From.Dr.junko

2018年12月2日
JCR2018Syllabus@Senri life sience center

I went to the lectures in Osaka about Rheumatology.
I gave a present Chocolate for lady doctor 。
During the lecture,I felt the presentations need to be

clear and understandable voices,and
simple and understandable slides.

I also learned

We don't have any date of prevention in Bone necrosis in Steroids.
Tacrolimus and Cyclosporin A were used renal failure patients.
we introduced eye clinic where they have SD-OCT.

2018年12月01日
Japanese college of Rheumatology in Takamatsu.

・・。

2018年11月18日
Seminar of Rheumatology in Okinawa

I never saw comfortable place like this other than Okinawa.
It’s close to Fukuoka. It’s just like Hawaii.

Today’s seminar, “FUO alacarte “ from Prof. Hagino.

We had 5 FUO.
One is CMV infection, 1 is depression, and 2persons are unknown and cured soon. One is like no sweat syndrome due to sjogren’s syndrome. Let’s make presentation!.
Picture is SYURI-castle in Okinawa.

2018年11月10日
Pain meeting for Fibramyalgia patients

Today we have meeting for fibromyalgia patients.

2018年10月23日
UBERーpool

I used UBER-pool for going to airport, downtown, museum, and hotel. It’s very cheap and convenient. We can talk with strangers.

Nowadays people tend to use UBER not taxi.

Put in destination,and car is appearing in a couple of seconds, and stops and says”Are you Junko?”
Ride a car and we have carpool. Talking and go to destination.
Get off the car and we have charge in credit card.It’s half of cab ride. Drivers are good because they will be evaluate and tip.

Aha! Sharing Era.

2018年10月23日
American College of Rheumatology -Antinuclear antibodies Mark H. Wener

…。

2018年10月23日
Novel SLE treatment-pipeline of portential new therapies

。。。。

2018年10月23日
Novel SLE treatment-Belimumab

Belimumab
・new phase 3
・Subcutaneous-BLISS -SC
・Long term Safety IV Belimumab
・Lupus Nephritis
・pediatric- Phase 2 PLUTO

2018年10月23日
Novel SLE treatment-immunosuppressive therapy

summary of evidence
Cyclophosphamide(IVCY)
・Effective in inducing renal remission and preventing renal failure.
・Improves survival
・Low dose(Euro-dosing)is as effective and appears to have less toxicity.
MMF
・evidence of effectiveness
・Effective as maintenance after both IVCY and MMF induction
・Appears to have less toxicity than IVCY
Tacrolimus(TAC)
・as effective as IVCY in menbranous GN
・Significantly higher rate of renal relapse after completion of 1 yr treatment






















2018年10月23日
Novel SLE treatmentーHydroxy chloroquine

Beyond disease activity~Multiethnic longitudinal cohort (n=635)~
reduced damage accrual
decrease in renal damage
decrease in skin-damage
decrease in vascular events.
Anti-malarial toxicity
Rertina-weight based dosing:Toxicity near 1% after 5-7years:Cumulative dose of 1000g :Baseline then annual after 5 yrs.
Skin-Hyperpigmentation
Muscle-Curvilinear bodies:muscle fiber atrophy:Vacuolar changes
Toxic-Myocardial Disease:47cases median doses 1050g for CQ and 1542g for HCQ Chronic heart failure.
Excreted by kidney
High risk patients-concomitant tamoxifen(increase risk 5-fold)
GFR<50cc/min, dose>5mg/kg
Risk is <2% up to 10 yrs but rises to 20 % after 20 years.
safe rule is 5x5 Screen after 5 yrs use and <5mg/kg real weight
[picture: a sunday on La Grande Jatte]