Rheumatology in Japan, Germany, and Egypt : A Comparison of Medical Practices

The doses of methotrexate used for the treatment of patients with rheumatic arthritis were compared among hospitals in Germany, Egypt and Japan and were found to be much higher in the former two than in Japan. German physicians have begun to use drugs yet to be approved in Japan, such as IL-1 receptor antagonist, mycophenolate mofetil, and Cox-2 inhibitors as well as weekly therapy with bisphosphonates. The anti-TNFα antibody, the soluble TNFα receptor construct, and leflunomide, all of which were recently approved in Japan, have been widely used in Germany. In Egypt, a rheumatologist is usually called "a rheumatologist and rehabilitation doctor." This doctor does not perform surgery (as orthopedic surgeons do) but does treat many orthopedic patients, such as those with back pain or osteoarthritis of the knee. It is important to understand the international situation in rheumatology and to let the world know the strengths of Japanese rheumatology, especially the treatment options developed in Japan.