류마티스 관절염 활액내 사이토카인의 농도

전찬홍 ( Chan Hong Jeon ),김진희 ( Jin Hee Kim ),박정호 ( Jung Ho Park ),안광성 ( Kwang Sung Ahn ),김형진 ( Hyung Jin Kim ),김응호 ( Eung Ho Kim ),안중경 ( Joong Kyong Ahn ),차훈석 ( Hoon Suk Cha ),고은미 ( Eun Mi Koh ) 대한내과학회 2003 대한내과학회지 Vol.64 No.5

목적 : 관절염의 진단과 임상양상에 따른 관절 활액내 사이토카인의 농도 차이 및 특징적 양태를 보기 위하여 류마티스 관절염 환자와 골관절염 환자의 활액에서 TNF-α 와 가용성 TNF 수용체 1, 2, IL-1β, IL-2, IL-2 가용성 수용체, IL-6, IL-6 가용성 수용체, IL-8, IL-10를 각각 측정하였다. 방법 : 진단 및 치료를 위한 수기 중 채취된 관절 활액에서 각각의 사이토카인 및 그 수용체의 농도를 효소면역측정법으로 측정하였으 Background : The assay of cytokines and their soluble receptors in the synovial fluid of inflammatory arthropathy may be useful in studying pathogenetic and immunoregulatory mechanisms of different arthritis. The aim of this study is to investigate cytoki

한국인에서의 통풍의 임상양상에 관한 연구

전찬홍(Hong Jeon Chan),김형진(Hyung Jin Kim),김응호(Eung Ho Kim),안중경(Joong Kyong Ahn),고재현(Jay Hyun Koh),차훈석(Hoon Suk Cha),고은미(Eun Mi Koh) 대한내과학회 2002 대한내과학회지 Vol.62 No.6

통풍 환자의 남녀비는 32.8:1이었으며 연령별로는 40대가 가장 많은 부분을 차지하고 유병기간은 평균 6.2년이었다. 만성 신기능 저하의 소견이 20.4%에서 관찰되었고, 고혈압 (41.4%), 허혈성 심질환 (14.7%), 뇌혈관 질환 (8.6%) 등 순환기계 질환과 고지혈증 (13.7%)의 빈도가 높았으며 환자 중 60.7%가 과체중 또는 비만에 해당하였다. 24시간 요중 요산치는 83.8%가 800 mg/day 이하인 저배설에 해당하였다. 관절염의 최초 발현 양상은 제1중족지절관절을 침범하는 단관절염의 형태가 62.2%로 가장 많았으며 족근관절, 슬관절, 족관절의 순이었다. 방사선학적 골미란은 관찰 환자 중 35%에서 발견되었고 토푸스는 전체 환자 중 20.4%에서 관찰되었으며, 골미란, 토푸스의 발현과 유병기간 간에는 통계적으로 유의한 상관관계가 있었다. 알로퓨리놀의 부작용 중 간기능 이상은 37.6%에서 관찰되었고, 중등도 또는 고도 이상을 보인 환자는 12.6%였다. 이상을 보인 환자에서도 주의 깊게 추적하면서 약물을 지속하거나, 일시적으로 투약을 중단 한 후 간기능이 회복되면 재사용하는 방법으로 재발이나 심각한 부작용 없이 대부분의 환자가 알로퓨리놀을 계속 투여할 수 있었다. 본 연구의 결과는 통풍의 발현양상을 관찰한 기존의 국내외의 보고와 큰 차이를 보이지는 않았다. 심혈관계 질환 및 신장 기능 저하, 과체중 등 대사성 이상의 빈도가 높게 나타났으며 진단 기술의 발달과 환경요인 변화에 의해 통풍의 유병률이 증가하고 있으므로, 임상에서도 이러한 점들을 고려한 치료적 접근이 필요하리라 생각된다. 알로퓨리놀에 의한 간기능 이상은 빈도가 매우 높은 부작용이나 급히 약물을 중단하기 보다는 조심스러운 추적하 사용이나 재사용 등의 방법을 우선 고려해 볼 수 있을 것으로 생각된다. Background : The prevalence of gout in Korea seems to be increasing but previous studies were outdated and small in number of cases. We enrolled relatively large number of patients and compared our data with previous studies to provide a better understanding of clinical manifestations of gout in Korean. Methods : From 1994 to 2000, 372 patients, visited Samsung medical center for gout, were reviewed retrospectively. Age, sex, duration of disease, body mass index, 24 hour urine uric acid level, involved joints, frequency of tophi, bone changes on simple X-ray, associated diseases and complications of treatments were investigated. Results : In 372 patients reviewed, 361 patients were male (97%) and only 11 patients (3%) were female. Age of onset was 46.4±13.3 years. Most frequently affected joint in first attack was 1st metatarsophalangeal joint (62.2%). Tophi were observed in 20.4% and bony erosions were detected in 34.6% of patients. The most commonly accompanied disease was hypertension (41.1%) and overweight and obesity were noted in 60.7% of patients. Liver function abnormalities associated with allopurinol were noted in 37.7% of patients and after cessation of drug, most of them showed complete recovery. Conclusion : Clinical features were similar to those of western countries. It may be due to changes in life style and usage of drugs that affect serum level of uric acid. So more emphasis on life style modification and control of chronic illness will be needed.(Korean J Med 62:648-656, 2002)

경부 경직과 고열로 발현한 Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease의

전찬홍 ( Chan Hong Jeon ),최원혁 ( Won Hyeok Choe ),안중경 ( Joong Kyong Ahn ),고재현 ( Jay Hyun Koh ),차훈석 ( Hoon Suk Cha ),안중모 ( Joong Mo Ahn ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.2

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is one of the most common causes of arthralgia in elderly. The acute form (pseudogout) may present as acute monoarticular or polyarticular arthritis. It is often accompanied by high fever and sometimes simulates acute infectious condition. The knee is the joint most frequently affected by pseudogout but other sites such as wrist, shoulder, ankle, elbow and hands may be affected. A few cases involving cervical and lumbar spine mistaken for CNS infection have also been described in foreign countries. We report here a case of CPPD crystal deposition disease mimicking meningitis.

Human Immunodeficiency Virus 감염 환자에서 발생한 축형 척추관절염 1예

김태진 ( Tae Jin Kim ),전찬홍 ( Chan Hong Jeon ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

항레트로바이러스 치료의 발전과 함께 HIV 감염 환자에서 류마티스성 합병증의 양상은 계속 변화하고 있다. 꾸준히 새로운 환자가 발생하고 있으며 효과적인 치료 방법이 아직 개발되지 않은 상태에서 이러한 류마티스성 합병증을 경험할 가능성은 크다고 판단되나 이에 대한 국내 보고는 거의 없었다. 저자들은 HIV 감염 환자에서 발생한 축형 척추관절염 환자를 경험하여 이를 문헌 고찰과 함께 보고하는 바이다. Human immunodeficiency virus (HIV) infection is a global pandemic affecting more than 2.9 million people. Aside from opportunistic infections and malignancies, it involves multiple organs, resulting in many complications, and frequently shows various rheumatic manifestations. With improving survival of patients due to the development of highly active anti-retroviral therapy, the number of HIV-infected patients with rheumatic complications is certain to increase. However, reports on HIV induced rheumatic manifestations in Korean patients are limited. On the other hand, spondyloarthropathy is the most common form of inflammatory arthropathy in HIV associated rheumatic manifestations and is frequently accompanied by peripheral arthritis and enthesitis, while axial skeletal involvement is a rare presentation. Herein we report on a 46-year-old man with HIV infection presenting with an axial spondyloarthropathy who was treated successfully with nonsteroidal anti-inflammatory drug, sulfasalazine, and low dose steroid. (J Rheum Dis 2015;22:303-307)

류마티스 및 골관절염 섬유모세포양 활막세포에서 저산소증에 의한 Matrix Metalloproteinase 및 Tissue Inhibitor of Metalloproteinase-1 발현의 조절

차훈석 ( Hoon Suk Cha ),전찬홍 ( Chan Hong Jeon ),최화정 ( Hwa Jung Choi ),안광성 ( Kwang Sung Ahn ),송영욱 ( Yeong Wook Song ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.2

Objective: The rheumatoid synovium is a hypoxic environment and hypoxia has been implicated to have a role in the pathogenesis of rheumatoid arthritis (RA). In this work, we tried to investigate the effect of hypoxia on the expression of matrix metalloproteinase (MMP)-1, -3 and tissue inhibitor of metalloproteinase (TIMP)-1 in rheumatoid and osteoarthritis (OA) fibroblast-like synoviocytes (FLS). Methods: FLS obtained from RA and OA patients were cultured under normoxic or hypoxic condition for 48 hours. Western blot analyses for MMP-1, -3 and TIMP-1 were performed. TIMP-1 mRNA levels were measured by Northern blot analysis. Results: Hypoxia increased MMP-1 expression in rheumatoid FLS compared with normoxia. TIMP-1 expression was decreased by hypoxia in rheumatoid FLS in both protein and mRNA levels. On the other hand, hypoxia did not significantly affect MMP-1, -3 and TIMP-1 expressions in OA FLS. Conclusion: These results suggest that microenvironment such as hypoxia may directly contribute to joint destruction in RA by increasing the ratio of MMP-1 to TIMP-1 production in FLS.

류마티스 섬유모세포양 활막세포에서 저산소증이 시토카인 생산에 미치는 영향

안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),고재현 ( Jae Hyun Koh ),김진희 ( Jin Hee Kim ),최화정 ( Hwa Jung Choi ),안광성 ( Kwang Sung Ahn ),차훈석 ( Hoon Suk Cha ),유석희 ( Suk Hee Yu ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.1

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased production of cytokines, proliferation of fibroblast-like synoviocytes (FLS) and joint destruction. It is well known that the involved joints in RA are hypoxic. Hypoxia may play a role in the pathogenesis of RA. We thought that hypoxia might alter the production of cytokines by FLS and these changes could affect the biologic behaviors of FLS. Based on that, we investigated whether hypoxia affects the production of cytokines in FLS and the effect of these changes on matrix metalloproteinases (MMPs) expression. Methods: Fibroblast-like synoviocytes from human rheumatoid synovial tissue obtained duringjoint replacement surgery were cultured in vitro. Hypoxic culture was performed by incubating cells in BBL(R) Gaspak pouch(TM) anaerobic system. After incubation under hypoxic condition for 24 hr, the concentrations of various cytokines in culture supernatants were determined by ELISA. To determine the effect of highly expressed cytokines on MMP expression, we performed ELISA of MMP-1, MMP-2 and MMP-3 in cultured FLS, after stimulation with respective cytokines. Results: In hypoxic state, IL-6, IL-8 and vascular endothelial growth factor (VEGF) concentrations were significantly increased compared to those in normoxic condition. However, there were little differences in IL-1, IL-2, IL-4, TNF-α and TGF-β. Stimulation of FLS with IL-6 and IL-8 showed the increased concentrations of MMP-1, MMP-2 and MMP-3. Conclusion: Hypoxic environment of rheumatoid synovium might affect FLS to produce proinflammatory and proangiogenic cytokine such as IL-6 and IL-8. These cytokines again could stimulate MMPs production in FLS leading to joint destruction.

5-FU, Cisplatin 사용 후 발생한 방사선 회상 근염 1예

유양선 ( Yang Seon Ryu ),전찬홍 ( Chan Hong Jeon ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.1

Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.

류마티스 관절염 환자에서 혈장 호모시스테인, 혈청 비타민 B12, 엽산 농도에 관한 연구

차훈석 ( Hoon Suk Cha ),전찬홍 ( Chan Hong Jeon ),고재현 ( Jay Hyun Koh ),이창근 ( Chang Keun Lee ),김진석 ( Jin Seok Kim ),김종원 ( Jong Won Kim ),강성욱 ( Seong Wook Kang ),송영욱 ( Yeong Wook Song ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Objective: Cardiovascular disease is the most frequent cause of death in rheumatoid arthritis(RA) patients and hyperhomocysteinemia is an independent risk factor for cardiovascular disease. We evaluated the status of homocysteine, vitamin B12 and folate in RA patients and the influence of the drugs used in RA on homocysteine and vitamin levels Methods: Fifty-six RA patients and 22 controls were studied. Plasma total homocysteine was measured by HPLC method and serum folate and vitamin B12 were measured by chemiluminescence immunoassay. In RA patients, age, sex, disease duration, medications and laboratory findings were analyzed. Results: Serum vitamin B12 level was significantly lower in RA patients compared to controls(p=0.033). No significant difference in serum folate level was found between RA patients and controls but plasma total homocysteine level was significantly higher in RA patients. There was no difference in plasma total homocysteine level between patients taking MTX with folate and controls, but plasma total homocysteine level was significantly higher in patients not taking MTX compared with controls(p=0.028). In RA patients taking only hydroxyl-chloroquine(HCQ) as a DMARD, there was significantly lower serum folate level(p=0.033) and higher plasma total homocysteine level(p=0.043) compared with controls. There was a significant negative correlation between plasma total homocysteine level and serum folate level in RA patients(r=-0.319, p=0.017). Conclusion: Plasma total homocysteine level was increased in RA patients but not in patients taking MTX and folate. These findings suggested that folate supplementation may be effective to prevent hyperhomocysteinemia in RA patients.

증례 : 류마티스 관절염 환자에서 발생한 중증근무력증 4예

채지영 ( Ji Young Chai ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),김병준 ( Byung Jun Kim ),고은미 ( Eun Mi Koh ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S

고요산혈증을 보이는 한국인 건강검진 내원자들에서의 통풍의 유병률과 관련 인자들에 관한 연구

김응호 ( Eung Ho Kim ),전경만 ( Kyeong Man Jeon ),박건우 ( Keon Woo Park ),김형진 ( Hyung Jin Kim ),안중경 ( Joong Kyong Ahn ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.1

Objective: To investigate the prevalence of gout among hyperuricemic Korean people who visited Health Screening Center and to study related factors in the development of gout. Methods: The medical records of 6,461 people who visited Health Screening Center from March to May in 2002 were reviewed. Five hundred twenty one out of 603 hyperuricemic individuals were interviewed by telephone. Gout was diagnosed according to the clinical criteria of Wallace. Basic demographic and lifestyle variables as well as biochemical data were collected. Results: The prevalence of hyperuricemia was 14.3% in men and 2.2% in women. The prevalence of gout among hyperuricemic population was 16.6% for men and 6.7% for women. The mean age was higher in gout patients compared to the hyperuricemic people without gout, and serum uric acid and creatinine levels were increased in gout patients. The mean systolic blood pressure and the alcohol consumption amount were also increased in gout patients. In the multiple logistic regression analysis, statistically significant related factors for the development of gout among hyperuricemic population were age, uric acid level and alcohol consumption amount. Conclusion: The prevalence of gout among hyperuricemic Korean people who visited Health Screening Center was 16.6% for men and 6.7% for women. The possible related factors in the development of gout among hyperuricemic population were age, uric acid level and alcohol consumption amount.