Aspects of the spectrum, prevalence and disease susceptibility determinants of Reiter's syndrome and related disorders associated with HIV infection

Summary Arthrocutaneous disorders including Reiter's syndrome, psoriasiform rashes, and other forms of chronic arthritis and enthesopathy, such as psoriatic arthritis, occur with an increased prevalence in the setting of HIV infection. Herein we describe the spectrum and prevalence of musculoskeletal and allied skin disorders as they occur in the setting of HIV infection. The role of genetic susceptibility in the development of these disorders is addressed. Based on the frequency of infectious agents capable of triggering reactive arthritis and the presence of HLA-B27 in 71% of these individuals, it is suggested that the disorder strongly resembles Reiter's syndrome as it occurs in the not HIV-infected group. Preliminary evidence indicates an enhanced penetrance for susceptibility among HLA-B27 individuals. In contrast, among HIV-infected patients with psoriasiform lesions there was no statistically significant association (P<0.05) between the presence of psoriasiform rash and the HLA alleles Cw6, B7, B17, Bw16, or Bw57 when compared with HIV-infected controls. These findings suggest that among HIV-infected individuals the development of Reiter's syndrome involves an immune recognition event primarily dependent upon HLA-B27 molecules in which an unknown antigen in the context of HLA-B27 is presented to CD8 lineage suppressor/cytotoxic cells. In contrast, the pathogenesis of psoriasiform lesions in HIV patients, despite their similarity to certain lesions in Reiter's syndrome, proceeds by distinct pathways that do not involve events influenced by specific polymorphic class I molecules.     

来氟米特与甲氨蝶呤治疗银屑病关节炎关节病变的临床研究

目的 评价来氟米特、甲氨蝶呤及甲氨蝶呤与来氟米特联用治疗银屑病关节炎(PsA)关节病变的疗效与安全性.方法 2个中心的开放性临床对照研究.选确诊的PsA患者,接受甲氨蝶呤(甲氨蝶呤组)、来氟米特(来氟米特组)、甲氨蝶呤+来氟米特(联合治疗组)中的任意一种治疗方案,治疗24周.以PsA疗效标准(PsARC)为主要疗效指标,修改的美国风湿病学会疗效标准提高20%(ACR20)为次要疗效指标,对关节病变进行评估,并分析具体评价指标[包括压痛关节数、肿胀关节数、疼痛视觉模拟评分、患者总体评价(PGA)、医生总体评价、健康评估问卷(HAQ)]的变化.结果 治疗24周时甲氨蝶呤组、来氟米特组、联合治疗组达到PsARC的比例分别为75.0%、68.8%、83.3%,达到ACR20的比例分别为66.7%、50.0%、83.3%.24周后3组患者压痛关节数、肿胀关节数、疼痛视觉模拟评分、PGA、医生总体评价、HAQ均显著低于基线水平(P<0.05).联合治疗组在疼痛视觉模拟评分、HAQ、ESR的改善程度显著高于来氟米特组,甲氨蝶呤组在疼痛视觉模拟评分、PGA、HAQ、ESR的改善程度亦显著高于来氟米特组.甲氨蝶呤、来氟米特、联合治疗组不良反应发生率分别为38.5%、38.9%、35.0%,无严重不良事件发生.结论 甲氨蝶呤与来氟米特联合治疗与单用药物治疗对PsA的关节病变均具有良好的疗效和安全性.     

来氟米特与甲氨蝶呤治疗银屑病关节炎关节病变的临床研究

目的 评价来氟米特、甲氨蝶呤及甲氨蝶呤与来氟米特联用治疗银屑病关节炎(PsA)关节病变的疗效与安全性.方法 2个中心的开放性临床对照研究.选确诊的PsA患者,接受甲氨蝶呤(甲氨蝶呤组)、来氟米特(来氟米特组)、甲氨蝶呤+来氟米特(联合治疗组)中的任意一种治疗方案,治疗24周.以PsA疗效标准(PsARC)为主要疗效指标,修改的美国风湿病学会疗效标准提高20%(ACR20)为次要疗效指标,对关节病变进行评估,并分析具体评价指标[包括压痛关节数、肿胀关节数、疼痛视觉模拟评分、患者总体评价(PGA)、医生总体评价、健康评估问卷(HAQ)]的变化.结果 治疗24周时甲氨蝶呤组、来氟米特组、联合治疗组达到PsARC的比例分别为75.0%、68.8%、83.3%,达到ACR20的比例分别为66.7%、50.0%、83.3%.24周后3组患者压痛关节数、肿胀关节数、疼痛视觉模拟评分、PGA、医生总体评价、HAQ均显著低于基线水平(P<0.05).联合治疗组在疼痛视觉模拟评分、HAQ、ESR的改善程度显著高于来氟米特组,甲氨蝶呤组在疼痛视觉模拟评分、PGA、HAQ、ESR的改善程度亦显著高于来氟米特组.甲氨蝶呤、来氟米特、联合治疗组不良反应发生率分别为38.5%、38.9%、35.0%,无严重不良事件发生.结论 甲氨蝶呤与来氟米特联合治疗与单用药物治疗对PsA的关节病变均具有良好的疗效和安全性.     

Genetic variants within ANRIL (antisense non coding RNA in the INK4 locus) are associated with risk of psoriasis

BackgroundPsoriasis is a systemic inflammatory disease which mostly affects skin. Evidences support the role of autoimmune responses in this disorder. The long non-coding RNA (lncRNA) antisense non coding RNA in the INK4 locus (ANRIL) has been shown to participate in modulation of immune response and in the pathogenesis of immune-related disorders.MethodsWe genotyped four single nucleotide polymorphisms (SNPs) with this lncRNA (rs1333045, rs1333048, rs4977574 and rs10757278) in 286 patients with psoriasis and 300 age-/sex-matched controls to identify the role of ANRIL as a risk locus for psoriasis.ResultsThe C allele of rs1333048 SNP was significantly more prevalent among cases compared with controls (OR (95% CI) = 1.56 (1.23–1.97), adjusted P value = 8.31E−4). The A allele of the rs4977574 had a protective effect against psoriasis (OR (95% CI) = 0.63 (0.49–0.81), adjusted P value = 0.001). The G allele of the rs10757278 conferred risk of psoriasis in the assessed population (OR (95% CI) = 1.9 (1.51–2.4), adjusted P value = 2.18 E−7). The C A G A haplotype (rs1333045, rs1333048, rs4977574 and rs10757278, respectively) was reported to be a protective haplotype against psoriasis (OR (95% CI) = 0.5 (0.35–0.71), adjusted P value = 0.001). The C A G G and T C G G haplotypes conferred risk of psoriasis in the assessed population (OR (95% CI) = 2.37 (1.59–3.54), adjusted P value = 2.4E−4; OR (95% CI) = 5.42 (2.88–10.22), adjusted P value = 1.1E−7, respectively).ConclusionConsequently, ANRIL can be regarded as a risk locus of psoriasis in the assessed population. Future studies are needed to verify whether this contribution is exerted through modulation of immune responses.     

Associations between interleukin-23R and interleukin-12B polymorphisms and psoriasis susceptibility: a meta-analysis

Objective: The aim of this study was to determine whether interleukin (IL)-23?R and IL-12B polymorphisms confer susceptibility to psoriasis.

Methods: The authors conducted a meta-analysis on associations between the IL-23?R and IL-12B polymorphisms and psoriasis susceptibility.

Results: A total of 14 comparison studies were included in this meta-analysis. The meta-analysis identified a significant association between psoriasis and 2 alleles of the rs11209026 and rs7530511 polymorphisms in Europeans (odds ratio [OR]?=?0.624, 95% confidence interval [CI]?=?0.565–0.697, p?<?1.0?×?10^?8; OR?=?0.804, 95% CI?=?0.743–0.869, p?=?3.0?×?10^?7, respectively). Meta-analysis of IL-12B showed a significant association between the 2 alleles of the rs6887695 and rs3212227 polymorphisms and the risk of developing psoriasis (OR?=?0.710, 95% CI?=?0.673–0.749, p?<?1.0?×?10^?8; OR?=?0.684, 95% CI?=?0.639–0.731, p?<?1.0?×?10^?8, respectively). Stratification by ethnicity identified an association between the rs6887695 and rs3212227 polymorphisms and psoriasis in Europeans.

Conclusions: This meta-analysis showed that the IL-23?R (rs11209026 and rs7530511) polymorphisms are associated with psoriasis risk in Europeans and that the IL-12B (rs6887695 and rs3212227) polymorphisms are associated with susceptibility to psoriasis in Europeans.     

沙利度胺与二丁酰环磷腺苷钙治疗老年重度寻常型银屑病的药物经济学评价

目的 对沙利度胺与二丁酰环磷腺苷钙治疗老年重度寻常型银屑病进行药物经济学评价。 方法 通过医院信息系统(HIS)采集2016年10月1日到2018年5月31日在大连市皮肤病医院老年重度寻常型银屑病患者的病历资料进行回顾性分析,比较接受沙利度胺与二丁酰环磷腺苷钙治疗老年重度寻常型银屑病的疗效和成本费用,并采用单因素敏感性分析结果的稳定性。 结果 沙利度胺组显效率为43.37%,二丁酰环磷腺苷钙组显效率为35.00%,应用χ²检验比较无统计学差异(P>0.05);沙利度胺组3、6个月未再次入院风险率为86.75%和71.08%,二丁酰环磷腺苷钙组3、6个月未再次入院风险率为75.00%和57.00%,应用χ²检验比较有统计学差异(P<0.05);沙利度胺组人均成本9999.86元,二丁酰环磷腺苷钙组人均成本9223.17元;以显效率为疗效指标二丁酰环磷腺苷钙成本最低,以3、6个月未再次入院风险率为疗效指标沙利度胺具有最优经济性(ICER=6472.42/5547.79元),敏感性分析显示结果可靠。 结论 二丁酰环磷腺苷钙治疗老年重度寻常型银屑病近期疗效成本最低,而沙利度胺的远期疗效更具有成本效果优势。     

寻常型银屑病皮损湿疹样改变的发生率及其相关因素

目的：探讨寻常型银屑病皮损出现湿疹样改变的发生率及相关因素。方法收集2013年12月—2014年4月就诊于空军总医院皮肤科门诊的寻常型银屑病患者241例,通过制订病例调查表记录患者信息和病情变化情况,利用图像采集设备记录皮损图像信息,应用SPSS16.0软件和Excel软件进行数据分析。结果241例中,出现湿疹样改变122例,发生率为50.6%;出现湿疹样改变与未出现湿疹样改变的患者在皮肤类型、瘙痒评分及疾病分期方面差异具有统计学意义（P＜0.05）;在性别、年龄、家族史、病程及皮损形态上差异无统计学意义（P＞0.05）。结论寻常型银屑病患者自觉瘙痒感强烈、皮肤干燥或处于进展期时,皮损易出现湿疹样改变,在治疗早期应当重视口服止痒药物及外用保湿剂,联合治疗,以提高疗效,促进皮损消退。     

复方丙酸氯倍他索联合他卡西醇治疗寻常型银屑病的疗效

目的：观察复方丙酸氯倍他索软膏与他卡西醇软膏联合治疗寻常型银屑病的疗效。方法将112例寻常型银屑病患者按照随机数字法分为研究组和对照组。对照组给予复方丙酸氯倍他索软膏,研究组给予复方丙酸氯倍他索软膏及他卡西醇软膏联合治疗,观察两组的临床治疗效果。结果研究组有效率为91.1％,明显高于对照组71.4％,差异有统计学意义（P＜0.05）。治疗后两组的上肢、躯干和下肢的靶损害部位评分较治疗前有明显改善,组间数据比较差异有统计学意义（P＜0.05）。研究组与对照组不良反应发生率为1.8％、3.5％,差异无统计学意义（P＞0.05）。结论复方丙酸氯倍他索软膏与他卡西醇软膏联合治疗寻常型银屑病效果显著,能有效改善患者临床症状,不良反应少,安全性高,值得临床应用。