Meet the editor

Akira Takeda, MD, PhD, is the founder and director of the Division of Clinical Immunology & Rheumatology at International University of Health and Welfare Hospital, Japan. He graduated from Akita University School of Medicine, Japan, after which he joined Jichi Medical School, where he was actively involved in clinical rheumatology practice as well as basic research in the field of Immunology. After completing his thesis studies, he

worked as an assistant professor at the University of Massachusetts Medical School while pursuing extensive studies of cellular and humoral immunity against pathogens to elucidate the precise host defense mechanisms. Upon his return to Japan, Dr. Takeda joined Dokkyo University School of Medicine and the current institute where he has been exploring the immuno-pathogenesis of connective tissue disease (CTD)-associated organ injury, leading to numerous publications including novel research into how T cells trigger and promote interstitial pneumonia in CTDs.

Contents

**Preface XI**

**Chapter 1 1**

**Chapter 2 27**

**Chapter 3 37**

**Chapter 4 57**

**Chapter 5 69**

Physical Exercise Improves Quality of Life in Patients with Connective

Growing Need for Diagnostic Precision in Rheumatoid Arthritis:

Lupus Erythematosus: Dermatologic Perspectives on the Diversity *by Ran Xin, Wang Peng, Huang Jinghong, Pradhan Sushmita,* 

The Established and Evolving Role of Nailfold Capillaroscopy

Ankylosing Spondylitis and Other Seronegative Arthritis

*by Ricardo Munir Nahas, Vivianne Horsti Dos Santos* 

Proposal of MR Imaging Criteria for Early Diagnosis

*by Akira Takeda and Hideharu Sugimoto*

*by Matthew J.S. Parker and Neil W. McGill*

*Yang Heli and Ran Yuping*

in Connective-Tissue Disease

*by Balaji Zacharia and Antony Roy*

Tissue Disease

*and Silvio Lopes Alabarse*

## Contents


Preface

Connective tissue diseases (CTDs) constitute a heterogenous group of systemic autoimmune disorders and related conditions, characterized by rheumatic manifestations, production of myriad autoantibodies, and varied immune-mediated organ injury. Included in this category are rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), scleroderma (systemic sclerosis; SSc), polymyositis/ dermatomyositis (PM/DM), systemic vasculitides, and Sjögren's syndrome (SS), among others. During the past few decades, a great paradigm shift has occurred in the realm of therapeutics due to advances in our understanding of disease etiopathology. Robust emerging evidence on the precise role of the innate and adaptive immune systems and their contributions to initiation and development of CTDs has facilitated our understanding of disease, generating great interest in immunotherapy including numerous biologics. To achieve the best outcomes for patients, timely and accurate evaluation has become fundamental and, as such, advanced diagnostic and assessment modalities have also been developed, and have had a revolutionary

impact in precise characterization of the disease conditions in CTDs.

fatigue in these diseases, with both short- and long-term effectiveness.

Written by expert clinical and research scientists who are directly involved in patient care and CTD research, this book covers a broad spectrum of interests and provide a deep understanding of this category of diseases for rheumatologists, physician

*Connective Tissue Disease: Current State of the Art* consists of five chapters that combine systematic reviews, investigations and original clinical studies; comprehensive rheumatologic perspectives on RA, lupus and the other arthritides such as spondyloarthritis; new concepts of diagnostic modalities; and clinical implications of physical therapy. In Chapter 1, which serves as an introductory chapter and which has original material, we start with a comprehensive overview of the recent and revolutionary paradigm shift in RA, the most common of the CTDs, emphasizing the urgent need for diagnostic precision. This leads us to the introduction of our proposed "diagnostic criteria for early RA with MRI findings." Chapter 2 discusses lupus, the most typical of the systemic autoimmune disease in its ability to cause widespread inflammation and tissue damage in affected organs including skin, joints, brain, lungs, kidneys, and blood vessels. The authors provide intriguing dermatologic perspectives based on their studies with dermoscopy and histopathology. Chapter 3 elegantly demonstrates recent advances in nail fold capillaroscopy, a modality that is extremely important today in the evaluation of patients with Raynaud's phenomenon and systemic sclerosis (SSc) spectrum diseases. Considering that vasculature changes by functional and structural alterations of the microcirculation play a central role in the pathogenesis of CTDs, this methodology gives new impetus for improvement of precision evaluation of disease in daily practice. Chapter 4 covers the disease concept of spondyloarthritis (SpA) in which several subtypes can be distinguished, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), SpA related to inflammatory bowel disease (IBD-SpA), reactive arthritis (ReA), and undifferentiated SpA (uSpA). Chapter 5 appraises the increasing importance of physical activity and exercise training in the clinical course of CTDs, explaining the benefits of exercise on physical limitations and
