Objective To systematically review the efficacy and safety of denosumab in the treatment of rheumatoid arthritis. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials (RCTs) of denosumab in the treatment of rheumatoid arthritis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 7 RCTs including 2 346 patients were included. The results of meta-analysis showed that administering 60 mg densuzumab every 6 months (Q6M) was superior to placebo in increasing the bone mineral density (BMD) of the lumbar spine, the hip, the femoral neck, and improving the modified total Sharp score. Administering 60 mg denosumab every 3 months (Q3M) and 60 mg Q6M were both superior to the placebo group at improving erosion score; in addition, the 60 mg Q3M group was superior to the 60 mg Q6M group. There was no significant difference between denosumab and the placebo in improving joint space narrowing score, the American College of Rheumatology 20%, 50%, or 70% responses, health assessment questionnaire disability index, or disease activity score. In terms of safety, there was no significant difference between denosumab and the placebo group. Conclusion Densuzumab can delay the progression of rheumatoid arthritis bone erosion, and its safety is acceptable. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To analyze the trends and influencing factors of rheumatoid arthritis disease burden in mainland China from 1990 to 2021 and predict its disease burden over the next 15 years. MethodsData on RA incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in mainland China were extracted from the Global Burden of Disease Study 2021 (GBD 2021). Joinpoint regression was used to analyze temporal trends, while an age-period-cohort model assessed age, period, and birth cohort effects. Decomposition analysis explored the contributions of population aging, population growth, and epidemiological changes. An ARIMA model was applied to predict future disease burden. ResultsFrom 1990 to 2021, the number of RA cases in mainland China increased by 93.5% (incidence), 133% (prevalence), 115% (deaths), and 107% (DALYs), though age-standardized rates showed smaller changes. The disease burden was significantly higher in women than in men, with sex-specific peaks in onset and prevalence. Joinpoint regression revealed rising age-standardized incidence and prevalence rates (AAPC=0.54% and 0.51%, respectively) but declining mortality (AAPC=−0.78%). Cohort effects indicated higher RA risk in later-born populations (RR=1.53 for the 2012 cohort). Decomposition analysis identified population growth as the primary driver of increased burden. Projections suggested that by 2036, the age-standardized incidence and prevalence would rise to 13.92/100 000 and 248.84/100 000, respectively, while DALYs rates might decline to 42.09/100 000. ConclusionThe RA disease burden in mainland China is driven by both population aging and epidemiological factors, with notable sex disparities and cohort effects. Targeted interventions for high-risk populations, optimized healthcare resource allocation, and further research on influencing factors are needed to develop precise prevention and control strategies.
Rheumatoid arthritis (RA) is a chronic autoimmune disease remarkably characterized by synovitis of joints, whose pathogenesis is complicated and not yet fully elucidated. A variety of cells, cytokines and intercellular signaling pathways are involved in the occurrence and development of RA. The mitogen activation protein kinase (MAPK) signaling pathway is closely related to the pathogenesis of RA, and plays an important role in the formation of pannus, synovitis, and bone destruction. This paper reviews the research progress of MAPK signaling pathway in RA from the aspects of the interaction of MAPK signaling pathway with a variety of key cells and cytokines in the pathogenesis of RA, in order to provide a direction and theoretical basis for anti-RA drug therapy research.
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:评价膝关节滑膜超声检查在类风湿关节炎(RA)患者随访中的价值及其与RA临床活动度之间的相关性。方法:收集确诊的RA病人40例,其中68个膝关节有阳性症状。分别收集40例RA患者的临床资料,计算其疾病活动度DSA28,同时行膝关节超声检查,对有阳性症状的膝关节动态随访三次上述指标,每月一次。结果:每月RA患者的DSA28分值与受检膝关节髌上囊内液体深度、滑膜内血流信号等级呈正相关(Plt;0.05);膝关节髌上囊内液体深度、滑膜内血流信号等级以及滑膜厚度三者之间均呈正相关(Plt;0.05)。结论:膝关节滑膜内血流信号等级和膝关节髌上囊内液体深度是良好的随访RA患者疗效与评估RA患者活动度的超声指标。Abstract: Objective: To evaluation the disease of synovial in knee joints in patients with RA by ultrasound, and investigate the relationship between the clinic activity of RA and findings by ultrasound. Methods: The clinic dates and ultrasound of 40 RA patients, including 68 knee joints have positive symptom were collected by every month. The course of treatment was 3 months. Results: The score of DSA28 was correlated with the thick of effusion in bursa supragenual and the blood single of synovial in knee joints(Plt;0.05);the correlation also found among the thick of effusion in bursa supragenual.the thick of synovial and the blood singal of synovial in knee joints (Plt;0.05). Conclusion: The thick of effusion in bursa supragenual and the blood single of synovial in knee joints was excellent ultrasound index in RA.
ObjectivesTo systematically review the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis.MethodsPubMed, EMbase, The Cochrane Library, VIP, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis from inception to June 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 970 patients were included. The results of meta-analysis showed that: there was no statistical difference between iguratimod and methotrexate in ACR20 (RR=1.06, 95%CI 0.91 to 1.23, P=0.49), ACR50 (RR=0.93, 95%CI 0.73 to 1.19, P=0.55), ACR70 (RR=0.92, 95%CI 0.62 to 1.39, P=0.70), morning stiffness time (MD=0.45, 95%CI –0.26 to 1.16, P=0.22), tender joint count (MD=0.07, 95%CI –2.31 to 2.45, P=0.95), swollen joint count (MD=–0.30, 95%CI –1.44 to 0.84, P=0.61), health assessment questionnaire (MD=0.01, 95%CI –0.05 to 0.07, P=0.73) and the rate of adverse effects (RR=0.66, 95%CI 0.41 to 1.07, P=0.09). Meta-analysis of 2 RCTs using double-blind method showed that, iguratimod was superior to methotrexat in the patient (MD=4.11, 95%CI 0.11 to 8.10, P=0.04) and physician (MD=4.81, 95%CI 0.93 to 8.69, P=0.01) global assessment of disease activities.ConclusionsCurrent evidence shows that the efficacy and safety of iguratimod in the treatment of rheumatoid arthritis are similar to methotrexate. And iguratimod is superior in global assessment of disease activities by patients and doctors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.