Publications by authors named "Hiroshi Oiwa"

40 Publications

Temporal arteritis as an initial manifestation of eosinophilic granulomatosis with polyangiitis: a case report and a literature review.

Mod Rheumatol Case Rep 2021 Mar 15:1-7. Epub 2021 Mar 15.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

A 79-year-old woman was admitted for suspected giant cell arteritis (GCA). She had suffered from dizziness, headache, jaw claudication and visual disturbance. Her medical history included bronchial asthma and parasinusitis. Her superficial temporal arteries were markedly enlarged with tenderness. Laboratory data showed eosinophilia (6968/µL) and a positive result of myeloperoxidase-ANCA. A histological examination of the biopsied artery revealed granulomatous inflammation consisting of lymphocytes and eosinophils with a multinucleated giant cell. Her conditions met both the criteria for GCA and eosinophilic granulomatosis with polyangiitis (EGPA). We finally considered that she had temporal arteritis as an initial manifestation of EGPA after a comprehensive literature review. To our knowledge, this is the first case in which temporal arteritis with a giant cell developed as an initial and sole manifestation of EGPA.
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http://dx.doi.org/10.1080/24725625.2021.1893944DOI Listing
March 2021

A case of systemic lupus erythematosus associated with cerebral arteritis: a case report and case-based literature review.

Nagoya J Med Sci 2020 Nov;82(4):807-814

Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

A 62-year-old female patient with systemic lupus erythematosus (SLE) was admitted for cerebral infarction. The magnetic resonance angiography showed focal narrowing of the cerebral arteries that was initially considered as atherosclerosis due to her cardiovascular risk factors. Ten weeks later, she was again admitted for multiple cerebral infarctions. Vessel wall magnetic resonance imaging revealed gadolinium enhancement of the arterial walls of the narrowing lesions, leading to a diagnosis of cerebral arteritis. Based on a literature review, cerebral medium-sized arteritis in SLE likely progresses insidiously during the active phase of SLE, which may later result in occlusion irrespective of disease activity.
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http://dx.doi.org/10.18999/nagjms.82.4.807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719457PMC
November 2020

A Case of Refractory Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis That Improved After Switching to Tofacitinib.

J Clin Rheumatol 2020 Nov 24. Epub 2020 Nov 24.

From the Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital.

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http://dx.doi.org/10.1097/RHU.0000000000001645DOI Listing
November 2020

Aseptic meningitis as an initial presentation of Sjögren syndrome: a report of two cases and literature review.

Nagoya J Med Sci 2020 Aug;82(3):595-602

Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

Sjögren syndrome (SS) is one of several collagen vascular diseases that occasionally involve the central nervous system. We report two cases of SS involving young patients who initially presented with aseptic meningitis. A male with recurrent AM was found to have anti-Ro/SSA and La/SSB antibodies in a screening test for autoimmune process. A minor salivary gland biopsy revealed lymphocytic infiltrations compatible with SS, although the patient did not exhibit sicca symptoms. A female presenting with AM and polyarthritis also reported xerophthalmia. Anti-Ro/SSA antibody testing and a positive result in a minor salivary gland biopsy led to the diagnosis of SS. In the literature review, we found that AM or aseptic meningoencephalitis (AME) preceded or had a concomitant onset with SS in approximately 70% of cases. Screening for anti-Ro/SSA antibody, as well as systemic assessment for rheumatic symptoms, may be useful for diagnosing AM/AME of unknown etiology.
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http://dx.doi.org/10.18999/nagjms.82.3.595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548251PMC
August 2020

Temporal artery involvement in AL amyloidosis: an important differential diagnosis for giant cell arteritis. A case report and literature review.

Mod Rheumatol Case Rep 2020 01 13;4(1):90-94. Epub 2019 Aug 13.

Department of Hematology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

AL amyloidosis (AL) is a systemic disorder due to extracellular tissue deposition of amyloid fibrils, composed of immunoglobulin light chains. Since the description of AL involving temporal arteries in 1986, this disorder has been known as one of the differential diagnoses of giant cell arteritis (GCA). We encountered a case of an elderly female presenting with headache and tender and enlarged temporal arteries, that was pathologically diagnosed with temporal artery involvement of AL due to Bence-Jones-type MM. To our knowledge, this was the first case of AL with temporal artery involvement in Japan, that presented with GCA-like features. Literature review of AL cases with temporal artery involvement showed close similarity between these disorders, but suggested that vasculature involvement (extremity claudication, kidney or heart), macroglossia, carpal tunnel syndrome and normal or low (<0.5 mg/dL) CRP levels may predict AL rather than GCA. Physicians should keep in mind that AL involving temporal arteries can be a pitfall in the diagnosis of GCA, as seen in our and previous cases.
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http://dx.doi.org/10.1080/24725625.2019.1650993DOI Listing
January 2020

Claw hand deformity in longstanding vasculitic neuropathy.

Eur J Rheumatol 2020 Sep 8. Epub 2020 Sep 8.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

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http://dx.doi.org/10.5152/eurjrheum.2020.20032DOI Listing
September 2020

Continuation Rate, Safety and Efficacy of Hydroxychloroquine Treatment in a Retrospective Cohort of Systemic Lupus Erythematosus in a Japanese Municipal Hospital.

Intern Med 2020 Oct 7;59(20):2485-2490. Epub 2020 Jul 7.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Japan.

Objective We investigated the continuation rate, safety and efficacy of treatment with hydroxychloroquine (HCQ) in a retrospective cohort of systemic lupus erythematosus (SLE) in a Japanese municipal hospital. Methods All of the patients with SLE who started treatment with HCQ were included in this study. A retrospective chart review was performed. Our primary outcomes were the continuation rate of HCQ treatment for 1 year and adverse events (AEs) during the treatment. We also investigated the efficacy of HCQ treatment in cases in which treatment with immunosuppressive therapies remained unchanged for the preceding six months. Results Forty-seven patients with SLE were included in this study. Twenty-five patients (53.2%) had AEs. Eleven (64.7%) of the 17 patients who tried the readministration of HCQ could continue HCQ treatment. The continuation rate of HCQ for a period of 1 year was 78.3% (36 of 46 patients). The development of cutaneous lesions was the most frequent adverse event (25.5%) followed by gastrointestinal symptoms (8.5%). In the 16 cases in which the immunosuppressive therapies remained unchanged for at least six months prior to starting HCQ treatment, the SLE disease activity index, anti-DNA antibody, immune complex, and serum complement activity significantly decreased over a period of 1 year, while the prednisolone dose significantly decreased. Conclusion The continuation rate of HCQ treatment was high in an SLE cohort of a Japanese municipal hospital. Although more than half of the patients experienced AEs, the readministration of HCQ was often successful. HCQ treatment provided benefits regarding the clinical and immunological findings in Japanese patients with SLE, which would likely lead to glucocorticoid tapering.
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http://dx.doi.org/10.2169/internalmedicine.5042-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662052PMC
October 2020

Provisional seven-item criteria for the diagnosis of polyarteritis nodosa.

Rheumatol Int 2020 Aug 27;40(8):1223-1227. Epub 2020 Feb 27.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima City, Hiroshima, 730-8518, Japan.

Polyarteritis nodosa (PAN) is a potentially life-threatening systemic vasculitis, which predominantly involves medium arteries. However, it may be difficult to diagnose PAN in its early stage. The aim of our study was to investigate the sensitivity and specificity of the American College of Rheumatology (ACR) and the Japanese Ministry of Health, Labour and Welfare (MHLW) criteria for the diagnosis of PAN in a single-centre retrospective cohort in Japan and to develop simplified criteria with favourable diagnostic performance. All patients with "PAN" or "suspicion of PAN," as indicated on insurance forms, were included. The patient population was classified into PAN and non-PAN groups based on a retrospective chart review. The sensitivity and specificity of the ACR and MHLW criteria were calculated. Items that favourably discriminated the PAN group from the non-PAN group were determined and used as items for our provisional criteria. Thirteen cases of PAN and 24 cases without PAN were included in this study. The sensitivities of the ACR and MHLW criteria were 61.5% (8/13) and 30.8% (4/13), respectively, whereas the specificities were 79.2% (19/24) and 87.5% (21/24), respectively. We developed provisional criteria consisting of seven items, and found that a cut-off of ≥ 4 items had a sensitivity of 92.3% (12/13) and specificity of 91.7% (22/24) (p < 0.000001). The provisional seven-item criteria, developed in our real-world cohort of patients suspected of having PAN, had a high sensitivity and specificity and may be useful in the diagnosis of PAN, although it should be validated in additional patient populations.
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http://dx.doi.org/10.1007/s00296-020-04535-2DOI Listing
August 2020

Polyarteritis Nodosa with Marked Eosinophilia, Associated with Severe Gastrointestinal Tract Involvement and Recurrent Venous Thrombosis.

Intern Med 2019 Oct 27;58(20):3051-3055. Epub 2019 Jun 27.

Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Japan.

A 45-year-old man was admitted with acute abdominal pain and eosinophilia. Abdominal computed tomography revealed thickness of the ascending and transverse colon with decreased contrast enhancement and a small amount of ascites. In an emergency operation, the necrotic colon was resected. Histopathology showed subserous medium-sized arteritis with abundant eosinophil infiltrates and thrombosis in the portal vein branches. He was diagnosed with polyarteritis nodosa (PAN), and immunosuppressive therapy improved his condition. Two years later, the disease recurred with ischemic cutaneous lesions and marked eosinophilia. Our experience suggests that marked eosinophilia in PAN may imply severe organ involvement, including gastrointestinal necrosis, as well as the association of venous thrombosis.
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http://dx.doi.org/10.2169/internalmedicine.2802-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859400PMC
October 2019

Diagnostic Performance of a Temporal Artery Biopsy for the Diagnosis of Giant Cell Arteritis in Japan-A Single-center Retrospective Cohort Study.

Intern Med 2019 Sep 22;58(17):2451-2458. Epub 2019 May 22.

Department of Plastic Surgery, Hiroshima City Hiroshima Citizens Hospital, Japan.

Objectives To investigate the sensitivity and specificity of a temporal artery biopsy (TAB) in the diagnosis of giant cell arteritis (GCA) in a single-center retrospective cohort in Japan. Methods A retrospective chart review was performed on consecutive patients who visited our hospital between April 2009 and October 2018 and underwent a TAB. The sensitivity and specificity were calculated for the three pathological standards for a TAB, predetermined according to the pathological criterion of the 1990 American College of Rheumatology (ACR) criteria: A) vasculitis characterized by predominant mononuclear cell infiltration; B) vasculitis with granulomatous inflammation; and C) vasculitis with multinucleated giant cells. We also analyzed the clinical parameters predicting the diagnosis of GCA and the impact of a diagnostic delay of ≥3 months on cardiovascular complications of GCA. Results Our study population was 16 cases in the GCA group and 13 in the non-GCA group. The sensitivity and specificity for Standard A of a TAB were 81% and 85%, respectively, while those for stricter Standards B or C were identical, at 75% and 100%, respectively. These pathological standards, but not any other parameters, significantly predicted the diagnosis. A diagnostic delay tended to cause cardiovascular complications (p=0.057). Conclusion The sensitivity and specificity of the pathological standards of a TAB were favorable in our cohort and were the only predictors for the diagnosis of GCA. Considering the possible impact of a diagnostic delay on cardiovascular complications, the early recognition and prompt initiation of glucocorticoid therapy is needed, even in Japan, where GCA is uncommon.
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http://dx.doi.org/10.2169/internalmedicine.2788-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761355PMC
September 2019

Histological Findings of Organizing Pneumonia, Based on Transbronchial Lung Biopsy, May Predict Poor Outcome in Polymyositis and Dermatomyositis: Report of Two Autopsied Cases.

Arch Rheumatol 2018 Sep 15;33(3):376-380. Epub 2018 Jan 15.

Department of General Internal Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan.

Interstitial lung disease in polymyositis and dermatomyositis is a serious complication, associated with poor prognosis. In this article, we describe two cases with histological findings of organizing pneumonia, based on transbronchial lung biopsy. One is a 66-year-old female patient with clinically amyopathic dermatomyositis with anti-melanoma differentiation-associated gene 5 antibody, and another is a 61-year-old female patient with polymyositis with anti-Jo-1 antibody. Both of our cases rapidly deteriorated to death, and autopsy findings showed diffuse alveolar damage. Our experience indicates that transbronchial biopsy findings of organizing pneumonia may be a poor prognostic factor in clinically amyopathic dermatomyositis and polymyositis, in spite of the profile of myositis-specific antibodies.
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http://dx.doi.org/10.5606/ArchRheumatol.2018.6577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328220PMC
September 2018

Muscle weakness as a presenting symptom in ANCA-associated vasculitis.

Eur J Rheumatol 2018 Jul 2;5(2):139-141. Epub 2017 Nov 2.

Department of Neurology, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, Japan.

Muscle weakness is rarely a presenting symptom of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), although the disease frequently involves the lungs, skin, neurons, and kidneys. Here we describe a case of AAV presenting with muscle weakness in which only muscle biopsy could confirm the diagnosis. The literature review, including three similar cases, suggested that patients with ANCA-associated muscle vasculitis likely had myalgia, normal levels of creatine kinase, pulmonary fibrosis, rheumatoid factor, and muscle edema on MRI.
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http://dx.doi.org/10.5152/eurjrheum.2017.17067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072691PMC
July 2018

Idiopathic Interstitial Pneumonia as a Possible Cause of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report.

Arch Rheumatol 2018 Mar 15;33(1):89-92. Epub 2018 Jan 15.

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.

There are conflicting data to date on the causal relationship between idiopathic interstitial pneumonia and antineutrophil cytoplasmic antibody (ANCA): (1) myeloperoxidase-ANCA may play a pathogenetic role in pulmonary fibrosis, or (2) pulmonary fibrosis may induce production of the antibody. In this article, we describe a case of an elderly female patient with microscopic polyangiitis that developed after positive conversion of myeloperoxidase-ANCA during the course of idiopathic interstitial pneumonia. Our experience as well as similar case reports may suggest that idiopathic interstitial pneumonia may induce production of ANCAs and even ANCA-associated vasculitis.
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http://dx.doi.org/10.5606/ArchRheumatol.2018.6532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864178PMC
March 2018

Clinical value of autoantibodies for lupus myelitis and its subtypes: A systematic review.

Semin Arthritis Rheum 2018 10 14;48(2):214-220. Epub 2018 Feb 14.

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.

Objective: We conducted a systematic review to investigate the clinical value of clinical characteristics and autoantibodies, especially lupus-specific antibodies, for lupus myelitis and its subtypes.

Methods: We searched PubMed, EMBASE, and ICHUSHI without language restrictions for case reports or series of lupus myelitis. We focused on cases reported since 1997, when the revised classification criteria for systemic lupus erythematosus were published. Associations between patient characteristics including autoantibodies and functional outcome, survival, subtypes of myelitis (grey and white matter myelitis), and treatment were examined. We attempted to contact authors to supplement missing information for analysis.

Results: Our search identified 224 cases from 105 articles. White matter myelitis predicted favorable function (odds ratio = 15.18; 99% confidence interval, 3.09-151.31; p < 0.0001). Grey matter myelitis was associated with longitudinally extensive transverse myelitis (p < 0.001) and anti-double-stranded DNA (p = 0.003), and tended to be associated with anti-β2-glycoprotein I (p = 0.011). White matter myelitis tended to be associated with optic neuritis and anti-neuromyelitis optica antibodies. Although our study might be susceptible to under-reporting of original cases and selection bias, we aimed to provide a conservative interpretation by setting the statistical significance threshold at p < 0.01.

Conclusions: This systematic review confirmed that grey matter myelitis predicted poor functional outcome and was associated with longitudinally extensive transverse myelitis and anti-double-stranded DNA antibodies. White matter myelitis was associated with favorable functional outcomes and may partially represent a complication of neuromyelitis optica.
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http://dx.doi.org/10.1016/j.semarthrit.2018.02.004DOI Listing
October 2018

Hypersegmented Neutrophils in Methotrexate Toxicity.

Intern Med 2018 Apr 21;57(7):1055-1056. Epub 2017 Dec 21.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.9684-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919873PMC
April 2018

Acute Arthritis of the Fingers in an Elderly Woman.

Intern Med 2017 12 11;56(23):3267-3268. Epub 2017 Oct 11.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.9284-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742407PMC
December 2017

Cartilage improvement in a case of relapsing polychondritis.

Rheumatology (Oxford) 2017 Oct;56(10):1720

Department of Otorhinolaryngology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

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http://dx.doi.org/10.1093/rheumatology/kex248DOI Listing
October 2017

Neurological Complications in Eosinophilic Granulomatosis with Polyangiitis (EGPA): The Roles of History and Physical Examinations in the Diagnosis of EGPA.

Intern Med 2017 Nov 15;56(22):3003-3008. Epub 2017 Sep 15.

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan.

Objective To investigate the clinical symptoms, the physical and neurological findings, and the clinical course of neurological complications in eosinophilic granulomatosis with polyangiitis (EGPA). Methods A retrospective chart review of EGPA cases managed by two referral hospitals was performed, with a focus on the neurological findings. The study analyzed the symptoms at the onset of EGPA and investigated their chronological relationship. The patient delay (the delay between the onset of symptoms and the initial consultation), and the physician delay (the delay from consultation to the initiation of therapy) were determined and compared. The involved nerves were identified thorough a neurological examination. The cases with central nervous system (CNS) involvement were described. Results The average duration of symptoms prior to the initiating of therapy for sensory disturbances, motor deficits, rash, edema, and fever was 23, 5, 21, 18, and 24 days, respectively. Among the EGPA-specific symptoms, sensory disturbance was often the first symptom (63%), and was usually followed by the appearance of rash within four days (63%). The average physician delay (32.9±38.3 days) was significantly longer than the average patient delay (7.9±7.8 days; p=0.010). Reduced touch sensation in the superficial peroneal area, and weakness of dorsal flexion of the first toe secondary to deep peroneal nerve involvement, were highly sensitive for identifying the presence of peripheral nerve involvement in our series of patients with EGPA. Two cases, with CNS involvement, had multiple skin lesions over their hands and feet (Janeway lesions). Conclusion Japanese physicians are not always familiar with EGPA. It is important for us to consider this disease, when an asthmatic patient complains about the new onset of an abnormal sensation in the distal lower extremities, which is followed several days later by rash.
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http://dx.doi.org/10.2169/internalmedicine.8457-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726955PMC
November 2017

A report of three cases with lupus myelitis.

Eur J Rheumatol 2017 Jun 1;4(2):148-150. Epub 2017 Jun 1.

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan.

Lupus myelitis (LM) is a rare but serious complication of systemic lupus erythematosus (SLE). In 2009, Birnbaum et al. suggested that LM could be classified into two subtypes, namely gray and white matter myelitis, based on neurological examination findings. Here we describe three cases of this disorder, one with signs of white matter dysfunction and two with signs of gray matter dysfunction. We discuss the potential role of autoantibodies in the development of LM.
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http://dx.doi.org/10.5152/eurjrheum.2017.160099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473454PMC
June 2017

Severe hypocalcemia and prolonged QT interval due to denosumab in an elderly woman with rheumatoid arthritis and chronic kidney disease.

Eur J Rheumatol 2016 Sep 29;3(3):144-145. Epub 2016 Jan 29.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Department of Immunology, Hiroshima University School of Biomedical and Health, Hiroshima, Japan.

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http://dx.doi.org/10.5152/eurjrheum.2015.0049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058456PMC
September 2016

Fever and Pulmonary Shadows in a Young Woman.

Intern Med 2016;55(10):1401-2. Epub 2016 May 15.

Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.55.6239DOI Listing
May 2016

A Distant Origin of Sternoclavicular Septic Arthritis.

Intern Med 2016 1;55(5):551. Epub 2016 Mar 1.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.55.5934DOI Listing
July 2016

Janeway Lesions in Eosinophilic Granulomatosis with Polyangiitis.

Intern Med 2016 1;55(5):549-50. Epub 2016 Mar 1.

Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.55.5819DOI Listing
July 2016

A role of the FDG-PET/CT in the differential diagnosis between elderly onset rheumatoid arthritis and polymyalgia rheumatica; Comment on the study by Dr. Takahashi et al.

Authors:
Hiroshi Oiwa

Mod Rheumatol 2016 09 25;26(5):804. Epub 2015 Aug 25.

a Department of Rheumatology , Hiroshima City Hiroshima Citizenz Hospital , Hiroshima , Japan.

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http://dx.doi.org/10.3109/14397595.2015.1072904DOI Listing
September 2016

Lymphoma Risk in Japanese Patients With Rheumatoid Arthritis: Comment on the Article by Kameda et al.

Authors:
Hiroshi Oiwa

Arthritis Care Res (Hoboken) 2015 Aug;67(8):1186

Hiroshima City Hospital, Hiroshima, Japan.

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http://dx.doi.org/10.1002/acr.22568DOI Listing
August 2015

Experience with seven Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with remission-induction therapy with intravenous cyclophosphamide according to the CYCLOPS protocol.

Intern Med 2014 15;53(20):2291-6. Epub 2014 Oct 15.

Department of Rheumatology, Hiroshima City Hospital, Japan.

Objective: In 2009, the European Vasculitis Study Group reported the results of CYCLOPS, a randomized controlled trial, in which pulse cyclophosphamide (CYC) was found to be similar to a daily CYC regimen in inducing remission in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). We herein conducted an observational study to describe our experience with Japanese AAV patients treated with pulse CYC according to the CYCLOPS protocol.

Methods: The inclusion criteria were as follows: 1) granulomatosis with polyangiitis, of either the limited or generalized type; 2) microscopic polyangiitis or renal limited glomerulonephritis with at least one poor prognostic factor; or 3) microscopic polyangiitis with a motor disturbance due to vasculitic neuropathy. The patients were treated with pulse cyclophosphamide and prednisolone according to the CYCLOPS protocol.

Results: Seven patients were included, all of whom (100%) achieved remission with a median time to remission of three months. After the first remission, two patients experienced relapse during the follow-up period of 14.8 months and both were successfully treated with additional pulse CYC therapy. Regarding safety, infection was observed in all patients, including three patients with respiratory tract infections, although all infectious episodes were successfully treated. Bronchoalveolar carcinoma was diagnosed in one patient.

Conclusion: The administration of pulse CYC according to the CYCLOPS protocol was found to be effective as remission induction therapy in our seven patients with AAV. With regard to safety, treating Japanese patients with AAV according to this protocol may require close attention for signs of respiratory infection. Our findings suggest that this protocol is therefore a viable option for Japanese patients with AAV.
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http://dx.doi.org/10.2169/internalmedicine.53.2553DOI Listing
June 2015

Grade 3 lymphomatoid granulomatosis in a patient receiving methotrexate therapy for rheumatoid arthritis.

Intern Med 2014 15;53(16):1873-5. Epub 2014 Aug 15.

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan.

Lymphomatoid granulomatosis (LyG) is a rare, B-cell derived, lymphoproliferative disorder that often presents as pulmonary nodular lesions with a histopathology of lymphatic invasion of the vascular wall. The development of LyG may be associated with reactivation of the Epstein-Barr virus under an immunosuppressive state. We herein report a case of Grade 3 LyG that developed during methotrexate therapy for rheumatoid arthritis and regressed following the withdrawal of the drug.
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http://dx.doi.org/10.2169/internalmedicine.53.2593DOI Listing
June 2015

Biopsy of the temporal artery in a patient with giant cell arteritis.

Intern Med 2013 ;52(18):2165

Department of Rheumatology, Hiroshima City Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.52.0884DOI Listing
April 2014

Refractory oral ulcers in a 26-year-old Japanese woman.

Intern Med 2013 ;52(12):1437

Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.52.0492DOI Listing
February 2014