Objectives We investigated relationships between subclinical COVID-19 (coronavirus disease 2019) and background factors. Methods We determined SARS-CoV-2 antibody (IgG) prevalence in 1603 patients, doctors, and nurses in 65 medical institutions in Kanagawa Prefecture, Japan and investigated their background factors. Antibodies (IgG) against SARS-CoV-2 were analyzed by Immunochromatographic test. Results The 39 subjects (2.4%) were found to be IgG antibody-positive: 29 in the patient group (2.9%), 10 in the doctor/nurse group (2.0%), and 0 in the control group. After adjustment for age, sex, and the antibody prevalence in the control group, antibody prevalence was 2.7% in the patient group and 2.1% in the doctor/nurse group. There was no significant difference between the antibody-positive subjects and the antibody-negative subjects in any background factors investigated including overseas travel, contact with overseas travelers, presence/absence of infected individuals in the living area, use of trains 5 times a week or more, BCG vaccination, and use of ACE inhibitor and ARB. Conclusions Antibody prevalence in the present survey at medical institution is higher than that in Tokyo and in Osaka measured by the government suggesting that subclinical infections are occurring more frequently than expected. No background factor that influenced antibody-positive status due to subclinical infection was identified.
Objectives The clinical characteristics of cases of rheumatoid arthritis in which biologics-free remission was maintained for 1 year or more with tocilizumab (TCZ) treatment were examined. Methods Thirteen of 35 patients introduced to TCZ at this clinic have maintained DAS remission (DAS28-ESR<2.6) for 1 year or more. Five of these 13 patients attained biologics-free remission, and three have maintained biologics-free remission for 1 year or more. We examined the clinical characteristics of these three cases. Results Case 1 is a 40-year-old woman classified as stage III and class 1, with anti-CCP antibody of 100 U/mL or higher. Treatment before TCZ was NSAIDs and SASP 500 mg/day. Disease duration prior to TCZ introduction was 2 years, DAS28-ESR was 3.5, and HAQ was 0.375. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 20 administrations when remission was maintained for 14 months. DAS was 0.5 and HAQ was 0.125 at the time of discontinuation. Case 2 is a 42-year-old woman classified as stage II and class 1, with anti-CCP antibody of 70.3 U/mL. Treatment before TCZ was NSAIDs, MTX 8 mg/week and IFX. Due to secondary IFX failure, it was changed to TCZ after 5 administrations. Disease duration prior to TCZ introduction was 15 months, DAS28-ESR was 6.2, and HAQ was 0.5. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 20 administrations when remission was maintained for 14 months. DAS was 0.97 and HAQ was 0.125 at the time of discontinuation. Case 3 is a 63-year-old woman classified stage II and class 1. Treatment before TCZ was NSAIDs, MTX 10 mg/week and IFX. Due to secondary IFX failure, it was changed to TCZ after 5 years and 4 months. Disease duration prior to TCZ introduction was 7 years, DAS28-ESR was 4.6, and HAQ was 0.75. DAS remission was attained after 4 TCZ administrations, and administration was discontinued after 21 administrations when remission was maintained for 16 months. DAS was 1.85 and HAQ was 0.25 at the time of discontinuation. Conclusions The 3 patients who maintained remission for 1 year or more were women. Age was 45.7 years, disease duration was 3.3 years, and classified stage was 2 patients stage II and 1 patient stage IV. Class was class I in all. Tender joint was 2.3, swollen joint was 3.3, and patient GVAS was 62.3 mm. ESR was 47.3 mm/hr, CRP was 1.44 mg/dl, MMP-3 was 555.1 ng/mL, and DAS28-ESR was 4.8. Two of the patients used IFX before TCZ. All three attained DAS remission after 4 TCZ administrations. Administration was stopped after continuing TCZ for 14.7 months after maintaining remission. Discussion In comparison of patients who maintained long-term biologics-free remission with the other patients, there was no relation to stage, class or patient GVAS. The treatment before introducing the biological was also unrelated. There was no relation to ESR, CRP or DAS28-ESR, but MMP-3 was high. The time after introducing the biologic until remission was very short at 4 months or less. A T...
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