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The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) have been recommended for evaluating function and disability in patients with ankylosing spondylitis (AS). The aim of this study was to develop a Chinese version of the BASDAI, BASFI, and BAS-G and assess their reliability and validity. The Chinese version was obtained after a translation and back-translation process. A total of 447 patients with adult and juvenile AS were assessed using these three instruments. Reliability was tested by internal consistency and test-retest reliability. Internal consistency of the instrument was given as Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient. To assess the sensitivity to change, 153 patients were included in an 8-week follow-up study. In our analysis, the reliability of these three instruments-the BASDAI, BASFI, and BAS-G-for a 24-h test-retest showed acceptable intraclass correlation coefficients (0.92-0.94). Our Chinese versions of the BASDAI, BASFI, and BAS-G also showed 0.87, 0.94, and 0.90, respectively, with Cronbach's alpha coefficient, indicating good reliability. For sensitivity to change in 8-week follow-up, all three instruments showed 5.0 to 5.4% changes. Our Chinese versions of the BASDAI, BASFI, and BAS-G showed adequate reliability, validity, and responsiveness to clinical change. Thus, disease activity and functional status in Chinese-speaking patients with AS may be adequately evaluated with these versions of the original instruments.

Specific and nonspecific panniculitis may occur during the course of connective tissue diseases. However, association of panniculitis and rheumatoid arthritis has only rarely been described, and with so few reports, it is difficult to know the significance of this unusual association. We describe 2 patients with rheumatoid arthritis and features of Sjogren syndrome in whom panniculitis developed during the course of the disease. Histologic confirmation of septal panniculitis was established in one case and the panniculitis in this case improved as the arthritis resolved.

Pulmonary arterial hypertension (PAH), a serious complication of autoimmune diseases, has rarely been reported in Taiwan.Nineteen patients with various autoimmune diseases diagnosed with PAH at Taipei Veterans General Hospital from 2002 to 2004 were enrolled; the underlying autoimmune diseases included systemic lupus erythematosus (n = 6), primary Sjögren's syndrome (n = 5), systemic sclerosis (n = 4), adult-onset Still's disease (n = 2), and mixed connective tissue disease (n = 2). The characteristic manifestations of underlying autoimmune diseases and the clinical features of PAH were analyzed.There were 16 female and 3 male patients. The median age at onset of PAH was 44 years and the mean right ventricular systolic pressure (RVSP) was 67.9 mm Hg. Patients without pneumonitis had a significantly higher RVSP value than those with pneumonitis (77.5 +/- 24.3 vs 54.8 +/- 18.4 mm Hg, p=0.041). Four out of 7 patients (57.1%) with RVSPor=80 mm Hg and 1 out of 12 patients (8.3%) with RVSP80 mm Hg died. In all of the 19 patients, the severity of RVSP was significantly correlated with serum uric acid (UA) level (r = 0.686, p=0.001). Among the PAH patients without pneumonitis, the severity of RVSP inversely correlated with the diffusion capacity of the lung for carbon monoxide (DLCO) [r = -0.856, p=0.003]. The characteristic manifestations of underlying autoimmune diseases included a high incidence of Raynaud's phenomenon (15/19, 78.9%), a high titer of antinuclear antibody (13/17, 76.5%), positive anti-ribonucleoprotein antibody (8/15, 53.3%), hypergammaglobulinemia (15/19, 78.9%), hyperuricemia (13/19, 68.4%), and less renal involvement.PAH in autoimmune diseases could be potentially fatal with characteristic manifestations. Moreover, RVSP correlated directly with serum UA level and inversely with DLCO.

Tripterygium wilfordii Hook F(TWH), commonly known as the Thunder-God-Vine, is a popular remedy for rheumatism in southern China. In this study, we investigated the effect of T2 (an extract from TWH) on adjuvant-induced paw oedema in rats and inflammatory mediators. The results showed that an intraperitoneal injection of T2 could significantly decrease the adjuvant-induced paw oedema of rats. During in vitro study, lipopolysaccharide (LPS)-stimulated human mononuclear prostaglandin E2 (PGE2) in the culture supernatant was significantly inhibited by T2 at a concentration of 2 μg/mL compared with the control group without T2 treatment (22352±4725 vs 43433±9014 pg/mL, p

A polarized heterodyne ellipsometer to characterize TN-LC by elliptical parameters of polarization state is proposed. The twist angle and untwisted phase retardation can be measured precisely that TN-LC is verified as an elliptical retarder properly

Second-degree atrioventricular (AV) block had not been reported as an early manifestation of adult systemic lupus erythematosus (SLE). An 18-year-old woman of SLE presented with asymptomatic second-degree AV block with 2:1 conduction block on electrocardiogram (ECG) during admission. Serologic tests were negative for anti-Sjögren's syndrome A (anti-SS-A/Ro) and anti-SS-B/La antibodies, but positive for anti-ribonuclearprotein antibodies. Her abnormal ECG completely resolved soon after high-dose intravenous methylprednisolone infusion, and she was maintained successfully with a low dose of oral steroid. The possible pathogenesis of this complication is discussed. Follow-up with periodical ECG is recommended for adult lupus patients to screen for possible conduction system involvement, and treatment should be started as soon as possible.

A 56-year-old human immunodeficiency virus (HIV)-infected man presented with progressive interstitial lung disease (ILD) and lymphocyte infiltration of the salivary glands which mimicked autoimmune disease. Pneumonia, which was very likely caused by Pneumocystis carinii, developed after 3 courses of monthly methylprednisolone pulse therapy for ILD. Both enzyme immunoassay and Western blot analysis confirmed the HIV infection. After antibiotic treatment, the pneumonia gradually resolved. Autoimmune manifestations such as ILD and xerostomia may be initial presentations of HIV infection. Immunosuppressive drugs must be used cautiously in these patients. Screening for HIV is mandatory in the differential diagnosis of patients with ILD or xerostomia.

Background Many infectious agents have been implicated as an etiology to develop Kawasaki disease (KD). In Taiwan, studies on the relationship between Yersinia and KD have not been reported. Methods We measured sera for anti- Yersinia antibodies by using enzyme immunoassay (EIA) in 31 patients with KD and 60 healthy children (HC). Yersinia strains included Y. pseudotuberculosis I, II, III, IV, V, VI and Y. enterocolitica O3, O8 and O9. Results Data of 31 patients with KD showed that for the IgG antibody, serum anti- Y. pseudotuberculosis II, III, Y. O8 and O9 antibody were significantly higher when compared to the HC. Except for Y. pseudotuberculosis IV, all other Yersinia strains of either IgA or IgM antibodies increased significantly in patients with KD vs. the HC. If we compared the number of patients who had significant elevation of OD and those of HC, we found IgA anti- Yersinia antibodies (PST I, PST II, O3, O8, O9), IgM (PST VI, O8) and IgG (PST II, O8, O9) were significantly elevated in KD patients than in HC. A significant relationship was present between KD with myocarditis and increased anti- Yersinia antibody titer. Conclusions The findings in this study suggest that preceding Yersinia infection may play a role in the pathogenesis of KD. Further study of the relationship between KD with myocarditis and increased anti- Yersinia antibody is needed.

OBJECTIVE--To study the association between the occurrence of peripheral arthritis and of acute anterior uveitis during the course of ankylosing spondylitis (AS). METHODS--Retrospective clinical follow up by both chart review and direct patient interview was performed on 271 individuals comprised of 222 local white and 49 Taiwanese individuals with AS. RESULTS--Of 89 white patients with acute anterior uveitis, 36 (40.4%) also had peripheral arthritis, compared with only 33 (24.8%) having peripheral arthritis among the 133 who did not have acute anterior uveitis (p < 0.02). Thirty seven (78.7%) of 49 Taiwanese individuals with AS had peripheral arthritis and these included all 10 patients with acute anterior uveitis from the entire disease cohort (p < 0.05). CONCLUSIONS--This cross-sectional survey of AS patients supports the view that patients who develop peripheral arthritis are also more likely to develop acute anterior uveitis.

Background Altered glycosylation of immunoglobulin G (IgG) has been demonstrated in patients with rheumatoid arthritis (RA). Specificity of IgG rheumatoid factor (RF) in recognizing degalactosylated IgG (Fab) 2 and Fc was analyzed in the present study. Methods (Fab) 2 and Fc fragments were prepared from IgG of normal healthy subjects. Enzymes, including peptide-N-glycosidase (PNGase), neuraminidase, and β-1,4-galactosidase, were used to digest (Fab) 2 and Fc fragments. Binding capacity of IgG RF from patients with RA, systemic lupus erythematosus (SLE), and from healthy subjects to (Fab) 2 and Fc treated with glycosidase, was measured with immunoassay. Results Treating (Fab) 2 and Fc with PNGase significantly diminished their binding capacity to IgG RFs. Degalactosylated (Fab) 2 revealed higher affinity to IgG RF in all tested groups. Fc lacking terminal galactose on oligosaccharide chains showed elevated binding with synovial IgG RF of RA patients. However, lesser binding was observed in sera of patients with RA and SLE. Conclusions Our data suggest that IgG molecules containing less terminal galactose on their oligosaccharide moieties are preferentially recognized by IgG RF. Furthermore, IgG RF display alternative binding specificity to degalactosylated (Fab) 2 and Fc in synovial fluids and sera of RA patients.

Myofascial pain syndrome (MPS) in the cervical and upper back regions is a common medical problem. The involved muscles include trapezius, multifidi, splenius cervicis, levator scapulae, supraspinatus or infraspinatus. Acupuncture is a well-known method for relief of chronic pain. In this study, we evaluated the effect of acupuncture in MPS and its durability by using the concept of meridians. Twenty-nine patients with chronic MPS in the upper back and cervical regions received acupuncture 2 times per week for 3 weeks. According to the pathways of the meridians, we chose acupuncture points by the pain regions located in which parts of meridian passing (i.e. "Where the meridian passes, where to treat the disease."). We evaluated the intensity of pain by visual analog scales (VAS) and active range of motion (ROM) of neck before and after therapy. After receiving acupuncture for 3 weeks, VAS of pain fell significantly from 9.0+/-1.0 to 4.9+/-2.5 and active ROM of neck significantly increased from 35.8+/-10.2 degrees to 61.3+/-9.4 degrees (p

The HLA-B27 antigen is an important genetic marker in ankylosing spondylitis (AS). Methods for the detection of B27 include the microlymphocytotoxicity test and, more recently, flowcytometry (FC). Here, we describe a new method, IMS-ELISA, for measuring the B27-antigen. It combines immunomagnetic separation (IMS), to obtain B27-positive cells from whole blood samples, with an enzyme-linked immunosorbent assay (ELISA) as a read-out. IMS-ELISA was tested on 367 samples obtained from five different hospitals in Taiwan. The sensitivity, specificity and accuracy of the method were compared with FC. Any conflicting data between IMS-ELISA and FC was confirmed by HLA-DNA typing via PCR-SSP (polymerase chain reaction-sequence specific primers). Overall, the results for sensitivity, specificity and accuracy obtained by IMS-ELISA and FC did not show any significant difference (p>0.05). However, when considering laboratory time, cost, ease of operation and the screening of large samples for HLA-B27, the IMS-ELISA was superior to the FC method. We conclude that IMS-ELISA may be used as a fast screening method for HLA B27 detection.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that affects the spine and sacroiliac joints, as well as the peripheral joints [1]. Hip arthritis occurs in 30% of all AS pat...

Three members of a Taiwanese kindred developed severe, systemic, early onset ( < age 25 years), biopsy-proven amyloidosis. Clinical features included upper and lower extremity sensorimotor neuropathy, abdominal pain, vomiting, corneal ulcerations, cardiomyopathy, and syncope. Immunohisto-chemical analysis indicated that the deposits consisted of transthyretin. Molecular genetic studies revealed a heterozygous codon 55 point mutation, resulting in a proline for leucine substitution, a mutation previously associated with aggressive familial amyloidosis in a US kindred of Dutch and German descent. The clinical courses and echocardiographic findings are typical for many types of amyloidosis; the pathologic data and genetic studies were necessary to establish a precise diagnosis.

Background There is evidence that adipocytokines play an important role in metabolism and in inflammation. Adipocytokines are involved in numerous rheumatic diseases, such as rheumatoid arthritis, osteoarthritis and systemic lupus erythematosus. They exert potent modulatory actions on target tissues and cells in rheumatic diseases, including cartilage, synovium and immune cells. Objectives The aim of our study is to determine the serum leptin, adiponectin and resistin levels in patients with ankylosing spondylitis (AS) and to investigate the relationship with disease activity markers. Methods Leptin, adiponectin and resistin serum levels were measured in 50 AS patients and in 20 matched healthy control using commercially available enzyme-linked immunosorbent assays. Leptin, adiponectin, and resistin levels were correlated with clinical parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath AS Disease Activity Index (BASDAI), Bath AS Disease Functional Index (BASFI), and Bath AS global score (BASG). Results AS patients exhibited significantly higher resistin [Mediun (interquartile range) 3.6 (2.3∼5.1) vs. 2.7 (1.9∼3.4) μg/ml, p=0.03], but no difference in leptin and adiponectin levels [31.9 (18.9-58.9) vs. 30.3 (11.9∼83.9) ng/ml; [28.5 (14.6∼51.4) vs. 24.5 (13.6∼48.5), respectively p=NS)]. No correlation was found between leptin, adiponectin, and erythrocyte sedimentation rate, c-reactive protein levels, or BASDAI, BASFI and BASG. The resistin level was correlated with BASDAI (r: 0.364; p=0.013). There are no changes in serum adipokine concentrations after 3 months TNF blocker treatment. Conclusions Serum level of resistin are increased in patients with AS and correlated with BASDAI. Further studies are needed to elucidate the role of adipocytokines in AS. Disclosure of Interest None Declared

OBJECTIVE--To investigate the potential influence of the HLA-linked LMP2 gene on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS). METHODS--A polymorphic CfoI restriction enzyme site in the coding region of the LMP2 gene was evaluated in genomic DNA samples from 193 white and 49 Chinese B27 individuals with well documented AS, 97 of whom had had acute anterior uveitis (AAU) and 97 peripheral arthritis; 42 samples from normal, white, B27 positive blood donors in whom AS was excluded were also evaluated. RESULTS--Analysis of B27 white AS individuals with AAU, peripheral arthritis, or both, revealed significant differences in genotypic distribution of this bi-allelic locus compared with B27 AS patients without extraspinal manifestations (p < 0.005) or B27 controls (p < 0.01). Furthermore, homozygosity for one LMP2 gene allele was significantly more prevalent in AS patients with AAU (71.3%) (p < 0.01) or peripheral arthritis (68.3%) (p < 0.02) than in B27 controls (45.2%). A similar genotypic distribution was noted in B27 Chinese AS individuals with extraspinal manifestations compared with those with axial disease alone. CONCLUSIONS--These findings support the involvement of the HLA linked LMP2 gene in the expression of disease in B27 individuals and represent a novel finding in rheumatic disease.

The traditional Chinese antirheumatic herb Danggui-Nian-Tong-Tang (DGNTT) was studied comparatively with indomethacin and allopurinol to evaluate its anti-inflammatory and antihyperuricemic effects in patients with gout. Results in this study did not show any significant improvement in reducing the total number of painful and swollen joints, articular index and pain score ( P > 0.05) by treatment with DGNTT. Unlike allopurinol, DGNTT did not lower the high serum level of uric acid. In vitro study in rats showed that DGNTT significantly inhibits the activity of β-glucuronidase ( P < 0.05) and lysozyme release ( P < 0.01) from neutrophils. In conclusion, despite the effect of inhibition on enzyme release from neutrophils, DGNTT is not effective in treating acute arthritis or hyperuricemia.

Septic sacroiliitis is an uncommon disease and is rarely reported as a complication of acupuncture. We present a case of unilateral septic sarcoiliitis, which developed as a complication of acupuncture because of failure to sterilise the skin properly before treatment. Bone scan and computed tomography were positive for sacroiliitis. After a course of antibiotics with oxacillin for 6 weeks, the condition was completely improved. This case report stresses the importance of sterilisation procedures before acupuncture therapy.

Although hyperamylasemia is known to occur in Sjogren’s syndrome (SS), pancreatitis is uncommon in early SS. Erythema multiforme (EM) develops in systemic lupus erythematosus (SLE), but does not occur in SS. Annular erythema is seen in SS [1], but Stevens-Johnson syndrome (SJS), a severe EM, never occurs with SS. We report a woman with SJS and acute pancreatitis who developed SS. She also had a thyroid disease prior to EM that was likely a component of SS. A 34-year-old woman developed generalized morbilliform rashes and high fever 2 days after taking acetaminophen and ampicillin for a common cold. Her past history included hyperthyroidism responsive to carbimazole. Serum amylase, lipase, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase and alanine phosphatase were elevated. Sonography showed swelling, decreased echogenicity of the pancreas and thickening of the gallbladder. Antinuclear antibodies (ANA) were 1:160 (speckled). The patient received i.v. methylprednisolone for 3 weeks. The skin lesions and abdominal symptoms subsided, and enzymes became normal 40 days later. Six months thereafter, arthritis developed in the left knee, right shoulder and ankles. Xerostomia and fullness recurred with a positive Schirmer test and ANA (1:640). Leukopenia and low C3/C4 appeared, and amylase fluctuated above 230 U/l. Hydroxychloroquine was started and symptoms subsided. Interruption of hydroxychloro

Clinically detectable joint swelling was found in 10 of 13 fully evaluated patients considered to have polymyalgia rheumatica. Five patients had some joint findings at disease onset. Knees were most commonly affected. Sternoclavicular involvement was seen in 3 patients. Joint effusions in 8 patients had 300-5,700 leukocytes/mm3 with a mean of 2,900. Six synovial biopsy specimens studied by light microscopy revealed mild to moderate synovial proliferation and chronic inflammation that was generally less severe than in typical rheumatoid arthritis. Electron microscopy identified microvascular changes and large amounts of vesicular and granular debris in lining cells. In 1 patient, a "fingerprint" pattern in the granular material was suggestive of the findings in some immune complexes. This still unexplained synovitis may, as previously suggested, be important in the pathogenesis of the polymyalgia rheumatica syndrome.