Tomohiro Akimoto

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.

Sjögren syndrome associated with multiple myeloma of the IgA κ-type.

Abstract We report a case of a 62-year-old female patient with Sjögren syndrome (SS) who developed multiple myeloma (MM) of the IgA κ-type. In 1986, the patient was admitted to our hospital with a facial rash, keratoconjunctivitis sicca, and xerostomia. She was diagnosed as having discoid lupus erythematosus (DLE) and SS. She was treated with bromhexine hydrochloride for SS and with topical fluorinated steroid for DLE. In 1992, she developed compression fractures of the lumbar vertebrae and was readmitted to our hospital. DLE was not recognized. Laboratory findings revealed IgA 2046 mg/dl, IgG 529 mg/dl, and IgM 21 mg/dl. Anti-SS-A antibody was 1 : 32 and anti-SS-B antibody was 1 : 2. M protein of IgA κ was demonstrated by immunoelectrophoresis. Aspiration biopsy of the bone marrow revealed 20.2% plasma cells. A bone scintigram demonstrated many hot spots at the cervical and lumbar vertebrae. She was diagnosed as having SS and MM of the IgA κ-type. After chemotherapy for MM, the percentage of plasma cells in the bone marrow and the concentration of serum IgA decreased to 6.2% and 532 mg/dl, respectively. SS is frequently associated with benign monoclonal gammopathy or lymphoproliferative disorders, especially Waldenströms macroglobulinemia or malignant lymphoma. Although benign monoclonal gammopathy has frequently been observed in patients with SS, SS associated with MM is extremely rare.

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.

Successful treatment of severe Reiter’s syndrome with etretinate

The management of a hyperkeratoitic cutaneous lesion in Reiter’s syndrome (RS) is often unrewarding. Recently, several reports have demonstrated that treatment with etretinate was especially beneficial for severe cutaneous lesion in RS or RS associated with human immunodeficiency virus. We describe a patient with RS whose skin lesions as well as arthritis were successfully treated with oral etretinate.