1.Musculoskeletal ultrasound features of gouty arthritis during different episodes
Xuerong DENG ; Yan GENG ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2016;(1):23-27
Objective To investigate the ultrasound features of gouty joints during acute and past attacks. Methods Clinical data and ultrasound features of joints during the acute and past attacks of gouty patients who were experiencing an acute attack were collected. The differences of ultrasound features between two episodes, as well as the relationship with clinical characteristics were analyzed. Results Sixty-four patients were enrolled with 21 (33%) patients at their first attack. The first metatarsophalangeal (MTP1) joints were most frequently involved, meanwhile, 9.4% patients had two or more joints attacked during one episode. The most prevalent feature was synovitis at the acute phase, followed by double contour (DC) sign (18 cases, 28%), bone erosion (12 cases, 19%) and tophi (10 cases, 16%), while 23 patients had two or more pathological changes. Whereas, the DC sign was found most in previously attacked joints (10 cases, 33%), followed by tophi (8 cases, 27%), bone erosion (7 cases, 23%) and synovitis (4 cases, 13.3%). No positive pathological changes were found in asymptomatic joints. Synovitis was more common in joints during their acute attacks (80% vs 13%, χ2=20.475, P<0.01), however, DC sign and tophi were more common in previous attacked joints (10% vs 33% and 0 vs 27%, χ2=3.892, 6.642, P<0.05, respectively). Both the DC sign and tophi were positively correlated with the disease duration. Conclusion Synovitis is the most prevalent feature in gouty joints during acute episodes; even bone erosion can be found at the first attack. The DC sign, tophi and bone erosion are common in past attacked joints. The prevalence of both DC sign and tophi are increased along with disease durations. Subclinical synovitis can be detected in a small past of joints which are not at acute attack.
2.Characteristics of Behavior and Self-concept in Psychological Abused/Neglected Juveniles with Generalized Anxiety Disorder
Bingqing GUAN ; Yunlong DENG ; Xuerong LUO
Chinese Journal of Clinical Psychology 2001;0(03):-
Objective: To invesgate the situation of psychological abuse and neglect among juveniles with generalized anxiety disorder(GAD) and explore the characteristics of behavior and self-concept in psychological abused/neglected juveniles with GAD.Methods: A sampling survey was made in 9495 juveniles(5~17) from six regions of Hunan Province.After using the two-stage epidemiologic research method,409 children including 206 normal controls,99 GAD without abuse/neglect and 104 GAD with abuse/neglect,completed CPANS,CSCS and their parents completed CBCL.Results: There were significantly higher rates of psychological abuse or neglect in the GAD group than the normal controls;the factor scores of juveniles with GAD were significantly higher than those with no mental disorders in all six aspects in CPANS(P=0.000),higher scores of internalizing and externalizing behaviors characterized the subgroup of juveniles with both GAD and abuse history compared with the subgroup with GAD without such history,and the scores including total score,behavior,anxiety,gregariousness and happiness factors(P=0.000),of the subgroup of juveniles with GAD and abuse histories were significantly lower than the GAD subgroup without abuse or neglect.Conclusion: Psychological abuse and neglect are more prevalent and severe in juveniles with GAD than in normal ones;when psychological abuse/neglect co-occurs with GAD,juveniles’ behavior problems are even greater and their level of self-concept are much lower.
3.Ultrasonographic features of knee osteoarthritis in Chinese population
Xiaohui ZHANG ; Xuerong DENG ; Yan GENG ; Lanlan JI ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2016;20(9):604-608
Objective To investigate the musculoskeletal ultrasound (MSUS) findings in Chinese knee osteoarthritis (OA) patients.Methods All the MSUS data were from the outpatients with knee OA who visited Department of Rheumatology and Clinical Immunology,Peking University First Hospital from February 2013 to August 2014.MSUS findings included number and position of osteophyte,synovitis,thickness of cartilage,and so on.Comparisons between groups were made using t test,Chi-square tests.Results Six hundreds and seventy-four patients were included.Almost all the patients (96.1%) had osteophytes,most patients had both knees osteophytes.The most common osteophyte location was femoral (85.2%),followed by tibia and the upper edge of patella.The number of osteophytes differed from none to ten,and the distribution of bilateral knee osteophytes was symmetrical in most patients.There was no significant difference in the number of osteophytes between male and female,and patients over 60 years old had more osteophytes than the patients aged 60 or below.In all bursae lesions,the suprapatellar bursa were the most commonly affected [effusion,279 (41.4%),synovial hyperplasia,189(28.0%),synovitis 24 (3.6%)].There was no significant difference in the cartilage thickness between bilateral knees.But the cartilage thickness of female patients was significantly thinner than that of men [left:(2.0±0.5) mm vs (2.5:1:0.8) mm,t=3.859,P<0.05;right:(2.0:1:0.5) mm vs (2.5±0.8) mam,t=4.109,P<0.05],and the patients over 60 years old had thinner cartilage than patients younger than 60 years old [left:(2.0±0.6) mm vs (2.2±0.6) mm,t=2.108,P<0.05;right:(2.0±0.6) mm vs (2.2±0.6) mm,t=2.507,P< 0.05].None patient had Calcium pyrophosphate dehydrate (CPPD) deposition in the cartilage.Conclusion In the ultrasonographic findings of knee OA in China,osteophyte could be found in 96% patients,the most common location of osteophyte is the femur area.The distribution of bilateral knee osteophytes is symmetrical in most patients.Patients over 60 years old have more osteophytes.Nearly haff patients have joint effusion,one third patients have synovial hyperplasia or synovitis.Bilateral knee cartilage degeneration is symmetrical.Women and patients over 60 years old have thinner cartilage.
4.Relationship between wrist bone mineral density and synovitis, erosion by ultra-sonography in female rheumatoid arthritis patients
Yu WANG ; Yan GENG ; Xuerong DENG ; Zhuoli ZHANG
Journal of Peking University(Health Sciences) 2015;(5):774-780
Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .ABSTRACT Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .
5.Standardized training can improve the validity of synovitis and tenosynovitis assessment by musculoskeletal ultrasound: a pilot study in Chinese doctors
Xuerong DENG ; Yan GENG ; Lanlan JI ; Xiaohui ZHANG ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2017;21(3):178-180
Objective To evaluate the validity of assessing synovitis and tenosynovitis by using musculoskeletal ultrasound scoring systems after standardized training in Chinese doctors.Methods All participants received a 30 minutes' training for the ultrasound scoring systems of synovitis and tenosynovitis.Ten static images were applied to evaluate the changes before and after training,respectively.Each parameter was assessed by a four scale semi-quantitative system recommended by outcomes measures in rheumatoid arthritis clinical trials (OMERACT).Paired t-test was used to assess the differences before and after training.Results Thirteen rheumatologists and two ultrasonographers completed the entire procedure.Significant differences were found before and after training when assessing the severity of gray-scale of synovitis (0.61± 0.30 vs 0.45±0.23;t=2.230,P<0.05) and power Doppler of synovitis (0.57±0.26 vs 0.31±0.18;t=2.928,P<0.05) and tenosynotis (0.56±0.15 vs 0.31±0.16;t=5.286,P<0.05),while no significant difference was found when assessing the gray scale of tenosynovitis (t=-1.679,P>0.05).Conclusion Standardized training is helpful to improve the validity of ultrasound scoring systems of synovitis and tenosynovitis in Chinese rheumatologists and ultrasonographers.The validity of assessing gray-scale of tenosynovits needs improvement.
6.Frequency of metabolic syndrome and correlation with metabolic syndrome in patients with psoriatic arthritis
Borui LI ; Xuerong DENG ; Zhibo SONG ; Guangtao LI ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2021;25(2):97-103
Objective:To investigate the frequency of metabolic syndrome (MS) in patients with psoriatic arthritis (PsA) and further analyze the correlation of MS and its components with clinical features of PsA.Methods:Data including demographics, clinical manifestations, laboratory tests, MS-associated features (height, weight, waist circumference, blood pressure, serum lipid spectrum, and so on) and history of complications (hypertension, diabetes mellitus, atherosclerosis, coronary heart disease, and cerebral vascular disease) were collected from PsA patients in our hospital from Jan 2017 to Sep 2019. The frequency of MS in PsA patients was calculated and the association between PsA clinical manifestations and MS as well as its components was investigated.Results:One hundred and sixty-two PsA patients who fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) were recruited. Hypertension was identified in 36 (22.2%) patients, diabetes mellitus in 28(17.2%) patients, coronary heart disease in 11(6.7%) patients, and cerebral vascular disease in 7 (4.3%) patients. Based on the criteria of the International Diabetes Federation (IDF), 58(35.8%) patients were diagnosed as MS. Compared with MS-free patients, patients with MS, hypertension or diabetes mellitus were older [(54±10 vs 44±13; 56±11 vs 45±12; 54±11 vs 44±13, respectively, t=5.058 , 4.450, 5.150, P<0.01 for all], with higher disease activity [DAPSA scores 16.75(11.25, 26.7) vs 8.8(4.8, 16.4), 16.3(9.6, 27.8) vs 10.0 (5.1, 18.0), 14.4 (9, 25.7) vs 9.5 (5, 17.7), Z=4.539 , 3.046, 3.063, P<0.01]. There was a positive correlation between the sum of components of MS and DAPSA score ( r=0.27 , P<0.01), but multiple linear regression showed no correlation between each component with DAPSA score ( P>0.05) except for hypertension ( P<0.01, standard coefficient=0.334) and elevated fasting blood glucose ( P=0.023, standard coefficient=0.247). PsA patients with hypertension had higher ESR [16.5 (9.5, 34.25) mm/1 h vs 10 (5, 24.5) mm/1 h, Z=2.127, P=0.012]. CRP level was higher in patients with dyslipidemia [5.6(2.1, 17.8) mg/L vs 3.7(1.5, 6.5) mg/L, Z=2.543, P<0.01]. Prevalence of inflammatory back pain was also higher in dyslipidemia patients (41.3% vs 22.4%, χ2=5.901, P=0.016). DAPSA score was higher in dyslipidemia patients (14.1 vs9.9, P=0.031). Conclusion:MS and its components are not rare comorbidities in PsA patients. PsA patients with MS tend to be older with higher disease activity, which calls for more attention.
7.Subclinical atherosclerosis in patients with rheumatoid arthritis
Yanjie HAO ; Ying YANG ; Wei MA ; Wei ZHOU ; Xuerong DENG ; Guangtao LI
Chinese Journal of Rheumatology 2016;20(4):246-252
Objective To evaluate the prevalence of subclinical atherosclerosis in rheumatoid arthritis (RA) and the related risk factors.Methods Fifty RA patients without overt atherosclerotic disease and 121 control subjects matched for age and sex were recruited.Duplex carotid sonography was used to measure intima-media thickness (IMT) and plaque formation assessment.Differences between RA and the control group were compared, and the risk factors were explored.RA patients then were divided into two subgroups according to IMT and the comparison between the two subgroups were completed.T test, Mann-Whitney U test, chi-square test, Pearson's correlation and Logistic regression analysis were used for statistical analysis.Results Although RA patients had lower level of serum lipids and body mass index than the control group, the mean IMT value was significantly higher in the RA group than that in the control group [(0.78±0.18) mm vs (0.62±0.14) mm, t=5.853, P=0.000], and plaque formation was more prevalent [56.0%(28/50) vs 36.4% (44/121),x2=5.596, P=0.018].The difference was especially significant in the younger groups (<50 years old group and 50-60 years old group).Logistic regression showed that the presence of RA [OR=7.34, 95%CI (2.53, 21.25)], male [OR=2.0, 95%CI (91.25, 3.17)] and old age [OR=1.1, 95%CI (1.04, 21.15)] were the independent risk factors for abnormal IMT (thickened or the presence of carotid plaques).The RA patients were divided into two subgroups according to IMT.Compared with patients with normal IMT, patients with abnormal IMT were older and more common in postmenopausal, and had longer RA duration and higher cholesterol level.In treatment, less patients with abnormal IMT had been taking methotrexate (MTX) for more than 3 months compared with patients with normal IMT.Among these parameters, old age [OR=1.13, 95%CI (1.03, 1.23)] was shown to be the independent risk factor for abnormal IMT in RA patients, and more than 3 months of MTX treatment [OR=0.12, 95%CI (0.02, 0.71)] was the protective factor.Conclusion Atherosclerosis occurs frequently and prematurely in patients with RA and the presence of RA is an independent risk factor for atherosclerosis.Early primary prevention for atherosclerosis should be recommended.MTX probably has a positive effect on preventing atherosclerosis for RA patients, which needs to be confirmed by further study.
8.The outcomes of patients with rheumatoid arthritis treated by different combination of synthetic disease modifying antirheumatic drugs under the treat-to-target strategy
Xuerong DENG ; Wei ZHOU ; Yu WANG ; Juan ZHAO ; Yanjie HAO ; Guangtao LI ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2014;18(6):365-368
Objective To investigate the outcomes of patients with rheumatoid arthritis (RA) treated by different combination of synthetic disease modifying antirheumatic drugs (DMARDs) under the guidance of treat-to-target strategy.Methods Forty-two RA patients with high disease activity were enrolled into this randomized,open-label and prospective study.It was comprised of a maximal 36-week induction phase and then followed by a maintenance phase up to 84 weeks.Combination of synthetic DMARDs was initiated in the induction phase,with or without low dose glucocorticoids (GCs) during the first 12 weeks.Patients who achieved low disease activity (LDA) were randomized into two maintenance groups.An increase of DAS28 by 0.6 was defined as relapse.The patients achieved LDA in the induction phase,relapsed during maintenance phase and possible relevant risk factors were analyzed.Results Twenty-seven (64%) patients achieved LDA during the induction phase.More non-smoking patients achieved LDA than those smoked [85% (11/13) vs 55%(16/29),P<0.05].During the maintenance phase,14 (61%) out of 27 patients relapsed.Patients taking GCs during the first 12 weeks had a significantly higher relapse rate compared to those without GC (83% vs 36%,P=0.021).Patients who entered maintenance phase at week 12 had a significantly higher tendency to relapse compared to those who entered the maintenance phase at week 24 [75%(9/12) vs 33%(3/9),P=0.026].Conclusion Smoking seems to be a risk factor for RA patients who fail to reach LDA.Low dose GCs as a bridge therapy may require a longer duration.High relapse rates in both the maintenance groups indicat that a longer tight induction phase may be appropriate before downstairs therapy.
9.Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment
Yu WANG ; Yanjie HAO ; Xuerong DENG ; Guangtao LI ; Yan GENG ; Juan ZHAO ; Wei ZHOU ; Zhuoli ZHANG
Journal of Peking University(Health Sciences) 2015;(5):781-786
Objective:To verify the fracture risk assessment tool ( FRAX) to estimate the probability of osteoporotic fracture in patients with rheumatoid arthritis ( RA ) with or without bone mineral density (BMD), and identify associated risk factors of osteoporosis .Methods: In the study, 200 patients with rheumatoid arthritis aged more than 40 years in Peking University First Hospital from Dec .2009 to Dec. 2012 were recruited.Clinical information was obtained from a questionnaire of their case history and medical records.FRAX tool was administered.Their lumber spine and left femoral BMD were determined by dual energy X ray absorptiometry.The gender, age, disease duration, menopause status, body mass index ( BMI) and accumulative dose of glucocorticoid were obtained in retrospect .Correlation analysis was conducted between the BMD and clinical information .Results:The study population ( female, 77.5%) had a mean age of 59.4 years, in which 10 (13%) patients showed a normal BMD, 67 (87%) were osteopenia or osteoporosis , while 32 patients (16%) had fragile fracture.Compared with the patients with normal BMD, the subjects with low BMD had significantly older age , longer period for corticoids usage , higher day dose and accumulated dose of corticoids .The 10-year fracture risk of sustai-ning major osteoporotic fractures and hip fracture was higher .No significant difference was observed be-tween the 10-year fracture risks calculated with BMD and without BMD .The values of the different area under the receiver operating characteristic ( ROC) curve ( AUC) for major and hip fractures calculated in three ways:without BMD, with the femoral neck BMD, and with T-score.The best result was for FRAX tool for hip fracture with the T-score ( AUC 0 .899 ) .A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low BMD . Three statistically significant variables for lumber BMD were pain on visual assessment scale ( VAS ) (P=0.02), fracture history (P=0.003) and a higher steroid accumulated dose (P=0.008).Three statistically significant variables for left hip BMD were age (P<0.001), fracture history (P=0.05) and lower BMI ( P=0.03) .Conclusion:Low BMD is a common complication in RA patients .Risk factors for major fracture and hip fracture are increased .There is a positive correlation between FRAX calculated with and without BMD or T score .FRAX with the femoral neck T score or BMD presents a discriminatory capacity better than FRAX without BMD , according to the AUC ROC .
10.Relationship between nephrolithiasis and dyslipidemia in primary gout patients
Yu WANG ; Xuerong DENG ; Zhuoli ZHANG
Chinese Journal of Rheumatology 2018;22(4):224-228
Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients.Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis,compared with gout patients without nephrolithiasis.The clinical parameters,urine analysis and lipid levels were analyzed.Patients were divided into groups based on serum lipid levels.The groups were compared based on demographic data and stone composition.Correlations were analyzed between serum lipid,urinary pH and uric acid stones.Moreover,the risk factors of uric acid stones were determined by logistic regression analysis.Analysis of variance,t-test,chi-square test,Spearman's test and Logistic regression were used for statistical analysis.Results ① A total of 144 gout patients were included in study,48 patients with urolithiasis and 96 patients without urolithiasis.② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9,2.1) mmol/L vs 2.2(1.4,3.2) mmol/L,Z=2.38,P=0.01],total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L,t=5.3,P=0.006];low density lipoprotein cholesterol (LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L,t=4.2,P=0.005].③ Compared to oxalate stone formers,uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L,t=4.9,P=0.001),TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L,t=1.8,P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L,t=3.5,P=0.045],while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L,t=-4.0,P=0.002].④ Percentage of uric acid stones in high TG group was higher than normal TG group [85%(17/20 vs 46.4%(13/28),x2=7.4,P=0.007],in addition,the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1%(23/28) vs 35.0%(7/20),x2=11.1,P=0.001].⑤ Uric acid stones were significantly correlated with high TG,low LDL and urinary pH(r=0.522,0.47,-0.212,respectively).Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38,95%CI(1.41,13.7);P=0.01] and lower HDL level [OR=0.01,95%CI(0.01,0.43);P=0.01].Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients.Specific alterations in patient's lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk.