类风湿关节炎患者血清可溶性人白细胞抗原-Ⅰ类抗原的检测分析

目的 探讨山西汉族人群血清可溶性人白细胞抗原-Ⅰ (sHLA-Ⅰ)水平与类风湿关节炎(RA)的关系.方法 酶联免疫吸附测定(ELISA)法检测血清sHLA-Ⅰ类抗原水平.将不同浓度的标准品和待检血清分别加人包被有特异性sHLA-Ⅰ抗体的酶标板,与生物素化的sHLA-Ⅰ、辣根过氧化物酶(HRP)标记的链霉亲和素共同孵育,弃上清并用洗涤液洗涤,加底物应用液四甲基联苯胺(TMB)显色,以酶标仪450 nm测定吸光度(A)值,根据不同浓度标准品显色后测得的A值绘制标准曲线.测定RA患者与健康人的sHLA-Ⅰ含量.结果 ①血清sHLA-Ⅰ类抗原水平:80名健康人为(390±106)ng/ml;80例RA患者为(632±169)ng/ml,其中50例活动期RA患者为(739±144)ng/ml,30例缓解期RA患者为(524±114)ng/ml,与健康人相比,活动期和缓解期RA患者血清sHLA-Ⅰ均显著增高(P＜0.01),且活动期RA患者显著高于缓解期患者(P＜0.0).②26例活动期RA患者治疗前血清sHLA-Ⅰ类抗原水平为(744±148)ng/ml,经治疗病情缓解后为(533±106)ng/ml,治疗前显著高于治疗后(P＜0.01).结论 RA患者血清sHLA-Ⅰ类抗原水平明显增高,且以活动期增高更为显著.     

类风湿关节炎患者血清基质金属蛋白酶-9水平及意义的研究

目的探讨类风湿关节炎(RA)患者血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的水平及意义。方法采用双抗体夹心酶联免疫吸附试验(ELISA)测定50例RA患者(就诊前6个月内未用过慢作用药及糖皮质激素)和18名正常健康对照者的血清MMP-9水平,并选取20例患者进行治疗后的MMP-9测定,比较不同时期MMP-9的水平。同时测定其治疗前的其他实验室及临床指标:类风湿因子(RF)-IgM、血沉(ESR)、抗环瓜氨酸肽抗体(抗CCP抗体)、抗角蛋白抗体(AKA)、抗核周因子(APF)、压痛关节数、疼痛关节数、肿胀关节数及手X线片,分析它们与MMP-9变化的相关性。结果RA患者血清MMP-9水平[(566±175)ng/ml]明显高于正常对照组[(340±246)ng/ml],P<0.01;RA活动期血清MMP-9水平[(894±357)ng/ml]高于缓解期[(438±302)ng/ml],P<0.01;治疗后血清MMP-9水平[(489±359)ng/ml]与治疗前水平[(902±407)ng/ml]相比,差异有统计学意义(P<0.01)。MMP-9水平与RA患者的ESR(P<0.01)、疾病活动分数(DAS)评分(P<0.01)、压痛关节数(P<0.05)、疼痛关节数(P<0.01)、肿胀关节数(P<0.01)、X线分期(P<0.05)呈正相关;而与年龄、病程、晨僵时间、功能分级、AKA、APF、RF、抗CCP抗体水平无明显相关性(P>0.05)。结论MMP-9在RA患者血清中高水平存在提示RA关节骨质破坏和疾病活动程度,可作为除ESR、C反应蛋白(CRP)外提示RA疾病进展与改善的血清学指标。     

类风湿关节炎患者血脂紊乱特点及与疾病活动的关系

目的探讨类风湿性关节炎(RA)患者血脂紊乱特点及与疾病活动的相关性。方法选择RA患者62例作为研究对象(RA组),年龄、性别匹配的健康体检者46例为对照组。根据疾病是否处于活动期,将RA组分为活动期RA组和非活动期RA组。记录一般情况及传统心血管病危险因素,计算体质指数,测量收缩压、舒张压,检测血清中甘油三酯、总胆固醇(TC)、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇(HDLC)、高敏C反应蛋白(hsCRP)及红细胞沉降率(ESR)。比较各组血脂、hs-CRP、ESR差异。用Pearson直线相关分析法分析RA患者血脂与hs-CRP、ESR的相关性。结果 RA组体质指数显著高于对照组(P0.05)。血清TC水平活动期RA组、非活动期RA组显著高于对照组(P0.05);血清HDLC水平活动期RA组显著低于非活动期RA组、对照组(P0.01),非活动期RA组显著低于对照组(P0.01);TC/HDLC比值活动期RA组显著高于非活动期RA组、对照组(P0.01),非活动期RA组显著高于对照组(P0.05)。RA患者血清HDLC水平与hs-CRP、ESR呈负相关(r=-0.532,P=0.000;r=-0.508,P=0.000),TC/HDLC与hs-CRP、ESR呈正相关(r=0.321,P=0.001;r=0.246,P=0.030)。结论 RA患者血脂代谢紊乱以HDLC降低为主,活动期RA患者血清HDLC水平显著降低,并与RA疾病活动密切相关。     

类风湿关节炎患者血清白细胞介素-4水平与间质性肺疾病的关系

目的明确类风湿关节炎(rheumatoid arthritis,RA)患者血清中白细胞介素-4(interleukin-4,IL-4)的水平及其与RA继发间质性肺疾病(interstitial lung disease,ILD)的关系,探讨RA及RA继发ILD的发病机制及相关因素。方法选择RA患者62例,其中单纯RA患者31例,RA伴发ILD患者31例;健康对照者30例。应用酶联免疫吸附(ELISA)法检测各组血清中IL-4水平,同时比较各组实验室指标免疫球蛋白(Ig)G、IgA、IgM、γ-球蛋白、类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)及关节肿痛数的差异,并进行相关性分析。结果 RA组血清IL-4水平为(61.87±41.36)pg/ml,健康对照组血清IL-4水平为(25.48±14.28)pg/ml,两组相比较差异有统计学意义(P<0.05);RA继发ILD组血清IL-4水平(92.70±32.01)pg/ml较单纯RA组(30.05±24.45)pg/ml明显升高,差异有统计学意义(P<0.05)。总RA组血清IL-4水平较健康对照组明显升高,差异有统计学意义(P<0.05);RA继发ILD组血清IL-4水平较单纯RA组明显升高,差异有统计学意义(P<0.05)。结论 IL-4可能参与RA的发病,且在RA并发ILD的发生发展中起一定作用。     

类风湿关节炎合并间质性肺病患者血清表面活性蛋白A和D水平及临床意义

目的 探讨类风湿关节炎(RA)合并间质性肺病(ILD)患者的血清表面活性蛋白A(SP-A)和D(SP-D)水平及临床意义.方法 采用双抗体夹心酶联免疫吸附试验(ELISA)法检测SP-A和SP-D,并比较单纯RA组、RA-ILD组、对照组血清样本SPA和SP-D水平的差异,分析其与RA合并ILD的相关性.计算3组血清SP-A和SP-D阳性检出率.分析SP-A和SP-D与年龄、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体、抗核抗体、抗核周因子(APF)和抗角蛋白抗体(AKA)之间的相关性.多组间均数的比较采用方差分析,数据间的相关性分析采用Spearman等级相关.结果 ①RA-ILD组、单纯RA组、对照组的血清SP-A水平分别为(51.2±9.2)、(25.9±2.6)、(15.4±0.3)μg/L,SP-D水平分别为(42.5±8.1)、(20.8±1.5)、(16.6±0.8)μg/L.RA-ILD组患者血清SP-A和SP-D水平高于单纯RA组以及对照组(P＜0.05).单纯RA组患者血清SP-A和SP-D水平和健康对照组比较差异无统计学意义(P＞0.05).②RA-ILD组血清SP-A和SP-D的阳性率明显高于单纯RA组(x2=5.21,P=0.02;x2=4.79,P=0.01)和健康对照组(x2=4.96,P=0.03;x2=4.75,P=0.02),RA-ILD组血清SP-D的阳性检出率大于血清SP-A(x2=4.95,P=0.04).③RA-ILD患者血清SP-A、SP-D水平与年龄、CRP呈正相关(r=0.687,P=0.001;r=0.571,P=0.009).④RA-ILD患者血清SP-D水平与RF、抗CCP抗体和AKA呈正相关,而血清SP-A、SP-D水平与抗核抗体、APF、ESR无相关性.结论 ①SP-A和SP-D可作为RA合并ILD的血清学标志;②SP-A和SP-D在早期诊断RA合并ILD方面有一定价值,SP-D更有效地提示RA合并ILD存在,判断肺损伤程度,预测疾病转归情况.     

血清高迁移率族蛋白1水平与类风湿关节炎临床指标的相关性

目的通过检测活动性类风湿关节炎(rheumatoid arthritis,RA)患者血清高迁移率族蛋白1(high mobility group box protein 1,HMGB1)表达水平,探讨HMGB1与RA患者疾病活动性、自身抗体及临床指标的相关性。方法采用双抗体夹心酶联免疫吸附试验测定67例活动性RA患者和21位健康对照者血清HMGB1水平。收集RA患者的同期临床资料并测定相关实验室指标:疼痛视觉模拟评分(visual analog scale,VAS)、疲乏VAS、肿胀关节数、压痛关节数、患者对疾病总体状况的VAS(patient′s global assessment,PGA)、健康评估问卷(health assessment questionnaire,HAQ)、疾病活动评分28(dise aseactivity score28,DAS28)、血沉、C-反应蛋白、类风湿因子-IgM、抗环瓜氨酸肽抗体等,分析以上指标与血清HMGB1的相关性。结果活动性RA组血清HMGB1中位数为8.7ng/ml,四分位间距为16.59ng/ml;健康对照组血清HMGB1中位数为3.47ng/ml,四分位间距为7.43ng/ml,活动性RA组血清HMGB1表达水平显著高于健康对照组,两组间比较差异有统计学意义(P0.01)。活动性RA患者血清HMGB1表达水平与类风湿因子呈正相关(P0.01),与疼痛VAS评分、疲乏VAS评分、肿胀关节数、压痛关节数、PGA、HAQ、DAS28评分及血沉、C-反应蛋白、抗环瓜氨酸肽抗体无相关性(P0.05)。结论活动性RA患者血清HMGB1表达水平较健康对照组显著升高,但可能与疾病活动无关。     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

血清骨桥蛋白水平与类风湿关节炎活动性的关系及在伴肺间质病变中的意义

Objective To investigate the association between serum level of osteopotin (OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. Methods Sixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group (n=43) and inactive group (n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed. Results ① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients (median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP (P<0.01) and the serum titer of RF-IgM, (P<0.05). Conclusion OPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.     

Serum Levels of TNF-α, TNF-αRI,TNF-αRII and IL-12 in Treated Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis (RA) is a chronic multisystem autoimmune disease common in all races and ethnics. Cytokines and cytokines receptors play an important role in RA pathogenesis and clinical presentation. Objective: To investigate the serum levels of TNF-α, TNF-α RI, TNF-α RII and IL-12 in RA patients and healthy control group. Methods: In this study 43 patients fulfilling the revised criteria of American College of Rheumatology (ACR) for RA and 13 healthy cases as a control group were selected for TNF-α, TNF-αRI, TNF-αRII and IL-12 serum level analysis. The patients' age was 42.2 ± 22 and the age of healthy group was 40.1 ± 19.2 years (p=0.1). The pa-tients had an active disease with at least six swollen and ten tender joints. Minimum ESR was 28 mm at first hours of the morning. Early morning stiffness in patients lasted longer than 45 minutes. Results: Our study showed that IL-12 serum level of the pa-tients (91.69 ± 43.07 ρg/ml) and control (61.79 ± 40.08 ρg/ml) group was significantly different (p<0.001). The serum level of TNF-αRI was 2.36 ± 0.77 ng/ml in the patient and 1.73 ± 0.37 ng/ml in the control group (p<0.01). TNF-αRII serum concentration in patients was 8.89 ± 2.3 ng/ml, while that of control group was 7.06±1.30 ng/ml (p=0.03). The serum level of TNF-α in patients was 32.90 ± 19.27 ρg/ml and that of the control group was 24.27± 8.28 ρg/ml (p=0.08) with no significant difference between the two. Conclusions: It is concluded that IL-12, TNF-αRI and TNF- αRII serum con-centrations are more important and better predictive factors than TNF-α in RA course and in the active forms of the disease.     

类风湿关节炎患者血清和滑膜骨桥蛋白的测定

目的 研究骨桥蛋白(OPN)在类风湿关节炎(RA)患者外周血中的浓度变化及在滑膜的表达,探讨OPN在RA患者中的发病机制.方法 收集91例RA患者以及29名正常对照人群临床资料和血清,用酶联免疫吸附试验(ELIsA)方法检测OPN在RA患者外周血中的浓度,分析其变化和RA临床及实验室指标的关系.收集7例RA患者和1名正常对照的滑膜组织,用免疫组织化学的方法观察OPN的表达情况.结果 与正常对照组相比,活动组和非活动组的RA患者外周血中OPN水平均明显升高(p＜0.01),且与RA患者的部分临床指标有相关性:与压痛关节数(r=0.435,P=0.005)、关节的X线分期(r=-0.415,P=0.007)、关节功能(r=0.394,P=0.012)显著相关.OPN在RA滑膜组织大量表达,而在正常对照仅见OPN的少量表达.结论 OPN在RA患者外周血中浓度显著升高,且在滑膜表达明显,OPN可能与RA滑膜增生、骨侵蚀有关.     

血清抗角蛋白抗体抗环瓜氨酸肽抗体和类风湿因子在类风湿关节炎中的意义

目的 评价抗角蛋白抗体(AKA)、抗环瓜氨酸肽(CCP)抗体和类风湿因子(RF)在类风湿关节炎(RA)中的意义.方法 收集82例RA患者及56例非RA患者,测定其抗CCP抗体、AKA和RF水平,评价对RA诊断的敏感性、特异性,比较RA患者中抗CCP抗体、AKA阳性组和阴性组的压痛关节数、肿胀关节数、红细胞沉降率(ESR)、C反应蛋白(CRP)、疾病活动指数(DAS)、Ritchie's指数(RAI).结果 单独检测AKA、抗CCP抗体、RF及联合检测的曲线下面积都较高(P<0.05).抗CCP抗体、AKA的特异度分别为92.9%、91.1%,联合检测AKA、抗CCP抗体和RF有任何一种及以上阳性的灵敏度最高,为95.1%.抗CCP抗体阳性组与阴性组的关节肿胀数、关节压痛数、ESR、CRP、DAS、RAI差异有统计学意义(P<0.05);AKA阳性组与阴性组的关节肿胀数、ESR、DSA差异均有统计学意义(P<0.05).结论 联合检测抗CCP抗体、RF、AKA对诊断RA有意义,抗CCP抗体、AKA可能与RA的活动度相关.     

Vascular endothelial growth factor levels in the serum and synovial fluid of patients with rheumatoid arthritis.

OBJECTIVE: To determine the vascular endothelial growth factor (VEGF) concentrations in serum and synovial fluid (SF) from patients with rheumatoid arthritis (RA) and to search for relationships between VEGF levels and clinical and laboratory variables. METHODS: We measured VEGF levels using an enzyme-linked immunosorbent assay. Serum samples were obtained from 99 RA patients, 49 osteoarthritis (OA) patients, and 80 normal controls. Paired samples of serum and SF were collected from 32 patients with RA and 15 with OA. RESULTS: The mean serum VEGF concentration was 590.1 pg/ml for RA patients, 286.7 pg/ml for OA patients, and 265.8 pg/ml in controls. The serum VEGF concentration was significantly higher in the RA patients than in the OA patients or the controls (both p < 0.001). Furthermore, the VEGF levels in SF from RA patients were significantly higher than in SF from OA patients (p = 0.017). However, there was no correlation between VEGF levels in serum and SF from the same RA patients. The serum VEGF concentration was correlated with the ESR, serum CRP concentration, serum rheumatoid factor, number of tender and swollen joints, Modified Health Assessment Questionnaire, and patient and physician global assessments of disease activity in RA patients. CONCLUSION: These results suggest that VEGF level is related to RA disease activity, suggesting that VEGF may play some role in the pathogenesis of RA.     

High serum and synovial fluid granulocyte colony stimulating factor (G-CSF) concentrations in patients with rheumatoid arthritis

OBJECTIVE: To determine the relationship between serum G-CSF, RA disease activity and the levels of inflammatory cytokines. METHODS: Sixty-one patients (5 men and 56 women; mean age; 56.1 +/- 11.4 [+/- SD] years, range, 22-70 years) who were selected at random and met the American College of Rheumatology criteria for RA were examined. Granulocyte-colony stimulating factor (G-CSF) levels in sera and synovial fluid were measured by solid-phase radioimmunoassay (RIA). We also measured various indices of RA disease activity and serum levels of IL-1 beta, IL-6 and TNF-alpha by ELISA. RESULTS: The morning stiffness, number of tender or swollen joints, ESR, Lansbury index and serum G-CSF levels in patients with active RA were significantly higher than the corresponding levels in patients with inactive RA. Serum G-CSF levels correlated significantly with morning stiffness, the number of tender or swollen joints and the Lansbury index. However, there was no correlation between serum G-CSF and ESR. High levels of IL-1 beta, IL-6 and TNF-alpha were detected in RA patients. The number of tender or swollen joints, ESR, Lansbury index, and IL-1 beta were significantly higher in G-CSF-positive RA patients than in G-CSF-negative RA patients. CONCLUSION: Our results suggest that G-CSF produced by synovial cells stimulated by inflammatory cytokines might contribute to inflammatory arthritis in RA patients.     

Clinical effects of actarit in rheumatoid arthritis: improvement of early disease activity mediated by reduction of serum concentrations of nitric oxide

OBJECTIVE: We previously reported the presence of high serum concentrations of nitric oxide (NO) in patients with rheumatoid arthritis (RA). In this study we evaluated the effect of actarit on patients with early and advanced stages of RA and the relationship between RA activity and serum NO levels. METHODS: Thirty-seven RA patients who were undergoing care at Sasebo Chuo Hospital were entered into the study. Patients were divided into two groups based on the severity of their disease: group I (stages I and II) and group II (stages III and IV). NO concentrations in serum samples were measured by the chemiluminescence method. RESULTS: Morning stiffness, the number of tender and swollen joints, grip strength, pain score, modified Health Assessment Questionnaire score (mHAQ), ESR, CRP and the Lansbury index significantly improved during 24 weeks of treatment in group I. Patients in group II did not show improvement in morning stiffness, pain score, ESR or CRP during treatment. The concentrations of NO in group I were significantly reduced at 8 weeks after administration of actarit. Those in group II showed a delayed response; a significant decrease in NO occurred at 20 weeks. The improvement in the number of tender and swollen joints, grip strength, pain score, mHAQ and Lansbury index noted in group I preceded the fall in NO concentrations. CONCLUSION: Our results demonstrate that actarit improves disease activity in early phase RA by suppressing serum NO levels. The results suggest that NO is a useful marker for monitoring improvement in the early stages of RA.     

Evaluation of rheumatoid arthritis and connective tissue disease-related interstitial lung disease with pulmonary physiologic test,HRCT, and patient-based measures of dyspnea and functional disability

Objectives

We aim to investigate the relationship between pulmonary function and imaging parameters with symptom-related patient-reported outcome measures (PROs).

Method

We included 65 patients of rheumatoid arthritis (RA) and connective tissue disease (CTD) with and without interstitial lung disease (ILD) into this cross-sectional study. We evaluated the relationship between FVC, DLco, and PROs and compared to HRCT findings. PROs included visual analogue scale for breathing, modified Borg scale, medical research council dyspnea scale, St. George’s respiratory questionnaire (SGRQ), Leicester cough questionnaire, and Short Form 36 quality of life (SF-36 QoL).

Results

The mean age was 57.4 ± 9.7 and 61.9% (39/65) of patients had an established ILD. In RA-ILD group, SGRQ score was higher (p < 0.001) and SF-36 physical functioning score was lower (p = 0.02) than CTD-ILD group. In RA group, there was a significant correlation between FVC and SF-36 role functioning/physical score (r = 0.724, p = 0.012). In CTD group, SF-36 general health score was correlated with both FVC (r = 0.441, p = 0.045) and DLco (r = 0.485, p = 0.035), and also SF-36 physical functioning score was correlated with FVC (r = 0.441, p = 0.040). PROs were found to be similar between ILD and non-ILD patients. SF-36 QoL total and SGRQ outcomes were worse in non-ILD group.

Conclusions

We concluded that PROs could be used to evaluate health-related quality of life (HRQoL) in RA- or CTD-related ILD. The physical health determinants of HRQoL are measurably worse in RA-ILD patients than in CTD patients. But, PROs may not be very helpful in differentiating patients with cough and/or shortness of breath due to ILD or non-ILD causes in RA/CTD.

Key points

? HRQoL may be affected differently among specific subtypes of ILD.

? PROs can be used to evaluate dyspnea and function of patients with RA- or CTD-related ILD but are not distinguished from patients with cough and/or shortness of breath due to non-ILD causes in RA/CTD.

     

Most patients receiving routine care for rheumatoid arthritis in 2001 did not meet inclusion criteria for most recent clinical trials or american college of rheumatology criteria for remission

OBJECTIVE: To determine the proportion of 2 cohorts of patients with rheumatoid arthritis (RA) in Nashville, Tennessee, who met 4 common criteria for inclusion in clinical trials: > or = 6 swollen joints, > or = 6 tender joints, erythrocyte sedimentation rate > or = 28 mm/h, and/or morning stiffness > or = 45 min. METHODS: Two cohorts of patients with RA, all of whom had met American Rheumatism Association (ARA) [now American College of Rheumatology (ACR)] criteria for RA at some time, were studied. Cohort L (late) included 146 consecutive patients whose mean disease duration was 14.0 years and who had been under care at a weekly academic rheumatology clinic for a mean of 6.2 years when seen in 1998-2001. Cohort E (early) included 232 patients of 5 private practice rheumatologists whose symptoms began in 1998 or later and whose mean disease duration was 1.8 years when seen in 2001. Patients were reviewed for the 4 inclusion criteria as well as 6 ARA remission criteria. RESULTS: In Cohort L, on a 28 joint count, 42.5% of patients had > or = 6 swollen joints, 25.3% had > or = 6 tender joints, 19.9% had both > or = 6 swollen and > or = 6 tender joints, 25.0% had ESR > or = 28, and 45.9% had morning stiffness > or = 45 min. In Cohort E, on a 42 joint count, 63.4% of patients had > or = 6 swollen joints, 50.4% had > or = 6 tender joints, 38.8% had both > or = 6 swollen and > or = 6 tender joints, 49.3% had ESR > or = 28, and 50.9% had morning stiffness > or = 45 min. Overall, 15.3% of Cohort L and 34.1% of Cohort E patients had > or = 6 swollen and tender joints, as well as an ESR > or = 28 or morning stiffness > or = 45 min. Only 4.1% of Cohort L and no patient in Cohort E met ARA criteria for remission. CONCLUSION: The majority of patients seen in routine care in these 2 cohorts did not meet criteria for inclusion in most contemporary RA clinical trials, including clinical trials sponsored by pharmaceutical companies to introduce new drugs or biological agents. Few of these patients met ARA criteria for remission. Controlled trial data are not available concerning results of treatment with new biological agents or disease modifying antirheumatic drugs in a large proportion, if not a majority, of patients with RA at this time.