Can a disaster affect rheumatoid arthritis status? A
retrospective cohort study after the 2011 triple disaster in
and Masatoshi FUJIWARA
Department of Internal Medicine, Soma Central Hospital,
Research Institute of Innovative Medicine (RIIM), Tokiwa Foundation,
Edinburgh University School of Social and Political Science, and
Minamisoma Municipal General Hospital, Fukushima, Japan
Objective: As status of rheumatoid arthritis (RA) is highly affected by environmental factors, a catastrophic dis-
aster may also affect RA activity. Herein we conducted a retrospective cohort study in the disaster area of the
2011 triple disaster in Fukushima, Japan: an earthquake, tsunamis and a nuclear accident.
Methods: Clinical records of RA patients who attended a hospital near the Fukushima Daiichi Nuclear Power
Plant were collected. For those who underwent whole-body counter testing, internal radiation exposure levels
were also collected. As clinical parameters may ﬂuctuate in the absence of a disaster, changes in values before
and after the disaster were also compared. Logistic regression was conducted to identify factors affecting RA
Results: Fifty-three patients (average age, 64.2 years; females, 83%; average disease duration, 15.7 years) were
included in the study. Five patients lived within the no-entry zone, 37 evacuated immediately after the disaster,
and four temporarily stopped RA treatment. The proportions of patients who showed worsened tender joint
counts, swollen joint counts and rheumatoid factor values were signiﬁcantly higher after the disaster compared
to those before. Among the 16 patients who underwent whole-body counter testing, only one showed a detect-
able, but negligible, radioactive cesium level. Use of methotrexate was identiﬁed as a possible preventive factor
for RA exacerbation in this setting.
Conclusion: This is the ﬁrst study to analyze detailed proﬁles of RA patients after a disaster. As methotrexate
may prevent disease exacerbation, continuity of care for this common chronic disease should be considered in
Key words: disaster, public health, rheumatoid arthritis.
Disasters can impact population health in many ways.
The health problems that emerge after a disaster are not
limited to incidental injuries and acute illnesses associ-
ated with disaster damage; rather, secondary events
associated with disasters, such as air pollution, mental
stress, lifestyle changes and medication loss, may indi-
rectly lead to exacerbation of chronic diseases, espe-
cially non-communicable diseases (NCDs), among
residents of the disaster area.
With the increasing glo-
bal burden of NCDs,
understanding the impact of a
Correspondence: Dr Sae Ochi, Soma Central Hospital, Oki-
nouchi 3–5-18, Soma City, Fukushima 976–0016, Japan.
© 2018 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1254–1262