Evaluation of changes in magnetic resonance images following 24 and 52 weeks of treatment of rheumatoid arthritis with infliximab, tocilizumab, or abatacept

<div><p><i>Objectives.</i> To compare MRI findings in rheumatoid arthritis (RA) patients treated with biologic disease-modifying anti-rheumatic drugs (DMARDs).</p><p><i>Methods.</i> The study subjects were 43 RA patients treated with biologic DMARDs (13 with infliximab, 15 with tocilizumab, and 15 with abatacept). They were evaluated using Simplified Disease Activity Index (SDAI) and low-field extremity MRI at baseline, and at 24 weeks and 52 weeks of treatment.</p><p><i>Results.</i> Synovitis scores were significantly lower by 24 weeks in all groups, compared with baseline (<i>P</i> < 0.05). Significant improvement in bone marrow edema (BME) scores were noted from baseline to 24 weeks in infliximab and abatacept groups (<i>P</i> < 0.05), but from 24 weeks to 52 weeks in tocilizumab group (<i>P</i> < 0.01). No significant change was found in erosion score. The synovitis score at baseline correlated significantly with SDAI at 24 weeks (<i>P</i> < 0.05), and the score at 24 weeks correlated significantly with SDAI at 52 weeks (<i>P</i> < 0.05).</p><p><i>Conclusions.</i> The results suggest that the inflammatory improvement by infliximab and abatacept may express earlier than those by tocilizumab, despite similar improvement in SDAI. MRI-detected synovitis could be a useful predictor of SDAI at 24 weeks of treatment. The MRI remains the best tool to detect and assess the effects of biologic DMARDs in RA.</p></div

Associations between maternal clinical features and fetal outcomes in pregnancies of mothers with connective tissue diseases

<p><b>Objectives:</b> The purpose of this study is to clarify associations between maternal clinical features and adverse pregnancy outcomes (APOs) in mothers with connective tissue diseases (CTDs).</p> <p><b>Methods:</b> We retrospectively examined maternal clinical features including backgrounds, autoantibodies, CTD flare-ups, and therapies during pregnancies as well as fetal outcomes in 90 pregnancies (66 mothers) at our hospital from January 2006 to September 2016.</p> <p><b>Results:</b> Underlying CTDs were SLE (<i>N</i> = 41), MCTD (<i>N</i> = 10), RA (<i>N</i> = 15), SS (<i>N</i> = 10), and others (<i>N</i> = 14). Anti-SS-A antibody was detected in 60.3%, lupus anticoagulant (LAC) was in 11.4%, and anti-cardiolipin-β2glycoprotein1 antibody was in 18.5%. Flare-ups of CTDs occurred in 20 pregnancies (22.2%). Corticosteroids (CS) was administered in 73 pregnancies, immunosuppressants in four, and biologics in one. Among the 85 pregnancies other than five early abortions within 12 weeks of gestational age, 33 cases had APOs while the remaining 52 cases were normal. Although disease duration, MCTD, high dose of CS, flare-ups of CTDs, and positive LAC significantly correlated with APOs by univariate analysis, only MCTD was a significant independent predictor for APOs by multivariate analysis.</p> <p><b>Conclusion:</b> Disease duration, MCTD, high dose of CS, flare-ups of CTDs, and LAC might be possible predictive risk factors for APOs in pregnancies with CTDs. Of these, MCTD was a significant independent risk factor.</p

Clinical features of patients with IgG4-related disease complicated with perivascular lesions

<p><i>Objective.</i> To define the clinical features of IgG4-related disease (IgG4-RD) complicated with perivascular lesions.</p> <p><i>Methods.</i> The clinical features of seven patients with IgG4-RD and perivascular lesions diagnosed at the University of Tsukuba Hospital between October 2008 and October 2013, were analyzed, including clinical background, results of imaging studies, satisfaction of the 2011 comprehensive diagnostic criteria (CDC) for IgG4-RD, laboratory data, distribution of perivascular lesions, involvement of other organs, and response to steroid therapy.</p> <p><i>Results.</i> We studied six men and one woman with a mean age of 66.9 ± 6.7 years (± SD). Six of seven patients were diagnosed as definite IgG4-RD, while the seventh was considered possible IgG4-RD, based on the CDC for IgG4-RD. Serum IgG4 levels at diagnosis were higher than 135 mg/dl in all seven patients (mean, 933 ± 527). Serum C-reactive protein (CRP) levels were elevated in two only (mean, 1.42 ± 3.56 mg/dl). The perivascular lesions were located in the pulmonary artery (<i>n</i> = 1), thoracic aorta (<i>n</i> = 2), abdominal aorta (<i>n</i> = 6), coronary (<i>n</i> = 1), celiac (<i>n</i> = 1), superior mesenteric (<i>n</i> = 1), renal (<i>n</i> = 2), inferior mesenteric (<i>n</i> = 5), and iliac (<i>n</i> = 3) arteries. In addition to perivascular lesions, six patients showed involvement of other organs. All seven patients were treated with prednisolone (0.6 mg/kg/day), which rapidly improved the perivascular and other organ lesions in six patients (the other one patient have not yet been evaluated due to the short follow-up).</p> <p><i>Conclusion.</i> Perivascular lesions show wide distribution in patients with IgG4-RD. Serum CRP levels are not necessarily elevated in these patients. Steroid therapy is effective in IgG4-RD and results in resolution of lesions.</p