Objective To evaluate the value of clinical findings and different diagnostic criteria for the diagnosis of adult onset Still's disease (AOSD). Methods The AOSD patients admitted to Zhongshan Hospital affiliated to Fudan University from 2003 to 2009 were enrolled. Non-AOSD patients with fever were selected. Different diagnostic criteria of AOSD were applied to all patients. Two indenpendent samples t test and wilco-xon test were used for statistical analysis. Results The clinical features such as rash, arthralgia, arthroncus, sore throat, myalgia, lymph node enlargement, hepatomegaly, splenomegaly, leuko-cytosis, neutrophil ≥80% and serum level of ferrin≥ 2000 ng/ml hadhigher specificity (65.87%~98.41%) with 2.00～5.00 of the positive likelihood ratio.High fever ( ≥39.0℃), negative of ANA and RF had higher sensi-tivity (85.25%~93.65%). Combinations of three parameters such as high fever, rash, sore throat, leukocy-tosis, arthralgia had higher positive likelihood ratio. The specificity of ARA criteria was the highest. The sensitivity and accuracy of Yamaguchi criteria were the highest. Conclusion There is no single parameter that could be specific to the identification of AOSD. Combing with several parameters can improve the diagnostic efficiency. The results of this study have shown that the commonly used diagnostic criteria has high specificity.

Objective To identify the clinical differences between central nervous system (CNS) infection and neuropsychiatric lupus in patients with systemic lupus erythematosus (SLE). Method Clinical manifestations, lab test results and prognosis of 12 SLE patients complicated with CNS infections, hospitalized in Nanjing Drum Tower Hospital in the past four years, were reviewed and compared with those of 15 concomi-tantly treated patients with central neuropsychiatric lupus (NPL). Two-indenpendent samples t test, Mann-whitney test and Fisher exact test were used for statistical analysis. Results 83% of SLE patients with CNS infections were female and the average disease onset age was (37±4) years. As compared to neuro-psychiatric lupus patients (the control group), those patients with CNS infections (infection group) had lower lupus disease activity (SLEDAI score 14.3±1.6 vs 6.4±1.2, P<0.01) and took higher dose of corticosteroids [average prednisone dose (28.3±2.5) vs (8.4±3.0) mg/d, P<0.01 ] and more immunosuppressives agents (83% vs 33%, P<0.05) before the occurrence of CNS symptoms. Headache and fever were more common in the infection group (100% vs 46.7% and 91.7% vs 20%, both P<0.01) and simultaneously higher serum albumin levels [(34.2±1.2) g/L vs (29.9±1.6) g/L] were detected in those patients compared to the NPL patients (P<0.05). Cerebrospinal fluid examination showed that agents for a long time but without strong evidence of lupus disease activity, CNS infection should be considered at the appearance of headache and fever, and timely cerebrospinal fluid examination is required for the diagnosis.

Objective To validate the discriminatory capacity of the new ankylosing spondylitis disease activity scores (ASDAS) in Chinese ankylosing spondylitis (AS) patients, and assess its clinical value. Method One hundred and twenty-nine patients with AS was included in the study, in which 87 were par-ticipat clinical trials with Etanercept (n=87) and 42 were participants of clinical trails with. The disease activity and treatment effecticacy were assessed by ASDAS, BASDAI and patient global assessment. Discriminatory ability of all the measures was analyzed as standardized mean difference (SMD) and (-score. Pearson's correlation, two indepen -dent samples t test and simple linear regression model were used for statistical analysis. Result The four ASDAS scores correlated well with patient global assessment (r=0.56～0.74), ESR (r=0.50～0.80) and CRP (r=0.50～0.69) both at baseline and the changes form baseline to 6 weeks after treatment. The four ASDAS outperformed BASDAI, patient global assessment, ESR and CRP in differentiating patients with different levels of disease activity and patients with different levels of change. There was little difference in performance between the four ASDAS versions. Conclusion The four ASDAS are highly discriminatory in evaluating the disease activity and the efficacy of drugs in Chinese AS patients, showing a significant value in clinical practice.

Objective To study the role of peripheral blood T regulatory cells (Treg) markers, as well as different Treg cells in the pathogenesis of systemic lupus erythematosus (SLE) and explore the correla-tion betweenCD127 and Foxp3. The immunosuppressive effect of CD4~+CD25~+CD127~(low/-) T cell is explored. Methods ①Four-color direct fluorescence-labeled and multi-parameter flow cytometry were used to detect peripheral blood CD4~+CD25~+ T cells and other Treg cells accounted for the proportion of CD4~+ T cells in 40 SLE patients (19 cases with active disease 21 cases in remission) and 15 healthy controls. Meanwhile, its correlations with anti-dsDNA antibodies among 7 groups were analyzed.②Flow cytometry sorting combined with cell culture were applied to detect and analyze the proliferation inhibition effect of CD4~+CD25~+CD127~(low/-)regulatory T cells to CD4~+CD25~-effector T cell.Two independent samples t test,ANOVA for repeated measures,Pearson's correlation and Spearman's correlation were used for statistical analysis.Results ①The cell ratio of the 7 groups of SLE patients was(6.1±1.7)%,(3.1±1.3)%,(2.1±1.0)%,(1.6±0.3)%(0.97±O.28)%,(0.69±0.23)%and(O.71±0.35)%respectively.In the SLE group,the proportion of the first 6 groups was lower than the control group (P<0.05).For CD4~+CD127~(low/-)Foxp3~+,there wag no difference in the two groups(P>O.05).②CD4~+CD25~+Foxp3~+,CD4~+CD25~(high)Foxp3~+ T cells and IgA ratio Was positivelv correlated.While CD4~+CD25~(high)CD127~(low/-) T cells and anti-SSB antibodies was positively correlated in SLE patients.③The seven group of cells,in addition to CD4~+CDl27~(low/-)Foxp3~+ T cell ratio were lower in early-onset SLE patients than those in patients at remission(P<0.05).④The cell propor-tion of the first 6 groups was lower than that of post steroid treatment(P<0.05).⑤Foxp3 expression of CD4~+CD25~+T ceils and CD4~+CD25~(high) T cells was positively correlated with low expression of CDl27 in the early onset group,remission group and the control group.⑥The CD4~+CD25~- effect T cells could be suppressed by their own CD4~+CD25~+CDl27~(low/-) regulatonry T cells in vitro,and the inhibition of SLE patients was significantly lower than controls.Conclusion The immunological abnormality of SLE may be associated with the qnatity and functional defects of immune regulatory T cells.CDl27 may be a possible alternative to Foxp3 regulatory T cell-specific surface markers.

Objective To investigate the effects of arsenic trioxide (ATO) on the expression of autoan-tibody and interleukin (IL)-10 IL-12 in MRL/lpr mice. Methods MRL/lpr mice wereseparated into 3 different groups. The 3 groups received arsenic trioxide (ATO, 0.4 mg·kg~(-1)·d~(-1)), cyclophosphamide (CTX,50 mg/kg) and sodium chloride (NS, volume weight-determined) abdominal injection respee-tively. The treatment stopped 2 months later. Afterwards, the rates of CD3~+(T) cells, CD3~+CD4~+(Th) cells and the CD3~+CD4~+cells which produced IL-10 and IL-12 were detected using single-cell measurement of intr-acellular eytokines by flow cytometry after polyclonal stimulation with PMA and ionomycin for 4 hours in 5% CO_(2.)Serum levels of IL 10 and IL-12 were assessed using the Mouse cytokines ELISA Kit. One-way ANOVA LSD test and paires t test were used for statistical analysis.Results ①The level of anti-dsDNA antibody after treatment was 0.92±0.06, while it was 1.14±0.58 before treatment. So the ds-DNA antibody level was significantly decreased in ATO group (P<0.01), while it was dramatically increased in the NS groups (P<0.05) after the treatment;②ATO group had significantly less CD3~+ cells and CD3~+CD4~+ cells[(44±4)% and (20±4)%]compared withNS group [(59±5)%and(30±3)%](P<0.01).③The serum level of IL-12 in the ATO group was (84±12) pg/ml,while it was (103±13)pg/ml in the NS group (P=0.018).④The intracellular levels of IL-10 and IL-12 produced by CD3~+CD4~+ (Th) cells in the ATO group were ( 1.5±0.4)% and (2.43±0.42)%, which was significantly lower than those in the NS group respectively (2.5±0.5)% and (3.24±0.40)%(P<0.01). Conclusion Arsenic trioxide can reduce the production of anti-dsDNA antibody,inhibit the activation and proliferation of both T cells and Th subsets in the MRLApr mice, and hence decrease the serum levels of IL-12 and the levels of IL-10, IL-12 produced by Th cells.

Objective To detect the expression levels of high mobility group box chromosomal protein 1 (HMGB1) and Th17 cells transcription factors, related cytokines in peripheral blood of rheumatoid arthritis (RA) patients and analyze the relations between HMGB1 and CRP, ESR, RF in RA patients. The other aim of this study is to identify the expression level of HMGBI and the relationship between HMGB1 and Th17 in RA patients. Methods The mRNA levels of HMGB1, RORyt, interleukin (IL)-17 in the peripheral blood mononuclear cells (PBMC) were determined by quantitative real-time PCR (QRT-PCR) from 80 patients with rheumatoid arthritis,including 32 RA patients in stable phase and 48 patients in active phase, and 50 healthy volunteers. The concentration of HMGB1, IL-23, IL-17 in plasma were detected by enzyme linked immunosorbent assay (ELISA), one-way ANOVA and Spearman's correleation were adopted for statistical analysis.Results The mRNAs of HMGBI, RORyt and IL-17 in RA patients were higher than that in healthy control group (P<0.05), especially in active RA patients [ HMGB 1 (0.424±0.262) pg/ml, RORγt (0.34±0.25) pg/ml,IL-17 (1.42±0.38) pg/ml,P<0.01 ] when compared with patients with stable disease. The concentration of HMGB1, IL-23 and IL-17 in the plasma of RA patients was higher than that of the healthy control group (P< 0.05), and was positively correlated with the expression levels of HMGB1, Th 17-associated factors and the level of CRP, ESR, RF in RA patients' plasma(P<0.05). Conclusion The HMGB1 and Thl7 cells levels are higher in active RA patients than those in patients with stable disease, arid there is significant positive correlation between them. Detection of peripheral HMGB1 and Thl7 cell-specific transcription factors or related cytokines can help to understand the development and progress of rheumatoid arthritis and provide clues for new treatment targets for RA.

Objective To investigate the serum concentration of interleukin (IL)-17 in patients with active rheumatoid arthritis and the clinical implication. Methods Serum IL-17 level of 51 active RA patients were assessed by enzyme-linked immunosorbentassay (ELISA). The relationship between serum levels of IL-17 in active RA patients and clinic features were analyzed. Two independent samples t test, ANOVA for repeated, one-way ANOVA and Spearman's Chi-square test were used for statistical analysis. Results ① Serum IL-17 levels were elevated in active RA patients (365±63) pg/ml than in normal controls (86±13) pg/ml (P<0.01); ② Serum IL-17 levels in active RA was correlated with morning stiffiness duration, swelling index, Ritchie index, CRP, ESR, RF, X-ray score, DAS score (r =0.423, 0.213, 0.252, 0.276, 0.346, 0.251, 0.412, 0.398; P<0.05). ③ The levels of IL-17 between phase I (296±79) pg/ml and Phase II (360±89) pg/ml, phase II and phase HI (464±74) pg/ml, Phase I and Phase Ⅳ (369±83) pg/ml in RA group were statistically significantly different (P<0.05). Conclusion The levels of serum IL-17 in active RA patients are higher than the normal controls. The elevated serum IL-17 levels may be the useful markers for active RA.In addition,interleukin-17 is involved in disease progression and bony erosion of RA, and it maybe a new treatmenttarget of RA.

Objective To investigate the immunoregulatory effect of thalidomide on the peripheral blood T-iymphocytes in systemic lupus erythematosus patients in vitro. Methods T-lymphoeytes were treated by thalidomide with different concentrations, then the proliferation of these T-lymphocytes proliferation was deteted by MTT while apoptosis and lymphocyte activation marker were analyzed by flow cytometry. The mRNA expression of IL-6, IL-10 and TNF-α was measured by real-time RT-PCR, One-way ANOVA was used for statistical analysis. Results In vitro, thalidomide inhibited the expression of CD3~+CD28~+ [500 μg/ml group vs the control group, (48±9)% vs (57±9)% P<0.05]. The pro-portion of apoptotic T-lymphoeytes in the 500 μg/ml group was (36±8)%, which was significantly higher than that in the control group [(23±5)%,P<0.05 ]. The values of A_(570nm) T-lymphocytes were significantly lower in the 100 μg/ml group, 300 μg/ml groupand 500 μg/ml group compared with those of the control group ( 100 μg/ml group vs 300 μg/ml group vs 500μg/ml group vs the control group, 0.39±0.05 vs 0.34±0.04 vs 0.30±0.03 vs 0.51±0.07, P<0.05), while thalidomide promoted the expression of CD8~+CD152~+ [ 100 μg/ml group vs 500 μg/ml group vs the control group, (5.0±0.6)% vs (7.8±0.7)% vs (4.2±0.6)%, P<0.05 ]. 500 μg/ml thalidomide inhibited the mRNA expression of IL-6, 2.5～500 μg/ml thalidomide inhibited IL-10, TNF-α mRNA expression of T-lymphocytes.Conclusion Thalidomide can inhibit the proliferative activities and CD28 expression of T-lymphocytes,reduce mRNA expression of IL-6, IL-10, TNF-α, stimulate CD28 expression and apoptosis of T-lymphocytes. These effects may play an important role in it's immune-suppressive effects on systemic lupus erythematosus.

Objective To identify the diagnostic criteria and investigate the incidence and distribution of the patellofemoral arthritis in aged people in Wuchuan region of the Inner Mongolia of China. Methods A population-based cross-sectional survey was conducted among 1030 residents aged 50 years and over of Wuehuan County, Inner Mongolia. Survey participants, mostly farmers, reported heavy physical activity, completed an interview-based questionnaire and Skyline View weight-bearing films were evaluated for KeU-gren and Lawrence (K/L) grade. Radiological patellofemoral arthritis (RPFA) and symptomatic patellofemoral arthritis (SPFA) were defined. Statistical package SPSS 14.0, crosstabs chi-squae test and Excel were adopted for statistical analysis. Results One thousanod and twenty-five participants were included in this study and 2050 knee joint Skyline View weight-bearing films were analyzed. The incidence of RPFA was 8.72%(6.8% in men, and 10.5% inwomen). The incidence of SPFA was 6.33% (4.8% in men, and 8.0% in women).The RPFA incidence of age groups 50～, 60～,≥70 was 3.8%, 10.6%, 22.9% respectively, while the incidence of SPFA was 2.7%, 7.7%, 17.3% respectively. The Three age groups' SPFA/RPFA was 71.7%, 72.0%, 75.6% respectively. The incidence of RPFA was 6.00/0, 7.3%, 11.0%, 11.3%, and the incidence of SPFA was 4.2%,5.2%, 7.3%, 9.6% and the four SPFA/RPFA was 70.0%, 71.3%, 66.7%, 84.8% in people whose BMI was less than 18.5, 18.5～, 23.0～ and higher than ≥25.0 kg/m~2 respectively, 73.6% people had joint pain among RPFA.Conclusion The prevalence of symptomatic patellofemoral arthritis in the rural areas of China is 6.8%, the incidence of that in women is higher than in men, and elder people suffer a high incidence. And the heavier the people are, the higher the incidence of patellofemoral arthritis.

Objective To investigate the relevance of the clinical score and pathology score and assess two scoring system including the British Islet Lupus Assessment Group2004 (BILAG2004) and systemic lupus erythematosus disease activity index 2000 (SLEI)AI2000) by analyzing the biopsy results and related laboratory tests on lupus nephritis (LN). Methods Retrospective analyzed 59 cases of patients with renal biopsy. All biopsied tissues were scored based on the to ISN/RPS2003 lupus nephritis pathological typing standards. Meanwhile, respective index (AI), chronic Index (CI) and tubulointerstitial lesions (TIL) score were used to evaluate the activities of lupus nephritis and SLEDAI2000 and BILAG2004 were used to evaluate the clinical disease activity. The adssociation between pathological changes and disease activities was assessed. Results ①According to ISN/RPS2003 pathological type standard, among these 59 patients, type Ⅳ was the most common type,which accounted for 44.07 percent of all biopsied tissues. ② For those patients. With LN typeⅡ,Ⅲ Ⅳ, their SLEDAI2000 score and BILAG2004 renal biopsy AI was positively correlated (00.05). Conclusion BILAG2004 score and SLEDAI2000 scoring system can be used to assess the disease pathology activity of patients with lupus nephritis. The study has found that BILAG2004 scoring system is superior to SLEDAI2000 score system for the assessment of LN patients on pathological activities, especially for with severe LN patients. As a non-invasive method of assessment, BILAG2004 score system is better than SLEDAI2000 score system in guiding clinical treatment.