Calcific Tendinitis of Flexor Carpi Ulnaris Insertion Site / 대한류마티스학회지

No abstract available.

The Role of MAPK Signaling of 1,25(OH)2D3-induced CYP24 Expression in Activated Human Macrophages / 대한류마티스학회지

OBJECTIVE: Several important roles of 1,25(OH)2D3 have been recognized in the immune system. The availability of 1,25(OH)2D3 at the cellular level is significantly influenced by the relative abundance of enzymes to synthesize (CYP27B1) and catabolize (CYP24) 1,25(OH)2D3. In this study, we examined the effect of 1,25(OH)2D3 on the expression of the CYP24 gene and the role of MAPK for the induction of CYP24 by 1,25(OH)2D3 in activated human macrophages. METHODS: For obtaining human activated macrophages, we treated U937 cells with PMA and we cultured these cells for 24 hours to adhere. After 24 hours treatment with PMA, the differentiated cells were washed with phosphate buffered saline (PBS), and then they were used for examining the effect of 1,25(OH)2D3 on the expression of the CYP24 gene. The mRNA expressions of the vitamin-D3 inducible genes were measured by real-time PCR, and the change of the protein expression by 1,25(OH)2D3 was measured by immunoblotting. RESULTS: 1,25(OH)2D3 significantly induced the expression of CYP24 in the U937 cells and the 1,25(OH)2D3-induced expression of CYP24 was strongly augmented in the PMA-differentiated U937 cells. The 1,25(OH)2D3-induced expression of CYP24 was mediated by Erk1/2 and p38 MAPKs. Parallel to the induced expression of CYP24, 1,25(OH)2D3 induced the expression and phosphorylation of the CCAAT enhancer-binding protein (C/EBPbeta). CONCLUSION: In this study, we found that 1,25(OH)2D3 inducedthe expression of CYP24 via activation of MAPKs. These results suggest that MAPK inhibitors may be useful for the treatment of inflammatory conditions, in which active vitamin D3 can be used as the therapeutic molecule, by increasing the availability of 1,25(OH)2D3.

A New Onset of Systemic Lupus Erythematosus Developed After Bee Venom Therapy

Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) can be triggered by numerous stimuli. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis. We present here a case of a 49-year-old female who experienced a new onset lupus after undergoing bee venom therapy, and this looked like a case of angioedema. The patient was successfully treated with high dose steroids and antimalarial drugs. We discuss the possibility of bee venom contributing to the development of SLE, and we suggest that such treatment should be avoided in patients with lupus.

A Case of Pa-tient with Wegener's Granulomatosis Showing Glomerular Immune Deposition in Kidney Biopsy / 대한신장학회지

Rapidly progressive glomerulonephritis (RPGN) in Wegener's granulomatosis patients typically has been characterized by pauci-immune glomerulonephritis (PIGN). In some patients, however, significant amount of glomerular immune deposits was detected and reported that they may have poor prognosis. A 30 year-old-female visited due to the skin rash of both lower extremities, arthralgia and nasal stiffness. She had sinusitis, lung opacity, and proteinuria. Serologic PR-3 ANCA was positive and histologic findings of nasal cavity and lung also showed necrotizing vasculitis and granuloma. Thus we could diagnose Wegener's granulomatosis. However, gross hematuria developed and renal function worsened in spite of treatment with high dose prednisolone and oral cyclophosphamide. Therefore we performed a kidney biopsy. The kidney biopsy showed crescentic glomerulonephritis with Ig A deposition in the mesangium. We experienced a case of Wegener's granulomatosis patient with significant IgA deposition in glomeruli. We report this case with brief review of the literature.

Diagnostic Accuracies of Anti-cyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Korean Patients with Rheumatoid Arthritis: A Meta-analysis / 대한류마티스학회지

No Abstract available.

Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum / 대한류마티스학회지

Wegener's granulomatosis is multi-systemic disease characterized by granulomatous necrotizing vasculitis and it usually affects upper and lower respiratory tracts. Cutaneous manifestation as an initial presentation is unusual and comprises about 15% of cases. The most frequent skin lesions are palpable purpura, papules, ulcerations, vesicles, subcutaneous nodules, necrotizing ulcerations. We report a patient with Wegener's granulomatosis who presents as a pyoderma gangrenosum.

A Case of Pulmonary Hypertension in a Patient with Adult-onset Still's Disease / 대한류마티스학회지

Pulmonary hypertension is one of the serious complications of autoimmune rheumatic disease, and it is becoming an important cause of morbidity and premature death. Pulmonary involvement occurs occasionally in adult-onset Still's disease (AOSD), but pulmonary hypertension has not been previously reported in Korea. We describe a 33-year-old woman with 5-year history of AOSD who presented with pulmonary hypertension, without evidences of pleural or parenchymal involvement of the lung, pulmonary embolism or any other obvious cause. Here, we report an AOSD patient with pulmonary hypertension with review of the literatures.

The relationship and clinical utility of serum levels of soluble receptor activator of nuclear factors B ligand (sRANKL) and osteoporosis in patients with ankylosing spondylitis / 대한내과학회지

No abstract available.

Clinical Manifestations of Mononeuritis Multiplex in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Mononeuritis multiplex is an extra-articular manifestation associated with rheumatoid arthritis. This study set out to investigate its clinical characteristics in Korea. MEHTODS: Clinical characteristics and laboratory data were compared retrospectively by review of medical records between 12 patients with mononeuritis multiplex (case) and randomly selected 116 age-matched patients without mononeuritis multiplex in patients with rheumatoid arthritis (control). RESULTS: Mean age of the case group was 51.8+/-8.4 years old with 7 males and 5 females which showed higher prevalence of male gender compared to the control group (p<0.05). There was no difference in mean duration of disease between two groups. Upper limbs, lower limbs and both upper and lower limbs were involved in 3, 7 and 2 patients, respectively. Major symptoms were tingling (66.6%), paresthesia (33.3%), pain (33.3%), foot drop (33.3%), or muscle weakness (16.7%). Skin ulceration was accompanied in 3 patients, but vasculitis of other organs was not found. Mean C-reactive protein level in the case group was 7.6+/-6.7 mg/dL, which was higher compared to 2.4+/-3.1 mg/dL in the control group (p<0.05). Rheumatoid factor was positive in 83.3% of the case, however positive rate and titer showed no significant difference with the control group. There was no difference in other extra-articular manifestations between two groups. Six patients were treated with glucocorticoid and immuno-suppressants and 6 patients with only glucocorticoid1 for 6.8+/-7.1 weeks. Symptoms improved after treatment in 10 patients but, it lasted in 2 patients. CONCLUSION: Rheumatoid arthritis associated mononeuritis multiplex was more prevalent in males with higher CRP levels, and responded well to medical intervention including glucocorticoid, and immunosuppressants.

Propylthiouracil-associated p-ANCA Positive Vasculitis with Focal Segmental Glomerulosclerosis / 대한신장학회잡지

Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis has been reported in Graves' disease patients treated with propylthiouracil (PTU). In most cases, it's renal involvements has been known as crescentic glomerulonephritis. A 41-year-old female patient with hyperthyroidism has been treated with PTU for 3 years. The patient had developed isolated hematuria and polyarthralgia with p-ANCA positivity, 6 months and 10 months after PTU treatment, respectively. She had been continuously treated with PTU until she was admitted at our hospital. Three months before admission, polyarthralgia was aggravated and purpura in both lower legs and hands was developed. Urinalysis revealed hematuria, proteinuria. Serologic evaluation showed p-ANCA positive. Skin biopy showed leukocytoclastic vasculitis and renal biopsy showed focal segmental glomerulosclerosis (FSGS). She was diagnosed as PTU-associated vasculitis with FSGS. Polyarthralgia and purpura were improved after discontinuing the PTU with prednisolone treatment but hematuria, proteinuria were not changed. We suggest that progression of PTU-associated focal segmental necrotizing glomerulonephritis to FSGS over two years might be due to continued PTU medication.

Angiotensin Converting Enzyme Insertion/Deletion Polymorphism in Korean Patients with Rheumatoid Vasculitis / 대한류마티스학회지

OBJECTIVE: Rheumatoid arthritis has various extra-articular manifestations including rheumatoid vasculitis. Angiotensin converting enzyme (ACE) gene shows insertion/deletion polymorphism and has II, ID, DD genotypes. ACE gene is related with vasoconstriction and endothelial dysfunction in cardiovascular disease. This study was undertaken to determine the association between ACE gene polymorphism and rheumatoid vasculitis. METHODS: Twenty-nine patients were collected as rheumatoid vasculitis group. DNA was isolated from blood samples collected from 114 Korean rheumatoid arthritis patients meeting American College of rheumatology 1987 revised criteria, and 114 healthy control group. Genotyping for the angiotensin converting enzyme gene insertion/deletion polymorphism was performed by polymerase chain reaction method. RESULTS: As vasculitis manifestation, 15 patients showed neuropathy, 13 showed scleritis, 3 showed skin rash. In rheumatoid vasculitis group, II, ID and DD polymorphism was seen in 8 (27.6%), 15 (51.7%), 6 (20.7%) patients respectively and 39 (34.2%), 57 (50.0%), and 18 (15.8%) in normal controls. There was no skewing of ACE I/D polymorphism in compared with normal group. In rheumatoid arthritis control group, II, ID and DD polymorphism was seen in 37 (32.5%), 64 (56.1%), and 13 (11.4%) patients. Among rheumatoid arthritis patient, there was no significant difference between patient with vasculitis and without vasculitis. CONCLUSION: Our results showed that genetic polymorphisms of angiotensin converting enzyme insertion/deletion gene has no association with the susceptibility to rheumatoid vasculitis.

Postsplenectomy Recurrence of Thrombocytopenia with an Accessory Spleen

Autoimmune thrombocytopenic purpura (AITP) is an autoimmune disorder that results from antiplatelet autoantibodies; these autoantibodies cause platelet destruction in the reticluoendothelial system. Oral corticosteroid therapy is the first line treatment. Splenectomy is the major treatment modality after the failure of more conservative medical therapy. Approximately 15% of the patients will relapse either soon after splenectomy or, as is less common, many years later. The presence of an accessory spleen should be sought. We experienced a patient with a known diagnosis of autoimmune thrombocytopenic purpura who had a worsening thrombocytopenia 11 years after splenectomy. This patient was diagnosed with an accessory spleen. Accessory splenectomy was performed with only a transient elevation of the platelets. We report here on this case with a review of the literature.