2017 Volume 29 Issue 2 Pages 85-97
There have been significant advances in the treatment of rheumatoid arthritis with methotrexate or biological disease-modifying antirheumatic drugs (bDMARDs). However, the number of rheumatologists is insufficient in Japan. Our rheumatic center is located in Niigata prefecture, which has heavy snow in winter. Many patients visit our rheumatic center from Yamagata prefecture or Fukushima prefecture as well as Niigata prefecture including Sado island. Since they cannot visit our rheumatic center in the event of an emergency in winter, we refer those patients to local general hospitals when we start bDMARDs. Patients who cannot use self-injectable subcutaneous bDMARDs by themselves, and patients with osteoporosis treated by weekly or monthly injectable drugs are also referred to local general practitioners (GPs) and receive injections there. We receive patients with fractures or with cerebrovascular diseases from Niigata Prefectural Shibata Hospital (a general hospital) and, provide rehabilitation at the convalescence rehabilitation ward. We have established a system for the referral of patients with proximal hip fractures to GPs for the prescription of bisphosphonate (BP). Since January 2015, we started to prescribe BP when discharging patients from our center and asked GPs to continue it. Since the osteoporosis outpatient ward was established in Shibata Hospital in April 2015, continuous checks have been performed for the progression of hip fractures and the adherence of BP is confirmed once a year.
