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Consideration of differences in drug usage between young-onset and elderly-onset rheumatoid arthritis with target of low disease activity. CiNiiでみる

著者名:
KUMAGAI Kosuke  OKUMURA Noriaki  AMANO Yasutaka  YAYAMA Takafumi  MIMURA Tomohiro  MAEDA Tsutomu  KUBO Mitsuhiko  MORI Kanji  Barrett-Jolley Richard  IMAI Shinji  熊谷 康佑  奥村 法昭  天野 泰孝  彌山 峰史  三村 朋大  前田 勉  久保 充彦  森 幹士  今井 晋二 

抄録:
Objectives:Elderly-onset rheumatoid arthritis (EORA) is reported to differ from young-onset rheumatoid arthritis (YORA) with regard to patient background and drug treatment. We examined the amount of drug administered to patients who achieved low disease activity (LDA) for rheumatoid arthritis at our hospital.Methods:Demographics, clinical history, and treatments were compared between patients with EORA (n = 70) and YORA (n = 190).Results:There was a significant difference in the average age (73.8 vs. 57.8 years), disease duration (6.66 vs. 14.7 years), and sex (62.9% males vs. 83.7% females), but no difference in rheumatoid factor positivity (85.3% vs. 80.7%), anti-citrullinated peptide antibody positivity (86.5% vs. 87.7%), simplified disease activity index (4.28 vs. 4.59), or disease activity score 28-CRP (1.99 vs. 2.04) in the EORA and YORA groups, respectively. There were also no significant differences in prednisolone use (37.1% vs. 36.3%), amount of methotrexate administered (MTX) (1.45 vs. 1.41 mg), and MTX use (55.7% vs. 65.3%). However, the MTX dose (2.89 vs. 4.09 mg/week, p = .011) and overall biologics use (32.9% vs. 56.3%, p = .0012) were significantly lower in patients with EORA than in those with YORA.Conclusion:Patients with EORA may be able to achieve LDA with lower drug dosage than those with YORA.

出版年月日:
2021-02-22 , 
巻:
, 
号:
, 
ページ:
1-10 , 
ISSN:
1439-7609

関節リウマチ治療中のWoCBA患者に対する看護師の役割 CiNiiでみる

著者名:
洲崎 みどり 

抄録:

 WoCBA(Woman of Child-Bearing Age)とは,出産可能年齢の女性のことを言う.2018年に報告された女性の平均初婚年齢と第一子出産年齢は30歳前後と言われている.妊娠については30歳代後半になると妊孕性が低下すると言われているが,昨今の多様化するライフスタイルの変化による晩婚化があげられているため,不妊の問題が増加傾向である.RAの好発年齢は30~50歳であり,WoCBAでRAを罹患している患者が該当する.しかし,生物学的製剤やJAK阻害剤の登場により,疾患活動性が良好になり,妊娠することへの期待が持たれている.妊娠~出産後のRAに対するケアは,時期によってその都度指導が必要であり,妊娠・出産に対する未知のイメージに加え,病状の変化について指導を行わなければならない.妊娠初期では,RAの悪化に対する不安の軽減,不妊治療の末,妊娠した場合の患者への精神的サポートが必要になる.妊娠中期では,体重増加による関節に与える負担の軽減について説明し,妊娠後期では,出産後の治療開始時期について,特に「授乳」に対する思いについて傾聴することが重要である.出産後,RAの治療を開始するタイミングとともに「断乳」についての指導は必須である.WoCBA世代のRA患者にとって,妊娠・出産をサポートするために,看護師は,医師と患者との架け橋となって支援していく.


出版年月日:
2021 , 
巻:
33 , 
号:
2 , 
ページ:
159-164 , 
ISSN:
0914-8760

Effects of brief self-exercise education on the management of chronic low back pain : A community-based, randomized, parallel-group pragmatic trial CiNiiでみる

著者名:
Hiroshige Jinnouchi  Matsudaira Ko  Kitamura Akihiko  Kakihana Hironobu  Oka Hiroyuki  Hayama-Terada Mina  山岸 良匡  Kiyama Masahiko  Iso Hiroyasu  CIRCS Investigators 

抄録:
Objective\nThis study aimed to develop and assess additional effects of brief self-exercise education (brief-See) for individuals with chronic low back pain (CLBP). The brief-See comprised 100-minute consultation, individualized self-exercise program, and direct short teaching.\nMethods\nWe conducted a 6-month, community-based, randomized, parallel-group trial in a community setting, and allocated into a brief-See or material-based education alone. Pain intensity (NRS, numeric rating scale), functional limitation (RDQ, Roland-Morris disability questionnaire), self-efficacy (PSEQ, pain self-efficacy questionnaire), and quality of life (EQ-5D, European quality of life-5 dimensions) were evaluated at 4, 12, and 24 weeks after the initial consultation.\nResults\nThe brief-See did not show additional improvement over material-based education on the NRS, but it did on the RDQ, PSEQ, and EQ-5D; the estimated mean group differences in changes from the baseline were −2.1 (–3.5 to −0.7, p = .005) on the RDQ, 6.9 (1.7–12.1, p = .010) on the PSEQ, and 0.07 (0.02–0.12, p = .004) on the EQ-5D.\nConclusion\nThe 100 minutes' education program could be more acceptable, and restores functional limitation, self-efficacy, and quality of life in addition to the effects of material-based education. This has the potential to contribute to the management of CLBP in a community.

出版年月日:
2020-10 , 
巻:
31 , 
号:
4 , 
ページ:
890-898 , 
ISSN:
1439-7595

Expressions of circadian clock genes represent disease activities of RA patients treated with biological DMARDs CiNiiでみる

著者名:
Kaneshiro Kenta  Yoshida Kohsuke  Morii Kanta  Oketani Yuto  Uchida Koto  Yaekura Arisa  Okumura Ikumi  Hashimoto Teppei  Kawasaki Yoshiko  Shibanuma Nao  Sakai Yoshitada  Hashiramoto Akira 

抄録:
Objectives: Rheumatoid Arthritis (RA) is the autoimmune disease representing the circadian variations of symptoms such as morning stiffness of joints or increased production of cytokines around midnight. Clock genes have been reported to affect on the pathogenesis of RA, however, the detailed relation between clock genes and disease activities of RA has remained unclear. Methods: In this study, 15 RA patients treated with biological disease modifying anti-rheumatic drugs (bDMARDs) were enrolled (TNF inhibitor, 5; IL-6 inhibitor, 5; CTLA4-IgG, 5). Blood samples were collected from RA patients before treatment and at the study end-point fulfilling DAS28-ESR < 3.2. Total RNA was extracted from leukocytes to examine the expressions of the clock genes. We then evaluated the correlation of the clock gene expression with disease activity and the diagnostic values of the clock genes. Results: The expressions of the clock genes were significantly modulated by bDMARDs treatments. Disease activities were significantly correlated with the clock genes expressions, and disease remission/low disease activity could be distinguished from moderate/high disease activity due to the sensitivities, the specificities and the areas under the curves of that. Conclusion: The expressions of the clock genes in leukocytes could be useful as novel biomarkers predicting disease activities and therapeutic efficacies for bDMARDs in RA treatments.

出版年月日:
2020-03-03 , 
巻:
30 , 
号:
2 , 
ページ:
293-300 , 
ISSN:
1439-7595

Comparison of recovery of mobility and self-efficacy after total knee arthroplasty based on two different protocols: A prospective cohort study CiNiiでみる

著者名:
谷口 匡史  Hiyama Yoshinori  Kamitani Tsukasa  Kubo Mitsuhiko  Kawasaki Taku  Wada Osamu  Mizuno Kiyonori  Matsusue Yoshitaka 

抄録:
Objectives: The purpose of this study was to compare the recovery of mobility and self-efficacy following total knee arthroplasty (TKA) between the 5-day and the 28-day protocol. This prospective cohort study was carried out at two hospitals. Methods: In total, 104 patients who underwent TKA were enrolled. The primary outcomes measured were Life Space Assessment (LSA) for mobility and modified-Gait Efficacy Scale (mGES) for self-efficacy. Knee Society Score (KSS) was used to estimate the functional outcomes. These assessments were performed in all patients preoperatively, and at 1, 3, and 6 months postoperatively. After calculating the propensity score using covariates, such as patient characteristics, LSA, mGES, and KSS at baseline, propensity score-adjusted multivariate analysis of covariance (MANCOVA) was performed. Results: MANCOVA revealed significant differences in LSA and mGES, but not in KSS, between the two protocols. The adjusted means of LSA and mGES in the 28-day protocol were significantly greater than those in the 5-day protocol in all the postoperative assessments. Conclusion: Mobility and self-efficacy were greater following the 28-day protocol than the 5-day protocol after TKA. Our findings suggest that the modified treatment procedure for improving mobility and self-efficacy is necessary to introduce the early discharge protocol in Japan.

出版年月日:
2020 , 
巻:
30 , 
号:
1 , 
ページ:
197-203 , 
ISSN:
1439-7595

Measurement of equivalence between the web and paper versions of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire CiNiiでみる

著者名:
Takegami Yasuhiko  Seki Taisuke  Higuchi Yoshitoshi  Osawa Yusuke  Ishiguro Naoki 

抄録:
Objectives: Digitised patient-reported outcome may be beneficial for physicians and patients. The Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) can only be completed with paper and pencil (pJHEQ). We newly developed a web version of the JHEQ (wJHEQ). This study aimed to determine whether the scores obtained with the wJHEQ are equivalent to those from the pJHEQ, how much the wJHEQ would decrease missing answers, and which JHEQ the participants preferred to use. Methods: To measure equivalence between the pJHEQ and wJHEQ, we evaluated the mean score difference for each subscale (pain, movement, mental) and Visual Analogue Scale (VAS; satisfaction, right hip pain, left hip pain) and then assessed the intraclass correlation coefficients (ICC) between the two scores. ICC values ≥0.75 were defined as excellent agreement. We used Bland–Altman analysis to assess level of agreement between the values of the two questionnaires. We compared the number of incomplete forms and amount of missing data between the two questionnaires. We investigated ease of use by asking the participants which format was easier to use. Results: This study comprised 113 patients (mean age 58.1 years, 81% female) with hip disease. Mean score differences for each subscale between the wJHEQ and pJHEQ were not significantly different. The values of ICC for each subscale and each VAS were all >0.75. All 113 participants completed the wJHEQ questionnaire, whereas nine patients did not complete the pJHEQ form. There was a significant statistical difference between the completion rate of the wJHEQ and that of the pJHEQ (p = .0017). Fifty-seven participants (55%) preferred the wJHEQ, whereas 33 participants (32%) preferred the pJHEQ. Conclusion: The wJHEQ was found to be equivalent to the original pJHEQ. The wJHEQ significantly decreased the numbers of missing answers and incomplete forms. The participants felt ease of use was nearly equivalent. The wJHEQ might help facilitate more complete assessments in clinical trials and research.

出版年月日:
2020 , 
巻:
30 , 
号:
2 , 
ページ:
397-401 , 
ISSN:
1439-7595

Pathogenesis of IgG4-related disease. Comparison with Sjögren's syndrome CiNiiでみる

著者名:
坪井 洋人  本田 文香  安部 沙織  近藤 裕也  松本 功  住田 孝之  Takahashi Hiroyuki  Ono Yuko 

抄録:
IgG4-related disease (IgG4-RD) is characterized by lympho-plasmacytic infiltration and fibrosis in multiple organs, accompanied by high serum IgG4 levels. Although both IgG4-RD and Sjögren's syndrome (SS) frequently affect salivary and lacrimal glands, the clinical and pathological features of these two conditions are different. In an attempt to delineate the pathomechanisms of IgG4-RD, we compared the gene expression patterns of various molecules in labial salivary glands (LSGs) between IgG4-RD and SS. First, using quantitative PCR, we demonstrated significantly higher mRNA expression levels of activation-induced cytidine deaminase (AID), IL-10, and TGFβ in LSGs of IgG4-RD than SS and healthy controls (HCs). We propose that the combination of AID and IL-10 contributes to IgG4-specific immunoglobulin class switch recombination, and that TGFβ induces LSGs fibrosis in IgG4-RD. Second, DNA microarray identified 2641 differentially expressed genes (DEGs) in LSGs; with 1321 up-regulated and 1320 down-regulated genes in IgG4-RD, relative to SS. Among the up-regulated DEGs in IgG4-RD, quantitative PCR confirmed significantly higher expression levels of chemokine (C–C motif) ligand 18 (CCL18) and lactotransferrin in LSGs of IgG4-RD than SS and HCs. The former has chemotactic activity on various types of lymphocytes and enhances collagen production from fibroblasts, while lactotransferrin is an iron-binding protein abundantly present in milk and has a wide range of functions, including fibroblast proliferation and maturation of dendritic cells (DCs). Third, immunofluorescence staining confirmed specific upregulation of CCL18 in macrophages, CD11c + and B cells, and plasmacytes of LSGs-IgG4-RD. These pathological findings could help in the identification of disease-specific biomarkers as well as development of novel therapeutic strategies.

出版年月日:
2019-08 , 
巻:
30 , 
号:
1 , 
ページ:
7-16 , 
ISSN:
1439-7595

Reactivation of human herpesviruses 6 and 7 in Kawasaki disease CiNiiでみる

著者名:
Kawano Yoshihiko  Kawada Jun-ichi  Nagai Noriko  Ito Yoshinori 

抄録:
Objectives: Kawasaki disease (KD) is one of the most common childhood vasculitides. Some serological studies have suggested an etiological relationship between KD and human herpesvirus (HHV)-6 or HHV-7. However, primary or reactivated HHV-6 and -7 has not been fully investigated in patients with KD. Methods: Twenty-three patients with KD were prospectively enrolled in this study. Peripheral blood was collected in the acute and convalescence phases, and HHV-6 and -7 viral loads were measured by real-time PCR. Results: In the acute phase, HHV-6 and -7 DNA was detected in 7 (30%) patients each, compared to 13 (57%) and 9 (39%) patients in the convalescence phase, respectively. HHV-6 and -7 DNA loads were significantly higher in the convalescence phase than in the acute phase. Significant increases in HHV-6 and -7 DNA loads were not observed in disease control patients. Taking into account HHV-6 and -7 serostatus, reactivation of HHV-6 and -7 was observed in 7 and 9 patients, respectively. KD patients with HHV-6 reactivation showed higher C-reactive protein levels and more frequently required steroid therapies than patients without reactivation. Conclusion: HHV-6 and -7 reactivation is frequent in KD patients. HHV-6 reactivation might exacerbate the severity of KD.Published online: 05 Sep 2018

出版年月日:
2019 , 
巻:
29 , 
号:
4 , 
ページ:
651-655 , 
ISSN:
1439-7595

Deep whole-genome sequencing reveals recent selection signatures linked to evolution and disease risk of Japanese CiNiiでみる

著者名:
鎌谷 洋一郎  Momozawa Yukihide  Sakaue Saori  Kanai Masahiro  Ishigaki Kazuyoshi  Akiyama Masato  Kishikawa Toshihiro  Arai Yasumichi  Sasaki Takashi  Kosaki Kenjiro  Suematsu Makoto  Matsuda Koichi  Yamamoto Kazuhiko  Kubo Michiaki  Hirose Nobuyoshi  Kamatani Yoichiro 

抄録:
Understanding natural selection is crucial to unveiling evolution of modern humans. Here, we report natural selection signatures in the Japanese population using 2234 high-depth whole-genome sequence (WGS) data (25.9×). Using rare singletons, we identify signals of very recent selection for the past 2000–3000 years in multiple loci (ADH cluster, MHC region, BRAP-ALDH2, SERHL2). In large-scale genome-wide association study (GWAS) dataset (n = 171, 176), variants with selection signatures show enrichment in heterogeneity of derived allele frequency spectra among the geographic regions of Japan, highlighted by two major regional clusters (Hondo and Ryukyu). While the selection signatures do not show enrichment in archaic hominin-derived genome sequences, they overlap with the SNPs associated with the modern human traits. The strongest overlaps are observed for the alcohol or nutrition metabolism-related traits. Our study illustrates the value of high-depth WGS to understand evolution and their relationship with disease risk.

出版年月日:
2018-04-24 , 
巻:
, 
号:
9 , 
ページ:
- , 
ISSN:
2041-1723

関節リウマチ症例に対するセメント人工股関節の成績 CiNiiでみる

著者名:
上田 祐輔  おおえ 賢一  中村 知寿  植田 成実  河村 孟  和田 孝彦  飯田 寛和  岡本 尚史 

抄録:

Objective: The guidelines for the management of rheumatoid arthritis issued by the Japan College of Rheumatology 2014, equally recommend uncemented total hip arthroplasty (THA) for patients with rheumatoid arthritis (RA), compared to cemented THA. In our institution, all THAs have been performed with cement. In the current study, we aimed to evaluate the clinical benefits of cemented THA for patients with RA.

Methods: Eighty-two patients with RA (98 joints) were retrospectively reviewed after they had cemented THAs performed at our institution, from January 2006 to November 2014, inclusive. There were 12 males (14 joints) and 70 females (84 joints). The mean age was 64.3 (range, 34-83) years old, the mean height was 152.4 (range, 132.8-170.0) cm, the mean weight was 50.0 (range, 32.1-75.0) kg, and the mean disease duration from development of RA to index surgery was 13.3 (range, 0.5-46) years, respectively. All THAs were performed via the direct lateral approach in the lateral position using a complete polyethylene socket and polished tapered stem with antibiotic-loaded acryl cement (ALAC). Eighty-two joints out of 98 could be followed up after two years from the index surgery, and 41 joints of the 98 could be followed up after five years. We evaluated the survivorship of implants, the clinical outcomes, and the occurrence of adverse events including deep infection, dislocation, and aseptic loosening.

Results: Of 98 THAs, only one revision THA was performed for multiple dislocations within the first year after the index surgery. The mean Japanese Orthopaedic Association hip score improved from 39.3 points preoperatively to 83.4 points two years after the index surgery in 65 patients (82 joints), and to 86.3 points five years after the index surgery in 30 patients (41 joints).

Discussion: There were no revision THAs for deep infection or aseptic loosening, and only one revision THA was performed for multiple dislocations. It is considered that cemented THAs using ALAC by optimal surgical techniques (using modern cementing techniques including bone-bed preparation, use of bone plagues, retrograde injection with cement gun, pressurization, and vacuum mixing) has great benefits for patients with RA due to the longevity and the resistance to deep infection.

Conclusion: Use of cemented THAs in patients with RA is an effective option with good device survival, and minimal associated dislocations or infections.


出版年月日:
2018 , 
巻:
37 , 
号:
1 , 
ページ:
13-19 , 
ISSN:
1883-2873

室内環境の微生物に関わる最近の話題(1):序論:室内環境微生物の諸問題に関わる住宅形態の変化と疾病 CiNiiでみる

著者名:
川上 裕司 

抄録:
本号より,「室内環境の微生物に関わる最近の話題」のタイトルで微生物分科会メンバー6名によるリレー解説を開始した。室内環境における微生物の問題は年を追うごとに深刻な社会問題となっている。「カビによる室内環境の汚染が引き起こすアレルギーの問題」,「職場や公共施設での感染症やアレルギーの問題」,「近年,頻発している地震,台風,火山噴火などの自然災害に伴う仮設住宅でのアレルギーや感染症の問題」など多岐に渡っている。このリレー解説では,住宅と職場環境にスポットを当て,微生物の汚染実態,感染経路,それに伴う健康影響と対策法について解説する。
序論として,住宅形態の変化と疾病について述べる。室内環境における微生物の感染経路から見ると,1)飛沫感染(droplet infection),2)空気感染(air-borne infection),3)媒介物(食物・接触)感染(vehicle-borne infection)の3つが特に重視されている。このうち空気感染は,気密性の高い住宅や公共施設など現代の室内環境で問題視すべき感染経路であり,アレルギー疾患の増加と対策においても考慮すべき事象である。実際に,幼稚園児から高校生まで鼻・副鼻腔疾患はどの年代でも罹患率が高く,特に小学生と中学生の罹患率が際立っている。また,近年65歳以上の高齢者の喘息罹患者が増加傾向にある。これらの要因として浮遊真菌の継続的な吸入が懸念されている。

出版年月日:
2018 , 
巻:
21 , 
号:
3 , 
ページ:
209-216 , 
ISSN:
1882-0395

Predictors of biologic discontinuation due to insufficient response in patients with rheumatoid arthritis who achieved clinical remission with biologic treatment: A multicenter observational cohort study CiNiiでみる

著者名:
Asai Shuji  Fujibayashi Takayoshi  Oguchi Takeshi  Hanabayashi Masahiro  Hayashi Masatoshi  Matsubara Hiroyuki  Ito Takayasu  Yabe Yuichiro  Watanabe Tsuyoshi  Hirano Yuji  Kanayama Yasuhide  Kaneko Atsushi  Kato Takefumi  Takagi Hideki  Takahashi Nobunori  Funahashi Koji  Takemoto Toki  Asai Nobuyuki  Watanabe Tatsuo  Ishiguro Naoki  Kojima Toshihisa 

抄録:
Objective: This study aimed to investigate predictors of biologic discontinuation due to insufficient response as a surrogate for relapse in patients with rheumatoid arthritis (RA) who achieved clinical remission with biologic treatment. Methods: This study was performed based on data from a multicenter registry, and included 404 patients who achieved clinical remission within the first year of treatment with their first biologic. Cumulative retention rate of the first biologic was estimated using Kaplan–Meier curves, and the impact of patient characteristics on biologic discontinuation was assessed with Cox proportional hazards models. Results: During follow-up, 50 patients discontinued their first biologic due to insufficient response. Overall discontinuation rates due to insufficient response after achieving remission were 6%, 11%, and 19% at 1, 2, and 5 years, respectively. Multivariate analysis revealed that concomitant glucocorticoids at achieving remission [hazard ratio (HR): 3.80, 95% confidence interval (CI): 1.89–7.64)] and a higher level of C-reactive protein (CRP) at achieving remission (HR: 1.47 per 1 mg/dL, 95% CI: 1.09–1.99) independently predict discontinuation due to insufficient response after achieving remission. Conclusion: Patients with RA who achieved remission with concomitant glucocorticoid treatment and a higher level of CRP are at high risk of subsequent biologic discontinuation due to insufficient response.

出版年月日:
2018 , 
巻:
28 , 
号:
2 , 
ページ:
221-226 , 
ISSN:
1439-7595

Serum cystatin C level is associated with locomotive syndrome risk and can be an early predictor in community-living people: The Yakumo study CiNiiでみる

著者名:
Tanaka Satoshi  Ando Kei  Kobayashi Kazuyoshi  Hida Tetsuro  Ito Kenyu  Tsushima Mikito  Morozumi Masayoshi  Machino Masaaki  Ota Kyotaro  Seki Taisuke  Suzuki Koji  Nishida Yoshihiro  Ishiguro Naoki  Hasegawa Yukiharu  Imagama Shiro 

抄録:
Objectives: The locomotive syndrome (LS) risk has been recently proposed as a criterion for evaluating physical ability. Serum cystatin C level is an early renal function marker and a cardiovascular disease predictor. This study aimed to evaluate the relationship between serum cystatin C level and LS risk. Methods: We enrolled 54 participants and conducted the two-step test, stand-up test, 25-question geriatric locomotive function scale, LS risk test, Timed Up and Go test, back muscle strength, grip strength, blood test and serum cystatin C level measurement. A comparative study was conducted in participants with and without LS risk and in subgroups aged <60 and ≥60 years. Results: No significant difference was found in the serum cystatin C level in subgroups aged <60 years and without LS risk. However, it was significantly higher in subjects with LS risk and aged ≥60 years. The area under the curve of the serum cystatin C level for LS risk was 0.824. Conclusion: The serum cystatin C level is significantly related to LS risk and can be an early predictor. In middle-aged and elderly people with high serum cystatin C levels, it is strongly recommended to enforce LS risk test and intervention.

出版年月日:
2018 , 
巻:
28 , 
号:
6 , 
ページ:
1035-1040 , 
ISSN:
1439-7595

Safety and effectiveness of subcutaneous tocilizumab in patients with rheumatoid arthritis in a real-world clinical setting CiNiiでみる

著者名:
Atsumi Tatsuya  Fujio Keishi  Yamaoka Kunihiro  Tomobe Minako  Kuroyanagi Kazuyuki  Kameda Hideto 

抄録:

出版年月日:
2018 , 
巻:
28 , 
号:
5 , 
ページ:
780-788 , 
ISSN:
1439-7595

Characteristics of functional impairment in patients with long-standing rheumatoid arthritis based on range of motion of joints: Baseline data from a multicenter prospective observational cohort study to evaluate the effectiveness of joint surgery in the treat-to-target era CiNiiでみる

著者名:
Kojima Toshihisa  Ishikawa Hajime  Tanaka Sakae  Haga Nobuhiko  Nishida Keiichiro  Yukioka Masao  Hashimoto Jun  Miyahara Hisaaki  Niki Yasuo  Kimura Tomoatsu  Oda Hiromi  Asai Shuji  Funahashi Koji  Kojima Masayo  Ishiguro Naoki 

抄録:
Objective: To explore the characteristics of functional impairment in patients with established rheumatoid arthritis (RA) based on the range of motion (ROM) of joints in a prospective observational study of RA patients undergoing joint surgery. Methods: We collected data on demographics, Health Assessment Questionnaire Disability Index (HAQ-DI), and the ROM of large joints including the shoulder, elbow, wrist, hip, knee, and ankle. Associations between the ROM of each joint and disability in the eight HAQ-DI categories were determined using receiver operating characteristic (ROC) and logistic regression analyses. ROM cut-off values of each joint for the absence of disability in each HAQ-DI category were determined using ROC curves. Results: A total of 460 patients were enrolled and analyzed in this study. Based on ROC analysis, the ROM of each joint was significantly associated with disability in each category. After adjusting for disease activity, age, and sex, shoulder abduction had the highest independent impact on disability in activity [cut-off: 139 degrees (OR: 5.26)], elbow flexion-extension in dressing [121 degrees (OR: 2.22)], wrist flexion-extension in reach [86 degrees (OR: 2.71)], hip flexion-extension in walking [126 degrees (OR: 3.42)], and knee flexion-extension in walking [134 degrees (OR: 2.97)]. Conclusions: Limited ROM of multiple joints was significantly associated with functional impairment in patients with long-standing RA. Motion in daily activity involves multiple joints, and at least two joints were independently involved in disability.Published online: 25 Jul 2017

出版年月日:
2018 , 
巻:
28 , 
号:
3 , 
ページ:
474-481 , 
ISSN:
1439-7595

Microarray analysis of circulating microRNAs in familial Mediterranean fever CiNiiでみる

著者名:
Wada Taizo  Toma Tomoko  Matsuda Yusuke  Yachie Akihiro  Itami Saori  Taguchi Y-h  Murakami Yoshiki 

抄録:
Objectives: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations in MEFV. Mutations in exon 10 are associated with typical FMF phenotypes, whereas the pathogenic role of variants in exons 2 and 3 remains uncertain. Recent evidence suggests that circulating microRNAs (miRNAs) are potentially useful biomarkers in several diseases. Therefore, their expression was assessed in FMF. Methods: The subjects were 24 patients with FMF who were between attacks: eight with exon 10 mutations (group A), eight with exon 3 mutations (group B), and eight without exon 3 or 10 mutations (group C). We also investigated eight cases of PFAPA as disease controls. Exosome-rich fractionated RNA was subjected to miRNA profiling by microarray. Results: Using the expression patterns of 26 miRNAs, we classified FMF (groups A, B, and C) and PFAPA with 78.1% accuracy. In FMF patients, groups A and B, A and C, and B and C were distinguished with 93.8, 87.5, and 100% accuracy using 24, 30, and 25 miRNA expression patterns, respectively. Conclusions: These findings suggest that expression patterns of circulating miRNAs differ among FMF subgroups based on MEFV mutations between FMF episodes. These patterns may serve as a useful biomarker for detecting subgroups of FMF. © 2017 Japan College of Rheumatology

出版年月日:
2017-11-02 , 
巻:
27 , 
号:
6 , 
ページ:
1040-1046 , 
ISSN:
1439-7595