Ostéo-arthrite à Yersinia enterocolitica : à propos d'un cas affectant la hancheSeptic arthritis of the hip caused by Yersinia enterocolitica: a case report.

We report a case of bacteriologically documented hip infection caused by Yersinia enterocolitica. A 67-year-old male with a history of valvular disease was admitted for pain and motion range limitation in the left hip with a fever. No organisms were recovered by needle aspiration, but Yersinia enterocolitica grew in joint fluid obtained by surgical arthrotomy. Investigations of the gastrointestinal tract were normal, and there was no evidence of endocarditis. After 6 weeks of appropriate antibiotic therapy and immobilization with transtibial traction, the clinical and laboratory test abnormalities improved. However, the patient died from an intercurrent condition. Y. enterocolitica, a well-known cause of reactive arthritis, can cause septic arthritis.     

Treatment of early septic arthritis of the hip in children: comparison of results of open arthrotomy versus arthroscopic drainage

Purpose  The goal of this study was to compare results of open arthrotomy versus arthroscopic drainage in treating septic arthritis of the hip in children. Methods  This prospective controlled study was conducted on twenty patients (20 hips) with acute septic arthritis of the hip. Diagnosis was suspected if there was: a history of fever, non-weight-bearing on the affected limb, erythrocyte sedimentation rate (ESR) of at least 40 mm/h, and white blood cell count of more than 12,000 cells per cubic millimeter. Diagnosis was established by ultrasonographic examination of the affected hip followed by ultrasound-guided aspiration of the joint. Patients were allocated to have either open arthrotomy or arthroscopic drainage of the joint. There were ten patients (ten hips) in each treatment group. The mean age of the patients was 7.3 years in the arthrotomy group, and 8 years in the arthroscopy group. The mean temperatures for the arthrotomy and arthroscopy groups were 38.8 and 38.7°C, respectively. All the children were unable to bear weight on the affected limb. Results   Staphylococcus aureus was the most common causative microorganism in both groups. The mean duration of the children’s hospital stay was 6.4 days in the arthrotomy group and 3.8 days in the arthroscopy group. The difference was highly significant. Infection could be eradicated in all patients of both groups. At the latest follow-up, seven children in the arthrotomy group (70%) had excellent results and three children (30%) had good results. In the arthroscopy group, nine children (90%) had excellent results and one child (10%) had good results. The difference was not statistically significant. Conclusions  Arthroscopic drainage is an effective method in treating septic arthritis of the hip. It is a minimal invasive procedure which is associated with less hospital stay. Arthroscopic drainage of septic arthritis of the hip in children is a valid alternative procedure in early uncomplicated cases and for orthopedic surgeons skilled in pediatric arthroscopy.     

秦艽、威灵仙及其配伍对类风湿关节炎成纤维样滑膜细胞的抑制、促凋亡作用及对相关炎症因子的影响

目的研究秦艽、威灵仙及其配伍对类风湿关节炎成纤维样滑膜细胞(RA FLSs)的抑制、促凋亡作用及对相关炎症因子的影响。方法将购得的RA FLSs复苏后,通过光学显微鉴定和Vimentin免疫荧光鉴定并传代培养,将生长密度为80%～90%的细胞随机分为空白组、阳性药(甲氨蝶呤)组、秦艽组、威灵仙组、秦艽-威灵仙药对组5组。将中药水煎液制成质量浓度为8000μg/m L的含药培养基,将阳性药制成质量浓度为400μg/m L的含药培养基,各组分别给予相应含药培养基进行干预,以CCK-8法检测各组RA FLSs的增殖活性,以Annexin V-FITC法检测各组RA FLSs的凋亡情况,以ELISA法检测各组RA FLSs培养上清液中类风湿因子(RF)、C-反应蛋白(CRP)的含量。结果光学显微鉴定结果显示购得的RA FLSs形态符合文献报道,免疫荧光鉴定结果显示购得的RA FLSs为人源RA FLSs,且纯度大于99%; CCK-8法检测结果显示,各药物组对RA FLSs增殖均具有抑制作用,其中威灵仙组对RA FLSs的增殖抑制作用最强(P<0.01);Annexin V-FITC法检...     

Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution

Targeted biologic therapies have revolutionised treatment of immune-mediated inflammatory diseases (IMIDs) due to their efficacy, speed of onset and tolerability. The discovery that clinically unrelated conditions, such as rheumatoid arthritis and Crohn's disease, share similar immune dysregulation has led to a shift in the management of IMIDs from one of organ-based symptom relief to mechanism-based treatment. The fact that anticytokine therapy has been effective in treating multiple orphan inflammatory conditions confirms the IMID paradigm. In this review we examine the biologic agents currently licensed for use in the US and Europe: infliximab, etanercept, adalimumab, rituximab, abatacept, anakinra, alefacept and efalizumab. We also discuss the rationale behind the management of IMIDs using rheumatoid arthritis, Crohn's disease, psoriasis and psoriatic arthritis as examples. For the medical profession, IMID represents a breakthrough in the way pathology is classified. In this burgeoning era of biologic therapy the prospect of complete disease remission is conceivable.     

类风湿关节炎血清学标志物的筛选：基于细胞因子蛋白芯片

目的 探讨多项血清中细胞因子及可溶性细胞因子受体蛋白在类风湿关节炎临床诊断中的应用价值。方法 选择2015年~2019年在本院确诊为类风湿关节炎（RA）的患者59例作为RA组,并以在我院接受定期体检的年龄和性别匹配的健康受试者46例作为健康对照组。通过人细胞因子蛋白芯片检测其中5例RA组及5例健康对照组血清样本,选取4种差异表达细胞因子LIMPII、ROBO3、Periostin、IGFBP-4及可溶性受体蛋白2B4、Tie-2,于另外54例RA组及41例健康对照组血清样本中,对其六者血清水平进行 ELISA验证。Spearman 相关分析检测细胞因子及可溶性细胞因子受体蛋白与临床指标（包括：类风湿因子（RF）、红细胞沉降率（ESR）、C反应蛋白（CRP）、疾病活动评分（DAS28）及健康评估问卷（HAQ））的关系;受试者工作特征曲线（ROC）分析评估其诊断价值。结果 与健康对照相比,2B4、LIMPII、Tie-2、ROBO3、Periostin和IGFBP-4在RA血清中的表达显著升高（P<0.01）。同时,RA血清中LIMPII、ROBO3和Periostin血清水平与类风湿因子、C反应蛋白、疾病活动评分及健康评估问卷等反映疾病活动程度评价指标正相关（P<0.01）。血清2B4、LIMPⅡ、Periostin、ROBO3、IGFBP-4和Tie-2表达水平均对RA的诊断有显著意义（P<0.05）,其中2B4曲线下面积为最大（AUC：0.861,P<0.001）,其次依顺序LIMPII、ROBO3、Periostin、Tie-2、 和IGFBP-4。结论 血清LIMPII、ROBO3和Periostin的表达水平可反映RA的疾病活动度,此外血清2B4、LIMPⅡ、Periostin、ROBO3、IGFBP-4和Tie-2可能作为RA的诊断的生物标记物。     

敦煌消痹定痛酊对胶原诱导性大鼠关节炎模型NO、cAMP和PGE2影响的实验研究

目的:研究敦煌消痹定痛酊治疗类风湿性关节炎的作用机制,探讨其对胶原诱导性关节炎(CIA)大鼠模型关节液一氧化氮(NO)和3,’5’-环腺苷酸(cAMP)及前列腺素E2(PGE2)含量的影响。方法:建立CIA大鼠模型,用双抗体夹心酶联免疫吸附(ELISA)法检测cAMP和PGE2含量,用亚硝酸盐-比色(Griess)法检测NO含量。结果:敦煌消痹定痛酊能显著降低CIA大鼠关节液中NO和PGE2的含量,升高cAMP的含量。结论:提示敦煌消痹定痛酊对CIA大鼠关节炎具有一定抑制作用,可通过抑制大鼠关节液中NO和PGE2的含量,升高cAMP的含量,从而减轻关节滑膜的炎症,这可能是其治疗类风湿性关节炎的作用机制之一。     

补肾活血解郁法治疗类风湿关节炎伴发抑郁症的临床观察

目的 观察补肾活血解郁法对类风湿关节炎(RA)伴发抑郁症肾虚血瘀证的临床疗效.方法 采用随机、对照原则,选取符合RA、抑郁症及中医学证候标准的66例患者,分为治疗组和对照组,在常规抗风湿治疗基础上,治疗组予补肾活血解郁方,每天1剂,对照组予氟西汀胶囊,20 mg/d,治疗6周后,观察对抑郁程度及RA的影响.结果 ①汉密顿抑郁量表(HAMD)评分显示,治疗组总显效率、总有效率分别为79.41%、88.24%;对照组为62.50%、81.25%.两组比较,P＞0.05.②按RA改善程度评估临床疗效,治疗组总显效率、总有效率分别为79.41%、91.18%;对照组为71.88%、87.50%,两组比较,P＞0.05.两组疗效相当.结论 肾虚血瘀、脑神失养是RA伴发抑郁症病机之一,补肾活血解郁法可减轻抑郁症状、改善RA病情.     

类风湿性关节炎中医证型分布研究

目的：探讨类风湿关节炎（RA）证候学分布规律.方法：选取符合类风湿性关节炎中西医诊断标准的166例患者作为研究对象,在就诊时或入院3 d内,用四诊合参的方法进行中医辩证分型,收集年龄、性别、病史等一般情况,检测血红蛋白、血小板、血沉.结果：不同证型间患者性别、血红蛋白、血沉分布相同,差异无统计学意义（ P＞0.05）;不同证型患者血小板分布不同,组间两两比较差异有统计学意义（χ^2＝10.130,P=0.038）.结论：RA疾病不断发展,证候相应不断变化、发展,由实转虚.血红蛋白偏低在一定程度上说明RA发病之内因.血瘀的病变贯穿RA证型从实证到虚证演变之始终.