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OBJECTIVE: The aim of this study is to assess the efficacy of treatment with tocilizumab (TCZ) on radiographic progression in patients with rheumatoid arthritis (RA) under routine clinical practice.
METHODS: Eighty-six non-smoking patients with RA who received TCZ for1year were analyzed. Their demographics and baseline characteristics prior to treatment are as follows: mean age was 60.5 years; mean disease duration was 12.3 years; the percentage of patients of Steinbrocker’s class I, II, III, and IV was 37%, 51%, 12%, and 0%, respectively; Steinbrocker’s stage I, II, III, and IV was 16%, 19%, 12%, and53%, respectively; mean TJC was 6.5; mean SJC was 5.6; mean ESR was 37.6mm/h; mean CRP was 1.7mg/dl; mean PGA-VAS was 5.04cm (on a0-10cm scale); and mean DAS28-ESR was 4.7. Radiographic progression was assessed by van der Heijde-modified total Sharp score (mTSS).
RESULTS: At 8.1 weeks, the mean DAS28-ESR reached 2.6. At one year, mean TJC was 0.3; mean SJC was 0.2; mean ESR was 5.3mm/h; mean CRP was 0.2mg/dl; mean PGA-VAS was 1.85cm; and mean DAS28-ESR was 1.4. ACR-EULAR Boolean remission was achieved in47% of the patients. No nonresponder was observed. The mean change from baseline in erosion score, joint space narrowing score, and mTSS was -0.2, 0.7, and 0.5, respectively. The structural remission rate (ΔmTSS≤0.5) was 69.8%.
CONCLUSION: TCZ strongly inhibited radiographic progression.

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Objective: We conducted a survey on actual doses administered to patients on long-term treatment with etanercept (ETN) to evaluate situations resulting in dose reduction and background factors for the increased likelihood of such dose reduction.
Subjects and methods: We investigated data such as actual doses and patient characteristics from rheumatoid arthritis patients receiving ETN for more than2years at Minami Osaka Rheumatology Conference member institutions.
Results: Twenty institutions contributed to this survey, reporting on82patients. Major patient characteristics: mean administration period 47.1±17.1 months (max 91months); mean age 57.3±13.1 years; and mean disease duration 10.6±9.0 years. Of the 82 patients, 27 (32.9％) had ETN dose reduction to 25 mg/wk, 25 mg/10 days, 25 mg/2 wks, 25 mg/3 wks and 25 mg/4 wks. Comparison of background factors between ETN dose reduction and maintenance groups showed a significant difference in disease duration, proportion of Class1＋2and presence/absence of previous treatment with other biologicals, but no difference in age, Stage and pre-dose disease activity.
Conclusion: Initiation of ETN treatment in the early time point of disease duration may increase possibility of dose reduction in patients that have to be on long-term treatment.

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    To determine the efficacy of leukocytapheresis (LCAP) using Cellsorba^® column for rheumatoid arthritis (RA), 5 apheresis procedures were performed in 72 drug-resistant RA patients, with 1-week intervals between procedures. We evaluated responses to LCAP therapy based on the American College of Rheumatology (ACR) core set and disease activity score (DAS) 28, SDAI and CDAI. As judged by ACR criteria, 65%, 35%, and 18% of patients achieved a 20%, 50% and 70% ACR response, respectively, 2 months after the last procedure. Based on the EULAR response criteria, 75% of patients exhibited better than a moderate response to therapy, 2 months after the last procedure. Mild adverse effects were encountered in 7 of 72 cases (9.7%). As judged by both ACR and EULAR response criteria, patients with stage I/II exhibited more effective responses than those with III/IV response to LCAP therapy. These data indicate that LCAP therapy is safe and clinically effective for RA,especially in early stage.

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    We report two cases of viral reactivation from resolved hepatitis B in patients with rheumatoid arthritis who received biologic antirheumatic agents.Case1was a70-year-old male who had a history of blood transfusion but was negative for hepatitis B virus (HBV) surface antigen at first. During the use of methotrexate (MTX) and eternercept (ETN), he developed de novo hepatitis B. Lamivudine was administered immediately and his hepatitis was relieved soon.Case2was a51-year-old female whose HBV surface antibody was positive. During the use of MTX and ETN, her HBV-DNA signals turned positive (the level was below 2.1 log copies/ml) without liver dysfunction. Treatment with ETN was continued, and follow-up was performed without administering nucleotide analogs. The patient again showed an HBV-DNA-negative reaction. From a medical record investigation, the incidence of reactivation was calculated to be 6.3/1,000 person-years in our hospital.

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【Case1】49y.o.male. Adalimumab (ADA) was introduced to the patients with rheumatoid Arthritis (RA) due to insufficiency effect of treatment with methotorexate (MTX) and mizoribine (MZR).He was hospitalized due to appearance of elevation of serum creatinekinase (CPK) and interstitial lung disease after the ADA treatment. The interstitial legion in chest X-rays was vanished after suspension of the ADA treatment. The patient was diagnosed as anti-aminoacyl tRNA synthetases (ARS) antibody syndrome because of myositis and presence of anti-EJ antibody. The disease was ameliorated by treatment with prednisolone (PSL) and tacrolimus (TAC).
【Case2】47y.o.female. Infliximab (IFX) was given to the patients with RA because insufficient effect of MTX treatment. She was hospitalized due to elevation of serum CPK level and appearance of interstitial lung disease after the IFX treatment. Although she was initially considered as polymyositis and treated with PSL and cyclosporine, she was diagnosed as anti-ARS antibody syndrome because anti PL-7antibody was detected in the course of hospitalization.
【Conclusion】This report suggested that blockade of TNF-α is a risk for onset of anti-ARS antibody syndrome. We should take into account for appearance or worsening of pulmonary complication and/or myositis after usage of such agents.

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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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