Objective To explore the efficacy and safety of tocilizumab in combination with disease-modifying anti-rheumatoid drugs (DMARDs) for the treatment of rheumatoid arthritis (RA) patients with moderate to severe activity and inadequate response to DMARDs. Methods Thirty-two RA patients with inadequate response to DMARDs were treated with tocilizumab along with stable dose of DMARDs for 12 weeks, adverse reactions were recorded, clinical laboratory and physiological indices were recorded 4, 8, and 12 weeks after treatment. The routine blood, liver and kidney function tests, morning stiffness, rest pain, tender joint count, swollen joint count, overall evaluation of the patient and physician to disease and health assessment questionnaire, blood sedimentation, C-reactive protein (CRP), Disease activity score 28 (DAS28), simplified disease activity index (SDAI) score, clinical disease activity index (CDAI). Repetitive measure analysis of variance wase used for statistical analysis. Results The clinical laboratory indices and DAS28, SDAI, CDAI scores observed in all of the patients were significantly improved (P<0.05). After 8 and 12 weeks of treatment, disease activity was further improved with statistical significance (P<0.05). The levels of IL-6 were downregulated obvious compared with before [(26±14) pg/ml vs (76±39) pg/ml, t=-6.925, P<0.01], and no obvious adverse reactions were observed. Conclusion Tocilizumab can quickly improve the symptoms and the control disease activity of refractory active RA within a few weeks.

Objective To evaluate therapeutic effects of simvastatin on serum expressions of cytokines and synovial tissue aspartic protease-3 (Caspase-3) in collagen induced arthritis (CIA) in rats, and the mechanism thereof. Methods The rat model of CIA was established by injecting bovine Ⅱ collagen. Sixteen model rats were randomly divided into two groups:CIA model group (sterile water 5 mL·kg-1·d-1 by gavage) and simvastatin group (2.0 mg·kg-1·d-1 by gavage). Seven normal rats were included in control group (sterile water 5 mL·kg-1·d-1 by gavage). The arthritis index (AI) and hind paw vol-umes were recorded once a week. The serum levels of cytokine, tumor necrosis factor (TNF)-αand interleukin (IL)-6 were measured by ELISA 42 days after the initial immunization. The expression of Caspase-3 in ankle synovial tissue was detect-ed by immunohistochemical method, and pathological results of HE staining in rat ankle were compared between three groups. Results Values of AI were decreased on the 24-d of the initial immunization in simvastatin group and CIA model group, which was significantly decreased on the 35-d of the initial immunization in simvastatin group than that of CIA model group (P＜0.05). The values of hind paw volumes were decreased on the 14-d of the initial immunization in simvastatin group and CIA model group, which was still significantly higher than those of control group (P＜0.05). The values of hind paw volumes were decreased on the 35-d and 42-d of the initial immunization in simvastatin group than those of CIA model group (P＜0.05). The serum levels of TNF-αand IL-6 on the 42-d of the initial immunization were significantly lower in simvastatin group than those of CIA model group, but which were significantly higher than those of control group ( P＜0.05). There were more synovial hyperplasia in simvastatin group than those of CIA model group. Only a small amount of inflamma-tory cell infiltration was found in simvastatin group. The expression of Caspase-3 was significantly higher in simvastatin group than that of CIA model group. Conclusion Simvastatin can significantly inhibit the serum levels of TNF-αand IL-6 in CIA model rats, and can up-regulate the expression of Caspase-3 in ankle of model rats.

Objective To investigate the change of adiponectin (AD),tumor necrosis factor-alpha (TNF-α) and S100 levels in serum elderly patients with rheumatoid arthritis and cerebral infarct in order to evaluate the therapeutic effect of dioscornin.Methods One hundred patients with rheumatoid arthritis and cerebral infarct were selected as our subjects,who were hospitalized in the Department of Neurology of Recovery Changzhi Municipal People's Hospital and the Department of Internal Medicine of the Affiliated Hospital of Shaoxing Medical College,between 2006 September and 2010 September.All subjects (male 55,female 45,average age of 57 years old) were randomly divided into regular and dioscomin groups,50 for per group.Patients in regular group were treated with routine therapy and patients in dioscornin groups were treated with dioscornin 80mg,three daily plus regular treatment drug.Meanwhile 40 middle patients with single rheumatoid arthritis subjects were severed as controls.The changes of BMI,fasting plasma glucose,lipid factors,insulin sensitivity index (ISI),serum adiponectin,TNF-α and serum S100B were determined at treatment before and 6 months after treatments.Results The level of TNF-α,serum S100 in ERA patients were significantly higher andAdiponectin significantly lower than that of the control group,(TNF-α:[(89.0 ± 25.3) ng/L,(88.0 ± 24.2)ng/L vs(74.0 ±21.0) ng/L,F =3.292,P ＜0.05],[S100B:(0.102 ±0.051) μg/L,(0.101 ±0.045) μg/L vs(0.092 ± 0.031) μg/L,F =2.792,P ＜ 0.05],and AD and BMI were lower [AD:(7.2 ± 1.4) μg/L,(7.3 ±1.4) μg/L vs (18.1 ± 3.5) μg/L,F =17.057,P ＜ 0.01],[BMI:(18.9 ± 2.4) kg/m2,(19.0 ± 1.9) kg/m2 vs (21.8 ± 1.8) kg/m2,F =6.147,P ＜ 0.01].There was a negative correlation between adiponect and TNF-α,S100B (r =-0.46,-0.52,P ＜ 0.01) and positive correlation between adiponect and BMI (r =0.44,P ＜0.01).The adiponectin level was significantly increased in patients for six months after dioscornin treatment than that of control group.[AD:(12.2±2.9) μg/L,(7.8 ±1.8) μg/L vs (18.0 ±4.3) μg/L,F=6.480,P＜0.01].The level of TNF-α and S100B significantly decreased than that of the control group,TNF-α:[(72.0 ±21.0) ng/L,(82.0±23.0)ng/L vs (68.0 ±20.0) ng/L,F =3.065,P ＜0.05],[S100B:(0.092 ±0.021)μg/L,(0.099 ±0.031) μg/L vs (0.091 ±0.029) μg/L,F=3.030,P＜0.05].Conclusion Dioscornin could ameliorate the prognosis through decreasing the levels of TNF-α and S100B,and increasing adiponectin level in patients with rheumatoid arthritis and cerebral infarct.

Objective To investigate the clinical significance of serum chemokine-4 (CXCL-4) in systemic sclerosis (SSc) patients complicated with SSc-interstitial lung disease (SSc-ILD).Methods Sixty-two patients with SSc wbo met the new classification criteria of American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) SSc in 2013 and were treated by rheumatology department of Jiangxi Provincial People's Hospital from September 2015 to July 2017 were divided into the SSc combined with ILD group (30 cases) and simple SSc group (32 cases) according to the results of HRCT test,in reference to the 2013 American Thoracic Society/European Respiratory Society (ATS/ERS) ILD diagnostic criteria.A certain number of healthy subjects were selected as healthy control group (35 cases).Serum concentrations of CXCL-4 were determined by enzyme-linked immunosorbent assay (ELISA),and the difference of CXCL-4 concentration among the 3 groups were analyzed.All data were analyzed by t test,x2 test,rank-sum test and Logistic regressive analysis.Results The level of CXCL-4 in the SSc-ILD group [(133±17) ng/ml] was higher than that of the SSc group [(122±19) ng/ml] and normal control group [(115±19) ng/ml] (t=11.414,P=0.012;t=17.917,P=0.000);there was no significant difference between the SSc group and the normal control group (t=6.504,P=0.130);binary Logistic regression analysis found that the level of CXCL4 was positively correlated with ILD [P=0.019,OR=1.035,95％CI(1.006,1.066)].Conclusion Elevated levels of CXCL-4 in patients with SSc may be associated with concurrent ILD,CXCL-4 is expected to be a new serological marker for early diagnosis and evaluation of patients with SSc-ILD.It may be used as a sensitive indicator for evaluating the condition and prognosis of patients with SSc-ILD and provide a new target for clinical guidance of SSc-ILD therapy.

Objective To evaluate early diagnostic value of matrix metalloproteinase 7 (MMP-7) and interferon inducible protein (IP-10) for rheumatoid arthritis-associated interstitial lung disease (RA-ILD).Methods Clinical and laboratory data and serum samples of patients with RA between March 2015 and June 2016 in our hospital were collected.Patients were subclassified as RA-without ILD,RA-with ILD,or RA-advanced ILD based on high-resolution computed tomography scans of the chest.Enzyme linked immunosorbent assay (ELISA) was used to assess MMP-7 and IP-10 in the serum of each group.The correlation between the two biomarkers and pulmonary function,the occurrence of ILD and other laboratory indexes were analyzed.Comparison of measurement data between the 3 groups was performed by single factor variance analysis,while count data was compared by Chi square test;the risk factors were analyzed by Logistic regression,receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic efficiency,correlation analysis was performed by Spearman correlation analysis.All statistical analysis was performed by Statistical Product and Service Solutions (SPSS) 19.0 statistical software.Results Serum levels of MMP-7 and IP-10 in RA-advanced ILD group and RA-mild ILD group were significantly higher than that of RA-without ILD group,the level of MMP-7 was [(1.9±3.0) ng/ml,(1.7±2.4) ng/ml,(0.2±0.2) ng/ml in turn,P＜0.05],IP-10 level was [(245± 394) pg/ml,(270±384) pg/ml,(38±26) pg/ml in turn,P＜0.05].And IP-10 level was significantly correlated with RA-ILD in both unadjusted and adjusted Logistic regression analyses,the values of OR were 1.024 and 1.023 respectively (P＜0.05).The ROC curves were plotted with MMP-7 and IP-10 respectively.The area under the curve (AUC) was 0.69 and 0.78 respectively.The AUC of combined detection increased to 0.83.Conclusion Levels of MMP-7 and IP-10 are elevated in the serum of RA patients with ILD,whether mild or advanced,supporting their value as pathogenically relevant biomarkers that may contribute to noninvasive detection of RA-ILD,and the combined estimate of them helps to improve the effectiveness of early diagnosis.

OBJECTIVETo investigate the changes in fecal flora and its correlation with the occurrence and progression of inflammatory bowel disease (IBD).

METHODSWe collected fresh fecal specimens from 167 IBD patients (including 113 with ulcerative colitis and 54 with Crohn's disease) and 54 healthy volunteers. The fecal flora was analyzed by gradient dilution method and the data of inflammatory markers including WBC, PLT, CRP and ESR were collected to assess the association between the fecal flora and the inflammatory markers.

RESULTSThe species Enterrococcus (6.60∓0.23, P<0.01), Saccharomyces (2.22∓0.27, P<0.05), Bacteriodes (5.57∓0.28, P<0.001), Bifidobacterium (5.08∓0.30, P<0.01), Peptococcus (6.22∓0.25, P<0.001), Lactobacillus (6.00∓0.26, P<0.001), and Clostridium (3.57∓0.30, P<0.05) all increased significantly, while Eubacterium (1.56∓0.24, P<0.01) reduced markedly in patients with ulcerative colitis compared with those in the control subjects. Enterrococcus (6.93∓0.28, P<0.01), Saccharomyces (2.73∓0.37, P<0.01), Bacteriodes (4.32∓0.52, P<0.05), Bifidobacterium (4.88∓0.42, P<0.05), Peptococcus (6.19∓0.32, P<0.01) and Lactobacillus (4.73∓0.47, P<0.001) all increased significantly and Eubacterium (1.01∓0.29, P<0.01) and Clostridium (0.87∓0.31, P<0.01) decreased in patients with Crohn's disease. The positivity rates of bacterial culture were consistent with the results of quantitative analysis of the fecal flora. The changes in fecal flora did not show a significant correlation with these inflammatory markers.

CONCLUSIONIBD patients have fecal flora imbalance compared with the healthy controls, and this imbalance may contribute to the occurrence and progression of IBD. The decline of Eubacterium contributes to the occurrence and development of IBD.

Adult ; Bacteria ; isolation & purification ; Bacteroides ; isolation & purification ; Bifidobacterium ; isolation & purification ; Biomarkers ; analysis ; Clostridium ; isolation & purification ; Colitis, Ulcerative ; microbiology ; Crohn Disease ; microbiology ; Enterococcus ; isolation & purification ; Eubacterium ; isolation & purification ; Feces ; microbiology ; Female ; Humans ; Inflammatory Bowel Diseases ; etiology ; microbiology ; Lactobacillus ; isolation & purification ; Male ; Peptococcus ; isolation & purification ; Saccharomyces ; isolation & purification

Objective:To investigate the rates of low disease activity and clinical remission in patients with systemic lupus erythematosus(SLE)in a real-world setting,and to analyze the related factors of low disease activity and clinical remission.Methods:One thousand patients with SLE were enrolled from 11 teaching hospitals.Demographic,clinical and laboratory data,as well as treatment regimes were collec-ted by self-completed questionnaire.The rates of low disease activity and remission were calculated based on the lupus low disease activity state(LLDAS)and definitions of remission in SLE(DORIS).Charac-teristics of patients with LLDAS and DORIS were analyzed.Multivariate Logistic regression analysis was used to evaluate the related factors of LLDAS and DORIS remission.Results:20.7％of patients met the criteria of LLDAS,while 10.4％of patients achieved remission defined by DORIS.Patients who met LLDAS or DORIS remission had significantly higher proportion of patients with high income and longer disease duration,compared with non-remission group.Moreover,the rates of anemia,creatinine eleva-tion,increased erythrocyte sedimentation rate(ESR)and hypoalbuminemia was significantly lower in the LLDAS or DORIS group than in the non-remission group.Patients who received hydroxychloroquine for more than 12 months or immunosuppressant therapy for no less than 6 months earned higher rates of LLDAS and DORIS remission.The results of Logistic regression analysis showed that increased ESR,positive anti-dsDNA antibodies,low level of complement(C3 and C4),proteinuria,low household in-come were negatively related with LLDAS and DORIS remission.However,hydroxychloroquine usage for longer than 12 months were positively related with LLDAS and DORIS remission.Conclusion:LLDAS and DORIS remission of SLE patients remain to be improved.Treatment-to-target strategy and standar-dized application of hydroxychloroquine and immunosuppressants in SLE are recommended.

Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.