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Aim The aim of this study was to determine the efficacy and safety of a weekly dose of leflunomide (50 mg/week) in early rheumatoid arthritis patients with mild or moderate disease activity. Methods The patients of early rheumatoid arthritis (ERA) with mild or moderate disease activity were randomly selected for inclusion in this study and were assigned to either the treatment group (leflunomide 50 mg/week, LEF50) or the control group (leflunomide 10 mg/day, LEF10). All patients were treated for 24 weeks. Clinical efficacy was assessed using the disease activity score in 28 joints ( DAS28) - erythrocyte sedimentation rate (ESR) and European League Against Rheumatism ( EULAR) response. A Chi-squared test, Fisher's exact-test and paired t-tests were used to analyze the data. Results A total of 244 patients who met the inclusion criteria and received at least one medicine dose were analyzed. At the baseline, the DAS28 (ESR) of the ERA patients were 4.41 ± 0.69 in LEF 50 group and 4.52 ± 0.64 in LEF 10 group, respectively. At week 24, the DAS28 (ESR) in two groups ( 2.94 ± 1.10 and 3.02 ± 1.14 ) were significant decreased compare with the baseline, respectively ( P<0.01). There was no significant difference in DAS28 (ESR) between the LEF50 and LEF10 groups at week 24. ( P > 0.05). At weeks 8, 12 and 24, the EULAR response (good responses + moderate responses) were 47.6%, 58.7% and 59.5%, in the LEF50 group and 43.2%, 49.1% and 53.4% in the LEF10 group, respectively. There was no significant different of EULAR response rates in the two groups at week 8, 12, and 24, respectively ( P>0.05). There was no serious adverse events during the study. Conclusion A weekly dose of 50 mg leflunomide showed similar benefits to a daily dose of 10 mg leflunomide for the treatment of mild-to-moderate early rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Objective: To understand the medical treatment and clinical characteristics of patients with IgG4-related disease (IgG4-RD) with complex clinical manifestations and easy to be misdiagnosed and missed, and to improve the recognition of this disease among doctors from relevant medical departments., Methods: A retrospective analysis was conducted on the medical records of patients diagnosed with IgG4-RD who were hospitalized and discharged from Peking University Third Hospital from January 1, 2012 to December 31, 2022. The patient' s medical visit status, clinical manifestations, laboratory examinations, diagnosis, and treatment information were summarized., Results: A total of 116 patients diagnosed with IgG4-RD were included in this study, with a male to female ratio of 2. 52∶ 1 and an average age of (61.83±10.80) years. The departments for initial visits were gastroenterology, general surgery, and ophthalmology. While the departments responsible for definitive diagnosis were gastroenterology, rheumatology and immunology, and respiratory medicine. Twenty-one patients (18. 10%) required consultation and treatment from three or more departments before receiving a definitive diagnosis. The median time from symptom onset to the initial clinic visit was 2 (1, 7) months, and the median time from symptom onset to diagnosis was 1 (1, 12) month. Twenty-four patients (20.69%) underwent surgical resection of the affected sites before diagnosis. According to the classification criteria of IgG4-RD, sixty-eight (58.62%) cases were diagnosed definitively, eight (6.9%) cases were likely to be diagnosed, and 40 (34.48%) cases were suspected to be diagnosed. In the 68 definitively diagnosed patients, the most commonly affected organs were submandibular gland, the pancreas, biliary tract, parotid in sequence. The median serum IgG4 (IgG4, immunoglobulin G4) level was 6.16 (3. 61, 12. 30) g/L. Fifty-seven patients (83.82%) were treated with glucocorticoids, and 14 patients (20.59%) were treated with immunosuppressants. The use of immunosuppressants was mainly in the rheumatology and immunology department (78. 57%)., Conclusion: IgG4-RD is more common in elderly males, with submandibular gland, the pancreas, biliary tract, and parotid being most commonly affected. The distribution of initial visit departments in patients is wide. The proportion of definitive diagnosis based on pathology is relatively low. In terms of treatment, the main approach is steroid treatment, while the use of immunosuppres-sants is not widespread.

Objective: To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics., Methods: The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m 2 referred to obese individuals, 25≤BMI < 30 kg/m 2 referred to overweight individuals, 18.5≤BMI < 25 kg/m 2 referred to normal individuals, BMI < 18.5 kg/m 2 referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors., Results: A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m 2 .Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m 2 , 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m 2 , amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m 2 , 24.7%) and 22 obese individuals (BMI≥30 kg/m 2 , 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs . 39.1%, P < 0.001), diabetes (25.5% vs . 15.0%, P =0.006), hyperlipidemia (22.7% vs . 10.9%, P =0.001), fatty liver (28.4% vs . 7.4%, P < 0.001), osteoarthritis (39.0% vs . 29.4%, P =0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs . 70.9%, P =0.016) and anemia (36.2% vs . 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs . 7.6%, P =0.442), cerebrovascular disease (6.4% vs . 8.8%, P =0.372) and peripheral atherosclerosis (9.2% vs . 7.6%, P =0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs . 2.35 mg/dL, P =0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs . 50.0 mm/h, P =0.003), pain visual simulation score (VAS) (3.66±3.08 vs . 4.40±2.85, P =0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs . 5.45±1.52, P =0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia., Conclusion: In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.

Objective: To analyze the differences of clinical manifestations and laboratory features between primary Sjögren's syndrome (pSS) patients with positive and negative anti-Sjögren's syndrome type B (SSB) antibody., Methods: The clinical data of pSS patients hospitalized in Department of Rheumato-logy and Immunology, Peking University Third Hospital were retrospectively analyzed to investigate the differences of clinical and laboratory features between anti-SSB positive and negative groups. The t test, Mann-Whitney U test, Chi-square test and Fisher's exact probability were used for analysis., Results: A total of 142 pSS patients were enrolled in this study, including 137 females and 5 males with a mean age of (54.8±13.3) years. The anti-SSB positive group included 44 patients accounting for 31.0% of the pSS patients. The anti-SSB positive pSS patients were younger at disease onset and at visit [age at visit: (50.9±14.5) years vs. (56.5±12.4) years; age at onset: (42.2±14.8) years vs . (49.5±15.3) years, P < 0.05]. The patients with anti-SSB positive more frequently presented with rash (29.5% vs . 14.3%, P < 0.05), enlargement of parotid glands (27.3% vs . 8.2%, P < 0.05), renal tubular acidosis (15.9% vs . 4.2%, P < 0.05), immune thrombocytopenia (9.1% vs . 1.0%, P < 0.05), rheumatoid factor (RF) positive (85.0% vs . 49.4%, P < 0.05), higher RF and antinuclear antibody (ANA) titers (median: 89.8 IU/mL vs . 20.5 IU/mL; median: 320 vs . 160, P < 0.05), anti-Sjögren's syndrome type A (SSA) antibody positive (97.7% vs . 64.3%, P < 0.05), elevation of γ globulin (71.4% vs . 38.5%, P < 0.05), higher levels of IgG (median: 21.0 g/L vs . 15.6 g/L, P < 0.05), higher proportions of CD3 - CD19 + cells [(21.0±11.9)% vs . (13.7±9.6)%, P < 0.05] and lower proportions of CD3 + cells [(67.2±14.4)% vs . (76.6%±13.1)%, P < 0.05] than those negative. However, the anti-SSB positive group was less likely to show anti-mitochondrial antibodies (AMA)-M2 positivity (10.5% vs . 35.6%, P < 0.05). Glucocorticoids (90.9% vs . 73.5%, P < 0.05) and immunosuppressants (54.5% vs . 36.7%, P < 0.05) were more frequently used in anti-SSB positive pSS patients than those negative., Conclusion: The anti-SSB positive pSS patients were younger at disease onset while more frequently presenting with various symptoms, higher levels of other antibodies and activation of B cells than those negative. Glucocorticoids and immunosuppressants were more frequently used, indicating that anti-SSB positive group presented with a more severe clinal phenotype.