No abstract available.
Purpura, Schoenlein-Henoch ; Skin

Dermatomyositis (DM) is rare systemic inflammatory disease with typical skin manifestations and muscular involvement. Various skin lesions can accompany this disease, such as Gottron's sign, Heliotrope rash, mechanic's hands, V sign and shawl sign. Scleredema is a very rare skin manifestation in DM. We report a case of DM in a 63-year-old woman, who had scleredema on her thighs. A diagnosis of DM was established by clinical manifestation, elevated muscle enzyme levels, electromyogram measures, and muscle biopsy findings. She was successfully treated with the immunosuppressants methotrexate, cyclosporine, and steroids (low dose).
Biopsy ; Cyclosporine ; Dermatomyositis ; Exanthema ; Female ; Hand ; Humans ; Immunosuppressive Agents ; Methotrexate ; Middle Aged ; Muscles ; Scleredema Adultorum ; Skin ; Skin Manifestations ; Steroids ; Thigh

One of the severe adverse reactions to anti-tumor necrosis factor (TNF)-alpha therapy is the reactivation of tuberculosis. We present a case of tuberculous peritonitis in a 57-year-old woman with rheumatoid arthritis (RA) that appeared during treatment with infliximab. Confirming a diagnosis of tuberculous peritonitis is difficult and can be delayed because of the nonspecific symptoms, the rarity of the disease and the low detection rate of mycobacteria in ascites fluid. This case illustrates that prompt anti-tuberculous therapy is needed for suspected cases of tuberculous peritonitis in RA patients treated with infliximab.
Antibodies, Monoclonal ; Arthritis, Rheumatoid ; Ascites ; Female ; Humans ; Middle Aged ; Necrosis ; Peritonitis, Tuberculous ; Tuberculosis ; Infliximab

Several autoimmune and chronic inflammatory conditions have been consistently linked with an increased risk of hematologic malignancies. Although ankylosing spondylitis (AS) is a chronic inflammatory disease, previous studies have demonstrated that it is not associated with an increase in risk of malignant lymphomas. Cases of AS accompanied by hematologic malignancies such as multiple myeloma, chronic myelogenous leukemia, and Hodgkin's disease have been reported. In Korea, AS with non-Hodgkin's lymphoma or follicular lymphoma has not been reported. We experienced a 38-year-old male who had been diagnosed with follicular lymphoma with bone metastasis, who achieved complete remission after having been treated with chemotherapy, developed new inflammatory back pain. An MRI of his hip showed an active inflammation of the left sacroiliac joint and a positive HLA-B27. The patient was diagnosed with AS and was treated with naproxen, which improved the pain in his back and buttock.
Adult ; Back Pain ; Buttocks ; Hematologic Neoplasms ; Hip ; HLA-B27 Antigen ; Hodgkin Disease ; Humans ; Inflammation ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lymphoma ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin ; Male ; Multiple Myeloma ; Naproxen ; Neoplasm Metastasis ; Sacroiliac Joint ; Spondylitis, Ankylosing

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology that is characterized by high-spiking fever, arthralgia, sore throat, and skin rash. The typical rash of AOSD is an evanescent, salmon-colored erythema, which is considered to be the major diagnostic criterion. Recently, other cutaneous manifestations of AOSD, such as persistent plaque and urticaria, have been reported. Here, we report a rare case of AOSD presenting with periorbital swelling and erythema. A 47-year-old woman was presented with periorbital swelling, erythema, high fever, arthritis, and a sore throat. One year prior to admission, she was diagnosed with AOSD based on the diagnostic criteria of Yamaguchi. The patient's periorbital swelling and erythema may not have been associated with periorbital cellulitis because they did not respond to antibiotics but did improve after treatment with steroids. Considering all of her signs and symptoms with a history of AOSD, periorbital lesion was suspected as atypical cutaneous manifestation of AOSD.
Arthralgia ; Arthritis ; Cellulitis ; Edema ; Erythema ; Female ; Fever ; Humans ; Middle Aged ; Pharyngitis ; Steroids ; Still's Disease, Adult-Onset ; Urticaria

Methotrexate is often used in patients with systemic lupus erythematosus for effective disease controlsand steroid-sparing, and has been known to involve the development of lymphoproliferative disorders for patients with autoimmune diseases. We report a case of spontaneous regression of Epstein-Barr virus-positive methotrexate-associated Hodgkin's lymphoma in a 24-year-old woman with systemic lupus erythematosus. Following 6 months of treatment with low-dose methotrexate, the patient developed a neck mass in the right submandibular area. A computed tomography scan of the neck, chest and abdomen revealed multiple enlarged lymph nodes. Excisional biopsy of the neck masses confirmed infiltrations of malignant lymphoid cells that were positive for CD15, CD30, and Epstein-Barr virus-encoded RNA. Reduction of the mass was observed 3 weeks after withdrawing from the methotrexate treatment. At 7 months after initial presentation, computed tomography revealed near-complete regression of lymphadenopathy. After 30 months, the patient was still in complete clinical remission.
Abdomen ; Autoimmune Diseases ; Biopsy ; Female ; Hodgkin Disease ; Humans ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Lymphoproliferative Disorders ; Methotrexate ; Neck ; Remission, Spontaneous ; Thorax ; Young Adult

OBJECTIVE: Although a series of trials support that rheumatoid arthritis (RA) is associated with increased atherosclerosis, the link between microvascular structural changes and the disease activity of RA has not been clarified. We measured changes in the retinal microvasculature using fundus fluorescein angiography (FAG) and investigated the association between the retinal vasculature and clinical parameters of RA. METHODS: Seventy-five RA patients and sixty healthy control were included. Morphometric and quantitative features in the capillary images including retinal vascular signs and vessel diameters were measured with fundus photography and FAG. RA activity was assessed based on high sensitivity C-reactive protein (hsCRP), disease activity score with 28 joints (DAS 28), and health assessment questionnaire (HAQ). RESULTS: Central retinal arteriolar equivalents (CRAE) was 118.1+/-31.3 microm in RA patients and 123.8+/-19.9 microm in control subjects, showing the tendency of retinal arteriolar narrowing in patients with RA but without statistical significance. The mean central retinal venular equivalents (CRVE) was 162.4+/-26.4 microm which was significantly higher than that of control group (144.1+/-23.1 microm, p<0.001). The prevalence of AVN was 34.7%, and significantly higher in RA group. Among retinal findings, the presence of early pinpoint hyperfluorescence and areas of delayed choroidal perfusion correlated with hsCRP. Age, disease duration, DAS 28, HAQ, and rheumatoid factor (RF) had no effect on CRAE and CRVE. In multivariate analysis, only hsCRP was found to be associated with wider venular caliber. CONCLUSION: Retinal venular widening was more common in RA patients. Retinal venular diameter had significant correlation with disease activity of RA. Retinal imaging is a comparative method for the assessment of microvascular findings of RA patients.
Arthritis, Rheumatoid ; Atherosclerosis ; C-Reactive Protein ; Capillaries ; Choroid ; Fluorescein ; Fluorescein Angiography ; Humans ; Joints ; Microvessels ; Multivariate Analysis ; Perfusion ; Photography ; Prevalence ; Rheumatoid Factor ; Surveys and Questionnaires

OBJECTIVE: To compare the urate-lowering efficacy and the safety of febuxostat, allopurinol and placebo in Korean patients with gout for 4 weeks. METHODS: Subjects (n=182) with gout were randomized to febuxostat (40, 80, 120 mg), allopurinol 300 mg, or placebo group. The primary end point was the proportion of subjects whose serum urate concentration fell to less than 6.0 mg/dL after the 4-week treatment. RESULTS: The primary end point was reached at 25.7%, 80.0% and 83.3% of patients receiving 40, 80 and 120 mg of febuxostat, respectively, 58.3% of those receiving 300 mg of allopurinol and none of the placebo (p<0.001: each febuxostat dose or allopurinol group versus placebo group, p=0.0484 and p=0.0196: febuxostat 80 and 120 mg compared with allopurinol, respectively). The number and proportion of subjects who developed adverse events (AEs) were 13 subjects (37%), 14 (39%) and 18 (50%) in the febuxostat of 40, 80 and 120 mg group, respectively, 21 (57%) in the allopurinol 300 mg group and 17 (46%) in the placebo group. No statistically significant differences in the incidence rates of adverse events were observed between the groups. There was no significant difference in gout flare-up incidence. CONCLUSION: Febuxostat, 80 mg or 120 mg, was more effective than allopurinol (300 mg) or placebo, when lowering the serum urate. The safety of febuxostat and allopurinol was comparable.
Allopurinol ; Gout ; Humans ; Incidence ; Thiazoles ; Uric Acid ; Febuxostat

Infection is a critical and challenging situation encountered in treatment of inflammatory rheumatic diseases (IRDs). It is associated with the disease activity itself and/or the immunosuppressant treatments. Vaccine preventable infections could be controlled by use of a timely vaccination protocol. Immunosuppressed situations observed in IRDs require some modification of the recommendation for the general population in each national society. Live attenuated vaccines are generally contraindicated in IRDs, except for varicella-zoster vaccination, which is solely permitted live vaccine and could be given on a case by case basis in autoimmune IRDs. Influenza and pneumococcal vaccines are strongly recommended due to increased mortality in patients with IRDs. The vaccination protocol reflects the current national medical environment and requirements; therefore, it could change with time. The Korean Rheumatology Society now requires that vaccination be recommended for patients with IRDs, with the possibility of both an adult and child version.
Adult ; Child ; Humans ; Influenza, Human ; Pneumococcal Vaccines ; Rheumatic Diseases ; Rheumatology ; Vaccination ; Vaccines, Attenuated

Many rheumatic diseases may involve any organ system of the body including the skin. Proper understanding of rheumatic skin disease is necessary for making a diagnosis. In addition, there are important relationships existing between the cutaneous and systemic manifestations of rheumatic diseases. In management of these diseases, the interdisciplinary approach could generate better results. Among rheumatic diseases, the cutaneous manifestations of three major rheumatic diseases such as lupus erythematosus (LE), dermatomyositis (DM)/polymyositis and scleroderma/systemic sclerosis (SSc) will all be reviewed.
Dermatomyositis ; Lupus Erythematosus, Systemic ; Rheumatic Diseases ; Polymyositis ; Scleroderma, Systemic ; Skin ; Skin Diseases