Rheumatoid Arthritis: China

Li B, Luo Y. · Department of Pharmacy, Jiangxi College of Traditional Chinese Medicine, Nanchang 330006, Jiangxi province,China · Zhong Yao Cai. · Pubmed #14626990 No free full text.

This publication has no abstract.

Mok CC, Kwan YK. · Tuen Mun Hospital, New Territories, Hong Kong, SAR China. · Clin Rheumatol. · Pubmed #14579167 No free full text.

Abstract: The case of a 69-year-old woman who presented with abrupt onset of rheumatoid-like symmetrical polyarthritis but who was subsequently diagnosed to have disseminated abdominal carcinomatosis is reported. The temporal relationship between the joint symptoms and the discovery of carcinoma suggested that the arthritis was a paraneoplastic manifestation of the latter. An underlying malignancy should always be looked for in elderly patients who present with explosive polyarthritis for the first time, particular if unexplained anaemia or constitutional symptoms persist after treatment.

Hou J, Wu Y, Ling Y. · Department of Pathology, Institute of Basic Medical Sciences, CAMS and PUMC, Beijing 100005, China. · Zhongguo Yi Xue Ke Xue Yuan Xue Bao. · Pubmed #12903410 No free full text.

Abstract: To identify the regulatory effect of sodium selenite and vitamin E on the complement-neutrophil-reactive oxygen(ROS) activation feedback (CNAF) mechanism mediated inflammatory response, we detected ROS production and complement activation in vitro tests by chemiluminescence technique and complement fixation and recognized the regulation of the inflammatory response in vivo mouse vasculitis models of skin, lung, and liver. Convincing results were observed as both in vitro and in vivo experiments showing inhibition of CNAF mechanism with sodium selenite and vitamin E could effect the reduced ROS production and complement activation. The incidence (100%) for vasculitis in control group decreased to 20%-57% in sodium selenite and vitamin E treated groups. Elucidation of the ancillary mechanism of CNAF enhancing inflammatory response is a promising area for new therapeutic developments in the modulation of inflammatory response. As in a clinical approach, a remarkable therapeutic effect with sodium selenite was observed during an epidemic episode of epidemic hemorrhagic fever in Henan province. The mortality rate of fulminant cases was reduced from 100% of untreated control cases to 36.6% by treatment with sodium selenite. The results of present studies strongly suggest that antioxidants such as selenium and vitamin E as well as others like flavonoids can exhibit a novel anti-inflammatory action via this CNAF mechanism. It is expected in the future an increasing number of patients with severe infections or inflammatory disorders in which excessive complement activation and adverse ROS production have been implicated, e. g. ischemia-reperfusion injury, severe sepsis and diverse inflammatory vascular injuries like rheumatoid arthritis, hepatitis and inflammatory bowel diseases should benefit from this newer concept guided adjuvant therapies which make use of nutrient antioxidants like selenium, vitamin E and others.

Gu MM, Wang ZG, Huang W, Fan LA. · Department of Medical Genetics, Shanghai Second Medical University, Shanghai, 200025 PR China. · Zhonghua Yi Xue Yi Chuan Xue Za Zhi. · Pubmed #12903047 No free full text.

Abstract: Six human leucocytic antigen(HLA)-associated diseases, including ankylosing spondylitis, rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, type 1 diabetes mellitus and psoriasis, were selected as objects of this review. The characteristics of these diseases in whole-genome scans on susceptibility genes or loci undertaken to date were analyzed and compared. Meanwhile, the potential proposals for dealing with the existing problems were put forward.

Liu JZ, Ji ZL, Hu YY. · Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, P.R. China 710032. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #12822354 No free full text.

Abstract: OBJECTIVE: To review the current concepts of gene therapy approaches mediated by adenovirus vectors for bone trauma and bone disease. METHODS: The recent literature concerned gene therapy mediated by adenovirus vectors was reviewed, which provides new insights into the treatments of bone trauma and bone disease. RESULTS: Adenovirus vectors was efficient, achieved high expression after transduction, and could transfer genes to both replicating and nonreplicating cells, such as osteoblasts, osteoclasts, fibroblasts, chondrocytes, bone marrow stromal cells, etc. Gene therapy mediated by adenovirus vectors achieved affirmative results in enhancing bone union and in curing bone diseases, such as osteoporosis and rheumatoid arthritis. CONCLUSION: Gene therapy mediated by adenovirus offers an exciting avenue for treatment of bone trauma and bone diseases.

Li SH, Wu LJ, Yin HY. · School of Traditional Chinese Materia Medicas, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China. · Zhongguo Zhong Yao Za Zhi. · Pubmed #12774626 No free full text.

Abstract: OBJECTIVE: To review the progress in the research of the active ingredients of Zushima and their pharmacological activities. METHOD: Base on the articles of the chemical constituents and pharmacological activities of Zushima. RESULT: Traditional Chinese drug, Zushima contains coumarins, diteropenoids, lignans, flavonoids, anthraquinones and sterols. Pharmacological investigation concludes that it has actions of painkilling, antiinflammation, inhibiting bacteria, antithrombus, antitumer and antifertility. CONCLUSION: Zushima has extensive actions in pharmacology. And plant resources are very rich. It is a meaning job to study the chemical ingredients and pharmacological activities of Zushima further.

Yang L, Yu M, Yang C. · Department of Rheumatology, PUMC Hospital, CAMS and PUMC, Beijing 100730. · Zhongguo Yi Xue Ke Xue Yuan Xue Bao. · Pubmed #12567457 No free full text.

Abstract: Autoantibodies to the heterogeneous nuclear ribonucleoproteins (hnRNP) have a great role in the diagnosis of rheumatic diseases. hnRNP-A/B proteins are the main autoantigens in Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and mixed connective tissue disease (MCTD). Anti-RA33 autoantibodies which target the hnRNP proteins A2, B1, B2 (the 'RA33 complex') help to the diagnosis of RA at early stage. Therefore, anti-hnRNP autoantibodies are not only valuable diagnostic markers but may also allow deep insights into the pathogenetic mechanisms of rheumatic diseases.

Fang YZ, Yang S, Wu G. · Department of Biochemistry and Molecular Biology, Beijing Institute of Radiation Medicine, Beijing, China. · Nutrition. · Pubmed #12361782 No free full text.

Abstract: Radiation hazards in outer space present an enormous challenge for the biological safety of astronauts. A deleterious effect of radiation is the production of reactive oxygen species, which result in damage to biomolecules (e.g., lipid, protein, amino acids, and DNA). Understanding free radical biology is necessary for designing an optimal nutritional countermeasure against space radiation-induced cytotoxicity. Free radicals (e.g., superoxide, nitric oxide, and hydroxyl radicals) and other reactive species (e.g., hydrogen peroxide, peroxynitrite, and hypochlorous acid) are produced in the body, primarily as a result of aerobic metabolism. Antioxidants (e.g., glutathione, arginine, citrulline, taurine, creatine, selenium, zinc, vitamin E, vitamin C, vitamin A, and tea polyphenols) and antioxidant enzymes (e.g., superoxide dismutase, catalase, glutathione reductase, and glutathione peroxidases) exert synergistic actions in scavenging free radicals. There has been growing evidence over the past three decades showing that malnutrition (e.g., dietary deficiencies of protein, selenium, and zinc) or excess of certain nutrients (e.g., iron and vitamin C) gives rise to the oxidation of biomolecules and cell injury. A large body of the literature supports the notion that dietary antioxidants are useful radioprotectors and play an important role in preventing many human diseases (e.g., cancer, atherosclerosis, stroke, rheumatoid arthritis, neurodegeneration, and diabetes). The knowledge of enzymatic and non-enzymatic oxidative defense mechanisms will serve as a guiding principle for establishing the most effective nutrition support to ensure the biological safety of manned space missions.

Li S. · Institute of Bioinformatics, Tsinghua University, Beijing 100084. · J Tradit Chin Med. · Pubmed #12125492 No free full text.

This publication has no abstract.

Ling PX, Liang H, He YL, Zhang TM. · Shandong Institute of Biopharmaceutical, Jinan Shandong, P. R. China 250014. · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. · Pubmed #11826640 No free full text.

Abstract: OBJECTIVE: To review the physiological function of sodium hyaluronate in joints and its clinical applications. METHODS: Many literatures were reviewed and analysed on therapeutic mechanism and the application foreground of sodium hyaluronate. RESULTS: Extrinsic sodium hyaluronate plays an important role in improving synovial fluid and protecting cartilages as well as suppressing inflammation, so it is used in the treatment of joint diseases such as knee osteoarthritis, rheumatoid arthritis or temporomandibular osteoarthritis. CONCLUSION: Sodium hyaluronate possesses a good applied prospect in joint diseases.

Ma Y, Lin BR, Lin B, Hou S, Qian WZ, Li J, Tan M, Ma J, Li BH, Wang H, Wen AD, Guo YJ. · Shanghai Key Laboratory of Cell Engineering and Shanghai National Engineering Research Center for Antibody Medicine, Shanghai, China. · Acta Pharmacol Sin. · Pubmed #19262560 links to  free full text

Abstract: AIM: To evaluate single-dose and multiple-dose pharmacokinetics of cytotoxic T-lymphocyte-associated antigen 4 fusion protein (CTLA4Ig) in healthy volunteers and patients with rheumatoid arthritis (RA). METHODS: The clinical trials included two phase I open studies: study 1 was an open-label dose-escalation study in 27 healthy volunteers and study 2 was a single-group, open-label study in patients with rheumatoid arthritis. In study 2, 9 patients were arranged to receive 10 mg/kg of CTLA4Ig at 0, 2, 4, 8, 12, and 16 weeks. The concentration-time data obtained by a validated ELISA method were subjected to non-compartmental pharmacokinetic analysis by DAS 2.1 software. RESULTS: In study 1, serum CTLA4Ig concentrations climbed rapidly to the peak and declined slowly with a t(1/2) of 15.1+/-2.6 d, 14.2+/-2.3 d, and 11.8+/-1.2 d after a single infusion of 1, 10, and 20 mg/kg, respectively. C(max) and AUC(0-infinity) increased proportionally with the dose. In study 2, the steady-state condition for CTLA4Ig following multiple doses of 10 mg/kg appeared to be attained at the fourth dose (d 56), with peak and trough concentrations of 239.8+/-45.3 mg/L and 20.5+/-7.9 mg/L, respectively. After multiple infusions, serum concentrations dropped slowly and the terminal half-life was 12.6+/-4.7 d. CONCLUSION: Intravenous infusion of CTLA4Ig was well tolerated in healthy volunteers and patients with rheumatoid arthritis. CTLA4Ig exhibited linear pharmacokinetics over the dose range of 1 to 20 mg/kg in healthy volunteers. The pharmacokinetics in RA patients appeared to be similar to that in healthy volunteers. No system accumulation appeared upon repeated infusions of 10 mg/kg every 4 weeks.

Liu W, Li X, Ding F, Li Y. · Department of Rheumatology, Shandong University Qilu Hospital, Jinan, P.R. China. · Scand J Rheumatol. · Pubmed #18415765 No free full text.

Abstract: OBJECTIVES: No satisfactory biomarkers are currently available to screen for rheumatoid arthritis (RA). We have developed and evaluated surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) for detection and analysis of multiple proteins for distinguishing individuals with RA from control individuals. METHODS: A total of 156 serum samples from 90 RA patients, 30 patients with ankylosing spondylitis (AS), and 36 healthy individuals were examined by SELDI technology. Spectral data were analysed by the support vector machine (SVM) approach and potential biomarkers were chosen for system training and were used to construct a diagnostic model. RESULTS: Pattern 1, consisting of four protein peaks with m/z values of 3899, 4594, 7566, and 13,842, distinguished RA from the healthy samples with sensitivity of 90.0% and a specificity of 91.7%. Pattern 2, consisting of m/z peaks 4287 and 6471, distinguished RA from AS with a sensitivity of 86.7% and a specificity of 85.0%. CONCLUSION: The combination of SELDI-TOF MS and SVM could facilitate the discovery of better biomarkers for RA and also provide a useful tool for molecular diagnosis in the future.

Wang R, Jiang C, Lei Z, Yin K. · Shaanxi College of Traditional Chinese Medicine, Xianyang, Shaanxi 712083, China. · J Tradit Chin Med. · Pubmed #17710802 No free full text.

Abstract: OBJECTIVE: To observe the effect of acupuncture therapeutic courses on rheumatoid arthritis. METHOD: Forty-seven patients were treated with acupuncture for 6 courses and at the end of the third and sixth course of treatment, the therapeutic effects of acupuncture on morning rigidity, swelling and pain of joints as well as rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were observed. RESULT: At the end of the third course, the markedly effective rate was 34.0% for morning rigidity, 9.5% for swelling and 23.4% for pain, the RF negative-turning rate was 2.2%, and there was no significant difference (P > 0.05) in the reduction of ESR and CRP as compared to that before treatment. However, at the end of the sixth course, the markedly effective rate was 80.9% for morning rigidity, 64.3% for swelling and 87.2% for pain, the RF negative-turning rate was 26.7%, and there was a very significant difference (P < 0.01) in the reduction of ESR and CRP as compared to that before treatment. CONCLUSION: More acupuncture therapeutic courses can bring about better therapeutic results on rheumatoid arthritis.

Chen G, Li N, Zang YC, Zhang D, He D, Feng G, Ni L, Xu R, Wang L, Shen B, Zhang JZ. · Shanghai Institute of Immunology, JiaoTong University School of Medicine, Shanghai, China. · Arthritis Rheum. · Pubmed #17265481 links to  free full text

Abstract: OBJECTIVE: This pilot clinical study was undertaken to investigate the role of T cell vaccination in the induction of regulatory immune responses in patients with rheumatoid arthritis (RA). METHODS: Autologous synovial T cells were selected for pathologic relevance, rendered inactive by irradiation, and used for vaccination. Fifteen patients received T cell vaccination via 6 subcutaneous inoculations over a period of 12 months. RESULTS: T cell vaccination led to induction of CD4+ Tregs and CD8+ cytotoxic T cells specific for T cell vaccine. There was selective expansion of CD4+,V(beta)2+ Tregs that produced interleukin-10 (IL-10) and expressed a high level of transcription factor Foxp3, which coincided with depletion of overexpressed BV14+ T cells in treated patients. CD4+ IL-10-secreting Tregs induced by T cell vaccination were found to react specifically with peptides derived from IL-2 receptor alpha-chain. The expression level of Foxp3 in CD4+ T cells and increased inhibitory activity of CD4+,CD25+ Tregs were significantly elevated following T cell vaccination. The observed regulatory immune responses collectively correlated with clinical improvement in treated patients. In an intent-to-treat analysis, a substantial response, defined as meeting the American College of Rheumatology 50% improvement criteria, was shown in 10 of the 15 patients (66.7%) and was accompanied by a marked improvement in RA-related laboratory parameters. CONCLUSION: These findings suggest that T cell vaccination induces regulatory immune responses that are associated with improved clinical and laboratory variables in RA patients.

Tam LS, Tomlinson B, Chu TT, Li TK, Li EK. · Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. · Clin Rheumatol. · Pubmed #17237906 No free full text.

Abstract: Patients with rheumatoid arthritis (RA) have increased cardiovascular mortality. TNF-alpha is a critical mediator of inflammation and metabolic response in patients with RA. Increased insulin resistance and dyslipidemia were known risk factors in patients with active RA, however, the regulation of these metabolic parameters by TNF-alpha is poorly understood. Neutralization of TNF-alpha with infliximab offers a unique opportunity to study TNF-alpha-mediated regulation of these metabolic parameters in RA. The aim of the study was to assess the in vivo TNF-alpha-mediated regulation of insulin resistance and lipids levels in RA. Nineteen patients with active RA treated with infliximab were prospectively followed for 14 weeks. Plasma lipids levels and insulin resistance were measured at baseline, 6 and 14 weeks after infliximab treatment. At week 14, the disease activity (DAS-28 score) improved significantly (p < 0.000), with a significant reduction in both C-reactive protein (p = 0.007) and erythrocyte sedimentation rate (p = 0.006) levels. The body weight did not change during the study period. After infliximab treatment, insulin resistance improved as reflected by the significant reduction in the Homeostasis Model Assessment Index. Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and apolipoprotein B (apoB) levels all increased significantly from baseline. Nonetheless, the atherogenic index, LDL-cholesterol/HDL-cholesterol ratio, and the LDL/apoB ratio remained unchanged. Infliximab improves insulin sensitivity and alters lipid profile in patients with active RA.

Shi MG, Lü HS, Guan ZP. · Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing 100044, China. · Zhonghua Wai Ke Za Zhi. · Pubmed #17081464 No free full text.

Abstract: OBJECTIVE: To retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA). METHODS: From January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one <or= 90 degrees (range, 5 degrees - 90 degrees ) and the other > 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty. RESULTS: The patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened. CONCLUSIONS: TKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.

Sun XY, Su Y, Ren LM, Han L, Li ZG. · Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China. · Beijing Da Xue Xue Bao. · Pubmed #16892137 No free full text.

Abstract: OBJECTIVE: To examine the clinical benefit and impact on cytokine production by methotrexate in rheumatoid arthritis. METHODS: Thirty patients with RA were treated with oral methotrexate (mean, 15 mg per week) as monotherapy for 24 weeks. Clinical assessment using the American College of Rheumatology (ACR) criteria for improvement was performed at baseline and at the end of 2, 4, 8, 12 and 24 weeks. The pro-inflammation cytokine TNF-alpha, INF-gamma,IL-1beta, IL-6 and anti-inflammation cytokine IL-10 were measured in RA sera at baseline and after 24 weeks of therapy. RESULTS: There was remarkable improvement in disease activity following the MTX treatment. At the end of 24 weeks, the percent age of ACR20 was 70% (21/30), ACR50 30% (9/30) and ACR70 10% (3/30). The levels of IL-6 (46.83+/-35.81 vs. 20.92+/-17.98, P=0.001), TNF-alpha (162.52+/-107.63 vs. 18.32+/-14.36, P=0.026) and INF-gamma (67.79+/-43.76 vs. 35.78+/-27.51, P=0.004) were significantly higher than those of the health control at baseline, respectively. The levels of TNF-alpha (123.36+/-89.61,P=0.018), INF-gamma (41.53+/-13.49, P=0.015), IL-1beta (7.47+/-7.33, P=0.026), IL-6 (26.01+/-25.64, P=0.025) were significantly decreased after treatment with methotrexate. In contrast, IL-10 was remarkably increased (71.76+/-41.01, P=0.02). CONCLUSION: Methotrexate is effective in patients with rheumatoid arthritis. It can suppress the symptoms and joint damage. In addition, methotrexate treatment decreases the levels of pro-inflammatory cytokine, and increases the level of anti-inflammatory cytokine.

Tam LS, Griffith JF, Yu AB, Li TK, Li EK. · Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hongkong, People's Republic of China. · Clin Rheumatol. · Pubmed #16868816 No free full text.

Abstract: The objectives of this study was to assess, using clinical and magnetic resonance imaging (MRI) criteria, the efficacy of combination infliximab therapy in patients with active rheumatoid arthritis (RA) refractory to methotrexate (MTX) treatment and to ascertain whether the changes in MRI parameters correlate with the clinical response. Four infusions of infliximab (3 mg/kg) at weeks 0, 2, 6, and 14 were added to a stable background dose of MTX in 19 patients with active disease. Clinical parameters were assessed before each infusion and at week 14. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at baseline and week 14. Synovitis severity, volume of synovitis, and synovial perfusion indices were evaluated. Significant improvement in all clinical disease activity parameters was seen at week 14 with reduction in C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28. Sixty-eight percent of patients achieved ACR20. MRI disease activity parameters also significantly decreased after treatment with reduction in grading of synovitis, volume of active synovitis, and perfusion enhancement slope. Significant positive correlations were seen between the baseline volume of synovitis and the pain score (r=0.65), patient global score (r=0.68), and health assessment questionnaire (HAQ) score (r=0.46). In conclusion, addition of infliximab to methotrexate rapidly reduces inflammation in longstanding patients with RA. Assessment of enhancing synovial volume and perfusion indices on serial MRI examination was helpful in documenting the effect of treatment over this short period.

Shen B, Yang J, Pei FX. · Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China. · Chin J Traumatol. · Pubmed #15769314 No free full text.

Abstract: OBJECTIVE: To report the clinical and radiological results of 24 total knee arthroplasty in which all-polyethylene tibial components were used. METHODS: Between December 2000 and December 2002, 24 cemented total knee arthroplasty in 21 patients were performed using all-polyethylene tibial components. The mean age of the 21 patients (9 men and 12 women) at operation was 55 years, ranging 48-61 years. The mean preoperative hospital for special surgery (HSS) score was 40.2 (range, 36-43). The diagnoses were degenerative osteoarthritis in 15 patients, rheumatoid arthritis in 5 and traumatic arthritis in 1. All the operations were performed by the same surgeon group and there were unilateral operations in 18 patients and bilateral operations in 3. RESULTS: Eighteen patients were followed up with a follow-up rate of 85.7%. The mean follow-up is 2.5 years (range, 1-3 years) and mean postoperative HSS scores was 87.5 (range, 83-89). Among them, 18 were excellent, 3 good, 3 poor and none was fair (the results of three lost patients were classified as poor). Of those reviewed, the prosthesis was all in situ and no revision occurred. Radiological assessment of these patients revealed 4 (16.67%) tibial components with radiolucent lines (mean width < or = 2 mm) distributed mainly in zone 1 and zone 4. None of these knees was symptomatic. CONCLUSIONS: The result of total knee arthroplasty using all-polyethylene tibial components is encouraging. The operative techniques are similar to those in arthroplasty using metal-backed tibial component.

Siu AM, Chui DY. · Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong SAR, PR China. · Patient Educ Couns. · Pubmed #15476991 No free full text.

Abstract: This study aims to evaluate the outcomes of a community rehabilitation service for people with rheumatoid arthritis, provided by the Community Rehabilitation Network (CRN) in Hong Kong. The three-phase community rehabilitation service consists of a number of standardized program elements, including orientation meeting, self-help course, stress management program, water exercises class, as well as informal social and recreational activities. Using a pre-, post-test non-equivalent groups design, the outcomes of 29 clients of the treatment group were compared with 16 clients of the comparison group at baseline and at the end of 9 months, using an 86-item self-completed questionnaire. The treatment group achieved significant more increases in self-efficacy of managing the illness, more increases in self-management behaviors, but no significant increases in the overall health status or health care utilization patterns, when compared with the comparison group.

Gao JS, Wu H, Tian J. · Department of Rheumatism and Immunology, Second Xiangya Hospital, Central South University, Changsha 410011, China. · Zhonghua Er Ke Za Zhi. · Pubmed #14748999 No free full text.

Abstract: OBJECTIVE: To evaluate the efficacy and safety of the combined therapy with leflunomide and methotrexate in the patients with juvenile rheumatoid arthritis (JRA). METHODS: Forty patients with active polyarthritis JRA were divided into 2 groups. Group 1 (n = 21) received leflunomide tablet (1 mg/(kg x day) on days 1 - 3; then [(0.2 - 0.4) mg/kg per day] plus methotrexate (0.3 mg/kg i.v. every two weeks till clinical remission, then oral tablet 0.2 mg/kg weekly). Group 2 received the same doses of methotrexate in the same way. Permitted concomitant drugs included stable doses of NSAIDs and a low dose of prednisone during the course of treatments. The clinical assessments included the number of tender and swollen joints, tender articular index, swollen articular index, general articular function score, parents and physician's evaluation score, erythrocyte sedimentation rate, serum C-reactive protein and rheumatoid factor. Drug safety was assessed by observing the reaction of mucous membrane, skin, gastrointestinal tract, nervous system, hematologic changes, liver and renal function. Statistical comparison between two groups was performed by using analysis of variance, t test and chi(2) test. RESULTS: Efficacy and safety was assessed at 12th and 26th week. Average improvement rate of leflunomide plus methotrexate group at 12th week and 26th week was respectively 39.6% and 71.9%; while that of control group was 27.5% and 49.5%, i.e., there was significant difference between the two groups (P < 0.01). Average remission rate of leflunomide plus methotrexate group at 12th week and 26th week was respectively 4.76% and 38.10%; while that of control group (methotrexate only) was respectively 0, 0. The clinical improvement in the group treated with leflunomide plus methotrexate was significantly greater than control group (P < 0.01). There was no significant difference (9.5% v 5.3%) in occurrence rate of side effects between the two groups. Side effects included leucocytopenia and raised aminotransferase. They were mostly mild and tolerable. CONCLUSION: The effect of the leflunomide and methotrexate therapy in patients with active JRA was better than methotrexate alone. The combination therapy with leflunomide and methotrexate was safe and well tolerated.

Bao C, Chen S, Gu Y, Lao Z, Ni L, Yu Q, Xu J, Li X, Liu J, Sun L, He P, Ma J, Xu S, Ding C. · Department of Clinical Immunology, Shanghai Renji Hospital, Shanghai Second Medical University, Shanghai 200001, China. · Chin Med J (Engl). · Pubmed #12935395 links to  free full text

Abstract: OBJECTIVE: To evaluate the efficacy and safety of leflunomide in comparison with methotrexate (MTX) on patients with rheumatoid arthritis (RA) in China. METHODS: Five hundred and sixty-six patients with active rheumatoid arthritis were randomly assigned to receive leflunomide at 20 mg once daily or MTX at 15 mg once weekly in a controlled trial. Five hundred and four patients completed the 12-week treatment and some patients continued the treatment for 24 weeks. RESULTS: Both leflunomide and MTX could improve the symptoms, signs, and joint function, but there were no changes in X-ray observations of patients with rheumatoid arthritis. In the leflunomide group, the overall rates of effectiveness at 12 weeks and 24 weeks were 86.94% and 92.31% respectively; the rates of remarkable improvement were 64.95% and 79.81% respectively. In the MTX group, the overall rates of effectiveness at 12 weeks and 24 weeks were 84.04% and 83.15% respectively; the rates of remarkable improvement were 56.81% and 75.28% respectively. According to intent-to-treat analysis, the ACR 20% response rates at 12 weeks and 24 weeks in the leflunomide group were 62.54% and 67.18% respectively, compared with 60.08% and 61.32% respectively in MTX group. No statistical differences were shown in the efficacy between the two groups (P > 0.05). The adverse events in the leflunomide group were gastrointestinal symptoms, skin rash, alopecia, nervous system symptoms, decreased leukocyte count, and elevation of alanine aminotransferase (ALT). Most of these side effects were mild and transient. The incidence of adverse events in the leflunomide group was 16.84%, significantly lower than that in MTX group (28.17%, P = 0.002). CONCLUSIONS: Leflunomide is effective in the treatment of RA with less adverse events than MTX. Its efficacy is similar to MTX, but the incidence of adverse events and the rate of withdrawal due to adverse events were lower in the leflunomide group than in MTX group.

Lee KK, You JH, Ho JT, Suen BY, Yung MY, Lau WH, Lee VW, Sung JY, Chan FK. · School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. · Aliment Pharmacol Ther. · Pubmed #12869082 links to  free full text

Abstract: AIM: To evaluate the economic impact of celecoxib therapy vs. diclofenac plus omeprazole therapy for the treatment of arthritis in Chinese patients with a high risk of bleeding, from the perspective of a public health organization in Hong Kong. METHODS: The medical records of 287 Chinese arthritic patients with a history of bleeding ulcers who had previously participated in a randomised study of celecoxib 200 mg twice daily and extended-release diclofenac 75 mg twice daily plus 20 mg of omeprazole daily for 6 months were reviewed. RESULTS: Compared to the diclofenac plus omeprazole group, the average total direct cost per patient in the celecoxib group showed a significant reduction of 11%, from HK 10,915 (range HK dollars 10,915-57,899) to HK dollars 9714 (range HK dollars 9714-89,770) (P<0.0001) (1 US dollars=7.8 HK dollars). The median direct medical cost for routine management in the celecoxib group was significantly lower (11%) than that for the diclofenac plus omeprazole group [HK dollars 10,915 (range 10,915-28,048) vs. HK dollars 9714 (range HK dollars 6946-26,179) (P<0.0001)]. In patients who experienced recurrent bleeding, the celecoxib group showed a significantly higher median cost of management of recurrent bleeding than the diclofenac plus omeprazole group [HK dollars 8466 (range 572-29,851) vs. HK dollars 23,210 (range HK dollars 12,318-65,823)] (P=0.036). CONCLUSIONS: Celecoxib therapy appears to cost less compared with diclofenac plus omeprazole for treatment of arthritis in Chinese patients with a high risk of bleeding.

Liang QH, Zhang HX, Tang T. · Institute of Combined Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha 410008, China. · Hunan Yi Ke Da Xue Xue Bao. · Pubmed #12536532 No free full text.

Abstract: OBJECTIVE: To observe the effect of BZX on T-lymphocyte subsets in the peripheral blood of patients with rheumatoid arthritis (RA) and study the mechanism of curative effects of BZX in immunization. METHODS: 42 patients with RA in active stage were divided into 1. treatment group with BZX 2. control group with western medicine and twenty healthy control group (HCG) was arranged before treatment. Their CD4+ and CD8+ were tested and the ratio of CD4+ cells to CD8+ cells was calculated before treatment and after 3 months treatment. RESULTS: In the peripheral blood of patients with RA, CD4+ was more than that of the HCG. but CD8+ was lower and the ratio of CD4+ cell to CD8+ cells was higher than that of the HCG. After 3 months treatment, CD4+ decreased, CD8+ increased and the ratio of CD4+ cells to CD8+ cells decreased. In addition, all results were similar to the normal. We found there were no significant differences between the two treatment groups in the results after treatment. CONCLUSION: There were cell immunoregulation disorders in patients with RA. BZX can regulate the disorder of T-lymphocyte subsets, help rebuild the immune steading and have effects of immune suppression similar to MTX combined medicine.

Li-Tsang CW, Hung LK, Mak AF. · Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom. · J Hand Ther. · Pubmed #12086029 No free full text.

Abstract: This paper reports a matched-pair experimental study to investigate the effect of corrective splinting on flexion contracture of rheumatoid fingers. Twenty-four patients with rheumatoid arthritis and finger flexion contracture participated in the study. After a 6-week baseline measurement of hand function-including measurement of grip strength and range of motion and administration of the Jebsen Hand Function Test-the patients were randomly placed into two groups. Patients in the first group were given dynamic (Capener) splints, and those in the second group were given static (belly gutter) splints. Hand function was re-assessed 6 weeks after the splinting program. Results indicated significant improvement in both groups, not only in the correction of the finger flexion contracture (p < 0.0005) but also in grip strength (p = 0.001) and hand function (p < 0.0005). Patients with dynamic finger extension splints did not differ from those with static splints in extension gains, but they did have better flexion than patients with static splints. Both types of splints can be recommended for flexion contracture of rheumatoid fingers, depending on patients' preferences and comfort.