1.Management of the arthritis related osteoporosis.
Korean Journal of Medicine 2006;70(1):119-125
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
2.Animal Models of Spondyloarthritis.
Journal of Rheumatic Diseases 2012;19(5):248-253
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
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Humans
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Inflammation
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Joints
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Leukocytes
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Mice
;
Models, Animal
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Rats, Transgenic
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Sacroiliac Joint
;
Tumor Necrosis Factor-alpha
4.Adult-onset Kawsaki Disease Complicated by Splenic Infarction and Coronary Aneurysm.
Byung Kwan CHO ; Seong Ryul KWON ; Seung Jai YOON ; Moon Hyun CHUNG ; Sun Nyuh LEE ; Sang Hyun LEE
Korean Journal of Infectious Diseases 2000;32(5):388-392
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
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Aneurysm
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Aspirin
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Cardiomyopathies
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Conjunctivitis
;
Coronary Aneurysm*
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Coronary Angiography
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Echocardiography, Transesophageal
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Exanthema
;
Fever
;
Follow-Up Studies
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Foot
;
gamma-Globulins
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Hand
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Humans
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Jaundice
;
Lymphatic Diseases
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Mucocutaneous Lymph Node Syndrome
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Mucous Membrane
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Pulmonary Edema
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Shock
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Skin
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Splenic Infarction*
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Young Adult
5.A Case of Kaposi's Sarcoma in a Systemic Lupus Erythematosus Patient after Long Term Immune Suppression.
Woong Gil CHOI ; Joon Mee KIM ; Seong Ryul KWON ; Moon Hei LEE ; Jin Soo LEE ; Won PARK
The Journal of the Korean Rheumatism Association 2006;13(1):70-75
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
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Adult
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Azathioprine
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Biopsy
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Dental Clinics
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Drug Therapy
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Dyspnea
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Exanthema
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Female
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Gingiva
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Humans
;
Lung
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Lupus Erythematosus, Systemic*
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Paclitaxel
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Physical Examination
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Prednisolone
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Sarcoma, Kaposi*
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Skin
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Thoracic Wall
;
Thorax
6.Safety and Efficacy Evaluation for the Addition of Either Etanercept or Leflunomide in Korean Rheumatoid Arthritis Patients Inadequately Responding to Methotrexate.
Kowoon JOO ; Won PARK ; Seong Ryul KWON ; Mie Jin LIM
Journal of Rheumatic Diseases 2013;20(3):166-171
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
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Humans
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Immunoglobulin G
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Isoxazoles
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Liver Function Tests
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Methotrexate
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Neutropenia
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Receptors, Tumor Necrosis Factor
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Rheumatology
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Stress, Psychological
;
Etanercept
7.Osteolysis of the Patella.
Kyong Hee JUNG ; Seong Ryul KWON ; Mie Jin LIM ; Won PARK
Journal of Rheumatic Diseases 2012;19(6):369-370
No abstract available.
Osteolysis
;
Patella
8.Acute Effects of Intravenous Administration of Pamidronate in Patients with Osteoporosis.
Mie Jin LIM ; Seong Ryul KWON ; Shin Goo PARK ; Won PARK
Journal of Korean Medical Science 2010;25(9):1277-1283
We investigated acute effects of intermittent large dose bisphophonate therapy in osteoporotic patients. Peripheral blood mononuclear cells were incubated with alendronate (100 micrometer) for 18 hr, in vitro and cytokine expressions were measured by real-time RT-PCR. Pamidronate 30 mg was administered on 26 osteoporotic patients; and acute phase reactants, inflammatory cytokines and bone biomarkers were measured. The in vitro study showed significant increase in mRNA expression of IL-6, TNF-alpha and IFN-gamma. A notable rise in serum C-reactive protein (CRP) was observed over 3 days after pamidronate infusion (P=0.026). Serum levels of TNF-alpha, IL-6 and IFN-gamma were also significantly increased (P=0.009, 0.014, 0.035, respectively) and the increase in IL-6 levels were strongly correlated with CRP levels (P=0.04). Serum calcium and c-telopeptide levels rapidly decreased after the treatment (P=0.02, <0.001, respectively). This study showed that mRNA expression of inflammatory cytokines at peripheral blood mononuclear cells (PBMC) level were observed within 18 hr and marked elevation of inflammatory cytokines and acute phase reactants were demonstrated after pamidronate infusion at the dose for osteoporosis. Our studies confirmed that intermittent large dose aminobisphosphonate causes acute inflammation.
Acute-Phase Proteins/biosynthesis/genetics
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Adult
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Aged
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Aged, 80 and over
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Alendronate/pharmacology
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Biological Markers/blood
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Blood Cells/drug effects
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Bone Density Conservation Agents/*administration & dosage
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C-Reactive Protein/genetics/metabolism
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Calcium/blood
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Collagen Type I/blood
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Diphosphonates/*administration & dosage
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Female
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Humans
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Injections, Intravenous
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Interferon-gamma/blood/genetics
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Interleukin-6/blood/genetics
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Male
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Middle Aged
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Osteoporosis/*drug therapy
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Peptides/blood
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RNA, Messenger/metabolism
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Tumor Necrosis Factor-alpha/genetics/metabolism
9.Effects of Gout Web based Self-management Program on Knowledge Related to Disease, Medication Adherence, and Self-management.
Hyun Soo OH ; Won PARK ; Seong Ryul KWON ; Mie Jin LIM ; Yeon Ok SUH ; Wha Sook SEO ; Jong Suk PARK
Journal of Korean Academy of Nursing 2013;43(4):547-556
PURPOSE: This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. METHODS: A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. RESULTS: According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. CONCLUSION: The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.
Adult
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Gout/*prevention & control
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Health Knowledge, Attitudes, Practice
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Hospitals, University
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Humans
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*Internet
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Male
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*Medication Adherence
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Middle Aged
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*Program Evaluation
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*Self Care
;
User-Computer Interface
10.Digital Thermography of the Fingers and Toes in Raynaud's Phenomenon.
Mie Jin LIM ; Seong Ryul KWON ; Kyong Hee JUNG ; Kowoon JOO ; Shin Goo PARK ; Won PARK
Journal of Korean Medical Science 2014;29(4):502-506
The aim of this study was to determine whether skin temperature measurement by digital thermography on hands and feet is useful for diagnosis of Raynaud's phenomenon (RP). Fifty-seven patients with RP (primary RP, n = 33; secondary RP, n = 24) and 146 healthy volunteers were recruited. After acclimation to room temperature for 30 min, thermal imaging of palmar aspect of hands and dorsal aspect of feet were taken. Temperature differences between palm (center) and the coolest finger and temperature differences between foot dorsum (center) and first toe significantly differed between patients and controls. The area under curve analysis showed that temperature difference of the coolest finger (cutoff value: 2.2degrees C) differentiated RP patients from controls (sensitivity/specificity: 67/60%, respectively). Temperature differences of first toe (cutoff value: 3.11degrees C) also discriminated RP patients (sensitivity/specificity: about 73/66%, respectively). A combination of thermographic assessment of the coolest finger and first toe was highly effective in men (sensitivity/specificity : about 88/60%, respectively) while thermographic assessment of first toe was solely sufficient for women (sensitivity/specificity: about 74/68%, respectively). Thermographic assessment of the coolest finger and first toe is useful for diagnosing RP. In women, thermography of first toe is highly recommended.
Adult
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Diagnosis, Differential
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Female
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Fingers/*physiology
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Humans
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Male
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Middle Aged
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ROC Curve
;
Raynaud Disease/*diagnosis
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Sensitivity and Specificity
;
Skin Temperature
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*Thermography
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Toes/*physiology