Modern Rheumatology

Imaging assessment of malignancy screening using computed tomography and diffusion-weighted whole-body imaging with background body signal suppression in rheumatoid arthritis

ABSTRACT Objectives To investigate differences in information obtained from plain computed tomography (CT) and diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) during malignancy screening in patients with rheumatoid arthritis. Methods We enrolled 524 patients with RA who underwent plain CT from the chest to the pelvis and DWIBS. CT and DWIBS were performed within 3 months of each other. Rheumatologists, radiologists, and pulmonologists interpreted the plain CT and DWIBS images. Results The prevalence of malignancy was 3.1%. Prostate, lung, breast, uterine, ovarian, and fallopian tube cancers were detected in 7, 4, 2, 1, 1, and 1 patient, respectively. The sensitivities of CT and DWIBS were 75.0% and 93.8%, respectively (P = .333). The specificities of CT and DWIBS were 76.0% and 85.8%, respectively (P < .001). The prevalence rates of interstitial lung disease, colonic diverticula, and kidney stones on CT were 17.6%, 27.1%, and 19.1%, respectively. The prevalence of lymphadenopathy in patients who underwent DWIBS was 3.6%. Conclusion This study suggests that DWIBS is superior to or equivalent to CT for malignancy screening. Our findings have important implications for imaging-based screening and can help address cancer-related issues in rheumatoid arthritis treatment.

Questionnaire survey on the prevention and development of cervical cancer in patients with systemic lupus erythematosus in Japan

ABSTRACT Objectives The aim is to evaluate the prevention and development of cervical cancer in systemic lupus erythematosus (SLE) patients in Japan and its background based on a questionnaire survey. Methods The questionnaire was handed to 460 adult female SLE patients at 12 medical institutions. The participants were grouped by age, and data related to their human papillomavirus vaccination status, age at first coitus, cervical cancer screening, and diagnosis of cervical cancer were analysed. Results A total of 320 responses were received. Patients aged 35–54 years included a higher proportion of patients whose age at first coitus was <20 years. This group also showed a higher rate of cervical cancer/dysplasia. Only nine patients had a human papillomavirus vaccination history. Adequate frequency of cervical cancer screening was slightly higher (52.1%) among SLE patients than in the Japanese general population. However, 23% of the patients had never undergone examination, primarily because of a feeling of troublesome. The incidence of cervical cancer was significantly higher among SLE patients. One reason for this may be associated with the use of immunosuppressants, although the difference was not significant. Conclusions SLE patients are at a higher risk of cervical cancer and dysplasia. Rheumatologists should proactively recommend vaccination and screening examinations for SLE female patients.