The osteoporosis is frequently observed in the patients with the inflammatory arthritis and painful rheumatism. The treatment of the osteoporosis for them is different from that for the patients without the arthritis or rheumatism. The recently developed biologic agents blocking tumor necrosis factor, interleukin(IL)-1, IL-6, or receptor activator of nuclear factor-kappaB ligand (RANKL) which are designed to treat the inflammatory arthritis are also expected to heal the osteoporosis in the inflammatory arthritis. The early use of the bisphosphonate is useful to prevent the glucocorticoid induced bone loss and to treat the spondyloarthropathy including the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. The clacitonin is useful for the painful rheumatism and osteoporotic fracture. The estrogen replacement is disputed because the stroke is known to occur more commonly in chronic inflammatory rheumatism than in general population. Moreover the pathogenesis of the most rheumatism may be partly related to the hormone. The parathyroid hormone therapy needs caution in the patients with calcium deposition disease and the hyperuricemia. We are reviewing the recent trend and development in the management of the primary, secondary and inflammatory osteoporosis in the patients with arthritis.
Acne Vulgaris ; Arthritis* ; Biological Factors ; Calcium ; Estrogen Replacement Therapy ; Female ; Humans ; Hyperostosis ; Hyperuricemia ; Interleukin-6 ; Osteoporosis* ; Osteoporotic Fractures ; Parathyroid Hormone ; RANK Ligand ; Rheumatic Diseases ; Rheumatic Fever ; Spondylarthropathies ; Stroke ; Tumor Necrosis Factor-alpha

The clinical spectrum of spondyloarthritis is included various diagnostic entities that share clinical, genetic and pathological characteristics. As human tissue specimens of the sacroiliac joints are very difficult to obtain, most of the new concepts have emerged from different animal models of disease. Animal models are available for the study of several different aspects of spondyloarthritis. The models include human leukocyte antigen (HLA) B-27 based on transgenic rat and mouse models, inflammation-driven models, and models of ankylosing enthesitis. Areas of investigation to which these models contribute include the role of HLA B-27, process of spinal and peripheral joint inflammation and calcification, immune responses to candidate antigens and the role of tumor necrosis factor.
Animals ; Humans ; Inflammation ; Joints ; Leukocytes ; Mice ; Models, Animal ; Rats, Transgenic ; Sacroiliac Joint ; Tumor Necrosis Factor-alpha

Kawasaki disease or mucocutaneous lymph node syndrome is an acute inflammatory illness of childhood characterized by systemic panvasculitis. It presents with high fever, dramatic changes of the skin and mucous membranes, and lymphadenopathy. Adult-onset Kawasaki disease is rare and reports on coronary involvement in adult are even rarer. Herein, we report a case of adult-onset Kawasaki disease complicated by splenic infarction and development of coronary aneurysm even despite of treatment with intravenous gamma globulin. A 20-year-old man presented with fever, erytheatous rash, induration and desquamation of hands and feet, pulmonary edema and shock due to cardiomyopathy, splenic infarction, bilateral conjunctivitis, jaundice, and cervical lymphadenopathy. After Kawasaki disease was suspected, intravenous gamma globulin (2 g/kg once) and aspirin (6 g/day) were administered. On the 30th hospital day, transesophageal echocardiography showed one coronary aneurysm and coronary angiography showed three aneurysms. Eight months after the first admission, follow-up coronary angiography showed normalization of the previous coronary abnormalities.
Adult ; Aneurysm ; Aspirin ; Cardiomyopathies ; Conjunctivitis ; Coronary Aneurysm* ; Coronary Angiography ; Echocardiography, Transesophageal ; Exanthema ; Fever ; Follow-Up Studies ; Foot ; gamma-Globulins ; Hand ; Humans ; Jaundice ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome ; Mucous Membrane ; Pulmonary Edema ; Shock ; Skin ; Splenic Infarction* ; Young Adult

Early differentiation between bacterial infections and disease flares in autoimmune disease patients is important due to different treatments. Seventy-nine autoimmune disease patients with symptoms suggestive of infections or disease flares were collected by retrospective chart review. The patients were later classified into two groups, disease flare and infection. C-reactive protein (CRP) and serum procalcitonin (PCT) levels were measured. The CRP and PCT levels were higher in the infection group than the disease flare group (CRP,11.96 mg/dL +/- 9.60 vs 6.42 mg/dL +/- 7.01, P = 0.003; PCT, 2.44 ng/mL +/- 6.55 vs 0.09 ng/mL +/- 0.09, P < 0.001). The area under the ROC curve (AUC; 95% confidence interval) for CRP and PCT was 0.70 (0.58-0.82) and 0.84 (0.75-0.93), which showed a significant difference (P < 0.05). The predicted AUC for the CRP and PCT levels combined was 0.83, which was not significantly different compared to the PCT level alone (P = 0.80). The best cut-off value for CRP was 7.18 mg/dL, with a sensitivity of 71.9% and a specificity of 68.1%. The best cut-off value for PCT was 0.09 ng/mL, with a sensitivity of 81.3% and a specificity of 78.7%. The PCT level had better sensitivity and specificity compared to the CRP level in distinguishing between bacterial infections and disease flares in autoimmune disease patients. The CRP level has no additive value when combined with the PCT level when differentiating bacterial infections from disease flares.
Adult ; Aged ; Area Under Curve ; Autoimmune Diseases/complications/*diagnosis ; Bacterial Infections/complications/*diagnosis ; C-Reactive Protein/analysis ; Calcitonin/*blood ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Protein Precursors/*blood ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

No Abstract available.
Arthritis, Rheumatoid* ; Humans ; Osteoclasts*

OBJECTIVE: To compare the safety and efficacy associated with the addition of etanercept (ETN) with that of leflunomide (LEF) in Korean rheumatoid arthritis (RA) patients, who inadequately respond to methotrexate (MTX) in a randomized, open-label study. METHODS: Twenty-nine subjects suffering moderate to severe RA, despite MTX treatment were randomly assigned to a combination therapy with either ETN or LEF. The primary end-point was the proportion of subjects achieving American College of Rheumatology (ACR20) criteria at week 16. RESULTS: Ninety percent (n=18) of the ETN+MTX group (n=20) and 22.2% (n=2) of the LEF+MTX group (n=9) achieved an ACR20 response (p=0.001). All patients (n=20) in the ETN+MTX group showed moderate or good EULAR response as compared with 55.6% (n=5) in the LEF+MTX group (p=0.012). All of the ETN+MTX subjects completed the study without adverse events. Adverse events occurred in 77.8% (n=7) of cases in the LEF+MTX group; significantly elevated serum AST/ALT levels in 6 subjects and mild neutropenia (ANC < 1,500/microL) in 1 subject. CONCLUSION: The ETN+MTX combination therapy was effective and safe, whereas the LEF+MTX combination therapy resulted in moderate efficacy in only half of the cases, and was accompanied by a high rate of adverse events. Elevated AST/ALT was the most common adverse event causing dose adjustment or discontinuation of therapeutic agent in the LEF+MTX group.
Arthritis, Rheumatoid ; Humans ; Immunoglobulin G ; Isoxazoles ; Liver Function Tests ; Methotrexate ; Neutropenia ; Receptors, Tumor Necrosis Factor ; Rheumatology ; Stress, Psychological ; Etanercept

No abstract available.

A 41-year-old woman was admitted because of dyspnea on exertion for one month. She was diagnosed to have systemic lupus erythematosus 4 years ago and has taken prednisolone and azathioprine. One month prior to admission she visited dental clinic for painful gingival swelling and gingival biopsy was performed. Physical examination showed multiple round elevated purpuric rashes in thoracic wall. Gingiva and skin biopsy showed Kaposi's sarcoma. Computed tomography of abdomen and chest revealed ill-defined nodules in both lung fields and multiple small para-aortic lymphadenopathies. Chemotherapy with paclitaxel was given for Kaposi's sarcoma. Prednisolone was tapered. After the 7th course of chemotherapy, the lesions show marked improvement in size and number.
Abdomen ; Adult ; Azathioprine ; Biopsy ; Dental Clinics ; Drug Therapy ; Dyspnea ; Exanthema ; Female ; Gingiva ; Humans ; Lung ; Lupus Erythematosus, Systemic* ; Paclitaxel ; Physical Examination ; Prednisolone ; Sarcoma, Kaposi* ; Skin ; Thoracic Wall ; Thorax

PURPOSE: The aim of the study was to investigate the change in usage and clinical outcomes of using a humidified high flow nasal cannula (HHFNC) in preterm infants. METHODS: A retrospective review of patients with gestational age <32 weeks born at our neonatal intensive care unit from January 2008 to March 2011 was performed. First, data were compared between Era 1 (January 2008 to February 2009) and Era 2 (March 2009 to March 2011) to describe the increased usage of HHFNC. Second, the patients (gestational age 25-30 weeks) were divided into two groups to compare clinical outcomes. nasal continuous positive airway pressure (NCPAP) and HHFNC groups who received either NCPAP or HHFNC as a respiratory support within 14 days of birth. RESULTS: Compared to Era 1, HHFNC usage increased from 10 to 55% in Era 2, whereas NCPAP usage decreased from 40 to 5%. No difference in pulmonary or adverse outcomes including the incidence of reintubation and bronchopulmonary dysplasia (BPD), days on oxygen and a ventilator, and other outcomes was observed between the HHFNC and NCPAP groups. Days to reach full feed (32.2+/-16.7 vs. 24.7+/-10.2, P=0.05) and regain birth weight (20.9+/-16.9 vs. 17.2+/-4.3, P=0.04) decreased in the HHFNC group. CONCLUSION: HHFNC was feasible and did not differ in respiratory and other outcomes, but days to reach full feed and regain birth weight decreased in the HHFNC, when compared with the NCPAP. An additional prospective multicenter designed study is needed to better define safety and efficacy of HHFNC.
Birth Weight ; Bronchopulmonary Dysplasia ; Catheters ; Continuous Positive Airway Pressure ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Oxygen ; Retrospective Studies ; Ventilators, Mechanical