Objective To revise the American College of Rheumatology classification criteria for rheumatoid arthritis(RA)with anti-cyclic citrullinated peptide(anti-CCP)antibodies and to evaluate its utility in the diagnosis of Chinese patients.Methods All patients from the Department of Rheumatology and Immunology of Peking University People's Hospital who had arthritis complaints in recent two years were enrolled.Patients were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The diagnostic value of ACR criteria and the anti-CCP revised criteria(RA-6,RA-7 and RA-8)were evaluated by analyzing the clinical and laboratory parameters.Results A total of 604 patients were included in the study.312 patients were diagnosed as RA and 292 were diagnosed as other rheumatic diseases by rheumatologists.For those patients who had disease course for less than 2 years,the sensitivity of 1987 ACR criteria,RA-6,RA-7 and RA-8 criteria was 82.0%,91.0%.87.0%and 87.0%,respectively.The specificity of them was 95.6%,83.9%,95.6%and 95.6%.respectively.The sensitivity of 1987 ACR criteria,RA-6,RA-7 and RA-8 criteria for all the RA patients was 92.3%,96.8%.94.6%and 94.6%,respectively.The speciflcity of them was 92.8%,83.6%,92.8%and 92.8%.respectively.Conclusion The 1987 ACR criteria have high sensitivity and specificity in established RA.but its sensitivity in early RA is low.The RA-6criteria can improve the sensitivity dramatically but with reduced specificity.The RA-7 criteria can increase the sensitivity without sacrifice the specificity,especially in early RA patients.It may be used as a new set of classification criteria in clinical practice.

0.05). The positive rate of the SE in rats experiencing longer arthritis duration (≥4 weeks) was significantly higher than that with shorter arthritis duration (

Objective: To study the prevalence of antibody to citrullinated human fibrinogen(ACF) in rheumatic diseases and the diagnostic values in rheumatoid arthritis.Methods: Human fibrinogen was deiminated by the peptidylarginine deiminase(PAD) in the presence of Ca~(2+) in vitro.ACF was detected by ELISA in 352 patients with rheumatic diseases(183 RA,121 SLE and 48 OA) and 108 healthy controls.The sensitivity and specificity in RA were calculated and the correlations between ACF and the clinical and laboratory parameters were analysed by SPSS statistical software.Results: Compared with SLE(25.62%),OA(18.75%) and healthy control(2.78%) respectively,the patients with RA had a significantly higher level of ACF(67.21%,P

Objective To detect antibodies against human papilloma virus-47 E2m345-362 peptide whichis homologous to profilaggri306324 peptide and anti-citrullinated human papilloma virus-47 E2345-362 peptide antibodies in rheumatoid arthritis(RA)and to investigate its role in the pathogenesis of RA.Methods Serum samples were obtained from 119 patients with RA, other rheumatic diseases and healthy individuals.We searched the homologus sequence of profilaggrin306-324peptide by using NCBI (the National Center for Bioteehnology Information)BLAST (basic local alignment search tool),and synthesized human papilloma virus-47 E2345-362 peptide which was highly homologous to profilaggrin306-324 peptide and the citrullinated Human papilloma virus-47 E2345-362 peptide.The presence of antibodies against E2345-362 peptide and citrullinated E2345-362 peptide was examined by enzyme-linked immunosorbent assay(ELISA).The associations between these antibodies and the clinical features of RA were evaluated.Results ①(41.2%)and titer (AU was 105.7)of anti citrullinated E2345-362 peptide antibodies in RA were significantly higher than those of patients with other rheumatic diseases and healthy individuals.However,the prevalence of anti-E2345-362 peptide antibodies in RA patients was similar to that of patients with other rheumatic diseases and healthy individuals(P>0.05).②The samples that were pre-incubated with cyclic citrullinated peptide (CCP) had lower titer of anti-citrulllinated E2345-362 peptide antibodies.③The titers of anti-CCP antibodies and anti-PAD14 antibodies in anti-citrullinated E2345-362 positive patients were higher than those of anti-citrullinated E2345-362 negtive patients.It showed significant correlations between anti-citrulllinated E2345-362 peptide antibodies and anti-PAD14 antibodies(r=0.485,P<0.01).④ DAS28 score,ESR,X-ray stages,AKA in anti-citrullinated E2345-362 positive patients were higher than those of anti-citrullinated E2345-362 negative patients.Conclusion The presence of anti-citrullinated E2345-362 peptide antibodies in RA indicates that HPV-47 E2 may act as an auto-antigen which may play an important role in the pathogenesis of RA.The increasing of PAD14 may make it easy for HPV-47 E2 to be citrullinated and may induce the subsequent auto-immune reactions.

Objective The present study investigated the expression of the citrullinated proteins in the synovium and serum of rheumatoid arthritis(RA)patients.Methods The expression of the citrullinated proteins in the synovium and serum of RA patients was analyzed by two-dimensional western blotting analysis (2-D WB),mass spectrometry MALDI-TOF/TOF MS,western blotting,immunohistochemistry and ELISA.Then we analyzed the data with one-way ANOVA,LSD test,Kruskal-Walls test and Spearman correlation analysis.Results Alpha-1-antitrypsin(A1AT),fibrinogen beta chain(FIBB),keratin type Ⅱ cuticular Hb4(KRT84),tubulin beta chain(TBB)and vimentin(VIME)were detected in RA serum and anti-citrulline antibody could be detected using 2-D WB.A1AT,KRT84 and TBB were expressed significantly in the synovial membranes and synovial fluids of RA patients.Furthermore,high levels of autoantibodies against KRT84 were detected in the blood of RA patients when compared with samples from the healthy controls.Conclusion Current study has identified novel autoantigens in RA,including A1AT,FIBB,KRT84,TBB and VIME using 2-D WB with purified RA sera and anti-citrulline antibody.FIBB and VIME have been confirmed to be autoantigens in the literature,this demonstrates the feasibility of our protocol and the reliability of our study results.

AIM: To provide a basis for appraising quality standard of Baohe Pill (Fructus Gataegi, Massa medicata fermentata, Rhizoma pinelliae, Pericapium citr reticulatae, Fructus forsythiae, Semen raphani, Fructus Mordei germinatus, Poria) inclusive of its RP-HPLC fingerprint chromatogram. METHODS: The chromatographic column was Kromasil C_ 18 column (4.6 mm?250 mm, i.d, 5-?m particle size). The mobile phase was 0.5% solution of ammonium dihydrogen phosphate (NH_4H_2PO_4), and the flow rate was 0.8 mL/min with UV detector at 214 nm. RESULTS: The RP-HPLC fingerprint chromatogram of Baohe Pill was established. In the experiment, for precision and repeatability, the RSD of each area of common peak was less than 3%. CONCLUSION: This method is simple and reliable.

Objective To evaluate the serum anti-Müllerian hormone(AMH)level in female patients with systemic lupus erythematosus (SLE),and to explore the association between AMH and anti-ovarian antibody(AOAB).Methods Serum levels of AMH and AOAB were measured with ELISA in 84 female SLE patients and 90 age-matched healthy women.The patients were not treated with steroids or immunosuppressive agents before their blood samples were collected.Clinical and laboratory data of the SLE patients were also analyzed by two independent samples t-test.Results The mean serum AMH level of 84 female SLE patients was (3.2±1.5)ng/ml,which was higher than that of 90 age-matched healthy women[(2.6±1.4)ng/ml,P<0.05].Moreover,the serum AMH level was closely associated with rash,lupus nephritis,and disease activity in the 84 SLE patients.The results showed that the serum AMH levels increased first,then decreased with aging,both in SLE patients and healthy women,but the appearance of peak serum AMH level in SLE patients was delayed.The frequency of AOAB wilts higher than that in healthy women.Interestingly,the mean serum AMH level of the AOAB-positive group[(4.1±1.8)ng/ml]was higher than that of the AOAB-negative group [(2.7±1.1)ng/ml,P<0.01].Conclusion The mean level of serum AMH in female SLE patients is higher than that in age-matched healthy women,and its high level in SLE patients is closely associated with rash,lupus nephritis,disease activity and serum AOAB level.

Objective Antibodies against citrulline-containing peptides such as anti-perinuclear factor (APF), anti-keratin antibodies (AKA), anti-filaggrin antibodies (AFA) and anti-cyclic citruilinated peptide (CCP) antibodies are very specific in RA. In recent years, detection of APF, AKA and anti-CCP antibodies have been widely used in clinical practice. Studies on the combined detection of these ACPA in diagnosing RA are limited in number. The aim of this study is to detect combined examination of APF, AKA, and anti-CCP antibodies and compare their values in the diagnosis of rheumatoid arthritis. The significance of combined detection of these ACPAs in rheumatoid arthritis is also investigated. Methods Five hunndred and fifly-one patients who suffered from arthritic problems during the recent two years were selected from the Department of Rheumatology and Immunology of Peking University People's Hospital. 304 of the patients were RA and 247 were diagnosed to have other rheumatic diseases based on the corresponding classification criteria. AKA and APF were tested by indirect immunofluorescence assay. Anti-CCP antibodies were tested antibodies, AKA and APF tests for RA were 76.2%, 43.6%, and 34.5%, respectively, and the specificities were highest specificity (100%), but it had a rather low sensitivity (28.3%). When two of the three ACPA were positive, the sensitivity and specificity for the diagnosis of RA was 48.4% and 99.2%, respectively. When either anti-CCP antibodies, AKA, or APF was treated as an individual parameter, the sensitivity was slightly increased (77.3%). However, the specificity decreased to 94.7%. Conclusion Anti-CCP antibodies are the most helpful makers for the diagnosis of rheumatoid arthritis among the three ACPAs which are used in clinical practice. The combined detection of anti-CCP antibodies, AKA, and APF cannot increase the diagnostic sensitivity and specificity of rheumaotid arthritis.

Objective To analyze the 5-year survival rate,causes of death and prognostic indicators of systemic lupus erythematosus (SLE).Methods A retrospective analysis was performed on 243 newly diagnosed SLE patients who Were admitted into our hospital from 1998 to 2005.The clinical features and serologic data were studied.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic indicators of mortality were studied by Cox proportional hazards models.Results The 1-,3- and 5-yr survival rate was 96%,94% and 91%,respectively.Renal failure and infection were the main causes of death,followed by lupus encephalotmthy and pulmonary hypertension.Cox regression analysis revealed that lupus nephritis and lupus encephalopathy at the diagnosis were independent risk determinants for mortality.However,age,sex,low C3 level,positive anti-dsDNA antibody,hematological abnormalities,lupus lung involvement and heart damages at diagnosis and immunosuppressant treatment had no strong association with survival.Conclusion Early diagnosis,control of SLE organ damage and infection prevention are critical to improve survival of SLE patients.

Objective To examine the effect of metformin on serum thyrotropin (TSH) level in diabetic patients with subclinical hypothyroidism (SCH).Methods The long-term effects of metformin on thyroid axis hormones were assessed in 55 diabetic patients with primary SCH who were untreated with L-T4(study group),as well as in 31 diabetic patients with normal thyroid function (control group).According to using metformin or not,patients of study group were divided into the metformin group (group 1,n =28),and the non-metformin group(group 2,n =27).Serum TSH levels were compared between baseline and follow-up in patients receiving metformin treatment.Results After 30 weeks of metformin administration,a significant TSH decrease(t =2.91,P ＜ 0.05) was observed in group 1 [from(6.98 ± 1.92) to(2.44 ± 0.61) mIU/L].After stopping metformin therapy,the level of TSH at 52 weeks fol low-up was back to the baseline level [(6.99 ± 1.76) mIU/L,P ＞ 0.05].There was no significant difference in TSH level between baseline and after 30 weeks follow-up in group 2[(6.01 ± 1.63) mIU/L vs(6.21 ± 1.71) mIU/L,P ＞0.05].At the end of 30 weeks follow-up,no significant differences were found in body mass index and thyroid func tion in both metformin group and non-metformin group.In control group,metformin administration for 30 weeks had no effect on TSH level(P ＞ 0.05).Conclusion Metformin administration influences TSH without change of FT4 level in type 2 diabetic patients with primary SCH.