Naoto Yokogawa

Tokyo Metropolitan Tama Medical Center, Edo, Tōkyō, Japan

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Publications (26)122.57 Total impact

  • T Nunokawa · N Yokogawa · K Shimada · K Enatsu · S Sugii ·
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    ABSTRACT: Objectives: The aim of this study was to assess the use of muscle biopsy for histopathological confirmation of small vessel vasculitis (SVV) or medium vessel vasculitis (MVV). Method: Muscle biopsies were performed for all consecutive cases of suspected SVV or MVV seen at Tokyo Metropolitan Tama Medical Centre between February 2012 and May 2014 except those for which a skin or renal biopsy was indicated. Results: Forty-nine patients underwent muscle biopsies. All patients were followed for a minimum of 6 months. Diagnosis of SVV or MVV was made in 35 patients. An unrelated condition was diagnosed in 11 patients and no diagnoses were made in three patients. Of the 35 patients in whom SVV or MVV was diagnosed, positive muscle biopsies were obtained in 20 patients [15 microscopic polyangiitis (MPA), three polyarteritis nodosa (PAN), and two eosinophilic granulomatosis with polyangiitis (EGPA)], while other findings led to the same diagnosis in 15 (seven MPA, four GPA, three PAN, and one rheumatoid vasculitis). The sensitivity of the muscle biopsy was 57% [20/35; 95% confidence interval (CI) 50-57]. Of 13 patients presenting with peripheral neuropathy, the muscle biopsy demonstrated vasculitis in nine patients, with 75% sensitivity (9/12; 95% CI 69-75). There were no complications in the procedure apart from delayed wound healing in one patient. Conclusions: Muscle biopsy is a safe method that offers a high diagnostic yield for SVV or MVV, especially in patients with vasculitic neuropathy.
    Scandinavian journal of rheumatology 10/2015; DOI:10.3109/03009742.2015.1086431 · 2.53 Impact Factor
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    ABSTRACT: We sought to identify clinical features at diagnosis that can distinguish isolated polymyalgia rheumatica (PMR) without giant cell arteritis (GCA) from PMR with GCA, and clinical features at diagnosis of isolated PMR that can predict subsequent relapse and corticosteroid discontinuation. A retrospective study of 115 patients with isolated PMR and 29 patients with GCA was performed. A comparison of the isolated PMR, GCA patients (with or without PMR), PMR with GCA was performed. Predictors of relapse and corticosteroid discontinuation were identified using a logistic regression in the patients with isolated PMR. Matrix metalloproteinase-3 (MMP-3) level was significantly different among the patient groups. MMP-3: 230.5 ± 201.5 ng/mL in isolated PMR, 80.5 ± 47.5 ng/mL in GCA (p<0.01), and 96.8 ± 54.8 ng/mL in PMR with GCA (p=0.03). In the patients with isolated PMR, female gender (OR 2.73; 95% CI 1.16-6.41; p<0.05) and Cr < 50 μmol/L (OR 2.48; 95% CI 1.02-5.99; p<0.05) were significant prognostic factors that predicted relapse. A low level of MMP-3 is an excellent positive predictor for PMR with GCA. Among patients with isolated PMR, female gender and Cr < 50 μmol/L were significant prognostic factors that predicted relapse.
    Modern Rheumatology 07/2015; DOI:10.3109/14397595.2015.1071304 · 2.40 Impact Factor
  • Y. Nagai · N. Yokogawa · K. Shimada · S. Sugii ·
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    ABSTRACT: Background Many systemic lupus erythematosus (SLE) patients require emergency room (ER) visits because of flares and other complications. Distinguishing between flares and complications such as infections in the emergency ward is crucial to timely implementation of the required treatment, but sometimes poses a challenge for primary care and emergency physicians alike, resulting in delays in diagnosis and intervention. Objectives The aim of this study is to describe the characteristics of SLE patients who visit the ER, and to determine the proportion of ER visits due to SLE flares with the ultimate aim of detecting the risk factors for ER visits using multivariate logistic analysis. Methods A four-year retrospective study was performed at Tokyo Metropolitan Tama Medical Center using patients' electronic medical records. All records of emergency room visits by SLE patients from April, 2008 to March, 2012 were extracted from the data. Results In total, 269 events were identified in 117 patients. Of these events, 91 (33.8%) were cases of infection, 32 (11.9%) of orthopedic problems and gastrointestinal disease, 31 (11.5%) of neurological disease, and 25 (9.3%) of cardiovascular events. Twenty four events (8.9%) were due to SLE flares, of which 10 (41.7%) were cases of neuropsychiatric lupus including disturbances in consciousness, aseptic meningitis, seizure, and visual field abnormality. The “ER user group” and “ER non-user group” comprised 117 and 88 patients, respectively. The dosage of glucocorticoids (prednisolone equivalent, 9.09±0.63mg, 5.36±0.73mg), intervention by psychiatrists (17/117 (14.5%), 3/88 (3.4%)), presence of neuropsychiatric lupus (23/117 (19.7%), 6/88 (6.8%)) and presence of lupus nephritis (48/117 (41.2%), 22/88 (25.0%)) were higher among the ER user group than the ER non-user group (p<0.05). As a result of multivariate logistic analysis, higher glucocorticoid dosage, duration of disease, and neuropsychiatric lupus were found to be risk factors for ER visits. Conclusions Among SLE patients, infection was the principal reason for visiting the emergency room. ER visits due to SLE flares comprised only 8.9% of the total. Multivariate logistic analysis demonstrated that higher glucocorticoid dosage, duration of disease, and neuropsychiatric lupus comprised risk factors for ER visits. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1108.1-1108. DOI:10.1136/annrheumdis-2015-eular.1631 · 10.38 Impact Factor
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    ABSTRACT: Background Polyarthritis caused by rheumatoid arthritis has wide variety in size and number of affected joints. In diagnosis and evaluation, swollen joint count and systemic inflammation markers (e.g. serum C-reacive protein (CRP) and erythrocyte sedimentation rate (ESR)) are considered independently. However, when systemic inflammation markers are supposed to reflect the total inflammation in the whole body, the level of the markers should vary according to the size and the number of the swollen, that is, inflamed joints. Objectives To investigate the correlation between the size of swollen joints with systemic inflammation markers using a large-scale patient database. Methods NinJa is the largest database of rheumatoid arthritis in Japan in which more than 10,000 patients are registered. Data registered to the NinJa database in 2012 were used. Sixty-six joints were classified into 3 size categories, namely, the digital joints (distal interphalangeal joints, proximal interphalangeal joints, interphalangeal joints, metacarpophalangeal joints and metatarsophalangeal joints) and acromioclavicular joints as small joints (joint surface area1 <10 cm2), the knees as large joints (joint surface area1 >100 cm2), and the others as medium-sized joints (joint surface area1 between 10 cm2 and 100 cm2). Patients with swollen joints limited to one joint-size category were grouped by swollen joint count and compared with patients with no swollen joint. 8574 cases were analyzed. Patients receiving anti-interleukin-6 or Janus-kinase-inhibiting therapies were excluded. Results Patients with larger numbers of swollen joints tended to show higher levels of both serum CRP and ESR in each joint-size category (Figure 1). In the medium-sized, or knee joint group, these levels were significantly higher than in the no-swelling group and small joint group with the same swollen joint count. Linear regression analysis revealed increments of CRP (mg/L) (ESR (mm/1hr) [95% confidence interval]) per swollen joint as 4.6 [3.7-5.5] (8.9 [6.5-11]) in the knee, 2.3 [2.0-2.7] (4.9 [4.0-5.9]) in medium-sized joints, and 0.56 [0.35-0.77] (0.89 [0.39-1.38]) in the small joints. Conclusions The strength of swelling in the joints affecting systemic inflammation markers increased with the involvement of larger and/or more numerous joints. References Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):694.1-694. DOI:10.1136/annrheumdis-2015-eular.1836 · 10.38 Impact Factor
  • N. Yokogawa · T. Kaneko · Y. Nagai · T. Nunokawa · T. Sawaki · K. Shiroto · K. Shimada · S. Sugii ·

    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1286.3-1287. DOI:10.1136/annrheumdis-2015-eular.2677 · 10.38 Impact Factor
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    ABSTRACT: Objectives: To validate Routine Assessment of Patient Index Data 3 (RAPID3) using a Japanese version of Multidimensional Health Assessment Questionnaire (MDHAQ) with Japanese rheumatoid arthritis (RA) patients and to describe the characteristics of RAPID3 by comparison with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI). Methods: The original MDHAQ was translated into Japanese with minor cultural modifications and was translated back in English. Test-retest reliability was evaluated in 50 Japanese RA patients and further validation was performed in 350 Japanese RA patients recruited by seven rheumatologists. RAPID3, CDAI, and DAS28 were assessed on two consecutive visits. Results: The test-retest reliability and the internal reliability of RAPID3 were excellent. Spearman's correlation coefficients between RAPID3 score versus CDAI score and DAS28 score were 0.761and 0.555. However, the agreement measured by kappa (weighted) for RAPID3 category versus CDAI category and for RAPID3 category versus DA28 category were 0.225 (0.382) and 0.187 (0.336). The sensitivity and specificity of "RAPID3 ≤ 3 and swollen joint ≤ 1" for predicting Boolean remission were 90.0% and 93.4%, respectively. Conclusions: RAPID3 obtained by Japanese MDHAQ was validated with Japanese RA patients and the remission criteria were found to have excellent clinical utility in usual care.
    Modern Rheumatology 08/2014; 25(2):1-6. DOI:10.3109/14397595.2014.948587 · 2.40 Impact Factor
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    ABSTRACT: Background Prophylaxis with trimethoprim-sulfamethoxazole (TMP/SMP) is highly effective for the prevention of Pneumocysitis pneumonia (PCP) and recommended in patients with connective tissue diseases (CTD) undergoing high-dose corticosteroid therapy.[1] Prophylaxis with TMP-SMZ is also reported to reduce the incidence of bloodstream infection with little discernible effect on the microflora in renal transplant but not studied in CTD. [2] Objectives To investigate the predictors of bloodstream infection including prophylaxis of TMP-SMZ in patients with CTD undergoing high-dose corticosteroid therapy Methods This is a retrospective cohort study. Patients with various CTD who fulfilled the following criteria were included: (1) patients were admitted to Tokyo Metropolitan Tama Medical Center between April 2008 and March 2013, (2) treatment with more than 50mg/day of prednisolone (PSL) was started after admission. Prophylaxis with TMP/SMX was 80mg of trimethoprim and 400mg of sulfamethoxazole. A half dose was also accepted. We classified patients into three group: “continued”, “discontinued”, and “no” prophylaxis with TMP/SMP against PCP. We analyzed the frequency and the characteristics of bloodstream infection for 24 weeks after starting high-dose corticosteroid and the predictors of bloodstream infection using univariate and multivariate analysis. Results Among 170 patients analyzed, “continued”, “discontinued”, and “no” prophylaxis with TMP/SMP against PCP were 113, 41, and 16 respectively. The reasons of discontinuation were cytopenia (8), hyperkalemia (5), abnormal liver function (3), diarrhea (2), and abnormal renal function (1). (Table 1) Two patients developed PCP: 1 in “continued” and 1 in “discontinued”. Total 10 Bloodstream infections were found: 2 (1.8%) in “continued”, 5 (12.2%) in “discontinued”, and 3 (18.8%) in “no” prophylaxis group. Six were catheter-related blood stream infection. Detected microorganisims were Methicillin-Resistant Staphylococcus epidermidis (4), Candida species (2), Escherichia coli (1), Klebsiella pneumoniae (1), Listeria monocytogenes (1), and α-streptococcus species (1) (Table 2). By univariate and multivariate analysis, central venous catheter use was strongly predicted bloodstream infection (AOR 17.8). In contrast, “continued” prophylaxis with TMP/SMP was protective compared to “discontinued” or “no” prophylaxis.: AOR of “no” vs “continued” was 8.98 and AOR of “discontinued” vs “continued” prophylaxis was 19.0. Conclusions Prophylaxis with TMP-SMZ against PCP may reduce the risk of bloodstream infection in patients with CTD undergoing high-dose corticosteroid therapy. References Acknowledgements Dr Yokogawa and Dr Kobayashi contributed equally to the study. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5775
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):285-285. DOI:10.1136/annrheumdis-2014-eular.5775 · 10.38 Impact Factor
  • N. Yokogawa · T. Seki · H. Takeuchi · S. Katase · T. Kaneko · S. Sugii ·
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    ABSTRACT: Background Crowned dens syndrome (CDS) is a clinical and radiographic entity characterized by acute neck pain, positive inflammatory indicators and periodontoid calcification by a cervical CT scan.[1,2] However, these features can be seen in other diseases such as giant cell arteritis, meningitis, rheumatoid arthritis, or subarachnoid hemorrhage. Therefore clinical suspicion and evaluation of CDS are important when examining patients with undiagnosed acute neck pain or headache. Objectives To investigate the diagnostic utility of chondrocalcinosis in knee X ray to diagnose CDS. Methods This study is a retrospective cohort study. The subjects were the patients with suspected CDS who underwent a cervical CT scan in our hospital between 8/1/2009 and 3/31/2013. Among them, we compared patients' characteristics. All patients with suspected CDS must have undiagnosed acute neck pain or headache. CDS is diagnosed if all of the following were met: acute neck pain or headache, positive inflammatory indicators (WBC>9000/μl; CRP >0.3 mg/dl, ESR>15mm/hr), presence of periodontoid calcification by cervical CT scan, and exclusion of other diseases. Two blinded radiologists reviewed the radiographs and gave consensus reading to rheumatologists. Two rheumatologists independently reviewed clinical information obtained from electric records and the radiologists' reading of the cervical CT scans and the knee x rays and made final diagnosis. Clinical parameters were compared between the group of patients diagnosed with CDS (CDS group) and the group of patients finally diagnosed with non-CDS (Non-CDS group). Results Of the 2240 patients who underwent a CT scan evaluating the cervical spine between August 1, 2009 and March 31, 67 patients underwent cervical CT scan for suspicious CDS. Among them, 36 had acute neck pain or headache with suspect of pseudogout attack, 27 had acute neck pain or headache with positive inflammation markers, and 4 had acute neck pain or headache only. One patient was excluded because of the dental artifact in the CT. Thirty-four patients were finally diagnosed with CDS. The final diagnosis of the 32 patients who were not diagnosed with CDS was as follows: rheumatoid arthritis (6), polymyalgia rheumatica (5), cervical spondylosis (4), giant cell arteritis (2), tumor metastasis to the cervical spine (1), osteomyelitis (1), ankylosing spondylitis (1), Calcific tendinitis of the longus colli (1), tension headache (1), neck spasm (1), and unknown (9).Table 1 shows clinical features of the CDS group and the Non-CDS group. Significant differences were observed with respect to age, recurrent neck pain, and chondrocalcinosis. Sensitivity and specificity of knee chodrocalcinosis were 64.3 (53.4-69.5) % and 89.5 (73.4-96.9)%. Multiple logistic regression analysis showed knee chondrocalcinosis is the single strongest predictor (AOR 16.7, p<0.001). Conclusions When CDS is suspected, chondrocalcinosis in plain knee X ray is helpful for clinical diagnosis of CDS. References Acknowledgements Dr. Yokogawa and Dr. Seki contributed equally to this study. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5587
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):1082-1082. DOI:10.1136/annrheumdis-2014-eular.5587 · 10.38 Impact Factor
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    ABSTRACT: To determine an appropriate focus score cutoff for childhood Sjögren syndrome (SS). Labial salivary gland tissue from specimens from children with SS and age-matched controls was retrospectively identified and reviewed by a blinded oral pathologist. The presence of any focal sialadenitis (focus score > 0 foci/4 mm(2)) was common among childhood SS samples but present in only 1 of 8 control samples. The presence of any focal lymphocytic sialadenitis in minor labial salivary gland tissue is suggestive of childhood SS and should be included in future childhood SS-specific diagnostic or classification criteria.
    The Journal of Rheumatology 05/2014; 41(6). DOI:10.3899/jrheum.131511 · 3.19 Impact Factor
  • Jay Mehta · Naoto Yokogawa · Scott Lieberman ·
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    ABSTRACT: Background/Purpose:Sjögren syndrome is a complex autoimmune disease that affects lacrimal and salivary glands along with the potential to cause damage to other organs. Diagnosis of childhood Sjögren syndrome is currently based on expert opinion due to the lack of child-specific diagnostic criteria. Children do not typically present with the sicca symptoms characteristic of adult Sjögren syndrome. While they most commonly present with recurrent parotitis, some children present with other organ involvement in the absence of parotitis. The latter may be severe requiring more extensive immunomodulatory therapy. The goal of this study was to compare serologic profiles of cohorts of children with Sjögren syndrome presenting with or without parotitis to determine if separate serology-based diagnostic criteria are needed for these two groups.Methods:We retrospectively reviewed childhood Sjögren syndrome cases from a single center as well as those in the published English literature with individual patient data. We collected available data on sicca symptoms, serologies (ANA, anti-SSA/B, RF), lacrimal and salivary gland function, imaging, and histopathology. For analyses of individual components, cases were excluded if specific data was not explicitly reported, so denominators may vary.Results:We identified 26 cases of childhood Sjögren syndrome diagnosed and followed at The Children's Hospital of Philadelphia and 67 cases in the literature that contained information on individual children. Parotitis status was reported for 82 cases and was a main feature of presentation in 59 (72%) cases. 28 of 51 (55%) children with parotitis and 13 of 22 (59%) children without parotitis presented with sicca symptoms. 53 of 58 (91%) children with parotitis and 21 of 23 (91%) children without parotitis were ANA positive. 49 of 58 (84%) children with parotitis and 20 of 23 (87%) children without parotitis were anti-SSA/B positive. 42 of 51 (82%) children with parotitis and 7 of 13 (54%) children without parotitis were RF positive. 56 of 58 (97%) children with parotitis and 22 of 23 (96%) children without parotitis were positive for either ANA or anti-SSA/B.Conclusion:A large majority (96%) of children with Sjögren syndrome have positive ANA and/or anti-SSA/B, and the serologic profiles do not significantly differ based on the presence or absence of parotitis. Thus, testing for ANA and anti-SSA/B is warranted in the diagnostic workup of any child suspected of having Sjögren syndrome, especially in patients who do not present with parotitis. Given the selection bias inherent in this approach, development of childhood Sjögren syndrome-specific diagnostic criteria are needed for future prospective studies to better characterize the prognosis and optimal therapies for this potentially devastating disease.
    Arthritis and Rheumatology 03/2014; 66(S11). DOI:10.1002/art.38489
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    ABSTRACT: Background “Treating to target (T2T) recommendations” are formulated to improve the management of rheumatoid arthritis (RA) in clinical practice. The following four overarching principles are highlighted: “(A) The treatment of rheumatoid arthritis must be based on a shared decision between patient and rheumatologist, (B) The primary goal of treating the patient with rheumatoid arthritis is to maximise long-term health-related quality of life through control of symptoms, prevention of structural damage, normalisation of function and social participation, (C) Abrogation of inflammation is the most important way to achieve these goals, (D) Treatment to target by measuring disease activity and adjusting therapy accordingly optimises outcomes in rheumatoid arthritis.” However, the T2T recommendations do not specify concrete and effective methods to implement. Objectives We developed an original computerized touch-panel system for facilitating the assessment of RA, called MiRAi.[1] We upgraded MiRAi to allow patients to track their RAPID3 score independently on their monitor even before consulting their physician. We evaluated whether this novel touch-panel system promoted shared decision making between patient and rheumatologist. Methods After obtaining the informed consent, registered nurses asked RA patients to fill out the same questionnaires before, and 6 months after, introduction of the touch-panel system. The questionnaires were anonymous and the physicians were blinded. The questionnaire included six visual analog scales (VAS): agreement to each of the four overarching principles, degree of “shared decision-making”, and degree of satisfaction with the care received. Since the key concept of the T2T is summarized in principle “D” as outlined above, we classified subjects with the lower quartile VAS of “D” (before introduction of this system) in the “poor comprehension group” and the rest in the “fair/good comprehension group”. We then compared the VAS between these two groups. Results The IRB approved this project. The initial evaluation was obtained from 302 patients. Six months after this system was introduced, the second evaluation was collected from 261 patients (86.4%). Whereas the “Poor comprehension group” showed improvement in all VAS except the RAPID3 score, the “fair/good comprehension group” showed improvement in RAPID3 and as well as satisfaction with the medical care they received. Conclusions The novel touch-panel system may promote comprehension and implementation of T2T recommendations. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A835-A835. DOI:10.1136/annrheumdis-2013-eular.2485 · 10.38 Impact Factor
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    ABSTRACT: Background Antisynthetase syndrome is associated with anti-aminoacyl-tRNA antibodies and often presents with inflammatory myopathy, interstitial lung disease and polyarthritis, which may mimic rheumatoid arthritis or erosive osteoarthritis. Objectives The aim of this study is to evaluate articular manifestations of antisynthetase syndrome based on the types of antibodies. Methods Clinical and radiological features of patients with antisynthetase syndrome were reviewed using electric chart system at our hospital. Results Twenty-two patients were diagnosed as antisynthetase syndrome associated with 5 types of anti-aminoacyl-tRNA antibodies: anti-Jo-1 10, anti-EJ 8, anti-PL-7 2, anti-KS 1, anti-OJ. Fifteen patients (68%) had arthralgia and/or arthritis. While only two patients with anti-EJ had articular involvement, all of the patients with anti-Jo 1 and three with other antibodies had. In hand X-rays, joint deformities, most frequently subluxations, were found in five patients with anti-Jo 1 and one with anti-PL 7. DIP involvement was observed in four patients, PIP in two, MCP in one. On MRI of four patients, tenosynovitis was prominent compared to bone erosion or edema. One patient presented marked periarticular calcinosis. Conclusions Anti-Jo-1 antibody exhibited more severe articular manifestations than other antibodies. Subclinical tenosynovitis may potentiate a progressive joint deformity, such as DIP subluxation. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):686-686. DOI:10.1136/annrheumdis-2012-eular.841 · 10.38 Impact Factor
  • T. Nunokawa · K. Ohashi · S. Sugii · K. Shimada · N. Yokogawa ·
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    ABSTRACT: Background Pneumocystis pneumonia (PCP) is rare, but life-threatening complications in patients with rheumatoid arthritis (RA). PCP in RA exhibits differently from PCP in acquired immunodeficiency syndrome (AIDS). Objectives The aim of this study is to reveal clinical and laboratory differences between PCP in patients with RA and PCP in AIDS. Methods We reviewed electric chart of our hospital from 1/2006 to 12/2011. PCP was difined by the following criteria a) symptoms and radiological findings compatible with PCP b) detection of P. jirovecii by polymerase chain reaction (PCR) in respiratory specimens, c) elevated plasma (1$→ $3)-β-D-glucan level. We compared the clinical features between RA patients and AIDS patients. Results Forty-one patients were diagnosed with PCP: 15 with RA, 10 with AIDS, 8 with connective tissue disease (CTD), 3 with cancer, 5 with others. In RA patients, 6 patients were on biologic therapy with or without low dose prednisolone. Seven patients were treated with low dose prednisolone and non-biologic DMARDs: 5 on methotrexate, 2 on methotrexate and tacrolimus, and 2 on steroids alone. Positivity of Grocott stain in RA patients was significantly lower than that in AIDS patients (7.1% vs 77.8%, p=0.0005). Serum LDH and CRP in RA patients were significantly higher than those in AIDS patients (p=0.04 and p=0.004, respectively). Three in RA patients died while none in AIDS patients. Conclusions In RA patients, low dose steroids or DMARDs can induce PCP and PCR method should be used to detect P. jirovecii. We speculate PCP in RA patients may have more intense inflammation with less parasite burden and, as a result, worse prognosis than PCP in AIDS patients Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):662-662. DOI:10.1136/annrheumdis-2012-eular.438 · 10.38 Impact Factor
  • N. Yokogawa · J. Nishino · T. Sawaki · K. Shimada · S. Sugii · S. Toma ·
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    ABSTRACT: Background Treatments based on measuring disease activity and adjusting therapy accordingly optimizes outcomes in rheumatoid arthritis (RA). In patients with long-standing disease, joint surgeries may be preferred due to considerable joint damage and prior treatment failures. However, the impact of joint surgeries on disease activity awaits more thorough study/investigation. Objectives Using the Japanese National Database, we evaluated the impact of joint surgery on disease activity using two validated disease activity indices with response criteria: the Disease Activity Score (DAS28) and the Routine Assessment of Patient Index Data 3 (RAPID3). Methods The subjects were patients with RA of 5 years’ duration or longer who had undergone joint surgery for the upper or lower extremities (synovectomy, arthroplasty, joint fusion, or joint replacement) in 2010 and whose records were available in the Japanese National Database. Patients with insufficient data for calculating the DAS28 and RAPID3 scores before and after operation were excluded. The changes in disease activity after joint surgeries were evaluated by the RAPID3 response, the EULAR-DAS28 response, and the Boolean remission, criteria. We also identified patients who achieved a good or moderate response (without adding or changing medication) and assessed the ideal “surgical window of opportunity” by ROC analysis. Results After excluding subjects with insufficient data, the remaining 93 patients were analyzed. The patients’ age and disease duration were 64.3±11.3 and 20.9±11.8 (yrs). According to the Steinbrocker classification, 64 (72.3%) were stage IV and 16 (18.2%) were Stage III. Fifty-seven (61.3%) had received joint replacement and thirty-six (38.7%) had undergone other procedures (21 arthroplasties, 9 joint fusions and 6 synovectomies). Seventy-three (78.5%) had undergone joint surgeries of the lower extremities. RAPID3 improved from 12.2±6.20 to 10.9±6.46 (p=0.0347) and DAS28 improved from 3.96±1.28 to 3.72±1.30 (p=0.0393). Good and moderate responses were observed in 13 (14.0%) and 20 (21.5%) subjects, respectively, by the EULAR-DAS28 response criteria and in 7 (7.5%) and 21 (22.6%) of the subjects, respectively, by the RAPID3 response criteria (kappa 0.235 p=0.0016, weighted kappa 0.386 p=0.0001). Nine patients (9.7%) achieved the Boolean remission criteria after operation. By a multiple regression analysis, disease duration, adding or changing medications, and types of operation (joint replacement) influenced patients’ responsiveness in DAS28 and RAPID3. The ROC analysis of good and moderate responses in RAPID3 showed that a disease duration of 11 years or less exhibited a sensitivity of 95% and a specificity of 95% (AUC 0.987), while that of DAS28 showed that a disease duration of 15 years or less exhibited a sensitivity of 75% and a specificity of 68% (AUC 0.759). Conclusions In patients with long-standing RA, joint surgeries, especially if performed within 11-15 years after the diagnosis, may help improve control of disease activity. Acknowledgements This work was supported in part by grants from the Ministry of Health, Labour and Welfare, Japan. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A843-A843. DOI:10.1136/annrheumdis-2013-eular.2510 · 10.38 Impact Factor
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    ABSTRACT: Medical management of systemic sclerosis (SSc)-associated chronic intestinal pseudo- obstruction (CIPO) has often proved inadequate. Percutaneous endoscopic colostomy (PEC) has been proposed as a method of treatment, but it is associated with a relatively high incidence of serious complications. We report herein a very severe case of SSc-associated CIPO in which complications were successfully controlled by long tube placement via a gastrostomy. Transgastric long tube placement may offer a relatively safe alternative to PEC in treating severe SSc-associated CIPO.
    Modern Rheumatology 11/2013; DOI:10.3109/14397595.2013.844385 · 2.40 Impact Factor
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    ABSTRACT: To describe and compare expectations of patients with rheumatoid arthritis (RA) and their physicians with regard to what is most important to achieve during a rheumatology clinic visit. Subjects were RA patients enrolled in four centers from China, one from Japan and one from the USA, and rheumatologists at those centers. The questionnaires were provided at clinics and patients were asked to list their three top priorities for the rheumatology clinic visit. Physicians were contacted separately and asked to give three general expectations, not for specific visits. We classified clinical expectations into a series of 24 terms for patients and 17 for physicians. We compared physicians' to patients' responses, compared expectations among centers in China, Japan and the USA, and evaluated relationships between patients' responses and age, gender, nationality, disease duration and DAS-28 (Disease Activity Score-28). Patients' clinical expectations for visits focused primarily on control of pain (63.7%), improvement of function (49.3%) and discussion of effects of medication (38.1%). Physicians also included control of pain (59.5%), but also emphasized inquiry about drug side-effects (47.8%) and objective assessment of disease activity (41.4%). We found no differences related to patients' gender, disease duration and DAS-28, but there were some differences related to age and nationality. We found some agreement and some discordance of clinical expectations between RA patients and physicians. There appear to be some different expectations in different countries. Findings from this pilot survey may help physicians consider patients' expectations in planning rheumatology clinic visits and may lead to further hypothesis-driven studies.
    International Journal of Rheumatic Diseases 08/2012; 15(4):380-9. DOI:10.1111/j.1756-185X.2012.01752.x · 1.47 Impact Factor
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    ABSTRACT: Scleroderma renal crisis (SRC) is a rare complication of systemic sclerosis (SSc) but can be severe enough to require temporary or permanent renal replacement therapy. Moderate to high dose corticosteroid use is recognized as a major risk factor for SRC. Furthermore, there have been reports of thrombotic microangiopathy precipitated by cyclosporine in patients with SSc. In this article, we report a patient with SRC induced by tacrolimus and corticosteroids. The aim of this work is to call attention to the risk of tacrolimus use in patients with SSc.
    American journal of therapeutics 07/2012; 21(5). DOI:10.1097/MJT.0b013e3182583ba1 · 1.13 Impact Factor

  • The Journal of Rheumatology 06/2012; 39(6):1296. DOI:10.3899/jrheum.111569 · 3.19 Impact Factor
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    ABSTRACT: BACKGROUND: Hydroxychloroquine (HCQ) is not available in Japan. To design a clinical trial of HCQ, we evaluated the response to HCQ in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI). METHODS: Twenty-seven patients with lupus-related skin disease who started HCQ at four hospitals were included. Patients were categorized into responders by the CLASI response criteria. The points and the rate of improvement in the CLASI activity score after 16 weeks of treatment were analyzed, focusing on six parameters: systemic lupus erythematosus (SLE), skin manifestations, disease duration, prednisolone, smoking, and severity. RESULTS: Twenty-seven patients, including 17 with SLE (6 with SLE/Sjögren's syndrome), were analyzed retrospectively. Twenty-three patients (85 %) were categorized as responders. The mean CLASI activity score improved from 10.1 to 4.5 (p < 0.0001). The improvement rate did not differ in these parameters except for that of annular erythema (81.6 versus 34.3 %, p = 0.036). On multivariate analysis, the baseline CLASI activity score (CLASI ≥9) correlated with the greatest decrease in CLASI activity score (F = 69.7, p < 0.0001). CONCLUSIONS: CLASI is a reliable indicator to evaluate the efficacy of the drug, and HCQ is an effective treatment for Japanese patients with lupus-related skin disease.
    Modern Rheumatology 05/2012; 24(4). DOI:10.1007/s10165-012-0656-3 · 2.40 Impact Factor

  • Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 04/2012; 18(3):159-60. DOI:10.1097/RHU.0b013e31824ea21d · 1.08 Impact Factor

Publication Stats

43 Citations
122.57 Total Impact Points


  • 2011-2014
    • Tokyo Metropolitan Tama Medical Center
      Edo, Tōkyō, Japan
  • 2010-2011
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2009
    • University of Pennsylvania
      • Division of Rheumatology
      Philadelphia, Pennsylvania, United States