A Case of Wegener's Granulomatosis with Thin Glomerular Basement Membrane Disease / 대한류마티스학회지

Wegener's granulomatosis is a necrotizing,granulomatous vasculitis that involves multiple organs including the upper and lower respiratory tract and the kidney.The kidney initially exhibits focal necrotizing glomerulonephritis,which progresses to crescentic glomerulonephritis in Wegener's granulomatosis.We experienced a case of Wegener's granulmatosis which was associated with a thin glomerular basement membrane disease.The patient suffered from nasal stuffiness,recurrent serous otitis media,and tinnitus.Despite antibiotic therapy and ventral tube insertion,symptoms did not improve and hearing difficulty was aggravated.Ulcerative,necrotizing granulomatous inflammations with multinucleated giant cells were seen on nasal biopsy.She had recurrent microscopic hematuria and the renal biopsy findings by light and immunofluorescent microscopy did not reveal any abnormalities but diffuse thinning of the glomerular basement membrane (226nm)was observed by electronmicroscopy. With the above clinical findings and biopsy results,we diagnosed Wegener's granulmatosis with thin glomerular basement membrane disease.Thin glomerular basement membrane disease,also called benign recurrent hematuria,is characterized by diffuse thinning of the glomerular basement membrane and hematuria. Weekly low-dose methotrexate together with prednisone was used as treatment regimen because nonglomerular microscopic hematuria may be the first sign of cyclophosphamide-induced renal toxicity.With the above combination therapy, she felt well-being sense and her hearing difficulty was also much improved. She has been treated as an outpatient with glucocorticoid.

A Case of P-ANCA Positive Necrotizing Glomerulonephritis with Eosinophilia / 대한류마티스학회지

Antineutrophil cytoplasmic antibodies (ANCAs) are now regarded as a serologic marker for pauci-immune crescentic necrotizing glomerulonephritis either in renal-limited form or in association with systemic vasculitis, such as Wegener? granulomatosis, microscopic polyarteritis, and Churg-Strauss syndrome. Two major ANCA antigens have been indentified: proteinase3, which produces a cytoplasmic staining pattern termed C-ANCA, and myeloperoxidase, which produces a perinuclear pattern termed P-ANCA on ethanol-fixed neutrophils by indirect immunofluorescence. In ANCA- associated diseases, eosinphilia in excess of 1.5X109/L has been proposed to be characteristic of Churg-Strauss syndrome and is rare in other forms of ANCA-associated systemic vasculitis and crescentic necrotizing glomerulonephritis. Recently, there were two cases of P-ANCA positive crescentic necrotizing glomerulonephritis with peripheral blood eosinophilia and extrarenal microscopic vasculitis without asthma or granulomas. We experienced a patient with P-ANCA positive pauci-immune necrotizing glomerulonephritis with few eosinophilic infiltration and eosinophilia. He improved with oral prednisolone along with combination of intravenous cyclophosphamide. So we report this case with the review of literature.

A Case of Pulmonary Hypertension and Left Vocal Cord Palsy in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

There have been few case reports on the association of vocal cord palsy and pulmonary hypertension in a systemic lupus erythematosus (SLE) patient. Most cases had left vocal cord palsy caused by compression of left recurrent laryngeal nerve secondary to pulmonary hypertension, and only two cases in the literature were caused by vasculitis or inflammation of the right recurrent laryngeal nerve not related to pulmonary hypertension. Recently, we have experienced a 23-year-old female patient who presented hoarseness and multiple joint pain. She was diagnozed as SLE and left vocal cord palsy, and echocardiographic examination demonstrated enlargement of right atrium, right ventricle, and elevated right ventricular pressure (systolic pressure 47mmHg). She took high-dose glucocorticoid and calcium channel blocker. About one month later, there was significant improvement of hoarseness, arthritis, and cardiomegaly, and showed improvement of the left vocal cord palsy on the laryngoscopic examination. We report a case of left vocal cord palsy and pulmonary hypertension accompanied by SLE who experienced improvement of hoarseness after steroid treatment.

Systemic Lupus Erythematosus and Thymoma: A Case Report / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is an autoimmune disease with a loss of the control over B lymphocytes which is normally exerted by T-suppressor cell. The thymus play a central role in regulating and controlling immune reaction through its effects on T cell differentiation of both T helper and T suppressor cells. Tumors of the thymus are rare but have been reported in concurrence with a variety of autoimmune diseases, including most frequently myasthenia gravis and rarely SLE and other disorders. The association of thymoma and SLE is very rare, fewer than 10 case reports in the world literature. The woman had been thymectomized because of incidental thymoma. After two years, she was diagnosed as SLE with features of arthritis, leukopenia, high titer of ANA, positivity of anti-dsDNA and hypocomplementemia. We report here one case of concurrent SLE and thymoma.

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.

Therapeutic Outcome and Prognostic Factor of Biopsy-Proven Lupus Nephritis -Retrospectice Analysis / 대한류마티스학회지

No abstract available.

Amyopathic Dermatomyositis with Interstitial Lung Disease: A Case Report / 대한류마티스학회지

Amyopathic dermatomyositis is defined by characteristic cutaneous manifestation of dermatomyositis without evidence of muscle involvement. There is no clinical difference between dermatomyositis and amyopathic dermatomyositis. Pulmonary involvement of dermatomyositis is so frequent than aggressive dianostic and therapeutic approach is needed. Early steroid or immunosuppresive treatment in pulmonary involvement of dermatomyositis gets better prognosis. Intravenous immunoglobulin treatment is an effective and safe alternative when the steroid or immunosuppresive treatment is ineffective or intolerable. We are reporting a case of amyopathic dermatomyositis with interstitial lung disease. This patient was improved with intravenous immunoglobulin treatment.

The Effect of Bucillamine in the Initial Treatment of Rheumatoid Arthritis and Treatment of Patients with Refractory Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To assess the clinical effect of bucillamine in rheumatoid arthritis (RA), we performed an open clinical trial for 3 months. METHODS: 10 out of 12 patients completed bucillamine trial(200mg/day) for their initial treatment against arthritis, and 9 out of 11 patients with refractory RA completed the bucillamine trial. Disease activity was assessed by the duration of morning stiffness(MS), visual analogue pain scale(VAPS), functional capacity(FC), tender joint counts(TJC), swollen joint counts(SJC), ESR, and CRP every month. Adverse effects were monitored monthly. RESULTS: At the end of trial, all parameters were decreased in the initial treatment group except of CRP. No parameters were decreased in the refractory group. Gastrointestinal disturbance was the most commmon adverse effect. Skin rash, stomatitis, proteiuria and elevated hepatic enzyme were minor adverse effects. CONCLUSION: Bucillamine was effective in the initial treatment of rheumatoid arthritis, but not effective in the patients with refractory rheumatoid arthritis. Bucillamine is relatively safe in the treatment of rheumatoid arthritis in both groups.

A Case of Bilateral Sacroiliitis in Systemic Lupus Erythematosus / 대한류마티스학회지

Sacroiliitis is a prototyical feature of the seronegative spondyloarthropathies. It has been reported rarely in patients with systemic lupus erythematosus. We report a case of bilateral sacroiliitis in a 26 year-old female who presented 5 out of 11 ARA criteria for systemic lupus erythematosus. She complained of right low back pain since 1 week after delivery. Plain roentgenogram, computed tomogram and magnetic resonance imaging revealed no evidence of subluxation or pyogenic infection that may be possibly related to delivery, but bilateral sacroiliitis especially more severe in the right side that showed concordantly increased uptake on bone scan. Also she had neither HLA DR-3 nor B-27 antigens and had no other clinical findings of limitation of motion of spine and chest expansion, which suggest that there is a less likelihood of coexistent ankylosing spondylitis. In this case, we suggested that sacroiliitis may be a infrequent manifestation of systemic lupus erythematosus.

A Case of Diffuse Idiopathic Skeletal Hyperostosis ( DISH ) Associated with Ossification of the Posterior Longuitudinal Ligament ( OPLL / 대한류마티스학회지

We experienced a case of diffuse idiopathic skeletal hyperostosis(DISH) associated with ossification of the posterior longitudinal ligament. A 58-year old man presented with clumsiness and hypesthesia of both hands. He showed weakness of sensory defit and weakness of motor function of hands. The lateral radiograph of cervical spine showed anterior hyperostosis and ossification of the posterior longitudinal ligament. A magnetic resonance image of cervical spine revealed a low-density defect posterior to cervical spine with evidence of spinal stenosis. Ossification of the posterior longitudinal ligament is a rare manifestation associated with DISH, and we report this case with a review of the literature.

Two Cases of Spontaneous Pneumomediastinum in Dermatomyositis / 대한류마티스학회지

Spontaneous pneumomediastnum has been reported only recently as a rare complication of dermatomyositis. We are reporting two cases of spontaneous pneumomediastinum in dermatomyositis. The diagnosis of dermatomyositis was based on the diagnostic criteria requiring symmetric weakness of limb-girdle muscles and anterior neck flexors, elevation of serum skeletal muscle enzymes, electromyograpic findings of inflammatory myopathy, positive findings on muscle biopsy and dermatologic features including heliotrope rash and Gottron s papule. Vasculitis may be the common denominator leading to the association of dermatomyositis and pneumomediasinum. In reported cases, the prognosis of pneumomediastinum seems unfavorable. Interestingly the 2 cases we are reporting resolved spontaneously without any recurrence.

Intravaginal desensitization in a woman with seminal fluid allergy / 천식및알레르기

Human seminal fiuid (HSP) hypersensitivity is rare, but possibly a life-threatening disease. The pathogenesis of seminal plasma hypersensitivity and the exact nature of the HSP allergens remains to be clarified. We report a case of 25-year-old female patient who complained of severe itching sensation, flushing and edema of external genitalia, facial edema and dyspnea after sexual intercourse. The diagnosis was established by skin pr ick test with her husbands diluted semen. Intravaginal desensitization was performed by modified Matloffs method. Dilutions was made with sterile human serum albumin(0.2%) and 0.4% pheno1-0.9% saline solution. Two ml each of progressively greater concentrations of semen dilutions(1: 100,000 v/v, 1: 10,000 v/ v, 1:1,000 v/v, 1:100 v/v, 1:10 v/v) were inserted intravaginally at 45-min intervals, followed by an undiluted specimen. The patient was successfully desensitized and could have unprotected intercourse without anaphylaxis.