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Nagaoka K, Iwanaga N, Takegoshi Y, Murai Y, Kawasuji H, Miura M, Sato Y, Hatakeyama Y, Ito H, Kato Y, Shibayama N, Terasaki Y, Fujimura T, Takazono T, Kosai K, Sugano A, Morinaga Y, Yanagihara K, Mukae H, Yamamoto Y. Mortality risk factors and fulminant sub-phenotype in anaerobic bacteremia: a 10-year retrospective, multicenter, observational cohort study. Eur J Clin Microbiol Infect Dis 2024; 43:459-467. [PMID: 38172403 DOI: 10.1007/s10096-023-04743-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE During the last decade, the incidence of anaerobic bacteremia (AB) has been increasing. Patients with AB may develop complex underlying diseases, which can occasionally be accompanied by fatal or fulminant outcomes. However, the risk factors for AB-related mortality remain unclear. Herein, we sought to elucidate the risk factors for AB-related mortality. METHODS In this multicenter, retrospective, observational study, we enrolled patients with culture-proven AB from six tertiary hospitals in Japan, between January 2012 and December 2021. Data on patient and infection characteristics, laboratory findings, treatment, and outcome were collected, and their associations with mortality were analyzed. RESULTS A total of 520 participants were included. The 30-day mortality in the study cohort was 14.0% (73 patients), and malignant tumors were frequently observed comorbidities in 48% of the entire cohort. Multivariable logistic regression analysis showed a Charlson comorbidity score of > 6, serum creatinine level of > 1.17 mg/dL, and hypotension to be independent risk factors for 30-day mortality in AB (odds ratios [ORs] 2.12, 2.25, and 5.12, respectively; p < 0.05), whereas drainage significantly reduced this risk (OR, 0.28; p < 0.0001). Twelve patients (2.3% of the whole cohort and 16.4% of the deceased patients) presented with extremely rapid progression leading to fatal outcome, consistent with "fulminant AB." CONCLUSIONS This study identified acute circulatory dysfunction and performance of drainage as independent predictive factors for 30-day AB-related mortality and revealed the existence of a fulminant AB sub-phenotype. Our findings could serve as a practical guide to predict the clinical outcomes of AB.
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Affiliation(s)
- Kentaro Nagaoka
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - N Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Y Takegoshi
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Y Murai
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan
| | - H Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan
| | - M Miura
- Department of Infection Control, Toyama Nishi General Hospital, Toyama, Japan
| | - Y Sato
- Department of Infection Control, Kamiichi General Hospital, Toyama, Japan
| | - Y Hatakeyama
- Department of Infection Control, Takaoka City Hospital, Toyama, Japan
| | - H Ito
- Department of Infection Control, Takaoka City Hospital, Toyama, Japan
| | - Y Kato
- Department of Infection Control, Toyama City Hospital, Toyama, Japan
| | - N Shibayama
- Department of Infection Control, Toyama City Hospital, Toyama, Japan
| | - Y Terasaki
- Department of Infection Control, Toyama City Hospital, Toyama, Japan
| | - T Fujimura
- Department of Infection Control, Toyama City Hospital, Toyama, Japan
| | - T Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - K Kosai
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - A Sugano
- Center for Clinical Research, Toyama University Hospital, Toyama, Japan
| | - Y Morinaga
- Department of Microbiology, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - K Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - H Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Y Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, 930-0194, Japan
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2
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Horai Y, Otsuka M, Kawahara C, Iwanaga N, Yamasaki Y, Watanobe T, Yasui J, Saishoji Y, Torisu Y, Mori T, Mori H, Izumi Y, Kawakami A. Clinical analysis of gender and pre-existing diabetes mellitus in patients with polymyalgia rheumatica: A retrospective study in a Japanese population. Mod Rheumatol 2023; 33:182-186. [PMID: 35134992 DOI: 10.1093/mr/roac012] [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] [Received: 11/30/2021] [Revised: 01/12/2022] [Accepted: 01/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study clarifies the involvement of gender and pre-existing diabetes mellitus (DM) in the clinical characteristics of polymyalgia rheumatica (PMR). METHODS The clinical records of patients diagnosed with PMR in our department between January 2011 and June 2021, especially in terms of gender and DM were retrospectively analysed. RESULTS We identified 89 patients with the median age of 75.37 cases were men and 52 cases were women. Pre-existing DM was found in 21 patients (23.6%). Male PMR patients exhibited a higher complication rate of pre-existing DM and C-reactive protein (CRP) levels at diagnosis (p = .04 and p < .01, respectively) than female patients, and men were more common in the patient group with pre-existing DM (p = .04). The CRP levels of male PMR patients without pre-existing DM were higher than female PMR patients without pre-existing DM. CONCLUSION Male PMR patients might have a varying pathophysiology from female patients in terms of high inflammation levels accompanied by a high prevalence rate of pre-existing DM and need a gender-specific approach.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Mizuna Otsuka
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yusuke Yamasaki
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Taro Watanobe
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Junichi Yasui
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yusuke Saishoji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yuichi Torisu
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Takahiro Mori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Hideki Mori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Origuchi T, Umeda M, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Tamai M, Tsukada T, Miyashita T, Iwanaga N, Horai Y, Arima K, Aramaki T, Ueki Y, Eguchi K, Kawakami A. Comparison of complications during 1-year follow-up between remitting seronegative symmetrical synovitis with pitting edema syndrome and elderly-onset rheumatoid arthritis. Immunol Med 2022; 45:168-174. [PMID: 35369853 DOI: 10.1080/25785826.2022.2046307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/22/2022] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE), a rheumatic disease affecting the elderly, responds well to corticosteroids; however, our RS3PE patients' corticosteroid therapy is longer than expected. Elderly-onset rheumatoid arthritis (EORA) patients are reported to be at a significantly increased risk for steroid-related side effects including cardiovascular diseases (CVDs). To clarify the complications during a 1-year follow-up in corticosteroid-treated RS3PE patients compared to EORA patients. We retrospectively analyzed the records of 47 RS3PE patients (28 men, 19 women, age 78.4 ± 7.5 years) and 46 EORA patients (10 men, 36 women; 77.0 ± 6.8 yrs) to compare the complications over a 1-year follow-up. The RS3PE and EORA groups' average initial PSL doses were 16.5 ± 7.2 mg/day and 7.3 ± 4.6 mg/day, respectively. During the 1-year follow-up after treatment, there was no significant increase in CVDs in both groups. However, infections occurred in nine RS3PE patients, which is a significantly higher incidence compared to the EORA patients with infections (n = 3). The initial PSL dose was the independent variable associated with the incidence of infection. Infections were significantly increased during elderly RS3PE patients' steroid therapy. The initial corticosteroid dose was an infection-risk factor.Key messagesInfections are increased during steroid therapy in elderly patients with RS3PE syndrome.The initial dose of corticosteroids was one of the risk factors for infections.
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Affiliation(s)
- Tomoki Origuchi
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki-city, Japan.,Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiaki Tsukada
- Department of Rheumatology, Aino Memorial Hospital, Unzen-city, Japan
| | - Taiichiro Miyashita
- Department of Rheumatology, Miyashita Rheumatology Clinic, Ohmura-city, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Ohmura-city, Japan
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Ohmura-city, Japan
| | - Kazuhiko Arima
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki-city, Japan
| | - Toshiyuki Aramaki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Horai Y, Shimizu T, Okada A, Tokumitsu J, Ikeoka T, Kuriya G, Iwanaga N, Izumi Y, Origuchi T, Kawakami A. Dipeptidyl peptidase-4 inhibitor use is associated with a lower erythrocyte sedimentation rate in patients with remitting seronegative symmetrical synovitis with pitting oedema and pre-existing diabetes mellitus. Mod Rheumatol 2021; 32:830-833. [PMID: 34908128 DOI: 10.1093/mr/roab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Akitomo Okada
- Department of Rheumatology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Nagasaki, Sasebo, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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5
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Akagi M, Iwanaga N, Torisu Y, Fujita H, Kawahara C, Horai Y, Izumi Y, Kawakami A. IgA Vasculitis Triggered by Infective Endocarditis of Pulmonary Artery with Congenitally Corrected Transposition of the Great Arteries. Int Heart J 2020; 61:404-408. [PMID: 32173704 DOI: 10.1536/ihj.19-446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A man in his 40s with a history of congenitally corrected transposition of the great arteries (CCTGA) and closure of ventricular septal defect was referred to our hospital with purpura and hematuria. Presence of purpura, renal damage, and pathological findings on skin biopsy led to the diagnosis of IgA vasculitis (IgAV). Oral prednisolone (PSL) was initiated. However, Streptococcus pseudoporcinus was isolated from blood cultures, and transthoracic echocardiogram revealed vegetation on the pulmonary valve. From these findings, the diagnosis of infective endocarditis (IE) was made. Although the patient's condition improved after PSL interruption and antibiotic administration, his purpura relapsed. PSL readministration improved symptoms, with no further relapse even after gradual PSL dose reduction. The present case raises awareness of the importance of recognizing the occurrence of IE in IgAV patients, especially in those with congenital heart disease. CCTGA should be acknowledged as a risk factor for IE in the right-sided heart.
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Affiliation(s)
- Midori Akagi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center.,Department of Rheumatology, JCHO Isahaya General Hospital
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center
| | - Yuichi Torisu
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Hisayuki Fujita
- Physiological Laboratory, National Hospital Organization Nagasaki Medical Center
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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6
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Horai Y, Ishikawa H, Iwanaga N, Izumi Y, Matsuoka Y, Miura S, Kawakami A. Development of hypocomplementemic urticarial vasculitis during certolizumab pegol treatment for rheumatoid arthritis: A case report. J Clin Pharm Ther 2020; 45:1179-1182. [PMID: 31990069 DOI: 10.1111/jcpt.13117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Tumour necrosis factor-α-blocking agents potentially cause vasculitis. However, no study has reported on the association between hypocomplementemic urticarial vasculitis (HUV) and certolizumab pegol (CZP) usage. CASE DESCRIPTION We present the first case of HUV development during CZP treatment for rheumatoid arthritis. Hypocomplementemic urticarial vasculitis improved after CZP was discontinued and the dose of oral prednisolone was increased. WHAT IS NEW AND CONCLUSION Clinicians should be aware about the potential development of HUV during CZP treatment, which is presumed to be safe considering its unique structural characteristics that differ from those of other tumour necrosis factor-α-blocking agents.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Hiroshi Ishikawa
- Department of Dermatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yuki Matsuoka
- Department of Pathology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shiro Miura
- Department of Pathology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Atsushi Kawakami
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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7
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Horai Y, Origuchi T, Iwanaga N, Tokumitsu J, Ikeoka T, Kuriya G, Izumi Y, Kawakami A. Clinical analysis of pre-existing diabetes mellitus and dipeptidyl peptidase-4 inhibitors in patients with remitting seronegative symmetrical synovitis and pitting edema syndrome. Mod Rheumatol 2019; 30:703-707. [PMID: 31500483 DOI: 10.1080/14397595.2019.1666463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/21/2023]
Abstract
Objectives: To analyze the association among remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, diabetes mellitus (DM), and antidiabetic drugs.Methods: We retrospectively analyzed the clinical and serologic manifestations of patients who had RS3PE syndrome with and without pre-existing DM. Then we performed a subanalysis in which patients with pre-existing DM were classified into two groups according to whether they were or were not taking a dipeptidyl peptidase 4 inhibitor (DPP4i), an antidiabetic drug that was suggested to have an association with the pathogenesis of RS3PE syndrome.Results: Pre-existing DM was found in 13 (35.1%) of 37 patients with RS3PE syndrome. No significant differences in age, gender, physical manifestations, and laboratory findings were observed between the patients with DM and those without DM. DPP4i had been administered to 6 of 13 patients with RS3PE and pre-existing DM. We observed no significant differences in manifestations of RS3PE syndrome before treatment; however, one relapse occurred in a patient with poorly controlled DM who had been continuing DPP4i therapy.Conclusion: This study revealed no evidence suggesting an association among RS3PE syndrome, DM, and antidiabetic drugs. DPP4i would be safe for use by most of patients with RS3PE syndrome. However, elderly patients and patients with poorly controlled DM might require careful observation.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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8
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Abstract
We report the case of an 80-year-old man with generalized granuloma annulare (GGA) who subsequently developed giant cell arteritis (GCA). Steroid treatment was effective for both diseases in this case. Although cases of concomitant GGA and GCA have rarely been reported, previous studies suggest that common histological characteristics underlie the two diseases. It is therefore necessary to recognize that GGA can be complicated by GCA, particularly when typical symptoms, such as headache and visual disturbance, are present.
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Affiliation(s)
- Yuichi Torisu
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Japan
| | - Tohru Michitsuji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Rheumatology, Sasebo City General Hospital, Japan
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Takahiro Mori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
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9
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Eguchi M, Iwanaga N, Sakai K, Michitsuji T, Tsuji Y, Kawahara C, Kobayashi H, Horai Y, Mori T, Izumi Y, Ito M, Kawakami A. Protein-losing gastroenteropathy in a patient with concomitant systemic lupus erythematosus and Sjögren's syndrome. Immunol Med 2019; 41:34-38. [PMID: 30938260 DOI: 10.1080/09114300.2018.1451614] [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: 10/14/2022] Open
Abstract
We report a female in her twenties who developed generalized edema. She was diagnosed as systemic lupus erythematous (SLE) and Sjögren's syndrome (SS) based on her physical manifestations and positive findings for antinuclear antibody and anti-SS-A/SS-B-antibody. Although she manifested hypoproteinemia, a possibility of lupus nephritis was denied due to a lack of significant abnormality in kidney function tests and urinalysis. The nature of hypoproteinemia and related symptoms was identified as protein losing gastroenteropathy (PLGE) based on α 1-antitrypsin clearance and histopathology findings. Physicians should be aware that PLGE may develop as an underlying cause of edema in SLE and SS.
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Affiliation(s)
- Mizuna Eguchi
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Nozomi Iwanaga
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan.,b Department of Rheumatology , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Kosuke Sakai
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Tohru Michitsuji
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Yoshika Tsuji
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan.,c Rheumatic and Collagen Disease Center , Sasebo Chuo Hospital , Sasebo , Nagasaki , Japan
| | - Chieko Kawahara
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Hitomi Kobayashi
- d Department of Gastroenterology , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Yoshiro Horai
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan.,b Department of Rheumatology , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan.,e Clinical Research Center , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Takahiro Mori
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Yasumori Izumi
- a Department of General and Internal Medicine , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Masahiro Ito
- e Clinical Research Center , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan.,f Department of Pathology , National Hospital Organization Nagasaki Medical Center , Omura , Nagasaki , Japan
| | - Atsushi Kawakami
- g Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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10
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Fukui S, Kuwahara-Takaki A, Ono N, Sato S, Koga T, Kawashiri SY, Iwanaga N, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Migita K, Arinobu Y, Niiro H, Tada Y, Akashi K, Maeda T, Kawakami A. Serum levels of fibroblast growth factor-2 distinguish Takayasu arteritis from giant cell arteritis independent of age at diagnosis. Sci Rep 2019; 9:688. [PMID: 30679579 PMCID: PMC6345929 DOI: 10.1038/s41598-018-36825-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022] Open
Abstract
Takayasu arteritis (TAK) and giant cell arteritis (GCA) are two major variants of large vessel vasculitis, and age is a major factor in their differential diagnosis. We sought to determine whether the two diseases exist on the same spectrum. We compared the serum levels of multiple cytokines and chemokines in 25 patients with TAK, 20 patients with GCA, and sex- and age-matched healthy donors for either condition (HD-TAK and HD-GCA). To evaluate the effects of age on the levels of cytokines and chemokines, we performed multiple logistic regression analysis using the least absolute shrinkage and selection operator (LASSO) method. The levels of IL-1RA, IL-10, GM-CSF, G-CSF, FGF-2, eotaxin, and IP-10 were significantly different between TAK and GCA, but no differences were found in the levels of IL-6, IL-12(p40), IL-17, IFN-γ, and TNF-α. Significant differences in the levels of IL-1RA, IL-10, GM-CSF, eotaxin, and IP-10 were observed between the HD-TAK and HD-GCA groups. Multiple logistic regression analysis demonstrated that only FGF-2 and IP-10 could significantly distinguish the diseases when added to age. Multiple logistic analysis using factors selected by the LASSO method revealed that FGF-2 was the only significant factor to distinguish the diseases when added to age. Among numerous cytokines and chemokines analyzed, only FGF-2 could be used together with age at diagnosis to differentiate TAK and GCA. Our results suggested the importance of considering the effects of age on serum cytokines.
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Affiliation(s)
- Shoichi Fukui
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. .,Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Ayako Kuwahara-Takaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuyuki Ono
- Department of Rheumatology, Saga University, Saga, Japan
| | - Shuntaro Sato
- Nagasaki University Hospital Clinical Research Center, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yojiro Arinobu
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yoshifumi Tada
- Department of Rheumatology, Saga University, Saga, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahiro Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Michitsuji T, Iwanaga N, Horai Y, Tsuji Y, Kawahara C, Izumi Y, Taniguchi K, Yoshida S, Kawakami A. Swollen joints and peripheral arthritis are signs of malignancy in polymyalgia rheumatica. Mod Rheumatol 2018; 29:1013-1016. [DOI: 10.1080/14397595.2018.1538027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tohru Michitsuji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yoshika Tsuji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Ken Taniguchi
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Shinichiro Yoshida
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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12
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Michitsuji T, Horai Y, Sako A, Asano T, Iwanaga N, Izumi Y, Kawakami A. [A case of mixed connective tissue disease positive for proteinase 3 antineutrophil cytoplasmic antibody in a patient with slowly progressive type 1 diabetes mellitus and chronic thyroiditis]. ACTA ACUST UNITED AC 2018; 40:467-470. [PMID: 29367532 DOI: 10.2177/jsci.40.467] [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: 11/15/2022]
Abstract
A female in her sixties with slowly progressive type 1 diabetes mellitus (SPT1DM) and chronic thyroiditis was referred to our rheumatology department with swelling in her fingers. A prominent atherosclerotic lesion was revealed upon brain magnetic resonance imaging, and she was found to have mixed connective tissue disease (MCTD) positive for proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA). This rare case of MCTD accompanying SPT1DM and PR3-ANCA suggested that a synergy between MCTD and PR3-ANCA triggers atherosclerosis.
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Affiliation(s)
- Tohru Michitsuji
- Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Yoshiro Horai
- Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center.,Department of Rheumatology, National Hospital Organization Nagasaki Medical Center.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center
| | - Ayaka Sako
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center
| | - Taro Asano
- Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Nozomi Iwanaga
- Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center.,Department of Rheumatology, National Hospital Organization Nagasaki Medical Center
| | - Yasumori Izumi
- Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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13
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Asano T, Furukawa H, Sato S, Yashiro M, Kobayashi H, Watanabe H, Suzuki E, Ito T, Ubara Y, Kobayashi D, Iwanaga N, Izumi Y, Fujikawa K, Yamasaki S, Nakamura T, Koga T, Shimizu T, Umeda M, Nonaka F, Yasunami M, Ueki Y, Eguchi K, Tsuchiya N, Tohma S, Yoshiura KI, Ohira H, Kawakami A, Migita K. Effects of HLA-DRB1 alleles on susceptibility and clinical manifestations in Japanese patients with adult onset Still's disease. Arthritis Res Ther 2017; 19:199. [PMID: 28899403 PMCID: PMC5596459 DOI: 10.1186/s13075-017-1406-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 03/26/2017] [Accepted: 08/22/2017] [Indexed: 01/01/2023] Open
Abstract
Background HLA-DRB1 alleles are major determinants of genetic predisposition to rheumatic diseases. We assessed whether DRB1 alleles are associated with susceptibility to particular clinical features of adult onset Still’s disease (AOSD) in a Japanese population by determining the DRB1 allele distributions. Methods DRB1 genotyping of 96 patients with AOSD and 1,026 healthy controls was performed. Genomic DNA samples from the AOSD patients were also genotyped for MEFV exons 1, 2, 3, and 10 by direct sequencing. Results In Japanese patients with AOSD, we observed a predisposing association of DRB1*15:01 (p = 8.60 × 10−6, corrected p (Pc) = 0.0002, odds ratio (OR) = 3.04, 95% confidence interval (95% CI) = 1.91–4.84) and DR5 serological group (p = 0.0006, OR = 2.39, 95% CI = 1.49–3.83) and a protective association of DRB1*09:01 (p = 0.0004, Pc = 0.0110, OR = 0.34, 95% CI = 0.18–0.66) with AOSD, and amino acid residues 86 and 98 of the DRβ chain were protectively associated with AOSD. MEFV variants were identified in 49 patients with AOSD (56.3%). The predisposing effect of DR5 was confirmed only in patients with AOSD who had MEFV variants and not in those without MEFV variants. Additionally, DR5 in patients with AOSD are associated with macrophage activation syndrome (MAS) and steroid pulse therapy. Conclusion The DRB1*15:01 and DR5 are both associated with AOSD susceptibility in Japanese subjects. A protective association between the DRB1*09:01 allele and AOSD was also observed in these patients. Our data also highlight the effects of DRB1 alleles in susceptibility to AOSD. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1406-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroshi Furukawa
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Makiko Yashiro
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroko Kobayashi
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tomoyuki Ito
- Department of Rheumatology Nagaoka Red Cross Hospital, 297-1, Senshu-2, Nagaoka, Niigata, 940-2085, Japan
| | - Yoshifumi Ubara
- Department of Rheumatology, Toranomon Hospital, Toranomon 2-2-2, Minato-ku, Tokyo, 105-8470, Japan
| | - Daisuke Kobayashi
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Honcho, Shibata, Niigata, 957-0054, Japan
| | - Nozomi Iwanaga
- Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Yasumori Izumi
- Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Health care Organization, Isahaya General Hospital, Eishohigashi-machi 24-1, Isahaya, 854-8501, Japan
| | - Satoshi Yamasaki
- Department of Rheumatology, Kurume University Medical Center, Kokubu 155-1 1-2-3, Kurume, 734-8551, Japan
| | - Tadashi Nakamura
- Department of Rheumatology, Sakurajyuji Hospital, Miyukibe 1-1-1, Kumamoto, 861-4173, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Fumiaki Nonaka
- Departments of Rheumatology, Sasebo City General Hospital, Hirase 9-3, Sasebo, 857-8511, Japan
| | - Michio Yasunami
- Department of Medical Genomics, Life Science Institute, Saga-ken Medical Centre Koseikan, 400 Kasemachi-Nakabaru, Saga, 840-8571, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Yamato 15, Sasebo, 857-1195, Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo Chuo Hospital, Yamato 15, Sasebo, 857-1195, Japan
| | - Naoyuki Tsuchiya
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
| | - Shigeto Tohma
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, 252-0392, Japan
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
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14
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Migita K, Iwanaga N, Izumi Y, Kawahara C, Kumagai K, Nakamura T, Koga T, Kawakami A. TNF-α-induced miR-155 regulates IL-6 signaling in rheumatoid synovial fibroblasts. BMC Res Notes 2017; 10:403. [PMID: 28807007 PMCID: PMC5556669 DOI: 10.1186/s13104-017-2715-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 11/08/2016] [Accepted: 07/29/2017] [Indexed: 12/18/2022] Open
Abstract
Background MicroRNAs (miRNAs) are important regulators of a variety of inflammatory mediators. The present study was undertaken to elucidate the role of miRNAs in the rheumatoid cytokine network. Methods We analyzed miRNA expression in rheumatoid synovial fibroblasts (RASFs). miRNA array-based screening was used to identify miRNAs differentially expressed between tumor necrosis factor-α (TNF-α)-activated RASFs and untreated RASFs. Transfection of RASFs with miR-155 was used to analyze the function of miR-155. Real-time polymerase chain reaction (PCR) was used to measure the levels of miR-155 in RASFs. Results miRNA microarray analysis revealed that miR-155-5p was the most highly induced miRNA in TNF-α-stimulated RASFs. TNF-α-induced miR-155 expression in RASFs was time-dependent and TNFα dose-dependent, whereas, IL-6 stimulation did not affect miR-155 expression in RASFs. Transfection of miR-155 mimics into RASFs resulted in the decrease JAK2/STAT3 phosphorylation in IL-6-treated RASFs. Conclusions The current results demonstrate that TNF-α modulated miRNA expressions in RASFs. Our data showed that miR-155, which is highly induced by TNF-α stimulation, inhibits IL-6-mediated JAK2/STAT3 activation in RASFs. These findings suggest that miR-155 contributes to the cross-regulation between TNF-α and IL-6-mediated inflammatory pathways in RA.
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Affiliation(s)
- Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan. .,Department of Rheumatology and Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan.
| | - Nozomi Iwanaga
- Department of Rheumatology and Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yasumori Izumi
- Department of Rheumatology and Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Chieko Kawahara
- Department of Rheumatology and Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Kenji Kumagai
- Department of Orthopedics, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Tadashi Nakamura
- Department of Rheumatology, Shinto Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Tomohiro Koga
- Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
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15
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Iwanaga N, Harada K, Tsuji Y, Kawahara C, Kurohama K, Izumi Y, Yoshida S, Fujikawa K, Ito M, Kawakami A, Migita K. TAFRO syndrome with primary Sjogren's syndrome. ACTA ACUST UNITED AC 2017; 39:478-484. [PMID: 27795506 DOI: 10.2177/jsci.39.478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 25-year-old woman diagnosed 1 year earlier with Primary Sjogren's syndrome was admitted to a nearby hospital with fever of unknown origin. Examination revealed anasarca, systemic lymphadenopathy, hepatosplenomegaly and high C-reactive protein level. The patient's symptoms were initially suspected to be caused by severe bacterial infection with Sjogren's syndrome flare. She was given antibiotics and prednisolone (PSL) at 50 mg/day. However, the patient developed anemia and thrombocytopenia and was transferred to our hospital for further care. Histological examination of the right inguinal lymph node showed neutrophilic infiltration. Bone marrow aspiration revealed a normocellular marrow with increased megakaryocytes and mild reticulin fiber hyperplasia. After initiation of minocycline hydrochloride, the patient's symptoms improved. However, as PSL was tapered, her symptoms worsened. The patient's clinical symptoms and laboratory data improved again with initiation of intravenous steroid pulse therapy and cyclosporine. TAFRO syndrome is characterized by a constellation of symptoms: Thrombocytopenia, Anasarca, Fever, Reticulin fibrosis and Organomegaly. Although histological findings of the lymph node in this case differed from previous reports, the patient's other symptoms and clinical course were similar to TAFRO syndrome. TAFRO syndrome can occur with several diseases, including infection, rheumatic disease and malignancies. We report a case in which infection might have triggered TAFRO syndrome.
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Affiliation(s)
- Nozomi Iwanaga
- Departments of General Internal Medicine and Rheumatology, Nagasaki Medical Center
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16
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Izumi Y, Akazawa M, Akeda Y, Tohma S, Hirano F, Ideguchi H, Matsumura R, Miyamura T, Mori S, Fukui T, Iwanaga N, Jiuchi Y, Kozuru H, Tsutani H, Saisyo K, Sugiyama T, Suenaga Y, Okada Y, Katayama M, Ichikawa K, Furukawa H, Kawakami K, Oishi K, Migita K. The 23-valent pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis: a double-blinded, randomized, placebo-controlled trial. Arthritis Res Ther 2017; 19:15. [PMID: 28122642 PMCID: PMC5264490 DOI: 10.1186/s13075-016-1207-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 05/26/2016] [Accepted: 12/09/2016] [Indexed: 12/27/2022] Open
Abstract
Background Pneumococcal pneumonia is the most frequent form of pneumonia. We herein assessed the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in the prevention of pneumonia overall in rheumatoid arthritis (RA) patients at risk for infections. We hypothesized that PPSV23 vaccination is superior in preventing pneumococcal pneumonia compared with placebo in RA patients. Methods A prospective, multicenter, double-blinded, randomized, placebo-controlled (1:1) trial was conducted across departments of rheumatology in Japanese National Hospital Organization hospitals. RA patients (n = 900) who had been treated with biological or immunosuppressive agents were randomly assigned PPSV23 or placebo (sodium chloride). The primary endpoints were the incidences of all-cause pneumonia and pneumococcal pneumonia. The secondary endpoint was death from pneumococcal pneumonia, all-cause pneumonia, or other causes. Cox regression models were used to estimate the risk of pneumonia overall for the placebo group compared with the vaccine group. Results Seventeen (3.7%) of 464 patients in the vaccine group and 15 (3.4%) of 436 patients in the placebo group developed pneumonia. There was no difference in the rates of pneumonia between the two study groups. The overall rate of pneumonia was 21.8 per 1000 person-years for patients with RA. The presence of interstitial pneumonia (hazard ratio: 3.601, 95% confidence interval: 1.547–8.380) was associated with an increased risk of pneumonia in RA patients. Conclusion PPSV23 does not prevent against pneumonia overall in RA patients at relative risk for infections. Our results also confirm that the presence of interstitial lung disease is associated with pneumonia in Japanese patients with RA. Trial registration UMIN-CTR UMIN000009566. Registered 17 December 2012.
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Affiliation(s)
- Yasumori Izumi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Noshio 2-522-1, Kiyose, Tokyo, 204-8588, Japan
| | - Yukihiro Akeda
- Research Institute for Microbial Diseases, Osaka University, Yamadaoka 3-1, Suita, Osaka, 565-8563, Japan
| | - Shigeto Tohma
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Fuminori Hirano
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Haruko Ideguchi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Ryutaro Matsumura
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Tomoya Miyamura
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Shunsuke Mori
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Takahiro Fukui
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Nozomi Iwanaga
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yuka Jiuchi
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hideko Kozuru
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hiroshi Tsutani
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kouichirou Saisyo
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Takao Sugiyama
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yasuo Suenaga
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Yasumasa Okada
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Masao Katayama
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kenji Ichikawa
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Hiroshi Furukawa
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kenji Kawakami
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan
| | - Kazunori Oishi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640, Japan
| | - Kiyoshi Migita
- Japanese National Hospital Organization (NHO) (Evidence-based Medicine Study Group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan. .,Department of Rheumatology, Fukushima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan.
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17
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Abstract
We report a case of reactive arthritis (ReA) triggered by Yersinia enterocolitica enteritis. A 24-year-old Japanese man developed polyarthritis in the lower limbs. Two weeks prior to these symptoms, he noted diarrhea, right lower abdominal pain and a fever. Y. enterocolitica was not isolated from a stool culture; however, he was diagnosed with ReA based on the colonoscopic findings of a high anti-Y. enterocolitica antibody titer and HLA-B27 antigen positivity. Following treatment with methotrexate and steroids, his arthritis improved. This is the first reported Japanese case of ReA in the English literature after a gastrointestinal infection caused by Y. enterocolitica.
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Affiliation(s)
- Kazuya Honda
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Yoshika Tsuji
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Chieko Kawahara
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Toru Michitsuji
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | | | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Kiyoshi Migita
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
- Department of Rheumatology, Fukushima Medical University School of Medicine, Japan
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18
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Fukui S, Iwamoto N, Shimizu T, Umeda M, Nishino A, Koga T, Kawashiri SY, Ichinose K, Hirai Y, Tamai M, Nakamura H, Aramaki T, Iwanaga N, Izumi Y, Origuchi T, Migita K, Ueki Y, Sato S, Kawakami A. Fewer subsequent relapses and lower levels of IL-17 in Takayasu arteritis developed after the age of 40 years. Arthritis Res Ther 2016; 18:293. [PMID: 27964745 PMCID: PMC5154144 DOI: 10.1186/s13075-016-1193-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/23/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background The clinical characteristics of Takayasu arteritis (TAK) developing in individuals older than 40 years (TAK >40) are little-known. Method We retrospectively analyzed 43 patients with TAK treated at three hospitals in Japan from April 2000 to March 2016. From medical records we collected baseline variables at diagnosis including clinical symptoms, laboratory data, and subsequent relapses. We compared these indices in the patients with TAK onset at >40 years of age (TAK >40) to those with TAK onset ≤40 years (TAK ≤40). Multiplex cytokine/chemokine bead assays were performed using preserved serum supernatants from 24 patients with TAK and 40 healthy donors. Results Of the 43 patients, 20 had TAK >40; this group had significantly fewer instances of orthostatic hypotension (2 (10%) vs. 10 (43%), p = 0.019), carotid bruit (7 (35%) vs. 16 (70%), p = 0.034), and chest pain (0 (0%) vs. 6 (26%), p = 0.023) compared to patients with TAK ≤40 (n = 23). The initial prednisolone dose was significantly lower in TAK >40 (median 30 mg vs. 40 mg per day, p = 0.024). Assessed by the log-rank test, the relapse-free survival rate after remission was significantly higher in the patients with TAK >40 (p = 0.029). The interleukin 17 levels were significantly lower in patients with TAK >40 compared to patients with TAK ≤40 and healthy donors. Conclusion Compared to TAK ≤40, TAK >40 could be treated by lower initial doses of prednisolone to achieve remission, and with fewer relapses. These differences might be due to the difference of T helper 17 (Th17) activity suggested by the cytokine profiles.
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Affiliation(s)
- Shoichi Fukui
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Naoki Iwamoto
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Toshimasa Shimizu
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masataka Umeda
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ayako Nishino
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tomohiro Koga
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shin-Ya Kawashiri
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.,Unit of Advanced Preventive Medical Sciences, Departments of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasuko Hirai
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mami Tamai
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hideki Nakamura
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshiyuki Aramaki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Tomoki Origuchi
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.,Unit of Rehabilitation Sciences, Department of Locomotive Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan
| | - Shuntaro Sato
- Nagasaki University Hospital Clinical Research Center, Nagasaki, Japan
| | - Atsushi Kawakami
- Unit of Advanced Preventive Medical Sciences, Departments of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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19
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Migita K, Izumi Y, Jiuchi Y, Iwanaga N, Kawahara C, Agematsu K, Yachie A, Masumoto J, Fujikawa K, Yamasaki S, Nakamura T, Ubara Y, Koga T, Nakashima Y, Shimizu T, Umeda M, Nonaka F, Yasunami M, Eguchi K, Yoshiura KI, Kawakami A. Familial Mediterranean fever is no longer a rare disease in Japan. Arthritis Res Ther 2016; 18:175. [PMID: 27473114 PMCID: PMC4967332 DOI: 10.1186/s13075-016-1071-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 04/15/2016] [Accepted: 07/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to evaluate the clinical manifestations and prevalence of familial Mediterranean fever (FMF) in Japanese patients with unexplained fever and rheumatic manifestations. Methods We enrolled 601 patients with unexplained fever or suspected FMF throughout Japan between 2009 and 2015. Patients were divided into three groups according to Tel Hashomer criteria: sure FMF, probable FMF, and non-FMF patients, including definitive rheumatic diseases. Mutation detection in exons 1, 2, 3, and 10 of the FMF gene MEFV was performed by direct sequencing. Results A total of 192 patients (31.9 %) were diagnosed with FMF according to FMF diagnostic criteria. These could be divided into sure FMF (56.3 %, n = 108) and probable FMF (43.7 %, n = 84) patients. Fever, abdominal symptoms, and thoracic symptoms were significantly more common in FMF than non-FMF patients. Among FMF patients, 26 (13.5 %) had concomitant rheumatic diseases. Most FMF patients (94.3 %, 181/192) carried at least one MEFV mutation. Allele frequencies of M694I (13.5 % vs 0 %) and E148Q (39.1 % vs 24.8 %) mutations were significantly higher in FMF compared with healthy subjects. Allele frequencies of common MEFV mutations in FMF patients were M694I (13.5 %), P369S (8.6 %), R408Q (8.1 %), G304R (2.9 %), R202Q (4.4 %), E148Q (39.1 %), L110P (11.7 %), and E84K (3.1 %). Patients with a sure FMF phenotype had a higher frequency of MEFV exon 10 mutation (M694I) and a lower frequency of MEFV exon 3 mutations (P369S, R408Q) compared with those with a probable FMF phenotype. Conclusion The high prevalence of FMF in Japanese patients with unexplained fever was confirmed in the present study. FMF should be suspected in cases of unexplained fever or non-specific rheumatic manifestations, and mutational analysis of MEFV could be useful to predict the clinical phenotypes of FMF in Japan.
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Affiliation(s)
- Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1295, Japan. .,Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan.
| | - Yasumori Izumi
- Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Yuka Jiuchi
- Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Nozomi Iwanaga
- Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, Nagasaki, 856-8562, Japan
| | - Chieko Kawahara
- Department of Rheumatology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1295, Japan
| | - Kazunaga Agematsu
- Department of Infectious Immunology, Shinshu University Graduate School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Takara13-1, Kanazawa, 920-8640, Japan
| | - Junya Masumoto
- Department of Pathology, Ehime University Proteo-Science Center and Graduate School of Medicine, Shitsukawa 454, Toon, Ehime, 791-0295, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Health care Organization, Isahaya General Hospital, Eishohigashi-machi 24-1, Isahaya, 854-8501, Japan
| | - Satoshi Yamasaki
- Department of Rheumatology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tadashi Nakamura
- Department of Rheumatology, Kumamoto Shinto General Hospital, Shinyashiki 1-17-27, Kumamoto, 862-8655, Japan
| | - Yoshifumi Ubara
- Department of Rheumatology, Toranomon Hospital, Toranomon 2-2-2, Minato-ku, Tokyo, 105-8470, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Fumiaki Nonaka
- Departments of Rheumatology, Sasebo City General Hospital, Hirase 9-3, Sasebo, 857-8511, Japan
| | - Michio Yasunami
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-7-1, Nagasaki, 852-8501, Japan
| | - Katsumi Eguchi
- Sasebo Chuo Hospital, Yamato 15, Sasebo, 857-1195, Japan
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
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20
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Tsuji Y, Iwanaga N, Mizoguchi A, Sonemoto E, Hiraki Y, Ota Y, Kasai H, Yukawa E, Ueki Y, To H. Population Pharmacokinetic Approach to the Use of Low Dose Cyclosporine in Patients with Connective Tissue Diseases. Biol Pharm Bull 2016; 38:1265-71. [PMID: 26328482 DOI: 10.1248/bpb.b15-00030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study describes the population pharmacokinetics and dose personalization of cyclosporine in 36 patients with connective tissue diseases. A one-compartment open model with absorption was adopted as a pharmacokinetic model, and a nonlinear mixed effects model was used to analyze the population pharmacokinetic models. In the final model, age (AGE) and total body weight (TBW) were influential covariates on clearance (CL/F), which was expressed as CL/F (L/h)=17.8×(AGE/60)(-0.269)×(TBW/46.9)(0.408), in addition to the volume of distribution (Vd/F), (L)=98.0 and absorption rate constant (Ka) (h(-1))=0.67 (fixed). The results of the present study provide novel insights into factors involved in determining the most suitable dose and dosing strategy for individual patients with connective tissue disease.
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Affiliation(s)
- Yasuhiro Tsuji
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama
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21
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Origuchi T, Arima K, Umeda M, Kawashiri SY, Tamai M, Nakamura H, Tsukada T, Miyashita T, Iwanaga N, Izumi Y, Furuyama M, Tanaka F, Kawabe Y, Aramaki T, Ueki Y, Eguchi K, Fukuda T, Kawakami A. Clinical outcomes in the first year of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Mod Rheumatol 2016; 27:150-154. [PMID: 27320419 DOI: 10.1080/14397595.2016.1192744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/21/2022]
Abstract
OBJECTIVE We investigated clinical outcomes in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. METHODS This is a retrospective multicenter study conducted in Nagasaki, Japan. We consecutively diagnosed a total of 41 patients with RS3PE syndrome between October 2003 and September 2012 and evaluated their outcomes from medical records from the first year of follow-up. RESULTS Although an excellent initial response to corticosteroids was noted in all 41 patients, 34 (82.9%) were still receiving corticosteroids and 13 (31.7%) showed elevated C-reactive protein (CRP) at one year. Multivariate analysis demonstrated that male gender and high CRP level at entry were independent variables associated with patients' one-year CRP level being ≥0.5 mg/dL. Odds ratios were 17.05 ([95% CI 2.41-370.12], p < 0.026) and 12.99 ([95% CI 1.78-269.62], p < 0.0096), respectively. Twenty-four patients (58.5%) were still receiving prednisolone (PSL) ≥ 5 mg/day at one year. Disease-modifying anti-rheumatic drugs including methotrexate were required in three patients (10.3%). Neoplasms were found in 14 patients (34.1%) and 1 of these had died due to lung cancer at one year. CONCLUSIONS RS3PE syndrome initially responds well to corticosteroids with remission of symptoms. However, outcomes of RS3PE syndrome appear to be worse than expected, and may be influenced by gender and initial CRP level.
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Affiliation(s)
- Tomoki Origuchi
- a Department of Rehabilitation Sciences and.,b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | - Kazuhiko Arima
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | - Masataka Umeda
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | - Shin-Ya Kawashiri
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | - Mami Tamai
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | - Hideki Nakamura
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
| | | | | | - Nozomi Iwanaga
- e Department of Rheumatology , National Hospital Organization Nagasaki Medical Center , Japan
| | - Yasumori Izumi
- e Department of Rheumatology , National Hospital Organization Nagasaki Medical Center , Japan
| | - Masako Furuyama
- f Department of Rheumatology , Nagasaki Kita Hospital , Japan
| | - Fumiko Tanaka
- g Department of Rheumatology , National Hospital Organization Ureshino Medical Center , Japan
| | - Yojiro Kawabe
- g Department of Rheumatology , National Hospital Organization Ureshino Medical Center , Japan
| | | | - Yukitaka Ueki
- h Department of Rheumatology , Sasebo Chuo Hospital , Japan , and
| | - Katsumi Eguchi
- h Department of Rheumatology , Sasebo Chuo Hospital , Japan , and
| | | | - Atsushi Kawakami
- b Department of Immunology and Rheumatology , Graduate School of Biomedical Sciences, Nagasaki University , Japan
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22
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Izumi Y, Nakaoka K, Kamata M, Iwanaga N, Imadachi S, Kurohama H, Ito M, Migita K. Steroid-resistant protein-losing gastroenteropathy complicated with Sjögren's syndrome successfully treated with mizoribine. Mod Rheumatol 2016; 28:716-720. [PMID: 26872871 DOI: 10.3109/14397595.2016.1145570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/13/2022]
Abstract
A 64-year-old woman with leg edema was diagnosed with protein-losing gastroenteropathy and Sjögren's syndrome. Central venous nutrition led to infection of her catheter, ascites, and deep vein thrombosis. Following successful treatment of these conditions with antibiotics and anticoagulants, she was treated unsuccessfully with prednisolone and steroid pulse therapy. Mizoribine add-on markedly reduced edema and normalized serum albumin. This is the first report of a steroid-resistant protein-losing gastroenteropathy patient with Sjögren's syndrome successfully treated with mizoribine.
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Affiliation(s)
- Yasumori Izumi
- a Department of Rheumatology.,b General Internal Medicine , and
| | - Kenjiro Nakaoka
- a Department of Rheumatology.,b General Internal Medicine , and
| | | | | | | | | | - Masahiro Ito
- c Pathology , NHO Nagasaki Medical Center , Omura , Japan
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23
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Migita K, Akeda Y, Akazawa M, Tohma S, Hirano F, Ideguchi H, Kozuru H, Jiuchi Y, Matsumura R, Suematsu E, Miyamura T, Mori S, Fukui T, Izumi Y, Iwanaga N, Tsutani H, Saisyo K, Yamanaka T, Ohshima S, Mori N, Matsumori A, Takahi K, Yoshizawa S, Kawabe Y, Suenaga Y, Ozawa T, Hamada N, Komiya Y, Matsui T, Furukawa H, Oishi K. Effect of abatacept on the immunogenicity of 23-valent pneumococcal polysaccharide vaccination (PPSV23) in rheumatoid arthritis patients. Arthritis Res Ther 2015; 17:357. [PMID: 26653668 PMCID: PMC4675027 DOI: 10.1186/s13075-015-0863-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/16/2015] [Indexed: 01/19/2023] Open
Abstract
Introduction Patients with rheumatoid arthritis (RA) treated with abatacept (ABT) are at increased risk for vaccine-preventable infections. The aim of the present study is to evaluate the humoral response to 23-valent pneumococcal polysaccharide (PPSV23) vaccination in RA patients receiving ABT. Methods The immunogenicity study was nested within a randomized, double-blind placebo-controlled study, designed to evaluate the efficacy of the PPSV23. PPSV23 was given to 111 RA patients, who were classified into three groups: RA control (n = 35), methotrexate (MTX) alone (n = 55), and ABT (n = 21). Before and 4–6 weeks after vaccination, we measured the patients’ concentrations of antibodies against pneumococcal serotypes 6B and 23F using an enzyme-linked immunosorbent assay and determined their antibody functionality using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI). Results The pneumococcal serotype-specific IgG concentrations and OIs were both significantly increased in all treatment groups in response to PPSV23 vaccination. In the ABT group, the IgG responses for the 6B serotype were lower compared with those in the MTX alone or control groups, whereas the OI responses were similar to those in the other two groups. In a subgroup analysis, the pneumococcal serotype-specific IgG responses were significantly lower in both serotypes (6B and 23F) in the ABT/MTX group; however, the OI responses in the ABT group were not different from the control group. There was no association between the pneumococcal serotype-specific IgG and OI responses for the 6B serotype in patients receiving ABT in contrast to the control or MTX alone patients. No severe adverse effects were observed in any of the treatment groups. Conclusions OI responses indicate antibody functionality rather than simply their amount, so the similarity of these measurements between all three groups suggests that RA patients receiving ABT still benefit from receiving the PPSV23 vaccination, even though they produce less IgG in response to it. The results suggest an influence of ABT on the humoral response to PPSV23 vaccination under MTX treatment; however, preserved opsonin responses are expected in RA patients treated with ABT plus MTX. Trial registration University Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012.
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Affiliation(s)
- Kiyoshi Migita
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan. .,Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, 856-8652, Japan.
| | - Yukihiro Akeda
- Research Institute for Microbial Diseases, Osaka University, Yamadaoka 3-1, Suita, Osaka, 565-8563, Japan.
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Noshio 2-522-1, Kiyose, Tokyo, 204-8588, Japan.
| | - Shigeto Tohma
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Fuminori Hirano
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Haruko Ideguchi
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hideko Kozuru
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yuka Jiuchi
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Ryutaro Matsumura
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Eiichi Suematsu
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Tomoya Miyamura
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shunsuke Mori
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Takahiro Fukui
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasumori Izumi
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Nozomi Iwanaga
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hiroshi Tsutani
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kouichirou Saisyo
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Takao Yamanaka
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shiro Ohshima
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Naoya Mori
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Akinori Matsumori
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Koichiro Takahi
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shigeru Yoshizawa
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yojiro Kawabe
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasuo Suenaga
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Tetsuo Ozawa
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Norikazu Hamada
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasuhiro Komiya
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Toshihiro Matsui
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hiroshi Furukawa
- Japanese National Hospital Organization (NHO) multi-center clinical studies for evidence-based medicine study group: Japanese study of Randomized controlled study for patients with RA using 23-valent pneumococcal polysaccharide vaccine (RA-PPV23), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kazunori Oishi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640, Japan.
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Migita K, Akeda Y, Akazawa M, Tohma S, Hirano F, Ideguchi H, Matsumura R, Suematsu E, Miyamura T, Mori S, Fukui T, Izumi Y, Iwanaga N, Jiuchi Y, Kozuru H, Tsutani H, Saisyo K, Yamanaka T, Ohshima S, Mori N, Matsumori A, Kitagawa K, Takahi K, Ozawa T, Hamada N, Nakajima K, Nagai H, Tamura N, Suenaga Y, Kawabata M, Matsui T, Furukawa H, Kawakami K, Oishi K. Opsonic and Antibody Responses to Pneumococcal Polysaccharide in Rheumatoid Arthritis Patients Receiving Golimumab Plus Methotrexate. Medicine (Baltimore) 2015; 94:e2184. [PMID: 26717361 PMCID: PMC5291602 DOI: 10.1097/md.0000000000002184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Vaccination against Streptococcus pneumoniae is recommended for rheumatoid arthritis (RA) patients receiving immunosuppressive treatments. The objective of this study was to evaluate the humoral response to 23-valent pneumococcal polysaccharide vaccination (PPSV23) in RA patients receiving methotrexate (MTX) alone or in combination with a tumor necrosis factor inhibitor, golimumab (GOM).PPSV23 was given to 114 RA patients, who were classified into three groups: RA control (n = 35), MTX alone (n = 55), and GOM + MTX (n = 24). Before and 4 to 6 weeks after vaccination, concentrations of antibodies against pneumococcal serotypes 6B and 23F were measured using an enzyme-linked immunosorbent assay and antibody functionality was determined using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI).The IgG concentrations and OIs were both significantly increased in all treatment groups in response to PPSV23 vaccination. In the GOM + MTX group, the IgG responses were lower than those in the MTX alone or control groups, whereas the OI responses were similar to those in the other 2 groups. Furthermore, discrepancies between the IgG and OI responses were found in GOM + MTX group. No severe adverse effect was observed in any treatment groups.OI responses indicate that antibody functionality rather than antibody quantity is important. The similarity of these measurements between all 3 groups suggests that RA patients receiving MTX + GOM still benefit from receiving the PPSV23 vaccination, even though they produce less IgG in response to it. These results can help clinicians to better schedule and evaluate pneumococcal vaccination for RA patients.
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Affiliation(s)
- Kiyoshi Migita
- From the Japanese National Hospital Organization (NHO), Multi-center Clinical Studies for Evidence-based Medicine Study Group; Japanese Study of Randomized Controlled Study for Patients with RA Using 23-Valent Pneumococcal Polysaccharide Vaccine (RA-PPV23), Meguro, Tokyo (KM, ST, FH, HI, RM, ES, TM, SM, TF, YI, NI, YJ, HK, HT, KS, TY, SO, NM, AM, KK, KT, TO, NH, KN, HN, NT, YS, MK, TM, HF, KK); Research Institute for Microbial Diseases, Osaka University, Suita, Osaka (YA); Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Kiyose, Tokyo (MA); and Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan (KO)
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Matsunaga T, Izumi Y, Iwanaga N, Kawahara C, Shigemitsu Y, Yoshida S, Kawakami A, Ogawa D, Migita K. Myelodysplastic syndrome precedes the onset of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. TOHOKU J EXP MED 2015; 235:47-52. [PMID: 25744363 DOI: 10.1620/tjem.235.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical synovitis predominantly involving the wrists, and is associated with marked pitting edema of the dorsum of the hands. Although the etiology of RS3PE syndrome is still unknown, several putative associations with malignancies and hematological disorders have been reported. Myelodysplastic syndrome (MDS) is characterized by infective hematopoiesis with possible transformation to leukemia; however, an association between RS3PE syndrome and MDS has been rarely reported. Here, we describe a 67-year-old man with MDS with refractory anemia who developed RS3PE syndrome 3 months after the diagnosis of MDS. The patient presented with polyarthritis with pitting edema at the dorsum of the hands, the elevated serum levels of C-reactive protein and a proinflammatory cytokine, interleukin-6, and the elevated plasma levels of vascular endothelial growth factor (VEGF). VEGF has been shown to be involved in the pathogenesis of RS3PE syndrome. Treatment with low doses of corticosteroids resulted in the regression of polyarthritis and pitting edema of the dorsum of the hands, as well as a reduction in the elevated levels of plasma VEGF. Partial resolution of refractory anemia was also observed with steroid therapy. In summary, RS3PE syndrome developed shortly after MDS was identified in this patient. The sequence of clinical events suggests that MDS-mediated immunological abnormalities including inflammatory cytokine induction may be responsible for the association between MDS and RS3PE syndrome. Patients with RS3PE syndrome should be screened for hematological disorders that promote proinflammatory mediators.
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26
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Fukui S, Ichinose K, Tsuji S, Umeda M, Nishino A, Nakashima Y, Suzuki T, Horai Y, Koga T, Kawashiri SY, Iwamoto N, Hirai Y, Tamai M, Nakamura H, Sato S, Aramaki T, Iwanaga N, Izumi Y, Origuchi T, Migita K, Ueki Y, Kawakami A. Hypocholesterolemia predicts relapses in patients with Takayasu arteritis. Mod Rheumatol 2015; 26:415-420. [DOI: 10.3109/14397595.2015.1083148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shoichi Fukui
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Sosuke Tsuji
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Takahisa Suzuki
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yoshiro Horai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Shin-ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
- Department of Public Health, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yasuko Hirai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Mami Tamai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Shuntaro Sato
- Nagasaki University Hospital Clinical Research Center, Nagasaki, Japan,
| | - Toshiyuki Aramaki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan,
| | - Nozomi Iwanaga
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Yasumori Izumi
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
- Department of Rehabilitation Sciences, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan,
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
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Migita K, Tsuji Y, Hisatomi K, Shigeno R, Izumi Y, Iwanaga N, Koga T. Acute exacerbation of rheumatoid interstitial lung disease during the maintenance therapy with certolizumab pegol. Mod Rheumatol 2015; 27:1079-1082. [PMID: 26044288 DOI: 10.3109/14397595.2015.1059008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/08/2023]
Abstract
We report a case involving a 68-year-old woman with rheumatoid arthritis (RA) with acute exacerbated interstitial lung disease (ILD) during certolizumab pegol maintenance therapy. She recovered quickly with steroid pulse therapy and was discharged without deterioration of basal pulmonary function. Immunoblot analysis demonstrated the circulating cleaved interleukin-1β at the phase of acute exacerbation of RA-associated ILD (RA-ILD) in this patient. The findings from this case suggested that the Nod-like receptor pyrin domain-containing protein 3 inflammasome is implicated in acute RA-ILD exacerbation.
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Affiliation(s)
- Kiyoshi Migita
- a Department of Rheumatology and Clinical Research Center , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Yoshika Tsuji
- a Department of Rheumatology and Clinical Research Center , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Keiko Hisatomi
- b Department of Respiratory Medicine , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Riyoko Shigeno
- a Department of Rheumatology and Clinical Research Center , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Yasumori Izumi
- a Department of Rheumatology and Clinical Research Center , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Nozomi Iwanaga
- a Department of Rheumatology and Clinical Research Center , Nagasaki Medical Center , Omura, Nagasaki , Japan
| | - Tomohiro Koga
- c First Department of Internal Medicine , Nagasaki University School of Medicine , Sakamoto, Nagasaki , Japan
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Migita K, Iwanaga N, Imadachi S, Jiuchi Y, Izumi Y, Tsuji Y, Kawahara C, Kawakami A, Furukawa H, Tohma S. Incidence of Symptomatic Vertebral Fractures Among Newly Diagnosed Autoimmune Diseases Initiating Glucocorticoid Therapy. Medicine (Baltimore) 2015; 94:e875. [PMID: 26166127 PMCID: PMC4504604 DOI: 10.1097/md.0000000000000875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Few data are available regarding vertebral fracture risk in patients treated with corticosteroids including patients with interstitial lung disease (ILD). The aim of the present study was to identify risk factors for symptomatic vertebral fracture analyzed in patients with newly diagnosed autoimmune diseases.This was an observational cohort study conducted in the National Hospital Organization-EBM study group from 2006 to 2008. The study subjects were autoimmune disease patients who were newly treated with glucocorticoids (GCs). The primary endpoint was the first occurrence of vertebral fracture diagnosed by x-rays. Cox proportional-hazards regression was used to determine independent risk factors for vertebral fracture with covariates including sex, age, comorbidity, laboratory data, use of immunosuppressants, and dose of GCs. Survival was analyzed according to the Kaplan-Meier method and assessed by the log-rank test.Among 604 patients of mean age 59.5 years and mean GC dose 50.4 mg/d (first 1 months), 19 patient (3.1%) had at least 1 symptomatic vertebral fracture during 1.9 years of follow-up period. Cox regression model demonstrated that the relative risk for symptomatic vertebral fracture was independently higher in patient with ILD (hazard ratio [HR] = 2.86, 95% confidence interval [CI] = 1.10-7.42, P = 0.031) and in every 10-year increment of the age of disease onset (HR = 1.57, 95% CI = 1.09-2.26, P = 0.015). Kaplan-Meier analyses demonstrated that the incidence of vertebral fractures in patients with ILD was significantly higher in comparison with those without ILD.Our results indicate a higher risk of vertebral facture in patients with ILD and elderly patients during the initial GC treatment against autoimmune diseases. There is a need for further, even longer-term, prospective studies subjected patients with autoimmune disease, including ILD, under GC treatment.
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Affiliation(s)
- Kiyoshi Migita
- From the Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki (KM, NI, SI, YJ, Yi, YT, CK); Japanese National Hospital Organization (NHO)-EBM Study Group for Adverse Effects of Corticosteroid Therapy (J-NHOSAC), Hikarigaoka, Meguro, Tokyo (KM); Department of Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki (AK); and Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara, Japan (HF, ST)
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Umeda M, Ichinose K, Okada A, Nishino A, Aramaki T, Iwanaga N, Terada K, Nakamura H, Ueki Y, Kawakami A. A rare case of hemorrhagic cystitis complicated with thrombocytopenia and hemophagocytic syndrome associated with BK virus, under immunosuppressive treatment of systemic lupus erythematosus. Mod Rheumatol 2015; 26:467-9. [PMID: 26011441 DOI: 10.3109/14397595.2015.1054080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Masataka Umeda
- a Sasebo Chuo Hospital , Nagasaki , Japan.,b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Kunihiro Ichinose
- b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Akitomo Okada
- b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | - Ayako Nishino
- b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | | | | | | | - Hideki Nakamura
- b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
| | | | - Atsushi Kawakami
- b Department of Rheumatology , Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University , Nagasaki , Japan
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30
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Migita K, Akeda Y, Akazawa M, Tohma S, Hirano F, Ideguchi H, Matsumura R, Suematsu E, Miyamura T, Mori S, Fukui T, Izumi Y, Iwanaga N, Tsutani H, Saisyo K, Yamanaka T, Ohshima S, Sugiyama T, Kawabe Y, Katayama M, Suenaga Y, Okamoto A, Ohshima H, Okada Y, Ichikawa K, Yoshizawa S, Kawakami K, Matsui T, Furukawa H, Oishi K. Pneumococcal polysaccharide vaccination in rheumatoid arthritis patients receiving tacrolimus. Arthritis Res Ther 2015; 17:149. [PMID: 26036592 PMCID: PMC4481124 DOI: 10.1186/s13075-015-0662-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/26/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction In rheumatoid arthritis (RA) patients receiving immunosuppressive treatments, vaccination against Streptococcus pneumoniae is recommended. The objective of the study was to evaluate the effects of tacrolimus (TAC) on immune response following administration of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients with established RA. Methods Patients with RA (n = 133) were vaccinated with PPSV23. Patients were classified into TAC (n = 29), methotrexate (MTX) (n = 55), control (n = 35), and TAC/MTX (n = 14) treatment groups. We measured the concentrations of pneumococcal serotypes 6B and 23F by using an enzyme-linked immunosorbent assay and determined antibody functionality by using a multiplexed opsonophagocytic killing assay, reported as the opsonization index (OI), before and 4 to 6 weeks after vaccination. A positive antibody response was defined as at least a twofold increase in the IgG concentration or as at least a 10-fold increase in the OI. Results IgG concentrations and OIs were significantly increased in all treatment groups after PPSV23 vaccination. The TAC treatment group appears to respond in a manner similar to that of the RA control group in terms of 6B and 23F serotype concentration and function. In contrast, the MTX group had the lowest immune response. Patients who received a combination of TAC and MTX (TAC/MTX) also had a diminished immune response compared with those who received TAC alone. Conclusions TAC monotherapy does not appear to impair PPSV23 immunogenicity in patients with RA, whereas antibody production and function may be reduced when TAC is used with MTX. Thus, PPSV23 administration during ongoing TAC treatment should be encouraged for infection-prone TAC-treated patients with rheumatic diseases. Trial registration University Hospital Medical Information Network Clinical Trials Registry: UMIN000009566. Registered 12 December 2012. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0662-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kiyoshi Migita
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan. .,Clinical Research Center, NHO Nagasaki Medical Center, Kubara 2-1001-1, Omura, 856-8652, Japan.
| | - Yukihiro Akeda
- Research Institute for Microbial Diseases, Osaka University, Yamadaoka 3-1, Suita, Osaka, 565-8563, Japan.
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Noshio 2-522-1, Kiyose, Tokyo, 204-8588, Japan.
| | - Shigeto Tohma
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Fuminori Hirano
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Haruko Ideguchi
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Ryutaro Matsumura
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Eiichi Suematsu
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Tomoya Miyamura
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shunsuke Mori
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Takahiro Fukui
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasumori Izumi
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Nozomi Iwanaga
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hiroshi Tsutani
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kouichirou Saisyo
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Takao Yamanaka
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shiro Ohshima
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Takao Sugiyama
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yojiro Kawabe
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Masao Katayama
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasuo Suenaga
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Akira Okamoto
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hisaji Ohshima
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Yasumasa Okada
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kenji Ichikawa
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Shigeru Yoshizawa
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kenji Kawakami
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Toshihiro Matsui
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Hiroshi Furukawa
- Japanese National Hospital Organization (NHO, EBM study group), Higashigaoka 2-5-23, Meguro, Tokyo, 152-8621, Japan.
| | - Kazunori Oishi
- Infectious Diseases Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640, Japan.
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Origuchi T, Arima K, Umeda M, Kawashiri SY, Koga T, Ichinose K, Tamai M, Nakamura H, Miyashita T, Fujikawa K, Mizokami A, Iwanaga N, Furuyama M, Nakashima M, Aramaki T, Ueki Y, Kawabe Y, Fukuda T, Eguchi K, Kawakami A. SAT0533 Early Diagnosis is Associated with the Less Flair in Patients with Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Migita K, Hisanaga S, Izumi Y, Kawahara C, Shigemitsu Y, Iwanaga N, Araki T, Kamata M, Izumi M, Kumagai K, Kawakami A. Protracted arthritis in a Japanese patient with familial Mediterranean fever. Mod Rheumatol 2015; 27:905-909. [PMID: 25800639 DOI: 10.3109/14397595.2015.1031722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kiyoshi Migita
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Sachi Hisanaga
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Yasumori Izumi
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Chieko Kawahara
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Yoshika Shigemitsu
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Nozomi Iwanaga
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Toshitaka Araki
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Masatsugu Kamata
- Departments of General Internal Medicine and Rheumatology, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Masahiro Izumi
- Department of Orthopedic surgery, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Kenji Kumagai
- Department of Orthopedic surgery, Nagasaki medical Center, Omura City, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Rheumatology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan
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Abe Y, Shima T, Izumi Y, Kitamura M, Yamashita H, Tsuji Y, Sasaki O, Maeda C, Kawahara C, Torisu A, Kawaguchi Y, Kurohama H, Ito M, Iwanaga N, Kawakami A, Nakayama T, Taguchi T, Migita K. Successful Management of Lupus Nephritis with High Titers of Myeloperoxidase Anti-Neutrophil Cytoplasmic Antibodies Using Tacrolimus. Intern Med 2015; 54:2929-33. [PMID: 26568012 DOI: 10.2169/internalmedicine.54.4343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old Japanese woman with a 30-year history of systemic lupus erythematosus developed macrohematuria and massive proteinuria after seroconversion of myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy indicated focal proliferative lupus nephritis (class III A/C) with a fibrous crescent formation. Methylprednisolone pulse therapy (500 mg, 3 successive days) was administered because of progressive proteinuria. Steroid therapy did not suppress the progressive proteinuria; therefore, tacrolimus was added as an alternative immunosuppressive therapy, resulting in the improvement of proteinuria and renal impairment. This case report suggests that MPO-ANCA might play a pathogenic role in the exacerbation of immune-complex-type lupus nephritis.
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Affiliation(s)
- Yoshikazu Abe
- Department of General Internal Medicine and Rheumatology, Nagasaki Medical Center, Japan
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Izumi Y, Takeshita H, Moriwaki Y, Hisatomi K, Matsuda M, Yamashita N, Kawahara C, Shigemitsu Y, Iwanaga N, Kawakami A, Kurohama H, Niino D, Ito M, Migita K. Multicentric Castleman disease mimicking IgG4-related disease: A case report. Mod Rheumatol 2014; 27:174-177. [PMID: 25528859 DOI: 10.3109/14397595.2014.985356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 12/16/2022]
Abstract
A 50-year-old woman was referred to our hospital for shoulder joint stiffness. She had a history of polyclonal hypergammaglobulinemia and an elevated C-reactive protein level. Her laboratory data revealed an elevated serum immunoglobulin G4 (IgG4) level, hypergammaglobulinemia, and rheumatoid factor positivity in the absence of anticyclic citrullinated peptide antibody. [18F]-Fluorodeoxyglucose positron emission tomography showed significant [18F]-fluorodeoxyglucose uptake in multiple lymph nodes (axillary, hilar, para-aortic, and inguinal). Biopsy of the inguinal lymph node showed expansion of the interfollicular areas by heavily infiltrating plasma cells, consistent with multicentric Castleman disease (MCD). Immunohistochemical analysis revealed a 37.3% IgG4-positive:IgG-positive plasma cell ratio, indicating overlapping IgG4-related disease. However, serological cytokine analysis revealed elevated levels of interleukin-6 (9.3 pg/ml) and vascular endothelial growth factor (VEGF) (1210 pg/ml), which are compatible with MCD. Corticosteroid treatment resolved the serological and imaging abnormalities. IgG4-related disease can mimic MCD, and it is crucial to distinguish between these two diseases. Serum interleukin-6 and VEGF levels may help to discriminate MCD from IgG4-related disease.
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Affiliation(s)
- Yasumori Izumi
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Hayato Takeshita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Yuji Moriwaki
- b Departments of Hematology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Keiko Hisatomi
- c Departments of Respiratory Medicine , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Masakazu Matsuda
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Natsuki Yamashita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Chieko Kawahara
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Yoshika Shigemitsu
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Nozomi Iwanaga
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Atsushi Kawakami
- d First Department of Internal Medicine , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hirokazu Kurohama
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Daisuke Niino
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Masahiro Ito
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Kiyoshi Migita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
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Migita K, Arai T, Jiuchi Y, Izumi Y, Iwanaga N, Kawahara C, Suematsu E, Miyamura T, Tsutani H, Kawabe Y, Matsumura R, Mori S, Ohshima S, Yoshizawa S, Suenaga Y, Ogushi F, Kawabata M, Furukawa H, Matsui T, Bito S, Tohma S. Predictors of mortality in patients with interstitial lung disease treated with corticosteroids: results from a cohort study. Medicine (Baltimore) 2014; 93:e175. [PMID: 25474431 PMCID: PMC4616396 DOI: 10.1097/md.0000000000000175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Interstitial lung disease (ILD) has a heterogeneous clinical presentation and establishing prognosis for these patients is challenging. We investigated the clinical characteristics and outcome of patients with idiopathic interstitial pneumonias (IIPs) and patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). We conducted a multicenter prospective study on 104 patients diagnosed with IIPs and 29 patients diagnosed with CTD-ILD, which were newly diagnosed and treated with corticosteroids initially. We compared the clinical characteristics, high-resolution computed tomography (HRCT) imaging date, and outcomes. Cox proportional hazard regression analysis was used to identify variables with increased risk of death. Survival was analyzed according to the Kaplan-Meier method and was assessed with the log-rank test. Of 133 patients with IIPs (n = 104) or CTD-ILD (n = 29), 44 patients died during the follow-up period (mean: 1.6 ± 0.78 years). Patients with IIPs seemed to be associated with worse survival compared with those with CTD-ILD; however, this difference was not significant (log-rank test, P = 0.084). Significant predictors for mortality in patients with IIPs at baseline were lower for performance status and definite usual interstitial pattern (UIP) on HRCT. Patients with UIP experienced worse survival than those with non-UIP. A definite UIP on HRCT and lower baseline performance status have important prognostic implications in patients with IIPs.
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Affiliation(s)
- Kiyoshi Migita
- From the Japanese National Hospital Organization (NHO)-EBM study group for Adverse Effects of Corticosteroid therapy (J-NHOSAC), Meguro, Tokyo (KM, TA, ES, TM, HT, YK, RM, SM, SO, SY, YS, FO, MK, HF, TM, SB, ST); and Department of Rheumatology and General Internal Medicine Nagasaki Medical Center, Omura, Nagasaki, Japan (KM, YJ, YI, NI, CK)
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Obata A, Ito S, Iwanaga N, Mizuno T, Jones JR, Kasuga T. Poly(γ-glutamic acid)–silica hybrids with fibrous structure: effect of cation and silica concentration on molecular structure, degradation rate and tensile properties. RSC Adv 2014. [DOI: 10.1039/c4ra08777a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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37
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Migita K, Izumi Y, Fujikawa K, Agematsu K, Masumoto J, Jiuchi Y, Kozuru H, Nonaka F, Shimizu T, Nakamura T, Iwanaga N, Furukawa H, Yasunami M, Kawakami A, Eguchi K. Dysregulated mature IL-1 production in familial Mediterranean fever. Rheumatology (Oxford) 2014; 54:660-5. [DOI: 10.1093/rheumatology/keu359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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38
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Origuchi T, Arima K, Kawashiri SY, Tamai M, Nakamura H, Kawakami A, Tsukada T, Miyashita T, Aramaki T, Furuyama M, Kawabe Y, Iwanaga N, Ueki Y, Fukuda T, Eguchi K. OP0117 Surveillance of the Outcome of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Iwanaga N, Arima K, Terada K, Ueki Y, Horai Y, Suzuki T, Nakashima Y, Kawashiri SY, Ichinose K, Tamai M, Nakamura H, Aoyagi K, Kawakami A, Origuchi T. Risk factors of adverse events during treatment in elderly patients with rheumatoid arthritis: an observational study. Int J Rheum Dis 2014; 20:346-352. [PMID: 24716863 DOI: 10.1111/1756-185x.12348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/24/2023]
Abstract
OBJECTIVES The risk factors of adverse events during a number of currently used treatments for rheumatoid arthritis (RA) in elderly patients were examined. METHODS A retrospective observational study was conducted for 300 elderly RA patients registered in December 2009 at Sasebo Chuo Hospital, Japan, and the adverse events during the treatments for RA were assessed. RESULTS The average age of the patients was 74.3 ± 5.8 years. The Steinbrocker stage was IV in almost one-half of the patients. Methotrexate (MTX) was used in 54.0% of patients and biologics in 23.0% of patients. Adverse events occurred in 103 patients (34.3%). The most common adverse events were infections (46.6%), including pneumonia (21.4%). Multiple logistic analyses revealed that the factors significantly related to infection were advanced Steinbrocker stage and the existence of respiratory diseases, and that of pneumonia was the existence of diabetes mellitus (DM). CONCLUSIONS The elderly RA patients with advanced stage, respiratory diseases or DM should be monitored for infections, including pneumonia, carefully during treatment.
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Affiliation(s)
- Nozomi Iwanaga
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan.,Deparment of Rheumatology, Nagasaki Medical Center, Kubara Omura-city, Japan
| | - Kazuhiko Arima
- Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Kaoru Terada
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo-city, Japan
| | - Yoshiro Horai
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Takahisa Suzuki
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Shin-Ya Kawashiri
- Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Kiyoshi Aoyagi
- Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan.,Department of Rehabilitation Sciences;, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki-city, Japan
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Iwanaga N, Origuchi T, Terada K, Ueki Y, Kamo Y, Kinoshita N, Yonemitsu N, Kawashiri SY, Ichinose K, Tamai M, Nakamura H, Kawakami A. Rheumatoid arthritis complicated with severe liver injury during treatment with abatacept. Mod Rheumatol 2014; 24:874-6. [PMID: 24611764 DOI: 10.3109/14397595.2013.844399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nozomi Iwanaga
- Department of Rheumatology, Sasebo Chuo Hospital , Sasebo , Japan
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Ichinose K, Iwanaga N, Okada A, Tamai M, Yamasaki S, Nakamura H, Origuchi T, Kawakami A. A case of microscopic polyangiitis in an elderly patient presenting predominantly with cholecystitis successfully treated with mizoribine. Mod Rheumatol 2014; 24:1011-4. [PMID: 24517554 DOI: 10.3109/14397595.2013.874742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/13/2022]
Abstract
An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 μg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.
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Affiliation(s)
- Kunihiro Ichinose
- Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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Izumi Y, Tominaga M, Iwanaga N, Huang M, Tanaka F, Aratake K, Arima K, Tamai M, Kamachi M, Nakamura H, Ida H, Origuchi T, Kawakami A, Eguchi K. Twenty-four-week follow-up examination of a leukocytapheresis therapy in rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-005-0448-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Origuchi T, Arima K, Kawashiri SY, Tamai M, Yamasaki S, Nakamura H, Tsukada T, Aramaki T, Furuyama M, Miyashita T, Kawabe Y, Iwanaga N, Terada K, Ueki Y, Fukuda T, Eguchi K, Kawakami A. High serum matrix metalloproteinase 3 is characteristic of patients with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema syndrome. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0556-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Iwanaga N, Nakamura S, Kajihara T, Imamura Y, Miyazaki T, Izumikawa K, Kakeya H, Yanagihara K, Tashiro T, Sunazuka T, Omura S, Kohno S. P9 The potency of a new erythromycin (EM) derivative, EM900, to reduce the density of the nasopharyngeal Streptococcus pneumoniae colonization. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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45
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Origuchi T, Arima K, Kawashiri SY, Tamai M, Yamasaki S, Nakamura H, Tsukada T, Aramaki T, Furuyama M, Miyashita T, Kawabe Y, Iwanaga N, Terada K, Ueki Y, Fukuda T, Eguchi K, Kawakami A. High serum matrix metalloproteinase 3 is characteristic of patients with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema syndrome. Mod Rheumatol 2011; 22:584-8. [PMID: 22089392 DOI: 10.1007/s10165-011-0556-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/31/2011] [Indexed: 12/14/2022]
Abstract
Recently, it was reported that remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome could be complicated with solid tumors. In a retrospective, multicenter study between October, 2003 and September, 2010, we investigated the characteristics of patients with paraneoplastic RS3PE syndrome who fulfilled following criteria: (1) bilateral pitting edema of hands or feet or both, (2) sudden onset of polyarthritis, and (3) age >50 years, (4) seronegativity for rheumatoid factor (RF). A total of 33 cases fulfilled the above criteria. Eight patients (seven men and one woman) developed cancer within 2 years of RS3PE syndrome onset. There was no significant difference between the neoplastic and nonneoplastic groups in the proportions of patients with fever, symmetrical polyarthritis, pitting edema, and good response to corticosteroids. Serum matrix metalloproteinase 3 (MMP-3) level (median 437.3 ng/ml) in the paraneoplastic RS3PE patients was significantly higher than that in patients without neoplasia (median 114.7 ng/ml) (p < 0.05). We found that high serum MMP-3 is characteristic of patients with paraneoplastic RS3PE syndrome.
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Affiliation(s)
- Tomoki Origuchi
- Department of Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
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Tamai M, Kawakami A, Uetani M, Takao S, Tanaka F, Fujikawa K, Aramaki T, Nakamura H, Iwanaga N, Izumi Y, Arima K, Aratake K, Kamachi M, Huang M, Origuchi T, Ida H, Aoyagi K, Eguchi K. Bone edema determined by magnetic resonance imaging reflects severe disease status in patients with early-stage rheumatoid arthritis. J Rheumatol 2007; 34:2154-2157. [PMID: 17918786] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine the significance of bone edema, detected by magnetic resonance imaging (MRI), in early-stage rheumatoid arthritis (RA). METHODS We simultaneously examined serologic variables, MRI of wrist sites and finger joints of both hands, clinical disease activity score (DAS), and HLA-DR typing at entry in 80 patients with early-stage RA. RESULTS The number of bones scored as positive for bone edema correlated with the number of sites scored as positive for MRI synovitis and MRI bone erosion, rate of enhancement (E-rate), and serum C-reactive protein (CRP), matrix metalloproteinase 3 (MMP-3), and interleukin 6 (IL-6). Findings for MRI synovitis and MRI bone erosion, E-rate, CRP, MMP-3, IL-6, seropositivity, and titer of anti-cyclic citrullinated peptide antibody (anti-CCP antibody), DAS28-CRP and HLA-DRB1*0405 allele carriership, were significantly higher in the positive versus the negative bone edema group. CONCLUSION Bone edema based on our scoring system may reflect severe disease status in patients with early-stage RA. However, its clinical value at entry in prognostication of RA should be examined through prospective clinical followup studies.
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Affiliation(s)
- Mami Tamai
- First Department of Internal Medicine, Graduate School of Biomedical Sciences, School of Health Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Japan
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Kawakami A, Nakashima K, Tamai M, Nakamura H, Iwanaga N, Fujikawa K, Aramaki T, Arima K, Iwamoto N, Ichinose K, Kamachi M, Ida H, Origuchi T, Eguchi K. Toll-like receptor in salivary glands from patients with Sjögren's syndrome: functional analysis by human salivary gland cell line. J Rheumatol 2007; 34:1019-26. [PMID: 17407216] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE We investigated expression of toll-like receptor (TLR) in labial salivary glands of patients with Sjögren's syndrome (SS) and functional TLR expression in the cultured salivary gland cell line. METHODS Expression of TLR2, TLR3, TLR4, and myeloid differentiation factor 88 (MyD88) in labial salivary glands was examined by immunohistochemistry. Human salivary gland (HSG) cell-line cells were cultured with TLR ligands [peptidoglycan, poly (I:C) and lipopolysaccharide], and CD54 expression and interleukin 6 (IL-6) production was studied. Phosphorylation of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), p38, and Akt was examined by Western blotting. Activation of nuclear factor-kappaB (NF-kappaB) p65 in HSG cells was studied by NF-kappaB p65 nuclear translocation by microscopic immunofluorescence or chemiluminescent electrophoretic mobility shift assay and detection of NF-kappaB p65 phosphorylation. RESULTS TLR2, TLR3, TLR4, and MyD88 were more strongly expressed in the labial salivary glands of SS patients (n =12) than in control subjects (n = 4), and were found in salivary-infiltrating mononuclear cells as well as acinar cells and ductal epithelial cells. In cultured HSG cells, a similar expression pattern was observed, and TLR ligands stimulated CD54 expression and IL-6 production. TLR ligands induced phosphorylation of ERK, JNK, and p38 in HSG cells, but not Akt phosphorylation or activation of NF-kappaB p65. CONCLUSION Although the putative ligands remain to be determined, our study indicated the activation of the TLR-mediated immune response in SS, and suggested that the TLR effect is mediated through the mitogen-activated protein kinase pathway.
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Affiliation(s)
- Atsushi Kawakami
- First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Iwanaga N, Kamachi M, Fujikawa K, Aramaki T, Izumi Y, Arima K, Tamai M, Aratake K, Nakamura H, Origuchi T, Ida H, Kawakami A, Taguchi T, Eguchi K. Membraneous glomerulonephritis and non-Hodgkin's lymphoma in a patient with primary Sjögren's syndrome. Intern Med 2007; 46:191-4. [PMID: 17301515 DOI: 10.2169/internalmedicine.46.1835] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The most common renal manifestation of Sjögren's syndrome is tubulointerstitial nephritis, and glomerular disease is rare (3). A 62-year-old woman with primary Sjögren's syndrome developed nephrotic syndrome. Kidney biopsy was consistent with membraneous glomerulonephritis. Steroid pulse therapy was not effective. Three months later she was diagnosed with non-Hodgkin's lymphoma of the tongue, and she was given CHOP therapy and radiation. Both the lymphoma and membraneous glomerulonephritis were resolved.
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Affiliation(s)
- Nozomi Iwanaga
- First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki, University, Nagasaki, Japan.
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Fujikawa K, Aratake K, Kawakami A, Aramaki T, Iwanaga N, Izumi Y, Arima K, Kamachi M, Tamai M, Huang M, Nakamura H, Nishiura Y, Origuchi T, Ida H, Eguchi K. Successful treatment of refractory neuro-Behcet's disease with infliximab: a case report to show its efficacy by magnetic resonance imaging, transcranial magnetic stimulation and cytokine profile. Ann Rheum Dis 2007; 66:136-7. [PMID: 17178762 PMCID: PMC1798413 DOI: 10.1136/ard.2006.056804] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2006] [Indexed: 11/04/2022]
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Mutsukura K, Nakamura H, Iwanaga N, Ida H, Kawakami A, Origuchi T, Furuyama M, Eguchi K. Successful treatment of a patient with primary Sjögren's syndrome complicated with pericarditis during pregnancy. Intern Med 2007; 46:1143-7. [PMID: 17634717 DOI: 10.2169/internalmedicine.46.0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 35-year-old woman with primary Sjögren's syndrome (pSS) developed fever and chest pain during pregnancy. When the dose of prednisolone was reduced, she experienced chest pain with elevated CRP and D-dimer, resulting in admission to our hospital with marked cardiomegaly and pleural effusion. Because there was no evidence of other autoimmune disorders or infection, oral prednisolone was increased to 30 mg daily with heparin, and hypercoagulopathy was carefully monitored. The patient's condition improved rapidly, and she delivered a healthy baby. This is the first case to support the beneficial effect of prednisolone in pericarditis with pSS, and illustrates its safety during pregnancy.
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Affiliation(s)
- Kazuo Mutsukura
- First Department of Internal Medicine, Graduate School of Biomedical Sciences, Nagasaki University
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