Objective　To better understand the clinical characters of juvenile onset spondyloarthropa-thies (JSpA).Methods　The clinical and laboratory data of 190 in-patients with JSpA were analyzed and the diagnosis,classification and differentiation of juvenile onset arthritis were discussed.Results　Among these 190 patients,163 were male,with a male to female ratio 6∶1.Of them 92.1% had the disease after the age of 8.Peak of age at onset was 12 to 15 years;157(82.6%) patients had peripheral arthritis and only 23(12.1%) patients felt low back pain at onset.During the disease course, peripheral arthritis was found in 187(98.4%) patients and the history of low back pain or buttock pain was recorded in 123(64.7%).The interval between peripheral arthritis and low back pain was from 0 to 20 years,with an average of (3.2±4.5)years.Extra-articular features including enthesitis in 67(35.3%)patients,dactylitis in 20(10.5%),iritis in 9(4.7%) were observed.HLA-B27 was positive in 87.9%(160/182) patients.Sacroiliitis on X-ray was observed in 76.0%(136/179) patients,and 106(55.8%) patients were diagnosed juvenile ankylosing spondylitis (JAS) according to 1984 New York modified criteria.The average disease course in JAS was (6.3±6.2) years,longer than that in JSpA (P＜0.01).Conclusion　The concept of JSpA is helpful to early diagnosis and treatment of juvenile onset arthritis.The JSpA are characterized by asymmetric lower limb predominant oligoarthritis,a wide spectrum of extra-articular features,presence of HLA-B27 and familial history of SpA or psoriasis.It will take an average of 6.3 years for JSpA patients to fulfill the diagnostic criteria of adult AS.

Objective To study the characteristics of IgA nephropathy (IgAN) secondary to ankylosing spondylitis (AS) compared with primary IgAN.Methods Clinical and pathologic data were collected in patients who were diagnosed with IgAN by renal biopsy and admitted to our hospital from Jan 2007 to Sep 2015.Patients with IgAN secondary to AS were recruited by the ratio 1 ∶ 5 of patients with primary IgAN as control group at the same period.Results There were 15 patients in AS group,proportionately 75 patients in the control group.Compared with those in control group,patients in AS group had shorter disease course [(10.1 ± 8.3) months vs (20.2 ± 27.9) months] and lower proportions of renal insufficiency and hypertension[1/15 vs 52.0％ (39/75);1/15 vs 46.7％ (35/75)].In laboratory tests,quantitative 24 hour urinary protein and serum ereatinine were significantly lower in group AS than those in the control group [(1.42±0.67)g vs (2.88 ±1.35)g;(79.0±18.2)mmol/L vs (145.3 ±77.6) mmol/L].The Lee grading of IgAN in two groups was comparable.The treatment in both groups was similar including steroids,immunosuppression agents,angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.After follow-up from 1 to 6 years,3/11 patients in AS group and 22.8％ (13/57) (13/75) in control group developed deterioration of renal function.Conclusion Patients with IgAN secondary to AS have shorter disease course and milder condition compared with patients with primary IgAN.Clinical outcome of renal function in both groups is similar according to comparable treatment.

Objective To analyze the clinical characters of psoriatic arthritis (PA) which antedates psoriasis.Method The clinical characters,laboratory tests and radiographic findings of fifteen PA patients whose arthritis antedated psoriasis were analyzed.Results The male to female ratio was 2 75∶1,the age of onset was 11 to 47 years.The course was 2 month to 30 years.HLA B27 was positive in 86 7%(13/15) of patients and sacroiliitis on X ray was noted in 10 patients.Conclusion There are more sacroiliitis in PA patients whose arthritis antedates psoriasis and they are associated with HLA B27.

Objective To improve clinicians' understanding of tuberculosis as the adverse event of the tumor necrosis factor alpha (TNF-α) antagonists therapy. Methods Two rheumatoid arthritis (RA) patients were reported to develop lymphoid tuberculosis and pulmonary tuberculoma after TNF-α antagonists therapy. The relevant literature were reviewed. Results The first ease was a 62 year-old female RA patient. Her skin PPD reaction was negative and chest X-ray was normal before the therapy. Following 4 doses of infliximab injection (each dose of 3 mg/kg) which were completed within 3 months, the patient developed fight supraclavicular lymphoids tuberculosis in the 5th month after the last treatment. The patient completely recovered after lymphoids excision and antituberculosis therapy with 4 anti-tuberculosis medications combination. The second case was a 44 year-old female RA patient. She did not take the skin PPD test and chest X-ray before the therapy. The patient developed fever and chest distress after etanercept therapy (25 mg hypodermic twice per week ) for 1.5 months. The chest X-ray showed a shadow in the median lobe of the right lung, which had gradually developed to a pulmonary tuberculoma. The patient's physical condition improved after the tubereuloma resection. It has been reported in recent years that ① TNF-α antagonists therapy could increase the incidence of tuberculosis, ② the incidence at which infliximab associated tuberculosis was higher than etanercept, ③ the majority of the patient having tuberculosis were old people, and ④ the incidence of extrapulmonary tuberculosis and the disseminated tuberculosis were higher than regular tuberculosis. Conclusion TNF-α antagonists may decrease the host defense ability against mycobacterium tuberculosis and increase the incidence of tuberculosis. The pre-treatment tuberculosis screening, as well as tuberculosis monitoring during and after treatment is mandatory.

Objective To investigate the long term efficacy and safety of thalidomide in the treatment of refractory ankylosing spondylitis.Methods A total of 232 patients with refractory ankylosing spondylitis were recruited into open study using thaiidomide at a dose of 150 mg/d, bath ankylosing spondylitis disease activity index ( BASDAI) , spinal pain score and thaiidomide related side effects were observed regularly.Results From the third month, BASDAI and spine pain score decreased significantly when compared with those of the base line ( P < 0.05).Such improvement became more obvious as time went on.A total of 148 patients (63.8% ) got >50% improvement in BASDAI and spine pain score, and 76 cases (32.8% ) reported absence of spine pain.The major side effects were drowsiness, constipation, dry mouth, dizziness and dandruff.Thirty two patients (13.8% ) withdrew from the study because of adverse events.Most of the adverse effects disappeared as thaiidomide was stopped.Conclusion Long term thaiidomide is effective and safe for treating resistant ankylosing spondylitis and it has cumulative effect as duration prolongs.

Objective To investigate the efficacy and safety of mycophenolate mofetil (MMF) for refractory autoimmune 1iver disease:Methods Six patients with autoimmune liver disease who had failed MMF treatment and variation of biochemical indexes.adverse effects of the MMF treatment were recorded.Results After MMF treatment.the serum 1evels of alanine aminotransferase (ALT) were decreased to nOrmal level in three of four patients with higher ALT.The serum levels of alkaline phosphatase (ALP) were decreased to more than fifty percent of normal level in four of five patients with higher ALP.The serum levels of γ-glutamyhransferase (GGT) were decreased to more than fifty percent of normal level in all five patients with higher GGT.The serum levels of immunoglobulin G (IgG) and γ-globulin were decreased to normal level in all two patients who had elevated IgG and r-globulin levels.The serum levels of total bilirublin and total bile acid.the count of white blood cell and platelet had no change.There were no adverse effects in a11 six patients.Conclusion MMF treatment for early refactory autoimmune liver disease is effective with few sideeffects.

Objective To investigate the value of imaging in the diagnosis of reflex sympathetic dystrophy(RSD).Methods The clinical manifestations and imaging findings of RSD in five patients were analyzed.Results The onset of clinical symptoms of patients was followed by an injury in all cases.Severe pain,swelling,limited range of motion and vasomotor instability were main complaints.Patchy bone demineralization could be found both on plain radiographs and CT.CT scan was superior to plain radiographs in detecting bone demineralization.Increased scintigraphic uptake in the involved extremities were demonstrated in all four patients who examined by bone scintigraphy.Bony erosions which were not easily visible on plain radiographs could be clearly seen on MRI in one patient at early stage.Conclusion Patchy bone demineralization on plain radiographs and CT is the most outstanding imaging finding in RSD.Bone scintigraphy and MRI can help early in diagnosis of the disease.

Objective: To investigate the effect of the dosageof chemotherapeutic agent on tumor chemotherapy linked with biotherapy and provide experimentalevidence for the dose choice of chemical drugs in the combination of chemotherapy and biotherapy.Methods: The high- and low-dosage of MMC was determined by injection of mice with different dosages of MMC. Mice inoculated with H22 hepatic carcinoma cells were treated with different dosages of MMC followed by three different kinds of biotherapy: transfection with plasmid pCH510 in vivo, immunization with Hsp70-tumor antigen peptide complexes and the combination of these two elements. Results: By toxicity test of MMC to mice, it was determined that 100 ?g of MMC was high dosage and 50 ?g was low dosage. The curative effect was significantly improved if chemotherapy was followed by different elements of biotherapy. Better efficacy was obtained when biotherapy elements were used to follow the chemotherapy with high dosage of MMC. In the case of low dosage of MMC, no difference could be observed in curative effect of three different kinds of biotherapy. When high dosage of MMC was used, the curative effect of three different kinds of biotherapy was signiferently different. The best efficacy was obtained if chemotherapy was followed by the combination of two biotherapy elements, transfection with plasmid pCH510 in vivo and immunization with Hsp70-tumor antigen peptide complexes. Conclusions: Using different chemical dosages, the curative effect of chemotherapy linked with biotherapy is different. In the case of high dose, the chemotherapy linking with biotherapy can reach more better efficacy.

Objective: To invistigate the relationship between time and efficacy of the linkage of tumor biotherapy after chemotherapy by studying the influence of chemotherapeutic drugs on immunocytes.Methods: The cytotoxicity of chemotherapeutic drugs to tumor cells, mouse peritoneal macrophages and spleen lymphocytes was observed by cell culture technique. The influence of chemotherapeutic drugs to the metabolism and activation of macrophages and lymphocytes at different time after peritoneal injection of drugs was observed. The mice were inoculated with tumor cells two days after the injection of drugs, and the growth of tumor was measured 14 days after inoculation by anatomizing mice. Results: Chemotherapeutic drugs had cytotoxicity in vitro to different cells, suppressed the function of immunocytes, and decreased the number of immunocytes in vivo. After injection of drugs, the number of immunocytes was the lowest on the third day and recovered to the nomal level on the 10th day. If drugs was injected two days before the inoculation of tumor cells, the growth of tumor became faster than control group. Conclusions: Chemotherapy not only decreases the number of immunocytes but also suppresses the function of immunocytes, and it can promote the growth of tumor after its cytotoxicity disappeared. So it is not good that biotherapy, which depends on immunocyte to kill tumor cells, is used immediately after chemotherapy and it is also not good for using biotherapy with a long interval after chemotherapy . It is good time to use biotherapy when the number of immunocytes is lowest or the recovery just starts.

Objective To improve the understanding of progressive pseudorheumatoid dysplasia (PPD). Methods The clinical and roentgeno graphic features of two patients with PPD diagnosed in our department were analysed, and the related literature was reviewed. Results The patients first experienced the osseous swelling in phalangeal joints of both hands in childhood, and progressively almost all joints were involved. The spine was also involved. By analyzing the clinical information of 53 cases, it was found that PPD involved both male and female similarly. The ages at onset of first symptoms, were from 1 to 10 years, and in seventy seven percent of patients the ages were 3 years to 5 years. Clinical features included progressive involvement of the major joints, including small joints of the hands, hips, knees, ankles, wrists and shoulders. Premature osteoarthritis developed in early adult life, and it was the major reason of disability. 38% of patients were short in stature. The roentgenographic features consisted of generalized platyspondyla with irregular delineation of the endplates of the vertebral bodies, varying degrees of epiphyseal involvement with enlargement of the large joints, metacarpal heads and phalanges, secondary degenerative arthritis with periarticular osteoporosis. The symptoms of PPD were similar to those of rheumatoid arthritis (RA), but differed from it by the Absence of synovitis and other inflammatory changes, and radiographically by the Absence of destructive changes and the presence of dysplastic bone changes. There was no specific treatment for cure. Conclusion PPD is a rare autosomal recessive skeletal disorder associated with WISP3 gene mutations. Its clinical features and typical roentgenographic features are helpful to the diagnosis.