"We know that it is not easy to taper patients safely. So if we find a patient’s toxicity scores are worsening we can try an immunosuppressant or a biologic drug and then we need to track to see if we can taper the glucocorticoids safely.”

Professor Yoshiya Tanaka MD, PhD is a leading international authority on systemic autoimmune diseases, rheumatic diseases, and osteoporosis. He is also the president of the Japanese Association of Clinical Immunology. director and board member of the Asia Pacific League of Associations for Rheumatology (APLAR), Japanese Society of Internal Medicine, Japanese College of Rheumatology (JCR), and Japanese Society of Inflammation and Regeneration.

Professor Tanaka found his calling after being advised by his Professor to study autoimmune diseases because they affect every system and organ in the body and there was a huge unmet need to understand their basic pathologies. Since then he has gone on to author and review nearly 600 publications and received numerous awards for his work.

He says that the treatment landscape for many autoimmune diseases has changed dramatically over the past 40 years: “in the ‘80s and ‘90s nearly every patient we saw with rheumatoid arthritis was treated with glucocorticoids. Today, we have so many more disease-modifying antirheumatic drugs (DMARDs) and access to biologics that we don't have to use glucocorticoids.:

“Sadly, for the majority of autoimmune conditions, this is not the case, and they require glucocorticoid treatments. Even so, we still try to reduce or taper the dosage to find a balance between safety and efficacy.”

“Glucocorticoids cause many major side effects such as mental disturbance and gastric ulcers, but we also have to be conscious of the minor adverse effects, especially on metabolism - bone metabolism, lipid metabolism, glucose metabolism, and vascular metabolism. Just one milligram of prednisone is harmful to the metabolism.”

He explains that all patients under his team's care are assessed for steroid-toxicity using the Glucocorticoid Toxicity Index (GTI), and he has published a number of papers using the instrument. He is in the process of writing new guidelines for the treatment of autoimmune patients and how glucocorticoid adverse events should be monitored using the GTI. He stresses the importance of these guidelines as they will help to improve the standard of care for patients across Japan.

He also sees the GTI as an important instrument to help clinicians safely taper patients off of long-term, high-dose glucocorticoid treatment regimens. “It is important to balance the safety and efficacy of glucocorticoid treatments, and we know that it is not easy to taper patients safely. So if we find a patient’s toxicity scores are worsening we can try an immunosuppressant or a biologic drug and then need to track to see if we can taper the glucocorticoids. When we start the new treatment we have to know the balance between safety and efficacy which we check using the GTI. If the treatment is successful we will continue to check the GTI scores to check for improvement due to the tapering.”

“We have also found that patients are grateful to see the improvement in the GTI scores.”
.



Professor Tanaka has authored and reviewed nearly 600 publications. His scientific focus is on the pathological analysis and development of novel treatments for systemic autoimmune diseases, rheumatic diseases, and osteoporosis. He is the president of the Japanese Association of Clinical Immunology and the past president of the Japanese Society of Bone and Mineral Research (JSBMR).

He is a director and board member of the Asia Pacific League of Associations for Rheumatology (APLAR), Japanese Society of Internal Medicine, Japanese College of Rheumatology (JCR), and Japanese Society of Inflammation and Regeneration.

He is also editor-in-chief of Modern Rheumatology Case Reports, an associate editor of Rheumatology, Cytokine, Arthritis Care and Research, Arthritis Research & Therapy, Inflammation Research, International Journal of Rheumatic Diseases, an editorial board member of Annals of Rheumatic Diseases, RMD Open, Modern Rheumatology, and Inflammation Research. He has received numerous awards from the Japanese Society of Inflammation, JSBMR, JCR, and EULAR.