Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists,neurologists and dermatologists

Although rheumatologists, neurologists and dermatologists see patients with polymyositis (PM) and dermatomyositis (DM), their management appears to vary depending on the physician's specialty. The aim of the present study was to establish the treatment consensus among specialists of the three fields to standardize the patient care. We formed a research team supported by a grant from the Ministry of Health, Labor and Welfare, Japan. Clinical questions (CQ) on the management of PM and DM were raised. A published work search on CQ was performed primarily using PubMed. Using the nominal group technique, qualified studies and results in the published work were evaluated and discussed to reach consensus recommendations. They were sent out to the Japan College of Rheumatology, Japanese Society of Neurology and Japanese Dermatological Association for their approval. We reached a consensus in 23 CQ and made recommendations and a decision tree for management was proposed. They were officially approved by the three scientific societies. In conclusion, a multidisciplinary treatment consensus for the management of PM and DM was established for the first time.     

Diagnostic importance of CD179a/b as markers of precursor B-cell lymphoblastic lymphoma.

Surrogate light chains consisting of VpreB (CD179a) and lambda5 (CD179b) are expressed in precursor B cells lacking a complete form of immunoglobulin and are thought to act as substitutes for conventional light chains. Upon differentiation to immature and mature B cells, CD179a/b disappear and are replaced with conventional light chains. Thus, these molecules may be useful as essential markers of precursor B cells. To examine the expression of the surrogate light-chain components CD179a and CD179b in precursor B-cell lymphoblastic lymphoma, we analyzed tissue sections using immunohistochemistry techniques. Among a number of monoclonal antibodies for the surrogate light chains, VpreB8 and SL11 were found to detect CD179a and CD179b, respectively, in acetone-fixed fresh frozen sections. Moreover, we also observed VpreB8 staining in formalin-fixed, paraffin-embedded sections. Using these antibodies, we found that CD179a/b were specifically expressed in precursor B-cell lymphoblastic lymphomas, but not in mature B-cell lymphomas in childhood. Furthermore, other pediatric tumors that must be included in a differential diagnosis of precursor B-cell lymphoblastic lymphoma, including precursor T-cell lymphoblastic lymphoma, extramedullary myeloid tumors, and Ewing sarcoma, were also negative for both CD179a and CD179b. Our data indicate that CD179a and CD179b may be important markers for the immunophenotypic diagnosis of precursor B-cell lymphoblastic lymphomas.     

Nucleolin as the earliest target molecule of autoantibodies produced in MRL/lpr lupus-prone mice

To elucidate the autoantigen against which autoantibodies are produced in the earliest phase of the disease process of systemic lupus erythematosus (SLE), serum samples were collected individually and serially from 10 NZB/NZW F1 and 10 MRL/lpr mice. Using immunoblots with mouse thymoma cell (EL-4) lysates as substrates, all mice were found to generate autoantibody against an either 150-kDa, 110-kDa, 75-kDa, or 55-kDa molecule in as early as 4 weeks. Anti-DNA antibodies occurred almost at the same time or after those against these four molecules. The number of antigens reactive with autoantibodies in immunoblots increased gradually with age. Antibodies against histone molecules were produced after 8 weeks of age. Among the four antigens, the 110-kDa molecule was identified as nucleolin, which is an abundant nucleolar phosphoprotein. Nucleolin binds DNA, RNA, and nucleic acid-binding proteins such as histone H1. Nucleolin is a target of granzyme A of cytotoxic T cells, and autoantibodies against it are found in sera from patients with SLE as well as from those with various viral infections. These results indicate that nucleolin is one of the immunodominant molecules that break down self-tolerance and initiate autoantibody-spreading in a mouse model of SLE.     

Takayasu's aortitis with dissection in systemic lupus erythematosus.

A forty-seven-year-old Japanese woman under treatment for systemic lupus erythematosus (SLE), complained of severe back pain. Chest X-ray and MRI showed an aneurysmal dilatation of the ascending aorta. Subsequently an aortic replacement was performed. Microscopically, the resected aorta showed Takayasu's aortitis with chronic dissection. Both aortitis and dissection are rare events in SLE patients. To our knowledge, this is the first report of Takayasu's aortitis with dissection in a patient with SLE.     

Third Report of the Japan Diabetes Society/Japanese Cancer Association Joint Committee on Diabetes and Cancer: Summary of the results of a questionnaire survey of oncologists and diabetologists—Secondary publication

The Japan Diabetes Society and the Japan Cancer Association launched a joint committee and published their “First Joint Committee Report on Diabetes and Cancer” in 2013, compiling recommendations for physicians and health-care providers as well as for the general population. In 2016, the “Second Joint Committee Report on Diabetes and Cancer” summarized the current evidence on glycemic control and cancer risk in patients with diabetes. The current “Third Joint Committee Report on Diabetes and Cancer”, for which the joint committee also enlisted the assistance of the Japanese Society of Clinical Oncology and the Japanese Society of Medical Oncology, reports on the results from the questionnaire survey, “Diabetes Management in Patients Receiving Cancer Therapy,” which targeted oncologists responsible for cancer management and diabetologists in charge of glycemic control in cancer patients. The results of the current survey indicated that there is a general consensus among oncologists and diabetologists with regard to the need for guidelines on glycemic control goals, the relevance of glycemic control, and glycemic control during cancer therapy in cancer patients.