ABSTRACT
Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.
ABSTRACT
Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.
ABSTRACT
This study was performed to examine the effect of a 7-week comprehensive health promotion program for improving pain, depression, and disability by employing a quasi-experimental design. The subjects were regular out-patients of a RA aclinic in an University Hospital in Inchon from November 11. 1998 to December 24. 1998. The Experimental group included 18 patients who participated in an arthritis health promotion program, and the control group included 18 patients who did not. The 7-week health promotion program, which had the objective to enhance health promoting skills, was provided to patients. The effects of this program on the patients' pain, depression, and functional disability were examined. According to the study results, a significant group difference was found on these dependent variables (Hotelling's T =.30, F=3.11, p=.04). To examine which dependent variables had significant effects, one-way ANOVAs were performed. There were significant group differences in pain (F=4.35, p=.05) and in depression (F=4.22, p=.05) However, no significant group differences on functional disability (F=.04, p=.84) were found. Conclusively, the arthritis health promotion program, which was designed to enhance 11 health promoting skills, can be evaluated as successfully achieving the ultimate goal of enhancing the patients' quality of life. It can also be contended that the improvement of the patients' quality of life was enabled by relieving pain and reducing depression.
Subject(s)
Humans , Arthritis , Arthritis, Rheumatoid , Depression , Health Promotion , Outpatients , Quality of Life , SulindacABSTRACT
This study was performed to examine the effect of a 7-week comprehensive health promotion program for improving pain, depression, and disability by employing a quasi-experimental design. The subjects were regular out-patients of a RA aclinic in an University Hospital in Inchon from November 11. 1998 to December 24. 1998. The Experimental group included 18 patients who participated in an arthritis health promotion program, and the control group included 18 patients who did not. The 7-week health promotion program, which had the objective to enhance health promoting skills, was provided to patients. The effects of this program on the patients' pain, depression, and functional disability were examined. According to the study results, a significant group difference was found on these dependent variables (Hotelling's T =.30, F=3.11, p=.04). To examine which dependent variables had significant effects, one-way ANOVAs were performed. There were significant group differences in pain (F=4.35, p=.05) and in depression (F=4.22, p=.05) However, no significant group differences on functional disability (F=.04, p=.84) were found. Conclusively, the arthritis health promotion program, which was designed to enhance 11 health promoting skills, can be evaluated as successfully achieving the ultimate goal of enhancing the patients' quality of life. It can also be contended that the improvement of the patients' quality of life was enabled by relieving pain and reducing depression.
Subject(s)
Humans , Arthritis , Arthritis, Rheumatoid , Depression , Health Promotion , Outpatients , Quality of Life , SulindacABSTRACT
This is a case report of systemic lupus erythematosus presented as a transverse myelitis. Central nervous system involvement in systemic lupus erythematosus is a relatively common complication. But the transverse myelitis as a central nervous system involvement in systemic lupus erythematosus is rare and the transverse myelitis as the first manifestation of systemic lupus erythematosus has not been reported in Korea. Thus we report a case of the transverse myelitis as a first manifestation of systemic lupus erythematosus with the literature review.
Subject(s)
Central Nervous System , Korea , Lupus Erythematosus, Systemic , Myelitis, TransverseABSTRACT
We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.
Subject(s)
Adult , Humans , Male , Biopsy , Fatal Outcome , Occupational Diseases/diagnostic imaging , Occupational Diseases/pathology , Occupational Diseases/chemically induced , Occupational Exposure , Pulmonary Alveoli/pathology , Pulmonary Fibrosis/diagnostic imaging , Pulmonary Fibrosis/pathology , Pulmonary Fibrosis/chemically induced , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/pathology , Respiratory Insufficiency/chemically induced , Steel/adverse effectsABSTRACT
OBJECTIVES: In HFRS, there is a varying degree of disseminated intravascular coagulation which was evident in the early phase of the illness. It is believed also that DIC would be the consequence, at least in part, of functional changes of endothelium resulting in kinin activation and clinical syndrome. This study investigated the role of adhesion molecule in the pathogenesis of Hantaan virus-related disease. METHODS: The expression of ICAM-1 antigen on the cell membrane of human umbilical vein endothelial cells was assessed by immunohistochemistry, and ICAM-1 mRNA in the endothelial cells was assessed by in situ hybridization after Hantaan virus infection (2.6 x 10(4) PFU/mL) with the time course. RESULTS: In immunohistochemistry, the number of ICAM-1 positive cells increased with time during the 12 or 24 hours after infection. 5 to 10% of HUVECs had been positive after 12-24 hours and the number of positive cells decreased abruptly after 24 hours. Hantaan antigen had been noticed after 12 hours focally on the HUVECs but continued to proliferate into day 7 post-infection when most of HUVECs were infected by Hantaan virus. In situ hybridization showed identical patterns of ICAM-1 mRNA expression after Hantaan virus infection. CONCLUSION: It implies that the Hantaan virus infection on HUVECs would express more ICAM-1 on their surface and implicated in the pathogenesis of early clinical syndrome of HFRS.
Subject(s)
Humans , Cell Line , Endothelium, Vascular/virology , Endothelium, Vascular/immunology , Gene Expression , Hantaan virus/pathogenicity , Hemorrhagic Fever with Renal Syndrome/immunology , Hemorrhagic Fever with Renal Syndrome/genetics , Hemorrhagic Fever with Renal Syndrome/etiology , Immunohistochemistry , In Situ Hybridization , Intercellular Adhesion Molecule-1/metabolism , Intercellular Adhesion Molecule-1/genetics , RNA, Messenger/metabolism , RNA, Messenger/geneticsABSTRACT
Systemic lupus ertthematosus(SLE) is a prototypic autoimmune disease characterized by the production of antibodies to components of the cell nucleus in association with a diverse array of clinical manifestations. Infection is a major source of morbidity and mortality in parients whth SLE. Although the most frequent etiologic agents are pyogenic organisms such as Staphylococcus species and Echerichia coli, opportunistic pathogens such as uncommon bacteria, fungal organisms, viruses and protozoans have been described. Cases of osteomyelitis due to Salmonella have been reported worldwide, however, it has never been reported in the Korean literature. A 35-year-old female patient with SEL, who has treated with corticosteroid was complicated by osteomyelitis on the life distar femur. A computerized tomography guided aspiration showed greenish yellow pus. Salmonella enteritidis was cultured from the pus. Incision and pus drainage was performed. After 6weeks of antiboitic theraphy, fever, local heat, and swelling improved and she was discharged. We report this patient with a review of relevant literatures.
Subject(s)
Adult , Female , Humans , Antibodies , Autoimmune Diseases , Bacteria , Cell Nucleus , Drainage , Femur , Fever , Hot Temperature , Lupus Erythematosus, Systemic , Mortality , Osteomyelitis , Salmonella enteritidis , Salmonella , Staphylococcus , SuppurationABSTRACT
Septic artiritis is a disease that causes a rapid joint destruction by various kinds of bacteria such as Staphylococcus aureus. It affects more frequently the patients with rheumatoid arthritis, diabetes, immunocompromised patients, and chronic steroid users. In patients with rheumatoid arthritis, 1 to 12% of patients are affected by septic arthritis. In these patients, it is very difficult to distinguish between an acute exacerbation of rheumatoid arthritis and a development of septic arthritis if the latter affects more than one joint. Septic arthritis usually affects single joint, especially the knee joint. If the diagnosis and treatment are delayed, it would cause sepsis resulting in high mortality and morbidity. Thus early diagnosis by arthrocentesis, prompt drainage, and antibiotics therapy are essential. We experienced a 46 years-old woman with rheumatoid arthritis who abused the steroids for 10 years and complaining recent aggravation of bilateral knee joint swelling, warmth, and tenderness. Large amount of pus from both knees showed Gram positive cocci. The immediate open surgical drainage of both knees was done. The patient recovered from septic arthritis after 6 weeks of antibiotics therapy. The synovial fluid microbiology study should be done in all joints of the patients with the risk factors of joint infection.
Subject(s)
Female , Humans , Middle Aged , Anti-Bacterial Agents , Arthritis, Infectious , Arthritis, Rheumatoid , Bacteria , Diagnosis , Drainage , Early Diagnosis , Gram-Positive Cocci , Immunocompromised Host , Joints , Knee Joint , Knee , Mortality , Risk Factors , Sepsis , Staphylococcus aureus , Steroids , Suppuration , Synovial FluidABSTRACT
OBJECTIVE: This study was aimed to evaluate the prevalence, titer and patterns of antinuclear antibody (ANA) expression, and its clinical significance in patients with rheumatoid arthritis (RA). METHODS: We divided 259 patients with seropositive RA into ANA positive and negative groups and compared the two groups with multiple clinical variables. RESULTS: 47.5% of patients with seropositive RA expressed ANA. Most of the patterns of ANA were homogenous (52.8%) and speckled (36.6%). Most frequently expressed anti-extractable nuclear antigen (ENA) antibody was anti-Ro antibody (34.1%). Patients in the ANA positive group had higher frequency of anemia, lower hemoglobin concentration, more hot joint area on radionuclide whole body bone scan, and lower T-score on bone mineral density (BMD) than patients in the ANA negative group. But other clinical parameters which reflect disease activity and systemic involvement were not different significantly between the two groups. Most patients expressed lower ANA (63.1%). Patients with high ANA titer were older and had lower hemoglobin concentration than patients with lower ANA titer. CONCLUSIONS: Almost the half of seropositive RA patients expressed ANA. Most of them had homogenous and speckled ANA pattern. Anti-Ro antibody was most frequent anti-ENA antibody. Except anemia, hot joint area in whole body bone scan, and BMD, the expression of ANA in patients with RA can not reflect disease activity and systemic involvement accurately.
Subject(s)
Humans , Anemia , Antibodies, Antinuclear , Arthritis, Rheumatoid , Bone Density , Joints , PrevalenceABSTRACT
A 16-year old girl was admitted for chronic diarrhea, generalized edema, severe pain of lower extremities, and general weakness. She could not walk because of burning pain of knee and ankle. 99mTc-MDP bone scan demonstrated increased periarticular uptake in both lower extremity with focal increased activity in proximal portion of both tibias.. Abnormal abdominal activity in ascending, transverse, and descending colon is also seen. Bone densitometry showed severe osteoporosis in lower extremity. 99mTc-HSA scan showed abnormal radioactivity in small bowel, and descending colon indicating protein losing enteropathy. Endoscopic biopsy of terminal ileum showed a few dilated lymphatics in the submucosa. After steroid and supplemental therapy, the symptoms and signs of both protein losing enteropathy and RSDS much improved simultaneously. Reflex sympathetic dystrophy syndrome is a complex of symptoms characterized by severe pain, swelling, autonomic vasomotor dysfunction, and impaired mobility of affected extremities. The important causes are trauma, fracture, and inflammation. We assumed that the reflex sympathetic dystrophy syndrome of this girl was due to protein losing enteropathy. And as far as we know there has not been reported case that protein losing enteropathy assumed as a cause of reflex sympathetic dystrophy syndrome.
Subject(s)
Adolescent , Female , Humans , Ankle , Biopsy , Burns , Colon, Descending , Densitometry , Diarrhea , Edema , Extremities , Ileum , Inflammation , Knee , Lower Extremity , Osteoporosis , Protein-Losing Enteropathies , Radioactivity , Reflex Sympathetic Dystrophy , Reflex , Technetium Tc 99m Aggregated Albumin , Technetium Tc 99m Medronate , TibiaABSTRACT
Protein S is a natural anticoagulant present in the plasma that serves as a cofactor for activated protein C. The protein S level is decreased in congenital deficiency, inflammatory syndrome, DIC, hepatic disorders, malignancy, and oral anticoagulant (warfarin) therapy. Protein S deficiency provokes recurrent thromboembolism, superficial and/or deep vein thrombosis. Behcet's disease is a multisystemic disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. The mechanism of vascular involvement of Behcet's disease is not fully understood. This is a case report of Behcet's disease associated with protein S deficiency in a 44 year old male patient with deep vein thrombosis. We report the case with relevant literature review.
Subject(s)
Adult , Humans , Male , Dacarbazine , Plasma , Protein C , Protein S Deficiency , Protein S , Thromboembolism , Ulcer , Venous ThrombosisABSTRACT
A silicone-covered modified Gianturco stent in patients with malignant esophageal stricture is an easy, safe, and effective palliative procedure, but reports of complications arising from stent placement in patients with this condition are numerous. There have been no reports of fracture of the modified Gianturco esophageal stent. We report a case of stent fracture in association with gastric migration of modified Gianturco esophageal stent in a patient with malignant esophageal stricture. It appears that the fracture was probably due to oxidation of the stent by gastric juice.
Subject(s)
Humans , Esophageal Stenosis , Gastric Juice , StentsABSTRACT
No abstract available.