Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy. METHODS: Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery. RESULTS: In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7). CONCLUSIONS: ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.

DOI： 10.1186/s12891-023-07151-w

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objectives

To report up to 3-year safety and effectiveness of certolizumab pegol (CZP) in Japanese patients with rheumatoid arthritis from a postmarketing surveillance study.

Methods

Patients enrolled previously completed 24 weeks of CZP in the 24-week postmarketing surveillance study. Adverse drug reactions (ADRs) were recorded for patients who received ≥1 CZP dose. Effectiveness outcomes were 28-joint Disease Activity Score with erythrocyte sedimentation rate and European Alliance of Associations for Rheumatology response. Week 24–156 safety and Week 0–52 effectiveness data are reported here.

Results

A total of 781 patients were enrolled, with 735 and 376 patients evaluated for safety and effectiveness, respectively. Within the safety set, 17.8% (131/735) of patients reported ADRs; 9.4% (69/735) reported serious ADRs. Among patients with history of respiratory, thoracic, and mediastinal disorders, 38.4% (28/73) reported ADRs. The most frequent ADRs were infections and infestations (11.8%; 87/735); skin and subcutaneous tissue disorders (1.9%; 14/735); respiratory, thoracic, and mediastinal disorders (1.6%; 12/735). Mean 28-joint Disease Activity Score with erythrocyte sedimentation rate reduced from 4.6 (Week 0) to 2.8 (Week 52). At Week 52, 51.8% (161/311) of patients achieved European Alliance of Associations for Rheumatology Good response.

Conclusions

The long-term safety and effectiveness of CZP in the real-world setting in Japan were consistent with previously reported data; no new safety signals were identified.

DOI： 10.1093/mr/roae019

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Other Link： https://academic.oup.com/mr/article-pdf/34/6/1103/60153600/roae019.pdf

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objectives

Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA.

Methods

These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology.

Results

The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline.

Conclusions

The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases.

DOI： 10.1093/mr/roae011

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Other Link： https://academic.oup.com/mr/article-pdf/34/6/1095/60153479/roae011.pdf

Language：English   Publishing type：Research paper (scientific journal)  

We retrospectively investigated the mid-term outcomes of arthroplasty using the AVANTA silicone implant for thumb metacarpophalangeal (MCP) joints with boutonniere deformity in patients with rheumatoid arthritis (RA). This study involved 36 thumbs of 33 RA patients with a mean follow-up period of 5.1 years (range, 2.0-13.3). Postoperatively, the mean extension was significantly increased and the mean flexion was significantly decreased (p<0.001, p<0.001, respectively), resulting in the mean arc of range of motion (ROM) shifting in the direction of extension after surgery. Implant fracture was observed in 10 thumbs (28%), and 4 of these (11%) underwent revision surgery. The survivorship with implant fracture and revision surgery as endpoints were 73.4% and 91.8% at 5 years, respectively. The preoperative arc of ROM and the postoperative flexion range of the implant-fracture group were significantly greater than those in the no-implant-fracture group (p=0.039, 0.034, respectively). These results suggest the importance of patient education and careful rehabilitation to prevent excessive flexion. Overall, the AVANTA silicone implant showed a relatively high rate of implant fracture at our institute.

DOI： 10.18926/AMO/66673

PubMed

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Publishing type：Research paper (scientific journal)  

DOI： 10.3390/ijms25031443

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Corrective osteotomy for intra-articular malunion is a challenging procedure. However, recent advancements, including patient-matched instruments created on the basis of preoperative computer simulation, enable accurate intra-articular correction. We hypothesized that intra-articular corrective osteotomy using patient-matched instruments for the treatment of distal radial intra-articular malunion would reduce intra-articular deformity and restore wrist function at 12 months of follow-up. METHODS: This prospective study included 12 patients with distal radial intra-articular malunion who underwent intra-articular corrective osteotomy external to the joint using patient-matched instruments. The primary end point was the maximum step-off on the articular surface of the distal radius, measured with use of computed tomography (CT), with an expected postoperative value of ≤1.5 mm. The secondary end points included the gap of the articular surface; range of motion; grip strength; pain evaluated using a visual analog scale (VAS); patient satisfaction; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Patient-Rated Wrist Evaluation (PRWE) score. A mean postoperative step-off of ≤1.5 mm for the primary end point was assessed with use of the 1-sample t test. The secondary end points were assessed with use of the Dunnett multiple comparison test. RESULTS: The average step-off significantly improved from 3.75 ± 1.04 mm preoperatively to 0.51 ± 0.40 mm at the 52-week postoperative follow-up and was maintained within 1.5 mm. The average wrist and forearm range of motion, VAS score, grip strength, DASH score, and PRWE score significantly improved. Eleven patients were either very satisfied or satisfied with their outcomes. CONCLUSIONS: The use of patient-matched instruments could contribute to improving postoperative outcomes of intra-articular corrective osteotomy procedures involving the distal radius. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.OA.24.00026

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.3288-23

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms &gt;12 months between the control and rehabilitation groups at the final follow-up.

DOI： 10.3390/jcm12227187

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Authorship：Lead author   Language：Japanese  

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Authorship：Lead author   Language：Japanese  

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Language：Japanese  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

Total wrist arthroplasty is a challenging procedure for wrist joints severely destroyed by rheumatoid arthritis. The most common postoperative complication of total wrist arthroplasty is the loosening of the carpal component. Revision surgeries for failed total wrist arthroplasties can be complicated owing to severe bone loss and concomitant soft-tissue problems. Here we report a case (68-year-old woman with a history of rheumatoid arthritis for 24 years) of severe aseptic loosening of semi-constrained total wrist arthroplasty and its salvage surgery. During the primary arthroplasty procedure, severe instability at the second through fifth carpometacarpal joints was observed, and arthrodesis of these joints was required. The radiographs obtained nine months after surgery showed loosening of the carpal component. Subsequently, she suffered a stroke, resulting in a loss of follow-up, and higher stress was loaded on her upper extremities during standing and walking. In the radiograph taken at her revisit 25 months after the primary surgery, the subsidence of the carpal component progressed, and loosening of the radial component was observed. Total wrist arthrodesis was performed using a bulk bone allograft of the femoral head, combined with a penetrating Wrist Fusion Rod®. Rapid bone union was achieved without soft tissue irritation. We conclude that wrist arthrodesis with a bulk bone allograft combined with an intramedullary nail is a reasonable option for failed total wrist arthroplasty.

DOI： 10.1093/mrcr/rxad048

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Authorship：Lead author   Language：Japanese  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objective

We retrospectively reviewed the records of rheumatoid arthritis (RA) patients who underwent orthopaedic surgery to examine the influence of the perioperative use of Janus kinase (JAK) inhibitors on early postoperative complications.

Patients and Methods

Thirty-two patients with RA under disease control with JAK inhibitors who underwent 49 orthopaedic procedures were included in the study. Patient records after surgery were investigated for surgical site infection (SSI), delayed wound healing (DWH), a flare-up of the disease, preoperative and postoperative absolute lymphocyte counts (ALCs), venous thromboembolism, and other postoperative complications.

Results

JAK inhibitors were continued during the perioperative period in 31 procedures. In the remaining 18 procedures, JAK inhibitors were discontinued perioperatively with a mean discontinuation period of 2.4 days. No instances of SSI were identified in any patient during at least 90 days’ follow-up, while DWH was seen in one patient. Disease flare-up was noted in two patients after 3 and 9 days of discontinuation of JAK inhibitors, respectively. The ALCs significantly decreased on postoperative Day 1 (P &amp;lt; .0001), and there was a significant correlation between pre- and post-one-day ALCs (r = 0.75, P &amp;lt; .0001).

Conclusion

JAK inhibitors seem to be safe during the perioperative period of orthopaedic surgery.

DOI： 10.1093/mr/road047

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(株)診断と治療社  

＜文献概要＞Headline 1 関節リウマチでは,薬物療法が適切に行われたうえで,残存する関節症状に対する非薬物療法が検討される.関節注射やリハビリテーション,装具療法などの保存療法が無効な場合は手術治療が検討される.2 関節破壊・変形が軽度な段階から高度に進行した段階まで,様々な手術方法の適応があるが,関節構造を温存し,より高度な機能再建を求めるならば早期に手術治療を行ったほうがよい.3 合併する腱断裂,絞扼性神経障害や脊椎脊髄障害などの進行にも注意する必要があり,発症・進行が疑われる場合は整形外科へのコンサルトが必要である.4 手術治療のタイミングを逸さないためには,手術適応の判断だけではなく保存的治療や経過観察も含めた内科・整形外科の連携体制がとられていることが望ましい.

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00697&link_issn=&doc_id=20230615020023&doc_link_id=%2Fae4digta%2F2023%2F011106%2F018%2F0823-0828%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4digta%2F2023%2F011106%2F018%2F0823-0828%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In chronic musculoskeletal pain patients, detection of sarcopenia is of significant clinical interest. Phase angle, which can be measured through bioelectrical impedance analysis (BIA), can detect sarcopenia; however, the evidence in chronic musculoskeletal pain patients is limited. This study aimed to assess the relationship between phase angle and sarcopenia in patients with chronic musculoskeletal pain. Our hypothesis was that phase angle would be a useful indicator to identify sarcopenia in patients with chronic musculoskeletal pain. METHODS: A total of 190 patients (51 men and 139 women) with chronic musculoskeletal pain were included in this retrospective cross-sectional study. Patient data of backgrounds, numeric rating scale score for pain, skeletal muscle index, and phase angle assessed using BIA were retrospectively reviewed. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. RESULTS: A total of 51 patients (26.7%), including 10 men (19.6%) and 41 women (29.5%), were diagnosed with sarcopenia. Phase angle, sarcopenia-related factors, age, and body mass index (BMI) differed significantly in patients with and without sarcopenia. On multiple logistic regression analysis, the prevalence of sarcopenia was significantly correlated with phase angle and BMI. The areas under the curve exhibited high accuracy in discriminating sarcopenia in men and moderate accuracy in both sexes and in women. CONCLUSIONS: Phase angle may be a valid discriminator of sarcopenia in patients with chronic musculoskeletal pain.

DOI： 10.1186/s13018-023-03567-1

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1302/2633-1462.41.BJO-2022-0151.R1

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Language：Japanese   Publisher：(一社)日本手外科学会  

関節リウマチ患者において,関節超音波検査(以下US)で滑膜炎を認めた関節と関節破壊が進行する関節は必ずしも一致しないことが報告されている.USで評価を行った手指・手関節の関節破壊に対する予後を検討した.調査開始時にUSによるパワードプラ(以下PD)スコアの計測が行われ,調査開始時および調査開始後1年以上経過時に両手単純X線写真による関節破壊の進行が評価可能であった関節リウマチ患者70例を対象とした.多変量解析ではPDスコアの合計値のみが関節破壊の有意な危険因子として同定された(オッズ比1.19,P=0.010).両手のPDスコアの合計値は手関節の関節破壊(P=0.001)およびMCP関節の関節破壊(P<0.001)と相関を認めた.各関節のPDスコアは同関節の関節破壊と相関を認めた(P<0.001).諸家の報告と異なりUSで滑膜炎を認めた関節は関節破壊が進行しやすい結果であった.(著者抄録)

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

当院では以前より尺骨突き上げ症候群に対しては尺骨骨幹部での短縮骨切りを施行してきたが,近年皮膚切開量が短く,骨癒合が有利な尺骨遠位部での骨切りをおこなっている.今回骨切り部位別に治療成績を比較検討したので報告する.尺骨突き上げ症候群に対して骨切り術を行い,術後評価可能であった37例を対象とした.骨幹部骨切り症例は15例,遠位部骨切り症例は,22例含まれていた.これらの群に対して平均の骨癒合期間,握力,手関節可動域,DASH,Pain-VAS,および術後合併症をそれぞれ比較した.平均骨癒合期間は骨幹部骨切り群では3.3ヵ月,遠位部骨切り群では2.6ヵ月,術後1年経過時の握力については骨幹部,遠位部骨切り群それぞれ平均31.7kg,30.2kgであった.術後1年経過時の掌背屈可動域は骨幹部,遠位部骨切り群それぞれ150.0度,152.7度,回内外可動域は骨幹部,遠位部骨切り群それぞれ155.0度,170.1度であり,平均術後成績に有意差は認められなかった.DASHに関しては骨幹部骨切りでは23.9から20.1,遠位部骨切りでは33.3から9.9へと遠位部骨切りに関してのみ術後有意差をもって改善していた.またVASを用いた痛み評価では骨幹部骨切りでは7.2から1.0,遠位部骨切りでは5.8から1.2へとどちらの群も有意差をもって改善していた.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jos.2022.09.017

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objectives

We examined the relationship between the Japanese version of Patient-Rated Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA).

Materials and Methods

This study involved 46 elbows of 40 RA patients. We collected clinical data 1 year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures preoperatively and postoperatively.

Results

Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength [B = −0.09; 95% confidence interval (95% CI) −0.17 to −0.01, p = 0.03] and preoperative Hand20 (B = 0.31, 95% CI 0.03–0.58, p = 0.03) were significant factors that might influence the postoperative PREE-J.

Conclusions

The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

DOI： 10.1093/mr/roab100

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Other Link： https://academic.oup.com/mr/article-pdf/32/6/1041/46543404/roab100.pdf

Language：Japanese   Publisher：(一社)日本運動器理学療法学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

Chronic pain coexists with disability, anxiety, depression, and sleep disturbances, which are factors of pain chronicity in the fear-avoidance model. Self-efficacy for managing pain plays a protective role against pain chronicity. For chronic pain sufferers, social support from caregivers is important. However, such caregivers face enormous physical and mental burdens. This study aimed to assess how self-efficacy and factors related to the fear-avoidance model affect caregiver burden. Participants were 135 chronic pain patients and their caregivers who visited our outpatient pain special clinic. In clinical assessments, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), Athens insomnia scale (AIS), pain disability assessment scale (PDAS), pain self-efficacy questionnaire (PSEQ) for the patients and Zarit Burden Interview (ZBI) for their caregivers were evaluated. Participants were divided into 2 groups (L group ZBI < 24 points and H group ZBI ≥ 24 points) and compared. Regression analyses were conducted to identify factors correlated with the ZBI scores. Compared to L group, H group showed significantly higher NRS and HADs depression scores, and lower PSEQ scores. In univariate regression analysis, ZBI scores were significantly correlated with NRS, PCS, HADS anxiety, HADS depression, PDAS and PSEQ. Multiple linear regression analysis revealed that ZBI scores were significantly correlated with PSEQ. The caregivers who perceived high caregiver burden had significantly higher patients' pain intensity, depression, and lower self-efficacy than those who perceived low caregiver burden. Caregiver burden correlated with the pain intensity, pain catastrophizing, anxiety, depression, disability, and self-efficacy of chronic pain patients. Among these factors, self-efficacy was the most negatively correlated with caregiver burden. Treatments focused on increasing self-efficacy for managing pain have the potential to reduce caregiver burden.

DOI： 10.1097/md.0000000000030802

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

慢性疼痛患者における集学的治療が6ヵ月間可能であった集団の治療経過における継時的推移について,活動能力を指標に潜在プロフィール分析(Latent Profile Analysis:LPA)を用い集団を類型化すること,類型化された各集団の特徴について検討することである。結果,慢性疼痛患者において,活動能力の継時的推移は4つの集団に類型化できること,その治療経過は開始時の身体的パフォーマンスの状態で異なる治療経過を辿る可能性を明らかにした。(著者抄録)

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Tendons and ligaments are jointed to bones via an enthesis that is essential to the proper function of the muscular and skeletal structures. The aim of the study is to investigate the effect of mechanical stress on the enthesis. We used ex vivo models in organ cultures of rat Achilles tendons with calcaneus including the enthesis. The organ was attached to a mechanical stretching apparatus that can conduct cyclic tensile strain. We made the models of 1-mm elongation (0.5 Hz, 3% elongation), 2-mm elongation (0.5 Hz, 5% elongation), and no stress. Histological evaluation by Safranin O staining and Toluidin Blue and Picro Sirius red staining was conducted. Expression of sex-determining region Y-box 9 (Sox9), scleraxis (Scx), Runt-related transcription factor 2 (Runx2), and matrix metalloproteinase 13 (Mmp13) were examined by real-time polymerase chain reaction and immunocytochemistry. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end-labeling and live/dead staining and was conducted for evaluation of the apoptosis and cell viability. The structure of the enthesis was most maintained in the model of 1-mm elongation. The electronic microscope showed that the enthesis of the no stress model had ill-defined borders between fibrocartilage and mineralized fibrocartilage, and that calcification of mineralized fibrocartilage occurred in the model of 2-mm elongation. Sox9 and Scx was upregulated by 1-mm elongation, whereas Runx2 and Mmp13 were upregulated by 2-mm elongation. Apoptosis was inhibited by low stress. The results of this study suggested that 1-mm elongation can maintain the structure of the enthesis, while 2-mm elongation promotes degenerative changes.

DOI： 10.1002/jor.25210

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PubMed

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jor.25210

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Early sarcopenia detection using screening tools, such as SARC-F and SARC-CalF, has been proven reliable. However, the relationship between chronic musculoskeletal pain with sarcopenia is unknown. This study assessed sarcopenia morbidity as well as the reliability of sarcopenia screening with SARC-F and SARC-CalF in patients with chronic musculoskeletal pain. METHODS: Overall, 172 patients with chronic musculoskeletal pain were included in this cross-sectional study. All participants completed the SARC-F, SARC-CalF, numeric rating scale (NRS), and pain disability assessment scale (PDAS) assessments. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. Correlations between SARC-F and SARC-CalF scores and each measured variable were evaluated using univariate and multiple linear regression analyses. A receiver operating characteristic curve analysis was conducted, and reliabilities of SARC-F and SARC-CalF scores for diagnosing sarcopenia were compared. RESULTS: Thirty-nine patients were diagnosed with sarcopenia. Among these, 10 patients were <65 years old, and 29 were >65 years old. Both SARC-F and SARC-CalF scores significantly correlated with grip power, gait speed, skeletal mass index, numeric rating scale score, and PDAS score. In multiple linear regression analysis, SALC-F and SALC-CalF scores significantly correlated with PDAS score, skeletal mass index, and gait speed. The area under the curve were 0.70 for SARC-F and 0.88 for SARC-CalF; SARC-CalF had a significantly higher area under the curve than SARC-F. DISCUSSION: Sarcopenia was diagnosed in patients aged <65 years with chronic musculoskeletal pain. SALC-F and SARC-CalF scores showed a significant correlation with disability due to pain and were reliable sarcopenia screening tools for chronic musculoskeletal pain. SARC-CalF was more reliable than SARC-F.

DOI： 10.1097/MD.0000000000029568

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objectives

To report 24-week safety and effectiveness of certolizumab pegol (CZP) in Japanese patients with rheumatoid arthritis from a post-marketing surveillance study.

Methods

Enrolled patients were newly receiving CZP. All adverse events (AEs) and adverse drug reactions (ADRs) were recorded for patients who received ≥1 CZP dose. Effectiveness outcomes included: 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) and European Alliance of Associations for Rheumatology (EULAR) response. Missing data were imputed using the last observation carried forward.

Results

3727 patients were enrolled; safety and effectiveness were evaluated in 3586 and 1794 patients, respectively. 24.9% of patients reported AEs (893/3586), 14.7% reported ADRs (528/3586), 8.3% (298/3586) reported serious AEs and 5.3% (190/3586) reported serious ADRs. Selected serious ADRs of interest: infections (110; 3.1%), tuberculosis (6; 0.2%), interstitial pneumonia (15; 0.4%), malignancy (8; 0.2%), and hepatic function disorder (7; 0.2%). No allergic reactions, autoimmune disease, cardiac failure, demyelinating diseases, or pancytopenia were reported. Mean DAS28-ESR reduced from 4.8 (baseline) to 3.4 (final evaluation). At final evaluation, 34.7% of patients achieved EULAR good response.

Conclusions

These real-world safety and effectiveness results were consistent with previously reported data, with no new safety signals identified. Long-term, real-world CZP safety and effectiveness data are needed.

DOI： 10.1093/mr/roac073

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Other Link： https://academic.oup.com/mr/article-pdf/33/3/460/49879660/roac073.pdf

Language：Japanese   Publisher：(一社)日本手外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

ABSTRACT

Objectives

The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) and prepare an algorithm for non-drug and surgical treatments. This article is a digest version of the guidelines.

Methods

The Japanese Ministry of Health, Labour and Welfare’s research group, in collaboration with the JCR, used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. The consensus was formed by CPG panel members.

Results

We raised 19 clinical questions regarding non-drug and surgical treatments for RA and developed recommendations. The treatments included exercise therapy; occupational therapy; joint injection of corticosteroids; and orthopaedic surgeries including cervical spine surgery, wrist and foot arthroplasty, ankle arthrodesis, and replacement arthroplasty of the shoulder, elbow, finger, hip, knee, and ankle. Recommendations regarding the risks of surgery and perioperative discontinuation of medications have also been developed. Based on these recommendations, we created an original algorithm for the non-drug and surgical treatment of RA.

Conclusions

These recommendations are expected to serve rheumatologists, health care professionals, and patients with RA as tools for shared decision-making to treat residual limb joint symptoms and functional impairment.

DOI： 10.1093/mr/roac019

PubMed

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Other Link： https://academic.oup.com/mr/article-pdf/33/1/36/48626507/roac019.pdf

Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objectives

To examine the risk factors of surgical site infection (SSI), delayed wound healing, and death after orthopedic surgery in patients with rheumatoid arthritis (RA).

Methods

We identified articles indexed in the Cochrane Library, PubMed, and Japan Centra Revuo Medicina Web published from 2013 to 2019 and other articles. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised according to the Grading of Recommendations Assessment, Development, and Evaluation system with some modifications.

Results

After inclusion and exclusion by full-text review, 29 articles were analyzed. Use of biological disease modifying antirheumatic drugs was a risk factor of SSI (risk ratio 1.66, 95% confidence interval 1.25–2.19), but not of delayed wound healing. RA itself was a risk factor of SSI, and oral glucocorticoid use was a risk factor of SSI in three of the four studies analyzed and of postoperative death. Age, male sex, comorbidities such as diabetes mellitus and chronic obstructive pulmonary disease, surgical factors such as foot/ankle and spine surgery and longer operative time were risk factors of those postoperative complications.

Conclusion

Patients with those factors should be dealt with appropriate cautions to strike a risk–benefit balance of orthopedic surgeries.

DOI： 10.1080/14397595.2021.1913824

PubMed

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Other Link： https://academic.oup.com/mr/article-pdf/32/2/296/42644947/1913824.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objectives

This study aimed to evaluate patients’ opinions regarding their rheumatoid arthritis (RA) therapy and to reflect the patients’ perspectives in the 2020 update of the Japan College of Rheumatology clinical practice guidelines.

Methods

A self-administered questionnaire was mailed to 1600 members of the Japan Rheumatology Friendship Association, who were randomly selected by age and prefecture.

Results

A total of 1156 patients returned the questionnaire (response rate, 72.3%; mean age, 63.0 ± 11.9 years). Those who reported having discussed their treatment goals with their doctors (450 respondents, 38.9%) were more likely to be satisfied with their current medical care (odds ratio, 7.13; 95% CI 4.72–10.8) compared with those who had not discussed their goals nor had them explained (287 respondents, 24.8%). The benefits exceeded the adverse effects for all pharmacotherapy (methotrexate, corticosteroids, conventional synthetic antirheumatic drugs, biological agents, Janus kinase inhibitor, and anti-RANKL antibodies). However, while 74.2% of the respondents using biological agents perceived that ‘the favorable aspects outweighed the unfavorable aspects,’ most of those taking anti-RANKL antibodies (69.2%) felt uncertain.

Conclusions

The questionnaire successfully collected information regarding patients’ perceptions regarding their therapy. Further implementation of treat-to-target is necessary in Japan to improve patient satisfaction.

DOI： 10.1080/14397595.2021.1913276

PubMed

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Other Link： https://academic.oup.com/mr/article-pdf/32/2/307/42644853/1913276.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objectives

To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults.

Methods

PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications.

Results

Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of −2.79 (95% confidence interval [CI] − 3.74 to −1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90–4.21) and 1.32 (95%CI 0.53–3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64–0.91) and 1.92 (95%CI 1.31–2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively.

Conclusion

This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.

DOI： 10.1080/14397595.2021.1912922

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Other Link： https://academic.oup.com/mr/article-pdf/32/2/313/42644941/1912922.pdf

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

OBJECTIVE: It has been reported that levels of soluble CD30 in serum and joint fluid are significantly elevated in patients with rheumatoid arthritis (RA). This study aimed to investigate whether CD30 could be a therapeutic target for RA. METHODS: The expression and localization of CD30 were examined by immunohistochemical and double immunofluorescence staining on synovial tissue samples obtained from patients with RA or osteoarthritis (OA) during surgery. Changes in CD30 expression of fibroblast-like synoviocytes (FLS) from RA patients with or without TNFα and IL-1β stimulation were examined by the polymerase chain reaction (PCR) and flow cytometry. Collagen antibody-induced arthritis (CAIA) was created in DBA/1 mice, and the therapeutic effect of brentuximab vedotin (BV) was examined by clinical score, histological findings and measurement of serum levels of SAA, IL-6, and TNFα. RESULTS: CD30 expression was significantly higher in samples from patients with RA than from those with OA. Double immunofluorescence showed a low rate of co-localization of CD30 with CD20 or CD90, but a high rate of co-localization of CD30 and CD138. CD30 mRNA expression was upregulated 11.7-fold in FLS following stimulation by inflammatory cytokines. The clinical scores of CAIA mice were significantly lower following both BV treatments, however, the histological scores of CAIA mice were significantly lower only following treatment with high dose BV (70 mg/kg). CONCLUSIONS: CD30 was expressed on immunocompetent cells in synovial tissue from RA patients and in cytokine-stimulated FLS in vitro. High dose BV (70 mg/kg) showed significant therapeutic effects in ameliorating inflammation and joint destruction in CAIA mice, but low dose BV (30 mg/kg) was insufficient.

DOI： 10.1007/s00011-021-01537-z

PubMed

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Other Link： https://link.springer.com/article/10.1007/s00011-021-01537-z/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objective

This study aimed to evaluate satisfaction with total joint replacement (TJR) surgery among patients with rheumatoid arthritis (RA).

Methods

We mailed questionnaires to randomly selected members of the Japan Rheumatism Friendship Association, stratified by age and prefecture, throughout Japan. The questionnaire collected demographic and clinical characteristics as well as patients’ satisfaction with TJR and their current therapy.

Results

Of the 1156 patients who returned the questionnaire, 339 (29.3%) responded that they had had TJR of any type. The mean age was 66.6 years, and 94.4% were women. The mean time period from the hip and knee TJR was 14–15 years. Over half of the patients who had had TJR were satisfied with the results, especially those who had had hip (89.6%) and knee TJR (87.3%), who reported a high level of satisfaction. Multivariable linear regression analysis revealed that, in patients with knee TJR, satisfaction with current therapy was significantly related to whether they were satisfied with the results of the surgery.

Conclusion

Most patients with RA who had undergone TJR were satisfied with the results even after a long period of time, and their level of satisfaction was associated with their satisfaction with current therapy.

DOI： 10.1080/14397595.2021.1892258

PubMed

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Other Link： https://academic.oup.com/mr/article-pdf/32/1/121/42083431/1892258.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objectives

To evaluate the efficacy and safety of biosimilars compared with reference biological disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) as a part of the process of developing the 2020 update of the Japan College of Rheumatology guidelines for the management of RA.

Methods

PubMed, Cochrane Library, and Japan Centra Revuo Medicina were searched for articles to conduct a systematic review (SR). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system.

Results

Twenty randomized controlled trials were included (biosimilars of infliximab, etanercept, and adalimumab). A meta-analysis revealed that the risk ratios (RRs) and 95% confidence intervals (CIs) of achieving the American College of Rheumatology 50% response (ACR50) at week 24 and serious adverse events (SAEs) for biosimilars compared with the reference bDMARDs were 1.04 (0.98–1.10) and 0.84 (0.61–1.18), respectively. The RRs of achieving ACR50 and SAEs at week 24 were respectively 0.93 (0.69–1.26) and 2.15 (0.55–8.35) in the patients who switched to biosimilars from the reference bDMARDs and 0.92 (0.76–1.12) and 1.41 (0.32–6.15) in those who continued the reference bDMARDs.

Conclusion

Biosimilars and reference bDMARDs were equally useful for the management of RA.

DOI： 10.1080/14397595.2021.1899591

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Other Link： https://academic.oup.com/mr/article-pdf/32/1/74/42083415/1899591.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Objectives

This study aimed to evaluate the impact of exercise therapy on patient-reported outcomes (PROs) in rheumatoid arthritis (RA) as part of the process of updating the 2020 Japanese guidelines for the management of RA according to the Grading of Recommendations, Assessment, Development, and Evaluation system.

Methods

We searched PubMed, Japana Centra Revuo Medicina Web, and the Cochrane Library (from 2009 to 2018) to identify articles that evaluated PROs of exercise therapy and RA disease activity.

Results

A total of 662 articles were identified, including nine RCTs, and meta-analyses were performed on six RCTs on systemic exercise therapy and three RCTs on upper extremity exercise therapy. Analyzed exercise therapies were diverse, differing in target population, intervention method, and duration. Significant improvements were observed in the Health Assessment Questionnaire Disability Index (mean difference −0.35, 95% confidence interval (CI): −0.60 to −0.10), pain (standardized mean difference −2.04, 95% CI: −3.77 to −0.32), and SF-36. For upper extremity exercise therapy, significant improvements in PROs (Disabilities of the Arm, Shoulder, and Hand Questionnaire, Michigan Hand Outcome Questionnaire) were observed.

Conclusion

Exercise therapy in RA treatment improves patient subjective assessment of pain, physical function, and quality of life.

DOI： 10.1080/14397595.2021.1886653

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Other Link： https://academic.oup.com/mr/article-pdf/32/1/96/42083491/1886653.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

DOI： 10.1053/j.jfas.2021.06.008

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Purpose

We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities.

Methods

17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores.

Results

Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group ( p &lt; .001) and from 50.1 to 74.2 in the MTH preservation group ( p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation.

Conclusion

Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

DOI： 10.1177/10225536221117903

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/10225536221117903

Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title>Osteoarthritis (OA), the most common aging-related joint disease, is caused by an imbalance between extracellular matrix synthesis and degradation. Here, we discover that both strands of microRNA-455 (miR-455), -5p and -3p, are up-regulated by Sox9, an essential transcription factor for cartilage differentiation and function. Both miR-455-5p and -3p are highly expressed in human chondrocytes from normal articular cartilage and in mouse primary chondrocytes. We generate miR-455 knockout mice, and find that cartilage degeneration mimicking OA and elevated expression of cartilage degeneration-related genes are observed at 6-months-old. Using a cell-based miRNA target screening system, we identify hypoxia-inducible factor-2α (HIF-2α), a catabolic factor for cartilage homeostasis, as a direct target of both miR-455-5p and -3p. In addition, overexpression of both miR-455-5p and -3p protect cartilage degeneration in a mouse OA model, demonstrating their potential therapeutic value. Furthermore, knockdown of HIF-2α in 6-month-old miR-455 knockout cartilage rescues the elevated expression of cartilage degeneration-related genes. These data demonstrate that both strands of a miRNA target the same gene to regulate articular cartilage homeostasis.

DOI： 10.1038/s41467-021-24460-7

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Other Link： http://www.nature.com/articles/s41467-021-24460-7

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(一社)日本小児整形外科学会  

股関節痛を契機に診断に至った、強直性脊椎炎:ankylosing spondylitis(以下、AS)の1例を経験したので報告する。症例は16歳男子で、右股関節痛のため近医を受診した。大腿骨寛骨臼インピンジメントの診断で当科に紹介された。当科初診時、右股関節痛は安静時と夜間に強く、運動時には感じなかった。右股関節の可動域制限を認め疼痛誘発テストは陽性であった。詳細に問診したところ、過去に腰臀部痛と両股関節痛を繰り返していた。単純X線では左仙腸関節に硬化像を認め、MRIでは右股関節水腫と両仙腸関節周囲の骨髄浮腫像を認めた。血液検査では炎症反応が上昇し、HLA-B27は陽性であった。ASと診断し、疾患活動性が高かったため、Infliximabの適応とした。治療は奏効し、現在も継続している。詳細な病歴聴取により早期の診断と治療が行えたため、短期の成績ではあるが経過良好であった。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

治療が困難なRA(Difficult t-to-treat rheumatoid arthritis;D2T RA)とは、数種類の治療を行っても症状が改善せず、患者および経済的負担が大きいRA患者を指す新しい概念である。欧州リウマチ学会議(EULAR)では(1)治療不成功の病歴があり、(2)活動性/症候性の特性を有し、(3)臨床的に認識されていること、の3つの基準がすべて揃うものをD2T RAとした。D2T RAはRA患者の5～10%程度に発生するという報告が多く、患者は社会生活、労働能力、QOLに直接影響する症状に悩まされ続ける他、年間にかかる医療コストが非D2T RA患者より高額である。臨床的背景として、呼吸器障害、心血管系障害などの合併症、薬剤に対する有害事象、治療に対するアドヒアランスの低さの他、線維筋痛症や変形性関節症なとの疼痛症候群の合併、喫煙、肥満、抑うつなどが報告されている。治療にあたっては、患者教育、運動療法、心理学的介入、患者ケアの強化や医療従事者とのコミュニケーションの強化を基本として、個々の患者において過去の薬剤歴やmode of actionを考慮した薬剤選択や、整形外科的介入などによるカスタマイズを行って治療の最適化を図る必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02269&link_issn=&doc_id=20220204090002&doc_link_id=10.14961%2Fcra.33.271&url=https%3A%2F%2Fdoi.org%2F10.14961%2Fcra.33.271&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)先端医学社  

人工関節感染の有意なリスク因子として、BMI、DM、ステロイド、低アルブミン、関節リウマチ(RA)、輸血、悪性腫瘍、免疫低下、手術時間の延長、過去の手術歴などが指摘されており、疾患活動性のコントロールを含めて術前に可能な限り改善しせめて手術に臨むべきである。抗リウマチ薬には免疫抑制効果の懸念があり、長期の休薬はRAの再燃を惹起する可能性があるため、周術期の薬剤マネジメントが重要である。メトトレキサート(MTX)については、わが国のガイドラインでは12.5mg/週以下の使用量であれば再燃のリスクを抑制し、術後感染症、創傷治癒遅延に影響しないとされているため、休薬の必要はない。生物学的製剤、JAK阻害薬は免疫抑制作用によってSSIのリスクを増大させる可能性があるが、現時点では休薬期間を設けることによって安全に整形外科手術が可能である。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J06622&link_issn=&doc_id=20211203480007&doc_link_id=%2Fae6locoe%2F2021%2F000704%2F008%2F0314-0318%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae6locoe%2F2021%2F000704%2F008%2F0314-0318%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

We investigated the effects of adipose-derived extract (AE) on cultured chondrocytes and in vivo cartilage destruction. AE was prepared from human adipose tissues using a nonenzymatic approach. Cultured human chondrocytes were stimulated with interleukin-1 beta (IL-1β) with or without different concentrations of AE. The effects of co-treatment with AE on intracellular signaling pathways and their downstream gene and protein expressions were examined using real-time PCR, Western blotting, and immunofluorescence staining. Rat AE prepared from inguinal adipose tissues was intra-articularly delivered to the knee joints of rats with experimental osteoarthritis (OA), and the effect of AE on cartilage destruction was evaluated histologically. In vitro, co-treatment with IL-1β combined with AE reduced activation of the p38 and ERK mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of the p65 subunit of nuclear factor-kappa B (NF-κB), and subsequently downregulated the expressions of matrix metalloproteinase (MMP)-1, MMP-3, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, IL-6, and IL-8, whereas it markedly upregulated the expression of IL-1 receptor type 2 (IL-1R2) in chondrocytes. Intra-articular injection of homologous AE significantly ameliorated cartilage destruction six weeks postoperatively in the rat OA model. These results suggested that AE may exert a chondroprotective effect, at least in part, through modulation of the IL-1β-induced inflammatory signaling pathway by upregulation of IL-1R2 expression.

DOI： 10.3390/ijms22189781

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Language：Japanese   Publisher：(一社)日本臨床リウマチ学会  

【目的】関節リウマチ(RA)患者におけるボディイメージ・アセスメントツール(BIAT)の信頼性と有効性を検証すること。【方法】本研究は横断的観察研究である。外来通院中(非手術群)および入院中(手術群)のRA患者265例および健常人62名を対象にBIAT質問用紙への回答を依頼した。信頼性の評価として、内部一貫法にはRA患者265例のbaselineのデータを、再テスト法には健常群62名のbaseline・3週後、および非手術群76例のbaseline・半年・1年後のデータを用いた。既存の評価法としてBDI-II(Beck Depression Inventory-II、ベック抑うつ質問票)を用いてBIATの臨床評価としての妥当性を検討した。RA患者265例をDAS28-CRPに基づき、寛解、低疾患活動性、中疾患活動性、高疾患活動性に群別し、BIATとの関連を検討した。さらに非手術群と手術群でBIATに差があるかどうかを検討した。【結果】BIATは全体の評価でも各構成概念の評価でもα係数は0.8以上を示しており、高い一貫性を有していた。再テスト法ではBIAT全体平均において、健常群のbaselineと3週後で相関係数0.75、非手術群のbaselineと半年後および1年後で相関係数0.79および0.78であり、比較的高い信頼性が確認できた。BIAT全体スコアはBDI-IIと有意な負の相関(r=-0.64、P<0.001)を示した。BIATは疾患活動性が高いほど低値となる傾向があることが示された。手術群でのbaselineの平均BIATの値はいずれの構成概念においても非手術群よりも有意に低値であった。【結論】RA患者に対するBIATは、高い一貫性、安定性を有する評価ツールであることが確認された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To examine the risk factors of surgical site infection (SSI), delayed wound healing, and death after orthopedic surgery in patients with rheumatoid arthritis (RA). METHODS: We identified articles indexed in the Cochrane Library, PubMed, and Japan Centra Revuo Medicina Web published from 2013 to 2019 and other articles. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised according to the Grading of Recommendations Assessment, Development, and Evaluation system with some modifications. RESULTS: After inclusion and exclusion by full-text review, 29 articles were analyzed. Use of biological disease modifying antirheumatic drugs was a risk factor of SSI (risk ratio 1.66, 95% confidence interval 1.25-2.19), but not of delayed wound healing. RA itself was a risk factor of SSI, and oral glucocorticoid use was a risk factor of SSI in three of the four studies analyzed and of postoperative death. Age, male sex, comorbidities such as diabetes mellitus and chronic obstructive pulmonary disease, surgical factors such as foot/ankle and spine surgery and longer operative time were risk factors of those postoperative complications. CONCLUSION: Patients with those factors should be dealt with appropriate cautions to strike a risk-benefit balance of orthopedic surgeries.

DOI： 10.1080/14397595.2021.1913824

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (-0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

DOI： 10.3390/ijerph18147520

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: This study aimed to evaluate patients' opinions regarding their rheumatoid arthritis (RA) therapy and to reflect the patients' perspectives in the 2020 update of the Japan College of Rheumatology clinical practice guidelines. METHODS: A self-administered questionnaire was mailed to 1600 members of the Japan Rheumatology Friendship Association, who were randomly selected by age and prefecture. RESULTS: A total of 1156 patients returned the questionnaire (response rate, 72.3%; mean age, 63.0 ± 11.9 years). Those who reported having discussed their treatment goals with their doctors (450 respondents, 38.9%) were more likely to be satisfied with their current medical care (odds ratio, 7.13; 95% CI 4.72-10.8) compared with those who had not discussed their goals nor had them explained (287 respondents, 24.8%). The benefits exceeded the adverse effects for all pharmacotherapy (methotrexate, corticosteroids, conventional synthetic antirheumatic drugs, biological agents, Janus kinase inhibitor, and anti-RANKL antibodies). However, while 74.2% of the respondents using biological agents perceived that 'the favorable aspects outweighed the unfavorable aspects,' most of those taking anti-RANKL antibodies (69.2%) felt uncertain. CONCLUSIONS: The questionnaire successfully collected information regarding patients' perceptions regarding their therapy. Further implementation of treat-to-target is necessary in Japan to improve patient satisfaction.

DOI： 10.1080/14397595.2021.1913276

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: To provide an evidence base for clinical practice guidelines (CPG) for the management of rheumatoid arthritis (RA) in older adults. METHODS: PubMed, Cochrane library, and Japan Centra Revuo Medicina databases were searched for articles published between 1990 and 2019. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, with some modifications. RESULTS: Among 702 identified articles, there were 5 post-hoc analyses of randomized controlled trials and 10 observational studies. Meta-analysis of the former yielded a mean difference of the van der Heijde-modified total Sharp score of -2.79 (95% confidence interval [CI] - 3.74 to -1.84) for treatment with tumor necrosis factor inhibitors. The risk ratio (RR) for the American College of Rheumatology 50% response rate, and for serious adverse events was 2.83 (95%CI 1.90-4.21) and 1.32 (95%CI 0.53-3.31), respectively, for Janus kinase inhibitors. Meta-analysis of the observational studies yielded an RR for disease activity score-28 remission and serious infections of 0.76 (95%CI 0.64-0.91) and 1.92 (95%CI 1.31-2.81) for older-versus-younger patients receiving biological disease-modifying antirheumatic drugs, respectively. CONCLUSION: This systematic review provides the necessary evidence for developing CPG for the management of RA in older adults.

DOI： 10.1080/14397595.2021.1912922

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

DOI： 10.1080/14397595.2020.1794101

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Language：Japanese   Publisher：真興交易(株)医書出版部  

腰痛、特に3ヵ月以上症状が持続する慢性腰痛においては、器質的な要因のみならず、心理社会的な因子(psychological and social factors)が少なからず影響している。したがって、治療にあたり生物心理社会モデルに沿って病態を評価し、多職種が連携したチームでの集学的アプローチが有用である。われわれは、2012年より運動器慢性痛に対する集学的アプローチとして「痛みリエゾン外来」を開設し、多角的集学的な外来を多職種で行っている。慢性腰痛の患者さんの一例を提示しながら当センターでのチームアプローチを紹介する。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: This retrospective study aimed to investigate the risk factors associated with delayed wound healing (DWH) after orthopedic surgery in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs). METHODS: We reviewed medical records of 276 orthopedic procedures for 187 RA patients treated with bDMARDs. As a preoperative nutritional status assessment, we evaluated body mass index, prognostic nutritional index (PNI), and controlling nutritional status (CONUT). We evaluated DAS28-CRP, DAS28-ESR, face scale, global health, and HAQ-DI to assess the disease activity. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for DWH. RESULTS: In 276 procedures, DWH was identified in 24 patients (8.7%). Disease duration, foot and ankle surgery, and preoperative use of tocilizumab were significant in the univariate analyses. These variables were entered into a multivariate model, and it was revealed that preoperative use of tocilizumab and procedures in the foot and ankle were associated with an increased risk of DWH. CONCLUSION: The current retrospective study suggested that preoperative use of tocilizumab and procedures in the foot and ankle were risk factors for DWH.

DOI： 10.1080/14397595.2020.1790138

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: This study aimed to evaluate satisfaction with total joint replacement (TJR) surgery among patients with rheumatoid arthritis (RA). METHODS: We mailed questionnaires to randomly selected members of the Japan Rheumatism Friendship Association, stratified by age and prefecture, throughout Japan. The questionnaire collected demographic and clinical characteristics as well as patients' satisfaction with TJR and their current therapy. RESULTS: Of the 1156 patients who returned the questionnaire, 339 (29.3%) responded that they had had TJR of any type. The mean age was 66.6 years, and 94.4% were women. The mean time period from the hip and knee TJR was 14-15 years. Over half of the patients who had had TJR were satisfied with the results, especially those who had had hip (89.6%) and knee TJR (87.3%), who reported a high level of satisfaction. Multivariable linear regression analysis revealed that, in patients with knee TJR, satisfaction with current therapy was significantly related to whether they were satisfied with the results of the surgery. CONCLUSION: Most patients with RA who had undergone TJR were satisfied with the results even after a long period of time, and their level of satisfaction was associated with their satisfaction with current therapy.

DOI： 10.1080/14397595.2021.1892258

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Language：Japanese   Publisher：日本保健科学学会  

[目的]慢性疼痛患者を対象とする、痛みリエゾン外来における治療後の活動能力の帰結を類型化し、各集団の開始時の属性と活動能力の回復推移の特徴を後方視的に検討すること。[対象と方法]当院の痛みリエゾン外来受診患者のうち、6ヵ月間の治療継続が可能であった112例。活動能力の指標にはPDAS修正因子構造モデル13項目を用い、治療終了時点のデータを基に潜在ランク理論を用い類型化した。また各ランク間で開始時の属性、活動能力得点の継時的推移を比較検討した。[結果]潜在ランク数の推定では、ランク3が適合度の許容水準を満たした。また各ランク間で開始時の身体的パフォーマンスと心理的属性に統計的有意差を認め、活動能能力の得点推移は開始時より各時点で統計的有意差を示した。[結語]痛みリエゾン外来における活動能力の帰結は3つの集団に類型化できる事、各集団は開始時の属性、活動能力の推移とともに異なる特徴を示す事を明らかにした。(著者抄録)

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Many histological, mechanical, and clinical studies have been performed on the medial meniscus posterior root attachment, as it often tears in patients with osteoarthritic knee. Medial meniscal root repair is recommended in clinical situations; however, to date, no studies have examined the differences between meniscal root and horn cells. The aim of this study was, therefore, to investigate the morphology, reaction to cyclic tensile strain, and gene expression levels of medial meniscal root and horn cells. METHODS: Meniscal samples were obtained from the medial knee compartments of 10 patients with osteoarthritis who underwent total knee arthroplasty. Root and horn cells were cultured in Dulbecco's modified Eagle's medium without enzymes. The morphology, distribution, and proliferation of medial meniscal root and horn cells, as well as the gene and protein expression levels of Sry-type HMG box 9 and type II collagen, were determined after cyclic tensile strain treatment. RESULTS: Horn cells had a triangular morphology, whereas root cells were fibroblast-like. The number of horn cells positive for Sry-type HMG box 9 and type II collagen was considerably higher than that of root cells. Although root and horn cells showed similar levels of proliferation after 48, 72, or 96 h of culture, more horn cells than root cells were lost following a 2-h treatment with 5% and 10% cyclic tensile. Sry-type HMG box 9 and α1(II) collagen mRNA expression levels were significantly enhanced in both cells after 2- and 4-h cyclic tensile strain (5%) treatment. CONCLUSIONS: Medial meniscal root and horn cells have distinct morphologies, reactions to mechanical stress, and cellular phenotypes. Our results suggest that physiological tensile strain is important to activate extracellular matrix production in horn cells.

DOI： 10.1016/j.jos.2020.02.015

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: This study aimed to evaluate the impact of exercise therapy on patient-reported outcomes (PROs) in rheumatoid arthritis (RA) as part of the process of updating the 2020 Japanese guidelines for the management of RA according to the Grading of Recommendations, Assessment, Development, and Evaluation system. METHODS: We searched PubMed, Japana Centra Revuo Medicina Web, and the Cochrane Library (from 2009 to 2018) to identify articles that evaluated PROs of exercise therapy and RA disease activity. RESULTS: A total of 662 articles were identified, including nine RCTs, and meta-analyses were performed on six RCTs on systemic exercise therapy and three RCTs on upper extremity exercise therapy. Analyzed exercise therapies were diverse, differing in target population, intervention method, and duration. Significant improvements were observed in the Health Assessment Questionnaire Disability Index (mean difference -0.35, 95% confidence interval (CI): -0.60 to -0.10), pain (standardized mean difference -2.04, 95% CI: -3.77 to -0.32), and SF-36. For upper extremity exercise therapy, significant improvements in PROs (Disabilities of the Arm, Shoulder, and Hand Questionnaire, Michigan Hand Outcome Questionnaire) were observed. CONCLUSION: Exercise therapy in RA treatment improves patient subjective assessment of pain, physical function, and quality of life.

DOI： 10.1080/14397595.2021.1886653

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Objectives: To evaluate the efficacy and safety of tacrolimus in adult patients with rheumatoid arthritis (RA) by using the GRADE approach. Methods: We searched PubMed, Japana Centra Revuo Medicina Web (Ichu-shi web), and the Cochrane Database of Systematic Reviews. Articles fulfilling the predefined inclusion criteria were appraised and used for meta-analysis. The primary outcomes were American College of Rheumatology 20 (ACR20) and serum creatinine elevation. Other outcomes included ACR50, ACR70, changes in C-reactive protein, modified Health Assessment Questionnaire Disability Index, gastrointestinal disorders, metabolic and nutritional disorders, and infections and infestations. Results: We identified five randomized controlled studies, four of which compared tacrolimus to placebo and were included in the meta-analysis. The risk ratio of ACR20 achievement was 1.71 (95% confidence interval [CI] 1.20-2.42) for 1-2 mg/day and 2.30 (95% CI 1.79-2.96) for 3 mg/day. The risk ratio of creatinine elevation was 1.95 (95% CI 1.18-3.23) for 1-2 mg/day and 3.81 (95% CI 2.43-5.99) for 3 mg/day. Conclusion: Tacrolimus is effective with acceptable safety in the management of RA.

DOI： 10.1080/14397595.2020.1719607

Web of Science

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We investigated the expression and localization of the receptor activator nuclear factor κB ligand (RANKL) in cartilage from patients with rheumatoid arthritis (RA) of relevance to cartilage degeneration. We also examined the role of exogenous lymphotoxin (LT)-α on RANKL expression in human chondrocytes and its effect on in vitro osteoclast differentiation. Cartilage and synovial fluid samples were obtained from 45 patients undergoing total joint replacement surgery or joint puncture, including 24 patients with osteoarthritis (OA) and 21 patients with RA. RANKL expression in articular cartilage was examined by immunohistochemistry. LT-α concentrations in synovial fluid were measured using an enzyme-linked immunosorbent assay (ELISA). Normal human chondrocytes were stimulated with LT-α, and the relative mRNA levels of RANKL, osteoprotegerin (OPG), matrix metalloproteinase-9, and vascular endothelial growth factor were examined by real-time polymerase chain reaction. Soluble RANKL protein in culture media was measured using ELISA, and membrane-bound RANKL protein in cells was examined by western blotting. Co-cultures of human chondrocytes with peripheral blood mononuclear cells (PBMCs) were stimulated with macrophage-colony stimulating factor and LT-α, and osteoclast differentiation was evaluated by staining for tartrate-resistant acid phosphatase. LT-α concentrations were higher in RA synovial fluid than in OA samples. The population of RANKL-positive chondrocytes of RA cartilage was higher than that of OA cartilage, and correlated with cartilage degeneration. Stimulation of cultured human chondrocytes by LT-α increased RANKL expression, the RANKL/OPG ratio, and angiogenic factors. Membrane-bound RANKL in chondrocytes was up-regulated after stimulation of LT-α, whereas soluble RANKL in culture medium did not increase. Co-cultures of human chondrocytes and PBMCs demonstrated that LT-α stimulated human chondrocytes to produce RANKL and induced osteoclastic differentiation of PBMCs. RANKL produced by chondrocytes may contribute to cartilage destruction during RA and LT-α could promote the expression of RANKL in human chondrocytes.

DOI： 10.1371/journal.pone.0254268

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本サルコペニア・フレイル学会  

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Language：Japanese   Publisher：(一社)日本サルコペニア・フレイル学会  

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Language：Japanese  

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

BACKGROUND: Prevention and treatment for locomotive syndrome (LS) are important for extending healthy life expectancy. The 25-question geriatric locomotive function scale (GLFS-25) was developed to diagnose LS. The Fear-Avoidance model was proposed to explain pain chronicity. LS and chronic pain decrease activities of daily living; however, the relationships between LS and factors related to chronic pain in the Fear-Avoidance model are unknown. Objective of the current study was to assess the prevalence of LS and examine the factors of the Fear-Avoidance model and the GLFS-25 that affect the prevalence of LS in patients with chronic pain. METHODS: Participants included 281 patients (99 men, 182 women) aged over 40 years with chronic pain who visited our outpatient clinic for chronic pain. All participants completed the GLFS-25, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), and Athene insomnia scale (AIS). According to a GLFS-25 cutoff point, participants were divided into three groups (LS-2; GLFS-25 ≥ 16, LS-1; 7 ≤ GLFS-25 < 16, and non-LS; GLFS-25 < 7 points) and each parameter was compared among the groups, followed by multiple logistic regression analysis. Next, multiple linear regression analysis was performed to determine the factors associated with the GLFS-25. RESULTS: Of all 281 patients, 241 (85.8%) patients were diagnosed with LS-2. Univariate analysis revealed there were significant differences in NRS, PCS, HADS anxiety, HADS depression, and AIS among groups. Multiple logistic regression analyses showed PCS was significantly associated with LS-2 prevalence. The GLFS-25 was positively correlated with NRS, HADS depression, AIS in multiple linear regression analysis. CONCLUSIONS: We found that patients with chronic pain in our outpatient clinic had a significant rate of LS-2. The prevalence of LS-2 was significantly correlate with pain catastrophizing, and the GLFS-25 was significantly correlated with higher pain intensity, depression, and insomnia.

DOI： 10.1016/j.jos.2020.08.007

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

運動器慢性痛に対しては,多職種連携のチームアプローチ,多面的なアプローチが有用であることが認識されつつある。運動器慢性痛の患者さんのゴールは生活であること,その目的を共有し実践するためには,いろいろな因子を多面的に評価し,食事,睡眠,運動,生活リズム,生活習慣に目を向けた多職種によるトータルマネージメントが重要である。そして,暗くなりがちな痛み診療を明るい医療を目指し,臨んでいきたいと考えている。(著者抄録)

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Mirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels. Both pregabalin and mirogabalin act as nonselective ligands at the α2δ-1 and α2δ-2 subunits. Mirogabalin has a unique binding profile and long duration of action. Pregabalin has been reported to produce intolerable adverse effects in some patients. This study investigated outcomes associated with mirogabalin administration in patients with peripheral neuropathic pain who ceased treatment with pregabalin. METHODS: We retrospectively assessed peripheral neuropathic pain using the neuropathic pain screening questionnaire (NeP score) in 187 patients (58 men, 129 women) who were treated with mirogabalin. All patients had switched from pregabalin to mirogabalin due to lack of efficacy or adverse events. Differences in the treatment course (i.e., numeric rating scale (NRS) scores) were compared using one-way analysis of variance with Bonferroni post hoc tests. RESULTS: The mean age of the patients was 72.3 years (range, 30-94 years), and the mean duration of disease was 37 months (range, 3-252 months). After treatment with mirogabalin for 1 week, NRS scores significantly decreased compared with baseline and continued to decrease over time. After 8 weeks, NRS scores improved by ≥ 30% from baseline in 113 patients (69.3%). Twenty-four patients (12.8%) stopped mirogabalin treatment due to adverse events. Somnolence (26.7%), dizziness (12.3%), edema (5.9%), and weight gain (0.5%) were noted as adverse events of mirogabalin. CONCLUSIONS: The results of this investigation indicate that mirogabalin is safe and effective for reducing peripheral neuropathic pain.

DOI： 10.1186/s13018-020-01709-3

PubMed

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)  

In patients with osteoarthritis (OA), there is a decrease in both the concentration and molecular size of hyaluronan (HA) in the synovial fluid and cartilage. Cell migration-inducing hyaluronidase 1 (CEMIP), also known as hyaluronan (HA)-binding protein involved in HA depolymerization (HYBID), was recently reported as an HA depolymerization-related molecule expressed in the cartilage of patients with OA. However, the underlying mechanism of CEMIP regulation is not well understood. We found that CEMIP expression was transiently increased by interleukine-1β (IL-1β) stimulation in chondrocytic cells. We also observed that ERK activation and NF-κB nuclear translocation were involved in the induction of CEMIP by IL-1β. In addition, both administration of HA and mechanical strain attenuated the CEMIP induction in IL-1β-stimulated chondrocytes. In conclusion, we clarified the regulatory mechanism of CEMIP in chondrocytes by inflammatory cytokines and suggested the potential involvement in osteoarthritis development.

DOI： 10.3390/ijms21093140

PubMed

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

症例1は93歳女性で、右膝痛による体動困難を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.015、尿酸結晶(-)、CPPD結晶(+)、細胞数46325/μL(分画:Stab1%、Seg85%、Mono13%、Lymph1%)、糖77mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。症例2は81歳女性で、誘因のない右股関節痛を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.020、尿酸結晶(-)、CPPD結晶(+)、細胞数20800/μL(分画:Stab0%、Seg82%、Mono13%、Lymph8%)、糖155mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。以後、2例とも疼痛の再燃を認めなかった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02438&link_issn=&doc_id=20200602230001&doc_link_id=%2Fcm4ortho%2F2020%2F003201%2F001%2F0001-0007%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2020%2F003201%2F001%2F0001-0007%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Journal of Rheumatology  

<sec><title>Objective.</title>To investigate whether abatacept (ABA) causes more adverse events (AE) than conventional synthetic disease-modifying antirheumatic drugs (csDMARD) after orthopedic surgery in patients with rheumatoid arthritis (RA).

</sec><sec><title>Methods.</title>A retrospective multicenter nested case–control study was performed in 18 institutions. Patients receiving ABA (ABA group) were matched individually with patients receiving csDMARD and/or steroids (control group). Postoperative AE included surgical site infection, delayed wound healing, deep vein thrombosis or pulmonary embolism, flare, and death. The incidence rates of the AE in both groups were compared with the Mantel-Haenszel test. Risk factors for AE were analyzed by logistic regression model.

</sec><sec><title>Results.</title>A total of 3358 cases were collected. After inclusion and exclusion, 2651 patients were selected for matching, and 194 patients in 97 pairs were chosen for subsequent comparative analyses between the ABA and control groups. No between-group differences were detected in the incidence rates of each AE or in the incidence rates of total AE (control vs ABA: 15.5% vs 20.7% in total, 5.2% vs 3.1% in death).

</sec><sec><title>Conclusion.</title>Compared with csDMARD and/or steroids without ABA, adding ABA to the treatment does not appear to increase the incidence rates of postoperative AE in patients with RA undergoing orthopedic surgery. Large cohort studies should be performed to add evidence for the perioperative safety profile of ABA.

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DOI： 10.3899/jrheum.181100

PubMed

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本手外科学会  

関節リウマチの人工指関節置換術において小指は十分な可動域が得られにくいという問題点がある.著者らは,シリコンインプラント(SBi Silicone人工指関節:旧AVANTA人工指関節)による人工指関節置換術を行っており,2014年以降小指に対してはプレフレックスタイプを使用している.ストレートタイプ(S群)27例とプレフレックスタイプ(P群)21例に対し,術後1年時の握力,可動域,HAND20,DASHを調査し,比較検討した.術後1年時のMP関節の屈曲角度はS群50.1度,及びP群67.4度であり,可動域もS群33.5度,及びP群60.7度(P<0.01)であり有意に大きかった.他の検討項目では有意差を認めなかった.屈曲角度に影響する因子は様々であるが,プレフレックスタイプの選択により小指の屈曲は有意に増加し,可動域が増加した.(著者抄録)

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Idiopathic chondrolysis of the hip (ICH), a very rare disorder of unknown etiology, occurs mainly in female adolescents. Characterized by pain, limp, stiffness and radiological narrowing joint space from the rapid destruction of the articular cartilage, ICH sometimes results in ankyloses. We present the case of a 10-year-old girl diagnosed with ICH based on arthroscopic inspection and synovium biopsy. The femoral deformity appeared gradually, like a cam-type femoroacetabular impingement. She was treated with intensive rehabilitation and immunosuppressive drug. We later performed an arthroscopic bumpectomy for residual symptoms. She achieved a favorable outcome as a 15-year-old at the latest follow-up.

DOI： 10.18926/AMO/57957

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultra-high-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventional-resolution CT (CRCT) and micro-CT ex vivo. METHODS: We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test. RESULTS: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024- and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm3 and 63.5 mg/cm3 versus 20.8 mg/cm3), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm3 and 0.74 l/mm3 versus 0.02 l/mm3, respectively). In vivo, the 512- and 1024-matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm3 versus 0.22 l/mm3, respectively). CONCLUSIONS: We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

DOI： 10.1186/s41747-019-0135-0

PubMed

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Language：Japanese   Publisher：(株)全日本病院出版会  

関節リウマチ(RA)手の障害は、スワンネック変形・ボタン穴変形・尺側偏位など多彩であり、一つの手に複数の変形が混在している。その中でも、中手指節(MCP)関節は早期から罹患率が高く関節変形が生じやすく、進行例ではシリコン製インプラントによるMCP人工関節置換術での良好な成績が報告されている。当院では、MCP人工関節置換術に対しては、スタンダードパスを用いて術後療法を行っている。しかし、RA手指においては隣接関節の障害や伸筋腱皮下断裂を伴っていることも多く、進行例の変形では必要に応じて追加手術が同時に実施される。本稿では、通常のMCP人工関節置換術からスワンネック変形・ボタン穴変形・若年者の関節変形の術後リハビリテーションについて概説する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J03505&link_issn=&doc_id=20200124130001&doc_link_id=%2Fap5meree%2F2020%2F000244%2F002%2F0001-0007%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fap5meree%2F2020%2F000244%2F002%2F0001-0007%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The fear-avoidance model is a theoretical paradigm for explaining acute and chronic pain. In this model, pain catastrophizing plays an important role. On the other hand, self-efficacy influences whether patients view their pain optimistically, ultimately preventing the conversion of pain into intractable pain. The aim of the present study was to evaluate the factors that influence self-efficacy in patients with chronic pain. METHODS: Study participants included 147 outpatients (35 men, 112 women) with intractable chronic pain who visited our hospital between September 2014 and July 2015. Their mean age was 71.0 (range 32-92) years. Pain sites were as follows: low back, 97 patients; knee, 71 patients; shoulder, 34 patients; and hip, 15 patients. All patients were assessed using the following measures: Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). All participants were further divided into two groups based on median PSEQ scores (group L: PSEQ of 35 points or less, n = 74; group H: PSEQ greater than 35 points, n = 73). The factors that influenced self-efficacy in these patients were analyzed using univariate and multiple linear regression analyses. RESULTS: Significant differences were observed in gender; pain duration; and NRS, PDAS, HADS, and PCS scores between group L and group H. Multiple linear regression analysis revealed that self-efficacy was correlated with PDAS score, HADS depression score, and pain duration. CONCLUSIONS: Patients with longer pain duration indicated greater self-efficacy and patients with higher pain disability and depression exhibited lower self-efficacy.

DOI： 10.1186/s13018-019-1535-9

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Language：Japanese   Publisher：(一社)日本関節病学会  

当院でRA(関節リウマチ)に対しMCP関節人工関節置換術を施行した72例(手術時平均年齢61.8歳±11.9歳)を対象に、術中に手関節背側部の腱剥離術を要した症例について検討した。その結果、術中に手関節背側部の腱剥離術を要した症例は12例(16.7%)であった。更に手関節部での手術歴を有している症例では、15例中6例(40.0%)で術中に腱剥離術の追加が必要であった。手関節手術歴のある例ではEDCの癒着が多い傾向にあり、手術歴のない例では全例でEDMの癒着がみられた。腱剥離(+)群、腱剥離(-)群ともにHAND20、DASHは術後改善傾向を示し、改善量は両群間で有意差は認められなかった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05177&link_issn=&doc_id=20191220140007&doc_link_id=%2Ffd8kanse%2F2019%2F003804%2F007%2F0471-0477%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffd8kanse%2F2019%2F003804%2F007%2F0471-0477%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞人工肘関節置換術(TEA)をはじめ,関節リウマチ(RA)では肘関節の障害に対して手術が必要となる例が以前は多くみられていた.薬物療法の進歩により減少はしているものの,手術適応症例がなくなることはない.本邦では優れた非連結型人工関節が開発され,特に最近いくつかの機種において10年以上にわたって90%を大きく上回るインプラント生存率など,優れた臨床成績が相次いで報告されている.今後は多関節罹患例や高度関節破壊例の減少と,インプラント性能・術式が改善されることでRA肘の手術成績はさらに向上するものと期待される.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01554&link_issn=&doc_id=20191202070007&doc_link_id=10.11477%2Fmf.1408201534&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408201534&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Objectives: The aim of the current study was to investigate the pattern of extensor pollicis brevis (EPB) insertion macroscopically and histologically using cadaveric thumbs, and to compare the incidence of different insertions with that of thumb boutonnière deformity in rheumatoid arthritis (RA) patients who required surgical reconstruction.Methods: We examined 103 thumbs of 58 adult cadavers with no evidence of RA, and reviewed the surgical records of 28 thumbs of 23 RA patients who underwent surgical reconstruction for thumb boutonnière deformity. The incidence of different insertion patterns of the cadaveric thumbs and the RA thumbs were compared using the Fisher's exact test.Results: Macroscopic and histologic examination revealed that the insertion patterns of EPB could be divided into three groups: insertion into the base of the proximal phalanx (Type P1), integration of EPB into the dorsal fibrocartilage of the MCP joint (Type P2), and insertion into the distal phalanx (Type D). The incidence of Type D was significantly higher in RA patients with thumb boutonnière deformity (64%) than that in the non-RA cadavers (29%; P < .05).Conclusion: EPB is inserted into the distal phalanx more frequently in RA patients who require surgery for thumb boutonnière deformity than non-RA cadavers, suggesting an additional possible mechanism of this deformity.

DOI： 10.1080/14397595.2018.1532484

PubMed

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：English   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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The synovial fluids of patients with osteoarthritis (OA) contain elevated levels of inflammatory cytokines, which induce the expression of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) and of the matrix metalloproteinase (MMP) in chondrocytes. Mechanical strain has varying effects on organisms depending on the strength, cycle, and duration of the stressor; however, it is unclear under inflammatory stimulation how mechanical strain act on. Here, we show that mechanical strain attenuates inflammatory cytokine-induced expression of matrix-degrading enzymes. Cyclic tensile strain (CTS), as a mechanical stressor, attenuated interleukin (IL)-1β and tumor necrosis factor (TNF)-α-induced mRNA expression of ADAMTS4, ADAMTS9, and MMP-13 in normal chondrocytes (NHAC-kn) and in a chondrocytic cell line (OUMS-27). This effect was abolished by treating cells with mechano-gated channel inhibitors, such as gadolinium, transient receptor potential (TRP) family inhibitor, ruthenium red, and with pharmacological and small interfering RNA-mediated TRPV1 inhibition. Furthermore, nuclear factor κB (NF-κB) translocation from the cytoplasm to the nucleus resulting from cytokine stimulation was also abolished by CTS. These findings suggest that mechanosensors such as the TRPV protein are potential therapeutic targets in treating OA.

DOI： 10.1016/j.yexcr.2019.111556

Web of Science

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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The fixation technique of bony fragments is crucial for the bone union of the tuberosities after humeral head replacement (HHR) for a comminuted fracture of the proximal humerus. To increase the bone union rate, we reduce tuberosities to overlap on the humeral shaft by approx. 1 cm and fix them with cable wire. Herein, we retrospectively investigated the clinical and radiographic outcomes of our procedure. Twenty-six patients who underwent cementless HHR for the treatment of comminuted fractures of the proximal humerus were investigated. The Constant-Murley score, active shoulder mobility, and bone union rate were evaluated. The mean duration of follow-up was 56.3 months (range 24-197). At the final follow-up, the average Constant-Murley score was 58 (range 40-76). Forward elevation was 126° on average (range 35°-180°). Twenty-three cases (88%) showed bone union between the tuberosities and the shaft at an average follow-up of 4.1 months (range 4-5 months) after surgery. Non-union was noted in 1 case, and bone resorption was noted in 2 cases. The bone union rate and the clinical outcome of our procedure were relatively favorable.

DOI： 10.18926/AMO/56931

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本疼痛学会  

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A disintegrin and metalloproteinase 12 (ADAM12) is known to be involved in chondrocyte proliferation and maturation; however, the mechanisms are not fully understood. In this study, expression and localization of ADAM12 during chondrocyte differentiation were examined in the mouse growth plate by immunohistochemistry. Adam12 expression during ATDC5 chondrogenic differentiation was examined by real-time PCR and compared with the expression pattern of type X collagen. The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 system was used to generate Adam12-knockout (KO) ATDC5 cells. Adam12-KO and Adam12 overexpressing cells were used for analyses of ADAM12 expression with or without TGF-β1 stimulation. ADAM12 was identified predominantly in chondrocytes of the proliferative zone in mouse growth plates by immunohistochemistry. Adam12 was upregulated prior to Col10a1 during chondrogenic differentiation in wild-type ATDC5 cells. In Adam12-KO ATDC5 cells, following initiation of chondrogenic differentiation, we observed a reduction in Igf-1 expression along with an upregulation of hypertrophy-associated Runx2, Col10a1, and type X collagen protein expressions. In ATDC5 wild-type cells, stimulation with TGF-β1 upregulated the expressions of Adam12 and Igf-1 and downregulated the expression of Runx2. In contrast, in Adam12-KO ATDC5 cells, these TGF-β1-induced changes were suppressed. Adam12 overexpression resulted in an upregulation of Igf-1 and downregulation of Runx2 expression in ATDC5 cells. The findings suggest that ADAM12 has important role in the regulation of chondrocyte differentiation, potentially by regulation of TGF-β1-dependent signaling and that targeting of ADAM12 may have a role in management of abnormal chondrocyte differentiation.

DOI： 10.1007/s00223-019-00549-6

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：日本運動器科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group's final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA.

DOI： 10.18926/AMO/56866

PubMed

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Language：Japanese   Publisher：日本運動器科学会  

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Language：Japanese   Publisher：日本運動器科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

Dupuytren拘縮に対して長軸切開にて部分手掌腱膜切除を行い,Z形成を追加して閉創を行った症例と,Zigzag切開にて部分手掌腱膜切除を行った症例について治療成績を比較検討した.2年以上追跡可能であった病的腱膜切除を施行した17例22指を対象とした.最終観察時の平均屈曲拘縮角度はZigzag切開を行った症例群では術前61.1度から術後27.8度へ,長軸切開を行った症例群では術前87.7度から術後21.2度へと,どちらも術前に比べ有意な改善を認めた.DASHスコアについてもZigzag切開を行った群では術前10.3から術後1.5へ,長軸切開を行った群では術前6.3から術後1.2へとどちらも術前に比べ有意な改善を認めた.Zigzag切開を行った症例のうち2年後再発により再手術した症例を1例認め,長軸切開にてアプローチした症例のうちで皮膚移植を行った症例を1例認めた.術後に創離開や皮膚壊死を生じた例は認められなかった.両アプローチとも,中程度から高度屈曲拘縮例においても安定した中期成績を示した.長軸切開にZ形成を追加する術式はアプローチにしやすさという点から有用と思われた.(著者抄録)

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10147-019-01512-z

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Language：English  

Hyaluronan (HA) is an extracellular matrix (ECM) component of articular cartilage and has been used to treat patients with osteoarthritis (OA). A disintegrin and metalloproteinases with thrombospondin motifs (ADAMTSs) play an important role in cartilage degradation in OA. We have previously reported that ADAMTS4 and ADAMTS9 were induced by cytokine stimulation. However, the effect of HA on the cytokine-inducible ADAMTS9 has never been investigated. Moreover, it is unclear whether HA protects cartilage by suppressing aggrecan degradation. Here, we examined the effects of HA on ADAMTS expression in vitro and on cartilage degradation in vivo. ADAMTS9 expression was higher than that of the other aggrecanases (ADAMTS4 and 5) in human chondrocytes, chondrocytic cells, and rat cartilage. ADAMTS4 and 9 mRNA levels were upregulated in cytokine-stimulated chondrocytes and chondrocytic cells. Pre-incubation with HA significantly inhibited ADAMTS9 mRNA expression in cytokine-stimulated cells. In a rat OA model, Adamts5 and 9 mRNA levels were transiently increased after surgery; intra-articular HA injections attenuated the induction of Adamts5 and 9 mRNA. HA also blocked aggrecan cleavage by aggrecanase in OA rats in a molecular size-dependent manner. These results demonstrate that HA attenuates induced aggrecanases expression in OA and thereby protects articular cartilage degradation by this enzyme. Our findings provide insight into the molecular basis for the beneficial effects of HA in OA. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:3247-3255, 2018.

DOI： 10.1002/jor.24126

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Language：Japanese   Publisher：(一社)日本手外科学会  

関節リウマチに対する尺骨遠位端切除術を併用した手関節部分固定術の治療成績を検討した.術後5年以上経過観察可能であった19例23手を対象とした.症例は全て女性で,手術時年齢は平均50.7歳,経過観察期間は平均9.9年であった.手術は橈骨月状骨間固定術が21手,橈骨月状骨三角骨間固定術が2手であり,術前のSchulthess分類はType IIが15手,Type IIIが8手であった.良好な除痛効果と手関節アライメントの矯正・維持が獲得されていた.最終調査時には掌背屈可動域に減少を認めたが,術後月状骨周囲に骨性硬直を生じた群で顕著であり,その頻度はSchulthess分類Type IIIの手関節で高かった.そのため手根中央関節の破壊が高度である場合は,手関節部分固定術後に月状骨周囲骨性強直が発生し,手関節アライメント異常の矯正は獲得される一方で,掌背屈可動域減少が生じる可能性が高いと考える.(著者抄録)

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Language：Japanese   Publisher：(株)メジカルビュー社  

腰痛に対する保存療法、薬物療法、手術療法が進歩するなかで、認知行動学的な集学的治療の重要性も昨今認識されてきている。そこで、腰痛のリエゾン療法についての効果・限界・今後の展望について紹介する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(株)南山堂  

＜Key Points＞◎慢性疼痛の治療は、個人差の大きいことから、その背景を十分に理解した上で、個別化した治療(医療)を提供する必要がある。◎慢性疼痛治療の目標は、「ADLとQOLの改善」であり、「痛みゼロ」を最重要目標としていない点でがん性疼痛治療と大きく異なっている。◎薬物療法マネジメントにおいて、薬剤使用の見極め(減量、中止や別の薬への変更)と副作用の発現リスクへの配慮が重要である。◎副作用マネジメントにおいて、漫然とした処方継続の回避と定期的な血液検査の奨励が必須である。◎高齢で慢性疼痛を呈する患者も多く、高齢者は副作用リスクも高いことから注意が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Drug dependence, which can exist concurrently with chronic pain, is seen as one of the major causes of rapidly increasing medical expenses. However, drug dependence in patients with chronic pain has not been evaluated. The aim of this study was to identify the risk factors for drug dependence in patients with chronic noncancer pain.This retrospective study included 151 patients with chronic noncancer pain (43 males, 108 females; mean age, 72 years). Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores. Patients with SDS scores ≥5 and <5 were classified into drug dependence and nondrug dependence groups, respectively. All patients completed self-report questionnaires. Factors that predict drug dependence were identified by performing univariate and multivariate analyses.Sixty (40%) of the 151 patients met the SDS criteria for drug dependence. Significant differences were found between patients with and without drug dependence for the LBP, hip pain, number of medications, and for the Numerical Rating Scale, Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale, and Pain Catastrophizing Scale (PCS) scores. Multiple regression analysis identified LBP, hip pain, PCS, and PDAS scores as factors related to drug dependence in patients with chronic noncancer pain.Drug dependence tends to differ in patients based on the location of their chronic pain. Pain catastrophizing and disability indicated a greater tendency for drug dependence. Thus, PCS and PDAS scores are useful screening tools for predicting drug dependence in patients with chronic pain.

DOI： 10.1097/MD.0000000000012748

PubMed

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Language：Japanese   Publisher：(一社)日本足の外科学会  

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Language：Japanese   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04037&link_issn=&doc_id=20181116320006&doc_link_id=10.15106%2Fj_besei74_23&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei74_23&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：日本リウマチリハビリテーション研究会  

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Language：Japanese   Publisher：(一社)日本足の外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：日本リウマチリハビリテーション研究会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We conducted this study to determine the short-term treatment outcomes of multidisciplinary approaches to chronic pain management for outpatients in Japan. We evaluated pain reduction and improvement in quality of life (QOL) after treatment. We analyzed 32 patients who had experienced intractable chronic pain for > 3 months. The patients received multidisciplinary therapeutic self-managed exercise instructions and then underwent evaluations 1 and 3 months after the treatment. We used the Pain Disability Short Form-36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Disability Assessment Scale (PDAS) to evaluate QOL. Although the pain levels were the same before and after the physical exercise program, the patients showed significant improvements in physical function on the SF-36 (48.5 vs. 54.5, 3 months vs. 1 month; p=0.0124), the magnification subscale on the PCS (6.8 vs. 5.9, 1 month vs. before; p=0.0164) and the PDAS (29.2 vs. 23.4, 3 months vs. before; p=0.0055). Chronic pain should be treated with a biopsychosocial approach, but time constraints and costs have limited the implementation of multidisciplinary and behavioral approaches to chronic pain management. Our findings demonstrate that clinical improvements are possible for patients with chronic pain, using multidisciplinary team resources widely available in Japanese clinical practice.

DOI： 10.18926/AMO/56169

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本骨・関節感染症学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会