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膠原病臨床研究について

 膠原病患者さんを対象とした複数の臨床研究を実施中です．特に，循環器内科・腎臓内科・膠原病内科という複数領域の医師が所属しているという第二内科の長所を活かして，「膠原病の心臓・腎臓合併症に関する臨床研究を行うことができる」ということが当科の強みであり，近年では顕微鏡的多発血管炎の心臓合併症に関する研究報告（Mod Rheumatol.2022,32:606-612）を行っており，現在も膠原病患者さんの心血管イベントに関する研究を行っています．

また，大学病院内の薬剤師・看護師とも共同研究を行っており，職種の垣根を越えて臨床研究を行い、どのような患者さんがグルココルチコイド（ステロイド）への恐怖心が強くなるのかという研究成果を報告しており(Medicine.2024;103:e38489)，今後も多職種での研究を継続していく予定です．

さらに，山口大学医学部附属病院以外の医療機関とも連携して，活発に臨床研究を行っており、山口県内の全身性エリテマトーデス患者さんを対象とした多施設共同研究（QUOLITY研究）や国内の多発性筋炎／皮膚筋炎関連間質性肺疾患の患者さんを対象とした多施設共同研究（統合レジストリによる多発性筋炎／皮膚筋炎関連間質性肺疾患の個別化医療基盤の構築）などの研究に参画しています．

日々の診療に際しても，心血管・腎臓領域の評価を詳細に行うことができることが特長であり、膠原病患者さんの血管病変のイメージング（Circulation Journal. 2021;85:1589. Vascular Medicine. 2021;26:459-461. 図はCirculation Journalに投稿した高安動脈炎に伴う頸動脈瘤をエコーで詳細に評価し得た1例です）や腎生検結果を踏まえての病態評価（Case Reports in Rheumatology. 2022, Article ID 9606981）は優れたものであると自負しています．また，患者さんの診療に当たる過程で既存検査法の問題点を見出して問題提起するなど（International Journal of Rheumatic Diseases.2019;22:1335-39），常に探求心をもって日々の診療に当たり，診療の中で生じた疑問（クリニカルクエッション）を解決することを心がけています．

代表論文（基礎研究関係）

1. Koyama K, Ohgami A, Nawata T, Sato K, Fujinaka M, Shibuya M, Kitahara T, Yano M. Serial changes in anxiety levels related to corticosteroid use: A single-center prospective study. Medicine (Baltimore), 2024;103(23):e38489

2. Nawata T, Yonezawa M, Fujinaka M, Shibuya M, Sano M. Chronic nonbacterial osteomyelitis associated with psoriasis. Rheumatology Advances in Practice, 2024;8(2):rkae052.

3. Nawata T, Goda K, Tsutsui M, Ikegami T, Akase H, Okuda S, Nakao F, Ueyama T, Uesugi N, Ikeda Y. Concurrent immunoglobulin G4-related disease and hypereosinophilia with persistent fever and simultaneous acute multi-organ involvement. Rheumatology Advances in Practice, 2023;7: rkad078.

4. Nawata T, Yano M. Sternoclavicular joint arthritis in a patient with psoriatic arthritis. Mediterranean Journal of Rheumatology. 2023;34:575-6.

5. Kinoshita N, Nawata T, Mochizuki M, Asami-Noyama M, Wada Y, Yano M. Usefulness of inhaled iloprost in managing exercise-induced pulmonary hypertension in a patient with systemic sclerosis-associated interstitial lung disease: A case report. Medicine Case Reports and Study Protocols. 2023,4:e0271.

6. Nawata T, Shibuya M, Takeshita Y, Kubo M, Uesugi N, Yano M. Glomerulonephritis and Interstitial Nephritis Originating from Vasculitis of the Interlobular Arteries of the Kidney in a Patient with Eosinophilic Granulomatosis with Polyangiitis. Case Reports in Rheumatology. 2022, Article ID 9606981.         

7. Nawata T, Yano M. Rheumatoid arthritis concurrent with striatal hand deformity. Rheumatology Advances in Practice. 2022;6:rkab068.

8. Nawata T, Kinoshita N, Ariyoshi T, Wada Y, Yano M. Usefulness of ultrasonographic superb microvascular imaging for diagnosis and management of splenic vein thrombosis. Journal for Vascular Ultrasound. 2022;46:177-178.

9. Nawata T, Kinoshita N, Okuda S, Kubo M, Wada Y, Kobayashi S, Tanaka N, Yano M. Echocardiographic features of acute phase microscopic polyangiitis in Japanese patients: A single-center retrospective study. Modern Rheumatology.2022,32:606-612.

10. Nawata T, Ota Y, Sakuraba M, Suzuki M, Gono T, Takeno M, Kuwana M. “Utility of Ultrasonography in Assessing Periaortitis Associated with Retroperitoneal Fibrosis: A Case Report. Journal of Nippon Medical School, 2022;89:612-615.

11. Nawata T, Shirai Y, Suzuki M, Kuwana M. Chest wall muscle atrophy as a contributory factor for forced vital capacity decline in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford), 2021;60:250-255.

12. Nawata T, Ariyoshi T, Fujinaka M, Shibuya M, Wada Y, Kubo M, Yano M. Ultrasonographic Assessment of a Carotid Artery Aneurysm in Takayasu Arteritis. Circulation Journal. 2021;85:1589.

13. Nawata T, Kubo M, Yano M. Rapid weight loss in a patient with anti-synthetase syndrome treated with sodium-glucose co-transporter-2 inhibitors and corticosteroids. Rheumatology Advances in Practice. 20217;5:rkab045.

14. Nawata T, Oishi K, Shibuya M, Sano Y, Kubo M, Obayashi M, Kawai M, Yano M. Granulomatosis with polyangiitis associated with rapidly progressive glomerulonephritis, diffuse alveolar hemorrhage, cerebral vasculitis, and peripheral nerve neuropathy A case report. Medicine Case Reports and Study Protocols. 2021;2 e0082.

15. Nawata T, Ariyoshi T, Okuda S, Wada Y, Kubo M, Yano M. Images in Vascular Medicine: Usefulness of carotid ultrasonography for diagnosis and management of polymyalgia rheumatica-associated large-vessel vasculitis. Vascular Medicine. 2021;26:459-461.

16. Sakuraba M, Watanabe S, Nishiyama Y, Takahashi K, Nakamichi K, Suzuki M, Nawata T, Komai K, Gono T, Takeno M, Suzuki T, Kimura K, Kuwana M. Infratentorial onset of progressive multifocal leukoencephalopathy in a patient with systematic lupus erythematosus complicated with lymphoma: a case report. Modern Rheumatology Case Reports. 2021;5:272-277.

17. Nawata T,  Shiragami K, Matsuura T, Honda N, Kubo M, Kawano H, Yano M. Oral ulcers with amyloidosis secondary to rheumatoid arthritis. Rheumatology (Oxford). 2021:60:3030.

18. Nawata T, Murakawa K, Shiragami K, Shibuya M, Kubo M, Yano M. Anti-neutrophil cytoplasmic antibody-associated vasculitis complicated with diffuse alveolar haemorrhage and central nervous system vasculitis. SAGE Open Medical Case Reports. 2021;9:2050313X211011814.

19. Nawata T, Kubo M, Oishi K, Murata Y, Oishi M, Y Okazaki, Omoto M, Okazaki Y, Kanda T, Kuwana M, Yano M. A case of cancer-associated myositis with anti-Mi-2 antibody: false-positive anti-transcriptional intermediary factor 1-γ antibody by commercial enzyme-linked immunosorbent assay. International Journal of Rheumatic Diseases.2019;22:1335-39.

20. Nawata T, Kubo M, Nomura T, Oishi K, Shiragami K, Ikegami T, Okada M, Kobayashi S, Yano M. Change in muscle volume after steroid therapy in patients with myositis assessed using cross-sectional computed tomography. BMC Musculoskeletal Disorders 2018;19:93. doi: 10.1186/s12891-018-2008-8.

21. Nawata T, Kubo M, Fujii S, Shiragami S, Ikegami T, Kobayashi S, Hisano S, Yano M. Treatment of class IV lupus nephritis with mycophenolate mofetil monotherapy. Internal Medicine. 2018. 57:2067-2070.

22. Nawata T, Kubo M, Mitsui H, Oishi K, Omoto M, Kanda T, Yano M. Dermatomyositis Complicated by Digital Ischemia and Lung Adenocarcinoma in a Patient with Positive Anti-signal Recognition Particle Antibodies. Internal Medicine. 2018, 57:883-886

23. Nawata T, Kubo M, Kobayashi S, Nakada N, Maeda M, Cui D, Kimura T, Ikeda E, Yano M. Mucormycete infiltration in the cardiac conduction system. Canadian Journal of Cardiology. 2018;34:92.e9-92.e10.

24. Nawata T, Kubo M, Shiragami K, Nakamura Y, Yano M. Successful treatment of hemophagocytic lymphohistiocytosis associated with lupus nephritis by using mycophenolate mofetil. Case Reports in Rheumatology. 2017; Article ID 4159727.

25. Nawata T, Kubo M, Okuda S, Omoto M, Yujiri T, Kanda T, Yano M. Successful treatment with intravenous cyclophosphamide for anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis associated with myelodysplastic syndrome. Scandinavian Journal of Rheumatology. 2017; 46: 496-498.