200311-one day opening. Professional rheumatoid arthritis connective tissue diseases (kougennbyou), but this group of diseases is requires examining the entire body in General. Comprehensively analyzing the body, and can quickly identify crisis, to work with highly specialized medical institutions, this is a basic attitude of "Nishinarita clinic".
And also the utmost problem of the body as well as mind or spirit will respond.
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Ill talk about

-Rheumatic rheumatica on the Q&A

< 6/4/2012 > FM is broadcast in the Hitachi "health information".

Disease Q. Sjogren's syndrome that is too

What is unfamiliar disease is any disease.

Of A Sjögren's is Sweden ophthalmologists in the name of the person. In this eye doctor caught this disease, that has this name.

Q remember difficult is the name of a disease.

A Yes. One single connective tissue disease in Sjogren's syndrome, is a disease, such as rheumatoid arthritis and relatives. It is a disease may develop from a 30-year-old in a 60-year-old as many, many women.

Q what symptoms do.

A this core of disease symptoms is dry skin and mucous membranes. In that dry. Dry eye is a so-called dry eye. Dry mouth is known as xerostomia.

If the skin is dry is dry skin.

There are a lot of people for A dry eye.

Q well, there are lots of dry eye, but of course, everyone with Sjogren's syndrome do not. People may say dry bite, almost without symptoms pointed to the eye doctor, realizing for the first time and then also complain of a variety of symptoms of dry eye. One on Sjogren's syndrome, for example "eye rolling to", "to feel like garbage into eyes" "eye sore" to reverse complaints, such as "itchy eyes" may be. In addition, people 'eyes are dazzling light"or"eyes are dry, eyes hard to drill"and the symptoms.

Q what symptoms of xerostomia is?

Is that called A xerostomia is dry mouth symptoms is variety. Become dry, dry, dry mouth in patients with Sjogren's syndrome, it is in Japan, "thirst" and say, for example that used the phrase "thirst", "thirsty a drink of water. Thirsty the drink of water, for example, is the common symptoms such as diabetics. However, is that in patients with Sjogren's Syndrome will repeat "dry", but dry. This can sometimes confuse patients.

Q so thirsty mouths become dry and what symptoms the patient,I would be complaining.

A. for example, well there is "spit out hard, stiff and dry, bread or by hard to eat dried", or "sticky mouth and bad feeling" difficult is talking bad breath bothers such as. In, like "tooth decay increases rapidly". No saliva is, of course, cavities are more likely. Better can angular Cheilitis, often repeating that over and over again. Also produce salivary glands is called "glands", but the parotid or submandibular. The Parotid gland is under the ear, often seen that swollen submandibular are around the Chin, but these locations repeatedly.

Q. that the disease called Sjogren's syndrome happens there are saliva lines?

A is such a thing. Glands in this disease of autoimmune immune abnormalities, lacrimal gland, tear out well, also occurs from chronic inflammation, salivary glands described above. As a result, is not dried tears and saliva secretion worsens, the symptoms.

Also refers to other glandular tissues, for example, sweat out the sweat glands and that this gland similar inflammation happens. It is difficult to sweat out, resulting in a so-called dry skin condition.

What better Q, dry eye who once thought also disease called Sjogren's syndrome.

A as I mentioned is all dry eye disease that does not. However, especially in the "eye rolling, foreign-body sensation" would, if that also suspects this disease better. Also, maybe I'd consulted a medical professional in the case as well as dry eyes and dry mouth symptoms. Phenomenon of the thirsty mouth, is aging, that happens to take you years.

Along with the age anyone decreases, so the amount of saliva. Then, taking tranquilizers or sleeping pill in the 渇kimasu mouth. Also better esophageal cancer radiation therapy is sometimes broken, salivary gland, saliva, will be difficult. This area is Sjogren's syndrome and unrelated xerostomia as prima facie understanding put was better.

Q do you do any tests, this disease is evident.

A first of all, in your blood quite how to diagnose if you must. Sjögren's syndrome is a blood test, it is a little difficult, but said the antibodies SSA and SSB antibodies usually is often seen observed test values can be positive. There is a negative for the antibodies SSA and SSB antibodies positive is this disease is pretty suspect.

However project the salivary glands actually x-rays at once suspected in the symptoms and blood tests, or cut some of the salivary glands in the lips, lip biopsy saying, exactly. This can clear up the diagnosis.

What is worried about diseases such as Q, who is in fact, hospital what hospital you good.

Or A beam, and the Department of internal medicine and Rheumatology, I think. But, we talked to have, sued the "dry" is colorful indeed. Diabetes care patients who are thinking "thirsty". Might be sick of teeth ' mouth is sticky"feel and think. "My eyes are itchy' Hay might be suspect. It is surprisingly difficult to diagnosis of the fact, grasped accurately dry the dry. Disease, and traveled a lot of discontented patients are not uncommon. Cooperation in many fields, such as dental, ophthalmology, otolaryngology, dermatology, teacher is important for disease diagnosis. Is this disease called Sjogren's syndrome are recognized widely in the West and Japan, compared to Western disease against I think recognition is a little low. The estimate of the number of patients without a diagnosis, latent never not sure, actually though 300000 people from 100000. General disease of rheumatoid arthritis, said about 800000 people in Japan, so that patients with Sjogren's syndrome of about 1-3 minutes.

Q: will that treatment, but treatment is what?

Cevimeline hydrochloride A the drug is very effective. Stimulates the secretion of saliva, will be smooth in the mouth. Effect of secretion of tears. Other will mainly deal with therapy for the eyes and mouth symptoms. Speaking at the various drops, tear the population, inadequate if tears point Prague, there are specialized eye treatment. For xerostomia artificial saliva spray. It is sprayed in the mouth. I often recommend that (7) is chewing gum containing xylitol, lick, including mouth piece of finely chopped plums, using throat lozenges, from time to time to gargle with salt water. It is important to train in repeat on a daily basis, combining these encourage the secretion of saliva.

Q Sjogren's syndrome symptoms, the talk has been that this disease but leave symptoms?

I A patients with a diagnosis of Sjogren's syndrome, introduction to explain the illnesses that the two will talk. One not only to dry symptoms, at a time and that there are various complications associated with this disease may also take their course, but if it is. And again the first, as mentioned, this disease connective tissue disease is in diseases like rheumatoid arthritis and relatives, including rheumatoid arthritis when that variety is that it can be merged with other connective tissue diseases. Believe that don't otherwise do not from the two main's Hospital is the only symptom to dry and becomes too easy, bothersome, hospital foot held aloof from it tend to be, but now said regard, still without eyes, firm course had to see the types of disease.

Is one of the first non-drying symptoms of Sjogren's syndrome complications, what would?

A first of all, is a symptom of Raynaud's phenomenon. It is the symptoms end up with cold water, or so-called cold stimuli such as cold wind caused impaired blood flow, such as fingers and toes, and white. Raynaud's phenomenon is seen as approximately 30% of patients with Sjogren's syndrome. In addition, various skin symptoms seen. Occurrences of small purple spots, Purpura and red spots and the red team. Or have strong time of ultraviolet light, such as at the moment, and hypersensitivity to sunlight, ultraviolet rays lose to, so caution is required. Then the joint pain is well recognized. However, arthritis in patients with Sjogren's syndrome, rheumatoid arthritis, unlike a progressive, chronic has made, is often not the repeated temporary joint pain. So basically absorbing deformation and tonic.

What complications affect the internal organs Q

A. it is not what symptoms have been described up to now is, of course, happens all the people of this disease. Rather than that visceral complications also happens to everyone

Is the implication that you carefully monitor that happen. Because different would happen first, as a complication of internal organs is important, Pneumonitis that is viral and bacterial pneumonia is inflammation of the lungs. Symptoms of coughing and shortness of breath. Seen more thyroid complications. Can cause thyroid insufficiency, chronic thyroiditis. Then, there is the chronic liver failure. I think it is necessary to examine whether or not clear cause of chronic hepatitis is usually, alcohol, alcohol consumption caused by or, or with fatty liver not these things is what's happening in type B or type C hepatitis virus, so-called famous well known but also chronic hepatitis, but hidden Sjogren's syndrome. I think you need to approach from the perspective of when will again have been described up to now, lung, thyroid, liver, this disease of visceral complications such as is typical, but is of unknown cause lung disease, thyroid disease, liver disease, complications of Sjogren's syndrome may also.

In A first, the disease was said to be like a relative of rheumatoid arthritis disease.

Q is it to the next important point. This disease is of autoimmune diseases typical disease of the same collagen in rheumatoid arthritis and one related to the leave. Or that come with this disease rheumatoid arthritis. Like I said, by experience arthritis syndrome. Features of rheumatoid arthritis symptoms is indistinguishable from symptoms of rheumatoid arthritis, is called sustainability. 1 month or more swollen joints, aching, when suspected complications of rheumatoid arthritis, there is better.

Q. is that dry disease, Sjogren's syndrome, but various symptoms appear.

A Sjögren's syndrome, and dry conditions, and that if you go after the symptoms alone are often, in the coming caused this disease in visceral complications, or rheumatoid arthritis and called it from the tied up said to be ill.

2011April 4, "FM Hitachi" is broadcast in the health guide.


Q: first of all that uric acid is what?

A: uric acid is a substance called purines are broken down and the metabolism. Says where the sources of uric acid purines are located and, first of all, we are in the body. This contains purine, and substance of nucleic acids in the cells of the body. Human cells repeat metabolism every day is released in the body is the amount of purines and uric acid and makes it.

Q: is that anyone who is uric acid in the blood?

A: Yes it is. It is that the normal values of uric acid in the blood. Is often measured in Checkup and screening the men would stay at 6. 5 mg / dl and women at 6.0 mg / dl within normal values.

Q: are women worse?

A: Yes it is. Female hormone uric acid-lowering effects less than men because they 用garu. Works will talk later, high uric acid and gout, gout overwhelmingly on men because of this is often. Well, beyond the normal uric acid exceeds 7.0 of hyperuricemia. Become sources of uric acid purines are more or less in the us to speak every day food. It is not taking a food consisting of uric acid purines.

Human beings cannot ultimately dissolves uric acid came from food. Uric acid exceeds 7.0 we deposited uric acid in various points of the body. Typical example is arthritis. Deposited in the joints and cause gout.

Enzyme dissolves uric acid in primates including humans somehow becomes a bytalk. From the point of evolution is a funny thing, birds and reptiles is this enzyme to break down uric acid, Craps. Will be falling on the car white bird droppings, but originally is that white is the uric acid. So the chimps might be gout, but Crow's cry is gout Crow Raven's rants, and instead of pain should not.

Q: what food was that contained in the purine, uric acid from which a variety of foods, especially often?

A. So, some tips and fish or meat lever includes large amounts of purines. And Milt, and like a sardine. Beef, large fillet steak in the quite of the purine. It is well known that with alcohol often included beer.

Q: you should avoid these foods are high in uric acid, and people who say?

A: that's basically. However, current medical thinking is very strict wosakenakute of these foods are good, that is.

Problem is that ingest on a daily basis and in large quantities.

Is that good fine drink and eat too much. One day, a total, total calories for is rather the problem. In fact, weight and uric acid correlate nicely. People who are obese are

Reduce the total calories eaten in one day can lose weight reduce uric acid. The violent motion of the falling weight how do you lose weight and high in uric acid, so is not recommended. Just a little story crossed some of the muscles and movement, but may rather flutters uric acid purines is released from the cell. As a result, can trigger an attack of gout often. Of course a moderate aerobic exercise is beneficial.

Q: diet is situated in the Centre.

A: Yes it is. Is to reduce the total amount of food. That way when, does not have just a thin, high uric acid and hyperuricemia, constitutionally excessive uric acid production or excretion of uric acid in a bad way, and then mixed with those three basic patterns. If the diet is mainly to drug use

You must decide what type of drugs or excessive production of uric acid excretion is slowing or mixed types or identify it.

Q: treatments that focus becomes how much uric acid treatment will I need?

A: the uric acid exceeds 7.0 "hyperuricemia" called it morbid. However, it does not exceed the 7.0 now drugs are required.

If you have a tendency to obesity in weight control is critical. You should have caused a gout attack in the past beyond 8.0, or high cholesterol, high blood pressure, diabetes complications when the drug treatment. If uric acid exceeds 9.0 is without drug treatment is necessary.

Q: would be easier for gout uric acid more than 8.0 occur?

A. Likely exceed 8.0 in the long term and certainly increases the risk of an attack of gout. However, treatment of hyperuricemia is not only never to prevent gout. Uric acid exceeds 7.0 at the beginning you talk about, and uric acid we deposited all over the place. Joints are of course, there is deposition in the kidneys and blood vessels. Deposition in the kidneys, causing kidney stones and renal failure. Deposits in the blood vessels and increases the risk of hardening of the arteries. Hardening of the arteries, typically heart diseases such as angina, myocardial infarction and stroke. In other words, is one important risk factor equivalent that high uric acid, high blood sugar and cholesterol, and cause various diseases. You may experience Angina and high uric acid, the risk increases that a scientific report.

Q: is that don't leave without high uric acid, gout attack.

A: that is correct. I think just cause gout hyperuricemia is not only, you understand that the most important risk factors for the cause of various diseases such as renal failure and angina pectoris.

< 1/2009 >
1/2009 February, called "health first" regional edition of the Asahi Shimbun (Ibaraki version) is a title that was serialized over five times.

Rheumatology physician best (1)

Due to modulation of the immune system

Breakthrough medications and treatments

Medical Department before, such as Freud, Jung, Fromm, studying psychology. There was aspiring initially Department of Psychiatry, school of medicine, but psychoanalytic approach in the current psychiatric care is quite difficult. Aimed at the next was that doctor you can see anything.

I specializes in any Department of the rheumatic diseases (kougennbyou) throughout the body including joints, skin and internal organs various internal organs all over the lookout, sometimes in the spirit realm should care. Also found Rheumatology from lung and kidney diseases, diseases of the skin where collagen is no less. Collaboration with specialists is important in that sense.

Rather than indicative of a disease in connective tissue diseases rheumatoid arthritis (RA),In a general term, such as Systemic Lupus Erythematosus (SLE), systemic sclerosis, polymyositis and Dermatomyositis, Vasculitis, Sjögren's syndrome. For more information on the cause of the disease is unknown, but genetic factors joined environmental factors, such as viral infections, modulation of the immune system (autoimmune phenomena) happen to be. In a morbid State of Autoimmunity and usually entering from outside bacteria and viruses on the immune system works, but would gladly attack your body's tissues and cells. From immune abnormalities, even what kind of connective tissue disease multiple organ failure can be. Obtained from blood test results indicate immune abnormalities, but it depends on the disease doesn't mean. Diagnosis is approved in time to specific clinical symptoms, gotta check it out. Abnormal blood tests alone over many years not uncommon. Of course if you do no need for treatment.

For clinicians not as terrible as the death of the patient. Remaining thoughts of how death. Is death an especially unforgettable. 1980s guide 20 years ago, but he was in the hospital, closed eyes SLE still refused to call "immobility mute" to fell. In the SLE neurological abnormalities. Got a lull in large amounts of steroid treatment is complicated by infection, but unfortunately died. Mr. B was in junior college students of mixed connective tissue disease (一 of connective tissue disease) in severe pulmonary hypertension complicated was. One morning, suddenly admitted to hospital lost consciousness. Was already in cardiac arrest. Later, from his father part of the incense money to study incurable diseases and would like to have declined politely got out. There in fact severe and treatment of difficult diseases, connective tissue diseases, were once referred to as "incurable disease". However, remedy, treatment strategies dramatically. Never it is not a fatal disease. Example Mr. A and Mr. B are now rather exceptional in, the death and my father never not to waste.

Most of the medical (2) rheumatoid arthritis (1)

Rheumatoid arthritis (hereinafter rheumatoid arthritis) is a typical disease of connective tissue diseases in the number of patients with the most. 25 years ago, textbooks listed and the number of patients approximately 300000 people. Now the number is more than 800000 people. Might be due to this as well as increased patient is nothing short has deepened understanding of rheumatic disease and rheumatoid arthritis diagnosis technology has progressed. Rheumatoid arthritis joint inflammation may occur swollen and aching. Leave and proceeds to leave the broken joint deformation caused heavy obstacles.  Details of the cause is still unclear. Rheumatoid arthritis is not understood only in a blood test. For example rheumatoid factor is the anomaly of relatively characteristic seen in rheumatoid arthritis is actually 60-, 70% positive to have. Rheumatoid factor in rheumatoid arthritis patients than a few the rheumatoid factor positive, healthy people. Among important joint swelling is seen many (three or more), left-right symmetry. These swellings are found in the joints of the wrists, hands and fingers.
Complain of hand pain and swelling, and received a 50-year-old Patricia. Cooking work has been for years. Indeed joints the tip of his hands are swollen. Hit and hurt. The blood test was abnormal. Stacey is no rheumatoid arthritis, osteoarthritis. The swelling of her hands to easily seen when manually, including many past is called Baden nodules, as related to the old age. In something like a medal for labor. Unexpectedly cannot properly capture this rather bite and swelling in the joints. I also often get lost. Will be in touch again to put a professional face. There are time consuming to diagnose. Better an excuse though.
Rheumatology white paper (in 2005, Japan rheumatic patients support Association) to the according patients worry, ask people to do something when "severe pain, treatment not each 30 percent more than the most. Patients with rheumatoid arthritis are 30-many women around the age of 50. Stress not deeply 係waraneba in housework and child-rearing age, unable to move, should rely on people you can imagine. To amplify the anxiety that stress is not pain or treatment. Is important for understanding of the family. It is not rare glimpse into this kind of trouble in the clinic. Become a doctor was fresh, many were bedridden patients with rheumatoid arthritis. Physicians era a call everyday part of the treatment is. But now, rheumatoid arthritis is incurable illness is no longer. Bed-ridden. Significant advances in treatment. Specifically anti-rheumatic (MTX) became a standard treatment drugs and biological products has appeared in. Followed by the next.

Most physicians (3) joint luma (below)

MTX and biological products

Impact on treatment progress

Over the 70-year-old's was visiting in a wheelchair. Rheumatoid arthritis (hereinafter rheumatoid arthritis) that turned into eight years. In the hand, knee pain ridden continues more than six months. No thin taper muscular legs. Anti-inflammatory drugs and corticosteroids administered to reduce the pain. Continues, however, kept no matter how painful or inflamed radical progressive disease, not prevent joint destruction and deformation.

Rheumatoid arthritis drug called drugs suppress the inflammation of rheumatoid arthritis and joint destruction. There are several types of commonly used with methotrexate (MTX). The drug primarily used worldwide are diagnosed with rheumatoid arthritis. Mr. S also treated with MTX. Three months later, the pain is better, but remains swollen and inflamed. We added the drugs known as Biologics. One month later, Mr. S stick yourself, has entered into an examination room.

By using drug substance produced by living organisms and biological products. Target and a missile aimed at established react to substances called cytokines cause the inflammation of rheumatoid arthritis. Currently has four types of biological products. Strong keep especially MTX with either effect is tremendous, not only to relieve pain and joint destruction. That is recommended from the acute joint damage does not start. Brought me new advances in rheumatoid arthritis treatment is not a panacea.

Biologic tried 20 cars had rheumatoid arthritis in the first half of the A's, was treated with anti-inflammatory drugs and MTX, prevent progression of joint damage in the future. Pain and swelling have improved dramatically in a short period of time. Current 4-year-old showed progressive joint destruction of the track at daily life also work well. Without taking anti-inflammatory drugs, succeeded in reducing MTX and biological products. To stop one of these two drugs in the future looks promising.

Just a biologic drugs more expensive, this is one single drawback. I have by"incurable" medical security system in many connective tissue diseases, rheumatoid arthritis is not this subject. Long term, 4-high amount of 50000 Yen reimbursement is quite a burden on patients. Have the confidence to the use of biological agents, even though there is a medical necessity for this patient. There are also patients who don't get forced to abandon its use. That I can't do as a doctor. What shall do? From any part cannot be expected of public assistance? "For necessary medical treatment is not received" is actually, as medical practitioners who seriously want to.

Most physicians (4) Sjögren's syndrome

50Mr. K of the aged woman. It goes dry cough last more than six months, was found. No cough than the symptoms of the common cold, sore throat and fever. Radiographic abnormalities are not. I had a unique to Sjögren's syndrome blood test abnormalities. That tendency to angular Cheilitis, dry eyes and listen again.

Sjogren's syndrome is of autoimmune diseases, develop symptoms of dry eyes, mouth and other mucous membranes and skin. The tear, fat eyes, itchy eyes, and sue. As the dry conditions in the mouth, dry mouth, no saliva, drank the water during the meal, increased tooth decay; Dry nose. Swollen Parotid gland; This disease is often in women. The dry conditions have been missed, patients with significant potential. Real, 10-estimated that 300000 people.

Part of the salivary glands showed suspected symptoms and blood tests if projects actually salivary glands, salivary gland scintigraphy, or labial salivary gland biopsy by a diagnostic to identify. Mr. K also confirmed by biopsy of salivary gland Sjogren's syndrome. Due to the bronchial dry cough in the angular Cheilitis, is seen in this disease symptoms in.

Hydrochloric acid se mildew Melin the drug as a treatment works better. Mr. K also administered this drug. Lightened up a little cough very much.

So may this illness and symptoms, but also a variety of complications that require attention. For example, in disorders of the thyroid gland and liver, rash, and arthritis. Also, because a merger of other connective tissue diseases, such as rheumatoid arthritis is silly.

"Dry mouth" (thirst), a patient's appeal, specifically the variety in the actual. "Thirsty" think diabetes teacher to visit. "Mouth icky" to"feel and maybe dental disease and not to undergo dental teacher. Also be the case. Neurologists may hay fever-like symptoms called "my eyes are itchy' and eye doctor. Be eligible to elicit symptoms (dry) that "dry" is surprisingly difficult. I think many more departments frequently and definitive diagnosis, as the patient. For this diagnostic importance is cooperation in many fields such as dentistry, ophthalmology, otolaryngology, teacher. Is the number of potential patients, should be no less.

There is, however, the following example. Admitted being worried about this thirsty mouth disease exceeded the 70-year-old's, but in the end, cause stabilizer was drinking at the aging and "insomnia" were influenced by. And H's 60-year-old is "spit out hard to" come, due to the effects of radiation treatment for cancer in the past was in.

Gout medicine best (5)

Sudden attacks of gout arthritis absorbed in and touch the wind hurts. Mr. K of the 45-year-old came to the doctor's Office and limped. It looks painful, red and swollen upper root of the thumb of the right leg and foot. There is no doubt that the gout attack. Exceeded the 9.0 mg/dl uric acid values of blood found at a later date. Cool the affected area with the rest during the attack in the massages are strictly prohibited. Administered anti-inflammatory drugs to control seizures, and 1 week after. Bouts are usually 3 days ~ that should subside in about 7 days. For hyperuricemia may cause drug not administered during an attack. You may conversely worsen seizures, uric acid balance of the blood and in the joint. 1 week after Mr. K visits, showed then was half a year later. Now it was in leg attacks. If left unchecked, could cause the attack on hands and knees.

Exceeded 7.0 mg/dl uric acid in the blood, and be easier to deposited in the body. In addition to causing acute arthritis, cause urinary tract and kidney failure. Also may be considered elements of the metabolic syndrome, hyperuricemia. Because high blood pressure and Dyslipidemia are merged in. In these cases, increases the risk of myocardial infarction and cerebrovascular disease. In not only causes gout only. Mr. K as well as uric acid high cholesterol, medical management needed in the long-term.

Purines ingested from food is metabolized to uric acid in the body and excreted in urine. Purine-rich food, for example liver, shrimp, sardines and eat too much uric acid in the blood to rise. In alcohol many included purines in beer. "Binge" of these "excessive drinking" is true that causes the seizures, but in the long run "quality" over "quantity" problem is a labyrinthine quality strict dietary restrictions don't. Are rather closely related to know is "obese". You tend to lose weight if overweight, go down uric acid. However, the fact is that normal weight with high uric acid, uric acid is Tamari, teaching quality, the Constitution difficult to be excreted.

Female hormones have uric acid-lowering effects for the gout is overwhelmingly male. 20% of adult males and hyperuricemia; Long before the peak of the onset of gout is 50-year-old. Currently, its peak is 30-year-old and said, there are more and more young people have been impressive. Mr. Y caused gout attack in the 22-year-old. Weighs more than 100 kg. Young and single and even a controlled diet is hard. Not only will aim at improvement of "lifestyle" patiently.

< 6/23/7 > 5/19/7, rheumatoid arthritis patients Association is the lecture. (At Mito)
We will talk on the theme of rheumatoid arthritis (RA) and the latest treatments. RA is a typical disease of connective tissue diseases. Rather than a single disease, rheumatology, is a collection of various diseases, a generic term. RA and Systemic Lupus Erythematosus (SLE).,Systemic sclerosis (Scleroderma) (SSc), polymyositis, Dermatomyositis, Vasculitis, mixed connective tissue disease (MCTD),Includes diseases such as Sjögren's syndrome, Behcet's disease. From the perspective of its pathogenesis also called autoimmune connective tissue diseases these are. However, autoimmune diseases that include disorders of other areas, such as ulcerative colitis and myasthenia gravis. In other words, it is rheumatology and autoimmune diseases are not completely equivalent.

So, what is immune? We have born of immune systems. It is a system referred to as enemies coming from the outside, these antigens are, for example, making some kind of antibody proteins against viruses, bacteria, or other foreign matter, to eliminate it. If you create favorable physiological, Antigen and antibody react and result is "immune". "Allergy" is enters certain particles, mold and dust, pollen, such as adverse biological results. For example, called allergic asthma and hay fever

Autoimmunity is the modulation of these immune system. It is only to antibodies against anything that comes in from the outside, is able antibodies against self cells and tissues, such as the internal components. Called these antibodies are autoantibodies, rheumatoid factor, antinuclear antibodies, many known. Connective tissue disease is a disease of multiple organ failure and that means, since such autoantibodies causes the reaction component of the self and end up including RA.

Well, is the prevalence of RA, but it is believed to be a 0.5-1.0%. And has a population of 1,000 people, and women in RA of about 5.4 has been. Men at the 1,000 people inside, about 1.1.

RA is commonly known as Association of Rheumatology (ACR) (revised 1987) classification standard as are diagnosed. If RA of seven distinctive items more than four items met the diagnosed with RA. If you summarize the RA arthritis is the inflammation of the joints of the left-right symmetry of multiple (three or more). If the right is the right way to happen on only one side. Also, not just one or two joints. Is that more features are to the hands and fingers. It is at the base of the wrist and finger joints (referred to as MTP joints), 2 second joint (known as PIP joint) arthritis. "Inflammatory" then pain is also important findings of the joint is the finding that the "swollen" (swelling) is more important. It is then is also important, rheumatoid factor is not necessarily positive on is not. There are many patients with RA rheumatoid factor negative. Also, does not have any disease, rheumatoid factor positive in the opposite number exists. It was previously affiliated with the hospital, examined the prevalence of rheumatoid factor of examinees in checkup. About 6 percent were positive. It was of course nothing abnormal is not much. Is that to say that RA is determined by blood tests is not.

That is now the treatment of RA, but one keeps the State of the "fire" of 'arthritis'. Another is the reason causing arthritis "fire" at all, should be called "Firebug" and "immune modulation (autoimmune)" is a, not necessary to rectify this. As a treatment for arthritis, and various non-steroidal anti-inflammatory drugs, and adrenal steroids (prednisolone) is a powerful anti-inflammatory drugs. To radically reduce the autoimmune drug widely known as anti-rheumatic drug (DMARD). It has a variety of drugs. Gold injections (ciozole) has been used since ancient times. Lindora gold pills. Also, use the metal Cape tose, Limacher, azalfidine, ochre, mover, bredinin drug. Methotrexate (MTX) available to it, recently, anti-rheumatic drugs such as Araba, where had appeared, too.

Well, in recent years, in the treatment of RA for thinking and treatment that has changed greatly and previous. Boils down to (1) early detection and early treatment, (2) changes in treatment strategy (3) Center with the MTX and properly evaluated for proper drug selection, and (4) the emergence of Biologics, and like that. Become capable of preventing the progression of joint damage, if treatment is started early, early diagnosis is done by a specialist. Should determine as soon as possible the usefulness of drugs is, of course, may vary from there, three months late, continue and somehow, given that is not 4,Should continue in the five months, whether the drug is really valid, or other drugs off the turn should do the evaluation is very important. And even if nothing else, now the RA treatment drug is MTX. Say drugs should be implemented early in the drug while at the same time. Superior clinical effectiveness, reduces also the progression of joint damage. Insurance is able to administer once a week to 8 mg. Effect comes relatively early. However, liver injury, while may develop pneumonia and blood loss a side effect from periodic inspections are required.

Another ground-breaking drug had appeared. It is what is called a "biological products". Been found that substances called TNF that SICA in RA, an important role to play. TNF alpha is a variety of other inflammatory cells and can cause arthritis and raises the IL6 and as clarified. Could inhibit TNF arthritis RA is expected pretty much control over. Even inhibits TNF alpha as it expected, "biological products" is the breakthrough drugs for RA treatment. Currently, Japan allows drug Remicade and ENBREL two types. Former intravenous drips, and the latter is a twice-weekly subcutaneous note. Is easier than produces ENBREL would be self injected and sushi, anyone can. About 30 people who use me, none highly effective. This drug inhibits the progression of joint damage as well, you can expect to improve bone erosions in the small joints, such as seen previously (destruction). However, big trouble biological products, cost is very high. Is not the situation in this regard, we also annoying to encounter.

Anyway, now, in RA treatment literally ADL of the patients dramatically improve the means made available the complete remission of the disease, and we have said.

In recent years < 3/10/6 > gout clinical and treatment
(3/15/6 radio NIKKEI, medical education cooperation course of lifelong"broadcasting-overview)
Gout and is defined as the disease causes a variety of symptoms, which became saturated as a result of hyperuricemia, uric acid is deposited and your organization. A typical symptom in acute monoarticular arthritis, Gouty uric acid stones, gout and kidney. Being human uric acid pool is useful amount 1400 mg and 200 mg is excreted more sweat and intestinal tract of 500 mg is excreted from kidney. Beyond the uric acid pool becomes "saturated" State and is 7 in serum uric acid levels. estimated that if to 0 mg/dl or more.
In recent years, young of age of onset of gout while there. In the 1960s, the peak of the onset of gout is 50-year-old. However, according to the survey of 1990, the 30-year-old peak. Also generalizes the serological monitoring of uric acid values say often encounter Gouty Tophus, such as advanced arthritis or ear became as a result, early revisions of hyperuricemia treatment has decreased.
But on the other hand, 20% of the adult males of the modern hyperuricemia has. Many have merged high blood pressure and high cholesterol at the same time, hyperuricemia is from the perspective of multiple risk syndrome, metabolic syndrome and lifestyle-related diseases associated with back is getting that seen. That is as important factors influencing prognosis insulin resistance with visceral obesity, diabetes, high blood pressure, high cholesterol, as well as one single thought is becoming that. This is 2002 in hyperuricemia and gout treatment guidelines gout and nucleic acid metabolism of heavily emphasized. In fact, in many epidemiological studies has been proven correlation between hyperuricemia and heart and cerebrovascular disease in patients with high blood pressure, presence of hyperuricemia are risk factors independent of cardiovascular events and. Hyperuricemia is on the reserve of the gout is not to emphasize you want.
Now, serum uric acid 7.0 mg/dl or more, men and women both "hyperuricemia" and be done. at 9.0 mg/dl more than once almost absolutely will be eligible for the drug treatment. It should be started drug therapy in case with risk factors, such as abnormally high blood pressure greater than or equal to 8.0 mg/dl, which previously gave, Hyperlipidemia, and glucose intolerance. If 7.0-8.0mg/DL without any complications, and no history of gout attacks, you should start from the guidance. Is life coaching (1) rid of obesity, (2) limit excessive alcohol (especially beer), (3) 10-amount of water intake, (4) jogging about aerobic exercise is recommended, (5) stress, such as that. Abstaining from foods such as dried foods high in purine content, for example on the subject, liver, shrimp, sardines is a meaningful, real life on a very strict pudding system limited diet is not recommended at present. Quality over quantity, weight control is effective in lowering the uric acid directly.
When drug therapy of hyperuricemia, diseases classification becomes important. Excessive production of uric acid or the where of excretion ability to know matters. By calculating the ratio of both uric acid and creatinine clearance in urine, urine can by disease classification, but is quite difficult in actual clinical situations. Then came patients as a method of recommended using the ratios of creatinine and uric acid in urine using urine from time to time when the. Remains the question of cut-off values, but this ratio is 0. And that degrading excretion in 4 or less if 0. With 6 or more you say significant and excessive types. If If excretion degrading a uricosuric, excessive types in, with uric acid production student drugs. Benzbromarone, the latter drug allopurinol is the former. With citrate preparation benzbromarone case, urine in PH from 6. We should keep around 5. Lead to the prevention of urinary calculi. Renal impairment should you choose if the urinary tract, such as replaceable, allopurinol.
Goal of uric acid treatment starting at 4.0-6.0mg/dl.
Pharmacotherapy of gout attack base is anti inflammation. Non-steroid system anti-inflammatory analgesic drug NSAID)Short-term high doses to principles. Valid in combination with indomethacin 50 mg suppository and diclofenac suppositories (not covered by insurance). May be administered about 15-20 mg of prednisolone in the gastrointestinal or renal failure, NSAID use is difficult. But in about 1 week to promptly to have lost weight is.
In recent years, in addition to the original interaction with uric acid-lowering effects for drugs that have emerged. In antihypertensive drug Losartan potassium, high cholesterol medicine Fenofibrate. When hyperuricemia as a multiple risk syndrome, metabolic syndrome, these drugs are guessed can play a certain role of hyperuricemia treatment strategy. This point goes and the challenges of the future.


Rheumatoid arthritis < 7/1/5 > (RA)New development of treatment
This spring, new antirheumatic drugs two drugs appeared. One is the new development of biological drugs etanercept (brand name: ENBREL), another one single should be on immune-suppressing drugs Tacrolimus (charts). Drugs are already used in Europe and America, which recognized certain of its effects.
Enbrel is a soluble TNF receptor, specifically to inhibit TNF-α, β. Whereas the same TNF blockers have already used Remicade Remicade chimeric preparations in ENBREL is human preparation, anaphylaxis occur less in Enbrel. Machine ENBREL works as a combined inhibition of TNF-alpha, whereas stratigraphic and Remicade to demonstrate efficacy as neutralization of TNF-α. Whereas the former is intravenous, subcutaneous note that difference is the latter. Enbrel is the obvious evidence to immediately suppress joint inflammation in RA symptoms improve, suppresses bone destruction. Clinical efficacy is methotrexate (MTX)That is better than has been shown. This drug is of two times a week. Be administered starting one month, to provide hospital twice a week with just one hurdle. (Diabetes self injections and so on), then recognized the self injections, should be training for my depression.
In our hospital, and already started using ENBREL for six, both have shown good clinical efficacy. Concern for the dysfunction of the RA, in his depression was concerned, neither is clear.
Oral dosage is another absolute bioavailability, charts, to demonstrate the effect by acting on activated T cells. If the drugs were already used in the transplant area, that is used in the RA, at doses of 3 mg (one day). Refractory also reports that are better than the MTX or MTX is also enabled for example.
It has no doubt that the appearance of these two drugs is RA treatment of great Gospel as a clinician for right eye as part of the "shadow" and "informed" enough is necessary in patients without a doubt. One is, of course, and side issues, one is the problem of cost.
Said earlier, but even from this new antirheumatic drugs we hand to will. How we use or establish a major treatment strategy is required.
Existing drugs also depending on the individual case, that should turn the eye correctly. Don't make stupid like using a shotgun to shoot small birds.

Topic < 8/23/4: Sjogren's syndrome
Sjögren's syndrome (SS)The variety of symptoms is indeed. Usually, symptoms of SS dry gland symptoms related to the symptoms and other extragonadal impression seems to be better called total SS organs lesions tend to be divided on the symptoms, but they could.
Dry cough so (dry cough), that is often overlooked. Colds and chronic bronchitis and allergic cough so, and often has been confused. You might say "throughout the year, have a cold", and that patient is unaware, in the interview for the first time speaking to suit easier to cough out. Because, of course, of SS dry cough, dry bronchus based upon what is normally cold and cough suppressant is not valid.  In recent years,
Whereas the xerostomia SS becomes available is of cevimeline hydrochloride, has become a big Gospel to improve the symptoms of patients with SS. Dry cough so that I reported effectiveness against ("Japan Clinical Immunology society Journal Vol.22No.2, 2004)。
SS gammopathy of emergence and networks within the tumor may occur when it is known. Many of the networks in the tumor in lymphoma. Gammopathy of emergence has experienced more often than not, and we have experience of MALT Lymphoma associated with the SS. (See Clinical Immunology society journal Vol25, No6, 2002)。 SSA antibody negative, high have often seen hypogammaglobulinemia, elderly men, but how?.
Depressive symptoms are often experienced in the SS, SSA antibody to undertake impressed many. But I like physicians ' depression ' evaluation, diagnosis is very difficult for acutely aware of Psychosomatic Medicine doctor, psychiatrist, and cooperation with, and. Depressive symptoms should be considered one single organ lesions of the SS or not, or whether or how much the incidence of further treatment options what should be many clinical challenges, maybe I need a joint research at other large is not or.
Dry cough so diagnosed rather, M-protein, lymphoma, or depressive symptoms, potential in the population of these pathologies, SS, we discovered at work is also very important thought it would be.
Lip biopsy and saliva glands examination is essential to the diagnosis of SS,. Anyway if the serological antibodies SSA and SSB antibodies are recognized, not only on the clinical eye and mouth symptoms quite like the above in confidence to the inspection. But even if SSA antibody is negative, or antinuclear antibody negative is recognized and/or rheumatoid factor positive and/or high γ-globulin blood thrombocytopenia or leukopenia, apparently even if dry conditions should make lip biopsy actively. (Salivary gland Imaging is a difficult procedure in the physician. ) If diagnosis of SS, a crazed patient in the future follow u up radically change should have.
Liumatrosist SS is often in the West, but also large difference in the rate of diagnosis and feels alone I would not.

Rheumatoid arthritis < 6/30/4 > (RA)The progress in treatment
Rheumatoid arthritis is known as 'rheumatoid arthritis' until about 3 years ago. Should be balanced in recent years, "chronic". As to why big reason would have variety, but RA advances in treatment necessarily "chronic", not that remission is permitted.
RA treatment and changes in recent years and are showing progress. One is the emergence of new therapeutic agents and the changes in the approach to treatment strategies or RA treatment is the one.
That detailed pathogenesis of RA is still unknown, although one single important KEY substances in the pathogenesis is the TNF alpha is no longer suspected. TNF alpha is a materials located in the upper reaches of the cytokine cascade, can inhibit TNF alpha theory fundamentally quench inflammation of RA can be expected. As these TNF alpha blockers, in the fall of 2003, Remicade R
(Anti-TNF α-chimeric monoclonal antibody) emerged, showing remarkable effect. Also, a plan during the reporting period, approved Embraer r (soluble TNF alpha antibodies). Rheumatoid arthritis with Leflunomide was approved to coincide with REMICADE (R Alava) are strong. Other new rheumatoid arthritis drugs such as T614 and FK506 (Tacrolimus) is approved and a matter of time, we will pick up one after another and a powerful new weapon against the RA.
I think these drugs appeared imminent radical changes RA treatment strategy.
Be obtained from the pyramid, a mild drug in the past, RA treatment effect and switch to other drugs was on the idea of minutae. Guidelines for treatment of the American Rheumatism Association points out that the RA diagnosis early, if possible within three months, to big impact on whether or not you can begin treatment with powerful functional prognosis of RA.
Drugs (oral and injectable), SH-based reagent (d-penicillamine, bucillamine), SASP (azalfidine), Actalit, Mizoribine(Bredinin), MTX (lumatrex), had in recent years used rheumatoid arthritis drug in MTX with no talk RA treatment.
My MTX now think RA treatment first-line drugs. Contraindications of MTX (absolute and relative) unless MTx in RA treatment drug. In chronic liver failure, chronic pulmonary disorders, kidney failure, raising children with applicants, gastrointestinal symptoms, etc., difficulties in patient compliance is considered as contraindications. Example MTX is not available to the other rheumatoid arthritis drugs will be considered. Of course is not a valid example of MTX or attenuation of the effect in there, would be considered new rheumatoid arthritis drugs, TNF-α blockers in such a case, which previously gave. Is not authorized in fact, neat these large RA treatment strategies, say the challenges of the future. Close by the Japan College of Rheumatology treatment guidelines are expected to be revealed, and trying to focus.
In any case, at this time, early treatment with RA at an early, early diagnosis, and MTX
Think of the start line.