Adverse Reactions of the Second Dose of the BNT162b2 mRNA COVID-19Vaccine in Healthcare Workers in Korea

We conducted a prospective, mobile-based survey on the self-reported adverse reactions in healthcare workers (HCWs) who received both doses of the BNT162b2 mRNA vaccine. Of the 342 HCWs who completed the two-dose vaccination, 265 (77.5%) responded to the survey at least once. Overall, the rates of adverse reactions were higher after the second dose compared with the first dose (89.1% vs. 80.1%, P = 0.006). The most common systemic reactions were muscle ache (69.1%), fatigue (65.7%), headache (48.7%), chills (44.2%), and fever (32.1%), and were notably more common after the second dose vaccine as well. We also noted a sex difference in which the frequency of adverse reactions after the second dose of the vaccine was significantly higher in females, which was not observed after the first dose. The rates of adverse reactions were lower in older age groups, and the rates and severities of the adverse reactions decreased during the 3-day period following vaccination.

Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea

Background@#We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. @*Methods@#HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. @*Results@#A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%];BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. @*Conclusion@#In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.

Adverse Reactions of the Second Dose of the BNT162b2 mRNA COVID-19Vaccine in Healthcare Workers in Korea

We conducted a prospective, mobile-based survey on the self-reported adverse reactions in healthcare workers (HCWs) who received both doses of the BNT162b2 mRNA vaccine. Of the 342 HCWs who completed the two-dose vaccination, 265 (77.5%) responded to the survey at least once. Overall, the rates of adverse reactions were higher after the second dose compared with the first dose (89.1% vs. 80.1%, P = 0.006). The most common systemic reactions were muscle ache (69.1%), fatigue (65.7%), headache (48.7%), chills (44.2%), and fever (32.1%), and were notably more common after the second dose vaccine as well. We also noted a sex difference in which the frequency of adverse reactions after the second dose of the vaccine was significantly higher in females, which was not observed after the first dose. The rates of adverse reactions were lower in older age groups, and the rates and severities of the adverse reactions decreased during the 3-day period following vaccination.

Adverse Reactions Following the First Dose of ChAdOx1 nCoV-19 Vaccine and BNT162b2 Vaccine for Healthcare Workers in South Korea

Background@#We performed a prospective survey on the adverse reactions following the first dose of two types of vaccines against coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs) in South Korea. @*Methods@#HCWs at a tertiary referral hospital in Seoul, South Korea, received a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) or an mRNA-based vaccine (BNT162b2) between March 5 and March 26, 2021. The HCWs were asked to report adverse reactions through a mobile self-report questionnaire for three days after vaccination. @*Results@#A total of 7,625 HCWs received the first dose of ChAdOx1 or BNT162b2 vaccine during the study period. Of them, 5,866 (76.9%) HCWs (ChAdOx1, n = 5,589 [95.3%];BNT162b2, n = 277 [4.7%]) participated at least once in the survey, of whom 77% were female and 86% were younger than 50 years. The overall adverse reaction rate was 93% in the ChAdOx1 group and 80% in the BNT162b2 group (P < 0.001). Both local and systemic reactions were more commonly reported in the ChAdOx1 group, and the difference was larger in systemic reactions such as fever and fatigue. In the ChAdOx1 group, the incidence of adverse reactions was significantly higher in females and those in the younger age groups, while the BNT162b2 group showed such difference according to age. @*Conclusion@#In our prospective survey, vaccine-associated adverse reactions were more commonly reported in the ChAdOx1 group than in the BNT162b2 group. Females and younger age groups experienced vaccine-associated adverse reactions more frequently.

Poor agreement between QuantiFERON-TB Gold test and tuberculin skin test results for the diagnosis of latent tuberculosis infection in rheumatoid arthritis patients and healthy controls

BACKGROUND/AIMS: We investigated the agreement between the QuantiFERON-TB Gold (QFT-Gold) test and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis (RA), compared with healthy controls, in Korea. METHODS: We recruited 64 patients with RA and 79 healthy controls at two university hospitals in South Korea. The participants underwent both the QFT-Gold test and the TST simultaneously between August 2006 and February 2009. All patients were diagnosed using the classification criteria for RA revised in 1987 by the American College of Rheumatology. Bacillus Calmette-Guerin vaccination status and current medications were evaluated, and disease activities were assessed using the Disease Activity Score in 28 joints. Eleven patients with RA produced indeterminate QFT-Gold test results and were thus excluded from the kappa analysis. RESULTS: Based on an induration of 10 mm in diameter as the TST cutoff value, the QFT-Gold test and TST demonstrated 75.0% agreement (kappa = 0.23) in patients with RA and 75.9% agreement (kappa = 0.19) in healthy controls. Among the 56 patients with RA who had negative TST results, 11 patients (17.2%) also yielded indeterminate QFT-Gold results. CONCLUSIONS: Our study showed poor agreement between the results of the QFT-Gold test and the TST in both RA patients and healthy controls. Based on these findings, we emphasize the importance of making clinical decisions in the diagnosis of latent tuberculosis in Koreans with or without RA.

Hepatotoxicity of Combination Treatment with Leflunomide and Methotrexate in RA Patients / 대한류마티스학회지

OBJECTIVE: Leflunomide is the newest disease-modifying anti-rheumatic drug (DMARD) that is known to have an equivalent clinical efficacy and tolerability to methotrexate (MTX). Previous studies reported that a co-treatment with MTX and leflunomide can induce additive clinical improvements in RA patients. However, a previous study also demonstrated a reversible elevation of the transaminase levels in up to 63% of patients administered a combination treatment of leflunomide and MTX. This study examined the hepatotoxicity of a combination treatment of MTX and leflunomide. METHODS: From March, 2004, to February, 2006, 203 patients who had been treated in 3 rheumatology clinics, Goyang city, South Korea, were reviewed retrospectively. The data showed that 38.92% of patients scored higher than grade 1 hepatotoxicity and 6.90% of patients scored higher than grade 2 according to the NCI/NIH (National Cancer Institute/National Institutes of Health) Common Toxicity Criteria. RESULTS: The median onset time of hepatotoxicity was 5.91 months after treatment. Leflunomide administration was stopped in 39 patients due to several adverse reactions. Among the 39 patients, hepatotoxicity was observed in only 20.51%, suggesting that the hepatotoxicity was not more frequent than expected. Hepatotoxicity did not increase in proportion to the dose of leflunomide and MTX, age, gender, and disease activity. CONCLUSION: These results indicate that a combined treatment of leflunomide and MTX can be used safely by monitoring the liver enzyme, particularly in the first six months.

Clinical Characteristics and Joint Involvement of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To investigate the clinical, laboratory, radiologic characteristics, and joint involvement of rheumatoid arthritis (RA) in Korean. METHODS: We retrospectively reviewed initial medical records of 210 patients diagnosed as rheumatoid arthritis in Seoul, Sanggye, and Ilsan Paik Hospital, Inje University. Evaluation included age, sex, disease duration, duration of morning stiffness, joint involvement, the number of tender and swollen joints, rheumatoid factor, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), and bony erosion in simple X-ray. RESULTS: In total 210 patients, mean age was 50.1+/-13.5 years, and male to female ratio was 1 to 5.6. Mean duration of arthritis was 51.8+/-72.6 months and positive rate of rheumatoid factor was 66.7%. Mean time interval between symptom onset and first visit was 14.1+/-19.1 months. Bony erosion rate was 15.3% in early RA patients, who had been diagnosed as RA within 1 year. The order of frequency of joint involvement was as the follows; metacarpophalangeal (MCP) joints, wrist joints, proximal interphalangeal (PIP) joints, metatarsophalangeal (MTP) joints, ankle joints, and knee joints. It was noted that the joints on the right and left sides behaved in like fashion. This pattern was not different with early RA. The titer of rheumatoid factor showed poor correlations with variables of clinical activity (ESR, CRP, duration of morning stiffness, and number of tender and swollen joints). CONCLUSION: In Korea, clinical manifestations and joint involvement of RA patients were not different from other published studies. The most commonly involved joints are MCP joints, wrist joints, PIP joints, and MTP joints.

A Case of SLE-systemic Sclerosis Overlap Syndrome Complicated with Nephrotic Syndrome / 대한류마티스학회지

Renal manifestations of systemic sclerosis are proteinuria, hypertension, azotemia and renal crisis. Mild proteinuria is common, but the nephrotic syndrome occurring in association with systemic sclerosis has been rarely reported. The majority of nephrotic syndrome cases are caused by glomerulonephritis in patients with an overlap syndrome of SLE and systemic sclerosis. This report suggests that the nephrotic syndrome can be an infrequent sequel of systemic sclerosis alone without glomerulopathy. A 38-year old woman was suffering from visual loss and headaches. She had Raynaud's phenomenon and thickened skin on nearly whole body. Urine protein was 4,950 mg/day and serum albumin level was 2.7 g/dL. The result of renal biopsy was renovasculopathy-compatible with systemic sclerosis.

Vasculo-Behcet's Disease Developing in a Patient with Ebstein Anomaly / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disease, involving several organs. It is well known that there are the marked regional differences in the disease expression of BD. In case of the vascular involvement in BD, the frequency rate has been described in 25~30% among the patients from the MiddLe East, whereas it has been noted in 5~15% in our country. In general, BD associated with large vessel lesions is named vasculo-BD. On the other hand, the cardiac involvement in BD has rarely been reported in the literature. Ebstein anomaly is a kind of malformation that is characterized by a downward displacement of the tricuspid valve into the right ventricle. We reported a 54-year-old male patient with vasculo-BD who had inferior vena cava obstruction and Ebstein anomaly. The association of Ebstein anomaly with vasculo-BD is considered to be coincidental. To the best of our knowledge, this is the first case of Ebstein anomaly associated with BD.

A Case of Sacroiliitis in Psoriasis with Behcet's Disease / 대한류마티스학회지

Psoriasis is a chronic inflammatory skin disorder, which is characterized by erythematous, sharply demarcated papules, and rounded plaques covered by silvery micaceous scale. Psoriatic arthritis is a heterogeneous disease with typical features of the spondyloarthropathies. Behcet's disease is an inflammatory condition involving multiple organ systems such as mucous membrane, skin, joint, intestine, lung, central nervous system, and vessel. The inclusion of Behcet's disease among seronegative spondyloarthropathies is still being debated. We described a 47-year-old female patient who currently had psoriasis and Behcet's disease. She developed a sacroiliitis that was probably precipitated by trauma.

Comparison of Hypoxanthine-Guanine Phosphoribosyltransferase Activity between Normal and Gout Patients / 대한류마티스학회지

OBJECTIVE: It has been known that the enzyme deficiency associated with uric acid production is the minor cause of gout. The purpose of this study is to evaluate the role of hypoxanthine- guanine phosphoribosyltransferase (HGPRT) activity deficiency in the development of gout. METHODS: Assay of HGPRT activity was performed on 38 gout patients and 107 controls compromising 82 men and 25 women. In the patients with gout, age of onset, sex, family history of gout, duration of disease, serum uric acid level, and uric acid concentration of 24-hour urine were analyzed. RESULTS: In gout patients and control male group, the HGPRT activity was lowest in the age of forties. But, in female, there was no decreasing tendency with aging. In 4 gout patients, HGPRT activities were severely deficient and their ages of onset were less than 30 years old, and all have a family history of gout. CONCLUSION: In men, the lowest HGPRT activity in the age of forties could be one of the factors that make the onset of gout is highest in the fifth decade of age. The deficiency of HGPRT enzyme and family history of gout are the important factors in the pathogenesis of early onset gout.

A Case of Pulmonary Cryptococcosis in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

Pulmonary cryptococcosis is a non-infectious opportunistic or silent infection caused by Cryptococcus neoformans. It enters the body through the respiratory tract and spreads to lung, skin, liver, and lymphoid organs. Recently its incidence has been gradually increasing because of developing diagnostic tools, increased use of steroids and immunosuppressive drugs, increased survival rate of patients with chronic diseases, and increased incidence of immunodeficiency syndrome. We report a case of pulmonary cryptococcosis in a patient with rheumatoid arthritis who was being treated with low dose glucocorticoid, methotrexate and cyclosporine for 14 months.

The Comparison of the Efficacy and Adverse Drug Reaction ofCelecoxib and Diclofenac in the Treatment of Osteoarthritis in Korean Multicenter Trial / 대한류마티스학회지

OBJECTIVE: Long-term use of the analgesic acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis is limited due to the lack of effectiveness and presence of side effects. Celecoxib is a selective inhibitor of cyclo-oxygenase (COX)-2 and expected to help NSAIDs in expressing the effective anti-inflammatory effect by not inhibiting COX-1. Thus, 200 mg of celecoxib and 100 mg of slow releasing diclofenac were compared for their effectiveness and safety in Korean patients with knee osteoarthritis. METHODS: We administered 200 mg of celecoxib or 100 mg of slow releasing diclofenac in 223 randomly selected patients with knee osteoarthritis for 4 weeks. The effectiveness of these drugs on osteoarthritis was assessed by evaluating pain in each patient, making overall evaluation on osteoarthritis by the patient and his/her attending physician, and measuring the severity indices on osteoarthritis before treatment, and 2 weeks and 4 weeks after treatment. Moreover, safety and drug resistance were evaluated by assessing the rate of adverse effects, rate of withdrawal, laboratory tests, and vital signs. RESULTS: The clinical symptoms of osteoarthritis were improved significantly by 4 weeks after treatment with celecoxib and diclofenac. According to the results of overall evaluation made by attending physicians 2 weeks after treatment, the rate of improvement was 49.5% in celecoxib group and 35.7% in diclofenac group, showing a statistically significant difference (p=0.023). Other than this difference, no other significant difference was present between the two groups with other variables used for the evaluation of effectiveness. The rate of adverse effects was significantly lower in celecoxib group compared with diclofenac group. According to laboratory findings, no abnormal figure was found in both groups but total bilirubin, SGOT, and SGPT were consistently higher in patients in diclofenac group. Thirteen patients dropped out of the study due to side effects (10 patients) and treatment failure (3 patients). CONCLUSION: Our findings from the clinical comparison of celecoxib and diclofenac in Korean patients with knee osteoarthritis were similar to those results found in previous studies. Although celecoxib showed similar effectiveness as diclofenac on knee osteoarthritis in the treatment of symptoms, it showed a lower rate of adverse effects; thus, we concluded that celecoxib is safer compared with diclofenac.

A Case of Polyarteritis Nodosa Preceded by Otitis Media / 대한류마티스학회지

Polyarteritis nodosa (PAN) is a disease of small and medium sized muscular arteries, typically involving the skin, kidney, peripheral nerves, muscle and gut. Although its etiology has not been known clearly yet, an immune complex is believed to initiate a vasculitis. Infections, such as hepatitis B virus, hepatitis C virus, and streptococcal infection, may be related with the development of PAN. We experienced a case of PAN preceded by Methicillin resistant staphylococcus aureus-associated otitis media in a 50-year-old woman. This is the first case reported in Korea.

A Case of Central Diabetes Insipidus in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Central diabetes insipidus is caused by the insufficient secretion of vasopressin and has been reported in great variety of disorder of brain tumor, systemic infiltrative disease such as histiocytosis, amyoidosis and vasculitis, leukemia, and other autoimmune diseases. But there has been reported only 3 cases of systemic lupus erythematosus (SLE) associated with central diabetes insipidus. The exact pathophysiologic process of pituitary gland involvement in SLE has been unknown, although there are some evidence that vascular impairment and autoantibodies to pituitary gland may be contributory factors. Here, we report a case of central diabetes insipidus complicated by neuropsychiatric systemic lupus erythematosus.

A case of bilateral psoas abscesses in a patient with rheumatoid arthritis / 대한내과학회지

A psoas abscess is a rare clinical entity that presents diagnostic and therapeutic challenges. Tuberculous vertebral osteomyelitis was formerly the principal cause of a psoas abscess, but now psoas abscesses most commonly result from direct extension of intraabdominal infections. Occasionally, a psoas abscess results from extension of a perinephric abscess due to secondary infection of a retroperitoneal hematoma. Staphylococcus aureus is the most common cause of psoas abscess secondary to vertebral osteomyelitis. Tuberculosis, malnutrition, alcoholism, diabetes mellitus, rheumatoid arthritis and steroid use are responsible for compromise in host defenses and consequent increase in the relative risk of psoas abscess. Bilateral psoas abscesses are rare. A 66-year old woman with rheuamoid arthritis presented bilateral psoas abscesses. We report a case of bilateral psoas abscesses in rheumatoid arthritis confirmed by surgical drainage and tissue culture. To our knowledge, this is the second case report of bilateral psoas abscesses due to Staphylococcus aureus in a patient of rheumatoid arthritis in a world.

Imaging and Acoustic Study of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.

The Comparison of Clinical Efficacy and Safety of Meloxicam versus Diclofenac in Korean Patients with Osteoarthritis of the Knee ; Open Multicenter Comparative Randomized Trial / 대한류마티스학회지

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.

The Comparison of Clinical Efficacy and Safety of Meloxicam versus Diclofenac in Korean Patients with Osteoarthritis of the Knee ; Open Multicenter Comparative Randomized Trial / 대한류마티스학회지

OBJECTIVE: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. METHODS: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician? and patient? global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. RESULTS: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician? and patient's global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%)(p<0.05). CONCLUSION: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.

Study on Effect of Benzbromarone in the Patients with Gout / 대한류마티스학회지

OBJECTIVE: Benzbromarone is a most potent uricosuric agent which has been marketed in Europe. The purpose of this study was to evaluate the safety and efficacy of benzbromarone as a uric acid lowering agent in gouty patients in Korea. METHOD: Twenty-one patients with gout, who were lower excreter of uric acid and had no other complication of gout, were treated with benzbromarone for 6 months. In these patients we checked complete blood count, liver function test, BUN, creatinine, serum uric acid, 24 hour urine uric acid excretion and uric acid clearance before and after treatment with benzbromarone. RESULTS: Significant improvements(p<0.01) were found in the serum uric acid level, 24h uric acid excretion and uric acid clearance. The mean serum uric acid decreased from 8.2mg/dl to 5.1mg/dl at the end of 6 months; mean urinary uric acid excretion increased from 425.9mg/day to 760.3mg/day; and the uric acid clearance increased from 3.5mL/min to 10.9mL/min. There are no clinical or laboratory side effects, except skin rash in the one patient. CONCLUSION: Benzbromarone was effective to control plasma uric acid concentration at doses ranging from 25 to 50mg/day.