BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and rela...BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.展开更多
233 cases of arthralgia-syndrome were randomly divided into five treatment groupswith double blind method:1)acupuncture pills cupping;2)acupoint medicinal injection;3)acupointmedicinal injection plus laser radiation;4...233 cases of arthralgia-syndrome were randomly divided into five treatment groupswith double blind method:1)acupuncture pills cupping;2)acupoint medicinal injection;3)acupointmedicinal injection plus laser radiation;4)acupoint medicinal injection plus field effect,and 5)electroacupuncture(EA)plus cupping for observation of the therapeutic effect.The total effective ratewas 89.2％.No significant differences were found among the five groups in the total effective rate.But,the markedly effective rate was highest in the acupoint medicinal injection plus field effect group.And the therapeutic effect in patients with pain arthralgia and migratory arthralgia and shorter courseof disease was best.展开更多
More than 40 medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome treated from eliminating pathogen and strengthening vital qi were sorted out,summarized and...More than 40 medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome treated from eliminating pathogen and strengthening vital qi were sorted out,summarized and analyzed,and the theory of treating arthralgia syndrome from eliminating pathogenic factors including dampness,heat,cold,phlegm and blood stasis,and strengthening vital qi basically reflected the academic thought of treating Bi syndrome from eliminating pathogen and strengthening vital qi in traditional Chinese medicine books.展开更多
Chifu refers to the skin covering the areafrom the wrist joint to the elbow joint, about 1chi (1/3 meter) in length in adults.Acupuncture with filiform needle at certainpoints within Chifu area exhibits quitesatisfact...Chifu refers to the skin covering the areafrom the wrist joint to the elbow joint, about 1chi (1/3 meter) in length in adults.Acupuncture with filiform needle at certainpoints within Chifu area exhibits quitesatisfactory therapeutic results for treatment ofsprain and contusion of the four extremities.The following are some examples.展开更多
Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower in...Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower incidence of hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic laboratory profiles of 39 ALL children were compared with 39 age and sex-matched sJIA cases. Result: Among 39 ALL patients 89.7% were initially misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL patients had oligo-articular joint involvement. In sJIA, small joints of the hands were most commonly involved. The total WBC count was significantly higher in ALL patients (p-value 0.0065). CRP and LDH values between the two groups showed significant differences (p-value 0.00006 and 0.00001 respectively). Conclusion: The presentation of leukemia with arthralgia or arthritis makes the diagnosis difficult for the physicians. The diagnosis of sJIA must be made with caution keeping the possibility of haematological malignancy in mind.展开更多
原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为...原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为神经系统症状,中枢神经系统、周围神经系统均可累及。其中干燥综合征首发表现为视神经脊髓炎谱系疾病的情况在临床上较少见,在实际的临床诊疗过程中,询问病史、筛查抗核抗体及抗水通道蛋白4(Aquaporin Protein 4,AQP4)抗体发挥重要的作用。文章报道1例以视神经脊髓炎谱系疾病为首发表现的干燥综合征青年女性患者,该患者以下肢麻木疼痛伴瘙痒为首发表现,多次就诊于皮肤科,发病2个月后才出现干燥症状,确诊后予中西医治疗,治疗后好转,随访1年未见复发。文章通过分析此病例的临床表现、化验检查、诊治预后等,以提高对此类疾病的认识,以便对病情进行早期诊断,以免出现误诊或漏诊,并及时进行中西医联合治疗,控制病情,避免出现不可逆转的损害。同时在此过程中还应注意动态随访,减少复发,提高患者的生活质量。展开更多
文摘BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.
文摘233 cases of arthralgia-syndrome were randomly divided into five treatment groupswith double blind method:1)acupuncture pills cupping;2)acupoint medicinal injection;3)acupointmedicinal injection plus laser radiation;4)acupoint medicinal injection plus field effect,and 5)electroacupuncture(EA)plus cupping for observation of the therapeutic effect.The total effective ratewas 89.2％.No significant differences were found among the five groups in the total effective rate.But,the markedly effective rate was highest in the acupoint medicinal injection plus field effect group.And the therapeutic effect in patients with pain arthralgia and migratory arthralgia and shorter courseof disease was best.
基金"Project of Strengthening Health through Science and Education"of Wuxi Health Commission:Study on the Effect of Huli Powder on Anti-inflammation and Bone Metabolism of Hand Osteoarthritis(2016,No.ZDRCPY013)Study on the Key Technology of"Yiqi Tongluo"Therapy of Wumen for Osteoarthritis(SS201876).
文摘More than 40 medical history works and classical medical literatures about the theory and prescription of arthralgia syndrome treated from eliminating pathogen and strengthening vital qi were sorted out,summarized and analyzed,and the theory of treating arthralgia syndrome from eliminating pathogenic factors including dampness,heat,cold,phlegm and blood stasis,and strengthening vital qi basically reflected the academic thought of treating Bi syndrome from eliminating pathogen and strengthening vital qi in traditional Chinese medicine books.
文摘Chifu refers to the skin covering the areafrom the wrist joint to the elbow joint, about 1chi (1/3 meter) in length in adults.Acupuncture with filiform needle at certainpoints within Chifu area exhibits quitesatisfactory therapeutic results for treatment ofsprain and contusion of the four extremities.The following are some examples.
文摘Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower incidence of hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic laboratory profiles of 39 ALL children were compared with 39 age and sex-matched sJIA cases. Result: Among 39 ALL patients 89.7% were initially misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL patients had oligo-articular joint involvement. In sJIA, small joints of the hands were most commonly involved. The total WBC count was significantly higher in ALL patients (p-value 0.0065). CRP and LDH values between the two groups showed significant differences (p-value 0.00006 and 0.00001 respectively). Conclusion: The presentation of leukemia with arthralgia or arthritis makes the diagnosis difficult for the physicians. The diagnosis of sJIA must be made with caution keeping the possibility of haematological malignancy in mind.
文摘原发性干燥综合征是一种以外分泌腺损伤为特征的慢性炎症性自身免疫性疾病。干燥综合征起病个体差异性较大,临床症状多样,损伤严重程度各不相同。原发性干燥综合征除了导致腺体损伤外,还可能涉及多个器官和系统,其常见的临床表现之一为神经系统症状,中枢神经系统、周围神经系统均可累及。其中干燥综合征首发表现为视神经脊髓炎谱系疾病的情况在临床上较少见,在实际的临床诊疗过程中,询问病史、筛查抗核抗体及抗水通道蛋白4(Aquaporin Protein 4,AQP4)抗体发挥重要的作用。文章报道1例以视神经脊髓炎谱系疾病为首发表现的干燥综合征青年女性患者,该患者以下肢麻木疼痛伴瘙痒为首发表现,多次就诊于皮肤科,发病2个月后才出现干燥症状,确诊后予中西医治疗,治疗后好转,随访1年未见复发。文章通过分析此病例的临床表现、化验检查、诊治预后等,以提高对此类疾病的认识,以便对病情进行早期诊断,以免出现误诊或漏诊,并及时进行中西医联合治疗,控制病情,避免出现不可逆转的损害。同时在此过程中还应注意动态随访,减少复发,提高患者的生活质量。
