ObjectiveTo evaluate the frequency of antinucleosome antibody(AnuA) in juvenile systemic lupus erythematosus(JSLE),comparing it to that observed for anti-dsDNA,anti-Sm antibodies,and explore the correlation of these antibodies with clinical manifestations and disease activity.MethodsWe included 80 children with JSLE and 56 children with other rheumatic diseases into this study.Clinical records were reviewed.AnuA,antinuclear antibody (ANA) and anti-Sm antibody were detected by ELISA,ⅡF and Western-blot respectively.Anti-DNA were detected by ELISA and ⅡF.Disease activity was assessed by SLEDAI score.ResultsAnuA showed sensitivity of 76.25％ and specificity of 98.21％.AnuA combine with anti-dsDNA antibody or anti-Sm antibody was detected,the sensitivities and specificities were 83.05％,86.44％ and 96.43％,98.21％,respectively.It showed that the sensitivity was higher than any one of the three.The presence of AnuA was associated with red blood cell count,hemoglobin level,ESR,hematuria,low complement levels and anti-dsDNA antibody (r=-0.499,-0.503,0.388,0.227,0.303,0.531,P=0.000,0.000,0.000,0.042,0.006,0.000).The presence of AnuA was associated with the SLEDAI score(P=0.000). Conclusion AunA hasthe highest sensitivity and specificityamongthese autoabtibodies,particularly,when combined with anti-dsDNA antibody or anti-Sm antibody.The level of AnuA is associated with the disease activity of JSLE.AnuA is not only useful for the diagnosis of JSLE but also for evaluation of the disease activity.

Hyperuricemia is the second largest metabolic disease next to the diabetes and is an independent risk factor for other chronic diseases. With the increase of incidence rate, it has become one of the common chronic diseases in general practice. For the implementation of hierarchical medical system, it is necessary to establish a sound and effective community model for the management of hyperuricemia in China. This article reviews the literature at home and abroad to provide information for building a community management model of hyperuricemic patients.

Ankylosing spondylitis (AS) is a systemic disease, which mainly causes to axial joint chronic inflammation. Spine, thoracic and peripheral joints may have varying degrees of activity limitation, and somatic activity is also likely to decline. Ankylosis of the spine and movement disorder of hip are the mainly causes of AS patients' disability, which not only affect the patients' motor function, and but also affect their social interaction, role affordability, mental state and daily living skills. Exercise therapy is the treatment unarmed or with equipment, for injuries, disease, residual patients, to restore or improve dysfunction. There are a number of studies about exercise therapy for joint function of patients with AS, confirmed that exercise therapy plays a crucial role in the treatment of AS patients, on the basis of the medications control.

Objective To investigate the synergistic effect of methotrexate (MTX) and cyclophos phamide (CTX) on cell cycle and cyclin D1 of periphery blood lymphocytes (PBLs) and bone marrow byflow cytometry. Methods Wistar rats were randomly divided into four groups including normal control, MTX and cyclophosphamide combination group, MTX and CTX only treatment groups respectively. PBLs were isolated for flowcytometry analysis for the changes of cell cycle and the expression of cyclin D1 at week 0, week 3,week 9, week18 and week 27. Mice were dissected and the changes of lymphoeytes cell cycle and the expressions of cyclin D1 in the bone marrow were measured at week 0, week 3, week 9, week 18 and week 27 increased and the ratio of phase S cells was decreased (P>0.05). In the CTX treatment group, there was no statistical difference in ratios of each phase. In the MTX and CTX combination treatment group, the proportion of phase G0/G1 cells decreased significantly and the percentage of phase S cells increased in both PBLs and bone marrow ceils (P<0.05). And there was no statistical significant difference in different time points after marrow between different groups or different dissecting time points. Conclusion MTX combined with CTX has been shown to have antagonistic effect on cell cycle. However, this effect is not via the cyclin DI pathway.

Juvenile idiopathic arthritis is a common connective tissue disease of children.The rate of disability is high.Therefore,early diagnosis is important.There are some study on the value of antibodies in juvenile idiopathic arthritts,such as rheumatoid factor,antiperinuclear factor,antikeratin antibody,antibodies to cyclic citrullinated peptides and so on.This review introduces the progress of them.

Objective In this study,we elucidated the role of high mobility group box chromosomal protein 1 (HMGB1) in collagen-induced arthritis (CIA) rat and the antagonist role of ethyl pyruvate by using a rat model of CIA as the research object by comparing the expression of HMGB1 in normal control group,CIA model group and ethyl pyruvate group.Methods Thirty-six rats were randomly divided into 3 groups (n=12):normal control group,CIA group and ethyl pyruvate group.Then the 6 rats were dissected at the 6th,9th week respectively.Thc expression of HMGB1 was analyzed by immunohistochemistry and Pathology-image analysis software in the cytoplasma.The expression of HMGB1 mRNA with real time-polymerse chain reaction (PCR) was evaluate,and the HMGB1 expression of each group were compared with t-test.Results The immunohistochemical results of HMGB1 showed that the expression intensity in the normal control group,CIA model group and ethyl pyruvate group was 2.1±0.6,7.3±1.2,6.0±1.2 respectively at the 6th week; and 2.2±0.7,12.4±4.5,5.5±1.0 at the 9th week respectively.The HMGB1 mRNA real time-PCR results had shown that the relative quantification of the normal control group and CIA model group were 1,2.865,2.602respectively at the 6th week and 1.005,4.694,1.729 at the 9th week.At those two points, the HMGB1 expressions of HMGB1 antagonist group were significantly higher than those of the normal controls (P＜0.05).In addition,there was statistical significant difference(P＜0.05) in the HMGB1 expression when compared with the placebo group.Furthermore, when the degree of HMGB1 expression among the three groups was compared,the HMGB1 antagonist group was decreased significantly (P＜0.05).Conclusion The results has demonstrated that HMGB1 could induce inflammation in the synovial tissue of CIA rats,and has provided the rationale that HMBG 1 could be the target of treating rheumatoid arthritis (RA).The results of this study have shown that ethyl pyruvate could antagonize the effect of HMGB1.This finding may provide a new therapeutic target for the treatment of RA.

Objective To study the efficiency and safety of short-term combination therapy with e-tanercept, methotrexate and eyclophosphamide in the patients with active rheumatoid arthritis. Methods Eighty-four patients with rheumatoid arthritis were included into this study. However, only fifty-six patients were treated with either twice-weekly subcutaneous etanercept, weekly oral MTX and CTX injection every three weeks or twice-weekly subcutaneous etanercept only. The American College of Rheumamatology (ACR) criteria for improvement was used for clinical efficacy assessment and the following laboratory papameters were analyzed:blood routine test, ESR, liver enzymes and renal function parameters, RF and anti-CCP antibody at baseline and the 2,4,8,12,24,36,52 weeks .At the same time ,all the adverse events were monitored throughout the study. Results The improvement of patients who received etanercept shortly, MTX and CTX periodically was as rapid as that of the patients who only received etanercept in ACR20, ACRYO, ESR and CRP (P>0.05). At the end of 36 weeks treatment, the level of anti-CCP antibody in the control group was higher than that of the test group. There was no significant difference between the two groups in adverse events (P<0.05). Conclusion The efficacy and safety of treatment with etanercept, methotrexate and cyclophosphamide in the patients with active rheumatoid arthritis is good.

Objective To study the clinical characteristics and prognosis of interstitial lung disease (ILD) associated with polymyositis (PM) and dermatomyositis (DM). Methods The clinical data of 107 DM related ILD,and its frequency rate was 26.2%. Arthritis as the first symptom had a higher presenting rate in patients with ILD than in patients with non- ILD. Arthritis, dry cough and short of breath occurred more dyspnea presented in patients with DM-ILD, and there was serious myalgia and muscle weakness in patients More DM-ILD patients had high HBDH and AST than those in PM-ILD. High CK and CK-MB were more The 7 of 8 severe cases had DM-ILD in which 5 died of respiratory failure (death rate was 17.9% in PM/elevated ESR and CRP tend to complicate with ILD. The DM patients who have characteristic skin rashes and high AST level are prone to develop ILD. The PM patients who have high CK and CK-MB are susceptible to

Objective To evaluate the safety and tolerance of tumor necrosis factor-or (TNF-α)antagonists in the treatment of rheumatic diseases. Methods The incidence of adverse events and their ultimate outcomes based on the clinical symptoms, signs and laboratory parameters of patients treated with etanereept or infliximab during January 2007 to October 2008 were analyzed. Results Severty eight patients were included. Most were rheumatoid arthritis (35%) and ankylosing spondylitis (41%) patients. Few of them were psoriasis arthritis (17%) patients and undifferentiated spondyloarthropathy (6%) patients. Among those patients, 59 patients were treated with etanercept, 7 patients (12%) had adverse events in which the majority were injection reactions, upper respiratory tract infection and tuberculosis. Nineteen patients were treated with infliximab, in which 3 patients (16%) had adverse events. One patient (AS) had upper respiratory tract infection. One case (AS) had red papules all over the body and palpitations in the first 24 hours after two infusions. One patient (RA) had fever without identifiable causes after the 4th infusion. Some of the adverse reactions might subside without intervention, while others were controlled after proper treatment. Conclusion Both etanercept and infliximab have good safety and tolerance in treating rheumatic diseases, the adverse reactions are generally mild and can be controlled by appropriate treatment.

Objective To investigate the prevalence of fatigue in rheumatoid arthritis (RA) and its relationship with other clinical and functional parameters used for the evaluation of disease activity and health related quality of life. Methods The fatigue was assessed in 230 patients with RA using visual analogue scale (VAS). The correlation between fatigue and the clinical disease activity including morning stiffness, pain, PGA, physician's global assessment, TJC, TJI, SJC, SJI, DAS28, HAQ and health-related quality of life were assessed. Results The prevalence of fatigue was 85.7% and the fatigue score of 51.7% patients was higher than 50 mm. After controlled for the possible confounding factors such as age, gender and disease duration, it was found that fatigue was highly correlated with pain, disease activity, functional disability, physical health and mental health. Conclusion Fatigue is an important symptom of RA and is correlated with pain, disease activity, functional disability and health-related quality of life.