Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

62歳女。1年前からJAK阻害薬(バリシチニブ)を使用中、肝機能障害が出現し受診した。食事内容の聞き取りで加熱不十分な豚肉を摂食していたことが明らかになり、ウイルス性肝炎を疑った。薬剤性肝炎の可能性も考えられたためバリシチニブは中止した。ウイルス検査の結果、HA-IgM、B型肝炎、C型肝炎は陰性で、HEV-IgA抗体が陽性であったことからE型肝炎と診断した。バリシチニブ中止後もASTとγ-GTP値は上昇したが、ALT値は上昇せず、約8週で肝機能は正常化した。その後バリシチニブを再開したが肝機能の悪化はなく、安全に使用可能であった。

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.0395-22

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

We describe the case of a 78 year-old man presenting with multiple edematous erythemas, fever, and arthralgia who subsequently developed neutrophil infiltration into the cartilage of the bilateral auricularis, consistent with relapsing polychondritis. A Skin biopsy of the erythema on his right arm showed dense neutrophilic infiltration into the dermis, while a bone marrow aspirate revealed myelodysplastic syndromes with characteristic vacuoles in myeloid precursor cells. Although the patient achieved remission with high–dose oral prednisolone, the inflammatory symptoms relapsed, and he was resistant to colchicine and cyclosporine. The patient spontaneously developed left leg edema and high-output cardiac failure caused by an arteriovenous fistula with a common iliac artery aneurysm. We successfully performed a two-stage surgery using internal iliac artery coil embolization and endovascular aortic repair of the iliac aneurysm. We assumed the patient was suffering from large-vessel vasculitis such as giant cell arteritis or Takayasu arteritis. We treated him with tocilizumab in addition to prednisolone, and the febrile events and elevated C-reactive protein levels improved. One year later, sequencing of ubiquitylation initiating E1 enzyme (UBA1) using peripheral blood leukocytes revealed somatic variants (c.121A > C p.Met41Leu), confirming the diagnosis of vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. This case suggests that arteriovenous fistula could be a complication of VEXAS syndrome with large-vessel vasculitis, and adequate surgical intervention and prompt diagnosis are essential for rescue. Although arteriovenous fistula is a rare complication of VEXAS syndrome, physicians should be aware of this complication to ensure prompt diagnosis and timely surgical intervention.

DOI： 10.1093/mrcr/rxac082

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The incidence of femoral localized periosteal thickening (LPT), which can precede atypical femoral fracture (AFF), is not low (1-10%) in Japanese patients with autoimmune inflammatory rheumatic diseases (AIRDs). We explored the associations between underlying AIRDs and the prevalence of LPT. METHODS: We conducted post-hoc analyses of two cohorts that included a total of 280 Japanese women, 105 of whom had AIRDs and had been taking bisphosphonate (BP) and prednisolone (PSL), and 175 of whom had rheumatoid arthritis (RA). RESULTS: LPT was detected in a total of 18 patients (6.4%) and three (1.1%) developed AFFs. RA was negatively correlated with LPT. A disease other than RA requiring glucocorticoid treatment, BP use ≥ 5 years, PSL use ≥ 7 years, and a PSL dose ≥ 5.5 mg/day were positively correlated with LPT. After adjusting for age, diabetes mellitus, and BP duration or daily PSL dose, RA was no longer associated with LPT. CONCLUSION: LPT in Japanese patients with AIRDs was associated with BP and glucocorticoid treatment rather than underlying AIRDs. When a PSL dose ≥ 5.5 mg/day is required long-term (typically combined with long-term BP treatment [≥ 5 years]), clinicians need to pay particular attention in case LPT and AFF, as well as glucocorticoid-induced osteoporosis.

DOI： 10.1093/mr/roac062

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

サルコペニアチェック検査を実施された関節リウマチ(RA)患者について、その結果とRAの疾患活動性や治療について分析した。当科外来でサルコペニアチェック検査を受けた65歳以上のRA患者20例(男性5例、女性15例、中央値75.5歳)を対象とした。サルコペニアは7例(35%)で全例女性、フレイルの4例(20%)は全例サルコペニアに該当し、4例中2例は重症サルコペニアで、サルコペニアとフレイルは関連していた。サルコペニア・フレイルに関する因子として、身体活動量とたんぱく質摂取量に有意差はなかったが、サルコペニア群では食事摂取量の低下が示唆された。骨粗鬆症については骨粗鬆症性骨折リスク評価で10年以内における骨粗鬆症性骨折・大腿骨近位部骨折リスクが15%以上の頻度はサルコペニア群の方が非サルコペニア群より有意に多く認められ、女性のみで比較しても骨粗鬆症性骨折リスクが15%以上の頻度はサルコペニア群で高かった。

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Femoral localized periosteal thickening (LPT, also termed "beaking") of the lateral cortex often precedes an atypical femoral fracture (AFF). Bisphosphonate (BP) use, glucocorticoid use, and Asian race are major risk factors for developing such fractures. The aim of this study was to determine whether the trabecular bone score (TBS) reflecting the lumbar trabecular microarchitecture was related to LPT in glucocorticoid-treated Japanese patients with autoimmune diseases. MATERIALS AND METHODS: We retrospectively investigated 111 women with autoimmune diseases treated with prednisolone (PSL) who had undergone both femoral X-ray and dual-energy X-ray absorptiometry of the L1 - L4 lumbar vertebrae and for whom TBS could be evaluated for two or more of these. RESULTS: Femoral LPT was evident in the X-rays of 18 of 111 patients (16.2%). Higher body mass index (BMI), longer duration of PSL use and longer duration of BP use were significant in patients with LPT compared to those without. The TBS was significantly lower in patients with LPT than in those without (1.314 ± 0.092 vs. 1.365 ± 0.100, p = 0.044); however, the lumbar bone mineral density did not differ significantly (0.892 ± 0.141 vs. 0.897 ± 0.154 g/cm2, p = 0.897). TBS was significantly associated with LPT (odds ratio, 0.004; 95% CI, 0 - 0.96; p = 0.048), but not in the multivariate analysis including BMI, duration of PSL use and duration of BP use. CONCLUSIONS: The TBS was lower in glucocorticoid-treated Japanese women with autoimmune diseases with LPT than in those without LPT, and deteriorated trabecular microarchitecture influenced by longer use of BP and glucocorticoid might be associated with the development of LPT.

DOI： 10.1007/s00774-021-01244-z

PubMed

researchmap

Language：English   Publisher：(一社)日本臨床リウマチ学会  

目的:慢性腎臓病(CKD)を合併した関節リウマチ(RA)患者における持続性エリスロポエチン受容体活性化剤(CERA)の有用性の検討。方法:CERAを使用した37例のRA患者のうち、11例は12ヵ月以内に死亡していた。12ヵ月以上CERAを使用した26例(男性2例、女性24例)について有用性を検討した。結果:患者年齢は77.4±7.0歳、罹病期間は17.9±14.5年であった。血液尿素窒素25.8±10.6mg/dl、血清クレアチニン(Cr)は1.2±0.5mg/dl、推算糸球体濾過量は41.6±16.0ml/min/1.73m2であった。血清鉄やフェリチンの低下はなく、不飽和鉄結合能は上昇しておらず、平均赤血球容積の低下は認めなかった。血清エリスロポエチンの上昇は認めなかった。CERAの使用により(43.1±21.4μg/month)、ヘモグロビン(Hb)は8.70±1.1g/dlから10.0±1.2g/dlに上昇していた(p<0.001)。鉄剤の使用やRAの治療強化のなかった15例でも、Hbは9.1±0.8g/dlから10.1±1.2g/dlに上昇していた(p=0.028)。8例でCERAを中止でき、その後3例は再開したが、1例は再度中止することが可能であった。結論:RA患者においては、CKDが疑われる場合ではCrが低い場合でも、CERAを使用すべきと考えられた。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

関節リウマチ(RA)患者の高齢化は若年発症RA患者の高齢化に加え、高齢発症の患者も増加している。我々は1991年のRA429症例と2018年のRA368例について横断的検討を行い年齢、性比を検討した。その結果1991年の平均年齢は55.3歳でRA患者のピークは50歳代と60歳代にあり、2018年の平均年齢は66.9歳で、70歳代にピークが認められ(P=0.000)、高齢化が確認された。性別の検討では2018年は1991年に比べて男性患者の増加が認められた(P=0.003)。2018年のRA症例の検討では、65歳以上で発症した高齢発症RA(EORA)では初発関節として大関節の割合多く65歳未満の若年発症RA(YORA)では小関節の発症が多かった(P<0.01)。RFはYORAが73.1%、EORAが60.7%(P=0.02)、抗CCP抗体はYORAが68.4%、EORAが58.3%(P=0.034)とRFと抗CCP抗体共にYORAで陽性率が高かった。治療ではMTXの使用頻度、量ともYORAが多く使用されていた。アミロイドーシスは全体の1.6%に存在し、全例がYORAで解析時に65歳以上であった。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：新潟県医師会  

researchmap

Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

<sec><title>Objectives</title> Anti-ribosomal P protein autoantibodies (anti-P) specifically develop in patients with systemic lupus erythematosus. Associations of anti-P with lupus nephritis (LN) histological subclass and renal outcome remain inconclusive. We sought to determine the association of anti-P and anti-double-stranded DNA antibody (anti-dsDNA) with renal histology and prognosis in LN patients.

</sec><sec><title>Methods</title> Thirty-four patients with LN, having undergone kidney biopsy, were included. The 2018 revised ISN/RPS classification system was used for pathophysiological evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate &lt; 60 mL/min/1.73 m² for &gt; 3 months.

</sec><sec><title>Results</title> Six patients (17.6%) were positive for anti-P and 26 (76.5%) for anti-dsDNA. Among the six patients with anti-P, one did not have anti-dsDNA, but did have anti-Sm antibody, and showed a histological subtype of class V. This patient maintained good renal function for over 14 years. The remaining five patients, who had both anti-P and anti-dsDNA, exhibited proliferative nephritis and were associated with prolonged hypocomplementemia, and the incidence of CKD did not differ from patients without anti-P.

</sec><sec><title>Conclusion</title> Although this study included a small number of patients, the results indicated that histology class and renal prognosis associated with anti-P depend on the coexistence of anti-dsDNA. Further studies with a large number of patients are required to confirm this conclusion.

</sec>

DOI： 10.1177/0961203320983906

researchmap

Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/0961203320983906

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/internalmedicine.E004-21

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2169/internalmedicine.E002-21

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objective To evaluate the effectiveness and drug retention rate of golimumab (GLM) for long-term use in daily practice for patients with rheumatoid arthritis (RA). Methods Patients with RA who started GLM therapy with a minimum follow-up period of 52 weeks were included. The patients were divided into a biologic-naïve group and switch group. The disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) (DAS28-ESR), grip power, and Japanese version of the health assessment questionnaire (J-HAQ) score were assessed. In addition, the treatment continuation rate was evaluated at the final follow-up. Patients Sixty-five patients (58 women and 7 men; median [range] age, 69 [61-74] years; median [range] disease duration, 9 [5-16] years) were included. Twenty-eight patients were biologic-naïve (naïve group), and 37 were switched to biologics (switch group). Results The median (range) follow-up period was 134 (58-162) weeks. The DAS28-ESR improved from a median (range) of 4.31 (3.52-5.25) to 2.65 (2.28-3.77) in the naïve group and from 4.27 (3.19-4.89) to 2.89 (2.49-3.88) in the switch group. The grip power improved in both groups (p<0.01); however, the J-HAQ score showed no marked improvement in either group. The continuation rates were 22/28 (78.6%) in the naïve group, and 26/37 (70.3%) in the switch group at the final follow-up. Conclusion We herein report for the first time that the long-term use of GLM improves the grip power. Improving the grip power may help prevent sarcopenia and frailty in the future. Given the efficacy and high continuation rate, we suggest that GLM would be a well-tolerated treatment option for RA.

DOI： 10.2169/internalmedicine.5381-20

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objectives: To evaluate changes in radiographic findings and plantar pressure distribution after rheumatoid forefoot surgery.Methods: This study was performed on patients with rheumatoid arthritis (RA) who underwent Swanson implant arthroplasty for the 1st metatarsophalangeal (MTP) joint combined with shortening oblique osteotomy at the 2nd through 5th metatarsal necks (group Sw, 55 feet). The following two groups were used as controls: group NS, consisting of 75 feet in RA patients without scheduled forefoot surgery, and group HC, consisting of 24 feet in healthy female subjects. Plantar pressure distribution, and radiographic findings of hallux valgus angle, the angle between the metatarsal bones, talocalcaneal angle, calcaneal pitch angle and calcaneo-first metatarsal angle (CFMA) were measured pre- and one year postoperatively. Peak pressure was measured in nine sections.Results: Calcaneal pitch angle decreased and CFMA increased in group Sw. Peak pressure at the 1st interphalangeal joint (IP) and the 2nd and 3rd MTPs in group Sw decreased, while that at midfoot increased.Conclusion: While the clinical outcome in group Sw was favorable, postoperative longitudinal arch decreased. Postoperative peak pressure at the 2nd through 5th MTPs was comparable with that in group NS; however, it was significantly lower than that in group HC.

DOI： 10.1080/14397595.2019.1680094

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objectives: The aim of this study was to identify the risk factors associated with severe infection in RA patients, with a particular focus on the association of the nutritional status.Methods: We retrospectively analyzed data from 74 patients with RA (male, n = 21; female, n = 53; age 74.2 ± 12.4) admitted to our hospital between 2016 and 2017 for infection (infection group). We also recruited control RA patients (n = 222) who were matched for age, gender and disease duration, with a match ratio of 1:3 (non-infection group). The nutritional condition was assessed based on controlling nutrition status (CONUT) score, and prognostic nutritional index (PNI). The data of the infection group were obtained from the most recent visit prior to the present admission, and non-infection group from the last regular visit in 2017.Results: The respiratory tract was the most frequent site of infection. The BMI and PNI were significantly lower and the CONUT score significantly higher in the infection group than in the non-infection group. A logistic regression analysis revealed that the CONUT score, underlying lung disease and use of prednisolone and biological disease-modifying anti-rheumatic drugs were independent and significant risk factors for serious infection.Conclusion: Poor nutritional status increases the risk of serious infection.

DOI： 10.1080/14397595.2019.1681653

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/14397595.2020.1823551

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

researchmap

Language：English   Publisher：(一社)日本臨床リウマチ学会  

目的:関節リウマチ(RA)患者における関節オーバーユースの発症状況とリスク因子を調査する。方法:関節に負荷がかかるイベントの後に腫脹もしくは疼痛を生じた患者を関節オーバーユースと定義した。2016年8月から10月に当院外来を受診し関節オーバーユースと診断されたRA患者の患者背景、疾患活動性の変化を調査し、年齢、性別をマッチさせた123名のRA患者と比較しリスク因子を調査した。結果:41名が関節オーバーユースと診断された。Clinical disease activity indexの中央値はオーバーユースにより5.0から9.0に上昇し、オーバーユース後には4.80に低下した。オーバーユースを発症する患者の背景因子をロジスティック回帰分析で検索したところ、生物学的製剤の使用、Health assessment questionnaire disability index(HAQ-DI)が低値であること、Steinbrocker Stage III、IVであること(各々Odds ratio 3.10、95% confidence interval 1.24-7.76;0.27(0.09-0.80);5.90(2.28-15.2))が抽出された。結論:生物学的製剤使用者、HAQ-DI低値患者、Stage進行患者はオーバーユースを発症しやすく、患者教育が重要となる可能性がある。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Hepcidin, a major regulator of iron metabolism and homeostasis, is regulated by inflammation. Recent studies have suggested that hepcidin and iron metabolism are involved in osteoporosis, and the aim of this study was to determine whether serum hepcidin levels are correlated with the degree of osteoporosis in patients with rheumatoid arthritis (RA). A total of 262 patients with RA (67.5 ± 11.4 years; 77.5% female) were enrolled. Serum iron, ferritin, and hepcidin levels were positively correlated each other. Multiple regression analyses revealed that the serum iron level was positively correlated with femoral T and Z scores, whereas the serum hepcidin level was not. Serum hepcidin level was correlated with the serum 25-hydroxy vitamin D level, which was in turn positively related to the femoral Z score. Serum hepcidin and serum iron were indirectly and directly related to osteoporosis in patients with RA.

DOI： 10.1038/s41598-020-66945-3

PubMed

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objective To investigate the clinical outcomes of rheumatoid arthritis (RA) patients who discontinued infliximab (IFX) treatment at our hospital. Methods Among 249 patients receiving IFX from 2007 to 2015, we retrospectively investigated the clinical courses of 18 who discontinued IFX after achieving the 28-joint disease activity score based on the erythrocyte sedimentation (DAS28-ESR) clinical remission (CR) and whose clinical courses were available continuously for 96 weeks after discontinuation. Results At IFX introduction, the median age was 56.9 (range 36.1-72.4) years, and the disease duration was 5.2 (0.4-25.6) years. The median duration of maintaining either CR or a low disease activity (LDA) with IFX was 37.2 (4.0-91.4) months, and the total duration of IFX therapy was 45.8 (17.1-96.9) months. After discontinuation, 8 patients (44.4%) maintained CR/LDA for 96 weeks (no-flare group), and 10 (55.6%) experienced flares (DAS28-ESR≥3.2) within 96 weeks (flare group). In the no-flare group, six patients receiving intensified conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy to prevent flare ups simultaneously either with or immediately after discontinuing IFX. In the flare group, four patients received intensified csDMARD therapy. Six patients restarted biological DMARDs (bDMARDs), and all achieved CR again. Ultimately, 12 patients (66.7%) maintained a Bio-free disease control for 96 weeks. A comparison of the clinical backgrounds between the flare and no-flare groups showed no marked difference in their disease duration, IFX dosage, duration of maintaining CR with IFX, or concomitant csDMARDs use. Conclusion Irrespective of the RA disease duration, more than half of all patients maintained a Bio-free condition for 96 weeks. Continuing LDA with IFX for a sufficiently long period of time before discontinuation and preventive intensification of csDMARD therapy may help maintain a Bio-free condition.

DOI： 10.2169/internalmedicine.3934-19

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Treatment of systemic lupus erythematosus (SLE) often continues with moderate-to-low doses of glucocorticoids for the long term. Bisphosphonates aid in the prevention and management of glucocorticoid-induced osteoporosis (GIOP). However, long-term use of bisphosphonates increases the relative risk of atypical femoral fracture (AFF) and the incidence is typically 16 or 113 per 100,000 person-years in patients treated with bisphosphonates for 5 or 10 years, respectively. Here, we explored bisphosphonate prescription rate and prevalence of AFF in patients with SLE. In total, 270 patients with SLE were enrolled. The Japanese Society for Bone and Mineral Research Guideline 2014 for GIOP management and treatment was used. We also explored AFF history through medical records. Most (n = 251) patients were recommended to treat by the GIOP guideline (scores ≥ 3); bisphosphonates, denosumab, teriparatide, or active vitamin D was prescribed for 85.7%. Bisphosphonates were currently used by 66.1% of the patients, and 65% had used them for ≥ 5 years. Of all patients, 76.7% had a history of bisphosphonate use, 5 of 270 (1.9%) had histories of AFF. Four of five patients with AFF had taken bisphosphonates for ≥ 3.5 years, in addition to moderate doses (≥ 10 mg/day) of glucocorticoids. For the SLE patients with a history of bisphosphonate use, the incidence of AFF was calculated to be 278 per 100,000 person-years. Our single-center study found that bisphosphonates were commonly used long term by Japanese patients with SLE. As AFF is not rare, AFF should be cared in patients with SLE.

DOI： 10.1007/s00296-019-04407-4

PubMed

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00990&link_issn=&doc_id=20200819040006&doc_link_id=%2Fdg3nigta%2F2019%2Fs13309%2F001%2F0349-0349%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2019%2Fs13309%2F001%2F0349-0349%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Haploinsufficiency of A20 (HA20) is caused by loss-of-function TNFAIP3 variants. Phenotypic and genetic features of HA20 remain uncertain; therefore, the clinical distinction between HA20 and Behçet's disease (BD) requires clarification. METHODS: We have collected 12 Japanese BD-like families. Probands of these families were analyzed by whole exome sequencing (WES) and subsequent Sanger sequencing. Clinical features were compared between 54 HA20 patients (including previously reported and new cases) and 520 Japanese BD patients. RESULTS: We identified c.1434C>A:p.(Cys478*) in one family and a 236 kb deletion at 6q23.3 containing TNFAIP3 in another family. Four HA20 patients in the two families presented with childhood-onset recurrent oral and genital ulcers and were initially diagnosed and treated as BD. Consistent with the clinical features of HA20, recurrent, refractory fever attacks (three of four patients), and digestive ulcers (two of the four patients) were observed. A comparison of clinical features between HA20 patients and cohorts of BD patients revealed several critical features specific to HA20. These were early-onset, familial occurrence, recurrent fever attacks, gastrointestinal involvement, and infrequent ocular involvement. CONCLUSIONS: We identified a novel nonsense variant and deletion of the entire TNFAIP3 gene in two unrelated Japanese HA20 families. Genetic screening of TNFAIP3 should be considered for familial BD-like patients with early-onset recurrent fevers.

DOI： 10.1186/s13075-019-1928-5

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To clarify systemic effects of orthopedic surgical intervention in patients with rheumatoid arthritis (RA). METHODS: A prospective observational cohort study was performed in RA patients who were scheduled to have primary elective orthopedic surgeries. Assessments were performed at baseline, 6 and 12 months after surgery using J-HAQ, General Health, EQ-5D, BDI-II, DAS28-CRP(4) and CRP for all registered patients, DASH and grip power for patients with upper-extremity surgeries, TUG for patients with lower-extremity surgeries, and JSSF for patients with ankle and forefoot surgeries. RESULTS: There were 294 sites in 276 patients whose average age was 64 (19-89) years and average disease duration was 16 (1-60) years. Surgical site was shoulder in six patients, elbow in 26, wrist in 74, hand in 63, hip in 13, knee in 50, ankle in 12, and forefoot in 50. In total, physical function (J-HAQ, grip power, DASH, TUG, JSSF), quality of life (J-HAQ, General Health, EQ-5D) and depression (BDI-II) improved and disease activity (CRP, DAS28-CRP(4)) decreased significantly 6 and 12 months after surgery (p<.01), despite some differences in their outcomes by the preoperative disease activity and the surgical site. CONCLUSION: Overall benefits were provided by orthopedic surgical intervention generally in patients with RA.

DOI： 10.1080/14397595.2018.1457468

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objectives The present study was performed with the aim of analyzing the biological disease-modifying antirheumatic drug (bDMARD)-free (Bio-free) condition of adalimumab (ADA)-treated rheumatoid arthritis (RA) patients in a real-world setting. Methods ADA was used in the treatment of 130 (male, n=21; female, n=109 females) RA patients. Among them, 26 patients (20.0%) discontinued ADA due to a good response. We analyzed 20 patients who were followed up for more than 6 months after the discontinuation of ADA. The Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and modified health assessment questionnaires (mHAQs) were evaluated. Results The mean age of the patients was 53.4±11.1 years. The mean disease duration was 4.5±4.3 years. Sixteen patients were bDMARD-naïve, while 4 switched from bDMARDs to ADA. At 6 months after the discontinuation ADA, 19 patients had achieved a clinical remission, and 1 had achieved a low disease activity. The Bio-free period was 26.4±15.5 months. The dose of prednisolone was significantly reduced from baseline (3.45±3.17 mg/day) at 6 months after the discontinuation of ADA (2.63±2.78 mg/day). The dose of methotrexate was unchanged. The number of conventional synthetic DMARDs (csDMARDs) was significantly increased (0.8±0.6 to 1.4±1.06). The mHAQ values were significantly ameliorated by ADA and remained good in patients with a Bio-free condition. A multivariate analysis showed that the dose of methotrexate (MTX) was an important factor for achieving a Bio-free condition. Conclusion A sustainable Bio-free condition in a real clinical setting can be achieved and may be a suitable way of reducing medical costs. The dose of MTX and the additional administration of csDMARDs is therefore thought to be important for ensuring a good outcome in these patients.

DOI： 10.2169/internalmedicine.1332-18

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with rheumatoid arthritis (RA) often have reduced muscle mass. Estimated glomerular filtration ratio using the serum cystatin C concentration (eGFRcys) is more accurate than eGFR using the serum creatinine (eGFRcreat) because cystatin C is not influenced by muscle mass, but glucocorticoid therapy may affect serum cystatin C concentration. METHODS: Fifty patients with RA were included in this study. Renal inulin clearance (Cin) was measured and compared with eGFRcreat, eGFRcys, or the mean of eGFRcreat and eGFRcys (eGFRavg). RESULTS: The mean creatine kinase (CK) concentration was low (36.8 ± 24.4 U/l).The eGFRcreat and eGFRcys regression lines were significantly different from y = x. The mean eGFRcreat value was significantly higher than Cin and that of eGFRcys was lower than Cin. The difference between eGFRcys and Cin was negatively correlated with daily PSL dose. The mean eGFRcys value of patients taking <10 mg PSL was not different from Cin and the eGFRcys regression line was not different from y = x. CONCLUSION: eGFRcys of patients taking a daily PSL dose ≥10 mg was inaccurate, while eGFRcys was underestimated. eGFRcys was more accurate than eGFRcreat or eGFRavg for patients taking a daily PSL dose of <10 mg.

DOI： 10.1016/j.cca.2018.10.022

PubMed

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00990&link_issn=&doc_id=20200130080004&doc_link_id=%2Fdg3nigta%2F2018%2Fs13211%2F001%2F0397-0397%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2018%2Fs13211%2F001%2F0397-0397%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

AIM: A retrospective questionnaire survey was conducted to investigate the long-term outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA). METHODS: One hundred and thirteen RA patients underwent primary elective elbow, wrist or hand surgery at our hospital between January 2002 and December 2003. To evaluate the outcomes at 10 years after surgery, the patient-reported outcomes were assessed using an original questionnaire that inquired about the site of treatment; the modified Stanford Health Assessment Questionnaire (mHAQ) was also used. RESULTS: Responses were obtained from 67 patients (98 sites). In the 10 years after surgery, the Disease Activity Score of 28 joint - erythrocyte sedimentation rate (4) and the modified Health Assessment Questionnaire scores of the patients showed significant improvement. Nearly 85% of patients were satisfied with the outcome at the surgical site. The most frequent reason for perceived improvement was 'pain relief' (all surgical sites). An 'improved appearance' was frequently reported after finger surgery and 'increased power' was frequently reported after wrist and thumb surgeries. With regard to elbow surgery, 30% of the patients were satisfied with the increase in motion and power. In contrast, approximately 20% of patients complained of decreased power around the surgical site after elbow and thumb surgeries. CONCLUSIONS: Our original patient-reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long-lasting benefits in RA patients. While the efficacy differed in some of the surgical sites, pain relief was the most favorable effect. Altered medical therapy may also have impacted the patient-perceived outcomes of surgery at 10 years.

DOI： 10.1111/1756-185X.13340

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objective To investigate the efficacy of minodronate in the treatment of glucocorticoid-induced osteoporosis (GIO). Methods The study population included patients in whom the administration of minodronate (50 mg, once every 4 weeks) had been newly started for the treatment of GIO in Niigata Rheumatic Center from 2012 to 2015. Patients who were bisphosphonate-naïve and those who switched from other bisphosphonates were classified into the naïve and switch groups, respectively. The changes in the bone mineral density (BMD) and bone metabolic markers after one year of minodronate treatment were retrospectively evaluated. We also compared the BMD and bone turnover marker changes of minodronate-naïve patients with those in whom alendronate or risedronate had been prescribed as a first bisphosphonate (control group). Results Minodronate was prescribed to 142 patients, and data were successfully obtained from 120 patients. New vertebral fractures were observed in 5 of the 142 patients; 1 fracture occurred during the cessation of minodronate for dental treatment, and 3 patients already had multiple vertebral fractures before the initiation of minodronate. The patients' tartrate-resistant acid phosphatase 5b (TRACP-5b) (-27.0%, p<0.001) and bone alkaline phosphatase (BAP) (-15.7%, p<0.01) levels were decreased, but no patients showed a decrease to below the normal range. One year of treatment with minodronate significantly increased the lumbar BMD in the naïve (+3.9%, p<0.001) and switch (+2.3%, p<0.001) groups. Although the femoral BMD did not change to a significant extent overall, the patients with a low young adult mean (YAM) (<80%) at baseline showed a significant increase in their femoral BMD (+2.1%, p=0.034) values. Compared with the control group, the minodronate-naïve group showed a significant decrease in the TRACP-5b levels and a significant increase in the lumbar BMD. Conclusion The administration of minodronate appears to be an effective treatment for GIO.

DOI： 10.2169/internalmedicine.9885-17

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The intensification of infliximab (IFX) treatment, involving escalation of the dose and shortening of interval, was approved in Japan in July 2009. We consider IFX intensification therapy to be preferable for patients with treatment-resistant active rheumatoid arthritis (RA). We retrospectively compared the efficacy of IFX with that of other bDMARDs in methotrexate (MTX)-resistant patients. METHODS: Patients who satisfied the following criteria were enrolled: (i) those who started bDMARDs between February 2011 and December 2016, and (ii) those who required bDMARDs after 180 d of MTX treatment. We compared 33 patients who had been treated with IFX (IFX group) and 146 who had received other bDMARDs treatment (non-IFX group). RESULTS: IFX was administered at a dose of 6.98 mg/kg/8-week equivalent at 52 weeks. Clinical disease activity index clinical remission (CDAI-CR) was achieved in 49 of the 179 patients at 52 weeks and 13 of these 49 patients received IFX. Logistic regression analysis showed that treatment with IFX was an important variable for the achievement of CDAI-CR at 52 weeks (odds ratio 2.69, 95% confidence interval 1.13-6.42). The severity and frequency of adverse events did not differ. CONCLUSION: Intensification of IFX was effective and well tolerated for MTX resistant patients.

DOI： 10.1080/14397595.2017.1380250

PubMed

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00990&link_issn=&doc_id=20190531080006&doc_link_id=%2Fdg3nigta%2F2018%2Fs13207%2F001%2F0281-0281%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2018%2Fs13207%2F001%2F0281-0281%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Objective To analyze the neuropathic pain (NeP) components in patients with rheumatoid arthritis (RA). Methods The painDETECT questionnaire (PD-Q) was completed by 300 RA patients (79 men, 221 women). Results Nine patients (3.0%) were categorized as likely NeP, 33 (11.0%) were categorized as possible NeP, and 258 (86.0%) were categorized as unlikely NeP. When we excluded patients with diabetes mellitus, spinal diseases, neurological diseases, and herpes zoster infection (conditions associated with NeP), 5 of the patients (1.7%) had likely NeP, and 23 (7.7%) had possible NeP without any underlying conditions. Furthermore, there were no marked differences in the percentages of these underlying conditions among the patients with likely, possible, and unlikely NeP. When we compared patients with likely and possible NeP (n=42) and unlikely NeP (n=258), the body mass index (BMI), disease activity score-28 based on the erythrocyte sedimentation rate, C-reactive protein level, pain visual analogue scale (VAS), and PD-Q score were significantly higher in the patients with likely and possible NeP than in those with unlikely NeP. A multivariate analysis showed that BMI ≥22 and not being in clinical remission were associated with NeP. Conclusion Although RA pain has usually been classified as nociceptive pain, the present study clarified that a significant number of patients might have NeP. The present findings suggest that high disease activity and being overweight are related to NeP in RA patients.

DOI： 10.2169/internalmedicine.9235-17

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

AIM: To investigate the clinical course of patients with elderly-onset rheumatoid arthritis (RA). METHODS: We compared the characteristics, and clinical course of 55 patients who developed RA at over 80 years of age (elderly-onset [EO] group) with 119 patients who developed RA at 40-59 years of age (non-elderly onset [non-EO] group). We also investigated the characteristics and clinical course of 19 patients who developed RA at over 80 and who received biological disease-modifying anti-rheumatic drugs (bDMARDs). RESULTS: The mean DAS28-ESR (DAS) and HAQ-DI (HAQ) of the EO were significantly higher in comparison to the non-EO group (4.91±1.31 vs 4.41±1.47, p=0.043, 1.2±0.9 vs 0.5±0.6, p<0.01). For the first treatment, 87.3% in the EO group received conventional synthetic DMARDs (csDMARDs), none received MTX. The rate of prednisolone (PSL) administration in the EO group was significantly higher than the non-EO group (56.4% vs 30.3%, p<0.01). The DAS and HAQ were significantly decreased in both groups, while the HAQ of the EO group was higher than the non-EO group. The decrease in DAS and HAQ of the PSL users was significantly greater than the non-PSL users (ΔDAS: 2.55±1.83 vs 1.83±1.23, p<0.01, ΔHAQ: 0.9±1.0 vs 0.3±0.6, p=0.027). Among the 19 patients with bDMARDs, the mean DAS and HAQ at baseline were significantly decreased 6 months later. CONCLUSION: Early use of csDMARDs and PSL was effective for functional disability of elderly-onset RA; however, some of them required bDMARDs. Further study should be performed to investigate the effectiveness of the early induction of MTX and bDMARDs.

DOI： 10.3143/geriatrics.55.251

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The objective of this study is to clarify the surgical indication for rheumatoid forefoot deformity according to background characteristics and plantar pressure. METHODS: Patients with rheumatoid arthritis were divided into a non-surgical group (group N) and a surgical group (group S). The former consisted of 225 ft, and the latter consisted of 88 ft. DAS28, Japanese Society for Surgery of the Foot rheumatoid arthritis foot and ankle scale (JSSF scale) and hallux valgus angle (HVA) were evaluated as background characteristics. Distribution of peak pressure as plantar pressure was measured in nine sections. RESULTS: In groups N and S, the mean DAS28 was 3.6 and 3.0, the mean JSSF scale was 81.1 and 63.0, and the mean HVA was 19.9° and 35.3°, respectively. The mean peak pressure of group S at the first and third metatarsophalangeal joints was significantly higher compared with group N. Significant differences between the two groups were also seen in Δ pressure (the difference between the maximum and minimum peak pressure values). The cut-off values were 75.0 for JSSF scale, 24.9° for HVA and 3.94 kg/cm2 for Δ pressure. CONCLUSIONS: The combined assessment of HVA and Δ pressure was found to be useful as an indication for surgical treatment of the forefoot.

DOI： 10.1080/14397595.2017.1301015

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To determine whether serum immunity to Porphyromonas gingivalis peptidylarginine deiminase (PPAD) affects the clinical response to biological disease-modifying antirheumatic drug (bDMARD) in patients with rheumatoid arthritis (RA). METHODS: In a retrospective study, rheumatologic and periodontal conditions of 60 patients with RA who had been treated with conventional synthetic DMARD were evaluated before (baseline) and after 3 and 6 months of bDMARD therapy. After serum levels of anti-PPAD immunoglobulin G (IgG) were determined at baseline, the patients were respectively divided into two groups for high and low anti-PPAD IgG titers according to the median measurements. Genotypes at 8 functional single nucleotide polymorphisms (SNPs) related to RA were also determined. RESULTS: After 3 and 6 months of therapy, patients with low anti-PPAD IgG titers showed a significantly greater decrease in changes in the Disease Activity Score including 28 joints using C-reactive protein (DAS28-CRP) (P = 0.04 for both) and anti-cyclic citrullinated peptide (CCP) IgG levels (P = 0.03 and P = 0.04) than patients with high anti-PPAD IgG titers, although these parameter values were comparable at baseline. The anti-PPAD IgG titers were significantly positively correlated with changes in the DAS28-CRP (P = 0.01 for both) and the anti-CCP IgG levels (P = 0.02 for both) from baseline to 3 and 6 months later. A multiple regression analysis revealed a significantly positive association between the anti-PPAD IgG titers and changes in the DAS28-CRP after 6 months of bDMARD therapy (P = 0.006), after adjusting for age, gender, smoking, periodontal condition, and RA-related SNPs. CONCLUSION: The serum IgG levels to PPAD affect the clinical response to bDMARD in patients with RA.

DOI： 10.1371/journal.pone.0154182

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN SOC INTERNAL MEDICINE  

Objective Our objective was to examine the safety and effects of therapy with biologics on the prognosis of rheumatoid arthritis (RA) patients with reactive amyloid A (AA) amyloidosis on hemodialysis (HD).
Methods Twenty-eight patients with an established diagnosis of reactive AA amyloidosis participated in the study. The survival was calculated from the date of HD initiation until the time of death, or up to end of June 2015 for the patients who were still alive. HD initiation was according to the program of HD initiation for systemic amyloidosis patients associated with RA.
Results Ten patients had been treated with biologics before HD initiation for a mean of 28.2 months (biologic group), while 18 had not (non-biologic group). HD was initiated in patients with similar characteristics except for the tender joint count, swollen joint count, and disease activity score (DAS) 28-C-reactive protein (CRP). History of biologics showed that etanercept was frequently used for 8 patients as the first biologic. There was no significant difference in the mortality rate according to a Kaplan-Meier analysis (p=0.939) and or associated risk of death in an age-adjusted Cox proportional hazards model (p=0.758) between both groups. Infections were significantly more frequent causes of death in the biologic group than in the nonbiologic group (p=0.021). However, treatment with biologics improved the DAS28-CRP score (p=0.004).
Conclusion Under the limited conditions of AA amyloidosis treated with HD, the use of biologics might affect infection and thus may not improve the prognosis. Strict infection control is necessary for the use of biologics with HD to improve the prognosis.

DOI： 10.2169/internalmedicine.55.6941

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Interleukin-6 (IL-6) may play a pathological role in rheumatoid arthritis (RA) and periodontitis. Although the efficacy of medication with IL-6 receptor inhibitor, tocilizumab (TCZ), has been demonstrated in the treatment of RA, very little is known about whether TCZ therapy affects periodontitis. The aim of the present study is to compare periodontal condition in patients with RA and periodontitis before and after TCZ therapy. The study participants consisted of 20 patients with RA and periodontitis who were treated with TCZ and 40 patients with RA and periodontitis who received medication with tumor necrosis factor inhibitor (TNFI). Clinical periodontal and rheumatologic assessments and serum biochemical measurements using enzyme-linked immunosorbent assays were performed at baseline and 3 and 6 months later. TCZ and TNFI therapies significantly reduced periodontal inflammation that was determined by gingival index, bleeding on probing, and probing depth (p < 0.017), although plaque levels were comparable before and after the therapies. Both therapies also significantly decreased disease activity score including 28 joints using C-reactive protein (CRP), number of tender and swollen joints, and serum levels of anti-cyclic citrullinated peptide antibodies, rheumatoid factor, CRP, and matrix metalloproteinase-3 (p < 0.017). Additionally, a significant decrease was observed in periodontal clinical attachment level after TCZ therapy (p < 0.017), but not after TNFI therapy. TCZ therapy significantly decreased serum levels of TNF-α, total immunoglobulin G, and serum amyloid A (p < 0.017), although serum levels of IL-6 and soluble IL-6R were significantly increased (p < 0.017). These results suggest a beneficial effect of TCZ therapy on levels of periodontal inflammation in patients with RA and periodontitis, which might be related to decrease in serum inflammatory mediators.

DOI： 10.1002/cre2.11

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The aim of this study was to analyze the efficacy of adalimumab (ADA) in patients with rheumatoid arthritis treated with or without methotrexate (MTX) and determine impact of the MTX dose. METHODS: Pearson's product-moment correlation coefficient was used to assess the correlations between the improvement in the Disease Activity Score (DAS) 28- erythrocyte sedimentation rate (ESR) score and the MTX dose in patients receiving treatment with MTX at a dose of <8 mg/week, 8 mg/week and >8 mg/week. PATIENTS: ADA therapy was initiated in 68 rheumatoid arthritis patients between July 2008 and June 2013. The mean MTX dose was 9.6 ± 2.6 mg/week, and the patients were followed for 24 weeks. RESULTS: The mean DAS28-ESR scores at baseline and week 24 were 4.6 ± 1.3 and 2.7 ± 1.2 in the 60 patients treated with MTX and 4.5 ± 1.0 and 4.2 ± 1.5 in the eight patients treated without MTX, respectively. Clinical remission was achieved in 48% and 25% of the patients, respectively, by week 24. Moreover, 90.0% of the patients taking MTX continued to receive ADA until week 24, while 50.0% of the patients not taking MTX continued to receive ADA until week 24. Among the 35 patients receiving MTX at a dose of >8 mg/week, the DAS28-ESR scores decreased rapidly from 4.4 ± 1.2 at baseline to 3.2 ± 1.1 at week 4 and further decreased to 2.4 ± 1.0 at week 24. Meanwhile, clinical remission was achieved in 57% of the patients receiving MTX at a dose of >8 mg/week and 36% of those receiving MTX at a dose of ≤8 mg/week. A significant correlation was noted between the improvement in the DAS-ESR score and the MTX dose. CONCLUSION: In this study population, enhanced clinical efficacy of ADA was achieved in combination with the administration of a sufficient dose of MTX, determined to be >8 mg/week.

DOI： 10.2169/internalmedicine.54.4085

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Although biological agents are of considerable benefit to patients with rheumatoid arthritis (RA), the potential for opportunistic infections is a critical issue. It is therefore important to achieve a balance between treatment efficacy and controlling opportunistic infection. We herein report the successfully managed case of a 53-year-old patient with RA who developed pulmonary Mycobacterium abscessus infection during treatment with tocilizumab and methotrexate.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

There have been many previously reported cases of adult-onset Still's disease (AOSD) which were successfully treated with tocilizumab (TCZ). However, the efficacy and safety of TCZ therapy for AOSD-associated macrophage activation syndrome (MAS), and the optimal duration of TCZ therapy, remain unclear. We herein report two cases of refractory AOSD, one of which was associated with MAS. These two patients were treated with TCZ, and the withdrawal of TCZ was planned according to the serum interleukin-6 level, which resulted in TCZ-free remission.

DOI： 10.2169/internalmedicine.54.4935

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Tumor necrosis factor (TNF)-α inhibitor has been shown to affect the periodontal condition of patients with rheumatoid arthritis (RA). The aim of the present study is to assess the effect of a fully humanized anti-TNF-α monoclonal antibody, adalimumab (ADA), on the periodontal condition of patients with RA and to compare serum protein profiles before and after ADA therapy. METHODS: The study participants consisted of 20 patients with RA treated with ADA. Clinical periodontal and rheumatologic parameters and serum cytokine levels were evaluated at baseline and 3 months later. Serum protein spot volume was examined with two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis. Proteins with significant difference in abundance before and after ADA therapy were found and identified using mass spectrometry and protein databases. RESULTS: The patients showed a significant decrease in gingival index (P = 0.002), bleeding on probing (P = 0.003), probing depth (P = 0.002), disease activity score including 28 joints using C-reactive protein (P <0.001), and serum levels of TNF-α (P <0.001) and interleukin-6 (P <0.001) after ADA medication, although plaque levels were comparable. Among a total of 495 protein spots obtained, nine spots were significantly decreased in abundance at reassessment, corresponding to complement factor H, phospholipase D, serum amyloid A, complement component 4, and α-1-acid glycoprotein (P <0.01). CONCLUSION: These results suggest a beneficial effect of ADA therapy on the periodontal condition of patients with RA, which might be related to differences in serum protein profiles before and after ADA therapy.

DOI： 10.1902/jop.2014.140194

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Multiple sclerosis is a relatively rare disease, and complications of multiple sclerosis and rheumatoid arthritis are much rarer. Since anti-tumor necrosis factor therapy increases exacerbations of multiple sclerosis, complications of demyelinating diseases contraindicate anti-tumor necrosis factor therapy. There have been few reports of anti-interleukin-6 receptor therapy for patients with rheumatoid arthritis complicated with multiple sclerosis. CASE PRESENTATION: A 53-year-old Japanese woman with multiple sclerosis and rheumatoid arthritis was admitted to our hospital because her rheumatoid arthritis was uncontrolled with oral methotrexate, tacrolimus, and prednisolone. She had developed multiple sclerosis when she was 25 years old and was treated with glucocorticoid therapy. Her multiple sclerosis was in remission for more than 9 years. Because anti-tumour necrosis factor therapy can exacerbate demyelinating disease, the anti-interleukin-6 receptor antibody tocilizumab was started at 8 mg/kg every 4 weeks. At the second administration of tocilizumab, complete remission was achieved. She has remained in remission with tocilizumab without recurrence of multiple sclerosis for more than 5 years. CONCLUSION: Anti-interleukin-6 therapy was safely used in this patient with rheumatoid arthritis without exacerbations of multiple sclerosis.

DOI： 10.1186/1756-0500-7-641

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Overproduction of interleukin (IL)-6 may play a pathologic role in rheumatoid arthritis (RA) and chronic periodontitis (CP). The present study assesses IL-6 receptor (IL-6R) inhibition therapy on the periodontal condition of patients with RA and CP. METHODS: The study participants were 28 patients with RA and CP during treatment with IL-6R inhibitor, and 27 patients with RA and CP during treatment without IL-6R inhibitor. Periodontal and rheumatologic parameters and serum levels of cytokine and inflammatory markers and immunoglobulin G against periodontopathic bacteria were examined after medication with IL-6R inhibitor for 20.3 months on average (T1) and again 8 weeks later (T2). RESULTS: No differences were observed between the groups in any parameter values at T1, except for serum IL-6 levels. The anti-IL-6R group showed a significantly greater decrease in gingival index, bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and serum levels of IL-6 and matrix metalloproteinase (MMP)-3 from T1 to T2 than the control group (P <0.05). A significant correlation was found between changes in serum anticyclic citrullinated peptide levels and those in PD and CAL in the anti-IL-6R group (P <0.05), whereas both groups exhibited a significant association between changes in serum MMP-3 levels and those in BOP (P <0.05). CONCLUSION: Changes in periodontal and serum parameter values were different between the patients with RA and CP during treatment with and without IL-6R inhibitor.

DOI： 10.1902/jop.2013.120696

PubMed

researchmap

Language：Japanese   Publisher：日本リウマチの外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We report an intriguing case of Epstein-Barr virus (EBV)-related multiple lymphadenopathy that clinically mimics immunoglobulin G4-related disease (IgG4-RD). A 72-year-old woman presented with a history of asthma attacks, systemic lymphadenopathy, hypergammaglobulinemia, proteinuria, and an elevated level of serum IgG4, leading to a possible diagnosis of IgG4-RD based on current comprehensive diagnostic criteria. However, a percutaneous kidney biopsy specimen showed mild mesangial proliferative glomerulonephritis with focal membranous transformation, and there was no interstitial lesion or lymphocyte infiltration. Cervical lymph node biopsy demonstrated follicular hyperplasia associated with prominent lymphoplasmacytic infiltration in the interfollicular area. However, only a few IgG4-positive plasma cells were present. An in situ hybridization study demonstrated many EBV-infected lymphocytes in the germinal center as well as in the interfollicular area. This case illustrates the diversity of conditions associated with elevated levels of serum IgG4 and the necessity for tissue biopsy when diagnosing IgG4-RD.

DOI： 10.1007/s10165-012-0695-9

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We report a case of orbital tumor and hypertrophic cranial pachymeningitis in a 64-year-old woman, who was initially suspected to have IgG4-related disease because of an elevated level of serum IgG4 at onset. However, her condition was resistant to glucocorticoid therapy, and additional cyclophosphamide was necessary to control the disease activity. Additional features included elevated levels of serum myeloperoxidase (MPO) and proteinase-3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and biopsy specimens from the orbital mass revealed very few infiltrating IgG4-positive cells. Instead, rupture of the elastic layer of the arterial walls with neovascularization and a small number of giant cells were observed. Considering these findings and the clinical course, the disease was considered more likely to be ANCA-associated pachymeningitis with elevation of the serum IgG4 level.

DOI： 10.1007/s10165-012-0613-1

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

The kidney is a major target organ for systemic amyloidosis, resulting in proteinuria and an elevated serum creatinine level. In patients with reactive amyloidosis associated with rheumatoid arthritis, a correlation between the amount of amyloid deposits and clinical parameters is not known. The purpose of this study was to clarify the association between various factors including renal function and the area of amyloid deposition in these patients. Fifty-eight patients with an established diagnosis of reactive AA amyloidosis were studied. We retrospectively investigated the correlation between clinical data and the area occupied by amyloid in renal biopsy specimens. All the patients showed amyloid deposits in renal tissues, and the percentage of the area occupied by amyloid was <10% in 54 of them. Mesangial proliferative glomerulonephritis and membranous nephropathy were frequently combined with renal amyloidosis. For statistical analyses, the percentage of the area occupied by amyloid was transformed to a common logarithmic value (Log(10) % amyloid), as the histograms showed a log-normal distribution. Log(10) % amyloid was found to be correlated with age, creatinine (Cr) level, creatinine clearance (Ccr), blood urea nitrogen (BUN) level, and the estimated glomerular filtration rate (eGFR). Multiple linear regression analyses were then performed to examine the sex- and age-adjusted association between Log(10) % amyloid and each of the clinical variables. Cr, Ccr, BUN, UA, CRP, and eGFR were significantly correlated with Log(10) % amyloid, but urinary protein was not. There was a significant correlation between the area of amyloid deposition in renal tissue and parameters of renal function, especially Cr and Ccr. If amyloid deposition in renal tissue can be arrested or prevented, then it may be possible to maintain renal function at an acceptable level.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The kidney is a major target organ for systemic amyloidosis that often affects the kidney including proteinura, and elevated serum creatinine (Cr). The correlation between amount of amyloid deposits and clinical parameters is not known. The aim of this study was to clarify correlation the amyloid area in all renal biopsy specimen and clinical parameters. METHODS: Fifty-eight patients with an established diagnosis of AL amyloidosis participated in the study. All patients showed amyloid deposits in renal biopsies. We retrospectively investigated the correlation between clinical data and amyloid occupied area in whole renal biopsy specimens. RESULTS: The area occupied by amyloid was less than 10% in 57 of the 58 patients, and was under 2% in 40. For statistical analyses, %amyloid-positive areas were transformed to common logarithmic values (Log10%amyloid). Cr showed significant correlation with Log10%amyloid and estimated glomerular filtration rate (eGFR) showed the significant negative correlation. Patient age, cleatinine clearance (Ccr), blood urea nitorogen, and urinary protein was not significantly correlated with Log10%amyloid. The correlation with other clinical factors such as sex, and serum concentrations of total protein, albumin, immunoglobulins, compliments was evaluated. None of these factors significantly correlated with Log10%amyloid. According to sex- and age- adjusted multiple linear regression analysis, Log10%amyloid had significant positive association with Cr and significant negative association with eGFR. CONCLUSION: There is significant association between amyloid-positive area in renal tissue and renal function, especially Cr and eGFR. The level of Cr and eGFR may be a marker of amount of amyloid in renal tissue.

DOI： 10.1186/1471-2369-13-118

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Reactive amyloid A (AA) amyloidosis is a serious and life-threatening systemic complication of rheumatoid arthritis (RA). We evaluated the safety of therapy with anti-tumor necrosis factor and anti-interleukin 6 biologic agents in RA patients with reactive AA amyloidosis, together with prognosis and hemodialysis (HD)-free survival, in comparison with patients with AA amyloidosis without such therapy. METHODS: One hundred thirty-three patients with an established diagnosis of reactive AA amyloidosis participated in the study. Clinical data were assessed from patient records at the time of amyloid detection and administration of biologics. Survival was calculated from the date when amyloid was first demonstrated histologically or the date when biologic therapy was started until the time of death or to the end of 2010 for surviving patients. Patients who had started HD were selected for inclusion only after the presence of amyloid was demonstrated. RESULTS: Fifty-three patients were treated with biologic agents (biologic group) and 80 were not (nonbiologic group). Survival rate was significantly higher in the biologic group than in the nonbiologic group. Nine patients in the biologics group and 33 in the nonbiologic group started HD. Biologic therapy had a tendency for reduced risk of initiation of HD without any statistical significance. CONCLUSION: Patients with amyloidosis have a higher mortality rate, but the use of biologic agents can reduce risk of death. The use of biologics may not significantly influence the HD-free survival rate.

DOI： 10.3899/jrheum.111453

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

In this report, we describe a case of a 48-year-old Japanese woman who is a hepatitis B (HB) carrier with rheumatoid arthritis (RA). She had the following antibody profile: HBs Ag(+), HBs Ab(-), HBe Ag(-), HBe Ab (+), HBc Ab(-) and undetectable HBV-DNA level. She was treated with auranofin, salazosulfapyridine, and bucillamine. Finally, she was treated with D: -penicillamine, but her disease activity remained elevated. Prophylactic treatment of entecavir 0.5 mg daily was started in March 2008 and all disease-modifying anti-rheumatic drugs were stopped. After 2 weeks, etanercept monotherapy was started at 25 mg subcutaneously once a week. Significant improvement in clinical parameters of disease activity and well being was observed. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and HB virus viral load did not change significantly. Serum ALT, AST, and HB virus viral load were followed-up at every 3-month intervals, from initiation of therapy up to 24 months after the start of treatment with etanercept. We have also summarized the course of nine RA patients who received etanercept and were HB carriers or had chronic HB according to our literature search. Based on the results of our study, treatment of these patients with etanercept co-administered with lamivudine or entecavir appears to be safe.

DOI： 10.1007/s00296-009-1344-2

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Our study was aimed to clarify an association between gastrointestinal (GI) amyloid-positive area and various kinds of factors including renal function in reactive amyloidosis associated with rheumatoid arthritis (RA). Twenty-five patients with an established diagnosis of reactive AA amyloidosis participated in the study between January 1989 and December 2009. Each patient satisfied the 1987 American Rheumatism Association criteria for RA. All patients showed amyloid deposits in both of GI and renal tissues. The average amyloid-deposited area was 2.2% in renal tissues and 3.7% in GI tissues although the difference was not statistically significant. Twenty-two patients out of 25 patients showed less than 5% of amyloidosis in renal tissues and nineteen patients showed 5% of amyloidosis in GI tissues. In 5 out of a total of 25 cases, the amyloid-deposited area in GI tissues was lesser than that in renal tissues. Mesangial proliferative glomerulonephritis, thin basement membrane disease (TBMD) and membranous nephropathy were frequently combined with renal amyloidosis. For statistical analyses, renal and GI tissues of % amyloid-positive areas were transformed to common logarithmic values (Log(10)%amyloid), since the histograms showed log-normal distribution. Clinical data were assessed by patient record at the time of GI biopsy. The correlation between Log(10)%GI-amyloid and age, creatinine (Cr), creatinine clearance (Ccr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) were not significantly associated with Log(10)%GI-amyloid in crude correlation analyses and also in sex- and age-adjusted linear regression analyses. Although GI biopsy was not correlated with clinical factors, GI amyloid-positive areas were larger than renal amyloid-positive areas. Endoscopic screening of the upper GI tract is common in Japan, and amyloid-deposited area in GI tissues was sufficient to use for the diagnosis of amyloidosis compared with renal tissues in terms of convenience and sensitivity.

DOI： 10.1007/s00296-010-1719-4

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Reactive amyloidosis is a serious systemic disease in rheumatoid arthritis (RA). Amyloid protein can be deposited in kidneys, heart or gastrointestinal tract leading to organ failure. Renal involvement is a well-known complication in amyloidosis as this may culminate in end-stage renal disease (ESRD). Hemodialysis (HD) is always considered the treatment of choice for such patients; however, the prognosis is usually poor due to a large number of sudden deaths immediately following HD therapy. To circumvent the problem of HD initiation while instituting HD safety, we devised a plan to start HD and compare patient's survival with our previous data. Sixty-three patients were treated with HD. They were categorized according to the initiation of first dialysis. All patients were divided into planned, unplanned and programmed initiation groups. First dialysis that had been initiated as not urgent was considered 'planned' (20 patients). First dialysis that had been performed urgently for life-threatening renal insufficiency was considered 'unplanned' (31 patients). First dialysis that had been initiated as not urgent and according to our dialysis program was considered 'programmed' (12 patients). Survival of these 63 patients from the initiation of HD at 38 days was 75%, at 321 days was 50% and at 1,784 days was 25%. Patients with unplanned initiation of HD showed a significant poor survival compared with those of both planned and programmed initiation. Additionally, patients with planned and programmed initiation of HD showed no significant difference for the patients' survival. Our study demonstrates that patients with amyloidosis have a higher mortality rate. Nevertheless, programmed initiation of HD will improve the prognosis of patients with ESRD. Such possibility needs to be considered in more detail in the future.

DOI： 10.1007/s00296-010-1448-8

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We report a case of Churg-Strauss syndrome (CSS) complicated by severe cardiac failure and peripheral neuropathy. Two courses of methylprednisolone pulse therapy were unable to control the disease activity. Repeated intravenous administration of high-dose human immunoglobulin (IVIg) was added together with intravenous cyclophosphamide pulse therapy (IVCY), and the patient's cardiac function and neurological symptoms were gradually ameliorated without any adverse event. Although glucocorticoid and cyclophosphamide comprise the standard therapy for patients with CSS, a number of patients with severe complications appear to be resistant to such conventional treatment. IVIg is thought to be an effective therapeutic option for such patients.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We describe a 20-year-old female with systemic lupus erythematosus (SLE) who developed renal failure during continuous ambulatory peritoneal dialysis (CAPD). The patient was treated with mizoribine (MZR). MZR peak concentration was 1.8 mug/ml and was sufficient for clinical efficacy as measured by serological data. Treatment with MZR was safe and useful even while undergoing CAPD. Achieving optimal MZR blood concentration was important for treatment of SLE, even though the patient was in end-stage renal failure.

DOI： 10.1007/s10165-009-0267-9

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We recently found that an increased plasma concentration of protein-conjugated acrolein is a good biomarker for stroke. Therefore we determine whether the concentration of protein-conjugated acrolein is increased in saliva from patients with primary Sjögren's syndrome. METHODS: Stimulated whole-mixed saliva was collected from 10 patients and 13 control subjects. The concentration of protein-conjugated acrolein in saliva and plasma was measured by either Western blotting or enzyme-linked immunosorbent assay. RESULTS: The concentration of protein-conjugated acrolein, especially albumin-conjugated acrolein, was greatly increased in saliva from patients with primary Sjögren's syndrome (p<0.001). The concentration of protein-conjugated acrolein was inversely correlated with the flow rate of saliva. CONCLUSION: The results indicate that the concentration of protein-conjugated acrolein, a marker of cell or tissue damage, in saliva is well correlated with seriousness of primary Sjögren's syndrome.

DOI： 10.1016/j.cca.2009.11.032

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To examine the effect of anti-tumor necrosis factor-alpha (anti-TNF) therapy in patients with reactive AA amyloidosis associated with rheumatoid arthritis (RA). METHODS: Fourteen patients with reactive AA amyloidosis associated with RA were prospectively evaluated. Four patients were treated with infliximab and 10 with etanercept. The mean period of anti-TNF therapy was 20.1 +/- 13.8 months. Laboratory findings and renal function were examined before and after initiation of anti-TNF therapy. In 9 patients the area of amyloid deposits in serial gastroduodenal mucosal biopsy specimens was examined and image analysis was performed. RESULTS: C-reactive protein and serum amyloid A protein levels were significantly reduced after initiation of anti-TNF therapy. Twenty-four hour creatinine clearance improved in 4 patients, did not change in 5, and deteriorated in 3. Twenty-four hour urinary protein excretion was significantly decreased in 3 patients, not exacerbated in 6, and increased in 3 after initiation of anti-TNF therapy. The biopsy specimens from the 9 patients who underwent serial gastroduodenal biopsies showed significant decreases in the area of amyloid deposits, from 8.8% +/- 6.4% to 1.6% +/- 0.6% (p = 0.003) after initiation of anti-TNF therapy. Four patients showed a sustained decrease in the areas of amyloid deposits in their third biopsy specimens, and amyloid deposits were not detectable in 2. CONCLUSION: Our results indicate a striking effect of anti-TNF therapy for rapid removal and sustained disappearance of amyloid deposits in gastric mucosal tissue with amelioration of renal functions in patients with reactive amyloidosis due to RA.

DOI： 10.3899/jrheum.090101

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

We report a case of HELLP syndrome, multiple liver infarctions, and intrauterine fetal death in a woman in the 17th week of pregnancy with SLE and APS who had been in remission on a regimen of low-dose prednisolone and aspirin. An increase in the dosage of corticosteroid together with intravenous heparin infusion led to improvement of the clinical symptoms, laboratory parameters, and multifocal low-density liver lesions detected by computed tomography. Early onset and signs of severe organ involvement are the characteristic features of HELLP syndrome associated with APS, and patients that are at risk should be followed up carefully.

PubMed

researchmap

Language：Japanese   Publisher：(NPO)日本臨床運動療法学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

【目的】イグラチモド(IGU)は2012年に薬価収載された新規抗リウマチ薬である。IGUの腎機能に与える影響を検討する。【対象・方法】新潟県立リウマチセンターで2015年から2016年の間にIGUを処方開始した201例(男性58例、女性143例、年齢68(60-77)歳)で開始前、開始後3ヵ月、6ヵ月の臨床データを2017年12月に診療録から後方視的に調査した。IGUが中止された症例では中止時と中止後3ヵ月のデータを調査した。【結果】開始後3ヵ月で関節リウマチの疾患活動性は有意に低下した(DAS28-ESR4.1(3.2-4.8)v.s.3.2(2.3-4.1)、p<0.001)。estimated glomerular filtration rate(eGFR)は開始前と比較して3ヵ月後で有意に低下した(eGFR77.3(63.9-91.2)、68.3(54.8-81.4)、p<0.001)。6ヵ月以内に51例がIGUを中止していたが、7例は腎機能低下が中止原因だった。中止例では中止時に比較して中止後3ヵ月でeGFR値は有意に上昇した(eGFR 70.7(57.6-79.7)v.s.75.7(63.4-88.7)、p=0.002)。多変量解析ではeGFR10ml/min以上低下に関わるリスク因子として非ステロイド性抗炎症薬(NSAIDs)の併用ありが抽出された。【結論】重篤な腎機能障害は少なかったが、IGU開始後、有意にeGFR値は低下した。IGU使用時には肝障害だけでなく腎障害にも留意する必要がある。しかし中止後は回復がみられており、可逆性の変化であることが示唆された。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02269&link_issn=&doc_id=20190806020008&doc_link_id=10.14961%2Fcra.31.145&url=https%3A%2F%2Fdoi.org%2F10.14961%2Fcra.31.145&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

当院で経験した80歳以上の高齢RA(関節リウマチ)合併アミロイドーシス3例(症例1:82歳、症例2:81歳、症例3:85歳、全例女性)について検討した。いずれの症例も感染症の発症リスクを下げることを目的にSAA(血清アミロイド-シスA蛋白)の測定結果を参考にして、生物学的製剤であるエタネルセプト(ETA) の使用間隔を延長し調整した。その結果、ETAの使用により全例で重症感染症は発症せず、生命予後の改善が得られた。

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00990&link_issn=&doc_id=20200130080005&doc_link_id=%2Fdg3nigta%2F2018%2Fs13211%2F002%2F0397-0398%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2018%2Fs13211%2F002%2F0397-0398%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医薬情報研究所  

目的:ステロイド内服患者において1,5-アンヒドログルシトール(1,5-AG)が、血糖の日内変動のマーカーとなりうるか、食後高血糖の早期発見に有効であるかを検討する。対象と方法:2010年11月〜2011年9月に当院に入院したプレドニゾロン(PSL)5mg/日以上を内服しており、1,5-AGを測定していた42例を対象としてレトロスペクティブに解析した。各患者の各食前・食後2時間血糖を、1,5-AG、HbA1c、homeostasis model assessment of insulin resistance(HOMA-IR)と比較検討した。血糖変動の指標としては、LAGE、M値を用いた。M値は、1/nΣ1000×|log10(Glucose/100)|3を用いた。患者背景は、男性15例、女性27例、年齢65.7±12.7歳、PSL内服量は7.9±2.5mg/日であった。原疾患は、関節リウマチ36例、全身性エリテマトーデス、顕微鏡的多発血管炎、多発性筋炎がそれぞれ2例ずつであった。糖尿病治療薬は、スルホニルウレアが11例、ビグアナイドが5例、グリニド、インスリンがそれぞれ4例、DPP-4阻害薬が2例、チアゾリジンが1例であった。結果:HOMA-IRは1.49±1.10、HbA1cは6.00±0.84%、1,5-AGは12.0±7.75μg/mL、M値は14.7±24.4であった。M値と1,5-AGには逆相関を、M値とHbA1cには正の相関を認めた。各血糖変動のパラメーターと1,5-AG、HbA1cの相関係数では、すべてのパラメーターで有意な相関を認めた。食後2時間血糖が200mg/dL以上で、HbA1cが正常値以下(5.8%以下)の患者は6例認められたが、5例で1,5-AGの低下が認められた。1例は、食後血糖が400mg/bLを超えていたが、HbA1cの上昇は認めず、1,5-AGは低下していた。考察:ステロイド糖尿病は食後高血糖を特徴とし、HbA1cが上昇しないことが多いが、1,5-AGの測定はステロイド糖尿病の発見に有用であると考えられた。(著者抄録)

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本老年医学会  

目的:当院における高齢発症関節リウマチ(RA)症例の初期治療と臨床経過を明らかにする。方法:1.80歳以上でRAを発症した55例(高齢発症群)の診断時背景、初期治療内容、治療反応性、合併症を調査し、40〜59歳で発症した119例(非高齢発症群)と比較した。2.80歳以上でRAを発症し当院で生物学的製剤を導入された19例の導入時背景、治療反応性、合併症を調査した。結果:1.高齢発症群の診断時平均DAS28-ESR(DAS)、HAQ-DI(HAQ)は非高齢発症群より有意に高かった(4.91±1.31 vs 4.41±1.47,p=0.043,1.2±0.9 vs 0.5±0.6,p<0.01)。高齢発症群では初期治療として87.3%に従来型合成抗リウマチ薬(csDMARDs)が使用されたがMTX使用例はなかった。56.4%にプレドニゾロン(PSL)が使用され非高齢発症群より有意に高率であった(p<0.01)。3、6ヵ月後両群ともDAS、HAQは有意に低下したがHAQは高齢発症群で高かった。PSL導入例31例は非導入例24例に比べ3ヵ月でDAS、HAQが有意に大きく低下した(ΔDAS:2.55±1.83 vs 1.83±1.23,p<0.01,ΔHAQ:0.9±1.0 vs 0.3±0.6,p=0.027)。感染症合併は高齢発症群で多かった。2.19例の導入時DASは4.93±1.17、HAQは1.5±1.0であった。このうち6ヵ月間観察できた15例のDAS、HAQは6ヵ月後有意に低下した。考察:当院では高齢発症例でMTX使用率が低く大部分はMTX以外のcsDMARDsとPSL併用で短期的な疾患活動性低下や身体機能改善を得られたが生物学的製剤を要する重症例もあった。現在高齢発症RA治療の明確な推奨はないが合併症リスクへの配慮と速やかな疾患コントロールをどのように目指すべきか、今後の検討課題と考えられた。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01214&link_issn=&doc_id=20180530290014&doc_link_id=130006742586&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130006742586&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：中部リウマチ学会  

65歳女。5年前にRAと診断され、タクロリムスとイグラチモドで治療されていた。2年前に両側耳下腺の腫脹が出現し、血清IgG4が高値であったことからミクリッツ病が疑われた。ミゾリビンを追加され、耳下腺腫脹は退縮傾向にあった。1ヵ月前から耐糖能が急速に悪化し、タクロリムスの副作用を疑われ投与中止されたが、耐糖能の改善はみられなかった。また、IgG4値の上昇と耳下腺腫大の増強を認め、当科に紹介された。諸検査の結果から、「IgG4関連自己免疫性膵炎(AIP)疑い」と診断し、PSLによる治療を開始した。結果、耳下腺腫大と血清IgG4値は速やかに改善したが、血糖コントロールの改善には至らなかった。RAを合併しており疾患活動性が高い状態にあることから、RAに対する治療効果とAIPに対するステロイド減量効果を期待してアバタセプトを併用したところ、血糖コントロールは良好となり、血清IgG4値は正常化した。

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(公社)日本整形外科学会  

researchmap

Language：Japanese   Publisher：(株)医薬情報研究所  

目的:膠原病・リウマチなどの患者におけるレイノー現象・冷え症に対する当帰四逆加呉茱萸生姜湯の検討 対象と方法:当帰四逆加呉茱萸生姜湯を7.5g/日、3回食前に投与されていた、レイノー現象・冷え症を有する39例(男性7例、女性32例、62.0±13.9歳)についてレトロスペクティブに検討した。原疾患は限局性強皮症が13例[うち原発性胆汁酸肝硬変合併2例、関節リウマチ(RA)合併1例、シェーグレン症候群(SS)合併1例]、全身性強皮症7例、RA6例(限局性強皮症合併例は限局性強皮症にカウント)、原発性SS3例、全身性エリテマトーデス、多発性筋炎、混合性結合組織病それぞれ1例ずつ、特定の膠原病の診断名確定せず7例であった。抗核抗体陽性(×40以上)は30例で、抗セントロメア抗体陽性13例、抗Scl-70抗体陽性7例、抗SS-A抗体陽性5例(うち2例は抗SS-B抗体陽性)、抗DNA抗体陽性、抗RNP抗体陽性が1例ずつであった。効果判定は、患者の自覚症状の改善、継続希望と主治医判断で行った。結果:25例(64.1%)が有効、3例(7.7%)がやや有効であった。4例(10.3%)が無効で中止し、さらに苦み、辛み、口の中がボロボロする、といった忍容性の問題で4例(10.3%)が、副作用(動悸、食思不振、嘔吐)で3例(7.7%)が内服を中止した。考察:抗セントロメア抗体や抗Scl-70抗体などが陽性の患者が対象であったが、他の薬剤の多剤使用が無効時に、当帰四逆加呉茱萸生姜湯は有効であると考えられた。本剤は安価であり、医療経済的にも優れていると考えられた。結語:膠原病・リウマチなどの患者のレイノー現象・冷え症に対し当帰四逆加呉茱萸生姜湯は有用であった。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

目的:アダリムマブ皮下注製剤(ADAsc(0.8))は注射時痛が比較的強い製剤であったが、2016年11月に注射時痛軽減が期待できるADAsc(0.4)が発売された。今回ADAsc(0.4)を中心に、各種皮下注生物学的製剤の注射時痛の比較検討を行った。対象・方法:当院通院中の皮下注生物学的製剤を使用中の関節リウマチ患者のうち同意が得られた423例(ADAsc群72例、他製剤351例)に対し注射時痛のアンケート調査を行った。結果:ADAsc製剤変更前後で疾患活動性に統計学的有意な変化は認めなかった。注射時痛のShort-Form McGill Pain Questionnaire version 2(SF-MPQ-2)スコアは、4.50(1.00-19.0)から1.00(0.000-5.00)点(p<0.001)に改善した。穿刺時痛は55.4%、薬液注入時痛は78.6%の患者がADAsc(0.4)の方がとてもよいと回答した。重回帰分析で注射時痛が高値(SF-MPQ-2スコア3点以上)となる因子を検討したところ、ADAsc(0.4)と比較してADAsc(0.8)、アバタセプト、エタネルセプト、セルトリズマブペゴルでオッズ比が高かった。結論:注射時痛が改善したことにより、ADAscはさらに使用しやすい製剤となった。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02269&link_issn=&doc_id=20180319110004&doc_link_id=10.14961%2Fcra.29.251&url=https%3A%2F%2Fdoi.org%2F10.14961%2Fcra.29.251&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：Japanese   Publisher：(一社)日本老年医学会  

researchmap

Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

メトトレキサート(MTX)と生物学的製剤(bDMARD)の使用により、関節リウマチ(RA)の治療は格段の進歩をとげたが、リウマチ専門医の数は限られており、各県のリウマチ専門病院の数も少ない。当センターの位置する新潟県は、冬季の悪天候があり、山形県や福島県など、近隣の県から通院している患者や佐渡島から通院している患者は、緊急時に当センターを受診できないという状況にあるため、bDMARD使用患者はあらかじめ地域の総合病院に紹介をし、緊急時の対応をお願いしている。bDMARDの自己注射の不可能な患者、骨粗鬆症治療薬などの、週に一回、あるいは月に一回の皮下注や静注製剤は医療連携で投与を行っている。また、当センターでは、隣接する総合病院の県立新発田病院からの大腿骨近位部骨折患者を中心とした整形外科疾患患者や脳血管障害患者を、回復期リハビリ病棟に受け入れ、リハビリテーションを行っているが、大腿骨近位部骨折患者では、再骨折予防についてかかりつけ医との医療連携を行っている。2015年からは当院で退院処方としてビスホスホネート製剤を処方し、かかりつけ医に継続を依頼している。また、骨折後のフォローアップ、骨粗鬆症治療薬の処方状況の確認などは、県立新発田病院に新たに開設された骨粗鬆症特殊外来で行うシステムを構築した。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02269&link_issn=&doc_id=20170913170002&doc_link_id=10.14961%2Fcra.29.85&url=https%3A%2F%2Fdoi.org%2F10.14961%2Fcra.29.85&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(公社)日本整形外科学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

関節リウマチ(RA)の疾患活動性のコントロールが栄養指標の改善につながるかどうかを検討した。生物学的製剤1剤目としてアバタセプト(ABT)を導入し、6ヵ月以上経過した35例(男8例・女27例・平均年齢67.0歳)を対象とした。その結果、ABTの使用により疾患活動性指標は統計学的有意に改善した。プレドニゾロン使用量も5.0mg/dayから4.0mg/dayに有意に減少し、メトトレキサート使用量は10mg/週から8mg/週に変化したが統計学的有意差は認めなかった。更に、BMI、Hb、リンパ球数、アルブミン数、消化管手術後の縫合不全を示す小野寺のPrognostic nutritional indexや福島のD値も統計学的有意に改善した。また、HAQ-DI、握力値も改善した。以上、RAの疾患活動性のコントロールで栄養指標が改善し、生命予後改善に結びつく可能性が示唆された。

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00990&link_issn=&doc_id=20170707020021&doc_link_id=%2Fdg3nigta%2F2017%2Fs13102%2F015%2F0132-0132%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2017%2Fs13102%2F015%2F0132-0132%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(有)科学評論社  

過去6年間に栄養サポートチーム(NST)が介入した関節リウマチ(RA)患者を対象に、栄養指標と生命予後の関係(解析1)、疾患活動性と栄養指標の関連(解析2)について検討した。対象は解析1は58名67件(男性20名、女性38名)で、介入時平均年齢72.4±9.27歳、罹病期間16.1±13.3年、解析2はbiological disease modifying antirheumatic drug(bDMARD)1剤目としてインフリキシマブ(IFX)を開始し、6ヵ月以上継続した40名(男性15名、女性25名)で、平均年齢58.8±10.5歳、罹病期間12.2±9.21年であった。解析1の結果、約40%の患者がBMI<18.5kg/m2で予後不良であり、低BMI患者は血清Alb値およびHb値が低いことが判明した。解析2の結果、RAの疾患活動性のコントロールにより栄養指標が改善することが明らかとなった。以上より、疾患活動性の高いRA患者は低栄養状態となりやすいため、栄養状態評価が重要であると考えられた。

researchmap

Language：Japanese   Publisher：(有)科学評論社  

通院中のRA患者224例にタクロリムスのジェネリック品(P社のカプセル剤またはT社の錠剤)を使用し、有効性と安全性について検討した。新規投与した群(84例)、先発医薬品から切り替えた群(140例)とも有効性に問題はなく、むしろ切り替えたことにより、それまで高価ゆえに増量できなかった患者でも容易に増量が可能となり、血中濃度が上昇して有効性が増した症例もあった。安全性については、重篤な副作用は認めなかったが、ジェネリックのカプセル剤から錠剤へ切り替えた後に全身の痛みを訴えた症例があった。

researchmap

Language：Japanese   Publisher：(NPO)日本心療内科学会  

researchmap

Language：Japanese   Publisher：(有)科学評論社  

トシリズマブ(TCZ)点滴静注製剤から皮下注製剤に切り替えた関節リウマチ(RA)35人(男5人、女30人、年齢58.0歳)を対象として、切り替え失敗に影響する要素について検討した。RA罹病期間は平均11.0年でTCZ点滴静注による治療期間は平均823日であり、経過観察期間に35人中6人が皮下注製剤の効果不十分を訴え、5人が平均75.0日で皮下注製剤を中止し点滴静注製剤を再使用していた。点滴製剤再導入となった5人と皮下注を継続した30人について患者背景、臨床効果を比較した結果、点滴製剤再導入群では患者体重と患者体表面積が有意に高値であった。今回の解析では、TCZ点滴静注製剤から皮下注製剤への切り替え失敗の要因の1つとして、体表面積の大きいことや体重の重いことが考えられた。

researchmap

Language：Japanese   Publisher：(NPO)日本歯科保存学会  

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY  

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

関節リウマチの手指関節(拇指を含む)・手関節・肘関節に対し手術を行った70例を対象に、術前、術後6ヵ月、術後1年に日本語版DAS28-CRP(4)とDASHを記録した。また、手術後の状態や使い勝手、満足度に関するアンケートを独自に作成し、術後に郵送した。その結果、DAS28-CRP(4)は術前に比べ術後6ヵ月、術後1年ともに有意に改善し、疾患活動性の改善が示された。DASHも術後6ヵ月、術後1年ともに有意に改善した。アンケートの結果、術後の状態について全体の90%が「大変良い」または「まあまあ良い」と回答した。使い勝手については全体の85%が「大変良い」または「まあまあ良い」と回答した。満足度については全体の85%が「大変満足」または「まあまあ満足」と回答した。「同じ手術を他人に進めるか」の質問には全体の67%が「手術を勧める」と回答した。

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05177&link_issn=&doc_id=20160815190004&doc_link_id=%2Ffd8kanse%2F2016%2F003502%2F005%2F0121-0130%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffd8kanse%2F2016%2F003502%2F005%2F0121-0130%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(有)科学評論社  

関節リウマチ(RA)患者におけるリンパ増殖性疾患(LPD)の発症状況について検討した。病理学的にLPDと診断したRA患者19例(男性10名、女性9名)を対象とした。RAの罹病期間の中央値は15.0年で、病期の進行している症例が多かった。LPD診断時のDAS28-ESRは3.5、血清CRP値は3.2mg/dlであった。病理組織学的診断は、び漫性大細胞リンパ腫が8例と最多で、次いでホジキンリンパ腫が4例であった。2015年9月時点で生存症例は11例、死亡症例は8例で、生存期間の中央値は31.0ヵ月であった。RAの病勢で説明できないCRP値の上昇はLPD発症時の特徴と考えられた。発症1年以内に死亡した5例は全例PS 4の症例であった。LPD発症後のRAの活動性は化学療法が施行された症例では一時的に改善するものの、その後13.0ヵ月でなんらかの治療介入がなされた。治療にもかかわらず、最終観察時のDAS28-ESRは中等度疾患活動性が3例、高疾患活動性が2例であった。

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

初回上肢手術を行った関節リウマチ患者70例(男12例、女58例、手術時平均年齢64歳、罹病期間平均15年)を対象として、どのような動作や症状が改善したか、日本語版Disabilities of the Arm,Shoulder and Hand(DASH)を用いて前向きに調査した。手術部位は手関節34例、手指32例、肘関節16例であり、術後は全体のDSAHスコアと全体のdisease activity score 28-C reactive protein(4)は有意に低下した。また、手関節手術では把持機能、疼痛・自信に関する項目が有意に改善し、手指手術では疼痛、自信に関する項目が、肘関節手術ではリーチ動作、疼痛、不眠に関わる項目がそれぞれ改善した。上肢に対する手術は疾患活動性を抑制し、長期的に関節破壊の進行をある程度予防する効果のあることが示唆された。

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

アバタセプト(ABT)の有効性と患者選択の背景を評価し、効果的なABT使用方法を検討した。ABT治療群17例(男12例、女5例、平均年齢68.1±12.0歳)とメトトレキサート併用エタネルセプト(ETN)治療群21例(男18例、女3例、平均年齢58.9±19.5歳)の治療成績を後ろ向きに比較した。その結果、ABTはanti-cyclic citrullinated antibody(抗CCP抗体)高値の症例で多く使用され、複合疾患活動性指標による評価はほぼ同等であったが、患者visual analogue scale、matrix metaroprotease-3の低下はETN治療群が良好であった。また、ABTの効果に関与する背景因子の検索ではPrednisolone 5mg/日以上使用例でABT有効性が高い傾向があり、抗CCP抗体高値は治療反応性不良因子とはならない可能性が示された。

researchmap

Language：Japanese   Publisher：新潟医学会  

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20160913040009&doc_link_id=%2Fdg3nigta%2F2016%2Fs13004%2F001%2F0265-0265%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2Fs13004%2F001%2F0265-0265%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：新潟県立病院医学会  

生物学的製剤を初期導入した関節リウマチ患者55名(男性8名、女性47名、年齢59.1±15.2歳)を対象に、導入時と導入6ヵ月後の栄養指標と疾患活動性、また栄養指標項目について解析した。対象のSteinbrockerの病期分類はStage Iが2名、Stage IIが11名、Stage IIIが16名、Stage IVが26名であり、Class 1が5名、Class 2が30名、Class 3が19名、Class 4が1名であった。治療薬の服用状況は生物学的製剤導入時のプレドニゾロン(PSL)の使用率は53%、平均使用量は5.7mg/日、MTXの使用率は71%、使用量は8.9mg/週であった。使用生物学的製剤はエタネルセプトが22名、インフリキシマブが12例、ゴリムマブが10例、アダリムマブが5名、アバタセプトが3名であった。その結果、栄養学的指標の変化では、生物学的製剤導入時のアルブミン(Alb)値は低く、約1/4が軽度の栄養障害で、TLCも低値で、軽度から中等度の栄養障害を示していた。だが、Hb、BMI値は正常範囲の症例が多かった。しかし、生物学的製剤の使用によりAlb、TLC、Hb、BMIなどの栄養指標は有意に上昇していた。

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(NPO)日本歯科保存学会  

researchmap

Language：Japanese   Publisher：(有)科学評論社  

関節リウマチ(RA)で、エタネルセプト(ETN)からトシリズマブ(TCZ)に切り替えた26例について検討した。ETNは全例50mgの週1回皮下注投与が行われていた。TCZは8mg/kgを4週おきに点滴静注した。TCZ導入4週前から導入時迄に経口プレドニゾロン(PSL)を増量した群(PSL経口増量群)8例と増量しなかった群(PSL経口変更なし群)18例について検討した。両群のメトトレキサート(MTX)、PSLの使用量の比較は全体の平均と、MTXを使用している患者のみ(PSL経口非増量群)15例とPSL経口増量群)6例での平均、PSLを使用している患者のみ(PSL経口非増量群17例と、PSL経口増量群6例)の平均で行った。ETN効果減弱時には患者の年齢、合併症、MTXの使用量などを考慮し、Bioを選択すべきであるが、高齢者を除いた患者でのETN効果減弱時のTCZへの切り替えは有効であった。ETN効果不十分症例で疾患活動性の高い場合はPSLを一時的に増量し、疾患活動性を抑えることでTCZの効果発現を引き出すことが可能で、一時的に増量したPSLは24週後時点で非増量群と同程度まで減量が可能であった。高疾患活動性のETN効果不十分症例でのPSL増量とTCZへの切り替えは有効な治療法と考えられた。

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：Japanese   Publisher：(有)科学評論社  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

2008年5月〜2013年6月の間にエタネルセプト(ETN)を投与された関節リウマチ(RA)患者330例中、導入時年齢75歳以上であった45例(男性17例、女性28例)を対象に、投与開始から24ヵ月後を最終評価点として患者背景、疾患活動性の推移、有害事象について後方視的に検討した。その結果、1)対象の平均年齢は79.0±2.9歳、平均罹病期間は7.0±10.2年であった。また、Steinbrocker Stage分類はStage 1が2例、Stage 2が4例、Stage 3が10例、Stage 4が20例、不明が9例で、Steinbrocker Class分類はClass 2が9例、Class 3が24例、Class 4が2例、不明が10例であった。2)ETN以前の生物学的製剤使用症例は9例で、内訳はインフリキシマブ(IFX)が2例、トシリズマブ(TCZ)が5例、アダリムマブが1例、IFX→TCZが1例であった。3)ETN導入用量は20mg/週、25mg/週、50mg/週での導入がそれぞれ1例、31例、13例であり、投与前と比較して関節所見、VAS、CRP、ESR、MMP-3、DAS28-ESR、SDAIは最終評価時有意に改善していた。4)有害事象では感染症が5例と最多で、内訳は結核、非結核性抗酸菌症疑い、ニューモシスチス肺炎、尿路感染症、感染症疑いが各1例で、うち4例がETNの投与を中止していた。5)転帰では45例中13例が2次無効により他の生物学的製剤に変更し、20例が現在(2014年8月現在)も投与継続中である。

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(株)ジェフコーポレーション  

researchmap

Language：Japanese   Publisher：(有)科学評論社  

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

関節リウマチ(RA)9例、成人発症スチル病(AOSD)疑い1例の計10例(男性7例、女性3例、45〜81歳、平均65.5歳)を対象に、生物学的製剤(Bio)の治療と合併症について検討した。平均罹病期間は10.8(2〜32)年、RA患者ではSteinbrockerのステージはII 2例、III 5例、IV 2例、クラスは2が7例、3が2例であった。Bioの平均使用日数は380.7(9〜1033)日であった。メトトレキサート(MTX)は7例、プレドニゾロン(PSL)は6例に使用されていた。Bioの使用はエタネルセプト(ETN)3、インフリキシマブ(IFX)3、トシリズマブ(TCZ)2、アダリムマブ(ADA)2例であった。紹介理由は非定型抗酸菌症精査・胸部異常陰影精査各3例、間質性肺炎悪化・低酸素血症各2例であった。転帰は生存9例、感染性心内膜炎で死亡1例、生存9例中、4例はBio継続、うち3例はBio変更を行わなかった。また、RA患者20例(男性1例、女性19例、46〜80歳、平均66.2±9.0歳)を対象に、副作用等でBioを中止し再投与を行わなかった例について検討した。使用していたBioはIFX 8例、TCZ 7例、ADA 4例、ETN 1例であった。中止理由は感染11例、注射時反応2例、間質性肺炎2例、乳癌2例であった。

researchmap

Language：Japanese   Publisher：新潟医学会  

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015001890

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

2004年〜2008年までにリウマチ外来でTNF阻害薬を導入した関節リウマチ(RA)症例142例を対象に継続率について検討した。TNF阻害薬の内訳はインフリキシマブ(IFX)が45例、エタネルセプト(ETN)が97例であった。その結果、1)1年継続率はIFXが80.1%、ETNが81.8%と同等であったのに対し、2年継続率はIFXが56.4%、ETXが74.8%と、ETXが高かった。一方、無効と二次無効をあわせた割合はIFXが22.2%、ETNが11.3%で、副作用で中止となった割合はIFXが4.4%、ETNが5.2%と有意差はみられなかった。2)無効、二次無効による中止群の導入時においてDAS28(3)-CRPは継続群に比べ高い傾向を示したことから、IFX、ETNいずれにおいても導入時のDAS23(3)-CRPが有効性の重要な指標である可能性が示唆された。3)無効、二次無効例では他の製剤へのswitchingが高率に行われ、更に無効の例では3剤目へのswitchingも行われていた。反面、有害事象にて中止した症例は全例他の生物学的製剤へのswitchingが現時点ではみられなかった。

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本関節病学会  

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.3109/03009742.2011.569754

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本糖尿病学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：日本臨床免疫学会  

researchmap

Language：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：中部リウマチ学会  

46歳女。関節リウマチにてメトトレキサート(MTX)を開始されたが難治性であった。開始約6年後に肝機能異常と発熱、右鼠径リンパ節腫脹が出現し、肝脾腫、リンパ節腫脹、胸腹膜炎を認めた。MTX中止のみで胸腹水はほぼ消失し、肝脾腫、リンパ節腫脹も改善したが、再度発熱が出現し、関節炎が悪化したため当院入院となった。多関節腫脹と関節痛を認め、検査所見では白血球減少、貧血、肝機能異常、IgG高値、抗核抗体陽性、抗RNP抗体陽性、sIL2R高値で、PCR法にて測定した末梢血中のEBV-DNAは増加していた。腹部CTでは肝腫大、肝、脾臓内の多発性低吸収域、大動脈周囲のリンパ節腫脹を認めた。前医でのリンパ節生検所見を再検討した結果、EBウイルス陽性、CD30陽性の大型細胞を認め、ホジキン病類似の所見であったが、典型的Reed-Sternberg細胞は認めず、CD15陰性より、ホジキンリンパ腫類似のMTX関連リンパ増殖症と診断した。Adriamycin、bleomycin、vinblastin、decairbadineによるABVD治療を行い、肝脾の病変、リンパ節腫脹は著明に改善し、血中EBV-DNA量も正常化した。

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-LISS  

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本リウマチ学会  

researchmap

Language：Japanese   Publisher：(一社)日本内科学会  

researchmap