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*For medical professionals to read and reference Frontiers in Rheumatology = 7.
561), published the titles "Sirolimus Monotherapy for Thrombocytopenia in Primary Antiphospholipid Syndrome: A Pilot Study From a Tertiary Referral Center" and "Incidence of and Risk Factors for Paradoxical Psoriasis or Psoriasiform Lesions in Inflammatory Bowel Disease Patients Receiving Anti-TNF Therapy" : Systematic Review With Meta-Analysis"
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These two studies aimed at the efficacy and safety of sirolimus monotherapy in primary antiphospholipid syndrome (APS) thrombocytopenia and TNF monoclonal antibody in the treatment of paradoxical psoriasis-like rash and silver lining in inflammatory bowel disease, respectively.
The incidence and risk factors of psoriasis were comprehensively analyzed
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Paper 1: "Sirolimus monotherapy for thrombocytopenia in primary antiphospholipid syndrome: a pilot study from a tertiary referral center" ▲The paper title (Front Immunol.
2022 Mar 25; 13: 857424) APS is an Systemic autoimmune disease characterized by persistently positive antiphospholipid antibodies
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Thrombocytopenia (TP) is one of the common out-of-standard clinical manifestations of APS, with an incidence of 15% to 53%
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The occurrence of TP not only does not reduce the risk of APS thrombosis, but also increases the mortality of APS, but there is still a lack of effective and safe drugs for long-term management of APS-TP
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Sirolimus (also known as rapamycin) is a macrolide antibiotic immunosuppressant, mainly by inhibiting cytokine receptor-dependent signal transduction, thereby blocking the activation of T cells and selectively increasing number of Treg cells
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Previous studies have shown that sirolimus is effective in the treatment of refractory connective tissue disease-related TP, but there are no case reports or clinical studies on the efficacy and safety of sirolimus in primary APS-TP
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 ▲Common clinical manifestations of APS (source Nat Rev Rheumatol.
2017 Sep;13(9):548-560.
) In response to this problem, Professor Zhang Zhuoli's research team launched this single-center single-agent sirolimus monotherapy for APS-TP , a single-arm pilot study
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Seven consecutive patients with primary APS were included in the study, all of whom completed 6 months of sirolimus therapy (duration: 6-15 months)
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Overall, median platelet counts increased significantly after sirolimus treatment [baseline: 59×109/L; 1st month: 90×109/L, p=0.
028; 3rd month: 131×109/L, p= 0.
028; 6th month: 178×109/L, p=0.
018 (Figure 1)]
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Among them, up to 85.
7% and 71.
4% of the patients achieved overall response and complete response, respectively, and 4 patients with primary APS-TP who were newly treated all achieved overall response
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In addition, antiphospholipid antibody levels decreased to varying degrees after sirolimus treatment (Figure 2)
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In terms of safety, only one patient experienced elevated cholesterol levels during treatment, which recovered rapidly after atorvastatin treatment
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 Figure 1.
Changes in platelet counts in patients with primary APS after sirolimus treatmentFigure 2.
Changes in antiphospholipid antibodies before and after treatment with sirolimus in patients with primary APS The efficacy and safety of primary APS-TP were initially explored, and the results showed that sirolimus monotherapy has good efficacy and tolerability in primary APS-TP
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The key findings of the study will provide important evidence-based evidence for the management of APS-TP
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After further validation in future large-sample studies, sirolimus monotherapy may be used as a first-line treatment for APS-TP in the future
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 Paper 2: "Incidence of and Risk Factors for Paradoxical Psoriasis or Psoriasiform Lesions in Inflammatory Bowel Disease Patients Receiving Anti-TNF Therapy: Systematic Review With Meta-Analysis" ▲Thesis title (Front Immunol.
2022 Mar 1;13:847160) Inflammatory Intestinal disease (IBD) is an idiopathic intestinal inflammatory disease involving the ileum, rectum, and colon, including ulcerative colitis (UC) and Crohn's disease (CD), affecting more than 10 million people worldwide
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The emergence of biological agents represented by TNF monoclonal antibody has greatly changed the clinical prognosis of IBD patients
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However, with the increased use of TNF mAbs, the occurrence of paradoxical inflammation within psoriatic or psoriasis-like skin lesions has become a growing concern
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Because in general, TNF monoclonal antibody can be used to treat psoriasis, but some IBD patients have been observed to develop psoriasis or psoriasis-like skin lesions after receiving TNF monoclonal antibody
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However, the incidence and risk factors of this paradoxical psoriasis or psoriasis-like skin lesions have not been systematically and comprehensively reported
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 ▲Anti-TNF therapy-induced paradoxical inflammation (source Nat Rev Gastroenterol Hepatol.
2012 Sep;9(9):496-503.
) In response to this problem, Professor Zhang Zhuoli's research team conducted a literature search, and as of February 2021 , Full-text published English-language studies analyzing the incidence and/or risk factors of psoriasis-like rash and/or psoriasis in IBD patients treated with TNF monoclonal antibody were selected, and 30 observational studies including 24,547 IBD patients were finally included
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The results showed that the incidence of psoriasis-like rash and/or psoriasis was 6.
0% (5.
0-7.
0%; I2=93.
9%) in IBD patients receiving TNF mAb; The incidence of psoriasis was 6.
9% (5.
1-8.
7%; I2 = 92.
4%) and 4.
6% (3.
6-5.
6%; I2 = 93.
9%), respectively
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Meta-regression results showed that study area and population differences (adults, children) were important reasons for the heterogeneity
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In terms of risk factors, female (OR 1.
46, 1.
23-1.
73), younger age (OR 1.
03, 1.
00-1.
05), smoking (OR 1.
97, 1.
56-2.
48), ileocolonic CD (OR 1.
48, 1.
03-2.
13), and adalimumab Antibiotics, certolizumab (compared with infliximab: OR 1.
48 and 2.
87) were independent predictors of developing psoriatic rash and/or psoriasis (Figure 3)
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 Figure 3.
Paper chart abstract This study is the first to conduct a comprehensive analysis and in-depth exploration of the incidence and risk factors of paradoxical psoriasis-like rash and psoriasis in the treatment of inflammatory bowel disease with TNF monoclonal antibody.
The occurrence of paradoxical psoriasis-like rash and psoriasis in IBD patients receiving TNF mAb is not uncommon, and its occurrence is closely related to the patient's gender, age, smoking and clinical phenotype and the type of TNF mAb
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This important discovery will provide important reference evidence for individualized treatment of IBD and help us understand the mechanism of paradoxical inflammation after TNF monoclonal antibody treatment
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It is reported that Frontiers in Immunology, founded in 2010, is a peer-reviewed open access journal and an official journal of the International Union of Immunological Societies (IUIS)
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The journal is dedicated to publishing important research results covering the entire field of immunology
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In the latest Journal Citation Report 2020 published by Clarivate Analytics, the journal is ranked 23 out of 170 immunology journals (JCR Q1 zone), with an impact factor of 7.
561 (immediate impact factor of 8.
228)
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The corresponding author of the paper is Professor Zhang Zhuoli, Department of Rheumatology and Immunology, Peking University First Hospital, and the first author is Dr.
Xie Wenhui, Department of Rheumatism and Immunology, Peking University First Hospital
.

Among them, associate professor Ji Lanlan of the Department of Rheumatology and Immunology of Peking University First Hospital and Dr.
Xiao Shiyu of the Department of Gastroenterology of Peking University Third Hospital are the co-first authors of the first and second papers respectively
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At present, Professor Zhang Zhuoli's team has led the application of musculoskeletal ultrasound, magnetic resonance, mini arthroscopy and other innovative technologies in rheumatology in China, which has promoted the development of rheumatology in China
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The Department of Rheumatology and Immunology of Peking University First Hospital has been nominated in Fudan University's China Best Hospital Specialty Ranking for seven consecutive years, and has entered the TOP10 list of Chinese Academy of Medical Sciences' scientific and technological influence for five consecutive years.
one
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In order to further promote the development of domestic rheumatology and immunology disciplines, Professor Zhang Zhuoli led the team to sponsor more than 40 sessions of "Training on Standardized Operation of Musculoskeletal Ultrasound", "Training Course on the Application of New Imaging Technology in Rheumatism", and the 4th "Peking University Training Course".
Rheumatism Immunization Hotspot Forum”, etc.
, has won unanimous praise from domestic rheumatology immunologists
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The first author, Dr.
Xie Wenhui, MD, a rheumatologist and immunologist at Peking University First Hospital, was selected for the 2022-2024 Young Talent Support Project of Beijing Association for Science and Technology.
He has published more than 40 papers as the first author, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, J Am Acad Dermatol, Autoimmun Rev and other authoritative journals served as guest editors of Frontiers in Medicine and more than ten reviewers of SCI journals such as J Inflamm Res, Rheumatol Ther, Pain Ther, Nutrients, etc.
Presided over 1 intramural fund, participated in many He is a general and youth project of the National Natural Science Foundation of China, and has been invited for many times to give oral presentations at the European League Against Rheumatism Annual Conference and other domestic and foreign conferences to give oral presentations.
Ji Lanlan, the first author of the Young Scientist Award and other first author, Deputy Chief Physician, MD, Deputy Chief Physician of the Department of Rheumatology and Immunology, Peking University First Hospital, Associate Professor dedicated to the research of antiphospholipid syndrome, systemic lupus erythematosus, rheumatoid arthritis and other diseases.
Participated in many global Center cooperation projects, including Asia Pacific Lupus Collaborative Group (APLC) and Antiphospholipid Syndrome International Cooperation and Clinical Trials Alliance (APS ACTION), published 20 SCI and domestic core journals in the above fields, presided over the National Natural Science Foundation of China and intra-academy funds, and received He has rich experience in musculoskeletal ultrasound operation and training, and has passed the advanced certification of musculoskeletal ultrasound by the European Association of Rheumatology, and serves as a domestic ultrasound training speaker
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Won the Asia Pacific, Japan, Korea Rheumatology Association Traveler Award
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Corresponding author Zhang Zhuoli Chief Physician Chief Physician, Professor, Doctoral Supervisor, Second-level Professor of Peking University Currently Director of the Department of Rheumatology and Immunology, Peking University First Hospital Incumbent Vice Chairman and Secretary General of Rheumatology Branch of Chinese Medical Association Standing Committee Member of Rheumatology Branch of Chinese Medical Doctor Association Beijing Vice Chairman of Rheumatology Branch of the Medical Association, Head of the Imaging Group of the Rheumatology and Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association, Head of the Rheumatology Group of the National Medical Examination Center of the National Medical Examination Center of the Health and Health Commission The original and applied achievements have won scientific research grants such as the National Natural Major Research Program and General Projects, the Chinese Women's Physician Association Wuzhou Women's Science and Technology Award, the Peking University "Good Teacher and Friend" Award, and the Yang Fuqing-Wang Yangyuan Academician Outstanding Teaching and Research Award.
More than 400 papers, including Ann Rheum Dis, Lancet Rheumatol, Arthritis Rheumatol, Eur Respir J, Blood, J Am Acad Dermatol, Autoimmun Rev and other authoritative journal article links: https:// .
2022.
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