[in Japanese]

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[in Japanese]

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    The definition of a new clinical remission was announced by ACR/EULAR in January, 2011. We evaluated the effectiveness on patients with rheumatoid arthritis (RA) of tocilizumab (TCZ) using various clinical composite measures (DAS 28-ESR, CDAI, SDAI, Boolean remission standard). Thirty-three RA patients treated with TCZ were investigated. Average age was 57.1 years old and the mean disease duration 13.4 years. The number of patients who had a past history of biologics was 25 (76％). DAS 28-ESR (DAS) was 5.0±1.2 at the initial administration of TCZ, 2.4±1.3 at 12 weeks and 2.2±1.3 at 24 week after administrations. SDAI was 5.0±1.2 before TCZ, 2.4±1.3 at 12-week, 2.2±1.3 at 24-week, and CDAI were 23.5±10.0, 10.1±7.9, and 8.2±7.0 respectively. All improved significantly at 12-week and 24-week.
    Remission rates were 73.3％ in DAS, 20.0％ in CDAI,23.3％ in SDAI, and 23.3％ in Boolean at 24-week. Remission rate of DAS was almost the same as number of the remission and low disease activity cases of CDAI and SDAI. The remission rates of CDAI, SDAI and Boolean were about 1/3of that of DAS. Although there was no significant difference in the remission rate of CDAI, SDAI, and Boolean, the remission rate of CDAI which does not include CRP or ESR, tended to be the lowest. The effectiveness of TCZ in this report showed the result equivalent to or better than most other reports which used DAS28-ESR. TCZ is a useful medicament like other biological preparations bring about remission through treat-to-target.

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Background: Abatacept is a soluble human recombinant fusion protein that inhibits T lymphocyte activation by modulating the CD80/CD86: CD28 costimulatory signal. The clinical efficacy and safety of abatacept have been reported in patients with rheumatoid arthritis (RA). Objective: To assess the efficacy, safety,and tolerability of abatacept in RA patients. Methods: Patients with active RA and an inadequate response to TNF inhibitors, an IL-6 inhibitor, and/or MTX were administered abatacept (within 10 mg/kg). The efficacy of abatacept therapy was evaluated using disease activity score (DAS)-28. Abatacept was administered via 30-min intravenous infusion at weeks 0,2, and 4 and at 4-week intervals thereafter. The patients are still undergoing therapy. Results: The study population consisted of 35 patients (men, 6; women, 29). The mean age was 61.6 years, and the mean disease duration was 9.3 years. Four patients did not respond to abatacept therapy. These patients did not respond to former biologic drug therapy either. Thirty-one patients responded well to abatacept and are still undergoing therapy. Serious adverse effects were not observed in abatacept-treated patients in this study. Conclusions: Biologic-naïve patients and former biologic-refractory patients both achieved a good response to abatacept therapy. The results suggest that abatacept therapy is a useful drug therapy option for patients with RA.

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    Objective: To estimate and compare the direct and indirect medical expenses in patients with connective tissue diseases (CTD). Method: Our study included 727 patients with CTD; rheumatoid arthritis: RA(n＝360), systemic lupus erythematosus: SLE(n＝112), systemic scleroderma: SSc(n＝60), Sjogren syndrome: SjS(n＝36), polymyositis/dermatomyositis: PM/DM(n＝28), polymyalgia rheumatica: PMR(n＝27), mixed connective tissue disease: MCTD(n＝22), vasculitis syndrome(n＝22), Behçet disease(n＝16), and other connective tissue disease(n＝44) who visited our clinic as out patients in November and December 2009. The blinded questionnaires were collected from all patients. Direct medical expenses were calculated from total expenses for hospital and pharmacy. Result: Mean direct medical expense in patients with CTD was 15,900 JPY/month. Mean direct medical expense was the highest in RA patients with a statistically significant difference (21,100 JPY/month) among all the patients. It is due to most patients except those with RA received public medical subsidies. It might be explained by the fact that 58.3% of the patients with CTD except RA received some kind of public medical subsidy for intractable diseases, while only 5.0% of RA patients received them. Conclusion: Sufficient medical support is necessary for RA patients.

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Objectives : We investigated the characteristics of RS3PE syndrome with malignancies, and investigated a relationship between RS3PE syndrome and malignancies.
Methods : A retrospective multicenter study of patients with RS3PE syndrome between October, 2003 and September, 2010, fulfilling the following criteria : (1)bilateral pitting edema of hands or feet, or both, (2) sudden onset of polyarthritis, (3) age ＞50 years, (4) seronegativity for rheumatoid factor (RF) was performed. Serum MMP-3 concentrations were examined byenzyme-linked immunosorbent assay (ELISA).
Results: A total of 9 cases fulfilled the above criteria for RS3PE syndrome. The serum CRP level was 10.8 mg/dl and the serum MMP-3 level was 437.3 ng/ml (median). All patients had a good response to corticosteroids. There were 7 male patients and 2 female patients, and they were complicated with gastric cancers, colon cancers, breast cancers, pulmonary cancers and prostatic cancer. In eight patients, malignant tumors were complicated within 2 years from onset of RS3PE syndrome. Three patients were complicated with malignancies one month before onset of RS3Pe syndrome and 3 patients within one month from onset of RS3PE syndrome. In these patients, serum MMP-3 levels were markedly elevated.
Discussions: We found that serum MMP-3 concentrations were very high in patients with RS3PE syndrome complicated with solid tumors.

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[in Japanese]

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[in Japanese]

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