Drug Retention Rate and Factors Associated with Discontinuation of Interleukin-17 Inhibitors in Patients with Axial Spondyloarthritis

Purpose@#To assess the drug retention rate of interleukin-17 inhibitors (IL-17is) over long-term observation in patients with axial spondyloarthritis (axSpA) in whom treatment with tumor necrosis factor inhibitors (TNFis) failed and to determine baseline factors associated with discontinuation of IL-17is. @*Materials and Methods@#This retrospective cohort study included 68 patients with axSpA started on IL-17is after an inadequate response or intolerance to ≥1 TNFis. Drug retention rates at 1, 2, and 3 years were assessed. Baseline (i.e., at initiation of IL-17is) factors associated with discontinuation of IL-17is were evaluated using multivariable Cox proportional hazard regression analysis. @*Results@#Over 1933.9 person-months of observation in 68 patients, discontinuation of IL-17is occurred in 27 (39.7%) patients. Twenty (29.4%) patients discontinued IL-17is because of ineffectiveness, and 7 (10.3%) patients discontinued IL-17is because of adverse events. The 1-year, 2-year, and 3-year drug retention rates for IL-17is were 71.9%, 66.5%, and 62.0%, respectively. Current smoking was associated with a higher risk of IL-17is discontinuation [adjusted hazard ratio (HR)=2.256, 95% confidence interval (CI)=1.053–4.831, p=0.036], while previous use of ≥3 TNFis (vs. 1) was significantly associated with a lower risk of IL-17is discontinuation (adjusted HR=0.223, 95% CI=0.051–0.969, p=0.045). @*Conclusion@#In patients with axSpA in whom TNFis failed, the long-term drug retention rate of IL-17is appears to be acceptable, with a 3-year drug retention rate of approximately 60%. Current smoking was associated with a higher risk of discontinuing IL-17is, whereas previous use of ≥3 TNFis was associated with a lower risk of discontinuing IL-17is.

Vascular Uptake on 18F-FDG PET/CT During the Clinically Inactive State of Takayasu Arteritis Is Associated with a Higher Risk of Relapse

Purpose@#To evaluate whether vascular uptake on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) during the clinically inactive state of Takayasu arteritis (TAK) is associated with disease relapse. @*Materials and Methods@#Patients with TAK who underwent 18F-FDG PET/CT during the clinically inactive state of the disease between 2006 and 2019 were included. Clinically inactive disease was defined as a status not fulfilling the National Institutes of Health (NIH) criteria for active disease in TAK. Relapse was defined as recurrence of clinically active disease after a clinically inactive period, requiring change in the treatment regimen. Vascular uptake on 18F-FDG PET/CT was assessed using target/background ratio (TBR), calculated as arterial maximum standardized uptake value (SUV)/mean SUV in venous blood pool. Multivariable Cox regression analysis was performed to identify factors associated with relapse. @*Results@#A total of 33 patients with clinically inactive TAK were included. During a median observation period of 4.5 (0.9–8.1) years, relapse occurred in 9 (27.3%) patients at median 1.3 (0.7–6.9) years. Notably, TBR [1.5 (1.3–1.8) vs. 1.3 (1.1–1.4), p=0.044] was significantly higher in patients who relapsed than in those who did not. On multivariable Cox regression analysis, the presence of NIH criterion 2 [adjusted hazard ratio (HR): 7.044 (1.424–34.855), p=0.017] and TBR [adjusted HR: 11.533 (1.053–126.282), p=0.045] were significantly associated with an increased risk of relapse. @*Conclusion@#Vascular uptake on 18F-FDG PET/CT and the presence of NIH criterion 2 are associated with future relapse in patients with clinically inactive TAK.

Vascular Uptake on 18F-FDG PET/CT During the Clinically Inactive State of Takayasu Arteritis Is Associated with a Higher Risk of Relapse

Purpose@#To evaluate whether vascular uptake on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18F-FDG PET/CT) during the clinically inactive state of Takayasu arteritis (TAK) is associated with disease relapse. @*Materials and Methods@#Patients with TAK who underwent 18F-FDG PET/CT during the clinically inactive state of the disease between 2006 and 2019 were included. Clinically inactive disease was defined as a status not fulfilling the National Institutes of Health (NIH) criteria for active disease in TAK. Relapse was defined as recurrence of clinically active disease after a clinically inactive period, requiring change in the treatment regimen. Vascular uptake on 18F-FDG PET/CT was assessed using target/background ratio (TBR), calculated as arterial maximum standardized uptake value (SUV)/mean SUV in venous blood pool. Multivariable Cox regression analysis was performed to identify factors associated with relapse. @*Results@#A total of 33 patients with clinically inactive TAK were included. During a median observation period of 4.5 (0.9–8.1) years, relapse occurred in 9 (27.3%) patients at median 1.3 (0.7–6.9) years. Notably, TBR [1.5 (1.3–1.8) vs. 1.3 (1.1–1.4), p=0.044] was significantly higher in patients who relapsed than in those who did not. On multivariable Cox regression analysis, the presence of NIH criterion 2 [adjusted hazard ratio (HR): 7.044 (1.424–34.855), p=0.017] and TBR [adjusted HR: 11.533 (1.053–126.282), p=0.045] were significantly associated with an increased risk of relapse. @*Conclusion@#Vascular uptake on 18F-FDG PET/CT and the presence of NIH criterion 2 are associated with future relapse in patients with clinically inactive TAK.

Worse Renal Presentation and Prognosis in Initial-Onset Lupus Nephritis than Early-Onset Lupus Nephritis

Purpose@#To compare the clinical characteristics and renal outcomes between patients who initially had lupus nephritis (LN) at the onset of systemic lupus erythematosus (SLE) (initial-onset LN) and those who developed LN within 5 years after SLE onset (early-onset LN). @*Materials and Methods@#SLE patients with biopsy-proven LN were retrospectively reviewed. The clinical parameters and renal outcomes were compared between initial-onset and early-onset LN groups. We used Cox regression analysis to estimate risk of worse renal outcomes according to the onset time of LN. @*Results@#Of all 136 LN patients, 92 (67.6%) and 44 (32.4%) patients were classified into the initial-onset and early-onset LN groups, respectively. The initial-onset LN group had higher prevalences of class IV LN (54.3% vs. 34.1%, ,p=0.027), impaired renal function (34.8% vs. 11.4%, p=0.004), microscopic hematuria (73.9% vs. 54.5%, p=0.024), and higher urine protein/creatinine ratio [4626.1 (2180.0–6788.3) mg/g vs. 2410.0 (1265.0–5168.5) mg/g,p=0.006] at LN diagnosis. Renal relapse (46.3% vs. 25.7%, p=0.039) and progression to chronic kidney disease (CKD) or end-stage renal disease (ESRD) were more common (24.4% vs. 8.3%, p=0.042) in the initial-onset LN group. In Cox regression analysis, the initial-onset LN group had higher risks of renal relapse [adjusted hazard ratio (HR) 3.56, 95% confidence interval (CI) 1.51–8.35,p=0.004] and progression to CKD or ESRD (adjusted HR 4.57, 95% CI 1.03–20.17,p=0.045), compared with the early-onset LN group. @*Conclusion@#Patients with LN at SLE onset may have more severe renal presentations and experience worse renal outcomes than those who develop LN within 5 years.

Clinical features and recurrent attack in gout patients according to serum urate levels during an acute attack

A substantial portion of gout patients have normal serum urate levels during an acute attack but data on the clinical characteristics and risk of recurrence compared with hyperuricemic patients are limited. Methods: In this retrospective cohort study, clinical features of normouricemic and hyperuricemic patients were compared. Multivariate analysis was performed to determine whether normouricemic patients were less likely to have a recurrent attack. Results: Among a total of 221 gout patients, 88 (39.8%) had normouricemia during an acute attack. Postsurgical gout (22.7% vs. 6.0%, p < 0.001), hemodialysis initiation (9.1% vs. 2.3%, p = 0.029) and inflammatory activity were higher in normouricemic patients than in hyperuricemic patients. The frequency of renal insufficiency was lower in normouricemic patients (25.0% vs. 53.4%, p < 0.001). However, the recurrence rate of gout attack was not different between the two groups (24.7% vs. 33.0%, p = 0.220). In multivariate analysis, female sex, history of urinary stone, presence of tophi, and use of thiazide were associated with increase of recurrent gout attack, but not with serum urate status during an acute attack (hazard ratio, 1.075; 95% confidence interval, 0.972 to 1.190; p = 0.159). Conclusions: Normouricemia during an acute gout attack was more frequently observed in postsurgical episodes, hemodialysis initiation and patients with preserved renal function. While higher inflammatory activity was observed in normouricemic patients, recurrent attack was not associated with serum urate levels during an acute attack. Thus, careful follow-up should be considered in gout patients regardless of serum urate levels during an acute attack.

Calcific Uremic Arteriolopathy Revealed Via Hand Radiography

No abstract available.

Role of IL-32 Gamma on Bone Metabolism in Autoimmune Arthritis

IL-32 acts as a pro-inflammatory cytokine by inducing the synthesis of inflammatory molecules as well as promoting the morphological changes involved in the transformation of monocytes into osteoclasts (OCs). Evaluation of the functions of IL-32 has mainly focused on its inflammatory properties, such as involvement in the pathogenesis of various autoimmune diseases. Recently, IL-32 was shown to be involved in bone metabolism, in which it promotes the differentiation and activation of OCs and plays a key role in bone resorption in inflammatory conditions. IL-32γ also regulates bone formation in conditions such as ankylosing spondylitis and osteoporosis. In this review, we summarize the results of recent studies on the role of IL-32γ in bone metabolism in inflammatory arthritis.

Budd-Chiari syndrome with antiphospholipid syndrome and systemic lupus erythematosus in a patient with Klinefelter's syndrome / 영남의대학술지

Klinefelter's syndrome is the most common congenital abnormality that causes primary hypogonadism. It is associated with diseases that predominantly affect women, such as systemic lupus erythematosus (SLE), and it can sometimes cause veno-occlusive disease. We experienced a case of Budd-Chiari syndrome (BCS) in a 33-year-old man with Klinefelter's syndrome presented with hematemesis and edema in both lower extremities. The clinical and laboratory findings were compatible with SLE, antiphospholipid syndrome, and BCS. To the best of our knowledge, this is the first case report to describe a simultaneous presentation of these four clinical syndromes in a single patient.

Budd-Chiari syndrome with antiphospholipid syndrome and systemic lupus erythematosus in a patient with Klinefelter's syndrome / 영남의대학술지

Klinefelter's syndrome is the most common congenital abnormality that causes primary hypogonadism. It is associated with diseases that predominantly affect women, such as systemic lupus erythematosus (SLE), and it can sometimes cause veno-occlusive disease. We experienced a case of Budd-Chiari syndrome (BCS) in a 33-year-old man with Klinefelter's syndrome presented with hematemesis and edema in both lower extremities. The clinical and laboratory findings were compatible with SLE, antiphospholipid syndrome, and BCS. To the best of our knowledge, this is the first case report to describe a simultaneous presentation of these four clinical syndromes in a single patient.

Vertebral Osteomyelitis Caused by Mucormycosis / 대한내과학회지

Mucormycosis is a rare but fatal disease and usually affects the rhinocerebrum, lungs, traumatic wounds or surgical sites. Vertebral osteomyelitis due to mucormycosis is very rare, with only three cases caused by mucormycosis since 1970 being reported, and none in Korea. Here, we present a case of vertebral osteomyelitis caused by mucormycosis in a 67-year-old woman, having type 2 diabetes mellitus for 10 years, who was in complete remission from acute leukemia after chemotherapy 3 years previously.

Aseptic Meningitis and Acute Kidney Injury after Immunoglobulin Infusion in a Patient with Systemic Lupus Erythematosus and Immune Thrombocytopenic Purpura

A 36-yr-old woman with systemic lupus erythematosus was admitted in our center because of thrombocytopenia that was being treated with corticosteroids. She was prescribed a four-day course of intravenous immunoglobulin (IVIG) infusion. After three days of IVIG infusion, she developed aseptic meningitis with severe pleocytosis in the cerebrospinal fluid, followed by acute kidney injury. These complications resolved completely with conservative management. Here, we report these rare complications of IVIG and the outcome.

Hyponatremia after Radioactive Iodine Treatment in Thyroid Cancer Patients

Radioactive iodine treatment (RAIT) after surgery reduces local recurrence and cancer related death. Cases of hyponatremia after preparation for RAIT have rarely been reported. We report 4 cases of hyponatremia which developed after RAIT. The cause of hyponatremia seemed to be related with over ingestion of free water which is recommended during RAIT. These cases highlighted the importance of weight adjusted water ingestion during RAIT.

HER2-Positive Gastric Hepatoid Adenocarcinoma / 대한내과학회지

Gastric hepatoid adenocarcinoma is a rare adenocarcinoma that develops in the stomach. The prognosis of gastric hepatoid adenocarcinoma is poorer than that of ordinary gastric adenocarcinoma. Here, we report the first case of human epidermal growth factor receptor 2 (HER2)-positive gastric hepatoid adenocarcinoma in Korea. A 57-year-old male presented with abdominal distension and underwent endoscopic gastric biopsy and percutaneous core needle liver biopsy. The pathological findings were consistent with HER2-positive gastric hepatoid adenocarcinoma. He received six cycles of chemotherapy with cisplatin-capecitabine plus trastuzumab, which is a HER2 targeted agent. After chemotherapy, a follow-up abdominal computed tomography scan showed a partial tumor response. This case emphasizes the importance of using trastuzumab in a patient with HER2-positive gastric hepatoid adenocarcinoma.

Two Cases of Pedunculated Lipofibroma / 대한피부과학회지

Pedunculated lipofibroma is a rare disorder characterized by ectopic deposits of mature adipose tissue in the dermis. It is a dorne shaped or sessile papule which occurs at any site and develops later in life. We, herein, report two cases of pedunculated lipofibroma which have developed on the chin of a 64-year-old man and the buttock of a 47-year-old woman.

A Case of Ant Sting By Brachyponera chinensis / 대한피부과학회지

The hypersensitive reactions to ant stings vary from local to systemic. Because repeated stings may induce severe skin reactions or serious systemic allergic reactions, the concerns about minor skin reactions by ant stings have been increasing. A 34-year-old man was stung on the right forearm by an ant. He experienced erythematous papules with pain, burning and dyspnea. The stinging ants collected from the patients skin and the ants resident in his garden were identified as Brachyponera chinensis.

Significance of Polymerase Chain Reaction for the Detection of Causative Fungi of Onychomycosis: Comparison with Fungus Culture and KONCPA(KOH+Nail Clipping+ PAS(periodic acid-Schiff) stain) / 대한피부과학회지

BACKGROUND: It has been known that the polymerase chain reaction(PCR) test of clinical specimens including blood, sputum, urine, and cerebrospinal fluid collected from patients with systemic fungal infection is a highly sensitive diagnostic method. Recently, the PCR test was applied to the diagnosis of onychomycosis. OBJECTIVE: This study was aimed to explore whether the PCR test would be a more sensitive diagnostic tool than the KOH smear, fungus culture and KONCPA(KOH+Nail Clipping+ PAS(periodic acid-Schiff) stain) test in diagnosing the onychomycosis. METHODS: Using 50 nail samples from 50 patients with onychomycosis, the result of the PCR test was compared with those of the KOH smear, fungus culture and KONCPA test. RESULTS: The results were as follows: 1. The positive rates for detecting the causative fungi from the KOH smear, fungus culture, KONCPA test and PCR test were 64.0%, 46.0%, 90.0%, and 100.0% respectively. 2. The fungus culture identified the causative fungi from 23 samples, of which 21(91.2%) were T. rubrum, 1(4.4%) Candida sp. and 1(4.4%) C. albicans. KONCPA test yielded higher positivity by detecting the pathogenic fungi in 45 samples: dermatophytes 35(77.8%), mixed infections of dermatophytes and Candida sp. 6(13.3%), molds 2(4.4%) and unclassified 2(4.4%). The PCR test yielded the highest positivity by detecting the pathogenic fungi in all samples ; T. rubrum 44(88.0%) and unclassified 6(12.0%). 3. Compared with the results of fungus culture and KONCPA test, that of PCR test showed some differences. The case of Candida sp. in fungus culture was identified as T. rubrum in PCR ; the case of C. albicans in fungus culture as unclassified in the PCR. Five cases of mixed infection and 2 cases of mold infection in the KONCPA test were diagnosed as T. rubrum infection in the PCR test. CONCLUSION: The PCR test is useful in diagnosing the onychomycosis because of its highest positive rate in detecting the causative fungi compared with fungus culture and the KONCPA test. Furthermore, a more accurate diagnostic method such as the PCR test will be necessary in case Candida sp. or mold is cultured from the infected nail specimen.

A Case of Paederus Dermatitis due to paederus fuscipes / 대한피부과학회지

Paederus dermatitis is a linear and self-healing blistering disease of the skin caused by contact with insects belonging to genus Paederus(Coieoptera : Staphylinidae). There have been only a few reports of paederus dermatitis in the southern part of Korea since 1968. We recently experienced a case of paederus dermatitis due to contact by P. fuscipes.

A Case of Pigmented Fungiform Papillae of the Tongue / 대한피부과학회지

Pigmented fungiform papillae of the tongue is a rare disorder in Korea. It is characterized clinically by pigmentation confined to the fungiform papillae and histopathologically by the presence of melanophages in the upper dermis. We report a case of pigmented fungiform papillae of the tongue in a 21-year-old woman who had brown to violaceous dots on the fungiform papillae and pigmented patches on the right lateral dorsum of the tongue. Histological findings showed increased melanophages in the upper dermis.

A Case of Progressive Zosteriform Macular Pigmented Lesion / 대한피부과학회지

Progressive zosteriform macular pigmented lesion(PZMPL) is a chronic pigmentary dermatosis similar to progressive cribriform and zosteriform hyperpigmentation(PCZH). This dermatosis described by Simoes in 1980 is characterized by a uniformly tanned macular pigmented lesion in a zosteriform distribution preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period. PZMPL is not a fully understood disease entity but it is thought to be a variant of PCZH. It is differentiated from PCZH by accompanying pruritus as a prodromal symptom, a characteristic clinical course, and histological findings such as pigmentary incontinence. We report herein a case of PZMPL in a 17 year-old girl with the pigmentary skin lesion extending from the left forearm to the left chest along the Blaschkos line. The histological findings revealed increased melanin pigments in the basal layer and focal pigmentary incontinence in the upper dermis. To our knowledge, this case is the first report of PZMPL in korea thought to be the same case reported by Simoes.

A Case of Sporotrichosis Associated with Lupus Vulgaris / 대한피부과학회지

Sporotrichosis is a chronic infection that follows accidental implantation of the fungus Sporothrix schenckii into the skin. The infection begins with skin trauma under conditions when conidia may be present. A 48-year-old woman presented with a 5-year history of an 8X 12 cm sized, centrally depressed, erythematous plaque on the left wrist. She had been treated with antifungal agents at an other hospital for about 6 months but there was no improvement. The histopathological findings showed an infiltration of mononuclear cells and tuberculoid structures on the whole dermis and subcutis. According to the histopathological findings and clinical manifestations, she was diagnosed as having lupus vulgaris. There was much improvement of the lesion after antituberculous therapy. However, 2 months later she developed asymptomatic multiple erythematous papules around the lesion of lupus vulgaris and along the lymphatic drainage of the left arm. The histopathological findings of the newly developed lesion showed a granulomatous reaction and an infiltrate of acute and chronic inflammatory cells. Moist and creamy colonies were changed into brown-to-black ones with a leathery appearance with age. This appearance and clinical manifestations confirmed the diagnosis of lymphocutaneous sporotrichosis. This clinical appearance reflects that the sporotrichosis developed on the ulcerative lesion or biopsy site of lupus vulgaris.