OBJECTIVE: To investigate the frequency, type and severity of cardiac abnormalities in the patients with ankylosing spondylitis and undifferentiated spondyloarthopathy. METHODS: A history, clinical examination, standard 12 lead electrocardiography, two dimensional, M mode, and Doppler echocardiographies were performed on 19 patients with ankylosing spondylitis, 15 patients with undifferentiated spondyloarthropathy and 21 normal controls. RESULTS: 1) Cardiac abnormalities were detected in 8 patients(42.1%) with ankylosing spondylitis. 2) Cardiac abnormalities were detected in 8 patients(53.3%) with undifferentiated spondyloarthropathy including 2 patients with aortic valve abnormalities(mild aortic insufficiency, aortic valve thickening. 3) Cardiac abnormalities were detected in one (4. 8%) among normal controls (mild tricuspid regurgitation). 4) There were sinus bradycardias on electrocardiography in 2 patients among patients witn anl;ylosing spond!litis and in 1 patient among undifferentiated spondyloarthropathy. But there was no conduction disturbance in both groups. 5) The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. 6) The mean age, mean disease duration, presence of uveitis, peripheral arthritis, HLA-B27, enthesopathy, Schober test and chest expansion in the patients with ankylosing spondylitis and undifferentiated spondyloarthropathy with cardiac abnormalities were not different from those in the patients without cardiac abnormalities. CONCLUSION: The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. The frequency, type and severity of cardiac involvement in patients with ankylosing spondylitis were not different from those in patients with undifferentiated spondyloarthropathy.
Aortic Valve ; Aortic Valve Insufficiency ; Arthritis ; Bradycardia ; Electrocardiography ; HLA-B27 Antigen ; Humans ; Rheumatic Diseases ; Spondylarthropathies* ; Spondylitis, Ankylosing* ; Thorax ; Uveitis

OBJECTIVE: To investigate whether synovial fluid adenosine deaminase activity is useful in the differential diagnosis of joint swelling and in estimating the disease activity. METHOD: Adenosine deaminase activity was determined in the synovial fluid taken from patients with rheumatoid arthritis (n=21), osteoarthritis (n=ll), ankylosing spondylitis (n=3), and gouty arthritis (n=2). This enzyme activity was compared with the laboratory indices (ESR, CRP) in the blood and the other parameters in the synovial fluid. RESULT: More increased adenosine deaminase activity was found in the synovial fluid taken from patients with rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis, as compared with that of osteoarthritis patients. Synovial fluid ADA activity was significantly corelated with the WBC count in the synovial fluid, but there was no statistical corelation between other synovial parameters and adenosine deaminase activity. CONCLUSION: Adenosine deaminase activity is useful in the differential diagnosis of joint swelling between inflammatory joint disease and osteoarthritis, but not useful in estimating the disease activity.
Adenosine Deaminase ; Adenosine* ; Arthritis, Gouty* ; Arthritis, Rheumatoid* ; Diagnosis, Differential ; Humans ; Joint Diseases ; Joints ; Osteoarthritis* ; Spondylitis, Ankylosing* ; Synovial Fluid*

OBJECTIVE: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. METHODS: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). RESULTS: Serum CK activity was significantly reduced in RA (mean+SD: 45.7 +24.2 IU/L) compared to controls (81.3+33.9 IU/L) (p < 0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: 0.31, p < 0.01; 0. 45, p < 0.001; 0.42, p < 0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant.
Adrenal Cortex Hormones ; Arthritis, Rheumatoid* ; Blood Sedimentation ; C-Reactive Protein ; Creatine Kinase* ; Creatine* ; Humans ; Platelet Count ; Retrospective Studies ; Rheumatic Diseases ; Steroids

OBJECTIVE: To investigate whether the serum levels of IL-10 in patients with rheumatoid arthritis are different from those of normal controls and SLE patients and to find out any correlation with disease activity parameters of rheumatoid arthritis. METHODS: Sera from 20 healthy normal persons, 16 rheumatoid arthritis patients and 16 patients with systemic lupus erythematosus were collected and measured for IL-10 and IL-6. Various disease activity parameters were measured in RA patients. RESULTS: The serum level of IL-10 in RA patients was significantly elevated compared to normal controls but lower than those of SLE patients. In RA patients there was no definite correlation between the disease activity parameters and serum IL-10 levels. Despite significant improvements in terms of various disease activity parameters, there was no significant change of serum IL-10 levels after treatment in RA patients. In seropositive RA patients, positive correlation was found between serun IL-10 and rheumatoid factor levels. CONCLUSION: Our findings show that the serum IL-10 levels in patietns with RA are elevated compared to normal controls but lower than those of SLE patients. There was no correlation between serum IL-10 levels and disease acivity parameters of RA.
Arthritis, Rheumatoid* ; Humans ; Interleukin-10* ; Interleukin-6 ; Lupus Erythematosus, Systemic ; Rheumatoid Factor

OBJECTIVES: Human osteoarthritis is a heterogeneous and multifactorial disease characterized by the progressive deterioration of the cartilage of diarthrodial joints. In some instances, there is an identifiable cause, such as trauma or congenital malformation, but, mostly the etiology remains unknown. Since familial aggregation is seen, genetic factors may be important, particularly in osteoarthritis of the hand. METHODS: Blood samples from patients and controls were obtained for DNA analysis. Exon 31 of type II procollagen gene was amplified by polymerase chain reaction, and screening for the mutation was undertaken using a restriction enzyme digestion (Dsa I). RESULTS: The patients phenotype represented typical, but earlyonset and family history, osteoarthritis. No mutation in exon 31 of type II procollagen gene could be identified. CONCLUSION: Screening of the 31 exon did not, however, reveal any mutation. It needs further evaluation in other sites of type II procollagen genes.
Cartilage ; Collagen Type II ; Digestion ; DNA ; Exons ; Hand ; Humans ; Joints ; Mass Screening ; Osteoarthritis* ; Phenotype ; Polymerase Chain Reaction ; Procollagen*

OBJECTIVE: To understand T cell role in the immunopathogenesis of rheumatoid arthritis(RA), authors investigated Vbeta usage of T cell receptor(TCR) in different onset RA lesion of the same patient using a reverse transcriptase-polymerase chain reaction. The current pathogenic model of RA plays a critical role in CD4+ T cells, which are thought to be able to recognize a disease-relevant antigen in the joint. In this model, activation of a certain, specific, antigen induced T cells plays a pivotal role in the development and maintenance of chronic inflammation. To search a common clone in different onset of inflammatory joints will furnish the most exact information about T cells which play a role at initiation and perpetuation of synovitis. Here, We first characterized the change in TCR Vbeta shape with elapsing time between the two joints that have the consecutive inflammation . METHODS: Synovial fluids and peripheral blood were obtained from a patient with active RA who had two successively developing inflammatory joints with 1 week interval(the right knee joint(RT) was involved first and the left knee joint(LT) later). RT-PCR technology was employed to examine synovial fluid and peripheral T cells. Oligonucleotide primers specific for individual TCR Vbeta gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in fresh T cells subpopulations(CD4+, CD8+ T cells). RESULTS: The CD4+ T cells with TCR Vbeta 1(LT: 4.78%, RT: 2.17%), Vbeta 2(LT: 5.84%, RT: 0. 63%), Vbeta 5.1 (LT: 3.40%, RT: 1. 07%), Vbeta 5. 2 (LT: l. 91%, RT: 0. 31%), Vbeta 8(LT: 4. 20%,RT: 0. 19%), Vbeta 9(LT: 2. 61%, RT: 0. 12beta), Vbeta 10(LT: 4. 08%, RT: l. 27%), Vbeta 12(LT: 4. 53%, RT: 0. 99%), Vbeta 22 (LT: 3. 85%, RT: 0. 38%), Vbeta 23(LT: 3. 99%, RT: 0. 63%) were used more predominantly in the left knee joint than in the right knee joint while Vbeta 15 and 18 were used far more in the right knee joint. The CD8+ T cells were used less frequently in the left side than in the right side except the Vbeta 3, 4 and 7 families. CONCLUSIONS: Among the CD4+ T cells, TCR Vbeta 1, 2, 5. 1, 5. 2, 8, 9, 10, 12, 22, 23 families might play a key role in early symptomatic synovitis in RA. The role of TCR Vbeta 15 and 18 families increase in progressing synovitis with time. On the other hand, the late recruitment of CD8+ T cells in the inflamed site might be related to nonspecific inflammatory reaction.
Arthritis, Rheumatoid* ; Clone Cells ; DNA Primers ; Genes, T-Cell Receptor ; Hand ; Humans ; Inflammation* ; Joints ; Knee Joint* ; Knee* ; Synovial Fluid ; Synovitis ; T-Lymphocytes

Systemic lupus erythematosus is a prototype of systemic autoimmune disease which is characterized by polyclonal B cell activation and production of various autoantibodies, especially antibodies against nucleosome. The pathogenesis of lupus does not depend on a single gene defect but depend on multiple genetic and environmental factors. Lately defects of apoptosis have been focused as a potential etiologic factor of systemic autoimmune diasease. Apoptosis is an active programmed cell death which removes unwanted cells without any inflammatory sequelae. Cells of immune system are programmed to be deleted unless recruited into appropriate immune response. The fate of certain cell may be controlled by the balance between cell death signals and survival signals for each cells. The importance of these pathways in maintaining tolerance is highlighted by the development of lupus-like disease in three different mouse strains that have spontaneous mutations in the Fas or its ligand. We have a lot of reports on the relationship between apoptosis and systemic lupus erythematosus in terms of pathogenesis after then. We need to review all information on apoptosis and lupus and find appropriate direction toward research and clinical aspect, even though we don t have complete knowledge on signal transduction and regulators of apoptosis. Here relationships between systemic lupus erythematosus and apoptosis were reviewed on a few different viewpoints : 1) too little apoptosis of immune cell, 2) accelerated spontaneous apoptosis and nucleosome secretion, 3) defective phagocytosis of macrophage, 4) relationship between antiphospholipid antibody and apoptosis.
Animals ; Antibodies ; Antibodies, Antiphospholipid ; Apoptosis* ; Autoantibodies ; Autoimmune Diseases ; Cell Death ; Immune System ; Lupus Erythematosus, Systemic* ; Macrophages ; Mice ; Nucleosomes ; Phagocytosis ; Signal Transduction

Idiopathic sclerosing peritonitis is a rare disease characterized by fibrosis and adhesion of the peritoneum to loops of the small intestine. It may be the cause of an unusual surgical emergency such as small bowel ileus. It is diagnosed predominantly in female adolescents. We report the case of an idiopathic sclerosing peritonitis in Korea. A 38-year-old man visited emergency room for recurrent small bowel ileus and migrating mass like lesion. Computed tomography (CT) of abdomen showed acute peritonitis with a diffuse wall thickening of terminal ileum and extraluminal fluid collectionaround the terminal ileum. He underwent laparotomy. The ileocolectomy with adhesiolysis was performed and its pathological examination revealed the characteristic findings of idiopathic sclerosing peritonitis. Symptoms recurred 2 months after surgery, but improved with steroid treatment.
Adolescent ; Male ; Female ; Humans

Tumor necrosis factor (TNF)-alpha blockade has been well proved to significantly improve the disease course of rheumatoid arthritis. However, since TNF-alpha plays an important role in the immune system against external infectious organisms, it was reported that TNF-alpha blockade could increase the frequency of serious opportunistic infections such as tuberculosis. Fungal bursitis is a rare infectious disease following sever infections, malignancies and immune deficiencies. Moreover, there was no report on fungal bursitis occurring after administration of TNF-alpha blockade in Korea to date. Recently we experienced a 58-year-old female patient with rheumatoid arthritis who presented soft buttock mass after treatment with etanercept and was finally diagnosed as fungal bursitis by Candida parapsilosis.
Female ; Humans ; Tumor Necrosis Factor-alpha

A 31-year-old woman was referred to our hospital and diagnosed as overlap syndrome with systemic lupus erythematosus and dermatomyositis. After completing the fourth cycle of intravenous immunoglobulin therapy, the patient developed acute confusional state with the Glasgow Coma Scale of 7. Considering the lack of response to high dose corticosteroid therapy (methylprednisolone 1 g per day for 3 days), rituximab (500 mg per week) was administered twice. The next day after the administration of the first dose of rituximab, the level of consciousness started to improve and 15 days after rituximab, mental status was fully recovered. The proportion of CD19+ B cells started to decrease within 1 week after the administration of rituximab and remained depleted for 14 weeks. There was also a gradual decrease in serum CD40 and CD80 concentration measured by ELISA up to 4 months. This case suggests the effect of rituximab for the treatment of neuropsychiatric lupus.
Female ; Humans