中药灌肠联合柳氮磺胺吡啶治疗慢性溃疡性结肠炎随机平行对照研究

[目的]观察中药灌肠联合柳氮磺胺吡啶治疗慢性溃疡性结肠炎疗效。[方法]使用随机平行对照方法,将90例住院患者按随机数字表法分为两组。对照组45例柳氮磺胺吡啶,1．0g／次,3次／d,口服。治疗组45例中药灌肠,黄连5g,广木香、茯苓、地榆、白术、乌梅各15g,五倍子、甘草各10g,山药、五味子各20g,党参30g;2次／d,水煎200mL,早晚100mL插）入肛门6～10cm灌肠。西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、不良反应。连续治疗4疗程,判定疗效。[结果]治疗组显效19例,有效23例,无效3例,总有效率93．33％。对照组显效13例,有效24例,无效8例,总有效率82．22％。治疗组疗效优于对照组（尸〈O．05）。[结论]中药灌肠联合柳氮磺胺吡啶在治疗慢性溃疡性结肠炎效果显著,值得推广。     

Psoriasis treatment: Unconventional and non-standard modalities in the era of biologics

Psoriasis is a potentially debilitating inflammatory dermatosis affecting 0.2%-4.8% of the population worldwide causing a significant occupational, personal or psychosocial morbidity to these patients for life. The basic aim of psoriasis therapy is to control the disease to maximum possible extent and improve the patient’s quality of life. Management of triggers for flare-ups, lifestyle modifications, and dietary supplements are often recommended. Intermittent or rotational therapy with frequent alterations in treatment options is usually needed to reduce toxicity of anti-psoriatic drugs in the absence of safer alternatives. Currently, several biological agents categorized as either T-cell targeted (e.g., Alefacept, Efalizumab) or cytokine modulating (e.g., Adalimumab, Infliximab, Etanercept) are available for treating severe psoriasis. However, their high cost is often precluding for most patients. The usefulness of systemic (methotrexate, cyclosporine, acitretin or several other therapeutic agents) or topical (tar, anthralin, corticosteroids or calcipotriol ointments, phototherapy with or without psoralens) therapies has been well established for the management of psoriasis. The literature is also replete with benefits of less used non-standard and unconventional treatment modalities (hydroxycarbamide, azathioprine, leflunomide, mycophenolate mofetil, isotretinoin, fumarates, topical calcineurin inhibitors, peroxisome proliferator-activated receptors agonists, statins, sulfasalazine, pentoxifylline, colchicine, grenz ray therapy, excimer laser, climatotherapy and balneophototherapy, peritoneal dialysis, tonsillectomy, ichthyotherapy, etc.). These can be used alternatively to treat psoriasis patients who have mild/minimal lesions, are intolerant to conventional drugs, have developed side effects or achieved recommended cumulative dose, where comorbidities pose unusual therapeutic challenges, or may be as intermittent, rotational or combination treatment alternatives.     

Is non-biological treatment of rheumatoid arthritis as good as biologics?

The management of rheumatoid arthritis (RA) in the past three decades has undergone a paradigm shift from symptomatic relief to a “treat-to-target” approach. This has been possible through use of various conventional and biologic disease modifying anti-rheumatic drugs (DMARDs) which target disease pathogenesis at a molecular level. Cost and infection risk preclude regular use of biologics in resource-constrained settings. In the recent years, evidence has emerged that combination therapy with conventional DMARDs is not inferior to biologics in the management of RA and is a feasible cost-effective option.     

Mesalazine preparations for the treatment of ulcerative colitis: Are all created equal?

Oral mesalazine(also known as mesalamine) is a 5-aminosalicylic acid compound used in the treatment of mild to moderate ulcerative colitis, with high rates of efficacy in induction and maintenance of remission.The therapeutic effect of mesalazine occurs topically at the site of diseased colonic mucosa. A myriad of oral mesalazine preparations have been formulated with various drug delivery methods to minimize systemic absorption and maximise drug availability at the inflamed colonic epithelium. It remains unclear whether different oral mesalazine formulations are bioequivalent. This review aims to evaluate the differences between mesalazine formulations based on the currently available literature and explore factors which may influence the selection of one agent above another.     

Oral treatment options for AS and PsA: DMARDs and small-molecule inhibitors

Spondyloarthritis (SpA) represents a group of common diseases that share a number of characteristic clinical manifestations including peripheral arthritis, spondylitis, enthesitis, and dactylitis. Additionally, they can often be associated with extra-articular manifestations including psoriasis, anterior uveitis, and inflammatory bowel disease. The two most widely studied clinical phenotypes are ankylosing spondylitis and psoriatic arthritis.Although a number of biologic agents have been shown to be highly effective in treating these conditions, rheumatologists must generally initiate therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) such as methotrexate and sulfasalazine. The use of these medications stems from our experience in rheumatoid arthritis, and there is a paucity of convincing clinical data supporting their use in SpA. More recently, new targeted synthetic DMARDs have become available and are a welcome addition to the management of these conditions.Through this review, we hope to highlight the evidence behind available treatment options on the various domains of these diseases including synovitis, enthesitis, dactylitis, and spondylitis. We also discuss the available evidence regarding co-medication of csDMARDs with biologic agents.     

白芍总苷联合柳氮磺胺吡啶治疗强直性脊柱炎的疗效观察

目的观察白芍总苷联合柳氮磺胺吡啶治疗强直性脊柱炎的疗效和安全性。方法 42例符合强直性脊柱炎的标准的患者随机分为治疗组22例和对照组20例,治疗组口服白芍总苷和柳氮磺胺吡啶,对照组口服柳氮磺胺吡啶,两组均给予消炎止痛药物,疗程为6个月。结果经过6个月的治疗,两组间的晨僵持续时间、血沉、C反应蛋白、胸廓扩张度、Schober实验等指标方面较治疗前均明显降低,两组之间的晨僵持续时间、血沉、C反应蛋白的差别具有显著意义。治疗组不良反应的发生率明显小于对照组。结论白芍总苷联合柳氮磺胺吡啶治疗AS具有疗效确切不良反应小等优点,在临床有推广意义。     

The x c − cystine/glutamate antiporter as a potential therapeutic target for small-cell lung cancer: use of sulfasalazine

Purpose  To determine whether the x_c⁻ cystine transporter could be a useful therapeutic target for small-cell lung cancer (SCLC). Methods  Human SCLC cell cultures were examined for growth dependence on extracellular cystine, x_c⁻ expression, glutathione levels and response to highly specific x_c⁻ inhibitors, i.e., monosodium glutamate (MSG) and the anti-inflammatory drug, sulfasalazine (SASP). In studying tumor growth inhibition by SASP, use was also made of a novel SCLC tissue xenograft model, LU6-SCLC, derived from a chemoresistant patient’s SCLC specimen. Results  Growth of NCI-H69 and NCI-H82 SCLC cells greatly depended on x_c⁻-mediated uptake of cystine. SASP substantially reduced their glutathione levels (>70%; 0.3 mM SASP; 24 h) and growth (72 h) with IC₅₀s of 0.21 and 0.13 mM, respectively; MSG also inhibited growth markedly. Both SASP- and MSG-induced growth arrests were largely prevented by cystine uptake-enhancing 2-mercaptoethanol (66 μM) indicating they were primarily due to cystine starvation. Without major side-effects, SASP (i.p.) restrained growth of NCI-H69 cell xenografts (~50%) and, importantly, substantially inhibited growth of the clinically more relevant LU6-SCLC tissue xenografts (~70% by stereological analysis), reducing tumor glutathione contents. Conclusions  The x_c⁻ cystine/glutamate antiporter is potentially useful as a target for therapy of SCLC based on glutathione depletion. Sulfasalazine may be readily used for this approach, especially in combination chemotherapy.     

三种氨基水杨酸制剂治疗溃疡性结肠炎的安全性和有效性研究

目的观察美沙拉嗪、奥沙拉嗪和柳氮磺吡啶治疗溃疡性结肠炎的临床疗效和不良反应。方法选择120例轻中度溃疡性结肠炎患者,随机分为美沙拉嗪组（n=40）、奥沙拉嗪组（n=39）和柳氮磺吡啶组（n=41）,分别接受上述三种药物治疗。美沙拉嗪组和奥沙拉嗪组患者口服药物剂量均为每次1．0g,每日3次;而柳氮磺吡啶组患者服用剂量为每次1．0g,每日4次。治疗12周后观察治疗疗效和不良反应发生情况。结果美沙拉嗪组、奥沙拉嗪组和柳氮磺吡啶组临床有效率分别为30．0％、28．2％和51．2％,总有效率分别为75．0％、76．9％和92．7％。柳氮磺吡啶组疗效优于美沙拉嗪组、奥沙拉嗪组（P〈0．05）。结论与美沙拉嗪、奥沙拉嗪相比,柳氮磺吡啶治疗溃疡性结肠炎有效性更高,但不良反应发生率稍高。