Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.

A Case of Ankylosing Spondylitis in a Patient with Henoch-Schonlein Purpura / 대한류마티스학회지

Ankylosing spondylitis (AS) is a common inflammatory arthritis that affects the axial skeleton, causing characteristic inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life. The disease can be accompanied by extraskeletal manifestations, such as acute anterior uveitis, inflammation in the colon or ileum, aortic insufficiency, cardiac conduction defects, fibrosis of the upper lobes of the lungs, neurologic involvement, or renal (secondary) amyloidosis. We report the case of a 19 year-old man who developed Henoch-Schonlein purpura (HSP) and subsequently AS. It has been recognized that AS may be associated with cutaneous vasculitis and IgA nephropathy, but the association of HSP with AS has not been reported. This association of IgA nephropathy or HSP with AS raises the possibility of a common or related pathogenesis.

The Prevalence and Risk Factors of Knee and Hand Osteoarthritis in Korea / 대한류마티스학회지

OBJECTIVE: To estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) and hand OA among community dwellers in a Korean rural area and to elucidate its risk factors. METHODS: This cross-sectional population based study was conducted on residents over 40 years of age in Ansung, Gyeonggi Province. Subjects completed an interview based on a standardized questionnaire and clinical evaluation including knee and hand radiographs. We defined a subject with the Kellgren and Lawrence grade > or =2 as having radiographic OA (ROA). Symptomatic OA (SOA) was defined by the presence of both radiographic OA and self-reported pain. RESULTS: We obtained both symptom information and radiographs from 3,876 subjects. The prevalence of radiographic and symptomatic knee OA was 14.9% and 5.4%, respectively. The prevalence of radiographic and symptomatic hand OA was 13.4% and 8.0%, respectively. The prevalence of knee and hand OA (ROA & SOA) was higher among women than men. Multiple logistic regression analysis showed a significant association of age and female sex with both knee and hand OA (ROA & SOA), of body mass index (BMI) with knee OA (ROA & SOA) and hand ROA. CONCLUSION: Both symptomatic and radiographic knee OA and hand OA is common in the general adult population of Korea, with preponderance for women. Age and female sex are common risk factors for knee and hand OA. Weight control is necessary for prevention of knee OA. Other factors might also contribute to the development of OA, but further study is needed to elucidate the role of these factors.

A Case of Therapeutic Embolization of Hemarthrosis due to Pseudoaneurysm / 대한류마티스학회지

Hemarthrosis can occur in patients with a predisposition to hemorrhage such as hemophilia or anticoagulant therapy. A 72-year-old man presented with an acute painful swelling in the right knee. He was on anticoagulant therapy after a mechanical aortic valve replacement due to aortic valve insufficiency. There was no history of trauma and international normalized ratio (INR) was maintained at 3.76. On arthrocentesis of the knee, bloody synovial fluid was obtained. With the diagnosis of hemarthrosis, INR was maintained at 2. With immobilization, the knee pain gradually improved. Three weeks after discharge, right knee painful swelling was exacerbated, and arthrocentesis again revealed bloody synovial fluid. After magnetic resonance imaging (MRI) was performed, pseudoaneurysm of the right lateral superior genicular artery was diagnosed. The angiographic embolization was performed after which, he showed marked improvement. Knee MRI should be considered in hemarthrosis with atypical clinical progress, because it can detect lesions amenable to therapeutic intervention as in this case.

A Case of Henoch-Schonlein Purpura in a Patient withRheumatoid Arthritis and Chronic Lymphocytic Thyroiditis / 대한류마티스학회지

Henoch-Schonlein purpura (HSP) is a small-vessel vasculitis involving skin, gut, and kidney associated with arthralgia, arthritis and characterized by immunoglobulin A (IgA)-dominant immune deposits in target organs. This vasculitis is common in children and rarely reported to be associated with other autoimmune disease such as rheumatoid arthritis, autoimmune thyroiditis. We report the case of 72 year-old man who developed adult-onset HSP and also had rheumatoid arthritis and chronic lymphocytic thyroiditis. This is the first report in South Korea.