The beneficial effects of low energy laser irradiation on rheumatoid arthritis (RA) joints have been reported, but the mechanisms of action of low energy lasers in RA are unclear. The synovial membrane in cases of RA was studied histologically to observe the effects of low energy laser irradiation. Fourteen knee joints of RA cases, which had been scheduled for arthroplasty, were irradiated with a gallium-aluminium-arsenide (Ga-Al-As) laser (790 nm in wavelength and 10 mW of output power) prior to the surgical operation, at six points of the external aspect of the knee joint for 80 seconds at each points once a day for 6 days. On the day following the last irradiation, pieces of synovial membrane from the lateral irradiated area and from the median nonirradiated area as a control were resected during the arthroplasty. The histological findings of the irradiated synovial membrane showed flattening of epithelial cells, decreased villous proliferation, narrowed vascular lumen, and less infiltration of inflammatory cells compared with those of nonirradiated synovia. The evaluation of slides was done in a blinded manner, and significant differences was seen by Wilcoxon's t-test (P < 0.01). Histological findings suggested that the low energy laser irradiation induced suppression of inflammation in the synovial membrane of RA.

The mental activity of elderly cardiac patients with dementia and/or brain atrophy improved with exercise from walking.

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Background An administration of tocilizumab (TOC) rapidly reduced inflammatory markers such as CRP and ESR, which made the diagnosis of infection difficult. According to PMS for 28 weeks, 553 events of infection and 163 events of serious infection (SI) were reported. There is a real need for the reduction of the infection risk. Objectives To validate the deterrence effect of infectious disease risk management (IDRM) in RA patients with TOC. Methods Forty-nine RA patients with TOC were enrolled from 4 universities and affiliated clinics. They were required to comply with IDRM policy during observation period. Primary endpoint was an occurrence frequency of SI (OFSI). Results Although 17 events of infection and 3 events of SI were observed, neither pneumonia nor cellulitis occurred. Risk factors were 10 year over disease duration and 5mg over CS dosage at the baseline. CDAI was changed from 61.1±3.7 to 18.3±4.4. The dose of CS was reduced by 41.8%. Persistence rate of TOC was 69.4% at 48 weeks. ACT4U study (48 weeks)PMS for 28 weeks (as a reference) # (Female)49 (93.9%)3881 (81.6%) Age (>70 y.o.)57.9±2.1 (26.5%)58.8±12.9 (20.5%) Concomitant respiratory disease22.4%17% Oral corticosteroid (%)/MTX (%)59.2%/64.0%77.1%/54.2% Infection (%)/OFSI (%)8 (16.8%)/1 (2.0%)389 (10.0%)/139 (3.6%) Conclusions In spite of higher frequency of concomitant lung disease, the incidence of respiratory infection and OFSI were lower in our study than PMS. IDRM could contribute to reduction of OFSI especially in respiratory infection. References Koike T, et al. Ann Rheum Dis 2011:70:2148-2151 Disclosure of Interest None Declared