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A Case of Refractory SAPHO Syndrome Treated with Etanercept.

Ye Ji KIM ; Song I BAE ; Sung Jae CHOI ; Young Ho LEE ; Jong Dae JI ; Gwan Gyu SONG

Journal of Rheumatic Diseases.2012;19(1):51-54. doi:10.4078/jrd.2012.19.1.51

SAPHO syndrome, which has different skin changes and osteoarticular inflammation, is an acronym that stands for synovitis, acne, pustulosis, hyperostosis, and osteitis. Treatment of SAPHO syndrome includes non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs, such as colchicines, corticosteroids and bisphosphonates, and disease-modifying agents. However, the treatment of SAPHO syndrome is controversial because it is a new clinical entity with unclear etiopathogenesis and inadequate clinical studies. We report a case with refractory SAPHO syndrome, which was successfully treated with a tumor necrosis factor (TNF)-alpha blocker.
Acne Vulgaris ; Acquired Hyperostosis Syndrome ; Adrenal Cortex Hormones ; Antirheumatic Agents ; Diphosphonates ; Hyperostosis ; Immunoglobulin G ; Inflammation ; Osteitis ; Receptors, Tumor Necrosis Factor ; Skin ; Synovitis ; Tumor Necrosis Factor-alpha ; Etanercept

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A Case of Secondary Gout Associated with Essential Thrombocythemia.

Young Min KIM ; Sora LEE ; Ji Eun LEE ; Do Hyoung LIM ; Il KIM ; Keon Woo PARK ; Soon Il LEE

Journal of Rheumatic Diseases.2012;19(1):47-50. doi:10.4078/jrd.2012.19.1.47

Gouty arthritis is a metabolic disorder characterized by hyperuricemia, deposition of monosodium urate crystal in the joints, and recurrent episodes of acute inflammatory arthritis. Depending on the actual causes of hyperuricemia, gout is classified as primary or secondary gout. In myeloproliferative neoplasms, a turnover of nucleic acids is greatly augmented and therefore the blood concentration of uric acid may be markedly increased. But an acute attack of gout is extremely rare in patients with myeloproliferative neoplasms. Essential thrombocythemia, one of the myeloproliferative neoplasms, is characterized by megakaryocytic hyperplasia in bone marrow and marked thrombocytosis. We report a case of secondary gout in a 66-year-old man with essential thrombocythemia.
Aged ; Arthritis ; Arthritis, Gouty ; Bone Marrow ; Gout ; Humans ; Hyperplasia ; Hyperuricemia ; Joints ; Nucleic Acids ; Thrombocythemia, Essential ; Thrombocytosis ; Uric Acid

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Acute Pancreatitis as a Complication of Adult Henoch-Schonlein Purpura.

Min Wook SO ; You Jae KIM ; Hwan Sung PARK ; Yong Gil KIM ; Chang Keun LEE ; Bin YOO

Journal of Rheumatic Diseases.2012;19(1):43-46. doi:10.4078/jrd.2012.19.1.43

Pancreatitis is a rare manifestation of adult Henoch-Schonlein purpura (HSP). We describe here a 53-year-old man who presented with acute pancreatitis as a complication of adult HSP. Pancreatic involvement in HSP is self-limiting and benign. Prompt resolution can be achieved by treatment with steroids. Elevated serum amylase and lipase concentrations may be early diagnostic indicators of HSP pancreatitis. Patients with HSP who have abdominal pain should be evaluated for pancreatitis by measuring serum amylase and lipase concentrations and by abdominal computed tomography scan, to plan specific treatment and avoid unnecessary surgery.
Abdominal Pain ; Adult ; Amylases ; Humans ; Lipase ; Middle Aged ; Pancreatitis ; Purpura, Schoenlein-Henoch ; Steroids ; Unnecessary Procedures ; Vasculitis

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Transverse Myelitis in Patient with Behcet's Disease.

Han Jun BAE ; Chang Gyu JUNG ; Ju Hyung LEE ; Tae Yul KIM ; Sunyoung LEE ; Jin Nyeong CHAE ; Hyuk Won CHANG ; Hyon Ah YI ; Sang Hyon KIM

Journal of Rheumatic Diseases.2012;19(1):39-42. doi:10.4078/jrd.2012.19.1.39

Behcet's disease (BD) is a multisystem disorder presenting recurrent oral and genital ulcerations as well as ocular lesions, involving the nervous system in a subgroup of patients. BD develops at a young age and is frequently presented with an acute or subacute brainstem syndrome or hemiparesis, as well as with other various neurological manifestations, the syndrome is often included in the differential diagnosis of multiple sclerosis, stroke of the young adult, and other neurological disorders. Transverse myelitis (TM) is a clinical syndrome in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations and autonomic dysfunction. Spinal Neuro-behcet's disease is rare case. We reported a 33-year old man who had been treated for BD for 3 years.
Brain Stem ; Diagnosis, Differential ; Humans ; Multiple Sclerosis ; Myelitis, Transverse ; Nervous System ; Nervous System Diseases ; Neurologic Manifestations ; Paresis ; Spinal Cord ; Stroke ; Ulcer ; Young Adult

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Identification of Independent Predictive Factors for Atherosclerosis in Rheumatoid Arthritis: Based on KARRA Cohort Study.

Ji Hun KIM ; Jong Wan KANG ; Na Ri KIM ; Gi Bum BAE ; Soo Kon LEE ; Churl Hyun IM ; Eon Jeong NAM ; Young Mo KANG

Journal of Rheumatic Diseases.2012;19(1):30-38. doi:10.4078/jrd.2012.19.1.30

OBJECTIVE: This study sought to investigate independent predictive factors for subclinical atherosclerosis in Korean patients with rheumatoid arthritis (RA). METHODS: We used high-resolution B-mode ultrasonography to measure the carotid artery intima-media thickness (IMT) and carotid plaque in 367 patients with RA. Detailed information on the demographic characteristics, cardiovascular (CV) risk factors, and RA disease characteristics were collected on all subjects. The relationship of the carotid artery IMT and carotid plaque to relevant clinical and laboratory variables were examined. RESULTS: Old age and male sex had the most significant association with increased IMT and presence of plaque than other factors. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and mKHAQ (Korean version of modified health assessment questionnaire) were significantly associated with both increased IMT and presence of plaque after univariate analysis adjusting for age and sex. A multivariable logistic regression analysis revealed that ESR and TJC68 were independent factors associated with the presence of plaque (p<0.001 and p=0.019, respectively). There was a significant linear correlation between the number of plaques and ESR (p<0.001 and R2=0.07). CONCLUSION: Our results indicated that markers of systemic inflammation contributed significantly to subclinical atherosclerosis in patients with RA. We emphasize the need for aggressive control of RA disease activity in patients who persistently demonstrate highly elevated ESR levels.
Arthritis, Rheumatoid ; Atherosclerosis ; Blood Sedimentation ; C-Reactive Protein ; Cardiovascular Diseases ; Carotid Arteries ; Cohort Studies ; Humans ; Inflammation ; Logistic Models ; Male ; Risk Factors

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Comparison of Effectiveness and Safety of Tramadol/Acetaminophen and Non-steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Knee Osteoarthritis in Elderly Patients.

Se Young KIM ; Ji Won RYOU ; Jin Wuk HUR

Journal of Rheumatic Diseases.2012;19(1):25-29. doi:10.4078/jrd.2012.19.1.25

OBJECTIVE: To compare the analgesic effectiveness and safety of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (tramadol/acetaminophen) with non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of osteoarthrits in elderly patients. METHODS: This randomized controlled study enrolled 48 patients with chronic knee osteoarthritis where the diagnostic period was over 3 months. Patients with at least moderate pain [visual analog scale (VAS) with scores > or =40/100 mm] after the washout period were randomized to tramadol/acetaminophen or NSAID. All patients received tramadol/acetaminophen 1 tablet TID or NSAID (naproxen 500 mg) BID. The primary outcome measures were the final pain VAS scores. Secondary measures included pain relief (5 point Likert scale), adverse events, and overall medication assessments. RESULTS: In total, 43 intent-to-treat (ITT) patients received tramadol/acetaminophen (n=21) or NSAID (n=22). Mean baseline pain VAS scores showed no difference between two groups. ITT analysis showed significantly better mean final VAS scores (38.45 vs 31.24, p=0.004) and mean final pain relief scores (2.18 vs 2.95; p=0.007) for tramadol/acetaminophen rather than for NSAID. The most common treatment related adverse events with tramadol/acetaminophen were nausea/vomiting (47.6%) and constipation (33.3%). Epigastric soreness and heartburn was more frequent in NSAID treatment. CONCLUSION: Tramadol/acetaminophen combination showed better effectiveness in pain reduction compared with NSAIDs when used for the treatment of osteoarthritis in elderly patients.
Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Constipation ; Heartburn ; Humans ; Knee ; Osteoarthritis ; Osteoarthritis, Knee ; Outcome Assessment (Health Care) ; Tablets ; Tramadol

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Juvenile Rheumatoid Arthritis in Children with Ebstein-barr Virus Infection.

Young Seok SHIM ; Joon Sik KIM ; Kyung Kyu LEE ; Kyu Man LEE ; Kwang Nam KIM

Journal of Rheumatic Diseases.2012;19(1):19-24. doi:10.4078/jrd.2012.19.1.19

OBJECTIVE: Juvenile rheumatoid arthritis (JRA) may occur in the wake of infection with several viruses including Ebstein-barr virus (EBV). EBV remains an interesting target. To determine the possible role of EBV infections in the clinical course of JRA, we attempt to demonstrate the radiologic changes and the frequency prescription of etanercept rather than classic therapy. METHODS: Total of 87 patients with JRA, who were hospitalized in Hangang Sacred Hospital and Kangnam Sacred Hospital in Seoul from 2002 to 2010, were assessed serologically for EBV infection (anti EBV VCA IgM and IgG) at admission. Patients with JRA were devided 2 groups, one is EBV VCA IgG (+) JRA patients who had been infected before and another is EBV VCA IgG (-) JRA patients who had not. RESULTS: EBV VCA IgG (+) were seen in 55 patients (63.2%). 31 boys (76%) and 24 girls (52%) were infected with EBV. The mean age of patients of EBV (+) JRA was 8.2+/-3.6 years and that of EBV (-) JRA was 5.3+/-3.4 years. 7 of EBV (+) JRA (13%) developed radiologic change within 2 years, compare with none of EBV (-) JRA. 22 of EBV (+) JRA (49%) with JRA did not respond to the classic therapy, compare with 7 of EBV (-) JRA (22%). CONCLUSION: JRA patients with past EBV infection were older in ages, more in male, more radiologic changes, needed more biologic treatment than those without past EBV infection.
Arthritis, Juvenile Rheumatoid ; Child ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Male ; Prescriptions ; Receptors, Tumor Necrosis Factor ; Viruses ; Etanercept

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Hidden Questions on Methotrexate.

Sang Won LEE

Journal of Rheumatic Diseases.2012;19(1):11-18. doi:10.4078/jrd.2012.19.1.11

Since the 1950's, methotrexatehas been the most widely used for the treatment of rheumatoid arthritis among various disease-modifying anti-rheumatic drugs (DMARDs). In this review, several hidden questions on methotrexate were discussed. First, so far, methotrexate has been considered to improve rheumatoid arthritis by inhibiting cell proliferation through the reduction of synthesis regarding purine and pyrimidine. Recently, a new concept was proposed that methotrexate could increase the release of adenosine, which subsequently decreases the inflammatory function of immune cells, and can finally quench the inflammation in affected joints of rheumatoid arthritis. Second, there were only three clinical trials done to directly compare the efficacy between methotrexate and biologics. With these results, methotrexate showed comparable therapeutic efficacy to biologics, but did not prevent radiological progression. In the future, clinical trials to directly compare the efficacy of methotrexate to biologics will be needed. Third, measuring the serum concentration of methotrexate is not appropriate, since circulating methotrexate is rapidly cleared by cellular uptake or renal excretion. Methotrexate polyglutamate is a more stable compound than methotrexate and it is more likely to relate to efficacy or adverse effects of methotrexate. Recently, the efforts to measure methotrexate polyglutamate in red blood cells have been done to increase therapeutic efficacy and reduce its adverse effects. Fourth, NSAIDs can decrease the excretion of methotrexate though renal tubular cells and it may increase the serum concentration of methotrexate and the risk of its toxicity, suggesting that physicians should pay close attention to dose adjustments concerning methotrexate combined with NSAIDs.
Adenosine ; Anti-Inflammatory Agents, Non-Steroidal ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Biological Agents ; Cell Proliferation ; Erythrocytes ; Inflammation ; Joints ; Methotrexate ; Polyglutamic Acid ; Polymethacrylic Acids ; Purines ; Pyrimidines

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Current and Upcoming Treatments for Osteoporosis.

Yoon Sok CHUNG

Journal of Rheumatic Diseases.2012;19(1):4-10. doi:10.4078/jrd.2012.19.1.4

Osteoporosis is a common senile disease that results in fragility fractures. With an ageing population, the medical and socioeconomic effect of osteoporosis, particularly postmenopausal osteoporosis, will increase further. Currently, good anti-fracture data supports many available anti-resorptive and anabolic drugs including bisphosphonates, selective estrogen receptor modulators, and recombinant human parathyroid hormones. Calcium and vitamin D are also essential treatments for the prevention and treatment of osteoporosis. Although, bisphosphonate is the cornerstone of osteoporosis treatment and is considered as the first line of therapy, their duration of therapy and long-term safety is under question. Novel agents, particularly denosumab, inhibitors of cathepsin K, andanabolic agents that act on Wnt signaling, will increase the therapeutic options for clinicians in the coming years.
Antibodies, Monoclonal, Humanized ; Calcium ; Cathepsin K ; Diphosphonates ; Female ; Humans ; Osteoporosis ; Osteoporosis, Postmenopausal ; Selective Estrogen Receptor Modulators ; Vitamin D ; Denosumab

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Uveitis in Rheumatic Diseases.

Jin Ju KIM ; Tae Hwan KIM

Journal of Rheumatic Diseases.2012;19(1):1-3. doi:10.4078/jrd.2012.19.1.1

No abstract available.
Rheumatic Diseases ; Uveitis

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