臨床リウマチ
Online ISSN : 2189-0595
Print ISSN : 0914-8760
ISSN-L : 0914-8760
20 巻, 2 号
臨床リウマチ
選択された号の論文の13件中1~13を表示しています
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  • 牧野 晋哉, 甲斐 睦章, 由浅 充崇, 津嶋 秀俊
    2008 年 20 巻 2 号 p. 113-119
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        The outcomes of tacrolimus therapy were evaluated in20patients who received the drug for 6 months or more before October 2007. The study focused on analysis of the background variables and evaluation of the drug efficacy according to the EULAR Response Criteria based on DAS28-CRP.
        The mean age of the patients was 70 years and the mean duration of sickness was 18.4 years. The disease stage was I in 2 cases, Ⅱ in 2 cases, Ⅲ in4cases and Ⅳ in 12 cases. The disease class was 2 in 13 cases, 3 in 4 cases and 4 in 3 cases; thus, the disease tended to be advanced in the majority. The mean steroid dose was 5.6 mg/day. The number of antirheumatic drugs used was 2.3, on average. Tacrolimus was often used in elderly patients and patients in whom MTX administration was difficult because of respiratory complications. The pre-treatment DAS28-CRP score was 4.1, on average (corresponding to moderate or higher activity). Moderate or better improvement was noted in 14 (70%) of the 20 cases. Adverse reactions noted were constipation (2 cases), bacterial pneumonia (1 case), cystitis (1 case) and subcutaneous abscess (1 case). Renal dysfunction was found in3cases, with recovery noted after dose reduction. Drug level monitoring to maintain optimal levels improved the therapeutic outcome. None of these necessitated discontinuation of tacrolimus. These results suggest that tacrolimus may serve as a useful drug for treating rheumatoid arthritis in elderly patients and patients in whom MTX administration might be difficult because of respiratory complications, etc.
  • 吉田 友紀子, 樋口 直子, 寺嶋 達雄, 後藤 干城, 秋山 良司, 福本 充, 國廣 英一
    2008 年 20 巻 2 号 p. 120-128
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        The methotrexate scored tablet, Metolate® tablet 2 mg (MTL), was developed for use by patients with rheumatoid arthritis (RA) in Japan as a generic drug of the methotrexate capsule, Rheumatrex® capsule 2 mg.Because it is a generic drug, MTL has no clinical evidence for RA patients. We therefore conducted a post-marketing observational study of MTL in patients with RA in order to collect clinical data concerning the safety and efficacy of the drug. As a result, the incidence of adverse drug reactions (ADR) was 16.2% (50/308) and major ADR included hepatic and gastrointestinal disorders. In terms of the efficacy judged by investigators, 62.6% (184/294) of the patients showed a positive response (29.9% marked improvement, 32.7% moderate improvement). The efficacy rate of DAS28 (3)-CRP and DAS28 (3)-ESR based on the EULAR response criteria was 65.9% (147/223) and 60.2% (77/128) respectively. On the other hand, the original drug was reported to have an ADR rate of 18.62% (715/3,839), major ADR included hepatic and gastrointestinal disorders, and the efficacy rate judged by investigators was 47.2% (1,090/2,310). In conclusion, this study revealed that MTL has similar safety and efficacy profiles to the original drug in indirect comparison with the results of the original drug’s post-marketing observational study. In addition, we have found that MTL may contribute to RA treatment by adjusting an optimum dosage in1mg units.
  • 中田 雄一郎, 上田 健治, 森 俊輔
    2008 年 20 巻 2 号 p. 129-136
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        The serum concentration of methotrexate (MTX) after oral administration of MTX was simulated using the following pharmacokinetics parameters (Ka=0.503(h⁻¹), Ke=1.391(h⁻¹), K₁₂=1.118(h⁻¹), K₂₁=0.1521(h⁻¹), α=2.5791(h⁻¹), β=0.082034 (h⁻¹)) which were calculated by population pharmacokinetics parameters in a previous paper (Yukawa, E., et al., Journal of Clinical Pharmacy and Therapeutics, 32: 573-578, 2007). These population pharmacokinetic parameters were investigated after low-dose MTX (Metolate® tablets 2 mg) in rheumatoid arthritis patients and healthy male volunteers. The simulation of MTX serum concentration was performed by three classes according to the weight of patients as 45, 60 and 75 kg. The Cmax was simulated 240 ng/mL at 1 hour after administration of 4 mg of MTX to the patient (45 kg). The simulation showed no accumulation of MTX after multiple dosing, and the serum concentrations of MTX measured after multiple administrations at a dose of 4 mg, 2 mg and 2 mg every 12 hours to patients (57-65 kg) were very close to the simulation results for the same dose to patients weighing 60 kg. We could conclude our simulation MTX was useful to estimate the serum profiles of MTX in individual patients and might permit selection of an appropriate dosage to achieve target MTX concentrations, thus enabling the clinician to achieve the desired therapeutic effect in Japanese patients.
  • 戸田 佳孝, 月村 規子
    2008 年 20 巻 2 号 p. 137-142
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        Back ground: A foot orthosis with medial arch support is often used as conservative therapy for metatarsalsia of rheumatoid arthritis (RA). However, some patients complain discomforts of patient with metatarsalgia of RA often complicate ankle disorders.In our previous study, the remission score of the severity index significantly improved in the participants wearing the arch support with ankle strapping band compared with that found in the group wearing the shoe inserted arch support. However, a possible limitation of the previous study was that there was no placebo group of patients who were treated only with the ankle strapping band. In this study, the efficacy of arch support with ankle strapping band and the arch support without band as a placebo orthosis.
        Methods: Forty three outpatients with metatarsalgia of RA were treated with an orthosis for four weeks. The Foot function index (FFI) at the final assessment was compared with that at baseline in both the arch support and placebo band groups.
        Results: All participants in both groups completed the four week study. Participants wearing arch support with ankle strapping (n=22) demonstrated significantly improved FFI values in comparison with their baseline assessments (P<0.0001). These significant differences were not found in the placebo band group (n=21), (P=0.21).
        Conclusion. The efficacy of a concomitant ankle strapping band when wearing an arch support will not be only stabilizes the ankle joint, but the pulling upwards is also helpful for the correction of arch height by arch support, resulting in an improvement of clinical outcome in patients with metatarsalgia of RA.
  • 城島 宏, 黒田 大輔, 内藤 正俊
    2008 年 20 巻 2 号 p. 143-146
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        Etanercept, which blocks the action of tumor necrosis factor (TNF), reduces disease activity in patients with rheumatoid arthritis (RA). However, not all patients having synovitis with RA respond to etanercept. We report the case of a RA patient whose knee synovitis was treated by arthroscopic synovectomy, even though etanercept had been used. The patient, a 65-year-old female, had been receiving etanercept 25 mg twice/week, 4 mg MTX/week and 10 mg of glucocorticoid hormone/day. Over a period of 2 months the number of swollen and painful joints gradually decreased, but not the left knee. The knee was swollen and tender, demonstrating active synovitis. Hyaluronic acid or corticosteroid was injected in the knee joint, but the pain and swelling did not decrease. X-ray findings of the knee showed no erosion or joint space narrowing; however, MRI showed a high intensity area in the suprapatellar pouch of the knee consistent with active synovitis in the knee. As the condition persisted, arthroscopic synovectomy was performed. The arthroscopic findings showed villonodular synovitis. After the operation, the symptom in the knee steadily decreased. Etanercept with methotrexate is usually an effective treatment for RA, however, in this case despite receiving such treatment, synovitis of the knee persisted. Our experience demonstrates that arthroscopic synovectomy is a safe and effective treatment for RA cases not responding to etanercept with MTX.
  • 大谷 和裕, 橋本 和喜, 金田 宗也, 斎藤 政克, 福田 寛二, 浜西 千秋
    2008 年 20 巻 2 号 p. 147-150
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        Total elbow arthroplasty (TEA) is going to be widely indicated for not only rheumatoid elbow but also unstable elbow, comminuted fracture of distal end of humerus and ankylotic elbow. We reported the case of a patient with rheumatoid elbow with post-traumatic varus deformity who had undergone TEA.
        A sixty-year old man who works as a lunch provider admitted our hospital for deformity and instability of the elbow.He had received DMARD and predonisorone for RA, which failed to control his disease activity. Thus he was started on anti-TNF alfa therapy, which reduced poly-arthralgia, however his symptoms in the elbow did not improve. Physical examination showed limitation of range of motion (ROM) and painful instability at his elbow. Radiographic examination revealed thirty degrees of varus deformity and dysplastic change of humeral trochlea. Semi-constrained TEA was selected for his unstable RA elbow, because of massive bone defect of the trochlea and loss of ligamentous structure. Two days after the operation, ROM exercise was started using CPM with flexion blocking over 90 degrees.Postoperatively, ROM (extension/flexion) improved from -30/90; preoperative to -30/120; post-operative,and pain and instability disappeared.The JOA score improved from 39 points preoperatively to 91 points postoperatively, and he returned to former job.
        It was thought that TEA was a good procedure for unstable rheumatoid elbow due to severe bone defects or lack of ligamentous stability. Careful follow-up examinations are necessary to prevent implant failures including breakage, aseptic loosening and penetration of humeral or ulnar cortex.
  • 秋山 唯, 中野 弘雅, 大岡 正道, 柴田 朋彦, 前田 聡彦, 船窪 正勝, 尾崎 承一
    2008 年 20 巻 2 号 p. 151-155
    発行日: 2008/06/30
    公開日: 2016/11/30
    ジャーナル フリー
        A 76-year-old woman presented in November 2005 with numbness in the hands and lower limbs, reduced dorsiflexion of the right thumb, myalgia, and a digital necrotic ulcer.The patient was suspected to have systemic vasculitis (polyarteritis nodosa) and administered prednisolone (50 mg/day) and lipoprostaglandin E1.
        On November 27, 2006, the patient had headache and fever. She was admitted on December 4 because of deterioration of the disease and given increasing doses of prednisolone to 45 mg/day. On December 14, the patient claimed right lower abdominal pain. Abdominal CT disclosed an aneurysm of the right iliac artery and retention of highly concentrated fluids, suspected to be bloody ascites in the pelvic cavity, which led to a diagnosis of ruptured aneurysm of the right iliac artery. A percutaneous arterial embolization for the ruptured iliac artery aneurysm was performed, which successfully obliterated the blood flow of the right iliac artery. The postoperative course was uneventful, and the patient was discharged on December 28.
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