長嶋 孝夫

We report the clinical features of 7 Japanese patients with anti-PL-12 antibody. Rheumatoid arthritis（ RA）was the most common diagnosis （4/7 patients）. Interstitial lung disease （ILD） was detected in all 7 patients,polyarthritis was present in 5 patients, and elevation of creatine kinase was noted in 2 patients. The 4 patients with RA were all positive for anti-cyclic citrullinated peptide（ CCP） antibody, and the titer was high in 3 of them. Bone erosions were detected in 3 patients. One patient developed rapidly progressive ILD. In conclusion, a high frequency of anti-CCP-positive RA was detected among Japanese patients with anti-PL-12 antibody.

Objective： To investigate the association between joint symptoms and related conditions in Japanese patientswith polymyositis（ PM） and dermatomyositis（ DM）.Methods： We retrospectively reviewed all patients with PM/DM who were admitted to our departmentfrom January 2007 to March 2012. Clinical data on these patients were retrieved from the medical records.Results： Seventy-eight patients （20 with PM and 58 with DM） were enrolled. Among them, 37 patients（47%）had arthralgia or arthritis. Joint symptoms were more frequent in DM than PM （53% vs. 30%,P=0.07）. Anti-aminoacyl tRNA antibodies （ASA） were positive in 25 patients （32%）, and anti-cyclic citrullinatedpeptide （CCP）antibody was positive in 7 patients （9%）. Patients with anti-Jo-1 antibody had a highfrequency of polyarthritis（ 82%）, while anti-CCP antibody was positive in 4 out of 11 patients with anti-Jo-1antibody （36%）. Among patients with joint symptoms, anti-Jo-1 antibody was positive in 67% of the patientswith PM, but was positive in only 16% of the patients with DM. Four of the 78 patients （5%） were initiallydiagnosed and treated as having rheumatoid arthritis. Multivariate analysis showed that fever, Raynaud'sphenomenon, and anti-Jo-1 antibody were associated with joint symptoms, whereas overall ASA positivityshowed no significant difference between patients with or without joint symptoms.Conclusion： Forty-seven percent of patients with PM/DM had joint symptoms. Except for anti-Jo-1 antibody,ASA were not associated with joint symptoms in Japanese PM/DM patients.

症例は55歳男性。15年前より関節症性乾癬に対して治療を受けておりコントロール良好であった。2007年2月に自己判断にて治療薬を中止したところ,皮膚および関節症状が再燃し,著しい疼痛により離床不能となり臀部に褥創を形成するに至った。シクロスポリンA,経口プレドニゾロンによる治療を行ったが効果不充分であり副作用を認めた。血清β-D-glucanの上昇を認め,本邦の生物学的製剤の使用ガイドラインに基づけばインフリキシマブの適応外となるが,臨床所見や他の検査によって活動性の真菌感染症は否定的であったことから同意取得後にインフリキシマブを開始した。結果,皮膚および関節症状は著明に改善し,真菌感染症を発症することなく血清β-D-glucanは正常化した。現在,インフリキシマブを継続して通常の生活を送ることができている。ガイドラインは一つの指針に過ぎず,重要なことは患者の全体像を臨床的に判断することである。

Objective Prednisolone has traditionally been tapered below 30 mg daily before patients are discharged from hospitals in Japan because of concerns regarding the development of infectious complications. We undertook this study to compare the incidence of infectious complications in patients taking more than 30 mg of prednisolone daily with those taking less than 30 mg. Patients and Methods The medical records of fifty-seven patients with systemic lupus erythematosus (SLE) were reviewed retrospectively, and divided into three groups based on the dose of glucocorticoids at the time of discharge: group A (n=13), newly-diagnosed SLE patients taking more than 30 mg of prednisolone daily; group B (n=22), newlydiagnosed SLE patients taking less than 30 mg; and group C (n=22), patients with an established diagnosis taking more than 30 mg daily for the treatment of an exacerbation of symptoms. The development of infectious complications within two months after discharge was identified from a review of the medical records to determine the effect of glucocorticoid dose at the time of discharge on the subsequent development of infectious complications. Results Two patients in group A and three in group C developed infectious complications within two months following discharge, while no patients in group B contracted an infection. These included herpes zoster in group A (n=2) and herpes zoster, urinary tract infection and Pneumocystis jirovecii pneumonia in group C (n=3, one each). However, the incidence of infectious complications comparing groups A and B, and groups A and C was not statistically significantly different( p>0.05). There was no correlation between the incidence of infection and the total dose of glucocorticoids given during admission.Conclusion Although this study was retrospective and involved only a small number of patients with SLE, there is no increased risk of developing infectious complications in pa-tients receiving more than 30 mg of prednisolone daily at the time of hospital discharge, compared to those taking less than 30 mg. Based on these results, prolonging hospitalization only to reduce the dose of prednisolone to less than 30 mg daily lacks justifiable grounds, even if it has been a tacit consensus in Japan.

2005年1月から6月までにアレルギーリウマチ科に入院した100症例を対象とし,入院時と入院1週間後に血中Dダイマー値を測定した。Dダイマーレベルが高値またはその変化が大きかった症例と,下肢深部静脈血栓症(DVT)を疑わせる症状を有する症例について下肢静脈超音波検査を行い,DVTの有無を検査した。その結果,100例中5例にDVTを認めた。うち3例は入院前からDVTを発症しており,2例は入院中に新たにDVTを発症した。DVTがみつかった5症例は全例臨床症状を伴っていたが,臨床症状を伴っていてもDダイマーレベルが上昇していない症例は,下肢静脈超音波検査にてDVTは見られなかった。Dダイマーレベルの変化と臨床症状が見られた症例に対して下肢静脈超音波検査を行うことにより,効率的にDVTを診断できるものと考えられた。