Hiroshi Uda1, Osamu Saiki2,3. 1. a Department of Rheumatology , Higashiosaka City General Hospital , Higashiosaka city , Osaka , Japan. 2. b Department of Rheumatology , Higashiosaka City General Hospital , Higashiosaka city , Osaka , Japan. 3. c Department of Rheumatology , Shiraishi Hospital , Imabari City , Japan.