Survey of Current Trends for Diagnosis and Treatment in Korean Gout Patients

OBJECTIVE: The prevalence of gout has increased so accurate diagnosis and constant treatment is important in its management. The purpose this study was to examine the current trends in the diagnosis and treatment of gout patients in Korea. METHODS: We enrolled patients who were diagnosed as having gout and received treatment in university hospital between 2005 and 2008. From the survey, we assessed and analyzed the patient's baseline characteristics, clinical aspects of gout attack, medical institution and specialized department in the first gouty attack, medical institution and specialized department where the gout was initially diagnosed, methods of diagnosis, treatment during gout attack, and knowledge about gout in patients. RESULTS: A total of 136 patients were included in this study, out of which 123 (90.4%) were male and the mean age was 55.2 (range 25~85) years. When patients experienced the first gout attack, the most common medical institution that they attended was a private clinic and the most common specialized department was orthopedics. Medication by oral route was the major method (80.9%) used for the treatment of gout, and the most common medication was a non-steroidal anti-inflammatory drug (NSAID) in 55.9%, allopurinol in 38.2% and colchicine in 20.6% of patients. Many gout patients inappropriately received allopurinol following signs of gout arthritis attack, with little information specifically about gout. CONCLUSION: In our survey, many gout patients received inadequate medications for the treatment of gout and had little knowledge about the disease. For the adequate treatment of gout, patients and doctors need to be educated sufficiently.

Adherence to Uric Acid Lowering Agent of Gouty Patients / 대한류마티스학회지

OBJECTIVE: Gout is crystal-induced arthritis with hyperuricemia. Uric acid lowering agent (UALA) is the maintenance drug of its treatment. Drug adherence is an important factor that influences treatment outcome. The purpose this study was to examine the drug adherence to UALA of 303 gouty patients and to analyze the factors associated with compliance. METHODS: We retrospectively assessed adherence to UALA in 303 patients who visited three hospitals affiliated with Hallym University. Patients were diagnosed as gout and used UALA with at least 6 month follow-up. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <70% was considered poor adherence and factors associated with poor adherence were examined. RESULTS: Among the 303 patients, 283 (93.4%) were male. Mean age was 55.4+/-13.7 years. Comorbidities included hypertension in 117 (38.6%), diabetic mellitus in 108 (35.6%), angina in 107 (35.3%), myocardial infarction in 108 (35.6%), and heart failure in 113 (37.3%). The mean PDC was 65.8% with 63.4% of patients considered poorly compliant over the study period. Mean treatment duration before an extended break occurred was 203.5 days. Factors associated with good adherence included hypertension and prescription from rheumatologist. CONCLUSION: In our study, adherence to UALA in gouty patient was poor. Understanding the factors associated with adherence to UALA and proper education of gouty patients to improve drug adherence are needed.

Associations between TBX21 Gene Polymorphisms and Korean Patients with Behcet's Disease / 대한류마티스학회지

OBJECTIVE: Behcet's disease (BD) is a chronic systemic inflammatory disease with unknown etiology. A number of clinical and laboratory findings suggest a strongly polarized Th1 immune response in BD. T-bet is a newly identified Th1 specific T-box transcription factor selectively expressed in Th1 cells. However, it is not yet clear whether the T-bet protein is involved in the proposed Th1-mediated pathogenesis of BD at the transcriptional level. Therefore, this study investigated the potential associations of two single nucleotide polymorphisms (SNPs) at positions -99 (C/G) and -1993 (T/C) in the exon and promoter regions of the TBX21 gene with susceptibility to BD in the Korean population. METHODS: 105 patients with BD and 105 healthy controls were studied. All subjects were genotyped using restriction fragment length polymorphism analysis. The genotypes of the two groups were compared with the chi-square or Fisher's exact tests. RESULTS: The genotypic and allelic distributions of the two SNPs did not differ significantly between the two groups. Furthermore, no associations between the polymorphisms and clinical manifestations were found, except a central nervous system manifestation and arthritis. Furthermore, no associations between the polymorphisms and severity were identified. CONCLUSION: TBX21 gene polymorphisms were not associated with susceptibility, clinical manifestations, or severity of BD in the Korean population.

Systemic Lupus Erythematosus Associated with Interstitial Pneumonia and Achalasia / 결핵및호흡기질환

Systemic lupus erythematosus (SLE) is a multisystem disorder where the etiology is not clearly known. Symptomatic chronic interstitial pneumonitis is an uncommon manifestation, with a reported prevalence of 3~13%. Achalasia is rare disease that presents with failure in the relaxation of the esophagus sphincter. A 22-year-old woman was admitted to our hospital because of fever, cough and dyspnea. The patient had a history of pericardial effusion and Raynaud's phenomenon. The results of laboratory tests indicated the presence of lymphopenia and included positive antibody tests for antinuclear antibody and anti Sm antibody. A chest X-ray demonstrated the presence of peribronchial infiltration on both lung fields. A Chest CT image showed interlobar septal thickening, ground-glass opacity and a honeycomb appearance in both lung fields and esophageal dilatation with air fluid level. An esophagogram showed the presence of dilated esophagus ends that represented the non-relaxed lower esophageal sphincter. Manometry demonstrated incomplete sphincter relaxation. The case was diagnosed as systemic lupus erythematosus associated with interstitial pneumonia and achalasia.

Clinical Features of Polyarteritis Nodosa in Korea

Polyarteritis nodosa (PAN) is a systemic vasculitis characterized by multi-organ involvement with protean manifestations. We evaluated the clinical features of PAN in Korea. Twenty-seven patients were diagnosed as PAN at Seoul National University Hospital between January 1990 and July 2003. The male-to-female ratio was 1.7:1 and mean age at onset (+/-SD) was 47.4+/-20 yr. Their presenting features at diagnosis were similar to those reported previously, i.e., myalgia, muscle weakness or leg tenderness (70%), fever (52%), weight loss >4 kg (44%), skin rash (44%), peripheral edema (33%), abdominal pain (33%), and arthralgia/arthritis (30%). However, the prevalence of testicular pain or tenderness was higher (24%) than reported previously and only three (11.5%) had HBsAg positivity without liver enzyme elevation. Nine patients (33%) had a five-factor score (FFS) of 2. Fourteen patients (52%) responded to treatment, 2 patients relapsed and 4 died within 1 yr of diagnosis. During a median follow-up of 55.5 months, three of the four PAN-related deaths had an initial FFS of 2. The clinical features of PAN were not significantly different from those reported previously. However, testicular pain or tenderness was more frequent and patients with a high FFS tended to have a poorer prognosis.

Polyarteritis Nodosa Presenting as Rhabdomyolysis / 대한류마티스학회지

Skeletal muscle involvement has been well documented and muscular symptoms are common in patients with polyarteritis nodosa (PAN). However, the level of muscle enzyme is uncommonly elevated and overt rhabdomyolysis is very rare. We report a case of PAN presenting as rhabdomyolysis. A 22-year-old man was admitted because of fever, severe myalgia and swelling in all extremities. Laboratory investigations showed markedly increased levels of serum creatine kinase and myoglobin. There was diffusely increased muscular uptake in bone scan. Muscle biopsy from the right deltoid revealed vasculitis involving medium-sized vessel with ischemic necrosis of muscle. On angiography, saccular aneurysms were found in multiple arterities. Therapy with methylprednisolone pulse therapy and cyclophosphamide was followed by improvement of his symptoms.

Clinical Analysis of Relapsing Polychondritis: 16 Cases in Korea / 대한류마티스학회지

OBJECTIVE: To investigate the clinical characteristics of relapsing polychondritis (RP) in Korea. METHODS: We retrospectively reviewed 16 patients with RP who were diagnosed at Seoul National University Hospital and Gyeongsang National University Hospital in the period from July 1987 to August 2003. RESULTS: There were 9 males and 7 females, the mean age was 45.4+/-12.8 years. The frequency of clinical manifestation was as follows; auricular chondritis (81.3%), nasal chondritis (68.8%), ocular inflammation (56.3%), respiratory tract involvement (56.3%), arthritis (50%) and audio-vestibular damage (25%). Westergren erythrocyte sedimentation rate (ESR) was elevated in 53.3% and antinuclear antibody (ANA) was positive in 20% of study patients. Rheumatoid factor was negative in all cases. CONCLUSION: Clinical manifestations were comparable to the reports of Western countries. However, the frequency of arthritis was lower in Korean patients with RP than Western reports.

The Influence of Non-steroidal Anti-inflammatory Drugs on Clinical Outcome in Patients with Bleeding Peptic Ulcers / 대한소화기학회지

BACKGROUND/AIMS: We conducted this study to find the clinical characteristics of ulcer bleeding that occurred in patients who had been taking non-steroidal anti-inflammatory drugs (NSAIDs) and to evaluate the influences of NSAIDs on clinical outcomes. METHODS: Between January 2000 and December 2002, a total of 310 patients with ulcer bleeding were analyzed. Study group composed of 49 patients who had taken NSAIDs regularly for at least 4 weeks before the admission. Other 261 patients who had not taken NSAIDs were classified as control group. Relevant informations were obtained from the medical records. RESULTS: Of the NSAIDs group, aspirin was the most common medication. The mean age and the proportion of females in the NSAIDs group were significantly higher than those of the control group. Prevalence of co-morbid illness was significantly higher in the NSAIDs group than in the control group (85.7% vs 30.7%, p<0.001). The severity of bleeding which was assessed by hemoglobin level at presentation, amount of transfusion, and duration of admission, was not different between two groups. There were no significant differences in frequency of re-bleeding, urgent surgery, and mortality. CONCLUSIONS: Ulcer bleeding among patients taking NSAIDs occurred more frequently in older females with co- morbid illness. However, NSAIDs is not associated with higher morbidity and mortality.

A Case of Primary Sjogren's Syndrome with Protein-losing Enteropathy / 대한류마티스학회지

Protein-losing enteropathy is a rare complication of autoimmune diseases. We report a case of primary Sjogren's syndrome with protein-losing enteropathy in 50-year-old female who complained of generalized edema. Protein-losing enteropathy of the small intestine was demonstrated by Tc-99m labeled albumin abdominal scintigraphy. Duodenal biopsies showed chronic inflammatory cell infiltration without lymphangiectasis or vasculitis. The patient received oral prednisolone (60 mg/day) for 4 weeks with subsequent clinical improvement. Primary Sjogren's syndrome or other autoimmune diseases should be considered in cases of protein-losing enteropathy.

A Case of Rapidly Progressive Glomerulonephritis (RPGN) Occurring Four Years after Kidney Transplantation / 대한신장학회잡지

Immunosuppressive medications after renal allograft transplantation have impacted the course of acute and chronic rejection: however, they have no defined effects on the prevention of recurrent and Glomerulonephritis (GN) in an allograft kidney. Authors experienced a case of rapidly progressive glomerulonephritis (RPGN). The 35-year-old female patient developed a rapid deterioration of renal function 4 years after renal transplantation. The allograft biopsy showed crescentic glomerulonephritis evolving from membranoproliferative glomerulonephritis (MPGN) type I. She was given pulse steroid and oral cyclophosphamide therapy immediately after the renal biopsy. Graft function stabilized and proteinuria decreased even though graft function did not recover to pre-treatment level and low grade proteinuria persisted.

Sweet's syndrome during the treatment of acute promyelocytic leukemia with all-trans retinoic acid

All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Quite many ATRA-related side effects, including retinoic acid syndrome, were reported. So far, it has rarely been reported that Sweet's syndrome, characterized by fever, neutrophilia, painful erythematous cutaneous plaques, dense dermal infiltrates of mature neutrophils and rapid response to steroid therapy, is associated with ATRA. In the case that Sweet's syndrome associated with ATRA is found, physicians will have to face a great challenge over the possibility of infectious conditions. We present here a case of Sweet's syndrome associated with ATRA. A 35-year-old female with APL developed fever, painful erythematous cutaneous plaques on both cheeks, right wrist and both shins during induction chemotherapy with ATRA. A skin biopsy revealed a dense dermal infiltrate, consisting of mature neutrophils without vasculitis or cutaneous immunoglobulin deposits, which is compatible with Sweet's syndrome. Oral prednisone was administered and the lesions started to improve within 48 hours

A Case of Rectal Adenocarcinoma with Radiation Colitis / 대한소화기내시경학회지

Radiotherapy induced colorectal adenocarcinoma with radiation colitis after radiotherapy has been reported as a rare case. A patient with rectal adenocarcinoma as a late complication of pelvic irradiation for gynecological malignancy is reported. A 55-year-old woman with bloody diarrhea for 6 months was admitted. She received radiation therapy for carcinoma of cervix 21 years ago. Colonoscopic findings revealed a polypoid mass on rectosigmoid colon. Histopathologic examination of the polypectomy specimen disclosed adenocarcinoma. We reported herein a case of rectal adenocarcinoma with radiation colitis. The patient who had received pelvic irradiation should have close follow-up with colonoscopic study for the early detection of colorectal cancer.

Helicobacter pylori VacA and Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric cancer is one of the most common malignant disease worldwide, particularly in Korean populations, but its etiology is not well-established. The infection with Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of gastroduodenal diseases and recent studies have focused on whether specific H. pylori strains are associated with gastric carcinogenesis. The aim of this study was to investigate whether VacA seropositivity is associated with increased risk of gastric cancer in Korean populations. METHODS: Gastroduodenoscopy was done in patients with upper gastrointestinal complaints. During the examination, rapid urease test for the presence of H. pylori infection was done using gastric biopsy specimens taken from normal gastric antrum. Sera were collected from 20 chronic gastritis and 23 gastric cancer patients with H. pylori infection. Western blotting was carried out using a commercially prepared kit-Helicoblot 2.0. RESULTS: VacA seropositivity was 35% (8/23) in patients with gastric cancer and 55% (11/20) in patients with chronic gastritis (p=0.15). According to Lauren classification of gastric cancer, the numbers of patients with the intestinal and diffuse type were 12 and 11, respectively. VacA seropositivity was 25% (3/12) in patients with the intestinal type and 45.4% (5/11) in patients with the diffuse type (p=0.30). CONCLUSIONS: The infection with VacA positive H. pylori strain is not associated with increasing risk of gastric cancer in Korean populations.