Objective: To demonstrate the effects of disease‐modifying antirheumatic drugs and antiinflammatory cytokines on human osteoclastogenesis through their effects on receptor activator of nuclear factor κB (RANK), osteoprotegerin (OPG), and RANK ligand (RANKL).Methods: Peripheral blood mononuclear cells (PBMCs) and rheumatoid arthritis (RA) fibroblast‐like synoviocytes (FLS) were cocultured in the presence of macrophage colony‐stimulating factor, 1,25‐dihydroxyvitamin D₃, and various concentrations of methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), anti–tumor necrosis factor α monoclonal antibody (infliximab), interleukin‐4 (IL‐4), and IL‐10. Osteoclast formation was assayed by counting cells after staining for tartrate‐resistant acid phosphatase. RANKL expression in RA FLS and RANK expression in PBMCs were assayed by Western blotting, reverse transcription–polymerase chain reaction (RT‐PCR), and real‐time PCR. OPG expression was measured by enzyme‐linked immunosorbent assay, RT‐PCR, and real‐time PCR in cultures of RA FLS.Results: MTX, SSZ, infliximab, and IL‐4, but not IL‐10 and HCQ, each inhibited osteoclast formation in a dose‐dependent manner. We observed no evidence of synergistic inhibition of osteoclast formation by IL‐4 and IL‐10. High doses of infliximab suppressed the expression of RANK in PBMCs. MTX, SSZ, infliximab, and IL‐4 each inhibited the expression of RANKL in RA FLS in a dose‐dependent manner, and also increased the secretion of OPG in RA FLS supernatants.Conclusion: MTX, SSZ, infliximab, and IL‐4 inhibit human osteoclastogenesis by modulating the interaction of RANKL, RANK, and OPG. These results are indicative of the underlying mechanisms of the antiresorptive effects of these 4 agents.

Objective. To define the standardized incidence ratio (SIR) of malignancy and factors associated with malignancies in Korean patients with dermatomyositis (DM) and polymyositis (PM). Methods. The demographic, clinical, and laboratory features of 151 patients diagnosed with DM/PM were compared in patients with and without malignancies. Results. Malignancies were found in 23 of 98 patients with DM (23.5%) and in 2 of 53 with PM (3.8%). Lung cancer (8 patients) was the most common malignancy. Compared with the period-specific, sex-matched, and age-matched Korean population, the SIR for malignancy in patients with DM was 14.2 (95% CI 9.0–21.3). Univariate analysis showed that factors associated with malignancy included older age (p < 0.001), DM (p = 0.002), dysphagia (p < 0.001), the absence of interstitial lung disease (ILD; p = 0.001), and lower elevations in aspartate aminotransferase (p = 0.005) and lactate dehydrogenase concentrations (p < 0.001). Multivariate analysis showed that factors independently associated with malignancy included older age (per 10 years, OR 2.3, 95% CI 1.6–3.5, p < 0.001), DM (OR 5.9, 95% CI 1.3–26.2, p = 0.020), dysphagia (OR 2.6, 95% CI 1.2–6.6, p = 0.042), and the absence of ILD (OR 0.1, 95% CI 0.01–0.9, p = 0.040). Conclusion. DM was associated with a greater risk of concomitant malignancies, especially lung cancer, than PM. Independent factors associated with malignancies in patients with DM/PM were older age, the presence of dysphagia, and the absence of ILD.

At first admission, we retrospectively reviewed patients’ demographic data, laboratory data, including autoantibody profiles (anti-dsDNA, anti-Sm antibody, anti-ribonucleoprotein antibody, anti-Ro antibody, anti-La antibody and antiphospholipid antibody), abdominal computed tomography scans and SLE disease activity index (SLEDAI; table 1 ⇓ ). Lupus enteritis was diagnosed clinically and from abdominal computed tomography findings: bowel thickening ⩾3 mm, target sign, dilatation of intestine, engorgement of mesenteric vessels and increased attenuation of mesenteric fat (fig 1 ⇓ ).^{2, 3} Patients were treated with intravenous methylprednisolone (1 mg/kg/day) and switched to oral prednisolone (median 5 days), which was tapered slowly over a period of 10 months. Bowel wall thickness was measured by an experienced radiologist who had no information about the clinical outcome.

Objectives: To compare the clinical characteristics of lupus enteritis (LE) and non-enteric lupus (non-LE) patients and identify predictors of LE recurrence. Methods: We retrospectively reviewed the medical records of 62 systemic lupus erythematosus (SLE) patients in a tertiary hospital who experienced enteric symptoms and underwent abdominal computed tomography scanning between January 1997 and December 2013. We compared the clinical characteristics between LE and non-LE patients and between recurrent LE and non-recurrent LE cases. Results: Out of 62 SLE patients with enteric symptoms, 46 cases (74%) were compatible with LE based on computed tomography findings. The C4 level was decreased in the LE group compared with the non-LE group (9.0 ± 5.6 vs. 12.3 ± 6.2, p = 0.032). Recurrence of LE was observed in 14 patients (28%). Initial involvement at the colon (79% vs. 41%, p = 0.026) and bladder with/without the ureter was more common in the recurrent group (57% vs. 25%, p = 0.048). By multivariate analysis, the hazard ratios of variables associated with recurrence were 4.689 for colon involvement (95% confidence interval: 1.245–17.659, p = 0.0220] and 5.468 for cystitis with/without ureteritis (95% confidence interval: 1.629–18.360, p = 0.006). Conclusion: Colon and urinary tract involvement in LE patients may be associated with the recurrence of LE.