Owing to the ability of musculoskeletal ultrasound (US) to depict cross sectional images of synovial joint and related structures, US has become the most reliable tool for evaluation of arthritic activity of rheumatoid arthritis (RA). US can detect early synovitis, assess disease activity, and determine true remission in patients with RA. US also can detect early enthesitis in patients with spondyloarthropathies. In addition, US can provide a reliable tool for measuring skin thickness in patients with systemic sclerosis. With guidance of injection or aspiration, US can result in a better clinical outcome. Thus, educational needs and research networks are increasing. We present a review of rheumatology US, focusing on recent trends and advances.
Arthritis, Rheumatoid ; Humans ; Joints ; Rheumatology* ; Scleroderma, Systemic ; Skin ; Spondylarthropathies ; Synovitis ; Ultrasonography* ; Ultrasonography, Doppler

Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment.
Aged ; Arthritis, Rheumatoid* ; Brain ; Dizziness ; Echocardiography ; Endocarditis ; Endocarditis, Non-Infective* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Mitral Valve ; Mortality ; Neurologic Manifestations ; Stroke ; Stroke, Lacunar ; Vomiting

OBJECTIVE: Diurnal preference is an attribute reflecting whether people are alert and preferring to be active either early or late in the day. It also referred to as chronotype or morningness-eveningness trait. The PER3 genes have been known to influence diurnal preference. In this study, we have investigated the associations between the PER3 gene polymorphisms and diurnal preference in a healthy young population, controlling for the social and environmental confounding factors. METHODS: The participants in this experiment included 299 unrelated medical college students (M=191, F=108), with a mean age of 22.9 years. Diurnal preference was measured by a single administration of the 13-item Composite Scale for Morningness (CSM). Genotyping of the PER3 VNTR (rs57875989) was performed using polymerase chain reaction. A two-tailed alpha of 0.05 was chosen. RESULTS: The mean+/-SD score on the CSM scale for all subjects was 31.90+/-6.39. There was no significant difference in total CSM score between gender groups, although females showed a trend towards higher morningness score. Although PER3 5R/5R showed the tendency towards high CSM scores, there were no significant differences on CSM scores among genotypes and allele status of PER3 VNTR (rs57875989). CONCLUSIONS: We could not confirm that the PER3 VNTR is associated with diurnal preference in a Korean healthy young population. The future studies need to investigate the association between diurnal preference and other polymorphisms of PER3 gene in larger sample of Korean young healthy population.
Alleles ; Female ; Genotype ; Humans ; Polymerase Chain Reaction

Rheumatoid arthritis (RA) can be evaluated with ultrasound using both gray scale and Doppler mode. Gray scale provides cross-sectional images of joints, whereas Doppler shows the vascularity of the proliferated synovium. In RA, ultrasound can detect sub-clinical or early synovitis, assess arthritis more accurately than through clinical examination, and predict recurrence. In particular, a Doppler signal detected inside the joint cavity correlates with disease activity. Imaging remission can reflect the true remission status more accurately than with clinical remission. In this review, we focus on the use of ultrasonographic findings for the diagnosis, assessment, and prediction of RA.
Arthritis ; Arthritis, Rheumatoid* ; Diagnosis ; Joints ; Recurrence ; Synovial Membrane ; Synovitis ; Ultrasonography

PURPOSE: This paper proposes proper and effective neck exercises by comparing the deep and superficial cervical flexor muscle activities and thickness according to the pressure level during cranio-cervical flexion exercises between a normal posture group and forward head posture group. METHODS: A total of 20 subjects (8 males and 12 females) without neck pain and disabilities were selected. The subjects' craniovertebral angles were measured; they were divided into a normal posture and a forward head posture group. During cranio-cervical flexion exercises, the thickness of the deep cervical flexor neck muscle and the activity of the surface neck muscles were measured using ultrasound and EMG. RESULTS: The results showed that the thickening of the deep cervical flexor was increased significantly to 28 and 30 mmHg in the forward head posture group. The sternocleidomastoid muscle activity increased significantly to 24, 26, 28, and 30 mmHg in the forward head posture group. The anterior scalene muscle activity increased significantly to 26, 28, and 30mmHg in the forward head posture group. A significant difference of 26, 28, and 30 mmHg in the sternocleidomastoid and anterior scalene muscles was observed between two groups. CONCLUSION: To prevent a forward head posture and maintain proper cervical curve alignment, the use of the superficial cervical flexor muscles must be minimized. In addition, to perform a cranio-cervical flexion exercises to effectively activate the deep cervical flexor muscles, 28 and 30 mmHg for normal posture adults and 28 mmHg for adults with forward head postures are recommended.
Adult ; Exercise ; Head ; Humans ; Male ; Muscles ; Neck ; Neck Muscles ; Neck Pain ; Posture ; Ultrasonography

The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.
Humans ; Magnetic Resonance Imaging ; Musculoskeletal System/ultrasonography ; Osteoarthritis/ultrasonography ; Rheumatic Diseases/*ultrasonography ; Sjogren's Syndrome/ultrasonography ; Spondylarthropathies/ultrasonography ; Synovitis/ultrasonography ; Tendinopathy/ultrasonography ; Vasculitis/ultrasonography

Dermatomyositis is an autoimmune disease characterized by chronic muscle inflammation that results in specific dermatological signs and decreased muscle strength. It is known to have a strong association with malignancy. Most neuroendocrine tumors arise from the gastrointestinal tract, with less than 1% of cases occurring at the ampulla of Vater. While cases of dermatomyositis associated with neuroendocrine tumors have been reported internationally, to date there have been no cases reported in Korea. This case report presents a 33-year-old male who had undergone pylorus-preserving pancreaticoduodenectomy for a neuroendocrine tumor located at the ampulla of Vater, and had been followed at the hospital after his procedure. Three years post-surgery, the patient developed serious muscle weakness in his upper-right and lower-left extremities, and was subsequently diagnosed with dermatomyositis. This paper presents the first domestic case of dermatomyositis developing in the context of a neuroendocrine tumor at the ampulla of Vater. A literature review on this subject follows in the discussion.
Adult ; Ampulla of Vater* ; Autoimmune Diseases ; Dermatomyositis* ; Extremities ; Gastrointestinal Tract ; Humans ; Inflammation ; Korea ; Male ; Muscle Strength ; Muscle Weakness ; Neuroendocrine Tumors* ; Pancreaticoduodenectomy

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits. Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department. Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm. Conclusion Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.

Retroperitoneal fibrosis (RPF) is a rare, progressive disease characterized by chronic non specific inflammation of the retroperitoneum. Although the pathogenesis of idiopathic retroperitoneal fibrosis (IRF) remains unclear, IRF has been reported in association with autoimmune disorders. However, few cases of IRF associated with rheumatoid arthritis (RA) have been reported. We experienced a rare case of IRF in a patient with RA and chronic B viral hepatitis. A 39-year-old Korean man with RA and hepatitis B was referred to our hospital due to left hydronephrosis. An abdominal computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a diffuse infiltrating retroperitoneal mass around the abdominal aorta and left ureter. The patient underwent intraureteral stent insertion and was treated with corticosteroid. Three months later, the follow up abdominal CT showed that the retroperitoneal mass had decreased in size. Herein, we report the first case of coexistent IRF, RA, and chronic B viral hepatitis with a literature review.
Adult ; Aorta, Abdominal ; Arthritis, Rheumatoid* ; Follow-Up Studies ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Hydronephrosis ; Inflammation ; Magnetic Resonance Imaging ; Retroperitoneal Fibrosis* ; Stents ; Tomography, X-Ray Computed ; Ureter

OBJECTIVE: Low self-esteem is associated with suicide risk in the general psychiatric population. The aim of this study was to examine associations between suicidality and self-esteem in patients with schizophrenia. METHODS: Subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for schizophrenia were enrolled. Sociodemographic and clinical variables, including previous suicide attempt history, were assessed. Psychopathology, self-esteem, and self-perceived stigma were also measured using the Positive and Negative Syndrome Scale, the Rosenberg Self-Esteem Scale (SES), the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, and the Korean version of the Internalized Stigma of Mental Illness scale (K-ISMI). RESULTS: Of the total of 87 participants, 20 (23.0%) had attempted suicide. Patients with a history of suicide attempts had significantly higher scores on the BDI (p=0.036) and K-ISMI (p=0.009), and significantly lower scores on the SES (p=0.001). Analysis of covariance revealed that the SES scores were significantly lower in patients with a history of previous suicide attempts than in those with no history, after controlling for K-ISMI and BDI scores (p=0.039). CONCLUSION: Low self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts.
Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Prospective Studies ; Psychopathology ; Schizophrenia* ; Suicide ; Suicide, Attempted