A case of Poncet's disease with tuberculosis of the intestine and lymph nodes / 대한내과학회지

In 1897, Poncet described polyarthritis in patients suffering from tuberculosis which was not caused by tuberculosis infection of the joints. Poncet's disease is characterized by a polyarthritis that occurs during the acute tuberculosis infection in which no mycobacterial involvement can be found or other known cause of polyarthritis detected. It is a different entity from tuberculous arthritis, which is usually monoarticular and is caused by direct tuberculous infection. It was little known for pathogenesis of Poncet's disease, but immunologic reaction was suggested. Poncet's disease is associated with an excellent prognosis with rapid resolution on commencing therapy and no sequelae. Therefore, recognition of Poncet's disease can be important. Poncet's disease remains a diagnosis of exclusion.Recently, we experienced one case of Poncet's disease which have characterized by the clinical manifestations, and report this case with a review of the literatures.

One case of Giardia lamblia-associated arthritis in a 23 year-old woman / 대한내과학회지

Giardia lamblia, a gastrointestinal protozoan, is one of the most common disease-causing parasites in the world. Giardiasis is primarily encountered in areas with poor sanitation, but it is also seen in more developed countries. A possible sequela of Giardia infections of the bowel is reactive arthritis or synovitis. Few reports of synovitis secondary to giardiasis exist in the literature. Arthropathy secondary to giardiasis is uncommon, but may be underdiagnosed. We present a 23 year-old woman who had polyarthritis after Giardia lamblia infestation. The synovitis subsided with treatment of the giardiasis with metronidazole. The diagnosis of Giardia synovitis should be suspected by the presence of Giardia cysts in the stool. Although uncommon, giardiasis can cause severe synovitis that may be confused with a septic joint.

Clinical Time Course in SLE Diagnosis,Risk Factors for Delayed Diagnosis,and Association with Prognosis / 대한류마티스학회지

OBJECTIVE: This study is aimed to investigate clinical time course in the diagnosis of SLE,clinical features at disease onset,and their effects on organ damage and disease activity METHODS: We evaluated 244 patients in the Korean Hanyang Lupus Cohort by medical record review and direct interview:the time at disease onset,clinical diagnosis,and diagnosis meeting ACR criteria for SLE (ACR diagnosis),clinical features at onset,SLICC/ACR damage index,SLAM-R,education,and income. The risk factors of delayed diagnosis and their effect on damage and activity were examined with uni and multivariate analyses. RESULTS: Mean age and disease duration were 33.9 (+/- 11.9)and 6.2 (+/- 4 .4 )years. The mean time from onset to clinical diagnosis and ACR diagnosis were 2.4 (+/- 3.6)and 2.7 (+/- 3.3)years.The clinical features at disease onset were as follows;arthritis (46.3%),skin rash (13.7%),fever (7.4%),hematologic disorder (7.4%),nephritis (5.7%),Raynaud phenomenon (3.7%),neuropsychiatric syndrome (2.4%).Diagnosis was delayed when oral ulcer,photosensitivity,and arthritis were presented as 1st clinical features compared to when nephritis, malar rash,and fever as 1st clinical features.Delayed diagnosis (based on median time in clinical diagnosis)was not associated with damage,disease activity,education,and income. CONCLUSIONS: SLE was diagnosed late over 2 years after first symptoms onset and the time interval from clinical symptoms to ACR diagnosis is about 4 months;the delayed diagnosis and the prognosis in terms of damage and activity might depend on 1st clinical features.

Secondary renal amyloidosis in adult onset Still's disease: case report and review of the literature

We report a 25-year-old Korean woman with Adult onset Still's disease (AOSD) presented with renal amyloidosis, which had developed four years after disease onset. We successfully treated her with prednisolone, colchicine and cyclophosphamide. A review of the literature uncovered about 10 cases, most of which were treated by various regimens that resulted in poor outcomes. Renal amyloidosis should be suspected in patients with AOSD who have unexplained proteinuria. Although the mechanism of renal amyloid deposition is not well known, earlier histopathologic diagnosis and choice of regimen may affect prognosis.

A case of parasymphyseal and associated insufficiency fractures of pubic rami in a patient with mixed connective tissue disease

Parasymphyseal insufficiency fractures are uncommon. Furthermore, none have been reported in systemic rheumatic diseases other than rheumatoid arthritis. In this article we report on parasymphyseal insufficiency fractures in a patient with mixed connective tissue disease.

Activation of Stat Protein in Synovial Cell in Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To characterize Stat activity in synovial tissue in rheumatoid arthritis (RA) in order to see if Stat molecule contributes to the pathogenesis of RA by regulatory expression of genes that play an important role in inflammation and tissue destruction. METHODS: Synovial tissue were obtained immediately after operative excision. Immuno-histochemistry was done with the antibodies for Stat 3 and Stat 5. Cells were stimulated with interleukin 6 (IL-6) and soluble interleukin 6 receptor (sIL-6R) or steroid using chambered slide. In supershift experiment, cell extracts were incubated with 0.5ng of 32P-labelled double-stranded oligonucleotide probe. Samples were resolved on 4.5% polyacrylamide gels, which was transferred to polyvinylidene fluoride membranes. Anti-phosphotyrosine Stat 3 antibody was used for Western blotting. RESULTS: Stat 3 was not shown on the synovial tissue section done by immuno-histochemistry. However, activated Stat 3 was expressed on cultured synovial cell stimulated with IL-6 and sIL-6R, and also with IL-6 and dexamethasone using chambered slide. In contrast to Stat 3, activated Stat 5 was expressed on the synovial tissue section, especially around blood vessel. CONCLUSION: Stat is activated in cultured synovial cells as shown in other immune associated cells, and IL-6 is the strong activator of Stat 3. Further analysis of the regulation of Stats in synovitis and the role of Stats in driving synovial inflammation will yield insight into the pathogenesis of RA and the development of novel therapeutic modality.

Two cases of pseudorheumatoid hand deformities in parkinson's disease / 대한내과학회지

Parkinson's disease is a chronic, progressive disorder characterized by progressive muscular rigidity, pill-rolling tremor, stooping posture, shuffling gait, and akinesia. Hand deformities associated with Parkinson's disease were first described in 1864 by Ordenstein. The hand deformity of Parkinsons disease consists of metacarpophalangeal joint flexion and interphalangeal joint extension. In clinical practice, the problem is often overlooked or misdiagnosed as rheumatoid arthritis. We experienced 2 cases of pseudorheumatoid hand deformities secondary to Parkinsons disease, and report these cases with a review of the literatures.

A Case of Microscopic Polyangiitis with Peripheral Neuropathy / 대한류마티스학회지

Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis of small-sized vessels (capillary, venule, or arterioles) whose clinical manifestations are very similar to those of PAN (polyarteritis nodosa), but it is characterized by the presence of rapidly progressive glomerulonephritis (RPGN), which is nearly constant, and pulmonary involvement usually absent in PAN. Peripheral neuropathy occurs in only 14~36% of the patients with MPA, distinctly less frequent than in those with classic PAN. While PAN may be considered a self-limiting disease which tend not to recur once remission is acquired, relapse occurs frequently in MPA. Prognosis has been transformed by corticosteroids and immunosuppressive drugs, especially cyclophosphamide. We reported a 72-year-old woman with subacute sensorimotor polyneuropathy involving peroneal and sural nerve accompanied by focal segmental glomerulonephritis which was proven by renal biopsy.

A Case of Intractable Diarrhea Associated with Early Onset Secondary Amyloidosis in Rheumatoid Arthritis / 대한류마티스학회지

Amyloidosis is a disease that characterized by accumulation of an amorphous, proteinaceous materials in the various tissues and organs, but its origin is unknown. Recent clinical study showed that incidence of amyloidosis in rheumatoid arthritis was near 10% to 21%. Secondary amyloidosis is caused by accumulation of serum amyloid. A which is doing the acute phase behavior faster than C reactive protein. Symptoms of amyloidosis are various according to the involved organ. Gastrointestinal symptoms are obstruction, ulcer, malabsorption, and bleeding. Diarrhea is very intractable with the conventional antidiarrheal agent, the mechanism of that is infiltration of amyloid material in the intestinal myenteric plexus, sympathetic nerve and ganglion. We report a case of 65 years old woman with rheumatoid arthritis presented with abdominal pain, intractable diarrhea which was not controlled by antidiarrheal agents. Duration of arthritis is only 2 years. Immunohistochemical stain showed AA type which meant secondary form. We treated with Octreotide analogue and total parenteral nutrition for chronic diarrhea.

Two Cases of Antisynthetase Syndrome Combined with Mechanic's Hand / 대한류마티스학회지

The antisynthetase syndrome is characterized by inflammatory myositis associated with intersititial lung disease (ILD), polyarthritis, mechanic's hand, and Raynaud's phenomenon, and usually with fever. The patients with these conditions have autoantibodies to aminoacy1-tRNA synthetases (histidy1-, threony1-, alany1-, isoleucy1-, and glycy1-tRNA synthetase) ; the most common is anti-histidy1-tRNA sythetase (anti Jo-1), present in 20% of myositis patients in Western countries. However, the mechanisms of production of autoantibodies to aminoacy1-tRNA synthetases are not understood. Several hypotheses about the relationship of anti-aminoacy1-tRNA synthetases with inflammatory myositis have been reported. The poor prognostic outcome for the antisynthetase patients are related to ILD. We experienced two cases of antisynthetase syndrome which have characterized by the clinical manifestations, and report these cases with a review of the literatures.

A Case of yersinia pseudotuberculosis sepsis presenting as multiple liver abscesser in systemic lupus erythematosus / 대한내과학회지

A 40-year-old man with systemic lupus erythematosus (SLE) and diabetes was found to have sepsis with multiple small hepatic abscesses secondary to Yersinia pseudotuberculosis which were detected by computed tomography (CT) scan and blood cultures. Sepsis with Y. pseudotuberculosis is uncommon but usually seen in patients with underlying liver diseases or diabetes. A few of those patients are accompanied by liver abscesses. Those patients with liver abscesses invariably have multiple small abscesses. CT scan of the liver was important in demonstrating the multiple small liver abscesses. Identification of the pathogen on blaod culture and elevated serum antibody titer to Y. pseudotu-berculosis are useful for diagnosis. Although rare, Y. pseudotuberculosis should be also considered as a possible cause in febrile patient with immunocompromised state such as SLE, diabetes or hemochromatosis.

Human adjuvant disease manifesting as SLE / 대한내과학회지

Human adjuvant disease means the autoimmune disease or autoimmune disease like syndrome developed after plastic surgery using foreign body implantation. After first report of HAD by Miyoshi at 1964, a number of cases have been reported especially from Japan. Silicone has been known as biologically inert material, but a couple of side reaction and experimental data argue against such conventional idea. It is impossible to identify the exact role of implanted substance in the occurrence of autoimmune disease, but there are a few indirect evidences for adjuvant effect of silicone. The spectrum of HAD are as follows: unclassifiable connective disease like syndrome, rheumatoid arthritis, SLE, polymyositis, adult Still's disease, ITP, Hashimoto's thyroiditis, etc. We experienced two cases of HAD manifesting as SLE who had been injected with silicone fluid with for augmentation mammoplasty and report this with a review of the literature.

Radiological Feature and Significance of Hand X-Rayin Early Rheumatoid Arthritis / 대한내과학회지

OBJECTIVES: To evaluate the disease status in relation to the radiological findings of hands using some short term indices of disease activity and laboratory tests in early rheumatoid arthritis. METHOD: 136 patients with symptoms of rheumatoid arthritis for less than 2 years were studied by means of measuring erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anti-nuclear antibody. Of these, 71patients were performed the radiographies of hands at mean 1.3months after diagnosis. Also, 30 radiological films of hands were studied for measurement of intra- & inter-observer variations by well-trained rheumatologist and radiologist. All films were scored by the modified Sharps method. RESULTS: The radiological features of hands showed that the carpal bone was involved more common in the bony erosion (5.7%) and the joint space narrowing (8.8%), and the radiological progression in the interval of 24 months was positively correlated with the disease duration (p<0.05). Also, the radiological lesions and progressions appeared more severe in high disease activity, C-reactive protein (r : 0.334, p : 0.004) and Ritchie index (r : 0.249, p : 0.01) at diagnosis. On the other hand, they were correlated negatively with the age of disease onset (r : -0.357, p : 0.002). The Spearman correlations of inter- & intra-observer variations were significant by 0.716 and 0.775. CONCLUSION: The development of radiological lesions in early rheumatoid arthritis is closely correlated with the duration of disease. The patients with early rheumatoid arthritis who had active arthritis at the time of diagnosis showed more severe radiological progressions.

Preliminary Study of Early Organ Damage in Systemic Lupus Erythematosus / 대한류마티스학회지

No abstract available.

Insufficiency Fractures of Sacrum and Pubic Rami in Rheumatoid Arthritis: Report of 3 Cases and Review of the Literature / 대한류마티스학회지

No abstract available.

Evaluation of Correlation between Automatic Ocillometric Sphygmomanometer and Standard Korotkoff Auscultatory Sphygmomanometer

BACKGROUND: Early diagnosis and treatment of hypertension is imperative to prevent the complications associated with this condition. The development of accurate and convenient methods of blood pressure measurement, therefore, is indispensible. At present, the JNC V has acknowledged the use of automatic sphygmomanometer that can be used without the help of someone else. We compared automatic oscillometric sphygmomanometers manufactured by Sein Electronics, korea(SE-7000 and SE-5000) with the standard Korotkoff auscultatory mercuy sphygmomanometer meter. The correlation between these two methods were calculated to determine whether these products could actually be used in clinical practice. This study was undertaken to ensure the clinical evaluation of these two products and standardization of an antomatic sphygmomanometer in korea before it is actually used. METHODS: The study included eighty-three patients, ranging in age from 14 to 81 years, who were admitted to Hanyang University Hospital in October, 1995. The blood pressure measured by the automatic oscillometric sphygmomanometer(SE-7000) in the right arm and was compared with that measured by the standard mercury sphygmomanometer(baumanometer) in the left arm. Also the blood pressure measured by the automatic oscillometric sphygmomanometer(SE-5000) at the wrist was compared by the baumanometer in the same side arm. The correlation between these methods were determined by the paired Student`s t-test and by the simple liner regression method. RESULTS: The p value of systolic blood pressure between two methods(SE-7000 and baumanometer) in the both arms was 0.896 and correlation coefficient was 0.8286. The p value of diastolic blood pressure between this two methods was 0.352 and correleation coefficient was 0.7455. The p value of systolic blood pressure between two methods(SE-5000 and baumanomter) by the arm and the wrist was 0.00018 and correlation coefficient was 0.8588, the p value of diastolic blood pressure between this two methods was 0.000048 and correlation coefficient was 0.5944. CONCLUSION: The blood pressure measured by the SE-5000 at the wrist was statistically different from that measured with the baumanometer in the arm. Further studies are necessary to use this product in clinical practice. However, the systolic and diastolic blood pressures measured with the SE-7000 in the arm were relatively similar to those measured by the baumanometer enabling this products to be effectively used in clinical practice.

Chest X-ray Findings and Acid-base Disturbances in the Early Phase of Leptospirosis / 대한내과학회지

BACKGROUND: Clinical syndrome of leptospirosis in Korea which accompanied by hemoptysis, pulmonary hemorrhage, respiratory failure was quite different from that of typical Weil's disease. The death rate in the early stage of disease has relationship with chest X-ray findings and acid-base disturbances resulted from hypoxia and asphyxia. We've come to consider chest X-ray findings and arterial blood gas findings as factors influencing the prognosis of the disease. METHODS: Forty one cases of leptospirosis diagnosed by acute febrille illness symptoms and serologic tests were graded for chest X-ray findings and grouped according to acid-base abnormalities. Retrospectively, we attempted to correlate the acid-base disturbances and chest X-ray findings with morbidity and mortality of the disease. RESULTS: The result were as follows. 1) Abnormal chest X-ray findings were observed in 30 cases(73%). Mortalities according to the chest X-ray findings were 0(0%), 2(17%), 3(0%), 4(0%), 5(33%), 6(50%) and chest X-ray findings influenced the mortality with statistical significance(p<0.05). 2) Acid-base abnormalities were observed in 39 cases(95%) and the types were divided to six groups . Respiratory alkalosis was the most common acid-base disturbance(44%). Five cases were died. Two of five were respiratory alkalosis, two cases were mixed respiratory metabolic acidosis and another case was mixed respiratory-metabolic alkalosis. As shown, acid-base abnormality influenced the mortality and mixed acid-base disturbances were showed high mortality with statistical significance (p<0.05). 3) Total mortality was 12%(five of forty-one). The chest X-ray score, morbidity, pH, pCO2, pO2, and HCO3 were 5.0 +/- 0.8, 3.4 +/- 1,3, 7.16 +/- 0.17, 32.5 +/- 1.1, 43.3 +/- 13.4 and 17.6 +/- 3.1 in died group, 2.4 +/- 0.4, 12.7 +/- 1.0, 7.46 +/- 0.01, 48.8 +/- 13.4, 65.4 +/- 3.7 and 23.4 +/- 0.9 in recovery group, respectively. There was difference between two groups with statistical significance. CONCLUSION: In this study, we concluded that chest X-ray findings and acid-base abnormalities influenced the mortality of leptospirosis. The factors above mentioned make us consider chest X-ray and blood gas analysis are essential to the patient hospitalized for the suspicion of leptospirosis. Especially, these factors pointed out the patient having chest X-ray abnormalities and mixed acid-base disturbances needed intensive care in the early stage of leptospirosis.

The Influence of Nonselective Beta-Adrenergic Blockade (carteolol) and ACE Inhibitor (captopril) in Plasma Potassium on Maintenance hemodialysis / 대한내과학회지

OBJECTIVES: The degree of hyperkalemia and effects of potassium removal by hemodialysis on the plasma potassium concentration to see the influence of nonselective beta-adrenergic blockade(carteolol) and ACE inhibitor(captopril) on patients in maintenance hemodialysis were evaluated. METHODS: This study was done on 16 patients with end-stage renal disease undergoing maintenance hemodialysis. These patients were classified two groups; group 1-patients with carteolol or captopril(9 patients) and group 2-patients without medication(7 patients). Measurement of plasma potassium and arterial blood gas analyses were performed at pre-dialysis and during hemodialysis(4 hours). To analysis the distribution of potassium kinetics during hemodialysis, dialysis potassium clearance rate was introduced in this study. RESULTS: 1) Among 16 patients studied, the mean age was 43 years old and the ratio of male to female was 2: 1 and the mean duration of hemodialysis was 17.9 months. The underlying cause of end-stage renal disease was chronic glomerulonephritis in the most patients. 2) The mean predialysis plasma potassium concentration of all patients, group 1 on medication, and group 2 without medication was 5.13 +/- 1.04mEq/L, 5.67 +/- 1.01mEq/L and 4.410.55mEq/L, with high significance(p<0.001) between groups 1 and 2. 3) The mean postdialysis plasma potassium concentration of group 1 on medication and group 2 without medication was 348 +/- 0.40mEq/L and 3.39 +/- 0.56mEq/L with insignificance between groups 1 and 2. 4) The pre- and post-dialysis concentration of plasma sodium, pH and bicarbonate between group 1 and group 2 was similar except glucose. 5) Despite the fall in absolute plasma concentration in group 1 more than twice than in group 2, the difference in dialysis potassium clearance rate measured at 1 hour of hemodialysis in group 1 compared to that of group 2 was only 12M. CONCLUSION: These data are consistent with at least a two-compartment distribution of plasma potassium rather than single pool in addition to frequent hyperkalemia on maintenance hemodialysis on nonselective beta-adrenergic blocker or ACE inhibitor contributed to partial impairment of extrarenal transcellular shifts of potassium during inter- and intra-dialytic phase.

Association Between HLA-B27 and Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of I-ILA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. METHODS: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University iHospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. RESULTS: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk(RR) and etiologic fraction(EF) of HLA-B27 were 5.99 and 0. 1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR, C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. CONCLUSIONS: An increased freuency of HLA-B27 in RA patients was significantly found in Korea(RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLA-B27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.

A Case of Takayasu's Arteritis with Multiple Occlusion of Pulmonary Arteries / 결핵

Takayasu's arteritis(aortoarteritis) is a chronic inflammatory disease involving the aorta, the arteries arising from the aorta, and the pulmonary arteries also may be involved. The inflammation leads to either stenosis and occlusion of the involved artery or formation of aneurysm or both. The arterial lesions can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular events, and premature death. The course and prognosis of patients with aortoarteritis show wide variation, and few authors have published systematic studies documenting the natural history of this disease. While the etiology of Takayasu's arteritis remains unknown, various modes of treatment including steroids, vascular surgery, and balloon angioplasty have been used for management of these patients. We experienced a case of Takayasu's arteritis with multiple occlusion of pulmonary arteries, which was confirmed by angiography and perfusion scan, so reported it with a review of literature.