Ryumachi. [Rheumatism]最新文献

Objectives: To evaluate the burdens of rheumatoid arthritis (RA) and osteoarthritis (OA), focusing on quality of life (QOL).

Methods: A questionnaire survey was conducted with 3407 qualified doctors of Japan Rheumatism Foundation (response rate 20%). Subjects were asked to assume three patient groups characterized by treatment status (outpatient, inpatient with inactive treatment and inpatient with active treatment) and to answer the questions about (1) percent distributions of the groups a decade ago and today and (2) QOL, including physical functions, daily living activities and social activities, of each group.

Results: More than 70% of patients with RA and OA were included in the outpatient group, who had problems in social activities rather than in physical functions and daily living activities. During the last decade, percentage of he outpatient group was increased, while those of the inpatient groups were decreased, and QOL of patients with RA and OA was improved. Compared with OA, RA showed lower percentages of the inpatient groups and greater losses in physical functions, daily living activities and social activities. Accordingly, the burden of RA was greater than that of OA.

Conclusions: In order to improve QOL and reduce the burden of RA, not only development of effective treatment but also assistance to social activities of the patients is required.

A 49-year-old female was admitted to our hospital because of worsening of congestive heart failure on November 2000 in a state after insertion of permanent pacemaker for complete atrioventricular block in 1986, followed by a clinical history of chronic heart failure due to dilated cardiomyopathy. After admission, her general condition had been improved, but, she had massive hemoptysis suddenly and died on February 2001. At autopsy, noncaseating granulomas were observed scattering in lungs, liver and spleen, not associated with any infectious lesions, therefore indicating systemic sarcoidosis. In lungs, granulomatous arteritis in small- and medium-sized muscular arteries associated with disputation of the media and elastic laminae were observed, suggesting the direct cause of hemoptysis. This is the extremely rare case of pulmonary arteritis with systemic sarcoidosis resulting the death from massive hemoptysis.

We successfully treated a 33-year-old woman with etoposide who developed systemic sclerosis (SSc)-associated refractory hemophagocytic syndrome (HPS). She had been diagnosed as SSc because she had had Raynaud's phenomenon, proximal scleroderma, telangiectasia, microstomia, thickening and shortening of lingual frenulum and positive antinuclear antibody since 1994. In September 1999, she showed high fever, anemia, thrombocytopenia, elevation of serum lactate dehydrogenase (LDH) and ferritin levels and hemophagocytosis in her bone marrow, which led to the diagnosis of HPS. Her symptoms were improved by 40 mg of daily oral prednisolone (PSL). While tapering PSL, she complained right coxalgia and magnetic resonance image (MRI) depicted avascular necrosis (AVN) of right femoral head. In May 2000, she again suffered from HPS when she was taking 19 mg of PSL daily. To avoid the development of another AVN of her bone, she was treated with monthly cyclophosphamide (CPA) pulse therapy (300-400 mg/day). Although her HPS transiently ameliorated with CPA, it flared up again with high fever, general fatigue, severe pancytopenia and extremely high serum LDH and ferritin levels after the 4th CPA pulse therapy. She was admitted again to our hospital and PSL was increased to 40 mg daily which did not improve HPS. We, therefore, treated her with intravenous etoposide (100 mg/day, three consecutive days) along with granulocyte-colony stimulating factor (G-CSF). She developed transient bone marrow suppression, but her laboratory data gradually normalized within two weeks and she became afebrile after 18 days of etoposide administration. This is the first case in the literature which suggests the efficacy of etoposide against refractory autoimmune-associated hemophagocytic syndrome.

Two hundred and five obese women with osteoarthritis of the knee (knee OA) were treated with one of the following interventions for six weeks: A nonsteroidal anti-inflammatory drug (NSAID) alone (Control, n = 16), NSAID combined with walking (n = 16), NSAID with non-weight bearing exercises (n = 16), NSAID with intra-articular hyaluronan injections (NH, n = 16), NSAID with supplement foods, glucosamine and condroitin (NS, n = 15), traditional shoe inserts, wedged insoles (NT, n = 20), NSAID with a novel insole with an elastic subtalar strapping (NN, n = 25), an energy restriction diet plus the NSAID (ND, n = 32), a diet combined with the NSAID and exercises (NDE, n = 25), and the diet combined with the NSAID and walking (NDW, n = 24). The Lequesne index was employed to obtain remission percentages, which were then compared between the ten groups. Compared with all but the NDW group, the NDE group showed a significant improvement. The NDW group also demonstrated a significant improvement, compared with all but the NDE and NN groups. The NN group showed a significant improvement compared with the control, NS and ND groups. However, for patients in the NDE and NDW groups, it was difficult to maintain body composition, even with these intervention methods. In this regard, the use of the insole with the elastic subtalar strapping was a simple and convenient method to maintain the body composition effect of the intervention method for knee OA patients.

We report the case of a 24-year-old woman with systemic lupus erythematosus (SLE). The patient presented with cervical erythema and multiple arthralgia in December, 1996. Based on the high level of antinuclear antibody and the positivity for anti-double-stranded-DNA antibody, we diagnosed the patient as having SLE. Her symptoms improved and her condition was maintained following steroid treatment. In August 2000, the patient suddenly had headache, nausea, vertigo, cerebellar ataxia, fixation nystagmus, and intention tremor. She was negative for the anti-phospholipid antibody. The cerebrospinal fluid IgG index and the IL-6 level were high. MRI of the right cerebellar hemisphere showed an equal-signal-intensity region in the T 1-enhanced image, and a high-signal-intensity region with a diffuse undefined border in the T 2-enhanced image. The increased cerebral blood flow at the site corresponding to a cerebellar lesion detected by magnetic resonance imaging (MRI) was observed by brain single photon emission computed tomography (SPECT). The central nervous system (CNS) lupus was confirmed by the presence of a lesion in the cerebellum. The abnormalities detected in MRI and SPECT images of the brain disappeared immediately after the steroid pulse therapy, and symptoms such as ataxic gait were improved. This patient was diagnosed as having acute neuropsychiatric SLE with cerebellar symptoms that are rarely observed as a localized neural sign of SLE. The MRI and SPECT images suggested the presence of an inflammatory edematous lesion that was confined in the cerebellar hemisphere. This is considered to be due to the increase of vasopermeability.

We encountered a patient with polymyalgia rheumatica (PMR) who exhibited fever as the main symptom for a long period without muscular pain. As an etiological factor, the condition may have been associated with nonsteroidal anti-inflammatory drugs (NSAIDs). A 71-year-old man consulted our Department of Orthopedics for fever and lumbar pain, which initially developed in early September 2000. Administration of NSAIDs resulted in the disappearance of lumbar pain. However, fever persisted. The C-reactive protein (CRP) level was persistently high. Therefore, on October 5, 2000, the patient was referred to our department. At the outpatient clinic, a detailed examination was performed. However, the etiology could not be determined. Repeated administration of NSAIDs resulted in pyretolysis, and the dose of NSAIDs was decreased from January 31, 2001. Severe fever appeared again, and inflammatory reaction also exacerbated. On March 11, 2001, muscular pain involving the bilateral shoulders and forearms suddenly developed. For diagnostic treatment, administration of prednisolone (PSL) at 10 mg/day was started. Muscular pain rapidly disappeared. According to Bird's criteria, PMR was diagnosed. After the dose of PSL was decreased to 7.5 mg/day, the course is good. PMR should be considered as the etiology of idiopathic fever in elderly patients.