Tocilizumab Significantly Decreases Reactive Oxygen Species Level in Patients with Rheumatoid Arthritis

To determine the effect of tocilizumab (TCZ) on reactive oxygen species (ROS) in 11 patients with rheumatoid arthritis (RA), reactive oxygen metabolites (d-ROM) were measured using a Free Radical Elective Evaluator. The Disease Activity Score (DAS28) and matrix metalloproteinase-3 (MMP-3) level were also evaluated. d-ROM measured 392 ± 110 Carratelli units [U. CARR] on initiation of TCZ, and significantly decreased to 237 ± 82, 248 ± 88, and 226 ± 91 U.CARR after 3, 6, and 12 months, respectively

Increased BAFF in serum is a novel biomarker related to disease activity in rheumatoid arthritis

OBJECTIVE To investigate the contribution of B cell activating factor of TNF family(BAFF)in the proliferation and activation of B cell in rheumatoid arthritis(RA),and to clarify whether high levels of BAFF is associated with clinical variables and lab parameters.METHODS Blood samples and peripheral blood mononuclear cells from RA patients and healthy controls(HCs)were collected and isolated respectively.Clinical variables and lab parameters,BAFF level,cytokines and immunoglobulins in serum were evaluated at entry.B cell subpopulations,BAFF receptors(BAFFR,BCMA,TACI),and alternative and canonical NF-κB pathway in B cell were analyzed in vivo and in vitro.RESULTS In RA patients,BAFF level and activated B cell subsets increased significantly.BAFF level was associated with CRP,RF,DAS28,swollen joint counts and tender joint counts.BAFFR,BCMA,TACI on B cells in RA over expressed.The expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52 were higher than that in HCs.In vitro,BAFF up regulated activated B cell subset and the expressions of BAFFR,BCMA and TACI.BAFF also enhanced the expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52.CONCLUSION Increased BAFF in serum is associated with the disease activity of RA,BAFF involves in the proliferation and activation of B cell in RA through alternative and canonical NF-κB pathway,indicating that BAFF might be a novel biomarker of diagnosis and therapy.

Prevalence and Incidence of Metabolic Syndrome in a Cohort of Patients with Rheumatoid Arthritis: A Correlation between Body Mass Index and Disease Activity

Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016;187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years;disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.

The Influence of Health Qigong on the Subjectively Expressed Psychophysical State of Patients with Rheumatoid Arthritis,Rheum,Osteoporosis,Osteopenia

This study assesses the impact of exercise on the health of the Qigong(Jibengong,Health Qigong Ba Duan Jin and Health Qigong Yi Jin Jing)in patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia.Through the given questionnaire we have come up with data showing how and how much health qigong affects the patients with rheumatoid arthritis,rheumatism,osteoporosis,osteopenia according to the subjective assessment.

Efficacy of MRP8/14 as a Marker of Disease Activity in Rheumatoid Arthritis

Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as calprotectin or S100A8/A9 is considered as a sensitive marker for local inflammatory activity in rheumatoid arthritis. The aim of this study is to demonstrate the efficacy of MRP8/14 as a marker of disease activity in RA. Methods: Thirty-one patients with diagnosis of RA who received treatment without biological drugs at our institution were included in this study. Serum MRP8/14, CRP and MMP-3 were tested in all patients. Disease activity was evaluated using DAS28-CRP and SDAI. Ultrasonography was performed on the wrists and MCP joints of both hands using semi-quantitative scale of power Doppler signal. The sum of scales in joints was calculated as the PD score. The correlation of MRP8/14 with serum biomarkers, disease activity and ultrasonography examination was investigated. Result: Serum MRP8/14 was strongly correlated with CRP (r = 0.63) and MMP-3 (r = 0.69). A correlation was observed between serum MRP8/14 and DAS28-CRP (r = 0.53) and SDAI (r = 0.66). No significant correlation was found between PD scores and MRP8/14. Conclusion: This study demonstrated that MRP8/14 is correlated with evaluated disease activity and markers of serum inflammatory response in patients not using biological drugs. MRP8/14 is considered an effective new method for objective evaluation of synovitis in RA.

Regulation of bone destruction in rheumatoid arthritis through RANKL-RANK pathways

Recent studies have demonstrated that osteoclasts, the primary cells responsible for bone resorption, are mainly involved in bone and joint destruction in rheumatoid arthritis(RA) patients. Recent progress in bone cell biology has revealed the molecular mechanism of osteoclast differentiation and bone resorption by mature osteoclasts. We highlight here the potential role of the receptor activator of nuclear factor κB ligand(RANKL)-RANK pathways in bone destruction in RA and review recent clinical trials treating RA by targeting RANKL.

Disease control by regulation of P-glycoprotein on lymphocytes in patients with rheumatoid arthritis

The main purpose of treatment of rheumatoid arthritis(RA) with disease modifying antirheumatic drugs(DMARDs) is to control activation of lymphocytes,although some patients do not respond adequately to such treatment. Among various mechanisms of multidrug resistance, P-glycoprotein(P-gp), a member of ATP-binding cassette transporters, causes drugresistance by efflux of intracellular drugs. Certain stimuli,such as tumor necrosis factor-α, activate lymphocytes and induce P-gp expression on lymphocytes, as evident in active RA. Studies from our laboratories showed spontaneous nuclear accumulation of human Y-boxbinding protein-1, a multidrug resistance 1 transcription factor, in unstimulated lymphocytes, and surface overexpression of P-gp on peripheral lymphocytes of RA patients with high disease activity. The significant correlation between P-gp expression level and RA disease activity is associated with active efflux of drugs from the lymphocyte cytoplasm and in drugresistance.However, the use of biological agents that reduce P-gp expression as well as P-gp antagonists(e.g., cyclosporine) can successfully reduce the efflux of corticosteroids from lymphocytes in vitro, suggesting that both types of drugs can be used to overcome drug-resistance and improve clinical outcome. We conclude that lymphocytes activated by various stimuli in RA patients with highly active disease acquire P-gpmediated multidrug resistance against corticosteroids and probably some DMARDs, which are substrates of P-gp. Inhibition/reduction of P-gp could overcome such drug resistance. Expression of P-gp on lymphocytes is a promising marker of drug resistance and a suitable therapeutic target to prevent drug resistance in patients with active RA.

Role of LIGHT in the pathogenesis of joint destruction in rheumatoid arthritis

AIM To characterise the role of substitutes for receptoractivator nuclear factor kappa-B ligand(RANKL) in rheumatoid arthritis(RA) joint destruction. METHODS Synovial fluid(SF) macrophages isolated from the knee joint of RA patients were incubated with 25 ng/m L macrophage-colony stimulating factor(M-CSF) and 50 ng/mL LIGHT(lymphotoxin-like, exhibits inducible expression and competes with herpes simplex virus glycoprotein D for herpes virus entry mediator, a receptor expressed by T lymphocytes) in the presence and absence of 25 ng/mL RANKL and 100 ng/mL osteoprotegerin(OPG) on glass coverslips and dentine slices. Osteoclastogenesis was assessed by the formation of multinucleated cells(MNCs) expressing tartrate-resistant acid phosphatase(TRAP) on coverslips and the extent of lacunar resorption pit formation on dentine slices. The concentration of LIGHT in RA and osteoarthritis(OA) synovial fluid was measured by an enzyme-linked immunosorbent assay(ELISA) and the expression of LIGHT in RA and OA synovium was determined by immunohistochemistry using an indirect immunoperoxidase technique. RESULTS In cultures of RA SF macrophages treated with LIGHT and M-CSF, there was significant formation of TRAP + MNCs on coverslips and extensive lacunar resorption pit formation on dentine slices. SF-macrophage-osteoclast differentiation was not inhibited by the addition of OPG, a decoy receptor for RANKL. Resorption pits were smaller and less confluent than in RANKL-treated cultures but the overall percentage area of the dentine slice resorbed was comparable in LIGHT-and RANKL-treated cultures. LIGHT significantly stimulated RANKL-induced lacunar resorption compared with RA SF macrophages treated with either RANKL or LIGHT alone. LIGHT was strongly expressed by synovial lining cells, subintimal macrophages and endothelial cells in RA synovium and the concentration of LIGHT was much higher in RA compared with OA SF.CONCLUSION LIGHT is highly expressed in RA synovium and SF, stimulates RANKL-independent/dependent osteoclastogenesis from SF macrophages and may contribute to marginal erosion formation.

A Single Center Experience in Biological Therapy for the Treatment of Rheumatoid Arthritis in Saudi Arabia

Background: Biological therapy is indicated in the treatment of RA (Rheumatoid Arthritis) after failure of disease-modifying anti-rheumatic drugs (DMARDS) by the ACR/EULAR recommendations. The objective of the study is to describe the characteristics of Saudi patients at the initiation of biological therapy and to evaluate clinical effectiveness of this therapy measured by the disease activity score DAS 28. Methods: This was a retrospective cohort study of RA (rheumatoid arthritis) patients in King Fahad Hospital in Jeddah, Saudi Arabia from January 2005-July 2011. Data were collected from the medical records of all RA patients on biological therapy including: demographics, disease characteristics, comorbid illnesses and DAS 28 score over a period of 1 year. Results: 139 patients were studied (mean age 46 ± 13 years), of which 118 (84%) were females;mean duration of affliction with RA was 7.2 years ranging 1-45 years. Rheumatoid factor (RF) was positive in 88 patients (63.3%) and one or more comorbidities were present in 102 patients (73.3%). First choice of biological drug was ADA (Adalimumab) 44 patients (31.7%) and RTX (Rituximab) was the 2nd frequently prescribed biological drug. Mean DAS 28 activity at baseline was in ADA 41 patients (6.10 ± 1.62), ETA (Etarnercept) 29 patients (6.64 ± 1.42) and RTX 50 patients (6.7 ± 1.32). Moderate to good EULAR response was obtained in 74%, 85.7% and 53.3% at 6 months in ADA, ETA and RTX patients respectively. Moderate to good EULAR response was obtained in 61.8%, 86.6% and 72% in ADA, ETA AND RTX patients respectively at 1 year of treatment. Therapeutic effectiveness was comparable with the response rates in published observational trials. Conclusion: Our data demonstrate daily clinical practice in management of RA. The pattern of prescription is in agreement with the ACR/EULAR recommendations for initiation of biologicals in the treatment of 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.

Curative efficacy of vitamin D3 in combination with tripterygium wilfordii polyglycoside in patients with rheumatoid arthritis and its influences on indices of bone restoration

Objective: To investigate the curative efficacy of vitamin D3 in combination with tripterygium wilfordii polyglycoside in patients with rheumatoid arthritis (RA) and its influences on indices of bone restoration. Methods: A total of 320 patients with RA were collected as observation objects to be randomly divided into the control group and the observation group with 160 cases in each group. The control group was given treatment of tripterygium wilfordii polyglycoside, while the observation group was given treatment of vitamin D3 in combination with tripterygium wilfordii polyglycoside. All patients received a course treatment with 3 months. The curative efficacy, improvement of joint symptoms, changes of laboratory tests, indices of bone restoration and adverse reactions were compared. Results: After 3 months, assessment of curative efficacy showed that the observation group had a total curative efficiency ratio of 90.6%, which was significantly higher than that of 81.2% in the control group. Among the indices which reflect the improvement of joint symptoms, the joint pain index, joint tenderness index and joint swollenness index were statistically reduced in the observation group than those in the control group. And after treatment, in comparison with the control group, indices of laboratory tests of rheumatoid factor (RF), antistreptolyisn O antibody (ASO), c-reactive protein (CRP) were statistically lower respectively in the observation group. As to indices of bone restoration after treatment, the observation group had statistically lower serum level of receptor activator of nf-kb ligand (RNKL) and higher level of osteoprotegerin (OPG) than those in the control group. During the treatment, incidences of adverse reactions in the control group and the observation group were statistically same. Conclusion: Vitamin D3 in combination with tripterygium wilfordii polyglycoside has well curative efficacy in patients with RA, which can significantly improve joint symptoms, indices of laboratory tests and bone restoration.

Flare and change in disease activity among patients with stable rheumatoid arthritis following coronavirus disease 2019 vaccination:A prospective Chinese cohort study

Background:Vaccination has been shown effective in controlling the global coronavirus disease 2019(COVID-19)pandemic and reducing severe cases.This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis(RA).Methods:A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status.Each of them was examined every 3 to 6 months.In the vaccination group,disease activity was compared before and after vaccination.The rates of flare defined as disease activity scores based on 28-joint count(DAS28)>3.2 withΔDAS28≥0.6 were compared between vaccination and non-vaccination groups.Results:A total of 202 eligible RA patients were enrolled.Of these,98 patients received no vaccine shot(non-vaccination group),and 104 patients received two doses of vaccine(vaccination group).The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days,respectively.The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar.At enrollment,gender,RA disease course,seropositivity,and disease activity were comparable across the two groups.Flare was observed in five(4.8%)of the vaccination group patients and nine(9.2%)of the non-vaccination group patients at post-vaccination assessment(P=0.221).In terms of safety,29(27.9%)patients experienced adverse events(AEs)after vaccination.No serious AEs occurred.Conclusions:COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity.Patients with stable RA should be encouraged to receive the COVID-19 vaccination.

Correlations of single photon emission computed tomography joints scan and bone metabolic markers in active rheumatoid arthritis

Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography(SPECT)and serum bone metabolic markers in patients with active rheumatoid arthritis(RA).Methods Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department

Chinese registry of rheumatoid arthritis: IV. Correlation and consistency of rheumatoid arthritis disease activity indices in China

Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and research studies of rheumatoid arthritis(RA).The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study,including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018,was conducted.The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots,quadratic weighted kappa,and discordance rates in the crosstab.For other indices,the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included,of whom 80.46%were women.Most individuals were with moderate disease activity or high disease activity.High correlations among DAS28-erythrocyte sedimentation rate(ESR)and DAS28-C-reactive protein(CRP),SDAI and CDAI were observed.Similarly,the weighted kappa value among the indices was high.In Bland-Altman plots,a positive difference between DAS28-ESR and DAS28-CRP was observed,with an absolute difference of>1.2 in 3079(10.09%)patients.In crosstab,approximately 30%of the patients were classified into different groups.Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR,DAS28-CRP,and CDAI were 3.06,2.37,and 3.20,respectively.Conclusions:Although DAIs had high correlations and weighted kappa values,the discordance between DAIs was significant in Chinese patients with RA.The four DAIs are not interchangeable.

Chinese registry of rheumatoid arthritis(CREDIT)V:sex impacts rheumatoid arthritis in Chinese patients

Background: The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients.Methods: Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits.Results: A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0vs. 6.7 mg/L), pain visual analogue scale (4.8vs. 4.5), patient’s and physician’s global assessment (4.9vs. 4.5 and 4.9vs. 4.5), 28-joint disease activity score using DAS28-CRP (4.3vs. 4.0) simplified disease activity index (21.9vs. 19.9), and clinical disease activity index (19.3vs. 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4%vs. 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women.Conclusions: In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.

The relationship between serum zinc levels and rheumatoid arthritis activity

目的：风湿性关节炎(RA ) 是最流行的长期的自体免疫的疾病之一；它典型地包含手，手腕，脚关节，并且最后所有关节。一些研究报导了锌浆液层次比在健康个人在有 RA 的病人是更低的。

烧山火针刺法联合甲氨蝶呤治疗类风湿关节炎活动期的效果及其对患者炎症因子和免疫功能的影响

目的 观察烧山火针刺法联合甲氨蝶呤治疗类风湿关节炎(RA)活动期的效果,并探讨其抗炎和调节免疫作用机制。方法 选取2020年2月至2022年10月郑州市第一人民医院收治的60例RA活动期患者纳入研究,按照随机数表法分为常规组和联合组各30例。常规组患者给予甲氨蝶呤治疗,联合组患者给予烧山火针刺法联合甲氨蝶呤治疗,均治疗两周。于治疗两周后比较两组患者的治疗效果,以及治疗前后的中医证候评分、28个关节疾病活动(DAS28)评分、疼痛(VAS)评分、炎性指标[血沉(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α (TNF-α)、类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体]、免疫指标(Treg细胞、Th17细胞、Treg/Th17细胞),同时比较两组患者治疗期间的不良反应发生情况。结果 联合组患者的治疗总有效率为93.33%,明显高于常规组的73.33%,差异有统计学意义(P<0.05);联合组患者治疗两周后的中医证候关节肿胀、冷痛、压痛、晨僵、屈伸不利评分分别为(0.72±0.18)分、(0.70±0.20)分、(0.81±0.22)分、(0.68±0.15)分、(0.77±0.19)分,明显低于常规组的(1.03±0.24)分、(0.96±0.23)分、(1.14±0.26)分、(0.91±0.21)分、(1.09±0.23)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的DAS28、VAS评分分别为(2.18±0.33)分、(2.46±0.22)分,明显低于常规组的(3.26±0.47)分、(2.89±0.27)分,差异均有统计学意义(P<0.05);联合组患者治疗两周后的ESR、抗CCP抗体、RF、CRP、TNF-α水平分别为(16.23±2.29) mm/h、(172.30±30.14) IU/mL、(130.85±15.42) IU/mL、(10.20±1.68) mg/L、(18.95±4.38) pg/mL,明显低于常规组的(21.84±3.41) mm/h、(205.68±36.77) IU/mL、(157.62±24.10) IU/mL、(13.65±2.06) mg/L、(24.51±6.02) pg/mL,差异均有统计学意义(P<0.05);联合组患者治疗两周的外周血Treg细胞百分比、Treg/Th17比值分别为(2.61±0.35)%、2.44±0.37,明显高于常规组的(2.17±0.28)%、1.68±0.32,Th17细胞百分比为(1.07±0.18)%,明显低于常规组的(1.29±0.22)%,差异均有统计学意义(P<0.05);两组患者治疗期间的不良反应发生率差异无统计学意义(P>0.05)。结论 烧山火针刺法联合甲氨蝶呤治疗RA活动期能明显减轻患者的临床症状,降低炎症反应,调节免疫功能,临床应用疗效显著,且安全性良好。

类风湿关节炎患者血清SAA、CCL20、MMP-3表达水平及临床意义

目的探讨类风湿关节炎(RA)患者血清淀粉样蛋白A(SAA)、趋化因子配体20(CCL20)及基质金属蛋白酶3(MMP-3)水平变化及临床意义。方法回顾性选取2020年9月至2023年1月大同市第五人民医院收治的RA患者108例作为研究对象,依据28个关节的疾病活动度评分(DAS28)评分,将患者分为缓解期组(n=35,DSA28评分<2.6)与活动期组(n=73,DSA28评分≥2.6),并将活动期患者进一步分为轻度活动期(n=20,DSA28评分2.6~3.2)、中度活动期(n=29,DSA28评分>3.2~5.1)与重度活动期(n=24,DSA28为>5.1);另选取同期健康体检者80名作为对照组。所有受试者均检测血清SAA、CCL20、MMP-3水平。比较不同组别血清SAA、CCL20、MMP-3水平;使用Pearson相关分析血清SAA、CCL20、MMP-3水平与红细胞沉降率(ESR)、C反应蛋白(CRP)的相关性;使用受试者工作特征(ROC)曲线评价各指标对RA疾病活动度的诊断价值。结果RA组血清SAA、CCL20、MMP-3水平分别为(42.25±13.46)mg/L、(45.69±12.78)pg/mL、(85.41±25.14)ng/mL,均显著高于对照组[(7.14±2.12)mg/L、(18.12±5.47)pg/mL、(27.36±8.21)ng/mL],差异均有统计学意义(P<0.05)。RA活动期组患者血清SAA、CCL20、MMP-3水平分别为(51.78±10.71)mg/L、(53.14±10.45)pg/mL、(106.10±20.39)ng/mL,显著高于缓解期组[(22.37±7.14)mg/L、(30.15±8.24)pg/mL、(42.25±13.64)ng/mL],差异均有统计学意义(P<0.05)。重度活动度组血清SAA、CCL20、MMP-3水平均高于中度活动度组和轻度活动度组,差异均有统计学意义(P<0.05),随着疾病活动度提高,血清SAA、CCL20、MMP-3水平逐渐增高。Pearson相关分析显示,活动期RA患者血清SAA、CCL20、MMP-3水平与CRP、ESR均呈正相关(P<0.05)。ROC曲线分析得出,血清SAA、CCL20、MMP-3区分RA轻度活动度与中度活动度的曲线下面积(AUC)分别为0.852、0.756、0.725,区分中度活动度与重度活动度的AUC分别为0.852、0.756、0.725,均显示出一定的诊断能力。结论RA患者血清SAA、CCL20、MMP-3水平均呈高表达,这3项指标可作为评估疾病活动度的生物标志物,可为临床预测病情进展提供参考。

红景天苷对类风湿关节炎患者血清脯氨酸羟化酶2及蛋白磷酸酯酶2A和丝裂原活化蛋白激酶表达水平的影响

目的分析红景天苷对类风湿关节炎(RA)患者血清脯氨酸羟化酶2(PHD2)及蛋白磷酸酯酶2A(PP2A)和丝裂原活化蛋白激酶(MAPK)表达水平的影响。方法选取青海省中医院2022年12月至2023年7月收治的RA患者96例。采用随机数字表法分为对照组和观察组,各48例。对照组采用常规西医治疗,观察组在常规西医治疗的同时予以红景天苷治疗,2组均治疗3个月。比较治疗前后2组中医证候评分、临床症状与体征、实验室检查指标[包括红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸肽抗体(anti-CCP)]、临床疗效,健康状况评定量表(HAQ)与28个关节疾病活动度评估(DAS28)评分,血清PHD2、PP2A、MAPK水平与基因表达,不良反应。结果治疗后2组主症、次症评分均低于治疗前且观察组均低于对照组(均P<0.05)。治疗后观察组临床症状与体征均轻于对照组,ESR、CRP、RF和anti-CCP水平均低于对照组(均P<0.05)。观察组总有效率高于对照组[95.8%(46/48)比80.4%(37/46)](P=0.020)。治疗后观察组HAQ与DAS28评分均低于对照组[(5.0±1.0)分比(7.2±1.2)分、(3.1±0.5)分比(4.1±0.7)分](t=9.528、7.444,均P<0.001)。治疗后观察组PHD2、MAPK水平及基因表达均低于对照组,PP2A水平及基因表达均高于对照组,差异均有统计学意义(均P<0.05)。2组不良反应发生率差异无统计学意义(P=0.528)。结论红景天苷治疗RA可增强临床效果、减轻患者症状、改善实验室指标且安全。推测与降低PHD2和MAPK表达、增加PP2A表达有关。

抗MCV抗体、抗CCP抗体对类风湿关节炎的诊断价值及其与疾病活动度的相关性

目的探讨抗突变型瓜氨酸波形蛋白(MCV)抗体、抗环瓜氨酸肽(CCP)抗体对类风湿关节炎(RA)的诊断价值,并分析其与RA疾病活动度的相关性。方法选取74例RA患者(RA组)、95例结缔组织病患者(非RA组)和60例健康体检者(健康对照组)作为研究对象。基于红细胞沉降率的28个关节疾病活动度评分(DAS28-ESR)将RA组患者分为高活动期组(n=22)、中活动期组(n=18)、低活动期组(n=14)和缓解期组(n=20)。比较RA组、非RA组、健康对照组之间的血清抗MCV抗体、血清抗CCP抗体、血清类风湿因子(RF)和ESR阳性率,以及RA不同活动期组之间的血清抗MCV抗体水平、血清抗CCP抗体水平、血清RF水平和ESR。通过绘制受试者工作特征曲线分析血清抗MCV抗体水平、血清抗CCP抗体水平、血清RF水平和ESR单独及联合诊断RA的价值。分析RA组患者血清抗MCV抗体水平、血清抗CCP抗体水平、血清RF水平和ESR与DAS28-ESR的相关性。结果(1)RA组的血清抗MCV抗体、血清抗CCP抗体、血清RF和ESR阳性率高于非RA组和健康对照组(P<0.05);非RA组的血清抗CCP抗体、血清RF和ESR阳性率高于健康对照组(P<0.05),但两组的血清抗MCV抗体阳性率差异无统计学意义(P>0.05)。(2)缓解期组、低活动期组、中活动期组、高活动期组的血清抗MCV抗体水平、血清抗CCP抗体水平和ESR依次升高(P<0.05);高活动期组血清RF水平高于其他3组(P<0.05),其他3组之间的血清RF水平差异无统计学意义(P>0.05)。(3)血清抗MCV抗体水平、血清抗CCP抗体水平单独诊断RA的曲线下面积(AUC)均>0.85,且均大于血清RF水平和ESR的AUC(P<0.05);血清抗MCV抗体水平与血清抗CCP抗体水平诊断RA的敏感度、特异度、AUC差异无统计学意义(P>0.05);血清抗MCV抗体水平、血清抗CCP抗体水平、血清RF水平和ESR联合诊断RA的AUC达0.935,大于任意单一指标诊断RA的AUC(P<0.05)。(4)RA患者的血清抗MCV抗体水平、血清抗CCP抗体水平和ESR与DAS28-ESR均呈正相关(P<0.05)。结论相比于传统指标血清RF和ESR,血清抗MCV抗体和血清抗CCP抗体对RA均有较高的诊断价值;将二者联合血清RF和ESR用于诊断RA,可明显提高诊断效能。血清抗MCV抗体水平、血清抗CCP抗体水平均与RA疾病活动度呈正相关,可作为评估患者疾病活动度的辅助指标。