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1.
Prog Rehabil Med ; 9: 20240022, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38895591

RESUMO

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.

2.
J Bone Metab ; 31(2): 162-168, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38886973

RESUMO

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.

3.
Mod Rheumatol ; 34(6): 1149-1152, 2024 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-38430527

RESUMO

OBJECTIVES: Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA. METHODS: Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline). RESULTS: Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods. CONCLUSIONS: Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA.


Assuntos
Artrite Reumatoide , Medidas de Resultados Relatados pelo Paciente , Humanos , Artrite Reumatoide/complicações , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Adulto , Atividades Cotidianas , Deformidades Adquiridas do Pé/etiologia , Inquéritos e Questionários
4.
Foot Ankle Int ; 45(3): 261-271, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38327241

RESUMO

BACKGROUND: With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction. METHODS: This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit. RESULTS: The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups. CONCLUSION: In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction. LEVEL OF EVIDENCE: Level III, case-control study.


Assuntos
Artrite Reumatoide , Joanete , Hallux Valgus , Articulação Metatarsofalângica , Humanos , Resultado do Tratamento , Estudos de Casos e Controles , , Artrite Reumatoide/cirurgia , Antepé Humano/cirurgia , Antepé Humano/anormalidades , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Articulação Metatarsofalângica/cirurgia
5.
Histochem Cell Biol ; 161(4): 325-336, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38216701

RESUMO

Su (var) 3-9, enhancer of seste, trithorax (SET)-domain bifurcated histone lysine methyltransferase (SETDB1) plays a crucial role in maintaining intestinal stem cell homeostasis; however, its physiological function in epithelial injury is largely unknown. In this study, we investigated the role of SETDB1 in epithelial regeneration using an intestinal ischemia/reperfusion injury (IRI) mouse model. Jejunum tissues were sampled after 75 min of ischemia followed by 3, 24, and 48 h of reperfusion. Morphological evaluations were performed using light microscopy and electron microscopy, and the involvement of SETDB1 in epithelial remodeling was investigated by immunohistochemistry. Expression of SETDB1 was increased following 24 h of reperfusion and localized in not only the crypt bottom but also in the transit amplifying zone and part of the villi. Changes in cell lineage, repression of cell adhesion molecule expression, and decreased histone H3 methylation status were detected in the crypts at the same time. Electron microscopy also revealed aberrant alignment of crypt nuclei and fusion of adjacent villi. Furthermore, increased SETDB1 expression and epithelial remodeling were confirmed with loss of stem cells, suggesting SETDB1 affects epithelial cell plasticity. In addition, crypt elongation and increased numbers of Ki-67 positive cells indicated active cell proliferation after IRI; however, the expression of PCNA was decreased compared to sham mouse jejunum. These morphological changes and the aberrant expression of proliferation markers were prevented by sinefungin, a histone methyltransferase inhibitor. In summary, SETDB1 plays a crucial role in changes in the epithelial structure after IRI-induced stem cell loss.


Assuntos
Intestinos , Traumatismo por Reperfusão , Camundongos , Animais , Histona-Lisina N-Metiltransferase/metabolismo , Traumatismo por Reperfusão/metabolismo , Células Epiteliais/metabolismo , Isquemia/metabolismo
6.
Mod Rheumatol ; 34(2): 329-333, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-37267207

RESUMO

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.


Assuntos
Antirreumáticos , Artrite Reumatoide , Humanos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Indução de Remissão , Progressão da Doença , Índice de Gravidade de Doença
7.
J Phys Ther Sci ; 35(12): 810-816, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38075516

RESUMO

[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.

8.
JBJS Case Connect ; 13(3)2023 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-37590560

RESUMO

CASE: A 74-year-old woman with rheumatoid arthritis had undergone total ankle arthroplasty (TAA) for severe ankle joint destruction at our hospital 14 years earlier. Radiographs of the ankle revealed displacement of the tibial component and subsidence of the talar component. Revision TAA was performed using a customized alumina ceramic total talar prosthesis. CONCLUSION: The 10-year outcome of revision TAA with a total talar prosthesis was satisfactory, with no postoperative complications, such as displacement of the tibial component, dislocation of alumina ceramic artificial talus, or progression of degenerative changes in the talonavicular and subtalar joints.


Assuntos
Artroplastia de Substituição do Tornozelo , Membros Artificiais , Feminino , Humanos , Idoso , Tornozelo , Seguimentos , Óxido de Alumínio
9.
Clin Exp Vaccine Res ; 12(2): 116-120, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37214144

RESUMO

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.

10.
Mod Rheumatol Case Rep ; 7(2): 350-353, 2023 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-37061836

RESUMO

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.


Assuntos
Artrite Reumatoide , Fibrose Pulmonar Idiopática , Inibidores de Janus Quinases , Doenças Pulmonares Intersticiais , Idoso de 80 Anos ou mais , Feminino , Humanos , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/tratamento farmacológico , Inibidores de Janus Quinases/uso terapêutico , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia , Indóis/uso terapêutico , Resultado do Tratamento
11.
Respir Investig ; 61(3): 359-363, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37031622

RESUMO

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.


Assuntos
Antirreumáticos , Artrite Reumatoide , Inibidores de Janus Quinases , Doenças Pulmonares Intersticiais , Humanos , Abatacepte/efeitos adversos , Inibidores de Janus Quinases/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Pulmonares Intersticiais/etiologia
12.
Intern Med ; 62(19): 2821-2825, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36823087

RESUMO

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.


Assuntos
Artrite Reumatoide , Perda de Dente , Humanos , Densidade Óssea , Perda de Dente/etiologia , Perda de Dente/complicações , Albumina Sérica , Vitamina D , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia
13.
J Bone Miner Metab ; 41(2): 220-226, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36625920

RESUMO

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.


Assuntos
Conservadores da Densidade Óssea , Osteoporose Pós-Menopausa , Osteoporose , Humanos , Feminino , Teriparatida/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Pós-Menopausa , Densidade Óssea , Osteoporose Pós-Menopausa/tratamento farmacológico
15.
Rheumatology (Oxford) ; 62(6): 2272-2283, 2023 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-36218391

RESUMO

OBJECTIVES: To construct a predictive model for the Sharp/van der Heijde score (SHS) and assess its applicability in clinical research settings. MATERIAL AND METHODS: A prediction model for SHS was constructed in three steps using convolutional neural networks (CNN) and an in-house RA image database: orientation, detection and damage prediction. A predictive model for radiographic progression (ΔSHS >3/year) was developed using a graph convolutional network (GCN). A multiple regression model was used to assess the association between predicted SHS using the CNN model and clinical features. RESULTS: In the orientation and detection phases, 100% accuracy was achieved in the image orientation correction, and all predicted joint coordinates were within 10 pixels of the correct coordinates. In the damage prediction phase, the κ values between the model and expert 1 were 0.879 and 0.865 for erosion and joint space narrowing, respectively. Using a dataset scored by experts 1 and 2, a minimal overfitting was determined to the scoring by expert 1. High-titre RF was an independent risk factor of ΔSHS per year, as predicted by the CNN model in biologics users. The AUCs of the GCN model for predicting ΔSHS >3/year in patients with and without biologics at baseline were 0.753 and 0.734, respectively, superior to those of the other models. The RF titre was the most important feature in predicting ΔSHS >3/year in biologics users in the GCN model. CONCLUSION: A high-performance scoring model for SHS that is applicable to clinical research was constructed.


Assuntos
Artrite Reumatoide , Humanos , Artrite Reumatoide/diagnóstico por imagem , Reprodutibilidade dos Testes , Fatores de Risco , Progressão da Doença
16.
Mod Rheumatol ; 33(1): 104-110, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34939107

RESUMO

OBJECTIVES: Operative procedures for rheumatoid forefoot deformities have gradually changed from arthrodesis or resection arthroplasty to joint-preserving surgery. Although joint-preserving arthroplasty has yielded good outcomes, painful plantar callosities may occur post-operatively. This study aimed to reveal the radiographic factors associated with painful callosities after joint-preserving surgery for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS: We retrospectively evaluated 166 feet in 133 patients with RA who underwent forefoot joint-preserving arthroplasty, including proximal rotational closing-wedge osteotomies of the first metatarsal, between January 2012 and December 2015. Logistic regression analysis was performed with the objective variable set as the presence/absence of painful plantar callosities at the final observation and the explanatory variables set as several radiographic factors, including post-operative relative first metatarsal length (RML), amount of dorsal dislocation of the fifth metatarsal (5DD), and arc failure of the lesser toes. RESULTS: At the final follow-up, 42 of the 166 feet (25.3%) had painful callosities under the metatarsal heads post-operatively. Logistic regression analysis showed that the RML, 5DD, and lesser toes' arc failure were significantly associated with painful callosities. CONCLUSIONS: We identified that RML, 5DD, and arc failure of the lesser toes were associated with painful plantar callosities after the surgery.


Assuntos
Artrite Reumatoide , Calosidades , Deformidades Adquiridas do Pé , Articulação Metatarsofalângica , Humanos , Estudos Retrospectivos , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/cirurgia , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/cirurgia , Dor , Resultado do Tratamento
17.
Intern Med ; 62(12): 1733-1737, 2023 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-36328576

RESUMO

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.


Assuntos
Antirreumáticos , Artrite Reumatoide , Humanos , Estudos Retrospectivos , Glucocorticoides/uso terapêutico , Inquéritos e Questionários , Avaliação da Deficiência , Artrite Reumatoide/tratamento farmacológico , Antirreumáticos/uso terapêutico , Índice de Gravidade de Doença , Dor/tratamento farmacológico , Resultado do Tratamento
18.
Mod Rheumatol ; 33(3): 509-516, 2023 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35536604

RESUMO

OBJECTIVES: A global downward trend in the number of rheumatoid arthritis (RA)-related surgeries has been reported. The purpose of our study was to investigate the latest trends in RA-related surgeries in a single-centre Japanese RA cohort. METHODS: This study was a retrospective analysis of RA-related surgeries between 2001 and 2020 in the Institute of Rheumatology Rheumatoid Arthritis cohort. An average of 4944 patients per semi-annual survey was included in the study. The primary goal was to analyse the half-year period prevalence proportion (HPP) of RA-related surgeries in a 20-year period, and the secondary goal was to analyse the HPP of surgeries by site or by categories of disease activity. RESULTS: There has been a downward trend in the HPP of RA-related surgeries in the 20-year study period. The total HPP of RA-related surgeries decreased by 50.3% during the 20-year study period. There was a significant decrease in knee, hip, shoulder/elbow, and hand procedures. Only foot/ankle joint surgeries significantly increased in volume during this period (p = .001). The HPP of RA-related surgeries remained unchanged in patients with remission or low disease activity. CONCLUSIONS: The number of RA-related surgeries decreased over a 20-year period, but foot/ankle joint surgeries increased in the site-specific evaluation.


Assuntos
Tornozelo , Artrite Reumatoide , Humanos , Estudos Retrospectivos , Tornozelo/cirurgia , Artrite Reumatoide/complicações , Estudos de Coortes , Articulação do Joelho
19.
Mod Rheumatol ; 33(3): 490-495, 2023 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35689558

RESUMO

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.


Assuntos
Artrite Reumatoide , Conservadores da Densidade Óssea , Osteoporose Pós-Menopausa , Osteoporose , Humanos , Feminino , Densidade Óssea , Denosumab/farmacologia , Denosumab/uso terapêutico , Projetos Piloto , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Conservadores da Densidade Óssea/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/tratamento farmacológico
20.
Knee Surg Sports Traumatol Arthrosc ; 30(9): 3131-3137, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35781580

RESUMO

PURPOSE: The purpose of this study was to evaluate perioperative and short-term clinical and radiographical results of a modern PS mobile-bearing cementless TKA system. METHODS: A retrospective review of a consecutive series of TKAs was performed by a single surgeon using a cementless or cemented TKA of the same design (Attune, DePuy Synthes, Massachusetts, USA). The 2011 Knee Society Score, Forgotten Joint Score-12, Hip-Knee-Ankle angle, and the presence of radiolucent lines (RLLs) were reviewed 1-year postoperatively with 1:1 matching performed for age, gender, body mass index, and preoperative UCLA score. Fisher's exact test or independent Student's t-test were used for statistical analyses. RESULTS: Forty-five cementless and 45 cemented TKAs were reviewed after 1:1 matching. The mean operative time was 8.8 min shorter (P < .01), and the mean amount of drainage was 40.0 ml greater (P = .04) in the cementless cohort. At 1-year postoperatively, there were no significant differences in both cohorts in 2011 Knee Scores and Forgotten Joint Scores-12, with no patients requiring revision surgery (NS). The incidence of RLLs was significantly higher in cementless TKAs (51%) than that in cemented TKAs (22%, P < .01). However, the mean width of RLLs in the cementless TKAs (0.2 mm) was significantly smaller (P < .01) than that in the cemented TKAs (0.8 mm) at 1-year postoperatively with no progression. CONCLUSION: A recently introduced cementless PS mobile-bearing TKA design demonstrated comparable postoperative and radiographical results to its cemented predecessor at 1-year follow-up. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Cimentos Ósseos , Seguimentos , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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