Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study.

OBJECTIVES: Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients. METHODS: Patients with RA were administered TCZ, with or without MTX, for 3 years; those who received TCZ+MTX combination therapy were selected. After remission was achieved, MTX was discontinued without flare development in one group (discontinued [DISC] group, n = 33) and continued without flare development in another group (maintain [MAIN] group, n = 37). The clinical efficacy of TCZ+MTX therapy, patient background characteristics, and adverse events were compared between groups. RESULTS: The disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) at 3, 6, and 9 months was significantly lower in the DISC group (P < .05, P < .01, and P < .01, respectively). Further, the DAS28-ESR remission rate at 6 and 9 months and Boolean remission rate at 6 months were significantly higher in the DISC group (P < .01 for all). Disease duration was significantly longer in the DISC group (P < .05). Furthermore, the number of patients with stage 4 RA was significantly higher in the DISC group (P < .01). CONCLUSIONS: Once remission was achieved, MTX was discontinued in patients who responded favorably to TCZ+MTX therapy, despite the prolonged disease duration and stage progression.

Retropharyngeal calcific tendinitis: A rare, benign, but painful condition with stiff neck.

A 51-year-old afebrile man visited the hospital with acute severe neck pain with stiff neck, but cervical CT showed no calcification around the odontoid process. Cervical MRI revealed prevertebral hyperintense area of edema at the C1-C5 vertebral bodies, providing the diagnosis of retropharyngeal calcific tendinitis. The patient was spared for lumbar puncture, and his symptoms swiftly disappeared only with oral NSAIDs.

Clinical features and radiological findings of 67 patients with SAPHO syndrome.

OBJECTIVES: The purpose of this study was to facilitate the understanding of the SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis) syndrome by analyzing the clinical and radiological features of 67 Japanese patients with SAPHO syndrome. METHODS: Sixty-seven Japanese patients (female/male: 44/23, mean age at onset: 48.5 years) were diagnosed with SAPHO syndrome from 2002 to 2013 at our hospital. Medical records and radiological imaging of these patients were retrospectively reviewed. RESULTS: Among the 67 patients, 41 had dermatological manifestations, such as palmoplantar pustulosis, acne, and psoriasis. Initial symptom was local pain in all patients, and the most common initial site of the symptom was the anterior chest. Bacterial and fungal cultures from 20 bone biopsies were all negative. Histopathological diagnosis of the specimens was non-specific inflammation in all cases. Bone lesions were observed in 65 patients (97.0%). On the other hand, articular lesions including enthesitis were found in 31 patients (46.2%). CONCLUSION: SAPHO syndrome had different clinical and radiological aspects. The clinical features were not remarkable, except the dermatological manifestations and the involvement of the anterior chest. Bone lesions including hyperostosis and osteitis were found radiographically in the majority of patients with SAPHO syndrome. These are the characteristics of the SAPHO syndrome, with the exclusion of other bone diseases.

Clinical and structural remission rates increased annually and radiographic progression was continuously inhibited during a 3-year administration of tocilizumab in patients with rheumatoid arthritis: A multi-center, prospective cohort study by the Michinoku Tocilizumab Study Group.

OBJECTIVE: To evaluate the clinical and structural efficacy of tocilizumab (TCZ) during its long-term administration in patients with rheumatoid arthritis (RA). METHODS: In total, 693 patients with RA who started TCZ therapy were followed for 3 years. Clinical efficacy was evaluated by DAS28-ESR and Boolean remission rates in 544 patients. Joint damage was assessed by calculating the modified total Sharp score (mTSS) in 50 patients. RESULTS: When the reason for discontinuation was limited to inadequate response or adverse events, the 1-, 2-, and 3-year continuation rates were 84.0%, 76.8%, and 72.2%, respectively. The mean DAS28-ESR was initially 5.1 and decreased to 2.5 at 6 months and to 2.2 at 36 months. The Boolean remission rate was initially 0.9% and increased to 21.7% at 6 months and to 32.2% at 36 months. The structural remission rates (ΔmTSS/year ≤ 0.5) were 68.8%, 78.6%, and 88.9% within the first, second, and third years, respectively. The structural remission rate at 3 years (ΔmTSS ≤ 1.5) was 66.0%, and earlier achievement of swollen joint count (SJC) of 1 or less resulted in better outcomes. CONCLUSIONS: TCZ was highly efficacious, and bone destruction was strongly prevented. SJC was an easy-to-use indicator of joint destruction.

The bone tissue compatibility of a new Ti-Nb-Sn alloy with a low Young's modulus.

A Ti-Nb-Sn alloy was developed as a new ß-type titanium alloy which had a low Young's modulus and high strength. The Young's modulus of the Ti-Nb-Sn alloy was reduced to about 45 GPa by cold rolling, much closer to human cortical bone (10-30 GPa) than that of Ti-6Al-4V alloy (110 GPa) and other ß-type titanium alloys developed for biomedical applications. The tensile strength of the Ti-Nb-Sn alloy was increased to a level greater than that of Ti-6Al-4V alloy by heat treatment after severe cold rolling. In this study the cytotoxicity of Ti-25Nb-11Sn alloy was evaluated in direct contact cell culture tests using metal disks and the bone tissue compatibility - examined using metal rods inserted into the medullary canal of rabbit femurs. The remarkable findings were that: (1) there were no significant differences in the relative growth ratio and relative absorbance ratio between cells grown with the Ti-Nb-Sn alloy, Ti-6Al-4V alloy and CP-Ti in direct contact cell culture tests; (2) there were no significant differences in the load at failure between the Ti-Nb-Sn alloy and Ti-6Al-4V alloy in pull-out metal rods tests; (3) there were no significant differences in new bone formation around metal rods between the Ti-Nb-Sn alloy and Ti-6Al-4V alloy in histological evaluations. The new Ti-Nb-Sn alloy with an elasticity closer to that of human bone is thus considered to be bioinert while also having a high degree of bone compatibility similar to that of Ti-6Al-4V alloy.