Modern Rheumatology最新文献

Objectives: This study was conducted to investigate factors involved in anaphylaxis related to diclofenac etalhyaluronate (DEH) [product name: Joyclu® (JCL)] (containing DEH and macrogol 400), which is used to treat patients with osteoarthritis.

Methods: Patients with osteoarthritis were divided into two groups that had (experienced patients) or had not experienced anaphylactic symptoms after JCL administration (nonexperienced patients). Five tests performed to assess factors related to anaphylaxis consisted of a skin prick test as the primary endpoint and the other tests including basophil activation test, allergen-specific IgE tests using enzyme-linked immunosorbent assay or immunochromatographic kits, and genetic study were secondary endpoints.

Results: The skin prick test showed 4 (wheal)/7 (erythema) of 15 experienced patients and 0/3 of 19 nonexperienced patients were positive for any of the test reagents containing DEH. The basophil activation test showed two experienced patients were positive for test reagents containing DEH. DEH- and diclofenac-allergen-specific IgE were detected in 3 and 1 of 12 experienced patients, respectively. No clear results were shown in the other tests.

Conclusions: DEH may be the main factor involved in the development of anaphylaxis. The skin prick test was more sensitive than the basophil activation and allergen-specific IgE tests for identifying factors associated with anaphylaxis.

Objectives: A disintegrin and metalloproteinase (ADAM)-15 and vascular endothelial (VE)-cadherin are involved in angiogenesis. We investigated the relationship between ADAM-15 and VE-cadherin expressions in rheumatoid arthritis (RA).

Methods: VE-cadherin concentrations in the serum of patients with RA were measured using the enzyme linked immunosorbent assay. We stimulated fibroblast-like synoviocytes (RA-FLS) with VE-cadherin and measured the vascular endothelial growth factor (VEGF) and inflammatory cytokine levels using ELISA. We also examined the correlation between serum VE-cadherin levels and DAS-28ESR, and used the Matrigel assay to examine VE-cadherin involvement in angiogenesis.

Results: Serum VE-cadherin levels were significantly higher in patients with RA than in healthy controls. A negative correlation was observed between VE-cadherin and DAS-28ESR. VEGF, chemokine ligand 16, intercellular adhesion molecule-1, and interleukin-8 levels in the supernatant of RA-FLS or human umbilical vein endothelial cells stimulated with VE-cadherin were significantly lower than those in the controls. The number of intercellular bridges formed by endothelial cells using Matrigel significantly decreased in RA synovial fluids from which VE-cadherin had been removed compared to synovial fluids treated with control immunoglobulin G.

Conclusion: VE-cadherin may have an inhibitory effect on inflammation depending on the phase of RA inflammation.

Objectives: We assessed physical function by three different methods in patients with knee osteoarthritis just before total knee arthroplasty (TKA) and investigated the relationship with pre-operative factors.

Methods: All patients scheduled to undergo TKA were assessed for basic attributes, clinical assessment, radiography, whole-body mode dual-energy X-ray absorptiometry, knee muscle strength, and frailty, sarcopenia, locomotive syndrome (LS) were evaluated.

Results: Among 204 patients (213 knees), 172 women the overall distribution in frailty was no: 14.6%, pre-frailty: 58.5%, frailty: 26.8%; in sarcopenia no: 93.3%, yes: 3.4%, severe: 3.4%; and in LS Stage 0: 0%, Stage 1: 3.3%, Stage 2: 11.4%, Stage 3: 85.3% . Eighty-seven per cent of the patients with frailty and 92% with LS Stage 3 did not suffer from sarcopenia. Statistically significant relationships were observed between sarcopenia and frailty, while there was no relationship between LS and frailty or LS and sarcopenia. Multivariate analysis of related factors with severity levels for frailty and LS revealed statistically significant correlations for frailty with gait speed, and LS with Knee Society Score and muscle strength.

Conclusion: In patients with knee osteoarthritis frailty and LS were not related to sarcopenia. Knee joint dysfunction without sarcopenia was well reflected by LS, but not by frailty.

Objectives: To investigate the utility of shear wave elastography (SWE) values in differentiating IgG4-related submandibular sialadenitis (IgG4-RSS) from healthy individuals and in monitoring the response to glucocorticoid treatment.

Methods: Patients with IgG4-RSS who underwent ultrasound between 2017 and 2023 were included. Gland size, border, internal echo pattern, vascularity, and SWE were measured. These parameters were compared with those of the healthy controls, and before and after treatment.

Results: Thirty-one glands from 16 patients were analysed. All glands had a nodular shape; the nodular hypoechoic was the most prevalent pattern, followed by the diffuse hypoechoic; the reticular was the least common. Most glands had rich vascularity, whereas two glands had minimal vascularity. The depth (mean 18 mm) and SWE (mean 3.57 m/s) were significantly higher in IgG-RSS (P = .003 and <.001, respectively) than in the healthy controls. Nine glands from five patients were enrolled to evaluate the treatment response. After treatment, the margins became smoother and all glands showed a reduction in size, hypoechoic area, and vascularity. The mean SWE decreased from 3.56 m/s to 2.50 m/s with a significant difference between pre- and post-treatment (P < .001).

Conclusions: The SWE is useful for diagnosing IgG4-RSS and assessing the effectiveness of treatment.

Objectives: To examine associations between osteoarthritis (OA)-related biochemical markers and knee symptoms in middle-aged adults over 10-13 year follow-up.

Methods: Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study (2004-06) and follow-up at CDAH-3. Serum samples from baseline (n=156) and follow-up (n=167) were analyzed for cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) using enzyme-linked immunosorbent assays. Knee symptoms were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale at follow-up. Zero-inflated Poisson regression models adjusted for age, sex, and body mass index were used for analysis.

Results: Significant associations were observed between COMP, MMP-3, and HA with knee pain and WOMAC-total score at follow-up. Baseline MMP-3 [ratio of means (RoM): 1.013; 95% CI: 1.006, 1.020], cumulative COMP (baseline + follow-up) [RoM: 1.022; 95% CI: 1.011, 1.033], and increased HA levels over time [RoM: 1.014; 95% CI: 1.007, 1.020] were positively associated with knee pain after 10-13 years.

Conclusion: Cumulative COMP, baseline MMP-3, and changes in HA were associated with knee pain over a a 10-13 year follow-up. These markers may help predict future knee symptoms in middle-aged adults.

Objectives: This study determined whether alkaline phosphatase (ALP) can be used to distinguish giant cell arteritis (GCA) complications in patients with polymyalgia rheumatica (PMR).

Methods: This retrospective study included patients diagnosed with PMR between January 2014 and October 2023 at our hospital. The predictive accuracy of biomarkers for diagnosing GCA was evaluated. Logistic regression was performed to identify factors predicting GCA complications.

Results: In total, 128 participants were included in this study and divided into two groups: isolated PMR (n = 111) and PMR with GCA (n = 17). The median ALP level of PMR with GCA group was significantly higher than that of the isolated PMR group (242.0 [interquartile range, 221.0-595.0] vs. 187.0 [interquartile range 97.5-254.5] U/L, P < .001). Setting a cut-off value of 214 U/L for ALP yielded a sensitivity and specificity of 0.88 and 0.55, respectively, for diagnosing GCA. Multivariate analysis revealed that ALP was a significant independent variable in the complications of GCA (odds ratio, 25.2; P = .032).

Conclusions: ALP can help distinguish GCA complications in patients with PMR.

Objectives: The aim of this study is to update the Japan College of Rheumatology Clinical Practice Guidelines for the Management of Rheumatoid Arthritis (CPG for RA).

Methods: The recommendations were developed based on the evidence published until the end of June 2022 using the Grading of Recommendations Assessment, Development, and Evaluation. The steering committee, CPG panel, systematic review (SR) group, and SR support team were organised.

Results: The treatment goal and drug treatment algorithm required no modifications; however, the footnotes of the drug treatment algorithm were modified. SR of 21 new or updated recommendations for subcutaneous methotrexate (n = 1), biological disease-modifying antirheumatic drugs (n = 1), rituximab (n = 5), Janus kinase inhibitors (n = 6), biosimilars (n = 2), older patients (n = 4), and pregnancy and lactation (n = 2) was conducted. The recommendations for comorbidities and surgery and rehabilitation remained unchanged from the 2020 CPG for RA.

Conclusions: The 2024 CPG for RA, which provide recommendations that reflect the current healthcare environment for rheumatoid arthritis in Japan, can be used effectively as a tool for shared decision-making between rheumatologists and patients in the treatment of RA.

Objective:: To elucidate the therapeutic effect of orthopaedic surgical intervention (OSI) in difficult-to-treat rheumatoid arthritis (D2T RA) compared with non-D2T RA.

Methods: A total of 534 recent surgeries were analysed only in patients who had undergone OSI since 2016 and for whom a 12-month postoperative follow-up was available. D2T RA was determined according to the European League against Rheumatism definition, and patients with D2T RA were matched to patients with non-D2T RA using propensity scores calculated by a logistic regression analysis. The Health Assessment Questionnaire-Disability Index (HAQ-DI), Disease Activity Index 28 (DAS28), face scale, and patient's assessment of general health were measured repeatedly at baseline and 6 and 12 months and were compared using a two-way analysis of variance.

Results: The HAQ-DI, DAS28, face scale, and general health showed significant postoperative improvements, and there were significant differences in the HAQ-DI and face scale scores between D2T RA and non-D2T RA. An additional analysis with DAS28 as a covariate showed no significant interaction for either, suggesting that these improvements in clinical assessment were due to OSI rather than improved disease activity.

Conclusions: In the absence of an effective pharmacological treatment strategy, OSI may be an effective treatment modality for the management of D2T RA.

Objectives: The aim of this article is to describe the safety and efficacy of filgotinib 200 mg (FIL200) or FIL 100 mg (FIL100) in Japanese patients with rheumatoid arthritis in a long-term extension (NCT03025308).

Methods: Patients who completed any of three parent studies (NCT02889796: inadequate response to methotrexate; NCT02873936: inadequate response to biologic disease-modifying antirheumatic drugs; NCT02886728: methotrexate-naïve) without rescue therapy could enter the long-term extension; patients taking FIL continued their dosage, and those who received comparators were rerandomised to FIL200 or FIL100. This analysis includes Week 156 interim results.

Results: Among Japanese patients, 110 received FIL200, and 97 received FIL100. Mean (SD) FIL200 and FIL100 exposure was 157.0 (51.49) and 156.0 (52.45) weeks. The exposure-adjusted incidence rates (95% confidence interval) for FIL200/FIL100 were 2.7 (1.4, 5.2)/2.4 (1.2, 5.1) for herpes zoster, 0.9 (0.3, 2.8)/1.0 (0.3, 3.2) for malignancy (excluding nonmelanoma skin cancer), and 0.6 (0.2, 2.4)/0.3 (0.0, 2.4) for major adverse cardiovascular events. More patients receiving FIL200 with prior FIL200 exposure achieved clinical remission vs other groups (including Clinical Disease Activity Index remission in 40% vs ≤27% at Week 156).

Conclusions: FIL200 and FIL100 were generally well tolerated by Japanese patients, without new, unexpected adverse events.

Objective: To assess the prevalence and outcomes among regimens of glucocorticoid tapering for microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) in real-world practice.

Methods: We retrospectively examined the Japan Collaborative Registry of Antineutrophil Cytoplasmic Antibodies-associated Vasculitis (J-CANVAS) registry, and evaluated the prevalence of glucocorticoid tapering regimens in the PEXIVAS trial. In patients with newly diagnosed MPA and GPA, we compared outcomes among standard and reduced pace regimens. Relapse-free survival rates were compared after propensity score matching.

Results: Of 364 eligible patients, 113 (31.0%) received standard tapering and 251 slower tapering. After matching, 87 pairs no significant difference was observed in relapse-free survival (P = .506). Regarding the reduced regimen, there were so few patients (14/364, 3.8%) that statistical analysis was not performed.

Conclusions: The glucocorticoid tapering for MPA and GPA in Japanese real-world practice was found to be generally slower than the standard regimen revealing a huge evidence-practice gap. Additionally, slower tapering did not improve relapse-free survival and might cause unnecessary glucocorticoid exposure.