2021 Fiscal Year Final Research Report

Elucidation of the mechanism of joint destruction in rheumatoid arthritis: approach using high-resolution CT

Research Project

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Project/Area Number	18K08390
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 54020:Connective tissue disease and allergy-related
Research Institution	Nagasaki University
Principal Investigator	Tamai Mami 長崎大学, 医歯薬学総合研究科(医学系), 准教授 (60380862)
Co-Investigator(Kenkyū-buntansha)	千葉恒長崎大学, 医歯薬学総合研究科(医学系), 助教 (00457574) 川尻真也長崎大学, 医歯薬学総合研究科(医学系), 講師 (20457576) 有馬和彦長崎大学, 医歯薬学総合研究科(医学系), 准教授 (30423635) 上谷雅孝長崎大学, 医歯薬学総合研究科(医学系), 教授 (40176582) 大山要長崎大学, 医歯薬学総合研究科(薬学系), 准教授 (50437860) 岩本直樹長崎大学, 医歯薬学総合研究科(医学系), 助教 (80437897) 川上純長崎大学, 医歯薬学総合研究科(医学系), 教授 (90325639)
Project Period (FY)	2018-04-01 – 2022-03-31
Keywords	関節リウマチ / 関節破壊 / 高解像度CT（HRpQCT）
Outline of Final Research Achievements	Joints were evaluated using high-resolution peripheral quantitative CT (HR-pQCT) in active rheumatoid arthritis with a high rate of autoantibody positivity, MRI bone marrow edema, and active synovitis on ultrasound. After 1 year, 80% remission was achieved and less radiographic progression was observed. On the other hand, HR-pQCT showed changes, with five new bone erosions, but half of the existing erosions were reduced in size, with a decrease in volume and an increase in bone density. Joint space increased in volume and width. These findings differed between drugs, with 50% of methotrexate-treated patients and 30% of biologic-treated patients showing a decrease in both volume and width.HR-pQCT was able to detect bone and joint changes earlier than radiographs, MRI, or US.
Free Research Field	リウマチ・膠原病内科学
Academic Significance and Societal Importance of the Research Achievements	高い解像度を有するHR-pQCTを用いて、関節リウマチ患者を対象に手指関節を治療経過と共に詳細に評価した。従来の高感度画像とされる超音波やMRIの研究では得られなかった知見を今回観察することができた。すなわち、関節裂隙、骨びらん、骨微細構造（骨粗鬆）の治療による経過が少ない症例ながら明らかになった。薬剤間で所見の違いが認められ、更なる研究の推進が望まれる。今後、日常診療に有用な知見を得られる可能性が高い。