Benefit-Finding Among Patients with Rheumatoid Arthritis: Positive Effects on Interpersonal Relationships

This longitudinal study of patients with rheumatoid arthritis used mixed methods to identify and describe the positive effects of illness on relationships, examine correlates of benefit-finding, and test the relationship between benefit-finding and adjustment outcomes. When asked about interpersonal benefits of their illness, 71.3% of the respondents described interpersonal benefits, whereas 16.2% reported another type of benefit, and 12.5% reported no benefits. The most frequently described benefit was appreciation of support received from loved ones. Less pain, lower psychological distress, and perceiving fewer social constraints were related to finding interpersonal benefits in the illness experience. Interpersonal benefit-finding predicted lower levels of disability at a 12-month follow-up. Findings are discussed with regard to conceptual issues, methodological recommendations, and implications for interventions.     

Illness cognition and behavior: An experimental approach

The study of illness cognition and behavior has relied primarily on nonexperimental research designs. In this paper we review the results of a program of experimental investigations of psychological reactions to health threats. Most of the studies employ a new experimental paradigm developed to study illness cognition and behavior in the laboratory. The paradigm has been used in several experiments to examine the cognitive and motivational processes underlying reactions to medical test results. A converging series of studies has shown that denial, manifested in a variety of ways, is a common initial reaction to threatening information. In addition, the studies demonstrate that the perceived prevalence of a health disorder is an important determinant of its perceived seriousness. The insights gained from these studies illustrate the complementary roles of basic experimental research and more naturalistic observational research in the formulation of comprehensive theories of health and illness behavior.     

Depression History,Stress, and Pain in Rheumatoid Arthritis Patients

This study examined the role of past episodes of depression on pain reports for patients with rheumatoid arthritis (RA) before and during stress induction. A history of major depressive episodes was assessed by diagnostic interviews for 138 RA patients, 74 who later participated in a set of laboratory procedures designed to induce interpersonal stress. Patients were evaluated by a rheumatologist and then asked to report joint and bodily pain throughout the laboratory study. We found that RA patients with a history of two or more episodes of major depression had more pain at baseline, and exhibited higher pain in response to the stress induction than did RA patients with either only one episode or no history of depression. Such findings provide new insight in the dynamic relationships between depression, stress, and pain.     

The Association of Illness Severity,Self-Reported Cognitive Impairment,and Perceived Illness Management with Depression and Anxiety in a Multiple Sclerosis Clinic Population

Within the multiple sclerosis (MS) population, high prevalence of psychiatric concerns, such as depression and anxiety, has been well documented. The purpose of this study was to examine factors contributing to higher depression and anxiety levels in a sample of 82 patients utilizing MS clinic services. Independent variables included MS physical severity, self-reported cognitive impairment, and perceived illness management, respectively. Results from hierarchical regression analyses indicated that depression was related to the physical severity, self-reported cognitive impairment, and perceived illness management variables. Anxiety was also related to the physical severity and self-reported cognitive impairment variables but not to the perceived illness management ones, suggesting that depression and anxiety symptoms may involve somewhat different processes within MS. The findings of this study support further clinical consideration and additional investigation of these variables in the treatment of anxiety and depression in an MS clinic population.     

Conceptions of Illness by Children with Juvenile Rheumatoid Arthritis: A Cognitive Developmental Approach

Investigated the conceptions of illness and accuracy of understandingabout their disease for children with juvenile rheumatoid arthritis(JRA). 54 children between the ages of 6 and 17 were interviewedindividually about various aspects of JRA, with results suggestingthat accuracy and illness conceptions could be reliably measured.As predicted, children's understanding about their disease followeda developmental progression, with older children demonstratinga more sophisticated understanding of JRA than younger children(significant differences between age groups on 3 of the 5 questions).Multiple regression analysis indicated that conceptual level(p < .001) was a better predictor of the child's accuracyof knowledge than was age (ns). Despite the developmental progression,there were a significant number of children functioning belowthe level expected for their age. In fact, the majority (75%)of children exhibited an understanding of JRA at the concreteoperational level of cognitive development. The within-subjectvariability and striking misconceptions argue for ongoing evaluationof each child's understanding as a way to improve educationalefforts.     

类风湿性关节炎发病机理

类风湿性关节炎（ＲＡ）是一种原因不明的慢性炎性多系统疾病。ＲＡ病变特征是持续性进行性的滑膜炎，通常累及对称的周围关节。滑膜炎能引起软骨破坏和骨侵蚀，继而引起关节畸形而作为该病的标志。ＲＡ病程可表现多种多样。基因和环境因素控制着炎性反应的进程、范围和类...     

类风湿关节炎患者血清IgG-IgM型类风湿因子免疫复合物检测的临床意义

目的 探讨血清IgM型类风湿因子与变性IgG抗原形成的复合物定量检测对类风湿关节炎诊断的临床意义.方法 收集类风湿关节炎(RA)患者36例、非RA患者41例和体检健康者40名作为研究对象.用包被有鼠抗人μ链抗体的ELISA孔板及HRP标记的兔抗人IgG对血清中IgM型类风湿因子(RF)与变性IgG抗原形成的免疫复合物水平进行检测,同时用胶乳凝集法检测RF,并对二者结果进行相关性分析;用ELISA试剂盒进行抗环瓜氨酸肽抗体(抗CCP抗体)的定性检测,并比较其与IgG-IgM型RF免疫复合物对于RA诊断的敏感性和特异性.结果 待检血清最佳稀释倍数为100倍.IgG-IgM型RF免疫复合物对于RA的敏感性为72.2％,特异性为95.3％.IgG-IgM型RF免疫复合物OD值与RF阳性程度相关系数为0.687(P ＜0.01).结论 血清IgG-IgM型RF免疫复合物水平对RA具有较高的敏感性和特异性,可作为RA诊断的参考指标.     

The Contribution of Negative and Positive Illness Schemas to Depression in Patients with End-Stage Renal Disease

This research examined the role of negative and positive illness schemas as predictors of depression in 109 ESRD patients who were recruited from dialysis clinics throughout the San Diego area. Specifically, the model evaluated whether negative and positive illness schemas would mediate the relationship between disease severity and depression, and social support and depression, in a cross-sectional design. The model was tested with the Cognitive Depression Inventory (CDI), derived from the Beck Depression Inventory (BDI), and the full Beck as criterion variables. Hierarchical multiple regression analysis employing path-analytic procedures revealed that while disease severity was unrelated to depression, negative illness schema contributed to higher BDI and CDI scores, and positive illness schema contributed to lower BDI and CDI scores. Furthermore, positive illness schema mediated the relationship between social support and depression in both the BDI and CDI models. The results illustrate the important contribution of illness schemas to depression in this life-threatening disease.     

Reactive Proliferative Lesions in Lymph Nodes from Rheumatoid Arthritis Patients

In 22 cases of rheumatoid arthritis (RA), including 4 cases of malignant RA (MRA), reactive proliferative lymph node lesions were studied clinicopathologically and immunohis-tochemically. This series included 5 males and 17 females. The period between disease onset and lymph node biopsy ranged from 3 months to 41 years. Generalized lymphadenopathy was noted in 13 cases and constitutional symptoms in 8. The histological findings characteristic of RA were 1) follicular hyperplasia with active germinal centers and 2) polyclonal plasma cell infiltration in the interfollicular area. Studies of intracytoplasmic immunoglobulin showed that γ-heavy chain-expressing plasma cells were a major component in the interfollicular area in 17 RA cases. However, in 4 MRA cases, a prominent increase of μ chain-expressing plasma cells was recognized in the same area. In the 3 cases for which fresh tissue sections were stained with monoclonal antibodies against lymphocytes, we found that the majority of T cells in the interfollicular area had helper/inducer markers. The identical locations of the T cell population and plasma cells indicated that both played a role in the proliferation and/or differentiation of B cells in lymph nodes in RA.     

血清中葡萄糖6-磷酸异构酶在类风湿关节炎中的诊断价值

目的探讨血清中葡萄糖6-磷酸异构酶（glucose-6-phosphate isomerase，GPI）抗原在类风湿关节炎（rheumatoid arthritis，RA）患者诊断中的意义。方法用酶联免疫吸附试验（ELISA）检测70例RA患者，26例其他风湿病患者和30例健康对照血清中GPI抗原的浓度，RA患者同时还检测了类风湿因子（RF）。结果70例RA患者血清中GPI浓度为（2．01±1．01）μg／mL，26例其他风湿性疾病组为（0．41±0．18）μg／mL，30例健康对照组为（0．090±0．030）μg／mL，RA患者血清中GPI浓度显著高于其他风湿病组和健康对照组（P〈0．01），在RA活动组和RA非活动组。亦有显著差异（P〈0．05）。通过分段回归分析发现GPI的浓度和RA病情活动成正相关。GPI抗原对RA检测的敏感性为61．4％．特异性为93．3％。结论GPI在部分RA患者血清中显著升高，有可能成为诊断RA及判断其疾病活动性的一个新指标。     

IgE Anti-IgG Antibodies in Patients with Juvenile and Adult Rheumatoid Arthritis Including Felty's Syndrome

Anti-IgG; antihodies (anti-IgG) of the IgE class were studied in sera from patients with juvenile rheumatoid arthritis (JRA). rheumatoid arthritis (RA) and patients with Felty's syndrome (FS) by use of an indirect immunofluorescence technique. Forty-two percent of 26 patients with JRA had IgE anti-IgG in serum all in low titers. Positive reactions prevailed in patients with multiple joint involvement. Sixty-three percent of 30 patients with RA and 80% of 20 patients with FS had IgE anti-IgG, the titers found in FS patients being significantly higher. In JRA and FS patients the IgE anti-IgG titers were correlated to the titers of anti-IgG of the IgG class, and for FS patients also with the IgM and IgA classes of anti-IgG. In six of 10 patients with RA the synovial fluid samples from both knees contained IgE anti-IgG. In four of these patients the titers of IgE anti-IgG were higher than in the corresponding serum sample, pointing to a local production. After G-200 Sephadex chromatography IgE anti-IgG were demonstrated in the void volume indicating the presence of these autoantibodies in immune complexes. IgE anti-IgG may be involved in the pathogenesis of JRA and RA by eliciting Type I and III reactions.     

类风湿关节炎患者焦虑及抑郁情绪与 疾病活动度的相关性

目的 分析类风湿关节炎患者焦虑及抑郁情绪与疾病活动度的相关性。方法 选取2017年1月~2018年3月在我院收治的类风湿关节炎患者105例作为研究对象,采用问卷调查的方式,调查患者焦虑、抑郁情绪评分以及疾病活动度程度,进一步分析患者焦虑及抑郁情绪与疾病活动度的相关性。结果 105例患者中存在焦虑情绪者43例,占40.95%,平均焦虑评分（42.94±3.88）分;抑郁情绪者33例,占31.42%,平均抑郁评分（46.83±3.91）分。患者平均疾病活动度指数得分（3.72±1.44）分,其中缓解期25例,占28.31%;轻度活动期16例,占15.23%;中度活动期44例,占 41.90%;重度活动期20例,占19.04%。不同疾病活动度患者焦虑、抑郁评分比较,差异有统计学意义（P＜0.05）;类风湿关节炎患者焦虑、抑郁情绪与疾病活动度评分呈正相关（r=0.273、0.322,P＜0.05）。结论 类风湿关节炎患者焦虑、抑郁情绪与疾病活动度存在一定的相关性,临床治疗过程中应重视对焦虑、抑郁情绪的疏导和环节,以促进患者的早日康复。     

抗核抗体谱在类风湿性关节炎患者中的检测意义

目的探讨抗核抗体谱(anti nuclear antibody spectrum,ANAs)在类风湿性关节炎患者中的检测意义。方法选取我院2015年9月至2017年9月间康复免疫科收治的类风湿性关节炎患者103例作为研究对象(研究组);另选取我院2015年9月至2017年9月期间的健康体检者120例作为对照组。采用间接免疫荧光法检测ANA,采用免疫印迹法检测ANAs。比较两组ANA阳性情况,类风湿性关节炎ANA阳性核型分布情况,及两组ANAs各项阳性情况。结果研究组ANA阳性率(60.19%)明显高于对照组(5.00%),且有统计学差异(P<0. 05)。类风湿性关节炎ANA阳性核型分布中,以胞浆颗粒型、核均质型和核颗粒型为主。类风湿性关节炎患者103例中,ANAs阳性71例,阳性率为68.93%;对照组80例中,ANAs阳性0例,阳性率为0.00%。类风湿性关节炎患者中,以抗Ro-52、抗SS-A和抗SS-B为主。研究组抗Ro-52、抗SS-A、抗SS-B、抗nRNP和抗dsDNA阳性率高于对照组(P <0. 05);研究组抗核小体、抗CENPB、抗Sm、抗Scl-70、抗Jo-1、抗Histone和抗PCNA阳性率高于对照组(P>0. 05)。结论 ANAs检测在类风湿性关节炎患者中具有重要价值,能够明确患者血清中自身抗体种类,具有重要临床研究意义。     

影响类风湿性关节炎患者心理健康的因素

目的探讨类风湿性关节炎患者心理健康状况及其影响因素,为进一步的护理干预提供科学依据。方法用自编的一般情况调查表、症状评定表、社会支持量表(SSRS)和症状自评量表(SCL-90)对80例类风湿性关节炎患者进行现况调查,比较本组患者SCL-90评分与国内常模的差别,分析患者一般资料、病情、SSRS评分与SCL-90评分之间的关系。结果本组患者SCL-90评分除人际关系和精神病性2个因子外,其余各因子分和总分以及阳性项目数显著高于国内常模(t=10.282,6.256,5.188,4.260,2.914,9.749,2.163,8.232,5.707;P<0.05);SCL-90总分与患者户籍、婚姻状况、职业、付费类别有明显关联(t=2.849,2.417,16.351,24.163;P<0.05);与患者年龄、关节疼痛、关节肿胀、功能障碍评分和晨僵时间及血沉速度呈显著正相关(t=0.250,0.896,0.847,0.766,0.778,0.730;P=0.001或0.000);与文化程度、经济状况和SSRS评分呈显著负相关(r=-0.300,-0.663,-0.555;P=0.001或0.000)。结论类风湿性关节炎患者心理健康状况较差,年龄较长、无配偶、农村、农民、低文化程度、经济状况和社会支持较差、病情较重患者,心理健康状况相对更差。     

Immunoelectronmicroscopic Characterization of Intracellular Inclusions in Synovial Fluid Cells of Patients with Rheumatoid Arthritis

Qualitative immunoelectronmicroscopic (IEM) analysis of intracellular inclusions in synovial fluid (SF) cells in rheumatoid arthritis (RA) was performed using the peroxidase-antiperoxidase (PAP) method. Cells from patients with chronic RA were fixed in glutaral-dehyde containing 0.05% saponin to permeabilize membranes before immunologic treatments. Intracellular inclusions of IgG, IgM, and C3 were observed in vacuoles of greater than 75% of both polymorpho-nuclear leukocytes (PMNs) and mononuclear phago-cytic cells. IgA-and fibrinogen-containing inclusions were less frequent. Intracellular staining for albumin was minimal. Other membranous, vesicular, and granular unstained materials of potential importance were also often present in the same vacuoles. Stained inclusions were clearly distinct from lipid bodies, which were negative for immunostaining. Control samples had only occasional, scattered and weak stain that was easily recognizable as nonspecific and thus established the specificity of the reactions. A few lymphocytes in 2 patients showed positive staining for IgG in vacuoles. Extracellular staining of clumps of immunoglobulins, C3, and fibrinogen was also present. The various materials phagocytized by the different SF cells may be important in perpetuation of joint inflammation.     

抗环瓜氨酸肽抗体检测对类风湿关节炎的临床诊断价值

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）检测对类风湿关节炎（RA）诊断的意义。方法采用酶联免疫吸附试验（ELISA）检测115份人血清的抗CCP抗体,同时采用免疫透射比浊法定量检测类风湿因子（RF）,包括40例RA患者,45例其它风湿病患者,30名正常人;并分析抗CCP抗体与RF实验结果之间的相关性。结果在40例RA病人中,抗CCP抗体的阳性率为80.0%,在其它风湿病人中的阳性率为7.0%,抗CCP抗体对RA的敏感性和特异性分别为80.0%、96.0%,其敏感性高于RF,但差异无统计学意义（P〉0.05）,特异性明显高于RF（P〈0.05）。联合应用抗CCP抗体与RF进行诊断,二者均阳性时敏感性为65.0%,特异性为97.3%。抗CCP抗体与RF实验结果之间无相关性。结论抗CCP抗体对RA具有较好的敏感性和很高的特异性,可与RF相互补充,联合检测可提高对RA早期诊断的准确性。     

Chemokine Signaling Pathway Involved in CCL2 Expression in Patients with Rheumatoid Arthritis

Purpose

Rheumatoid arthritis (RA) is an inflammatory joint disorder, the progression of which leads to the destruction of cartilage and bone. Chemokines are involved in RA pathogenesis. In this study, we investigated the chemokine signaling pathway associated with CCL2 in peripheral blood (PB) and synovial tissues (ST) of RA patients based on our previous work about chemokine signaling pathway involved in the activation of CCL2 production in collagen-induced arthritis rat ST.

Materials and Methods

Total RNA was isolated from PB leukocytes and synovium of the knee joint in both RA patients and control populations. Real-time polymerase chain reaction was used to determine CCL4, CCR5, c-Jun, c-Fos, and CCL2 expressions. Serum level of CCL2 was assessed by enzyme-linked immunosorbent assay, and the production of CCL2 in ST was analyzed immunohistochemically.

Results

The expressions of CCL4, CCR5, c-Jun, c-Fos, and CCL2 messenger RNA in RA patients were significantly higher than those in healthy controls, both in ST and on PB leukocyte. Serum CCL2 levels were elevated in RA patients. Histological examination of rheumatoid joints revealed extensive CCL2 expression in RA ST.

Conclusion

CCL2, CCL4, c-Jun, c-Fos, and CCR5 may play an important role in the recruitment of PB leukocytes into the RA joints. These data provide evidence that the chemokine signaling pathway is involved in CCL2 expression in RA patient tissues, which may contribute to chronic inflammation associated with RA. Targeting this signaling pathway may provide a novel therapeutic avenue in RA.     

类风湿性关节炎三种Ig类别RF的测定及其临床意义

用聚合兔IgG为固相抗原,抗人Ig的F(ab′)_2为酶结合物,建立了定量检测IgM、IgG、IgA类RF的ELISA方法。对135例正常人,86例类风湿性关节炎(RA)患者及162例其它疾病患者检测的结果提示,RA患者三类RF均明显升高;IgM、IgG、IgA类RF的检出率分别为80.2％,62.8％,和51.2％,三类RF均与血管炎的发生密切相关,与RA活动程度相关,以IgM-RF最显著。SLE等风湿病及其它内科疾病三类RF检出率为0～45％,某中干燥综合征(SS)、混合性结缔组织病(MCTD)IgG,IgA类RF检出率为40％左右。