A 62-year-old Korean woman was admitted to our department to evaluate a chronic cough and sputum, which had begun several weeks ago. The patient had been diagnosed with systemic sclerosis in 2004. Autoantibody screening tests were negative for the anticentromere and antitopoisomerase antibodies. She received therapy with combined cyclophosphamide, a calcium channel blocker, D-penicillamine, and low dose steroid. In 2006, a pulmonary function test (PFT) showed a restrictive pattern, and a computed tomography (CT) scan of the lungs revealed interstitial lung disease, but no symptoms were present, so we maintained her on the medication. In October 2008, a chest x-ray and CT scan of the lungs demonstrated aggravation with bilateral basal interstitial infiltrates and hilar lymphadenopathy. Cyclophosphamide pulse therapy was conducted six times during 6 months, but there was no change on her chest CT and PFT, and she had no symptoms, so we decided to follow up. On admission, no significant interval change in the reticular opacity of both lower lungs was observed, but several lymph nodes were enlarged on a chest and neck CT. The skin showed multiple large polygonal-shaped scaled lesions on her upper and lower extremities. Biopsies were taken from the skin of the lower extremities and the left cervical lymph node. Typical non-caseating granulomas corresponding to sarcoidosis were found along with systemic sclerosis findings.
Antibodies ; Biopsy ; Calcium Channels ; Cough ; Cyclophosphamide ; Female ; Follow-Up Studies ; Granuloma ; Humans ; Lower Extremity ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Lymphatic Diseases ; Mass Screening ; Middle Aged ; Neck ; Penicillamine ; Respiratory Function Tests ; Sarcoidosis ; Scleroderma, Systemic ; Skin ; Sputum ; Thorax

OBJECTIVE: The purpose of this study was to evaluate whether serum C1q-circulating immune complexes (C1q-CIC) serve as a predictive marker for renal flares in patients with lupus nephritis. METHODS: Twenty-five patients with lupus nephritis and 24 healthy controls were enrolled. Patients with lupus nephritis had their serum C1q-CIC titers and other serologic parameters such as serum C3, C4, anti-dsDNA antibody, and erythrocyte sedimentation rate measured simultaneously. The systemic lupus erythematosus disease activity index (SLEDAI) was also checked. RESULTS: Serum C1q-CIC titers were higher in patients with lupus nephritis than in healthy controls (109.33+/-53.79 microg/mL vs. 75.28+/-22.91 microg/mL, p=0.008). A statistically significant association was found between serum C1q-CIC titers and C3 (p=0.011), C4 (p=0.027), and anti-dsDNA antibody (p=0.014). SLEDAI was also correlated with serum C1q-CIC titers (p=0.022). CONCLUSION: Serum C1q-CIC appears to be related to renal disease activity in patients with lupus nephritis. These results suggest that serum C1q-CIC is a predictive marker for renal flares in patients with lupus nephritis.
Antigen-Antibody Complex ; Blood Sedimentation ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis

OBJECTIVE: Controversies exist as to whether early treatment for Kawasaki disease might increase the need for additional intravenous immunoglobulin (IVIG) treatment and whether it could reduce cardiac complications. We conducted this study to add useful clues, which could be helpful when setting up a treatment plan. METHODS: 359 patients who were newly diagnosed with Kawasaki disease at Severance Hospital were divided into two groups; patients who received IVIG treatment within 3 days (group A) and those who received IVIG treatment after 3 days (groups B and C). We compared the laboratory data, fever duration, frequency of additional IVIG treatment, and echocardiography follow-up results. RESULTS: IVIG was administered 1.11+/-0.34 (mean+/-SD), 1.15+/-0.39, and 1.17+/-0.42 times in groups A, B, and C, respectively; p=0.29 (A vs. B), p=0.21 (A vs. C). The incidence of cardiac complications checked within the first 2 weeks from disease onset was 3.6%, 5.2%, and 5.1% in groups A, B, and C, respectively; p=0.52 (A vs. B), p=0.55 (A vs. C), and the values checked at 2 months were 3.6%, 5.6%, and 5.7% in groups A, B, and C, respectively; p=0.43 (A vs. B), p=0.43 (A vs. C). CONCLUSION: Early IVIG treatment in patients with Kawasaki disease decreased fever duration and may prevent cardiac complications by limiting inflammation.
Echocardiography ; Fever ; Follow-Up Studies ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Inflammation ; Mucocutaneous Lymph Node Syndrome

OBJECTIVE: This study was designed to identify prognostic determinants of radiographical severity in patients with ankylosing spondylitis (AS) living in Daegu and Kyungpook territories. METHODS: One hundred-nineteen patients with AS were consecutively enrolled from four regional general hospitals. Clinical data including smoking habits, alcohol intake, disease duration, HLA-B27 positivity, involvement of peripheral joints, occupational activity, and regular exercise were investigated. Radiographical severity was assessed by the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses were performed using the independent Student's t-test, Pearson's correlation coefficient analysis, and multivariate regression analysis. RESULTS: Radiographical severity, as evaluated with the mSASSS, was associated with age of disease onset (p=0.011) and disease duration (p<0.001). Additionally, mSASSS was significantly higher in males than females (p=0.039) and in patients without involvement of ankle arthritis than those with involvement of ankle arthritis (p=0.026). Patients with hip arthritis had significantly higher mSASSS scores than those without hip arthritis. A multivariate regression analysis showed that older age of disease onset, male gender, and disease duration were independent predictors of AS radiographical severity (p<0.001, p=0.013, and p<0.001, respectively). Hip arthritis was an independent predictor of C-spine radiographical severity in AS (p=0.031). CONCLUSION: Radiographical severity of the prognosis was determined by age of disease onset, gender, and disease duration in patients with AS living in Daegu and Kyungpook territories.
Animals ; Ankle ; Arthritis ; Female ; Hip ; HLA-B27 Antigen ; Hospitals, General ; Humans ; Joints ; Male ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Spondylitis, Ankylosing

OBJECTIVE: Gout is one of the most common forms of inflammatory arthritides among men, which is caused primarily by chronic hyperuricemia. Although pharmacological therapy is the mainstay treatment to manage gout, limiting the consumption of dietary purine is also important. Several epidemiological studies have reported that alcohol consumption is closely related to hyperuricemia and gout. The objective of this study was to determine the purine content in common Korean alcoholic beverages using high performance liquid chromatography (HPLC) to provide a dietary guideline for those with hyperuricemia or gout. METHODS: Thirty-five alcoholic beverages were analyzed. Blindly labeled samples of each alcoholic beverage were degassed and frozen. The sample preparation prior to HPLC followed the methods of Japanese researchers. HPLC was performed to analyze adenine, guanine, hypoxanthine, and xanthine content in the alcoholic beverages. RESULTS: The standard curves were linear for all purines. Purine contents were as follows: beer (42.26~146.39 micromol/L, n=12), medicinal wine (8.2 and 40.41 micromol/L, n=2), rice wine (13.19 micromol/L), Makgeolri (11.71 and 24.72 micromol/L, n=2), red wine (0, 6.03, and 17.9 micromol/L, n=3). No purines were found in fruit wine (n=2), Kaoliang (n=1), white wine (n=1), or distilled alcoholic beverages, such as soju (n=10) or whiskey (n=1). CONCLUSION: Among popular Korean alcoholic beverages, beer contained a considerable amount of purines, whereas distilled alcoholic beverages did not. Patients with either gout or hyperuricemia should avoid alcoholic beverages, especially those containing large amounts of purines.
Adenine ; Alcohol Drinking ; Alcoholic Beverages ; Alcoholics ; Arthritis ; Asian Continental Ancestry Group ; Beer ; Chromatography, High Pressure Liquid ; Chromatography, Liquid ; Fruit ; Gout ; Guanine ; Humans ; Hyperuricemia ; Hypoxanthine ; Male ; Purines ; Wine ; Xanthine

OBJECTIVE: Behcet's disease (BD) is a chronic systemic inflammatory disease with unknown etiology. A number of clinical and laboratory findings suggest a strongly polarized Th1 immune response in BD. T-bet is a newly identified Th1 specific T-box transcription factor selectively expressed in Th1 cells. However, it is not yet clear whether the T-bet protein is involved in the proposed Th1-mediated pathogenesis of BD at the transcriptional level. Therefore, this study investigated the potential associations of two single nucleotide polymorphisms (SNPs) at positions -99 (C/G) and -1993 (T/C) in the exon and promoter regions of the TBX21 gene with susceptibility to BD in the Korean population. METHODS: 105 patients with BD and 105 healthy controls were studied. All subjects were genotyped using restriction fragment length polymorphism analysis. The genotypes of the two groups were compared with the chi-square or Fisher's exact tests. RESULTS: The genotypic and allelic distributions of the two SNPs did not differ significantly between the two groups. Furthermore, no associations between the polymorphisms and clinical manifestations were found, except a central nervous system manifestation and arthritis. Furthermore, no associations between the polymorphisms and severity were identified. CONCLUSION: TBX21 gene polymorphisms were not associated with susceptibility, clinical manifestations, or severity of BD in the Korean population.
Arthritis ; Central Nervous System ; Exons ; Genotype ; Humans ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Th1 Cells ; Transcription Factors

Among the many regions (joints) of the human extremities, the foot and ankle area has a variety of disorders, which seem difficult to diagnose mainly because the anatomy seems rather complex. There are two main regions i.e. ankle and foot where the foot is divided into forefoot, midfoot and hindfoot. Among the many disorders, some of the most common and important disorders such as hallux valgus, osteochondral lesion of talus and lateral ankle instability are summarized in the aspect of clinical manifestations, physical examination, differential diagnosis, radiographic findings, initial treatments and the criteria for the surgery. The recent trend of surgical treatment options have also been described with related references.
Animals ; Ankle ; Diagnosis, Differential ; Extremities ; Foot ; Hallux Valgus ; Humans ; Physical Examination ; Talus

Magnetic resonance imaging (MRI) is a highly reliable tool for diagnosing ankylosing spondylitis. MRI can identify cartilage abnormalities, subcortical erosions, bone marrow edema with inflammation, and synovial enhancement. Subchondral sclerosis and juxta-articular fat deposition are noted in the chronic stage of ankylosing spondylitis. Spinal changes associated with spondyloarthropathy are florid anterior spondylitis (or Romanus lesion), florid diskitis (Anderson lesion), ankylosis, and arthritis of the apophyseal and costovertebral joints. A MRI grading system for inflammation in sacroiliac joints and the spine could help clinicians evaluate the anti-inflammatory efficacy of therapeutics. Newer technologies based on MRI are aimed at broadening the diagnostic scope and facilitating the quantification of active inflammation but still require extensive validation.
Ankylosis ; Arthritis ; Bone Marrow ; Cartilage ; Discitis ; Edema ; Inflammation ; Joints ; Magnetic Resonance Imaging ; Sacroiliac Joint ; Sacroiliitis ; Sclerosis ; Spine ; Spondylarthropathies ; Spondylitis ; Spondylitis, Ankylosing

No abstract available.

No abstract available.
Arthritis, Rheumatoid* ; Humans