A 77-year-old Japanese womanwith massive painless ascites caused by chronic lupus peritonitis is reported. Peritoneal effusion had been resistant to the administration of steroids during the whole treatment period. It was characteristic that the titers of anti-DNA antibodies and the level of immunecomplex were elevated in the peritoneal fluid with suppressed levels of complements in ascites, although serum immunological markers reflecting the activity of SLE presented improvement after initiation of the treatment. Fifteen patients with chronic lupus peritonitis were reported previously. Wereviewed the literature and suggest that chronic lupus peritonitis at elderly onset may demonstrate a poor response to the glucocorticoid therapy because of persistent inflammation in the peritoneum and the presence of impaired vascular circulation in addition to immunological mechanisms.

Objectives Rheumatoid arthritis (RA) is an independent risk factor of osteoporosis. However, if disease activity is successfully controlled using the treat-to-target (T2T) strategy, the risk of bone mineral density (BMD) loss can be diminished. We evaluated if RA is a risk factor even when the T2T is applied in clinical cases. Methods From September 2017 to August 2019, 741 patients were examined using dual-energy X-ray absorptiometry; of these, 279 were diagnosed with RA who attained clinical remission within 6 months (RA-rem) and 53 could not attain clinical remission (RA-nonrem), while 409 were not diagnosed with RA (non-RA). The following characteristics between RA-rem and non-RA were matched using the propensity score matching (PSM) technique: age, sex, past bone fragility fracture experience, osteoporosis drug intervention ratio, glucocorticoid administration ratio, mean dose, Barthel Index score, body mass index, serum-creatinine-to-cystatin C ratio, and the number of comorbidities. The BMDs and changes of the lumbar spine, femoral neck, total hip, and greater trochanter were statistically compared between the RA-rem and the non-RA after PSM, and between RA-nonrem and RA-rem after PSM using the Mann-Whitney U test. Results In total, 107 patients of RA-rem and 108 of non-RA were recruited. BMDs and changes of every part demonstrated no significant differences between the 2 groups. BMDs in every part of RA-rem after PSM were significantly greater than those in every part of RA-nonrem, while no significant difference in change during follow-up. Conclusions If disease activity is controlled in clinical remission, RA will not contribute to BMD reduction.

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These results suggested that HAQ-DI is deeply influenced by PS-VAS. The effect of DAS28-CRP overlapped with the effect of PS-VAS in a major way. Pain control for RA patients is the most important factor contributing to activities of daily living, as well as disease activity control.

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BackgroundGlucocorticoid induced osteoporosis (GIO) is serious problem for raising risk of bone fragile fracture. In general, first choice drug for GIO is bisphosphonate (BPH), however, denosumab (dMAB), a monoclonal antibody of receptor activator of nuclear factor kappa-B ligand, is closed up as a alternative selection for GIO recently.ObjectivesThe aim of this study is to evaluate effectiveness of dMAB in bone mineral density (BMD) for GIO treatment compared to BPH.MethodsIn the patients in whom glucocorticoid steroid (GCs) have been administered for more than three months, who met indication criteria for GIO what was determined by the Japanese Society for Bone and Mineral Research in 2014, that is matrix calculated in adding points of past fracture history, age, dosage of GCs, and BMD value (1), were enrolled. Before March 2013, data was lacking, so patients who have been administrated GCs after April 2013 were picked up. Patients BMD at GCs administration, at 6 months after initial treatment, if drug was changed, also at 6 months after second treatment, for minimum lumbar spine (LS), femoral neck (FN), and greater trochanter (GT) were measured with dual-energy X-ray absorptiometry (DEXA). Patients were classified by drug for initial treatment and second drug if administered. Patients age, initial, average, and total dose of GCs, term length of administration, and BMD and its gain for each chance were compared with Mann-Whitney U-test and Student's paired T-test.Results149 patients in whom 48 with no drug administrated (N), 24 for BPH naïve and continued (BB), 22 for BPH naïve and changed to dMAB (BD), 21 for dMAB naïve and continued (DD), 34 for dMAB naïve and changed to BPH (DB) were counted. In these, sex distribution was 26 for men and 123 for women. Underlying disease for administration of GCs were rheumatoid arthritis for 114, polymyalgia rheumatica for 12, idiopathic thrombocytopenic purpura for 9, systemic lupus erythematosus for 6, and others for 8. For groups, age at baseline, initial, average, and total dose, and term length of administration of GCs demonstrated no significant difference between any pairs of the groups. BMD at baseline for Group N demonstrated significant greater per-cent of young adult mean (%YAM) than Group DD (p<0.01) in all parts, yet greater than the other groups but not statistically significant. In Group N, BMD had significantly decreased from the baseline to 6 months later in all parts (p<0.01). In the other groups, BMD had shown gain at 6 months after drug administration in all part, however, in Group DB showed mean %YAM loss for GT after first and second drug administration compared to Group BD had shown %YAM loss after first but gain after second drug for FN (Table 1).ConclusionsFrom these results, dMAB is effective role in raising BMD for GIO as a initial drug, and a second drug even after inadequate response to BPH. dMAB could be possible to be chosen as a first choice drug for GIO treatment.References Suzuki, Y., Nawata, H., Soen, S. et al. J Bone Miner Metab (2014) 32:...