The Effect of Early Diagnosis and Treatment on the Disease Activity and Joint Damages in Korean Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: We investigated the effect of the early diagnosis and treatment on the disease activity and joint damage in patients with rheumatoid arthritis (RA). METHODS: We enrolled 242 RA patients (male 50 patients, female 192 patients, mean age 49.7+/-13.5 years old) in this study. They were divided into two groups according to lag-time to diagnose RA from the onset of symptoms. 136 RA patients whose lag-time did not exceed 12 months were classified into early diagnosed RA group and 106 RA patients whose lag-time over 12 months were classified into delayed diagnosed RA group. Baseline date were assessed at the time of diagnosis. Disease activity was assessed by sums of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) during first year after diagnosis. Radiological joint damages were evaluated using modified Sharp score. RESULTS: At the time of diagnosis, the age of patients, ESR and platelet counts were significantly decreased, and hemoglobin level was significantly increased in early diagnosed RA group. Early diagnosed RA group showed lower sums of ESR and CRP than delayed diagnosed RA group significantly. Modified sharp score at the time of diagnosis and after treatment were significantly lower in early diagnosed RA group than delayed diagnosed RA group. The difference of modified sharp score between at the time of diagnosis and after treatment were lower in early diagnosed RA group than delayed diagnosed RA group too. CONCLUSION: The early diagnosis and treatment of RA reduced extent of joint damage and provoked better response to treatment significantly.

A Case of Focal Myositis Associated with Rheumatoid Arthritis / 대한류마티스학회지

Focal myositis is an uncommon benign inflammatory myopathy of unknown cause affecting skeletal muscle, and presenting as a localized painful swelling within the soft tissue of an extremity. According to some reports, focal myositis may occur in patients with rheumatoid arthritis, sarcoidosis, and other connective tissue diseases. To our knowledge, there has been no case report of focal myositis associated with rheumatoid arthritis. We report first case of focal myositis in a patient with rheumatoid arthritis.

Clinical Characteristics of Membranous Glomerulonephritis Developed after Renal Transplantation / 대한이식학회지

PURPOSE: Survival rate after renal transplantation has increased due to the development of new immunosuppressive agents and operative techniques. Therefore, chronic complications have increased. Membranous glomerulonephritis (MGN) is one of the common glomerular diseases diagnosed in transplanted kidneys. The exact impact of posttransplantation MGN on the risks for graft loss and long-term graft outcomes is not defined clearly. Risk factors to predict a poor outcome are not well established. METHODS: The retrospective analysis was performed in 20 patients with posttransplantation MGN based on renal biopsy among 2,375 patients who underwent kidney transplantation in Shinchon Severance Hospital from April 1979 to December 2003. RESULTS: After renal transplantation, five patients had de novo MGN and three patients had recurrent MGN. MGN was diagnosed by biopsy at 38.0+/-25.0 months after transplantation. (5~99 months) The duration of graft survival was 115.5+/-52.4 months. The lower was BUN level at 1 month after transplantation, the longer was the interval between renal transplantation and diagnosis of MGN. But donor age, dialysis duration, creatinine at diagnosis of MGN and immunosuppressive agents were not significantly related with the time from transplantation to diagnosis. In 10 cases, renal function was aggravated gradually and the other 10 cases, renal function remained stable. Graft loss occurred in 7 of 20 patients. Five of seven patients with graft loss transferred to peritoneal dialysis and the other 2 patients transferred to hemodialysis. CONCLUSION: De novo MGN and recurrent MGN can develop at any time after transplantation. Graft outcome is variable, with some patients progressing to graft failure, and others maintaining stable graft function. In conclusion, MGN after renal transplantation was more likely to occur in male. Aggressive evaluation such as renal biopsy will be needed when accompanied by hypertension and proteinuria. Renal function of de novo MGN will be maintained with proper immunosuppressive agents and conservative management.

A Case of Internal Jugular Vein Thrombosis after in vitro Fertilization

Severe clinical ovarian hyperstimulation syndrome (OHSS) may occur after ovarian stimulation with gonadotropins A hypercoagulable state, a serious form of OHSS, is due to hemoconcentration as a result of a shifting of the intravascular fluid into the third space. Antiphospholipid syndrome is also a well-known hypercoagulable state, which manifests as an arterial or venous thrombosis and recurrent fetal loss. If OHSS, combined with a hypercoagulable state, such as antiphospholipid syndrome, develops, the potential of a thrombosis can be synergistically enhanced, creating a vicious cycle that results in serious thromboembolic complications. A 30-year-old woman, with an unusual right internal jugular venous thrombosis, occurring secondary to the development of OHSS and antiphospholipid syndrome, was treated.