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Usefulness of Carotid Intima Media Thickness as Cardiovascular Risk Factor in Patient with SLE.

Chang Mo KWON ; Yeong Hoon HONG ; Choong Ki LEE

The Journal of the Korean Rheumatism Association.2005;12(4):285-290.

OBJECTIVE: The purpose of this study was to investigate the complication using carotid intima media thickness (CIMT) as an indicator for atherosclerosis and to verify the risk factors in systemic lupus erythematosus (SLE) patients compared with those of control group. METHODS: The study recruited 48 asymptomatic SLE and 32 healthy control group. These are examined by B-mode ultrasound (Acuson(TM) SequoiaC256 8 MHz linear transducer) to measure the CIMT at the far wall of the common carotid artery. A wide range of contribution factors to CIMT including age, body mass index, lipid profile, total cumulative steroid dose, SLEDAI, and proteinuria were considered. RESULTS: Although the results of CIMT in both groups were within normal limit (In healthy adult 0.25~1.5 mm, values > 1.0 mm often regarded as abnormal), the mean CIMT in patient group was 0.721+/-0.162 mm, which was thicker than that of control group with 0.5219+/-0.096 mm (p<0.001). In multiple regression analysis, only age showed significant contribution to CIMT (p<0.01). Disease duration, SLEDAI and serum lipids were of no statistical significance with CIMT. CONCLUSION: We were to elucidate the advance of atherosclerosis with measuring CIMT and assess factors associated with SLE. Even if the results of CIMT in both groups were within normal range, it is significant that the arterial thickening is more advanced in SLE than that of healthy control. Further studies based on CIMT are needed to screen and prevent cardiovascular complications from disease progression.
Adult ; Atherosclerosis ; Body Mass Index ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Disease Progression ; Humans ; Lupus Erythematosus, Systemic ; Proteinuria ; Reference Values ; Risk Factors* ; Ultrasonography

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Hormone Replacement Therapy (HRT), Other Reproductive and Life Style Variables and Rheumatoid Arthritis in Postmenopausal Women.

Ki Ho LEE ; Duck Joo LEE ; Sang Man KIM ; Sang Hyun JE ; In Kwon HAN

The Journal of the Korean Rheumatism Association.2005;12(4):278-284.

OBJECTIVE: To compare the differences of hormone replacement therapy (HRT) and reproductive, life style characteristics in postmenopausal women with and without rheumatoid arthritis (RA). METHODS: A total of 360 women, 120 rheumatoid arthritis patients and 240 age matched healthy women were randomly selected from the health care center. Subjects were labeled as rheumatoid arthritis and normal menopausal women. Each group was compared for their HRT status, life style and reproductive characteristics. RESULTS: There were significantly less HRT received subjects in RA group (50.0% vs 76.1%, respectively, OR=0.30, p<0.05). More frequently alcohol consumed in RA group (26.7% vs 11.7%, respectively, p<0.05). There was no significant difference in the history of hysterectomy and smoking as well as body mass index (BMI) between the two groups. Women with serum follicular stimulating hormone (FSH) over 40 IU/L were more frequently observed in RA group (70.0% vs 57.5%, respectively, OR=1.75, p<0.05). CONCLUSION: Increased FSH and history of alcohol drinking were more frequently observed in patients with RA, whereas history of HRT was lower in RA group comparing to that of the control. A prospective study should be designed to confirim the protective effect of HRT and reproductive characteristics on postmenopausal RA patients.
Alcohol Drinking ; Arthritis, Rheumatoid* ; Body Mass Index ; Delivery of Health Care ; Female ; Hormone Replacement Therapy* ; Humans ; Hysterectomy ; Life Style* ; Postmenopause ; Smoke ; Smoking

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IL-4 Induces CD4+CD25+ Regulatory T Cells from CD4+CD25- T Cells in Peripheral Blood.

Seong Beom HEO ; Mi La CHO ; Mi Kyung PARK ; So Youn MIN ; Ji Hyun JOO ; Kyung Soo PARK ; Young Kyu CHO ; Chong Hyeon YOON ; Sung Hwan PARK ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2005;12(4):263-277.

OBJECTIVE: The CD4+CD25+ regulatory T cells (Treg) can be induced by TGFbeta and IL-10 in the periphery, and understanding the biological function of cytokine-induced Treg is critically important for the control of autoimmune diseases. We investigated the IL-4-induced CD4+CD25+ regulatory T cells in human PBMCs, which were derived from the CD4+CD25- T cells. METHODS: The CD4+CD25- T cells from human PBMC were isolated by MACS and cultured in the presence of IL-4 or absence of IL-4. The presence and phenotype of induced CD4+CD25+ T cells were determined by flow cytometry. Supressive activity of induced CD4+CD25+ T cells were assessed by culturing CD4+CD25- and CD4+CD25+ T cells with anti-CD3 monoclonal antibodies and antigen-presenting cells, followed by proliferation RESULTS: After 5 days, significant amount of CD4+CD25+ T cells were generated from the CD4+CD25- T cells cultured with anti-CD3 antibody in the presence of IL-4. These IL-4 induced CD4+CD25+ T cells presented with similar phenotype to natural occurred Treg cells, including CD45RO(hi), CD45RA(lo), CTLA-4(hi), OX40(hi), CD62L(hi) and HLA-DR(hi), and also exhibited high expression of Foxp3 molecule. In addition, the IL-4 induced CD4+CD25+ T cells can suppress the proliferative responses against anti-CD3. The regulatory property of IL-4 induced CD4+CD25+ T cell was partially abrogated after treatment with anti-IL-10 and anti-TGFbeta antibodies. CONCLUSION: These data indicate that IL-4 induced CD4+CD25+ Treg cells can be generated from the CD4+CD25- T cells in the peripheral blood, and may contribute to the important immunoregulatory function in human.
Antibodies ; Antibodies, Monoclonal ; Antigen-Presenting Cells ; Autoimmune Diseases ; Flow Cytometry ; Humans ; Interleukin-10 ; Interleukin-4* ; Phenotype ; T-Lymphocytes* ; T-Lymphocytes, Regulatory* ; Transforming Growth Factor beta

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Rituximab Treatment for the Patient with Refractory Lupus Nephritis.

Ji Youn YOUM ; Yoon Kyoung SUNG ; Wan Sik UHM ; Jae Bum JUN ; Dae Hyun YOO ; Sang Cheol BAE

The Journal of the Korean Rheumatism Association.2005;12(4):251-262.

OBJECTIVE: To determine preliminary evidence for the safety and efficacy of B lymphocyte depletion therapy in refractory systemic lupus erythematosus (SLE). METHODS: Four female lupus nephritis patients who had been refractory to steroid and one or more immunosuppressive therapy were treated on an open-label basis. During a 4-week period, each patient received two 500-mg infusions of rituximab and two 750-mg infusions of cyclophosphamide. RESULTS: Patient 1, 2, and 3 were responded with rituximab treatment with improvements in SLEDAI and laboratory parameters such as C3/C4 and 24 hour urine protein. However, patient 4 had not improved with rituximab. The variation in the level of anti-double-stranded DNA antibody was different in individual patients. No significant adverse events were observed during follow-up. CONCLUSION: This study provides an evidence for the safety and possible efficacy of B lymphocyte depletion therapy in refractory lupus nephritis. However a further randomized trial is needed to confirm the efficacy and durability of remission.
Cyclophosphamide ; DNA ; Female ; Follow-Up Studies ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Lymphocyte Depletion ; Rituximab

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The Marginal Zone B Cells have an Increased Antibody Expression in Mice with Collagen-induced Arthritis.

Yun Ju WOO ; Jun Ki MIN ; Mi La CHO ; Young Joo KIM ; Joo Yeon JHUN ; Min Jung PARK ; Young Mi MOON ; Mi Kyung PARK ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2009;16(1):23-32. doi:10.4078/jkra.2009.16.1.23

OBJECTIVE: Mature B cells in the spleen of mouse can be divide into two main subsets: the follicular (FO) B cells and the marginal zone (MZ) B cells. In this study, we investigated which subtype of B cells is involved in the production of costimulatory molecules, cytokine and antibody during the induction of autoimmune arthritis. METHODS: The MZB and FOB cells isolated from DBA/1J induced- and collagen-induced arthritis (CIA) mice were stimulated with LPS or CpG. The costimulatory molecules were measured by flow cytometry (FACs). The cytokines were measured by ELISA. Production of antibodies by the MZB cells or FOB cells was measured by ELISA and the results were observed by confocal microscopy. RESULTS: The expression of co-stimulatory molecules was stronger in the MZB cells than that in the FOB cells. The production of cytokines (IL-10, IL-6) and antibodies was higher in the MZB cells. The IgG expression of the MZB cells, which is known to be associated with the acceleration of autoimmunity, was higher in the CIA mice than that in the DBA/1J mice. CONCLUSION: We observed that the MZB cells were increased in the CIA mice. The costimulatory molecules, cytokine and auto-antibodies were increased in the MZB cells compared to that of the FOB cells. Our results suggest that MZB cells mainly produce autoantibodies, and they play a key role in development of autoimmune arthritis.
Acceleration ; Animals ; Antibodies ; Arthritis ; Arthritis, Experimental ; Autoantibodies ; Autoimmunity ; B-Lymphocytes ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Immunoglobulin G ; Mice ; Microscopy, Confocal ; Spleen

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Hepatotoxicity of Combination Treatment with Leflunomide and Methotrexate in RA Patients.

Je Ho CHANG ; Eun Sook JUNG ; Ju Hyun LEE ; Bo Young YOON ; Chan Hee LEE ; Yun Woo LEE

The Journal of the Korean Rheumatism Association.2009;16(1):16-22. doi:10.4078/jkra.2009.16.1.16

OBJECTIVE: Leflunomide is the newest disease-modifying anti-rheumatic drug (DMARD) that is known to have an equivalent clinical efficacy and tolerability to methotrexate (MTX). Previous studies reported that a co-treatment with MTX and leflunomide can induce additive clinical improvements in RA patients. However, a previous study also demonstrated a reversible elevation of the transaminase levels in up to 63% of patients administered a combination treatment of leflunomide and MTX. This study examined the hepatotoxicity of a combination treatment of MTX and leflunomide. METHODS: From March, 2004, to February, 2006, 203 patients who had been treated in 3 rheumatology clinics, Goyang city, South Korea, were reviewed retrospectively. The data showed that 38.92% of patients scored higher than grade 1 hepatotoxicity and 6.90% of patients scored higher than grade 2 according to the NCI/NIH (National Cancer Institute/National Institutes of Health) Common Toxicity Criteria. RESULTS: The median onset time of hepatotoxicity was 5.91 months after treatment. Leflunomide administration was stopped in 39 patients due to several adverse reactions. Among the 39 patients, hepatotoxicity was observed in only 20.51%, suggesting that the hepatotoxicity was not more frequent than expected. Hepatotoxicity did not increase in proportion to the dose of leflunomide and MTX, age, gender, and disease activity. CONCLUSION: These results indicate that a combined treatment of leflunomide and MTX can be used safely by monitoring the liver enzyme, particularly in the first six months.
Academies and Institutes ; Humans ; Isoxazoles ; Liver ; Methotrexate ; Republic of Korea ; Retrospective Studies ; Rheumatology

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Fibromyalgia Syndrome.

Seong Ho KIM

The Journal of the Korean Rheumatism Association.2009;16(1):1-15. doi:10.4078/jkra.2009.16.1.1

Fibromyalgia syndrome is a major cause of chronic widespread pain and this affects 2.2% of all Koreans. Evidence exists for a genetic contribution to fibromyalgia. Those people who are predisposed to develop fibromyalgia may have this condition "triggered" by a variety of environmental "stressors," including certain types of infections, physical trauma and catastrophic events. Some patients with fibromyalgia have been found to have abnormalities in a number of the body's "stress response" systems, including the hypothalamus-pituitary-adrenal axis and the autonomic nervous system. The most consistently detected objective abnormalities in fibromyalgia involve the pain-processing systems. Patients with fibromyalgia have displayed quantitative abnormalities in pain perception under experimental conditions. Fibromyalgia may be related to a decrease in the activity of the descending, antinociceptive pathways. In addition to neurobiologic mechanisms, psychologic and behavioral factors also play a role for many patients for the different symptoms they express. Diagnosing and treating these patients is especially challenging due to the limited knowledge of the etiology of this disease and the poor response to conventional pain treatments. Strict adherence to the ACR classification criteria in clinical practice is not required to effectively treat patients with fibromyalgia. The treatments of fibromyalgia should be targeted to the central pain and the neuropsychological symptoms. Current evidence advocates a multifaceted program that emphasizes patient education, medications for improving symptoms and aggressive use of exercise and cognitive-behavioral therapy to restore function.
Autonomic Nervous System ; Axis, Cervical Vertebra ; Chronic Pain ; Fibromyalgia ; Humans ; Pain Perception ; Patient Education as Topic

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A Case of Overlap Syndrome with Systemic Sclerosis and Rheumatoid Arthritis.

Seung Won CHOI ; Chang Ho SONG ; Wook Jin CHUNG ; Jong Suk PARK ; Chan Hee LEE ; Ji Soo LEE ; Soo Kon LEE

The Journal of the Korean Rheumatism Association.1996;3(2):195-200.

Overlap syndrome is used to describe patients who have two or more of the following well-defined connective tissue diseases such as rheumatoid arthritis(RA), systemic lupus erythematosus(SLE), systemic sclerosis(SSc) and polymyositis. Overlap syndrome most commonly includes polymyositis with either SSc or SLE. Distingishing SSc from RA can present difficulties, since arthralgia and arthritis frequently arise in the course of SSc and are often the initial manifestations. We report ,a rare case of overlap syndrome, SSc and RA, which progressed from having SSc and then RA.
Arthralgia ; Arthritis ; Arthritis, Rheumatoid* ; Connective Tissue Diseases ; Humans ; Polymyositis ; Scleroderma, Systemic*

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Effect of Cyclophospharmide Pulse and Combined with Per Oral Low Dose Glucorticoid on Pulmonary Fibrosis in Patient with Sistemic Sclerosis.

Gwan Gyu SONG ; Young Ho LEE ; Jae Jeong SHIM ; Kyung Ho KANG

The Journal of the Korean Rheumatism Association.1996;3(2):187-194.

OBJECTIVE: To investigate the efficacy of combined intravenous cyclophophamide pulse and low dose oral prednisolone treatment in patients with systemic sclerosis with -interstitial lung disease. METHOD: Six patients with systemic sclerosis with interstitial lung disease were treated with intravenous infusion of cyclophosphamide(0. 75g/m2 body surface area) and low dose oral prednisolone (10mg/day). RESULTS: 1) Respiratory symptoms, cough and dyspnea, were improved in all patients in both frequency and severity. 2) The mean value of FVC, FEV1, and DLC test showed tendency of increase during the follow up period (upto 24 months) compared to decrease in the past studies. 3)There was no serious side effect during the trreatment. Herpes zoster was developede in I patient during treament. CONCLUSIONS: Combined intravenous cyclophosphamide pulse and low dose oral prednisolone treatment is effective for the patients with systemic sclerosis with interstitial lung disease. A controlled prospective trial is warranted in patients with systemic sclerosis with interstitial lung disease.
Cough ; Cyclophosphamide ; Dyspnea ; Follow-Up Studies ; Herpes Zoster ; Humans ; Infusions, Intravenous ; Lung Diseases ; Lung Diseases, Interstitial ; Prednisolone ; Pulmonary Fibrosis* ; Scleroderma, Systemic ; Sclerosis*

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CD20dim T Cell Expression in Rheumatoid Arthritis.

Jong Wook LEE ; Jung Woon LEE ; Hyon Suk KIM ; Oh Hun KWON ; Soo Kon LEE

The Journal of the Korean Rheumatism Association.1996;3(2):179-186.

OBJECTIVE: This study was designed to investigate CD20dim expression on T cells between healthy control subjects and rheumatoid arthritis patients and to investigate the association between CD20dim T cells and clinical manifestations in rheumatoid arthritis. METHODS: Peripheral bloods from twenty seven healthy controls and twenty six rheumatoid patients were evaluated by dual color immunophenotyping. We used IgGla and IgG2a for negative control, then, divided T cells and B cells on CD3/CD19 combination. And we evaluated two subpopulation CD5+CD20dim T cell (CD20dim T cell) and CD5+CD20bright cell(CD5 B cell) on CD5/20 combination for comparison. In order to correlate the CD20dim T cell datas with patient's clinical status, patients charateristcs such as age, disease duration, morning stiffness, rheumatoid factor(RF), and antinuclear antibody(ANA) were reviewed. RESULTS: The mean percent positivity of T cells(CD3) and B cells(CD19) in 27 healthy control donors was 63.2+/-7.7%, and 11.4+/-2.6 %. The mean percentages of CD20dim T cell and CD5 B cell(Leul) were 2.3+/-1.0% and 1.4+/-0.9% and upper limit of reference values of CD20dim T cells and CD5 B cells(Leul) that calculated from normal healthy controls were 4.3%0 and 3. 2 %. Compared with healthy controls, CD20dim T cells were significantly elevated in total patient groups(4.4+/-2.7%, p(0.01). and significantly increased more than upper limit of reference values in eleven of 26 patients. Compared with CD20dim T cells according to disease duration, disease duration of most patients(10/11) with elevated CD20dim T cell were less than 2 years. CONCLUSION: The results indicated that CD20dim T cells were expressed at low levels in healthy controls but elevated levels of CD20dim T cells in rheumatoid arthritis patients were observed and close relationship to CD20dim T cells expression and disease duration was noted.
Arthritis, Rheumatoid* ; B-Lymphocytes ; Humans ; Immunoglobulin G ; Immunophenotyping ; Reference Values ; T-Lymphocytes ; Tissue Donors

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