MRI of Rheumatoid Arthritis:Comparing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) Scoring and Volume of Synovitis for the Assessment of Biologic Therapy

The outcome measures in rheumatology clinical trials (OMERACT) scores are the most mature quantitation system for rheumatoid arthritis (RA) on magnetic resonance imaging (MRI). Direct measuring techniques of synovial volume have been reported with good reproducibility, although few reports have demonstrated the changes of these measures in response to treatment. To assess these clinical responses, we evaluated the correlation of the changes of clinical activity score 28-joints disease activity score (DAS28-CRP) with the changes of OMERACT scores and with synovial volume measurements. Eight RA patients who were treated by biologic agents were examined with MRI of the dominant affected wrist and finger joints before and one year after the treatment. The total OMERACT score was reduced from 48.0 to 41.3, and synovial volume was reduced from 15.4 to 8.8 milliliters. Positive correlations were seen between the changes of DAS28-CRP and the changes of OMERACT synovitis score (r＝0.27), OMERACT total score (r＝0.43) and synovial volume (r＝0.30). Limited to synovium assessment, synovial volume showed a better correlation with DAS28-CRP than the OMERACT synovitis score. On the other hand, the OMERACT total score showed a higher correlation with DAS28-CRP than synovial volume, probably because the OMERACT total score includes scores for bone erosion and bone edema as well

Association between Public Assistance and Frequent Emergency Department Visits in Urban Areas of Japan: A Case-Control Study

Emergency department（ED）crowding due to frequent visitors increases medical costs and endangers the safety of patients who need prompt treatment. Although some studies have examined the social background of frequent visitors to the ED, there are few comprehensive studies of factors related to frequent ED visits in Japan. The present study examined whether public assistance status, age, and underlying conditions are associated with frequent visits to the ED. Subjects in this study were patients over 20 years of age who visited the ED of General Medicine in Showa University Hospital in Tokyo, Japan, from April 1, 2014, to March 31, 2015（n＝6,182）. Information regarding sex, age, public insurance, hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, cancer, dysuria, bronchial asthma, and chronic kidney disease was collected using a patient database created from medical and hospital records. Based on a previous study, subjects who visited the ED four or more times were defined as frequent visitors, while those who visited the ED less than four times were considered infrequent visitors. Logistic regression analysis was performed to calculate odds ratios（ORs）and 95％ confidence intervals（CIs）for frequent ED visits. Receipt of public assistance significantly increased the OR for frequent visits（4.26, 95％ CI: 1.90-9.56）, even after adjusting for sex, age, and potential confounding factors（OR: 3.89, 95％ CI: 1.62-9.35）. The current study found a significant association between frequent ED visits and the receipt of public assistance. Emergency physicians and medical practitioners need to share information with outpatient physicians and welfare officers and work together with patients to address their specific medical and social vulnerabilities

Japanese VLBI Network observations of radio-loud narrow-line Seyfert 1 galaxies

We performed phase-reference very long baseline interferometry (VLBI) observations on five radio-loud narrow-line Seyfert 1 galaxies (NLS1s) at 8.4 GHz with the Japanese VLBI Network (JVN). Each of the five targets (RXS J08066+7248, RXS J16290+4007, RXS J16333+4718, RXS J16446+2619, and B3 1702+457) in milli-Jansky levels were detected and unresolved in milli-arcsecond resolutions, i.e., with brightness temperatures higher than 10^7 K. The nonthermal processes of active galactic nuclei (AGN) activity, rather than starbursts, are predominantly responsible for the radio emissions from these NLS1s. Out of the nine known radio-loud NLS1s, including the ones chosen for this study, we found that the four most radio-loud objects exclusively have inverted spectra. This suggests a possibility that these NLS1s are radio-loud due to Doppler beaming, which can apparently enhance both the radio power and the spectral frequency.Comment: 8 pages, 2 figures, accepted for publication in PAS

Prevalence of and Risk Factors for the Progression of Upper Cervical Lesions in Patients with Rheumatoid Arthritis

We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group’s final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA