Spinal dural arteriovenous fistula (SDAVF) is known for its ambiguous and various clinical presentations. Among these presentations, congestive myelopathy is one of the most common, yet it is challenging to correctly diagnose SDAVF at initial presentation. Several diseases present as myelopathy, including demyelinating diseases. Herein, we present two cases of congestive myelopathy due to SDAVF presenting to the emergency room (ER) with progressive quadriparesis. Even though the patients had a proper magnetic resonance imaging (MRI) examination from the initial presentation, there was a delay in making a final diagnosis. Both patients’ clinical presentation and MRI mimicked central nervous system (CNS) demyelinating disease initially, and a more thorough examination revealed SDAVF. Such a delay in diagnosis can result in more neurological deterioration and may result in more sequelae. Hence, SDAVF should always be considered as a differential diagnosis when examining patients with myelopathy.

OBJECTIVE: Lupus erythematosus panniculitis (LEP) is a rare subtype of chronic cutaneous LE. Until now, a few studies about the clinico-histopathological data of LEP have been conducted in Korea. The aim of this study was to investigate clinical, serological, and histopathologic features of LEP. METHODS: The clinical survey was retrospectively performed through the available medical records in 15 cases with LEP. The histopathologic, serologic and clinical findings were included in this analysis. RESULTS: LEP occurred primarily in females (F:M=4:1). The mean age at diagnosis was 37.5 years. 20% (3/15) of the patients was associated with SLE. DLE was accompanied with LEP in 26.6% (4/15). The predilectional sites were as follows in order: upper limbs (33.3%), lower limbs (20%), trunk (26.6%), buttock (13.3%) and face (6.6%). The fluorescent antinuclear antibody (FANA) was positive in 46% (7/15) of all cases. The main histopathologic characteristics of LEP were lymphocytic lobular panniculitis (100%), hyaline degeneration (86.6%), lymphoid aggregates (60%), mucin deposition (60%), lymphocytic vasculitis (40%). The treatment included anti-malarial agents, systemic corticosteroid, dapsone, intralesional triamcinolone injection. Although significant remission was proven in most cases (86.6%) of LEP, they represented a chronic relapsing course (83.3%). CONCLUSION: LEP is a chronic inflammatory disease of subcutaneous adipose tissue that can develop during the course of SLE. Evaluation of patients suspected of having LE panniculitis should include a complete history taking and physical examination as well as serologic studies, determination of peripheral blood counts, and tests of renal function.
Antibodies, Antinuclear ; Buttocks ; Dapsone ; Diagnosis ; Female ; Humans ; Hyalin ; Korea ; Lower Extremity ; Lupus Erythematosus, Systemic ; Medical Records ; Mucins ; Panniculitis ; Panniculitis, Lupus Erythematosus* ; Physical Examination ; Retrospective Studies ; Subcutaneous Fat ; Triamcinolone ; Upper Extremity ; Vasculitis

Background/Aims: The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period. Methods: We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020. Results: Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly during the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack. Conclusions Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.

No abstract available.
Arthritis, Gouty* ; Humans ; Pelvic Bones*

Secondary amyloidosis is a severe complication of refractory rheumatoid arthritis for which no effective treatment exists. Although the benefits of tumor necrosis factor alpha inhibitors in rheumatoid arthritis treatment are well known, their role in renal amyloidosis secondary to rheumatoid arthritis is unclear and their safety in patients with chronic kidney disease is not well reported. We present an unusual case of a 65-year-old female with moderate renal failure and severe proteinuria, who was diagnosed with secondary amyloidosis associated with refractory rheumatoid arthritis subsequent to treatment with corticosteroids, methotrexate, hydroxychlorquine, and leflunomide. She was treated with etanercept 25 mg, administered as a subcutaneous injection twice weekly for 8 months. The patient had no complications following the treatment. Treatment with etanercept led to a decrease in proteinuria and stabilization of renal function over time.
Adrenal Cortex Hormones ; Aged ; Amyloidosis* ; Arthritis, Rheumatoid* ; Female ; Humans ; Injections, Subcutaneous ; Methotrexate ; Proteinuria ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Tumor Necrosis Factor-alpha ; Etanercept

Objective: The extent of regional variations in cardiovascular risk and associated risk factors in patients with gout in South Korea remains unclear. Therefore, we aimed to investigate the risk of major cardiovascular events in gout patients in different regions. Methods: This was a nationwide cohort study based on the claims database of the Korean National Health Insurance and the National Health Screening Program. Patients aged 20 to 90 years newly diagnosed with gout after January 2012 were included. After cardiovascular risk profiles before gout diagnosis were adjusted, the relative risks of incident cardiovascular events (myocardial infarction, cerebral infarction, and cerebral hemorrhage) in gout patients in different regions were assessed. Results: In total, 231,668 patients with gout were studied. Regional differences in cardiovascular risk profiles before the diagnosis were observed. Multivariable analysis showed that patients with gout in Jeolla/Gwangju had a significantly high risk of myocardial infarction (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.02~1.56; p=0.03). In addition, patients with gout in Gangwon (aHR, 1.38; 95% CI, 1.09~1.74; p<0.01), Jeolla/Gwangju (aHR, 1.41; 95% CI, 1.19~1.67; p<0.01), and Gyeongsang/ Busan/Daegu/Ulsan (aHR, 1.37; 95% CI, 1.19~1.59; p<0.01) had a significantly high risk of cerebral infarction. Conclusion We found there were regional differences in cardiovascular risk and associated risk factors in gout patients. Physicians should screen gout patients for cardiovascular risk profiles in order to facilitate prompt diagnosis and treatment.

Milwaukee shoulder syndrome (MSS) is a rare disease in which joints are destroyed and occurs mainly in elderly women. We describe rapidly progressive MSS with complete destruction of the shoulder joint within 2 months. An 80-year-old woman visited the outpatient clinic with shoulder pain for 2 weeks. rotator cuff tear arthropathy was diagnosed, and nonsteroidal anti-inflammatory drugs were prescribed. Two months later, her shoulder pain worsened without trauma. Shoulder swelling and tenderness, and arm lifting inability were observed. Complete humeral head disruption was observed by radiography. We diagnosed MSS based on the presence of serohematic and noninflammatory joint effusion, periarticular calcific deposits, and rapid joint destruction, and initiated conservative treatment. When initially treating elderly patients with shoulder arthropathy, it is advisable to perform short-term follow-up and to consider the possibility of crystal-induced arthropathy.
Aged ; Aged, 80 and over ; Ambulatory Care Facilities ; Arm ; Female ; Follow-Up Studies ; Humans ; Humeral Head ; Joints ; Lifting ; Radiography ; Rare Diseases ; Rotator Cuff ; Shoulder Joint ; Shoulder Pain ; Shoulder ; Tears