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1 X 22 RA 2009ACR/EULAR MTX 3 TNF 3 IL-6 1 MTX RA Key words rheumatoid arthritisra 2009RA criteria 2009 biologicstnf anti-tnf drugsremission I rheumatoid arthritisra X II TEL FAX mitoi@meiji-u.ac.jp 1RA HE

2 2 The Bulletin of Meiji University of Integrative Medicine 2 X 23 RA PIP 3RA RA III RA ACR X RA ACREULAR 2009ACR/EULAR 2 4 1RA ACR ACR 22 RA 1 RA RA RA definite RA RF CCP ACPA RF IgG Fc IgG 8 CCP RA RF RA 2/3 3 ESR C CRP MMP-3 A SAA RA RA 2 70 remission

3 3 2ACR/EULARRA X RA X 4 MRI X 5 X CT

4 4 The Bulletin of Meiji University of Integrative Medicine IV T1 4 RA RA 3 5 T non-steroidal antiinflammatory drugnsaid RA COX II 5,6 disease modifying anti-rheumatic drugdmard RA 3 MTXDMARD golden standard 8mg/ 7,8 biologics

5 5 A B: -IgG Fc 6 TNF human anti-chimeric antibody: HACA 10-25mg MTX 13 TNF 4 RA 2009 TNF MTX 12,13 RA 65 5 RA MTX tumor necrotizing factor 3 TNF TNF TNF IL-6 RA 4 3mg/kg ACRAmerican Collage of Rheumatology 2 DAS28Disease activity score 2 6 DAS VAS100mm ESR CRP MTX MTX 5.1 high moderate3.2

6 6 The Bulletin of Meiji University of Integrative Medicine 5RA TNF 8 DASCRPSAAMMP-3 7RA 9X

7 7 10TKA V 12THA low RA 54 DASCRPSAAMMP X X 2 RA RA RA RA (2): , RA

8 8 The Bulletin of Meiji University of Integrative Medicine Frontiers in Rheumatology & Clinical Immunology, 2(3): , (4): , ACR/EULAR RA_ACR-EULAR.pdf 5. 60(12): , van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, et al.: Low-dose predonisone therapy for patients with early active rheumatoid arthritis: Clinical efficacy, disease-modifying properties, and side effects: Arandomized, double-blind, placebo-controlled clinical trial. Ann Intern Med, 136(1): 1-12, (12): , Bathon JM, Martin RW, Fleischmann RM, et al.: A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med, 343: , (7): , (7): , (7): , TNF Frontiers in Rheumatology & Clinical Immunology, 1(1): 22-26, Klareskog L, van der Heijde D, de Jager JP, et al.: TEMPO(Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes) study investigators. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomized controlled trial. Lancet, 363: , 2004.

9 9 Current Therapeutic Strategies for Rheumatoid Arthritis Megumi Itoi Department of Orthopedic Surgery, Meiji University of Integrative Medicine ABSTRACT Biologics targeting cytokines have revolutionized the treatment of rheumatoid arthritis (RA), producing significant improvement in both clinical and radiographic response leading to remission of RA. These developments have been called a paradigm shift in the therapeutic strategies for RA. For earlier diagnosis and treatment with disease modifying anti-rheumatic drugs (DMARDs), ACR/ EULAR announced new diagnostic criteria for RA in October This is the first complete revision of the criteria in 22 years. These new criteria are very simple and consist of four items, number of swollen or painful joints, serum factor of RA (RF and anti-ccp antibody), duration of synovial inflammation and markers of inflammation (ESR and CRP) in order to calculate numerical scores. Recently methotrexate (MTX) has been considered an anchor drug and recommended as the first choice. When MTX is not effective after 3 months, biologics should be selected. In Japan, three kinds of anti-tnf drugs (infliximab, etanercept, adalimumab) and one kind of anti-il-6 drug (tocilizumab) have been approved and sold. The anti-cytokine therapeutics with MTX will lead RA to remission, inhibiting the progression of joint damage and improving physical function and mortality. However, physicians should be careful regarding the incidence of severe adverse events like pneumonia and other infections. Despite progress in the ability to treat RA, the cause of RA remains unknown. I strongly hope that pathogenesis of RA will be clarified and more effective and safer therapeutics will be developed in the future.

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio

8 The Bulletin of Meiji University of Integrative Medicine API II 61 ASO X 11 7 X-4 6 X m 5 X-2 4 X 3 9 X 11 7 API 0.84 ASO X 1 1 MR-angio 7-14 2010 1 1 1 2 1 1 1 2 Fontaine II ASO61 3 API ASO ASO ASO API API KKKKKKKKKK ASO Fontaine II API Received April 14, 2009; Accepted July 16, 2009 I arteriosclerosis obliterans: ASO ASO 50 70 1,2 Fontaine

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