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Takanoha S.,NCNP | Kuroda K.,Asahikawa Medical Center | Kon K.,NHO Aomori National Hospital | Mamiya S.,Akita | And 18 more authors.
Brain and Development | Year: 2012

Although muscular dystrophy patients often have feeding difficulty and need long-term enteral nutrition, only a few reports have described gastrostomy feeding in these patients. This study was designed to evaluate the efficacy and tolerance of gastrostomy feeding in patients with muscular dystrophy. We performed a retrospective, multicenter study on 144 patients with muscular dystrophy who received gastrostomy feeding between 2007 and 2009 in 25 neuromuscular centers in Japan. There were 77 Duchenne muscular dystrophy (median age at gastrostomy placement 26. years, range 13-47. years), 40 myotonic dystrophy (median age 54.5. years, range 13-70. years), 11 Fukuyama congenital muscular dystrophy (median age 22. years, range 13-29. years), 5 limb girdle muscular dystrophy (median age 62. years, range 43-78. years), and 5 facioscapulohumeral muscular dystrophy (median age 52. years, range 28-67. years) patients. Many benefits including amelioration of malnutrition, swallowing difficulty and respiratory status were observed after the introduction of gastrostomy feeding. Especially in patients with Duchenne muscular dystrophy, mean body weight significantly increased after gastrostomy placement. Although most complications, which are commonly observed in other populations, were tolerable, respiratory failure and peritonitis were important concerns. These findings suggest that gastrostomy placement at an appropriate time is advisable in patients with muscular dystrophy. © 2011 The Japanese Society of Child Neurology.

Kudo-Tanaka E.,Osaka Minami Medical Center | Shimizu T.,Osaka Minami Medical Center | Nii T.,Osaka Minami Medical Center | Teshigawara S.,Osaka Minami Medical Center | And 18 more authors.
Modern Rheumatology | Year: 2015

Objectives. To examine whether or not earlier therapeutic intervention with methotrexate (MTX) prevents the development of rheumatoid arthritis (RA) in patients with recent-onset undifferentiated arthritis (UA) showing high anti-citrullinated peptide antibody (ACPA) titers.Methods. The patients were divided into two groups, one was treated with MTX (MTX+ group, n = 29), and the other was treated without MTX (MTX- group, n = 19), and other disease-modifying anti-rheumatic drugs were not permitted in the two groups before the primary endpoint was met. The primary endpoint is the occurrence of definite RA, and it was compared in the two groups after 1 year.Results. The percentage of patients who developed definite RA in the MTX+ group (17.2%) was significantly lower than that in the MTX- group (78.9%) (log-rank test, P < 0.001, n = 48); adjusted hazards ratio: 0.028 [95% confidence interval (CI): 0.003-0.250, P = 0.001, n = 39]. Treatment effectiveness was not decreased by major risk factors of RA onset such as smoking habits and human leukocyte antigen-DRB1 shared epitope (SE) (smoking habit, odds ratio [OR]: 0.041 [95% CI: 0.007-0.246] P < 0.001; SE, OR: 0.022 [95% CI: 0.002-0.204] P < 0.001). The safety issues were comparable between the two groups.Conclusions. This suggests that early therapeutic intervention with MTX could safely prevent the development of RA in patients with recent-onset UA showing high ACPA titers. © 2015 Japan College of Rheumatology.

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