B cells play a central role in the pathogenesis of rheumatoid arthritis(RA) through multiple mechanisms.Clinical trials have demonstrated that anti-CD20 monoclonal antibody(Rituximab) is effective and safe to treat refractory RA through depletion of B cells.Rituximab is now approved by FDA for use concurrently with methotrexate to treat RA in patients who have an inadequate response to one or more tumor necrosis factor inhibitors.

Objective To investigate the clinical manifestations of cytomegalovirus (CMV) infection in patients with systemic lupus erythematosus (SLE). Methods Data of the consecutive cases of SLE complicated with active CMV infection including clinical manifestations, SLEDAI score, dosage of corticosteroid and immunosuppressants used for treatment,radiological and laboratory examinations were collected and analyzed.Results Among 2221 consecutive patients of SLE, 5.4%(121 cases) were diagnosed to be complicated with active CMV infection. Fever was the most common symptom, followed by serious liver function damage,respiratory symptoms,hematological abnormalities, myocarditis, and encephalopathy, accounted for 81%(98cases), 6.6%(8 cases), 4.1%(5 cases), 3.3%(4 cases), 0.8%(1 case), and 0.8%(1 case)respectively; in addition, 22 (18.2%) cases had no symptom. SLEDAI was higher than 15 in 47.1% cases, and 10-14 in 28.1% cases. 81% of patients were treated with corticosteroid, and 55.4% were treated with immunosuppressants. Ganciclovir was given once the diagnosis of active CMV infection was established. In most of the patients, active CMV infection had been controlled within 14-28 days, except 4 died and 6 gave up the therapy. Conclusion SLE with active CMV infection is common,especially in patients who are treated with corticosteroid and/or immunosuppressants. Clinical manifestations of SLE complicated with active CMV infection are generally nonspecific.In patients with unexplained fever,or liver damage,or lung disease,or active SLE patients who have no symptom but are refractory to the treatment, CMV infection should be suspected and the relevant laboratory tests should be ordered for early diagnosis and treatment.

The clinical data of 16 patients with synovitis,acne,pustulosis,hypemstosis,osteitis (SAPHO) syndrome were retrospectively analyzed.There were 7 men and 9 women with a mean age of (38 ± 11) years at onset and middle-aged females predominated.The most common clinical manifestations were palmoplantar pustulosis and osteoarticular disease involving anterior chest wall,spondylarthrilides and shoulder joint.ECT was the sensitive imaging examination for SAPHO syndrome.Combined treatment can alleviate symptoms of the disease.

Objective To investigate the clinical significance of IgG subclasses in patients with primary Sj(o)gren's syndrome (pSS) patients.Methods The serum was collected from 101 pSS patients and 40 healthy subjects.The content of IgG subclasses was determined by immuno-scatter turbidmetry.The difference of IgG subclasses distribution between pSS patients and healthy subjects was analyzed.Com-bined with the clinical information of the SS patients,the difference of IgG subclasses distribution in SS patients with different characteristics was analyzed.For group comparisons,measurement data were compared using unpaired Student's t test.Results The average levels of serum IgG1-4 in 40 healthy controls were (8085±1566) mg/L,(5406±2151) mg/L,(395±233) mg/L and (566±420) mg/L.The percentage of IgG1-4 were (56.8±8.2)％,(36.6±7.8)％,(2.7±1.5)％ and (3.9±2.8)％.The average levels of serum IgG1-4 in 101 pSS patients were (14 094±5534) mg/L,(3912±1750) mg/L,(565±565) mg/L and (404±504) mg/L,The percentage of IgG1-4 were(73.0±10.9)％,(21.7±9.8)％,(3.1±2.0)％ and (2.2±2.4)％.In pSS patients,the levels of IgG1,IgG3 and IgG1/IgG were significantly higher,while the IgG2,IgG2/IgG and IgG4/IgG levels were significantly lower,compared with those of the healthy subjects (P＜0.05).There was no significant difference in the IgG subclasses distribution between the pSS patients whose had systemic involvement and the pSS patients who did not have systemic involvement(P＞0.05).The IgG subclasses distribution was abnormal in SS patients who IgG was normal,compared with the healthy subjects.Conclusion A characteristic IgG subclasses distribution abnormality exists in pSS patients,and the production of anti-SSA (Sj(o)gren's syndrome A) antibody is associated with the increase of IgG1.However,no relationship has been found between the systemic involvement of pSS patients and the abnormal distribution of IgG subclasses.

Objective To introduce a new kind of circuit with temperature and voltage double compensation function in view of the deficiency of ambient temperature change on existing respiratory signal detection circuit. Methods The respiratory signal is detected by the characteristics of diode junction voltage with temperature changes. Results The functions of automatic temperatures compensation and automatic voltage fluctuation compensation are realized with the differential connection of two identical diodes. Conclusion The experimental results shows that the proposed circuit is basically immune to the fluctuation of ambient temperature changes and voltage fluctuation, its structure is simple and the accuracy of breathing signal detection is also improved.

Objective To analyze the clinical features of Takayasu′s arteritis (TA) and to evaluate the usefulness of 2D color Doppler flow imaging (2D CDFI) and digital subtraction angiography (DSA) in diagnosing TA.Methods Fifty eight patients with TA were analyzed.In 26 cases,the 2D CDFI findings were compared with that of DSA.Results ① One hundred and eighty two peripheral arteries were involved in 58 patients including 176 arteries with stenosis or occlusion,mainly with aortic arch syndrome and left side involved.② Compared with DSA,2D CDFI had a higher sensitivity (88%) in diagnosing stenosis and occlusion of vessel cavity in aorta and its main branches,and had a positive predictive value of 100% and anegative predictive value of 0% respectively.Conclusion 2D CDFI has some outstaning features as non invading,safety,cheapness and so on in diagnosing TA,compared with DSA that is usually used as "the gold standard" for the definitive diagnosis of this disease.2D CDFI is able to depict vessel wall thickening,which is a major pathologic feature of the disease and it is suitable for long term repeated follow up.

Objective To evaluate the efficacy and safety of recombinant human tumor necrosis factor-α receptor Ⅱ IgG: Fc fusion protein for injection (rhTNFR: Fc) treatment in Chinese patients with early rheumatoid arthritis (ERA) and active spondyloarthritis. Methods This was a large-scale, multicenter, open-label, phase Ⅳclinical observational study. The dosage of rhTNFR: Fc was 50 mg per week, combined or not combined with other drugs. The primary endpoint of efficacy included the proportion of patients with low disease activity [simplified disease activity index (SDAI)≤11] at 3 month and 6 month. Secondary endpoint variables included clinical disease activity index (CDAI), disease activity score 28 based on C-reactive protein (DAS28-CRP) and health assessment questionnaire(HAQ). The primary endpoint of SpA was the ankylosing spondylitis disease activity score (ASDAS-CRP) at month 3. The secondary endpoints were the proportion of subjects achieving ASDAS<1.3 and ASDAS<2.1, Bath AS functional index (BASFI) and CRP. All subjects in the study were evaluated for safety. T test, χ2 test and rank sum test were used for satistical analysis. Results One thousand two hundred and seventy subjects with ERA were studied. The difference between the baseline and month 3 after treatment in SDAI, CDAI, DAS28-CRP were 26 ±16, 23 ±15, 1.86 ± 1.01 respectively (P<0.01). The above parameters 6 months after treatment were similar to those at 3 months after treatment, which demonstrated the persistence of drug efficacy. Two thousand three hundred and twenty eight subjects of SpA were studied. The difference between the baseline and 3 months after treatment in ASDAS, BASFI was 2.6 ±1.7, 3.4 ±3.8 respectively (t=73 .54, t=42 .36, P<0.01). The overall incidence of adverse events was 8.03%(289/3 598), including the common adverse events such as injection site reactions, skin rash and elevated liver enzyme levels. Adverse events were improved after proper treatment, without severe infections and tumor. These data confirmed that the overall safety of rhTNFR: Fc was good. Conclusion The study confirms that rhTNFR: Fc is effective for the treatment of ERA and SpA, and it is safe and well-tolerated.

Objective To investigate the clinical features of central nervous system involvement in pSS.Methods The clinical data of 21 CNS-SS patients in our hospital were retrospectively reviewed.Results There were a variety of neuropsychiatrie presentations in pSS,in which 12 patients had brain involvement and 9 patients had spinal cord involvement,accounting for 57.1% and 42.9% respectively.Seven patients had con- current peripheral nervous system involvement.Neurological involvement of 10 patients preceded other syrup- toms of pSS.The mean duration of pSS at the onset of CNS-SS was(4?6)years.Abnormal MRI results had been found in 13 patients,of which 8 patients had demyelination lesions,which was the most frequent presen- tation,and accounted for 38.1%.Cerebral spinal fluid abnormality was seen in 11 CNS-SS patients,among which protein elevation was found in 10,pressure elevation in 6 and white cell count elevation in 5.Conclu- sions Central nervous system may be involved in pSS.MRI and cerebral spinal fluid tests are essential for the diagnosis of CNS-SS.CNS-SS may features of spinal cord and the peripheral nervous system involvement CNS-SS usually carries a mild clinical process and frequently oceurrs in stable pSS.

Objective To study clinical manifestations, risk factors and prognosis of patients with systemic lupus erythematosus (SLE) complicated with digital gangrene. Methods Data of 2684 inpatients with SLE admired to Peking Union Medical College Hospital during December 1997 to August 2007, including demographic information, clinical features, laboratory findings, as well as therapeutic regimens, were retrospectively analyzed, and 18 of those complicated with digital gangrene were identified and followed up. Results Average age at onset in patients of SLE complicated with digital gangrene was(33±12)years, with an average duration of disease course of (99±60 ) months.Longer course duration ( ≥ 4 yrs), Raynaud's phenomenon, elevated serum C-reactive protein (CRP) and positive anti-SSA antibody all were associated with occurrence of digital gangrene in patients of SLE, with P values of 0.012, 0.004, 0.037 and 0.087 respectively, and odds ratios of 1.03 (95% CI 1.01～1.05 ), 39.05 (95% CI 3.31～460.13 ), 17.99 (95%(CI 1.19～271.29) and 7.01 (95% CI 0.75～65.12), respectively. Fifteen of 18 SLE patients complicated with digital gangrene started treatment with predisone ≥1 mg˙kg-1 ˙d-1, and eighteen all were treated with cyclophosphamide, though eight cases failed and ultimately received digital amputation. Prompt corticosteroid treatment (predisone ≥ 1 mg˙kg-1˙d-1 within three weeks after occurrence) could decrease risk for amputation, with P =0.081 and OR =0.135 (95% CI 0.01～1.28). Conclusions Longer duration of disease course, Raynaud's phenomenon, elevated serum CRP and positive anti-SSA antibody all are independent predictors of SLE complicated with digital gangrene. Early and aggressive treatment can prevent occurrence of gangrene from its progression and improve its prognosis.

Objective To analyze clinical features and prognosis for the patients of primary biliary cirrhosis (PBC)complicated with interstitial lung disease(ILD).Methods Medical records of 139inpatients of PBC were retrospectively analyzed and their clinical features,biochemical parameters,spectrum of autoantibodies and Maye risk score were compared between subgroups with and without ILD.Resuits Among twenty two(16%)patients of PBC complicated with ILD,50 percent had respiratory symptoms such as chest distress,short breath,cough,and so on,and 50 percent had diffusing and obstructive ventilation impairment by pulmonmary function test.Patients of PBC complicated with ILD had a faster erythrocyte sedimentation rate(ESR)than that in those without ILD(P＜0.05).There was no significant difference in other biochemical parameters,positive rates of autoantibodies and Mayo risk score between the two subgroups (P＞0.05).Logistic regression analysis showed that odd ratios(ORs)of Raynoud's phenomenon and other connective tissue diseases(CTD)complication in patients of PBC to develop ILD were 3.54 and 2.56(P=0.03 and P=0.05),respectively,though 46 percent of PBC patients with ILD did not have other CTD complications.Conclusions Half of the patients of PBC complicated with ILD have respiratory symptoms.PBC patients with Raynoud's phenomenon and other CTD complications are more likely to develop ILD,but those without complications can also do.