Systemic lupus erythematosus is an autoimmune disease involving many organs. tt is likely that hyperthyroidism is also and autoimmune disease. Although thyroid disease has been associated with systemic rheumatic diseases, systemic lupus erythematosus is not commonly associated with hyperthyroidism. The case of 23 year-old, who had hyperthroidism and systemic lupus erythematosus is described, and the relationship of the two diseases is discussed.
Autoimmune Diseases ; Humans ; Hyperthyroidism* ; Lupus Erythematosus, Systemic* ; Rheumatic Diseases ; Thyroid Diseases ; Young Adult

Eosinophilia is usually accompanied by parasite infestation, allergic condition, drug, collagen disease, and idiopathic hypereosinophilic syndrome. In about 10 to 40% of rheumatoid arthritis patients, peripheral blood reveals eosinophilia. Of the rheumatic disease, eosinophilia may occur in rheumatoid arthritis, sarcoidosis, polyarteritis nodosa and other vascultis. Patient with eosinophilia must be carefully followed up due to possibility of progression to eosinophilic leukemia or myeloproliferatire disease. We experienced a case of rheumatoid arthritis with severe eosinophilia for a period of more than one year in a 53 year-old female patient, eosinophil more than 85% in the peripheral blood, but in spite of careful laboratory study, there was no evidence of parasite infestation, allergic disease and malignant condition that may cause eosinophilia. Therefore we concluded that her severe eosinophilia was associated with rheumatoid arthritis itself, and now she is intensively followed up at the outpatient department. We have to look for any malignant transformation during her clinical course. Marked eosinophilia associated with rheumatoid arthritis is very rare, so we report this case with a review of literatures.
Arthritis, Rheumatoid* ; Collagen Diseases ; Eosinophilia* ; Eosinophils ; Female ; Humans ; Hypereosinophilic Syndrome ; Middle Aged ; Outpatients ; Parasites ; Polyarteritis Nodosa ; Rheumatic Diseases ; Sarcoidosis

We report a pateint with CNS-SLE who initially manifested liver involvement. We emphasize the difficulty in differentiating autoimmune hepatitis and hepatic involvement of SLE, clinically, immunologically, radiologically, pathologically. Neuropsychiatric disorders casued by lupus activity occur during the course of the illness in 35~75% of patients with SLE. It is a poor prognostic sign and frequent cause of death in lupus patients. Recently some evidence suggest that single-photon-emission computed tomography(SPECT) of brain is useful for detecting abnormalities of regional cerebral blood flow in patients with CNS lupus. We were able to conclude that CNS symptoms in this patient were due to CNS involovement of SLE. Although MRI of brain showed some high signal intensity in parenchyme of brain, this findings were said to be common in chronic liver diseases. In this situdation we think that SPECT of brain might be performed for differentiation of the cause of CNS symptoms in SLE patient with chronic liver disease.
Brain ; Cause of Death ; Central Nervous System* ; Hepatitis, Autoimmune ; Humans ; Liver Diseases ; Liver* ; Lupus Erythematosus, Systemic* ; Magnetic Resonance Imaging ; Tomography, Emission-Computed, Single-Photon

Sjogren's syndrome is an autoimmune exocrinopathy that develops into systemic autoimmune disease in 25% of patients, leading to general complications, one of which is kidney involvement. It presents mainly as interstitial nephritis, disclosed by hyposthenuria, distal renal tubular acidosis and diabetes insipidus. We here describe one case of secondary Sjogren syndrome with distal renal tubular acidosis who developed nephrocalcinosis and renal insufficiency.
Acidosis, Renal Tubular* ; Autoimmune Diseases ; Diabetes Insipidus ; Humans ; Kidney ; Nephritis, Interstitial ; Nephrocalcinosis ; Renal Insufficiency ; Sjogren's Syndrome*

OBJECTIVE: For the past quarter of a century, the medical treatment of rheumatoid arthritis has been both illustrated and influenced by the therapeutic pyramid. In this plan of sequential drug administration, the initial choice, the base of pyramid, is aspirin or one of the many other NSAIDs. Droxicam, a new NSAID, is a pro-drug of piroxicam and acts by inhibition of PGE2~. Although it belongs to oxicam family, it is characterized by being a pro-drug of piroxicam, the molecule undergoing conversion by hydrolysis once dissolved in the digestive tract. So, its analgesic and anti-inflammatory potentials are the same as those of piroxicam, but G-I trouble, its major adverse effect, is less troublesome. This study was aimed to evaluate the clinical efficacy and safety of Droxicam. METHODS: Thirty three cases of active RA had been selected, 20mg of Droxicam was administrated to them per oral daily for 4 weeks and changes in pain score, numbers of tender/swollen joints, severity of their tenderness/swelling, duration of morning stiffness, grip strength, ESR and side effects of the drug were estimated. RESULTS: l. Pain rated by the patients with visual analogue scale was improved. the average pain score decreased gradually as follows: 7.0 in preadministration, 5.0 in the second weeks of post-treatment and 3.7 in the fourth weeks. 2. The numbers of tender/swollen joints and severity of their tenderness/swelling were gradually decreased after treatment. 3. Average durations of morning stiffness were 70.6 minutes in pre-administration, 67.3 in 2weeks and 59.7 in 4weeks after treatment, and average grip strengths were 45.5, 45.8, and 47,5mmHg in orders. 4. Average ESR decreased after administration : 41.3mm/hour in pre-treatment and 32.3mm/hour in 4weeks after administration. 5. Untoward effects were G-I trouble, edema, dizziness and weight gain. CONCLUSIONS: In summary, Droxicam seems to be useful drug in the treatment of active PA. However, further longterm follow-up is necessary.
Anti-Inflammatory Agents, Non-Steroidal ; Arthritis, Rheumatoid ; Aspirin ; Dizziness ; Edema ; Follow-Up Studies ; Gastrointestinal Tract ; Hand Strength ; Humans ; Hydrolysis ; Joints ; Piroxicam ; Weight Gain

OBJECTIVE: Discoid erythema is most common skin lesions in chronic cutaneous lupus erythematosus (CCLE), and patients with multiple discold lesions occasionally transform into systemic lupus erythematosus (SLE). METHOD: Four patients of CCLE with 1 or 2 another criteria for the diagnosis of SLE (incomplete/latent SLE) were identified. With these patients, we undertook prospective studies regarding the response to treatment (topical corticosteroids/antimalarials) and the course of disease over a period of 3 years. RESULTS: During the past 3 years, all of the patients continued to be stable, and only experienced minor exacervations of cutaneous and/or systemic symptoms. They showed no evidences of complete remission or developing additional criteria to determine SLE. CONCLUSION: It is suggested that incomplete/latent SLE with discold cutaneous lesions infrequently evolve to SLE, and it would appear that our cases probably have good prognosis, without or minimum systemic involvements.
Diagnosis ; Erythema ; Humans ; Lupus Erythematosus, Cutaneous* ; Lupus Erythematosus, Systemic* ; Prognosis ; Prospective Studies ; Skin

OBJECTIVE: The adhesion molecule that mediate cell-cell and cell-extracellular matrix adhes.ion provides very important role in growth and differentiation of cells and tissue. VLA integrin is a prototype of adhesion molecule which participate in cell-cell and cell-extracellular matrix interacton, especially for collagen, laminin and fibronectin. The biologic functions of VLA-integrin are very diverse. Cartilage is the target tissue of various arthritides including rheumatoid arthritis and osteoarthritis and the process of homeostasis in cartilage matrix may be very important in preservation of cartilage. Although VLA integrin may participate in the process of cartilage degeneration and repair mechanism, tissue.distribution and exact role of VLA integtin in cartilage was not yet clearly defined. METHODS:Immunohistochemical analysis of VLA-integrin in cryostat section of articular cartilage was conducted using monoclonal antibody and avidin-biotin complex method. Analysis was performed in 10 rheumatoid arthritis specimens, 7 osteoarthritis specimens and 1 normal control. RESULTS: 1) Normal cartilage showed strong and diffuse stain with CD29, CD51 and moderate stain of VLA-5. Staining pattern of VLA-1 and 3 was inconstant and weak in intensity. 2) The intensity of VLA expression in articular cartilage of osteoarthritis was upregulated chiefly in CD29, CD51 and slightly in VLA-5. The positive rate of VLA-1 and 3 was similar to that of normal cartilage though the intensity was increased especially at cluster of chondrocytes. 3) VLA-integrin expression of rheumatoid arthritis cartilage was similar to that of osteoarthritis cartilage. CONCLUSION: VLA integrins functioning as fibronectin receptor such as VLA-5 and alpha, beta1 were upregulated in osteoarthritis and rheumatoid arthritis. Intensity was increased at clusters of chondrocytes. It was able to presume from above findings that VLA molecule has some role in the maintenance and repair of articular cartilage. The regulation of expression by cytokines and growth factors and exact function of VLA molecule in cartilage have to be elucidated.
Arthritis ; Arthritis, Rheumatoid ; Cartilage ; Cartilage, Articular* ; Chondrocytes ; Collagen ; Cytokines ; Fibronectins ; Homeostasis ; Integrin alpha1beta1 ; Integrin alpha5beta1 ; Integrins ; Intercellular Signaling Peptides and Proteins ; Laminin ; Osteoarthritis

OBJECTIVE: Raynaud's phenomenon is a vascular disorder characterized by reversible spasm of arteries of fingers. It is the first symptom in 70% of partlents with systemic sclerosis. The more systemic involvment the worse prognosis is expected in patients with systemic sclerosis. A more reliable indication of systemic sclerosis is the microvascular involvement by the disease (characteristic patterns of capillary abnormality in the nail-fold). Our puroses were to evaluate the significance of the degree of nailfold capillary abnormlitry in making the diagnosis fo systemic sclerosis, and in determining organ involvement in patients with systemic sclerosis. METHODS: Twenty-six patients with Raynaud's phenomenon whose diagnosis were systemic sclerosis(10 patients), SLE(10 patient), Raynaud's disease(6 patients) were observed for nailfold capillary abnormalities by widefield microscopy. RESULTS: Capillary abnormalities were seen in 100% of the systemic sclerosis (10 patients), 30% of the SLE (3 patients) and 50% of the Raynaud's disease (3 patients). A significant correlation between degree of finger lesions (r=0.718) or organ involvement (X2=20.4, p=0.015) and capillary abnormality class was found although a significant correlation was not found between the duration of the disease and the degree of capillary abnormality in patients with systemic sclerosis (r=0.32). CONCLUSIONS: Nailfold capillary abnormality can easily be observed and could be used as an assistive tools for the diagnosis and prediction of prognosis and extent of organ involvement in patients with Raynaud's phenomenon especially in patients with systemic sclerosis.
Arteries ; Capillaries* ; Connective Tissue Diseases ; Diagnosis ; Fingers ; Humans ; Microscopy ; Prognosis ; Raynaud Disease ; Scleroderma, Systemic ; Spasm

BACKGROUND: Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies that are specific for proteins in the cytoplasm of neutrophils and monocytes. In the 10 years since their discovery, ANCA have become widely used serological markers for various systemic necrotizing vasculitides, including Wegener's granulomatosis, polyarteritis nodosa, crescentic glomerulonephritis, and Churg-Strauss syndrome. Rheumatic manifestations (such as arthralgia, myalgia, even frank arthritis) are observed frequently in the group of primary vasculitides. In the group of collagen vascular diseases and the various forms of chronic inflammatory arthritis, vasculitis may severely complicate the course of the disease. Since atypical vasculitic diseases are indistingushable from other rheumatic disorders in the initial period of disease, immunological studies must be performed. We conducted this study for obtaining the seroprevalence of ANCA in rheumatic disorders including vasculitides which are common in Korea. METHOD: ANCA was detected with indirect immunofluorescent microscopy of alcohol-fixed granulocytes. RESULTS: Total 185 patients were enrolled in this study. There was no patient having C-ANCA except one patient with Wegener's granulomatosis. Total 5 patients were positive for P-ANCA; 2 of 41 SLE patients, 1 of 22 dermatomyositis/polymyositis patients, 2 of 50 Behcet's disease patients. All 11 patients with Takayasu's meritis were ANCA-negative. These results were similar to those of others. CONCLUSION: ANCA, as a adjunct to other autoantibodies, will be helpful for differential diagnosis of various vasculitides and rheumatic disorders.
Antibodies, Antineutrophil Cytoplasmic* ; Arthralgia ; Arthritis ; Autoantibodies ; Churg-Strauss Syndrome ; Collagen ; Cytoplasm ; Diagnosis, Differential ; Glomerulonephritis ; Granulocytes ; Humans ; Immune System Diseases ; Korea ; Microscopy ; Monocytes ; Myalgia ; Neutrophils ; Polyarteritis Nodosa ; Prevalence* ; Rheumatic Diseases* ; Seroepidemiologic Studies ; Vascular Diseases ; Vasculitis* ; Wegener Granulomatosis

OBJECTIVE: Mixed connective tissue disease(MCTD) was first described by Sharp and coworkers in 1972 as distinct rheumatic diseases characterized by the overlapping features of systemic lupus erythematosus (SLE), systemic sclcrosis (SSc) and dermatomyositis/polymyositis and associated with the serologic marker anti-nRNP antibody at high titer. METHODS: We reviewed 18 cases(all females) of MCTD who were admitted or visited to rheumatism center of Hanyang University Hopital, from October 1989 to September 1992. RESULTS: 1) The average age at onset of MCTD was 38.6 years. The average duration of the disease was 5.3 years. 2) Raynaud's phenomenon was found in 100%. Arthritis was found in 13 cases but rheumatoid factor was found in 15 cases. 3) Hand swelling was found in 15 cases and myositis was found in 56% (10 cases). 4) All patients with MCTD have anti-nRNP antibodies by high titer. In general, the titer does not correlate with disease activity. CONCLUSIONS: These data suggested that the clinical features of MCTD in Korean patients revealed similar to those of previous reports regarding foreign ethnic groups.
Antibodies ; Arthritis ; Connective Tissue ; Ethnic Groups ; Hand ; Humans ; Korea* ; Lupus Erythematosus, Systemic ; Mixed Connective Tissue Disease* ; Myositis ; Rheumatic Diseases ; Rheumatoid Factor