Objective To study the role of transforming growth factor-?1(TGF-?1) and bone morphogenetic protein 2 (BMP2) in the ankylosing spondylitis, and to evaluate whether synovial levels of TGF-?1/ BMP2 mRNA and TGF-?1/BMP2 protein expression correlate with disease activity and macroscopic observation during arthroscopy. Metheds TGF-?1/BMP2 mRNA and protein were detected by in situ hybridization and immunohistochemistry.The vascular morphology of synovial membrane was assessed for vascular morphology, tortuous vessels, straight vessels, vascular density, synovial hypertrophy, by 2 blinded observers and Reece's method using a validated VAS methods. They were significantly higher in AS than that in RA in different synovial regions. Results TGF-?1 mRNA and TGF-?1 expression were significantly higher in early AS than that in early RA in perivascular region and sublining interstitial tissue. BMP2 mRNA and BMP2 expression were significantly higher in AS than that in RA in different synovial regions.No significant relation was found between TGF-?1/BMP2 expression and CRP/ESR/platelet count in early AS. A positive relation was found between the TGF-?1 and synovial hypertrophy in synovium lining layer region, and between TGF-?1 and straight vessels,vascular density in perivascular region, and between BMP2 and synovial hypertrophy in sublining region in early AS. Conclusion Expression of TGF-?1 mRNA and TGF-?1 protein is higher in AS synovial tissue than that in RA. BMP2 mRNA and BMP2 expression are significantly higher in AS than that in RA.

Objective To investigate spinemagnetic resonance imaging(MRI) findings in patients with axial spondyloarthritis (SpA) and to analyze the correlation between imaging and clinical manifestation.Methods The clinical data of patients with axial SpA were recorded.All patients underwent whole spine MRI scanning.The MRI findings of spinal involvement were explored.Moreover,the correlation between lesions in spinal MRI and Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI),Bath Ankylosing Spondylitis Metrology Index (BASMI),nocturnal pain visual analogue scale (VAS) score,back pain VAS score,global disease activity VAS score,Ankylosing Spondylitis Disease Activity score (ASDAS),erythrocyte sedimentation rate,C-reactive protein was analyzed.Results Thirty-three patients with axial SpA were included in this study.The image abnormalities of the spine were confirmed in 29 axial SpA patients by MRI,including Romanus lesion,Andersson lesion,the inflammation of facet joints and syndesmophyte.In correlation study,BASMI was positively correlated to the numbers of acute Romanus lesions,chronic Romanus lesions,chronic Andersson lesions and whole spinal lesions(r =0.440,P＜0.05; r =0.483,P＜0.05; r=0.421,P＜0.05; r=0.589,P ＜ 0.05 respectively).There was a statistically significant correlation between chronic Andersson lesions and BASFI(r =0.392,P ＜0.05).But no significant associations were found between MRI lesions and other clinical findings.Conclusions MRI lesions in axial SpA were associated with findings reflecting the spinal function,which can better guide the clinical treatment.

Objective To analyze the clinical characteristics of amyopathic dermatomyositis (ADM).Methods Twenty six patients diagnosed as ADM from January 2006 to January 2010 in PLA General Hospital were retrospectively analyzed.The clinical manifestation,laboratory findings,imaging manifestations,treatment and prognosis of the 26 patients were recorded.Results There were 18 females and 8 males with age of 30-68 years.Overall disease course after diagnosis was 2-18 months.All patients had Gottron rash and interstitial pneumonia.Fifteen patients had history of pulmonary infections.Three patients had comorbidity of tumor.Creatine phosphokinase,creatine phosphokinase isoenzyme,glutamicoxaloacetic transaminase and lactate dehydrogenase were normal in all 26 patients.Four patients had positive anti-Jo-1 antibodies.Antinuclear antibodies were positive in nine patients.Electromyogram was slightly abnormal in 5 patients.Muscle biopsy was abnormal in 19 patients.Twenty patients had improved after receiving corticosteroids and immunosuppressive agents.Six patients died.Conclusions It has been estimated that ADM represents approximately 20％ of all cases of dermatomyositis.It seems that patients with ADM have greater incidence of lung involvement and combined cancer.ADM patients need to be treated positively to improve the prognosis.

Objective To improve the understanding of severe anaphylactic reactions to infliximab retreatment. Methods Delayed hypersensitivity to infliximab in two patients with ankylosing spondylitis who had previously received infliximab and resumed after discontinuation over 4 years were reported and the related literatures were reviewed. Results Two patients ( 1 male, 1 female ) who were diagnosised with ankylosing spondylitis for more than 10 years, both individuals had received infliximab treatment during a clinical trial approximately 4-5 years prior to further therapy. On day 6 after subsequent infusion, one patient had pruritic skin rash covering her whole body, followed by flustered, dyspnea, hypotension and anaphylactic shock, she was successfully treated with epinephrine and glucocorticoid. Another patient experienced a skin rash and itching 9 days after reinfusion, he was successfully treated with antihistaminics.Conclusion A distant infliximab retreatment is associated with high rates of reinfusion reactions, including fever, urticaria, myalgia, arthralgia,even hypotension, dyspnea, laryngeal edema and anaphylactic shock.We recommend careful monitoring of those patients who receive infliximab retreatment, particularly after a lengthy interval.

The functional experimental teaching reform plays a very important role in raising the teaching resources,consummating the experimental teaching management system,enhancing the student to practice the ability and so on and has obtained the good effect.But it also faces some problems waiting urgently to be solved and further perfected,to which this article has made the analysis and the discussion from the management science angle.The goal lies in deepening the educational reform in functional experiment unceasingly to provide the model.

Objective To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis.Methods This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. Results Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ±11.1 (P ＜0.0001 ), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5(P =0.0015). A mean (34.9 ±38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while ( 17.9 ±24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P =0.0467). Adverse events were observed in eight patients (19.0% ) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. Conclusions Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.

Objective To evaluate the therapeutic effect and safety of the rituximab in the treatment of severe rheumatoid arthritis (RA). Methods A total 22 severe RA patients with DAS28＞5.1 were treated with rituximab 500～1000 mg/24week, or placebo/24 week, along with methotrexate (MTX) 10～25 mg/week.Chi-square test was adapted for statistical analysis if the results met the data criteria for the analysis. Rank conversion analysis was used to test the results if the data did not satisfy the Chi-square test. Results Twenty-two patients (93% were females with the median age of 50 yd and the average MTX dosage was 17.6 mg/week ) completed the treatment. The proportion of ACR 20 responders at 72 week was 80%, 60%,57% respectively. Other secondary efficacy endpoints showed that rituximab could provide substantial benefits to patients with RA by reducing clinical signs and disease activity score. The most frequently occurred adverse event was upper respiratory tract infection. Tne second most frequent adverse events were reduction of lymphocytes and elevation of liver enzymes. Most treatment-related adverse events were mild to moderate in severity. Conclusion Rituximab has demonstrated to be effective and is well tolerated by patients in the treatment of active RA.

Base on the clinical characteristics of septic arthritis in a group of systemic lupus erythematosus patients,this study has found out that high systemic lupus erythematosus disease activity index,leucopenia,high cumulative dose of glucocorticoid,methylprednisolone intravenous pulse therapy and joint cavity puncture were closely correlated with septic arthritis.Once septic arthritis is suspected,culture specimens should be collected and appropriate antibiotics are suggested immediately.Also,surgical drainage is a very useful approach.

Objective To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain.Methods We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology,the PLA General Hospital from January 2013 to December 2015,including clinical manifestations,laboratory examinations and MRI data of sacroiliac joints.Results There were 238 men and 152 women recruited.A total of 326 cases were diagnosed as axial SpA,including 216 men and 110 women with mean age (27.10 ± 8.64) years and mean duration (7.64 ± 3.50) months.Among these 326 patients,243 (74.5％) were HLA-B27 positive.The other 64 patients were considered as diagnoses rather than SpA (non-SpA),consisting of 22 men and 42 women with mean age (31.29 ± 7.76) years and mean duration (5.75 ±2.90)months.Non-SpA group had 10 (15.6％) patients with HLA-B27 positive.There were 68.1％ and 65.0％ SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively.Although there were 25.0％ non-SpA patients with bone marrow edema and 7.8 ％ with bone erosion in MRI of sacroiliac joint,the scores of bone marrow edema 0.00 (0.00,0.75) and bone erosion [0.00(0.00,0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00 (0.00,4.00),bone erosion scores 1.00 (0.00,3.00);P ＜ 0.05].The scores of fat infiltration [1.00 (0.00,4.25),1.00 (0.00,4.00)] and bone sclerosis [0.00 (0.00,1.00),0.00(0.00,1.75)] were not statistically different between two groups.Diagnostic sensitivity of bone marrow edema and bone erosion for axial SpA were 56.4％ and 64.1％ respectively,specificity were 93.8％ and 92.2％ respectively.The positive predictive value of bone marrow edema and bone erosion for axial SpA were 9.09 and 8.21,negative predictive value were 0.46 and 0.38.Diagnositic sensitivity of fatty infiltration and bone sclerosis for axial SpA group were 29.1％ and 57.7％,specificity were 64.1％ and 46.9％.The positive predictive value of fatty infiltration and bone sclerosis for axial SpA were 0.81 and 1.08,negative predictive valne were 1.10 and 0.90.Conclusion Sacroiliac joint MRI is a valuable method to diagnose axial SpA in patients with chronic low back pain.Yet it still has some limitations.Clinical presentations and spinal MRI would be helpful in some patients.

Objective To study the clinical and imaging characteristics of patients with infectious sacroiliac arthritis.Method Twenty-one patients diagnosed with infectious sacroiliac arthritis were analyzed retrospectively between 2000 and 2014.The chief complaint was pain in hip and lumbosacral area.Their clinical features,laboratory tests and pathological examination results as well as CT/MRI/PET-CT images were evaluated.Results There were nine males and thirteen females eighteen (85.7％) patients had unilateral sacroiliac joint involvement.Among these patients,three were diagnosed with brucellosis sacroiliac arthritis(BSI),eight patients with tuberculosis sacroiliac arthritis (TSI),and ten patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis (ISI).For those patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis,white blood cell count,erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)were dramatically increased.Twelve patients were diagnosed pathologically including 6 ISI,2 BSI and 4 TSI.Twelve patients and seventeen patients were scanned by CT and MRI respectively.Two patients undertook PET-CT examination.Antibiotic therapy showed significant therapeutic effects in all patients.Conclusion Infectious sacroiliac arthritis patients with hip or lumbosacral pain as the chief complaint can be easily misdiagnosed as spondyloarthritis.Comprehensive analysis of clinical features,imaging and laboratory findings is essential for accurate diagnosis.