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The purpose of this study is to identify the factors that require arthroplasty due to the progression of joint destruction, even when an anti-tumor necrosis factor (TNF) biological agent is used for rheumatoid arthritis (RA). Among 91 cases that used the anti-TNF biological agent for more than 1 year, two groups of 21 cases that resulted in arthroplasty (surgery group) and 70 cases that did not result in arthroplasty (non-surgery group) were compared and examined. When the anti-TNF biological agent was first administered, disease activity and internal use of glucocorticoid (PSL) were not different in these two groups. The average DAS28-CRP(4) (disease activity score including a 28-joint count/C-reactive protein) (p < 0.001) and the amount of internal use of PSL (p < 0.05) were significantly decreased in the non-surgery group compared with the surgery group at the final survey. To inhibit the need for joint surgery in patients using the anti-TNF biological agent, it is important to maintain tight control over RA activity.

Purpose To investigate the prevalence of and factors associated with dysfunctional low back pain (LBP) in patients with rheumatoid arthritis (RA). Methods This cross-sectional study included 1276 RA outpatients from two hospitals. The Roland-Morris Disability Questionnaire was used to address the functional-dysfunctional state criterion. Clinical variables, such as medical status, disease activity, bone mineral density, and spinopelvic alignment parameters, were compared between patients with and without dysfunctional LBP. Results Mean age and disease duration were 64.6 and 13.4 years, respectively; the prevalence of dysfunctional LBP was 32.8%. On univariate analysis, significant differences existed in many variables, except sex, body weight, C-reactive protein (CRP) level, and prevalence of biological agent users, between patients with and without dysfunctional LBP. Multivariate logistic regression analysis revealed body mass index (BMI; odds ratio [OR], 1.116; P < 0.001), onset age of RA (OR, 1.020; P = 0.020), disease duration of RA (OR, 1.043; P < 0.001), methotrexate (MTX) use (OR, 0.609; P = 0.007), vertebral fractures (OR, 2.189; P = 0.001), vertebral endplate and/or facet erosion (OR, 1.411; P = 0.043), disease activity score (DAS) in 28 joints-CRP (DAS-28CRP) (OR, 1.587; P = 0.001), pelvic tilt (PT; OR, 1.023; P = 0.019), and sagittal vertical axis (SVA; OR, 1.007; P = 0.043) as associated factors. Conclusion The factors associated with dysfunctional LBP in patients with RA were more vertebral fractures, higher DAS-28CRP, vertebral endplate and/or facet erosion, higher BMI, longer disease duration, greater PT, older onset age, greater SVA, and less MTX use. Strictly controlling patients' body weight and disease activity with MTX and avoiding spinopelvic malalignment through vertebral fracture prevention are important.

Pustulotic arthro‐osteitis (PAO) is a major complication of palmoplantar pustulosis (PPP). In orthopedic surgery outpatient clinics, PPP patients with osteoarticular symptoms are seen frequently, but PAO's clinical features remain not well known. To determine Japanese patients’ clinical features and treatment status with PAO, we conducted a single‐center retrospective epidemiologic survey. Clinical features, including gender, age, smoking habit, the onset pattern, interval between skin manifestation and osteoarticular symptoms, and the incidence of sternoclavicular joint lesions, axial and peripheral joint lesions, were examined. The association between physical status and image findings by X‐ray, computed tomography, bone scintigraphy with Technetium99, or magnetic resonance imaging was evaluated. The distribution pattern of peripheral joint lesions and the treatment status were evaluated. We identified 51 patients, 10 men and 41 women, with PAO. The average age was 48 years and 59% were smokers. The frequency of onset patterns was skin‐leading type (63%), simultaneous onset (18%), and osteoarticular leading type (16%). The average interval between skin involvement and osteoarticular involvement in skin‐leading type was significantly longer than that in osteoarticular leading type (7.1 years vs. 2.0 years). A sternoclavicular joint (SCJ) lesion was detected in 65% cases, and the physical findings of SCJ were significantly related to the image findings. Axial and peripheral joint lesions were detected in the same ratio (23 cases, 45%). In the peripheral joints, the finger joint was the most common (26%), followed by the shoulder joint (21%). Patients were treated with nonsteroidal anti‐inflammatory drugs (76%), followed by conventional synthetic disease‐modifying antirheumatic drugs (DMARDs) (29%) and biological DMARDs (9.8%). Tonsillectomy was performed in 11 cases. In conclusion, PAO more frequently involves SCJ in middle‐aged women who smoke. Given that osteoarticular leading type was detected in 16% cases, seronegative oligoarthritis patients should be monitored for PPP, leading to a diagnosis of PAO.

To determine the effect of tocilizumab (TCZ) on reactive oxygen species (ROS) in 11 patients with rheumatoid arthritis (RA), reactive oxygen metabolites (d-ROM) were measured using a Free Radical Elective Evaluator. The Disease Activity Score (DAS28) and matrix metalloproteinase-3 (MMP-3) level were also evaluated. d-ROM measured 392 ± 110 Carratelli units [U. CARR] on initiation of TCZ, and significantly decreased to 237 ± 82, 248 ± 88, and 226 ± 91 U.CARR after 3, 6, and 12 months, respectively (p < 0.05). The DAS28-4-ESR was 4.77 ± 1.0 on initiation of TCZ, and significantly decreased to 2.19 ± 1.23, 1.51 ± 0.71, and 1.48 ± 0.48 after 3, 6, and 12 months, respectively (p < 0.05). Serum MMP-3 level was 197 ± 150 ng/ml on initiation of TCZ, and was significantly decreased to 92 ± 56, 73 ± 53, and 69 ± 41 ng/ml after 3, 6, and 12 months, respectively (p < 0.05). Pearson analysis showed that d-ROM value was significantly correlated with DAS28 (r = 0.543, p < 0.05), but not with MMP-3 (r = 0.174, p = 0.29). TCZ was found to rapidly and significantly decrease ROS in patients with RA, and d-ROM value may be useful as a marker of disease activity of RA.