Gout is a metabolic disease resulting from the accumulation of monosodium urate (MSU) in joints, leading to crystal-induced arthritis. In China, gout is common, but there is insufficient knowledge regarding standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of gout in China. The purpose was to standardize gout diagnosis methods as well as treatment opportunities and strategies in order to reduce misdiagnosis, missed diagnosis, and irreversible damage.

Systemic sclerosis (SSc) is an autoimmune rheumatic disease that is characterized by skin fibrosis with multi-organ involvement. In China, the standardized diagnosis and treatment for SSc is still lacking. Based on the diagnosis criteria and guidelines from China and abroad, Chinese Rheumatology Association developed the current standardization of diagnosis and treatment for SSc. The purposes of this guideline are to standardize clinical management for SSc in China, to interpret the key evaluation tools for SSc, and to recommend therapeutic principle and strategies.

Antibodies, Antinuclear ; Autoantibodies ; China ; Cohort Studies ; Humans ; Scleroderma, Systemic

Objective:To explore the clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy (PML) in patients with rheumatoid arthritis (RA).Methods:The relevant domestic and international databases (as of November 2021) were searched and case reports on PML in RA patients treated with rituximab were collected. Clinical data such as gender, age, underlying disease, use of rituximab, combination drugs, time to onset of PML, clinical manifestations, results of ancillary examinations(imaging, cerebrospinal fluid), intervention and prognosis were extracted and analyzed descriptively.Results:A total of 10 patients were enrolled in the study, including 1 male and 9 females, aged from 51 to 83 years with an average of 66 years. All of the patients were suffering from moderate to severe RA, 9 of which had a disease duration of ≥3 years and 1 had no disease duration record. The usage and dosage of rituximab in the 10 patients were in accordance with the instructions, and all the patients received combined medication with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids. The time from the last dose of rituximab to the onset of PML was recorded in 9 patients, which were 2-8, 16, and 18 months in 7, 1, and 1 patient respectively, with a median time of 6 months. Clinical symptoms were recorded in 6 patients, mainly including ataxia, speech disorders, cognitive impairment, and focal sensory deficits, etc. Six patients had head magnetic resonance imaging, and all of the results were consistent with the imaging changes of PML. Four patients had cerebrospinal fluid anti-John Cunningham virus test, which were positive for viral DNA in 3 patients and negative in 1 patient (the patient was diagnosed with PML by brain tissue biopsy). After the diagnosis of PML, 1 patient received no intervention, 3 had no record of intervention measures, 5 were treated with mefloquine and mirtazapine alone or in combination (2 of which were combined with plasma exchange and 1 with glucocorticoids), and 1 was treated with mirtazapine and nitrofurantoin in combination. Seven patients died due to ineffective treatment, 2 survived but had severe neurological sequelae, and the final outcome of 1 patient was not reported.Conclusions:Rituximab-related PML mostly occurs 2 to 8 months after the last application of the drug, which has similar clinical manifestations and imaging to that due to other causes and usually aggravate progressively with a high mortality rate. The survivors may have severe neurological sequelae.

Objective:To explore the clinical characteristics of rituximab-related progressive multifocal leukoencephalopathy (PML) in patients with rheumatoid arthritis (RA).Methods:The relevant domestic and international databases (as of November 2021) were searched and case reports on PML in RA patients treated with rituximab were collected. Clinical data such as gender, age, underlying disease, use of rituximab, combination drugs, time to onset of PML, clinical manifestations, results of ancillary examinations(imaging, cerebrospinal fluid), intervention and prognosis were extracted and analyzed descriptively.Results:A total of 10 patients were enrolled in the study, including 1 male and 9 females, aged from 51 to 83 years with an average of 66 years. All of the patients were suffering from moderate to severe RA, 9 of which had a disease duration of ≥3 years and 1 had no disease duration record. The usage and dosage of rituximab in the 10 patients were in accordance with the instructions, and all the patients received combined medication with conventional synthetic disease-modifying anti-rheumatic drugs or glucocorticoids. The time from the last dose of rituximab to the onset of PML was recorded in 9 patients, which were 2-8, 16, and 18 months in 7, 1, and 1 patient respectively, with a median time of 6 months. Clinical symptoms were recorded in 6 patients, mainly including ataxia, speech disorders, cognitive impairment, and focal sensory deficits, etc. Six patients had head magnetic resonance imaging, and all of the results were consistent with the imaging changes of PML. Four patients had cerebrospinal fluid anti-John Cunningham virus test, which were positive for viral DNA in 3 patients and negative in 1 patient (the patient was diagnosed with PML by brain tissue biopsy). After the diagnosis of PML, 1 patient received no intervention, 3 had no record of intervention measures, 5 were treated with mefloquine and mirtazapine alone or in combination (2 of which were combined with plasma exchange and 1 with glucocorticoids), and 1 was treated with mirtazapine and nitrofurantoin in combination. Seven patients died due to ineffective treatment, 2 survived but had severe neurological sequelae, and the final outcome of 1 patient was not reported.Conclusions:Rituximab-related PML mostly occurs 2 to 8 months after the last application of the drug, which has similar clinical manifestations and imaging to that due to other causes and usually aggravate progressively with a high mortality rate. The survivors may have severe neurological sequelae.

Objective To investigate the role of Power Arm in en-masse retraction of maxillary anterior teeth using clear aligner (CA) and micro-implant anchorage (MIA). Methods The three-dimensional (3D) model of maxillary anterior teeth by combined use of CA and MIA was established, and the 6 mm-height Power Arm, was attached to the canine or appliance. The initial displacement and the maximum von Mises stress of periodontal ligament under three loading conditions were analyzed, namely the force was loaded by CA+150 g retraction force at canine, CA+150 g retraction force on Power Arm at appliance, CA+150 g retraction force on Power Arm at canine. Results In sagittal direction, the crown and root displacement difference of maxillary central incisor was 129, 129, 133 μm，respectively. The crown displacement of the maxillary first molar was -23.3, -23.5, -26.8 μm, respectively. The maximum von Mises stress of periodontal ligament in central incisor was 48.4, 72.6, 40.0 kPa, respectively, and that of the first molar was 5.3, 10.5, 5.8 kPa, respectively. Conclusions It can not be testified that retraction of the 6 mm-height Power Arm at canine or appliance with 5 mm-height mini-screw has more advantages than retraction of the canine directly for more favorably controlling the torque of incisors, saving anchorage of posterior teeth and decreasing von Mises stress of the periodontal ligament.

Gout is a crystal associated arthritis caused by monosodium urate (MSU) accumulating in joint, and it belongs to metabolic rheumatic disease. In China, gout is common but it is insufficient for education of standardized diagnosis and treatment for gout. Based on the evidence and guidelines from China and other countries, Chinese gout Collaborative Research Group developed standardization of diagnosis and treatment of gout in China. The purpose is to standardize the methods for diagnosis of gout, treatment opportunity and strategies in order to reduce misdiagnosis, missed diagnosis and irreversible damage.

Febuxostat,an oral non-purine selective xanthine oxidase inhibitor,was approved firstly in Europe in 2008 for the treatment of chronic hyperuricemia in gout patients,and then in 2009 for the treatment of gout by the US FDA.In 2013,it was found by researchers that there was a possible correlation between febuxostat and cardiovascular thromboembolism events.In 2017,the US FDA issued a safety warning for febuxostat.In March 2018,the results of an eight-year study on Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Comorbidities (CARES) was officially published.The study showed that febuxostat increased all-cause mortality and cardiovascular mortality in gout patients with cardiovascular disease.However,in subsequent clinical studies related to febuxostat,it was concluded that febuxostat did not increase cardiovascular risk and mortality,and could have cardiocerebrovascular and renal protective effects in patients with hyperuricemia.Currently,the pros and cons of febuxostat on cardiovascular safety are not clear in general studies,and more clinical studies are needed,especially in the Chinese population.Thus,before treatment with febuxostat,it is necessary to carefully inquire whether the patient has a history of cardiovascular diseases,and whether there is a combination use of NSAID,antiplatelet drugs and so on.Febuxostat should be used only after a full consideration of the possible risks.

Febuxostat,an oral non-purine selective xanthine oxidase inhibitor,was approved firstly in Europe in 2008 for the treatment of chronic hyperuricemia in gout patients,and then in 2009 for the treatment of gout by the US FDA.In 2013,it was found by researchers that there was a possible correlation between febuxostat and cardiovascular thromboembolism events.In 2017,the US FDA issued a safety warning for febuxostat.In March 2018,the results of an eight-year study on Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Comorbidities (CARES) was officially published.The study showed that febuxostat increased all-cause mortality and cardiovascular mortality in gout patients with cardiovascular disease.However,in subsequent clinical studies related to febuxostat,it was concluded that febuxostat did not increase cardiovascular risk and mortality,and could have cardiocerebrovascular and renal protective effects in patients with hyperuricemia.Currently,the pros and cons of febuxostat on cardiovascular safety are not clear in general studies,and more clinical studies are needed,especially in the Chinese population.Thus,before treatment with febuxostat,it is necessary to carefully inquire whether the patient has a history of cardiovascular diseases,and whether there is a combination use of NSAID,antiplatelet drugs and so on.Febuxostat should be used only after a full consideration of the possible risks.