This study aimed to investigate whether depression is associated with quality of life and development of complications in patients with rheumatoid arthritis. Seventy-two Japanese patients with RA and 59 age-were registered along with sex-matched patients with connective tissue disease without RA as control subjects. We assessed clinical parameters and Self-rating Depression Scale (SDS), and Medical Outcomes Study 36-Item Short-Form Health Survey Version 2 (SF-36v2). Further, we evaluated the degree of development of complications during 1-year observation in RA patients. SDS scores were not significantly elevated in RA patients compared with the control subjects. However, 17 patients with RA showed high SDS scores (＞49). SF-36 summary mental scores (MSC) (standard correlation coefficients ［B］＝－0.546, P＜0.001), physical scores (PSC) (B＝－0.483, P＜0.001), and degree of joint pain (B＝0.335, P＝0.031) were independently associated with SDS in RA patients. We classified RA patients into 3 groups graded by baseline SDS scores. A significant difference between the degree of development of complications in the 3 groups was seen when the whole period of follow up was compared with Kaplan-Maier analysis and log rank test (P＝0.019). We conclude that depression is closely associated with QOL and development of complications in patients with RA.

View full abstract

Background. In 2003, treatment with TNF blockade was introduced for the management of RA in Japan. Emerging evidence indicates that TNF blockade with infliximab is especially effective in reducing the clinical signs and symptoms of RA.As the secondary outcome, the effect of this agent on the health-related quality of life (HR-QOL) is expected.
Objective. To evaluate the effects of infliximab on HR-QOL in Japanese RA patients.
Method. The total of109moderate-to-severe RA patients were entried into this study. These patients injected with infliximab were subjected to be analyzed the modified Health Assessment Questionnaire (mHAQ), including23cases, who were subjected to be analyzed using the Arthritis Impact Measurement Scales (AIMS2) and the Short-Form 36items (SF36).
Results. The average mHAQ score was reduced from 1.2 to 0.7 (p＜0.001). In the AIMS2 analysis, the average scores of symptoms (pain), physical disability, and limitation of work were improved (p＜0.05). In SF-36, the average score of role limitations due to emotional functioning improved in accordance with the improvement of physical functions.
Conclusion. We suggested that infliximab improved mental status as well as role limitations due to physical functioning through the reduction of pain.

View full abstract

    Although methotrexate (MTX) has been used as a standard means of drug therapy for rheumatoid arthritis (RA), its use in elderly patients requires particular care in view of the possibility to compromise renal function. We recently investigated the use of this drug for elderly patients with RA and assessed its long-term efficacy and safety. The survey involved 129 patients with RA aged 70 years or older receiving MTX 2 mg tablet therapy as of July 2006 (32 males and 97 females). In each patient, the situation surrounding medication, continuity of medication, responses, dose level, adverse reactions, etc. were investigated. The mean MTX dose level was 5.3 mg/week, and the mean duration of medication was 5 years and 7 months. When responses to the therapy were assessed using DAS28, the score was 3.2 or lower (low disease activity) in 108 (83.7%) of the 129 patients. Adverse reactions were seen in 29 patients (22.5%).Thus, when MTX 2 mg tablet therapy was applied to elderly patients with RA, continuation of treatment was possible in a high percentage of patients, and efficacy and safety were high. If the dose level is selected carefully, this drug may serve as a standard drug for treatment of RA also in elderly patients.

View full abstract

    A woman of 50 years of age who had a 13-year history of hypothyroidism was diagnosed with systemic lupus erythematosus (SLE) with butterfly rash, leukopenia, positivity of antinuclear antibody, anti-DNA antibody and anti-Sm antibody. Two years later, she developed nephritis (WHO type IV) and remitted with corticosteroid pulse and intermittent intravenous cyclophosphamide pulse therapy (IVCY). Four years after the onset of SLE, she relapsed with proteinuria and leukopenia when she was taking 9 mg/day of prednisolone (PSL) but she stopped all the medication of her own accord. Four months passed without any therapy, she was admitted to our hospital with disturbance of consciousness and anasarca. Laboratory findings showed pancytopenia (WBC 1300/μl, RBC 233×10⁴/μl, Hb6.9g/dl, Plt3.6×10⁴/μl), aggravation of lupus nephritis and hypothyroidism. Chest X-ray and ultrasonography demonstrated pleural and pericardial effusion and the absence of hepatosplenomegaly. She was also diagnosed with myelofibrosis upon bone marrow inspection. Three instances of corticosteroid pulse therapy, oral corticosteroid (PSL was tapered from 50 mg/day) and supplement therapy of levothyroxine improved every symptom and pancytopenia. The second bone marrow biopsy showed reduced fibrosis and recovery of bone marrow cells. These findings implied the secondary myelofibrosis caused by SLE because the myelofibrosis came along with aggravation of SLE and corticosteroid therapy was effective. This is a rare case of SLE in which myelofibrosis improved by high-dose corticosteroid therapy, which was confirmed by bone marrow biopsy and suggests the pathogenic mechanisms for myelofibrosis.

View full abstract

    The patient was a 68-year-old man. He had been diagnosed with adenocarcinoma of the prostate in December 2006 and was treated at our hospital. The slight dyspnea and the fatigue of both femoral regions appeared in April 2007. He was attended with a dyspnea and pyrexia in May. The chest X-ray and the computed tomography showed ground glass opacity. He was diagnosed with polymyositis (PM) accompanied with interstitial pneumonia (IP) due to clinical findings, the elevation of serum muscle enzymes (creatine kinase, aldolase, myoglobin), the positive test for anti Jo-1antibody,the elevation of KL-6and the depression of O₂ saturation. First, he was treated with methylprednisolone pulse therapy and mechanical ventilation, but the condition of the patient worsened. Thereafter, he was treated with cyclosporine A, cyclophosphamide pulse, high dose intravenous immunoglobulin and plasmapheresis. Finally he died due to respiratory failure. The autopsied lung revealed nonspecific interstitial pneumonia (NSIP). IP accompanied with PM, in general, suggests a pattern of NSIP, and the prognosis of positive cases of anti Jo-1antibody is reported to be good. We report a rare case, which was accompanied with resistant IP following up adenocarcinoma of the prostate and which was subject to both IP and PM at same time.

View full abstract

    Fever of unknown origin is challenging to diagnosis, we have to distinguish between infections, malignancies, especially lymphoma, and autoimmune diseases such as vasculitis. Giant cell arteritis (GCA) is a chronic vasculitis of large and medium sized vessels, and can cause fever of unknown origin in elderly patients. A 78-year old female patient complained of fever and dry cough that persisted for more than two months without visual disturbance, polymyalgia rheumatica or new onset of localized headache. Her physical examination did not show any tenderness or reddishness of the temporal artery. Laboratory tests showed an elevated erythrocyte sedimentation rate (ESR) of 127 mm/hr, elevated C-reactive protein (CRP) of 6.4 mg/dL, and decreased serum albumin of 2.4 g/dL. FDG-PET showed subclinical inflammation in the aorta, and the sub-clavian, axillary, iliac, and femoral arteries, the common carotid and temporal arteries, although neither computed tomography nor Gallium scintigraphy showed any significant findings. A temporal artery biopsy confirmed the diagnosis of GCA. Brain magnetic resonance imaging showed a single small subacute cerebral infarction of the pons without any neurological abnormality. After oral administration of 40 mg-per-day of prednisolone, fever and dry cough disappeared in two days. Six months later, she has no symptoms under the administration of 15 mg-per-day of prednisolone, without any elevation of ESR or CRP. FDG-PET has a high sensitivity for the rapid detection of inflammatory sites through the body, which makes it a valuable diagnostic modality when used as a guide for early diagnosis of GCA.

View full abstract