A New Onset of Systemic Lupus Erythematosus Developed After Bee Venom Therapy

Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) can be triggered by numerous stimuli. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis. We present here a case of a 49-year-old female who experienced a new onset lupus after undergoing bee venom therapy, and this looked like a case of angioedema. The patient was successfully treated with high dose steroids and antimalarial drugs. We discuss the possibility of bee venom contributing to the development of SLE, and we suggest that such treatment should be avoided in patients with lupus.

A Case of Pa-tient with Wegener's Granulomatosis Showing Glomerular Immune Deposition in Kidney Biopsy / 대한신장학회지

Rapidly progressive glomerulonephritis (RPGN) in Wegener's granulomatosis patients typically has been characterized by pauci-immune glomerulonephritis (PIGN). In some patients, however, significant amount of glomerular immune deposits was detected and reported that they may have poor prognosis. A 30 year-old-female visited due to the skin rash of both lower extremities, arthralgia and nasal stiffness. She had sinusitis, lung opacity, and proteinuria. Serologic PR-3 ANCA was positive and histologic findings of nasal cavity and lung also showed necrotizing vasculitis and granuloma. Thus we could diagnose Wegener's granulomatosis. However, gross hematuria developed and renal function worsened in spite of treatment with high dose prednisolone and oral cyclophosphamide. Therefore we performed a kidney biopsy. The kidney biopsy showed crescentic glomerulonephritis with Ig A deposition in the mesangium. We experienced a case of Wegener's granulomatosis patient with significant IgA deposition in glomeruli. We report this case with brief review of the literature.

Diagnostic Accuracies of Anti-cyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Korean Patients with Rheumatoid Arthritis: A Meta-analysis / 대한류마티스학회지

No Abstract available.

Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum / 대한류마티스학회지

Wegener's granulomatosis is multi-systemic disease characterized by granulomatous necrotizing vasculitis and it usually affects upper and lower respiratory tracts. Cutaneous manifestation as an initial presentation is unusual and comprises about 15% of cases. The most frequent skin lesions are palpable purpura, papules, ulcerations, vesicles, subcutaneous nodules, necrotizing ulcerations. We report a patient with Wegener's granulomatosis who presents as a pyoderma gangrenosum.

Polymorphisms in the STAT-6 Gene and SLE / 대한류마티스학회지

OBJECTIVES: To investigate whether the new polymorphism at position 2964 (G/A) in the 3' untranslated region of the STAT-6 gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: A polymerase chain reaction of genomic DNA-restriction fragment length polymorphism was used to determine genotypes of the STAT-6 in 90 SLE patients and 148 healthy controls. Clinical and serological manifestations were analyzed in each patient and correlated with the genotypes. RESUTLS: The genotype distribution of the STAT-6 differed significantly between SLE patients and control subjects (AA, AG, GG genotypes 7, 74, 9 vs. 1, 119, 28 controls respectively, p= 0.003). The frequency of AA genotype (7.8%) is significantly increased in SLE patients compared with controls (0.7%)(OR=12.398, 95% CI 1.50~102.5, Fisher's exact test, p=0.005). Clinically in the lupus patients according to the STAT-6 genotypes, there was no significant difference in age at onset, anti-ds-DNA titer, C3, C4 level, SLEDAI, SLICC/ACR Damage Index, or autoantibodies such as RF, anti-Ro, La, RNP, Sm antibodies, except for renal involvement. The frequency of lupus nephritis was significantly higher in the AA genotype in comparison with GG genotype (Fisher's exact test, p=0.019). CONCLUSION: Our data show that the STAT-6 AA genotype may contribute to susceptibility to SLE and may be associated with development of lupus nephritis.

A Case of Scleroderma Presented with Malignant Lymphoma of Breast / 대한류마티스학회지

We report a patient with scleroderma who had the unusual development of an anaplastic large/null cell malignant lymphoma of her breast at the time of diagnosis of scleroderma. It is well known that patients with scleroderma have malignant neoplasms such as lung cancer, breast cancer, and lymphoproliferative diseases more frequently than normal population. Although it is not well known about disease process of underlying cancer in patients with scleroderma, there must be some possible explanations. In brief, one disease may increase the risk of the other as a direct complication or as a result of the treatment given. Alternatively, the two disorders may share common risk factors. So it seems very important to emphasize that associated malignancy might be validated properly on rapidly developing scleroderma.

The Prevalence of Metabolic Syndrome in Patients with Gout: A Multicenter Study

It has been suggested that hyperuricemia and possibly gout are associated with the metabolic syndrome, but there have been no direct studies. This study was undertaken to obtain the prevalence of the metabolic syndrome in patients with gout and to compare it with those from the general population studies. This was a 4-institutional case-historical control study composed of 168 patients with gout. We assessed the prevalence of metabolic syndrome according to the ATP III criteria and compared the prevalence with that of the historical controls. To elucidate the factors in gout that were associated with metabolic syndrome, a multivariate analysis was done. The age-adjusted prevalence of metabolic syndrome in gout patients was 43.6%, which was significantly higher than that of the Korean control population (5.2%) from the previous studies. Patients with gout had more components of metabolic syndrome than did the controls. Body mass index (BMI, OR=1.357 (95%CI 1.111-1.657)) and high density lipoprotein (HDL, OR=0.774 (95%CI 0.705-0.850)) were the variables most significantly associated with the occurrence of metabolic syndrome in gout, but alcohol consumption did not show such associations. Gout is associated with the metabolic syndrome, and furthermore, obesity and dyslipidemia were the factors most associated with the syndrome in these patients.

Prevalence of the Metabolic Syndrome in Patients with Gout / 대한류마티스학회지

OBJECTIVE: Metabolic syndrome is a constellation of metabolic abnormalities such as obesity, hypertension, glucose intolerance, and hyperlipidemia. The association of metabolic syndrome and hyperuricemia is well known, but not with gout. Therefore, the association of gout and metabolic syndrome is investigated through comparing the prevalence of metabolic syndrome in normal controls and patients with gout. METHODS: This is a case-historical control study of 64 patients with gout recruited from Korea University Anam and Guro Hospital. Clinical factors were checked according to the diagnostic criteria of metabolic syndrome from the ATP III guidelines. Additional waist circumference adjustment was done according to the WHO Asia-Pacific obesity criteria recommendations. The prevalence was compared with historical control studies from the US and Korea. RESULTS: The prevalence of metabolic syndrome in patients with gout was 42.2% according to ATP III criteria and 59.4% with waist circumference adjustment and is significantly higher than control studies (23.7% (US), 6.8% (Korea), ATP III), 10.9% (Korea, WHO Asia-Pacific obesity criteria)(p<0.001 in all cases). Multivariate logistic regression analysis revealed that high BMI and low HDL levels (both ATP III/WHO Asia-Pacific obesity criteria) and the presence of hypertension (ATP III) are the statistically significant risk factors of having metabolic syndrome in gout patients. CONCLUSION: The prevalence of metabolic syndrome in patients with gout is significantly higher than normal control groups. This indicates an association between gout and metabolic syndrome. Especially, being obese or hypertensive, or having low HDL levels are risk factors for the metabolic syndrome in gout patients.

A Case of Transluminal Stent-Graft for Right Common Iliac Artery Aneurysm with Behcet's syndrome / 대한류마티스학회지

Behcet's disease is characterized by recurrent orogenital ulcers and ocular and cutaneous inflammatory lesions. It is a multisystem disorder affecting the skin, mucous membrane, eyes, joints, CNS and blood vessels. The vascular involvements consist of thrombophlebitis, arterial occlusion and arterial aneurysm. Rupture of large artery aneurysm is the leading cause of death in patients with Behcet's disease and surgical treatment is necessary. But, surgical treatment is often difficult and may lead to formation of further false aneurysms at the site of vascular anastomosis. Endovascular stent-graft placement emerged as an alternative treatment that is less invasive with a lower risk. We report a case of the aneurysm of right common iliac artery associated with Behcet's disease. Percutaneous stent-graft placement was attempted and successfully controlled aneurysmal manifestations.

The prevalence and clinical manifestations of chronic fatigue syndrome in persons who visited health management center / 대한내과학회지

BACKGROUND: To determine the prevalence of chronic fatigue syndrome and idiopathic chronic fatigue in Korea and to describe demographic, clinical, and psychological differences among those with chronic fatigue syndrome (CFS), those with idiopathic chronic fatigue, and healthy controls. METHODS: 1,526 persons aged 18-76 years who visited Korea university hospital health management center for general check-up between December 1998 and August 1999 were participated in the study. The questionnaire made according to the Centers for Disease Control and Prevention criteria was administered to the recruited persons and patients with chronic fatigue syndrome were diagnosed by questionnaire, physical examination and laboratory tests. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. RESULTS: Of the 1,526 persons studied, 433 (29.4 %) reported severe fatigue lasting at least 6 months. Of the 202 persons with unexplained chronic fatigue, 31 persons (2.0% of the study population) were classified as CFS cases. The prevalence of CFS was 2.81% in women, 1.49% in men respectively (p<0.05). When CES-D cut-off score of 25 was used, 30.43% of persons with CFS and 5.93% of persons without chronic fatigue had scores suggestive of depression. CFS patients had higher mean scores on CES-D than persons without chronic fatigue (p<0.05). CONCLUSION: Persons who met the criteria for chronic fatigue syndrome were found in 2.0%. The prevalence of chronic fatigue syndrome in our study were high, compared with previous studies in other countries. CFS patients had higher mean scores on CES-D than persons without chronic fatigue.

Expression of cyclooxygenase-1 and -2 in rheumatoid arthritis synovium

The aim of this study was to investigate the expression and localization of cyclooxygenase-1 and -2 (COX-1 and COX-2) in synovial tissues from patients with rheumatoid arthritis (RA). Synovial tissues from 9 patients with RA and 5 patients with osteoarthritis (OA) were examined for COX-1 and COX-2 expressions by immunohistochemical staining using 2 polydonal COX-1 and COX-2 antibodies. In RA synovia, synovial lining cells showed intense immunostaining for COX-1, whereas slight to moderate staining was observed in inflammatory cells, stromal fibroblast-like cells and vascular endothelial cells. There was no significant difference in COX-1 expression between RA and OA synovia. The localization of COX-2 expression dearly differed from that of COX-1 expression, being most intense in inflammatory cells. However, there was no difference in COX-1 and COX-2 expressions between RA and OA synovial tissues. Our observations support that inflammatory mechanisms modulated by COX-1 and COX-2 in chronic RA synovium might be similar to those in chronic OA synovium.

Polymorphisms of CTLA-4 Exon 1 and Promoter Genes in Systemic Lupus Erythematosus and Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Strong genetic evidence has shown an association between cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and autoimmune diseases. This study was set out to determine whether the polymorphisms of the CTLA-4 exon 1 and promoter are associated with susceptibility to systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and their clinical features. METHODS: Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism using Bst E II and Tru9 I was used to determine genotypes of the CTLA-4 exon 1 and promoter in 80 SLE, 86 RA patients and 86 healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype frequency of the CTLA-4 exon 1 differed between SLE patients and controls (chi-squared=.74, 2 degrees of freedom (df), p=.03). The CTLA-4 AG genotype occurred more frequently in patients with SLE (46.3% vs. 33.7% controls). On the other hand, the CTLA-4 AA genotype as well as the CTLA-4 GG genotype was less frequent among SLE patients than among control subjects (1.3% vs. 9.3% and 52.5% vs. 57.0% respectively). The genotype distribution of the CTLA-4 promoter differed between SLE patients and control subjects (CT, TT, CC genotypes 27.5%, 0%, 72.5% vs. 16.3%, 4.7%, 79.1% controls respectively, chi-squared=.36, 2 df, p=0.04). When the association was analyzed with respect to sex, the distribution of the CTLA-4 exon 1- promotor genotypes was significantly different between female SLE patients and females in the control group (chi-squared=8.16, 3 df, p=0.04). The frequencies of the CTLA-4 exon 1 and promoter genotypes, allele and phenotypes and exon 1-promotor genotypes were not significantly different between RA patients and control subjects. Clinically, there were no significant differences in patients with SLE and RA according to the CTLA-4 polymorphisms. CONCLUSION: The polymorphisms within the CTLA-4 exon 1 and promoter appear to play a role in susceptibility to SLE, but not to be associated with clinical features of SLE, susceptibility to RA and its clinical features.

A case of Stevens-Johnson syndrome after taking herb medicine in a patient with systemic lupus erythematosus / 대한류마티스학회지

Stevens-Johnson syndrome is an acute devastating condition which is related to certain drugs or infections. This syndrome involves multiple organs such as mucocutaneous, respiratory, occular and gastrointestinal systems. Patients who have underlying immunologic diseases are thought to be more susceptible. In lots of case reports and studies, more than 100 drugs have been implicated as causes of Stevens-Johnson syndrome or toxic epidermal necrolysis, but not so much as in Chinese Herb medications. Recently, we have experienced a patient with Stevens-Johnson syndrome after taking herb medicine and diagnosed as SLE during evaluation and treatment. We report this patient with a brief review of literatures.

Dermatomyositis without elevation of creatine kinase presented as bronchiolitis obliterans organizing pneumonia

A case of dermatomyositis presented as bronchiolitis obliterans organizing pneumonia has been rarely reported. We describe a 46-year-old female patient with dermatomyositis without elevation of creatine kinase presented as bronchiolitis obliterans organizing pneumonia. She was treated with prednisolone and azathioprine. Over a 2-year follow-up she has had no elevation of creatine kinase. The patient remains asymptomatic and has no medication for dermatomyositis and bronchiolitis obliterans organizing pneumonia two years after initial treatment. It has been suggested that the prognosis of dermatomyositis without creatine kinase elevation may be poor. Because the prognosis of bronchiolitis obliterans organizing pneumonia is generally believed to be good, we tentatively suggest that the normal value of creatine kinase in dermatomyositis does not always seem to herald a poor prognosis, an associated malignancy or severe interstitial lung disease.

Evaluation of Fas Promoter Gene Polymorphism in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To investigate whether the polymorphism of Fas promoter gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism using MvaI was used to determine genotypes of the Fas promoter in 87 SLE patients and 87 healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype distribution of the Fas promoter did not differ between SLE patients and control subjects (AA, GA, GG genotypes 31.0%, 54.0%, 14.9% in SLE patients vs. 29.9%, 55.2%, 14.9% in controls respectively, chi2=0.03, 2 degrees of freedom, p=0.99). No significant differences were also found in allele frequencies between the groups. Clinically in the lupus patients according to the Fas promoter polymorphism, there were no significant differences in age at onset, anti-ds DNA titer, C3, C4 level, renal involvement, number of ACR (American College of Rheumatology) criteria presented, SLE Disease Activity Index, SLICC/ACR (The Systemic Lupus international Collaborating Clinics/American College of Rheumatology) damage index, and autoantibody profiles except for anti-RNP antibody. The frequency of anti-RNP antibody in the lupus patients was increased in AA group (71.4%) compared to GA and GG groups (26.2% and 30.0%, p=0.007). CONCLUSION: The Fas promoter polymorphism does not seem to confer susceptibility to SLE, but seems to have some influence on the development of certain autoantibody like anti-RNP antibody, suggesting that the Fas promoter polymorphism is functional.

Evaluation of Fas Promoter Gene Polymorphism in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To investigate whether the polymorphism of Fas promoter gene is associated with susceptibility to systemic lupus erythematosus (SLE) and its clinical features. METHODS: Polymerase chain reaction of genomic DNA-restriction fragment length polymorphism using MvaI was used to determine genotypes of the Fas promoter in 87 SLE patients and 87 healthy control subjects. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype distribution of the Fas promoter did not differ between SLE patients and control subjects (AA, GA, GG genotypes 31.0%, 54.0%, 14.9% in SLE patients vs. 29.9%, 55.2%, 14.9% in controls respectively, chi2=0.03, 2 degrees of freedom, p=0.99). No significant differences were also found in allele frequencies between the groups. Clinically in the lupus patients according to the Fas promoter polymorphism, there were no significant differences in age at onset, anti-ds DNA titer, C3, C4 level, renal involvement, number of ACR (American College of Rheumatology) criteria presented, SLE Disease Activity Index, SLICC/ACR (The Systemic Lupus international Collaborating Clinics/American College of Rheumatology) damage index, and autoantibody profiles except for anti-RNP antibody. The frequency of anti-RNP antibody in the lupus patients was increased in AA group (71.4%) compared to GA and GG groups (26.2% and 30.0%, p=0.007). CONCLUSION: The Fas promoter polymorphism does not seem to confer susceptibility to SLE, but seems to have some influence on the development of certain autoantibody like anti-RNP antibody, suggesting that the Fas promoter polymorphism is functional.

Incidence and clinical manifestations of chronic fatigue in Korea / 대한내과학회지

OBJECTIVES:It was reported that fatigue was the seventh most common symptom in primary care and 24% of the general adult population had fatigue lasting 2 weeks or longer in the united states. No medical cause was found in 59% to 64% of those persons. Chronic fatigue syndrome is chracterized by debilitating fatigue of at least 6 months duration accompanied by other symptoms such as fever, pharyngitis, painful lymph nodes, headache, myalgia, sleep disturbances, neurocognitive complaints, and depression. Idiopathic chronic fatigue is defined as clinically evaluated, unexplained chronic fatigue that fails to meet criteria for the chronic fatigue syndrome. The objectives of this study were to determine the prevalence of idiopathic chronic fatigue and chronic fatigue syndrome (CFS) in Korea and to analysis the symptoms of those patients. METHODS: Five hundred thirty persons who visited Korea university hospital health management center between March 1998 and June 1998 were participated in the study. The questionnaire made according to the Centers for Disease Control and Prevention criteria was administerd and patients with idiopathic chronic fatigue and chronic fatigue syndrome were diagnosed by this questionnaire, physical examination and laboratory tests. RESULTS: Ten persons(1.9%) met the criteria for chronic fatigue syndrome. and 115 persons (21.7%) met the criteria for idiopathic chronic fatigue. The symptoms in patients with chronic fatigue syndrome were memory loss or forgetfullness(90%), sore throat(20%), painful lymph node(30%), myalgia(80%), multiple arthralgia(20%), headache(50%), unrefreshing sleep(100%), postexertional malaise(90%). CONCLUSION: Persons who met the criteria for chronic fatigue syndrome were found in 1.9%. The incidence of chronic fatigue syndrome in our study was high, compared with previous studies.

A Case of Eosinphilia-Myalgia Syndrome / 대한류마티스학회지

Eosinophilia-myalgia syndrome (EMS) is a multisystemic disorder characterized by severe myalgia and peripheral eosinophilia, and frequently accompanied by fasciitis, neuropathy and various cutaneous manifestations associated with consumption of L-tryptophan. Although EMS has not been uncommon in the United States, it has not been reported in Korea. We experienced a 28-year-old man who presented with severe myalgia, peripheral eosinophilia, right upper extremity motor weakness developed during ingestion of L-tryptophan containing food. He was diagnosed as EMS based on the diagnostic criteria by the Centers for Disease Control. His symptoms and laboratory findings including severe myalgia and eosinophilia rapidly improved after steroid treatment. To our knowledge, this is the first case report of EMS developed in L-tryprophan users in Korea. We report a case of EMS with a review of literature.

Expression of Cyclooxygenase-1 and -2 in Synovial Tissues from Patients with Rheumatoid Arthritis / 대한류마티스학회지

No abstract available.

Colchicine in the Treatmint of Dupuytren's Contracture / 대한류마티스학회지

No abstract available.