The Observation of Humoral Responses after Influenza Vaccination in Patients with Rheumatoid Arthritis Treated with Japanese Oriental (Kampo) Medicine: An Observational Study

Objective. The efficacy of influenza vaccination in patients treated with Japanese Oriental (Kampo) Medicine is unknown. The objectives of this study were to observe the efficacy of influenza vaccination in RA patients treated with Kampo. Methods. Trivalent influenza subunit vaccine was administered to 45 RA patients who had received Kampo. They were divided into 2 groups: RA patients treated without MTX (“without MTX group”) and treated with MTX (“with MTX group”). Antibody titers were measured before and 4 weeks after vaccination using hemagglutination inhibition assay. Results. Geometric mean titers (GMTs) of anti-influenza antibodies significantly increased for all influenza strains. Response to the influenza vaccination in RA patients treated with Kampo was not lower than that of healthy subjects and the response in the “with MTX group” had a tendency to be higher than that in RA patients treated with MTX in the previous study. There was no significant difference in the GMT after 4 weeks between the “with MTX group” and the “without MTX group.” A decreased efficacy in both seroprotection and seroconversion was not found in the “with MTX group.” Conclusion. These observations may open the way for further clinical trials to establish the efficacy for the influenza vaccination in RA patients treated with Kampo

Effect of Kampo Medicine on Pain and Range of Motion of Osteoarthritis of the Hip Accompanied by Acetabular Dysplasia: Case Report and Literature Review

We report a 52-year-old female with end-stage osteoarthritis of the hip accompanied by acetabular dysplasia in whom quality of life (QOL) was improved by Kampo treatment

A case of rheumatoid arthritis with a decrease in the serum concentration of soluble CD23 by traditional herbal medicine

Traditional herbal (Kampo) medicine for the treatment of rheumatoid arthritis (RA) has not been evaluated for changes in immune status during its use, although several anti-inflammatory effects have been studied in vitro. In this case report, we describe a 32-year-old Japanese female with RA who was effectively treated with the Kampo medicine, Hochu-ekki to (Bu-Zhong-Yi-Qi-Tang, 補中益気湯) . This treatment decreased the serum concentration of soluble CD23 (sCD23) and RA activity, in addition to tumor necrosis factor-α. These findings suggest that the therapeutic action of herbal medicine might be attributable to suppression of B cell activation. 和漢薬治療は慢性関節リウマチ(RA)に対して極めて有用な治療法であるが,その作用機序に関しては,In Vitroによる生薬の抗炎症効果は解析されているものの,In Vivoでの免疫学的な評価はいまだ未着手な部分が多い。われわれは補中益気湯などが有効であったRAの一例を経験した。この患者は,RAの疾患活動性の低下に加えて血清中可溶性CD23(sCD23)が低下し,さらに,血清TNF-α濃度も,漸次低下していた。このことからRAの治療において和漢薬は単に抗炎症効果を有するだけでなくImmunomodulatorとして作用している可能性が示唆された。その一部としてRA患者でのB細胞の活性化を抑制している可能性がある

No Correlation Exists between Disease Activity and the Expression of Killer-Cell Immunoglobulin-Like Receptors in Patients with Rheumatoid Arthritis

Objective. The genes for killer-cell immunoglobulin-like receptors (KIRs) have been cloned and their functions and expression in patients with rheumatoid arthritis (RA) have been partially clarified. However, the correlation between their expression and disease activity has not been analyzed in patients with RA. Thus, we measured KIR expression on lymphocytes in patients with RA, and assessed the correlation between KIR expression and disease activity. Patients and Methods. In the cross-sectional study, 15 patients (9 females and 6 males) who fulfilled the diagnostic criteria for RA were assessed. In the longitudinal study, patients who were followed-up for 3 months were assessed. CD158a/b expression on peripheral blood mononuclear cells (PBMC) of RA patients was analyzed using flow cytometry. Results. No significant correlation between KIR expression and CRP, ESR, or IgM-RF was observed. There was no remarkable change in the expression of KIRs between the baseline and after 3 months. Additionally, in the 5 patients whose expression of KIRs particularly changed, the time-related changes in the expression of KIRs were independent from those of inflammation parameters and IgM-RF. Conclusion. There was no correlation between KIR expression and disease activity; therefore, the clinical use of KIR expression should be limited, while unnatural KIR expression may be involved in the pathogenesis of RA, but not a recruitment of chronic inflammation to induce joint damage

The examination of endoscopic findings in 221 cases of rheumatoid arthritis treated with Japanese Oriental (Kampo) medicine

OBJECTIVES: To evaluate the efficacy of Japanese Oriental (Kampo) medicine on treatment of rheumatic arthritis (RA) patients from the point of view of preventing the complication of gastroduodenal ulcer. METHODS: We examined endoscopic findings and contents of treatment in 221 rheumatoid arthritis (RA) cases treated with Japanese Oriental (Kampo) medicine retrospectively. RESULTS: A gastroduodenal ulcer was found in 10 patients (4.5%), an ulcer scar was found in 21 patients (9.5%) and a cancer was found in 6 cases (2.7%). Next, we compared the incidence of gastroduodenal ulcers in the group of patients who were receiving nonsteroidal antiinflammtory drugs (NSAIDs) therapy with the group of patients treated with Kampo medicine alone. The incidence of gastroduodenal ulcers was 9.3 % in NSAIDs group and 2.1 % in the group of patients treated with Kampo medicine alone. CONCLUSIONS: The incidence of gastroduodenal ulcers in RA patients treated with Kampo medicine was lower than that in other studies carried out in patients with RA. These findings suggested that treatment with Kampo medicine for RA is beneficial from the point of view of preventing gastroduodenal complication. 和漢薬治療中の関節リウマチ(RA)患者の胃十二指腸病変を検討した。【方法】当科で和漢薬治療中のRA患者のうち,1980年1月から2000年10月までに上部消化管内視鏡検査を施行した221例について内視鏡所見とRAの活動度,治療内容との関連を検討した。【結果】対象221例中,活動性の消化性潰瘍は10例(4.5%)。内訳は胃潰瘍9例,十二指腸潰瘍3例であった。潰瘍瘢痕は21例(9.5%)。内訳は胃潰瘍瘢痕16例,十二指腸瘢痕5例であった。その他,びらん性変化が12例(5.4%),早期胃癌が4例(1.8%)に認められた。非ステロイド性消炎鎮痛剤(NSAIDs)またはステロイド剤(ス剤)併用治療群(107例)と和漢薬単独治療群(96例)で比較検討すると,前者の活動性胃十二指腸潰瘍合併例が10例(9.3%)であるのに対し,後者では2例(2.1%)とNSAIDsまたはス剤併用群に有意に多く活動性潰瘍が合併していた。【考察】1999年CheatumらはNSAIDs服用中のRA患者の胃十二指腸病変を内視鏡検査で検討し,1009例中239例(23.6%)に胃または十二指腸潰瘍があったことを報告している。RA患者の胃十二指腸潰瘍の合併頻度については,Farahらの185例中67例(1988年),塩川らの1008例中175例(1991年)などがあり,いずれもNSAIDs投与との関連性が指摘されている。今回の検討では,221例中10例とこれらの報告と比較して少ない傾向にあった。和漢薬を中心とした治療で,NSAIDs使用を最小限にとどめることにより,消化性潰瘍の合併を減らしうる可能性が示唆された

Insights to Clinical Use of Serial Determination in Titers of Cyclic Citrullinated Peptide Autoantibodies

Anti-cyclic citrullinated peptide (CCP) antibody is a useful marker for the diagnosis and prognosis of rheumatoid arthritis (RA). Recently, clinical significance of follow-up in anti-CCP antibody titer has been pointed out. Thus, we investigated the serial determination in anti-CCP antibodies titer in RA patients. Six patients with RA, who were followed up for longer than 5 years, were assessed in anti-CCP antibodies and radiographs (Larsen score). Anti-CCP antibodies in frozen sera were measured using ELISA. As a result, 6 patients with RA were divided into two groups: one possessed high titers without variation, and the other was without high titers. Joint damage progressed during observation in 2 out of 3 patients with high anti-CCP titers in a retrospective assessment. In contrast, the RA patient, whose anti-CCP titer decreases although it had been high titer at baseline, did not show increase in the Larsen score. These findings suggest that it might be necessary to analyze changes in anti-CCP to predict the prognosis of joint destruction

Clinical Study Insights to Clinical Use of Serial Determination in Titers of Cyclic Citrullinated Peptide Autoantibodies

Anti-cyclic citrullinated peptide (CCP) antibody is a useful marker for the diagnosis and prognosis of rheumatoid arthritis (RA). Recently, clinical significance of follow-up in anti-CCP antibody titer has been pointed out. Thus, we investigated the serial determination in anti-CCP antibodies titer in RA patients. Six patients with RA, who were followed up for longer than 5 years, were assessed in anti-CCP antibodies and radiographs (Larsen score). Anti-CCP antibodies in frozen sera were measured using ELISA. As a result, 6 patients with RA were divided into two groups: one possessed high titers without variation, and the other was without high titers. Joint damage progressed during observation in 2 out of 3 patients with high anti-CCP titers in a retrospective assessment. In contrast, the RA patient, whose anti-CCP titer decreases although it had been high titer at baseline, did not show increase in the Larsen score. These findings suggest that it might be necessary to analyze changes in anti-CCP to predict the prognosis of joint destruction