Objective Rheumatic and musculoskeletal diseases (RMD) may exhibit different immune responses to novel coronavirus (COVID-19) infection compared to healthy individuals. While previous studies have primarily investigated changesin COVID-19-related antibodies post-vaccination for RMD patients, this study sought to explore the dynamics of SARS-CoV-2 IgG antibodies and neutralising antibodies (NAb) in RMD patients after COVID-19 infection. Methods In this longitudinal study, we monitored the SARS-CoV-2 IgG antibodies and NAb levels in RMD patients and healthy controls (HC) at 60 and 90 days post-COVID-19 infection. Chemiluminescent immunoassay was used todetect the levels of novel coronavirus-specific IgG (anti-S1/S2 IgG) antibodies and NAb. Results A total of 292 RMD patients and 104 HC were enrolled in the study. At both the 60-day and 90-day post-COVID-19 infection, RMD patients exhibited significantly lower levels of anti-S1/S2 IgG and NAb than those in the HC group (p<0.001). The anti-S1/S2 IgG antibody levels remained relatively stable, while the NAb levels in RMD patients could vary greatly between the 60th and 90th days. A logistic regression analysis revealed that the prior administrationof glucocorticoids (GC), immunosuppressants, and b/tsDMARDs stood out as independent risk factors associated with reduced anti-S1/S2 IgG and NAb levels, irrespective of the specific RMD subtypes. Conclusion GC and anti-rheumatic medications can potentially alter the production of specific antibodies, especially NAb, in RMD patients post-COVID-19 infection. These findings emphasise the importance of continuous monitoring forNAb fluctuations in RMD patients following a COVID-19 infection.

Background Regulatory T (Treg) cells are one of the important mechanisms in maintaining self-tolerance and immune homeostasis. CD4+CD25+Foxp3+Treg is considered to have a role in the pathogenesis of systemic lupus erythematosus (SLE). However, the data reported is controversial, and a conclusive result has not been given thus far. The aim of the present study is to evaluate the role of CD4+Treg in SLE further. Methods The peripheral blood T cells (PBMCs) from patients with SLE and healthy controls were isolated, and followed by the isolation of CD3+T cells. The PBMCs were tested for the expressions of CD25 and Foxp3 molecules on the surface of CD4+T cells, and CD3+T cells were tested for their cytokine expressions including IFN-γ, TGF-β, and IL-10, with the method of flow cytometry. The correlations of test results with clinical features of the disease were evaluated by linear correlation analysis. Results CD4+CD25+ Foxp3+Treg decreased in SLE patients and was correlated with the SLE Disease Activity Index (SLEDAI), and a few immunological abnormalities, including anti-dsDNA antibody positive, IgG increase and C3 decrease, and types of tissue damage, including leukocytopenia and kidney damage. IFN-γ+ cells in the CD4+CD25+T subset fresh-isolated from SLE patients increased slightly, but IFN-γ-producing response to stimulation in CD4+CD25+T subset of SLE decreased. The number of TGF-β-producing cells in the CD4+CD25+T subset from SLE patients also decreased. While the percentages of CD4+CD25+IL-10+T subset in the CD3+T cells increased in SLE, however, these changes of cytokine expressions did not show any significant correlations with SLEDAI. Conclusions There is clear and definite evidence from the present study indicating the important role of CD4+CD25+Foxp3+Treg in the pathogenesis of SLE, for the abnormalities in functional cytokine productions of the CD4+CD25+ T subset, and for the feasibility of a CD4+CD25+Foxp3+Treg- based immunotherapy in SLE.

Atherosclerosis is one of the most common complications of rheumatoid arthritis (RA). The objective of this study is to evaluate differences in large artery compliance (C1) and small artery compliance (C2) between RA and controls and evaluating factors associated with reduced compliance in the RA population. The profiling of large and small arterial compliance was analyzed in 185 RA patients and 88 healthy controls using Cardiovascular Profiling Instrument. The correlations of arterial compliance and the relevant clinical data were determined in these subjects. Then correlation analysis and regression analysis were performed to find whether rheumatoid arthritis patients have more risk factors than healthy controls in artery compliance and to explore the possible element involved in RA patients including traditional cardiovascular risk factors, RA disease-related factors, and the therapy. Compared with healthy controls, levels of C1 and C2 were significantly decreased in RA patients. Having adjusted the traditional risk factors associated with atherosclerosis, C1 and C2 decline was still a significant indicator in RA patients [odds ratio = 7.411(95%CI 3.275, 16.771) and 10.184(95%CI 4.546, 22.817)]. Using multi-factor regression analysis to adjust traditional risk factors for arterial compliance, we found that the levels of ESR was correlated with the abnormal large artery compliance [odds ratio = 1.021(95%CI 1.007, 1.035)]. The HAQ values and the current usage of leflunomide were correlated with the abnormal small artery compliance in RA patients [odds ratio = 1.161(95%CI 1.046, 1.289) and 6.170(95%CI 1.510, 25.215)]. The values of C1 and C2 are indicators of artery compliance in RA patients. ESR, HAQ values, and the usage of leflunomide might be possible risk factors of artery compliance. The evaluation of artery compliance could be an easy and reliable test that could help us to screen and predict cardiovascular disorders in RA patients.

Objective To investigate the incidence and treatment of bone loss in rheumatic patients treated with glucocorticoid in China. Methods From November 1, 2012 to January 31, 2013, 3136 cases of rheumatic disease who had been or were taking glucocorticoid from 46 rheumatology centers nationwide were included and their clinical data, medications, as well as bone mass were investigated. Results (1) RA (1069 cases) and SLE ( 983 cases) patients accounted for the majority . Osteopenia or osteoporosis was observed in 90% of the 3136 patients, and 41. 4% patients were found to be osteoporotic. Nearly half of patients ( 44. 7% ) with a dosage of glucocorticosteroid ( equivalent to prednisone ) >7. 5 mg/d. Even those with a daily dose of glucocorticosteroid (equivalent to prednisone) ≤2. 5 mg, 58. 5% were reported to be osteoporotic. (2) There were increased risk of osteoporosis and fracture with age. In patients younger than 30 years of age, 74. 4% were reported of bone mass reduction or osteoporosis. (3) The incidence of abnormal bone mineral density in women were higher than that in men. The mean age at menopause was lower than that the average (45. 8 years) . (4) Most patients were not giv-en adequate treatment. Prophylactic anti-osteopontin therapy was never given in 32. 7% of patients, nor did 35. 6%of patients with T score <-2. 5 received prophylactic anti-osteoporosis treatment. The mostly used treatment were calcium and vitamin D, 20. 9% received calcium alone, only 4% received bisphosphonates. Conclusion The in-cidence of bone mass reduction or osteoporosis in Chinese rheumatic patients is high while most patients are not giv-en adequate treatment.

目的:探讨CBL(case-based learning)教学发在风湿免疫科住院医师规范化培训的教学效果.方法:将36名在风湿免疫科轮转的住院医师随机分为CBL教学组和传统带教组,经1个月的临床轮转后,以系统性红斑狼疮为基础病例,对2组同学病史采集、病历书写、病历分析、专业理论、专业操作、与患者沟通能力6方面进行入、出科评价(主观题)和考试分值(客观题)比较.结果:CBL教学组无论主观题还是客观题的评分均显著高于传统带教组.结论:在风湿科住院医师规范化培训中恰当引入CBL教学法,有助于提高住院医师的临床思维能力及诊疗、医患沟通能力.

目的 探讨SAPHO综合征的临床特点.方法 收集8例SAPHO综合征患者临床资料进行分析总结.结果 8例中男5例,女3例,平均年龄39岁.8例均有皮肤和骨关节病变,其中,掌跖脓疱病者7例.暴发性痤疮者1例,脊柱受累3例,前胸壁受累4例,外周关节受累5例.6例患者误诊时间超过3月.结论 SAPHO综合征主要见于中青年患者,男性多见,该病临床表现异质性强,容易误诊.

We previously found, using microarray, haptoglobin (HP) expression signal was 5.1-fold increased in peripheral blood mononuclear cells (PBMCs) from methotrexate (MTX)-resistant rheumatoid arthritis (RA) patients.To investigate whether serum levels of HP are associated with the response of 12 weeks MTX therapy in recent-onset RA patients.Sixty-nine active RA patients with recent onset (< 24 months) were treated with MTX. Clinical variables, levels of HP messenger RNA (mRNA) in PBMCs and HP serum levels were tested at week 0 and week 12.After 12 weeks of MTX treatment, 34.7% of RA patients were categorized as responders according to European League Against Rheumatism (EULAR) response criteria (Week 12 Disease Activity Score of 28 joints [DAS-28] ≤ 3.2 and decrease > 1.2) and all others (65.2%) were defined as non-responders. The baseline HP mRNA in PBMCs from non-responders is significantly higher than those in responders (P < 0.05). Similar to mRNA expression, non-responders showed significantly elevated serum HP levels at baseline (369.9 ± 159.8 mg/dL) compared to those in responders (255.3 ± 143.9 mg/dL) (P = 0.01). Serum HP levels were decreased significantly from 255.3 ± 143.9 mg/dL at baseline to 186.4 ± 108.5 mg/dL at week 12 (P = 0.04) in responders, but remained at high levels in non-responders.High serum levels of HP at baseline are associated with inadequate response of 12 weeks MTX treatment in recent-onset RA patients. Further replication studies in larger samples are needed to validate HP as a potential predictive biomarker for response to MTX therapy in RA.

Objective To investigate the prevalence and risk factors of hyperuricemia (HUA) in rural residents of Gaoyou City,Jiangsu Province.Methods A total of 4504 rural residents were investigated in a cross-sectional study.Questionarre survey and physical examination were used for the stndy.Fatsing venous blood samples were collected for biochemical examination.T-test,chi-square test for multiple-group data comparison and logistic regression analysis were used for statistical analysis.Results The prevalence of HUA was 11.9％,15.7％ in male,which was significantly higher than 8.6％ in the female (P＜0.01),the risks of HUA in male was 1.98 times higher than in female.The average value of serum uric acid in this population was higher than.that of female.The prevalence of HUA in female increased with age.Non-conditional logistic regression analysis showed WHR,Cr,Tg,hypertension were the independent risk factors of male patients with HUA.Age,BMI,Cr,Tg,hypertension were independent risk factors of HUA in female.Conclusion The prevalence of HUA can be affected by age and sex.Weight control,keeping blood pressure and blood lipid profiles in normals levels are important for the prevention of HUA.

Background Among the several available DMARDs, Methotrexate (MTX) is currently the most widely used drug in clinical practice. About 30-40% of the patients could experience an adequate response to MTX alone; thus, it might not be necessary to start intensive combination therapy for all newly diagnosed RA patients. Given ACR20 response rate of MTX monotherapy is only 46% ∼65%, it is possible that a significant number of early RA patients could suffer from a failure of monotherapy. Therefore, it is important to identify biomarkers predictive of non-response to MTX monotherapy. In the past, using microarray genome-wide analysis of gene expression profile of peripheral blood mononuclear cells (PBMCs), we have discovered a small set of discriminative transcripts between MTX- responsive and MTX-resistant RA patients. In this set, the Haptoglobin (HP, OMIM:140100) expression signal was 5.1 fold increased in MTX resistant RA patients. These observations prompted us to investigate whether serum HP levels are able to predict the efficacy of MTX treatment over a period of 3 months. Objectives To investigate whether serum levels of Haptoglobin (HP) could predict responsiveness to methotrexate (MTX) at the 12th week of treatment in patients with recent-onset RA. Methods A total of 69 patients with newly diagnosed and active RA were treated with MTX (initiated at a dosage of 10 mg/week and increased to 20 mg/week after 4-6 weeks). Clinical variables associated with disease activity were recorded at week 0 and week 12. Levels of HP mRNA in PBMCs and serum levels of circulating HP protein at week 0 and week 12 were determined using Real-time PCR and ELISA, respectively. Results After 12 weeks of MTX treatment, 39.1% (n=27) and 60.9% (n=42) of all 69 evaluable patients were classified as responders or non-responders, respectively, according to the DAS-28-ESR score. The baseline HP mRNA expression in PBMCs from non-responders is significantly higher than those in responders (p<0.05). Similar to mRNA expression, non-responders who had inadequate response to 12 weeks MTX therapy showed significantly elevated HP levels at baseline (369.9±159.8 mg/dl) compared to those in responders (255.3±143.9 mg/dl) (p =0.01). Serum HP levels decreased significantly from 255.3±143.9 mg/dl at baseline to 186.4±108.5 mg/dl at week 12 (p =0.04) in responders, but remained at high levels in non-responders (369.9±159.8 mg/dl at baseline vs. 309.6±183.9 mg/dl at week 12; p=0.71). Conclusions Serum levels of HP might predict response to MTX treatment in recent-onset RA patients. References Klareskog L, van der Heijde D, de Jager JP, Gough A, Kalden J, Malaise M et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 2004; 363(9410):675-81 Ranganathan P, Eisen S, Yokoyama WM, McLeod HL. Will pharmacogenetics allow better prediction of methotrexate toxicity and efficacy in patients with rheumatoid arthritis? Ann Rheum Dis 2003; 62(1):4-9. Disclosure of Interest None Declared

Objective:To score the synovitis in patients with rheumatoid arthritis (RA) using grey scale (GS) and power Doppler (PD) ultrasonography (US),and explore the potential value of the two methods for assessment of disease activity. Methods:The DAS28,ESR and CRP of 40 RA patients were recorded. A total of 18 joints,including bilateral wrist,the second through fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints,were examined using GSUS and PDUS measures to derive US scores for each patient. Results:US detected significantly more joints with synovitis than clinical examination did. The GS joint count (GSJC),GS joint score (GSJS) and the PD joint score (PDJS) were significantly correlated with DAS28. The PD joint count (PDJC),PDJS and the GSJS were significantly correlated with ESR and CRP. We did not find significant correlations between the PDJC and DAS28. Similarly,GSJC did not correlate with ESR and CRP. Conclusion:Sonography has the potential to evaluate disease activity in RA patients.

Objective To investigate the cause of death in patient with dermatomyositis or polymyositis (DM/PM). Methods Collecting medical records of 121 inpatients with DM/PM in our hospital during the latest 3 years,which were retrospectively analyzed by Logistic regression. Results Sixteen patients with DM/PM died in hospital or died only after they left from hospital and the death rate was 13.2%. Logistic regression analysis of univariate factor showed the conditions, such as male, interstitial lung disease, pulmonary infection,respiratory failure,malignant tumor, significantly correlated with death, however, types of myopathy, age, course of disease, musle force, serum creatase CK did not correlate with death. Logistic regression analysis of multiple factors showed that respiratory failure significantly correlated with death. Conclusion There are high death rate in patients with DM/PM. Male, respiratory system involvement and malignant tumor are possible risk factors of death in patients with DM/PM.

皮肌炎或多发性肌炎(dermatomyositis or polymyositis,DM/PM)是一种主要以骨骼肌非化脓性炎症为特征的自身免疫性炎性肌病,和多种恶性肿瘤的发生有关.为提高对DM/PM并发恶性肿瘤的认识,我们对近三年多来在我院住院的121例DM/PM患者临床资料进行分析总结,现报告如下.

Objective To establish a convenient and feasible HPLC method for determination of cyclosporine A level in blood.Methods The blood samples was separated with column C18(5 μm×150 mm×4.6 mm)after an improved extraction.The mobile phase was a mixture of methanol,water,acetonitrile and isopropanol with the ratio of 25∶57∶18∶1.5.and the flow rate was 1.0 mL/min.The column temperature was maintained at 70 ℃ and the wave length of UV for detection was 208 nm.Results A good line relationship was obtained within the blood CsA level range from 50 ng/mL to 2 000 ng/mL(r=0.998 0).The minimal level of of CsA that could be detected was 50 ng/mL.The ABSolute recovery of CsA was 92.1%~95.7% and relative recovery of CsA was 94.3%~99.8%.Conclusion The method is accurate,simple,sensitive and suitable for therapeutic monitoring of CsA after transplantation.

目的 探讨多发性肌炎/皮肌炎合并急性间质性肺炎的血清肌酶的特点,提高诊断治疗水平.方法 对江苏省人民医院及丹阳市人民医院2000年1月至2007年8月收治的13例多发性肌炎/皮肌炎合并急性间质性肺炎患者的临床资料进行回顾性分析.结果 10例皮肌炎患者均有典型皮肌炎皮疹,其中9例肌炎症状轻微,所有病例抗JO-1抗体阴性,乳酸脱氢酶(LDH)7例持续升高,6例轻度升高,13例患者肌酸磷酸激酶(CK)7例升高,3例多肌炎升高明显,天冬氨酸转氨酸(AST)9例皮肌炎升高,5例CK/AST水平下降,3例多肌炎均升高.在确诊多发性肌炎/皮肌炎同时或短期内并发出现高热、干咳、呼吸困难,X线片和胸部CT提示多发的片状肺间质改变,并且进展迅速,抗感染和大剂量甲基泼尼松龙治疗无效,10例死亡.结论 急性间质性肺炎可能是无肌病皮肌炎或肌病轻微的皮肌炎的肺部表现,CK水平与预后无明显相关性,LDH持续升高提示预后不良,AST水平与肺间质改变相关.

Objective To study the expression of Adiponectin (AD) and its receptors Adiponectin receptor 1 (Adipo R1) and Adipo R2 in the synovial fluids and the synovium of rheumatoid arthritis (RA). Methods ELISA was used to determine the levels of AD in 23 RA and 23 osteoarthritis (OA) patients. Real-time PCR and Western blot techniques were employed to study the expression of AD, AdipoR1 and AdipoR2 in the synovium of 10 RA and OA patients. Results It was observed that approximately twice more adiponeetin in the synovial fluids of patients with RA than with OA. Adiponectin and AdipoR1, but not AdipoR2 mRNA, were significantly expressed in synovium of RA patients in comparison with OA. Adiponectin and AdipoR1 protein were wuch more expressed in synovium from RA than those from OA. Conclusion High expression of Adiponectin and AdipoRl is likely to contribute to the formation of inflammatory joints in RA.

原发性干燥综合征(pSS)是以外分泌腺淋巴细胞浸润为特征的自身免疫性疾病,唾液腺和泪腺受累所致口干、眼干是本病的基本表现,但常被患者或医师忽略.以外分泌腺体外的器官损害为首发表现者早期诊断困难,以致本病误诊发生率较高.本文回顾分析了93例诊断pSS患者的临床表现及特点,提高早期诊断水平,减少误诊率.

[Objective]To study the diagnostic value of various MRI signs of hand and wrist in early rheumatoid arthritis. [Methods]To follow up 93 patients who complaint of multiple arthrigia,investigate X-ray of hands and MRI signs in all the patients to find out the sensitivity and specificity of MRI and the difference between MRI and X-ray. [Results]In early RA patients,MRI can detect joint fluid (50pts) ,synovium thicken (40pts) ,bone marrow edema (16pts) ,cartilage and bone erosion (28pts) ,soft tissue affection (8pts) . In non-RA patients,joint fluid (6pts) ,synovium thicken (lpts) ,bone erosin (5pts) ,soft tissue affection (lpts) can been in MRI. the sensitivity of MRI is 97.06%,the specificity is 57.89%. The positive rate is higer than X-ray. In enhancement scaning,the sensitive of synovium enrichment and pannus formation is 94.12%,while the specificity is 85.71%. There is significant differ ence between RA and non-RA on joint fluid,synovium thicken,pannus and bone marrow edema. There are 28 early RA patients have cartilage and bone erosion in MRI while only 3 can be found in X ray. The cartilage and bone erosion can been in 33.33% patients whose duration is 3 months,47.06% whose duration is 6~12months and 100% whose duration is 12~24months. [Conclusion]MRI of wrist and hand may reflect the early RA histologic changes,it has high sensitivity and specificity,which is more better than traditional X-ray.

Objective To develop a method for studying in vitro vascular lesion in patients with systemic lupus erythematosus(SLE)the methods of model of jnjured vascular endothelial cells(VEC)of the patients with systemic lupus.Methods Human umbilical vein endothelial cell strain(ECV-304)was stimulated by the serum collected from SLE patients in active stage.ELISA was used to detect the concentration of von Willebrand factor(vWF)and soluble thrombomodulin(sTM)in the supernatant.Results The concentration of vWF and sTM in the supernatant in the group which was stimulated by the serum of SLE patients in active stage was significantly higher than that in the group which was not stimulated.Conclusion The serum of SLE patients in active stage can injure the ECV-304.

Objective: To investigate the pathogenesis of cytokines in systemic lupus erythematosus (SLE) through evaluating the relationship between the serum levels of them and the disease activity. Methods: Fifty cases of active SLE were studied. Their serum levels of IFN-α,IL-6,IL-10 were measured by ELISA assay, their clinical manifestations and other immunologic findings were recorded to evaluate the disease activitives. Results: ① The serum levels of IL-6,IL-10 in SLE patients increased significantly as compared with those in normal controls. ②There was a positive correlation between serum levels of IFN-α,IL-6,IL-10 and the disease activity (SLEDAI) in SLE patients. ③There was a positive correlation between the serum levels of IFN-α,IL-6,IL-10 and the clinical manifestations and immunologic findings in SLE patients. Conclusion: The abnormally increased cytokines in SLE patients may have important significance in recognizing the pathogenesis and the treatment of SLE.