Objective To get known about the disease burden and quality of life (QOL) of rheumatoid arthritis (RA) in China by conducting a systematic review. Methods The observational studies about the disease burden and QOL of RA in China were systematically searched in the following databases: CNKI, CBM, VIP, WanFang Data, MEDLINE/Pub Med, EMbase, and Science Citation Index. The retrieval time was from January 1st, 1990 to July 31st, 2010. According to the inclusion and exclusion criteria, the literature was screened, the data were extracted, and the methodological quality of the included studies was assessed. The morbidity of RA was pooled by adopting generic inverse variance model, the meta-analyses on 8 dimensions of SF-36 life quality score (LQS) was conducted by suing RevMan5.0 software, the weighted mean difference (WMD) was regarded as the indicator of intervention effect, and the impact of studies’ quality on the results was assessed by sensitivity analysis. Results A total of 20 studies with medium quality in general were included. The morbidity of RA was 14.7/100 000. The disability adjusted of life years (DALYs) per capita were 4.92. If excluding the cost resulted from DALY, the overall economic cost was RMB 1 250.45 yuan per capita per year; While considering DALY, the cost was RMB 15 717.91 yuan per capita per year. The average cost of outpatient medications was RMB 8 018±17 238 yuan per capita per year. The weighted morbidity was 0.42% (95%CI 0.39% to 0.45%), and it was higher in female than male (Plt;0.05). There was no secular trend and difference between southern and northern (Pgt;0.05), but there were statistical significances in the WMD of 8 dimensions of SF-36 LQS. Sensitivity analyses revealed that the weighted pooled results were stable. Conclusion The epidemiological and economic burden of rheumatoid arthritis are heavier in China, which needs to be concerned by both government and society.
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。
Objective To evaluate the efficacy and safety of Leflunomide (LEF) in the treatment of Rheumatoid Arthritis (RA), so as to provide scientific proof for applying LEF in China. Methods Randomized controlled trials (RCTs) about the effect of LEF on patients with RA from January 1989 to January 2011 were searched from the following databases, CNKI, WanFang Data, MEDLINE, EMbase and CBM. After two reviewers independently screened the studies according to the inclusion and exclusion criteria, extracted the data and assessed the quality, the data were analyzed by RevMan 5.0 software. Results Among 3247 patients in 16 included RCTs, 1711 patients were in the LEF group, while the other 1536 patients were in the Methotrexate (MXT) group. The results of meta-analyses showed there was no significant difference in the efficacy between LEF and MXT (RR=1.03, 95%CI 0.94 to 1.11, Pgt;0.05), but a significant difference was found in the side reaction (RR=0.67, 95%CI 0.49 to 0.94, Plt;0.05). Conclusion Based on the current studies, Leflunomide is as effective as the commonly-used Methotrexate in the treatment of rheumatiod arthritis at present, much safer than Methotrexate, and thought as a safe and effective SAARD. For the quality restrictions of the included studies, more double blind RCTs with high quality are required to further assess the effects.
Objective To assess effectiveness and safety in rheumatoid arthritis （RA）patients treated with the indigenous leflunomide in comparison with Airohua produced by Cinkate Corp. Methods A double blind and double dummy randomized controlled trial was conducted in the outpatient clinic of rheumatology. Fifty-six Chinese RA patients were divided into two groups who received either indigenous Leflunomide or Airohua of 20 mg daily and the two matching placebo tablets of Airohua or indigenous Leflunomide with the constant dose of Oxaprozin （0.4 g, qd） in the first 6 weeks. Clinical and laboratory data were collected every 6 weeks during 24 weeks of follow-up. Results This study showed that the patients of both groups significantly improved on main variables except erythrocyte sedimentation rate （EXR） at the 12th week . The variables such as ESR, and the level of c-reaction protein in both groups at 24th week showed no statistical difference compared with those at the baseline. There were also no statistical difference in the clinical characteristics and laboratory findings between the two groups at the 12th week and 24th week （P 〉0. 05）. The effcacy of Airohua（37% ） was lower than that of indigenous Leflunomide（64% ） at the 12th week （P 〈0. 05 ） and slightly better than indigenous Leflunomide group at the 24 week （81.5% vs 77.3% , （ P 〉0. 05）. The administration of Airohua and indigenous leflunomide presented a similar pattern and frequency of adverse events. Serious adverse events such as interstitial pneumonitis, pulmonary infiltration, and liver impairment etc. were not reported in either group. Conclusions The study shows that the indigenous Leflunomide has a superior therapeutic effect. Its efficacy and safety are similar to Airohua in the treatment of acfive RA patients in China.
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 探讨“5.12”地震后北川羌族人群中类风湿关节炎（RA）患者外周血 T细胞亚群的表达情况并分析创伤后应激障碍（PTSD）对RA患者细胞免疫之间的影响。 方法 2009年3月－2010年3月，对98例北川羌族RA患者、112例健康对照，以及同期绵阳郊区84例RA患者、120例健康对照进行分析。用流式细胞仪分别检测CD3+、CD3+CD4+、CD3+ CD8+ T淋巴细胞数及CD4/+CD8+比值， RA疾病活动性采用DAS28测定，应用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）诊断标准调查RA人群中的PTSD患者，应用PTSD检查表平时版（PCL-C）检查对PTSD患者进行分析。 结果 北川羌族与绵阳郊区RA活动组患者（分别为58例、39例）与健康对照组比较，CD8+ T淋巴细胞数降低，CD+4/CD8+比值增高，差异有统计学意义（P＜0.05）；北川羌族RA活动组与绵阳郊区RA活动组比较，CD3+ T淋巴细胞数降低，差异有统计学意义（P＜0.05）。北川RA患者中PTSD者（38例）与非PTSD者（60例）比较，PTSD组CD3+ T淋巴细胞数和CD4+/CD+8比值均明显低于PTSD组，差异有统计学意义（P＜0.05）；PCL-C对北川RA患者中PTSD的测定发现，PCL高分组CD3+ T淋巴细胞数显著低于PCL低分组（P＜0.05）。 结论 “5.12”地震后一部分RA患者出现T细胞免疫功能异常，且免疫功能异常与PTSD有关，对合并有PTSD的进行RA患者早期心理干预及药物治疗，改善患者生存质量。
【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.