[in Japanese]

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[in Japanese]

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Background: Rheumatoid arthritis (RA) and collagen disease patients sometimes exhibit digestive symptoms as a result of medications such as prednisolone (PSL) and non-steroidal antiinflammatory drugs; however, the number of patients with gastrointestinal symptoms is unclear because only a few cases have been reported.
Aim and Method: We investigated patient background, proton pump inhibitor (PPI) and PSL usage rate, and QOL in patients with gastrointestinal symptoms using the Global Overall Severity (GOS) and Gastrointestinal Symptom Rating Scale (GSRS) for outpatients of our department. We observed the change in the GOS score before and 2 weeks after administering esomeprazole (EPZ)in patients with a GOS score of＞3 who wanted a change in PPI.
Results: The number of surveyed patients was 152(RA,n＝68;systemic lupus erythematous ［SLE］,n＝20;M :F ratio,20:132;age,56.9±13.8 years; BMI,21.03±2.46). The GSRS scores in all outpatients were higher than that in the control (1.68±0.71 vs.1.53), which indicates that the QOL deteriorated in RA and collagen disease patients with gastrointestinal symptoms. A high incidence of constipation was observed in RA (1.95±1.08) and SLE (1.97±0.80) patients that was independent of the use of PPI or PSL. Stomach acid reflux, stomach conditions, and dyspepsia persisted in SLE patients despite PPI treatment. In 29 patients, EPZ treatment significantly improved the heavy feeling in the stomach(p＝0.0186).
Discussion: This study showed that digestive symptoms persisted in RA and collagen disease patients despite PPI treatment. Further studies are needed to improve the QOL in patients with gastrointestinal symptoms.

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    Many studies have shown marked changes in syntheses of cartilage matrix macromolecules, matrix metalloproteinases and proinflammatory molecules, including cytokines and chemokines, in cultures of chondrocytes, osteoblasts, synoviocytes and inflammatory cells after addition of hyaluronan to the culture medium, but there are few studies showing the effect of high molecular weight hyaluronan on the synthesis of these proteins or gene expression in joint cartilage in vivo. The purpose of this study was to identify target genes for high molecular weight hyaluronan in OA cartilage in vivo. Iodoacetate was injected into rat joints to develop a rat OA model. Gene expression in articular cartilage of the OA model at knee joints was examined by DNA microarray analysis after intraarticular injections of high molecular weight hyaluronan. High molecular weight hyaluronan enhanced mRNA expression of collagen type IV, IX and XI and adrenomedullin, which were suppressed in the OA model. In contrast, it decreased mRNA expression of several proinflammatory molecules, including phospholipase A2 and toll-like receptor8, which were enhanced in the OA model. These target genes may be involved in the beneficial action of hyaluronan in OA cartilage, and may be useful in the evaluation of the hyaluronan action on OA joints.

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    Owing to recent reports on its diagnostic utility, ultrasound (US) findings were added to EULAR/ACR 2012 provisional classification criteria for polymyalgia rheumatica (PMR). US findings of shoulder abnormalities (subacromial bursitis/bicipital tenosynovitis/glenohumeral effusion) or abnormalities in hip (hip effusion, trochanteric bursitis) are included in scoring algorithm, which improve the specificity of the clinical criteria significantly. However, in Japan, practical reports of US with PMR are limited. We report sequential ultrasonographic observation in three patients with PMR. Two of these patients, who were 81-year-old and 71-year-old male, presented with bilateral shoulder pain. One patient was 90-year-old female, who had unilateral headache. At baseline, all of them had US inflammation in bilateral shoulders, and elevation of erythrocyte sedimentation rate and C-reactive protein was seen. In female patient with headache, temporal artery US detected the finding of giant cell arteritis. Prednisolone was administered in all patients, and US follow-up was done after administration. US findings responded to corticosteroid therapy rapidly, as with their symptom and laboratory findings. Especially, in two of these patients, US inflammatory findings showed better sensitivity to change than laboratory markers of PMR activity. Asymptomatic bicipital tenosynovitis was observed in one patient during corticosteroid tapering. US appears to be useful for follow-up in addition to diagnosis with PMR.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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