Letters to the Editor

function test results and chest HRCT findings in dermatomyositis patients with acute/subacute interstitial pneumonia. Clin Rheumatol 2011;30:1021–8. 7 Koldingsnes W, Nossent JC. Baseline features and initial treatment as predictors of remission and relapse in Wegener’s granulomatosis. J Rheumatol 2003;30:80–8.

Disclosure statement: T.A. has received honoraria and grants/research support from Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Bristol-Myers Squibb Co., Astellas Pharma Inc., Daiichi Sankyo Co., Ltd. and Mitsubishi Tanabe Pharma Co. All other authors have declared no conflicts of interest.

Shinsuke Yasuda1, Takashi Kurita1, Tetsuya Horita1 and Tatsuya Atsumi1 Rheumatology 2015;54:1129 doi:10.1093/rheumatology/kev033 Advance Access publication 31 March 2015

SIR, We appreciate Nagashima et al. [1] having an interest in our clinical research concerning the treatment of PM/ DM-related interstitial lung diseases (ILDs) [2]. First, we have to confirm a limitation of this study, in that it was not designed as a randomized controlled study due to the rarity of PM/DM-related ILD. Instead we conducted an observational study using propensity score. Selected confounders for the use of tacrolimus were age, sex, DM, amyopathic manifestation, oxygen administration, acute progression within 60 days, serum KL-6 levels, groundglass opacity and extensive ILD [2]. Tacrolimus, where given, was administered within 28 days of the initiation of treatment, and disease duration was chosen as one of the confounders; therefore, we believe that timing of admission (as well as tacrolimus treatment) was taken into account in the study. Serum ferritin levels and positive anti-MDA5 antibody are now known to indicate poor prognosis. However, the ferritin levels were not routinely measured in our series, except in some cases with cytopenia and/or iron deficiency, and anti-MDA5 antibody titre was not available in most of our patients [2]. Thus, these two parameters did not affect our choice of treatment. As Drs Nagashima and Minota [1] correctly point out, treatment with tacrolimus tended to be chosen in relatively recent patients; this was related to the timing of approval of this immunosuppressant in Japan. Thus, improvement in supportive therapy or more intensive combination therapy including tacrolimus, might have affected our results. Ciclosporin was administered in only seven patients in the conventional therapy group; thus, it was difficult to compare the difference in efficacy of tacrolimus and ciclosporin [2]. That comparison was not our aim. Hence, in this observational study [2], we only sought to compare therapies that included tacrolimus with those that didn’t include tacrolimus. Superiority of tacrolimus over ciclosporin was not demonstrated, partly due to our retrospective design. To overcome the limitations raised by Drs Nagashima and Minota [1], as well as by ourselves, future prospective studies should be conducted. Funding: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.

Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan Correspondence to: Shinsuke Yasuda, Department of Medicine II, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan. E-mail: [email protected]

References 1 Nagashima T, Minota S. Comment on: The efficacy of tacrolimus in patients with interstitial lung diseases complicated with polymyositis or dermatomyositis. Rheumatology 2015;54:1128–9. 2 Kurita T, Yasuda S, Oba K et al. The efficacy of tacrolimus in patients with interstitial lung diseases complicated with polymyositis or dermatomyositis. Rheumatology 2015;54: 39–44.

Rheumatology 2015;54:1129–1131 doi:10.1093/rheumatology/kev025 Advance Access publication 31 March 2015

Good response to tumour necrosis factor alpha blockade results in an angiogenic T cell recovery in rheumatoid arthritis patients SIR, The increased cardiovascular (CV) morbidity of RA is associated with disease activity and the underlying inflammatory burden [1], although the actual mechanisms by which they play a role in CV susceptibility remain unclear. It has been proposed that angiogenic T cells (Tang), in cooperation with endothelial progenitor cells (EPCs), play a role in vascular repair. However, both populations are decreased in the circulation of RA patients, Tang being strongly related to disease activity [2]. Actually, disease activity may have a role in microparticle shedding from Tang, thereby suggesting a detrimental role for disease activity in this subset [3] that could potentially account for the decreased Tang levels in RA. Therefore, we aimed to analyse the effect of clinical response to TNFa-blockade on circulating Tang, EPCs and Tangderived microparticles (Tang-MPs). A total of 13 RA patients naive to TNFa blockers were longitudinally recruited [age: 48 (range 32–65) years, 1 man and 12 women, disease duration 1.50 (range 1.00–7.17) years, 5 RF+, 6 anti-CCP+, 3 active smokers], and a blood sample was taken immediately before as well as 3 months after anti-TNFa therapy (11 golimumab and 2 etanercept). All patients were on concomitant MTX, and

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