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Matama G, Okamoto M, Fujimoto K, Johkoh T, Tominaga M, Mukae H, Sakamoto N, Komiya K, Umeki K, Komatsu M, Shimizu Y, Takahashi K, Tokisawa S, Zaizen Y, Matsuo N, Nouno T, Kaieda S, Ida H, Izuhara K, Hoshino T. Periostin Is a Biomarker of Rheumatoid Arthritis-Associated Interstitial Lung Disease. J Clin Med 2023; 12:7100. [PMID: 38002712 PMCID: PMC10672657 DOI: 10.3390/jcm12227100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Periostin was investigated as a biomarker for rheumatoid arthritis-associated interstitial lung disease (RA-ILD). This prospective study measured serum monomeric and total periostin, Klebs von den Lungen-6 (KL-6), surfactant protein D (SP-D), and lactate dehydrogenase (LDH) in 19 patients with RA-ILD, 20 RA without ILD, and 137 healthy controls (HC). All biomarkers were higher in RA-ILD than HC or RA without ILD. KL-6 accurately detected ILD in RA patients (area under curve [AUC] = 0.939) and moderately detected SP-D and monomeric and total periostin (AUC = 0.803, =0.767, =0.767, respectively). Monomeric and total periostin were negatively correlated with normal lung area and positively correlated with honeycombing, reticulation, fibrosis score, and the traction bronchiectasis grade but not inflammatory areas. Serum levels of SP-D, KL-6, and LDH did not correlate with the extent of those fibrotic areas on high-resolution CT. Serum monomeric and total periostin were higher in patients with RA-ILD with definite usual interstitial pneumonia pattern compared with other ILD patterns. Immunohistochemical analyses of biopsy or autopsy lung tissues from RA-ILD during the chronic phase and acute exacerbation showed that periostin was expressed in fibroblastic foci but not inflammatory or dense fibrosis lesions. Periostin is a potential biomarker for diagnosis, evaluating fibrosis, and deciding therapeutic strategies for patients with RA-ILD.
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Affiliation(s)
- Goushi Matama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Inabasou 3-1-69, Amagasaki 660-0064, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki 852-8501, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki 852-8501, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-Machi, Yufu 879-5593, Japan
| | - Kenji Umeki
- Department of Respiratory Medicine, Tenshindo Hetsugi Hospital, Nihongi 5956, Nakahetsugi 879-7761, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Yasuo Shimizu
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Kitakobayashi 880, Mibu 321-0293, Japan
| | - Koichiro Takahashi
- Department of Respirology, Saga Medical School, Nabeshima 5-1-1, Saga 849-8501, Japan
| | - Saeko Tokisawa
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan
| | - Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Hiroaki Ida
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Nabeshima 5-1-1, Saga 849-8501, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-Machi 67, Kurume 830-0011, Japan; (G.M.)
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Nishii Y, Okamoto M, Zaizen Y, Kojima T, Nouno T, Naitou-Nishida Y, Matsuo N, Takeoka H, Ishida M, Nakamura M, Masuda T, Tanaka T, Miyamura T, Hoshino T. Successful Treatment of a Patient with Drug-Refractory Rheumatoid Arthritis-Associated Interstitial Lung Disease with Upadacitinib: A Case Report. Medicina (Kaunas) 2023; 59:1960. [PMID: 38004009 PMCID: PMC10673512 DOI: 10.3390/medicina59111960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
Insufficient evidence exists regarding the efficacy of Janus kinase inhibitors (JAKis), a class of targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs), in the treatment of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). Herein, we present a case of RA-ILD refractory to previous treatments that exhibited favorable response to upadacitinib. A 69-year-old man, former smoker, was diagnosed with RA-ILD based on persistent symmetric polyarthritis, elevated C-reactive protein levels and erythrocyte sedimentation rate, reduced diffusing capacity for carbon monoxide/alveolar volume (DLCO 69.9%), and bilateral ground-glass attenuation with traction bronchiectasis, predominantly in the lower lung lobe. Initial treatment with oral prednisolone and methotrexate was started; however, the patient showed worsening dyspnea, chest high-resolution computed tomography abnormalities, and decreased pulmonary function. The dose of prednisolone was increased, and methotrexate was shifted to tacrolimus; however, tacrolimus was eventually discontinued because of renal dysfunction. Subsequent treatment changes included abatacept followed by intravenous cyclophosphamide, but ILD activity continued to worsen and met the criteria of progressive pulmonary fibrosis. Approximately 4.5 years after the RA diagnosis, dyspnea, radiological abnormalities, and DLCO improved following treatment switch to upadacitinib, one of JAKis. JAKi therapy may have potential as a treatment option for refractory RA-ILD.
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Affiliation(s)
- Yuuya Nishii
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Masaki Okamoto
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Takashi Kojima
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Takashi Nouno
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Yoshiko Naitou-Nishida
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Norikazu Matsuo
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Hiroaki Takeoka
- Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
| | - Motoko Ishida
- Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Masataka Nakamura
- Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Toru Masuda
- Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Takafumi Tanaka
- Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Tomoya Miyamura
- Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan
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Tanaka T, Okamoto M, Matsuo N, Naitou-Nishida Y, Nouno T, Kojima T, Nishii Y, Uchiyashiki Y, Takeoka H, Nagasaki Y. Case Series of Patients with Coronavirus Disease 2019 Pneumonia Treated with Hydroxychloroquine. Medicina (B Aires) 2023; 59:medicina59030541. [PMID: 36984543 PMCID: PMC10057902 DOI: 10.3390/medicina59030541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The efficacy of hydroxychloroquine (HCQ) therapy, a previous candidate drug for coronavirus disease 2019 (COVID-19), was denied in the global guideline. The risk of severe cardiac events associated with HCQ was inconsistent in previous reports. In the present case series, we show the tolerability of HCQ therapy in patients treated in our hospital, and discuss the advantages and disadvantages of HCQ therapy for patients with COVID-19. A representative case was a 66-year-old woman who had become infected with severe acute respiratory syndrome coronavirus 2 and was diagnosed as having COVID-19 pneumonia via polymerase chain reaction. She was refractory to treatment with levofloxacin, lopinavir, and ritonavir, while her condition improved after beginning HCQ therapy without severe side effects. We show the tolerability of HCQ therapy for 27 patients treated in our hospital. In total, 21 adverse events occurred in 20 (74%) patients, namely, diarrhea in 11 (41%) patients, and elevated levels of both aspartate aminotransferase and alanine transaminase in 10 (37%) patients. All seven grade ≥ 4 adverse events were associated with the deterioration in COVID-19 status. No patients discontinued HCQ treatment because of HCQ-related adverse events. Two patients (7%) died of COVID-19 pneumonia. In conclusion, HCQ therapy that had been performed for COVID-19 was well-tolerated in our case series.
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Affiliation(s)
- Tomohiro Tanaka
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Masaki Okamoto
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
- Correspondence: ; Tel.: +81-92-852-0700
| | - Norikazu Matsuo
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yoshiko Naitou-Nishida
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Nouno
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Kojima
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yuuya Nishii
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yoshihiro Uchiyashiki
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Hiroaki Takeoka
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yoji Nagasaki
- Department of Infectious Disease, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan
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Koga T, Okamoto M, Satoh M, Fujimoto K, Zaizen Y, Chikasue T, Sumi A, Kaieda S, Matsuo N, Matama G, Nouno T, Tominaga M, Yatera K, Ida H, Hoshino T. Positive Autoantibody Is Associated with Malignancies in Patients with Idiopathic Interstitial Pneumonias. Biomedicines 2022; 10:biomedicines10102469. [PMID: 36289730 PMCID: PMC9598916 DOI: 10.3390/biomedicines10102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Various autoantibodies are associated with clinical outcomes in patients with idiopathic interstitial pneumonias (IIPs). We retrospectively analyzed the association between autoantibodies and malignancies in IIP patients. Comprehensive analyses of autoantibodies were performed using immunoprecipitation and enzyme-linked immunosorbent assays in 193 consecutive IIP patients. Cancer-related factors were analyzed using logistic regression analysis. In total, 22 of 193 patients (11.4%) with IIP had malignant disease. In univariate analysis, positivity for any autoantibody (odds ratio (OR), 3.1; 95% confidence interval (CI), 1.2-7.7; p = 0.017) and antinuclear antibody titer ≥1:320 (OR, 3.4; CI, 1.2-9.8; p = 0.024) were significantly associated with malignancies. Positive anti-aminoacyl tRNA synthetase (ARS) (OR, 3.7; CI, 0.88-15.5; p = 0.074) and anti-Ro52 antibody (OR, 3.2; CI, 0.93-11.2; p = 0.065) tended to be associated with malignancies. In multivariate analysis, independent risk factors were male sex (OR, 3.7; CI, 1.0-13.5; p = 0.029) and positivity for any autoantibody (OR, 3.9; CI, 1.5-10.1; p = 0.004) in model 1, and male sex (OR, 3.9; CI, 1.0-15.3; p = 0.049), antinuclear antibody titer ≥1:320 (OR, 4.2; CI, 1.4-13.3; p = 0.013), and positivity for anti-ARS antibody (OR, 6.5; CI, 1.2-34.1; p = 0.026) in model 2. Positivity for any autoantibody, antinuclear and anti-ARS antibodies, and male sex were independent risk factors for malignancies in IIP patients. Testing autoantibodies in IIP patients might help the early diagnosis of malignancies.
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Affiliation(s)
- Takuma Koga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
- Correspondence: ; Tel.: +81-92-852-0700
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Fukuoka 807-8555, Japan
- Department of Medicine, Kitakyushu Yahata Higashi Hospital, Fukuoka 805-0071, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Tomonori Chikasue
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Akiko Sumi
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Goushi Matama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka 807-8555, Japan
| | - Hiroaki Ida
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
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Matsuo S, Okamoto M, Ikeuchi T, Zaizen Y, Inomoto A, Haraguchi R, Mori S, Sasaki R, Nouno T, Tanaka T, Hoshino T, Tsuda T. Early Intervention of Pulmonary Rehabilitation for Fibrotic Interstitial Lung Disease Is a Favorable Factor for Short-Term Improvement in Health-Related Quality of Life. J Clin Med 2021; 10:jcm10143153. [PMID: 34300319 PMCID: PMC8305639 DOI: 10.3390/jcm10143153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with fibrosing interstitial lung disease (FILD) have poor health-related quality of life (HRQOL). We analyzed predictors of short-term improvement of HRQOL after starting pulmonary rehabilitation (PR) in moderate to severe FILD patients. This study involved 28 consecutive patients with FILD (20 males, median age of 77.5 years), who participated in PR program of our hospital for >6 weeks. The St. George’s Respiratory Questionnaire (SGRQ) score and the 6-min walk distance (6MWD) were evaluated before and after PR, and the predictors of efficacy of PR were analyzed. The duration from diagnosis of FILD to start of PR showed a positive correlation with the increase in the SGRQ score, and the baseline SGRQ score showed a negative correlation with increase in the 6MWD. The FILD subtype, modified Medical Research Council score, and treatment history were not associated with the endpoints. According to the receiver operating characteristic curve (ROC) analyses, starting PR within 514 days after diagnosis of FILD was a significant favorable predictor of improvement in the SGRQ total score more than a minimal clinically important difference of 4. In this study, early intervention of PR and lower SGRQ score were associated with the favorable response to PR. PR for FILD should be initiated early before the disease becomes severe.
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Affiliation(s)
- Satoshi Matsuo
- Kirigaoka Tsuda Hospital, Kirigaoka 3-9-20, Kokura-kita-ku, Kitakyushu, Fukuoka 802-0052, Japan; (S.M.); (T.I.); (S.M.); (R.S.); (T.T.)
| | - Masaki Okamoto
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan; (T.N.); (T.T.)
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-machi 67, Kurume, Fukuoka 830-0011, Japan; (Y.Z.); (T.H.)
- Correspondence: ; Tel.: +81-942-31-7560
| | - Tomoyuki Ikeuchi
- Kirigaoka Tsuda Hospital, Kirigaoka 3-9-20, Kokura-kita-ku, Kitakyushu, Fukuoka 802-0052, Japan; (S.M.); (T.I.); (S.M.); (R.S.); (T.T.)
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-machi 67, Kurume, Fukuoka 830-0011, Japan; (Y.Z.); (T.H.)
| | - Atsushi Inomoto
- Department of Rehabilitation, Kyushu Nutrition University, Kuzuharatakamatsu 1-5-1, Kokura-minami-ku, Kitakyushu, Fukuoka 800-0298, Japan;
| | - Remi Haraguchi
- Department of Rehabilitation, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan;
| | - Shunichiro Mori
- Kirigaoka Tsuda Hospital, Kirigaoka 3-9-20, Kokura-kita-ku, Kitakyushu, Fukuoka 802-0052, Japan; (S.M.); (T.I.); (S.M.); (R.S.); (T.T.)
| | - Retsu Sasaki
- Kirigaoka Tsuda Hospital, Kirigaoka 3-9-20, Kokura-kita-ku, Kitakyushu, Fukuoka 802-0052, Japan; (S.M.); (T.I.); (S.M.); (R.S.); (T.T.)
| | - Takashi Nouno
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan; (T.N.); (T.T.)
| | - Tomohiro Tanaka
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuou-ku, Fukuoka 810-0065, Japan; (T.N.); (T.T.)
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Ashahi-machi 67, Kurume, Fukuoka 830-0011, Japan; (Y.Z.); (T.H.)
| | - Toru Tsuda
- Kirigaoka Tsuda Hospital, Kirigaoka 3-9-20, Kokura-kita-ku, Kitakyushu, Fukuoka 802-0052, Japan; (S.M.); (T.I.); (S.M.); (R.S.); (T.T.)
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Kyono M, Okamoto M, Sakamoto S, Iwanaga T, Momosaki S, Takeoka H, Toyama T, Naitou-Nishida Y, Nouno T, Yamada H, Yano R, Miyamura T, Hoshino T. A case report, a case who developed limited cutaneous scleroderma and pulmonary hypertension 8 years after diagnosis of anti-centromere antibody-positive Sjögren syndrome. Mod Rheumatol Case Rep 2020; 4:248-252. [PMID: 33086997 DOI: 10.1080/24725625.2020.1755516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 52-year-old woman was diagnosed as having anti-centromere antibody (ACA)-positive primary Sjögren syndrome (pSS). Eight years later, she visited our hospital because she had developed dyspnoea. She was diagnosed as having pulmonary arterial hypertension (PAH) with pulmonary veno-occlusive disease on the basis of the results of right heart catheterisation, a severe decrease in diffusing capacity of the lung for carbon monoxide (DLCO, 17%) and desaturation (69%) after a 6-minute walk test. She was also diagnosed as having limited cutaneous systemic sclerosis (lcSSc) because she had developed finger sclerosis. The six-minute walk distance had improved by 54 m 3 months after commencing treatment with tadalafil. Clinicians should be alert to the possibility of patients with ACA-positive SS developing lcSSc and PAH during their clinical course.
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Affiliation(s)
- Mari Kyono
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masaki Okamoto
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Sakamoto
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomoaki Iwanaga
- Department of Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hiroaki Takeoka
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takayuki Toyama
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshiko Naitou-Nishida
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Nouno
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyoshi Yamada
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryo Yano
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.,Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomoya Miyamura
- Department of Rheumatology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
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7
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Nakamura M, Okamoto M, Fujimoto K, Shimizu S, Tominaga M, Tsuneyoshi S, Zaizen Y, Nouno T, Sakamoto S, Kawayama T, Hoshino T. A Case of Autoimmune Pulmonary Alveolar Proteinosis with Pulmonary Fibrosis and Asbestosis-Like Features. Kurume Med J 2020; 66:59-63. [PMID: 32336733 DOI: 10.2739/kurumemedj.ms661005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 78-year-old man who had worked in the building industry visited our hospital because of groundglass opacity with smoothly thickened, intralobular interstitial lines and interlobular septal lines on chest high-resolution computed tomography (HRCT). HRCT image also showed a focal area of reticulation and pleural thickening. Lung specimens obtained by surgical lung biopsy showed accumulations of intra-alveolar periodic acid-Schiffpositive materials, usual interstitial pneumonia (UIP)-like subpleural lung fibrosis and asbestos bodies (1 body/cm2 in high-power field, ×400). Serum granulocyte-macrophage colony stimulating factor autoantibody was positive. The patient was diagnosed as having autoimmune pulmonary alveolar proteinosis (PAP) and needed differential diagnosis from secondary PAP caused from pulmonary asbestosis and UIP. Careful observation of the manifestations of pulmonary asbestosis and the progression of fibrosis using HRCT will be necessary in this patient.
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Affiliation(s)
- Masayuki Nakamura
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Kiminori Fujimoto
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine
| | - Shigeki Shimizu
- Department of Pathology, Kindai University Faculty of Medicine
| | - Masaki Tominaga
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Shingo Tsuneyoshi
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Takashi Nouno
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Satoshi Sakamoto
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Tomotaka Kawayama
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine
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8
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Nouno T, Okamoto M, Ohnishi K, Kaieda S, Tominaga M, Zaizen Y, Ichiki M, Momosaki S, Nakamura M, Fujimoto K, Fukuoka J, Shimizu S, Komohara Y, Hoshino T. Elevation of pulmonary CD163 + and CD204 + macrophages is associated with the clinical course of idiopathic pulmonary fibrosis patients. J Thorac Dis 2019; 11:4005-4017. [PMID: 31656675 DOI: 10.21037/jtd.2019.09.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background M2-like/repair macrophages are thought to contribute to fibrotic process of idiopathic pulmonary fibrosis (IPF). We analyzed the association between pulmonary accumulation of M2-like macrophages and survival in IPF patients. Methods Lung tissues were obtained by surgical lung biopsy from patients with IPF (n=16), nonspecific interstitial pneumonia (NSIP, n=8) and control subjects (n=14). Samples were also obtained at autopsy from 9 patients who died of acute exacerbation (AE) of IPF. Lung specimens and/or human peripheral blood mononuclear cells-derived macrophages were evaluated by immunohistochemistry for expression of CD68 (pan-macrophage marker), CD163, and CD204 (M2-like macrophage markers), and by in situ mRNA hybridization and ELISA for production of transforming growth factor-β1 (TGF-β1). Results CD68+, CD163+, and CD204+ cell counts and CD163+/CD68+ and CD204+/CD68+ cell ratios were comparable in IPF and NSIP lung tissues and significantly higher than in control tissues. IPF-AE lung samples contained significantly elevated CD68+ and CD163+ cell counts and CD163+/CD68+ cell ratio compared with IPF samples, whereas CD204+ cell counts and CD204+/CD68+ cells ratio did not differ. High CD163+/CD68+ and CD204+/CD68+ cell ratios were significantly associated with shorter overall survival and time-to-AE in IPF patients. In vitro-differentiated human CD163+ and CD204+ macrophages both secreted TGF-β1; however, the novel IPF drug pentraxin 2/serum amyloid protein could suppress secretion only by CD204+ macrophages. Conclusions Pulmonary accumulation of CD163+ and CD204+ macrophages is associated with worse clinical course in IPF patients. Suppression of macrophage activation and TGF-β1 secretion may be a potential therapeutic target for IPF.
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Affiliation(s)
- Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Koji Ohnishi
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Chuou-ku, Kumamoto, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Masao Ichiki
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Jigyohama, Chuou-ku, Fukuoka, Japan
| | - Seiya Momosaki
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Jigyohama, Chuou-ku, Fukuoka, Japan
| | - Masayuki Nakamura
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Kiminori Fujimoto
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Shigeki Shimizu
- Department of Pathology, Kindai University Faculty of Medicine, Ohnohigashi, Osakasayama, Osaka, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Chuou-ku, Kumamoto, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi, Kurume, Japan
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9
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Nakamura M, Okamoto M, Fujimoto K, Ebata T, Tominaga M, Nouno T, Zaizen Y, Kaieda S, Tsuda T, Kawayama T, Hoshino T. A retrospective study of the tolerability of nintedanib for severe idiopathic pulmonary fibrosis in the real world. Ann Transl Med 2019; 7:262. [PMID: 31355229 DOI: 10.21037/atm.2019.05.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Nintedanib is a tyrosine kinase inhibitor that has been shown to suppress progression of idiopathic pulmonary fibrosis (IPF). The efficacy and tolerability of nintedanib for IPF has been previously proven in the INPULSIS® and INPULSIS-On® trials. The aim of our study was to clarify the tolerability of nintedanib in the real world for severe IPF patients who were unable to enter the INPULSIS® and INPULSIS-On® trials. Methods We retrospectively investigated medical records of 8 patients with severe IPF and 14 patients with non-severe IPF who had been treated with nintedanib. The criteria to define severe IPF were forced vital capacity (FVC) of <50% predicted and/or diffusing capacity of the lung for carbon monoxide/alveolar volume (DLCO/VA) of <30% predicted or unmeasurable. Severity of adverse event was evaluated using the Common terminology criteria for each adverse event version 4.0. We compared changes in FVC and serum KL-6 level, incidence and severity of adverse events, and incidence of permanent or temporary discontinuation of nintedanib in between severe and non-severe IPF groups. Results The median treatment period was 578.5 days. The most frequent adverse event was diarrhea (73%). Only 2 patients required permanent discontinuation of nintedanib due to adverse events. There was no difference in incidence or severity of adverse events or incidence of permanent or temporary discontinuation of nintedanib in between severe and non-severe IPF groups. Among subjects, decline in FVC during 6 months post-nintedanib treatment were significantly lower than prior to treatment, but change in serum KL-6 level showed no significant difference between these 2 timepoints. Conclusions Our study showed that nintedanib was tolerable for IPF patients who would not have been eligible for entry into previous clinical trials due to low pulmonary function. Although therapeutic strategy for severe IPF should be planned carefully, initiation of nintedanib treatment should not be dismissed solely for reasons of low pulmonary function.
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Affiliation(s)
- Masayuki Nakamura
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kiminori Fujimoto
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomohiro Ebata
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tohru Tsuda
- Kirigaoka Tsuda Hospital, Kokura-kita-ku, Kitakyushu, Fukuoka, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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10
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Sakamoto S, Okamoto M, Kaieda S, Fujimoto K, Nagata S, Tominaga M, Nakamura M, Zaizen Y, Nouno T, Koga T, Kawayama T, Kuwana M, Ida H, Hoshino T. Low positive titer of anti-melanoma differentiation-associated gene 5 antibody is not associated with a poor long-term outcome of interstitial lung disease in patients with dermatomyositis. Respir Investig 2018; 56:464-472. [PMID: 30150008 DOI: 10.1016/j.resinv.2018.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5-Ab) is associated with fatal rapidly progressive interstitial lung disease (RP-ILD) in patients with dermatomyositis (DM). We attempted to clarify whether anti-MDA5-Ab is associated with long-term outcomes in patients with DM-ILD. METHODS Thirty-six patients with DM-ILD were retrospectively analyzed for their serum anti-MDA5-Ab by using an enzyme-linked immunosorbent assay. We analyzed the association between clinical parameters, including the serum levels of anti-MDA5-Ab and ferritin. RESULTS Fourteen patients (39%) were positive for anti-MDA5-Ab. The serum levels of anti-MDA5-Ab and ferritin in 7 patients with acute death were higher than those in the surviving patients. An "unclassifiable pattern" on chest computed tomography and the development of RP-ILD were also prognostic markers. The serum levels of anti-MDA5-Ab and ferritin (cut-off levels, 100 IU/mL and 899 ng/mL, respectively) were markers predictive of acute death, showing good sensitivity (86% and 83%) and specificity (97% and 100%). All 7 patients with acute death developed RP-ILD and were positive for anti-MDA5-Ab, including 6 patients with a high titer (≥100 IU/mL), whereas only 2 patients (29%) developed RP-ILD among the 7 survivors with a low titer of anti-MDA5-Ab ( < 100 IU/mL). In contrast, a low positive titer of anti-MDA5-Ab was not associated with changes in pulmonary function for 2 years. CONCLUSIONS Although a high serum titer of anti-MDA5-Ab (≥100 IU/mL) is associated with acute death via the development of RP-ILD, outcomes in the chronic phase for patients with a low titer of anti-MDA5-Ab ( < 100 IU/mL) were similar to those of patients without anti-MDA5-Ab.
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Affiliation(s)
- Satoshi Sakamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Kiminori Fujimoto
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Shuji Nagata
- Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Masayuki Nakamura
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Takuma Koga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Sendagi 1-1-5, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Hiroaki Ida
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka 830-0011, Japan.
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11
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Okamoto M, Tominaga M, Shimizu S, Yano C, Masuda K, Nakamura M, Zaizen Y, Nouno T, Sakamoto S, Yokoyama M, Kawayama T, Hoshino T. Dental Technicians' Pneumoconiosis. Intern Med 2017; 56:3323-3326. [PMID: 29021460 PMCID: PMC5790721 DOI: 10.2169/internalmedicine.8860-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 40-year-old female dental technician visited our hospital for the investigation of a chest X-ray abnormality. Chest computed tomography demonstrated centrilobular nodules and lung volume reduction, and her serum KL-6 level was elevated. A histological analysis of the specimens obtained on a surgical lung biopsy showed peribronchiolar fibrosis with pigmented macrophages and cholesterol clefts. An energy-dispersive X-ray analysis showed that these lung tissues contained some metals, including indium. The serum indium level was also elevated. We diagnosed this patient with pneumoconiosis caused by exposure to sandblasting certain dental metals. This is the first reported case of pneumoconiosis in a dental technician associated with exposure to indium.
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Affiliation(s)
- Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Shigeki Shimizu
- Department of Pathology, Kindai University Faculty of Medicine, Japan
| | - Chiyo Yano
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Ken Masuda
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Masayuki Nakamura
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Takashi Nouno
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Satoshi Sakamoto
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Mitsuru Yokoyama
- Shared-Use Research Center, University of Occupational and Environmental Health, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Japan
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