OBJECTIVE: To define the state of remission based on American College of Rheumatology (ACR) preliminary criteria in Korean patients with rheumatoid arthritis (RA). METHODS: A hundred three patients of RA, followed up over 1 year, were selected at Ewha medical center from May 2000 to May 2006. Remission was defined by ACR preliminary criteria. Data were obtained from the initial and the last visit. Data on initial tender joint count (TJC) and swollen joint count (SJC), treatment, disease duration, remission duration were collected. Initial ESR, CRP, rheumatoid factor (RF), TJC and SJC were also performed at the last clinical visit or at the time of remission. RESULTS: Patients in remission were 35%. The maintenance duration of remission was 4.8+/-9.0 (mean+/-SD) months. Remission group had shorter disease duration (20.2+/-34.7 vs. 58.2+/-83.2 months, p=0.010), were at earlier stage of the disease (<2 years of symptom onset) (80.6 vs. 52.2%, p=0.006) compared to non-remission group. Percentage of patients showing decrease in RF titer was significantly higher in the remission group compared to the non-remission group (p=0.049). However, seronegative conversion of RF was not related to remission status (15.6 vs. 14.8%). In the non-remission group, pain was the most persistently non-satisfying clinical variable of the ACR preliminary criteria. CONCLUSION: Patients at early stage of disease achieved clinical remission in higher rate. Changes of RF titer was affected by clinical remission status.

No abstract available.
Humans ; Hyperuricemia ; Renal Insufficiency, Chronic

Gut microbiota produce dietary metabolites such as short-chain fatty acids, which exhibit anti-inflammatory effects. Free fatty acid receptor 2 (FFA2, formerly known as GPR43) is a specific receptor for short-chain fatty acids, such as acetate that regulates inflammatory responses. However, the therapeutic potential of FFA2 agonists for treatment of atopic dermatitis has not been investigated. We investigated the efficacy of the FFA2 agonist, 4-chloro-α-(1-methylethyl)-N-2-thiazoylylbenzeneacetanilide (4-CMTB), for treatment of atopic dermatitis induced by 2,4-dinitrochlorobenzene (DNCB). Long-term application of DNCB to the ears of mice resulted in significantly increased IgE in the serum, and induced atopic dermatitis-like skin lesions, characterized by mast cell accumulation and skin tissue hypertrophy. Treatment with 4-CMTB (10 mg/kg, i.p.) significantly suppressed DNCB-induced changes in IgE levels, ear skin hypertrophy, and mast cell accumulation. Treatment with 4-CMTB reduced DNCB-induced increases in Th2 cytokine (IL-4 and IL-13) levels in the ears, but did not alter Th1 or Th17 cytokine (IFN-γ and IL-17) levels. Furthermore, 4-CMTB blocked DNCB-induced lymph node enlargement. In conclusion, activation of FFA2 ameliorated DNCB-induced atopic dermatitis, which suggested that FFA2 is a therapeutic target for atopic dermatitis.

Sphingosine-1-phosphate (S1P) and its receptors have been implicated in atopic dermatitis. S1P2 was found to function as a proallergic receptor, while its antagonist JTE-013 was found to suppress allergic asthma in mice. Topical application of JTE-013 has not been investigated in an in vivo model of atopic dermatitis. Therefore, the therapeutic potential of JTE-013 topical application was evaluated by the use of a 2,4-dinitrochlorobenzene (DNCB)-induced atopic dermatitis mouse model. DNCB-induced inflammation and mast cell accumulation in skin tissues were significantly suppressed by topical JTE-013 treatment in BALB/c mice. DNCB-induced increase of lymph nodes sizes and elevated inflammatory cytokines (IL-4, IL-13, IL-17, and IFN-γ) in lymph nodes were also significantly reduced by the JTE-013 treatment. Elevated serum levels of IgE were significantly suppressed by the topical treatment of JTE-013. In summary, the topical treatment of JTE-013 S1P2antagonist suppressed DNCB-induced atopic dermatitis symptoms and immune responses. These results suggested JTE-013 as a potential therapeutic agent for atopic dermatitis.

Tumor necrosis factor (TNF) is known to play a critical role in the pathogenesis of rheumatoid arthritis (RA). Etanercept is a recombinant soluble fusion protein of TNF type II receptor and IgG, which acts as a specific TNF- antagonist. Anti-TNF-therapy has been an important advance in the treatment of RA. However, induction of autoantibodies in some proportion of patients treated with TNF inhibitors raised concerns for development of systemic autoimmune diseases such as systemic lupus erythematosus (SLE). Although new autoantibody formation is common with anti-TNF therapy, there are only rare reports of overt SLE, most of which manifested without major organ involvement and resolved shortly after discontinuation of the therapy. We describe a 55-yr-old Korean woman who developed overt life threatening SLE complicated by pneumonia and tuberculosis following etanercept treatment for RA. This case is to our knowledge, the first report of etanercept-induced SLE in Korea.
Receptors, Tumor Necrosis Factor ; Middle Aged ; Lupus Erythematosus, Systemic/*chemically induced ; Immunoglobulin G/*adverse effects ; Humans ; Female ; Arthritis, Rheumatoid/*drug therapy ; Antirheumatic Agents/*adverse effects

Dermatomyositis and polymyositis are uncommon, acquired idiopathic inflammatory myopathies of an unknown etiology. Although there are 9 reported cases in the literature of developing dermatomyositis or polymyositis after collagen dermal injection, it is still controversial whether there is a link between injectable filler materials and autoimmune diseases, and specifically dermatomyositis/polymyositis. We experienced a case of a 40-year-old woman who developed dermatomyositis after repeated injections of multiple filler materials, including collagen for cosmetic purposes, which suggests a temporal relation between the two factors. The benefit-to-risk ratio should be assessed for repeated cosmetic surgical procedures that use filler materials.
Adult ; Aluminum Hydroxide ; Autoimmune Diseases ; Carbonates ; Collagen ; Cosmetics ; Dermatomyositis ; Female ; Humans ; Myositis ; Polymyositis

Patients with severe active lupus nephritis (LN) require immunosuppressive therapy to induce remission. However, the development of profound hypogammaglobulinemia causing cytomegalovirus (CMV) disease is a rare occurrence during standard immunotherapy. A 27-year-old woman who presented with active LN along with moderate renal impairment was treated with of mycophenolate mofetil (MMF) and methylprednisolone. MMF was soon switched with low-dose intravenous (IV) cyclophosphamide (CYC) owing to the development of posterior reversible encephalopathy syndrome and deterioration of renal function requiring hemodialysis. After two cycles of IV CYC, she developed CMV colitis and pneumonia. Although her serum immunoglobulin (Ig) concentrations before receiving immunosuppressive treatment were normal, they were profoundly reduced at CMV disease onset and continued to maintain low level for 30 months. Severe hypogammaglobulinemia can occur during standard therapy for LN, especially in patients with impaired renal function, pointing out the importance of close monitoring of Ig levels and CMV infection.
Adult ; Agammaglobulinemia ; Colitis ; Cyclophosphamide ; Cytomegalovirus Infections ; Cytomegalovirus ; Female ; Humans ; Immunoglobulins ; Immunotherapy ; Lupus Nephritis ; Methylprednisolone ; Pneumonia ; Posterior Leukoencephalopathy Syndrome ; Renal Dialysis

OBJECTIVES: To compare the epidemiology, clinical presentation, laboratory findings, seasonality and hospital course of enteroviral meningitis (EM) and non-enteroviral meningitis (NEM) cases in infants under 3 months of age. METHODS: A retrospective chart review was performed of infants under 3 months of age or less with viral meningitis admitted to Ewha Womans University Mokdong Hospital between January 2010 and December 2016. RESULTS: EM patients were more likely to have siblings compared with NEM. Most of EM was diagnosed during the summer season. Almost 80% of EM was diagnosed between July and September. Fever lasted longer in EM patients compared to NEM. White blood cell count (WBC) from the cerebrospinal fluid was higher in EM patients compared with NEM patients. WBC in blood were lower in EM patients compared with NEM patients. C-reactive protein was lower in EM patients compared with NEM patients. Most of the patients were initially started on antibiotics therapy to rule out bacterial meningitis. EM patients received shorter duration of antibiotic treatment compared with NEM patients. CONCLUSION: This study was conducted to augment the understanding of the incidence, epidemiology, transmission in infants, clinical presentation, laboratory findings, seasonality and hospital courses of enteroviral meningitis compared to NEM. Early recognition, rapid diagnosis and proper clinical management can reduce duration of antibiotic treatment.
Anti-Bacterial Agents ; C-Reactive Protein ; Cerebrospinal Fluid ; Diagnosis ; Enterovirus ; Epidemiology* ; Female ; Fever ; Humans ; Incidence ; Infant* ; Leukocyte Count ; Meningitis* ; Meningitis, Bacterial ; Meningitis, Viral ; Polymerase Chain Reaction ; Retrospective Studies ; Seasons ; Siblings

Background: Two methods of counting cells in body fluids were compared;manual counting using a Neubauer chamber, and automated cell countingusing an XN-350 hematology analyzer. Methods: Cells from 32 body fluid samples were counted by manualexamination and by an automated analyzer. Total cells (TC), white bloodcells (WBC), red blood cells (RBC), polymorphonuclear leukocytes (PMN),mononuclear leukocytes (MN), neutrophils, lymphocytes, monocytes, andeosinophils were each counted by both methods. The results were comparedusing the Pearson correlation test, Bland-Altman regression analysis, andPassing-Bablok regression analysis. Results: The two methods showed very strong correlation in TC, WBC,RBC, PMN, and MN counts, strong correlation in % neutrophils, and %lymphocytes, and weak correlation in % monocytes and % eosinophils.Using Bland-Altman regression analysis, the mean biases for TC, WBC, andRBC were -270, -257.4, and -1,256.09, respectively, and 0.15 for PMN andMN. Research parameters were compared as well: mean biases were -1.31,-2.46, -5.16, and -3.58 for % neutrophils, % monocytes, % lymphocytes,and % eosinophils, respectively. Passing-Bablok regression equationswere y=1.039x+20, y=1.037x+19, y=1.259x+0.0, y=0.983x+1.541, andy=0.983x+0.125 for TC, WBC, RBC, PMN, and MN, respectively. The equationswere y=0.955x+2.194 for % neutrophils, y=0.965x+1.184 for % monocytes,y=1.003x+0.161 for % lymphocytes, and y=x+0.75 for % eosinophils. Conclusions WBC differential count results performed by an automatedhematology analyzer generally show good correlation with our referencemethod, Neubauer chamber counting.

Background: In this study, we aim to examine the effects of pre-analytical factors such as specimen type (serum or plasma), collection and storage conditions, and time, on the results of chemiluminescence immunoassay. Methods: Blood samples were collected from 10 individuals and aliquoted into two sets of K3-ethylenediaminetetraacetic acid (EDTA) and serumseparating tubes (SST) each, for plasma and serum collection, respectively.For all the samples, one set of tubes was centrifuged within 1 hour and other set was centrifuged after 4 hours, followed by cell separation.Chemiluminescence assay was performed for adrenocorticotropic hormone (ACTH), parathyroid hormone (PTH), osteocalcin, C-telopeptide, and insulin at 0, 6, 24, and 48 hours after centrifugation; all the samples were assayed in duplicate. The samples were stored at 4℃ before the assay. Results: The results obtained showed that the levels detected in plasmas were more consistent and stable as compared to serum. After a 6-hour storage at 4℃, a significant decrease was observed in the levels of ACTH and osteocalcin in plasma and serum; whereas, PTH and C-telopeptide levels were stable in plasma but decreased significantly in serum. Insulin levels in serum showed a decrease after a 6-hour storage while the levels in plasma were found to be stable until 24-hour storage. Serum samples separated after 4 hours showed a significant decrease in all hormone levels, while C-telopeptide and insulin levels were stable in plasma samples separated after 4 hours. Conclusions The results were found to be more stable in plasma samples from K3-EDTA tubes as compared to serum samples from SST in the measurement of unstable biological analytes. These results suggest that K3-EDTA tubes are preferable in the specimen collection for assaying biological analytes.