There have been many reports that anti-cyclic citrullinated peptide (anti-CCP) antibodies are useful serological markers of early diagnosis and good predictors of the clinical course for patients with rheumatoid arthritis (RA). Anti-CCP antibodies are produced locally in RA joints, and citrullinated proteins are localized in synovial tissue. In this study, we evaluated the clinical significance of anti-CCP antibodies in the knee joint fluids of the patients with RA. Knee joint fluids were obtained from 61 RA patients (6 males and 55 females, 60.0±9.1 years) and 81 osteoarthritis (OA) patients of (22 males and 59 females, 64.3±13.3 years). Anti-CCP antibodies were measured by ELISA (DIASTAT anti-CCP test). Anti-CCP antibody levels in RA patients were significantly higher than those in OA patients (RA: 106.51±45.44 U/ml, OA: 1.07±0.55 U/ml). In RA patients, the value of anti-CCP in the knee joint fluids varies according to the stage and class grade of the disease. Fifty-nine of 61 (96.7%) patients with RA in the knee joint were positive for anti-CCP antibodies. On the other hand, there was no positive cases in OA joint fluids. Therefore, we concluded that an anti-CCP antibody assay in the knee joint fluids is very useful for diagnosis, and it could be a useful clinical predictive test for RA.

View full abstract

Objective: We compared the difference between assessments by RA patients and assessments by their families according to the functional disability score (FDS) classification of RA patients.
Method: 121 RA patients and their families were included in the study. Both RA patients and their families independently completed Arthritis Impact Measurement Scales version 2 (AIMS2) health status questionnaires. Various fields of QOL scores of the assessments of each group were compared according to the functional disability score (FDS) classification of RA patients.
Results: QOL concerns such as “support from family and friends” and “arthritis pain” were underestimated by the families. In addition, in the low scores of FDS, there was a gap in QOL concerns such as “support from family and friends” and “arthritis pain”. But, in the high score of FDS, there were few differences in mean QOL scores between the two groups.
Conclusion: The present study reveals that the level of physical disability in RA patients was connected with the gap between the assessments of the two groups. Medical worker for the families of RA patients are required to make an adjustment to deepen the understanding in the families of RA patients depending on the level of physical disability in RA patients.

View full abstract

    Twenty patients with active rheumatoid arthritis treated with etanercept (ETA) from March to August 2005 were enrolled. Patients’ characteristics were: 18 females and 2 males; mean age 59.4±9.5 years; mean disease duration 85.3±87.5 months; RF positive in 95.0%; Stage I/II/III/IV＝5/9/4/2: Class 1/2/3/4＝0/17/3/0; steroid use in 65.0%; mean daily dose of prednisolone 5.7±3.4 mg. The mean values of clinical and laboratory variables at baseline reflecting the disease activity at starting the ETA treatment were: swollen joints 10.8±6.1, tender joints 10.5±5.8, patient’s assessment of pain VAS 60.2±15.2 mm, patient’s global assessment of disease activity VAS 60.7±22.4 mm, physician’s global assessment of disease activity VAS 64.0±15.4 mm, MHAQ score 1.1±0.5, ESR 93.7±28.2 mm/h, CRP 5.35±3.75 mg/dl, DAS score 6.41±0.58. Moderate or better DAS28 response was achieved in 75% from Week 2. ACR20, ACR50, ACR70 and ACR90 responses were achieved at Week 12 in 95%, 75%, 40% and 10%, respectively. These figures demonstrated the high efficacy of ETA. The steroid dose could be reduced by more than 20% in 4 patients. Nineteen patients shifted to self-injection, and 19 returned to their job as workers (6) and as housewives (13). All side effects in 5 patients including injection site reaction in 4, thrombophlebitis in 1, and acute upper respiratory inflammation in 1 were mild. ETA was demonstrated to be useful in treating active rheumatoid arthritis.

View full abstract

    Osteoarthritis of the Knee (OA) is a disease with pain. It is essential to relieve these symptoms for patients of the disease. Therefore, the evaluation of treatment effects based on QOL is important. We compared the effects of high molecular weight hyaluronic acid (HA) with low molecular weight HA on a disease specific QOL score (WOMAC) and a disease non-specific QOL score (EQ-5D) in 21 OA patients. Patients with Kellgren-Lawrence OA gradeⅠ toⅢ were included. Informed consent was obtained from all patients, and each patient was randomly assigned to receive either 1900 kDa or 800 kDa HA for 5 weeks. Age, weight, height, Kellgren-Lawrence grade and duration of symptoms did not differ significantly between two groups of patients. The total WOMAC score and the EQ-5D score were compared between the treatment groups. There was no difference in each base-line between two groups. There was a significant difference of the WOMAC total score between the 1900 kDa HA group and 800 kDa HA group (mean±SE, 23.06±4.66, 38.95±5.74; p＝0.0488) after 6 times of intra-articular injections. A significant improvement of the EQ5D score were also observed in 1900 kDa HA group (mean±SE, 0.71±0.03; p＝0.0212). There were no severe adverse events in either group. We supposed that high molecular weight HA had more effectiveness in QOL for treatment of OA.

View full abstract

    A 26-year-old woman was admitted to our hospital because of edema, photo-sensitivity, and abdominal pain in July 2004. Laboratory findings showed proteinuria (20 g/day), decreased complements (CH50 3.7 U/ml, C3 18.4 mg/dl), positive anti-nuclear antibody, positive anti-ds-DNA antibody (161.9 IU/ml), and elevated levels of serum creatinine (1.44 mg/dl) and pancreatic Enzymes (: trypsin＞900 ng/ml, PST1 42 ng/ml, phospholipase A2 1110 ng/dl, esterase 618.0 ng/nl). Computed tomography of the abdomen showed a swollen pancreas, but did not show dilatation of the pancreatic duct. Magnetic resonance cholangio pancreatography showed the bile duct and pancreatic duct to be normal. She was diagnosed as having lupus nephritis and acute severe pancreatitis associated with systemic lupus erythematosus (SLE). She was treated with methylprednisolone pulse therapy (500 mg×3 days), prednisolone (60 mg/day), cyclophosphamide pulse therapy (total 1400 mg), gabexate mesilate (1000 mg/day) and ulinastatin (200000 U/day). Her pancreatitis was not caused by drugs such as prednisolone and immunosuppressive drugs and by other general factors. Her pancreatitis was improved concomitant with lupus symptoms. More than half of SLE patients have manifestations of the digestive organ system, but pancreatitis is rare. Although pancreatitis associated with SLE was reported to have poor prognosis, we got a good outcome in this patient with intensive immunosuppressive therapy.

View full abstract