Arthritis, Rheumatoid ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Early Diagnosis ; Humans ; Male

The idiopathic hypereosinophilic syndrome (HES) is a disorder marked by the sustained overproduction of eosinophils. The disease is characterized by damage of multiple organ including heart, nerve system, skin and lung due to eosinophilic infiltration and the diagnosis is one of exclusion. Rheumatologic manifestations of HES are infrequent. In about 10~40% of rheumatoid arthritis (RA) patients, persistent eosinophilia is observed. That can be due to the RA itself and is often associated with active disease and extra-articular features. Sometimes, it is attributed to the drug therapy, especially gold and penicillamine. We would like to report a 37-year-old female patient with HES who developed seronegative RA 2 years later.
Adult ; Arthritis, Rheumatoid* ; Diagnosis ; Drug Therapy ; Eosinophilia ; Eosinophils ; Female ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Lung ; Penicillamine ; Skin

The past decade has greatly enhanced our understanding of rheumatoid arthritis (RA). Not only have new drug therapies become available, but this period has witnessed dramatic changes in treatment strategies as well. Since 1989, when the proposal on reversing the pyramid approach (the step-down bridge concept) was published, the concept of early and aggressive treatment of RA has become the leading paradigm. The theory underlying this approach is based on a bet-ter understanding of the devastating long term consequences of RA in most patients, and the logical tenet that irreversible damage must be prevented before it occurs. Evidence has shown the irreversible joint damage in RA occurs early in the disease, making a "wait and see" approach unacceptable. Thus, it appears logical to begin treatment as soon as a diagnosis of RA is confirmed, to slow disease progression by treatment with disease modifying antirheumatic drugs. This review will address the evidence supporting the benefit and the principles of early treatment, as well as the current update on pharmacological management in early RA.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Diagnosis ; Disease Progression ; Drug Therapy ; Humans ; Joints ; Logic

OBJECTIVETo find out Chinese herbal compounds (CHCs) with high frequency in treating rheumatoid arthritis (RA) patients of cold-dampness obstruction syndrome (CDOS) by inductively reviewing literatures concerning clinical application of CHCs, thus improving theoretical and medical practice levels of Chinese medical recipes.

METHODSThe CHCs for treating RA patients of CDOS published in medical journals in recent 30 years were retrieved. The database of CHCs was set up. The herbal functions, meridian tropism, flavors and properties were statistically analyzed.

RESULTSThere were 126 single herbs in CHCs for treating RA patients of CDOS. The top 31 single herbs occupied 70.7% cumulative frequency, being high frequency CHCs for treating RA patients of CDOS. From the function aspect, the anti-rheumatic herbs, asthenia supplementing herbs, diaphoretic, and herbs for activating blood circulation and removing blood stasis were identified as high frequency CHCs. From the meridian tropism aspect, Gan-meridian, Pi-meridian and Shen-meridian, occupied the top 3. As for flavors, acid, bitter, and sweet occupied the top three. As for drug nature, herbs of warm property were used most frequently.

CONCLUSIONThe high frequency CHCs obtained from analytical statistics could provide evidence for clinical medication.

Arthritis, Rheumatoid ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; methods ; Phytotherapy ; methods

OBJECTIVETo summarize Professor ZHOU Zhong-ying's academic ideas and clinical experiences in diagnosing and treating rheumatoid arthritis (RA).

METHODSTotally 153 clinical case reports were recruited. Data mining techniques like frequencies, factor analysis, and association analysis were used in order to find out laws of syndrome, pathogenesis, treatment methods, formulae and medication.

RESULTSBy statistical analyses, we found 14 main symptoms, 76 commonly used clinical drugs, 8 core prescriptions for RA, and the correlation between main pathogeneses and related drugs.

CONCLUSIONResults analyzed and summarized from mining his experiences in RA treatment were in line with clinical practice.

Antirheumatic Agents ; therapeutic use ; Arthritis, Rheumatoid ; diagnosis ; drug therapy ; therapy ; Data Mining ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; methods ; Phytotherapy ; Treatment Outcome

OBJECTIVETo study whether the effects of Leflunomide were different in treating patients with rheumatoid arthritis (RA) of different Chinese medical syndrome patterns.

METHODSTotally 150 RA patients were recruited and assigned to 5 Chinese medical syndrome types, i.e., the heat-dampness blocking collateral type, cold-dampness blocking collateral type, Shen-qi deficiency cold type, Gan-Shen yin deficiency type, and stagnant blood blocking collateral type according to Chinese medical syndrome typing standards. They were treated with Leflunomide, 3 months as one therapeutic course. The parameters including numbers of joint tenderness and swelling, morning stiffness time, scores estimated by Visual Analog Scale (VAS), as well as laboratory indices involving rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American College of Rheumatology 20% improvement (ACR20), and American College of Rheumatology 50% improvement (ACR50) were observed before and after treatment, and statistically analyzed.

RESULTSAfter treatment the numbers of joint tenderness, numbers of joint swelling, VAS scores, ESR, CRP, and RF all decreased, showing statistical difference when compared with those before treatment (P < 0.05). The morning stiffness time was shortened in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type, showing statistical difference (P < 0.05). Of them, the numbers of joint tenderness, the numbers of joint swelling, the morning stiffness time, RF, VAS scores, and the improvement of the total effective rate were obviously better in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type than in the Shen-qi deficiency cold type and Gan-Shen yin deficiency type, showing statistical difference (P < 0.05).

CONCLUSIONSLeflunomide showed significant effects in treating RA. Of them, its effects were obviously better in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type than in the Shen-qi deficiency cold type and Gan-Shen yin deficiency type.

Adolescent ; Adult ; Aged ; Arthritis, Rheumatoid ; diagnosis ; drug therapy ; Female ; Humans ; Isoxazoles ; therapeutic use ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Yin Deficiency ; drug therapy ; Young Adult

Arthritis, Rheumatoid ; classification ; diagnosis ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Phytotherapy ; methods ; Syndrome

Arthritis, Rheumatoid ; diagnosis ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Phytotherapy ; methods

OBJECTIVETo compare the clinical characteristics of traditional Chinese medicine (TCM) and Western medicine (WM) in diagnosing rheumatoid arthritis (RA).

METHODSA total of 85 clinical RA related messages were enacted and classified into 5 sets as pathological locations, quantitative diagnosis, symptomatic descriptions, general status and environment factors. The respective frequency of their presence in the TCM or WM data sets for RA diagnosis collected from MEDLINE and China National Knowledge Infrastructure (CNKI) were analyzed statistically by Chi-square test, and the relationship of some TCM diagnostic factors/conditions with the RA related biological factors was analyzed by co-occurrence-based literature approach of mining.

RESULTSThere was significant difference between the diagnostic pattern of WM and TCM (P < 0.01). Compared with that of WM, TCM diagnosis on RA paid more attention to environmental factors and symptomatic descriptions, which showed definite association with the cytokines and neuro-endocrine factors in RA.

CONCLUSIONExamination of environmental factors and symptomatic descriptions for RA diagnosis is one of the important characteristics of TCM treatment in accordance to syndrome differentiation, it has its potential biologic basis. A novel approach is proposed for exploring the characteristics of TCM in diagnosis and observation.

Arthritis, Rheumatoid ; diagnosis ; Diagnosis, Differential ; Drug Therapy ; methods ; statistics & numerical data ; Humans ; Information Storage and Retrieval ; methods ; statistics & numerical data ; Medicine, Chinese Traditional

Suppurative arthritis of the knee is a well known complication following intra-articular injection of steroids on the other hand, tuberculous arthritis following such injection is rare. From January, 1981 to April, 1986, 46 patients of tuberculous arthritis of the knee were admitted to Severance Hospital and Yong-Dong Severance Hospital of Yonsei University College of Medicine. Among them 22 patient (48%) had a history of intra-articular injection of steroids and we analyzed them. The results were as follows: 1. The average age was 48.6 years (3–71 years). And sex ratio was in 1:2.7 as female predominant. 2. Initial diagnosis before the steroid injection were osteoarthritis (13 patients), rheumatoid arthritis (6 patients), and traumatic arthritis (3 patients). The fifty percent of the patients were injected by the local practitioner and fourty five percent had a history of accupuncture and moxa cautery. The preoperative diagnosis (diagnosis on admission) were tuberculous arthritis (12 patients), pyogenic arthritis (5 patients), rheumatoid arthritis (3 patients) and osteoarthritis(2 patients). 3. The number of intra-articular injection ranged from 2 to 100 times (average 12.8) during periods ranging from 1 month to 4 years (average 19.2 months). And interval between last injection and confirmation of tuberculous arthritis ranged from 1 week to 2 years (average 7.0 months). 4. Eight patients (36%) had a active or inactive pulmonary tuberculosis. 5. The positive cultures of typical Mycobacteria tuberculosis were obtained from 11 patients 59%). 6. The modalities of treatment were synovectomy or curettage in 16 patients and arthrodesis in 6 patients. And all patients were treated by antibuberculous chemotherapy. In conclusion, we observed that tuberculous arthritis developed not infrequently after intra-articular injection of steroids. And we considered the causes of tuberculous arthritis following intra-articular injection of steroids were; 1) reactivation of dormant injection or hematogenous, spreed due to interferance of host defence mechanisms, 2) contamination by the instrument and equipment, 3) aggravation of preexisting tuberculous lesions. Whenever one try to inject the steroid into joint, bacterial culture foi the pyogenic organism including tuberculosis and fluid analysis from the joint fluid should be done before the injection. We recommend that other method for the confirmation for the tuberculosis is needle biopsy of the synovium. If the symptoms are not improved after injection or the joint shows inflammatory reaction, one must discontinue the injection and reexamine the joint fluid analysis and culture for the confirmation of the infection.
Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Arthrodesis ; Biopsy, Needle ; Cautery ; Curettage ; Diagnosis ; Drug Therapy ; Female ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Knee ; Methods ; Osteoarthritis ; Sex Ratio ; Steroids ; Synovial Membrane ; Tuberculosis ; Tuberculosis, Pulmonary