Changes in foot function, disease activity, and disability after forefoot resection arthroplasty in patients with rheumatoid arthritis.

The purpose of this study was to investigate the changes in foot function, disease activity, and disability in patients with RA after resection arthroplasty of the forefoot (arthroplasty). Arthroplasty was performed on 11 patients with RA. All study patients underwent clinical assessment to measure disease activity (Disease Activity Score in 28 Joints-C-reactive protein, DAS28-CRP), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI) and foot function (Foot Function Index, FFI) at the following stages: preoperatively and 1, 3, and 12 months after surgery. Following arthroplasty, foot function improved significantly, as assessed by FFI total and subscales (pain, disability, and limitation of activity) (P<0.001, P<0.001, P<0.001, and P=0.002, respectively). Disease activity was significantly improved in relation to DAS28-CRP and its subscales of number of swollen joints and patient global assessment (PtGA) (P=0.033, P=0.008, and P=0.038, respectively). There was no significant difference in disability, as assessed by the HAQ-DI and its subscale, HAQ-walking (P=0.150 and P=0.597, respectively). Foot function improved significantly after arthroplasty, and was maintained at 12 months postoperatively. Additionally, our study showed that disease activity and its subscale PtGA improved after arthroplasty.

Association of higher methotrexate dose with lymphoproliferative disease onset in rheumatoid arthritis patients.

OBJECTIVE: Methotrexate (MTX) is used as an anchor drug for rheumatoid arthritis (RA). Lymphoproliferative disease (LPD) occasionally develops in patients treated with MTX, and is known as MTX-associated LPD (MTX-LPD). Although MTX-LPD occurs mainly in RA patients, it has not been established if MTX administration is an independent risk factor for LPD in RA patients. We examined the clinical characteristics of MTX-LPD in Japanese RA patients and attempted to determine the risk factors for MTX-LPD development. METHODS: We performed a nested case-control study on RA patients. We enrolled 5,753 RA patients from Kagawa, Japan. In age- and sex-matched patients, we separated patients who did not develop LPD under MTX treatment (MTX non-LPD group) from those that did (MTX-LPD group) and conducted a comparative examination. We used multivariate analysis to determine the independent risk factors for MTX-LPD onset. RESULTS: There were 28 patients in the MTX-LPD group and 125 patients in the MTX non-LPD group. Multivariate analysis of the parameters extracted by univariate analysis revealed that the mean MTX dose was a risk factor for MTX-LPD after adjusting for age; therefore, higher MTX dose is associated with LPD onset in RA patients. CONCLUSION: MTX is an independent risk factor for LPD onset in Japanese RA patients.

A case of femoral nerve palsy caused by iliopectineal bursitis associated with rheumatoid arthritis.

We report the case of a 46-year-old woman with rheumatoid arthritis who developed femoral nerve palsy caused by an enlarged iliopectineal bursa. Surgical excision revealed that the iliopectineal bursa was connected with the hip joint. The patient showed good recovery from the femoral nerve palsy after surgery. It was considered that iliopectineal bursitis had developed following the synovial inflammation of the hip joint.

Dermatomyositis associated with membranous nephropathy in a 43-year-old female.

A 43-year-old woman was admitted to our hospital for myalgic pain and erythema of the face and thighs. She had been diagnosed with dermatomyositis at another hospital 8 years earlier and proteinuria had developed suddenly. Renal histological examination revealed membranous nephropathy. Membranous nephropathy associated with dermatomyositis is very rare. To date, malignant disease has not been detected in our patient, but the serum level of CA125, a tumor marker, has been elevated to 1,097 U/ml. The increased CA125 level is related to the degree of proteinuria and after prednisolone and cyclosporine therapy, proteinuria and the CA125 level gradually decreased.

Autoantibody in a patient with chronic hepatitis C virus infection showing complete remission after interferon therapy.

A 42-year-old woman was admitted to Kinashi Ohbayashi Hospital for liver dysfunction. She presented with hepatitis C viral infection accompanied by autoimmune hepatitis-like serological manifestations, such as antinuclear antibody (ANA), antismooth muscle cell antibody and especially anti-ribonucleoprotein (RNP) antibody and anti-SSB antibody. After interferon therapy, hepatitis C virus was not detected and ANA, anti-RNP antibody and anti-SSB antibody disappeared. To our knowledge, this is the first reported hepatitis C patient showing anti-RNP antibody and anti-SSB antibody, having complete remission after interferon therapy.