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A Case of Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Associated with Gout.

Hagwon JUHNG ; Shin Seok LEE ; Yun A KIM

The Journal of the Korean Rheumatism Association.2002;9(2):146-150.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease has various patterns of clinical manifestation ranging from an absence of symptoms to a severely destructive arthropathy. A number of metabolic diseases and physiologic stresses, such as aging and trauma, have been associated with CPPD crystal deposition. The coexistence of CPPD crystal deposition disease and gout varies from 2 to 8%. The mechanism of this association has been postulated to be a predisposition to the local deposition of pyrophosphate due to the presence of urate crystal, perhaps acting as a nucleating agent or factor which predispose to the deposition of both kinds of crystals. In Korea, although it is considered that CPPD crystal deposition occasionally coincides monosodium urate crystal, it has not been reported so far. We report a case with CPPD crystal deposition disease combined with gout in a patient who has suffered from osteoarthritis, which is diagnosed by polarized microscopic examination of synovial fluid.
Aging ; Calcium Pyrophosphate* ; Calcium* ; Gout* ; Humans ; Korea ; Metabolic Diseases ; Osteoarthritis ; Synovial Fluid ; Uric Acid

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A Case of Rapid Destruction of Hip Joint Associated with a Subchondral Insufficiency Fracture.

Jun Ki MIN ; Jin A KIM ; Mi Sook SUNG

The Journal of the Korean Rheumatism Association.2002;9(2):141-145.

We report a case of rapidly destructive arthrosis of hip joint (RDA) associated with a subchondral insufficiency fracture (SIF) in a 77-year-old female patient. She complained of left hip joint pain which became progressively worse. Findings on radiographs obtained shortly after the onset of hip pain were unremarkable except for osteopenia. However, within 9 months after onset of pain, joint space narrowing rapidly progressed with collapse. She was diagnosed clinically as RDA related to osteonecrosis. She was treated by total hip replacement. The evidence of SIF was confirmed histologically by the presence of a unique granulomatous lesion in the marrow space, which consisted of amorphous debris and fragmented bone surrounded by giant cells. There was no evidence of antecedent osteonecrosis. Osteopenia and overweight were considered as predisposing factors of SIF and rapid joint destruction in this case.
Aged ; Arthralgia ; Arthroplasty, Replacement, Hip ; Bone Diseases, Metabolic ; Bone Marrow ; Causality ; Female ; Fractures, Stress* ; Giant Cells ; Hip Joint* ; Hip* ; Humans ; Joints ; Osteonecrosis ; Overweight

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Deep Neck Infection due to Severe Neutropenia induced by Terbinafine in a Patient with Systemic Lupus Erythematosus.

Jong Tae YANG ; Young Shin CHO ; Yoo Chul JOO ; Dai Yong JANG ; Jong O KIM ; Hee Kwan KOH

The Journal of the Korean Rheumatism Association.2002;9(2):137-140.

Terbinafine, a fungicidal agent used for the treatment of onychomycosis, has been found to be safe and adverse effects are usually mild and transient. Neutropenia is a rare side effect of terbinafine. Terbinafine-induced neutropenia have been reported 7 cases worldwide and these patients had no predisposing factors that give rise to developing neutropenia. To date there has not been reported in Korea. We report a case of systemic lupus erythematosus of 47-yearold female patient who developed deep neck infection requiring intravenous antibiotics, tracheostomy, granulocyte colony-stimulating factor(G-CSF) to recover from terbinafine-induced neutropenia.
Anti-Bacterial Agents ; Causality ; Female ; Granulocytes ; Humans ; Korea ; Lupus Erythematosus, Systemic* ; Neck* ; Neutropenia* ; Onychomycosis ; Tracheostomy

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A case of myasthenia gravis in a patient with diffuse systemic sclerosis developed during D-penicillamine treatment.

Do Hyun PARK ; Eun Young LEE ; Man Su AHN ; In KIM ; Son Mi CHUNG ; Jung Hyun SHIN ; Chang Keun LEE ; You Sook CHO ; Bin YOO ; Kwang Kuk KIM ; Hee Bom MOON

The Journal of the Korean Rheumatism Association.2002;9(2):131-136.

D-penicillamine has been used to reduce skin thickening and prevent the development of significant organ involvement in the treatment of scleroderma. This drug has a number of serious adverse reactions including glomerulonephritis with nephrotic syndrome, aplastic anemia, thrombocytopenia, and myasthenia gravis. A 44-year-old woman was admitted for weakness of the extremity muscle during repeated use. Eight months before admission, she visited dermatology department of our hospital. She was diagnosed as having scleroderma. D-penicillamine was started for the treatment of skin lesions. Based on the fluctuation of proximal muscle weakness, high titer of acetylcholine receptor antibody and definite decremental response of Jolly test, she was diagnosed as myasthenia gravis. D-penicillamine was discontinued because of the suspicion of D-penicillamine induced myasthenia gravis. Muscle weakness improved after D-penicillamine was withdrawn. The development of reversible myasthenia gravis may be regarded as a part of general predisposition for autoimmune disease related to the D-penicillamine therapy.
Acetylcholine ; Adult ; Anemia, Aplastic ; Autoimmune Diseases ; Dermatology ; Extremities ; Female ; Glomerulonephritis ; Humans ; Muscle Weakness ; Myasthenia Gravis* ; Nephrotic Syndrome ; Penicillamine* ; Scleroderma, Diffuse* ; Skin ; Thrombocytopenia

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Korean Medical Insurance System in Rheumatic Diseases.

Jung Yoon CHOE ; Chae Gi KIM ; Sang Cheol BAE

The Journal of the Korean Rheumatism Association.2002;9(2):124-130.

Korean resource-based relative value scale (RBRVS) was developed first in 1997 for the alternative of the traditional Korean fee-for-service system. The knowledge about the RBRVS-based fee schedule is necessary to understand the physician payment system of Korean medical insurance. Still now, it is considered that a few more issues should be modified for the most balanced and rational fee schedule in specific situation of Korea. In this article, we analyzed the current Korean medical insurance fee schedule, especially the RBRVS related to rheumatic diseases. And we introduced the guide of the medical service for rheumatic diseases in the view of approved limit under the medical insurance. In addition, the new optional medical service system, which was operated recently, was also evaluated briefly. It is suggested that the medical insurance fee schedule be modified to more acceptable and reasonable one for the best medical services. For that purpose, it is necessary for medical committee and its members to make an efforts continuously on the basis of the great insights of the current fee schedule of Korean medical insurance.
Fee Schedules ; Insurance* ; Korea ; Relative Value Scales ; Rheumatic Diseases*

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Elevated serum interleukin 15 (IL-15) in Behcet's disease.

Kyung Su PARK ; So Youn MIN ; Mi La CHO ; Chong Hyeon YOON ; Yong Ju KIM ; Jong Seo PARK ; Jin Jung CHOI ; Wan Uk KIM ; Do June MIN ; Youn Sik HONG ; Jun Ki MIN ; Sung Hwan PARK ; Chul Soo CHO ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2002;9(2):117-123.

OBJECTIVE: To evaluate clinical significance of interleukin 15 (IL-15) in patients with Behcet's disease (BD). METHODS: Serum samples were obtained from 31 patients with BD and 29 healthy controls. BD patients were divided into active and inactive group according to the presence of clinical manifestations on the day of sampling. Serum levels of IL-15 and IL-8 were measured by sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of IL-15 and IL-8 were significantly higher in BD patients than in healthy controls (117.2+/-26.2 pg/ml versus 51.8+/-15.4 pg/ml, p<0.01, 287.7+/-100.9 pg/ml versus 138.5+/-17.2 pg/ml, p<0.01, respectively). There was a significant correlation between serum levels of IL-15 and IL-8 IL-15 levels compared with those without it (161.1+/-68.8 pg/ml versus 96.4+/-3 4 . 8pg/ml, p<0.05). Serum levels of IL-15 and IL-8 tended to be higher in active group than in inactive group, but didn't reach statistical significance. CONCLUSION: Serum level of IL-15 was elevated in patients with BD, especially those with uveitis, but it did not seem to be useful as a marker of disease activity in BD.
Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-15* ; Interleukin-8 ; Interleukins* ; Uveitis

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T cell Proliferative Response to Type II collagen is related to Inflammatory Process and Joint Damage in Rheumatoid Arthritis.

Jin Jung CHOI ; Wan Uk KIM ; Mi La CHO ; Myeung Su LEE ; Young Il SEO ; Do June MIN ; Sung Hwan PARK ; Chul Soo CHO ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2002;9(2):106-116.

OBJECTIVE: To investigate the role of T cell responses to type II collagen (CII) in disease progression in rheumatoid arthritis (RA). METHODS: T cell proliferative responses to bovine CII by peripheral blood mononuclear cells (PBMC) from early RA patients (duration <5 years) were assayed by mixed lymphocyte culture. Clinical and laboratory variables including erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were examined at the time of sampling. Radiographic damage on hand X-rays was evaluated by the method of Steinbrocker and Sharp. RESULTS: In a cross-sectional study, patients (n=22) with positive T cell responses (stimulation index: SI>or =2) had higher levels of CRP and ESR than those (n=21) not showing T cell responses. The number of damaged joints (by Steinbrocker's method) and damaged joint scores (by Sharp's method) were significantly higher in patients with positive T cell responses than in those without. The joint space narrowing scores correlated well with T cell responsiveness to CII. Patients (n=15) with both positive T cell responses and RA-susceptible allotypes, HLA-DR1 or DR4, had greater damaged joint scores than the rest of patients (n=24). CONCLUSION: T cell proliferative responses to CII are associated with inflammatory activity and radiographic severity in RA. Our data suggest that CII reactive T cells may play an important role in the pathogenic process of joint damage.
Arthritis, Rheumatoid* ; Blood Sedimentation ; C-Reactive Protein ; Collagen Type II* ; Cross-Sectional Studies ; Disease Progression ; Hand ; HLA-DR1 Antigen ; Humans ; Joints* ; Lymphocytes ; T-Lymphocytes

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Urinary Excretion of Rantes is Elevated in Lupus Nephritis.

Chong Hyeon YOON ; Kyung Soo PARK ; Jin Jung CHOI ; Mi La CHO ; So Youn MIN ; Wan Uk KIM ; Do June MIN ; Jun Ki MIN ; Yeon Sik HONG ; Sung Hwan PARK ; Chul Soo CHO ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2002;9(2):97-105.

OBJECTIVE: Infiltrating T cells and monocytes have been implicated in the pathogenesis of lupus nephritis (LN). Chemokines may play a key role in the recruitment of these cells. We investigated whether RANTES (regulated on activation normal T cell expressed and secreted), one of the CC chemokine family, may be involved in the pathogenesis of LN. METHODS: We measured the levels of RANTES in sera and urine from 87 systemic lupus erythematosus (SLE) patients and 78 healthy controls using ELISA. Clinical and laboratory assessment including SLE disease activity index (SLEDAI) were performed at the time of sampling. RESULTS: Serum RANTES levels were significantly higher in the patients with SLE than in healthy controls (115.0+/-5.6 vs. 91.5+/-4.0 pg/ml, p=0.001, mean+/-SEM). Serum RANTES levels correlated well with anti-dsDNA antibody titer (r=0.29, p<0.05) and inversely with serum complement C4 level (r=-0.28, p<0.05). Urinary RANTES/creatinine ratios were significantly higher in patients with nephritis than those without (3.4+/-0.4 vs. 2.2+/-0.3, p=0.004), while serum RANTES level was not different between patients with nephritis and those without. Moreover, urinary RANTES/creatinine ratio positively correlated with urine protein/creatinine ratio (r=0.41, p<0.001). CONCLUSIONS: Our results demonstrate that serum RANTES was elevated in patients with SLE and urinary excretion of RANTES was strongly associated with presence of nephritis. These data suggest that RANTES may be expressed in renal inflammatory sites and may participate in the pathogenesis of LN possibly by augmenting the recruitment of T cells and monocytes.
Chemokine CCL5* ; Chemokines ; Complement C4 ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Monocytes ; Nephritis ; T-Lymphocytes

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Dehydroepiandrosterone sulphate (DHEAS) levels in premenopausal women with systemic lupus erythematosus.

Jin Hyuk YUN ; Seung Hoon RYU ; Won Tec JUNG ; Sung Won LEE ; Won Suk AN ; Hyuck LEE ; Choon Hee SON ; Seong Eun KIM ; Duk Gyu KIM ; Won Tae CHUNG

The Journal of the Korean Rheumatism Association.2002;9(2):90-96.

OBJECTIVE: Dehydroepiandrosterone sulphate (DHEAS), the major steroidal product of the human adrenal, is abnormally low in patients with SLE. Moreover, a recent study confirms a positive effect of the precursor DHEA on the disease course in SLE, which supports an etiologically important role of the hormone on SLE. The aim of this study is to search for an interrelation between clinical manifestations, laboratory findings, and disease activities and DHEAS in patients with SLE. METHOD: DHEAS were measured by radioimmunoassay kit using 125I-labeled DHEA-SO4 antibody-coated tube in the serum of 48 patients with SLE and in 46 control subjects. Laboratory findings, clinical symptoms, signs and SLE disease activity index (SLEDAI) in SLE patients were evaluated at blood sampling time. RESULTS: DHEAS was lower in patients with SLE compared to controls (45.60+/-42.62 mug/dL vs 101.55+/-56.54 mug/dL, p<0.005). The serum DHEAS levels were significantly negative correlation with SLEDAI (r=-0.333, p<0.05). There were significantly negative correlations between daily steroid dose and DHEAS (r=-0.384, p=0.012), and the amount of steroid used during previous 2 months and DHEAS (r=-0.011, p=0.011). CONCLUSIONS: Patients with SLE have low levels of DHEAS and significant negative correlation between SLEDAI, steroid dose and DHEAS.
Dehydroepiandrosterone* ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Radioimmunoassay

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A New Paradigm for Pathogenesis of Rheumatoid Arthritis.

Jae Hong PARK ; Hyung Bae PARK ; Sungsoo JUNG

The Journal of the Korean Rheumatism Association.2002;9(2):85-89.

Arthritis, Rheumatoid* ; Glucose-6-Phosphate Isomerase

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