Incidence and prevalence of seropositive rheumatoid arthritis among Korean women of childbearing age: a nationwide population-based study

Background/Aims@#Women with rheumatoid arthritis (RA) are often diagnosed with the disease during their reproductive years; however, its incidence and prevalence among women of childbearing age have not been studied. The objective of this study was to estimate the incidence and prevalence of seropositive rheumatoid arthritis (SPRA) among Korean women of childbearing age. @*Methods@#Women aged 20 to 44 years with SPRA were identified from National Health Insurance Service-National Health Information Database (2009 to 2016). SPRA was defined by International Classification of Diseases, 10th revision code, M05. Incidence and prevalence were calculated per 100,000 person-years and stratified by year and age. @*Results@#The average incidence and prevalence of SPRA from 2011 to 2016 among women of childbearing age was 24.1/100,000 person-years (95% confidence interval [CI], 23.7 to 24.5) and 105.2/100,000 person-years (95% CI, 100.9 to 109.5), respectively. The incidence increased annually from 21.0/100,000 person-years (95% CI, 20.1 to 21.9) in 2009 to 28.4 person-years (95% CI, 27.3 to 29.5) in 2016. Similarly, the prevalence increased annually from 95.7/100,000 person-years (95% CI, 93.7 to 97.6) in 2009 to 111.0 person-years (95% CI, 108.9 to 113.2) in 2015, with a slight decrease in 2016 (110.4 person-years; 95% CI, 108.2 to 112.6). The incidence and prevalence of SPRA increased with advancing age. The peak age for both incidence and prevalence of SPRA among women of childbearing age was 40 to 44 years. @*Conclusions@#The risk of SPRA is high in women during their childbearing years; this population bears a significant disease burden. This calls for special attention to this particular population group to reduce the risk and burden of this disease.

Risk of Pregnancy Complications and Low Birth Weight Offsprings in Korean Women With Rheumatic Diseases: A Nationwide Population-Based Study

Background@#To determine the risk of pregnancy complications and adverse offspring outcomes in Korean women with rheumatic diseases (RDs). @*Methods@#Women aged 20–44 years with pregnancies ending in delivery were identified from the National Health Insurance Service-National Health Information Database (2009–2016).Women with RD including systemic lupus erythematosus (SLE), seropositive rheumatoid arthritis (SPRA), and ankylosing spondylitis (AS) (n = 4,284) were age-matched with controls (n = 26,023). Outcome variables included threatened abortion (TA), preterm birth (PB), preeclampsia/eclampsia (PE/E), intrauterine growth retardation (IGR), urinary tract infection, low birth weight (LBW) offsprings, and offspring death within 1 year of birth. @*Results@#Women with RDs had increased risks for cesarean section delivery (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.4–1.6), TA (OR, 1.4; 95% CI, 1.2–1.5), PB (OR, 2.4; 95% CI, 1.9–3.2), PE/E (OR, 4.4; 95% CI, 3.3–5.9), and IGR (OR, 2.4; 95% CI, 2.0–3.1) than the controls. The risk of pregnancy complications was increased in SLE and SPRA pregnancies but not in AS pregnancies. Offsprings of women with RDs had an increased risk of LBW (OR, 4.0; 95% CI, 3.2–4.9). The offspring mortality rate within 1 year of birth was higher in women with RDs (6.2/10,000 persons) than in the controls (4.9/10,000 persons). @*Conclusion@#Women with RDs are at a risk of developing pregnancy complications, and the risk of LBW offsprings and offspring death within 1 year of birth is increased in these women.Therefore, this population requires special attention during their childbearing years.

Clinical Study Using Healthcare Claims Database

The healthcare claims database is a database created using claims data accumulated while operating the government’s health insurance system. The National Health Insurance Service (NHIS) provides benefits for health promotion, prevention, diagnosis, and disease and injury treatment, as well as for rehabilitation, birth, and death. Ninety-seven percent of the total population is enrolled in the NHIS; individuals pay a monthly insurance contribution to the system, and the NHIS pays a portion of the cost of reimbursement items to the medical institution when the subscriber receives medical services. In this process, the NHIS and Health Insurance Review Agency (HIRA) decide on payment, and claims data are documented items that medical institutions claim to these government agencies. The NHIS and HIRA have established a database to support policy and academic research, and they provide this database to researchers. Health claims data are representative of the nation, reflecting the actual medical environment. They also shorten the time and cost required for research and have several advantages as research data. However, studies should be conducted with an understanding of the limitations of claims data, a sufficient understanding of the characteristics of the Korean insurance system, and criteria for providing reimbursed services. Moreover, validating the healthcare claims database will facilitate more useful and reliable research.

Clinical Study Using Healthcare Claims Database

The healthcare claims database is a database created using claims data accumulated while operating the government’s health insurance system. The National Health Insurance Service (NHIS) provides benefits for health promotion, prevention, diagnosis, and disease and injury treatment, as well as for rehabilitation, birth, and death. Ninety-seven percent of the total population is enrolled in the NHIS; individuals pay a monthly insurance contribution to the system, and the NHIS pays a portion of the cost of reimbursement items to the medical institution when the subscriber receives medical services. In this process, the NHIS and Health Insurance Review Agency (HIRA) decide on payment, and claims data are documented items that medical institutions claim to these government agencies. The NHIS and HIRA have established a database to support policy and academic research, and they provide this database to researchers. Health claims data are representative of the nation, reflecting the actual medical environment. They also shorten the time and cost required for research and have several advantages as research data. However, studies should be conducted with an understanding of the limitations of claims data, a sufficient understanding of the characteristics of the Korean insurance system, and criteria for providing reimbursed services. Moreover, validating the healthcare claims database will facilitate more useful and reliable research.

Trends of Gout Prevalence in South Korea Based on Medical Utilization: A National Health Insurance Service Database (2002∼2015)

Objective@#. Although gout is the most common form of inflammatory arthritis, data on gout prevalence and management are sparse, especially in Korean populations. This study reevaluated the most recent prevalence and incidence of gout values in Korean people to update the findings from our previous study in 2011. @*Methods@#. We used the National Health Insurance Service-National Health Information Database (NHIS-NHID) to identify patients diagnosed with gout in South Korea during 2002∼2015. We selected patients with gout as principal diagnosis or 1st∼4th additional diagnosis. @*Results@#. The prevalence of gout increased 5.17-fold, from 0.39% in 2002 to 2.01% in 2015. This increase occurred in all age groups, but was stronger in those aged 80 years or older, with a 13.1-fold increase from 2002 to 2015. The prevalence of gout increased in all regions of South Korea. The prevalence of the disease was also related to income levels: in 2015, medical insurance subscribers with the highest income were twice more likely to have gout than those in the lowest income bracket. By contrast, the prevalence of gout in medical benefit recipients was 5.58- and 5.25-times higher than that of the general population and of those in the highest income bracket, respectively. @*Conclusion@#. The prevalence of gout has increased rapidly, although the degree of increase varied according to sex, age, region, and income group. This study sheds some light on the current prevalence of gout among national insurance subscribers in Korea, and will help educate patients and medical staff on the management of gout.

A Case of Mammary-Type Myofibroblastoma of the Tongue / 대한이비인후과학회지

A mammary-type myofibroblastoma is a rare benign mesenchymal neoplasm composed of spindle cells initially described to occur in the breast. However, they also arise at extra-mammary sites including the inguinal area, breast, chest wall/axilla, trunk, upper and lower extremities, and head and neck regions. In particular, mammary-type myofibroblastoma of the head and neck are extremely rare and may occur at any age. Immunohistochemically, it is typically CD34 and desmin positive. Currently, complete excision is considered as the first line treatment and recurrence of the tumor is rare. We experienced a 41-year-old man who visited with 1 cm sized firm mass of the tongue. The mass was resected and tissue biopsy revealed a diagnosis of mammary-type myofibroblastoma. Herein we report a rare case of mammary-type myofibroblastoma of the tongue with a review of the literature.

Clinical Application and Update of Video Head Impulse Test / 대한평형의학회지

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.

Clinical Usefulness of Speech Mapping for Fitting of Hearing Aids / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of speech mapping based on real ear measurement for routine hearing aid fitting and to compare functional gains for evaluating subjective satisfaction of hearing aid users. SUBJECTS AND METHOD: Twenty two participants with bilateral symmetric (< 10 dB HL difference) sensorineural hearing loss were enrolled in this study. All participants were fitted unilateral hearing aids with speech mapping using the National Acoustic Laboratories-Nonlinear 2 formula. After the initial fitting, patients were followed with the 2nd and 3rd fitting at two weeks and six weeks, respectively, and measured for aided pure tone average (PTA), aided speech discrimination score (SDS), the difference between target gain and real ear insertion gain (REIG) using speech mapping and subjective satisfaction via Korean Adaptation of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire before further fitting was performed. We analyzed correlation of each parameter at 2nd and 3rd fitting with the K-IOI-HA score. RESULTS: Every sequential aided PTA and SDS at 2nd fitting and 3rd fitting were significantly improved after repeated hearing aid fitting (all p < 0.01). In the correlation analysis between K-IOI-HA and each parameter, the aided PTA and aided SDS did not show significant correlations with subjective satisfaction from the 2nd and 3rd fittings. But the difference between the target gain and R EIG in speech mapping showed significant negative correlations with the satisfaction scores at various speech level (r=–0.609 to –0.709, all p < 0.01). CONCLUSION: Speech mapping using real ear measurement was useful to expect subjective satisfaction of hearing aid users and it would be a valuable tool for fine tuning to achieve individual preferences.

A Case of Mammary-Type Myofibroblastoma of the Tongue / 대한이비인후과학회지

A mammary-type myofibroblastoma is a rare benign mesenchymal neoplasm composed of spindle cells initially described to occur in the breast. However, they also arise at extra-mammary sites including the inguinal area, breast, chest wall/axilla, trunk, upper and lower extremities, and head and neck regions. In particular, mammary-type myofibroblastoma of the head and neck are extremely rare and may occur at any age. Immunohistochemically, it is typically CD34 and desmin positive. Currently, complete excision is considered as the first line treatment and recurrence of the tumor is rare. We experienced a 41-year-old man who visited with 1 cm sized firm mass of the tongue. The mass was resected and tissue biopsy revealed a diagnosis of mammary-type myofibroblastoma. Herein we report a rare case of mammary-type myofibroblastoma of the tongue with a review of the literature.

A Case of Polymyositis Associated with Immunoglobulin A Nephropathy

Polymyositis (PM) is a chronic inflammatory disease that predominantly affects muscles. Systemic organ involvement, including the respiratory and gastrointestinal tracts, is frequently observed in PM, but renal involvement is rare. Herein, we report the case of a 56-year-old woman presenting with weight gain, edema, and generalized myalgia. Laboratory tests revealed elevated creatinine kinase level, hypoalbuminemia, and proteinuria. Histopathological examination of muscle biopsy revealed inflammatory myositis, and a renal biopsy confirmed immunoglobulin A (IgA) nephropathy. Based on the clinico-pathological results, the patient was diagnosed with PM with IgA nephropathy. This is a report of a rare occurrence of IgA nephropathy in a patient with PM presenting with chronic glomerulonephritis.

Acquired Hemophilia A Combined with Systemic Lupus Erythematosus: A Case Report and Literature Review

Acquired hemophilia A (AHA) is a rare hemorrhagic disorder caused by autoantibodies against factor VIII (FVIII). An 80-year-old woman presented multiple bruises on her upper and lower extremities, along with gross hematuria. Extensive ecchymosis and swelling were observed on the buttocks. She had anemia and normal platelet count. The initial coagulation results showed prolonged activated partial thromboplastin time (aPTT, 68.5 seconds) and normal prothrombin time. According to the mixing test, we observed a decreased FVIII activity (2%), increased factor VIII inhibitor (FVIII-I) titer (74.4 BU), and negative lupus anticoagulant. AHA was diagnosed based on late onset bleeding and increased FVIII-I titer. Additionally, she met the criteria for systemic lupus erythematosus (oral ulcer, photosensitivity, renal disorder, and positivity for antinuclear and anti-β2-glycoprotein-I antibodies). She was started on oral prednisolone for FVIII-I eradication. Post-treatment, her bleeding tendency, aPTT (47.3 seconds), and FVIII-I titer decreased (1.24 BU), and FVIII activity increased (10%).

A Case of Esophageal Achalasia Misconceived as Laryngopharyngeal Reflux Disease

Laryngopharyngeal reflux disease (LPRD) is common in laryngologic practice. In Korea, up to 1 out of every 5 patients who visit otorhinolaryngology clinic is supposed to have LPRD with symptoms and physical findings. Major symptoms of LPRD include hoarseness, cough, reflux symptom and mild dysphagia. Even though LPRD is common, its diagnosis may be difficult, because its symptoms are nonspecific and the laryngeal findings are not always associated with symptom severity. In Recent study, 66.4% of Patient who has LPRD also associated with esophageal motility disorders. Esophageal achalasia is a disease of unknown etiology characterized by an absence of peristalsis in the body of esophagus and nonrelaxing hypertension of the lower esophageal sphincter. Common cause is loss of ganglion cells in Auerbachs plexus. The classic triad of symptoms in achalasia includes dysphagia, regurgitation and weight loss. LPRD and esophageal achalasia have similar symptoms but have different treatment of choice. The Differentiation diagnosis of theses disease is important and should be established by history, radiologic examination and endoscopic examination. We recently assessed a 59-year-old female patient who complained of an epigastric pain, dysphagia and chronic cough. LPRD was initially diagnosed on Laryngoscopic examination and Reflux Symptom Index, but patient was not relieved of any symptoms after treatment of Proton Pump Inhibitor for 3 months. After high resolution manometry, esophageal achalasia was finally diagnosed. We report this case regarding the diagnosis and treatment with review of literatures because we have to think about esophageal motility disorders as a differential diagnosis in laryngology.

A Case of Erdheim-Chester Disease with Laryngeal Involvement / 대한이비인후과학회지

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with multi-organ involvement. Bones, cardiovascular system, central nervous system, kidney, skin and many different organs can be involved but laryngeal involvement has not been reported in literatures. The diagnosis of ECD was based on clinical manifestations and immunohistochemical findings including CD68(+), CD1a(-) and S100(-). Currently, Interferon-a is the most extensively studied agent in the treatment of ECD and serves as the 1st line of treatment. Surgical resection of involved lesions can be tried but it leads to temporary improvement. A 60-year-old man visited with respiratory symptoms because of ECD with laryngeal involvement. We resected the obstructive lesion to relieve the symptoms. Tissue biopsy gave a diagnosis of ECD. As it is rare to encounter ECD involving the larynx, we report this case with a review of literatures.

Case of Moyamoya Disease Aggravated during the Treatment of Behçet’s Disease

Behçet’s disease (BD) is a multi-organ involved inflammatory disorder described by recurrent oral ulcers and other systemic manifestations. Almost all the clinical manifestations of BD are believed to be due to vasculitis. On the other hand, the cerebral arteries are rarely involved. Moyamoya disease (MMD) is an unusual chronic cerebrovascular disorder that is described by bilateral progressive stenosis or occlusion of the internal carotid artery and an abnormal collateral vascular network. A 32-year-old woman with MMD was referred for fever, oral pain, and diarrhea, and was diagnosed with BD. Her MMD was aggravated during treatment with high dose steroids to control the intestinal BD and a reduction in the MMD medication due to gastrointestinal bleeding. This is the first reported case of intestinal BD in a patient previously diagnosed with MMD, who experienced aggravation of her MMD after the cessation of MMD medication due to aggravated intestinal BD.

Comparison of Video Head Impulse Test with Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential / 대한평형의학회지

OBJECTIVE: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT). METHODS: Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT. RESULTS: Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss's kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT. CONCLUSION: cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.

A Case of Nasal Cavity Foreign Bodies by Inhalation of Polyurethane Foam

Foreign bodies in the nasal cavity are commonly encountered in otorhinolaryngologic practice, particularly among children and mentally handicapped patients. Such foreign bodies include plastic toys, pebbles, seeds, buttons, and many others. Many of these foreign bodies can be easily removed with simple tools. However, some of them adhere to the nasal mucosa, resulting in complications such as necrosis or neurovascular injury of the nasal mucosa. Polyurethane foam in the nasal cavity has never been reported in Korea. Furthermore, the complications caused by polyurethane foam in the nasal cavity have not yet been reported. In this article, we report a man who presented with polyurethane foam that had spread into both nasal cavity and nasopharynx by inhalation and adhered to the nasal cavity and sinuses.

Comparison of Correlation between Prostate Volume and Obesity Indices

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common condition in males over 40 years old, and the incidence of BPH has a tendency to increase with age. Obesity is state of excessive accumulation of fat in the body that leads to changes in the body's metabolism and endocrine function. Therefore, progression of BPH occurs in the obese state according to many articles. The purpose of this study was to compare the efficacy of obesity indices which correlate with prostate volume. METHODS: The study was carried out in 285 males, who visited a health promotion center and underwent transrectal ultrasonography and abdominal fat computed tomography from April, 2010 to June, 2013. Anthropometric parameters were measured directly and blood samples were obtained in the morning after over eight hours of fasting. The correlation between obesity indices and prostate volume was analyzed. RESULTS: After adjusting for age, prostate volume was positively correlated with BMI (r=0.227, P<0.001), waist circumference (WC) (r=0.151, P=0.011), waist to height ratio (WHtR) (r=0.149, P=0.012), and visceral fat area (VFA) (r=0.157, P=0.008). However prostate volume showed no correlation with subcutaneous fat area (SFA) and visceral to subcutaneous ratio (VSR). WHtR had the largest area under the curve (AUC) for the identification of prostate volume more than 30 mL (AUC=0.595, P=0.017) followed by VFA and BMI in order. CONCLUSION: Prostate volume was positively correlated with BMI, WC, WHtR, and VFA among the obesity indices and WHtR had the largest AUC followed by VFA and BMI in order.

Differences in Clinical Manifestations and Outcomes between Adult and Child Patients with Henoch-Schonlein Purpura

We aimed to investigate differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schonlein purpura (HSP), and to analyze the factors associated with poor prognosis for HSP nephritis. This retrospective 10-yr study enrolled 160 patients with HSP who visited Severance Hospital. Purpura was mostly detected in lower extremities, but purpura in upper extremities was more frequently observed in adults than children (41.7% vs 19.3%). Children had a greater frequency of arthralgia (55.4% vs 27.1%), while adults had a greater frequency of diarrhea (20% vs 1.6%). Anemia, elevated C-reactive protein, and level of IgA were more frequently observed in adults (25% vs 7.1%, 65.6% vs 38.4%, 26.3% vs 3.5%). Renal involvement in adults was more severe than in children (79.2% vs 30.4%). Chronic renal failure showed a significant difference in outcomes of HSP between adults (10.4%) and children (1.8%) after a follow up period of an average of 27 months. Furthermore, renal insufficiency at diagnosis was significantly related to the progression to chronic renal failure. Our results showed several differences in the clinical features of HSP between adults and children. Adults with HSP had a higher frequency of renal insufficiency and worse renal outcomes than children. Renal insufficiency at diagnosis might be of predictive value for the progression to chronic renal failure in HSP patients.

Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures

PURPOSE: This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures. MATERIALS AND METHODS: Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score. RESULTS: The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%). CONCLUSION: We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

Two Cases of Central Vertigo Presenting as Apogeotropic Direction Changing Positional Nystagmus / 대한평형의학회지

Positional vertigo and nystagmus without focal neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). And the apogeotropic positional nystagmus can be diagnosed as cupulolithiasis of the horizontal semicircular canal. However, cerebellar lesion involving especially nodulus could be initially presented as positional vertigo like a BPPV without other neurologic signs. In most of the patients with cerebellar involvement, initial presentation shows dysarthria, ataxia, headache, nausea, vomiting and unsteadiness. But in some central lesions, positional nystagmus might be observed in head roll test as if BPPV was presented. It is very important for clinicians of dizziness care unit to differentiate central positional vertigo (CPV) from BPPV. But it is difficult to diagnose CPV at initial visit by history and physical exam only. Therefore, we introduce two cases with cerebellar infarction and hemorrhage initially presenting isolated positional vertigo mimicking BPPV.