Joint Symptoms in Henoch - Schonlein Purpura / 대한정형외과학회잡지

Henoch-Sch nlein purpura is a small-vessel vasculitis characterized by palpable purpura, abdominal pain, hematuria and arthralgia. Joint involvement occurs in 2/3 of the cases and the joint symptoms are misapprehended as an orthopaedic problem because they are often severe and occurs before characteristic purpura. It has been reported that the joint symptoms can be improved without any sequelae. But, recently some authors suggest that severe joint destruction can occur when combined with rheumatoid arthritis and the patients are FILA-DR4 positive. So, the regular follow-up for joint symptoms and screening test for the risky patients having possibility for progression of arthritis are required. In order to increase the attention of the orthopaedic surgeons on this disease and study the progression of joint symptoms, possibility of development of screening test for the risky patients and the characterisitics of the disease, we analyzed the 58 patients of Henoch-Sch nlein purpura. The following results were obtained. Among 58 patients 34 cases were male and 25 cases were female, 5 to 10-year-old children were affected more frequently and the disease occurs frequently in spring and winter season. Joint symptoms developed in 22/58 patients(37.9%) and occurs before characteristic purpura in 5/22 patients(22.7%) among the joint symptom-developed patients. Knee and ankle were affected in most patients and the inflammatory signs such as high fever, leukocytosis and elevated ESR were accompanied with joint symptom, so it resembled the symptoms and signs of pyogenic arthritis. Most of the patients recovered without remaining sequelae but 9 patients(15.5%) among joint symptom-developed patients complained repeated attacks of arthralgia. The HLA B27 were all positive in those patients. So, it was assumed that the joint symptom in Henoch-Sch nlein purpura has a correlation with genetic environment and through the broad prospective study, the HLA typing can be a screening test for the risky group prone to suffer from repeated attack or aggravation of arthritis.

Prevalence rate of lead related subjective symptoms in lead workers / 예방의학회지

The relationship between lead related subject symptoms and lead exposure indices was studied in 435 male lead workers in thirteen lead using industries. 212 male office workers who were not exposed to lead occupationally were also studied as a control group. Fourteen lead related symptoms were selected. They were further subdivided into 4 sub-symptom groups such as 1) gastrointestinal, 2) neuromuscular and joint 3) constitutional, and 4) psychological symptoms. Symptom questionnaires were provided to the workers and filled up by themselves and reconfirmed by interviewer(doctor). The test used for the evaluation of lead exposure were blood lead (PbB), zinc protoporphyrin in whole blood(ZPP), hemoglobin(Hb), hematocrit(Hct), delta-aminolevulinic acid in urine(DALA). The results obtained were as follows; 1. The higher prevalence rate in the sub-group of neuromuscular and joint symptoms was observed in occupationally lead exposed subjects than non-exposed subjects. Among the sub-groups, the most frequent symptom was "numbness of finger, hands of feet", and the prevalence of the symptom of "arthralgia", "weakness of fingers, hands or feet" and "myalgia" were higher in order. 2. While the symptom which showed the biggest difference of prevalence rate among the 14 symptoms between exposed and non-exposed subjects was "numbness of fingers, hands or feet" , the symptom which showed the highest prevalence rate was "feeling tired generally" in exposed and non-exposed subjects, but no statistical difference of symptom prevalence were observed. 3. In total study population, PbB and ZPP had dose-response relationship with 4 symptoms of neuromuscular and joint symptoms ("numbness of finger, hands or feet", "arthralgia", "weakness of fingers, hands or feet" and "myalgia") and one symptom of gastrointestinal group("intermittent pains in lower abdomen"). 4. In lead exposed workers, only neuromuscular and joint symptoms group showed dose-response relationship with PbB and ZPP. 5. In lead exposed workers, the prevalence rate of overall symptoms of lead workers with age below 39 years was higher than that of lead workers with age above 40. While neuromuscular and joint symptoms group had a dose-response relationship with PbB in former group, it had a dose-response relationship with ZPP in latter group. 6. Age adjusted odds ratios of symptoms of non-exposed with exposed and odds ratios of low exposed with high exposed workers showed the dose-response relationship of lead exposure with neuromuscular and joint symptoms group("numbness of fingers, hands or feet", "arthralgia", "weakness of fingers, hands or feet" and "myalgia") and gastrointestinal symptoms group("intermittent pains in lower abdoman").