Interleukin-18 is associated with the presence of interstitial lung disease in rheumatoid arthritis: a cross-sectional study.

OBJECTIVE: Serum interleukin-18 (IL-18) levels are increased in patients with interstitial lung disease (ILD). In addition, IL-18 levels are increased in patients with rheumatoid arthritis (RA) and are associated with arthritis activity. We determined whether increased IL-18 levels are associated with ILD in RA. METHOD: RA patients were enrolled using an RA cohort database. Plasma IL-18 levels were measured by enzyme-linked immunosorbent assay. ILD was determined by a pulmonologist and a radiologist based on chest radiography and computed tomography findings. IL-18 levels for RA with ILD and RA without ILD were compared. Associations between ILD and various markers including IL-18 and confounding factors (e.g. smoking history) were investigated by logistic regression analysis. Diagnostic values of IL-18 for the presence of ILD were investigated using receiver operating characteristics curve analysis. RESULTS: ILD was complicated in 8.2% (n = 26) of the study population (N = 312). Plasma IL-18 levels were higher for RA patients with ILD than for RA patients without ILD (721.0 ± 481.4 vs 436.8 ± 438.9 pg/mL, p < 0.001). IL-18, Krebs von den Lungen-6, and anti-cyclic citrullinated peptide antibody titre and glucocorticoid doses were independently associated with the presence of ILD during multivariate logistic regression analysis. Sensitivity and specificity of IL-18 levels for the detection of ILD in RA patients were 65.3% and 76.3%, respectively (area under the curve = 0.73). CONCLUSION: Plasma IL-18 levels were higher for RA patients with ILD than for those without ILD. Increased IL-18 levels were associated with the presence of ILD.

Periarticular osteoporosis of the forearm correlated with joint destruction and functional impairment in patients with rheumatoid arthritis.

UNLABELLED: The relationship between periarticular osteoporosis in the distal forearm and joint destruction or functional impairment in patients with rheumatoid arthritis (RA) is not sufficiently elucidated. From a single institutional cohort study, we found a strong correlation between periarticular forearm bone mineral density (BMD) and joint destruction or functional impairment. INTRODUCTION: This study was conducted to investigate (1) the difference between various periarticular regions of interest (ROIs) of BMD of the forearm, (2) the correlation between periarticular forearm BMD and joint destruction and physical function, (3) the independent variables for predicting BMD of the forearm, and (4) the forearm BMD of different ROIs in the early stage of RA. METHODS: We conducted a cross-sectional study in an RA cohort. Measurements included BMD of the distal forearm, joint destruction of the hands assessed by modified total Sharp score (mTSS), functional impairment assessed by a health assessment questionnaire (HAQ), and other clinical data. Variables affecting the forearm BMD values were analyzed by correlation and stepwise regression analyses. RESULTS: Of the 405 patients enrolled in the present study, 370 (average age; 62.9 years) were identified as having definite RA with a complete set of data. BMD in the distal end of the forearm (BMDud) was significantly reduced compared with that in the distal third of the forearm (BMD1/3). In a stepwise regression analysis, the mTSS in BMD1/3 was an independent predicting variable, while age and partial HAQ scores associated with the upper extremity were common independent variables in BMDud and BMD1/3. BMDud was significantly less than BMD1/3, even in patients with a short duration of the disease. BMD1/3 was significantly less in non-remission group compared with that in remission group in patients with a short duration of the disease. CONCLUSION: Periarticular BMD in the distal forearm is closely correlated with joint destruction and functional impairment in RA. Periarticular BMD in the distal forearm may be already reduced at the clinical manifestation of the disease.

A nationwide study of SLE in Japanese identified subgroups of patients with clear signs patterns and associations between signs and age or sex.

We performed a nationwide study to determine the distributions of the signs and clinical markers of systemic lupus erythematosus (SLE) and identify any patterns in their distributions to allow patient subclassification. We obtained 256,999 patient-year records describing the disease status of SLE patients from 2003 to 2010. Of these, 14,779 involved patients diagnosed within the last year, and 242,220 involved patients being followed up. Along with basic descriptive statistics, we analyzed the effects of sex, age and disease duration on the frequencies of signs in the first year and follow-up years. The patients and major signs were clustered using the Ward method. The female patients were younger at onset. Renal involvement and discoid eczema were more frequent in males, whereas arthritis, photosensitivity and cytopenia were less. Autoantibody production and malar rash were positively associated with young age, and serositis and arthritis were negatively associated. Photosensitivity was positively associated with a long disease duration, and autoantibody production, serositis and cytopenia were negatively associated. The SLE patients were clustered into subgroups, as were the major signs. We identified differences in SLE clinical features according to sex, age and disease duration. Subgroups of SLE patients and the major signs of SLE exist.

Discordance and accordance between patient's and physician's assessments in rheumatoid arthritis.

OBJECTIVES: The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria for rheumatoid arthritis (RA) are more stringent than index-based criteria, making it more difficult to achieve a patient's global assessment (PGA) than an evaluator's global assessment (EGA). We investigated the reason for the discrepancy between the PGA and the EGA in a Japanese clinical cohort. METHOD: We assessed clinical and laboratory variables in our clinical cohort. The frequency of remission achievement according to the ACR/EULAR remission criteria and predictors of the discrepancy between the PGA and EGA were analysed. RESULTS: Of 370 patients with RA, 89 fulfilled PGA criteria and 167 patients fulfilled EGA criteria. The PGA was highly correlated with the visual analogue scale (VAS) pain score and non-inflammatory variables including Steinbrocker class and the Health Assessment Questionnaire Disability Index (HAQ-DI). Conversely, inflammatory variables, including swollen joint count (SJC), tender joint count (TJC), and C-reactive protein (CRP) levels, were significantly associated with the EGA. The main predictors of the discrepancy between the PGA and the EGA were patient's VAS pain score, SJC, and functional disability. CONCLUSIONS: Increased pain and functional disability led to a discrepancy towards a worse PGA than EGA, whereas increased SJC led to an accordance towards a worse EGA.

Interferon-gamma release assay for diagnosing Mycobacterium tuberculosis infections in patients with systemic lupus erythematosus.

Our aim was to analyze the performance of an interferon-gamma release assay, QuantiFERON-TB Gold (QFT-2G), for diagnosing Mycobacterium tuberculosis (MTB) infection in patients with systemic lupus erythematosus (SLE). We performed the QFT-2G and tuberculin skin test (TST) in 71 SLE patients. The QFT-2G results of 279 patients with other connective tissue diseases (CTD) and 35 healthy controls were analyzed. Of the 71 SLE patients, two (2.8%) were positive and 46 (64.8%) were negative by QFT-2G. All SLE patients had no evidence of active MTB infection, apart from one. QFT-2G produced a significantly higher number of indeterminate results in patients with SLE (23/71, 32.4%) compared with those with other CTD (5.7%) or healthy controls (0%) (p < 0.0001 and p < 0.0001). Decreased lymphocyte counts and high SLEDAI scores in SLE patients were shown to be risk factors for indeterminate results by multivariate analysis (p = 0.02 and p = 0.04). Among all patients with CTD, SLE itself and lymphocytopenia were found to be independent risks for indeterminate results (p = 0.00000625 and p = 0.000107). In conclusion, QFT-2G may have more potential to assist in the diagnosis of active and latent MTB infection than TST in SLE patients. However, because of the high frequency of indeterminate results, caution must be used when interpreting the results of QFT-2G among SLE patients, especially those who have parallel or subsequent flares.

Medical consultation rate of allergic rhinitis and pollinosis surveillance in Aichi, Japan.

The medical consultation rate of allergic rhinitis (AR) was analysed using Japan National Health Insurance records of Aichi Prefecture for May 1989. Data collected from 88 cities, towns and villages were tabulated and divided into five-year age groups. The standardized medical consultation rate (SMCR) of AR in each municipality was then calculated. It was found that SMCR of AR did not correlate well with the pollen count for Japanese cedars, Japanese cypresses or gramineae, respectively, but a weak correlation with the mean yearly levels of nitrogen dioxide was suggested by the data. There was a significant positive correlation between SMCR of AR and the mean yearly levels of suspended particulate matter, the major element of which is diesel exhaust particulate.

An epidemiological study on marital status and cancer incidence.

The relationship between marital status and cancer incidence was examined based on 49,191 incident cases aged 30 or over in 1980-1984 by using the data from Aichi Cancer Registry and census data. Although married and widowed people did not show increased incidence for any cancer site studied, single and divorced people showed statistically significantly increased or decreased risks for several sites of cancer. Single males showed an increased risk for esophageal cancer and a decreased risk for lung cancer. Divorced males showed increased risks for cancers of the mouth & pharynx, esophagus, liver, skin and brain. Single females showed increased risks for cancers of the esophagus, stomach, small intestine, liver, pancreas, lung, breast, corpus uteri, ovary & fallopian tube and other female genital organs and a decreased risk for cervical cancer. Divorced females showed increased risks for cancers of the larynx, breast, all parts of uterus and cervix uteri and a decreased risk for biliary tract cancer. The increased risk for breast cancer in single females was more pronounced in older age groups and the increased risks for several sites of cancer in divorced people were more pronounced in younger age groups. These findings may be partly explained by differences in reproductive factors and life style, especially smoking and drinking habits.

Alcohol consumption and cancers of hormone-related organs in females.

The relations between alcohol consumption and cancers of the breast, corpus uteri and ovary were investigated in a case-control study involving 1,740 cases of breast cancer, 239 cases of cancer of the corpus uteri, 417 cases of ovarian cancer and 8,920 controls with other cancer sites identified from the Aichi Cancer Registry, Japan 1980-1986. The age-adjusted relative risk (RR) of daily alcohol drinkers compared to non-drinkers was significantly increased for breast cancer (RR = 1.36, 95% confidence interval (CI) 1.04-1.78), that for cancer of the corpus uteri was lowered insignificantly (RR = 0.44, 95% CI 0.15-1.38) and that for ovarian cancer was significantly lowered (RR = 0.38, 95% CI 0.16-0.90). The increase in the risk of breast cancer associated with daily alcohol drinking was evident in the age range 50 and over, the risk specified by type of alcoholic beverage being highest for beer. Multivariate analyses controlled for age, residence, marital status, occupation, smoking habit and family history of breast cancer did not materially change the RRs of daily alcohol drinkers. Despite the several limitations of the study, the results were consistent with those of previous studies from other countries, suggesting that alcohol consumption may contribute to the risk of breast cancer in Japanese woman, as it dose elsewhere. The present study also suggested alcohol consumption not to be associated with elevated risks of cancer in other hormone-related organs in females, and possibly to be associated with a decreased risk of ovarian cancer.

Pseudothrombocytopenia with cold-type platelet agglutinins.

Pseudothrombocytopenia is an in vitro phenomenon of platelet agglutination and clumping in the presence of EDTA on the electronical measurement of platelet count. Agglutinins reacting with platelet antigens belong to one heavy and one light chain of immunoglobulins with or without complement by immunofluorescence. The platelets are markedly agglutinated in EDTA, but scarcely in the presence of other anticoagulants. Agglutinations seem to occur more readily at cold temperature rather than at 37 degrees C.