Low rates of adherence for tumor necrosis factor-α inhibitors in Crohn's disease and rheumatoid arthritis: Results of a systematic review

AIM:To investigate adherence rates in tumor necrosis factor-α (TNF-α)-inhibitors in Crohn's disease (CD) and rheumatoid arthritis (RA) by systematic review of medical literature. METHODS:A structured search of PubMed between 2001 and 2011 was conducted to identify publications that assessed treatment with TNF-α inhibitors providing data about adherence in CD and RA. Therapeutic agents of interest where adalimumab, infliximab and etanercept, since these are most commonly used for both diseases. Studies assessing only drug survival or continuation rates were excluded. Data describing adherence with TNF-α inhibitors were extracted for each selected study. Given the large variation between definitions of measurement of adherence, the definitions as used by the authors where used in our calculations. Data were tabulated and also presented descriptively. Sample size-weighted pooled proportions of patients adherent to therapy and their 95%CI were calculated.To compare adherence between infliximab, adalimumab and etanercept, the adherence rates where graphed alongside two axes. Possible determinants of adherence were extracted from the selected studies and tabulated using the presented OR. RESULTS:Three studies on CD and three on RA were identified, involving a total of 8147 patients (953 CD and 7194 RA). We identified considerable variation in the definitions and methodologies of measuring adherence between studies. The calculated overall sample size-weighted pooled proportion for adherence to TNF-α inhibitors in CD was 70% (95%CI:67%-73%) and 59% in RA (95%CI:58%-60%). In CD the adherence rate for infliximab (72%) was highercompared to adalimumab (55%), with a relative risk of 1.61 (95%CI:1.27-2.03), whereas in RA adherence for adalimumab (67%) was higher compared to both infliximab (48%) and etanercept (59%), with a relative risk of 1.41 (95%CI:1.3-1.52) and 1.13 (95%CI:1.10-1.18) respectively. In comparative studies in RA adherence to infliximab was better than etanercept and etanercept did better than adalimumab. In three studies, the most consistent factor associated with lower adherence was female gender. Results for age, immunomodulator use and prior TNF-α inhibitors use were conflicting. CONCLUSION:One-third of both CD and RA patients treated with TNF-α inhibitors are non-adherent. Female gender was consistently identified as a negative determinant of adherence.

Preparation and analysis of active rat model of rheumatoid arthritis with features of TCM toxic heat-stasis painful obstruction

Objective:To establish a collagen type II-induced rat model of rheumatoid arthritis(RA)presenting characteristics of the human form of the traditional Chinese syndrome pattern of toxic heat-stasis painful obstruction(bi zheng;arthromyodynia)as well as pathologic features of active RA.The Chinese herbal medicine Tengmei decoction was used to validate the animal model.Methods:Ninety specific pathogen free Sprague-Dawley rats were randomly divided into a normal group of 6 rats and a model group of 84 rats.To establish the rat model of collageninduced arthritis(CIA),bovine type II collagen in complete Freund’s adjuvant was injected into the model group rats as a priming dose(Day 0)and boosting dose(Day 9).Changes in arthritic index(AI)scores,including limb swelling,were monitored.Thereafter,24 successfullyestablished CIA rats were randomly assigned to 4 groups with 6 animals each:model,positive control drug,high-dose traditional Chinese herbal medicine,and traditional Chinese herbal medicine.A blank control group of 6 rats was included.After 12 weeks of intervention with Tengmei decoction,articular synovial tissue and serum specimens were collected to detect interleukin-2(IL-2)and IL-17 transcription and protein expression levels.

The petroleum ether fraction of Celastrus paniculatus Willd. seeds demonstrates antiarthritic effect in adjuvant-induced arthritis in rats

Objective:Celastrus paniculatus(CP)Willd.is a plant indigenous to India with medicinal properties.It is used in the ayurvedic treatment of inflammatory ailments such as rheumatoid arthritis.The present study was designed to investigate the therapeutic efficacy of the petroleum ether fraction(PCP)obtained from CP seeds on adjuvant-induced arthritis in rats.Methods:Arthritis was induced in SpragueeDawley rats by immunization with Freund’s complete adjuvant(FCA).Arthritis severity was evaluated by arthritis score,paw volume,tibiotarsal joint thickness,body weight,dorsal flexion pain,motility test,stair climbing ability and index of thymus and spleen.Moreover,histopathology of knee joints supported by haematological analysis was used to assess the anti-arthritic action of PCP.The levels of superoxide dismutase(SOD),glutathione(GSH),catalase(CAT),nitric oxide(NO)and malondialdehyde(MDA)in liver were also assessed.Serum samples were collected for estimation of aspartate transaminase(AST),alanine transaminase(ALT)and alkaline phosphatase(ALP).In addition,cytokines such as tumour necrosis factor-alpha(TNF-a)and interleukin-6(IL-6)were estimated in plasma.Results:PCP significantly alleviated arthritic progression with regards to paw swelling,arthritic score,immune organ indices,hyperalgesic effect and body weight.This phenomenon was correlated with significant suppression of overproduction of inflammatory cytokines(TNFa and IL-6),oxidant stress markers(MDA and NO)and cellular enzyme(AST,ALT and ALP)levels versus arthritic rats without treatment.Moreover,PCP restored the decreased levels of SOD,CAT and GSH.Conclusion:Our results suggest that the anti-arthritic properties of PCP may be due to immunosuppressive effects,cytokine regulation,antioxidant effects and bone-protective activities.

Relief of osteoarthritis with a herbal-amino acid supplement: A randomized double-blind placebo controlled trial

A redox active medicinal plant and L-leucine mixture (HLM) was investigated in subjects with established osteoarthritis of the knee in a multi-center, rando- m-ized, placebo-controlled, double-blind clinical trial. A total of 96 subjects with osteoarthritis were enrolled and randomized to either placebo (n = 38) or HLM treatment group (n = 38). The HLM group re- ceived a combination of Uncaria tomentosa (300 mg), Boswellia serrata (200 mg), Lepidium meyenii (1000 mg) and L-Leucine (700 mg) given as 3 capsules once a day. The placebo group received matching capsules with carboxymethylcellulose. The treatment period was 8 weeks, with assessments made at days 7, 14, 28 and 56. The primary outcome was reduction in total WOMAC score. VAS pain, tolerability, investigator assessments, use of rescue medication (acetominophen), and safety assessments of vital signs and laboratory assessments were included. Subject randomization was effective for age, gender and disease severity. In the placebo group 32/38 subjects completed the trial and for HLM 35/38. WOMAC scores (pain, stiffness, physical performance and total) steadily declined over the course of the 8 week study in both groups, but the magnitude was significantly greater for HLM (P < 0.05). Total WOMAC was reduced 46.5% for HLM and 25.4 % for placebo. VAS pain was reduced 21.8% in the placebo group (p < 0.002) but the changes were significantly greater (37.8% p < 0.03) with HLM treatment. Investigator’s global assessment rating of good-excellent was 24/35 (69%) for HLM and 14/32 (44%) for placebo (P = 0.05). Rescue medication consumption and tolerability were comparable for HLM and placebo. No safety issues were evident with either group. As expected a placebo effect was observed, nevertheless HLM was clearly more effective in relieving the symptoms of osteoarthritis. This HLM represents a safe and effective new approach to the management of osteoarthritis symptoms.

Anti-arthritic effect of Distemonanthus benthamianus extracts against rheumatoid arthritis in rats

Objective:To evaluate the anti-arthritic effect of aqueous and methanolic extracts of Distemonanthus benthamianus.Methods:Monoarthritis was induced by an injection of 0.3 mL zymosan A(0.9%NaCl,v/v)in the right posterior knee joints of rats.Then,joint diameter and pain threshold were determined.Polyarthritis was induced by an intracaudal injection of complete Freund’s adjuvant and rats were treated from day 14 post 1st complete Freund’s adjuvant injection until 28 day.The clinical,hematological,biochemical and oxidative stress parameters were evaluated.In addition,histological analysis of the knee joint was perfomed in both tests.Results:The aqueous and methanolic extracts of Distemonanthus benthamianus at a dose of 500 mg/kg ameliorated zymosan A-induced monoarthritis,as evidenced by reduced joint diameter,increased pain threshold,as well as improved joint architecture.In addition,both extracts of Distemonanthus benthamianus markedly increased body weight and pain threshold,while reducing paw edema in polyarthritic rats.They also led to a marked decrease in platelets and white blood cells(P<0.05),as well as a significant increase in red blood cells,hemoglobin and hematocrit(P<0.05).The aqueous and methanolic extracts of Distemonanthus benthamianus significantly reduced alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase activities,while increasing serum protein levels(P<0.05)with no significant variation in creatinine level.Moreover,both extracts increased catalase and glutathione activities(P<0.05),and inhibited malondialdehyde and nitric oxide production(P<0.01 and P<0.001)in the liver and kidneys.Histological analysis of the joints showed that both extracts triggered tissue reparation.Conclusions:Distemonanthus benthamianus could be used as a potential candidate in the treatment of rheumatoid arthritis.

Unusual Presenting Syndrome of Rheumatoid Arthritis Exacerbation

We herewith report the rare case of a patient with juvenile rheumatoid arthritis who developed on 2 occasions the clinical picture of an isolated unilateral palsy of the inferior oblique muscle—Brown’s syndrome, following pregnancies, each time in a different eye. Although the eye is frequently involved in rheumatoid arthritis (RA), the Brown’s syndrome is seldom reported in literature with regards to RA.

Assessment of Knowledge and Attitude in a Sample of Patients with Rheumatoid Arthritis and Its Association with Disease Activity and Severity: A Cross-Sectional Study

Background: Rheumatoid arthritis (RA) is a chronic and disabling disease that has a major impact on the lives of patients. Objectives: To test the patients’ knowledge about their disease, its treatment, its complications, and if this affects severity of the disease as measured by the disease activity index (DAS 28). Patients and Methods: A sample of 100 patients with RA who met the Criteria of American College of Rheumatology for RA agreed to participate in this study over the period September 2011-March 2012. Patients’ data were obtained by personal interview. The questionnaire included demographic characteristics and the patients’ knowledge about their disease. The disease activity was measured using standard (DAS28). Results: Thirty three percent of the patients didn’t have an idea about their disease, 20% didn’t know the reason for the investigations, 49% didn’t know the treatment and 40% didn’t know the side effects of their medications. Most patients had a high disease activity index, and there was a poor correlation between patients’ educational level and the disease activity. Conclusions: Neither the educational level nor the frequency of hospital admissions had effects on the knowledge about this disease. As most patients had a high disease activity, a better knowledge may improve disease control and prevent complications.

Biophoton Imaging Evaluation of the Process of Rheumatoid Arthritis in Rats

Rheumatoid arthritis (RA) is a common form of chronic inflammatory arthritis, and it mainly causes the destruction of small joints. The development of this disease is a relatively secret and repeated process, and therefore early diagnosis and evaluation of the disease is usually difficult. In this study, an arthritis model was successfully induced by injecting complete Freund’s adjuvant (CFA) into the toes of lower limbs of Wistar rats. Seven days after injection of CFA, obvious redness and swelling appeared at the toe joints of lower limbs accompanied by more sensitivity to thermal stimulation. Using the ultraweak bio-photon imaging system (UBIS) established by us, the toe joint area of the lower limbs of rats was imaged 7 days after injection of CFA. It was found that the volar part of lower limbs of arthritis rats showed significantly higher biophoton emissions compared with the control group. The results of this study may provide a basis for further research and devel-opment of early diagnosis and assessment of lesion progression of rheumatoid arthritis.

Undifferentiated Arthritis Revealing Cogan’s Disease

Background: Cogan’s syndrome is a rare autoimmune vasculitis (less than 300 cases described in the literature) characterized in its typical form by cochleovestibular involvement, interstitial keratitis, and an inflammatory involvement of large vessels. It is frequently accompanied by general signs and cardio-vascular, rheumatologic, and digestive complications. Its management is essentially based on the use of corticosteroids and immunosuppressants. The outcome of the treatment, even if rapid, does not always avoid functional complications. This disease is probably under-diagnosed in Africa. Objective: The objective of this study was to report a case of Cogan syndrome in sub-Saharan Africa. Case report: A 78 year old black African female patient presented with arthritis of the left knee without fever. The examination also revealed a bilateral deafness of rapidly progressive onset. The patient was known to be diabetic and hypertensive, and was regularly monitored. The biology revealed an inflammatory syndrome and an inflammatory joint puncture fluid. Pure tone audiometry confirmed a 77% hearing loss. The ophthalmological examination revealed stromal oedema and hypertensive retinopathy of Kendall stage III. The rheumatological evolution was good under methylprednisolone and methotrexate, but the deafness persisted. The occurrence of a fever on day 12 of treatment required further investigations (blood culture, PCR-Covid 19 test, cytobacteriological examination of sputum, thoracic CT). The evolution was unfavourable with the death of the patient. Conclusion: Cogan’s disease is a rare inflammatory disease. Its diagnosis and management are multidisciplinary. The treatment can be disappointing.

Ocular Manifestations in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of this autoimmune disease vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Their appearance, as well as their severity are related to RA chronicity and resistance to therapy. The treatment consists of corticosteroids, NSAIDs and cytotoxic drugs, depending on the type of ocular manifestations and the patient’s response to treatment.

Immunologic effect of tiger's urine on patients of rheumatoid arthritis

Objective To study immunologic mechanism of tiger＇ s urine on patients of rheumatoid arthritis.Method We used ELISA method to detect TNF values of serum;we also used MTT colorimetric method to detect the inhibition of tiger＇ s urine on T -cell.Result TNF values of RA patient ＇ s serums at both active stage and stat ionary phase before the therapy were higher than those of healthy group;T NF values of patient ＇ s serums after the therapy were lower than those before the therapy;tiger＇ s urine had obvious inhibitive actio n on proliferation of peripheral blood＇ s T -cell.Conclusion Tiger＇ s urine could inhibit T -cell＇ s proliferation and TNF＇ s secretion,which may be the im-portant mechanism of curing RA.

头臂型Takayasu’s动脉炎:评价多层螺旋CTA诊断价值

目的分析头臂型Takayasu’s动脉炎弓上分支及颈动脉多层螺旋cT血管成像（MDCTA）表现，探讨MDCTA在头臂型大动脉炎诊断中的价值。资料与方法临床已确诊头臂型Takayasu’s动脉炎21例，行MDC．TA，范围从主动脉弓到颅底颈动脉，注射流率4ml／s，有效层厚为1．3mm，获得的容积数据采用最大密度投影重组。将头臂型Takayasu’s动脉炎弓上分支及颈动脉分段评价，采用NASCET标准判断颈动脉的狭窄程度。结果21例大动脉炎中，左侧弓上分支及颈动脉段正常或轻度狭窄31段，中度狭窄32段，重度狭窄45段，闭塞16段，瘤样扩张2段。累及右侧依次为60，26，29，8，3段。弓上分支及颈动脉近心段病变发病率为57．1％，中远段为61．9％。动脉管壁厚度为1．2—4．1mm，平均3．2mm。其他征象包括管壁模糊47段，管壁环状强化35段，管壁不均匀强化23段，双环征12段。结论头臂型Takayasu’s动脉炎弓上分支及颈动脉狭窄比闭塞多见，闭塞比动脉瘤样扩张多见。其中，左侧颈总动脉受累的概率高于右侧，狭窄程度重于右侧。原始横断面图像可显示大动脉炎特有的管壁改变，准确显示病变范围以及判断病变是否活动。

Crohn's disease and Takayasu's arteritis: An uncommon association

Takayasu’s arteritis(TA)and Crohn’s disease(CD)are two rare autoimmune disorders;however some reports describe the presence of both diseases in the same patient.This finding has suggested the possibility that both diseases could share some common etiologic origin.We describe a case of a 13-year-old male affected by CD characterized by fever,diarrhea,weight loss,abdominal pain and elevation of inflammatory markers.Clinical and histological features from colonic specimens were consistent with CD.Treatment with steroids and azathioprine was started,however disease flared every time steroids were tapered.One year later,while still on treatment,he came back to our attention for dyspnea at rest and at night,tiredness and weakness.At physical examination a diastolic heart murmur was found as well as a left carotid artery bruit.A transthoracic echocardiography showed mild aortic valve insufficiency,left ventricular hypertrophy and a dilated ascending aorta with same findings at the aortic arch.A computed tomography scan showed abdominal aortathickening,dilated thoracic aorta and the presence of a thoracic aortic aneurysm.TA associated with CD was diagnosed and medical treatment with cyclophosphamide,steroids and aminosalicylic acid was started,with good clinical response at 6 mo follow-up.We discuss the presence of possible common causes for the two diseases and the importance of differential diagnosis in those patients characterized for intractable disease.

Clinical features of aortic dissection associated with Takayasu＇s arteritis

Takayasu＇s arteritis （TA） is a chronic and nonspecific in- flammatory vessel disease that involves the aorta and its major branches. TA results in stenosis, occlusion or aneu- rysmal degeneration of large arteries pathologically. Al- though TA is an unusual disease, it is more commonly ob- served to occur in Asian females compared to the general population worldwide. Aortic dissection is a very rare com- plication of TA, and only a limited number of TA cases presenting with aortic dissection have been published so far.

Takayasu's arteritis following Crohn's disease in a young woman:Any evidence for a common pathogenesis?

Takayasu's arteritis and Crohn's disease are chronic in-flammatory diseases of uncertain aetiology. They rarely occur together, with only twenty nine cases of co-ex-istent Takayasu's arteritis and Crohn's disease reported in the literature. In 88% of these cases, Takayasu's arteritis was diagnosed simultaneously or following a diagnosis of Crohn's disease. We present a case of a young Caucasian medical student, incidentally found to have bilateral carotid bruits on auscultation by a colleague. Magnetic resonance angiography revealed stenoses of the common carotid arteries with estab-lished collaterals, and a diagnosis of Type 1 Takayasu's arteritis was made. An 18F-fluorodeoxyglucose positron emission tomography scan revealed no active disease. Nine months later, she presented with a short history of abdominal pain, vomiting and abdominal disten-sion. Barium follow-through and computer tomography revealed a terminal ileal stricture and proximal small bowel dilation. An extended right hemicoloectomy was performed and histopathology supported a diagnosis of Crohn's disease. This case report is presented with a particular focus on the temporal relationship between these two disease processes and explores whether their concurrence is more than just co-incidence.

Successful Management of Takayasu’s Arteritis with Pulmonary Hypertension in Pregnancy: A Rare Case

Introduction: Takayasu’s arteritis (TA) is a rare systemic, chronic inflam-matory, progressive, idiopathic disease of aorta and its main branches. Taka-yasu’s arteritis causes narrowing, occlusion and aneurysm of arteries. The eti-ology of TA is still unknown. It may be autoimmune or genetic in origin or infective diseases. It is commonly found in Asia and oriental countries. Worldwide annual incidence is 1.2 - 2.6 cases/million. Women are affected in 80% - 90% of cases with age of onset below 40 years. TA does not worsen or improve with pregnancy but has adverse effect on pregnancy in the form of abortion, Intrauterine fetal death, superimposed preeclampsia, Intrauterine growth restriction, abruption and congestive heart failure. Because the disease is common in women of childbearing age, management of pregnancy in these patients becomes important;however optimal management for pregnant pa-tients with this disease has not yet been established. Due to the manifold car-diovascular complications that can occur in the course of the disease, man-agement of pregnancies in TA patients is a challenge for the clinician. An in-terdisciplinary collaboration of obstetrician, rheumatologist, cardiologist and anaesthetist is necessary to improve maternal and fetal prognosis. This was the first reported case of TA in pregnancy in Hasan Sadikin Hospital with superimposed preeclampsia and pulmonary hypertension. Materials and Methods: The patient, G1P0A0 was diagnosed as TA since one year ago, and when the patient was pregnant, the patient routinely came to obstetric and rheumatology clinics. Angiographic examination showed dilatation of aorta ascendant, narrowing of aorta descendent at 8 thoracal vertebrae, and arcus aorta, abdominal aorta and the branches were without abnormalities that lead to type IIb TA. On physical examination blood pressure was 200/100 mmHg on the right arm, and 140/100 mm Hg on the left arm, right hand pulse 120 x/m, left hand pulse 113 x/m, respiration rate 20 x/m, temperature 36°C. Laboratory values showed Elevated C-reactive protein 6.8 Mg/dl, anemia hemoglobin 10.5 g/dL, elevated rate of sedimentation of blood 36 mm/hours, and proteinuria + 2. The results of other examinations: Glucose, Ureum, Creatinine, GOT, GPT and electrolytes were in normal limits. Thoracal examination/rontgen showed revealed cardiomegaly. Echocardiogram at 20 - 21 weeks gestational age showed an ejection fraction of 55%, hypertensive heart disease and pulmonal hypertension. The ultrasound examination at 36 - 37 weeks’ gestation showed a 2066 g estimated weight (IUGR simetris). Doppler of the umbilical artery showed a resistance index (RI) of 0.49, pulsatility index (PI) 0.70 with a positive end diastolic flow (EDF). Doppler of the median cerebry media artery showed a resistance index (RI) of 0.72, pulsatility index (PI) 1.26. Amniotic Fluid Index 11, 43 cm, Placenta anterior. The pregnancy was controlled tightly in our clinic. During pregnancy in the first trimester, the patient got methylprednisolone 1 × 4 mg, Azathioprin 1 × 50 mg, folic acid 1 × 1 mg. Additional therapy at second trimester were calcium 1000 mg, multivitamin 1 x/day, methyldopa 3 × 250 mg and Acetylsalicylic acid 1 × 80 mg. She was scheduled for a cesarean section at 37 - 38 weeks of pregnancy. Results: According to the American College of Rheumatology (ACR) 1990, our patient fulfilled 4 of 6 TA criteria: age Conclusions: The management of TA in pregnancy is still a challenge. A multidisciplinary team involving obstetrician, cardiologist, rheumatologist and anaesthetist is absolutely needed to get an optimal development of the pregnancy. The risk of complication on the mother and fetus might occur any time. Adequately controlled blood pressure and fetal monitoring might result for better outcome. Birth delivery (pervaginam or perabdominal) is still a problem according to obstetrical condition, general condition of the mother and other additional factors. Careful assessment, treatment of TA complication, and regular antenatal follow-up improve maternal and fetal outcome.

Mycobacterium tuberculosis in the aorta of a patient with takayasu’s arteritis. extra pulmonary tuberculosis

Takayasu’s arteritis (TA), of unknown etiology, has been related with Mycobacterium tuberculosis infection. The published cases are controversial. A 29- year-old man died, prolapse of the aortic valve and unspecific arteritis were demonstrated at necropsy. Our objective was to search in the fresh aortic tissues, the infectious agent of tuberculosis through culture, as well as by performing histopathology and searching by the molecular study, sequences of genes associated to micobacteria and Ziehl’s stain. Results. The bacillus of tuberculosis was observed by the Ziehl’s stain and the sequences of insertion IS6110 gene were identified. Our findings support the relation of TA with possible tuberculosis infection.Conclusion. The possibility that Takayasu’s arteritis is an extra pulmonary tu-berculosis must be explored.

Large Vessel Vasculitis in a Patient with Systemic Lupus Erythematosus Presenting as Takayasu’s Pulseless Arteritis

Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic stroke meeting the criteria for the diagnosis of SLE and findings consistent with an aortitis on imaging but mimicking the diagnosis of Takayasu’s pulseless arteritis. Blood and imaging investigations revealed the finding of SLE aortitis following an acute stroke presentation. Thus, it is imperative to note that even though it is infrequent, SLE can be associated with a large vessel vasculitis.

EFFECT OF ELECTROACUPUNCTURE ON THE IMMUNOREACTIVITY OF FOCAL CUTANEOUS μ-OPIOID RECEPTOR IMMUNOREACTION-POSITIVE FIBERS IN ADJUVANT ARTHRITIC RATS

Objective：To study the effect of μ-opioid receptor （MOR） expression in the inflammatory skin tissue and the effect of electroacupuncture （EA） on the topical immunoreaction （IR） of MOR positive fibers in adjuvant arthritic （AA） rats. Methods： A total of 48 SD rats were randomized into control （n = 8）, model （n = 10）, focus-side-EA （n = 10）, non-acupoint-EA （n = 10）, and healthy-side-EA （ n = 10） groups. AA model was established by subcutaneous injection of complete Freund＇s adjuvant （CFA, 50 μL） into the left hind paw. EA （4-16 Hz, 0.5-1.5 V） was applied to “Huantiao” （环跳 GB 30） and“Yanglingquan” （阳陵泉 GB 34） on the focus or healthy side and non-acupoints for 30 min. Non-acupoints used were the two sites 5 mm to GB 30 and GB 34 on the healthy side. The topical MOR IR-positive fibers in the dermal and subcutaneous tissues of the focus was stained with immunohistochemical method. The severity of pain was detected by foot （anklejoint）-bending test. Results： Compared with model group, the “foot-bending test” score decreased significantly in focus-side-EA group on the 9^th and 11^th day （P〈 0.05） and in non-acupoint-EA group on the 8^th, 9^th and 11thd after injection of CFA （P 〈 0.05）, indicating that EA of bilateral GB 30 and GB 34 and non-acupoints all can relieve pain. From the 13^th day on, no significant differences were found in “foot-bending test” scores among the 3 EA groups and model group （P 〉0.05）. In comparison with control group, the area values of MOR IR-positive nerve fibers in the focus tissue were significantly higher in 3 EA groups （P 〈 0.05）. The area values of MOR IR-positive nerve fibers in the focus in model group and 3 EA groups were significant higher than that in control group （P〈 0.05）. Compared with model group, the area values of MOR IR-positive fibers in focus-side-EA group and healthy-side-EA group increased significantly （P 〈 0.05）; while those of MOR IR-positive fibers in non-acupoint-EA group and healthy-side-EA group were significantly lower than that in focus-side-EA group （ P 〈 0.05 ）, and no significant differences were found among model group, healthy-side-EA group and non-acupoint-EA group in the area of MOR IR-positive fibers （P 〉0.05）, indicating a stronger effect of EA of acupoints on the focus side. Conclusion： EA of GB 30 and GB 34 can relieve inflammatory pain and up-regulate the expression of MOR IR-positive fibers in the focal skin tissues in AA rats, exerting anti-inflammatory and analgesic effects.

Syphilitic Aortitis Mimicking Takayasu’s Arteritis

SIR, Syphilis is a sexually-transmitted infectious disease caused by the bacteria Treponemapallidum. A characteristic manifestation of the third stage is arteritis of the aorta, which leads to necrosis and loss of tissue. Here, we report on a 48-year-old woman admitted with suspected Takayasu’s arteritis (TA) due to localized inflammation confined to the aortic root and valve, which could be diagnosed as syphilitic aortitis.