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Nogi S, Oka S, Higuchi T, Furukawa H, Shimada K, Azuma T, Sugiyama T, Hirano F, Okamoto A, Fujimori M, Horai Y, Ihata A, Hashimoto A, Komiya A, Matsui T, Fukui N, Katayama M, Migita K, Tohma S. Human leucocyte antigens and Japanese patients with polymyalgia rheumatica: the protective effect of DRB1*09:01. RMD Open 2024; 10:e003897. [PMID: 38253597 PMCID: PMC10806501 DOI: 10.1136/rmdopen-2023-003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE The hallmarks of the chronic inflammatory disease polymyalgia rheumatica (PMR) include pain, and morning stiffness in areas of the neck, shoulder and pelvic girdle. The human leucocyte antigen (HLA) gene was reported to be an important risk factor for PMR, but it has not been analysed precisely, especially in populations other than Europeans. METHODS Genotyping of DRB1 and DQB1 was performed in Japanese PMR patients (n=270) and controls (n=413). Associations between allele carrier and genotype frequencies were determined for PMR. RESULTS DRB1*04:05 was associated with a predisposition to PMR (p=0.0006, Pc=0.0193, OR 1.85, 95% CI 1.31 to 2.62). DRB1*09:01 was associated with protection against PMR (p=1.46×10-5, Pc=0.0004, OR 0.40, 95% CI 0.26 to 0.61). A shared epitope (SE) associated with PMR (p=3.07×10-6, OR 2.11, 95% CI 1.54 to 2.88). DQB1*03:03 (p=0.0010, Pc=0.0140, OR 0.52, 95% CI 0.35 to 0.77) was associated with protection against PMR and DQB1*04:01 (p=0.0009, Pc=0.0140, OR 1.82, 95% CI 1.28 to 2.58) was associated with predisposition to PMR. A gene dosage effect was observed for DRB1*09:01 and DQB1*03:03, but not for DRB1*04:05, SE or DQB1*04:01. Haplotype and logistic regression analyses suggested a protective effect for DRB1*09:01. CONCLUSION This study is the first to demonstrate predisposing associations of DRB1*04:05, SE, and DQB1*04:01, and protective associations of DRB1*09:01 and DQB1*03:03 with PMR in Japanese patients. Our data indicate HLA has predisposing and protective effects on the pathogenesis of PMR.
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Affiliation(s)
- Shinichi Nogi
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Shomi Oka
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Takashi Higuchi
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
| | - Hiroshi Furukawa
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Kota Shimada
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | | | - Takao Sugiyama
- Department of Rheumatology, NHO Shimoshizu Hospital, Yotsukaido, Japan
| | - Fuminori Hirano
- Department of Internal Medicine, NHO Asahikawa Medical Center, Asahikawa, Japan
| | - Akira Okamoto
- Department of Rheumatology, NHO Himeji Medical Center, Himeji, Japan
| | - Misuzu Fujimori
- Department of Rheumatology, NHO Himeji Medical Center, Himeji, Japan
| | - Yoshiro Horai
- Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Japan
| | - Atsushi Ihata
- Department of Rheumatology, NHO Yokohama Medical Center, Yokohama, Japan
| | - Atsushi Hashimoto
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Akiko Komiya
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Clinical Laboratory, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Naoshi Fukui
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Masao Katayama
- Department of Internal Medicine, NHO Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kiyoshi Migita
- Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeto Tohma
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
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Tanaka Y, Tanaka S, Takahashi T, Kato N. Clinical features of polymyalgia rheumatica patients in Japan: Analysis of real-world data from 2015 to 2020. Mod Rheumatol 2023; 34:201-207. [PMID: 36881671 DOI: 10.1093/mr/road026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To assess clinical features in patients with polymyalgia rheumatica (PMR) in Japan by the International Classification of Disease (ICD)-10 code assignment. METHODS Demographics, treatment patterns, and concomitant diseases (identified using ICD-10 code only) in patients who were assigned the PMR ICD-10 code M35.3 at least once between 1 January 2015 and 31 December 2020 were aggregated from a nationwide medical information database owned by the Health, Clinic, and Education Information Evaluation Institute. RESULTS The cumulative number of patients with PMR was 6325 (mean [standard deviation] age, 74.3 [11.4] years; male:female, 1:1.3). Most patients were >50 years (96.5%) with >33% between 70 and 79 years. Glucocorticoids were prescribed in ∼54% of patients within 30 days of PMR code assignment. All other drug types were prescribed in <5% of patients. Hypertension, diabetes mellitus, rheumatoid arthritis, and osteoporosis were noted in >25% and giant cell arteritis in 1% of patients. During the study period, 4075 patients were newly assigned the PMR code and 62% were prescribed glucocorticoids within 30 days. CONCLUSIONS This is the first retrospective real-world data analysis describing the clinical features of PMR in a large patient population from Japan. Further studies of prevalence, incidence, and clinical features are warranted in patients with PMR.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinichi Tanaka
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | | | - Naoto Kato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
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3
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Zhao C, Liu B, Yao Y, Yang K, Zang B, Liu B. Evaluation of clinical efficacy of tumor necrosis factor‑α inhibitors in treatment of distal extremity swelling with pitting edema in psoriatic arthritis of inadequate response to conventional therapy: A 10‑year retrospective study. Exp Ther Med 2023; 25:263. [PMID: 37206568 PMCID: PMC10189727 DOI: 10.3892/etm.2023.11962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/31/2023] [Indexed: 05/21/2023] Open
Abstract
Distal extremity swelling with pitting edema in psoriatic arthritis (PsA) is a rare rheumatological condition, whose management presents a challenge. The aim of the present study was to identify the clinical characteristics of, and formulate a standardized management strategy for, patients with distal extremity swelling with pitting edema in PsA. The medical records of consecutive patients with PsA, with or without distal extremity swelling with pitting edema, were systematically analyzed over a ~10-year period (between September 2008 and September 2018) in a single center and a comprehensive review (pathogenic mechanisms, clinical manifestations, and treatments) was undertaken. A total of 167 patients with PsA were evaluated, and distal extremity swelling with pitting edema was recorded in 16 of these patients. In three of the 16 patients, distal extremity swelling with pitting edema occurred as the first, isolated manifestation of PsA. The upper and lower extremities were affected, predominantly asymmetrically. Female patients with PsA were more likely to be affected with pitting edema and the blood test results revealed that the patients with PsA and pitting edema also presented with a significantly higher erythrocyte sedimentation rate and concentration of C-reactive protein. The onset of pitting edema was associated with the activity of the disease. Lymphoscintigraphy and magnetic resonance imaging (MRI) scans revealed that edema might have resulted from inflammation of the tenosynovial structures. Furthermore, treatment with tumor necrosis factor-α inhibitor (TNFi) elicited improvements in patients with pitting edema that were not responsive to conventional synthetic disease-modifying antirheumatic drug therapy. In conclusion, distal extremity swelling with pitting edema, also termed atypical remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, may represent the initial isolated manifestation of PsA. The atypical RS3PE syndrome in PsA was attributable to inflammation of the tenosynovial structures, and TNFi may serve as a potential treatment.
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Affiliation(s)
- Chenyang Zhao
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Bingqian Liu
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Yuan Yao
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Kevin Yang
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Faculty of Medicine, Lund University, 22002 Lund, Sweden
| | - Bo Zang
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Bin Liu
- Department of Rheumatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
- Correspondence to: Dr Bin Liu, Department of Rheumatology, The Affiliated Hospital of Qingdao University, 16 Jiang Su Lu, Shi Nan, Qingdao, Shandong 266003, P.R. China
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4
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Borges T, Silva S. RSЗPE Syndrome: Autoinflammatory Features of a Rare Disorder. Mod Rheumatol 2022:6651678. [PMID: 35904275 DOI: 10.1093/mr/roac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RSЗPE) syndrome was first described by McCarty in 1985 and is characterized by pitting edema and an acute symmetrical synovitis of small joints. Self-directed inflammation in autoimmune disorders is caused by an abnormal activation of the adaptive immune system, while in autoinflammatory disorders is due to aberrant activation of the innate immune system without autoantibodies or autoreactive T cells. The role of autoimmunity in the pathogenesis of RSЗPE syndrome is suggested by possible associations with some autoimmune diseases and HLA haplotypes. However, several other features point to a possible role of autoinflammation in RSЗPE syndrome. In this review, the relative contributions of both innate and adaptive immune systems to the pathogenesis of RSЗPE syndrome are discussed.
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Aung TKK, Chuah TY, Chua MWJ. More Than Meets the Eye: A Patient with Hand Swelling and Newly Diagnosed Diabetes Mellitus. Am J Med 2021; 134:1357-1361. [PMID: 34102158 DOI: 10.1016/j.amjmed.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Tyng Yu Chuah
- Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
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6
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Leyens J, Bender TTA, Mücke M, Stieber C, Kravchenko D, Dernbach C, Seidel MF. The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis. Orphanet J Rare Dis 2021; 16:326. [PMID: 34294115 PMCID: PMC8296612 DOI: 10.1186/s13023-021-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.
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Affiliation(s)
- Judith Leyens
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Neonatology and Pediatric Care, Children's University Hospital, Bonn, Germany
| | - Tim Th A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Institute of Human Genetics, University Hospital, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
| | - Christiane Stieber
- Institute of General Practice and Family Medicine, University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Radiology, University Hospital, Bonn, Germany
| | - Christian Dernbach
- Division of Medical Psychology and Department of Psychiatry, University Hospital, Bonn, Germany
| | - Matthias F Seidel
- Department of Rheumatology, Spitalzentrum-Centre hospitalier, Biel-Bienne, Switzerland.
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Lakhmalla M, Dahiya DS, Kichloo A, Fatima T, Edigin E, Wani F. Remitting seronegative symmetrical synovitis with pitting edema: a review. J Investig Med 2020; 69:86-90. [DOI: 10.1136/jim-2020-001613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/23/2022]
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare benign rheumatological condition characterized by sudden-onset symmetrical distal extremity edema. It can present as an isolated disease process or could be associated with other conditions. Rheumatoid factor and anticitrullinated protein antibodies are negative by definition. In current literature, there is paucity of data about the disease process. We performed a literature search using the PubMed database to identify 38 articles that met our inclusion and exclusion criteria. Our literature review focuses on the clinical picture and its diverse associations. Role of various acute phase reactants has also been outlined. There is a generalized consensus among clinicians on using moderate dose steroids for treatment. Other management options for refractory cases have also discussed. Value of several imaging modalities in diagnostic evaluation of this disease entity is touched on. Since RS3PE can be associated with other diseases, specifically cancer, timely diagnosis of this condition is necessary.
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8
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Laidler NK, Delaney T. Remitting seronegative symmetric synovitis with pitting edema (RS3PE) with painful erythematous nodules. BMJ Case Rep 2020; 13:13/4/e234197. [PMID: 32327460 DOI: 10.1136/bcr-2019-234197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is an uncommon syndrome characterised by acute onset severe synovitis of the radiocarpal and small joints of the hands, with associated pitting edema. Discussed here is the case of a 69-year-old man who presented to the emergency department of a tertiary hospital with acute bilateral hand swelling. This was on a background of a recent diagnosis of metastatic adenocarcinoma of the caecum and subsequent hemicolectomy. There was a history of general malaise, fever and lethargy for 5 days prior to the swelling of the hands. On examination, the upper limbs were swollen to the elbow bilaterally. Painful erythematous nodules were noted on the dorsal and palmar aspects of the hands and violaceous periungual discolouration was observed on the right fourth and fifth fingers. Prednisolone was commenced resulting in a dramatic resolution of the articular and cutaneous manifestations within 3 weeks.
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Affiliation(s)
| | - Thomas Delaney
- Dermatology Department, Royal Perth Hospital, Perth, Western Australia, Australia
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9
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Bas O, Ozbek A, Guven D, Aktepe O, Kılıc L, Kertmen N, Erman M. Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema in a patient with renal cell carcinoma. J Oncol Pharm Pract 2019; 26:1230-1233. [PMID: 31735133 DOI: 10.1177/1078155219884113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors and angiogenesis inhibitors are novel treatment options for renal cell carcinoma and widely used in clinical practice. They are related with adverse events that occur as a consequence of immune system activation and inhibition of angiogenesis. Herein, we report a rare case of inflammatory arthritis seen in a patient treated with an anti Programmed cell death-1 pembrolizumab and an anti-vascular endothelial growth factor pazopanib. CASE REPORT A 60-year-old Caucasian male presented to our clinic with inflammatory arthritis with pitting edema. He had been started on pembrolizumab therapy for metastatic renal cell carcinoma after enrolling in the KEYNOTE-679 study. After six cycles of treatment with pembrolizumab, metastasis had been determined in the lung. Then, the patient's therapy was changed to pazopanib. While the patient was on pazopanib treatment, he noticed a gradual swelling of both hands. Rheumatoid factor, anti-nuclear antibody and anti-cyclic citrullinated peptide were negative. Joint ultrasonography revealed acute tenosynovitis and soft tissue swelling with pitting edema, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. Management and outcome: He was started on 10 mg prednisolone daily. His symptoms dramatically responded to corticosteroid. He continued to take pazopanib. Then, the patient was discharged with 10 mg prednisolone daily. DISCUSSION Pembrolizumab- and/or pazopanib-induced remitting seronegative symmetrical synovitis with pitting edema can be among the rare rheumatic immune-related adverse events that clinicians may encounter as the immune check point inhibitors and anti-VEGF use increases. Corticosteroid therapy can relieve symptoms and cessation of therapy may not be necessary.
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Affiliation(s)
- Onur Bas
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aral Ozbek
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Denizcan Guven
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Oktay Aktepe
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Levent Kılıc
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Neyran Kertmen
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Erman
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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10
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Horai Y, Origuchi T, Iwanaga N, Tokumitsu J, Ikeoka T, Kuriya G, Izumi Y, Kawakami A. Clinical analysis of pre-existing diabetes mellitus and dipeptidyl peptidase-4 inhibitors in patients with remitting seronegative symmetrical synovitis and pitting edema syndrome. Mod Rheumatol 2019; 30:703-707. [PMID: 31500483 DOI: 10.1080/14397595.2019.1666463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: To analyze the association among remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, diabetes mellitus (DM), and antidiabetic drugs.Methods: We retrospectively analyzed the clinical and serologic manifestations of patients who had RS3PE syndrome with and without pre-existing DM. Then we performed a subanalysis in which patients with pre-existing DM were classified into two groups according to whether they were or were not taking a dipeptidyl peptidase 4 inhibitor (DPP4i), an antidiabetic drug that was suggested to have an association with the pathogenesis of RS3PE syndrome.Results: Pre-existing DM was found in 13 (35.1%) of 37 patients with RS3PE syndrome. No significant differences in age, gender, physical manifestations, and laboratory findings were observed between the patients with DM and those without DM. DPP4i had been administered to 6 of 13 patients with RS3PE and pre-existing DM. We observed no significant differences in manifestations of RS3PE syndrome before treatment; however, one relapse occurred in a patient with poorly controlled DM who had been continuing DPP4i therapy.Conclusion: This study revealed no evidence suggesting an association among RS3PE syndrome, DM, and antidiabetic drugs. DPP4i would be safe for use by most of patients with RS3PE syndrome. However, elderly patients and patients with poorly controlled DM might require careful observation.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Tani K, Kawaminami S, Okura Y, Tabata R, Yuasa S, Nakanishi Y, Kawahito K, Inaba K, Inaba K, Kondo K, Umetani K, Miyatake A, Suzuki Y, Yamaguchi H. Predictive factors associated with the therapeutic response in patients with polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema syndrome. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:112-118. [DOI: 10.2152/jmi.66.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenji Tani
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Shingo Kawaminami
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Yoshihiro Okura
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Ryo Tabata
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Shino Yuasa
- Tokushima Prefectural Central Hospital, Tokushima,Japan
| | - Yoshinori Nakanishi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | - Keisuke Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Kaori Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | - Yoshihiro Suzuki
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Harutaka Yamaguchi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
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12
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Isono H, Ito Y, Takamura N. Development of polymyalgia rheumatica during hospitalization and diagnosis based on history taking by physical and occupational therapists. J Gen Fam Med 2019; 20:28-30. [PMID: 30631657 PMCID: PMC6321836 DOI: 10.1002/jgf2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/06/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is frequently reported in the outpatient setting and presents with pain, morning stiffness, mild fever, and fatigue. However, the clinical course of PMR during hospitalization is unknown. We report a case of PMR that developed during hospitalization. PMR diagnosis should begin with an evaluation of core inclusion and exclusion criteria. However, when examining elderly patients, retrieving symptom information from the patient or their family is often difficult, especially during prolonged hospitalization. History taking by physical and occupational therapists or by other health care professionals is paramount in the symptomatic diagnoses of inpatients.
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Affiliation(s)
- Hiroki Isono
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
- Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaIbarakiJapan
| | - Yuri Ito
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
| | - Noriko Takamura
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
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Kenzaka T, Goda K. Serum matrix metalloproteinase 3 in detecting remitting seronegative symmetrical synovitis with pitting edema syndrome: A case report. World J Clin Cases 2018; 6:84-87. [PMID: 29774220 PMCID: PMC5955732 DOI: 10.12998/wjcc.v6.i5.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 02/05/2023] Open
Abstract
We report a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a 71-year-old woman. She referred to our hospital with finger stiffness, edema of both hands and feet, pain of bilateral shoulder, wrist, metacarpophalangeal, proximal interphalangeal, and ankle joints. Rheumatoid factor was negative, human leukocyte antigen -B7 antigen was positive. Moreover, matrix metalloproteinase 3 (MMP-3) was high. She was diagnosed with RS3PE syndrome, and treatment with prednisolone (15 mg/d) was started. One week after prednisolone treatment initiation, CRP decreased to negative, and joint pain was almost completely resolved. However, hand stiffness persisted, and MMP-3 level was still high. Thus, prednisolone dose was increased to 20 mg/d, and the stiffness resolved. Twenty days after treatment initiation, MMP-3 was normalized. MMP-3 was more indicative of RS3PE syndrome symptoms than CRP. Thus, MMP-3 seems to be more sensitive to RS3PE syndrome symptoms.
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Affiliation(s)
- Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Hyogo 669-3395, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Hyogo 652-0032, Japan
| | - Ken Goda
- Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Hyogo 669-3395, Japan
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Ngo L, Miller E, Valen P, Gertner E. Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report. J Med Case Rep 2018; 12:48. [PMID: 29478412 PMCID: PMC6389137 DOI: 10.1186/s13256-018-1579-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/21/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Novel immune checkpoint inhibitors have been often utilized for different types of malignancies as salvage therapy with varying success. One obstacle to immune checkpoint inhibitor use is the higher incidence of immune-mediated side effects that can prompt discontinuation of therapy. Remitting seronegative symmetrical synovitis with pitting edema has been described with immune checkpoint inhibitors only once previously. We report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema related to immune checkpoint inhibitor therapy and stress that these symptoms can be managed without cessation of immune checkpoint inhibitor therapy. CASE PRESENTATION We present a 70-year-old white man who presented with 4 months of progressive inflammatory arthritis with pitting edema. He had been started on nivolumab therapy for his metastatic melanoma with excellent response prior to symptom onset. The symptoms started in his knees and subsequently involved both hands and feet. On evaluation, he was wheelchair bound and completely dependent for all activities of daily living. Evaluation revealed negative serological testing and plain film imaging. Ultrasound demonstrated diffuse flexor tenosynovitis and soft tissue swelling, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. He was treated with orally administered corticosteroids (0.5 mg/kg per day) which improved his symptoms significantly and allowed him to regain prior independent functioning. His corticosteroids were tapered (0.15 mg/kg per day) but not discontinued and his nivolumab treatment was not interrupted. In follow up he continued to have stable control of his melanoma as well as his remitting seronegative symmetrical synovitis with pitting edema. CONCLUSIONS In conclusion we present the first case of nivolumab-induced remitting seronegative symmetrical synovitis with pitting edema that is controlled by maintenance low-dose orally administered corticosteroids allowing for continuation of nivolumab therapy. Clinicians who encounter mild-to-moderate immune checkpoint inhibitor immune-mediated adverse effects can consider maintaining immune checkpoint inhibitor therapy with concomitant low-dose corticosteroids rather than abrupt cessation of the immune checkpoint inhibitor.
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Affiliation(s)
- Linh Ngo
- University of Minnesota, Medicine Rheumatology Office, D615Mayo, 420 Delaware St SE, Minneapolis, MN 55455-034 USA
| | - Eric Miller
- Hennepin County Medical Center, Minneapolis, USA
| | - Peter Valen
- Minneapolis VA Medical Center, University of Minnesota, Minneapolis, USA
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Fujio K. III. Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome. ACTA ACUST UNITED AC 2017. [DOI: 10.2169/naika.106.2131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keishi Fujio
- Department of Alleregy and Rheumatology, Graduate School of Medicine, The University of Tokyo
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16
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Makihara H, Goto M, Watanabe H, Sugita Y, Ariji Y, Maeda H, Kurita K. Age-related EBV-associated B-cell lymphoproliferative disorders of the minor salivary gland: a case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2016. [DOI: 10.1016/j.omsc.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Amodeo M, Poyato M, Rodríguez M. El síndrome RS3PE: actualización de su tratamiento a propósito de un caso. Semergen 2015; 41:429-34. [DOI: 10.1016/j.semerg.2015.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 11/27/2022]
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18
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Oyama K, Taniguchi JI, Goto R, Matsui K. Remitting seronegative symmetrical synovitis with pitting edema syndrome in individuals with type 2 diabetes mellitus or impaired glucose tolerance. Diabetes Res Clin Pract 2015; 110:e5-e8. [PMID: 26293448 DOI: 10.1016/j.diabres.2015.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/28/2015] [Indexed: 11/29/2022]
Abstract
An association between remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and insulin or dipeptidyl peptidase-4 (DPP4) inhibitor therapy were previously reported. We encountered four cases of RS3PE syndrome with type 2 diabetes mellitus or impaired glucose tolerance (IGT) without insulin or DPP4 inhibitor medication.
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Affiliation(s)
- Kohta Oyama
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
| | - Jun-Ichi Taniguchi
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan.
| | - Rieko Goto
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
| | - Kunihiko Matsui
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
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19
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20
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Ruiz-Rivero J, Demelo-Rodríguez P, Nuevo-González JA, Cano-Ballesteros JC. [RS3PE syndrome: A case description and a literature review]. Rev Esp Geriatr Gerontol 2014; 49:299-300. [PMID: 24948523 DOI: 10.1016/j.regg.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 04/18/2014] [Accepted: 04/28/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Juncal Ruiz-Rivero
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Pablo Demelo-Rodríguez
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.
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21
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Kanda H. [Rheumatology: Progress in Diagnosis and Treatments. Topics: III. Rheumatoid Arthritis and Allied Conditions; 2. Allied Conditions, 4) RS3PE syndrome]. ACTA ACUST UNITED AC 2014; 103:2457-64. [PMID: 27514194 DOI: 10.2169/naika.103.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Rooney PJ, Rooney J, Balint G, Balint P. Polymyalgia rheumatica: 125 years of epidemiological progress? Scott Med J 2014; 60:50-7. [PMID: 25201886 DOI: 10.1177/0036933014551115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the epidemiology of this disease and whether such studies have advanced our knowledge of its aetiopathogenesis and management. METHODS The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. RESULTS This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts investigating the populations susceptible, the geographic distribution of these affected populations and the associated sociological and genetic elements that might contribute to its occurrence, polymyalgia rheumatica remains a difficult problem for the public health services of the developed world. CONCLUSIONS Polymyalgia rheumatica remains a clinical enigma and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely. Until then, clear guidelines on the future incidence and prevalence of polymyalgia rheumatica and the public health problems of the disease and its management, especially in relation to the use of long term corticosteroids, will be difficult to provide.
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Affiliation(s)
- Patrick J Rooney
- Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Jennifer Rooney
- Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Geza Balint
- Consultant Rheumatologist, National Institute of Rheumatology and Physiotherapy, Hungary
| | - Peter Balint
- Head of Department and Consultant Rheumatologist, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Hungary
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23
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Kim IY, Seo GH, Lee S, Jeong H, Kim H, Lee J, Koh EM, Cha HS. Epidemiology of Polymyalgia Rheumatica in Korea. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.6.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- In Young Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, Seoul, Korea
| | - Seulkee Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyemin Jeong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Okumura T, Ohhira M, Kumei S, Nozu T. A higher frequency of lumbar ossification of the posterior longitudinal ligament in elderly in an outpatient clinic in Japan. Int J Gen Med 2013; 6:729-32. [PMID: 24023522 PMCID: PMC3767490 DOI: 10.2147/ijgm.s48941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Little is known about the prevalence and epidemiological characteristics of lumbar ossification of the posterior longitudinal ligament (OPLL). We analyzed the rate of lumbar OPLL in an outpatient unit where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease. Methods We analyzed consecutive, first-time visiting outpatients who received abdominal and pelvic computed tomography (CT) scan at the Department of General Medicine, Asahikawa Medical University Hospital, Japan, between April 2009 and March 2012. Each parameter such as age, sex, and clinical presentation was investigated. Results Out of 393 patients who underwent abdominal and pelvic CT scan, 33 (8.4%) were diagnosed as lumbar OPLL. When compared with patients without lumbar OPLL (n = 360), there was no significant difference in gender, body mass index (BMI), presence of hypertension, diabetes mellitus or hyperlipidemia, and smoking habit, while the age in patients with lumbar OPLL was significantly higher. Conclusion These results suggest for the first time that lumbar OPLL is frequently observed in elderly people in the primary care setting, in Japan.
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Affiliation(s)
- Toshikatsu Okumura
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
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25
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Okumura T, Ohhira M, Nozu T. High rate of smoking in female patients with Mondor's disease in an outpatient clinic in Japan. Int J Gen Med 2012; 5:735-8. [PMID: 22969305 PMCID: PMC3437915 DOI: 10.2147/ijgm.s36616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 11/27/2022] Open
Abstract
Purpose: Little is known about the epidemiology of Mondor’s disease. The aim of this study was to analyze the clinical features of Mondor’s disease in an outpatient clinic where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease. Patients and methods: The data for consecutive outpatients who were new visitors to the Department of General Medicine in the teaching hospital (Asahikawa Medical University Hospital) at Asahikawa Medical University, Asahikawa, Hokkaido, Japan, between April 2004 and March 2012 were analyzed. Parameters such as age, sex, diagnosis, and clinical presentation were investigated. Results: During the 8-year period covered in this study, six (0.07%) out of 8767 patients were diagnosed as having Mondor’s disease. All of these patients with Mondor’s disease were female, and the mean age was 41 plus or minus 12 years; the overall rate of Mondor’s disease in all female patients involved in this study was 0.12%. The patients complained of pain and a cord-like structure in the anterolateral thoracoabdominal wall. The painful mass had persisted for 1–4 weeks before presenting at the Department of General Medicine and it disappeared within a couple of weeks. Current smoking was significantly higher in the patients with Mondor’s disease than in the age-matched female patients without Mondor’s disease who were also evaluated in this study. Conclusion: These results suggest that a high rate of smoking in middle-aged females may be a characteristic feature of Mondor’s disease. These epidemiological data may be useful in detection of the disease in the primary care setting in Japan.
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