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Lan X Chen

Publications and source records attributed to Lan X Chen.

14 recordsLinked to original sources
PubMed2006

[Decision-making about gout by physicians of China and influencing factors thereof].

OBJECTIVE: To investigate the decision-making about gout by physicians of China and influencing factors thereof. METHODS: A questionnaire survey, including 13 multiple choice questions, was divided into 2 stages. The first/stage questionnaire survey was conducted among 121 physicians of the departments of internal medicine and rheumatology respectively during the grand ward rounds, and the second-stage questionnaire survey was conducted among 75 physicians attending a national continuous medical education (CME) workshop of rheumatology. The data thus collected were pooled and analyzed by logistic regression models. RESULTS: 62 effective questionnaires were collected in the first/stage survey, and 38 effective questionnaires were collected in the second-stage survey, both with a missing rate < 10%. 78.3% of the respondents considered aspiration of the joint fluid as critical for the definitive diagnosis of gout, but only 2.4% of the respondents did so frequently. When treating acute gout in otherwise healthy patients, 69.2% of the respondents preferred oral colchicine, and while treating the patients with renal dysfunction, 41.7% of the respondents used corticosteroids or corticotrophin as the first choice. For long-term uric acid-lowering therapy, 99 of them (82.5%) described a variety of incorrect indications, 107 of them (89.2%) initiated the treatment too early (< or = 2 weeks after the remission), and 92 of them (76.7%) failed to sustain the treatment for at least 5 years. Only 17 physicians (14.2%) used prophylaxis while initiating the uric acid-lowering treatment and only 7 of them (5.8%) selected a prophylaxis time of 7 approximately 12 months. Multiple logistic regression analysis showed that only CMD on gout was associated with correct diagnosis strategy (OR 7.1, 95% CI 2.1 approximately 23.7). CONCLUSION: The management of gout by the physicians in China is often not consistent with that generally accepted internationally. High quality CME may improve the decision-making ability of physicians.

Decision Making↗
PubMed2006

Gout: can we create an evidence-based systematic approach to diagnosis and management?

The management of gout can be subdivided into four phases. Asymptomatic hyperuricaemia represents the basic underlying metabolic abnormality that can lead to gout. Studies are evaluating whether interventions may be indicated in some cases. Diagnostic criteria for gout and acute flares are still not well defined unless urate crystals are found. Acute attacks of gout are treated with anti-inflammatory measures and the agent of choice is often determined by attack stage, severity and comorbidities that may contra-indicate one or more agents. After attacks subside, there are asymptomatic periods during which decisions must be made about when and how to start urate-lowering measures. If hyperuricaemia persists, there is generally persistence of urate crystals in the joint. Anti-inflammatory prophylaxis is needed when urate-lowering therapy is started. Lifestyle measures should be addressed. If chronic tophaceous gout is diagnosed, urate lowering should be started without delay. New agents are under development that may help with difficult cases.

Acute Disease↗
PubMed2006

Newer therapeutic approaches: gout.

Newer approaches to the treatment of gout have included modifications and further attention to aspects of current therapies, and development of interesting new therapies. Colchicine prophylaxis appears to be needed longer than previously recognized after introduction of a urate-lowering agent. Diet has received attention, though most dietary effects are small. New agents under investigation include pegylated formulations of uricase and a new potent xanthine oxidase inhibitor, febuxostat. Some cardiovascular drugs have been shown to be uricosuric.

Anti-Inflammatory Agents↗
PubMed2006

Current trends in crystal identification.

PURPOSE OF REVIEW: This review is an attempt to keep current in the sparse literature addressing the still underutilized area of crystal identification. RECENT FINDINGS: The emphasis has been on the subtleties of the microscopic identification of common crystals and other less common potentially confusing crystals. Imaging is noted to provide increasing help, but microscopic crystal identification remains the gold standard. SUMMARY: Quality control is still a concern as is the infrequency of attempted arthrocentesis for crystal identification.

Calcinosis↗
PubMed2006

The management of gout at an academic healthcare center in Beijing: a physician survey.

OBJECTIVE: Gout is a less commonly diagnosed rheumatic disease in China compared with Western countries, but its prevalence appears to be climbing. It is not known how Chinese physicians diagnose and treat their patients with gout, so we evaluated physician management of gout at a major academic healthcare center in Beijing, and investigated factors associated with better decision-making. METHODS: A 13-question anonymous survey was distributed and collected at a medical grand rounds and then at a rheumatology grand rounds at a major teaching hospital in Beijing. Physician demographic data including educational background, work experience, job titles, specialty or subspecialties, gout patient volume seen in a year, and continuing medical education (CME) in gout were also collected in the survey. Data were analyzed by multivariate regression models to identify factors associated with appropriate answers. RESULTS: Twenty-seven residents and general internists, 26 rheumatologists and fellows, and 28 physicians and fellows of other medical subspecialties from the Department of Medicine including visiting physicians responded to the survey. Among respondents, 78% think it is important for a definitive diagnosis of gout, but few actually perform aspiration of the affected joint fluid. Eighty-four percent report that they often follow the serum urate level of their patients with diagnosed gout. When treating acute gout in otherwise healthy patients, most physicians (77%) prefer oral colchicine, and in patients with renal impairment, about half of them (48%) choose corticosteroids or corticotropin as their first treatment. For longterm urate-lowering therapy, most physicians (87%) described a variety of indications that we consider less appropriate. They (86%) tend to initiate it early (< 2 weeks) after acute flares. When urate-lowering therapy is used, 80% of physicians sustain it less than 5 years. Further, only 12% of physicians use antiinflammatory prophylaxis during the initiation of urate-lowering treatment, and only 5% maintain it for an appropriate period of time. Logistic regression analysis of physician demographic data, educational background, and work experience found no consistent independent factors associated with better decision-making, other than CME, that were associated with establishing the definite diagnosis correctly. Specifically, the number of gout patients seen by physicians was not related to better decision-making. CONCLUSION: The physicians' reported management of gout at this major academic healthcare center in Beijing was often inconsistent with current evidence. High quality CME is required to improve Chinese physician management of gout.

Academic Medical Centers↗
PubMed2005

Injectable corticosteroids in treatment of arthritis of the knee.

Injection of corticosteroid preparations for the local treatment of musculoskeletal disorders affecting the knee, such as osteoarthritis and rheumatoid arthritis, has been used widely since the 1950s. This local therapy minimizes systemic toxicity and can result in rapid improvement in symptoms, most often as an adjunctive therapy for acute or severe symptom flares. The evidence assessing safety and efficacy is reviewed and analyzed. Intra-articular knee injection technique is described and is a procedure that is easy to learn and can be performed quickly in an office or hospital setting.

Adrenal Cortex Hormones↗
PubMed2005

Prophylactic effect of highly selective COX-2 inhibition in acute monosodium urate crystal induced inflammation in the rat subcutaneous air pouch.

OBJECTIVE: To examine the ability of rofecoxib prophylaxis to blunt the effect of monosodium urate (MSU) crystal inflammation induced in the rat subcutaneous air pouch. METHODS: Eight rats were used in each of 4 groups. On day one, air was injected subcutaneously to create the pouches and gavage feedings were started with placebo or 2 different doses of rofecoxib. Six days later MSU crystals or saline were injected into the pouches. Twenty-four hours later, rats were examined, sacrificed, and pouch fluid studied. RESULTS: Rofecoxib 15 or 30 mg/kg given for 6 days before MSU crystal injection into rat air pouches significantly suppressed the inflammation following injection of 10 mg crystals (p = 0.001) and tended to suppress the milder inflammation induced by 5 mg MSU. Greater effects on phagocytosis were seen with 30 mg/kg rofecoxib. Tumor necrosis factor-alpha levels in pouch fluid measured by ELISA were not suppressed by the rofecoxib. CONCLUSION: Prophylactic use of this cyclooxygenase 2 (COX-2) selective inhibitor in this pilot study suppressed acute MSU crystal induced inflammation. Effects on cytokines need further investigation. COX-2 inhibitors deserve consideration for prophylactic use in interim gout.

Animals↗
PubMed2005

Outcome measures for acute and chronic gout.

Gout provides some unique challenges in classification and measurement of outcomes. Our aim was to evaluate criteria for classification and to develop and validate optimal instruments to measure outcomes for acute and chronic gout. A planning committee and interested attendees met to propose classification criteria and domains for outcomes. Seven of the current American Rheumatism Association preliminary criteria for classification were proposed as the best current criteria for acute gouty arthritis, pending further studies. The presence of gout is best established by crystal identification, although this technique has limitations. Five domains for acute gout outcomes and 9 for chronic gout were identified along with proposed instruments for testing and validation. The unique problems of gout evaluation can and will be addressed.

Acute Disease↗
PubMed2004

Update on identification of pathogenic crystals in joint fluid.

Crystal identification in joint fluid has been an essential part of diagnosis of joint disease. Recent advances have included progress in crystal identification on stained slides, attention to aspiration techniques, and arthrocenteses of asymptomatic joints. Challenges remain to increase use and optimize techniques.

Biopsy, Fine-Needle↗
PubMed2003

A look at rheumatology in China (2002).

This report describes a visit by an international group interested in Rheumatology to the Rheumatology centers and traditional Chinese medicine units in the People's Republic of China. Differing disease patterns and treatment approaches offer opportunities for studies and collaborations. We can also learn from the traditional Chinese approach with individualization of therapy and attention to health maintenance.

Journal Article↗
PubMed2003

Ultrasonography for assessment of subcutaneous nodules.

OBJECTIVE: To characterize a variety of subcutaneous lesions by their ultrasonographic (US) appearance, and establish these images as a starting point to measure changes with treatments. METHODS: Twenty-six patients with 48 subcutaneous nodular swellings of various types were imaged using a portable US machine equipped with a 10 MHz linear transducer. All patients had a known diagnosis of a rheumatic disease. We used US to examine subcutaneous lesions and the underlying cortical surface of the bone or joint. Two measurements of some tophi and rheumatoid nodules were done on different dates to examine reproducibility of the measurements. RESULTS: Nodular lesions included 20 tophi and 20 rheumatoid nodules, 2 sarcoid nodules, 2 lipomas, and 4 synovial cysts. Tophi most often appeared as heterogeneous masses; hypoechoic areas in 2 tophi were decreased after aspiration of chalky liquid tophaceous material. Occasionally tophi had calcifications appearing hyperechoic with acoustic shadowing. Cortical bone erosions could be seen adjacent to some tophi. The nodules in patients with rheumatoid arthritis were often attached closely to the bone surface and less erosive to bone, allowing the cortical bone to be seen easily. The nodules were more homogeneous. Some showed a central sharply demarcated hypoechoic area, possibly corresponding to necrosis inside the rheumatoid nodules. Nodules were easily measured. The repeated measurements of both tophi and rheumatoid nodules showed excellent reproducibility. Lipomas had different echogenic patterns depending on composition of the associated connective tissue and position of the mass. They could be hypoechogenic, hyperechogenic, or mixed, but were easily distinguished by oval shapes with well demarcated capsules. Synovial cysts seen in this study had a characteristic hypoechoic pattern. CONCLUSION: Subcutaneous nodules examined by sonography show characteristics and patterns that, although not diagnostic, can be used to help distinguish their etiology. Tophi and rheumatoid nodules can be easily measured and these measurements used to help follow disease progression or response to therapy.

Aged↗