In response to the rapid rise of social interest, the importance of medical care throughout lifelong, including the development of transitional medical care, has been reviewed. In addition, since 2015, the incurable disease policy in Ministry of Health, Labor and Welfare has been enriched as a national policy. However, the university courses in Japan have not successfully departed from the traditional framework of internal medicine and pediatrics so far; and these two departments have developed separately. Especially in intractable immune diseases, because the cause has not yet been fully elucidated; the commonalities and differences between children, adults, and the elderly in these diseases have not at all been sorted out, and studies of these diseases have independently been developed by age groups with little being merged across groups. The universal and uniform diagnostic methods and/or treatment for a lifetime have not yet been available in the current situation.
Therefore, it is now required to establish a system to study of and treat immune intractable diseases such as rheumatic diseases seamlessly from children to the elderly. Following such circumstances, in 2016, our university established a donation course in cooperation with a course in which specialists in immunological intractable diseases play an important role (Rheumatology and Pediatrics), and Masaaki Mori who had been conducting Pediatric rheumatology at Yokohama City University joined as a member. Pediatrics staff and Rheumatology staff shared a room, and very started the course as a "mixed team". This course, with the cooperation of Department of Rheumatology and Pediatrics, promotes the integration of research, education, and clinical system for life-long immunological intractable diseases which have not been achieved by existing courses, and aims to develop a new course that leads the reform and enhancement of medical care and learning for all intractable diseases.
1) Establishment of a research system in cooperation with Pediatrics and Rheumatology
This course clarifies the differences and similarities of rheumatic diseases between children and adults, and develops and embodies a universal approach to "countermeasures for intractable diseases throughout life-full courses". Especially in the transitional phase from pediatric to adult, there may be many transition-specific problems such as changes in the department/physician in charge from pediatrics to internal medicine, and changes in the required amount of medication due to changes in drug metabolism and physique.
In addition, we will propose treatment strategies that consider the needs and issues of those who wish to have children and are restricted from treatment with immunosuppressive drugs, and the elderly who are concerned about complications and compliance.
2) Clinical epidemiological study aiming to construct a database in the transition from childhood to adulthood
This course will lead the construction of a nationwide database of pediatric rheumatic diseases that has not been organized in Japan so far. The cohort studies in Japan have independently investigated children and adults in the recognition as "specified pediatric chronic diseases" and "designated intractable diseases" by the Ministry of Health, Labor and Welfare.
This course will construct a database of patients from childhood to adulthood in cooperation with the international community to clarify the current situation of the treatment of patients with childhood rheumatism and collagen diseases in Japan. Then, basic data to unify the description of registered items will be presented for immune intractable diseases that cross both the childhood chronic specific disease system and the designated intractable disease system.
Specifically, we will complete CoNinJa, a database focusing on JIA patients, based on NinJa which is a database that focuses on adult patients with rheumatoid arthritis. We will collect data in the future and clarify the actual situation of JIA medical treatment.
3) Genomic and immunological marker studies related to differences and similarities between children and adults
In this course, we will utilize the disease bioresource center of our university, which has the latest technology such as whole exome sequencing, next-generation sequence analysis and immunomarker research to make an effort to clarify all the intractable diseases of children and adults (rheumatic and collagen diseases, vascular inflammatory diseases, primary immunodeficiency syndrome, and autoinflammatory syndrome), and comprehensively explore the childhood-onset, transition from childhood to adulthood, adult onset, and elderly.
4) Development and expansion of new treatments through doctor-initiated clinical trials, etc.
Clinical tests (clinical trials) for drug approval have rapidly been globalizing, and an increasing number of people have been participating in international joint trials. In addition, the review period has been significantly reduced following the establishment of a drug approval review system, and improvements in medical drug lag are expected.
In this course, we will actively promote clinical tests and trials of new drugs in the transitional phase, which are considered difficult to be implemented in the transition period between children and adults. As a result, it is expected that the therapeutic goals of rheumatic/collagen diseases for children through adults will be advanced, and that the treatment options will be complicated and diverse; hence, the direction of establishing the tailor-made treatments for children to the elderly are explored, considering the actual use of these drugs.
5) Implementation of clinical studies for adults to the elderly and preparation of clinical guidelines.
The following studies were conducted in cooperation with the rheumatology. Rheumatoid arthritis: analysis of cohort study of the elderly-onset rheumatoid arthritis, analysis of NinJa of elderly patient data, systematic review of elderly rheumatoid arthritis and preparation of clinical guidelines for rheumatoid arthritis, continuation of a multi-center prospective cohort study of rheumatoid arthritis, and implementation of a new prospective cohort study of middle age to the elderly. Vasculitis syndrome: Implementation of a cohort study of large and small vasculitis, data analysis, preparation of clinical guidelines for vasculitis, establishment of the remission criteria and treatment strategies for large vessel vasculitis, and starting a cohort study using an intractable disease platform. Adult-onset Still's disease, systemic juvenile idiopathic arthritis: Implementation of a Tokyo Medical and Dental University cohort study for children and adults, preparation of a prospective cohort study using intractable disease platform.
Fostering a “hybrid physician” who can provide consistent medical care from children to adults
The clinical system so far has been separated for children and adults. From the perspective of patients, many feel confused and anxious about the change of the department in charge and the attending physician once they reach a certain age when they grow up despite the same disease. The adult physicians also often struggle with how those patients have progressed the diseases, what problems or worries of patients have had other than medical concerns while growing up, and whether those patients in carry-over case can be treated in the same manner as adults. For this purpose, this course plays a central role in providing an educational system for fostering "hybrid physicians" who are specialists in rheumatism treatment, are well familiar with treatment for both children and adults, and transcend the boundaries between children and adults.
Lectures & Courses
In this course, with the cooperation of Department of Rhewumatology and Pediatrics, we will promote the integration of research, education, and clinical systems for intractable immune diseases throughout the life of patients, and further aim to be a pioneer of renovation and enhancement of medical treatment and academics for intractable diseases. And this course is intending to foster pediatricians and adult physicians who can solve various problems for patients in the transition from childhood to adulthood and from adulthood to the elderly.
Clinical Services & Other Works
(Clinical and off-campus activities)
Pediatrics and rheumatology cooperated to provide treatment for collagen and rheumatic diseases from children to the elderly.
Professor Masaaki Mori plays a role as the research representative in the followings.
1. Health and Labor Sciences Research Fund Grant/Refractory Disease Policy Research Project (Immune and Allergic Disease Policy Research Project (Immune and Allergic Disease Policy Research Field)(Ministry of health, labor and welfare 2017~2019)
"Analysis of national survey data of patients with pediatric rheumatism in childhood and a transitional phase to adulthood, and standardization of standard treatment by establishing a nationwide "seamless" clinical network based on their differences and similarities"
2. Health and Labor Sciences Research Fund Grants/Refractory Disease Policy Research Project (Refractory Disease Policy Research Project)
(2017-2019, Ministry of Health, Labor and Welfare) "Research on autoimmune diseases" [Research representative: XXX]
3. Research Grant for NPO Japan Kawasaki Disease Research Center (2017/2018, Japan Kawasaki Disease Research Center) "Elucidation of Kawasaki disease by clustering based on clinical information and new biomarkers"
Associate Professor XXXX works as a research coordinator for the followings:
# Research designated by the Ministry of Health, Labor and Welfare, research to support for patients with rheumatoid arthritis according to life stages
# Health Labor Administration Promotion Research Project Subsidy, Immune/Allergic Disease Policy Research Project, Clinical epidemiological study in regard to standardization of rheumatoid arthritis medical care in Japan
# Health and Labor Sciences Research Grants, Intractable Disease Policy Research Project, Investigation and research on intractable vasculitis
#AMED multi-layer study for CQ solution of intractable vasculitis treatment
# Health and Labor Sciences Research Grants, Intractable Disease Policy Research Project, Investigation and research on autoimmune diseases
The results of the research indicated above were reported at academic conferences and workshops in Japan and overseas.
The Lifelong Intractable Immunological Diseases Lecture, “is a unique university course that cannot be found elsewhere in the world, which aims to integrate research, education, and treatment systems for "immune intractable diseases", such as collagen and rheumatic diseases, for a lifetime from children to adults and the elderly”. This course in our University has assessed various problems for patients with intractable diseases in the transitional phase from pediatric to adult or adult to elderly, which have not been solved by conventional medical system of Pediatrics and Internal medicine.