Centers & Services

Rheumatology Department

What are Rheumatology?

We provide treatment mainly for rheumatic disease including rheumatoid arthritis and collagen disease such as systemic lupus erythematosus.

Our physicians

Director, Rheumatology Department

Jun Wada, Professor
[Diabetes, kidney disease and rheumatic disease]

Staff

Kenichi Shikata Professor (Center for Innovative Clinical Medicine) [Diabetes, kidney disease and metabolic syndrome]
Kenei Sada Associate professor [Rheumatic disease and kidney disease]
Kenichi Inagaki Associate professor (Endocrine Center) [Endocrine and thyroid disease]
Shinji Kitamura Lecturer [Kidney disease]
Ken Kinomura Lecturer (Hemodialysis and Apheresis Unit) [Kidney disease and dialysis]
Jun Eguchi Lecturer [Diabetes, dyslipidemia and obesity]
Atsuko Nakatsuka Assistant Professor [Diabetes, dyslipidemia and obesity]
Tomoko Kawabata Assistant Professor [Rheumatic disease]
Haruhito Uchida Associate Professor (Chronic kidney disease (CKD) Chronic vascular disease (CVD) area cooperation, Medical School Department of Chronic kidney Disease and Cardiovascular Disease) [Hypertension, arteriosclerosis, kidney disease, dyslipidemia and obesity]
Atsuhito Tone Assistant Professor (Diabetes Center) [Diabetes]
Satoshi Miyamoto Assistant Professor (Center for Innovative Clinical Medicine) [Diabetes]
Hiroshi Morinaga Assistant Professor (Medical Information Unit) [Kidney disease, CAPD and dialysis]
Katsuyuki Tanabe Assistant Professor (Hemodialysis and Apheresis Unit) [Kidney disease and dialysis]
Naoko Yamauchi Assistant Professor (Endocrine Center) [Endocrine and thyroid disease]
Masashi Kitagawa Assistant Professor [Kidney disease and dialysis]
Haruki Watanabe Assistant Professor [Rheumatic disease]
Kishio Toma Assistant Professor [Endocrine and thyroid disease]
Toshio Yamanari Assistant Professor [Kidney disease, CAPD and dialysis]
Yoshinori Matsumoto Assistant Professor [Rheumatic disease]

Department of Human Resource Development of Dialysis Therapy for Kidney Disease (HDAK)

Hitoshi Sugiyama Professor [Kidney disease and CAPD]
Akifumi Onishi Assistant Professor [Kidney disease, CAPD and dialysis]

Medical School Department of Primary Care and Medical Education

Sanae Teshigawara Assistant Professor [Diabetes]

*Specialty shown in [ ]

Clinical sections available by day of the week

  Monday Tuseday Wednesday Thursday Friday
Clinical sections available by day of the week AM
PM
Internal Medicine, Kidney Disease, Diabetes, Rheumatic Disease, Hypertension, Arteriosclerosis, Endocrine and Thyroid Disease
    Renal failure / CAPD Detailed CKD examination Renal failure / CAPD Detailed CKD examination

Treatment system

Outpatient special care of the Department of Rheumatology is available in the morning and afternoon from Monday through Friday. Care is provided by our specialists for the diagnosis for first-visit patients, determination of the treatment policy, and regular follow-up of patients in stable disease conditions. Inpatient care is provided by specialists and doctors mainly for patients in conditions that are difficult to interpret and for those in severe conditions and who require hospitalization.

Treatment policy

The treatment policy for inpatients is discussed and determined in the new patient conference and the professor's round, which are held every week with the participation of doctors and full-time doctors including assistant professors and those with greater authority. Moreover, in the rheumatic disease group, each case is discussed in detail in a conference for the determination of definitive diagnosis and treatment policy.

Specialties

Early detection of rheumatoid arthritis and collagen disease by serology and imaging such as MRI and CT.
Selection of therapy for severe, treatment-resistant or complicated rheumatoid arthritis and collagen disease depending on pathological conditions (such as anti-rheumatic agents, immunosuppressants, biological products [anti-cytokine therapy], plasmapheresis, and immunoadsorption therapy).

Scope of target diseases

Rheumatoid arthritis, malignant rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), polymyositis, dermatomyositis, mixed connective tissue disease, vasculitis (giant cell arteritis, Takayasu's arteritis, polyarteritis nodosa, microscopic polyangiitis, granulomatosis with polyangiitis [Wegener's granulomatosis], eosinophilic granulomatosis with polyangiitis [allergic granulomatous angiitis], Sjogren's syndrome, Behcet's disease, adult onset Still's disease, polymyalgia rheumatica and spondylarthritis (ankylosing spondylitis, reactive arthritis and psoriatic arthritis), etc.

Description of medical care

The Department of Nephrology, Diabetology and Endocrinology and the Department of Rheumatology provide specialized care mainly for diabetes, hyperlipidemia, kidney disease, hypertension, rheumatic disease, and endocrine disease. For refractory kidney disease and rheumatic disease that are resistant to existing therapies, we endeavor to improve clinical outcomes using state-of-the-art treatment methods such as blood purification and immunosuppressive therapy. We also specifically emphasize preventive medicine for lifestyle diseases (such as diabetes, hyperlipidemia and hypertension), which pose a severe public problem.
Among metabolic diseases, comprehensive care is provided for diabetes, hyperlipidemia and obesity, which have been increasing considerably in terms of the number of patients. Our diabetes care has an established reputation in intensive patient education in close cooperation with the nursing division, pharmacists and nutritionists, strict blood sugar control (improvement in glucotoxicity) by intensive insulin therapy, early detection of complications such as nephropathy, preventive treatment, and evaluation of insulin resistance by glucose clamp.
For kidney disease, we endeavor to formulate accurate diagnoses and appropriate treatment based on renal biopsy findings for widely diverse diseases that exhibit glomerulonephritis, nephrotic syndrome, and chronic renal failure. Therapeutic effects have been achieved in patients with nephritis that is refractory, frequently recurrent, or with severe complications by the concomitant use of immunosuppressive therapy and LDL apheresis. For patients with renal failure, renal function is maintained in the conservative period by treatment including diet therapy and blood pressure control. Appropriate care and patient education are provided by specialized staff for the introduction of dialysis (peritoneal dialysis and hemodialysis).
As for rheumatic disease, about 1000 patients with rheumatoid arthritis, systemic lupus erythematosus, and vasculitic syndrome, etc. are visiting us for treatment. We have a history of practice ahead of other medical institutions and plenty of experience in immunosuppressive therapy, biological products, plasmapheresis and immunoadsorption therapy for patients with collagen disease that are severe, refractory and with complications in addition to typical cases. Moreover, we currently provide treatment for about 40 various kinds of rheumatic diseases, and also endeavor for early detection and early treatment using that experience.
For endocrine disease, diagnosis is made comprehensively by endocrine tests, diagnostic imaging, and genetic tests, and other methods. Care is provided in collaboration with surgeons under the collaboration system by the Endocrine Center. For thyroid disease, we play the role of the central specialized medical institution of the community, providing treatment regularly for nearly 200 patients.

For outpatient visits

For revisiting outpatients

  • How to make an appointment: Your appointment is registered in the PC at the end of consultation.
  • Appointment time frame: The time frame is written on the revisit appointment sheet.

Highly advanced/special medical treatments

Techniques covered by health insurance programs

  • Biological products (anticytokine therapy): Biological products are therapeutic drugs for active rheumatoid arthritis, and Remicade, Enbrel, Actemra, Humira, Orencia, Simponi, Cimzia, and Xeljanz are used at present.
    Although efficacy higher than existing antirheumatic agents can be expected, care should be taken to avoid and mitigate adverse reactions, and the team medical care system including our staff controls and supports integrated care from introduction (hospital admission) to follow-up treatment in the outpatient clinic. In addition, rituximab is used for refractory vasculitis.

Techniques conducted as clinical trial studies

  • A Phase III clinical trial is ongoing with a new biologicals for rheumatoid arthritis.
  • A Phase III clinical trial is ongoing with a new biologicals for steroid-resistant lupus nephritis.
  • A Phase III clinical trial is ongoing with a new therapy for steroid-resistant microscopic polyangiitis.

Main methods for testing and explanation

  • Blood testing (rheumatoid factor, anti-CCP antibody, complement, antinuclear antibody, and disease-specific autoantibody)
  • Joint X-ray, joint/muscle MRI, and joint paracentesis
  • Kidney biopsy (activity assessment for nephritis such as systemic lupus erythematosus)

Main testing methods and medical equipment

Diabetes education

The diabetes education for diabetes patients is held monthly from Monday through Friday by the staff specialized in diabetes care including doctors, nurses, pharmacists, registered dietitians and physical therapists medical technologists, dentists, and dental hygienists. The class is designed to provide a better understanding of diabetes by easy and specific explanation using pamphlets and slides, and to support diabetes treatment for patients.

Kidney biopsy

Kidney biopsy, the most important testing method for the diagnosis and treatment of kidney disease, is performed in 150 cases annually. Our department is a pioneer institution to perform kidney biopsy in Japan, and kidney biopsy has been established as a safe and reliable diagnostic method along with improvement in devices. Skilled doctors collect the kidney tissue under the guidance of ultrasound and examine of differently stained samples microscopically, with immunofluorescence and electron microscopy. Subsequently, they formulate a diagnosis comprehensively based on the resulting observations. The relation between detailed histological evaluation and long-term prognosis is followed up so that the results will be fed back to the long-term treatment of individual patients. A hospital stay of about a week is necessary to avoid and mitigate postoperative complications.

Comprehensive and detailed examination for kidney disease

Testing including laboratory tests, immunology, urine protein assay (24-hour urine collection), clearance, diagnostic kidney imaging (such as ultrasonography and CT) and molecular biology in addition to kidney biopsy are performed to assess the patient's overall pathological condition and to gain information that can be sed to formulate the therapeutic strategy of the patient.

Hemodialysis and Apheresis Unit

We provide specialized care to perform emergency hemodialysis safely for rapidly progressive glomerulonephritis and acute renal failure, and to introduce hemodialysis for chronic renal failure with complications. Plasma exchange, double filtration plasmapheresis, immunoadsorption therapy, and lymphocytapheresis are performed for refractory collagen disease and neurological diseases, and LDL apheresis is performed for refractory nephrotic syndrome.

Continuous ambulatory peritoneal dialysis (CAPD)

CAPD is a treatment method with benefits that different from those of existing hemodialysis as maintenance therapy for chronic renal failure. Our department provides education and training for the introduction and maintenance of CAPD as home therapy that can be performed according to self-management by the patient with renal failure.

Immunological testing

Tests on autoantibodies and complements are important for the diagnosis and treatment of collagen disease and rheumatic disease. For example, antineutrophil cytoplasmic antibody has recently been used for the diagnosis, classification and treatment of vasculitic syndrome, although we have performed tests earlier in our medical school department. Various specialized immunological tests like this are available. Furthermore, we endeavor to ascertain the pathological condition of lung lesions that affect the prognosis of collagen disease through diagnostic imaging, endoscopy and biopsy, etc., and aim to establish appropriate treatment methods.

Endocrine testing

Pituitary function testing and adrenal function testing, endocrine organ diagnostic imaging (MRI, CT and scintigraphy), thyroid ultrasonography and guided cytology testing are conducted. Comprehensive diagnoses of various endocrine diseases are formulated by endocrine metabolism specialists. In addition, measurement of pressor hormones and 24-hour ambulatory blood pressure monitoring (ABPM) for hypertension patients are also available. These are used in the differential diagnosis of secondary hypertension as well as in the pathological condition analysis of and selection of appropriate therapeutic drugs for essential hypertension.


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  • Hemodialysis and Apheresis Unit
    Hemodialysis and Apheresis Unit