The incidence of depression in patients with rheumatoid arthritis is higher. The concomitant depression will increase medical expense, reduce drug efficacy, lower its compliance, increase the incidence of complication, and affect the cure of rheumatoid arthritis. The influence of depression to rheumatoid arthritis is usually ignored in clinical work. In recent years, the pertinence between depression and immune disease in pathogenesis is found in research: depression will increase the risk of immune diseases in activate inflammation as well as extend and promote the release of inflammatory factors. This article reviews research progress of correlation between depression and rheumatoid arthritis.
ObjectivesTo systematically review the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis.MethodsPubMed, EMbase, The Cochrane Library, VIP, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis from inception to June 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 970 patients were included. The results of meta-analysis showed that: there was no statistical difference between iguratimod and methotrexate in ACR20 (RR=1.06, 95%CI 0.91 to 1.23, P=0.49), ACR50 (RR=0.93, 95%CI 0.73 to 1.19, P=0.55), ACR70 (RR=0.92, 95%CI 0.62 to 1.39, P=0.70), morning stiffness time (MD=0.45, 95%CI –0.26 to 1.16, P=0.22), tender joint count (MD=0.07, 95%CI –2.31 to 2.45, P=0.95), swollen joint count (MD=–0.30, 95%CI –1.44 to 0.84, P=0.61), health assessment questionnaire (MD=0.01, 95%CI –0.05 to 0.07, P=0.73) and the rate of adverse effects (RR=0.66, 95%CI 0.41 to 1.07, P=0.09). Meta-analysis of 2 RCTs using double-blind method showed that, iguratimod was superior to methotrexat in the patient (MD=4.11, 95%CI 0.11 to 8.10, P=0.04) and physician (MD=4.81, 95%CI 0.93 to 8.69, P=0.01) global assessment of disease activities.ConclusionsCurrent evidence shows that the efficacy and safety of iguratimod in the treatment of rheumatoid arthritis are similar to methotrexate. And iguratimod is superior in global assessment of disease activities by patients and doctors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo evaluate the efficacy and safety of tocilizumab for treating active rheumatoid arthritis (RA).MethodsSeventy-seven patients with active RA who treated from November 2013 to April 2015 in the Outpatient Department of Rheumatology in West China Hospital of Sichuan Universiy with follow-up data were involved. Their clinical data were retrospectively analyzed. Tocilizumab was infused every 4 weeks at a dose of 8 mg/kg and concomitant use of other disease-modifying anti-rheumatic drugs (DMARDs) was allowed. Activity and efficacy were evaluated by Disease Activity Score-28 (DAS28) and European League Against Rheumatism (EULAR) response.ResultAfter the treatment, the DAS28 devreased from the baseline 6.88±1.09 to 4.99±1.53 (4th week), 4.31±1.37 (8th week), 3.74±1.15 (12th week) and 2.66±0.68 (24th week) (P<0.05). The disease activity level assessed by DAS28 was 11.1%, and the low activity was 9.5%, and the values were 10.5%, 32.2% and 66.6%, 16.7% (P<0.05) respectively at the 12th and 24th week. EULAR good/moderate response rates were 17.5%/76.2%, 39.0%/57.4% and 66.7%/33.3% at 8, 12 and 24 weeks. The differences in the decline over time in tender joint count, swollen joint count visual analogue score, Health Assessment Questionnaire score, erythrocyte sedimentation rate and C-reactive protein before and after the treatment were statistically significant (P<0.05). Adverse event was found in 21 cases who were alleviated after the treatment (1 anaphylactic reaction, and the other were mild).ConclusionTocilizumab is safe and effective in treatment of active RA patients.
摘要:目的:评价膝关节滑膜超声检查在类风湿关节炎(RA)患者随访中的价值及其与RA临床活动度之间的相关性。方法:收集确诊的RA病人40例,其中68个膝关节有阳性症状。分别收集40例RA患者的临床资料,计算其疾病活动度DSA28,同时行膝关节超声检查,对有阳性症状的膝关节动态随访三次上述指标,每月一次。结果:每月RA患者的DSA28分值与受检膝关节髌上囊内液体深度、滑膜内血流信号等级呈正相关(Plt;0.05);膝关节髌上囊内液体深度、滑膜内血流信号等级以及滑膜厚度三者之间均呈正相关(Plt;0.05)。结论:膝关节滑膜内血流信号等级和膝关节髌上囊内液体深度是良好的随访RA患者疗效与评估RA患者活动度的超声指标。Abstract: Objective: To evaluation the disease of synovial in knee joints in patients with RA by ultrasound, and investigate the relationship between the clinic activity of RA and findings by ultrasound. Methods: The clinic dates and ultrasound of 40 RA patients, including 68 knee joints have positive symptom were collected by every month. The course of treatment was 3 months. Results: The score of DSA28 was correlated with the thick of effusion in bursa supragenual and the blood single of synovial in knee joints(Plt;0.05);the correlation also found among the thick of effusion in bursa supragenual.the thick of synovial and the blood singal of synovial in knee joints (Plt;0.05). Conclusion: The thick of effusion in bursa supragenual and the blood single of synovial in knee joints was excellent ultrasound index in RA.
目的:探讨甲氨蝶呤联合依那西普(MTX+ETA)和甲氨蝶呤联合来氟米特(MTX+LEF)治疗重度活动的类风湿关节炎(RA)的疗效差异。方法:收集重度活动的RA患者50例。A组24例,给予MTX 10mg/次,一周一次,口服,联合ETA 25mg/次,一周2次,皮下注射后病情缓解后依那西普减量为25mg/次,1周一次至随访结束;B组26例,给予MTX 10mg一周一次联合来氟米特20mg/d。两组随访时间为24周。定期随访其红细胞沉降率(ESR)、C反应蛋白(CRP)、DSA28评分、sharp评分、RF、ANA、ACR核心标准评定。结果:①A组在治疗半年前后其VAS评分、晨僵时间、关节肿痛个数、DSA28评分、HAQ、患者评分、医生评价、ESR、CRP方面改善明显,有统计学意义(Plt;0.05);B组在治疗半年前后其VAS评分、晨僵时间、关节肿痛个数、DSA28评分、HAQ、患者评分、医生评价方面改善明显,有统计学意义(Plt;0.05);A组和B组在治疗半年后在VAS评分、晨僵时间、关节触痛个数、DSA28评分、HAQ、患者评分、医生评价、ESR、CRP方面改善明显,有统计学意义(Plt;0.05)。②各组ACR20有效率逐步增加,在各随访期内两组的ACR20的达标率的差异无明显的统计学意义(Pgt;0.05);ACR50则在第4、20、24周,A组的达标率为12%、79%、87%与B组的8%、46%、50%差异有统计学意义(Plt;0.05);ACR70虽然在各期A组均高于B组,但差异均无差异性(Pgt;0.05)。③A组在第2、4、12周DSA28指数下降明显,跟前次随访指标的差异有统计学意义(Plt;0.05);B组在第16、24周DSA28指数下降明显,跟前次随访指标的差异有统计学意义(Plt;0.05);而A组与B组同期DSA28的比较发现,A组从第4周起各期DSA28分值均低于B组,且差异均有统计学意义(Plt;0.05)④两种治疗方案不良反应发生情况均低,且两组不良事件发生率差异无统计学意义。结论:ETA+MTX和LEF+MTX联合治疗重度活动的RA均是安全有效的,其中前者常常可以更早期的达到诱导缓解病情的目的。
目的 检测类风湿关节炎（RA）患者血清和关节液白细胞介素17A（IL-17A）的变化，探讨其与临床炎症指标、疾病活动性的关系。 方法 2011年6月－2012年6月采用酶联免疫吸附试验检测30例活动性RA患者和20例健康对照血清IL-17A水平，其中18例有膝关节积液RA患者同时检测配对血清和关节液IL-17A水平。 结果 RA组患者血清IL-17A水平显著高于健康对照组[（40.651 ± 16.402）、（23.799 ± 10.693） pg/mL，P＜0.05]。RA患者关节液IL-17A水平明显高于其血清中水平[（63.555 ± 23.405）、（43.727 ± 17.212） pg/mL，P＜0.05]。RA患者血清IL-17A水平只与疾病活动性评分（DAS28）呈正相关（r=0.498，P=0.020），而RA患者关节液IL-17A水平与DAS28和血清C反应蛋白有相关性（r=0.515，P=0.029；r=0.498，P=0.035）。 结论 RA患者血清和关节液IL-17A水平与疾病活动性显著相关，提示IL-17A可作为衡量疾病活动和关节损伤的标志之一。
目的:观察来氟米特和雷公藤多甙联合治疗重症类风湿关节炎3个月后的疗效及不良反应。 方法:将46例重症类风湿关节炎随机分为治疗组和对照组各23例,治疗组接受国产来氟米特和雷公藤甙联合治疗,对照组接受甲氨喋呤和柳氮磺胺吡啶联合治疗,总疗程均为三个月。观察两组治疗前后各项临床和实验室指标的变化,并比较不良反应发生率。结果:治疗组与对照组比较各项临床和实验室指标的变化量及总有效率均无显著性差异,不良反应发生率亦无显著性差异。结论:国产来氟米特联合雷公藤多甙治疗重症类风湿关节炎安全有效。
【摘要】 目的 探讨女性类风湿关节炎（rheumatoid arthritis，RA）患者性激素的变化及其与炎症指标的关系。 方法 2008年1月-2009年12月检测RA组45例女性患者（绝经期组16例、黄体期组14例和滤泡期组15例）和正常对照组40例女性（绝经期组14例、黄体期组、滤泡期组各13例）血清性激素水平，同时检测RA组血沉（SR）、C反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸肽（抗CCP） 抗体的水平。 结果 RA患者绝经期雌二醇（E2）浓度明显高于正常对照组（Plt;0.05）；RA组黄体期泌乳素（PRL）的浓度明显高于正常对照组（Plt;0.05）；RA组孕酮（PROG）浓度明显低于正常对照组（Plt;0.05）；RA组滤泡期PRL明显高于正常对照组（Plt;0.05）。RA组黄体期PRL与其孕酮（PROG）呈正相关（r=0.754，P=0.031），绝经期E2，黄体期PRL和PROG以及滤泡期PRL与SR、CRP、RF、抗CCP无相关性（Pgt;0.05）。 结论 女性RA患者月经周期的不同阶段，性激素水平的改变不同，绝经期以雌激素升高明显，黄体期和滤泡期则以孕激素改变明显。黄体期PRL与其PROG呈正相关；女性RA患者性激素的变化与其炎症指标无相关性。【Abstract】 Objective To explore the change of sex hormone levels in female patients with rheumatoid arthritis (RA) and its relationship with inflammatory markers. Methods The serum sex hormones of 45 female patients with RA (RA group, including menopausal group of 16 patients, luteal phase group of 14 patients and follicular phase group of 15 patients) and 40 females (control group: including menopausal group of 14 females, luteal phase group of 13 females and follicular phase group of 13 females) in the control group between January 2008 and December 2009 were detected. The inflammatory makers of erythrocyte sedimentation rate (SR), C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (anti-CCP) of patients in the RA group were also detected. Results The menopausal estradiol (E2) level and the concentration of prolactin (PRL) of patients with RA were significantly higher than that of patients in the normal control group (Plt;0.05), while the progesterone (PROG) level was significantly lower than that of patients in the control group (Plt;0.05). The PRL level of follicular phase group was significantly higher than that of the normal control group (Plt;0.05). PRL level in the luteal phase was positively correlated with its PROG level (r=0.754, P=0.031). The menopausal E2, the luteal PRL and PROG as well as the follicular phase PRL had no correlation with SR, C-reactive protein, RF, or anti-CCP antibodies (Pgt;0.05). Conclusions At different stages of the menstrual cycle in women with RA, the changes of sex hormone levels were different. The concentration of estrogen has increased significantly in menopause, while the progesterone has changed markedly in luteal and follicular phases. PRL in luteal phase is positively correlated with PROG. The changes of sex hormones in female patients with RA show no correlation with inflammatory markers.
【摘要】 目的 采用高分辨率超声测定类风湿关节炎（rheumatoid arthritis，RA）患者颈动脉内中膜厚度和是否有斑块以及是否存在动脉硬化。 方法 分析2009年4月—2010年9月间150例RA患者的一般情况、发病情况、疾病活动性评分（DAS28评分），及实验室指标如:血沉（ESR）、C反应蛋白（CRP）、抗环瓜氨酸抗体（ACCP）、类风湿因子（RF）、总胆固醇、三酰甘油、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1 （ApoA1）、载脂蛋白B（ApoB）、脂蛋白a及血尿酸的测定。采用颈动脉彩色多普勒超声测定RA患者与正常对照组120例颈动脉内中膜值及是否有斑块。 结果 150例RA患者20例出现动脉硬化，120例健康人群中3例出现动脉硬化，RA颈动脉内硬化危险因素单因素分析中，病程、DAS28评分、ApoA1、ApoB、HDL-C及尿酸与RA动脉硬化有关，而年龄、性别、ESR、CRP、RF、ACCP等与RA发生动脉硬化无关；RA动脉硬化多因素回归分析示:病程、尿酸及高密度脂蛋白是RA发生动脉硬化的危险因素。 结论 颈动脉内中膜测定对RA动脉硬化具有一定临床价值。【Abstract】 Objective To detect the carotid artery intima-media thickness and the existence of carotid plague and arteriosclerosis by high-resolution ultrasonography in patients with rheumatoid arthritis (RA). Methods A total of 150 RA patients treated in our hospital between April 2009 and September 2010 were included in this study. Their general condition, onset of the disease and disease activity score (DAS28 scoring) were analyzed. Laboratory indexes like erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Anti-cyclic citrullinated peptide (ACCP) antibody, rheumatoid factor (RF), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apo A1), apolipoprotein B (apo B), lipoprotein(a) (Lp(a)), and uric acid (UA) were measured. Carotid color ultrasonography was used to detect the carotid intima-media thickness and the existence of carotid plague in 150 patients with RA and 120 patients in the control group. Results Twenty out of the 150 RA patients and three out of the 120 controls manifested arteriosclerosis. Single factor analysis showed a correlation between arteriosclerosis in RA patients and course of disease, DAS28 scoring, Apo A, Apo B, HDL-C, and UA, and no correlation between arteriosclerosis and age, gender, ESR, CRP, RF, and ACCP. Multivariate regression analysis showed that the course of disease, UA and HDL-C are independent risk factors for arteriosclerosis in RA patients. Conclusion Analysis of the carotid intima-media has a certain clinical value in predicting arteriosclerosis in RA patients.
目的:本文研究5·12四川汶川大地震造成停药、居住条件恶劣、创伤后应激障碍（posttraumatic stress disorder，PTSD）、是否并发感染、地震破坏烈度等多种因素对类风湿关节炎（RA）患者的影响。方法:对58例确诊为RA的重灾区（北川、平武、江油、安县）地震前病情稳定患者震后一月进行血沉（ESR）和C反应蛋白（CRP）测定，同时评估患者关节肿胀、关节压痛、晨僵情况，了解患者是否病情活动，分析地震造成停药、居住条件恶劣、PTSD、并发感染及地震破坏烈度等多种因素对RA的影响。采用fisher确切概率法，分析地震破坏烈度与疾病活动是否有相关性，采用SPSS12.0软件对地震可能影响RA患者病情活动的其它相关因素进行Logistic回归分析。结果:58例患者中34例RA患者出现病情活动。fisher确切概率法分析显示:上述四县患者疾病活动构成比差别无统计学意义。病情活动者中62%患者停药；85%患者居住条件恶劣；59%患者患有PTSD；35%患者并发感染。Logistic回归分析发现停药、居住条件恶劣、PTSD及并发感染与RA患者病情活动相关（P均小于0.05）。结论：本研究中涉及的四个县RA患者疾病活动构成比差异无显著性，地震造成的停药、居住条件恶劣、PTSD、并发感染可使一部分RA患者病情活动。