OBJECTIVE: We compared the Disease Activity Score 28 (DAS28) using C-reactive protein (DAS28-CRP) with DAS28 using erythrocyte sedimentation rate (DAS28-ESR) in assessing rheumatoid arthritis (RA) activity and determining European League Against Rheumatism (EULAR) response criteria. METHODS: We searched the PubMed, EMBASE, and Cochrane databases and performed a meta-analysis to examine comparisons between DAS28-CRP and DAS28-ESR by RA activity and EULAR response criteria. RESULTS: A total of ten studies were included in this meta-analysis. Significantly more patients were classified as having remission or low disease activity when using DAS28-CRP than when using DAS28-ESR (odds ratio [OR]=1.869, 95% confidence interval [CI]=1.180 to 2.959, p=0.008; OR=1.411, 95% CI=1.256 to 1.586, p=7.0×10⁻⁸), whereas fewer patients were classified as having high disease activity when using DAS28-CRP than when using DAS28-ESR (OR=0.534, 95% CI=0.388 to 0.734, p=1.1×10⁻⁴). More patients were classified as having good response with criteria were based on DAS28-CRP than with DAS28-ESR (OR=1.390, 95% CI=1.183 to 1.632, p=6.10×10⁻⁵). CONCLUSION: Our meta-analysis demonstrates that DAS28-CRP underestimates disease activity and overestimates response by the EULAR response criteria compared to DAS28-ESR.
Arthritis, Rheumatoid* ; Blood Sedimentation* ; C-Reactive Protein* ; Erythrocytes* ; Humans ; Rheumatic Diseases

OBJECTIVETo identify the candidate auto-antigen of rheumatic heart disease as a molecular marker for this disease.

METHODSThe total RNA of the heart tissue of patients with rheumatic heart disease was extracted and reverse-transcribed into long cDNA to construct the phage expression library. The library was screened using the serum from patients with active rheumatic fever, and the positive clone was identified and analyzed by bioinformatics and expressed in vitro. The expressed products were evaluated with Western blotting and its cross-reactivity was assessed.

RESULTSThe phage expression library of the heart tissue of patients with rheumatic heart disease was constructed, with the titer of the primary library of 3.3×10(6) pfu/ml, recombinant rate of 99%, and 81% of the inserted segments were larger than 1 kb. An auto-antigen RHDAG1 was identified by screening, which was homologous to keratin 18. RHDAG1 was detected in the serum of patients with active rheumatic fever and of those with rheumatic heart disease, but not in the serum of healthy subjects.

CONCLUSIONPhage display library can be an effective strategy to screen the auto-antigens of rheumatic heart disease. The auto-antigen RHDAG1 can be a candidate molecular biomarker of rheumatic heart disease and/or rheumatic fever.

Autoantibodies ; blood ; immunology ; Autoantigens ; immunology ; isolation & purification ; Autoimmune Diseases ; blood ; immunology ; Humans ; Peptide Library ; Rheumatic Heart Disease ; immunology

OBJECTIVES: To analyze arthritic manifestations in Behcet disease, which is one of the most common manifestations of Behcet disease. METHODS: Among the patients who visited the Rheumatology Division, Keimyung University Dongsan Medical Center, Taegu, Korea from March 1997 to February 1998, 35 patients, with more than 3 months follow-up, were compatible for the diagnosis of Behcet disease according to the Shimizu criteria, after exclusion of uncertain or possible Behcet cases. The presence of various manifestations was evaluated. Regarding the joint manifestations, the involved joint, signs and the pattern of the articular symptoms were examined. Basic laboratory tests, HLA studies and simple radiologic studies were done. RESULTS: All 35 patients had evident, recurrent, painful oral ulcers by the study definition. Genital ulcers were found in 29%, skin lesions in 77%, uveitis in 9%, gastrointestinal ulcerations in 6% and vascular manifestations in 6%. Joint manifestations appeared in 97%. Knee(91%), proximal interphalangeal (53%) and metacarpophalangeal joints(21%) were the main sites. Tenderness was prominent in 91% and swelling in 44%. Polyarticular presentation was found in 47%. In most cases (76.4%), the articular symptom was short-lasting. C-reactive protein was likely to be positive in active Behcet disease. HLA B51 was positive in 46%. CONCLUSIONS: In Behcet disease, various manifestations can be found. The arthritic manifestation seems quite common. It may present as seronegative rheumatoid arthritis. Otherwise, it may present as palindromic rheumatism.
Adult ; Arthritis, Rheumatoid/diagnosis* ; Arthritis, Rheumatoid/blood ; Behcet's Syndrome/diagnosis* ; Behcet's Syndrome/blood ; C-Reactive Protein/metabolism ; Comparative Study ; Diagnosis, Differential ; Female ; Human ; Joints/pathology ; Male ; Middle Age ; Rheumatic Diseases/diagnosis* ; Rheumatic Diseases/blood

OBJECTIVE: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). METHODS: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. RESULTS: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. CONCLUSION: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.
Achilles Tendon ; Arthritis, Psoriatic ; Arthritis, Reactive ; Blood Sedimentation ; Bursitis ; C-Reactive Protein ; Fascia ; Humans ; Rheumatic Diseases* ; Spondylarthropathies* ; Spondylitis ; Tendons ; Ultrasonography

OBJECTIVETo investigate the feasibility and safety of autologous peripheral blood hematopoietic stem cell transplantation (auto-PBHSCT) and its therapeutic effect on refractory rheumatism among preschool children.

METHODSThree boys with juvenile rheumatoid arthritis (JRA), juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM) respectively, 3 to 6 years old with the mean age of 5 years with 3.5 to 22 months course of disease with 14 months on average, received auto-PBHSCT. Their conditions were so severe that conventional therapy failed to control the diseases. The changes of both clinical manifestations and immunologic indexes were observed before and after transplantation with long term following up at specialty clinic of rheumatism.

RESULTThe time when neutrophil count >or= 0.5 x 10(9)/L in the 3 children was days +9, +13 and +11 respectively, that of platelet count >or= 20 x 10(9)/L was days +14, +18 and +13 respectively. The cellular immune function remained abnormal with CD4 cells at a low level and CD4/CD8 being inverted. As to the JDM child, the skin rash had disappeared and his muscle tone was improved to grade 5 within one month after the transplantation. The EMG and serum creatase level returned to normal and muscle MRI findings were improved greatly within 2 months after the transplantation. As to the JSLE child, skin rash and proteinuria had disappeared, MRI of brain showed that the pathological changes had been absorbed and EEG returned to normal 3 months after the transplantation, all the autoantibodies turned to negative within 8 months after transplantation. As to the JRA child, the arthritis had been improved remarkably within 3 weeks after auto-PBHSCT. There was no swelling of joints nor movement limitation 3 months post transplantation. The steroids and immunosuppressive drugs were discontinued post transplantation. Cushing syndrome disappeared. Their body heights increased by 10 to 15 cm in the past 18 months, and they all returned to school. There was no relapse during follow-up periods of 25 - 27 months.

CONCLUSIONThe therapy with auto-PBHSCT for refractory rheumatism among preschool children was remarkably effective in a short-term, yet the safety and long-term effect still need to be further studied.

Child ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Peripheral Blood Stem Cell Transplantation ; Rheumatic Diseases ; therapy ; Transplantation, Autologous ; Treatment Outcome

Wegener's granulomatosis (WG) is highly correlated with cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA). Patients with rheumatoid arthritis (RA) rarely contract WG. Although several concurrent cases have been reported overseas, there are no known cases in Korea. Here we report a unique case of RA with atypical WG testing positive for perinuclear ANCA (p-ANCA) and negative for anti-myeloperoxidase (MPO) antibodies. The 62-yr-old female patient presented with multiple joint pain and showed typical blood test results for RA, i.e., an elevated erythrocyte sedimentation rate and C-reactive protein concentration, and positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. RA was clear based on a total score of 10 when applying the classification criteria developed by the American College of Rheumatology/European League Against Rheumatism (2010). In an autoimmune target test, speckled and skeleton patterns were observed. In an ANCA test, p-ANCA was observed (titer, 1:2,560), and tests for anti-proteinase 3 (PR3) and anti-MPO antibodies were negative. After admission, multiple nodules were detected on a chest X-ray and a computed tomography scan. We suspected that she had rheumatic nodules or vasculitis and performed an open lung biopsy. We detected necrotic granulomatous vasculitis, classified as WG, thus leading to WG diagnosis. In conclusion, WG was diagnosed in an RA patient who was negative for c-ANCA (negative PR3) and positive for p-ANCA (negative anti-MPO), and this peculiar finding is likely to improve diagnosis in cases of RA with atypical WG.
Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Arthritis, Rheumatoid* ; Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Classification ; Cytoplasm ; Diagnosis ; Female ; Hematologic Tests ; Humans ; Korea ; Lung ; Rheumatic Diseases ; Rheumatic Nodule ; Rheumatoid Factor ; Skeleton ; Thorax ; Vasculitis ; Wegener Granulomatosis*

Aortic regurgitation is a common valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart disease, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decreascendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular disease, Segal et al (1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic reguritation in patients with predominent mitral disease has begun to be appreciated recently, especially as commisurotomies for the relief of mitral stenosis are performed more frequently. Nowadays eventhough the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved. This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortography at Severance Hospital from January, 1970 to August, 1976. 1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency. 2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical heaving, and left ventficular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram. 3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade I, and 10 patients being grade II on cineaortogram.
Aortic Valve Insufficiency* ; Blood Pressure ; Chest Pain ; Diagnosis ; Electrocardiography ; Heart Murmurs ; Heart Valve Diseases ; Humans ; Hypertrophy ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Rheumatic Fever ; Syphilis ; Thorax

OBJECTIVETo establish the migraine rheumatism stasis syndrome animal model.

METHODThe rat migraine rheumatism stasis syndrome animal model was established through rheumatism stimulation with manual climate box, 5-HT reduction caused by reserpine and local cerebral vasospasm. General vital signs (activity, weight, eye gum, hair, feeding, excrement), head scratch frequency and image collection were observed to analyze the changes in biological signs of stasis syndrome (tongue image RGB), thrombin and serotonin of model rats.

RESULTThe reserpine group and the reserpine plus rheumatism model group showed significant reduction in blood coagulation time, pain threshold and 5-HT content in blood and brain (P < 0.01); the reserpine plus rheumatism model group showed an increase in eye gum and decreases in activity, feeding, with thin sloppy stool. According to the tough RGB values, the control group showed light red toughs, the reserpine group showed dark purple toughs, the reserpine plus rheumatism model group showed gray toughs, with notable differences in tough RGB values in all three group.

CONCLUSIONThe rheumatism stimulation with manual climate box, 5-HT reduction caused by reserpine and local cerebral vasospasm can be used to induce the migraine rheumatism stasis syndrome animal model, but its modeling assessment method and process shall be further improved.

Animals ; Blood Circulation ; Diagnosis, Differential ; Disease Models, Animal ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Migraine Disorders ; diagnosis ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Rheumatic Diseases ; diagnosis ; physiopathology

OBJECTIVE: We investigated the long-term outcomes of autologous peripheral blood stem cell transplantation (PBSCT) to treat refractory rheumatic diseases. METHODS: Patients who underwent PBSCT for refractory rheumatic diseases at our institution between 2002 and 2005 were assessed for outcomes including treatment response, adverse events, damage accrual, and survival at 6 months and last follow-up. RESULTS: Eleven patients, including six with systemic lupus erythematosus (SLE), four with systemic sclerosis (SSc), and one with Still's disease were treated with PBSCT. In SLE patients, two showed complete response, two partial response, and two expired. One patient who expired responded completely two months after transplantation but discontinued treatment by choice and expired at six months due to an SLE flare. Long-term, two patients went into remission without organ damage, one patient went into remission with organ damage, and one had low disease activity with organ damage. Of the four patients with SSc, two showed a complete response, one a partial response, and there was one transplantation-related death at six months. At the last record notation, two remained in remission without relapse and one was lost to follow-up. The Still's disease patient partially responded at six months and was in remission at the last record notation. CONCLUSION: The ten-year survival rate was 70% with a 40% recurrence rate and 20% treatment-related mortality rate.
Follow-Up Studies ; Humans ; Lost to Follow-Up ; Lupus Erythematosus, Systemic ; Mortality ; Peripheral Blood Stem Cell Transplantation* ; Recurrence ; Rheumatic Diseases* ; Scleroderma, Systemic ; Survival Rate

OBJECTIVE: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. METHODS: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). RESULTS: Serum CK activity was significantly reduced in RA (mean+SD: 45.7 +24.2 IU/L) compared to controls (81.3+33.9 IU/L) (p < 0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: 0.31, p < 0.01; 0. 45, p < 0.001; 0.42, p < 0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant.
Adrenal Cortex Hormones ; Arthritis, Rheumatoid* ; Blood Sedimentation ; C-Reactive Protein ; Creatine Kinase* ; Creatine* ; Humans ; Platelet Count ; Retrospective Studies ; Rheumatic Diseases ; Steroids