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Keshvani C, Laylani N, Davila-Siliezar P, Kopel J, Lee AG. Neuro-ophthalmic challenges and multi-morbidity in vasculitis among the older adults. Expert Rev Clin Immunol 2024; 20:781-791. [PMID: 38572928 DOI: 10.1080/1744666x.2024.2339893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/03/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Vasculitides are a heterogeneous group of disorders producing inflammation of blood vessels (e.g. arteries or veins). All major vasculitides potentially have ophthalmological symptoms and signs including visual loss. Co-morbidity, multimorbidity, polypharmacy, and geriatric syndromes all play important roles in patient outcomes for these rheumatic conditions in the elderly. This monograph reviews the NCBI PubMed database (Feb 2023) literature on the neuro-ophthalmic and geriatric considerations in vasculitis. AREAS COVERED Cogan Syndrome, Granulomatosis with Polyangiitis, Giant Cell Arteritis, Polyarteritis Nodosa, Takayasu Arteritis, Vasculitis epidemiology, and neuro-ophthalmological symptoms. EXPERT OPINION Geriatric patient care for vasculitis with neuro-ophthalmological manifestations can be complicated by the interplay of multiple co-morbidities, polypharmacy, and specific geriatric syndromes. The valuation and treatment of vasculitis and the complications associated with the disease can negatively impact patient care. Advances in noninvasive imaging and updates in diagnostic criteria have enabled increased identification of patients at earlier stages with less severe disease burden. Novel therapeutic agents can be glucocorticoid sparing and might reduce the adverse effects of chronic steroid use. Holistic care models like the 5 M geriatric care model (mind, mobility, medications, multicomplexity, and matters most) allow patients' needs to be in the forefront with biopsychosocial aspects of a patient being addressed.
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Affiliation(s)
- Caezaan Keshvani
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Noor Laylani
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jonathan Kopel
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Andrew G Lee
- Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- Department of Ophthalmology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Sener S, Basaran O, Kaya Akca U, Atalay E, Kasap Cuceoglu M, Balik Z, Aliyev E, Bayindir Y, Batu ED, Hazirolan T, Bilginer Y, Ozen S. Treatment of childhood-onset Takayasu arteritis: switching between anti-TNF and anti-IL-6 agents. Rheumatology (Oxford) 2022; 61:4885-4891. [PMID: 35262635 DOI: 10.1093/rheumatology/keac149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Biologics are new treatment alternatives in Takayasu arteritis (TA), although data in childhood are limited. The aim of this study was to share our experience in seven childhood-onset TA patients who received a TNF-α inhibitor (adalimumab) or an IL-6 receptor inhibitor (tocilizumab) and the effect of switching therapy. METHODS We retrospectively evaluated the medical treatment records of seven patients with TA, followed between August 2005 and January 2021 at the Pediatric Rheumatology Department of Hacettepe University Faculty of Medicine. RESULTS The median age of patients was 14 (IQR 4) years, and six were female. All of the patients had severe disease and high acute-phase reactants. The patients initially received only steroids or steroids+CYC. Prednisone was decreased, and biologic agents were started once the acute phase reactants decreased, and the Indian Takayasu Activity Score (ITAS) returned to normal. Initially, four patients received tocilizumab (TCZ) [median 25.5 (IQR 41) months] and three patients received adalimumab (ADA) [median 13 (IQR 31) months]. However, due to the progression of MR angiography findings or persistent elevation in acute-phase reactants, the biologic agents were switched from TCZ to ADA in four patients and from ADA to TCZ in three patients. The patients' median follow-up time after changing was 50 (IQR 77) months, and median ITAS was evaluated as '0' after 2 (IQR 4) months. CONCLUSIONS In conclusion, both TNF-α and IL-6 inhibitors are effective alternatives in treating patients with childhood-onset TA. However, prospective randomized controlled trials are needed for the comparison of their effectiveness.
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Affiliation(s)
- Seher Sener
- Division of Pediatric Rheumatology, Department of Pediatrics
| | - Ozge Basaran
- Division of Pediatric Rheumatology, Department of Pediatrics
| | | | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics
| | | | - Zeynep Balik
- Division of Pediatric Rheumatology, Department of Pediatrics
| | - Emil Aliyev
- Division of Pediatric Rheumatology, Department of Pediatrics
| | - Yagmur Bayindir
- Division of Pediatric Rheumatology, Department of Pediatrics
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics
| | | | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics
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3
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Zaldivar Villon MLF, de la Rocha JAL, Espinoza LR. Takayasu Arteritis: Recent Developments. Curr Rheumatol Rep 2019; 21:45. [DOI: 10.1007/s11926-019-0848-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Tomelleri A, Campochiaro C, Sartorelli S, Cavalli G, De Luca G, Baldissera E, Dagna L. Gender differences in clinical presentation and vascular pattern in patients with Takayasu arteritis. Scand J Rheumatol 2019; 48:482-490. [PMID: 31064248 DOI: 10.1080/03009742.2019.1581838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To compare clinical characteristics and pattern of vascular involvement at disease onset according to gender specificity in patients with Takayasu arteritis (TA).Methods: Data from 117 TA patients (11 male, 106 female), diagnosed according to the American College of Rheumatology criteria, from our centre were retrospectively collected. Differences between men and women regarding demographic features, diagnostic delay, signs and symptoms attributed to TA, and arteries involved at diagnosis were compared. Data were obtained from three published articles describing gender differences in TA. A global analysis of these three cohorts plus ours (a total of 578 patients; 108 men, 470 women) was performed.Results: In our TA cohort, age at disease onset and age at diagnosis were not significantly different between genders. Diagnostic delay was higher in men. Male patients showed higher involvement of iliac arteries (right, p = 0.016; left, p = 0.021); females suffered more frequently from upper limb claudication (p = 0.026). In the overall analysis, men had higher prevalence of arterial hypertension (p = 0.007) and more frequent involvement of abdominal aorta (p = 0.026), renal arteries (right, p < 0.001; left, p < 0.001), and iliac arteries (right, p = 0.009; left, p = 0.002). Women more frequently exhibited upper limb claudication (p = 0.042) and involvement of left subclavian artery (p = 0.005), carotid arteries (right, p < 0.001; left, p < 0.001), and supradiaphragmatic aorta (ascending, p = 0.050; arch, p < 0.001; descending, p = 0.003). Inflammatory markers were more frequently raised in women (p = 0.005).Conclusions: In TA patients, gender has a strong influence on pattern of vascular involvement and consequently on clinical presentation. Specifically, women have a higher involvement of the supradiaphragmatic vessels, whereas in men the abdominal vessels are more frequently affected.
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Affiliation(s)
- A Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - C Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - S Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - G Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - G De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - E Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Demir S, Sönmez HE, Özen S. Vasculitis: Decade in Review. Curr Rheumatol Rev 2019; 15:14-22. [PMID: 30047330 DOI: 10.2174/1573397114666180726093731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/26/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the last decade, we have come to better understand and manage the vasculitides. The classification of vasculitides has been revised. Genome- wide association studies and linkage analyses have been undertaken in hope of better understanding the pathogenesis of vasculitides. Comprehensive genetic studies have highlighted new pathways that may guide us in more targeted therapies. Description of the monogenic forms of vasculitis, such as deficiency of adenosine deaminase type 2 (DADA2), Haploinsufficiency of A20 (HA20), have introduced a new perspective to vasculopathies, and introduced alternative treatments for these diseases. CONCLUSION In this review, the important discoveries in pathogenesis and consensus treatment recommendations from the past decade will be summarized.
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Affiliation(s)
- Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Vijayvergiya R, Jindal AK, Pilania RK, Suri D, Gupta A, Sharma A, Sinha SK, Singhal M, Bahl A, Singh S. Complex interventions of abdominal aorta and its branches in children with Takayasu arteritis: Clinical experience from a tertiary care center in north-west India. Int J Rheum Dis 2018; 22:140-151. [PMID: 30398008 DOI: 10.1111/1756-185x.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/04/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ankur K. Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Rakesh K. Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Deepti Suri
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Anju Gupta
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Ashish Sharma
- Department of Renal Transplant Surgery; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Saroj K. Sinha
- Department of Gastroenterology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Ajay Bahl
- Department of Cardiology, Advanced Cardiac Centre; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advanced Paediatrics Centre; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Park EH, Lee EY, Lee YJ, Ha YJ, Yoo WH, Choi BY, Paeng JC, Suh HY, Song YW. Infliximab biosimilar CT-P13 therapy in patients with Takayasu arteritis with low dose of glucocorticoids: a prospective single-arm study. Rheumatol Int 2018; 38:2233-2242. [PMID: 30229280 PMCID: PMC6223861 DOI: 10.1007/s00296-018-4159-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/11/2018] [Indexed: 11/18/2022]
Abstract
To evaluate the efficacy and safety of infliximab biosimilar CT-P13 in patients with active Takayasu arteritis (TAK). In this single-center open-label trial, patients with active TAK received CT-P13 at a starting dose of 5 mg/kg at weeks 0, 2, 6, and then every 8 weeks up to week 46. They were followed up until week 54. From week 14 to week 46, patients with inadequate response received increased dose of CT-P13 by 1.5 mg/kg. Concomitant prednisolone was allowed ≤ 10 mg/day. The primary efficacy end point was the achievement of partial or complete remission at week 30. All patients underwent positron emission tomography–computed tomography (PET–CT) at baseline and week 30. Twelve patients with TAK received CT-P13; one patient with protocol violation was excluded from analysis. Nine (81.8%) patients had taken concomitant prednisolone with median dose of 5.0 mg/day. At week 30, three (27.3%) patients achieved complete remission and six (54.5%) patients achieved partial remission. Statistically significant improvements in modified Indian Takayasu Clinical Activity Score (ITAS2010), ITAS-A, and serum levels of erythrocyte sedimentation rate and C-reactive protein were seen at week 30 from baseline. PET parameters were significantly reduced from baseline to week 30, including maximum standardized uptake value, target-to-vein ratio, target-to-liver ratio, and PET Vascular Activity Score. There were no serious adverse events. Treatment with CT-P13 may lead to improvement in clinical, radiographic, and serological activities with lower glucocorticoid requirement in TAK. Trial registration number NCT02457585.
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Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - You Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Wan-Hee Yoo
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University, Jeonju, South Korea
| | - Byoong Yong Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hoon Young Suh
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, South Korea. .,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, South Korea.
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8
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Masood QF, Naeem A, Tariq SM, Asad A, Habib S. Takayasu Arteritis: A Diagnosis Made Using a Multidisciplinary Approach. Cureus 2018; 10:e2781. [PMID: 30112257 PMCID: PMC6089487 DOI: 10.7759/cureus.2781] [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] [Indexed: 11/05/2022] Open
Abstract
Takayasu arteritis is an idiopathic chronic vasculitis that involves large blood vessels, including the aorta and its main branches. This disease presents typically as ischemia or aneurysms that could be prevented by timely diagnosis and vigilant management. We present here the case of a 19-year-old male who presented with a history of visual disturbance, chest pain, dizziness, and a feeble pulse.
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Affiliation(s)
| | - Anika Naeem
- Graduate, Allama Iqbal Medical College, Lahore, Pakistan, Lahore, PAK
| | - Syed Maaz Tariq
- Department of Medicine, Jinnah Sindh Medical University (SMC), Karachi, PAK
| | - Ali Asad
- Pediatric Surgery, University of Health Sciences, Lahore, Lahore, PAK
| | - Sara Habib
- Neuro-Critical Care, Thomas Jefferson University, Philadelphia, USA
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Jung JH, Lee YH, Song GG, Jeong HS, Kim JH, Choi SJ. Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis. Eur J Vasc Endovasc Surg 2018; 55:888-899. [PMID: 29622513 DOI: 10.1016/j.ejvs.2018.02.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/25/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE/BACKGROUND Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. METHODS A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I2 statistic. RESULTS The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78-9.62; p < .001). In subgroup analysis according to the involved lesions, endovascular intervention patients showed more restenosis than open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12-0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. CONCLUSION This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries.
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Affiliation(s)
- Jae Hyun Jung
- Korea University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Young Ho Lee
- Korea University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Cardiovascular Centre, Korea University Anam Hospital, Seoul, South Korea
| | - Gwan Gyu Song
- Korea University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Cardiovascular Centre, Korea University Anam Hospital, Seoul, South Korea
| | - Han Saem Jeong
- Korea University College of Medicine, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Cardiovascular Centre, Korea University Anam Hospital, Seoul, South Korea
| | - Jae-Hoon Kim
- Korea University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Sung Jae Choi
- Korea University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea.
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Tombetti E, Mason JC. Takayasu arteritis: advanced understanding is leading to new horizons. Rheumatology (Oxford) 2018; 58:206-219. [DOI: 10.1093/rheumatology/key040] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Enrico Tombetti
- Department of Immunology, Transplantation and Infections Disease, Vita-Salute San Raffaele University and San Raffaele Scientific Institute, Milan, Italy
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Justin C Mason
- Vascular Sciences and Rheumatology, Imperial Centre for Translational and Experimental Medicine, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
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Tanimura S, Kato M, Abe N, Ohira H, Tsujino I, Atsumi T. Successful treatment of tocilizumab-resistant large vessel pulmonary arteritis with infliximab. Immunol Med 2018; 41:39-42. [DOI: 10.1080/09114300.2018.1451616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shun Tanimura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuya Abe
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Ohira
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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