A Korean Rheumatic Diseases Screening Questionnaire

The aim of our study was to develop a Korean rheumatic diseases-screening questionnaire. The questionnaire was constructed based on American College of Rheumatology criteria for rheumatic diseases and a connective tissue diseases screening questionnaire. Two groups of patients were selected and completed the questionnaire: (i) those with osteoarthritis (n=46), rheumatoid arthritis (n=52), systemic lupus erythematosus (n=50), scleroderma (n=8), polymyositis or dermatomyositis (n=7), Sjogren's disease (n=4), and mixed connective-tissue disease (n=9) as case subjects; and (ii) those with fibromyalgia (n=8) and general disease without evidence of any rheumatic disease (n=72) as controls. Laboratory results were analyzed for correlation with actual data using kappa (kappa) statistics. Test-retest reliability was performed in 12 patients, and showed strong agreement between the first and second interviews (kappa=0.91). The sensitivity of the questionnaire ranged from 77.8 to 100%, and specificity ranged from 68.8 to 95.0%. Negative predictive values were very high in the general population, from 98.4 to 99.99%. The kappa statistic for agreement between laboratory items was 0.22-0.56, except for rheumatoid factor, antinuclear antibody test, and muscle enzyme level. We have developed a simple and sensitive Korean rheumatic diseases-screening questionnaire for the epidemiologic study of rheumatic diseases in Korea.

A Case of Cytomegalovirus Colitis with Colon Perforation in Systemic Lupus Erythematosus / 대한류마티스학회지

Cytomegalovirus (CMV) infection is a common human viral infection, affecting 40% to 100% of normal adult, especially in the immune compromised patients. CMV infection can produce variable gastrointestinal (GI) diseases in healthy adults, but can cause severe life-threatening illness involving many organs, including lung, retina, central nervous system, liver and GI tract in immunocompromised host. We experienced CMV colitis with colon perforation in a SLE patient during low dose steroid and azathioprine therapy, and she recovered after medical treatment without surgical interventions. A 33-year-old woman was diagnosed as SLE 7 years ago and treated with low dose, immunosuppressive therapy during 6 years. She complained of a severe abdominal pain and hematochezia. She was diagnosed as CMV colitis with colon perforation by pathologic, immunologic and image studies. After medical treatment, such as intravascular ganciclovir, there was progressive medical improvement, but has been a recurrent CMV colitis with lower GI bleeding.

Health-Related Quality of Life in Korean Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: The rheumatic disease is a chronic disease, which can result in a functional disability and impaired health-related quality of life (HRQOL). Recently, the concerns about the HRQOL have been increasing especially in chronic diseases, but there has been no report with Korean patients with rheumatic disease. The objective of this study is to assess HRQOL and the correlation among each measurement and to identify the predictors for HRQOL in Korean patients with rheumatic disease. METHODS: A cross-sectional study with 100 patients with rheumatoid arthritis (RA), 103 patients with osteoarthritis (OA), 111 patients with systemic lupus erythematosus (SLE), 104 patients with fibromyalgia (FM), 90 patients with ankylosing spondylitis (AS), and 228 healthy persons as control was done. We measured the HRQOL (with 36 item Short Form Health Survey (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG) method), the disease specific health state (with Korean Health Assessment Questionnaire (KHAQ) for RA, Korean Western Ontario and McMaster Universities (KWOMAC) for OA, SLE Disease Activity Index (SLEDAI) & Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) for SLE, Korean Fibromyalgia Impact Questionnaire (KFIQ) for FM, Korean Bath Ankylosing Spondylitis Functional Index (KBASFI) for AS), the psychosocial factors (with Centers for Epidemiologic Studies-Depression (CES-D), social support, social network, self-efficacy scale), and clinical features. We compared the means of each group by Student's t-test and ANOVA test, analyzed the correlation among HRQOL and other variables with Pearson and/or Spearman coefficient, and performed the multiple regression analysis with SF-36 as a dependent variable. RESULTS: There were significant differences in sociodemographic and clinical features among groups. Therefore these differences were compensated later in multiple regression analysis. The HRQOL of disease group was significantly lower than that of healthy control. Among disease groups, the SF-36 global score was highest in SLE and lowest in FM. The SF-36 physical component summary was highest in SLE and lowest in OA and FM. The SF-36 mental component summary was lowest in FM. The EQ-5D utility was highest in SLE and lowest in OA, RA, and FM. The EQ-5D visual analog scale was highest in SLE and lowest in OA, AS, and FM. The CES-D was highest in FM and the self-efficacy scale was lowest in FM. The social support and social network was highest in SLE and lowest in OA and FM. In correlation analysis, the SF-36 and EQ-5D were well correlated with each other, but SG and TTO were not. In general, the disease specific health state (except SLEDAI & SDI), CES-D, and self-efficacy scale were well correlated with SF-36 & EQ-5D. In multivariate models, in a point of view of 5 diseases as a whole, the statistically significant variables of SF-36 global were age, income, the disease specific health state, and self-efficacy scale. The statistically significant variables of SF-36 PCS were age, income, the disease specific health state, and self-efficacy scale, and the statistically significant variables of SF-36 MCS were age, the disease specific health state, social support, and self-efficacy scale. The disease type itself was a statistically significant variable with all SF-36 scores in multiple regression analysis. CONCLUSION: These results suggest that HRQOL in Korean patients with rheumatic disease is significantly lower than healthy control and there is a difference in HRQOL among disease types. Among variables, age, disease type, the disease specific health state, CES-D, self-efficacy were most constant meaningful variables correlated with HRQOL. Therefore, the efforts to improve HRQOL for Korean patients with rheumatic disease should be designed to improve the self-efficacy and to alleviate the depression in addition to conventional treatment. In addition, to define the more definite feature of HRQOL in Korean patients with rheumatic disease, the study with more and larger epidemiological controlled disease group and detailed variable adjustment should be done.

Health-Related Quality of Life in Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: The objective of this study is to assess the health-related quality of life (HRQOL), to examine the correlation among each measurement, and to identify the predictor for HRQOL in Korean patients with rheumatoid arthritis (RA). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO) and standard gamble (SG) using computer software, Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Korean Health Assessment Questionnaire (KHAQ), functional class, radiologic classification, morning stiffness, Ritchie index, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) respectively from 100 outpatients with RA. And the data of the SF-36 and EQ-5D in RA patients were compared with those in 228 healthy controls. RESULTS: Of the 100 subjects with RA, 93 (93 %) were women with mean age of 51.7+/-9.8 years. The mean years of disease onset were 11.16+/-9.23. The mean scores of SF-36 global health (GH), mental component summary (MCS) and physical component summary (PCS) were 51.5+/-20.6, 61.6+/-26.6, and 47.1+/-24.1, respectively. The mean EQ-5D utility and visual analog scale (VAS) score were 0.58+/-0.3 and 61.7+/-20.5, respectively. The mean scores of the TTO and SG were 0.56+/-0.58 and 0.51+/-0.39. The SF-36 and EQ-5D scores in RA patients were significantly lower than those in healthy controls. The mean scores of 8 KHAQ disability index and visual analog pain scale were 0.83+/-0.65 and 50.0+/-23.7, respectively. The mean scores of CES-D, self-efficacy scale, social support, and social network were 9.67+/-6.76, 68.2+/-15.2, 2.37+/-0.19, and 2.19+/-0.55, respectively. The KHAQ mean score was negatively correlated with the scores of SF-36 GH, MCS, PCS, EQ-5D utility, EQ-5D VAS score, social support, social network (r=-0.62, r=-0.47, r=-0.64, r=-0.60, r=-0.39, r=-0.26, r=-0.36, respectively, all p's<0.001), and self-efficacy scale (r=-0.24, p=0.02), and positively correlated with the CES-D (r=0.61, p<0.001). In multivariate models, the predicting variables of SF-36 GH were KHAQ and self-efficacy scale. The predicting variables of SF-36 MCS were age, KHAQ, and self-efficacy scale and the predicting variables of SF-36 PCS were age, income, KHAQ, and self-efficacy scale. CONCLUSION: These results suggest that HRQOL in Korean patients with rheumatoid arthritis is significantly lower than healthy control. The age, HAQ, CES-D, self-efficacy scale were meaningful variables that was significantly correlated with HRQOL. Therefore, the efforts to improve HRQOL may be designed to improve the self-efficacy and the depression in addition to conventional treatment.

Health-related Quality of Life in Korean Patients with Osteoarthritis / 대한류마티스학회지

OBJECTIVE: In this study, we aimed to assess the health-related quality of life (HRQOL), to evaluate the relationship between HRQOL, and various factors in Korean patients with osteoarthritis (OA). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO) and standard gamble (SG) using computer software, Centers for Epidemiologic Studies Depression (CES-D), social support, self-efficacy scale, Western Ontario and McMaster Universities (WOMAC), functional class, and radiological grading, respectively, in 103 outpatients with OA. And the data of the SF-36 and EQ-5D in OA patients were compared with those in 228 healthy controls. RESULTS: Of the 103 subjects, 99 (96.1%) were women with a mean age of 61.1?6.7 years. The mean year of disease duration was 9.44+/-7.44. The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 51.5?20.6, 61.6?26.6 and 47.1?24.1, respectively. The mean EQ-5D utility and visual analog scale (VAS) scores were 0.56+/-0.26 and 60.0+/-17.3, respectively. The mean scores of the TTO and SG were 0.74+/-0.22 and 0.60+/-0.31, respectively. The mean scores of CES-D, self-efficacy scale, social support and social network were 9.52+/-5.67, 60.6+/-16.0, 2.32+/-0.22, and 2.01+/-0.66, respectively. The mean scores of WOMAC pain, stiffness and function were 28.8+/-15.4, 6.08+/-3.79, and 2.17+/-1.92, respectively. In the correlations analysis among health-related quality of life and other variables, the cores of KWOMAC, CES-D, and self-efficacy showed the good correlation with the scores of SF-36 and EQ-5D. In multivariate models, the statistically significant variables of SF-36 global and PCS were KWOMAC, and the statistically significant variables of SF-36 MCS were marital status and KWOMAC. CONCLUSION: This study shows that HRQOL in Korean patients with osteoarthritis is significantly lower than healthy control. Among the variables, only the WOMAC was significantly correlated with HRQOL. Therefore, the efforts to improve HRQOL should be focused on controlling the disease activity and on improving the functional state.

Health-Related Quality of Life in Korean Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To assess the health-related quality of life (HRQOL) of systemic lupus erythematosus (SLE) patient, to compare the HRQOL of SLE patients with that of healthy controls, and to identify the predicting variables on physical and mental health in Korean patients with SLE. METHODS: In this cross sectional study, the HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), self-efficacy scale, social support, social network, SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI), respectively, from 111 outpatients with SLE. And the data of the SF-36 and EQ-5D in SLE patients were compared with those in 228 healthy controls. RESULTS: 106 (95.5%) were women and 5 (4.5%) were men, with a mean (+/-SD) age of 33.2 years (+/-9.9) and mean disease duration of 7.19 years (+/-4.59). The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 62.2 (+/-20.4), 67.5 (+/-24.6), and 65.7 (+/-24.8), respectively. The mean EQ-5D utility and visual analogue scale (VAS) score were 0.73 (+/-0.20) and 67.5 (+/-17.9). The mean scores of the TTO and SG were 0.60 (+/-0.55) and 0.59 (+/-0.45). The scores on the SF-36 global, EQ-5D utility and EQ-5D VAS in healthy controls were 77.5 (+/-13.1), 0.73 (+/-0.20) and 67.5 (+/-17.9), respectively. The mean scores of CES-D, self-efficacy scale, social support, and social network were 9.09 (+/-6.82), 66.5 (+/-17.4), 2.53 (+/-0.17) and 2.29 (+/-0.46), respectively. The mean SLEDAI and the mean SDI were 5.87 (+/-4.32) and 0.73 (+/-1.02). The SDI was negatively correlated with the scores of SF-36 global, PCS, and EQ-5D VAS (r=-0.30, p<0.001; r=-0.34, p<0.001; r=-0.28, p<0.003), and positively correlated with the CES-D (r=0.19, p<0.04). In multivariate models, the predicting variables on SF-36 global and 6 MCS was self-efficacy, and the predicting variables on SF-36 PCS were SLEDAI and self-efficacy. CONCLUSION: In this study, we observed that HRQOL in Korean patients with SLE was lower than those in healthy control. The SF-36 and the EQ-5D were valid measurements to assess HRQOL in patients with SLE. In multivariate model, self-efficacy and SLEDAI were only meaningful variables correlated with HRQOL among variables. Therefore, to improve the HRQOL in Korean patients with SLE, we should focus on a program to improve self-efficacy.

Health-related Quality of Life in Korean Patients with Fibromyalgia / 대한류마티스학회지

OBJECTIVE: Fibromyalgia (FM) is a rheumatic disorder characterized by widespread bodily pain, tenderness at multiple sites, and fatigue. It has a major impact on the quality of life. However, there has been no report regarding the health-related quality of life (HRQOL) in Korean patients with FM. The objective of this study was to assess the HRQOL and the correlation among each measurement and to identify the predictors for HRQOL in Korean patients with FM. METHODS: The HRQOL and clinical parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol 5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Fibromyalgia Impact Questionnaire (FIQ), and tender points, respectively, from 104 outpatients with FM. RESULTS: Of the 104 subjects, 99 (95.2 %) were women with mean (+/-SD) age of 49.2 years (+/-11.1). The mean (+/-SD) years of disease onset was 8.06 (+/-7.38). The mean (+/-SD) scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 41.6 (+/-19.8), 47.4 (+/-25.0), and 43.5 (+/-23.7), respectively. The SF-36 GH, PCS, MCS scores of FM patients were lower than that of healthy controls (p<0.001). The mean (+/-SD) EQ-5D utility and visual analog scale (VAS) were 0.52 (+/-0.32) and 55.6 (+/-19.4). The mean (+/-SD) scores of the TTO and SG were 0.49 (+/-0.44) and 0.47 (+/-0.42). The mean (+/-SD) scores of CES-D, self-efficacy scale, social support and social network were 16.0 (+/-10.2), 55.9 (+/-19.4), 2.37 (+/-0.27), and 2.07 (+/-0.58), respectively. The mean (+/-SD) scores of FIQ was 46.4 (+/-17.7). The FIQ total score was negatively correlated with the scores of SF-36 GH, MCS, PCS, EQ-5D utility and VAS, TTO, SG, social support, social network, and self-efficacy scale (r=-0.63, r=-0.60, r=-0.48, r=-0.59, r=-0.56, r=-0.32, r=-0.27, r=-0.25, r=-0.31, r=-0.54, respectively. all p's<0.001), and positively correlated with the CES-D (r=0.67, p<0.001). In multivariate models, the predicting variables of SF-36 GH and PCS were age, FIQ, and self-efficacy and the predicting variables of SF-36 MCS were income, FIQ, and social support. CONCLUSION: These results suggest that the HRQOL in Korean patients with FM is lower than healthy subjects. In a simple correlation analysis, FIQ, CES-D, social support, and self-efficacy were meaningful variables correlated with HRQOL. In multivariate model, age, FIQ, and self-efficacy were independent variables correlated with HRQOL. Therefore, the efforts to improve HRQOL in Korean patients with FM should be designed to improve the self-efficacy and depression in addition to conventional approach.

Health-Related Quality of Life in Korean Patients with Ankylosing Spondylitis / 대한류마티스학회지

OBJECTIVE: To assess the health-related quality of life (HRQOL), the correlation among each measurement, and to identify the predictors for HRQOL in Korean patients with ankylosing spondylitis (AS). METHODS: The HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, occiput to wall test, ESR, and CRP from 90 patients with AS. RESULTS: 78 patients (86.7%) were men with a mean (+/-SD) age of 28.4 (+/-7.9) years. The mean years of disease onset was 10.44 (+/-6.95). The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 53.4 (+/-21.2), 61.8 (+/-26.3), and 51.7 (+/-24.4), respectively. The mean EQ-5D utility and visual analog scale (VAS) score were 0.63 (+/-0.2) and 57.1 (+/-18.6). The mean scores of the TTO and SG were 0.46 (+/-0.6) and 0.46 (+/-0.6). The scores of the SF-36 and EQ-5D in AS patients were lower than those in healthy control. The mean scores of CES-D, self-efficacy scale, social support and social network were 10.5 (+/-6.8), 65.3 (+/-14.6), 2.46 (+/-0.22), and 2.33 (+/-0.47), respectively. The mean score of BASFI was 2.48 (+/-2.13). The BASFI total score was negatively correlated with the scores of SF-36, MCS, PCS, EQ-5D utility and VAS score, social network, and self-efficacy scale, and positively correlated with CES-D. In multivariate models, the predicting variables of SF-36 global and PCS were BASFI and self-efficacy scale and the predicting variables of SF-36 MCS were BASFI, social support, and self-efficacy scale. CONCLUSION: In this study, we observed that HRQOL in Korean patients with ankylosing spondylitis is decreased compare to healthy control. And the efforts to improve HRQOL should be designed to improve the self-efficacy and social support in addition to active treatment to prevent functional disability.

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.

Clinical Characteristics of Pulmonary Cryptococcosis / 결핵

BACKGROUND: So far, there have been numerous reports on organ damage due to cryptococcosis, however, cases of lung localization have been infrequently reported. Recently pulmonary cryptococcosis has been reported more frequently than before due to enhanced diagnostic techniques and increased underlying diseases. METHODS: The author, therefore, analyzed the clinical manifestations of 5 cryptococcosis cases that we experienced at Hanyang University Hospital from 1985 to 1996 and 9 cases reported in Korea from 1984 and 1996 retrospectively. The following results were obtained. RESULTS: Cryptococcosis occured frequently over sixth decade and the male to female ratio was 3.6:1. Underlying diseases included acute rejection after kidney transplantation, rheumatoid arthritis, autoimmune hepatitis, diabetes mellitus and state of bilateral adrenalectomy. Remaining 8 cases had no evidence of an underlying disease. Because the symptoms were subacute & nonspecific, and not improved by conventional antibiotics, 6 patients of 14 pulmonary cryptococcosis patients were treated as pulmonary tuberculosis before correct diagnosis was made. There were three asymptomatic cases. According to the results of CXR, solitary alveolar consolidation was the most common finding(8 cases) followed by diffuse infiltration(5 cases). It also showed pleural effusion, hilar lymphadenopathy and cavity formation that was rarely reported in world literature. The diagnosis was made through fine needle aspiration biopsy in 10 cases, open thoracotomy in 2 cases, transbronchial lung biopsy in 1 case and thoracentesis with pleural biopsy in 1 case. Only one case showed positive result in sputum stain and culture ,serum latex agglutination test for cryptococcus neoformans. Treatment modalities were various such as fluconazole, amphotericin B, flucytosine, ketoconazole, surgery and it's combination. After 1990 year, there was a trend that fluconazole or ketoconazole are more used than other therapeutic modalities. CONCLUSION: Because the symptoms are subacute & nonspecific and not improved by conventional antibiotics, pulmonary cryptococcosis is likely to misdiagnosis as pulmonary tuberculosis in Korea. Because the diagnostic yield of sputum stain, culture and serologic test for pulmonary cryptococcosis is low, histologic diagnosis is need in most pulmonary cryptococcosis.

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.