2023欧洲风湿病联盟关于炎性风湿病和肌肉骨骼疾病患者疲劳管理建议解读

疲劳在炎性风湿病和肌肉骨骼疾病(inflammatory rheumatic and musculoskeletal diseases,I-RMDs)患者中普遍存在,因其无形、普遍和不可预测的性质成为最具治疗挑战性的症状之一。尽管对疲劳没有统一的概念或定义,但人们认识到I-RMDs的疲劳不同于正常的疲惫感。I-RMDs患者将疲劳描述为不堪重负、困扰、痛苦和耗尽心力,且疲劳在I-RMDs疾病发作时、低活动度期和缓解阶段均可出现。

An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis

We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nudear antibody-positive, and had high serum gamma globulin and IgG4 levels. Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.

Intermediate and Late Rheumatoid Arthritis Treated by Tonifying the Kidney, Resolving Phlegm and Removing Blood Stasis

Eighty-seven cases of intermediate and late rheumatoid arthritis were treated with Instant Shu GuanWen Jing Granules(疏关温经冲剂 Relaxing Joints by Warming Channels)and Instant Shu GuanQing Luo Granules(疏光清络冲剂 Relaxing Joints by Removing Heat from the Lung Channel)totonify the kidney resolve phlegm and remove blood stasis,and compared with 41 cases treated withInstant Wang Bi Granules(尪痹冲剂 Prescription for Arthralgia-syndrome).The treatment produceda clinical cure rate of 54.0% and a total effective rate of 90.8% as in against 29.3% and 73.2%respectively in the control group.The difference was significant(P<0.01).Improvement in mainsymptoms and laboratory findings in the treatment group was all more marked than that in thecontrol group (P<0.05 or P<0.01),with no side effects observed.

Expression of CC Chemokine Ligand 5 in Patients with Rheumatoid Arthritis and Its Correlation with Disease Activity and Medication

Objective To determine the levels of CC chemokine ligand 5 (CCL5) in serum and synovial fluid (SF) from patients with rheumatoid arthritis (RA) and their relations with disease activity and medication. Methods CCL5 in serum and SF was quantified by enzyme-linked immunosorbent assay (ELISA) in 28 RA patients and 21 osteoarthritis (OA) patients. In RA patients, the correlations of CCL5 levels in serum and SF with disease activity were analyzed. Meanwhile, the serum CCL5 levels among RA patients treated with disease-modifying antirheumatic drugs (DMARDs), Tripterygium Glucosides, and other Chinese herbs without disease-modifying effects were also compared. Results CCL5 levels in both serum and SF of RA patients were significantly higher than those of OA patients (P<0.05). Moreover, the level of CCL5 was higher in SF than that in serum of RA patients (P<0.01). Serum CCL5 level was correlated significantly with the number of swollen joints (r=0.3329, P<0.05), erythrocyte sedimentation rate (r=0.4001, P<0.05), and C reactive protein (r=0.3735, P<0.01). In addition, the level of CCL5 had a trend of lower in patients treated with DMARDs or Tripterygium Glucosides than those treated with other Chinese herbs, although the difference was not significant among those patients due to the small number of patients in each group. Conclusions In RA patients, the expression of CCL5 increases and correlates with some clinical and laboratory parameters of RA, which indicate that CCL5 plays an important role in RA and may serve as a useful marker of disease activity. DMARDs and Tripterygium Glucosides might exert their clinical effects through reducing CCL5 production in RA.

THE STUDY ON AUTOIMMUNE PATHOLOGY IN OSTEOARTHRITIS

Sixteen patients with osteoarthritis (13 knees and 3 hips), 3 patients with rheumatoid arthritis (RA) and 4 cadaver were studied for evidence of immune complex in the destroyed articular cartilage tissues. Frozen sections of the articular cartilage from arthroplasty were stained with fluoresceinated antibodies to human immunoglobulins IgG, IgA, IgM and complement C3. The results showed: 1. There were immune complexes linear deposited in the surface of the irregular articular cartilage tissues and on some chondro- cytes remained in most patients with osteoarthritis (14/16). The patterns of immune complexes are IgA, complement C3, IgG and IgM, their percentage is 81. 25%, 75%, 75% and 50% respectively. 2. In all of 3 patients with RA, the surfaces of articular tissues were seen with patchy diffusely positive areas for IgA, IgG, IgM (excepting negative in I case) and complement C3. 3. There were no immune complexes deposited in the surfaces of 4 cases of normal articular tissues. The presence of immune complexes in the cartilages suggested that an autoimmune reaction participated in the pathological process of osteoarthritis and that the autoimmunity may be responsible for the continuous degeneration of the osteoarthritis.

CLINICAL OBSERVATION ON THERAPEUTIC EFFECT OF ACUPUNCTURE AT ZUSANLI FOR LEUKOPENIA

In recent years, leukopenia is clinically very common. The leukopenic patient is significantly low in immunocompetence and is likely to suffer from various kinds of infections. Zusanli (St 36), an

胃镜和结肠镜检查对风湿性疾病患者诊断和治疗的影响——一项回顾性队列研究

许多风湿性疾病本身或治疗药物会对胃肠道造成影响。此外,一些原发性消化道疾病可能导致风湿性疾病表现。为研究胃镜和结肠镜检查在炎性风湿病患者临床诊断中的作用,Schafer等开展了一项回顾性队列研究。他们收集了2年内接受了胃镜和结肠镜检查的风湿性疾病患者,总计456例（男261例,女195例）,共计752例次胃镜或结肠镜检查（419例次胃镜检查,333例次结肠镜检查）,其中152例（33.3%）没有胃肠道症状。

Four Proven Cases by Acupuncture

In late November 2006, I was honored to participate in the Advanced Class on the Inheritance of Shanghai Senior TCM Doctors＇ Academic Experience, and studied under Professor CHEN Han-ping for 3 years. Now I introduced some of my clinical experience on acupuncture as follows.