We evaluated the prevalence of Helicobacter pylori infection and the association of H. pylori infection and/or nonsteroidal anti-inflammatory drug (NSAID) use with upper gastrointestinal (UGI) ulcers in a cohort of Japanese patients with rheumatoid arthritis (RA). Using the clinical database of the cohort of RA patients and the serum titers of H. pylori antibody, 1815 patients were analyzed. Clinical data were successfully collected for 1529 patients over 2 years, and the history of NSAID use and the occurrence of newly diagnosed UGI ulcer were ascertained by patient self-reports and confirmed by their medical records. A total of 871 patients (49.3%) were H. pylori antibody-positive. Rates of positivity for H. pylori in patients with and without NSAID use were 47.5% and 54.7%, respectively (odds ratio = 0.75, 95% confidence intervals [CI]: 0.58-0.96). The incidence of newly diagnosed UGI ulcer was 0% in the H. pylori-/NSAID- group, 1.24% in the H. pylori-/NSAID+ group, 1.06% in the H. pylori+/NSAID- group, and 3.46% in the H. pylori+/NSAID+ group. The odds ratios of H. pylori infection and NSAID for the occurrence of new UGI ulcers after adjusting for age and sex were 2.97 (95% CI: 1.19-7.38) and 4.31 (95% CI: 0.57-32.4), respectively. Although the prevalence of H. pylori antibody was low in patients with RA compared with that in healthy Japanese individuals, H. pylori infection was a significant risk factor for UGI ulcer in patients with RA.
We evaluated the effects of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) on endoscopic and histological findings in patients with rheumatoid arthritis (RA) before and after the eradication of Helicobacter pylori infection. Helicobacter pylori (H. pylori) eradication using lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 mg twice daily for 1 week was conducted in 44 patients (mean age: 56.5 years) with RA. Using the updated Sydney system, endoscopic and histological findings of the greater curvature of the antrum, the greater curvature of the upper corpus, and the lesser curvature of the lower corpus were compared before and after eradication, for a mean follow-up period of 3.5 months. Overall, H. pylori eradication was successful in 32 patients (72.7%). Of these 32 patients, 23 were NSAID users. In the successful eradication group, (1) there was no significant change on endoscopic findings, including gastric erythema and erosion in all three regions irrespective of NSAIDs use; (2) of 17 active ulcers before eradication in NSAIDs users, all healed except for one duodenal ulcer that persisted, where one patient newly developed a gastric ulcer, one developed erosive duodenitis, and two developed reflux esophagitis, all in NSAID users; (3) neutrophil infiltration and chronic inflammation were significantly improved in all three regions after H. pylori eradication irrespective of use of NSAIDs, while atrophic change and intestinal metaplasia did not change. In the eradication failure group; (1) there was no significant change on endoscopic and histological findings in the three regions; (2) two of three ulcers present before eradication on NSAID users persisted even after eradication, and no new cases of gastric ulcer or erosive duodenitis occurred. In conclusion, over a mean follow-up period of 3.5 months, use of NSAIDs in Japanese patients with RA did not impair the healing process of gastric and duodenal ulcers nor did it affect the endoscopic and histological improvements associated with H. pylori eradication.
Journal Article Therapeutic effects of the combination of methotrexate and bucillamine in early rheumatoid arthritis: a multicenter, double-blind, randomized controlled study Get access Yoichi Ichikawa, Yoichi Ichikawa Department of Rheumatic, Collagen and Allergic Diseases, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan Correspondence to: Yoichi Ichikawa, St. Joseph's Hospital, 28 Midorigaoka, Yokosuka 238-8502, Japan Tel. +81-46-822-2134; Fax +81-46-822-3134 e-mail: j-incho@aqua.ocn.ne.jp Search for other works by this author on: Oxford Academic Google Scholar Terunobu Saito, Terunobu Saito Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Hisashi Yamanaka, Hisashi Yamanaka Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Masashi Akizuki, Masashi Akizuki Department of Internal Medicine, Yokohama Municipal Citizens' Hospital, Yokohama, Japan Search for other works by this author on: Oxford Academic Google Scholar Hirobumi Kondo, Hirobumi Kondo Department of Internal Medicine, Kitazato University School of Medicine, Kitazato, Japan Search for other works by this author on: Oxford Academic Google Scholar Shigeto Kobayashi, Shigeto Kobayashi Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Hisaji Oshima, Hisaji Oshima Department of Internal Medicine, Fujita Health University, Nagoya, Japan Search for other works by this author on: Oxford Academic Google Scholar Shinichi Kawai, Shinichi Kawai Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan Search for other works by this author on: Oxford Academic Google Scholar Nobuaki Hama, Nobuaki Hama Department of Rheumatic, Collagen and Allergic Diseases, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan Search for other works by this author on: Oxford Academic Google Scholar Hidehiro Yamada, Hidehiro Yamada Department of Rheumatic, Collagen and Allergic Diseases, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan Search for other works by this author on: Oxford Academic Google Scholar ... Show more Tsuneyo Mimori, Tsuneyo Mimori Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan Search for other works by this author on: Oxford Academic Google Scholar Koichi Amano, Koichi Amano Second Department of Internal Medicine, Saitama Medical Center, Kawagoe, Japan Search for other works by this author on: Oxford Academic Google Scholar Yasushi Tanaka, Yasushi Tanaka Department of Internal Medicine, Konan Kakogawa Hospital, Kakogawa, Japan Search for other works by this author on: Oxford Academic Google Scholar Yasuo Matsuoka, Yasuo Matsuoka Department of Internal Medicine, Kawasaki Municipal Hospital, Kawasaki, Japan Search for other works by this author on: Oxford Academic Google Scholar Sumiki Yamamoto, Sumiki Yamamoto The Centre for Rheumatic Diseases, Matsuyama Red Cross Hospital, Ehime, Japan Search for other works by this author on: Oxford Academic Google Scholar Tsukasa Matsubara, Tsukasa Matsubara Department of Orthopedics, Matsubara Mayflower Hospital, Hyogo, Japan Search for other works by this author on: Oxford Academic Google Scholar Norikazu Murata, Norikazu Murata Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan Search for other works by this author on: Oxford Academic Google Scholar Tomiaki Asai, Tomiaki Asai Department of Orthopedics, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan Search for other works by this author on: Oxford Academic Google Scholar Yasuo Suzuki, Yasuo Suzuki Department of Rheumatic, Collagen and Allergic Diseases, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan Search for other works by this author on: Oxford Academic Google Scholar MTX–BUC Combination Study Group, Japanese Ministry of Health, Labour and Welfare's "Research for Establishment of Therapeutic Guidelines in Early Rheumatoid Arthritis" MTX–BUC Combination Study Group, Japanese Ministry of Health, Labour and Welfare's "Research for Establishment of Therapeutic Guidelines in Early Rheumatoid Arthritis" Search for other works by this author on: Oxford Academic Google Scholar Modern Rheumatology, Volume 15, Issue 5, 1 October 2005, Pages 323–328, https://doi.org/10.3109/s10165-005-0420-z Published: 01 October 2005 Article history Received: 26 May 2005 Accepted: 27 June 2005 Published: 01 October 2005
RA Center Liaison Council conducted a comparative study of Auranofin and GST by envelope method on the patients with early RA who experienced the onset of the disease not more than two years ago. In final assessment of overall improvement, 57.9% of Auranofin-administered cases (22/38) showed moderate improvement or above. The comparable figure for GST group was 71.8% (28/39), but there was no statistically significant difference. Adverse reaction ADR incidence for Auranofin group was 12.2% (5/41), while 22.0% for GST (9/41), but the difference was not statistically significant. Drop out due to ADR was observed in 9.8% of Auranofin-administered cases and in 19.5% of GST-administered cases. The results of the study indicate that Auranofin is a most suitable DMARD than GST to be used for early RA, and GST is suitable for more active RA in view of its efficacy. But GST should be administered carefully because of its high ADR incidence.
Objective. To investigate earlier prediction of future articular destruction in patients with early rheumatoid arthritis (RA). Methods. We randomly allocated patients with RA with disease duration < 2 years to different nonbiologic disease modifying antirheumatic drug (DMARD) therapies in a double-blind trial. Progression of articular destruction over the 96-week treatment period was assessed using the modified Sharp method. Results. Progression of articular destruction correlated more strongly with the American College of Rheumatology (ACR) core set measures after 12 weeks of treatment than with pretreatment values. Multiple regression analysis of data after 12 weeks yielded a correlation coefficient of 0.711. The sensitivity and specificity to predict articular destruction over the 75th percentile of the cohort were 78.6% and 84.6%, respectively. Patients who showed articular destruction over the 75th percentile of the cohort had low response to treatment at 12 weeks, and continued to have high clinical disease activity thereafter. Contrasting data were found in patients with slow progression of articular destruction. Conclusion. In patients with early RA, ACR core set measures after 12 weeks of nonbiologic DMARD treatment may predict articular destruction 2 years later. Low response to treatment at 12 weeks and continuing high disease activity thereafter were found in patients with rapid radiological progression. These data can be used to determine the appropriateness of treatment at 12 weeks and aid the decision to introduce biologic DMARD.
We describe a case of dermatomyositis with concurrent clinical and laboratory features of idiopathic thrombocytopenia associated with anti-Ku antibody. A diagnosis of dermatomyositis was established by the characteristic skin changes together with a muscle biopsy. Scintigraphic studies indicated cardiac involvement. Autoimmune idiopathic thrombocytopenia (AITP) has been described in association with both systemic lupus erythematosus (SLE) and scleroderma, but there are few reports describing AITP associated with myositis. To our knowledge, this is the first report of a case of dermatomyositis associated with AITP and anti-Ku antibody.
