Gout is the most common crystal-associated arthropathy. Gout is caused by deposition of monosodium urate crystals within the joints, and it is often associated with hyperuricemia. Acute gout involves the first metatarsophalangeal joint (podagra) in approximately 50% of cases and its peak incidence occurs in middle age. Although the clinical features can help with making the diagnosis of gout, many inflammatory diseases such as cellulitis, pseudogout and septic arthritis can mimic or coexist with it. The definitive diagnosis requires polarized light microscopy of the fluid aspirated from the involved joint and this shows needle-shaped, negative birefringent monosodium urate crystals. However, joint aspiration can be technically difficult, and none of the conventional imaging modalities for gout specifically identifies the chemical composition of uric acid. The advent of Dual-Energy CT (DECT) is a noninvasive method that has the potential to confirm gout and monitor the response to treatment. DECT scan can show monosodium urate deposition by using color coding. The authors performed DECT scans for detecting uric acid deposition and confirming the gout noninvasively.
Arthritis, Infectious ; Cellulitis ; Chondrocalcinosis ; Clinical Coding ; Gout ; Humans ; Hydrazines ; Hyperuricemia ; Incidence ; Joints ; Metatarsophalangeal Joint ; Microscopy, Polarization ; Middle Aged ; Organothiophosphorus Compounds ; Uric Acid

Necrotizing fasciitis (NF) is an uncommon, life-threatening infection of the subcutaneous tissue and superficial fascia. The clinical course of NF is rapid and progressive, and it is often fatal despite the appropriate therapy. The prognosis of NF depends on a timely diagnosis and then proper treatment. At onset it may not be possible to clearly distinguish NF from minor soft-tissue infections. Although infection are common due to the use of steroids and immunosuppressive agents in patients with systemic lupus erythematous (SLE), it is interesting that NF has rarely been reported with SLE. Here, we present two cases of NF with SLE.
Fasciitis, Necrotizing ; Humans ; Immunosuppressive Agents ; Prognosis ; Steroids ; Subcutaneous Tissue

We present a 24-year-old woman with systemic lupus erythematosus presented with multiple patches of non-scarring alopecia closely resembling alopecia areata. Scalp biopsy showed a predominantly subcutaneous and dermal lymphocytic infiltrate that surrounded the deep follicular segments and hair bulb. This pattern is capable of producing a temporary hair loss, clinically misdiagnosed as alopecia areata. The clinical history, presence of erythema on bald patches and scalp tenderness as well as the biopsy findings were important clues in diagnosis of lupus erythematosus. We report here a case of lupus panniculitis that presented as multiple bald patches misdiagnosed as alopecia areata.
Alopecia ; Alopecia Areata ; Biopsy ; Erythema ; Female ; Hair ; Humans ; Lupus Erythematosus, Systemic ; Panniculitis, Lupus Erythematosus ; Scalp ; Young Adult

Dermatomyositis is a inflammatory myopathy associated with interstitial lung disease in 5~10% of cases. The occurrence of diffuse alveolar hemorrhage (DAH) is considered exceptional in the course of dermatomyositis. We experienced a case of DAH in a 58-year-old female with dermatomyositis. DAH was diagnosed by anemia, infiltration on chest X-ray and computed tomography, and a bloody aspirate on bronchoscopy. Combined Pneumocystis jiroveci (PJP) pneumonia was suspected, as the polymerase chain reaction for PJP was positive. After intravenous the administration of immunoglobulin and treatment for the PJP, she markedly improved but subsequently developed nosocomial pneumonia and died.
Anemia ; Bronchoscopy ; Dermatomyositis ; Female ; Hemorrhage ; Humans ; Immunoglobulins ; Lung Diseases, Interstitial ; Middle Aged ; Myositis ; Pneumocystis jirovecii ; Pneumonia ; Polymerase Chain Reaction ; Thorax

Nontuberculous mycobacteria (NTM) are widely distributed in nature and are usually of low pathogenic potential. NTM rarely has been recognized as a cause of musculoskeletal infections that involve joints, bone and soft tissue in immunocompetent patients. The risk factors of its infection are local traumas caused by surgery, injury, or injection. A fifty five-year-old immunocompetent patient visted to hospital due to right wrist mass and pain. Excisional biopsy was done. Histologically granulomatous inflammation was identified and Mycobacterium intracellulare was cultured. Although very rare, NTM should be suspected at least once as a causative pathogen of chronic arthritis when the cause is uncertain.
Arthritis ; Biopsy ; Humans ; Inflammation ; Joints ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Risk Factors ; Wrist

Rheumatoid arthritis is associated with an increased risk of hematological malignancy as a result of the RA itself or its treatment. We report here on an unusual case of a 55-year-old female with long-standing rheumatoid arthritis and who was treated with low dose methotrexate and hydrochloroquine. She was diagnosed with chronic myelogenous leukemia that manifested with severe thrombocytosis and basophilia, and this was treated with imatinib mesylate. After 6 months, she achieved a complete cytogenetic response of the CML and a complete resolution of all the RA symptoms without DMARDs.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Benzamides ; Cytogenetics ; Female ; Hematologic Neoplasms ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mesylates ; Methotrexate ; Middle Aged ; Piperazines ; Pyrimidines ; Thrombocytosis ; Imatinib Mesylate

Among osteoporosis medications, Teriparatide is an agent that promotes bone formation and it seems to have an effect, due to an anabolic mechanism, in the early postoperative period after osteosynthesis or joint replacement. But to the best of our knowledge, the effect of teriparatide on pedicle screw loosening has not been previously reported. We report there on a case of pedicle screw loosening after corrective osteotomy in a patient with ankylosing spondylitis with osteoporosis, which was not improved by teriparatide, and we review the related literature.
Humans ; Joints ; Osteogenesis ; Osteoporosis ; Osteotomy ; Postoperative Period ; Spondylitis, Ankylosing ; Teriparatide ; Transplants

Paclitaxel takes effects as an anti-neoplastic agent by interfering with microtubules and then blocking cell growth. It has been used to treat patients with lung, ovarian, breast, head and neck cancer, and advanced forms of Kaposi's sarcoma. Along with its reputation as an effective chemotherapeutic drug, paclitaxel has numerous adverse effects. Among them, cutaneous adverse effects of paclitaxel include pruritis, bullous fixed eruption, onycholysis, and transient erythrodysesthesia. Only several cases of scleroderma-like lesions have been reported throughout the world, and in Korea, only one case of paclitaxel induced scleroderma has been reported in 2006. We report a case of paclitaxel induced scleroderma in an 83-year old woman with ovarian cancer. After administration of paclitaxel and cisplatin, the patient presented with edema in both brachial areas, Raynaud's phenomenon, and sclerotic skin lesions in both extremities.
Breast ; Cisplatin ; Edema ; Extremities ; Female ; Head and Neck Neoplasms ; Humans ; Korea ; Lung ; Microtubules ; Onycholysis ; Ovarian Neoplasms ; Paclitaxel ; Pruritus ; Sarcoma, Kaposi ; Skin

OBJECTIVE: We wanted to investigate the mechanisms that could account for the pathogenesis of rheumatoid arthritis, so we examined the different expressions of the genes in rheumatoid arthritis (RA) synovial fluid macrophages as compared with that of normal peripheral blood (PB) monocyte-derived macrophages using microarray and bioinformatic analysis. METHODS: We examined the expression of genes by using a gene expression oligonucleotide microarray. The differences of the gene expressions between the RA synovial macrophages and the normal PB monocytes-derived macrophages were analyzed using bioinformatic tools, including cytoscape and its plugin. RESULTS: In this study, we found that 899 genes (464 genes up-regulated and 435 genes down-regulated) were differentially expressed between the two groups. Among the 899 genes, 552 genes were included for gene ontology analysis and network analysis. Based on biological process ontology, they were categorised mainly into immune response processes, responses to stimulus and signaling and regulation of biological processes. In addition to the genes related with STAT1 and AP-1 signaling, we found that the genes involved in the antigen processing and the cell cycle are abundantly expressed in RA synovial macrophages, suggesting that these genes may play an important role in the pathogenesis of RA. CONCLUSION: Our study suggest that this approach using integration of the gene expression profile with the protein interaction data may help to find several important pathogenic mechanisms in RA.
Antigen Presentation ; Arthritis, Rheumatoid ; Biological Processes ; Cell Cycle ; Computational Biology ; Gene Expression ; Genes, vif ; Macrophages ; Oligonucleotide Array Sequence Analysis ; Synovial Fluid ; Transcription Factor AP-1 ; Transcriptome

OBJECTIVE: We wanted to evaluate the prevalence of gout and its features in Korean people using the National Health Insurance Corporation (NHIC) database. METHODS: Using the NHIC database from 2001 to 2008, we selected the gout patients who were coded as having gout as a main diagnosis. From the total number of gout patients, we evaluated the prevalence of gout and its features. RESULTS: The prevalence of gout prevalence was 0.171% in 2001 and 0.397% in 2008, and there was a 2.317 fold increased during over the 7 years. In 2008, the percentage of fifth and sixth decade patients was 48.5% and that of the male patients were 89.8% of the total gout patients. The increasing rate of the prevalence of gout during the same period was also higher in males (the male vs. female ratio was 5.3:1 in 2001 and 8.8:1 in 2008). The gout prevalence increased year by year to the eighth decade, and the peak prevalence age group was the ninth decade in 2001, the eighth decade in 2002-2005 and the seventh decade in 2006-2008. The prevalence ratio of 2008 to 2001 was higher for the males and the younger age group; that of third decade for males was 9.87 , which was over the 10 times higher compared to that of the ninth decade (9.87 vs. 0.89, respectively). CONCLUSION: The prevalence of gout in 2008 using the NHIC database was 0.397%, so the prevalence of gout increased 2.317 fold over the 7 years, and nearly 90% of the gout patients were male. The increasing rate of gout prevalence was higher in the males and the younger age group.
Clinical Coding ; Databases, Factual ; Female ; Gout ; Humans ; Male ; National Health Programs ; Prevalence