Factors associated with time to diagnosis from symptom onset in patients with early rheumatoid arthritis

BACKGROUND/AIMS@#To identify the factors associated with time to diagnosis after symptom onset in patients with early rheumatoid arthritis (RA).@*METHODS@#Early RA patients with ≤ 1 year of disease duration in the KORean Observational study Network for Arthritis (KORONA) database were included in this analysis. Patients were further divided into two groups according to the time to diagnosis from symptom onset: the early diagnosis group (time to diagnosis ≤ 1 year) and the late diagnosis group (time to diagnosis > 1 year). Using the multivariable regression model, we identified factors associated with early diagnosis.@*RESULTS@#Among 714 early RA patients, 401 patients (56.2%) and 313 patients (43.8%) were included in the early diagnosis and late diagnosis groups, respectively. The mean disease duration was 0.47 years in the early diagnosis group and 0.45 years in the late diagnosis group. In multivariable model analysis, greater age at onset (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02 to 1.05), high school education or higher (OR, 1.68; 95% CI, 1.14 to 2.47), higher income (OR, 1.48; 95% CI, 1.05 to 2.08), and initial small joint involvement (OR, 1.42; 95% CI, 1.02 to 1.98) were factors associated with early diagnosis. At diagnosis, disease activity scores using 28 joints on diagnosis (3.81 ± 1.44 vs. 3.82 ± 1.42, p = 0.92) and functional disability (0.65 ± 0.61 vs. 0.57 ± 0.62, p = 0.07) did not different between the two groups. However, hand joint erosion on X-ray (37.8% vs. 25.6%, p < 0.01) was more common in the late diagnosis group than the early diagnosis group.@*CONCLUSIONS@#Older onset age, higher educational level and income, and initial small joint involvement were positive factors for early diagnosis of RA.

Effect of Medial Branch Block in Chronic Facet Joint Pain for Osteoporotic Compression Fracture: One Year Retrospective Study

OBJECTIVE: To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze. METHODS: Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two. RESULTS: VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome. CONCLUSION: Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.

Kambin's Triangle Approach of Lumbar Transforaminal Epidural Injection with Spinal Stenosis

OBJECTIVE: To compare the short-term effect and advantage of transforaminal epidural steroid injection (TFESI) performed using the Kambin's triangle and subpedicular approaches. METHOD: Forty-two patients with radicular pain from lumbar spinal stenosis were enrolled. Subjects were randomly assigned to one of two groups. All procedures were performed using C-arm KMC 950. The frequency of complications during the procedure and the effect of TFESI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual numeric scale (VNS) and a five-grade scale. Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors (Kambin's triangle or subpedicular approach, age, duration of symptoms and sex) and the therapeutic effect. RESULTS: VNS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VNS, effectiveness and contrast spread pattern between these two groups. No correlation was found between the other variables tested and therapeutic effect. Spinal nerve pricking occurred in five cases of the subpedicular and in none of the cases of the Kambin's triangle approach (p<0.05). CONCLUSION: The Kambin's triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). The Kambin's triangle approach maybe an alternative method for transforaminal epidural steroid injection in cases where needle tip positioning in the anterior epidural space is difficult.

A Case of Type III Proximal Spinal Muscular Atrophy Distinguished from Distal Spinal Muscular Atrophy: A case report

Spinal muscular atrophy (SMA) is a neuromuscular disorder characterized by progressive anterior horn cell degeneration leading to motor weakness, muscular atrophy and denervation. Recently, the genes responsible for proximal muscular atrophy have been identified and named as survivor motor neuron (SMN) and neuronal apoptosis inhibitory protein genes. The clinical symptoms, courses and evaluation findings of proximal SMA type III are similar to those of distal SMA and proximal muscle myopathies such as limb gir-dle muscular dystrophy and fascioscapulohumeral muscular dystrophy. It cannot be diagnosed with muscle biopsy and electromyographic findings exclusively. In our case, the patient showed similar clinical manifestations of distal SMA. So we couldn't diagnose this case as SMA type III until we detected SMN 1 gene deletion. This case could be a good model for diagnostic approach to SMA type III and differential diagnosis to similar diseases.

Cognition Associated with Dystrophin Deletion in Duchenne Muscular Dystrophy

OBJECTIVE: To find correlations between the deletion of dystrophin gene and cognitive status in Duchenne muscular dystrophy (DMD). METHOD: Cognitive abilities of 49 DMD children with dystrophin deletion were tested. Korean Wechsler Intelligence Scale for children was used to evaluate the cognitive status in DMD. Gene deletion was classified into two groups according to the location of the rearrangement (proximal region: central and 3' region of the gene). RESULTS: Molecular study by multiplex PCR (Polymerase Chain Reaction) of dystrophin exons was performed to identify 49 deletions in the 110 DMD patients. 13 out of 49 DMD were mentally impaired. In patients with distal deletions, total IQ (Intelligence Quotient) score was lower than the those with proximal deletions; which was not statistically significant. And the difference of the verbal and performance intelligence scale was not statistically significant. But comparisons of molecular and neuropsychological features showed that deletions localized in the central and 3' regions of the gene were preferentially associated with the mental impairement. CONCLUSION: We concluded that deletions in the distal portions of the gene were more related to the mental retardation, although deletions with variable locations might lead to cognitive impairments.

Follow-up Magnetic Resonance Imaging Study of Patients with Herniated Cervical Intervertebral Disc

OBJECTIVE: To clarify the relationship between the morphologic changes of and the clinical course of conservatively treated herniated cervical disc patients METHOD: Follow-up magnetic resonance imaging (MRI) and clinical assessment by the visual analogue scale were performed in 21 patients at a mean interval of 22.7 months. RESULTS: An average reduction ratio of herniation on the sagittal and axial images were 11.65% and 19.5%, respectively. The clinical features improved significantly and the degree of clinical improvement was unrelated to the reduction ratio of herniation. CONCLUSION: 8 out of 21 (38.09%) showed reduction of herniated mass on follow up MRI after conservative treatment. The patients with extruded and sequestered disc herniation showed more morphologic changes on MRI. There was no correlation between the clinical state and the morphological change of herniated cervical disc.