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Rheumatoid arthritis (RA) patients often have altered body composition including reduced muscle mass and increased fat mass. Some RA patients are likely to increase visceral fat without obesity [Body Mass Index (BMI) ≥ 25]. The objective of the study was to determine the association between obesity and/or visceral adiposity and the risk for atherosclerosis in Japanese RA patients. Obesity was evaluated using the BMI, with visceral adiposity evaluated using the visceral fat area (VFA) and the visceral/subcutaneous fat ratio (V/S ratio), quantified using the dual bioelectrical impedance method. Atherosclerosis was evaluated based on the intima–media thickness (IMT) and Plaque score (PS) of the carotid artery, measured using ultrasonography. Multivariate analysis was performed to determine the factors associated with IMT and PS. IMT and PS were compared among groups of patients sub-classified according to BMI and VFA levels. The V/S ratio was higher in RA patients than healthy controls, after adjustment for age, BMI, and waist circumference. On multivariate analysis, the V/S ratio, but not the BMI, was independently associated with the IMT and PS. Among the sub-classifications for BMI and VFA, non-obese patients with a high visceral adiposity (18.5 ≤ BMI

Objective: Ultrasonography (US) is a useful tool for evaluating the activity of rheumatoid arthritis (RA) patients. As the systemic evaluation of many joints is time-consuming, a method to evaluate this activity with a smaller number of joints is needed. The aim of this study was to clarify whether the number of joints assessed may be reduced using patient-oriented joint selection. Methods: A total of 492 RA patients were recruited at Kyoto University Hospital. Bilateral metacarpophalangeal (MCP), (proximal) interphalangeal (PIP/IP), and wrist joints were evaluated by US. Gray scale and power Doppler imaging findings were scored by a 0–3 semi-quantitative method. Clinical assessments were performed by physicians who were blind to US results, and a questionnaire on subjective symptoms was collected from each patient. Results: The correlation between the US score of all 22 joints (US22) and patient-oriented painful joints (PtUS) or physician-oriented tender and/or swollen joints were moderate (Spearman’s ρ = 0.435) and weak (ρ = 0.383), respectively. These correlations were weaker than that between the total US score of 5 preselected joints (unilateral 2MCP, 3MCP, 2PIP, 3PIP, and the wrist) and US22 (ρ = 0.813). However, when focusing on patients whose painful joints were 5 and more, the correlation between PtUS and US22 was markedly stronger (ρ = 0.757). Conclusion: Patient-oriented joint selection reflected actual joint inflammation to some extent. However, excessive reductions in the number of joints assessed need to be avoided even if patients do not have arthralgia because of the potential for underestimations.

Aim Previous studies have reported that patients with rheumatoid arthritis (RA) have a higher risk of developing cardiovascular disease (CVD) than the general population. A major cause of CVD is atherosclerosis, which can be evaluated with carotid ultrasonography (US). As far as we know, there have been no large-scale carotid artery US studies in Japanese patients with RA. The aim of this study was to identify the risk factors for atherosclerosis in Japanese patients with RA. Methods The study subjects underwent physical examinations, laboratory tests and US examination, and answered a questionnaire about their lifestyle. Carotid US was performed to measure the maximum carotid intima media thickness (max cIMT) and to detect plaques. Results Atherosclerosis was detected in 238 patients (52%). Age, hypertension, and total/high-density lipoprotein cholesterol ratio were positively related to max cIMT. Presence of plaques was related to age, Disease Activity Score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR), smoking, and any biological treatment. DAS28-ESR correlated positively not with cIMT but with the development of plaques in our patients with low disease activity (average DAS28-ESR of 2.7). Conclusion Disease Activity Score of 28 joints-erythrocyte sedimentation rate was related to the size and number of plaques, whereas only traditional risk factors were related to max cIMT. This indicated that the inflammatory conditions of RA could affect the formation of atherosclerotic plaques. For the management of CVD in patients with RA, it may be important to control not only traditional risk factors, but also RA disease activity.

Background Because elbows are important joints for the function of upper limbs, the daily activity of the patients with rheumatoid arthritis (RA) may be impaired by synovitis of elbows. Although elbows are included into the 28 essential joints for evaluation of the disease activity of RA, ultrasonography (US) examination of elbows is not routinely performed and there have been a few surveys on the correlation between US scores of elbows and disease activity. Objectives To reveal whether there is a correlation between US scores of elbows and disease activity in the patients with RA. Methods We recruited 198 patients with RA form KURAMA cohort, which is the database of the patients with RA treated in the Kyoto University Hospital, and performed US examination of proximal interphalangeal (PIP) joints, metacarpophalangeal (MP) joints, wrist joints and elbow joints. Synovial hypertrophy is scored semiquantitatively on a scale of 0–3. We analysed correlations between the total scores of each component (PIP, MP, wrist and elbow) and clinical parameters. Results We found weak correlations between DAS28-ESR and the US scores of PIPs, MPs and wrists (rho=0.25, 0.21 and 0.29, respectively) whereas there was little correlation between DAS28-ESR and the US score of elbows (rho=0.16). However, multivariable analysis showed that the US scores of PIPs, wrists and elbows were independently associated with DAS28-ESR (p=0.021, 0.0027 and 0.025, respectively). US scores of elbows showed little or weak correlations with US scores of PIPs, MPs and wrists (rho=0.23, 0.16 and 0.11, respectively). Conclusions US examination of elbows may be useful to assess the disease activity of patients when combined with US examination of PIPs and wrists although US scores of elbows alone has a weak correlation with DAS28-ESR. US examination of elbows may detect the disease activity which is overlooked by the US examination of joints of hand. Disclosure of Interest None declared

Nerve sheath myxoma is a rare benign tumor of nerve sheath origin that typi­ cally presents as a small solitary skin nodule and rarely affects the oral cavity. A case of nerve sheath myxoma of the tongue in a 51­year­old male is reported. The patient had a painless submucosal nodule in the lateral margin of the tongue for several months. The tumor was surgically removed under local anesthesia. Histopathologically, the removed tumor consisted of several loosely textured myxofibrous nodules in which spindle­ or stellate­shaped cells with eosinophilic cytoplasm and hyperchromatic nuclei were scattered. Immunohistochemically, the myxoid stroma was strongly positive for perlecan, a basement membrane type heparan sulfate proteoglycan, and the tumor cells were individually circumscribed by type IV collagen­positive fibers. In addition, the tumor cells were strongly positive for vimentin, S­100 protein, neuron­ specific enolase, and cathepsin D. However, they were not positive for epithelial membrane antigen, neurofilament protein, CD34, CD10, calponin, actin, or any subtypes of keratin. A review of the literature revealed that 11 cases of oral nerve sheath myxoma had been documented. The mean age of the patients was 29 years old, and there was no predilection between males and females. They arose most frequently in the tongue. (Oral Med Pathol 2009; 13: 105-110 doi: 10.3353/omp.13.105)