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Case of Brain Biopsy Proven Giant Cell Arteritis.

Ho Hyun PARK ; Seung Heon KANG ; Sang Hoon PARK ; Jae Sung PARK ; Bon San KOO

Journal of Rheumatic Diseases.2016;23(6):396-400. doi:10.4078/jrd.2016.23.6.396

Giant cell arteritis (GCA) is categorized as vasculitis of the large and medium-sized vessels. Visual loss is one potential consequence of cranial arteritis. Temporal artery biopsies are performed frequently to demonstrate the involvement of arteritis. On the other hand, cerebral artery involvement with pathological findings is not well documented in patients with GCA. We report a rare case of GCA with cerebral vessel involvement in a 76-year-old woman.
Aged ; Arteritis ; Biopsy* ; Brain* ; Cerebral Arteries ; Female ; Giant Cell Arteritis* ; Giant Cells* ; Hand ; Humans ; Temporal Arteries ; Vasculitis

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Case of Follicular Bronchiolitis in Rheumatoid Arthritis.

Jong Hwa LEE ; MyungWoo CHOI ; Sung Sik OH ; Mi Rim CHOI ; Hyun Ju YANG ; Kwang Min LEE ; Kyoung Hwa CHOI

Journal of Rheumatic Diseases.2016;23(6):392-395. doi:10.4078/jrd.2016.23.6.392

Follicular bronchiolitis is an uncommon bronchiolar disorder that is characterized by the presence of hyperplastic lymphoid follicles with reactive germinal centers. The condition is associated with connective tissue diseases such as rheumatoid arthritis, Sjögren’s syndrome, and immunodeficiency disorders. A 56-year-old man with rheumatoid arthritis was admitted to hospital with a progressively enlarging pulmonary nodule in the left upper lobe. A follow-up contrast tomography scan showed that the nodule had increased in size from 4.2 mm to 6.3 mm over a 3 month period. An open lung biopsy was performed to establish a definite pathologic diagnosis of the pulmonary nodule, which was suspected to be a lung malignancy. The nodule was diagnosed as follicular bronchiolitis based on the histopathology findings. We describe a patient with follicular bronchiolitis that was confirmed by an open lung biopsy, and is believed to have had rheumatoid involvement.
Arthritis, Rheumatoid* ; Biopsy ; Bronchiolitis* ; Connective Tissue Diseases ; Diagnosis ; Follow-Up Studies ; Germinal Center ; Humans ; Lung ; Middle Aged ; Solitary Pulmonary Nodule

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Case of Moyamoya Disease Aggravated during the Treatment of Behçet’s Disease.

Eun Seong PARK ; Yoon Jeong OH ; Byung Woo YOO ; Sung Soo AHN ; Jin Su PARK ; Pyeong Ho YOON ; Chan Hee LEE

Journal of Rheumatic Diseases.2016;23(6):386-391. doi:10.4078/jrd.2016.23.6.386

Behçet’s disease (BD) is a multi-organ involved inflammatory disorder described by recurrent oral ulcers and other systemic manifestations. Almost all the clinical manifestations of BD are believed to be due to vasculitis. On the other hand, the cerebral arteries are rarely involved. Moyamoya disease (MMD) is an unusual chronic cerebrovascular disorder that is described by bilateral progressive stenosis or occlusion of the internal carotid artery and an abnormal collateral vascular network. A 32-year-old woman with MMD was referred for fever, oral pain, and diarrhea, and was diagnosed with BD. Her MMD was aggravated during treatment with high dose steroids to control the intestinal BD and a reduction in the MMD medication due to gastrointestinal bleeding. This is the first reported case of intestinal BD in a patient previously diagnosed with MMD, who experienced aggravation of her MMD after the cessation of MMD medication due to aggravated intestinal BD.
Adult ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebrovascular Disorders ; Constriction, Pathologic ; Diarrhea ; Female ; Fever ; Hand ; Hemorrhage ; Humans ; Moyamoya Disease* ; Oral Ulcer ; Steroids ; Vasculitis

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Acute Myositis of the Tibialis Anterior Muscle after Performance of 108 Prostrations.

Sung Yeon LEE ; Mi Jung KWON ; Young Il SEO ; Hyun Ah KIM

Journal of Rheumatic Diseases.2016;23(6):382-385. doi:10.4078/jrd.2016.23.6.382

Exercise-induced muscle damage (EIMD) can be caused by novel or unaccustomed exercise resulting in a temporary decrease in muscle function, increased muscle soreness and swelling, and an increase in muscle proteins in blood. A 38-year-old female presented with a 2-week history of bilateral lower leg pain and swelling that developed suddenly after performing 108 prostrations. Fat-suppressed contrast-enhanced T1-weighted magnetic resonance imaging showed bilateral symmetric high signal intensity of the tibialis anterior muscles. Our patient was diagnosed with acute myositis and treated with naproxen. History of physical exertion and acute onset of typical clinical findings of myositis were key elements in the diagnosis. Acute myositis related to exercise is a common and self-limiting condition which fully resolves after 2 to 3 weeks. However, other causes of myositis should be excluded in patients with atypical clinical features.
Adult ; Diagnosis ; Female ; Humans ; Inflammation ; Leg ; Magnetic Resonance Imaging ; Muscle Proteins ; Muscles ; Myalgia ; Myositis* ; Naproxen ; Physical Exertion

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Diagnostic Accuracies of Anti-carbamylated and Anti-citrullinated Fibrinogen Antibodies in Rheumatoid Arthritis: A Meta-analysis.

Young Ho LEE

Journal of Rheumatic Diseases.2016;23(6):373-381. doi:10.4078/jrd.2016.23.6.373

OBJECTIVES: This study evaluated the diagnostic performance of anti-carbamylated protein (anti-CarP) and anti-citrullinated fibrinogen (ACF) antibodies in rheumatoid arthritis (RA). METHODS: We searched the Pubmed, Embase, and Cochrane library databases, and performed two meta-analyses on the diagnostic accuracy of anti-CarP and ACF antibodies in patients with RA. RESULTS: The meta-analysis included data from 12 studies. Of these, seven studies, which included 1,749 patients and 1,044 controls, examined anti-CarP antibody, and five studies, which included 733 patients and 1,178 controls, examined ACF antibody. The pooled sensitivities and specificities of anti-CarP antibody were 43.9% (95% confidence interval [CI], 41.6~46.3) and 94.5% (95% CI, 93.0~95.8), respectively, and those of ACF antibody were 68.3% (95% CI, 64.9~71.6) and 95.8% (95% CI, 94.5~96.9), respectively. The positive likelihood ratio (PLR) of anti-CarP antibody were 9.901 (95% CI, 5.005~19.58), negative likelihood ratio (NLR) was 0.597 (95% CI, 0.541~0.658), and diagnostic odds ratio (DOR) was 14.64 (95% CI, 8.004~34.45). For ACF antibody, PLR was 16.14 (95% CI, 10.23~25.42), NLR was 0.292 (95% CI, 0.192~0.444), and DOR was 58.61 (95% CI, 26.61~129.1). There were no significant difference in sensitivity, specificity, PLR, NLR, AUC, or Q* index between ACF and anti-cyclic citrullinated peptide (anti-CCP) in the diagnosis of RA. CONCLUSION: Our meta-analysis demonstrates that both anti-CarP and ACF antibodies are highly specific for diagnosing RA. However, while ACF and anti-CCP showed comparably high diagnostic accuracy, anti-CarP antibody showed low sensitivity in diagnosing RA.
Antibodies* ; Area Under Curve ; Arthritis ; Arthritis, Rheumatoid* ; Diagnosis ; Fibrinogen* ; Humans ; Odds Ratio ; Sensitivity and Specificity

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Gene Expression Profile in Patients with Axial Spondyloarthritis: Meta-analysis of Publicly Accessible Microarray Datasets.

Robin PARK ; Tae Hwan KIM ; Jong Dae JI

Journal of Rheumatic Diseases.2016;23(6):363-372. doi:10.4078/jrd.2016.23.6.363

OBJECTIVE: To identify a gene expression signature in axial spondyloarthritis/ankylosing spondylitis (SpA/AS) and genomic pathways likely to be involved in pathogenesis of SpA/AS patients. METHODS: Four publicly accessible microarray studies from SpA/AS patients were integrated, and a transcriptomic and network-based meta-analysis was performed. This meta-analysis was compared with a published microarray study in whole blood of AS patients. RESULTS: According to our meta-analysis, 1,798 genes were differentially expressed in the whole blood of SpA/AS patients compared to healthy controls, while 674 genes were differentially expressed in the synovium of SpA/AS patients compared to healthy controls. When the whole blood meta-analysis data was compared with a published microarray study that also analyzed whole blood in SpA/AS patients, pathways involved in Toll-like receptor signaling, osteoclast differentiation, T cell receptor signaling and janus kinase–signal transducer and activator of transcription (Jak-STAT) signaling were often enriched in SpA/AS. On the other hand, eomesodermin, RUNX3, and interleukin-7 receptor (IL7R) were usually decreased in SpA/AS patients, suggesting that deficiency of these genes contributes to increased IL-17 production in AS. CONCLUSION: Several common enrichment pathways including Toll-like receptor signaling pathway, osteoclast differentiation, T cell receptor signaling pathway and Jak-STAT signaling pathway were identified in the differentially expressed genes of whole blood and synovium from SpA/AS patients, suggesting that these pathways are involved in the pathogenesis of SpA/AS.
Dataset* ; Gene Expression* ; Genes, vif ; Hand ; Humans ; Interleukin-17 ; Interleukin-7 ; Osteoclasts ; Receptors, Antigen, T-Cell ; Spondylitis ; Spondylitis, Ankylosing ; Synovial Membrane ; Toll-Like Receptors ; Transcriptome* ; Transducers

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Tumor Necrosis Factor Blockade Stimulates Circulating Osteoblastic Lineage Cells Activity while Reducing Circulating Osteoclasts.

Mie Jin LIM ; Seong Ryul KWON ; Kyong Hee JUNG ; Won PARK

Journal of Rheumatic Diseases.2016;23(6):356-362. doi:10.4078/jrd.2016.23.6.356

OBJECTIVE: This study examines the effects of tumor necrosis factor (TNF) blockade on markers of bone metabolism in peripheral blood from active rheumatoid arthritis (RA) patients. METHODS: Eighteen patients (16 women, 2 men) aged 50 years (range 37-63 years), with persistently active RA (mean disease duration 7 years) were studied. Most took methotrexate (mean dose 12.5 mg) and all except one received corticosteroid (mean dose 5.7 mg). Four were treated with etanercept, eight received adalimumab and six received infliximab. Before and six months after taking TNF blockers, blood was sampled to obtain peripheral blood mononuclear cells (PBMCs), and serum bone turnover markers and acute phase reactants were measured. PBMCs were seeded and cultured to produce osteoblastic lineage cells and osteoclasts. RESULTS: The formation of calcified nodules by osteoblastic lineage cells from PBMC increased from 205.7±196.3 µmol/well at the baseline to 752.5±671.9 µmol/well after TNF blockade (p<0.024). The serum levels of bone formation markers, including bone specific alkaline phosphatase and osteocalcin also increased. The number of circulating osteoclasts and area of bone resorption pits made by osteoclasts were reduced after TNF blockade. CONCLUSION: The activity of circulating osteoblastic lineage cells increased after TNF blockade, whereas peripheral osteoclastogenesis tended to be suppressed. This is the first study of cultured human peripheral osteoblastic lineage cells in RA patients. Given that peripheral bone formation is difficult to study using radiologic methods, culture of these cells may provide a new modality for studying bone metabolism in RA.
Acute-Phase Proteins ; Adalimumab ; Alkaline Phosphatase ; Arthritis, Rheumatoid ; Biological Therapy ; Bone Remodeling ; Bone Resorption ; Etanercept ; Female ; Humans ; Infliximab ; Metabolism ; Methotrexate ; Osteoblasts* ; Osteocalcin ; Osteoclasts* ; Osteogenesis ; Tumor Necrosis Factor-alpha*

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Agreement of Major Diagnosis and Comorbidity between Self-reported Questionnaire and Medical Record Review in Patients with Rheumatic Disease.

Ga Young AHN ; Soo Kyung CHO ; Dam KIM ; Chan Bum CHOI ; Eun Bong LEE ; Sang Cheol BAE ; Yoon Kyoung SUNG

Journal of Rheumatic Diseases.2016;23(6):348-355. doi:10.4078/jrd.2016.23.6.348

OBJECTIVE: Self-report questionnaires are frequently used to obtain information in epidemiological research. However, information reported by patients are sometimes inconsistent with medical records. This study compared self-reported major rheumatologic diagnoses and co-morbid conditions with those from a medical record review. METHODS: A cross-sectional survey was conducted at two tertiary academic hospitals. All patients who visited the rheumatology department from September 2, 2009 to September 13, 2009 were enrolled in this survey. Structured patient questionnaires and medical record reviews were performed in each hospital. We evaluated agreement with kappa statistics (κ) between these two data sources for major rheumatologic diagnosis and Charlson Comorbidity Index (CCI) score. Multiple logistic regression models were used to investigate factors associated with disagreement. RESULTS: A total of 369 patients were interviewed at clinic exit. Of them, 302 patients (81.8%) were female, and the average age was 52.1 years. The agreement for major rheumatologic diagnosis between the questionnaire and patient chart was good (κ=0.763). The agreement rate for all rheumatic diseases was 81.8%; rheumatoid arthritis with 94.9%, systemic lupus erythematosus with 96.3%, and ankylosing spondylopathy with 100%. Higher educational level and longer attendance at our clinic were associated with agreement between major rheumatologic diagnoses. The agreement rate for CCI score between the data sources was 76.1%. CONCLUSION: In patients with rheumatologic diseases, the agreement for major diagnoses between self-reports and the medical record review was good, although it varied with the specific disease and patient characteristics. Comparing major rheumatologic diagnoses, the agreement rate for CCI was low.
Arthritis, Rheumatoid ; Comorbidity* ; Cross-Sectional Studies ; Diagnosis* ; Female ; Humans ; Information Storage and Retrieval ; Logistic Models ; Lupus Erythematosus, Systemic ; Medical Records* ; Rheumatic Diseases* ; Rheumatology ; Self Report

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Roles of Reactive Oxygen Species in Rheumatoid Arthritis Pathogenesis.

Su Jin YOO ; Eunbyeol GO ; Ye Eun KIM ; Sunyoung LEE ; Jaeyul KWON

Journal of Rheumatic Diseases.2016;23(6):340-347. doi:10.4078/jrd.2016.23.6.340

Rheumatoid arthritis (RA) is an autoimmune disease that starts with decreased tolerance to modified self-antigens and eventually leads to synovitis and destruction of bone and cartilage. Age is a risk factor for developing RA. Major changes in the immune system come with age due to chronic oxidative stress on the deoxyribonucleic acid (DNA) damage pathway, somatic mutation, modifications of auto-antigens, T cell tolerance and activation of fibroblast-like synoviocytes (FLS). Reactive oxygen species (ROS) generated by nicotinamide adenine dinucleotide phosphate oxidase 2 (NADPH oxidase 2) suppress T cell receptor signaling. Sirtuin 1 (SIRT1) is a critical immune suppressor of T cell activation and a key regulator of oxidative stress. When oxidative stress reduces activity of SIRT1, the breakdown of tolerance to modified self-antigens is expected. Generation of ROS can be perpetuated by enhanced DNA damage and dysfunctional mitochondria in a feedback loop during the development of RA. Through major T cell loss and selective proliferation of peripheral T cells, pro-inflammatory T cell pools with abnormal features are established in the T cell compartment. Hypoxic and inflammatory condition in synovium perpetuates ROS generation, which leads to the activation of FLS. In both T cell and synovium compartment, oxidative stress reshapes the immune system into the development of pre-clinical RA.
Arthritis, Rheumatoid* ; Autoantigens ; Autoimmune Diseases ; Cartilage ; DNA ; DNA Damage ; Immune System ; Mitochondria ; NADP ; NADPH Oxidase ; Oxidative Stress ; Oxidoreductases ; Reactive Oxygen Species* ; Receptors, Antigen, T-Cell ; Risk Factors ; Sirtuin 1 ; Synovial Membrane ; Synovitis ; T-Lymphocytes

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Are Platelet Indices of Clinical Use to Monitor Disease Activity and Inflammatory Burden in Axial Spondyloarthritis?.

Min Chan PARK

Journal of Rheumatic Diseases.2016;23(6):337-339. doi:10.4078/jrd.2016.23.6.337

No abstract available.
Blood Platelets*

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