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Disease Course and Prognostic Factors of Juvenile Idiopathic Arthritis.

Jae Il SHIN ; Dong Soo KIM ; Soo Kon LEE ; Hyun Woo KIM

The Journal of the Korean Rheumatism Association.2003;10(4):374-393.

OBJECTIVE: To assess the disease course and prognostic factors in juvenile idiopathic arthritis (JIA). METHODS: We performed a retrospective study of 136 patients between 1990 and 2000. Patients were classified with respect to the International League of Associations for Rheumatology (ILAR) criteria and prognostic factors were evaluated according to the different subtypes. Poor outcome measures were persistent disease, joint destruction and physical disability. RESULTS: There were 73 males and 63 females and the mean follow up period was 5 years (range 2~25). Predictors of persistent disease in the systemic onset type were polyarticular involvement, symmetric arthritis, and the presence of active systemic disease at 6 months. A poor outcome in the oligoarticular onset type correlated with polyarticular extension, joint erosion, chronic arthritis (duration>6 months), relapse, high antinuclear antibody (ANA) titers (>1:160), persistently high erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Polyarticular extension was associated with chronic arthritis, involvement of small joints at disease onset, and positive HLA-B27. Predictors of persistent disease in the polyarticular type were chronic arthritis, relapse, and the presence of anemia at disease onset. The risk of joint destruction correlated with sex (female>male), polyarticular involvement, polyarticular extension, chronic arthritis, persistently high ESR or CRP, high ANA titers (>1:160), relapse, and positive rheumatoid factor. CONCLUSION: Factors predictive of severity in JIA were identified and prognosis was related more to the disease course than the onset type of JIA. So early diagnosis and more aggressive treatment of patients with poor prognostic features could improve functional outcome.
Anemia ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Blood Sedimentation ; C-Reactive Protein ; Early Diagnosis ; Female ; Follow-Up Studies ; HLA-B27 Antigen ; Humans ; Joint Diseases ; Joints ; Male ; Outcome Assessment (Health Care) ; Prognosis ; Recurrence ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology

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Urinary Transforming Growth Factor-beta Induced Gene-h3 (betaig-h3)as a Marker of Lupus Activity in SLE with Nephritis.

Il KIM ; Cheol Ho HONG ; Hyun Seok CHO ; Sun Jin YOU ; Chang Hee PAIK ; Hye Soon LEE ; Wan Sik UHM ; Tae Hwan KIM ; Jae Bum JUN ; Dae Hyun YOO ; Think You KIM ; Chang Hwa LEE ; Chong Myung KANG ; Moon Hyang PARK ; In San KIM ; Sang Cheol BAE

The Journal of the Korean Rheumatism Association.2003;10(4):365-373.

BACKGROUND: TGF-beta-induced gene-h3 (betaig-h3) is a novel gene induced by active TGF-beta and the association with other renal disease is reported. Lupus nephritis is characterized by excessive extracelluar matrix accumulation and the implication that TGF-beta is increased in lupus nephritis is known. We measured the urinary betaig-h3 in lupus nephritis and sought its association with the activity of lupus nephritis through renal biopsy. The objective of this study was to examine urinary betaig-h3 excretion in lupus nephritis and the association with activity of lupus nephritis. METHODS: Fifteen patients (median age 32.6 2.9 years, range 18~64) who developed lupus nephritis underwent renal biopsy. At the time of biopsy, they showed significant proteinuria. Total urinary betaig-h3 concentration was assayed by enzyme-linked immunoabsorbent assay and expressed as a ratio to urinary creatinine concentration. RESULTS: There were correlations between urinary betaig-h3 and the reduction of C3 (r= 0.566, p=0.028<0.05), the magnitude of proteinuria (r=0.531, p=0.042<0.05). The Activity Index, Chronicity Index in the renal biopsy, C4, anti-dsDNA Ab titer were not significantly correlated with urinary betaig-h3 excretion, but the patients with high Activity Index had the increased level of urinary betaig-h3. Five patients who had fibrinoid necrosis in renal biopsy showed higher level of urinary betaig-h3 than the others (107.78 43.02 vs. 50.21 10.12 ng/ ml, p=0.061) CONCLUSION: In this study, There is some correlation between urinary betaig-h3 and the activity of lupus nephritis. Urinary betaig-h3 may play a role in predicting the active lupus nephritis. A further study is needed in large population and in situ expression of betaig-h3.
Biopsy ; Creatinine ; Humans ; Lupus Nephritis ; Necrosis ; Nephritis* ; Proteinuria ; Transforming Growth Factor beta

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Developing the Hardtack Test to Screen and Monitor the Sjogren's Syndrome in Korea.

Sung Soo KIM ; Jung Soo SONG ; Bo Hyoung PARK ; Yong Hwan LEE ; Sung Kwon BAE ; Won PARK

The Journal of the Korean Rheumatism Association.2003;10(4):358-364.

OBJECTIVE: To investigate the usefulness of the Hardtack test to screen the Sjogren's syndrome compared with non-stimulated whole salivary flow (NSWSF) and Schirmer-1 test. METHODS: Fifty patients with RA and other connective tissue disease who had complained sicca symptoms (7 males and 43 females) and twenty healthy participant, were undergone the Hardtack test, NSWSF, and Schirmer-1 test. The Hardtrack test were compared with NSWSF and Schirmer-1 test for the screening of Sjogren's syndrome. And the relationship between the tests were evaluated. RESULTS: 1) The time of dissolution of the hardtack was 88.7sec (Max: 136, Min: 44) in healthy group, and 321 sec (Ma: 900, Min: 92) in patient group (p<0.001). 2) NSWSF was 0.6 ml/min (Max: 1.32, Min: 0.14) in healthy group, and 0.28 ml/min (Max: 0.8, Min: 0.01) in patient group (p<0.001). 3) The lacrimal flow in Schirmer-1 test was 22.0 mm (Max: 30, Min: 8) in healthy groups and 5.26 mm (Max: 21, Min: 0) in patient group (p<0.001). 4) The correlation coefficient between the hardtack test and NSWSF was 0.56 (p<0.001). The correlation coefficient between the hardtack test and Schirmer-1 test was 0.51 (p<0.001). NSWSF was correlated with Shirmer-1 test but not significantly (r=0.254, p=0.075). In the hardtack test, the best balance between sensitivity and specificity was seen with a cut-off value of 120 seconds. CONCLUSION: The Hardtack test is useful screening test to discriminate between subjects with normal and reduced salivary flow. The Hardtack test is easy to perform, inexpensive, imposes minimal discomfort on the subject with xerostomia and correlated well with the NSWSF and the Schirmer-1 test. So it can also be used as to monitor the Sjogren's syndrome before the salivary flow measurement or Schirmer-1 test.
Connective Tissue Diseases ; Humans ; Korea* ; Male ; Mass Screening ; Sensitivity and Specificity ; Sjogren's Syndrome* ; Xerostomia

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Predictive Factors for Seizure Attack in Patients with Systemic Lupus Erythematosus.

Min Chan PARK ; Yong Beom PARK ; Hyun Wook KIM ; Chul Sik KIM ; Tae Won HONG ; Soo Kon LEE

The Journal of the Korean Rheumatism Association.2003;10(4):351-357.

OBJECTIVE: This study was designed to identify the risk factors associated with seizure attack in patients with systemic lupus erythematosus (SLE) and to propose the usefulness of them as predictive factors for seizure attack. METHODS: One hundred patients with SLE were included in this study. Twenty-five of these patients had seizure attacks during the course of their disease and age-, sex-matched 75 patients who did not have seizure were control group. We compared clinical manifestations and laboratory findings between the two groups. Seizures not related to SLE were excluded. RESULTS: Risk factors associated with seizure attack in SLE were high damage index at initial presentation and the presence of anticardiolipin antibody IgG regardless of its titer. Underlying illness other than SLE, duration of SLE, presence of previous organic brain abnormality, SLEDAI at initial presentation, clinical manifestations of SLE, laboratory findings (including hematologic, immunologic parameters and known laboratory activity indices) and medications before seizure attack were not significantly associated with seizure attack. Recurred seizure was not associated with any of these factors. CONCLUSION: High damage index at initial presentation and the presence of anticardiolipin antibody IgG were associated with seizure attacks in patients with SLE. These factors may be used as predictive factor for seizure attack in SLE.
Antibodies, Anticardiolipin ; Brain ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic* ; Risk Factors ; Seizures*

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Clinical Aspects of Insufficiency Fracture in Chronic Inflammatory Joint Disease.

Bo Ra YUN ; Myung Ho LEE ; Hye Sun LEE ; Yoon Young CHOI ; Tae Hwan KIM ; Jae Bum JUN ; Sang Cheol BAE ; Dae Hyun YOO

The Journal of the Korean Rheumatism Association.2003;10(4):344-350.

OBJECTIVE: Insufficiency fracture (IF) occurs when normal or physiological muscular activity stresses a bone that is deficient in mineral or elastic resistance. We studied clinical characteristics of IF in patients with chronic inflammatory joint diseases in Korea. METHODS: Between Aug. 1997 and Feb. 2003, thirty five patients with 77 fractures were studied at the authors' institution when they were being treated for their rheumatic diseases. The clinical and laboratory data were collected by review of medical record retrospectively. RESULTS: All patients except four were postmenopausal women (mean age 63.0+/-10.0 years) with long disease duration (mean 14.2+/-11.6 years). Thirty three patients had rheumatoid arthritis, 1 ankylosing spondylitis and 1 systemic lupus erythematosus. Twenty nine patients (85.7%) were receiving regular steroid treatment (mean dose 4.0+/-2.3 mg/day, mean duration 6.1+/-4.2 years). Twenty four patients were treated with methotrexate. The significant reduction in their bone mineral density was found 27 patients based on BMD or QCT. Eight patients without osteoporosis were treated with steroid or MTX. Twenty three patients were ever used for osteoporosis treatment. Most patients except four presented with pain in the low back, groin, hip, pelvic, leg and knee. Initial simple radiography was positive in only 7 patients, with vertebral compression fracture in 11 patients and no effect on mobility except ten. Diagnosis was delayed (mean duration of symptom until diagnosis was 45.6+/-64.5 days). IF was confirmed using the bone scan. Sacrum and pelvic bone was most frequently affected site. The other sites were SI joint, iliac wing, symphysis pubis, acetabulum and femur neck. Twenty nine patients required in-patient stay (mean 17.4 days). All but one patient showed an uneventful recovery with conservative treatment. CONCLUSION: The low grade nature of symptoms, minimal effect on mobility, absence of significant trauma and missed on initial plain radiography make diagnosis difficult and delayed. IF should be suspected in cases of unexplained pain with local tenderness in patients of chronic inflammatory joint diseases. The technetium-99m diphosphonate bone scintigraphy was valuable diagnostic tool in the early recognition of IF.
Acetabulum ; Arthritis, Rheumatoid ; Bone Density ; Diagnosis ; Female ; Femur Neck ; Fractures, Compression ; Fractures, Stress* ; Groin ; Hip ; Humans ; Joint Diseases* ; Joints* ; Knee ; Korea ; Leg ; Lupus Erythematosus, Systemic ; Medical Records ; Methotrexate ; Osteoporosis ; Pelvic Bones ; Radiography ; Radionuclide Imaging ; Retrospective Studies ; Rheumatic Diseases ; Sacrum ; Spondylitis, Ankylosing

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Accelerated Atherosclerosis in Rheumatoid Arthritis.

Yong Beom PARK ; Soo Kon LEE

The Journal of the Korean Rheumatism Association.2003;10(4):335-343.

It is well known that rheumatoid arthritis (RA) causes significant morbidity as a result of synovial inflammation, joint destruction, and associated disability. In addition to these articular manifestations of RA, there is growing recognition of an excess mortality, which is due to increased atherosclerosis. Approximately 50% of atherosclerotic coronary artery disease in the community occurs in the absence of traditional risk factors, such as smoking, hypertension, diabetes mellitus, and hypercholesterolemia. Recently, inflammation has emerged as an important pathogenic mechanism of atherosclerosis. Inflammation has a role in both the initiation and the progression of atherosclerosis. C-reactive protein (CRP) is a sensitive marker for underlying systemic inflammation. Prospective studies indicate that baseline levels of CRP are associated with increased risk of myocardial infarction and stroke among apparently healthy individuals. Furthermore, the value of high-sensitivity testing for CRP appears to be additive to that of total and HDL- cholesterol for cardiovascular risk prediction. RA is a typical chronic inflammatory disease and CRP well reflects on the disease activity of RA. Several studies have reported increased cardiovascular disease and mortality among patients with RA. As a potential underlying mechanism for this observation, the inflammation of RA may play an important role. Studies have shown evidences that patients with RA haveaccelerated atherosclerosis, which is associated with the inflammation of RA. In this article, we reviewed the relationship between RA and accelerated atherosclerosis.
Arthritis, Rheumatoid* ; Atherosclerosis* ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Coronary Artery Disease ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Inflammation ; Joints ; Mortality ; Myocardial Infarction ; Risk Factors ; Smoke ; Smoking ; Stroke

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A Case of Localized Skin Infection Due to Scedosporium apiospermum in a Patient with Rheumatoid Arthritis.

Bo Ra KIM ; Young Keun KIM ; Tae Young KANG

The Journal of the Korean Rheumatism Association.2010;17(1):100-102. doi:10.4078/jkra.2010.17.1.100

No abstract available.
Arthritis, Rheumatoid ; Humans ; Scedosporium ; Skin

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Calcific Tendinitis of Flexor Carpi Ulnaris Insertion Site.

Jin Hyun WOO ; Seunghun LEE ; Suk Joo HONG ; Gwan Gyu SONG

The Journal of the Korean Rheumatism Association.2010;17(1):98-99. doi:10.4078/jkra.2010.17.1.98

No abstract available.
Tendinopathy

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A Case of Scleromalacia Perforance That Developing after Surgery for Excision of the Pterygium in a Patient with Rheumatoid Arthritis.

Jae Hee KIM ; Hyun Ok KIM ; Yong Geun JEONG ; Seong Un YUN ; Kyeong Ju LEE ; Chang Min LEE ; Wan Soo KIM ; Joon Kyung SONG ; Sang Il LEE

The Journal of the Korean Rheumatism Association.2010;17(1):93-97. doi:10.4078/jkra.2010.17.1.93

The ocular manifestations of rheumatoid arthritis (RA) are common and they can vary from patient to patient. However, necrotizing anterior scleritis without inflammation (scleromalacia perforans) is a rare and serious opthalmic complication, and it is typically associated with long-standing RA. Although the etiology and pathogenesis of scleromalacia perforans are diverse and they are not completely understood, ophthalmic surgery is one of the well known causes of scleromalacia perforans. Patients with systemic autoimmune disease such as RA have an especially higher risk of scleromalacia perforans after opthalmic surgery. Because scleromalacia perforans is a potential threat not just to eyesight, but to life as well, early diagnosis and prompt treatment are required for its successful management. We experienced a case of scleromalacia perforans that developed after scleral excision of pterygium in a 58 year old woman who had a 7 year history of RA, and this was well treated with an early screral graft. We report here on this case along with a review of the relevant literature.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Early Diagnosis ; Female ; Humans ; Inflammation ; Polyenes ; Pterygium ; Scleritis ; Transplants

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Treatment of Late Onset Ankylosing Spondylitis with TNF Antagonist: A Case Series.

Ji Sun LEE ; So young BANG ; Dae Hyun YOO ; Young Sang BYUN ; Soo Yuk PARK ; Tae Hwan KIM

The Journal of the Korean Rheumatism Association.2010;17(1):86-92. doi:10.4078/jkra.2010.17.1.86

Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients' older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.
Age of Onset ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis ; Back Pain ; HLA-B27 Antigen ; Humans ; Loa ; Methotrexate ; Sacroiliitis ; Spondylarthropathies ; Spondylitis, Ankylosing ; Steroids ; Sulfasalazine

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