BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive asse...BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive assessment of disease activity,and how subgroups of subjective and objective items reflect change in disease state over time.METHODS Selective raw data from three prospectively collected datasets were combined,including 703 children with full PCDAI data at baseline,at 3-mo(Q1,n=670),and 1-year(Q4,n=474).Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.RESULTS Abdominal pain,well-being,weight,and stooling had the highest change scores over time.Objective indicators including albumin,abdominal exam,and height velocity followed.Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4(P<0.001 and P<0.05).Subjective and objective subgroups of items predicted less variance(18%and 22%)on total PCDAI scores at Q1 and Q4 compared to the full PCDAI,or a composite scale(both 32%)containing significant predictors.CONCLUSION Although subjective items on the PCDAI change the most over time,the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone.Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.展开更多
AIM To optimize the efficacy of noninvasive evaluations in monitoring the endoscopic activity of inflammatory bowel disease(IBD).METHODS Fecal calprotectin(FC), clinical activity index(CDAI or CAI), C-reactive protein...AIM To optimize the efficacy of noninvasive evaluations in monitoring the endoscopic activity of inflammatory bowel disease(IBD).METHODS Fecal calprotectin(FC), clinical activity index(CDAI or CAI), C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), and procalcitonin(PCT) were measured for 136 IBD patients. Also, FC was measured in 25 irritable bowel syndrome(IBS) patients that served as controls. Then, endoscopic activity was determined by other two endoscopists for colonic or ileo-colonic Crohn's disease(CICD) with the "simple endoscopic score for Crohn's disease"(SES-CD), CDrelated surgery patients with the Rutgeerts score, and ulcerative colitis(UC) with the Mayo score. The efficacies of these evaluations to predict the endoscopic disease activity were assessed by Mann-Whitney test, χ~2 test, Spearman's correlation, and multiple linear regression analysis.RESULTS The median FC levels in CD, UC, and IBS patients were 449.6(IQR, 137.9-1344.8), 497.9(IQR, 131.7-118.0), and 9.9(IQR, 0-49.7) μg/g, respectively(P < 0.001). For FC, CDAI or CAI, CRP, and ESR differed significantly between endoscopic active and remission in CICD and UC patients, but not in CD-related surgery patients. The SES-CD correlated closely with levels of FC(r = 0.802), followed by CDAI(r = 0.734), CRP(r = 0.658), and ESR(r = 0.557). The Mayo score also correlated significantly with FC(r = 0.837), CAI(r = 0.776), ESR(r = 0.644), and CRP(r = 0.634). For FC, a cut-off value of 250 μg/g indicated endoscopic active inflammation with accuracies of 87.5%, 60%, and 91.1%, respectively, for CICD, CD-related surgery, and UC patients. Moreover, clinical FC activity(CFA) calculated as 0.8 × FC + 4.6 × CDAI showed higher area under the curve(AUC) of 0.962 for CICD and CFA calculated as 0.2 × FC + 50 × CAI showed higher AUC(0.980) for UC patients than the FC. Also, the diagnostic accuracy of FC in identifying patients with mucosal inflammation in clinical remission was reflected by an AUC of 0.91 for CICD and 0.96 for UC patients. CONCLUSION FC is the most promising noninvasive evaluation for monitoring the endoscopic activity of CICD and UC. CFA might be more accurate for IBD activity evaluation.展开更多
BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient outcomes.Brazil is the largest Latin American country,and it presents socio...BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient outcomes.Brazil is the largest Latin American country,and it presents socioeconomic and health care differences across its geographical regions.This country has the highest increase in IBD incidence and prevalence in Latin America,but information about the clinical and treatment characteristics of IBD is scarce.AIM To describe the sociodemographic,clinical,and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast,South and Northeast/Midwest regions.METHODS Multicenter,cross-sectional study with a 3-year retrospective chart review component.Patients with moderate-to-severe Crohn’s disease(CD)or ulcerative colitis(UC)were consecutively enrolled between October 2016 and February 2017.Active CD at enrollment was defined as a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or a calprotectin level>200μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year;active UC was defined as a partial Mayo score≥5.Descriptive statistics were used to analyze all variables.RESULTS In a total of 407 included patients,CD was more frequent than UC,both overall(264 CD/143 UC patients)and by region(CD:UC ratios of 2.1 in the Southeast,1.6 in the South and 1.2 in the Northeast/Midwest).The majority of patients were female(54.2%of CD;56.6%of UC),and the mean ages were 45.9±13.8 years(CD)and 42.9±13.0 years(UC).The median disease duration was 10.0(range:0.5-45)years for both IBD types.At enrollment,44.7%[95%confidence interval(CI):38.7-50.7]of CD patients and 25.2%(95%CI:18.1-32.3)of UC patients presented with active disease.More than 95%of IBD patients were receiving treatment at enrollment;CD patients were commonly treated with biologics(71.6%)and immunosuppressors(67.4%),and UC patients were commonly treated with mesalazine[5-Aminosalicylic acid(5-ASA)]derivates(69.9%)and immunosuppressors(44.1%).More than 50%of the CD patients had ileocolonic disease,and 41.7%presented with stricturing disease.One-quarter of CD patients had undergone CD-related surgery in the past 3 years,and this proportion was lower in the Northeast/Midwest region(2.9%).CONCLUSION In Brazil,there are regional variations in IBD management.CD outweighs UC in both frequency and disease activity.However,one-quarter of UC patients have active disease,and most are receiving 5-ASA treatment.展开更多
OBJECTIVE To investigate the contribution of B cell activating factor of TNF family(BAFF)in the proliferation and activation of B cell in rheumatoid arthritis(RA),and to clarify whether high levels of BAFF is associat...OBJECTIVE To investigate the contribution of B cell activating factor of TNF family(BAFF)in the proliferation and activation of B cell in rheumatoid arthritis(RA),and to clarify whether high levels of BAFF is associated with clinical variables and lab parameters.METHODS Blood samples and peripheral blood mononuclear cells from RA patients and healthy controls(HCs)were collected and isolated respectively.Clinical variables and lab parameters,BAFF level,cytokines and immunoglobulins in serum were evaluated at entry.B cell subpopulations,BAFF receptors(BAFFR,BCMA,TACI),and alternative and canonical NF-κB pathway in B cell were analyzed in vivo and in vitro.RESULTS In RA patients,BAFF level and activated B cell subsets increased significantly.BAFF level was associated with CRP,RF,DAS28,swollen joint counts and tender joint counts.BAFFR,BCMA,TACI on B cells in RA over expressed.The expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52 were higher than that in HCs.In vitro,BAFF up regulated activated B cell subset and the expressions of BAFFR,BCMA and TACI.BAFF also enhanced the expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52.CONCLUSION Increased BAFF in serum is associated with the disease activity of RA,BAFF involves in the proliferation and activation of B cell in RA through alternative and canonical NF-κB pathway,indicating that BAFF might be a novel biomarker of diagnosis and therapy.展开更多
BACKGROUND The expression of jumonji domain-containing 3(Jmjd3)and trimethylated H3 lysine 27(H3K27me3)in active ulcerative colitis(UC)and the correlation between vitamin D receptor(VDR)and the Jmjd3 pathway are unkno...BACKGROUND The expression of jumonji domain-containing 3(Jmjd3)and trimethylated H3 lysine 27(H3K27me3)in active ulcerative colitis(UC)and the correlation between vitamin D receptor(VDR)and the Jmjd3 pathway are unknown.AIM To study the relationship between VDR,Jmjd3 and H3K27me3 in patients with active UC.METHODS One hundred patients with active UC and 56 healthy controls were enrolled in this study.The patients with active UC were divided into groups according to mild(n=29),moderate(n=32)and severe(n=29)disease activity based on the modified Mayo score.Vitamin D levels were measured by radioimmunoassay.Colonic mucosal tissues from UC patients and controls were collected by colonoscopy.The expression of VDR,Jmjd3 and H3K27me3 in the intestinal mucosa was determined by immunohistochemistry staining.RESULTS Patients with active UC had lower levels of serum vitamin D(13.7±2.8 ng/mL,P<0.001)than the controls(16.2±2.5 ng/mL).In the UC cohort,serum vitamin D level was negatively correlated with disease activity(r=-0.323,P=0.001).VDR expression in the mucosa of UC patients was reduced compared to that in normal tissues(P<0.001)and negatively correlated with disease activity(r=-0.868,P<0.001).Similar results for VDR expression were noted in the most serious lesion(defined as UC diseased)and 20 cm proximal to the anus(defined as UC normal)(P<0.05).Simultaneously,Jmjd3 expression significantly increased in UC patients(P<0.001),but no difference was found between the different sites in UC patients.H3K27me3 expression in UC patients was significantly down-regulated when compared with normal tissues(P<0.001),but up-regulated in the mild disease activity group in comparison with the moderate disease activity group of UC patients(P<0.05).Jmjd3 Level was negatively correlated with the level of VDR(r=-0.342,P=0.002)and H3K27me3(r=-0.341,P=0.002),while VDR level was positively correlated with H3K27me3(r=0.473,P<0.001).CONCLUSION Serum vitamin D and VDR were inversely correlated with disease activity in active UC.Jmjd3 expression increased in the colonic mucosa of active UC patients and was negatively associated with VDR and H3K27me3 level.展开更多
Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with ...Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016;187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years;disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.展开更多
Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as c...Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as calprotectin or S100A8/A9 is considered as a sensitive marker for local inflammatory activity in rheumatoid arthritis. The aim of this study is to demonstrate the efficacy of MRP8/14 as a marker of disease activity in RA. Methods: Thirty-one patients with diagnosis of RA who received treatment without biological drugs at our institution were included in this study. Serum MRP8/14, CRP and MMP-3 were tested in all patients. Disease activity was evaluated using DAS28-CRP and SDAI. Ultrasonography was performed on the wrists and MCP joints of both hands using semi-quantitative scale of power Doppler signal. The sum of scales in joints was calculated as the PD score. The correlation of MRP8/14 with serum biomarkers, disease activity and ultrasonography examination was investigated. Result: Serum MRP8/14 was strongly correlated with CRP (r = 0.63) and MMP-3 (r = 0.69). A correlation was observed between serum MRP8/14 and DAS28-CRP (r = 0.53) and SDAI (r = 0.66). No significant correlation was found between PD scores and MRP8/14. Conclusion: This study demonstrated that MRP8/14 is correlated with evaluated disease activity and markers of serum inflammatory response in patients not using biological drugs. MRP8/14 is considered an effective new method for objective evaluation of synovitis in RA.展开更多
Background:Vaccination has been shown effective in controlling the global coronavirus disease 2019(COVID-19)pandemic and reducing severe cases.This study was to assess the flare and change in disease activity after CO...Background:Vaccination has been shown effective in controlling the global coronavirus disease 2019(COVID-19)pandemic and reducing severe cases.This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis(RA).Methods:A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status.Each of them was examined every 3 to 6 months.In the vaccination group,disease activity was compared before and after vaccination.The rates of flare defined as disease activity scores based on 28-joint count(DAS28)>3.2 withΔDAS28≥0.6 were compared between vaccination and non-vaccination groups.Results:A total of 202 eligible RA patients were enrolled.Of these,98 patients received no vaccine shot(non-vaccination group),and 104 patients received two doses of vaccine(vaccination group).The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days,respectively.The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar.At enrollment,gender,RA disease course,seropositivity,and disease activity were comparable across the two groups.Flare was observed in five(4.8%)of the vaccination group patients and nine(9.2%)of the non-vaccination group patients at post-vaccination assessment(P=0.221).In terms of safety,29(27.9%)patients experienced adverse events(AEs)after vaccination.No serious AEs occurred.Conclusions:COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity.Patients with stable RA should be encouraged to receive the COVID-19 vaccination.展开更多
Background: Behçet’s Syndrome (BS) is characterized by a heterogeneous vessel involvement, a fluctuating natural history and by the absence of biological markers correlated to disease activity that’s why ob...Background: Behçet’s Syndrome (BS) is characterized by a heterogeneous vessel involvement, a fluctuating natural history and by the absence of biological markers correlated to disease activity that’s why objective clinical scores are needed for the assessment of its activity. The Behçet’s Disease Clinical Activity Form (BDCAF) is the most recent and widely used clinical activity score. Objectives: To perform a cross-cultural adaptation of the Behçet’s Disease Current Activity Form (BDCAF) to the Tunisian Dialect (Arabic Language) and to evaluate the metrological characteristics of the Tunisian version (Tu-BDCAF) especially its reliability in BD activity evaluation. Methods: Cross-cultural adaptation was done according to the established guidelines. Reliability of Tu-BDCAF was tested among 40 BD patients (mean age: 38 years, sex ratio: 1.37). Patients were questioned by two BD specialists at 20 minutes interval to evaluate inter-observer reproducibility and twice by the same physician at 48 hours interval to assess the intra-observer reproducibility. k Coefficient was used to test the concordance between qualitative variables and correlation between quantitative variables was evaluated used Pearson coefficient and Bland and Altman graphical method. Results: There was a good correlation between global scores calculated by the two physicians on the same day (r = 0.94, p < 0.0001) and also between the scores calculated by the same clinician at different times (r = 0.98, p k Coefficient analyses demonstrated a good intra and inter observer reliability for all the Tu-BDCAF items excepted for diarrhea and Clinician’s impression. As the original version, Tu-BDCAF is an objective, easy-calculated and reliable index for assessing disease activity in BD. The main limit of the BDCAF score remains the absence of a cut-off point defining BD activity. Conclusion: Tu-BDACF is a Tunisian version of the BDCAF score which can be used in routine to assess BD activity but also in international studies and clinical trials.展开更多
Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and resea...Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and research studies of rheumatoid arthritis(RA).The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study,including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018,was conducted.The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots,quadratic weighted kappa,and discordance rates in the crosstab.For other indices,the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included,of whom 80.46%were women.Most individuals were with moderate disease activity or high disease activity.High correlations among DAS28-erythrocyte sedimentation rate(ESR)and DAS28-C-reactive protein(CRP),SDAI and CDAI were observed.Similarly,the weighted kappa value among the indices was high.In Bland-Altman plots,a positive difference between DAS28-ESR and DAS28-CRP was observed,with an absolute difference of>1.2 in 3079(10.09%)patients.In crosstab,approximately 30%of the patients were classified into different groups.Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR,DAS28-CRP,and CDAI were 3.06,2.37,and 3.20,respectively.Conclusions:Although DAIs had high correlations and weighted kappa values,the discordance between DAIs was significant in Chinese patients with RA.The four DAIs are not interchangeable.展开更多
BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colit...BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.展开更多
AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed a...AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated and verified on a visual analog scale (VAS). RESULTS: 87.9% of patients reported pain. Females and males reported comparable pain intensities and HRQOL. Surgery reduced pain in both genders (P = 0.023), whereas HRQOL only improved in females. Interestingly, patients on analgesics reported more pain (P = 0.003) and lower HRQOL (P = 0.039) than patients not on analgesics. A significant correlation was found in UC patients between pain intensity and HRQOL (P = 0.023) and CAI (P = 0.027), and in CD patients between HRQOL and CDAI (P = 0.0001), but not between pain intensity and CDAI (P = 0.35). No correlation was found between patients with low CDAI scores and pain intensity. CONCLUSION: Most IBD patients suffer from pain and have decreased HRQOL. Our study reinforces the need for effective individualized pain therapy in IBD patients.展开更多
Objective Nonalcoholic fatty liver disease(NAFLD)is a common cause of clinical liver dysfunction and an important prepathological change of liver cirrhosis.Central obesity,type 2 diabetes mellitus,dyslipidemia,and met...Objective Nonalcoholic fatty liver disease(NAFLD)is a common cause of clinical liver dysfunction and an important prepathological change of liver cirrhosis.Central obesity,type 2 diabetes mellitus,dyslipidemia,and metabolic syndrome are the major risk factors for NAFLD.Sitagliptin(Sig)is a novel hypoglycemic agent that improves blood glucose levels by increasing the level of active incretin.Sig has been shown to prevent the development of fatty livers in mice on a fructose-rich diet.The purpose of this study was to observe the efficacy of Sig on NAFLD in type 2 diabetic mice.Methods The diet-induced obesity mouse model was established,and the diabetic mice were screened by an intraperitoneal glucose tolerance trial.The mice were randomly divided into four groups for 8 weeks of intervention:high-fat diet(HFD)group,Sig group,metformin(Met)group,and Sig+Met group.After the intervention,the liver function indexes as well as the blood glucose and blood lipid levels of the mice were measured.In addition,the wet weight of the liver was measured;the pathological sections of the liver tissues were stained to observe the hepatocyte fatty degeneration,inflammation,necrosis,and fibrosis;and the hepatic histological injury was recorded as the NAFLD activity score(NAS).Results Compared with the normal control group,the body weight,liver weight,blood glucose level,insulin resistance(IR),blood lipid level,and transaminase level of the mice in the HFD group were significantly increased,showing typical metabolic syndrome.After treatment with Sig and/or Met,the mice gained less weight,had lower levels of blood glucose,triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and transaminase,and had improved IR compared with the HFD group.The liver pathological NASs in the Sig group(P=0.01),Met group(P=0.028),and Sig+Met group(P<0.001)were lower than those in the HFD group(P<0.05),suggesting that the use of the two drugs alone or in combination can improve the state of liver inflammation.In terms of fibrosis,there was no fibrosis in the control group but there was significant fibrosis in the HFD group(P<0.001).There was no significant difference between the drug intervention groups and the HFD group,indicating that the drug therapy(Sig and/or Met)did not significantly improve the pre-existing fibrosis.Conclusion Our experiment proved that Sig can improve NAFLD,including improvement of the serum transaminase level,hepatic pathological inflammation level,and hepatocyte adiposis,suggesting that Sig may play a role by improving glucose and lipid metabolism,reducing the body weight and liver weight,improving insulin sensitivity,and inhibiting fatty liver inflammation.Sig may be a new direction for the treatment of patients with a nonalcoholic fatty liver and diabetes,delaying the progression of NAFLD.展开更多
Members of the tumor-necrosis factor-α(TNF-α) and TNF-α receptor(TNFR) superfamilies of proteins(TNFSF and TNFRSF, respectively) play important roles in the function of the immune system. Decoy receptor 3(Dc R3, TN...Members of the tumor-necrosis factor-α(TNF-α) and TNF-α receptor(TNFR) superfamilies of proteins(TNFSF and TNFRSF, respectively) play important roles in the function of the immune system. Decoy receptor 3(Dc R3, TNFRSF6b) is a decoy receptor that binds to three TNFSF ligands, Fas L, LIGHT and TL1 A. Association to these ligands competes with the corresponding functional receptors and blocks downstream signaling, leading to immunomodulatory effects, including the prevention of apoptosis. Dc R3 lacks a transmembrane region and exists only as a secreted protein, which is detectable in biological fluids. Recent studies have shown that Dc R3 is upregulated and may be pathogenetically implicated in several and diverse chronic inflammatory diseases. The strongest associations have been described for rheumatological diseases, mainly systemic lupus erythematosus and rheumatoid arthritis, inflammatory bowel disease, and serious infectious conditions, including systemic inflammatory response syndrome. In the majority of these conditions, Dc R3 m RNA and protein expression is elevated both at the target tissues as well as in the systemic circulation. Dc R3 concentration in the serum is untraceable in the majority of healthy individuals but can be detected in patients with various inflammatory diseases. In mostsuch cases, soluble Dc R3 correlates with disease severity, as patients with severe forms of disease have significantly higher levels than patients with milder or no activity. In addition, effective anti-inflammatory treatment leads to the disappearance of soluble Dc R3 from the circulation. Taken together, current evidence suggests that serum Dc R3 may become a useful biomarker for chronic inflammatory disorders, as it is upregulated in response to inflammatory stimuli, and may serve both as a prognostic marker for disease severity and as a surrogate indicator of response to treatment.展开更多
<b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">The present study estimated the prevalence of anemia among children and...<b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">The present study estimated the prevalence of anemia among children and adolescents with pediatric rheumatological diseases in a referral center, and analyzed the associated clinical and biological parameters.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Methods:</span></b><i><span style="font-family:""> </span></i><span style="font-family:""><span style="font-family:Verdana;">A retrospective chart review included 49 children with rheumatological diseases, who were diagnosed by a pediatric rheumatologist and classified according to the International League of Associations for Rheumatology (ILAR) guidelines and criteria endorsed by the American College of Rheumatologists. Anemia was defined as hemoglobin level lower than the 5th centile for the corresponding age and gender. Disease activity was indicated by serum levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), where available. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Participants were aged 2 - 18 years (mean ± SD = 10.41 ± 4.23 years), 38 (77.6%) of them had JIA, and 8 (16.3%) had systemic lupus erythematosus. The most frequent subtype of JIA was the polyarticular (16 out of 38, 42.1%), followed by systemic (14, 36.8%). The prevalence of anemia was 46.9% (95% CI = 32.5% - 61.7%), with no significant difference between JIA and other diseases or between the different JIA subtypes. Nevertheless, anemia was more frequently observed in younger patients (age 2 - 6 years: 69.2% vs <48%) and those with elevated ESR (68.8% vs 33.3%) or CRP (60.0% versus 45.2%), compared with their counterpart respectively;however, only the association with ESR was statistically significant (p = 0.049). No agreement was found between CRP and ESR (Kappa = 0.140). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><i> </i><span style="font-family:Verdana;">Anemia is frequent in JIA and other rheumatologic diseases in children, concerning approximately 50% of the patients and responding to anemia of inflammation as the major pathophysiological mechanism. Further research is warranted to provide more accurate insight into the pathophysiological mechanisms and clinical characteristics of anemia in pediatric rheumatological disease and to measure its morbidity, to provide efficient and evidence-based management strategies.展开更多
Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely valida...Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.展开更多
BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omah...BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.展开更多
BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stres...BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.展开更多
Background: Methotrexate (MTX) is the most effective and commonly used disease-modifying anti-rheumatic drug in the management of juvenile idiopathic arthritis. Several patients develop side effects, which may lead to...Background: Methotrexate (MTX) is the most effective and commonly used disease-modifying anti-rheumatic drug in the management of juvenile idiopathic arthritis. Several patients develop side effects, which may lead to low quality of life and non-compliance to MTX. To reduce MTX-induced side effects, folic acid supplementation is prescribed by most rheumatologists. Even after that, some patients have symptoms while receiving MTX. Objectives: To assess the efficacy of folinic acid in comparison to folic acid for reducing the side effects of MTX in JIA patients. Material and methods: In this prospective observational study, newly diagnosed cases of JIA who would be getting MTX were included by purposive sampling. Data were collected using a predesigned questionnaire. Among 40 patients, 20 received folinic acid (Group A), and 20 received folic acid (Group B). Disease activity levels were assessed by JADAS-27 (Juvenile Arthritis Disease Activity Score). Contents from the MISS (MTX Intolerance severity score) questionnaire were used to assess the side effects. All patients were evaluated at baseline, 6th, and 12th weeks. Results: There were significant differences in the frequency of MTX-related adverse events between folinic acid (Group A) and folic acid (Group B). Group A patients only had nausea (10% and 15% in the 6th & 12th week respectively) and vomiting (5% at both follow-ups). On the other hand, in addition to nausea (70% and 95% in the 6th & 12th week) and vomiting (20% and 90% in the 6th & 12th week), folic acid group patients had restlessness, crying, and irritability. Self-discontinuation of MTX was present in the folic acid group (5% & 10% in the 6th & 12th week). Improvement of disease activity was more in the folinic acid group. Conclusion: The folinic acid group had significantly fewer side effects. Improvement of disease activity was more and compliance was also better among them. Methotrexate (MTX) is the most effective and commonly used disease-modifying anti-rheumatic drug in the management of juvenile idiopathic arthritis. A number of patients develop side effects, which may lead to low quality of life and non-compliance to MTX. To reduce MTX induced side effects, folic acid supplementation is prescribed by most rheumatologists. Even after that, some patients have symptoms while receiving MTX.展开更多
Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7...Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.展开更多
文摘BACKGROUND The pediatric Crohn’s disease activity index(PCDAI)is used as a standard tool to assess disease activity in clinical trials for pediatric Crohn’s disease.AIM To examine which items on the PCDAI drive assessment of disease activity,and how subgroups of subjective and objective items reflect change in disease state over time.METHODS Selective raw data from three prospectively collected datasets were combined,including 703 children with full PCDAI data at baseline,at 3-mo(Q1,n=670),and 1-year(Q4,n=474).Change in individual PCDAI scores from baseline to Q1 and to Q4 were examined using the non-weighted PCDAI.RESULTS Abdominal pain,well-being,weight,and stooling had the highest change scores over time.Objective indicators including albumin,abdominal exam,and height velocity followed.Change scores for well-being and abdominal exam did not explain significant variance at Q1 but were significant predictors at Q4(P<0.001 and P<0.05).Subjective and objective subgroups of items predicted less variance(18%and 22%)on total PCDAI scores at Q1 and Q4 compared to the full PCDAI,or a composite scale(both 32%)containing significant predictors.CONCLUSION Although subjective items on the PCDAI change the most over time,the full PCDAI or a smaller composite of items including a combination of subjective and objective components classifies disease activity better than a subgroup of either subjective or objective items alone.Reliance on subjective or objective items as stand-alone proxies for disease activity measurement could result in misclassification of disease state.
基金Supported by National Natural Science Foundation of China to Biao Nie,No.81471080
文摘AIM To optimize the efficacy of noninvasive evaluations in monitoring the endoscopic activity of inflammatory bowel disease(IBD).METHODS Fecal calprotectin(FC), clinical activity index(CDAI or CAI), C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), and procalcitonin(PCT) were measured for 136 IBD patients. Also, FC was measured in 25 irritable bowel syndrome(IBS) patients that served as controls. Then, endoscopic activity was determined by other two endoscopists for colonic or ileo-colonic Crohn's disease(CICD) with the "simple endoscopic score for Crohn's disease"(SES-CD), CDrelated surgery patients with the Rutgeerts score, and ulcerative colitis(UC) with the Mayo score. The efficacies of these evaluations to predict the endoscopic disease activity were assessed by Mann-Whitney test, χ~2 test, Spearman's correlation, and multiple linear regression analysis.RESULTS The median FC levels in CD, UC, and IBS patients were 449.6(IQR, 137.9-1344.8), 497.9(IQR, 131.7-118.0), and 9.9(IQR, 0-49.7) μg/g, respectively(P < 0.001). For FC, CDAI or CAI, CRP, and ESR differed significantly between endoscopic active and remission in CICD and UC patients, but not in CD-related surgery patients. The SES-CD correlated closely with levels of FC(r = 0.802), followed by CDAI(r = 0.734), CRP(r = 0.658), and ESR(r = 0.557). The Mayo score also correlated significantly with FC(r = 0.837), CAI(r = 0.776), ESR(r = 0.644), and CRP(r = 0.634). For FC, a cut-off value of 250 μg/g indicated endoscopic active inflammation with accuracies of 87.5%, 60%, and 91.1%, respectively, for CICD, CD-related surgery, and UC patients. Moreover, clinical FC activity(CFA) calculated as 0.8 × FC + 4.6 × CDAI showed higher area under the curve(AUC) of 0.962 for CICD and CFA calculated as 0.2 × FC + 50 × CAI showed higher AUC(0.980) for UC patients than the FC. Also, the diagnostic accuracy of FC in identifying patients with mucosal inflammation in clinical remission was reflected by an AUC of 0.91 for CICD and 0.96 for UC patients. CONCLUSION FC is the most promising noninvasive evaluation for monitoring the endoscopic activity of CICD and UC. CFA might be more accurate for IBD activity evaluation.
文摘BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient outcomes.Brazil is the largest Latin American country,and it presents socioeconomic and health care differences across its geographical regions.This country has the highest increase in IBD incidence and prevalence in Latin America,but information about the clinical and treatment characteristics of IBD is scarce.AIM To describe the sociodemographic,clinical,and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast,South and Northeast/Midwest regions.METHODS Multicenter,cross-sectional study with a 3-year retrospective chart review component.Patients with moderate-to-severe Crohn’s disease(CD)or ulcerative colitis(UC)were consecutively enrolled between October 2016 and February 2017.Active CD at enrollment was defined as a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or a calprotectin level>200μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year;active UC was defined as a partial Mayo score≥5.Descriptive statistics were used to analyze all variables.RESULTS In a total of 407 included patients,CD was more frequent than UC,both overall(264 CD/143 UC patients)and by region(CD:UC ratios of 2.1 in the Southeast,1.6 in the South and 1.2 in the Northeast/Midwest).The majority of patients were female(54.2%of CD;56.6%of UC),and the mean ages were 45.9±13.8 years(CD)and 42.9±13.0 years(UC).The median disease duration was 10.0(range:0.5-45)years for both IBD types.At enrollment,44.7%[95%confidence interval(CI):38.7-50.7]of CD patients and 25.2%(95%CI:18.1-32.3)of UC patients presented with active disease.More than 95%of IBD patients were receiving treatment at enrollment;CD patients were commonly treated with biologics(71.6%)and immunosuppressors(67.4%),and UC patients were commonly treated with mesalazine[5-Aminosalicylic acid(5-ASA)]derivates(69.9%)and immunosuppressors(44.1%).More than 50%of the CD patients had ileocolonic disease,and 41.7%presented with stricturing disease.One-quarter of CD patients had undergone CD-related surgery in the past 3 years,and this proportion was lower in the Northeast/Midwest region(2.9%).CONCLUSION In Brazil,there are regional variations in IBD management.CD outweighs UC in both frequency and disease activity.However,one-quarter of UC patients have active disease,and most are receiving 5-ASA treatment.
基金The project supported by National Natural Science Foundation of China(81473223,31100640,81302517 and 81330081)China Postdoctoral Science Foundation(2013M540509)
文摘OBJECTIVE To investigate the contribution of B cell activating factor of TNF family(BAFF)in the proliferation and activation of B cell in rheumatoid arthritis(RA),and to clarify whether high levels of BAFF is associated with clinical variables and lab parameters.METHODS Blood samples and peripheral blood mononuclear cells from RA patients and healthy controls(HCs)were collected and isolated respectively.Clinical variables and lab parameters,BAFF level,cytokines and immunoglobulins in serum were evaluated at entry.B cell subpopulations,BAFF receptors(BAFFR,BCMA,TACI),and alternative and canonical NF-κB pathway in B cell were analyzed in vivo and in vitro.RESULTS In RA patients,BAFF level and activated B cell subsets increased significantly.BAFF level was associated with CRP,RF,DAS28,swollen joint counts and tender joint counts.BAFFR,BCMA,TACI on B cells in RA over expressed.The expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52 were higher than that in HCs.In vitro,BAFF up regulated activated B cell subset and the expressions of BAFFR,BCMA and TACI.BAFF also enhanced the expressions of MKK3,MKK6,p-p38,p-NF-κB65,TRAF2,NF-κB52.CONCLUSION Increased BAFF in serum is associated with the disease activity of RA,BAFF involves in the proliferation and activation of B cell in RA through alternative and canonical NF-κB pathway,indicating that BAFF might be a novel biomarker of diagnosis and therapy.
基金Supported by The Key Projects of Natural Science Research of Anhui Province in China,No.201904a07020043.
文摘BACKGROUND The expression of jumonji domain-containing 3(Jmjd3)and trimethylated H3 lysine 27(H3K27me3)in active ulcerative colitis(UC)and the correlation between vitamin D receptor(VDR)and the Jmjd3 pathway are unknown.AIM To study the relationship between VDR,Jmjd3 and H3K27me3 in patients with active UC.METHODS One hundred patients with active UC and 56 healthy controls were enrolled in this study.The patients with active UC were divided into groups according to mild(n=29),moderate(n=32)and severe(n=29)disease activity based on the modified Mayo score.Vitamin D levels were measured by radioimmunoassay.Colonic mucosal tissues from UC patients and controls were collected by colonoscopy.The expression of VDR,Jmjd3 and H3K27me3 in the intestinal mucosa was determined by immunohistochemistry staining.RESULTS Patients with active UC had lower levels of serum vitamin D(13.7±2.8 ng/mL,P<0.001)than the controls(16.2±2.5 ng/mL).In the UC cohort,serum vitamin D level was negatively correlated with disease activity(r=-0.323,P=0.001).VDR expression in the mucosa of UC patients was reduced compared to that in normal tissues(P<0.001)and negatively correlated with disease activity(r=-0.868,P<0.001).Similar results for VDR expression were noted in the most serious lesion(defined as UC diseased)and 20 cm proximal to the anus(defined as UC normal)(P<0.05).Simultaneously,Jmjd3 expression significantly increased in UC patients(P<0.001),but no difference was found between the different sites in UC patients.H3K27me3 expression in UC patients was significantly down-regulated when compared with normal tissues(P<0.001),but up-regulated in the mild disease activity group in comparison with the moderate disease activity group of UC patients(P<0.05).Jmjd3 Level was negatively correlated with the level of VDR(r=-0.342,P=0.002)and H3K27me3(r=-0.341,P=0.002),while VDR level was positively correlated with H3K27me3(r=0.473,P<0.001).CONCLUSION Serum vitamin D and VDR were inversely correlated with disease activity in active UC.Jmjd3 expression increased in the colonic mucosa of active UC patients and was negatively associated with VDR and H3K27me3 level.
文摘Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016;187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years;disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.
文摘Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as calprotectin or S100A8/A9 is considered as a sensitive marker for local inflammatory activity in rheumatoid arthritis. The aim of this study is to demonstrate the efficacy of MRP8/14 as a marker of disease activity in RA. Methods: Thirty-one patients with diagnosis of RA who received treatment without biological drugs at our institution were included in this study. Serum MRP8/14, CRP and MMP-3 were tested in all patients. Disease activity was evaluated using DAS28-CRP and SDAI. Ultrasonography was performed on the wrists and MCP joints of both hands using semi-quantitative scale of power Doppler signal. The sum of scales in joints was calculated as the PD score. The correlation of MRP8/14 with serum biomarkers, disease activity and ultrasonography examination was investigated. Result: Serum MRP8/14 was strongly correlated with CRP (r = 0.63) and MMP-3 (r = 0.69). A correlation was observed between serum MRP8/14 and DAS28-CRP (r = 0.53) and SDAI (r = 0.66). No significant correlation was found between PD scores and MRP8/14. Conclusion: This study demonstrated that MRP8/14 is correlated with evaluated disease activity and markers of serum inflammatory response in patients not using biological drugs. MRP8/14 is considered an effective new method for objective evaluation of synovitis in RA.
基金supported by grants from the National Natural Science Foundation of China(Nos.81771740,81901646)Interdisciplinary Clinical Research Project of Peking University First Hospital(No.2021CR30)Peking University Medicine Seed Fund for Interdisciplinary Research supported by the Fundamental Research Funds for the Central Universities(No.BMU2022MX003)
文摘Background:Vaccination has been shown effective in controlling the global coronavirus disease 2019(COVID-19)pandemic and reducing severe cases.This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis(RA).Methods:A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status.Each of them was examined every 3 to 6 months.In the vaccination group,disease activity was compared before and after vaccination.The rates of flare defined as disease activity scores based on 28-joint count(DAS28)>3.2 withΔDAS28≥0.6 were compared between vaccination and non-vaccination groups.Results:A total of 202 eligible RA patients were enrolled.Of these,98 patients received no vaccine shot(non-vaccination group),and 104 patients received two doses of vaccine(vaccination group).The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days,respectively.The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar.At enrollment,gender,RA disease course,seropositivity,and disease activity were comparable across the two groups.Flare was observed in five(4.8%)of the vaccination group patients and nine(9.2%)of the non-vaccination group patients at post-vaccination assessment(P=0.221).In terms of safety,29(27.9%)patients experienced adverse events(AEs)after vaccination.No serious AEs occurred.Conclusions:COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity.Patients with stable RA should be encouraged to receive the COVID-19 vaccination.
文摘Background: Behçet’s Syndrome (BS) is characterized by a heterogeneous vessel involvement, a fluctuating natural history and by the absence of biological markers correlated to disease activity that’s why objective clinical scores are needed for the assessment of its activity. The Behçet’s Disease Clinical Activity Form (BDCAF) is the most recent and widely used clinical activity score. Objectives: To perform a cross-cultural adaptation of the Behçet’s Disease Current Activity Form (BDCAF) to the Tunisian Dialect (Arabic Language) and to evaluate the metrological characteristics of the Tunisian version (Tu-BDCAF) especially its reliability in BD activity evaluation. Methods: Cross-cultural adaptation was done according to the established guidelines. Reliability of Tu-BDCAF was tested among 40 BD patients (mean age: 38 years, sex ratio: 1.37). Patients were questioned by two BD specialists at 20 minutes interval to evaluate inter-observer reproducibility and twice by the same physician at 48 hours interval to assess the intra-observer reproducibility. k Coefficient was used to test the concordance between qualitative variables and correlation between quantitative variables was evaluated used Pearson coefficient and Bland and Altman graphical method. Results: There was a good correlation between global scores calculated by the two physicians on the same day (r = 0.94, p < 0.0001) and also between the scores calculated by the same clinician at different times (r = 0.98, p k Coefficient analyses demonstrated a good intra and inter observer reliability for all the Tu-BDCAF items excepted for diarrhea and Clinician’s impression. As the original version, Tu-BDCAF is an objective, easy-calculated and reliable index for assessing disease activity in BD. The main limit of the BDCAF score remains the absence of a cut-off point defining BD activity. Conclusion: Tu-BDACF is a Tunisian version of the BDCAF score which can be used in routine to assess BD activity but also in international studies and clinical trials.
基金supported by grants from the Chinese National Key Research R&D Program(Nos.2017YFC0907601,2017YFC0907604)the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.2019-I2M-2-008)the Fundamental Research Funds for CAMS&PUMC(No.2019PT330004).
文摘Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and research studies of rheumatoid arthritis(RA).The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study,including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018,was conducted.The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots,quadratic weighted kappa,and discordance rates in the crosstab.For other indices,the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included,of whom 80.46%were women.Most individuals were with moderate disease activity or high disease activity.High correlations among DAS28-erythrocyte sedimentation rate(ESR)and DAS28-C-reactive protein(CRP),SDAI and CDAI were observed.Similarly,the weighted kappa value among the indices was high.In Bland-Altman plots,a positive difference between DAS28-ESR and DAS28-CRP was observed,with an absolute difference of>1.2 in 3079(10.09%)patients.In crosstab,approximately 30%of the patients were classified into different groups.Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR,DAS28-CRP,and CDAI were 3.06,2.37,and 3.20,respectively.Conclusions:Although DAIs had high correlations and weighted kappa values,the discordance between DAIs was significant in Chinese patients with RA.The four DAIs are not interchangeable.
文摘BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.
文摘AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated and verified on a visual analog scale (VAS). RESULTS: 87.9% of patients reported pain. Females and males reported comparable pain intensities and HRQOL. Surgery reduced pain in both genders (P = 0.023), whereas HRQOL only improved in females. Interestingly, patients on analgesics reported more pain (P = 0.003) and lower HRQOL (P = 0.039) than patients not on analgesics. A significant correlation was found in UC patients between pain intensity and HRQOL (P = 0.023) and CAI (P = 0.027), and in CD patients between HRQOL and CDAI (P = 0.0001), but not between pain intensity and CDAI (P = 0.35). No correlation was found between patients with low CDAI scores and pain intensity. CONCLUSION: Most IBD patients suffer from pain and have decreased HRQOL. Our study reinforces the need for effective individualized pain therapy in IBD patients.
基金Research Foundation of Beijing Friendship Hospital(No.yyqdkt2018-8).
文摘Objective Nonalcoholic fatty liver disease(NAFLD)is a common cause of clinical liver dysfunction and an important prepathological change of liver cirrhosis.Central obesity,type 2 diabetes mellitus,dyslipidemia,and metabolic syndrome are the major risk factors for NAFLD.Sitagliptin(Sig)is a novel hypoglycemic agent that improves blood glucose levels by increasing the level of active incretin.Sig has been shown to prevent the development of fatty livers in mice on a fructose-rich diet.The purpose of this study was to observe the efficacy of Sig on NAFLD in type 2 diabetic mice.Methods The diet-induced obesity mouse model was established,and the diabetic mice were screened by an intraperitoneal glucose tolerance trial.The mice were randomly divided into four groups for 8 weeks of intervention:high-fat diet(HFD)group,Sig group,metformin(Met)group,and Sig+Met group.After the intervention,the liver function indexes as well as the blood glucose and blood lipid levels of the mice were measured.In addition,the wet weight of the liver was measured;the pathological sections of the liver tissues were stained to observe the hepatocyte fatty degeneration,inflammation,necrosis,and fibrosis;and the hepatic histological injury was recorded as the NAFLD activity score(NAS).Results Compared with the normal control group,the body weight,liver weight,blood glucose level,insulin resistance(IR),blood lipid level,and transaminase level of the mice in the HFD group were significantly increased,showing typical metabolic syndrome.After treatment with Sig and/or Met,the mice gained less weight,had lower levels of blood glucose,triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),and transaminase,and had improved IR compared with the HFD group.The liver pathological NASs in the Sig group(P=0.01),Met group(P=0.028),and Sig+Met group(P<0.001)were lower than those in the HFD group(P<0.05),suggesting that the use of the two drugs alone or in combination can improve the state of liver inflammation.In terms of fibrosis,there was no fibrosis in the control group but there was significant fibrosis in the HFD group(P<0.001).There was no significant difference between the drug intervention groups and the HFD group,indicating that the drug therapy(Sig and/or Met)did not significantly improve the pre-existing fibrosis.Conclusion Our experiment proved that Sig can improve NAFLD,including improvement of the serum transaminase level,hepatic pathological inflammation level,and hepatocyte adiposis,suggesting that Sig may play a role by improving glucose and lipid metabolism,reducing the body weight and liver weight,improving insulin sensitivity,and inhibiting fatty liver inflammation.Sig may be a new direction for the treatment of patients with a nonalcoholic fatty liver and diabetes,delaying the progression of NAFLD.
文摘Members of the tumor-necrosis factor-α(TNF-α) and TNF-α receptor(TNFR) superfamilies of proteins(TNFSF and TNFRSF, respectively) play important roles in the function of the immune system. Decoy receptor 3(Dc R3, TNFRSF6b) is a decoy receptor that binds to three TNFSF ligands, Fas L, LIGHT and TL1 A. Association to these ligands competes with the corresponding functional receptors and blocks downstream signaling, leading to immunomodulatory effects, including the prevention of apoptosis. Dc R3 lacks a transmembrane region and exists only as a secreted protein, which is detectable in biological fluids. Recent studies have shown that Dc R3 is upregulated and may be pathogenetically implicated in several and diverse chronic inflammatory diseases. The strongest associations have been described for rheumatological diseases, mainly systemic lupus erythematosus and rheumatoid arthritis, inflammatory bowel disease, and serious infectious conditions, including systemic inflammatory response syndrome. In the majority of these conditions, Dc R3 m RNA and protein expression is elevated both at the target tissues as well as in the systemic circulation. Dc R3 concentration in the serum is untraceable in the majority of healthy individuals but can be detected in patients with various inflammatory diseases. In mostsuch cases, soluble Dc R3 correlates with disease severity, as patients with severe forms of disease have significantly higher levels than patients with milder or no activity. In addition, effective anti-inflammatory treatment leads to the disappearance of soluble Dc R3 from the circulation. Taken together, current evidence suggests that serum Dc R3 may become a useful biomarker for chronic inflammatory disorders, as it is upregulated in response to inflammatory stimuli, and may serve both as a prognostic marker for disease severity and as a surrogate indicator of response to treatment.
文摘<b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">The present study estimated the prevalence of anemia among children and adolescents with pediatric rheumatological diseases in a referral center, and analyzed the associated clinical and biological parameters.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Methods:</span></b><i><span style="font-family:""> </span></i><span style="font-family:""><span style="font-family:Verdana;">A retrospective chart review included 49 children with rheumatological diseases, who were diagnosed by a pediatric rheumatologist and classified according to the International League of Associations for Rheumatology (ILAR) guidelines and criteria endorsed by the American College of Rheumatologists. Anemia was defined as hemoglobin level lower than the 5th centile for the corresponding age and gender. Disease activity was indicated by serum levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), where available. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Participants were aged 2 - 18 years (mean ± SD = 10.41 ± 4.23 years), 38 (77.6%) of them had JIA, and 8 (16.3%) had systemic lupus erythematosus. The most frequent subtype of JIA was the polyarticular (16 out of 38, 42.1%), followed by systemic (14, 36.8%). The prevalence of anemia was 46.9% (95% CI = 32.5% - 61.7%), with no significant difference between JIA and other diseases or between the different JIA subtypes. Nevertheless, anemia was more frequently observed in younger patients (age 2 - 6 years: 69.2% vs <48%) and those with elevated ESR (68.8% vs 33.3%) or CRP (60.0% versus 45.2%), compared with their counterpart respectively;however, only the association with ESR was statistically significant (p = 0.049). No agreement was found between CRP and ESR (Kappa = 0.140). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><i> </i><span style="font-family:Verdana;">Anemia is frequent in JIA and other rheumatologic diseases in children, concerning approximately 50% of the patients and responding to anemia of inflammation as the major pathophysiological mechanism. Further research is warranted to provide more accurate insight into the pathophysiological mechanisms and clinical characteristics of anemia in pediatric rheumatological disease and to measure its morbidity, to provide efficient and evidence-based management strategies.
文摘Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.
基金Yantai Science and Technology Plan Project,No.2019YD061.
文摘BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.
文摘BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.
文摘Background: Methotrexate (MTX) is the most effective and commonly used disease-modifying anti-rheumatic drug in the management of juvenile idiopathic arthritis. Several patients develop side effects, which may lead to low quality of life and non-compliance to MTX. To reduce MTX-induced side effects, folic acid supplementation is prescribed by most rheumatologists. Even after that, some patients have symptoms while receiving MTX. Objectives: To assess the efficacy of folinic acid in comparison to folic acid for reducing the side effects of MTX in JIA patients. Material and methods: In this prospective observational study, newly diagnosed cases of JIA who would be getting MTX were included by purposive sampling. Data were collected using a predesigned questionnaire. Among 40 patients, 20 received folinic acid (Group A), and 20 received folic acid (Group B). Disease activity levels were assessed by JADAS-27 (Juvenile Arthritis Disease Activity Score). Contents from the MISS (MTX Intolerance severity score) questionnaire were used to assess the side effects. All patients were evaluated at baseline, 6th, and 12th weeks. Results: There were significant differences in the frequency of MTX-related adverse events between folinic acid (Group A) and folic acid (Group B). Group A patients only had nausea (10% and 15% in the 6th & 12th week respectively) and vomiting (5% at both follow-ups). On the other hand, in addition to nausea (70% and 95% in the 6th & 12th week) and vomiting (20% and 90% in the 6th & 12th week), folic acid group patients had restlessness, crying, and irritability. Self-discontinuation of MTX was present in the folic acid group (5% & 10% in the 6th & 12th week). Improvement of disease activity was more in the folinic acid group. Conclusion: The folinic acid group had significantly fewer side effects. Improvement of disease activity was more and compliance was also better among them. Methotrexate (MTX) is the most effective and commonly used disease-modifying anti-rheumatic drug in the management of juvenile idiopathic arthritis. A number of patients develop side effects, which may lead to low quality of life and non-compliance to MTX. To reduce MTX induced side effects, folic acid supplementation is prescribed by most rheumatologists. Even after that, some patients have symptoms while receiving MTX.
文摘Objective:To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis.Methods:A systematic search was carried out up to January 2022,obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation;198 of them were treated with rituximab,while 447 were treated with mycophenolate mofetil or cyclophosphamide.We determined the odds ratio(OR)and mean difference(MD)with 95%confidence index(CI)to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random-or fixed-effects model by dichotomous or continuous techniques.Results:The rituximab group showed significantly higher complete renal remission rate(OR=2.52;95%CI 1.30-4.91,P=0.006)and total renal remission rates(OR=2.22;95%CI 1.36-3.63,P=0.001)than the control group.However,there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score(MD-1.16;95%CI-2.88-0.57,P=0.19),proteinuria(MD-0.31;95%CI-0.70-0.09,P=0.013),and serum creatinine(MD 0.01;95%CI-0.04-0.07,P=0.64)between the rituximab group and the control.Conclusion:Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates,with no significant difference in terms of shorter-end SLEDAI,proteinuria,and serum creatinine,compared with the control in individuals with lupus nephritis.
