Mitsuhiko Tanaka

Klinefelter's syndrome and rheumatoid arthritis report of a case and review of the literature

SummaryOur case report describes a patient with Klinefelters syndrome (KFS) associated with rheumatoid arthritis (RA). He had active RA in 1985 but his arthritis almost subsided in 1993 without intensive treatments for RA as well as KFS. Recently, the lower levels of testosterone in male RA patients, especially at the active phase has been reported. However, it is still questionable whether hypogonadism is a predisposing factor or just a consequence of disease. Since our case had a mild clinical course, and since the incidence of RA associated with KFS is very rare in comparison with other rheumatic diseases, may suggest that the low levels of testosterone are not a predisposing factor to the activity of RA.

Risk factors for recurrent thrombosis: prospective study of a cohort of Japanese systemic lupus erythematosus.

Not only antiphospholipid antibodies (aPLs) but also other factors should be considered in assessing the risk of thrombosis development in patients with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPLs). The kinds of risk factors, including past history of thrombotic event (PHTE), hypertension, hypercholesterolemia, diabetes mellitus (DM), obesity, and smoking, in conjunction with aPLs, that contribute to the development of new thrombotic events in patients with SLE and aPLs were studied prospectively over a 5-year observation period. One-hundred and sixty-six Japanese patients with SLE (55 patients with aPLs and 111 patients without aPLs) were examined and followed up for 5 years. Five major risk factors for ischemic coronary disease and stroke according to the Framingham heart cohort study were evaluated objectively in these patients. A significant difference was seen for 4 factors: past history of thrombotic event (PHTE; odds ratio: 101.93; 95% confidence interval: 12.29-845.22; p<0.0001), hypertension (odds ratio: 8.87; 95% CI: 2.58-30.53; p<0.001), DM (odds ratio: 5.42; 95% CI: 1.44-20.46; p<0.05), and lupus anticoagulant (LAC; odds ratio: 47.41; 95% CI: 5.88-382.03, p<0.0001) as aPLs, when the incidence of these risk factors was compared between patients with and without new thrombotic events. Furthermore, PHTE (odds ratio: 30.19, 95% CI: 1.33-683.13), hypertension (odds ratio: 15.44; 95% CI: 1.77-134.80), and LAC (odds ratio: 14.11; 95% CI: 0.48-412.42) showed higher odds ratios than DM (odds ratio: 11.53; 95% CI: 0.83-159.94) on multivariate logistic analysis as well as analysis of the combination of risk factors, suggesting that these are important risk factors for the development of new thrombotic events in patients with SLE and aPLs.

Poststreptococcal reactive arthritis and tonsillitis induced reactive arthritis

Post-streptococcal reactive arthritis (PSRA) is a temporary arthritis following pharyngeal and/or tonsillar infection with Group A, β-haemolytic streptococci. We investigated the clinical manifestations of adult patients with reactive arthritis (ReA) induced by tonsillitis. All patients were diagnosed and treated at Juntendo Hospital. Patients were 9 male and 12 female aged from 20 to 55 years old. Episode of recurrent arthritis ranged from 2 weeks to 10 years (median: 24 months). Elevated ASO/ASK was revealed in 13 of 21 patients (62.0%) and Group A Streptococcus was isolated in 12 patients (57.1%). Pseudomonas and other bacteria were identified from resected tonsillar abscess. Asymmetrical oligoarthritis of large joints and enthesitis were demonstrated. Non-specific abdominal pain and erythema were noted in a few patients. No patient revealed carditis during the course of illness and follow-up period of at least 2 years. Rheumatoid factor was positive in 9.5%. HLA-B39 and BW61(B40) were demonstrated in 33.3 and 46.7% (p<0.005, p<0.01, respectively). Eight patients underwent tonsillectomy. Resected tonsils revealed presence of cryptic abscess. Tonsillectomy was especially effective for patients with recurrent tonsillitis and ReA associated with tonsillar abscess.

Anterior uveitis and poststreptococcal reactive arthritis

Abstract Anterior uveitis has been reported to occur during the course of illness and/or after pharyngeal or tonsillar streptococcal infection. We recently reported the first two adult patients with poststreptococcal reactive arthritis (PSRA), both whom concomitantly developed uveitis. The clinical manifestations of our patients presented at The 5th International Symposium on Tonsils and Mucosal Barriers of Upper Airways at Wakayama in April 2003 are summarized, and the possible pathogeneses of uveitis and antibiotic prophylaxis are discussed.

Scleredema: report of a case

Abstract We describe a patient with scleredema. Thickened skin was observed in the posterior region of her neck, shoulders, and back. A skin biopsy revealed thickened dermis consisting of numerous thickened collagen bundles. Laboratory data revealed that she was suffering from diabetes mellitus (DM). The skin lesions ameliorated within a period of one month when her DM condition was controlled by oral hypoglycemics. Scleredema is a rare connective tissue disorder; its cutaneous manifestation should be distinguished from scleroderma.