Objective: To clarify the safety and influence of the recombinant zoster vaccine（RZV）on disease activity（DA）in Japanese patients with rheumatic diseases.

Patients: We administered RZV to 67 patients（male, n=11; female, n=56）with rheumatic diseases（including 60 rheumatoid arthritis [RA] patients）. The mean age（n=67）and observational period after the second dose（n=64）were 73.5 ± 10.2 years old and 12.6 ± 5.7 months, respectively.

Methods: Adverse events（AEs）, the occurrence of herpes zoster（HZ）, and changes in disease activity were analyzed. Patients using Janus kinase inhibitors（JAKis）with and without RZV were compared retrospectively.

Results: After the first dose, an 82-year-old female RA patient died of pneumonia. Twelve（17.9%）and six（9.4%）AEs occurred after the first dose and second dose, respectively, but most were mild. No patients developed HZ after two doses of RZV. The DA in 57 RA patients was ameliorated at 6 months after RZV due to treatment intensification. The DA of 17 RA patients without treatment change before COVID-19 vaccination was unchanged. Patients who used JAKis without RZV were significantly younger and had a shorter disease duration than those who used JAKis with RZV. Eight of 54 patients（14.8%）who did not receive RZV developed HZ, while none who received RZV developed HZ.

Conclusion: RZV was relatively safe, and no patients developed HZ, although the observational period was only approximately one year. RZV did not worsen DA in Japanese patients with rheumatic diseases.

Background: The disease activity and functional status of patients with rheumatoid arthritis（RA）are strongly affected by natural disasters. Understanding the real voices and experiences of patients could help improve disaster preparedness of medical providers and governments. Herein we conducted a narrative analysis of responses to a questionnaire survey of patients with RA who were affected by a natural disaster.

Methods: Patients with RA living in an area affected by a heavy rain disaster in 2018 were invited to participate in a questionnaire survey in 2020. Descriptions by the patients in the open-ended text fields were categorized and analyzed.

Results: Among 60 respondents, 30 included narrative items. There were 32 requests for hospital and pharmacy services. Many patients wanted online consultations and prescriptions. There were 16 requests for evacuation centers with the most frequent requests for the centers being facility management and infection control. Causes of worsening general condition, like overloading from cleaning up or carrying heavy objects during the disaster, were described. Respondents described mental stress worsening over time, which had persisted to the time of the survey. A patient described lowering the dose of his medication on his own due to his concerns about drug shortages.

Conclusions: Patients with RA must be educated before a natural disaster on how to deal with changes in their physical and mental condition during the natural disaster. Medical providers and governments must develop a system for medical care and drug procurement in the event of a disaster.

【Objective】The purpose of this study was to investigate the effects of locomotion training on physical function and disease activity in elderly patients with rheumatoid arthritis.

【Subjects and Methods】Locomotion training was performed on 30 rheumatoid arthritis patients aged 60 years and older, and lower limb muscle strength, 10-m walking time, Timed Up-and-Go（TUG）test, 2-step values, and disease activity were compared between baseline and 3 months after the start of training.

【Results】During locomotion training, three patients had worsening arthralgia, so training was discontinued. Another patient discontinued training due to trauma unrelated to training. Finally, 26 patients were able to continue locomotion training for 3 months. The strength of hip abductor muscle increased significantly from 37.5 N to 40.5 N（P<0.001）. The 10-m walking time significantly decreased from 7.83 to 7.42 seconds（P=0.026）, and TUG test significantly decreased from 8.28 to 8.06 seconds（P=0.012）. On the other hand, CRP and SDAI were unchanged between baseline and 3 months, and there was no worsening of disease activity.

【Conclusion】Locomotion training may improve physical function and not worsen disease activity in elderly patients with rheumatoid arthritis.

Objective: To compare the prevalence of sarcopenia and the status of nutrition and exercises between rheumatoid arthritis（RA）patients and healthy control subjects.

Subjects: Fifty-three RA patients（66.5 years old, all female）and 30 healthy controls（65.8 years old, all female）.

Methods: The skeletal muscle mass index（SMI）, grip strength, 10-m walking speed, and 5-time Sit-to-Stand Test were measured, and the nutritional status（Mini Nutritional Assessment Short-Form [MNA-SF], frequency of animal protein intake）and exercise frequency and exercise contents were assessed.

Results: Sarcopenia was significantly more prevalent（37.8% vs. 3.2%）and the SMI and leg muscle mass were significantly lower in the RA group than in the control group. The percentage of RA patients who did not consume animal protein at least twice a day was 54.7 %（vs. 20.0 % in the control group）. The RA group with sarcopenia was older and more undernourished than the RA group without sarcopenia, but they exercised more frequently of aerobic exercise than the control subjects, and they had received no rehabilitative guidance.

Conclusions: The RA group had a higher prevalence of sarcopenia than the control group, and the low frequency of animal protein intake. RA patients with sarcopenia tended to be undernourished. Although they exercised more frequently, they received no rehabilitative guidance. This study suggests that combined intervention of nutritional guidance and exercise therapy is desirable from the early stage of RA.

［Purpose］Secondary osteoporosis includes rheumatoid arthritis and glucocorticoid-related osteoporosis, but some hospitalized patients do not receive appropriate therapeutic intervention. We report on the effectiveness of osteoporosis ward rounds conducted by our OLS musculoskeletal care team.

［Subjects and Methods］Patients were screened from July 2017 to December 2019 based on steroid medication use and history of fragility fractures to assess the need for drug administration, patientsʼ general condition, and therapeutic intervention.

［Results］A total of 472 patients were screened, the most common reason being steroid and pioglitazone use（322 patients）. Forty-five patients had collagen disease-related conditions, of which rheumatoid arthritis was the most common（33 patients）. The results of the collagen disease-related patientsʼ rounds were: “treated: 13 patients,” “low dose of steroids: 12 patients,” “ambulatory induction: 6 patients,” “drug prescription: 5 patients,” “poor general condition: 5 patients,” and “other: 4 patients.”

［Discussion］The osteoporosis rounds enabled us to treat untreated secondary osteoporosis. As the rounds continued, requests from ward nurses and pharmacists increased, and eventually an internal medicine physician joined the team. This initiative prevented osteoporosis from being overlooked, and at the same time increased awareness of osteoporosis among physicians and medical staff.

Conclusion: Osteoporosis ward rounds by our OLS athletic care team were useful in increasing the intervention rate of treatment for secondary osteoporosis.