Two-Year Outcomes of Daily and Twice-Weekly Teriparatide Treatment in Postmenopausal Women with Severe Osteoporosis: A Randomized Non-Blinded Prospective Study.

BACKGROUND: The long-term effects of daily teriparatide (D-TPTD) and twice-weekly TPTD (W-TPTD) injections are compared among postmenopausal women with severe osteoporosis. METHODS: A total of 102 patients were enrolled and randomly allocated into two groups for the administration of either D-TPTD or W-TPTD. Treatment efficacy was measured as the percentage change in bone mineral density (ΔBMD) from baseline in the lumbar spine, total hip, and femoral neck. The findings were compared between the two groups. RESULTS: At 24 months after treatment, the persistence rates and medication possession ratios in the D-TPTD and W-TPTD groups were 68.6% and 56.9%, and 87.8% and 92.0%, respectively. The ΔBMD in the lumbar spine, total hip, and femoral neck were 15.6%±10.2%, 5.3%± 6.3%, and 5.5%±6.2%, respectively, in the D-TPTD group; and 9.5%±7.9%, 2.3%±6.2%, and 3.1%±7.4%, respectively, in the W-TPTD group following 24 months of treatment. The ΔBMD of the lumbar spine (p=0.008) at 24 months and total hip (p=0.024) at 18 months differed significantly between the two groups. CONCLUSIONS: D-TPTD administration resulted in a significantly higher BMD in the lumbar spine and total hip, supporting this therapeutic regimen for postmenopausal women with severe osteoporosis.

Effects of Locomotion Training on Bone Mineral Density in Patients with Rheumatoid Arthritis.

Objectives: This study aimed to evaluate the effects of locomotion training on bone mineral density (BMD) and the factors associated with increased BMD in patients with rheumatoid arthritis (RA). Methods: We enrolled 85 patients with RA who underwent locomotion training for 6 months after receiving instructions from a physical therapist. We evaluated the BMD of the lumbar spine, total hip, and femoral neck 1 year before baseline (the start of locomotion training) and 1 year after baseline. Results: The change in BMD from 1 year before baseline (non-exercise period) and 1 year after baseline (exercise period) were 0.1 ± 3.1% and 1.6 ± 3.7% (P=0.007) for the lumbar spine, -0.2 ± 2.4% and 1.0 ± 2.4% (P=0.005) for the total hip, and -0.6 ± 3.9% and 1.8 ± 3.5% (P<0.001) for the femoral neck, respectively. The Health Assessment Questionnaire Disability Index score at baseline was associated with increased BMD at the femoral neck. No factor was associated with increased BMD in the lumbar spine or total hip. Conclusions: Locomotion training increased the BMD of the lumbar spine, total hip, and femoral neck during the exercise period compared with that during the non-exercise period. The current treatment for RA and osteoporosis accompanied by optional therapy with locomotion training might be effective in increasing BMD in patients with RA.

Intensive treatment for the progression of joint damage in rheumatoid arthritis patients with low disease activity or remission.

OBJECTIVES: To investigate the effects of intensive treatment on joint damage in patients with rheumatoid arthritis (RA) showing progression of joint damage and low disease activity or remission. METHODS: Eighty-nine patients who had change in the van der Heijde modified total Sharp score (TSS) of >0.5 points at baseline when compared with the score 1 year ago were enrolled and categorized into two groups to receive intensive (intensive group) or current (current group) treatment. The intensive and current groups were compared for change (Δ) from baseline to 1 year of erosion score, joint space narrowing score, and TSS. RESULTS: The ΔTSS values at 1 year in the intensive and current groups were 0.67 ± 1.09 and 1.79 ± 1.70, respectively (P < 0.001). In the intensive and current groups, the ΔTSS ≤ 0.5 at 1 year were 66.7% and 32.4%, respectively (P = 0.010). CONCLUSIONS: The intensive treatment was more effective at suppressing joint damage than the current treatment. The progression of joint damage is an important target to consider for intensive treatment.

Effectiveness of locomotion training in patients with rheumatoid arthritis: a prospective clinical trial.

[Purpose] The present study aimed to determine the effectiveness of locomotion training on physical function and quality of life in patients with rheumatoid arthritis (RA) and identify factors associated with its effectiveness. [Participants and Methods] Data were obtained from 103 patients with rheumatoid arthritis who underwent locomotion training for 6 months using the Health Assessment Questionnaire Disability Index, pain visual analog scale, 10-meter walking speed, timed up-and-go test, single-leg standing time, grip strength, 25-question Geriatric Locomotive Function Scale, Short Form-8, fat-free mass index, and fat mass index. [Results] A significant improvement in the Health Assessment Questionnaire Disability Index, pain visual analog scale score, maximum 10-meter walking speed, timed up-and-go test, single-leg standing time, grip strength, and physical component summary in Short Form-8 was observed at six months. [Conclusion] The current study demonstrated that locomotion training for 6 months improved physical function, certain aspects of quality of life, and sarcopenia in patients with RA. We believe that locomotion training should be recommended as a non-pharmacological therapeutic option for improving physical function in patients with RA.

Changes in SARS-CoV-2 antibody titers 6 months after the booster dose of BNT162b2 COVID-19 vaccine among health care workers.

Purpose: In Japan, the data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers after the booster dose of the coronavirus disease 2019 (COVID-19) vaccine are insufficient. The aim of this study is to evaluate changes in SARS-CoV-2 antibody titers before, 1, 3, and 6 months after the booster dose of the BNT162b2 COVID-19 vaccine among health care workers. Materials and Methods: A total of 268 participants who received the booster dose of the BNT162b2 vaccine were analyzed. SARS-CoV-2 antibody titers were measured before (baseline) and at 1, 3, and 6 months after the booster dose. Factors associated with changes in SARS-CoV-2 antibody titers at 1, 3, and 6 months were analyzed. Cutoff values at baseline were calculated to prevent infection of the omicron variant of COVID-19. Results: The SARS-CoV-2 antibody titers at baseline, and 1, 3, and 6 months were 1,018.3 AU/mL, 21,396.5 AU/mL, 13,704.6 AU/mL, and 8,155.6 AU/mL, respectively. Factors associated with changes in SARS-CoV-2 antibody titers at 1 month were age and SARS-CoV-2 antibody titers at baseline, whereas changes in SARS-CoV-2 antibody titers at 3 and 6 months were associated with the SARS-CoV-2 antibody titers at 1 month. The cutoff values of the SARS-CoV-2 antibody titers at baseline were 515.4 AU/mL and 13,602.7 AU/mL at baseline and 1 month after the booster dose, respectively. Conclusion: This study showed that SARS-CoV-2 antibody titers increase rapidly at 1 month after the booster dose of the BNT162b2 vaccine and begin to decrease from 1 to 6 months. Hence, another booster may be needed as soon as possible to prevent infection.

Radiological evaluation of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept or JAK inhibitors for 1 year.

BACKGROUND: We evaluated the radiological deterioration of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) treated with abatacept (ABT) or Janus-kinase inhibitors (JAKi) for 1 year. METHODS: This study enrolled 84 patients with RA who had started treatment with ABT (48 patients) or JAKi (36 patients) between 2017 and 2020. All patients underwent chest CT before administration and at 1 year post-treatment. RESULTS: In all patients, the rate of deterioration of ILD in ABT and JAKi was 4.2% and 5.6%, respectively (p = 0.847). In the patients with pre-existing ILD, the rates of deterioration of ILD in the ABT and JAKi groups were 10.5% and 18.2%, respectively (p = 0.611). Meanwhile, newly developed ILD did not occur in the two groups without pre-existing ILD. CONCLUSION: The present study demonstrated that the safety of pulmonary toxicity with ABT and JAKi treatments was similar in patients with RA. JAKi may be a potentially acceptable treatment option for patients with RA.

Combination treatment with Janus kinase inhibitor and nintedanib for rheumatoid arthritis with progressive interstitial lung disease: A case report.

Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA). Nintedanib has been approved for the treatment of idiopathic pulmonary fibrosis. Herein, we described the case of an 87-year-old woman treated with Janus kinase inhibitor (JAKi). Chest computed tomography revealed increased honeycombing; she was administered nintedanib while continuing RA treatment. The combination treatment (JAKi and nintedanib) controlled the RA disease activity without ILD deterioration. This case shows the potential of combination treatment with JAKi and nintedanib for the prevention of worsening of disease activity in RA and ILD.

Smoking, Serum Albumin and 25-hydroxy Vitamin D Levels, and Bone Mineral Density Are Associated with Tooth Loss in Patients with Rheumatoid Arthritis.

Objectives This study investigated factors associated with tooth loss in patients with rheumatoid arthritis (RA). Methods A total of 429 patients with RA were enrolled in the study. We examined tooth loss and clinical data. Patients were classified into two groups: a group with tooth loss (tooth loss-positive group), and a group without tooth loss (tooth loss-negative group). Patients were included in the tooth loss-positive group if they had fewer remaining teeth than the number defined by the Ministry of Health, Labour and Welfare in Japan to be the normal number teeth for that age and sex. Factors associated with tooth loss were analyzed by comparing the tooth loss-positive and loss-negative groups. Results The frequency of patients with tooth loss was 39.6%. The factors associated with tooth loss were smoking [odds ratio (OR) 1.638; 95% confidence interval (CI) 1.165-2.302], serum levels of albumin (OR 0.325; 95% CI 0.149-0.707) and 25-hydroxy vitamin D (OR 0.947; 95% CI 0.915-0.980), and total hip T score (OR 0.713; 95% CI 0.535-0.950). Conclusion This study revealed that tooth loss is associated with smoking, serum levels of albumin and 25-hydroxy vitamin D, and the total hip T score in patients with RA. Our findings may help prevent tooth loss in patients with RA.

Comparison of different parameters between daily and twice-weekly teriparatide in postmenopausal women with severe osteoporosis.

INTRODUCTION: Once-daily teriparatide (D-TPTD) and twice-weekly TPTD (W-TPTD), which are self-administered injections, are generally used in the treatment of severe osteoporosis. This study aimed to reveal the differences in the persistence, safety, and effectiveness of D-TPTD and W-TPTD. MATERIALS AND METHODS: A total of 102 patients received D-TPTD (n = 51) and W-TPTD (n = 51). The bone mineral densities (BMD) of the lumbar spine, total hip, and femoral neck were measured using dual energy X-ray absorptiometry. The persistence and effectiveness of the two treatments were compared at 12 months. RESULTS: The persistence in the D-TPTD and W-TPTD groups was 80.4% and 66.7% at 12 months, respectively (p = 0.178). The % changes (Δ) in BMD values from baseline for the lumbar spine in the D-TPTD were significantly higher than those in the W-TPTD (11.2% vs. 6.3%; p < 0.001) at 12 months. The ΔBMD values for the total hip (3.7% vs. 1.3%; p = 0.065) and femoral neck (2.2% vs. 1.6%; p = 0.489) did not differ significantly between the two groups at 12 months. The incidence of new morphological vertebral fractures in the D-TPTD and W-TPTD groups was 7.3% and 8.6%, respectively, at 12 months (p = 1.000). CONCLUSIONS: Lumbar spine BMD (LS-BMD) was significantly increased. Moreover, ΔLS-BMD in the D-TPTD group was higher than that in the W-TPTD group. This study showed that the persistence, ΔTH-BMD, ΔFN-BMD and incidence of vertebral fractures did not differ between the two groups.

Comparison of romosozumab versus denosumab treatment on bone mineral density after 1 year in rheumatoid arthritis patients with severe osteoporosis: A randomized clinical pilot study.

OBJECTIVES: To investigate the effect of romosozumab versus denosumab treatment on bone mineral density (BMD), disease activity, and joint damage in patients with rheumatoid arthritis and severe osteoporosis. METHODS: Fifty-one postmenopausal women were enrolled and randomized equally into two groups to receive either romosozumab or the denosumab. Changes (Δ) in the BMD (at lumbar spine, total hip, and femoral neck), disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), and van der Heijde-modified Total Sharp Score (TSS) from baseline to 12 months after treatment were evaluated. RESULTS: The ΔBMD at 12 months in the romosozumab and denosumab groups were 10.2 ± 5.6% and 5.0 ± 3.1% (p = .002) for the lumbar spine, 3.7 ± 4.9% and 3.5 ± 3.0% (p = .902) for the total hip, and 3.6 ± 4.7% and 3.2 ± 4.9% (p = .817) for the femoral neck, respectively. The ΔDAS28-ESR and ΔTSS at 12 months did not differ between these two groups. CONCLUSIONS: Our results suggest that romosozumab treatment was more effective in increasing the BMD at the lumbar spine than denosumab and may be selected for patients who require a significant increase in the lumbar spine BMD.

Factors Associated with Five-year Deterioration of the Health Assessment Questionnaire-Disability Index in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study.

Objectives We investigated the factors associated with the deterioration of the Health Assessment Questionnaire-Disability Index (HAQ-DI) over five years in patients with rheumatoid arthritis (RA). Methods Clinical data were obtained from 391 patients who were classified into 2 groups: a group with HAQ-DI deterioration (in which the HAQ-DI had worsened) and a group without HAQ-DI deterioration. A multivariable logistic regression analyses of the age, sex, disease duration, body mass index, anti-cyclic citrullinated peptide antibody, the use of biological disease-modifying antirheumatic drugs or targeted synthetic disease-modifying antirheumatic drugs, methotrexate use, glucocorticoid use, C-reactive protein, pain visual analog scale (pain VAS), disease activity score 28 erythrocyte sedimentation rate (DAS28-ESR), the HAQ-DI, and van der Heijde modified total Sharp score was performed at baseline and five years to determine significant factors associated with the HAQ-DI. Results The significant factors associated with HAQ-DI deterioration were age [odds ratio (OR): 1.05; 95% confidence interval (CI): 1.02-1.08], glucocorticoid use (OR: 1.95; 95% CI: 1.03-3.71), DAS28-ESR (OR: 1.92; 95% CI: 1.33-2.79), change in pain VAS from baseline (OR: 1.02; 95% CI: 1.01-1.04), and change in DAS28-ESR from baseline (OR: 1.67; 95% CI: 1.15-2.44). Conclusion The present study suggests that glucocorticoid tapering as well as disease activity and pain control are required to prevent deterioration of the HAQ-DI in patients with RA.

Two-year effectiveness of zoledronic acid with or without eldecalcitol in Japanese patients with osteoporosis: A randomized prospective study.

Objectives: This study aims to examine the 2-year outcomes of zoledronic acid (ZOL) with or without eldecalcitol (ELD) on bone mineral density (BMD) and fracture in Japanese patients with osteoporosis. Methods: The subjects were 98 patients who were randomly (1:1) assigned to treatment with ZOL combined with ELD (ZOL + ELD group; n = 51) and ZOL alone (ZOL group; n = 47). Treatment efficacy was examined based on a comparison of changes in BMD from baseline (ΔBMD) in the lumbar spine, total hip, and femoral neck in the 2 groups. Results: The percent change from baseline in BMD values for the lumbar spine, total hip, and femoral neck at 24 months were 10.8% ± 6.1%, 6.0% ± 6.6%, and 5.1% ± 5.1%, respectively, in the ZOL + ELD group, and 7.7% ± 6.2%, 5.1% ± 5.6%, and 2.9% ± 8.3%, respectively, in the ZOL group. The percent change from baseline BMD for the lumbar spine at 24 months differed significantly between the 2 groups. Conclusions: The effect of a combination of ZOL + ELD on BMD for 24 months was more favorable than that of ZOL alone. This drug combination is promising for the treatment of drug-naïve Japanese patients with primary osteoporosis.

Effects of Locomotion Training on the Physical Functions and Quality of Life in Patients with Rheumatoid Arthritis: A Pilot Clinical Trial.

Objectives: This study investigated the effects of locomotion training on physical functions and quality of life in patients with rheumatoid arthritis (RA). Methods: Thirty-five patients with RA underwent locomotion training for 6 months. Health data collected from the subjects at baseline and after 6 months were the Health Assessment Questionnaire Disability Index (HAQ-DI), pain Visual Analog Scale, 10-m walking test, Timed Up-and-Go (TUG) test, single-leg standing test, Short Form-8 score with physical and mental component summaries, and 25-question Geriatric Locomotive Function Scale. The primary endpoint was a change in HAQ-DI at 6 months. Results: In terms of the primary outcome, the HAQ-DI significantly improved from 0.48 ± 0.69 at baseline to 0.27 ± 0.36 at 6 months (P=0.011). The significant secondary outcomes were a change in TUG test for comfortable walking from 9.8 ± 2.1 s at baseline to 8.9 ± 2.0 s at 6 months (P=0.002) and increased single-leg standing times for the right and left legs from 24.7 ± 23.5 s and 22.6 ± 22.8 s at baseline to 30.9 ± 22.1 s and 32.4 ± 24.1 s at 6 months (P=0.004, P <0.001), respectively. Conclusions: The findings suggest that locomotion training for 6 months may improve the HAQ-DI in patients with RA.

Factors Associated with Change in SARS-CoV-2 Antibody Titers from Three to Six Months after the Administration of the BNT162b2 mRNA COVID-19 Vaccine among Healthcare Workers in Japan: A Prospective Study.

Objective We evaluated the change in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers from three to six months after the administration of the BNT162b2 vaccine among healthcare workers. Methods A total of 337 healthcare workers who received 2 doses of the BNT162b2 vaccine were included in this study. Factors associated with SARS-CoV-2 antibody titers at three and six months and the change in SARS-CoV-2 antibody titers between three and six months after vaccine administration were analyzed using a logistic regression analysis. Results The SARS-CoV-2 antibody titer at 3 months was 4,812.1±3,762.9 AU/mL in all subjects and was lower in older workers than in younger ones. The SARS-CoV-2 antibody titer at 6 months was 1,368.9±1,412.3 AU/mL in all subjects. The SARS-CoV-2 antibody titers that were found to be high at three months were also high at six months. The change in SARS-CoV-2 antibody titers from 3 to 6 months was -68.9%±16.1%. The higher SARS-CoV-2 antibody titers at three months showed a more marked decrease from three to six months than lower titers. Conclusion This study demonstrates that SARS-CoV-2 antibody titers at three months decreased with age and were associated with the antibody titers at six months and the change in titer from three to six months. Older individuals in particular need to be aware of the declining SARS-CoV-2 antibody titers at six months after the BNT162b2 vaccine. The results of this study may provide insight into COVID-19 vaccine booster strategies.

Traumatic brachial artery injury successfully treated with a stent-graft: A case report.

There are few reports on brachial artery injury treated with stent-grafts. A 69-year-old man presented with a crush injury to the left upper arm. Enhanced computed tomography revealed left humerus fracture and disruption of the blood flow of the brachial artery along with paresis of the forearm. Following external fixation of the fracture, we performed endovascular therapy for brachial artery injury. Using real-time ultrasound imaging guidance, the injured lesion was crossed by the wire, and Viabahn endoprosthesis was placed in the left brachial artery. Hemostasis was achieved, and blood flow to the forearm was restored. Subsequently, the paresis improved.

Effects of the COVID-19 pandemic on body composition among patients with rheumatoid arthritis.

OBJECTIVES: To evaluate effects of the COVID-19 pandemic on body composition among patients with rheumatoid arthritis (RA). METHODS: A total 102 patients with RA were enrolled. We examined muscle mass, fat-free mass index (FFMI) and fat mass index (FMI) values using bioelectrical impedance analysis between November 2019 and January 2020 (for the first measurement) and September 2020 and January 2021 (for the second measurement). RESULTS: The muscle mass was significantly decreased from a median of 34.6 kg at the first measurement to a median of 33.9 kg at the second measurement (p = 0.002). The FFMI was significantly decreased from a median of 15.3 at the first measurement to a median of 14.8 at the second measurement (p = 0.011). CONCLUSIONS: The present study reveals that muscle mass and FFMI decreased among patients with RA during the COVID-19 pandemic.

Foot and ankle functions and deformities focus on posterior tibial tendon dysfunction using magnetic resonance imaging in patients with rheumatoid arthritis.

OBJECTIVES: Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). METHODS: A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. RESULTS: PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). CONCLUSIONS: The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

Discussion on effect of material on UV reflection and its disinfection with focus on Japanese Stucco for interior wall.

Research has previously shown that ultraviolet light C (UV-C) can inactivate unexpected infection. However, this type of potential disinfection is dramatically reduced for the shadow area such as under desk or medical equipment. Because the UV-C reflectance ratio is low on the general wall surfaces. We compared Stucco against the other materials to investigate whether we could improve disinfection for the shadow area. The reflectance ratios of UV-C irradiation of each material were examined, with particular attention to the rates for the author's Modified Stucco. To evaluate the disinfection effects of the UV-C reflective lighting, colonies of E. coli and of Staphylococcus hominis were cultured in an agar media and counted over a certain time period after applying UV-C irradiation from a sterilizing lamp onto the investigation materials. The author's Modified Stucco, produced reflectance ratios that was 11 times that of white wallpaper. This demonstrated that the UV-C reflected on the Stucco wall having optimum components and their compositions inhibited the number of E. coli and S. hominis, resulting in significantly disinfection effects on white wallpapers. The space with Modified Stucco and then irradiated by a UV-C may give a strong disinfection effect.