/100,000 for systemic lupus erythematosus, and 0.45% for primary Sjögren’s syndrome. In the past decade, prevalence of gout and hyperuricemia was 0.22–0.43 and 12.1–25.2%, respectively. In elderly Chinese age ≥60, prevalence of symptomatic cervical OA, lumbar OA, knee OA and hand OA was 14.5, 24.0, 19.4, and 5.0%, respectively. Symptomatic hip OA was rare. Rheumatoid arthritis and gout are less frequent in Chinese than in Caucasians. The prevalence of ankylosing spondylitis, systemic lupus erythematosus and primary Sjögren’s syndrome is comparable to that in Caucasians. In comparison to the whites, the Chinese population has a higher prevalence of knee OA, a lower prevalence of hand OA, and a much lower prevalence of hip OA.     

Diet and disease symptoms in rheumatic diseases — Results of a questionnaire based survey

Summary Experiences with food intake, diet manipulations and fast were registered in rheumatic patients. The study was a questionnaire-based survey in which 742 patients participated. It comprised 290 patients with rheumatoid arthritis, 51 patients with juvenile rheumatoid arthritis, 87 patients with ankylosing spondylitis, 51 patients with psoriatic arthropathy, 65 patients with primary fibromyalgia and 34 patients with osteoarthritis. One third of the patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthropathy reported aggravation of disease symptoms after intake of certain foods while 43% of the patients with juvenile rheumatoid arthritis and 42% of the patients with primary fibromyalgia stated the same. Twenty-six percent of the patients with juvenile rheumatoid arthritis and 23% of the patients with rheumatoid arthritis, ankylosing spondylitis and primary fibromyalgia had previously tried certain diets in the attempt to alleviate disease symptoms, whereas 13% of the patients with sporiatic arthropathy and 10% with osteoarthritis had tried diet therapy. Less pain and stiffness were reported by 46% of the patients and 36% reported reduced joint swelling. Similar beneficial effects of diet were also reported in other rheumatic disease groups. Fifteen percent of the patients with rheumatoid arthritis and ankylosing spondylitis had been through a fasting period. Less pain and stiffness were reported by 2/3 of the patients in both groups and half of the patients in both groups reported a reduced number of swollen joints.     

Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study

OBJECTIVE: To carry out a cross-sectional survey on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. METHODS: In Shanghai, 4 communities comprising 7603 inhabitants over 15 years of age in an urban population were randomly selected from 13 communities. Interviews were conducted from September 1997 to March 1998 by trained physicians using the COPCORD Core Questionnaire. Physical and radiographic examinations and serologic tests were carried out when required to classify categories of rheumatic diseases. The diagnoses of RA, systemic lupus erythematosus (SLE), and gout were based on American Rheumatism Association criteria. The diagnosis of AS strictly followed the modified New York criteria of 1984. Crude prevalence rates were standardized according to a standard Chinese population for age and sex structure. RESULTS: A total of 6584 adults (3394 women, 3190 men) were interviewed, and response rate was 86.6%. The age and sex standardized prevalence rate of rheumatic symptoms at any site amounted to 13.3% (95% CI 12.5-14.1%). Symptoms occurred more frequently in the following sites: knee 7.0% (95% CI 6.4-7.6%), lower back 5.6% (95% CI 5.0-6.2%), shoulder 4.7% (95% CI 4.2-5.2%), and neck 2.4% (95% CI 2.0-2.8%). Women complained of rheumatic symptoms more frequently than men. The standardized rates of RA, AS, gout, symptomatic knee osteoarthritis, and soft tissue rheumatism were 0.28% (95% CI 0.15-0.41%), 0.11% (95% CI 0.03-0.19%), 0.22% (95% CI 0.11-0.33%), 4.1% (95% CI 3.6-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively. Two cases of SLE, one case of dermatomyositis, and one case of systemic sclerosis were found. CONCLUSION: Compared with rates in European and Western countries the prevalence rates of RA, AS, and gout are low in Shanghai, China, although the prevalence rates of rheumatic symptoms are high.     

Disease burden of rheumatic diseases in India: COPCORD perspective

The maiden WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan (1996–2014) demonstrated that musculoskeletal (MSK) pain was the commonest self-reported ailment in the community, soft tissue rheumatism, ill-defined MSK symptoms and osteoarthritis (OA) were the predominant disorders and about 10% cases suffered from inflammatory arthritis. The burden of rheumatoid arthritis (RA) was high with point prevalence of 0.7%. Bone and joint decade (BJD) India conducted several standardized and uniform surveys (2004–2010) all over India and collected data from over 55,000 persons at 12 sites. The pooled age sex adjusted (India census population 2001) prevalence reported by the recent surveys was – RA (0.34), OA knees (3.34), undifferentiated inflammatory arthritis (0.22), Spondyloarthritis (0.23), ankylosing spondylitis (0.03), psoriatic arthritis (0.01) soft tissue rheumatism (1.39), gout (0.05) lupus (0.01); prevalence percent in parenthesis. Several forms of collagen vascular disorders and vasculitis are described in hospital based case series. Musculoskeletal infections including tuberculosis remain an important clinical burden. The 2006 India Chikungunya epidemic has put an additional burden of chronic MSK pain and arthritis. The recently launched national health programs pertaining to non-communicable diseases, rural and women health does not even mention rheumatic diseases thus there is urgent need to study the burden of rheumatic diseases and its impact on society.     

Spondyloarthritiden

Spondyloarthritides are a group of inflammatory rheumatic disorders related by clinical symptoms and genetic predisposition; the most important subtype is ankylosing spondylitis. The other subtypes include psoriatic spondyloarthritis, after preceding infections, in association with chronic inflammatory bowel diseases, and undifferentiated spondyloarthritis. The most significant clinical symptoms are inflammatory back pain and peripheral, usually asymmetric oligoarthritis and enthesitis. The possibility of other organs being involved is typical to some extent and the frequency varies among the subtypes: particularly affected are the eyes, the skin, and the intestines. Less commonly aortic valve defects and arrhythmias occur. The strongest genetic factor is the MHC class I molecule HLA-B27, which is exhibited by 90% of the patients with ankylosing spondylitis. The diagnostic possibilities for early identification have improved in the last few years. Early determination of HLA-B27 and magnetic resonance imaging have contributed to this development. Conventional radiography still represents the gold standard in the diagnostic workup. New criteria for classification of axial and peripheral spondyloarthritis have recently become available and international recommendations for the management of ankylosing spondylitis were recently published.     

Rheumatic diseases in Alaskan Indians of the southeast coast: high prevalence of rheumatoid arthritis and systemic lupus erythematosus.

A review of rheumatic diseases in the southeast coastal Indians of Alaska revealed high frequencies of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Both prevalence and incidence rates of RA were significantly higher and the peak age of incidence was younger in the southeast Alaskan Indian population than in Alaskan Eskimo groups and the United States population in general. The prevalence of SLE in the Alaskan Indian population was about twice that reported for most white populations. The frequency of seronegative spondyloarthropathic disorders was similar in the Alaskan Indian and Eskimo populations. Comparable studies of the prevalence of spondyloarthropathy in general have not been carried out in white populations. The prevalence rate of ankylosing spondylitis, one of the major types of spondyloarthropathy, did not differ significantly in the SE Indians from rates in predominantly white US populations.     

Ankylosing spondylitis: An important cause of severe disturbances of the cardiac conduction system: Prevalence among 223 pacemaker-treated men

The cause of severe disturbances of the cardiac conduction system is seldom possible to establish clinically at pacemaker implantation, apart from cases of acute myocardial infarction or digitalis intoxication and in relatively rare cases of inflammatory disorders such as sarcoidosis and systemic sclerosis. Since cardiac manifestations, mainly conduction disturbances, occur in patients with ankylosing spondylitis, the prevalence of this disease was determined using radiologie screening for sacroillitis in a population of 223 men who had permanently implanted pacemakers. Sacroillitis was found in 19 men (8.5 percent), 15 of whom fulfilled the diagnostic criteria for ankylosing spondylitis. In six patients, sacroillitis was asymptomatic and two of the patients were completely free of symptoms other than those originating from their heart manifestations. In seven of the 15 patients with ankylosing spondylitis and in the four patients with sacroillitis without clinical criteria of ankylosing spondylitis, the diagnosis was previously unknown. Uveltis and aortic regurgitation occurred in five patients each, while peripheral arthritis was twice as common. The prevalence of sacroillitis and ankylosing spondylitis of 8.5 and 6.7 percent, respectively, differ significantly (p < 0.01) from the frequencies found in general Caucasian populations of 1 to 2 and 0.1 to 0.5 percent, respectively. HLA B27 was present in more than 80 percent of the patients with sacrolilltis and/or ankylosing spondylitis, compared with 8 to 10 percent in the general population. This strong association is in accordance with previous studies of patients with symptomatic sacroillitis and/or ankylosing spondylitis. Thus sacroillitis, diagnosed by x-ray, can be considered a marker for this relatively common rheumatic cause of severe disturbances of the cardiac conduction system.     

The prevalence of severe fatigue in rheumatic diseases: an international study

Fatigue is a common, disabling, and difficult-to-manage problem in rheumatic diseases. Prevalence estimates of fatigue within rheumatic diseases vary considerably. Data on the prevalence of severe fatigue across multiple rheumatic diseases using a similar instrument is missing. Our aim was to provide an overview of the prevalence of severe fatigue across a broad range of rheumatic diseases and to examine its association with clinical and demographic variables. Online questionnaires were filled out by an international sample of 6120 patients (88 % female, mean age 47) encompassing 30 different rheumatic diseases. Fatigue was measured with the RAND(SF)-36 Vitality scale. A score of ≤35 was taken as representing severe fatigue (90 % sensitivity and 81 % specificity for chronic fatigue syndrome). Severe fatigue was present in 41 to 57 % of patients with a single inflammatory rheumatic disease such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Sjögren’s syndrome, psoriatic arthritis, and scleroderma. Severe fatigue was least prevalent in patients with osteoarthritis (35 %) and most prevalent in patients with fibromyalgia (82 %). In logistic regression analysis, severe fatigue was associated with having fibromyalgia, having multiple rheumatic diseases without fibromyalgia, younger age, lower education, and language (French: highest prevalence; Dutch: lowest prevalence). In conclusion, one out of every two patients with a rheumatic disease is severely fatigued. As severe fatigue is detrimental to the patient, the near environment, and society at large, unraveling the underlying mechanisms of fatigue and developing optimal treatment should be top priorities in rheumatologic research and practice.