Objective To compare the T cell receptor recombination excision cycle (TREC) levels in peripheral blood mononuclear cells (PBMC) of systemic lupus erythematosus (SLE) patients with normal age- and gender- matched controls. To investigate the correlations between TREC levels of SLE patients and their clinical features. Methods We studied TREC levels in peripheral blood mononuclear cells (PBMC) of 21 SLE patients and 22 normal age- and sex- matched controls. TREC concentration was determined by real-time quantitative polymerase chain reaction (real-time qPCR) as the number of TREC copies/1000 PBMCs. The clinical features of the SLE patients such as systemic lupus erythematosus disease activity index (SLEDAI) , ESR, C reaction protein (CRP) , ANA, anti-dsDNA and complement levels and organ involvement were recorded and assessed. Results SLE patients had lower TREC levels [ (9.6 ± 7.5 )copies/1000 PBMC] than controls[ (16.1 ±11.1) copies/1000 PBMC,P = 0.033]. There was an inverse correlation between age and TREC levels in controls (r =- 0. 614, P = 0. 002) but not in SLE patients.There was an inverse correlation between SLEDAI and TREC levels in SLE patients(r =-0. 656, P =0. 001) and TREC levels seemed to have relations to skin lesions ( r = - 0. 620, P = 0. 003 ). No other clinical association was observed between TREC levels and clinical and laboratory SLE manifestations.Conclusion SLE patients had lower TREC levels than normal controls and there is a tendency that TREC level is reversely correlated with disease activity. The decrease PBMC TREC level is indicative of a low proportion of recent thymic emigrant (RTE) in SLE and could be caused by decreased RTE output and/or by increased peripheral T cell proliferation in this disease. The under-representation of RTE in the peripheral T cell pool may play a role in the immune tolerance abnormalities observed in SLE.

Objective To investigate the difference and treatment strategy of malignancy-associated dermatomyositis and other para-neoplastic neurological syndromes (PNS).Methods The clinical characteristics of a patient with malignancy-associated dermatomyositis and poly radiculoneuropathy was reported and the relevant literature was reviewed.Results Patients with dermatomyositis had increased risk of malignancies,and should routinely screened.Dermatomyositis and polyradiculoneuropathy was clinically similar,but could rarely be seen in the same malignant patient.Malignancy -associated dermatomyositis and PNS had similar pathogenesis.The treatment strategy of both was similar.Malignancy specific treatment should be initiated and immune suppressive agents should be prescribed concurrently.Conclusion Rheumatolgists should aware the association between dermatomyositis and potential underlying malignancies.Multiple para-neoplastic syndromes could be seen in the same patient,but the diagnosis should be considered as one.

Objective To investigate the efficacy of tumor necrosis factor alpha (TNF-α) antagonists therapy and the possible eauses of new onset or exacerbation of psoriatic skin lesion in patients with arthritides treated with TNF-α atagonists therapy. Methods One patient with definite psoriatie arthritis and one patient with definite ankylosing spondylitis, who were treated with TNF-α antagonist therapy developed an unexpected exacerbation or new onset of psoriatic skin lesion, were investigated in this study. Furthermore, the literatures associated with psoriasis induced by anti-TNF-α therapy were reviewed. Results The patient with psoriatic arthritis experienced exacerbation of psoriatic skin lesion and the skin lesions subsided after discontinuation ofetanereept therapy. The skin lesions recurred with re-introduction of etanereept, which improved after withd-rawal of etanercept therapy. The patient with ankylosing spondylitis unexpectedly developed psoriasis vulgaris after receiving etanercept therapy. The skin lesion waxed and waned followed the administration or discon-tinuation of etanercept therapy. The same settings were reported in patients with rheumatoid arthritis receiving different types of anti-TNF-α therapy. Conclusion Blockage of TNF-α is highly effective in arthritides. Ho-wever, some patients with arthritides can unexpectedly develop either a new onset or exacerbation of psoriatic skin lesions after initiation of TNF-α antagonist therapy. The skin lesions subside after discontinuation of the TNF-α antagonist therapy, but the causes remain unclear.

Objective To determine the diagnostic value of antifilaggrin antibodies(AFA) in rheumatoid arthritis(RA) and to compare the correlation among AFA,anti-perinuclear factor(APF) and anti-keratin antibodies(AKA). Methods Filaggrin was extracted from human epidermis and then partially purified. AFA in 103 cases of RA and 140 cases of controls were detected by western blot. APF and AKA were detected using indirect immunofluorescence. Results AFA test resulted in diagnosis of 35.9% of 103 RA samples, with a specificity of 93.7%. The result was significantly higher than the controls (P

NAT2 is an important drug metabolizing enzymes in humans.Polymorphisms in NAT2 gene produce variants at amino acid including seven mutation sites.In vivo NAT2 takes part in 20 kinds of drugs metabolism and activation of carcinogen.Polymorphism of NAT2 has been related to some diseases.This paper reviews the polymorphisms and genotyping about NAT2 and their implications in drug and clinical research.

Objective To investigate the characteristics of clinical manifestations,treatment and prognosis of patients with systemic lupus erythematosus (SLE) complicated with central nervous system (CNS) infoction.Methods The medical records of 30 patients with SLE complicated with CNS infeetion were retrospectively reviewed.Results In the cohort of 3039 SLE patients admitted during last 20-year8,30 patients (1%) were identified with CNS infection.The mean age of patients with CNS infection was (34±11) years.Twenty-seven (90%) out of the 30 patients were fomale.Patients could be divided into 3 groups based on the offending microorganisms:mycobacterium tuberculosis (TB),non-TB bacterial and fungal infection groups respectively.TB infection was identified in 11 patients (37%),non-TB bacterial infections could be confirmed in 11 (37%),and fungal infection in 8 (26%).The most common presentations of CNS infeetion were fever,headache,and conscious level changes.There was no difierence among the three groups in morta-lity rate.Conclusion The clinical presentations of SLE patients complicated with CNS are generally atypical.Tubereulosis meningitis is the most prevalent CNS infection in patients with SLE.CSF analysis should be done as soon as possible for establishing early diagnosis.A lOW sernm albumin level,low C3 level and a low intracranial pressure predicts for unfavorable outcomes.

ObjectiveTo analyze the clinical characteristics of systemic lupus erythematosus (SLE) patients with cerebral tuberculosis.MethodsTen SLE patients with cerebral tuberculosis admitted to Peking Union Medical College Hospital(PUMCH) from January 1995 to October 2010 were retrospectively analyzed.ResultsThe median duration from onset of SLE to cerebral tuberculosis was 1.5 years(range from 0.6 to 30 years).All patients had received higher doses of steroid therapy (equal to prednisolone l mg· kg-1·d-1 ),and 3 of them had received methylprednisolone pulse therapy.Nine patients had taken immunosuppressant.When cerebral tuberculosis was diagnosed,the most common features were fever and headache,followed by nausea/vomiting and focal neurological signs.Nine patients were complicated with extra-cerebral infections.The cerebrospinal fluid(CSF) pressures was(247±66) cm H2O(range from 180 to 350 cm H2O),which was higher than normal.The mean CSF protein level was(1.4±0.7) g/L (0.15～0.45 g/L),which was normal or increased.Image examinations were helpful for the diagnosis of cerebral tuberculosis in SLE patients.Pointenhanced or ring-enhanced lesions were found in enhanced magnetic resonance imaging( MRI ) of brain in all patients who had donethis test (8 patients).After treated with targeted antibiotics and specific adjuvant therapies,the symptoms had relieved in 7 patients,however,I patient died,and 2 patients were lost during the follow-up.ConclusionWhen SLE patients with stable disease have unexplained fever,headache,and focal neurological signs,cerebral tuberculosis should be considered.Enhanced MRI of brain and chest X ray are helpful for the diagnosis of infectious cerebral lesions and should be performed promptly.Extracerebral tuberculosis infections can provide clues forthe identification of the causativeagents.Anti-tuberculosis treatment should be initiated as soon as the diagnosis is confirmed,and early treatment can markedly improve the outcomes.

Objective To investigate clinical features of cutaneous sarcoidosis. Methods A retrospective analysis was carried out based on the clinic data of 35 patients with cutaneous sarcoidosis who were hospitalized in Peking Union Medical College Hospital during 1980-2009. They were divided into two groups, the group without systemic involvement (skin group )and the group with systemic involvement ( systemic group). Results ( 1 ) The ratio of men and women with cutaneous sarcoidosis was 1: 3. 38, and the average incident age was (47. 5 ± 10. 0) years old. The average incident age of skin group and systemic group were (41.8 ± 12.5 ) years old and ( 50. 5 ± 7. 1 ) years old, respectively. (2) The most common skin manifestation was subcutaneous nodule, followed by maculopapule and erythema nodosa. The most common involved sites were limbs. (3) The common involved systems extra-skin included the lung, joints and lymph nodes. The involvement rate of lung in cutaneous sarcoidosis of our present data was lower than those of foreign reports. However, the involvement rates of joints, lymph nodes, kidney, muscles and nervous system showed higher in our data. (4) The incidences of fatigue and weight loss in systemic group were higher than those in skin group ( P ＜ 0. 05 ). The indexes of erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor in systemic group were higher than those in skin group ( P ＜ 0. 05 ). More patients in systemic group were treated with corticosteroid than that in skin group ( 95.7% vs 66.7%, P ＜ 0. 05 ).Conclusions Subcutaneous nodules are the most common and the involvement rate of lung is lower in cutaneous sarcoidosis of our present data. Compared to the patients without systemic involvement, the average incident age of systemic ones is older, the indexes of inflammation markers and the usage of corticosteroid are higher.

0.05),Conclusion The possibihty of thymoma should be considered among those late-onset SLE patients.The glucocorticoid-based immunosuppressive therapy is effective for thymoma-associated SLE.To treat SLE is not an indication for thymectomy.

Objective To improve the understanding of drug-induced lupus (DIL) and the differences from systemic lupus erythematosus (SLE).Methods Clinical manifestation and treatment of patients with definite DIL were retrospectively analyzed.Results Six patients with DIL were enrolled in this study,including 4 females and 2 males.Two patients were diagnosed after receiving interferon,one after soluble tumor necrosis factor receptor fusion protein,one after propylthiouracil,one after penicillamine,and one after levofloxacin.High titer of antinuclear antibody was identified in all six patients,including 3 with positive anti-dsDNA antibody.One patient had positive anti-Sm antibody.One patient had positive anti-RNP antibody.One patient had anti-nucleosome antibody.One patient had anti-histone antibody.One patient had antimitochondrial antibodies-M2,and one patient had anticardiolipin antibodies.Conclusion Patients with DIL are not as severe as those with SLE.After cessation of suspected drugs and administration of standard treatment,the clinical outcome of DIL is satisfying.