高梨　敏史 （タカナシ　サトシ）

Takanashi, Satoshi

写真a

所属（所属キャンパス）

医学部 臨床研究推進センター （信濃町）

職名

特任助教（有期）
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  • Effects of Aging on Rheumatoid Factor and Anticyclic Citrullinated Peptide Antibody Positivity in Patients With Rheumatoid Arthritis

    Takanashi S., Takeuchi T., Kaneko Y.

    The Journal of rheumatology （The Journal of rheumatology）  50 （ 3 ） 330 - 334 2023年03月

    ISSN  0315162X

    　概要を見る

    OBJECTIVE: We investigated the factors that affect rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) positivity in patients with rheumatoid arthritis (RA). METHODS: The study included all consecutive patients with RA treated at Keio University Hospital between 2016 and 2017. We recorded age at diagnosis, sex, smoking habit, BMI (kg/m2), and family history, and investigated the association between these variables and RF and anti-CCP positivity. RESULTS: We recruited 1685 patients with RA. The mean age at diagnosis was 51.9 years, and 83.4% of the patients were women. Positivity rates of RF and anti-CCP almost linearly decreased along with the increase in age at RA diagnosis (grouped by decade) after ≥ 30 years of age (RF: 80.5%, 84.2%, 81.1%, 78%, 74.6%, 62.6%, 51.4%, P < 0.001; anti-CCP: 79.9%, 87.4%, 81.7%, 74%, 70.5%, 60.2%, 37.1%; P < 0.001). Multivariable analysis revealed that age was independently associated with seronegativity in women (RF: odds ratio [OR] 0.98, 95% CI 0.97-0.99, P < 0.001; anti-CCP: OR 0.97, 95% CI 0.96-0.98; P < 0.001), nonsmoking history (RF: OR 0.98, 95% CI 0.97-0.99, P < 0.001; anti-CCP: OR 0.97, 95% CI 0.96-0.98; P < 0.001), and BMI < 25 (RF: OR 0.98, 95% CI 0.97-0.99; P < 0.001; anti-CCP: OR 0.97, 95% CI 0.97-0.98; P < 0.001). CONCLUSION: Aging is an independent contributor for seronegative RA in patients who are female, have a nonsmoking history, and a BMI < 25.

  • A case of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated rapidly progressive interstitial lung diseases developed after administration of COVID-19 vaccine and subsequent pneumococcal vaccine

    Takahashi S., Kato A., Hashimoto K., Takehara T., Ishioka K., Takanashi S.

    Respirology Case Reports （Respirology Case Reports）  10 （ 12 ）  2022年12月

    　概要を見る

    Five cases of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated rapidly progressive interstitial lung diseases (anti-MDA5-positive DM-RPILD) following COVID-19 vaccination have been reported previously. We present the first case of the disease that developed following the sequence of COVID-19 infection, COVID-19 vaccination, and 23-valent pneumococcal polysaccharide vaccine (PPSV23) administration. A 75-year-old-Japanese man received the third dose of Pfizer COVID-19 vaccine 4 weeks after he had a mild COVID-19 infection. Eleven weeks after vaccination, he received PPSV23 for the first time. He developed fever, malaise, and anorexia the day after the PPSV23, rash a week later, and shortness of breath 2 weeks later. He was then admitted to a local hospital and treated with antibiotics, but his condition worsened. He was transferred to our hospital 4 weeks after the PPSV23 and was diagnosed with anti-MDA5-positive DM-RPILD. Despite intensive treatment, the patient died on the 10th hospital day.

  • Late-onset rheumatoid arthritis registry study, LORIS study: study protocol and design

    Kojima M., Kawahito Y., Sugihara T., Kojima T., Harada R., Hirata S., Hashimoto M., Hidaka T., Ishikawa H., Ito H., Kishimoto M., Kaneko Y., Matsui K., Matsui T., Matsushita I., Morinobu A., Nishida K., Tanaka E., Abe A., Ishitoku M., Asai S., Kida T., Onishi A., Takanashi S., Harigai M.

    BMC Rheumatology （BMC Rheumatology）  6 （ 1 ）  2022年12月

    　概要を見る

    Background: Although drug treatment strategies for rheumatoid arthritis (RA) are relatively well established, there is a paucity of evidence on the treatment in older patients. The purpose of this study is to build a registry for late-onset RA (LORA), which is expected to increase rapidly worldwide. In addition, we aim to propose optimal treatment strategies according to the patient background including frailty, thereby contributing to improving the quality of treatment and daily living in patients with RA. Methods/design: The LORIS (Late-onset Rheumatoid Arthritis Registry) Study is a prospective nation-wide multicenter observational study of patients with LORA. The inclusion criteria were patients aged ≥ 65 years at onset, meeting 2010 ACR/EULAR classification criteria for RA, and starting either any disease-modifying antirheumatic drugs (DMARDs) in a DMARD-naïve patient or the first biologic/targeted synthetic DMARDs during the study period. Enrollment was started on 11 January, 2022 and will be closed on 31 December, 2023. Patients will undergo a comprehensive baseline assessment including clinical data, medication, cognitive and physical function, psychosocial factors, and frailty. Data will be collected at baseline, Month 3, 6, 12, 18, 24, 36, and summarized descriptively. The factors associated with adverse events and achieving remission will be determined. Discussion: A multi-disciplinary panel including patients, rheumatologists, and geriatric specialists will discuss the results and build a consensus regarding the treatment goals of LORA. We expect to provide a broad range of information for evidence-based shared decision making in the treatment of LORA. Study registration: Registered at the UMIN registry (UMIN000046086) on 1 January 2022.

  • Should we reconsider the definition of elderly-onset rheumatoid arthritis in an ageing society?

    Uchiyama S., Takanashi S., Takeno M., Gono T., Kaneko Y., Takeuchi T., Kuwana M.

    Modern Rheumatology （Modern Rheumatology）  32 （ 2 ） 323 - 329 2022年03月

    ISSN  14397595

    　概要を見る

    Objectives: The management of elderly-onset rheumatoid arthritis (EORA) is challenging due to progressive functional disability, increased comorbidities, and high drug-related risks. EORA is defined as disease onset after 60 years since 1985. We assessed whether this cut-off age was optimal in a progressively ageing society. Methods: This study used two cohorts of consecutive rheumatoid arthritis (RA) patients: the Nippon Medical School (NMS) cohort (n = 204) and the Keio cohort (n = 296). Clinical findings independently correlated with the age of RA onset were selected as 'EORA features' from previously reported EORA characteristics using univariable and multivariable regression analyses. Receiver operating characteristic curve analysis was conducted to determine the cut-off age that best selected patients with all EORA features. Results: Acute onset, negative anti-cyclic citrullinated peptide antibody, and high erythrocyte sedimentation rate were selected as 'EORA features' in both cohorts. Patients with all EORA features were more numerous with age and almost exclusively older than 65 years. The optimal EORA cut-off age was 73 years with an area under the curve (AUC) of 0.82 in the NMS cohort and 68 with an AUC of 0.93 in the Keio cohort. In the NMS cohort, Health Assessment Questionnaire-Disability Index and comorbidities in patients with disease onset between 60 years and the projected cut-off age were similar to those in younger-onset RA, but differed from those in patients with disease onset older than the projected cut-off age. Conclusion: The optimal EORA cut-off age was greater than the conventional definition, but this needs to be validated in different patient populations.

  • Characteristics of patients with difficult-to-treat rheumatoid arthritis in clinical practice

    Takanashi S., Kaneko Y., Takeuchi T.

    Rheumatology (Bulgaria) （Rheumatology (Bulgaria)）  60 （ 11 ） 5247 - 5256 2021年11月

    ISSN  13100505

    　概要を見る

    The aim of this study was to investigate the clinical characteristics of patients with difficult-to-treat RA (D2T RA) and the usefulness of switching to drugs with different modes of action in real-world. Methods. We reviewed all consecutive patients with RA treated at Keio University Hospital between 2016 and 2017 with a definition of D2T RA. We analysed clinical characteristics and evaluated the usefulness of changing drugs according to mode of action. Results. Among 1709 patients with RA, 173 (10.1%) were D2T RA. The reason for the D2T RA was multi-drug resistance in 59 patients (34.1%), comorbidity in 17 (9.8%), and socio-economic reasons in 97 (56.1%). The multidrug- resistance group had significantly higher tender joint count and evaluator global assessment than the other groups, despite receiving the most intensive treatment. The comorbidity group showed a significantly older age and higher rheumatic disease comorbidity index. Although changing the drug to another with a different mode of action was useful, the proportion of patients who achieved remission or low disease activity decreased as the number of switches increased. Conclusion. Of the patients with RA, 10.1% were still difficult to treat in clinical practice, despite intensive treatment. Their characteristics were distinct by the reasons of D2T RA, which suggests the need for a personalized approach to D2T RA.

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