We should consider the condition when we judge the X-rays images of the joint. In RA, bone erosion starts from bare area, just beside articular surface. Sometime we may see ankylosis under well-controlled RA. When disease control is insufficient, we may find instability to cervical spine. In PsA, osteogenesis is occurred out of joint, whereas bone resorption is occurred in joint. It leads to form pencil in cup deformity.

Ankylosis of the sacroiliac joint is characteristic in AS, and we should focus on articular surface located in lower half of sacroiliac joint. In AS, straight syndesmophytes start from enthesis of disk and spinal body. On the other hand, in PsA, chunky syndesmophytes start from a bit distant part of the enthesis. We should distinguish AS or PsA form PAO, DISH, or OCI.

It is important to ascertain existence of inflammation and a structural change in MRI. The inflammation, so called bone edema, is recognized as low intensity in T1WI and high intensity in STIR or T2fs. The structural change is judged with T1WI.

Objective: To examine the relationship between subjective symptoms and objective signs in patients who were underwent diagnostic testing for Sjögren’s Syndrome（SS）.

Methods: Clinical data of 87 patients suspected of having dry mouth by symptoms and/or physician’s observations, who visited our hospital from February 2017 to June 2021 and were underwent diagnostic testing for SS. Patients were classified according to each of 14 xerostomia-related questions into asymptomatic and symptomatic groups.

Results: The ratio of asymptomatic to symptomatic did not differ between 49 of SS and 38 of non-SS in all the 14 questions. Sensitivity and specificity of salivary glands echogram scoring by Ariji method for SS diagnosis was 70.7% and 91.7%, respectively. That by Outcome Measures in Rheumatology Clinical Trials（OMERACT） method was 68.3% and 91.7%, respectively. In the half of 14 questions, the amount of salivary flow in the symptomatic group was significantly lower than those with the asymptomatic group. Some dryness symptoms（feeling dryness in mouth, difficulty talking for a long time, and pain sensation in mouth）were related with parotid-gland-echo scores.

Conclusion: Among various oral dryness symptoms, there existed some peculiar symptoms that reflected objective abnormalities.

Objectives: The aim of this study was to identify risk factors for failure and find preventive measures in patients with pre-difficult-to-treat rheumatoid arthritis（pre-D2T RA）.

Methods: RA patients who received a treat-to-target treatment strategy were selected. D2T RA status was determined according to the EULAR definition of D2T RA, and pre-D2T RA status was determined as follows: Category-1（administration of a second drug with a different effect due to failure of one biologic or JAK inhibitor）and -2（Moderate disease activity, glucocorticoid dose greater than 7.5 mg prednisolone equivalent, rapid radiographic progression, or quality of life score reduced in 6 months） were defined, and the first time a match was made during treatment was taken as baseline. Results were determined at final observation at more than 1 year. When patients left each category, they were judged as “success” or “failure” if they continued. Risk factors for “failure” in the patient context and observation items in the treatment were assessed by category. Patients who met Category 2 were also selected as the target group, and risk factors were examined.

Results: A total of 47 in pre-D2T RA and 444 patients in control group were recruited. In pre-D2T RA patients, significant risk factor was higher simplified disease activity index（SDAI）score and prescription of a new glucocorticoid formulation（GCS）during treatment（p<0.05）. In the control group, significant risk factors were non-prescription of methotrexate throughout the treatment period and disease control including SDAI during follow-up.

Conclusions: The most important factor for prevention of D2T RA was strict disease activity control. GCS prescription in pre-D2T RA should be avoided.

Objectives: In patients with dry mouth, salivary buffering capacity and oral pH decrease due to decreased salivary bicarbonate（HCO₃⁻）concentration; this is associated with the development of dental caries and oral candidiasis. It is considered that mouth rinse using sodium bicarbonate water supplements salivary buffering capacity. This study investigated the usability and changes in dry mouth symptoms after use of sodium bicarbonate mouth rinse in patients with Sjogren’s syndrome（SS）.

Methods: Twenty-seven patients with SS who had used sodium bicarbonate mouth rinse were enrolled. Usage status, usability, and changes in subjective symptoms regarding dry mouth were investigated by a questionnaire. Medication and countermeasures against dry mouth in the daily life were continued as usual.

Results: Highest frequency of use was twice a day（33.3%）, and common use situations were before bedtime（66.7%）, and after meals（63.0%）. Twenty patients（74.1%）had “very good” or “good” sense of use. Eighteen patients（66.7%）had relief of symptoms related to dry mouth. Pros were “feeling refreshed in the mouth”（51.9%）, followed by “becomes less sticky”（29.6%）, “easy to make”（25.9%）, and “inexpensive”（22.2%）. Some respondents said they had less glossitis, angular cheilitis, and stomatitis（14.8%）. For cons “troublesome” was the highest（37.0%）, followed by responses regarding taste（22.2%）. There were also many responses to “none in particular”（25.9%）. No obvious accidents occurred, and twenty patients（74.1%） wished to continue using the mouth rinse.

Conclusions: Sodium bicarbonate mouth rinse was considered an effective self-care method for managing dry mouth in SS patients.

Objectives: To evaluate the efficiency of hand hygiene in patients with rheumatoid arthritis（RA）, we assessed the compliance and quality of the handwashing technique in RA patients.

Patients and Methods: From July to November 2021, 55 RA patients（mean age, 69.7 years; male, n=8; female, n=47）hospitalized at our medical institution were subjected to a questionnaire survey on handwashing and a handwashing check. We conducted a survey on unwashed parts of the hands to investigate the handwashing situation and the relationship between patient background factors and unwashed hands.

Results: The most unwashed parts of the hands were the interdigital areas on the dorsal side of both hands（87%）, followed by the areas around the nail plates（77%）. Factors significantly related to unwashed hands were the presence or absence of family members living together and the number of hand deformities. There were no significant associations between unwashed hands scores and age, disease duration, use of biologics, presence or absence of guidance, grip strength of both hands, hand stiffness, Health Assessment Questionnaire（HAQ）score, or the assessment of shoulder, elbow, and hand pain using a visual analogue scale.

Conclusion: It is more important than ever to implement proper handwashing instruction in RA patients with hand deformities who were living alone.