Hypocomplementemic Urticarial Vasculitis in Systemic Lupus Erythematosus

Urticarial vasculitis is characterized clinically by urticarial skin lesions and histologically by leukocytoclastic vasculitis. Hypocomplementemic urticarial vasculitis is associated with connective tissue diseases such as systemic lupus erythematosus (SLE). We report a case of urticarial vasculitis that preceded manifestations of SLE.

A Case of Multiple Gastric Carcinoid in a Woman with Systemic Lupus Erythematosus / 대한류마티스학회지

Gastric carcinoid tumor is a rare neoplasm and it accounts for only 0.3% of all the gastric neoplasms. Gastric carcinoid tumor has high incidence in patients who are aged between 50 and 70 years, and it usually develops over a long period of time. Type I gastric carcinoid tumors are associated with autoimmune atrophic gastritis and pernicious anemia, and there are a few cases of gastric carcinoids in patients with other autoimmune diseases like Sjogren's syndrome and autoimmune thyroiditis. Here, we report on a case of recurrent type I gastric carcinoid tumors in a 42-years old woman who suffered with systemic lupus erythematosus.

Demyelinating Syndrome Resembling Multiple Sclerosis as the First Manifestation of Systemic Lupus Erythematosus: Report of Two Cases / 대한류마티스학회지

Neurologic manifestations rarely occur as presenting feature of systemic lupus erythematosus (SLE). We describe two women who presented with several episodes of neurologic symptoms mimicking multiple sclerosis. Several years after disease onset, clinical and laboratory finding were compatible with SLE. These cases show that demyelinating syndrome resembling multiple sclerosis may present as a first manifestation of SLE.

Dorsomedial Cutaneous Nerve Conduction Study in Hallux Valgus

OBJECTIVE: To show the prevalence of the dorsomedial cutaneous nerve (DMCN) injury in the hallux valgus and to evaluate whether the sensory nerve damage contributes to pain and sensory impairment in the great toe. METHOD: Sixty feet of healthy adults (normal group) and 26 feet of patients with hallux valgus (hallux valgus group) were evaluated with sensory nerve conduction study of DMCN. The prevalence of the nerve injury was compared between the two groups. Sensory nerve action potentials of DMCN in hallux valgus feet were analyzed and compared according to the patient's symptom and the severity of the radiographic measurements of the feet. RESULTS: The prevalence of DMCN injury was 42.3% of the hallux valgus group. The peak latency of the DMCN sensory action potential of the symptomatic feet showed statistically significant delay compared to the asymptomatic group (p<0.05). Delay of the peak latency and decrement of the amplitude of the DMCN were statistically significant among the three groups as the valgus deformity worsened (p<0.05). CONCLUSION: DMCN injury should be considered in addition to soft tissue injury or arthritis in the differential diagnosis of the pain, burning sensation or numbness associated with hallux valgus.

Amyloid Arthropathy Simulating Rheumatoid Arthritis in the Patient with Multiple Myeloma / 대한류마티스학회지

No abstract available.

Nitric Oxide(NO) in Inflammatory Arthritis / 대한내과학회지

OBJECTIVES:Nitric Oxide(NO) is a toxic, inorganic, gaseous free radical produced during the metabolism of L-Arginine by NO synthase(NOS). It has been implicated in a rapidly growing number of physiological and pathophysiological processes such as cytotoxic effects against microbes and tumor cells, blood vessel dilation and neurotransmitter. Recently there is growing evidence implicating NO in immune regulation, inflammation, autoimmunity, and arthritis. We performed this study to determine a role for nitric oxide in inflammatory arthritis especially rheumatoid arthritis(RA). METHODS: We measured (1) the concentrations of nitrite, a breakdown product of nitric oxide, in serum and synovial fluid from patients with RA and osteoarthritis(OA) and in the serum of controls (2) the concentrations of nitrite in the supernatant of cultured synovial tissue with RA and OA and (3) determined whether human chondrocytes and synoviocytes can synthesize nitric oxide and if so, how production is regulated by cytokines and antirheumatic drugs. RESULTS: 1) Serum nitrite concentrations in patients with RA and OA were higher than in controls. In both disease groups synovial fluid nitrite was higher than serum nitrite. Serum and synovial fluid nitrite concenrations in RA were higher than those in OA. However, those findings are not statistically significant. 2) Although these findings are not statistically significant, the concentration of nitrite in the supernatant of cultured synavial tissue with RA was higher than that in OA. 3) IL-1beta and TNF-alpah induced the biosynthesis of NO by chondrocytes and synoviocytes. IGF-1 and TGF-beta failed to provoke the production of NO. The biosynthesis of NO required an induction period of approximately 6 hours and was inhibited by L-NMMA and cycloheximide. Dexamethasone, indomethacin, gold sodium thiomalate and methotrexate had no effect on the induction of NO biosynthesis. CONCLUSION: These results suggest a role for nitric oxide as an inflommatory mediator in inflammatory arthritis.

The Clinical Characteristics of Male Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: To document the clinical characteristics of Korean male patients with rheumatoid arthritis that are different from those of female counterparts. METHODS: Six hundred and seventy-five patients who had met the ACR criteria for rheumatoid arthritis were included in the study. Clinical and laboratory data were retrospectively reviewed and radiologic features of hands and feet were graded by Steinbroker's method. RESULTS: The female : male ratio in the total patients studied is 567 : 108 (5.25). The symptom onset age was 39.5 +/- 11.8 in woman and 44.0 +/- 11.3 in men. The functional class at the time of diagnosis and the incidence of anemia showed little significant difference. Among the extraarticular manifestations, only interstitial lung disease was more common in males. There were significant differences between both sexes on positivity of antiperinuclear factor, C-reactive protein, and titer of rheumatoid factor in the seropositive groups, but not on rheumatoid factor positivity. Radiologically there was no significant difference in the hands and feet joints between males and females. Higher dosage of steroid was initially prescribed for male patients. CONCLUSIONS: The males seem to have slightly more active disease and to show significant differences in antiperinuclear factor positivity, the titer of rheumatoid factor and C-reactive protein, and lung involvement. However, we failed to demonstrate that the disease in males was more severe than compared to that of their female counterparts.

Analysis of TCR Vfi Gene Repertoire in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: Polymerase chain reaction (PCR) technology was eamine synovial fluid and peripheral T cells in patients with rheumatoid arthritis(RA) to determine the preferential usage of the T cell receptor(TCR) variable region(V) gene. METHODS: Oligonucleotide primers specific for individual TCR Vfi gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in unselected T cell populations. RESULTS: The result of Vfi utilization was generally heterogenous, similar with previous reports. However, the mean expression of Vfi16 and Vfi18 in RA was more preferentially utilized compared to normal donors. The usage of Vfi in peripheral blood from 3 patients with RA demonstrated restrictions in Vfi16, Vfi 20 and Vfi18 genes, respectively. Analyses of synovial fluid resulted in restriction in Vfi12, Vfi20 and Vfi20, respectively. Although there was no significant pattern of skewed Vfi gene mean usage when comparing the synovial fluids with the peripheral blood T cells from RA patients, there were significant biased Vfi genes, Vfi12, V~I and Vfi20, each 3 patients. As the HLA type is a determining factor in shaping TCR repertoire of peripheral T cells, we compared the Vfi utilization in HLA-DR4 expressing groups that have susceptibility and gene dosage effect in disease progression. It was a little different that comparing the pattern of Vfi usage in peripheral blood and synovial fluid from RA patients between HLA-DR4 positive and negative group. CONCLUSION: The results were consistent with the conclusion that the increased Vfi family T cells infiltrate synovium and are dependent on each patient and may be involved in inducing and maintaining the synovitis that characterizes RA. The different outcome of each patient may be due to the difference in disease duration, genetic background and geographic region. A more important factor may be the stage of disease, because epitope 'induced immune reaction may change over time. Therefore, selecting patients early in the course of disease may be important and may facilitate the need for more in-depth TCR analysis in the future.

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.

Isolation and Characterization of Human Muscle Cells / 대한류마티스학회지

OBJECTIVES: To isolate and culture of human muscle cells by manipulating culture conditions. METHODS: Muscle samples were obtained during total hip replacement or bedside muscle biopsy. We isolated myoblasts from freshly obtained human muscle tissue by trypsin and collagenase digesion. RESULTS: Selective isolation of myoblasts was identified through histologic examination by light-microscope. We identified monoc]onal antibodies(Leu-19) as molecular markers in human skeletal muscle were expressed. CONCLUSIONS: This study demonstrated that it had been possible to culture morphologically and immunelogically identifiable myoblasts isolated from human skeletal muscle tissue.

Bicipital Synoival Cysts in Juvenile Rheumatoid Arthritis / 대한류마티스학회지

Herniation of the synovium from the joint space into perioarticular soft tissues is a relatively common complication of adult rheumatoid arthritis, but rare in juvenile rheumatoid arthritis. The most completely described is the popliteal cysts. However, cysts have rarely been reported in the arm. Authors experienced a case of a boy with systemic form of juvenile rheumatoid arthritis who have bicipital synovial cysts in both arm and report this with a review of literature.

A Case of Odontoid Fracture in Rheumatoid Arthritis / 대한류마티스학회지

It's now well recognized that the cervical spine is commonly affected in rheumatoid arthritis(RA) and that subluxation of the atlas is frequently present and may occasionally be fatal. It is not widely appreciated, however, that some rheumatoid patients may develop fractures of the odontoid process in association with relatively minimal trauma or no trauma at all. This is a fracture caused by erosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subluxation working on the odontoid in cervical extension. We evaluated a patient with RA who had a fracture of the odontoid process. Following diagnosis she underwent surgery for which the prognosis was excellent.

The Roles of Intercellular Adhesion Molecule I in T Cell Adhesion Tosynovial Cell in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: It has previously been shown that cellular interaction between infiltrating mononuclear cells and synoviocyte are important in the initiation and perpetuation of autoimmune processes in the synovial tissue of patients with rheuamtoid arthritis. Thus, we have investigated the molecular basis of T cell-synovial cell interaction in the cultured synoviocytes from patients with rheumatoid arthritis. METHODS: Using an immunohistochemical staining technique and inhibition study with monoclonal antibody, we studied the expression and the function of intercellular adhesion molecule 1 (ICAM-1) in T cell-synovial cell interaction in the cultured synoviocytes. RESULTS: Expression of ICAM-1 was diffusely observed in most components of rheumatoid synovium and readily up-regulated by IL-1. T cell-synovial cell interaction was inhibited by monoclehal antibody aganinst ICAM-1. CONCLUSION: These results showed that ICAM-1 was involed in the cellular interaction between T lymphocytes and synovial cells in patients with rheumatoid arthritis.

The Effect of Bucillamine of Trace Element Levels of Hair in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: We investigated the changes of trace element levels in hair of patients with rheumatoid arthritis after bucillamine treatment. METHODS: We performed inductively coupled plasma atomic emission spectrometry in determination of trace element levels in hair of patients with rheumatoid arthritis. RESULTS: The results were as follows: 1) There was a significant increase of copper concentration, but no change in zinc level after bucillamine treatment. 2) There were no significant changes in copper and zinc concentrations between the proximal and distal portions of hair after long-term bucillamine treatment. CONCLUSIONS: Our results showed the significant increase of copper level and no significant change of zinc level in hair after bucillamine treatment, but, although statistically not significant, copper and zinc levels were decreased on experiment with divided hair. So, our findings do not permit any conclusion on the influence of bucillamine on trace element levels in hair. Further studies in large samples and comparison with the effect of D-penicillamine will be necessary to clarify the association of trace element levels in hair of rheumatoid arthritis patients and bucillamine treatment.

Clinical Trial of Dysprosium-165 HMA in the Treatment of Rheumatoid Knee Synovitis / 대한류마티스학회지

OBJECTIVES: To evaluate the efficacy and safety of radiation synovectomy with Dy-165 HMA in chronic rheumatoid synovitis of the knee METHODS: Two hundred thirty six knees of 212 patients with rheumatoid arthritis and persistent synovitis of the knee were treated with the intraarticular injection of 250~300 mCi of Dy-165 HMA which was prepared by KAERI. Efficacy was assessed by the following parameters: visual analog scale of the knee pain while walking and resting, circumference of the knee, range of motion of the knee. The final global assessment was classified as good, fair or poor. Estra-articular leakage of Dy-165 HMA was determined by blood pool and urine radioactivity and scintigraphic evaluation of liver, groin, and knee joints. RESULTS: l) The optimum radiation dose was 260mCi. 2) The mean follow up periods were 50.4(24-112) weeks. 3) Forty four percent of the knees showed good results, 32% fair results, and 24% shwoed good results. 4) In knees with stage I radiographic changes, 81% showed improvement, of which 54% showed good results. In knees with stage II changes, 78% showed improvement including 39% of the patients with good results. There was a direct correlation between the radiographic stage and response to treatment. 5) The mean period of improvement for the 180 knees that reponded to treatment was 41.4(24-106) weeks. Ten of the 180 knees with improvement relapsed after the mean period of 64(28-80) weeks. 6) Leakage of radioactivity from the injected joint was minimal. 7) Adverse reactions were rare(radiation burn : 4, transient postinjection "flare" : 14). CONCLUSIONS: The optimum radiation dose in Korean was somewhat less than of other foreign reports. Dy-165 HMA radiation synovectomy is a safe and useful therapy for chronic synovitis of the knee joint.

Clinical Features Of Psoriatic Arthritis: 17 Cases / 대한류마티스학회지

OBJECTIVES: To investigate the clinical, laboratory and radiological features of psoriatic arthritis. METHODS: Seventeen patients with psoriatic arthritis were studied. The diagnosis of psoriatic arthritis was based on the presence of an inflammatory arthritis associated with psoriasis, usually seronegative. Other rheumatic conditions were excluded. RESULTS: 1) There were 8 men and 9 women(male to female ratio of 1:1.13) and mean age was 41 years old. 2) Thirteen patients developed arthritis an average of 7. 3 years after the onset of psoriasis ; Three had a simultaneous onset of skin and joint disease(within 6 months), while in one patient the arthritis preceded psoriasis by a 10 years. 3) Ten patients had nail lesions, and dactyliris was presented in 6 patients. 4) The frequency of positive rheumatoid factor was 18 percent of the patients, and HLA-B27 was detected in 24 percent. 5) The prevalences of clinical patterns were as follows : oligoarthritis(41.2%), polyarthritis(29.4%), spondyloarthritis(23.5%) and arthritis in distal joint (5.9%). CONCLUSIONS: In contrast to rheumatoid arthritis, psoriatic arthritis occured frequently in males as in females and oligoarthritis was the most common joint pattern.