Papers by Susumu Nishiyama
日本リウマチ学会総会・学術集会プログラム・抄録集, 2017
日本リウマチ学会総会・学術集会プログラム・抄録集, 2017
International Journal of Rheumatic Diseases, Jun 27, 2022
BackgroundDiscordance between patient global assessment (PGA) and physician global assessment (Ph... more BackgroundDiscordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA‐PhGA discordance and the variables associated with future positive discordance (PGA &gt; PhGA) based on the NinJa database in Japan.MethodsWe examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10‐cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis.ResultsDue to the small number of patients with RA categorized as having negative discordance (PGA &lt; PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C‐reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP.ConclusionsPositive discordance may persist. Circumventing this requires adequate management of pain and functional impairment.
BMC Musculoskeletal Disorders, Jan 18, 2019
Background: Previous studies suggest that RA activity is sensitive to seasonal changes. This stud... more Background: Previous studies suggest that RA activity is sensitive to seasonal changes. This study explored the influence of season on RA activity, particularly the distribution of affected joints, using a nationwide database in Japan. Methods: We investigated 12,839 patients whose RA activity was recorded in spring (n = 3250), summer (n = 916), fall (n = 1021), and winter (n = 7652). Disease activity score (DAS) 28-CRP, simplified disease activity index (SDAI), and clinical disease activity index (CDAI) were used as indices of disease activity. Disease activity was also assessed according to DAS28-CRP scores (remission, low, moderate, or high). The affected joint distribution was investigated using novel joint indices (x, y, z), where x and y are indices for the upper and lower joints, respectively, and z is the index for large joint predominance. Results: Mean DAS28-CRP and median SDAI and CDAI scores were highest in spring and lowest in fall. There was a significant difference in the DAS28-CRP for fall versus spring and winter. Fall was associated with a higher remission rate, and spring and winter with high and moderate RA activity, respectively. Significant differences in x, y, SDAI, and CDAI scores were found for spring versus summer, fall, and winter, in addition to fall versus winter (except in y). There was no seasonal difference in the z index. Conclusions: RA activity in the upper and lower extremities may be highest in spring, followed by winter. Seasonal changes should be considered in patients with RA to better understand their symptoms.
Annals of the Rheumatic Diseases, Jun 1, 2014
fluid culture. According to the local recommendation, joint puncture was done using sterile non-t... more fluid culture. According to the local recommendation, joint puncture was done using sterile non-touch technique and patients were informed of the risk of joint infection, and urged to contact us if any suspicion of infection was found or lack of improvement Results: A total of 3921 IA GC injections and 1147 arthrocentesis were registered. Two patients developed subsequently a SA respectively 7 and 18 days after the injections. Both patients, one with RA and one with gout, contacted us as advised, none of these two got irreversible join damage (0,05% of all GC injections). Evaluating the three most common diagnostic groups at our department in 2013 it was discovered that among 652 patients with RA 2 had done an arthrocentesis, 261 a GC injection and 76 had both procedures performed. For Pts with PsA the corresponding numbers were 11, 57 and 11 and for the Gout patients 35, 74 and 19. None of these procedures resulted in an iatrogenic arthritis Conclusions: IA joint puncture plus/minus subsequent GC injection is a safe procedure, when using an aseptic technique and proper information to the patients. The overestimated risk of inducing a SA might mean that patients do not get a prompt and sufficient treatment of the individual joint problem. Of course this should not lead to contraindications to arthrocentesis and relevant information to the patients overridden. Because patients were urged to contact us in case of signs of infection after joint puncture, we think data are complete concerning the numbers of patients having a SA secondary to the procedures. It does not appear, that there is any difference between the frequencies of the procedures between the patients with RA, PsA or gout References: [1] Hetland ML, Hørslev-Petersen K. The CIMESTRA study: Intra-articular glucocorticosteroids and synthetic DMARDs in treat-to-target strategi in early rheumatoid arthritis.
Annals of the Rheumatic Diseases, May 30, 2023
The Health Assessment Questionnaire Disability Index (HAQ-DI) is the best-known index for measuri... more The Health Assessment Questionnaire Disability Index (HAQ-DI) is the best-known index for measuring functional capacity in patients with rheumatoid arthritis (RA). This index is well known to be influenced by disease activity, aging, joint deformities and pain. However, these parameters are related to each other and it remains unclear how joint involvement affects HAQ-DI in RA patients. The aim of this study is to determine how joint involvement affects HAQ-DI in RA patients using a retrospective cohort study. Methods: Patients with RA who have been monitored since the first visit for tenderness and swelling of the whole body and limb joints, patient's global assessment (PGA), evaluator's global assessment (EGA), pain score using a visual analog scale (PS), and HAQ-DI at every visit were included in the study. The patient's mean age, HAQ score, PGA, EGA, C-reactive protein (CRP), and Sharp/van der Heijde score (SHS) were collected. Joint Index Vector (JIV) was used as an index of joint lesions. JIV represents the joint prevalence of the upper limb in X coordinates (Vx), the joint prevalence of the lower limb in Y coordinates (Vy), and the difference in joint prevalence between large and small joints in Z coordinates (Vz) [1]. The average value of the triaxial coordinates of the JIV was also collected. As a preliminary study, the correlation between the mean HAQ score of all cases collected and other parameters such as patient gender and serum albumin level (ALB) was evaluated using multivariate linear regression analysis. Statistical significance was set as less than 1.0*10 -10 . Next, the association of the HAQ score with other parameters at baseline, the association of the HAQ score after 1 year at baseline with other parameters at baseline and the change from baseline to 1 year, and the annual change in the HAQ score and other parameters at baseline and the annual change in these parameters were statistically evaluated using multivariate linear regression analysis. Statistical significance was set as less than 5.0%. Results: A total of 601 patients in these 166 males and 435 females data were used in the study. The HAQ score positively correlated with male gender, older age, higher SHS, higher PGA, lower EGA, higher PS, higher Vy, and higher Vz with beta values of 0.09, 0.22, 0.17, 0.19, -0.12, 0.17, 0.07, and 0.11, respectively. The HAQ score at baseline positively correlated with older age, higher PGA, higher CRP, higher PS, higher SHS, and higher Vy at baseline with beta values of 0.26, 0.13, 0.21, 0.14, 0.14, and 0.10, respectively. The HAQ score at one year after the baseline positively correlated with older age, higher PS, and higher SHS at the baseline, and higher annual change of the PS with beta values of 0.26, 0.25, 0.22, and 0.15, respectively. The annual change of the HAQ score positively correlated with higher SHS and higher Vy at the baseline, and higher annual change of PS, Vx, Vy, and Vz with beta values of 0.04, 0.11, 0.04, 0.67, 0.43, and 0.09, respectively. Conclusion: These results indicate that there is a close association between HAQ scores and aging, degree of pain, and joint deformities, and in addition, joint involvement also influences HAQ scores. In particular, changes in HAQ scores are governed by joint involvement. The effect of disease activity on HAQ scores will be largely governed by joint involvement. [1] Nishiyama S, Sawada T, Nishino J, Tohma S. Joint index vector: a novel assessment measure for stratified medicine in patients with rheumatoid arthritis.
Annals of the Rheumatic Diseases, May 30, 2023
and positive/positive group, respectively. Conclusion: These results suggest that Vxy > 0.012 and... more and positive/positive group, respectively. Conclusion: These results suggest that Vxy > 0.012 and PS-VAS > 25 mm are available risk indicators for inc-BFF. The composite indicator should be more predictable. REFERENCES: NIL.
Modern Rheumatology, Mar 16, 2023
Objective To evaluate the prevention and development of cervical cancer in SLE patients in Japan ... more Objective To evaluate the prevention and development of cervical cancer in SLE patients in Japan and its background based on a questionnaire survey. Methods The questionnaire was handed to 460 adult female SLE patients at 12 medical institutions. The participants were grouped by age, and data related to their HPV vaccination status, age at first coitus, cervical cancer screening, and diagnosis of cervical cancer were analyzed. Results A total of 320 responses were received. Patients aged 35–54 years included a higher proportion of patients whose age at first coitus was &lt;20 years. This group also showed a higher rate of cervical cancer/dysplasia. Only 9 patients had a HPV vaccination history. Adequate frequency of cervical cancer screening was slightly higher (52.1%) among SLE patients than in the Japanese general population. However, 23% of the patients had never undergone examination, primarily because of a feeling of troublesome. The incidence of cervical cancer was significantly higher among SLE patients. One reason for this may be associated with the use of immunosuppressants, although the difference was not significant. Conclusion SLE patients are at a higher risk of cervical cancer and dysplasia. Rheumatologists should proactively recommend vaccination and screening examinations for SLE female patients.
Annals of the Rheumatic Diseases, Jun 1, 2020
of BMD at the left and right hip, and at the lumbar spine, as well as average percent far and oth... more of BMD at the left and right hip, and at the lumbar spine, as well as average percent far and other risk factors for osteoporosis, including the FRAX risk factors. We used only the measures collected at baseline (time of first scan). We modelled the T scores of the BMD measurements using a linear regression model including percentage fat and BMI as explanatory variables, and adjusting for gender, age at scan, and other known risk factors for osteoporosis, including the FRAX risk factors. BMI and average percent fat were standardised. Results: The number of patients included was 33037, (82% female). Results of both regression models are shown in table 1 below. We show the standardised effect size estimates for average percent fat and BMI.
Annals of the Rheumatic Diseases, Jun 1, 2014
Background: Interstitial lung disease (ILD) is a heterogeneous group of disorders that are classi... more Background: Interstitial lung disease (ILD) is a heterogeneous group of disorders that are classified together because of similar clinical and radiographic manifestations. However, prognosis and therapeutic response are influenced by the presence of an underlying cause. The aim is to study the etiologic profile of ILD in internal medicine. Methods: A retrospective analysis of patients with ILD hospitalized in internal medicine department of military hospital from 2000 to 2013. Results: We evaluated 44 patients (30 women, 14 men) with a mean age of 57 years. Among them, 32% were smokers. The most common symptom was progressive dyspnea occurring in 83% of cases. All the patients had abnormal chest radiographs, mainly confluent reticular infiltrates or diffuse reticulonodular shadowing. Pulmonary function tests were restrictive in pattern in 54% of the subjects. The most frequent disease was connective tissue disorders (CTD) -associated ILD (64% of all cases): Sjogren's syndrome (20%), systemic sclerosis (16%), systemic lupus erythematosus (11%), rheumatoid arthritis (9%), antisynthetase syndrome (5%) and dermatomyositis in one case. The diagnostic of both CTD and ILD was made at the same time in 57% of cases. ILD induced by drugs was observed in 16% followed by sarcoidosis in 11% of cases. Idiopathic pulmonary fibrosis was observed in 3 cases and Churg-Strauss syndrome in one case. Corticosteroid therapy was prescribed in 68% of variable dosage depending on the cause and severity of lung disease. Immunosuppressive treatment with cyclophosphamide was indicated in only 4 cases. The response to therapy was favorable in 48% of cases and not satisfactory in 25% of the cases. Conclusions: Collagen and vascular diseases are more common than previously appreciated. A multi-disciplinary evaluation of patients with DPLD can enhance diagnosis, improve prognosis and quality of care.
Annals of the Rheumatic Diseases, Jun 1, 2014
Conclusions: The protective role of fat and lean mass on BMD is preserved in patients. The patter... more Conclusions: The protective role of fat and lean mass on BMD is preserved in patients. The pattern of sarcopenia, after adjusting for disease activity was associated with low bone mass in RA. This suggests an independent role of this sarcopenia on bone density in RA, but not in healthy subjects.
Annals of the Rheumatic Diseases, Jun 1, 2013
Objectives To compare clinical features in patients with RA classified by ACR/EULAR (A/E) remissi... more Objectives To compare clinical features in patients with RA classified by ACR/EULAR (A/E) remission and mHAQ≤0.5, and to explore clinical factors for reaching or maintaining the remission. Methods Data of 831 patients receiving MTX monotherapy for a continuous period of 3 years from 2008 were extracted from Ninja 2010, an annually updated nationwide database in Japan. The patients were divided into four groups according to their remission states, both A/E and HAQ remission (A), only A/E remission (B), only HAQ remission (C) and neither A/E nor HAQ remission (D). Total joint index (TJI) was calculated as the sum of tender and swollen joint counts divided by the number of evaluable joints in the region of interest (1). Results Clinical features of the 4 groups were different (table 1). SDAI was different in each groups whereas DAS28 did not differ between the group A and B, and between the group C and D. The majority of patients remained in their groups throughout the period, and a transition between the group A and C occurred in around 20% of patients. Patients remained in the group A for at least 2 years had higher rate of mHAQ=0 and lower levels of physician global assessment and SDAI than patients moved from the group A to C. Patients moved from the group C to A had low levels of pain VAS, patient global assessment, physician global assessment, DAS28, and SDAI and possessed low rate of TJI>0 in upper/large and upper/small regions compared to patients remained in the group C for at least 2 years. Table 1. Comparison of clinical features between RA patients with and without remission in 2010 Group A B C D ACR/EULAR remission YES YES NO NO HAQ remission YES NO YES NO n 217 17 347 250 Age (years), mean (SD)¶ 59.6 (10.9) 68.2 (11.9) 60.1 (12.3) 64.7 (11.1) Disease duration (years), mean (SD)¶ 9.4 (8.9) 22.0 (11.3) 10.4 (8.2) 18.6 (12.0) Female (%)¶ 79.7 94.1 82.1 90.0 Stage I+II (%)† 65.9 0.0 46.4 19.1 mHAQ =0 (%)† 75.6 0.0 39.8 0.0 Pain VAS (mm), mean (SD)‡ 8.1 (8.6) 14.1 (14.2) 30.0 (19.6) 44.4 (21.2) Patient global assessment (mm), mean (SD)‡ 7.8 (7.3) 11.5 (8.4) 30.4 (18.1) 47.6 (21.0) Physician global assessment (mm), mean (SD)‡ 5.1 (5.0) 5.7 (5.7) 19.6 (12.7) 26.3 (18.2) SDAI, mean (SD)‡ 1.82 (1.06) 2.04 (0.93) 8.96 (5.15) 13.47 (8.00) DAS28-CRP, mean (SD)§ 1.54 (0.31) 1.51 (0.23) 2.73 (0.77) 3.36 (0.97) Total joint index >0 (%) Upper/large region‡ 11.1 11.8 56.5 68.4 Upper/small region§ 11.1 0.0 49.0 49.6 Lower/large region# 10.1 5.9 33.1 50.4 Lower/small region$ 4.6 5.9 13.5 8.8 ¶A+C < B+D; †A > B, C, D and C > B, D; ‡A < C, D and B < C, D and C < D; §A < C, D and B < C, D; #A < C, D and B < D and C < D; $A < C. Conclusions Clinical features were different between the 4 groups classified according to A/E and HAQ remission states. Patients that achieved and/or maintained both A/E and HAQ remission shared common features of low levels of physician global assessment and SDAI. References Nishiyama S, et al, Proposing a method of regional assessment and a novel outcome measure in rheumatoid arthritis. Rheumatol Int. DOI 10.1007/s00296-011-2058-9, 2011 Disclosure of Interest None Declared
Frontiers in Pediatrics
IntroductionThis study established an independent evaluation index for patients with childhood-on... more IntroductionThis study established an independent evaluation index for patients with childhood-onset chronic diseases in Japan.MethodsFrom November to December 2020, three Delphi rounds were conducted. Thirty-nine participants completed at least one survey. We asked them about targets of social independence for 10 types of activities (education/labor/finance/acquisition of necessities/housing/transportation/leisure/social relationship/intimate relationships/sexuality). The Delphi technique was to be repeated until a consensus of over 80% of participants was reached.ResultsThe targets chosen for measuring independence in patients with childhood-onset chronic diseases were as follows: “Graduation from high school,” “Labor for livelihood (including temporary turnover),” “Financially independent (including temporary turnover, excluding students),” “Buy or rent a house and buy the daily necessities and get the public services you need to live,” “Do housework alone,” “Plan alone and use t...
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Modern Rheumatology, 2022
Objective To clarify the efficacy and safety of intravenous abatacept for glandular and extraglan... more Objective To clarify the efficacy and safety of intravenous abatacept for glandular and extraglandular involvements in Sjögren’s syndrome (SS) associated with rheumatoid arthritis (RA). Materials and methods We performed an open-label, prospective, 1-year, observational multicenter study (ROSE and ROSE II trials). The primary endpoint was the remission rate as measured by SDAI at 52 weeks. The secondary endpoints included the changes in the Saxon’s test, Schirmer’s test, ESSDAI and ESSPRI. Adverse events and adherence rates were also analyzed. Results 68 patients (36 in ROSE and 32 in ROSE II, all women) were enrolled. SDAI decreased significantly from 23.6 ± 13.2 at baseline to 9.9 ± 9.5 at 52 weeks. Patients with SDAI remission increased from 0 (0 weeks) to 19 patients (27.9%) at 52 weeks. Saliva volume increased significantly at 24 weeks. Tear volume increased significantly at 52 weeks. Both ESSDAI and ESSPRI were significantly decreased at 12 weeks, and these responses were main...
Modern Rheumatology, 2022
Objectives Evaluate the efficacy and safety of anifrolumab in the subpopulation of Japanese patie... more Objectives Evaluate the efficacy and safety of anifrolumab in the subpopulation of Japanese patients with systemic lupus erythematosus (SLE) in phase 3 TULIP-2 trial. Methods TULIP-2 was a 52-week randomized placebo-controlled trial (N = 362) that evaluated efficacy and safety of anifrolumab 300 mg IV every 4 weeks vs. placebo in patients with moderate to severe SLE who were receiving standard therapy. We performed a post hoc analysis of the primary and key secondary endpoints, and safety, of TULIP-2 in the Japanese subpopulation. Results In the Japanese subpopulation (anifrolumab, n = 24; placebo, n = 19), the proportion of patients who achieved a British Isles Lupus Assessment Group–based Composite Lupus Assessment response at Week 52 (primary endpoint) was greater in the anifrolumab group vs. placebo [50.0% (12/24) vs. 15.8% (3/19); treatment difference: 34.2%, 95% confidence interval 6.9, 61.5; nominal p = .014]. Improvement in skin activity and flare rates (key secondary endpoi...
IgG4-Related Disease, 2013
We outline the pharmacotherapy for IgG4-related disease (IgG4-RD), with a particular focus on typ... more We outline the pharmacotherapy for IgG4-related disease (IgG4-RD), with a particular focus on type 1 autoimmune pancreatitis (AIP). The basis of therapy for type 1 AIP is oral prednisolone administration. Prednisolone at a dose of 30–40 mg/day is typically employed for remission induction. Assuming improvement, the dose is then tapered to a maintenance dose over a period of 2–4 months. Maintenance therapy, which is typically continued for 6–12 months, usually ranges from 5 to 10 mg/day. Patients must be followed carefully for the possibility of recurrence.
Annals of the Rheumatic Diseases, May 30, 2023
Background: Total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) is considere... more Background: Total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) is considered the most effective intervention reducing knee pain and improving physical function. However, higher risk of late complication and worse surgery outcomes may be observed in patients with active disease. [1] Objectives: To study the knee joint function and pain before and after the TKA in patient with rheumatoid arthritis. Methods: 69 RA patients (10 (14,5%) males and 59 (85,5%) females) with an average age of 59 [52; 64] years were included into the study group. 81 osteoarthritis (OA) patients (38 males (46,9%) and 43(53,1%) females) aged 66 [61; 73] years, were included into the control group. 23,2% of RA patients had a highly active disease at the moment of intervention. All patients underwent cemented TKA and completed Oxford Knee score (OKS) before the surgery, after discharge and 3 and 12 months after the surgery. Knee pain was assessed using VAS score also before intervention, straight after and 3 and 12 months after the surgery. All analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). A p value of less than 0.05 was considered statistically significant. Results: Patients in RA group had significantly lower preoperative OKS results, than OA patients (25.0 [23.5; 27.0] versus 29.0 [26.5: 30.0], p=0.00, Mann-Whitney) as well as lower postoperative OKS results before the discharge (34.0 [34; 38] versus 40.0 [35; 40] p=0.00, Mann-Whitney). 3 months after the intervention OKS scores were comparable within the two groups (43.0 [42; 44] versus 43.0 [42; 44], p=0.557; Mann-Whitney). The same was found for OKS scores 12 months after the surgery (44.0 [44; 47] versus 44.0 [44; 47], p=0.328,. Pain intensity in RA patients varied from 60 to 90 mm according to VAS prior to surgery and was lower than among OA patients (80.0 [80; 90] versus 90.0 [80; 100], p=0.00, Mann-Whitney) which can be explained by patients' higher pain tolerance due to "usual" pain in RA. The same tendency was observed immediately after the intervention (55.0 [50; 60] versus 65.0 [50; 65], p=0.00, Mann-Whitney). 3 months after the surgery pain intensity was similar in both groups (30.0 [30; 35], p=0.349, Mann-Whitney). 1 year after the intervention RA patients reported higher VAS scores probably due to RA activity (20.0 [20; 20] versus 10.0 [10; 15], p=0.00, Mann-Whitney). The effectiveness of TKA for pain reduction and improvement of knee function in patients with RA was comparable to that among patients with OA. OKS scores were lower in RA group prior to surgery, however, 3 and 12 months after the intervention they did not differ between the patients with RA and OA. [1] Lee DK, Kim HJ, Cho IY, Lee DH. Infection and revision rates following primary total knee arthroplasty in patients with rheumatoid arthritis versus osteoarthritis: a meta-analysis.
Journal of Clinical Medicine
We investigated the relationship between distal interphalangeal (DIP) joint involvement and disea... more We investigated the relationship between distal interphalangeal (DIP) joint involvement and disease activity in 10,038 patients with adult-onset rheumatoid arthritis (RA). The affected joint distribution was investigated using the joint indices (JI) x, y, and z, corresponding to the upper and lower joints, and the predominance of large-joint involvement, respectively. DIP joint involvement (defined by the presence of tenderness and/or swelling in DIP joints) was present in 206 (2.1%) of 10,038 patients with RA. Patients with RA exhibiting DIP joint involvement were significantly younger, and more frequently women. DIP joint involvement was positively associated with Disease Activity Score-28 using C-reactive protein, and clinical variables related to high RA disease activity, including JIs x and y, and was negatively associated with JI z. JI x was significantly higher than JI y in RA patients with DIP joint involvement. An odds ratio analysis revealed that small-to-medium sized and ...
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Papers by Susumu Nishiyama