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Clinical Characteristics and Joint Involvement of Rheumatoid Arthritis.

Bo Young YOON ; Chan Hee LEE ; Seong Hoon HAN ; Yun Woo LEE

The Journal of the Korean Rheumatism Association.2004;11(3):227-234.

OBJECTIVE: To investigate the clinical, laboratory, radiologic characteristics, and joint involvement of rheumatoid arthritis (RA) in Korean. METHODS: We retrospectively reviewed initial medical records of 210 patients diagnosed as rheumatoid arthritis in Seoul, Sanggye, and Ilsan Paik Hospital, Inje University. Evaluation included age, sex, disease duration, duration of morning stiffness, joint involvement, the number of tender and swollen joints, rheumatoid factor, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and bony erosion in simple X-ray. RESULTS: In total 210 patients, mean age was 50.1+/-13.5 years, and male to female ratio was 1 to 5.6. Mean duration of arthritis was 51.8+/-72.6 months and positive rate of rheumatoid factor was 66.7%. Mean time interval between symptom onset and first visit was 14.1+/-19.1 months. Bony erosion rate was 15.3% in early RA patients, who had been diagnosed as RA within 1 year. The order of frequency of joint involvement was as the follows; metacarpophalangeal (MCP) joints, wrist joints, proximal interphalangeal (PIP) joints, metatarsophalangeal (MTP) joints, ankle joints, and knee joints. It was noted that the joints on the right and left sides behaved in like fashion. This pattern was not different with early RA. The titer of rheumatoid factor showed poor correlations with variables of clinical activity (ESR, CRP, duration of morning stiffness, and number of tender and swollen joints). CONCLUSION: In Korea, clinical manifestations and joint involvement of RA patients were not different from other published studies. The most commonly involved joints are MCP joints, wrist joints, PIP joints, and MTP joints.
Ankle Joint ; Arthritis ; Arthritis, Rheumatoid* ; Blood Sedimentation ; Female ; Humans ; Joints* ; Knee Joint ; Korea ; Male ; Medical Records ; Metatarsophalangeal Joint ; Retrospective Studies ; Rheumatoid Factor ; Seoul ; Wrist Joint

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Catalase and PPAR-gamma Polymorphisms of Rheumatoid Arthritis in Korean.

Chan Bum CHOI ; Ahmed El SOHEMY ; Sang Seokg SEONG ; Yong Wook PARK ; Hye Soon LEE ; Wan Sik UHM ; Tae Hwan KIM ; Jae Bum JUN ; Dae Hyun YOO ; Sang Cheol BAE

The Journal of the Korean Rheumatism Association.2004;11(3):217-226.

OBJECTIVE: To investigate the association between a single nucleotide polymorphism in the catalase and peroxisome proliferator activated receptor- gamma (PPAR-gamma) genes with risk and severity of rheumatoid arthritis (RA) in Korea. METHODS: DNA was isolated from blood samples collected from 473 Korean patients with RA and 400 Korean controls. Genotyping for the C-262T polymorphism of catalase and the Pro12Ala polymorphism of PPAR-gamma was performed by PCR-RFLP (restriction fragment length polymorphism) analysis. Subjects were classified according to ACR criteria for RA, KHAQ, and radiological severity classification by Steinbroker. RESULTS: In patient group, catalase C/T and T/T polymorphism was seen in 23 (4.9%) and 0 patients while Pro/Ala and Ala/Ala PPAR-gamma polymorphism was seen in 42 (8.9%) and 1 (0.2%) patients. In control group, catalase C/T and T/T polymorphism was seen in 25 (6.3%) and 1 (0.2%) controls while Pro/Ala and Ala/Ala PPAR-gamma polymorphism was seen in 34 (8.5%) and 4 (1%) controls. Catalase and PPAR-gamma polymorphism showed no association with the susceptibility to RA individually but, when combined association was found although it had no statistical significance, which was possibly due to its low frequency. Catalase and HLA-DRB1 polymorphism showed significant interaction on development of RA but, no interaction was found between PPAR-gamma and HLA-DRB1. Catalase and PPAR-gamma polymorphism showed no association with the severity or functional status of RA. CONCLUSION: Our results show that genetic polymorphisms of catalase and PPAR-gamma has no association with the susceptibility to RA. Catalase and HLA-DRB1 polymorphism showed significant interaction on development of RA.
Arthritis, Rheumatoid* ; Catalase* ; Classification ; DNA ; HLA-DRB1 Chains ; Humans ; Korea ; Peroxisomes ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide

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Arthrodesis of the First Metatarsophalangeal Joint for Rheumatoid Hallux Valgus, using 2 Crossed Screws.

Il Hoon SUNG ; Sung Wook CHOI ; Choong Hyeok CHOI ; Ye Soo PARK

The Journal of the Korean Rheumatism Association.2004;11(3):212-216.

OBJECTIVE: To investigate the clinical results of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of the rheumatoid arthritis, using the fixation method with 2 crossed screws. METHODS: 19 cases of the rheumatoid hallux valgus deformity were tried to treat with the first metatarsophalangeal arthrodesis, using 2 crossed screws. The follow-up period was averaged in 16 months. The subjective and objective findings were evaluated. Radiologically measurements for the hallux valgus angle, 1, 2 intermetatarsal angle and dorsiflexion angle were measured. RESULTS: Cases, of which the first metatarsophalangeal joint successfully fixated with 2 crossed screws, were 14 (73.7%). 5 failed fixations with 2 crossed screws due to breakage of the cortical bone were immediately refixed with fixation methods (the dorsal plating for three cases, additional K-wire fixation for one, and threaded Steinmann pins fixation for one case). After the arthrodesis of the first metatarsophalangeal joint, the subjective signs in pain, function and alignment were improved as all above fair grade. The radiological fusion was observed at average 8 weeks after the operation in all cases. The hallux valgus angle and 1, 2 intermetatarsal angle were reduced from 45.6+/-7.5degrees and 16.2+/-5.2degrees to 14.2+/-2.0degrees and 10.9+/-2.5degrees respectively. The dorsiflexion angle was measured in 20.5+/-2.2degrees after the fusion. CONCLUSION: To correct the rheumatoid hallux valgus deformity, the arthrodesis of the first metatarsophalangeal joint with 2 crossed screws is a method for the satisfactory results, once the fixation is achieved. However, other fixation procedures should be prepared in case of the failed fixation, which could be happened intraoperatively.
Arthritis, Rheumatoid ; Arthrodesis* ; Congenital Abnormalities ; Follow-Up Studies ; Hallux Valgus* ; Hallux* ; Metatarsophalangeal Joint*

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Elevated Serum Levels of Macrophage Migration Inhibitory Factor (MIF) in Patients with Behcet's Disease.

Sung Dong KIM ; Sang Hyon KIM ; Hae Rim KIM ; Mi Kyung PARK ; Chong Hyeon YOON ; Wan Uk KIM ; Sang Heon LEE ; Sung Hwan PARK ; Chul Soo CHO ; Ho Youn KIM

The Journal of the Korean Rheumatism Association.2004;11(3):205-211.

OBJECTIVE: Macrophage migration inhibitory factor (MIF) has emerged recently as an important regulator of inflammatory and immune responses. This work was undertaken to evaluate serum levels of MIF and in vitro MIF production by whole blood cells in patients with Behcet's disease and investigate the relationship between serum levels of MIF and clinical manifestations. METHODS: Sixty-five patients with Behcet's disease and forty-eight healthy controls were studied to evaluate serum levels of MIF. Six patients with Behcet's disease and Five healthy controls were studied for evaluating the production of MIF by whole blood cells. Serum and culture supernatant levels of MIF were measured by enzyme-linked immunosorbent assay (ELISA). The production of MIF by whole blood cells was investigated by culturing peripheral blood cells in the absence or presence of Concanavalin A (Con A). RESULTS: Serum levels of MIF were higher in patients with Behcet's disease than in healthy controls. Serum levels of MIF were changed in each patient with Behcet's disease according to clinical disease activity (higher at active state). The MIF production by Con A-stimulated peripheral blood cell culture was higher in patients with Behcet's disease than in healthy controls. CONCLUSION: Circulating levels of MIF are higher in patients with Behcet's disease than in healthy controls and the levels of MIF may be associated with clinical disease activity. MIF may play an important role as a mediator of inflammation in Behcet's disease and provide opportunity for the development of anti-MIF strategy for the treatment of patients with Behcet's disease.
Blood Cells ; Concanavalin A ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Macrophages*

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New Insights on the Pathogenesis of Behcet's Disease.

Hyun Kyu CHANG

The Journal of the Korean Rheumatism Association.2004;11(3):193-204.

Behcet's disease (BD) is a chronic inflammatory disorder of unknown cause, characterized by recurrent oral ulcerations, genital ulcerations, ocular and skin lesions. Although the exact pathogenesis for BD is not completely understood, it has been suggested that the disease is triggered in genetically susceptible individuals by environmental factors, such as microbial agents. It is noted that multiple genes, including MHC and non-MHC genes, are implicated in the pathogenesis of BD. Although the HLA-B51 is known to be the candidate gene showing the strongest association with BD, it is necessary to be determined whether this HLA molecule is directly involved in the pathogenesis of BD. Cross-reactivity between microbial 65-kD and human 60-kD heat shock proteins is demonstrated to cause an increased T cell (particularly gammadelta T cell) response. The resultant overexpression of pro-inflammatory cytokines (mainly Th-1 type) from several immune cells seems to be responsible for the enhanced inflammatory reaction, and this may be associated with the genetic factors.
Cytokines ; Heat-Shock Proteins ; HLA-B51 Antigen ; Humans ; Oral Ulcer ; Skin ; Ulcer

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A Case of Juvenile Ankylosing Spondylitis with Atlantoaxial Bony Ankylosis and Rheumatoid-like Hands.

Hyo Shick CHANG ; Ki Chul SIN ; Jae Duk KIM ; Young Ah PARK ; Myung Ju KI ; Hyun Kyu CHANG ; Jee Young LEE

The Journal of the Korean Rheumatism Association.2003;10(2):206-211.

Ankylosing spondylitis (AS) is a heterogeneous and systemic rheumatic disorder of unknown cause that is characterized by inflammation of the spine and sacroiliac joints. It is more common in young men. The disease is frequently associated with peripheral arthritis, enthesitis, anterior uveitis and high prevalence of HLA-B27. In some patients with AS, peripheral arthritis can occurs earlier than spinal symptom and more commonly affects the lower extremities than the upper extremities. Unlike men, women appear to have milder or atypical AS, especially at juvenile onset. However, involvement of the hands is extremely rare. Juvenile AS, defined as onset of disease prior to the age of 16 years, is considered a pediatric form of AS. On the other hand, although the atlantoaxial subluxation has been infrequently observed in patients with ankylosing spondylitis, atlantoaxial bony ankylosis has not been described in the literature. We describe a 23-year-old woman with juvenile AS who developed the atlantoaxial bony ankylosis and the hand involvement mimicking rheumatoid arthritis. Besides the rheumatoid-like hands and atlantoaxial bony ankylosis, she has shown the typical features of spondyloarthrpathy such as bilateral sacroiliitis, inflammatory spinal pain, enthesitis, severe arthritis of both hip joints, and positive HLA-B27 test.
Ankylosis* ; Arthritis ; Arthritis, Rheumatoid ; Female ; Hand* ; Hip Joint ; HLA-B27 Antigen ; Humans ; Inflammation ; Lower Extremity ; Male ; Prevalence ; Sacroiliac Joint ; Sacroiliitis ; Spine ; Spondylitis, Ankylosing* ; Upper Extremity ; Uveitis, Anterior ; Young Adult

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A Case of Seronegative Rheumatoid Arthritis with Idiopathic Hypereosinophilic Syndrome.

Jung Hyeon CHOI ; Jae Wook JUNG ; Hyun Ju SONG ; Kyoung Eun SONG ; Jeong Hee CHOI ; Yu Jin SUH ; Hae Sim PARK ; Chang Hee SUH

The Journal of the Korean Rheumatism Association.2003;10(2):200-205.

The idiopathic hypereosinophilic syndrome (HES) is a disorder marked by the sustained overproduction of eosinophils. The disease is characterized by damage of multiple organ including heart, nerve system, skin and lung due to eosinophilic infiltration and the diagnosis is one of exclusion. Rheumatologic manifestations of HES are infrequent. In about 10~40% of rheumatoid arthritis (RA) patients, persistent eosinophilia is observed. That can be due to the RA itself and is often associated with active disease and extra-articular features. Sometimes, it is attributed to the drug therapy, especially gold and penicillamine. We would like to report a 37-year-old female patient with HES who developed seronegative RA 2 years later.
Adult ; Arthritis, Rheumatoid* ; Diagnosis ; Drug Therapy ; Eosinophilia ; Eosinophils ; Female ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Lung ; Penicillamine ; Skin

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Widespread Persistent Erythemas and the 'Holster Sign' in Dermatomyositis.

Chan SAGONG ; Chang Woo LEE

The Journal of the Korean Rheumatism Association.2007;14(1):101-102.

No Abstract available.
Dermatomyositis* ; Erythema*

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Recurrent Acute Myocardial Infarctions and Budd-Chiari Syndrome in Young Woman with Behcet's Disease.

Myung Hee CHANG ; So Young BANG ; Tae Hwan KIM ; Jae Bum JUN ; Dae Hyun YOO ; Sang Cheol BAE ; Wan Sik UHM

The Journal of the Korean Rheumatism Association.2007;14(1):96-100. doi:10.4078/jkra.2007.14.1.96

We report here a case of vascular Behcet's disease. 32-year-old young woman who suffered from chest pain was diagnosed with acute myocardial infarction four years before admission. At that time she manifested symtoms of Behcet's disease, such as oral ulcers, genital ulcers, multiple arthralgia, and a peculiar hyperirritability reaction to needle puncture. At this time she was admitted due to acute chest pain and intermittent abdominal pain. The diagnosis of an acute anteroseptal myocardial infarction was made on the basis of the electrocardiography findings. Cardiac catheterization revealed segmental stenosis up to 95% at the mid-left anterior descending artery without aneurysm formation at other coronary trees and there were no atherosclerotic changes. Coronary stent was inserted in the lesion. Abdominal CT showed inferior vena cava and right hepatic vein obstruction, which supports the diagnosis of Budd-Chiari syndrome. Our case demonstrated the followings which are not common to vasculo-Behcet disease; 1) initial clinicopathologic manifestations at the coronary artery, 2) abrupt total occlusion with clear cut lesion at left anterior descending artery, 3) recurrent myocardial infarctions, 4) Budd-Chiari syndrome, 5) combined superior mesenteric artery, inferior mesenteric artery and celiac trunk obstruction. Among the systemic manifestation of Behect's disease, cardiac involvement is very rare but should be considered as one of the most important features that influences the prognosis.
Abdominal Pain ; Adult ; Aneurysm ; Anterior Wall Myocardial Infarction ; Arteries ; Arthralgia ; Budd-Chiari Syndrome* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Female ; Heart Diseases ; Hepatic Veins ; Humans ; Mesenteric Artery, Inferior ; Mesenteric Artery, Superior ; Myocardial Infarction* ; Needles ; Oral Ulcer ; Prognosis ; Punctures ; Stents ; Tomography, X-Ray Computed ; Ulcer ; Vena Cava, Inferior

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Rectus Sheath Hematoma Complicated by Rectus Abdominus Myonecrosis in a Patient with Rheumatoid Arthritis.

Hyung Ran YUN ; Ki Deok YOO ; Yoon Jeong KIM ; Tae Seok YOO ; Soon Young SONG ; Jae Bum JUN

The Journal of the Korean Rheumatism Association.2007;14(1):91-95. doi:10.4078/jkra.2007.14.1.91

Rectus sheath hematoma is an uncommon cause of acute abdomen, caused by a tear in deep epigastric vessels or its branches. It occurs spontaneously, after trauma or surgery. Rectus abdominus myonecrosis is a life threatening complication of rectus sheath hematoma. We report a case with fatal rectus sheath hematoma complicated by rectus abdominus myonecrosis caused by ischial fracture in a chronic active rheumatoid arthritis patient.
Abdomen, Acute ; Arthritis, Rheumatoid* ; Hematoma* ; Humans

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