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

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 (scientific journal)  

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

PubMed

researchmap

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

DOI： 10.2169/internalmedicine.0395-22

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：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：Japanese   Publisher：(一社)日本腎臓学会  

researchmap

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

Antiribosomal P protein (anti-P) autoantibodies commonly develop in patients with systemic lupus erythematosus. We have previously established hybridoma clones producing anti-P mAbs. In this study, we explored the pathogenesis of behavioral disorders induced by anti-P Abs using these mAbs. New Zealand Black × New Zealand White F1, New Zealand White, C57BL/6, and BALB/c mice were treated with 1 mg of anti-P Abs once every 2 wk. The behavioral disorder was evaluated by the tail suspension test, forced swim test, and open field test. Following administration of anti-P Abs, New Zealand Black × New Zealand White F1 and C57BL/6 mice developed depressive behavior and showed increased anxiety with elevated serum TNF-α and IL-6 levels. Anti-P Abs were not deposited in the affected brain tissue; instead, this mood disorder was associated with lower serum and brain tryptophan concentrations. Tryptophan supplementation recovered serum tryptophan levels and prevented the behavioral disorder. TNF-α and IL-6 were essential for the decreased serum tryptophan and disease development, which were ameliorated by treatment with anti-TNF-α neutralizing Abs or dexamethasone. Peritoneal macrophages from C57BL/6 mice produced TNF-α, IL-6, and IDO-1 via interaction with anti-P Abs through activating FcγRs, which were required for disease development. IVIg, which has an immunosuppressive effect partly through the regulation of FcγR expression, also prevented the decrease in serum tryptophan and disease development. Furthermore, serum tryptophan concentrations were decreased in the sera of systemic lupus erythematosus patients with anti-P Abs, and lower tryptophan levels correlated with disease activity. Our study revealed some of the molecular mechanisms of mood disorder induced by anti-P Abs.

DOI： 10.4049/jimmunol.2000260

PubMed

researchmap

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

OBJECTIVES: 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. METHODS: 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 < 60 mL/min/1.73 m2 for > 3 months. RESULTS: 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. CONCLUSION: 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.

DOI： 10.1177/0961203320983906

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00198-020-05601-y

researchmap

Other Link： http://link.springer.com/article/10.1007/s00198-020-05601-y/fulltext.html

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：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：中部リウマチ学会  

1991年の関節リウマチ429例と2018年の関節リウマチ368例を対象に、年齢や性を比較した。その結果、2018年に70歳代が4倍、80歳以上が15倍に増加し、男性が有意に増加していた。次に、2018年の368例の腎機能障害を調査した。65歳以上発症108例(A群)、65歳未満発症260例(B群)に分類し、更にB群で65歳未満発症で65歳以上の症例129例(C群)を抽出し、3群間で腎機能を比較した。その結果、発症時の血算や血清Cr、尿異常(血尿、蛋白尿等)は3群間に差がなかった。eGFR、抗CCP抗体はB群がA群、C群より有意に高かった。RFはB群がA群より有意に高かったが、力価に差はなかった。AAアミロイドーシスを全体の1.6%に認め、全例がC群であり、C群の4.7%を占めた。治療はステロイドの使用頻度、量ともに3群間に差はなかったが、メトトレキサートとbDMARDsの使用頻度、量はB群がA群、C群より有意に多かった。

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：(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   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：(一社)日本腎臓学会  

researchmap

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

researchmap

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

Purpose: TAFRO syndrome is a novel disorder manifesting as fever, anasarca, thrombocytopenia, renal insufficiency and organomegaly, and its etiology has not been clarified. The aim of this study was to elucidate similarities and differences between systemic lupus erythematosus (SLE) and TAFRO syndrome. Methods: We examined 46 consecutive patients diagnosed with SLE and determined whether they meet the proposed diagnostic criteria for TAFRO syndrome (2015 version). Results: Of the 46 patients with SLE, four (8.7%) also met the TAFRO syndrome criteria (TAFRO-like group). All patients in the TAFRO-like group were males, and their mean age was significantly higher than that of the non-TAFRO group (67.5 ± 8.7 vs. 39.3 ± 18.1 years, p = 0.004). C-reactive protein and γ-glutamyl transpeptidase levels were significantly higher, and frequencies of anti-dsDNA and anti-Sm antibodies were significantly lower in the TAFRO-like than non-TAFRO group. Elder cases (onset age ≥ 50 years) met significantly more categories of the diagnostic criteria for TAFRO syndrome than did those with younger cases. Conclusions: Several patients with SLE, especially elder cases, showed features similar to those of TAFRO syndrome. Although exclusion of SLE is needed in the diagnostic criteria for TAFRO syndrome, TAFRO syndrome-like SLE should be considered.

DOI： 10.1177/0961203317725589

Scopus

researchmap

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

researchmap

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

researchmap

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

The kidney is a major target organ for systemic amyloidosis, which results in proteinuria and an elevated serum creatinine level. The clinical manifestations and precursor proteins of amyloid A (AA) and light-chain (AL) amyloidosis are different, and the renal damage due to amyloid deposition also seems to differ. The purpose of this study was to clarify haw the difference in clinical features between AA and AL amyloidosis are explained by the difference in the amount and distribution of amyloid deposition in the renal tissues. A total of 119 patients participated: 58 patients with an established diagnosis of AA amyloidosis (AA group) and 61 with AL amyloidosis (AL group). We retrospectively investigated the correlation between clinical data, pathological manifestations, and the area occupied by amyloid in renal biopsy specimens. In most of the renal specimens the percentage area occupied by amyloid was less than 10%. For statistical analyses, the percentage area of amyloid deposition was transformed to a common logarithmic value (Log10%amyloid). The results of sex-, age-, and Log10%amyloid-adjusted analyses showed that systolic blood pressure (SBP) was higher in the AA group. In terms of renal function parameters, serum creatinine, creatinine clearance (Ccr) and estimated glomerular filtration rate (eGFR) indicated significant renal impairment in the AA group, whereas urinary protein indicated significant renal impairment in the AL group. Pathological examinations revealed amyloid was predominantly deposited at glomerular basement membrane (GBM) and easily transferred to the mesangial area in the AA group, and it was predominantly deposited at in the AL group. The degree of amyloid deposition in the glomerular capillary was significantly more severe in AL group. The frequency of amyloid deposits in extraglomerular mesangium was not significantly different between the two groups, but in AA group, the degree amyloid deposition was significantly more severe, and the deposition pattern in the glomerulus was nodular. Nodular deposition in extraglomerular mesangium leads to renal impairment in AA group. There are significant differences between AA and AL amyloidosis with regard to the renal function, especially in terms of Ccr, eGFR and urinary protein, even after Log10%amyloid was adjusted; showing that these inter-group differences in renal function would not be depend on the amount of renal amyloid deposits. These differences could be explained by the difference in distribution and morphological pattern of amyloid deposition in the renal tissue.

DOI： 10.1080/13506129.2017.1338565

PubMed

researchmap

Language：Japanese   Publisher：新潟急性血液浄化研究会  

researchmap

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

researchmap

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

Although calcineurin (CN) is distributed in many cell types and functions in regulating cell functions, the precise roles ofCNremained in each type of the cells are not well understood yet. ACNinhibitor (CNI) has been used for steroid-resistant nephrotic syndrome. ACNIis assumed to ameliorate proteinuria by preventing the overproduction of T-cell cytokines. However, recent reports suggest thatCNIhas a direct effect on podocyte. It is accepted that a slit diaphragm (SD), a unique cell-cell junction of podocytes, is a critical barrier preventing a leak of plasma protein into urine. Therefore, we hypothesized thatCNIhas an effect on theSD In this study, we analyzed the expression ofCNin physiological and in the nephrotic model caused by the antibody against nephrin, a critical component of theSD We observed thatCNis expressed at theSDin normal rat and human kidney sections and has an interaction with nephrin. The staining ofCNat theSDwas reduced in the nephrotic model, whileCNactivity in glomeruli was increased. We also observed that the treatment with tacrolimus, aCNI, in this nephrotic model suppressed the redistribution ofCN, nephrin, and otherSDcomponents and ameliorated proteinuria. These observations suggested that the redistribution and the activation ofCNmay participate in the development of theSDinjury.

DOI： 10.14814/phy2.12679

PubMed

researchmap

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

The purpose of this study was to clarify the factors related to silent osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE). Seventy-eight patients with SLE were selected on the basis of having been newly diagnosed and requiring high-dose prednisolone, including pulse therapy with methylprednisolone, as the initial treatment. All the patients initially underwent MRI at 3 months after the start of corticosteroid treatment to detect any early changes in the femoral head. These examinations were then performed again 3 months later. Laboratory parameters were evaluated at the start of steroid treatment and at 1 month thereafter. By 3 months after the start of corticosteroid treatment, silent ONFH was diagnosed by MRI in 21 patients (26.9 %), being bilateral in 11 patients and unilateral in 10. The occurrence of silent ONFH was not related to SLE disease activity index, serological activity, or renal function; it was also unrelated to body mass index (BMI), body surface area (BSA), and the initial dose of prednisolone per unit body weight. However, the total cholesterol level at 4 weeks after the start of steroid treatment tended to be higher in patients with silent ONFH. Patients with a higher triglyceride level showed a significantly higher frequency of silent ONFH both before (p = 0.002) and 4 weeks after (p = 0.036) steroid initiation.A high triglyceride level is an important risk factor for silent ONFH in patients with SLE, and large-scale epidemiologic surveys of such early events are needed in this patient population.

DOI： 10.1007/s10067-015-3075-y

PubMed

researchmap

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

researchmap

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

The glomerular visceral epithelial cell (podocyte) is characterized as a specialized structure of the interdigitating foot processes, covering the outer side of the glomerular basement membrane (GBM). The neighboring foot processes are connected by a slit diaphragm, which is a key structure regulating the barrier function of the glomerular capillary wall to prevent proteinuria. We have previously reported that synaptic vesicle protein 2 B (SV2B) is expressed in the podocyte and that the expression is clearly decreased in nephrotic models. However, the precise function of SV2B in the podocyte is unclear. To investigate the role of SV2B in maintaining the podocyte function and to better understand the function of the neuron-like vesicle expressing SV2B in the podocyte, we analyzed them with SV2B knockout (KO) mice. An increase in the amount of proteinuria, effacement of the foot process of the podocyte, and alterations of the GBM were detected in SV2B KO mice. It was also found that the expression of CD2AP, nephrin, and NEPH1, the functional molecules of the slit diaphragm, and laminin, a critical component of the GBM, is clearly altered in SV2B KO mice. Synaptotagmin and neurexin, which have a role in the synaptic vesicle docking in neurons, are downregulated in the kidney cortex of SV2B KO mice. We have previously reported that neurexin interacts with CD2AP, and the present study shows that SV2B interacts with CD2AP. These findings suggest that the SV2B-neurexin complex is involved in the formation and maintenance of the slit diaphragm. In addition, SV2B is densely expressed close to the cell surface in the presumptive podocyte in the early stage of glomerulogenesis. These results suggest that SV2B has an essential role in the formation and maintenance of the glomerular capillary wall.

DOI： 10.1038/labinvest.2015.39

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：中部リウマチ学会  

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：新潟県医師会  

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：Japanese   Publisher：新潟医学会  

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=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=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：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：Japanese   Publisher：(一社)日本腎臓学会  

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：(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=20180328050011&doc_link_id=%2Fdg3nigta%2F2017%2Fs13110%2F001%2F0617-0617%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2017%2Fs13110%2F001%2F0617-0617%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

researchmap

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

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：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

researchmap

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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：中部リウマチ学会  

27歳女。13歳時に両手関節、手指の疼痛、腫脹が出現し若年性特発性関節炎(JIA)と診断され、PSL、メトトレキサート(MTX)等で治療されていた。今回、小児科から内科への移行のため当科を紹介受診した。MTXを8mg/週に増量したが、低疾患活動性から中疾患活動性で推移していた。また、右手関節は職業上酷使されるため疼痛、腫脹が強く、レントゲン上も骨破壊が認められたため、年齢、職業、将来の挙児希望、骨破壊の程度を勘案しInfliximab 200mgを開始した。開始5ヵ月後に腫脹が消失し、その後疼痛も消失した。2年間は8週おきに継続し寛解状態を維持していたが、嘔気が出現しMTXの副作用と考えられたため6mg/週に減量した。寛解状態が続いていたためInfliximabは10週間隔に延長し、その後12週間隔に延長したもののMTXによる嘔気が強く、MTXを含む全ての経口薬を中止しInfliximabも中止した。Loadingを行わずセルトリズマブ・ペゴルにスイッチし徐々に間隔を延長し、以後も寛解が維持されていたため中止とした。なお、右手関節の骨病変には軽度の修復が認められた。

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：中部リウマチ学会  

症例1:58歳女。47歳時に甲状腺乳頭癌に対し甲状腺全摘出術を施行されていた。今回、食欲不振、倦怠感のため入院となり、入院時から腰痛があり、腰椎圧迫骨折と診断された。ビスホスホネート製剤は剤型や内服方法の問題で自己中断しており、デノスマブ60mg皮下注射を行い、アルファカルシドール1μgをエルデカルシトール0.75μgに変更した。注射6日後に補正血清カルシウムが6.3mg/dLに低下し、経口および点滴で補充を行い改善した。症例2:67歳女。65歳時にIV型進行胃癌に対し胃全摘術を施行されていた。今回、骨密度低下を指摘され、胃全摘術後から嘔気が続いていたことからビスホスホネート製剤ではなくデノスマブ60mg皮下注射を行い、アルファカルシドール0.5μgと乳酸カルシウム2gを併用した。下肢蜂窩織炎および食欲不振のため注射後32日目に入院した際、補正血清カルシウム値が7.5mg/dLと低下しており、点滴で補充を行い改善した。

researchmap

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

60歳男。鼠径部の腫瘤の精査・加療を主訴とした。20年前に関節リウマチ(RA)と診断され、メソトレキサート(MTX)開始から約4年に左鼠径部の腫瘤と左下肢の浮腫が出現した。入院時検査では軽度の貧血、肝機能上昇、炎症反応の著増とsIL-2レセプターの上昇を認め、リンパ節生検の結果はdiffuse large B-cell lymphomaであり、EBウイルスは既感染パターンであったが、組織のin situ hybridizationは陰性であった。悪性リンパ腫の診断でR-CHOPを行い、治療後にRAが増悪したため、MTXは使用せずB細胞に影響を与えない生物学的製剤を導入したが、感染症を繰り返し発症した。

researchmap

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

73歳女。息切れ、咳嗽を主訴とした。右頸部リンパ節結核の既往があり、関節リウマチ(RA)に対しメトトレキサート、エタネルセプト(25mg/週)にて加療中であった。感冒症状にて受診し、胸部レントゲンで両側中下肺野に軽度のスリガラス様陰影を認めた。入院時検査ではβ-Dグルカンの上昇を認めたが、気管支肺胞洗浄液中に有意菌や結核菌は検出されず、PCR法にてPneumocystis jiroveciiが検出された。胸部CTでは右中葉の地図状スリガラス様濃度の上昇と下葉の牽引性気管支拡張を伴う構造変化が観察された。ニューモシスチス肺炎と診断して集学的治療を開始したが、急激に間質性肺炎が増悪して低酸素血症と肺の構造変化が進行し、第25病日に死亡した。

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=20160913040011&doc_link_id=%2Fdg3nigta%2F2016%2Fs13004%2F003%2F0266-0266%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2Fs13004%2F003%2F0266-0266%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟急性血液浄化研究会  

researchmap

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

全身性エリテマトーデス(SLE)77症例(男性8例、女性69例)を対象に高脂血症治療薬による特発性大腿骨頭壊死症(ION)発生の有無について検討した。ステロイド治療前および最終診療時にMRIで確認し、ステロイド性ION発生の関連について患者背景、疾患活動性、脂質検査から調べた。その結果、1)77例中21例にIONの発生が認められた。だが、年齢や性別、プレドニゾロン(PSL)初期量、抗リン脂質抗体の有無、ステロイドパルス療法の有無、常習飲酒の有無においてION発生に差は認められなかった。2)一部症例でPSL開始時よりストロングスタチン(アトルバスタチン、ピタバスタチン、ロスバスタチン)が使用されたが、IONの発生に差は認められなかった。但し、IONの発生には喫煙者に多い傾向がみられた。3)SLEの疾患活動性とION発生の有無ではC3、C4、CH50、抗dsDNA抗体価ほか、血清クレアチニン値、推算糸球体濾過量、1日蛋白尿との関連性は認められなかった。4)ION発生の有無に関してBMI、BSA、体重・BMI・BSAあたりのPSL初期投与量とに関連は認められなかった。一方、ION発生症例ではステロイド開始前とステロイド開始4週時の中性脂肪(TG)値は有意に上昇していた。以上より、ステロイド治療開始からTGを低下させることによりIONの発生が抑えられる可能性が示唆された。

researchmap

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

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=2015&ichushi_jid=J00990&link_issn=&doc_id=20150811070023&doc_link_id=%2Fdg3nigta%2F2015%2Fs12904%2F009%2F0225-0226%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2015%2Fs12904%2F009%2F0225-0226%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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：(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