BackgroundSteroid therapy, a key therapy for inflammatory, allergic, and immunological disorders, is often associated with steroid myopathy as one of the side effects. Steroid therapy is considered the first-line therapy for myositis; however, there have been no reports strictly comparing the muscle mass in patients with myositis before and after steroid therapy. Thus, it is currently unclear whether steroid therapy for such patients affects muscle volume in addition to muscle strength. We aimed to determine the change in muscle mass after steroid therapy via cross-sectional computed tomography (CT) in patients with myositis.MethodsData from seven patients with myositis and eight controls, who were all treated with high doses of steroids, were assessed before and after steroid therapy. Clinical factors in patients with myositis included serum muscle enzyme levels and muscular strength. The cross-sectional area of skeletal muscle and the low muscle attenuation rate at the level of the caudal end of the third lumbar vertebra were obtained using CT and measured using an image analysis program for all patients. Data were subjected to statistical analysis using several well-established statistical tests. The Wilcoxon signed-rank test was used for comparing paired data for each patient. The Mann-Whitney U test was used to compare sets of data sampled from two groups. The Spearman’s rank correlation coefficient was used for determining the correlations between two variables. Statistical significance was set at p < 0.05.ResultsMuscular strength and serum muscle enzyme levels improved following steroid therapy in patients with myositis. In both groups, the cross-sectional areas of skeletal muscles decreased (myositis group: p = 0.0156; control group: p = 0.0391) and the low muscle attenuation rate tended to increase (myositis group: p = 0.0781; control group: p = 0.0547). In the myositis group, patients with chronic obstructive pulmonary disease showed a tendency toward muscle volume loss (p = 0.0571).ConclusionIn patients with myositis treated with steroid therapy, muscle mass decreased after steroid therapy suggesting that the improvement in muscle strength was due to factors other than a change in muscle volume. Our study suggests the importance of therapies that not only improve muscle mass but also improve the quality of muscle strength.

he incidence of hypertension (HT) and of diabetes mellitus (DM) has been continuously increasing with the aging of society and changes in lifestyle. HT and DM can be factors in cardiac and vascular disorders, and chronic renal insufficiency (CRI), so the probability of encountering coronary artery disease in a patient with CRI is relatively high. Contrast-induced nephropathy (CIN) is defined as acute renal dysfunction manifesting as temporary elevated serum creatinine level (Scr) because of the use of a contrast agent, with no other causes, and is reversible with sufficient fluid infusion in most cases. However, there may be an irreversible disturbance. The elevation of Scr in CIN is 0.3-1.0 mg/dl or more, or by 20-50% from the previous level. 1 Recently it has become clear that renal function is an independent prognostic factor of cardiovascular diseases. 2,3 The efficacy of hemofiltration (HF) after using a contrast agent has also been indicated. However, it has been reported that hemodialysis (HD) after the administration of a contrast agent does not completely prevent complications such as CIN,5 and that CIN could not be prevented even when the area under curve of the level of contrast agent concentration decreased. 6 Contrast nephrotoxicity is believed to b temporary and furthermore, the effect on renal function over the long term is unknown. Therefore, the Circulation Journal Vol.72, March 2008effect of a contrast agent on long-term renal function was studied. Methods Study PatientsIn CIN, acute renal failure tends to occur first, and thereafter some renal insufficiency may remain. Therefore, to investigate the effect of a contrast agent on renal function in the acute phase, Scr values before the use of a contrast agent, immediately after the use of a contrast agent (max. Scr within 2 weeks after use of a contrast agent), and after use of a contrast agent in the recovery phase (within 2 months after use of a contrast agent) were recorded. Among the patients who had been administered a contrast agent from July 1997 to April 2004, those with a Scr of less than 1.2 mg/dl before the administration of a contrast agent were classified as Group N (20 patients), and those having a Scr of at least 1.2 mg/dl but less than 2.0 mg/dl before administration of a contrast agent were categorized into the following 2 groups: Group D1: 10 patients without hemodiafiltration (HDF) after use of a contrast agent, and Group D2: 15 patients with HDF after use of a contrast agent.The subjects in groups N, D1, and D2 were selected randomly. All patients gave informed consent individually before enrolling. This study was approved by the Review Committee for Clinical Research of Yamaguchi University Hospital.The background of the patients is shown in Table 1. Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease Study (MDRD) method. 7 Scr was 0.85±0.18 mg/dl, 1.45±0.14 mg/dl, and 1.59±0.26mg/dl for Groups N, D1 and D2, respectively, and the respective GFR were 71.0±15.0ml/min, 36.8±4.1ml/min,...

An estimated 0.9% to 2.4% of patients with systemic lupus erythematosus (SLE) also have hemophagocytic lymphohistiocytosis (HLH). HLH associated with autoimmune diseases is often refractory to corticosteroid treatment; thus, additional immunosuppressive drugs, such as cyclosporine, cyclophosphamide, or tacrolimus, are required. Here, we describe the case of a 44-year-old Japanese woman who developed HLH associated with lupus nephritis. Initially, her HLH was refractory to treatment with a corticosteroid, tacrolimus, and mizoribine. However, alternative treatment with a corticosteroid, mycophenolate mofetil, and tacrolimus improved both her HLH and lupus nephritis. This case suggests the possibility of mycophenolate mofetil as a key drug for treating HLH associated with SLE.

Lupus nephritis (LN) occurs in up to 60% of systemic lupus erythematosus patients. Combination therapy involving a corticosteroid and cyclophosphamide or mycophenolate mofetil (MMF) has been a standard therapy for LN. However, clinicians generally prefer to minimize steroid use in LN treatment. We herein report the case of a Japanese man with LN whose severe chronic heart failure prevented us from using steroid therapy. Instead, his LN was successfully treated with MMF monotherapy. Based on our experience with this case, we suggest that MMF monotherapy may represent a feasible LN treatment option in patients who cannot tolerate steroid therapy.

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