Genetic Association for P2X7R rs3751142 and CARD8 rs2043211 Polymorphisms for Susceptibility of Gout in Korean Men: Multi-Center Study

The aim of this study was to determine the association between P2X7R rs3751142 and CARD8 rs2043211 polymorphisms and gout susceptibility in male Korean subjects. This study enrolled a total of 242 male patients with gout and 280 healthy controls. The polymorphisms of two individual genes including rs3751142(C>A) in the P2X7R gene and rs2043211(A>T) in the CARD8 gene were assessed using Taq-Man analysis. Statistical analyses were performed using the Chi-square test, Kruskal-Wallis test, and logistic regression analyses. A difference in genotypic frequency of the P2X7R rs3751142 and CARD8 rs2043211 genes was not detected between gout and control patients. Clinical parameters including age, onset age, disease duration, body mass index, and serum uric acid levels were not different among the three genotypes for either P2X7R or CARD8 (P > 0.05 for all). A pair-wise comparison of P2X7R rs3751142 and CARD8 rs2043211 genotype combinations revealed that subjects with the CA P2X7R rs3751142 genotype and the TT CARD8 rs2043211 genotype had a trend toward a higher risk of gout compared to the CC/AA combination (P = 0.056, OR = 2.618, 95% CI 0.975 - 7.031). In conclusion, this study revealed that genetic variability of the P2X7R rs3751142 and CARD8 rs2043211 genes might, in part, be associated with susceptibility for gout.

Use of post-operative negative-pressure wound therapy for gouty ulcer / 영남의대학술지

Gouty ulcer can be caused by the accumulation of clumps of uric acid in body tissues that lead to acute or chronic inflammation at sites of accumulation. Furthermore, tophi-inhibiting granulation tissue may form a canal that channels microbial infection from the underlying involved joint space, and thus, presents the risk of osteomyelitis development. Accordingly, gouty ulcer must be treated appropriately. In this case, refractory wounds on gouty ulcers at the left shin and left radial ankle were treated by surgical debridement. Negative-pressure wound therapy was used successfully to prevent post-operative delayed wound healing.

Proposed Master Plan for Reform of the National Infectious Disease Prevention and Management System in Korea

A Middle East respiratory syndrome (MERS) - coronavirus (CoV) cluster that attacked Korea in May 2015 revealed several weaknesses in Korea's health care system in the face of the crisis of an emerging infectious disease and its public health implications. This experience has shown that is necessary to prepare comprehensive countermeasures through the cooperation of civil and public agencies to prevent a second or even third MERS outbreak and to control future crises of infectious disease and public health. The MERS Policy Committee of the Korean Medical Association has thus proposed a master plan for reform of the national infectious disease prevention and management system to prepare a new framework for national infectious disease prevention and control. The specific targets of the master plan are improvement of the system of usage of medical services and of the medical culture among national health insurance subscribers, improvement of the emergency room management system to prevent the spread of infectious disease, the establishment of a support system to promote effective voluntary infectious disease prevention activities among medical institutions, the building of a public health crisis communication system in collaboration with medical organizations, the establishment of an independent Ministry of Health and capacity building of the Korea Centers for Disease Control (KCDC), the securing of an advanced research and development system in the field of prevention and control of infectious disease, and the capacity building of professional epidemiologists and personnel needed to prevent and control infectious disease. The five core strategies of the master plan have been planned by medical experts in this order of priority: the reform of the healthcare delivery system, the independence of the Ministry of Health and capacity building of the KCDC, fundraising for a public infection management fund, enforcement of medical organization infection control, and improvement of the emergency room management system.

Result of Joint Preserving Surgery Using Axial Shortening Metatarsal Osteotomy for the Treatment of Severe Hallux Valgus and Claw Toes Deformity in Advanced Rheumatoid Arthritis / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. MATERIALS AND METHODS: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. RESULTS: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. CONCLUSION: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

A Case of Hypomyopathic Dermatomyositis / 영남의대학술지

Dermatomyositis is a rare and idiopathic inflammatory myopathy with a characteristic cutaneous manifestation. A 62-year-old female complained of polyarthralgia that lasted for many years. She was diagnosed with hypomyopathic dermatomyositis by the typical skin rash associated with dermatomyositis but without muscle involvement such as muscle weakness, elevated level of creatinine phosphokinase and aldolase. Her symptoms improved with treatment of hydroxychloroquine and prednisolone. We experienced a case of hypomyopathic dermatomyositis on 62-year-old female patient and report with review of literatures.

A ureteral ulcer and stricture in a patient with Behcet's disease / 대한내과학회지

Behcet's disease is a chronic multisystem inflammatory disorder. Genetic, environmental, and immunological factors have been suggested as possible causes of Behcet's disease. Although seen at any age, Behcet's disease generally begins when individuals are in their 20s or 30s. The common major symptoms of Behcet's disease include recurrent oral ulcers, genital ulcers, and eye inflammation. The disorder may also cause various skin lesions, arthritis, bowel inflammation, meningitis, and cranial nerve palsies. The common urinary system manifestations are glomerulonephritis, cystitis, epididymitis, orchitis, and genital ulceration, whereas ureteral ulcers and strictures are uncommon. Here, we report an uncommon case of a ureteral ulcer and stricture in a 34-year-old man with Behcet's disease.

Two cases of infliximab treatment in Patients with Behcet's disease and intractable colon ulcers / 대한내과학회지

Behcet's disease is a chronic disease characterized by recurrent systemic vasculitis. The pathogenesis remains unclear. This disease involves various organs of the body and it can have a variety of symptoms with an unpredictable course. The diagnosis of Behcet's disease is made in patients with oral and genital ulcers and uveitis. In addition, gastrointestinal symptoms are frequently present; however, intestinal ulcers are infrequent. The most common extra-oral sites of gastrointestinal involvement are ileocecal and colon lesions. The lesions are typically resistant to medical treatment and frequently recur after surgical treatment. Here we present two cases treated with the monoclonal antibody anti-tumor necrosis factor (TNF) and regression of all symptoms.

The Effect of Aroma-therapy Combined with Heat Application on the Pain, Range of Motion of Lower limb Joint, and Discomfort of Activities of Daily Living among Patients with Rheumatoid Arthritis / 성인간호학회지

PURPOSE: This study was conducted to examine the effects of aroma-therapy combined with heat application on pain, ROM of lower limb joints, and discomfort from activities of daily living(ADL) among the patients with rheumatoid arthritis. METHODS: Aroma blended oil was rubbed over the knees and ankles of 19 experimental group A and 20 B, and then heat therapy was given using an electric hot & wet poultice pad to only group A. There was no treatment on the 19 control group. There was measured for pain, ROM of lower limb joints and discomfort of ADL. The data was analyzed using SPSS/WIN 11.0 program. RESULTS: In comparing the effects of pain reduction by time, the ROM of lower limb joints, and discomfort of ADL, there were significant differences among three groups. There was no significant difference between experimental group in pain scale by time, range of ROM of knee and ankle joint and discomfort of ADL. CONCLUSION: On the basis of results, aroma-therapy can be applied as a nursing intervention to reduce pain for not only rheumatoid arthritis patients but also for other patients with other diseases.

A Case of Pyoderma Gangrenosum Associated with Takayasu's Arteritis Responding to Methotrexate / 대한류마티스학회지

Pyoderma gangrenosum (PG) is a vasculitic process, often associated with systemic diseases, including Takayasu's arteritis (TA), rheumatoid arthritis, and inflammatory bowel disease. Most cases of PG associated with TA have been observed in Japan. However, this association is not commonly observed in North American and European patients. PG is often refractory to therapy, requiring high dosages of glucocorticoids. Here, we describe a case of recalcitrant PG that was associated with TA and successfully treated with methotrexate.

Focal Segmental Glomerulosclerosis in a Patient with Behcet's Disease: A Case Report and Review of Literature / 대한신장학회잡지

No abstract available.

Cytoprotective Effect of 15-deoxy-Delta(12,14) Prostaglandin J2 (15d-PGJ2) against H2O2 Induced Death of Neuronally-differentiated PC12 Cells

BACKGROUND: Neurodegenerative diseases are associated with oxidative stress. Antioxidants including 15-deoxy- Delta (12,14) prostaglandin J2 (15d-PGJ2) have been tried as potential therapeutic regimens of the experimental model of neurodegenerative disease. In this study, we investigated the neuroprotective role of 15d-PGJ2 on cytochrome c mediated apoptotic signals in oxidative stress injured neuronally-differentiated PC12 cells (nPC12 cells) by exposing them to H2O2. METHODS: Following 100 micor M H2O2 exposure, the viability of nPC12 cells (pretreated with 15d-PGJ2 vs. not pretreated) was evaluated by using MTT assay. Immunoreactivity (IR) of cytochrome c, caspase-3, and poly (ADP-ribose) polymerase (PARP) was examined by using a Western blot. RESULTS: In this study, 15d-PGJ2 pretreated nPC12 cells showed an increase in cell viability until the concentrations of 15d-PGJ2 reached up to 4 micor M, but there was no increment of cell viability in higher concentrations. The inhibition of cytochrome c release, activation of caspase-3, and cleavage of PARP were demonstrated by the pretreatment of 15d-PGJ2 up to 4 micor M. However, these were not observed in the pretreatment with 8 micor M 15d-PGJ2. CONCLUSIONS: These data show that 15d-PGJ2 affects the apoptotic pathway through downstream signals including cytochrome c and caspase-3 pathway. Therefore, these results suggest that 15d-PGJ2 could be a new potential therapeutic candidate for the oxidative stress-injury model of neurodegenerative diseases.

A Case of Takayasu Arteritis in a Patient with Juvenile Onset Ankylosing Spondylitis / 대한류마티스학회지

Juvenile onset ankylosing spondylitis is a chronic inflammatory arthritis showing oligoarthritis and enthesopathy of the peripheral and axial skeleton. This have been shown to have different clinical presentation and outcome from adult onset ankylosing spondylitis. Takayasu arteritis is a uncommon, chronic inflammatory disease of elastic arteries such as the aorta, its larger branches and the pulmonary artery trunk. Although, it has rare report about association between ankylosing spondylitis and Takayasu arteritis, there was no report of juvenile onset ankylosing spondylitis with Takayasu arteritis. Thereby, we report a patient with Takayasu arteritis who had juvenile onset ankylosing spondylitis in the course of his disease.

A Case of Sweet's Syndrome in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Sweet's syndrome is an uncommon reactive dermatosis characterized by fever, polymorphonuclear leukocytosis, painful erythematous cutaneous plaques and dense dermal infiltrate of neutrophils at the skin lesions. Unlike Sweet's syndrome associated with patients with malignancies, autoimmune diseases, antecedent infectons-most commonly the upper respiratory infections, it is reported to be rarely associated with systemic lupus erythematosus (SLE). Here we report a rare case of young female with Sweet's syndrome and SLE presenting with high fever.

Avascular Necrosis of the Femoral Head in Patient with Psoriatic Arthritis / 대한류마티스학회지

Psoriatic arthritis and avascular necrosis of the femoral head each are relatively common diseases. However, avascular necrosis of the femoral head in psoriatic arthritisis extremely rare disease and a few cases have been reported to date. It is suggested that the use of steroids or chemotherapeutic agents, hyperuricemia, alcohol abuse, immunologic disorders, coagulopathies are risk factors of the development of avascular necrosis of the femoral head in psoriatic arthritis. This report describes a 58-year-old female patient without any of forementioned risk factors who underwent total hip replacement for femoral head avascular necrosis associated with psoriatic arthritis.

A Case of Polymyositis with Dilated Cardiomyopathy Associated with Interferon alpha Treatment for Hepatitis B

Polymyositis is a rare complication of interferon alpha treatment as a result of immunemodulating role of the drug itself. In this case, interferon alpha induced polymyositis and cardiomyopathy is diagnosed in a 33-yr-old male patient with history of chronic hepatitis B. To treat hepatitis B, interferon alpha was administered until the proximal muscle weakness developed. Thereafter, sixteen cycles of immunoglobulin treatment (400 mg/kg) along with corticosteroids were instituted and led to an improvement in subjective symptoms with decreases in level of CPK and LDH. However, dilated cardiomyopathy has not improved in spite of the cessation of interferon treatment. Unlike the persistently elevated serum HBV DNA level, the serum ALT and AST levels have gradually decreased. Our case shows that clinical symptoms of polymyositis improved with steroid and immunoglobulin treatment without deterioration of the hepatitis B. To our knowledge, this is the first case of polymyositis associated with dilated cardiomyopathy after the administration of interferon in a patient with hepatitis B.

Depression and its Associated Factors with Rheumatoid Arthritis / 대한류마티스학회지

Depression is common in the patients with rheumatoid arthritis (RA). Estimates of the prevalence of depression in the patients with RA have ranged from 14 to 46%, depending on the criteria used and the patient subgroups studied. Our objectives were to show how frequently depression occur among patients with RA, to compare depression in RA and osteoarthritis (OA) patients, and to identify the disease and sociodemographic variables with which depression are associated. Subjects included in this study were 119 RA patients, and 140 OA patients. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. The Korean health assessment questionnaire (KHAQ) was used to assess physical function in patients with RA. The associations of sociodemographic variables, disability, severity and other variables with CES-D score were evaluated by multiple regression analysis. RESULTS: When CES-D cut-off score of 25 was used, 54 (50.9%) of 106 RA patients, and 32(23.5%) of 122 OA patients had scores suggestive of depression, and the difference was still significant after adjusting age, sex, disease duration, pain scale and fatigue scale (p<0.05). RA patients had higher mean scores on CES-D than OA patients after adjusting above variables, too (p<0.05). The bivariate analysis showed that age, sex, education level, fatigue scale, pain scale, KHAQ-disability score, WBC, ESR were significantly associated with CES-D scores in RA patients; and the duration of disease, pain scale and fatigue scale were associated with those in OA patients (p<0.05). By stepwise selection in multiple logistic regression model, the age, pain scale and KHAQ-disability score were selected as significant independent variables in RA patients. In OA patients, the duration of disease and pain scale were selected as significant independent variables. CONCLUSION: RA patients are significantly more depressed than OA patients, and the associated factors with depression are patient? age, pain scale and KHAQ disability score in RA.

A Case of Gastroduodenal Crohn's Disease Mistaken for a Gastric Malignancy / 대한소화기내시경학회지

Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy.

A Case of Catastrophic Primary Antiphospholipid Syndrome / 대한내과학회지

Catastrophic antiphospholipid syndrome is a rare clinical syndrome characterized by acute multi-organ failure occurring in patients with antiphospholipid antibodies. It is associated with involvement of several end-organs particularly kidneys, lungs, gastrointestinal tracts and adrenal glands and presents catastrophic clinical pictures such as acute renal failure with thrombotic microangiopathy, myocardial failure, adult respiratory distress syndrome, convulsion and disseminated intravascular coagulation. Conventional treatments(e.g. intravenous heparin, steroid, immunosuppressants) were not effective, while plasmapheresis seems to be a useful therapy. We experienced a case of catastrophic primary antiphospholipid syndrome in 41-year-old woman proved by renal biopsy and immuno-serological tests. She developed acute renal failure, multiple esophageal and oral ulcers, adult respiratory distress syndrome, abnormal elevation of hepatic and pancreatic enzymes and signs of disseminated intravascular coagulation. Evidences of any other connective tissue diseases were not found. Renal biopsy revealed features of thrombotic microangiopathic nephropathy and serum antiphospholipid antibody level was elevated(34GPL). In spite of steroid, cyclophosphamide and supportive therapies, her respiratory distress was not improved.

Phospholipase A2 as an Index of Disease Activity in Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: A limited retrospective study of patients with rheumatoid arthritis (RA) found that serum phospholipase A2 (PLA2) activity correlates with disease activity. To assess the strength of this relationship we investigated prospectively 25 patients with RA using a double blind approach. METHODS: Twenty five patients who fulfilled the 1987 American College of Rheumatology criteria for RA had clinical and laboratory assessments. PLA2 activity was measured before and after treatment of 3 months in patients with RA. Fourteen healthy individuals were also enrolled as controls. PLA2 activity was assayed using E.coli membrane phospholipid substrate labelled with[14C]-oleic acid. RESULTS: 1) Serum PLA2 activity was significantly higher in patients with RA than that of normal healthy controls (p<0.001). 2) In Patients with RA, synovial fluid PLA2 activity was higher than serum PLA2 activity, and a positive correlation between PLA2 in synovial fluids and matched sera was found in these patients (p<0.05). 3) After treatment, PLA2 activity was significantly decreased with improvement of clinical(morning stiffness and Ritchie index) and laboratory(ESR, CRP and rheumatoid factor)assessments (p<0.001). 4) Among the clinical and laboratory markers of disease activity, ESR showed the best correlation with serum PLA2 activity (r=0.493, p<0.05). 5) In the patients who did not respond clinically to treatment (n=5), there was no significant decrease in PLA2 activity. CONCLUSION: PLA2 activity significantly correlates with RA activity and may serve as an index of disease activity in RA.

A Case of Primary Antiphospholipid Syndrome Presented with Membranoproliferative Glomerulonephritis pattern / 대한신장학회잡지

Though the renal abnormality is usually accompanied in the patient with antiphospholipid syndrome, it is not frequent that the symptoms of antiphospholipid syndrome are confined to kidney. We experienced a case of 40-year-old woman suffered from intermittently developed nephrotic range proteinuria combined with generalized edema during last 10 years. She had no past history of thrombosis, spontaneous abortion, or symptoms related to SLE. Laboratory findings revealed that she had nephrotic syndrome. Her antinuclear antibody was negative, but her serum antiphospholipid IgG antibody level was 32 GPL IU. In the renal biopsy specimen, half of the glomeruli showed global sclerosis and remaining glomeruli showed chronic thrombotic microangiopathy and membranoproliferative glomerulonephritis without immune deposit. Combined therapy with steroid and aspirin improve the amount of proteinuria, and she is free from edema without deterioration of renal function during follow up. Though this case lacked the typical symptoms of antiphospholipid syndrome, her glomerulonephritis presented with membranoproliferative pattern may be associated with it. We report this case with a review of literatures.