Identification of Interleukin 1-Responsive Genes in Human Chondrosarcoma SW1354 cells by cDNA Microarray Technology / 영남의대학술지

BACKGROUND: Accumulating evidence shows that interleukin(IL)-1 plays a critical role in inflammation and connective tissue destruction observed in both osteoarthritis and rheumatoid arthritis. IL-1 induces gene expression related to cytokines, chemokines and matrix metalloproteinases by activation of many different transcription factors. MATERIALS AND METHODS: The chondrosarcoma cell line, SW1353, is known to be a valuable in vitro system for investigating catabolic gene regulation by IL-1beta in chondrocytic cells. To explore and analyze the changes in gene expression by IL-1 responsible for arthritis, SW1353 was treated with IL-1 for 1, 6 and 24 h and then total RNAs were purified for each time. The changes in gene expression were analyzed with 17k human cDNA microarrays and validated by semi-quantitative RT-PCR. RESULTS: Greater than a two-fold change was observed in 1,200 genes including metallothioneins, matrix metalloproteinases, extracellular matrix proteins, antioxidant proteins, cytoskeleton proteins, cell cycle regulatory proteins, proteins for cell growth and apoptosis, signaling proteins and transcription factors. These changes appeared to be correlate with the pathophysiological changes observed in early osteoarthritis. CONCLUSION: cDNA microarray analysis revealed a marked variability in gene expression, and provided insight into the overall molecular changes. The result of this study provide initial information for further studies to identify therapeutic targets in osteoarthritis pathogenesis.

A Case of Behcet's Disease with Pericarditis, Thrombotic Thrombocytopenic Purpura, Deep Vein Thrombosis and Coronary Artery Pseudo Aneurysm

Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.

A Case of Protein-losing Enteropathy Treated with High Dose Intravenous Glucocorticoid Therapy in Systemic Lupus Erythematosus / 영남의대학술지

Generalized edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include: Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to our hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.

Usefulness of Carotid Intima Media Thickness as Cardiovascular Risk Factor in Patient with SLE / 대한류마티스학회지

OBJECTIVE: The purpose of this study was to investigate the complication using carotid intima media thickness (CIMT) as an indicator for atherosclerosis and to verify the risk factors in systemic lupus erythematosus (SLE) patients compared with those of control group. METHODS: The study recruited 48 asymptomatic SLE and 32 healthy control group. These are examined by B-mode ultrasound (Acuson(TM) SequoiaC256 8 MHz linear transducer) to measure the CIMT at the far wall of the common carotid artery. A wide range of contribution factors to CIMT including age, body mass index, lipid profile, total cumulative steroid dose, SLEDAI, and proteinuria were considered. RESULTS: Although the results of CIMT in both groups were within normal limit (In healthy adult 0.25~1.5 mm, values > 1.0 mm often regarded as abnormal), the mean CIMT in patient group was 0.721+/-0.162 mm, which was thicker than that of control group with 0.5219+/-0.096 mm (p<0.001). In multiple regression analysis, only age showed significant contribution to CIMT (p<0.01). Disease duration, SLEDAI and serum lipids were of no statistical significance with CIMT. CONCLUSION: We were to elucidate the advance of atherosclerosis with measuring CIMT and assess factors associated with SLE. Even if the results of CIMT in both groups were within normal range, it is significant that the arterial thickening is more advanced in SLE than that of healthy control. Further studies based on CIMT are needed to screen and prevent cardiovascular complications from disease progression.

Lipid profiles in patients with systemic lupus erythematosus / 대한내과학회지

BACKGROUND: The aims of this study were the identification of the abnormalities in lipid profiles and the correlations between serum lipid profiles and inflammatory parameters in patients with systemic lupus erythematosus. METHODS: The subjects were 50 patients with systemic lupus erythematosus who have been treated in rheumatology clinic, Yeungnam University Hospital. Serum lipids and apolipoproteins were measured and compared with those of age- and sex-matched controls. In systemic lupus erythematosus group, disease activities were assessed by systemic lupus erythematosus disease activity index and erythrocyte sedimentation rate. RESULTS: All lipid profiles were within normal range but most of lipoprotein levels were higher in patients with systemic lupus erythematosus than controls. Triglyceride, low-density lipoprotein and very-low-density lipoprotein were statistically significant (p=0.001, p=0.023, and p=0.001 respectively). Total cholesterol and low-density lipoprotein were significantly increased in systemic lupus erythematosus patients with proteinuria (>or=100 mg/dL/24hr) than in patients without proteinuria. Total cholesterol and low-density lipoprotein had positive correlations and apolipoprotein A-II had negative correlation with systemic lupus erythematosus disease activity index. Low-density lipoprotein and apolipoprotein B had positive correlations, high-density lipoprotein and apolipoprotein A-II had negative correlations with erythrocyte sedimentation rate. But differences of lipid profiles according to the duration of disease and total doses of steroid were not significant. CONCLUSION: This study showed that triglyceride, low-density lipoprotein, and very-low-density lipoprotein in patients with systemic lupus erythematosus were higher than controls. Total cholesterol and LDL in patients with SLE had positive correlations with disease activities.

A Case of Pyoderma Gangrenosum in Rheumotoid Arthritis Patient / 영남의대학술지

Pyoderma gangrenosum is uncommon neutrophilic dermatosis characterized by richness of the mature neutrophilic polynuclear dermal infiltrate. Pyoderma gangrenosum is associated with variable diseases, most commonly inflammatory bowel disease, hematological diseases, malignancies, but it is reported rarely in rheumatoid arthritis. We report a case of pyoderma gangrenosum in rheumoid arthritis patient. A 50-year-old woman admitted to our hospital due to painful pretibial ulcerative skin lesions. She had been treated as rheumatoid arthritis for 8 years. At admission, body temperature was 36.5degrees C and other vital sign was unremarkable. Physical examination revealed right pretibial ulceration, multiple pustules on left pretibial area and both palms. Laboratory studies revealed WBC count 7,600/uL (neutrophils 60.3%, eosinophil 3.2%), hemoglobin 11.4 g/dL, platelet count 319,000/uL, ESR 65 mm/hour. Other lab findings were also unremarkable. Skin biopsy was done, which showed dense dermal infiltrate of neutrophils and wound culture were negative. By 8 weeks after systemic high dose corticosteroid (1 mg/kg/day), cyclosporine A (5 mg/kg/day), sulfasalazine 2 g therapy, symptoms and skin ulceration were being improved. Without skin relapse, she is followed up our hospital with low dose corticosteroid and sulfasalazine.

Autonomic Nervous System Dysfunction in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To investigate the prevalence of autonomic dysfunction and to evaluate the relationship between autonomic dysfunction and clinical parameters in patients with systemic lupus erythematosus (SLE). METHODS: Fifty-eight patients with SLE who met the American College of Rheumatology criteria for SLE and forty-five healthy controls were selected at our hospital. Cardiovascular autonomic nervous function (CAN) test, including heart rate variation in deep breathing, Valsalva maneuver and orthostatic change and blood pressure response to standing, handgrip, was done in patient group and controls. Erythrocyte sedimentation rate (ESR), antinuclear antibody, anti-dsDNA antibody, complete blood count, complement and disease duration of patients were retrospectively reviewed and disease activity was assessed by Mexican SLE disease activity index (MEX-SLEDAI). RESULTS: The frequency of parasympathetic damage was 51.7% in patients with SLE and 15.6% in controls. There was significant difference between 2 groups in heart rate variation in deep breathing. No significant correlations were observed between autonomic dysfunction and ESR, antinuclear antibody, anti-dsDNA antibody, thrombocytopenia, complement, disease duration of patients, but there was slightly positive correlation between number of abnormal parasympathetic function test and MEX-SLEDAI (r=0.32, p<0.05). CONCLUSION: The prevalence of autonomic dysfunction was high in SLE patients and there was high frequency in patients with high disease activity. Prospective studies are needed to determine the clinical significance of autonomic dysfunction in the morbidity and mortality of SLE.