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Objective: To predict the cessation of infliximab in advance at the time administration is started.Method: Among 282 RA patients, 145 discontinued and 137 continued infliximab between Aug 2003 to Aug 2009.
Results: The cause of discontinuation was: (ⅰ) loss of efficacy in 73 cases; (ⅱ) adverse reactions in 47 cases; (ⅲ) 6 cases at patient’s request; (ⅳ) change of hospital in 17 cases; (ⅴ) remission in 2 cases. Patients’ profiles were similar among groups (ⅰ), (ⅱ) and those who continued infliximab. The disease activity of groups (ⅰ) and (ⅱ) at the time of start was higher than that of patients who continued therapy. Cessation due to infection was most frequent 6 weeks after the start of therapy. Cessation due to loss of efficacy was most frequent 6 months after the start of therapy.

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［Objectives］Questionnaire surveys were conducted to investigate the current status of management of rheumatoid arthritis (RA) by orthopedic surgeons in Osaka Prefecture.
［Methods］Two surveys were carried out on members of the Osaka Clinical Orthopaedic Association (first survey in July 2003 and second in November 2008). Each survey used an anonymous questionnaire, which was sent and collected by mail. The responses to major questions common to both surveys were analyzed.
［Results］Both the number of subjects and respondents were slightly greater for the survey conducted in 2008 than for 2003. The response rate was over 30% in both surveys. Results reveal a trend for drug use in RA treatment, with an increased in prescriptions for Rheumatrex and Azulfidine during the five-year period between 2003 and 2008. In the 2008 survey, some orthopedic surgeons reported positive use of biological preparations.
［Conclusion］During the 5-year period, biological preparations were marketed one after another, and their positive use was reported by some orthopedic surgeons working as general practitioners. Results also revealed that the range of disease-modifying antirheumatic drugs (DMARDs) used for the management of RA has increasingly narrowed to the drugs listed as recommendation class A drugs (excluding Arava) in the EBM-based Guidelines for Treatment of Rheumatoid Arthritis prepared by the Japan Rheumatism Foundation and the Ministry of Health, Labour and Welfare Study Group in 2004.

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    In this case, a 50-years-old woman with LN developed proteinuria, in spite of an administration of tacrolimus. The urinary level of proteinuria had not been reduced, then ARB was added, but the reduction of the urinary level of proteinuria was partially.
    ARB, therefore, was switched to ACE-I, then proteinuria was improved to a normal level. Both ACE-I and ARB show the protective effects for a renal function. These effects are observed in the chronic phase of lupus nephritis. The difference of the effect between ACE-I and ARB is not so much clear, and it has been postulated that the major pharmacological mechanism to the reducing proteinuria is the suppression of AngII activity in both drugs. Recently, it is suggested that the proper effect of ACE-I might have a great part of protection for renal function. This case suggests that ACE-I can be effective to the patients with LN who resists to ARB with different pharmacological activity.

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    Thirty-seven patients with rheumatoid arthritis being treated by biological agents (infliximab 20 patients, etanercept 17 patients) received 23-valent pneumococcal polysaccharide vaccine intramuscularly. The adverse events considered to be related to the vaccination and antibody responses to the 14-capsular polysaccharide antigens were examined. The frequencies and characteristics of vaccination-related adverse events in the present RA patients were similar to those observed in the clinical trials conducted for the drug approval in which the healthy volunteers were vaccinated. The adverse events were also not different in their frequencies and severities between the 28 patients and 9 patients vaccinated by pneumococcal polysaccharides and influenza vaccines on the same day and different day respectively. After the pneumococcal vaccination, patients with rheumatoid arthritis showed significant antibody responses (more than two-fold increase of antibody titer) to all of the 14-polysaccharide antigens to which the specific antibodies were measured. The magnitudes of these antibody responses were lower in patients with rheumatoid arthritis than those reported in the original clinical trials. Between the RA patient groups treated by either infliximab or etanercept, differences in antibody responses to pneumococcal antigens were not observed.
    The results of the present study indicate that the vaccination to pneumococcal polysaccharides in rheumatoid arthritis patients do not results in the significant adverse events and although the maginitudes of specific antibody responses were lower than in healthy subjects, patients with rheumatoid arthritis produce significant amounts of the specific antibodies.

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[in Japanese]

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