IL-4、IL-6、IL-17、TNF-α在不同证型类风湿关节炎诊断中的应用

目的　探讨血清中白细胞介素（interleukin,IL）-4、IL-6、IL-17、肿瘤坏死因子-α（tumor necrosis factor α,TNF-α）水平与类风湿关节炎不同中医证型之间的关系。方法　本研究为前瞻性研究。选取2021年6月至11月辽宁中医药大学附属医院收治的类风湿关节炎患者共100例,同时纳入60例健康志愿者作为对照组。比较各组研究对象的性别、年龄、病程等一般资料,同时比较各组研究对象的IL-4、IL-6、IL-17、TNF-α水平。采用卡方检验、t检验及单因素方差分析。结果　100例类风湿关节炎患者中男12例,女88例,年龄36～72（51.48±12.93）岁。对照组中男14例,女46例,年龄18～60（52.27±13.21）岁。两组研究对象的一般资料比较,差异均无统计学意义（均P>0.05）。与对照组相比,肝肾不足证、寒湿痹证、湿热痹阻证、痰瘀痹阻证患者的IL-4、IL-6、IL-17、TNF-α水平均有所升高,差异均有统计学意义（均P<0.05）。其中,寒湿痹证患者IL-4、IL-17、TNF-α水平分别为（8.27±2.20）pg/ml、（56.58±10.80）pg/ml、（16.61±2.90）pg/ml,明显高于其他证型组;湿热痹阻证患者IL-6为（95.28±16.20）pg/ml,明显高于肝肾不足证组、寒湿痹证组和痰瘀痹阻证组［（57.54±12.04）pg/ml、（52.18±10.30）pg/ml、（51.75±13.03）pg/ml,均P<0.001］。结论　不同证型类风湿关节炎患者的血清炎性因子水平不同,寒湿痹证型患者IL-4、IL-17、TNF-α水平最高,湿热痹阻证患者IL-6水平最高,或可作为临床辨证分型依据。     

瑞香素通过含半胱氨酸的天冬氨酸蛋白水解酶通路对胶原诱导性关节炎大鼠成纤维样滑膜细胞增殖与凋亡的影响

目的探讨瑞香素(DAP)通过含半胱氨酸的天冬氨酸蛋白水解酶(caspase)通路对胶原诱导性关节炎(CIA)大鼠成纤维样滑膜细胞(FLS)增殖与凋亡的影响。方法体外培养 CIA-FLS,选取对数生长期细胞以不同浓度 DAP(0、5、10、20、40、80 mg/     

The usage of functional wrist orthoses in patients with rheumatoid arthritis

Objective. To describe the usage of functional wrist orthoses and to identify factors contributing to usage in patients with rheumatoid arthritis (RA).

Methods. A multicentre, cross-sectional study, including a random selection of patients with RA visiting outpatient clinics. A total of 240/362 eligible patients (66%) completed questionnaires, a semi-structured interview and a clinical assessment. Usage was registered according to eight categories ranging from 'always' to 'never'. Factors potentially associated with usage included demographic variables, the presence of wrist and hand complaints, general disease characteristics, mental and physical functioning, coping strategies and satisfaction with functional wrist orthoses. Logistic regression analyses were used to determine which factors were associated with the usage of wrist splints.

Results. One hundred twenty-eight patients (53%) possessed functional wrist orthoses, whereas 74/128 (58%) were actually using them. Patients used them mainly during house keeping and cycling/driving. Main reasons for using the orthoses were relief of pain and joint protection, and main reasons for not using them were no need and problems with ease of use. Factors significantly associated with usage included the presence of wrist and hand complaints, worse physical functioning and greater satisfaction with comfort of the wrist orthoses.

Conclusion. About half of patients with RA possessed functional wrist orthoses, with 58% of them actually being used. Apart from local complaints and general functional ability, satisfaction with comfort of the functional wrist orthoses appears to be an important factor for their usage. These results point at the need for additional research regarding modifiable factors associated with compliance, such as comfort and ease of use.     

Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study

Opioids are widely prescribed for non-cancer pain conditions (NCPC), but there have been no large observational studies in actual clinical practice assessing patterns of opioid use over extended periods of time. The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured population (HealthCore plan data) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000–2005). We track enrollees with the four most common NCPC conditions: arthritis/joint pain, back pain, neck pain, headaches, as well as HIV/AIDS. Rates of NCPC diagnosis and opioid use increased linearly during this period in both groups, with the Medicaid group starting at higher rates and the HealthCore group increasing more rapidly. The proportion of enrollees receiving NCPC diagnoses increased (HealthCore 33%, Medicaid 9%), as did the proportion of enrollees with NCPC diagnoses who received opioids (HealthCore 58%, Medicaid 29%). Cumulative yearly opioid dose (in mg. morphine equivalents) received by NCPC patients treated with opioids increased (HealthCore 38%, Medicaid 37%) due to increases in number of days supplied rather than dose per day supplied. Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.     

Sea urchin spine arthritis of the hand

PURPOSE: Although rare, hand injury caused by puncture with the sea urchin spine can result in serious complications. To emphasize its clinical significance, this article describes a group of patients who sustained chronic granulomatous arthritis induced by puncture with sea urchin spine (designated sea urchin spine arthritis). METHODS: Five patients who developed sea urchin spine arthritis of the hand after puncture with sea urchin spine were treated at our hospitals. All lesions involved the proximal interphalangeal (PIP) joint (4 index fingers and 1 middle finger). Patients experienced pain, swelling, and discomfort around the site of puncture immediately after the injury. These initial symptoms subsided within a few days, and secondary symptoms including fusiform swelling, limited motion, and mild pain of the PIP joint appeared from 1 to 2 months later. Laboratory tests of inflammation and blood cell counts were negative. Plain radiographs showed soft tissue swelling and osteolysis but no visible spine. Thorough synovectomy of the PIP joint was performed, and the granulation tissue around the joint was also removed. RESULTS: No microorganism was identified from tissue culture or polymerase chain reaction in any of the 5 patients. At a mean follow-up of 21 months, 2 patients exhibited essentially normal active motion of the affected PIP joint, whereas the remaining 3 patients had diminished range of motion. CONCLUSIONS: Diagnosis of sea urchin spine arthritis can be made by history of sea urchin spine injury, a symptom-free period before the development of synovitis, and the absence of laboratory test abnormalities. Neither antibiotics nor nonsteroidal anti-inflammatory agents are effective. Undertaken early enough, thorough synovectomy might avoid complications and obtain favorable results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Treatment of the wrist in rheumatoid arthritis

Wrist involvement is common in rheumatoid arthritis and affects up to 50% of patients within the first 2 years after the onset of the disease, including bilateral involvement. It is a progressive disease that destroys the articular cartilage and surrounding soft tissues, thus leading to severe deformities. Radiological changes are characteristic and include narrowing of the joint line, cysts, and periarticular osteoporosis. Clinical changes are characterized by different scoring systems, indicating different therapeutic options. Surgical orthopedic treatment options include joint-preserving techniques to prevent further damage (radiosynoviorthesis, synovectomy, or axial correction with tendon transfers in earlier stages) and joint replacing techniques to restore function (arthrodesis, resection arthroplasty or total joint arthroplasty in later stages). This article reviews pathologic changes in the rheumatoid hand and their surgical treatment alternatives.     

Anti-arthritic activity of a biopolymeric fraction from Euphorbia tirucalli

The present study was undertaken to investigate the anti-arthritic activity of a biopolymeric fraction (BET) from plant Euphorbia tirucalli Boiss (Euphorbiaceae). The fraction showed dose dependent anti-arthritic activity and also showed in vivo immunomodulatory capacity being a major component in inhibiting arthritis. It caused suppression of CD4(+) and CD8(+) T cells, inhibition of intracellular Interleukin-2 (IL-2) and Interferon-gamma (IFN-gamma) by flowcytometry. It inhibited vascular permeability and the migration of leucocytes at the site of the insult. The oral LD(0) in both rats and mice was more than 2000 mg/kg.     

Antinociceptive and antiarthritic activity of Cissampelos pareira roots

In the present study, 50% aqueous ethanolic extract of Cissampelos pareira (Menispermaceae) roots (C. pareira) at the dose levels of 100-400 mg/kg, once daily for 3 days exhibited significant (P < 0.001) resistance against mechanical pain after 30 min in analgesymeter induced pain in mice. In acetic acid (0.6%; i.p.) inducing writhing, Cissampelos pareira significantly (P < 0.05) decreased the writhing episodes; the degree of percent protection at 200 and 400 mg/kg was 22.73 and 51.63. The hot plate reaction time was increased by 2.07 (P < 0.05) and 2.70 (P < 0.001) folds. respectively. Further Cissampelos pareira showed the dose dependent significant protective effect against complete Freund's adjuvant induced arthritis. The percentage protection on the 18th day was 40.54 (P < 0.01) and 71.52 (P < 0.001) at 200 and 400 mg/kg respectively. Lysosomal enzymes (acid phosphatase and N-acetyl glucosaminidase) were decreased by 50% (P < 0.01) and 26.26% (P < 0.05) by using Cissampelos pareira, dextramethasone decreased them 56.56% (P < 0.01) and 31.82% (P < 0.01) and the glycoprotein contents (total hexose and sialic acid) were increased by 1.55-folds (P < 0.01) and 1.51-folds (P < 0.05) by using Cissampelos pareira while dextramethasone increases them by 1.51-folds (P < 0.001) and 1.60-folds (P < 0.01) respectively in stomach homogenate with respect to arthritic group. The increased pain threshold and protective effect against CFE by Cissampelos pareira vindicated its medicinal value in treatment of pain and arthritis.     

Car mirrors for drivers with restricted neck mobility

A postal survey of 50 car drivers with restricted movement of the cervical spine revealed that many experienced difficulties when negotiating junctions or reverse parking. In many cases supplementary interior mirrors increased the drivers' field of vision, enabling them to perform manoeuvres more safely. Choice of suitable mirrors and their exact positioning depends on the design of the vehicle and the individual's disability.