2.Recent Paradigm Shifts in the Diagnosis and Treatment of Rheumatoid Arthritis.
The Korean Journal of Internal Medicine 2012;27(4):378-387
Rheumatoid arthritis (RA) is a progressive inflammatory disease with severe symptoms of pain and stiffness. Chronic persistent inflammation of RA often leads to joint destruction, deformity and limitation of function, which ultimately results in significant deterioration of quality of life (QoL). RA is characterized pathogenetically by immunologically driven, chronic synovitis, and production of autoantibodies, such as rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Although the cause of RA is yet unknown, advances in the molecular biology led to in-depth understanding of its pathogenesis, and have fostered the recent development of novel treatments. The last decade has seen the dramatic change in the landscape of RA treatment with more aggressive therapy early in the disease course and with treatment guided by a structured assessment of disease activity, with the ultimate goal of reaching remission. In addition, prevention and control of joint damage and improvement in QoL are important goals. To achieve these goals, a multidisciplinary approach to reduce disease activity with disease modifying antirheumatic drugs and biological therapy is needed. We also need to find ways to identify those patients who are at risk for more rapid disease progression who would benefit from intensive therapy early in the course of disease.
Antibodies, Monoclonal/therapeutic use
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Antirheumatic Agents/therapeutic use
;
Arthritis, Rheumatoid/*diagnosis/etiology/*therapy
;
Biological Products/therapeutic use
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Humans
;
Tumor Necrosis Factor-alpha/antagonists & inhibitors
3.An under-recognized cause of polyarthritis: leprosy.
Khor Jia KER ; Jiun Yit PAN ; Nai Lee LUI ; Hong Liang TEY
Annals of the Academy of Medicine, Singapore 2013;42(7):366-367
Anti-Inflammatory Agents
;
administration & dosage
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Arthritis
;
diagnosis
;
drug therapy
;
etiology
;
physiopathology
;
Arthritis, Rheumatoid
;
diagnosis
;
Clofazimine
;
administration & dosage
;
Dapsone
;
administration & dosage
;
Delayed Diagnosis
;
Diagnosis, Differential
;
Humans
;
Leprostatic Agents
;
administration & dosage
;
Leprosy
;
complications
;
diagnosis
;
drug therapy
;
physiopathology
;
Male
;
Middle Aged
;
Prednisolone
;
administration & dosage
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Rifampin
;
administration & dosage
;
Treatment Outcome
4.A Case of Pseudomembranous Colitis in a Juvenile Rheumatoid Arthritis Patient Taking Methotrexate.
Jihan YU ; Na Young KIM ; Hae Min LEE ; Ha Ni LEE ; Hyo Jun AHN ; Sang Woo KIM ; Kyu Yong CHOI
The Korean Journal of Gastroenterology 2010;56(6):387-390
Pseudomembranous colitis is mainly caused by antibiotics and Clostridium difficile infection. But conditions such as gastrointestinal surgery, antacid medication, anti-neoplastic agent or immunosuppressive agent which influences the normal flora of colon can induce colitis without the administration of any antibiotics. We experienced a 13 year-old male who was taking low-dose methotrexate for juvenile rheumatoid arthritis complained diarrhea and abdominal pain for 3 weeks. Sigmoidoscopic findings revealed diffuse patch yellowish pseudomembranes on the rectum. Histologic finding was compatible to pseudomembranous colitis. His symptom was improved after stop taking methotrexate and the administration of metronidazole. If a patient treated with immunosuppressive agents or antineoplastic agents complains diarrhea, fever or abdominal pain and has not improved with conservative care, pseudomembranous colitis should be taken into account as a differential diagnosis and prompt treatment is required for better prognosis.
Abdominal Pain/etiology
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Adolescent
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Anti-Infective Agents/therapeutic use
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Antirheumatic Agents/*adverse effects/therapeutic use
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Arthritis, Juvenile Rheumatoid/*drug therapy
;
Diagnosis, Differential
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Diarrhea/etiology
;
Enterocolitis, Pseudomembranous/*diagnosis/drug therapy/pathology
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Humans
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Male
;
Methotrexate/*adverse effects/therapeutic use
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Metronidazole/therapeutic use
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Sigmoidoscopy
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Tomography, X-Ray Computed
5.Relapsing Course of Sulfasalazine-Induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Complicated by Alopecia Universalis and Vitiligo.
Bertrand Sy LIAN ; Inny BUSMANIS ; Haur Yueh LEE
Annals of the Academy of Medicine, Singapore 2018;47(11):492-493
Alopecia
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chemically induced
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diagnosis
;
Antirheumatic Agents
;
administration & dosage
;
adverse effects
;
Arthritis, Rheumatoid
;
drug therapy
;
Biopsy
;
methods
;
Cyclosporine
;
administration & dosage
;
Dermatologic Agents
;
administration & dosage
;
Drug Hypersensitivity Syndrome
;
diagnosis
;
etiology
;
physiopathology
;
therapy
;
Humans
;
Male
;
Middle Aged
;
Prednisolone
;
administration & dosage
;
Skin
;
pathology
;
Sulfasalazine
;
administration & dosage
;
adverse effects
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Symptom Flare Up
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Treatment Outcome
;
Vitiligo
;
chemically induced
;
diagnosis
6.Mortality in patients with rheumatoid arthritis-associated interstitial lung disease treated with an anti-tumor necrosis factor agent.
Bon San KOO ; Seokchan HONG ; You Jae KIM ; Yong Gil KIM ; Chang Keun LEE ; Bin YOO
The Korean Journal of Internal Medicine 2015;30(1):104-109
BACKGROUND/AIMS: To evaluate the impact on mortality of anti-tumor necrosis factor (anti-TNF) treatment of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS: We retrospectively reviewed the medical records of 100 RA-ILD patients who visited our tertiary care medical center between 2004 and 2011, identified those treated with an anti-TNF agent, divided patients into non-survivor and survivor groups and evaluated their clinical characteristics and causes of death. RESULTS: A total of 24 RA-ILD patients received anti-TNF therapy, of whom six died (25%). Mean age at initiation of anti-TNF therapy was significantly higher in the nonsurvivor versus survivor group (76 years [range, 66 to 85] vs. 64 years [range, 50 to 81], respectively; p = 0.043). The mean duration of anti-TNF treatment in the non-survivor group was shorter (7 months [range, 2 to 14] vs. 23 months [range, 2 to 58], respectively; p = 0.030). The duration of anti-TNF therapy in all nonsurviving patients was < 12 months. Pulmonary function test results at ILD diagnosis, and cumulative doses of disease-modifying drugs and steroids, did not differ between groups. Five of the six deaths (83%) were related to lung disease, including two diffuse alveolar hemorrhages, two cases of acute exacerbation of ILD, and one of pneumonia. The sixth patient died of septic shock following septic arthritis of the knee. CONCLUSIONS: Lung complications can occur within months of initial anti-TNF treatment in older RA-ILD patients; therefore, anti-TNF therapy should be used with caution in these patients.
Adult
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Aged
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Aged, 80 and over
;
Antirheumatic Agents/adverse effects/*therapeutic use
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Arthritis, Rheumatoid/complications/diagnosis/*drug therapy/immunology/mortality
;
Female
;
Humans
;
Lung Diseases, Interstitial/diagnosis/etiology/*mortality
;
Male
;
Middle Aged
;
Republic of Korea
;
Retrospective Studies
;
Risk Assessment
;
Risk Factors
;
Tertiary Care Centers
;
Time Factors
;
Treatment Outcome
;
Tumor Necrosis Factor-alpha/*antagonists & inhibitors