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ABSTRACT: An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 μg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.
Modern Rheumatology 02/2013; · 1.58 Impact Factor
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ABSTRACT: IgG4-related disease is an emerging disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4-positive plasma cells. In IgG4-related disease, tumor-like lesions develop in multiple organs, such as the lacrimal gland, salivary gland, lung, pancreas, kidney, and lymph nodes. We report here three cases of IgG4-related orbital inflammation that presented as unilateral pseudotumors. The patients all were men, with an age range of 65-75 years. The patients had been pointed out unilateral intra-orbital masses, and histopathological examinations revealed marked accumulation of IgG4-positive plasma cells (IgG4/IgG ratio: 51.1-71.6 %) with fibrosis. But storiform fibrosis was seen in only one case, and no obliterative phlebitis was seen. The serum levels of IgG4 were increased to 178-670 mg/dL. The masses had well-defined homogeneous signal intensities, and they were hypo-intense on T1-weighted MR images and iso-intense on T2-weighted MR images. Gadolinium enhanced mass lesions in two cases. All orbital mass lesions responded well to corticosteroid treatment.
Rheumatology International 11/2012; · 1.88 Impact Factor
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Yoshiro Horai,
Ayuko Tokuyama,
Remi Sumiyoshi,
Yoshikazu Nakashima,
Takahisa Suzuki,
Akitomo Okada,
Shin-Ya Kawashiri,
Kunihiro Ichinose,
Yasumori Izumi,
Taiichiro Miyashita,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura,
Tomayoshi Hayashi, Tomoki Origuchi,
Atsushi Kawakami
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ABSTRACT: We report a case of a 60-year-old female with cutaneous polyarteritis nodosa (CPN) of the left ankle, accompanied by elevated serum interleukin (IL)-6 levels. Computed tomographic angiography revealed severe narrowing of medium-sized arteries in her left leg. Destructive arthropathy in the left ankle was identified by X-ray and magnetic resonance imaging. This is the first Japanese case of severe CPN complicated by destructive arthropathy. Quantification of serum IL-6 might be useful in diagnosis and evaluation of CPN.
Modern Rheumatology 09/2012; · 1.58 Impact Factor
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Kunihiro Ichinose, Tomoki Origuchi,
Naoki Tashiro,
Shin-Ya Kawashiri,
Naoki Iwamoto,
Keita Fujikawa,
Toshiyuki Aramaki,
Kazuhiko Arima,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura,
Hiroyuki Moriuchi,
Atsushi Kawakami
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ABSTRACT: A 76-year-old woman was diagnosed with chronic active Epstein-Barr virus (EBV) infection (CAEBV) with sustained fever, anemia, numbness of the lower limbs, and liver dysfunction. The patient had an unusual anti-EBV antibody profile and high viral load, positive rheumatoid factor, and cryoglobulinemia. She suffered from recurrent hemosputum with pleural effusion and thrombocytopenia caused by CAEBV infection, and she died in July 2008. Here, we present a rare case of CAEBV infection with cryoglobulinemia in an elderly patient.
Modern Rheumatology 08/2012; · 1.58 Impact Factor
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Yoshiro Horai,
Oka Satoru,
Samuel Lapalme-Remis,
Remi Sumiyoshi,
Yoshikazu Nakashima,
Takahisa Suzuki,
Akitomo Okada,
Shin-Ya Kawashiri,
Kunihiro Ichinose,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura,
Fuminao Takeshima, Tomoki Origuchi,
Atsushi Kawakami
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ABSTRACT: A 22-year-old female with ulcerative colitis that was successfully treated with infliximab (IFX), and remained stable following tapered discontinuation of prednisolone, developed anterior neck pain and elevation of C-reactive protein following her fourth administration of IFX. She was diagnosed with Takayasu arteritis (TA) based on neck ultrasound and computed tomography angiography. This is the first report describing the development of TA during treatment of UC with IFX.
Modern Rheumatology 06/2012; · 1.58 Impact Factor
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Junko Kita,
Mami Tamai,
Kazuhiko Arima,
Shin-Ya Kawashiri,
Yoshiro Horai,
Naoki Iwamoto,
Akitomo Okada,
Tomohiro Koga,
Yoshikazu Nakashima,
Takahisa Suzuki,
Satoshi Yamasaki,
Hideki Nakamura, Tomoki Origuchi,
Hiroaki Ida,
Kiyoshi Aoyagi,
Masataka Uetani,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: OBJECTIVE: To identify the value of magnetic resonance imaging (MRI)-proven bone edema in patients with very early rheumatoid arthritis (RA). METHODS: All of the 13 patients included in the study were positive at entry for MRI-proven bone edema of the wrist and finger joints and anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. A tight control approach was applied for 12 months. Plain MRI and radiographs of both wrist and finger joints were examined every 6 months. MRI was scored by the RA MRI scoring (RAMRIS) technique and plain radiographs were scored using the Genant-modified Sharp score. Variables that were correlated with plain radiographic changes at 12 months were examined. RESULTS: Simplified disease activity index (SDAI) remission was achieved in 7 patients, and a significant reduction in the RAMRIS bone edema score, which declined to <33 % as compared with the baseline, was achieved in 8 out of 13 patients. Four patients showed plain radiographic progression while 9 patients did not. Significant reductions in the RAMRIS bone edema score (p = 0.007) and the time-integrated SDAI (p = 0.031) were the variables involved in plain radiographic progression. CONCLUSIONS: Improvement in bone edema may be associated with protection against structural damage in very early RA patients managed using the tight control approach.
Modern Rheumatology 06/2012; · 1.58 Impact Factor
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Shin-Ya Kawashiri,
Takahisa Suzuki,
Akitomo Okada,
Satoshi Yamasaki,
Mami Tamai,
Hideki Nakamura, Tomoki Origuchi,
Akinari Mizokami,
Masataka Uetani,
Kiyoshi Aoyagi,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: OBJECTIVE: We investigated whether musculoskeletal ultrasonography (MSKUS) assists the diagnostic performance of the 2010 rheumatoid arthritis (RA) classification criteria. METHODS: Sixty-nine early arthritis patients were consecutively enrolled. None of the patients had been treated. In MSKUS of bilateral wrist and finger joints from 22 sites, the findings obtained by gray-scale and power Doppler (PD) assessment were graded on a semiquantitative scale from 0 to 3. Plain magnetic resonance imaging (MRI) of both wrist and finger joints was also examined. Diagnosis of RA was defined by the initiation of disease-modifying antirheumatic drugs within the first 3 months. The diagnostic performance of the patients was evaluated at entry using 2010 RA classification criteria in conjunction with MSKUS. RESULTS: The indispensable MSKUS finding for differentiating RA was the presence of a PD grade 2 or 3 that was superior to 2010 RA classification criteria or MRI-proven bone edema. We propose that the decision tree algorithm of 2010 RA classification criteria with PD grade 2 or 3 reveals the best discriminative ability. CONCLUSION: MSKUS, especially with a strong PD signal, is very useful to assist the diagnostic performance of the 2010 RA classification criteria in the early recognition of RA.
Modern Rheumatology 04/2012; · 1.58 Impact Factor
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Yoshiro Horai,
Eriko Isomoto,
Tomohiro Koga,
Akitomo Okada,
Shin-Ya Kawashiri,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura, Tomoki Origuchi,
Yasuhito Hamaguchi,
Manabu Fujimoto,
Masataka Kuwana,
Atsushi Kawakami
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ABSTRACT: We report two cases of clinically amyopathic dermatomyositis (CADM) complicated by rapid progress interstitial lung disease (RPILD). The diagnosis of CADM was based on Gottron's papule and RPILD, and the absence of muscle weakness. The female patients were treated with early immunosuppressive therapies including steroid pulse therapy, resulting in significant improvement in respiratory symptoms, clinical data, and imaging. Measurement of anti-CADM-140/MDA5 antibody was useful for obtaining a definitive diagnosis of CADM in these cases.
Modern Rheumatology 03/2012; · 1.58 Impact Factor
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Tomohiro Koga,
Keita Fujikawa,
Yoshiro Horai,
Akitomo Okada,
Shin-Ya Kawashiri,
Naoki Iwamoto,
Takahisa Suzuki,
Yoshikazu Nakashima,
Mami Tamai,
Kazuhiko Arima, [......], Tomoki Origuchi,
Yasuhito Hamaguchi,
Manabu Fujimoto,
Yuji Ishimatsu,
Hiroshi Mukae,
Masataka Kuwana,
Shigeru Kohno,
Katsumi Eguchi,
Kiyoshi Aoyagi,
Atsushi Kawakami
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ABSTRACT: Interstitial lung disease (ILD), especially rapidly progressive ILD (RPILD), is a major poor prognostic factor in patients with DM. We investigated the association of anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab) with clinical characteristics and mortality in Japanese patients with DM.
Seventy-nine DM patients, comprising 58 classic DM and 21 clinically amyopathic DM (CADM) patients, were enrolled. Serum Abs were screened by immunoprecipitation assays, and an immunosorbent assay (ELISA) was used for MDA5. The relationships of clinical characteristics and mortality with each Ab were investigated.
Anti-MDA5 Ab was detected in 17 patients. Anti-clinically amyopathic DM 140 kDa polypeptide Abs (anti-CADM-140 Abs) were found in 16 of the 17 anti-MDA5 Ab(+) patients. Skin ulcers, palmar papules, CADM, RPILD and mediastinal emphysema were widely distributed in anti-MDA5 Ab(+) patients. Mortality at 6 months as well as 5 years was also significantly higher in anti-MDA5 Ab(+) patients than in anti-MDA5 Ab(-) patients. In a multivariable Cox regression analysis, mortality was independently associated with anti-MDA5 Ab (relative hazard 6.33; 95% CI 1.43, 28.0). All of the deaths in anti-MDA5 Ab(+) patients were attributed to respiratory failure of RPILD; however, RPILD did not worsen in any of the anti-MDA5 Ab(+) patients who survived the first 6 months.
The presence of anti-MDA5 Ab identifies the characteristic skin, musculoskeletal, pulmonary and prognostic features in patients with DM. In addition, anti-MDA5 Ab seems to predict a group of patients with CADM-complicated fatal RPILD.
Rheumatology (Oxford, England) 02/2012; 51(7):1278-84. · 4.24 Impact Factor
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ABSTRACT: Bone oedema is a pathological change in rheumatoid arthritis (RA) that is detectable by magnetic resonance imaging (MRI). Recent histological analyses revealed that a prominent feature of bone oedema is the replacement of adipose tissue with inflammatory cells. Here, we demonstrate the possible roles of mesenchymal stromal cells (MSCs) in bone oedema formation and the pathogenic potential of the cells in RA.
Adipogenesis of bone marrow-derived human MSCs was induced by a standard adipogenic induction medium in the presence or absence of cytokines. The cytokine productions from MSCs were screened by an antibody array system and confirmed by ELISA. The migration assay was performed to determine the locomotive abilities of undifferentiated MSCs or MSCs after adipogenesis. The expression of α smooth muscle actin (SMA) and F-actin was examined by immunostaining and phalloidin staining, respectively.
TNF-α, interleukin (IL)-1β, IL-6, and TGF-β clearly inhibited the adipogenesis of MSCs. Production of IL-6 was markedly reduced, and IL-8 secretion was augmented in MSCs after adipogenesis. The mobility of MSCs after adipogenesis was clearly reduced in migration assays compared to that of undifferentiated MSCs. Consistent with these findings, SMA and F-actin expressions were clearly suppressed in MSCs committed to adipogenesis.
Our data suggest that the inflammatory milieu promotes bone oedema by blocking adipogenesis of MSCs. In bone oedema, the enhanced IL-6 production and the increased mobility of MSCs may contribute to the progression of RA. Therefore, bone oedema may be an important target lesion in the treatment of RA.
Clinical and experimental rheumatology 02/2012; 30(3):332-7. · 2.15 Impact Factor
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Masataka Umeda,
Keita Fujikawa, Tomoki Origuchi,
Toshiaki Tsukada,
Akira Kondo,
Shinya Tomari,
Yuichi Inoue,
Hisashi Soda,
Hideki Nakamura,
Shoko Matsui,
Atsushi Kawakami
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ABSTRACT: We report a 72-year-old man with respiratory involvement of immunoglobulin G4 (IgG4)-related disease, who developed dry cough and shortness of breath on effort. The chest computed tomography scan image showed massive and diffuse ground-glass opacity, interlobular thickening, and bronchial wall thickening. The infiltration of IgG4-positive plasma cells in the transbronchial lung biopsy and high serum IgG4 concentrations were found. The patient was treated with 0.6 mg/kg oral prednisolone and showed rapid improvement. This is a case of IgG4-related disease in which the only complication was respiratory involvement.
Modern Rheumatology 02/2012; · 1.58 Impact Factor
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Yoshiro Horai,
Ayako Nishino,
Yoshikazu Nakashima,
Takahisa Suzuki,
Akitomo Okada,
Shin-ya Kawashiri,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura, Tomoki Origuchi,
Atsushi Kawakami
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ABSTRACT: We herein report the case of a female with Sjogren's syndrome (SS) complicated with trigeminal nerve palsy. Although her sicca symptoms had been unnoticed, head magnetic resonance imaging (MRI) for detecting brain abnormalities revealed parotid gland changes associated with SS. SS should be considerd as a possible cause of trigeminal nerve disturbances. In addition, parotid gland changes related to SS should be aware in examination of cranial nerve disturbances with MRI.
Japanese Journal of Clinical Immunology 01/2012; 35(3):199-202.
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Mami Tamai,
Atsushi Kawakami,
Masataka Uetani,
Aya Fukushima,
Kazuhiko Arima,
Keita Fujikawa,
Naoki Iwamoto,
Toshiyuki Aramaki,
Makoto Kamachi,
Hideki Nakamura,
Hiroaki Ida, Tomoki Origuchi,
Kiyoshi Aoyagi,
Katsumi Eguchi
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ABSTRACT: To explore whether synovitis and bone lesions in the wrists and finger joints visualized by plain magnetic resonance imaging (MRI)-based findings correspond exactly or not to those judged by gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI-based findings.
Magnetic resonance imaging of the wrists and finger joints of both hands were examined in 51 early-stage rheumatoid arthritis (RA) patients whose median disease duration from the onset of articular manifestations to entry was 5 months, by both plain (T1 and short-time inversion recovery images) and Gd-DTPA-enhanced MRI (post-contrast fat-suppressed T1-weighted images) simultaneously. We focused on 15 sites per hand, to examine the presence of synovitis and bone lesions (bone edema and bone erosion). Gd-DTPA-enhanced MRI-based findings were considered "true" lesions, and we evaluated the accuracy of plain MRI-based findings in comparison to Gd-DTPA-enhanced MRI-based findings.
Synovitis, judged by plain MRI-based findings, appeared as false-positive at pretty frequency; thus, the specificity, positive predictive value and accuracy of the findings were low. The rate of enhancement (E-rate) in false-positive synovitis sites was significantly low compared with true-positive synovitis sites where Gd-DTPA enhancement appears. In contrast to synovitis, the false-positivity of bone lesions, judged by plain MRI-based findings, was very low compared with Gd-DTPA-enhanced MRI-based findings.
Synovitis judged by plain MRI-based findings is sometimes considered false-positive especially in sites where synovitis is mild. However, plain MRI is effective in identifying bone lesions in the wrist and finger joints in early-stage RA.
Modern Rheumatology 12/2011; 22(5):654-8. · 1.58 Impact Factor
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Tomohiro Koga,
Satoshi Yamasaki,
Kiyoshi Migita,
Junko Kita,
Akitomo Okada,
Shinya Kawashiri,
Naoki Iwamoto,
Mami Tamai,
Kazuhiko Arima, Tomoki Origuchi,
Hideki Nakamura,
Makoto Osaki,
Toshiyuki Tsurumoto,
Hiroyuki Shindo,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: Zc3h12a is an RNA binding protein with a CCCH-type finger motif and is known to regulate mRNA metabolism. Previous reports suggest that Zc3h12a acts as a negative regulator of inflammatory processes because it is involved in the degradation of IL-6 mRNA. We investigate the effect of Zc3h12a on IL-6 production in fibroblast-like synovial cells (FLS) from rheumatoid arthritis (RA) patients.
The expression of Zc3h12a in FLS was determined by polymerase chain reaction. To knock down Zc3h12a expression in FLS, siRNA for Zc3h12a was transfected by the lipofection method. The supernatants were collected after siRNA transfection for the quantification of IL-6 production. The phosphorylation of the signal transducer and activator of transcription 3 (STAT3) was examined by Western blotting. Cell proliferation was analysed by the Cell Counting Kit-8 assay after Zc3h12a knockdown.
mRNA for Zc3h12a were demonstrated in FLS from RA patients. Zc3h12a transcripts were induced by LPS or IL-1β in FLS. The production of IL-6 as well as its mRNA expression was significantly increased by the Zc3h12a knockdown. The Zc3h12a knockdown also induced the activation of STAT3, which the anti IL-6 receptor antibody inhibited. Proliferation of Zc3h12a-knockdown FLS increased significantly in the presence of recombinant soluble IL-6 receptor (sIL-6R).
Our data suggest that Zc3h12a is a novel IL-6 regulator in FLS, which may be involved in the progression of RA.
Clinical and experimental rheumatology 11/2011; 29(6):906-12. · 2.15 Impact Factor
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Naoki Iwamoto,
Atsushi Kawakami,
Mami Tamai,
Kazuhiko Arima,
Hideki Nakamura,
Shin-Ya Kawashiri,
Junko Kita,
Akitomo Okada,
Tomohiro Koga,
Makoto Kamachi,
Satoshi Yamasaki,
Kunihiro Ichinose,
Hiroaki Ida, Tomoki Origuchi,
Masataka Uetani,
Katsumi Eguchi
Clinical and experimental rheumatology 11/2011; 29(6):1062-3. · 2.15 Impact Factor
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Tomoki Origuchi,
Kazuhiko Arima,
Shin-Ya Kawashiri,
Mami Tamai,
Satoshi Yamasaki,
Hideki Nakamura,
Toshiaki Tsukada,
Toshiyuki Aramaki,
Masako Furuyama,
Taiichiro Miyashita,
Yojiro Kawabe,
Nozomi Iwanaga,
Kaoru Terada,
Yukitaka Ueki,
Takaaki Fukuda,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: Recently, it was reported that remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome could be complicated with solid tumors. In a retrospective, multicenter study between October, 2003 and September, 2010, we investigated the characteristics of patients with paraneoplastic RS3PE syndrome who fulfilled following criteria: (1) bilateral pitting edema of hands or feet or both, (2) sudden onset of polyarthritis, and (3) age >50 years, (4) seronegativity for rheumatoid factor (RF). A total of 33 cases fulfilled the above criteria. Eight patients (seven men and one woman) developed cancer within 2 years of RS3PE syndrome onset. There was no significant difference between the neoplastic and nonneoplastic groups in the proportions of patients with fever, symmetrical polyarthritis, pitting edema, and good response to corticosteroids. Serum matrix metalloproteinase 3 (MMP-3) level (median 437.3 ng/ml) in the paraneoplastic RS3PE patients was significantly higher than that in patients without neoplasia (median 114.7 ng/ml) (p < 0.05). We found that high serum MMP-3 is characteristic of patients with paraneoplastic RS3PE syndrome.
Modern Rheumatology 11/2011; 22(4):584-8. · 1.58 Impact Factor
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Junko Kita,
Mami Tamai,
Kazuhiko Arima,
Yoshikazu Nakashima,
Takahisa Suzuki,
Shin-Ya Kawashiri,
Naoki Iwamoto,
Akitomo Okada,
Tomohiro Koga,
Satoshi Yamasaki,
Hideki Nakamura, Tomoki Origuchi,
Hiroaki Ida,
Kiyoshi Aoyagi,
Masataka Uetani,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: We aimed to identify whether drug-free remission could be achieved in patients with very early rheumatoid arthritis (RA) with poor prognosis factors by treatment with synthetic disease-modifying antirheumatic drugs (DMARDs). Thirteen patients with very early RA, whose disease was considered to have highly erosive potential, were included. Magnetic resonance imaging (MRI)-proven bone edema and autoantibodies were determined in these patients. A treat-to-target strategy initiated with synthetic DMARDs was employed for 12 months. If the patients achieved simplified disease activity index (SDAI) remission along with a reduction of the RA MRI scoring bone edema score to <33% as compared with baseline at 12 months, DMARD treatment was stopped and the clinical status was further observed for the following 12 months. Synthetic DMARDs were stopped at 12 months in 5 patients. One of the 5 was lost to follow-up because of sustaining an injury that required orthopedic surgery. Three of the remaining 4 patients showed continued SDAI remission that was DMARD-free without any evidence of radiographic progression for the following 12 months. Although this was a small clinical trial, we have shown-for the first time-that true remission of very early RA with poor prognosis factors can be achieved by treatment with synthetic DMARDs.
Modern Rheumatology 09/2011; 22(3):346-52. · 1.58 Impact Factor
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ABSTRACT: To investigate whether the frequency of peripheral blood (PB) regulatory T cells (Treg) correlates with the clinical disease activity of rheumatoid arthritis (RA).
PB Treg cells, defined as the CD4+CD25(high)CD127(low/-) population, were examined by flow cytometry in 48 patients with RA, including 13 who had never received disease-modifying antirheumatic drugs (DMARD), 19 with active disease who were receiving (n = 14) or had received (n = 5) DMARD, and 16 receiving DMARD whose disease was in remission. The clinical disease activity of the patients was defined by the 28-joint Disease Activity Score (DAS28). The association of DAS28, C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR) with the frequency of PB Treg cells was examined.
The frequency of PB Treg cells in patients with RA was significantly low compared with that of healthy controls (n = 14). Among the 3 populations of patients with RA, Treg cell frequency was lowest in patients with active RA. In contrast, the Treg cell frequency of patients with RA in remission was similar to that of healthy controls. Accordingly, the frequency of CD4+CD25(high)CD127(low/-) Treg cells negatively correlated with DAS28, CRP, and ESR in patients with RA.
The data suggest that Treg cells, defined as the CD4+CD25(high)CD127(low/-) population, may contribute to the pathogenesis of RA and be an indicator of disease activity.
The Journal of Rheumatology 09/2011; 38(12):2517-21. · 3.69 Impact Factor
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Junko Kita,
Mami Tamai,
Kazuhiko Arima,
Yoshikazu Nakashima,
Takahisa Suzuki,
Shin-ya Kawashiri,
Akitomo Okada,
Tomohiro Koga,
Satoshi Yamasaki,
Hideki Nakamura, Tomoki Origuchi,
Toshiyuki Aramaki,
Munetoshi Nakashima,
Keita Fujikawa,
Toshiaki Tsukada,
Hiroaki Ida,
Kiyoshi Aoyagi,
Masataka Uetani,
Katsumi Eguchi,
Atsushi Kawakami
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ABSTRACT: We aimed to investigate whether delayed treatment with tumor necrosis factor (TNF) inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drugs (DMARDs) was effective among patients with very early rheumatoid arthritis (RA) with poor prognosis factors. We examined 22 patients with very early RA who were positive for anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. The mean disease duration at entry was 14.1 weeks. A treat-to-target strategy, aiming at simplified disease activity index (SDAI) remission, was initiated with synthetic DMARDs. SDAI remission was not achieved in 9 of the 22 patients with synthetic DMARDs alone, and TNF inhibitors were added in these patients. SDAI values in these 9 patients were further examined for the following 6 months. The TNF inhibitors (infliximab 8, etanercept 1) were added at a mean interval of 34.1 weeks after the initiation of synthetic DMARDs. SDAI remission was achieved in 4 of the 9 patients (44.4%) at 3 months and in 8 of the 9 patients (88.9%) at 6 months after the introduction of the TNF inhibitors. Radiographic damage had not progressed in these patients. Delayed treatment with TNF inhibitors is effective and tolerable for patients with very early RA with poor prognosis factors.
Modern Rheumatology 09/2011; 22(2):195-201. · 1.58 Impact Factor
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ABSTRACT: A 50-year-old Japanese woman, a patient with systemic lupus erythematosus (SLE) complicated with chronic lupus peritonitis, developed massive small intestinal hemorrhaging. She was treated with intravenous pulse of methylprednisolone, intravenous pulse of cyclophosphamide (IVCY), and immunoabsorption, but the peritonitis was refractory to these treatments. Subsequently, she was treated with oral corticosteroid and tacrolimus, and received IVCY monthly, but she developed massive small intestinal hemorrhaging 1 year after. Abdominal angiography detected multiple bleeding sites from the jejunal and ileal arteries. After transarterial embolization treatment, the melena disappeared. The pathology of this case appeared to be lupus mesenteric vasculitis.
Modern Rheumatology 07/2011; 22(2):312-5. · 1.58 Impact Factor
