Comparative effectiveness of JAK inhibitors and biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis

Background/Aims@#We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease- modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. @*Methods@#A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). @*Results@#Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. @*Conclusions@#Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

Baseline use of hydroxychloroquine or immunosuppressive drugs and the risk of coronavirus disease 2019

Background/Aims@#The preventive role of hydroxychloroquine (HCQ) on coronavirus disease 2019 (COVID-19) remains unclear. The aim of this study was to examine the effects of HCQ and other immunosuppressive drugs on the incidence of COVID-19. @*Methods@#The data were collected from the South Korea National Health Insurance Sharing-COVID-19 database. All individuals who underwent nasopharyngeal and oropharyngeal swab tests for COVID-19 from January 2020 to May 2020 are included. The association between COVID-19 risk and HCQ use was examined in a propensity score-matched population. Factors associated with COVID-19 were identified using multiple logistic regression analysis. @*Results@#Total 8,070 patients with COVID-19 and 121,050 negative controls were included from the database. Among all participants, 381 were HCQ users. In a propensity score-matched population, the incidence of COVID-19 was 7.1% in HCQ users and 6.8% in non-users. The odds ratio (OR) for HCQ use was 1.05 with a 95% confidence interval (CI) of 0.58 to 1.89. Among the subpopulation of patients with rheumatoid arthritis (RA), 33 were diagnosed with COVID-19 and 478 were not. Use of HCQ, glucocorticoids, or other immunosuppressive drugs was not associated with COVID-19 risk, whereas abatacept use was. Chronic lung disease was an independent risk factor for COVID-19 diagnosis in patients with RA (adjusted OR, 6.07; 95% CI, 1.10 to 33.59). @*Conclusions@#The risk of COVID-19 did not differ between HCQ users and non-users. Glucocorticoids, conventional disease-modifying antirheumatic drugs (DMARDs), and biological DMARDs other than abatacept did not increase the risk of COVID-19.

Biologic therapies for the treatment of systemic lupus erythematosus

Systemic lupus erythematosus is a typical autoimmune disease with a complex etiology, including the interaction of genetic/epigenetic factors and environmental and hormonal factors with innate immune cells or B/T lymphocytes. Studies on possible therapeutic targets have been conducted in recent decades, motivated by developments in immunology and molecular engineering. The current treatment guidelines recommend conventional immunomodulation with glucocorticoid and antimalarial agents depending on disease severity. However, targeted therapy based on the diverse disease pathophysiology is still not established and widely applied. Furthermore, although rituximab, belimumab, and other conventional immunomodulators have been approved by the Food and Drug Administration and are widely used, several clinical trials testing other biological products have failed to show satisfactory results. This review introduces novel biological agents that can potentially improve therapeutic performance in patients with systemic lupus erythematosus. These agents include humanized anti-CD20, anti-CD22, and anti-CD40L antibody; interferon α inhibitor; rigerimod; Bruton’s tyrosine kinase; and immunocomplex blockers.

Prevalence of osteoporosis in patients with systemic lupus erythematosus: A multicenter comparative study of the World Health Organization and fracture risk assessment tool criteria

Objectives@#Osteoporosis and fracture are known complications of systemic lupus erythematosus (SLE). We assessed the prevalence and risk factors for osteoporosis in patients with SLE. @*Methods@#A total of 155 female SLE patients were recruited retrospectively in 5 university hospitals. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and the fracture risk assessment tool (FRAX) for high-risk osteoporotic fractures was calculated with and without BMD. @*Results@#The mean age was 53.7 ± 6.8 years, and osteoporotic fractures were detected in 19/127 (15.0%) patients. The proportion of patients having a high-risk for osteoporotic fractures in the FRAX with and without BMD, and osteoporosis by the World Health Organization (WHO) criteria were 25 (16.1%), 24 (15.5%), and 51 (32.9%), respectively, and 48.0–68.6% of them were receiving treatment. On multivariate logistic analysis, nephritis (odds ratio [OR] 11.35) and cumulative dose of glucocorticoid (OR 1.1) were associated with high-risk by the FRAX with BMD, and low complement levels (OR 4.38), erythrocyte sedimentation rate (ESR) (OR 1.04), and cumulative dose of glucocorticoid (OR 1.05) were associated with osteoporosis by the WHO criteria in patients with SLE. @*Conclusions@#Among Korean female patients with SLE, the proportion of patients having a high-risk of osteoporotic fractures by the FRAX tool was 15.5%–16.1% and the proportion of patients having osteoporosis by the WHO criteria was 32.9%. In SLE, nephritis, low level of complement, ESR, and cumulative dose of glucocorticoids may contribute to fracture risk.

Activation of Transient Receptor Potential Melastatin Family Member 8 (TRPM8) Receptors Induces Proinflammatory Cytokine Expressions in Bronchial Epithelial Cells

Purpose@#Cold air is a major environmental factor that exacerbates asthma. Transient receptor potential melastatin family member 8 (TRPM8) is a cold-sensing channel expressed in the airway epithelium. However, its role in airway inflammation remains unknown. We investigated the role of TRPM8 in innate immune responses in bronchial epithelial cells and asthmatic subjects. @*Methods@#The TRPM8 mRNA and protein expression on BEAS2B human bronchial epithelial cells was examined by real-time polymerase chain reaction (PCR), immunofluorescence staining and western blotting. Additionally, interleukin (IL)-4, IL-6, IL-8, IL-13, IL-25 and thymic stromal lymphopoietin (TSLP) levels before and after menthol, dexamethasone and N-(4-tert-butylphenyl)-4-(3-chloropyridin-2-yl) piperazine-1-carboxamide (BCTC) treatments were measured via real-time PCR. TRPM8 protein levels in the supernatants of induced sputum from asthmatic subjects and normal control subjects were measured using enzyme-linked immunosorbent assay, and mRNA levels in sputum cell lysates were measured using real-time PCR. @*Results@#Treatment with up to 2 mM menthol dose-dependently increased TRPM8 mRNA and protein in BEAS2B cells compared to untreated cells (P < 0.001) and concomitantly increased IL-25 and TSLP mRNA (P < 0.05), but not IL-33 mRNA. BCTC (10 μM) significantly abolished menthol-induced up-regulation of TRPM8 mRNA and protein and IL-25 and TSLP mRNA (P < 0.01). TRPM8 protein levels were higher in the supernatants of induced sputum from asthmatic subjects (n = 107) than in those from healthy controls (n = 19) (P < 0.001), and IL-25, TSLP and IL-33 mRNA levels were concomitantly increased (P < 0.001). Additionally, TRPM8 mRNA levels correlated strongly with those of IL-25 and TSLP (P < 0.001), and TRPM8 protein levels were significantly higher in bronchodilator-responsive asthmatic subjects than in nonresponders. @*Conclusions@#TRPM8 may be involved in the airway epithelial cell innate immune response and a molecular target for the treatment of asthma.

Eosinophilic fasciitis: A case report with a brief literature review

Eosinophilic fasciitis (EF) is a scleroderma-like immune-allergic disorder of unknown etiology and pathogenesis. This rare disease is characterized by the progressive induration of the skin and soft tissue, and peripheral eosinophilia. Here, we report a case of EF. A 21-year-old female was referred due to edema in the upper and lower extremities for 1 month. Laboratory results were unremarkable except for severe eosinophilia. Parasite infestation, venous thrombosis, and cardiac and renal problems were excluded. Magnetic resonance imaging of both the lower extremities revealed symmetrical thickening and contrast enhancement of crural fascia with adjacent subcutaneous fat infiltration. A full-thickness biopsy at the lower extremity showed infiltration of the fascia by eosinophils, plasma cells, and lymphocytes with marked edema. Thus, this patient was confirmed to have EF and she was treated with systemic corticosteroids, resulting in a remarkable improvement in both edema and eosinophilia.

The Practice Guideline for Vaccinating Korean Patients With Autoimmune Inflammatory Rheumatic Disease

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.

The Practice Guideline for Vaccinating Korean Patients with Autoimmune Inflammatory Rheumatic Disease

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and theKorean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.

Activation of Transient Receptor Potential Melastatin Family Member 8 (TRPM8) Receptors Induces Proinflammatory Cytokine Expressions in Bronchial Epithelial Cells

Purpose@#Cold air is a major environmental factor that exacerbates asthma. Transient receptor potential melastatin family member 8 (TRPM8) is a cold-sensing channel expressed in the airway epithelium. However, its role in airway inflammation remains unknown. We investigated the role of TRPM8 in innate immune responses in bronchial epithelial cells and asthmatic subjects. @*Methods@#The TRPM8 mRNA and protein expression on BEAS2B human bronchial epithelial cells was examined by real-time polymerase chain reaction (PCR), immunofluorescence staining and western blotting. Additionally, interleukin (IL)-4, IL-6, IL-8, IL-13, IL-25 and thymic stromal lymphopoietin (TSLP) levels before and after menthol, dexamethasone and N-(4-tert-butylphenyl)-4-(3-chloropyridin-2-yl) piperazine-1-carboxamide (BCTC) treatments were measured via real-time PCR. TRPM8 protein levels in the supernatants of induced sputum from asthmatic subjects and normal control subjects were measured using enzyme-linked immunosorbent assay, and mRNA levels in sputum cell lysates were measured using real-time PCR. @*Results@#Treatment with up to 2 mM menthol dose-dependently increased TRPM8 mRNA and protein in BEAS2B cells compared to untreated cells (P < 0.001) and concomitantly increased IL-25 and TSLP mRNA (P < 0.05), but not IL-33 mRNA. BCTC (10 μM) significantly abolished menthol-induced up-regulation of TRPM8 mRNA and protein and IL-25 and TSLP mRNA (P < 0.01). TRPM8 protein levels were higher in the supernatants of induced sputum from asthmatic subjects (n = 107) than in those from healthy controls (n = 19) (P < 0.001), and IL-25, TSLP and IL-33 mRNA levels were concomitantly increased (P < 0.001). Additionally, TRPM8 mRNA levels correlated strongly with those of IL-25 and TSLP (P < 0.001), and TRPM8 protein levels were significantly higher in bronchodilator-responsive asthmatic subjects than in nonresponders. @*Conclusions@#TRPM8 may be involved in the airway epithelial cell innate immune response and a molecular target for the treatment of asthma.

Prevalence of osteoporosis in patients with systemic lupus erythematosus: A multicenter comparative study of the World Health Organization and fracture risk assessment tool criteria

Objectives@#Osteoporosis and fracture are known complications of systemic lupus erythematosus (SLE). We assessed the prevalence and risk factors for osteoporosis in patients with SLE. @*Methods@#A total of 155 female SLE patients were recruited retrospectively in 5 university hospitals. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and the fracture risk assessment tool (FRAX) for high-risk osteoporotic fractures was calculated with and without BMD. @*Results@#The mean age was 53.7 ± 6.8 years, and osteoporotic fractures were detected in 19/127 (15.0%) patients. The proportion of patients having a high-risk for osteoporotic fractures in the FRAX with and without BMD, and osteoporosis by the World Health Organization (WHO) criteria were 25 (16.1%), 24 (15.5%), and 51 (32.9%), respectively, and 48.0–68.6% of them were receiving treatment. On multivariate logistic analysis, nephritis (odds ratio [OR] 11.35) and cumulative dose of glucocorticoid (OR 1.1) were associated with high-risk by the FRAX with BMD, and low complement levels (OR 4.38), erythrocyte sedimentation rate (ESR) (OR 1.04), and cumulative dose of glucocorticoid (OR 1.05) were associated with osteoporosis by the WHO criteria in patients with SLE. @*Conclusions@#Among Korean female patients with SLE, the proportion of patients having a high-risk of osteoporotic fractures by the FRAX tool was 15.5%–16.1% and the proportion of patients having osteoporosis by the WHO criteria was 32.9%. In SLE, nephritis, low level of complement, ESR, and cumulative dose of glucocorticoids may contribute to fracture risk.

Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults

BACKGROUND/AIMS@#To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea.@*METHODS@#A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made.@*RESULTS@#The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the right-side second and third MCP joints were 0.55 and 0.55 mm, and those of the left-side joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology.@*CONCLUSIONS@#We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

Korean rheumatology workforce from 1992 to 2015: current status and future demand

BACKGROUND/AIMS@#Rheumatology in Korea has rapidly advanced in the 24 years since the subspecialty board certification program was established in 1992. The objective of this investigation was to analyze the distribution of rheumatology practices in Korea in order to better understand the rheumatology workforce.@*METHODS@#Using a membership list from the Korean College of Rheumatology (KCR), we obtained information on practicing rheumatologists. We mapped the ratio of rheumatologists to the general population and to patients with rheumatologic disease using data from Statistics Korea and the 2015 Health Insurance Review & Assessment Service (HIRA).@*RESULTS@#In the 16 administrative districts of Korea in 2015, there were 311 practicing rheumatologists on the list of KCR members. There were 218 members practicing in metropolitan areas and 93 members in the provinces. The mean number of rheumatologists per 100,000 people was 0.60, with 0.33/100,000 in the provinces, but 0.92/100,000 in metropolitan areas, a 2.7-fold difference. The number of rheumatologists per 100,000 patients with chronic rheumatic disease was 17.21 in metropolitan areas but 6.57 in the provinces, according to 2015 HIRA data. This geographic maldistribution emerged as a problem; indeed, the regional disparity in the distribution of Korean rheumatologists was striking when compared to the published medical professional distribution in 2014.@*CONCLUSIONS@#Because of the uneven distribution of rheumatologists, it is likely that some patients with chronic rheumatic conditions have limited access to rheumatology care. Thus, a policy-based approach is needed to alleviate this disparity.

Fate of Abstracts Presented at the Korean College of Rheumatology Annual Scientific Meetings

OBJECTIVE: To evaluate the fate of abstracts presented at scientific meetings of the Korean College of Rheumatology (KCR). METHODS: This study examined the abstracts presented at annual meetings of the KCR from 2005 to 2014. Only original studies were selected, excluding case reports. A manual search was conducted using PubMed, KoreaMed, Cochrane Library, and Embase to track the published articles. The abstracts were considered to have been published if the authors, title, study design, and results were the same for a published article. In addition, they were considered published if the author and the study design matched, even if the results of the abstract and the results of the published articles were not identical. RESULTS: A total of 928 abstracts from 2005 to 2014 were analyzed. Of the 928 abstracts, 468 (50.43%) abstracts were published in a peer-reviewed journal and the mean time to publication was 19 months. Of the 468 abstracts, 414 were published in a science citation index extended (SCI[E]) journal, and 54 were published in non-SCI(E) journals. The proportion of SCI(E) articles increased annually. The average impact factor for the SCI(E) journals was 2.93. In subgroup analysis, the abstracts that were awarded the best oral or best poster presentation were more likely to be published as full-length articles with a higher impact factor than the abstracts not awarded. CONCLUSION: Half of the abstracts presented in the KCR annual meetings were published in a peer-reviewed journal. Approximately 90% of the articles were published in a SCI(E) journal.

Normality Test in Clinical Research

In data analysis, given that various statistical methods assume that the distribution of the population data is normal distribution, it is essential to check and test whether or not the data satisfy the normality requirement. Although the analytical methods vary depending on whether or not the normality is satisfied, inconsistent results might be obtained depending on the analysis method used. In many clinical research papers, the results are presented and interpreted without checking or testing normality. According to the central limit theorem, the distribution of the sample mean satisfies the normal distribution when the number of samples is above 30. However, in many clinical studies, due to cost and time restrictions during data collection, the number of samples is frequently lower than 30. In this case, a proper statistical analysis method is required to determine whether or not the normality is satisfied by performing a normality test. In this regard, this paper discusses the normality check, several methods of normality test, and several statistical analysis methods with or without normality checks.

Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

OBJECTIVE: To estimate the prevalence of non-adherence to rheumatoid arthritis (RA) medication and identify the associated factors for non-adherence in RA patients. METHODS: Among the KORean Observational study Network for Arthritis 3,523 patients who completed a questionnaire about the adherence to RA medication were analyzed. The patients were divided into two groups: 1) adherent group, patients who skipped medication ≤5 days within the past 2 months; and 2) non-adherent group, patients who skipped ≥6 days of medication. The baseline characteristics were compared, and multivariable regression analysis was performed to identify the associated factors for non-adherence. RESULTS: The non-adherent group had 339 patients (9.6%). The common causes of non-adherence were forgetfulness (45.8%), absence of RA symptoms (24.7%), and discomfort with RA medication (13.1%). Younger age (odds ratio [OR] 1.02, p < 0.01) and higher income (OR 1.70, p < 0.01) were associated with an increased risk of non-adherence. Whereas higher functional disability (OR 0.68, p < 0.01) and oral corticosteroid use (OR 0.73, p=0.02) were associated with a decreased risk of non-adherence. The associated factors differed according to cause of non-adherence. Having adverse events (OR 2.65, p=0.02) was associated with the risk of non-adherence due to discomfort with RA medication while a higher level of education (OR 2.37, p=0.03) was associated with the risk of non-adherence due to an absence of RA symptoms. CONCLUSION: The 9.6% of Korean RA patients were non-adherent to RA medication. The associated factors differed according to the cause of non-adherence. Therefore, an individualized approach will be needed to improve the adherence to RA medication.

Acute Pseudogout of the Neck: "Crowned Dens" Revisited

Calcium pyrophosphate dihydrate crystal deposition disease is associated with an acute mono- or pauciarthritis, termed "pseudogout" in elderly patients, involving a large joint (including the knees, ankles) or a chronic arthropathy manifesting as mild joint pain and stiffness. Pseudogout is a crystal-deposition disease of peripheral joints, usually encountered in elderly patients. However, acute presentation of pseudogout around the odontoid process comprises a "crowned-dens" appearance, and requires contemplation of differential diagnoses. We recently experienced a case of pseudogout in the cervical spine presenting with fever and acute neck pain that was successfully treated with a colchicine and low-dose oral steroid. We reported this case with a review of the relevant literature.

Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

Factors Associated with Airway Disease and Interstitial Lung Disease in Rheumatoid Arthritis

OBJECTIVE: This study examined lung involvement in patients with rheumatoid arthritis (RA) and identified factors associated with airway disease (AD) and interstitial lung disease (ILD). METHODS: A total of 507 RA patients were enrolled in a cross-sectional study. Lung involvement was assessed by high-resolution computed tomography scan. The patient groups were classified according to normal, AD, and ILD. Multinomial logistic regression analysis was performed to identify factors associated with AD and ILD. RESULTS: The most frequent lung involvement was AD (38.3%) followed by ILD (12.6%). Old age (adjust odds ratio [aOR] 2.58, 95% confidence interval [CI] 1.70 to 3.90 for AD; aOR 4.38, 95% CI 2.30 to 8.35 for ILD), male gender (aOR 2.57, 95% CI 1.22 to 5.42 for AD; aOR 5.48, 95% CI 2.20 to 13.65 for ILD) were factors associated with AD and ILD in RA patients. ILD was associated with short disease duration (aOR 0.30, 95% CI 0.14 to 0.62), AD was associated with high titers of anti-cyclic citrullinated peptides antibodies (anti-CCP; aOR 1.61, 95% CI 1.07 to 2.44). CONCLUSION: AD was the most frequent lung involvement in patients with RA. Old age and male gender were both associated with AD and ILD. Short disease duration was associated with ILD. High titers of anti-CCP was associated with AD.

Awareness of COPD in a High Risk Korean Population

PURPOSE: Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is an important aspect of disease management. The aim of this study was to explore COPD awareness among smokers participating in a smoking cessation program. MATERIALS AND METHODS: Face-to-face interviews were conducted with 289 subjects in three smoking cessation clinics, using a structured questionnaire. RESULTS: A total of 68.2% of subjects had COPD-related symptoms, and 19.7% were in poor health. Only 1.0% of the subjects knew that COPD was a respiratory disease. A total of 2.4% of subjects had been diagnosed with COPD and received treatment. Television was the most common source of information about COPD, with 57.1% of the subjects receiving information in this way. After being informed about COPD, smoking-cessation willingness increased in 84.1% of the study group. It increased in 86.3% of the subjects without awareness of COPD and in 81.2% of subjects with COPD-related symptoms. CONCLUSION: We found that awareness of COPD is very poor among current smokers in Korea. Many smokers perceived their health status as good, despite the presence of COPD-related symptoms. As the level of smoking-cessation willingness was different between those with and without awareness of COPD or COPD-related symptoms, a personalized education program with various educational tools may be needed to enhance awareness of the disease and to motivate smokers to quit.

Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement

OBJECTIVES: The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). MATERIALS AND METHODS: Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. RESULTS: A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. CONCLUSION: We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID.