深谷 修作

The significance of evaluations of stressors in rheumatoid arthritis (RA) patients was investigated from the perspective of holistic medicine. The subjects were RA patients treated in the rheumatology outpatient clinic. They included 30 patients from 1987, 30 from 2002, and 137 from 2009. To investigate the specific causes of stress, the patients were asked the question, "What do you feel is your strongest stressor?" The same patients also underwent psychological testing and was examined the disease activity. Pain was the strongest stressor in RA patients in 1987, 2002, and 2009. However, the percentage of patients citing pain as their major stressor was decreasing with each year. CRP was significantly lower in 2009 than in 2002. CRP was also significantly lower in patients who used biologics than in patients who did not. In 2009, DAS28-CRP was significantly higher in patients whose largest stressor was pain than in patients whose largest stressor was another factor. In 2009, the values for both state anxiety and trait anxiety were significantly higher in patients who said that they had stressors than in those who said they did not. The strongest stressor in RA patients was pain. However, the percentage decreased over the years with lower disease activity from advances in therapeutic agents such as biologics. Meanwhile, stressors other than pain were the same or somewhat increased, and they were related to anxiety or depression. Understanding stressors in RA is thus important in treating RA patients.

混合性結合組織病（MCTD）は全身性エリテマトーデス，強皮症，多発性筋炎のうち2つ以上の疾患の特徴を併せ持ち，抗U1-RNP抗体陽性の疾患であり，治療反応性や予後が良好なことがその特徴とされた．一時，欧米でその疾患独立性に疑問をもたれたが，指・手背の腫脹や無菌性髄膜炎など特異的な症状をもち高率に肺高血圧症が合併することなどから近年では独立疾患とされることが多くなってきている．肺高血圧症は無症候性のものを含めると16％に合併する．大部分は肺動脈性であるが，血栓塞栓によるものも見られる．後者では外科的適応のあるものもあり，その鑑別は重要である．肺動脈性肺高血圧症については，特発性肺動脈性肺高血圧症に対する薬剤が用いられるが，ステロイドなどの免疫抑制療法薬の有効例もあり，治療可能な合併症となっている．<br>

Serum (1 -&gt; 3)-beta-d-glucan levels and clinical findings were evaluated in 229 inpatients with connective tissue diseases (CTDs) during the period between June and October 2004. The mean serum (1 -&gt; 3)-beta-d-glucan level was 129.7 +/- A 207.6 pg/mL in patients with a definitive diagnosis of fungal infections and 10.5 +/- A 8.6 pg/mL in patients without fungal infections. Analysis of the diagnostic sensitivity/specificity for various (1 -&gt; 3)-beta-d-glucan cutoff levels gave the best results for a cutoff level of 15 pg/mL, with a sensitivity of 92.3% and specificity of 81.3%. This level was therefore determined to be the optimal cutoff in patients with CTDs.