Safety and Efficacy Evaluation for the Addition of Either Etanercept or Leflunomide in Korean Rheumatoid Arthritis Patients Inadequately Responding to Methotrexate

( Kowoon Joo ),( Won Park ),( Seong Ryul Kwon ),( Mie Jin Lim ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.3

Objective. To compare the safety and efficacy associated with the addition of etanercept (ETN) with that of leflunomide (LEF) in Korean rheumatoid arthritis (RA) patients, who inadequately respond to methotrexate (MTX) in a randomized, open-label study. Methods. Twenty-nine subjects suffering moderate to severe RA, despite MTX treatment were randomly assigned to a combination therapy with either ETN or LEF. The primary end-point was the proportion of subjects achieving American College of Rheumatology (ACR20) criteria at week 16. Results. Ninety percent (n=18) of the ETN+MTX group (n=20) and 22.2% (n=2) of the LEF+MTX group (n=9) achieved an ACR20 response (p=0.001). All patients (n=20) in the ETN+MTX group showed moderate or good EULAR response as compared with 55.6% (n=5) in the LEF+MTX group (p=0.012). All of the ETN+MTX subjects completed the study without adverse events. Adverse events occurred in 77.8% (n=7) of cases in the LEF+MTX group; significantly elevated serum AST/ALT levels in 6 subjects and mild neutropenia (ANC < 1,500/μL) in 1 subject. Conclusion. The ETN+MTX combination therapy was effective and safe, whereas the LEF+MTX combination therapy resulted in moderate efficacy in only half of the cases, and was accompanied by a high rate of adverse events. Elevated AST/ALT was the most common adverse event causing dose adjustment or discontinuation of therapeutic agent in the LEF+MTX group.

Cholestatic Hepatitis Cauced by Tongyeong Strain of Orientia tsutsugamushi

Joo, Kowoon,Kim, Mee Kyung,Kil, Se-Hee,Chung, Moon-Hyun,Kim, Joon-Mee,Kang, Jae-Seung 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

In Korea, the clinical manifestation of scrub typhus in humans appears to be severe in the northern regions of the country and mild in the southern areas, Studies on the geographic distribution of the serotype of Orientia tsutsugamushi revealed that the Boryong serotype is predominant in the southern Korean peninsula, whereas the Gilliam, KarP, and Gilliam-Karp serotypes prevail in the northern or central peninsula. We report a case of severe scrub typhus caused by the Japanese Gilliam type of Orientia tsutsugamushi in a 66-year-o1d woman from Tongyeong, a city located in the southern part of Korean peninsula. The patient was admitted to the hospital with fever on August 29th, 2001. Scrub typhus complicated by shock, Pneumonitis, and encephalitis was diagnosed. Additionally, markedly elevated alkaline phosphatase levels was observed, which necessitated an ultrasonographic examination, which showed an ill-defined hyperechogenic mass on the right hepatic lobe. Liver biopsy showed cholestatic hepatitis and blood culture showed growth of O. tsutsugamushi. Gene sequencing of the amplicons of a polymerase chain reaction using primers for the amplification of the gene encoding the 56-kDa protein of 0. tsutsugamushi revealed a nucleotide sequence that matched Yonchon strain of 0. tsutsugamushi.

Early effects of tumor necrosis factor inhibition on bone homeostasis after soluble tumor necrosis factor receptor use

( Mie Jin Lim ),( Seong Ryul Kwon ),( Kowoon Joo ),( Min Jung Son ),( Shin Goo Park ),( Won Park ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.6

Background/Aims: Our aim was to assess whether short-term treatment with soluble tumor necrosis factor (TNF) receptor affects circulating markers of bone metabolism in rheumatoid arthritis (RA) patients. Methods: Thirty-three active RA patients, treated with oral disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids for > 6 months, were administered etanercept for 12 weeks. Serum levels of bone metabolism markers were compared among patients treated with DMARDs at baseline and after etanercept treatment, normal controls and naive RA patients not previously treated with DMARDs (both age- and gender-matched). Results: Bone-specific alkaline phosphatase (BSALP) and serum c-telopeptide (CTX)-1 levels were lower in RA patients treated with DMARDs than in DMARD- naive RA patients. After 12 weeks of etanercept treatment, serum CTX-1 and sclerostin levels increased. In patients whose DAS28 improved, the sclerostin level increased from 1.67 ± 2.12 pg/mL at baseline to 2.51 ± 3.03 pg/mL, which was statistically significant (p = 0.021). Increases in sclerostin levels after etanercept treatment were positively correlated with those of serum CTX-1 (r = 0.775), as were those of BSALP (r = 0.755). Conclusions: RA patients treated with DMARDs showed depressed bone metabolism compared to naive RA patients. Increases in serum CTX-1 and sclerostin levels after short-term etanercept treatment suggest reconstitution of bone metabolism homeostasis.

A Comparison of Three Different Guidelines for Osteoporosis Treatment in Patients with Rheumatoid Arthritis in Korea

Yoon, Jiyeol,Kwon, Seong-Ryul,Lim, Mie-Jin,Joo, Kowoon,Moon, Chang-Gi,Jang, Jihun,Park, Won The Korean Association of Internal Medicine 2010 The Korean Journal of Internal Medicine Vol.25 No.4

<P><B>Background/Aims</B></P><P>Osteoporotic fractures are an important comorbidity with rheumatoid arthritis (RA). We determined the overall fracture risk as assessed by the World Health Organization (WHO)'s FRAX® tool in Korean patients with seropositive RA. Additionally, we compared treatment eligibility according to the criteria of the Korean Health Insurance Review Agency (HIRA), FRAX, and the National Osteoporosis Foundation (NOF).</P><P><B>Methods</B></P><P>Postmenopausal women and men ≥ 50 years of age with seropositive RA were recruited from one rheumatism center in Korea. The FRAX score was estimated using the Japanese model. Patients were classified as eligible for treatment using the HIRA, NOF, and FRAX thresholds for intervention.</P><P><B>Results</B></P><P>The study of 234 patients included 40 men (17%). The mean age was 60 ± 9 years, and 121 (52%) patients had osteoporosis according to the WHO criteria. The overall median 10-year fracture risk was 13% for major osteoporotic fractures and 3.5% for hip fractures. HIRA guidelines identified 130 patients (56%) eligible for treatment, FRAX included 126 patients (54%), and 151 patients (65%) were included according to NOF guidelines. Older patients with a greater number of risk factors were included by FRAX compared to HIRA. The overall concordance between HIRA and FRAX, expressed as the kappa index, was 0.67, but was as low as 0.44 when limited to patients ≥ 60 years of age.</P><P><B>Conclusions</B></P><P>One-half of the patients had osteoporosis requiring treatment. RA patients have a high risk of fracture, and the adoption of a risk-scoring system should be considered.</P>

Poster Session : PS 0749 ; Rheumatology ; Usefulness of Infrared Thermography on Hands and Feet in Raynaud`s Phenomenon as the Screening Tool

( Mie Jin Lim ),( Seong Ryul Kwon ),( Kyong Hee Jung ),( Kowoon Joo ),( Won Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Raynaud`s phenomenon (RP) is characterized by a three-phase color change after cold exposure. We supposed that infrared thermography could be used as screening tool as cold-induced vasoconstriction of distal extremities in RP lowers skin temperature which could be easily detected by thermography. Methods: fifty-seven patients with RP (primary RP, n=33; secondary RP, n=24) and 146 healthy volunteers were recruited. After acclimation to temperature of 24 ℃, thermal imaging of palmar aspect of hands and dorsal aspect of feet were taken. A fi nger with lowest temperature among 2nd, 3rd and 4th fi nger was chosen as ‘thecoolest fi nger’. The temperature difference of the coolest fi nger/fi rst toe was defi ned as temperature of palm/dorsum was subtracted by temperature of the coolest fi nger/ 1st toe, respectively. Results: Temperature differences of both coolest fi ngers and fi rst toes signifi cantly differed between patients with RP and controls. They successfully distinguished male patients with RP from male controls but temperature difference of the coolest fi nger from non-dominant hand did not differ between female patients with RP and female controls. The area under curve analysis showed that temperature difference of the coolest finger (cutoff value: 2. 2 ℃) differentiated patients with RP from controls (sensitivity/specifi city : 65-68 %/ 57-62 %, respectively). Temperature differences of fi rst toe (cutoff value: 3. 11 ℃) discriminated patients with RP (sensitivity/specifi city : 72-74 %/ 64-68 %). Thermographic assessment of the coolest fi nger and fi rst toe combined was highly effective (sensitivity/ specifi city : 88-90 % / 44-45 %), especially in men (sensitivity/ specifi city : 88 %/ 58-62 %). However, in women, thermographic assessment of fi rst toe was solely suffi cient (sensitivity/specifi city : 88-90 % / 31-36 %). Conclusions: Thermographic assessment of the coolest fi nger and fi rst toe is useful as the screening tool for RP.

Poster Session : PS 0680 ; Rheumatologyy ; A Case Report of SAPHO Syndrome Treated with Alendronate

( Hyun Ik Shim ),( Seong Ryul Kwon ),( Won Park ),( Ji Hyeon Baek ),( Yeo Ju Kim ),( Kyong Hee Jung ),( Kowoon Joo ),( Mie Jin Lim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) syndrome is an osteoarticular- skin syndrome characterised by sterile infi ammatory arthro-osteitis of the anterior chest wall. Due to its diverse musculoskeletal and skin manifestations, SAPHO syndrome is very hard to diagnose and despite the effect of empirical treatment with steroids and DMARD, there is not enough clinical studies to establish proper treatmentprotocol. We report a case of SAPHO syndrome presenting anterior chest wall pain and pustulosis who was successfully treated with alendronate.

사례보고 : Alverine citrate에 의해 유발된 급성 간염 1예

한지영 ( Jee Young Han ),이진우 ( Jin Woo Lee ),김준미 ( Joon Mee Kim ),주고운 ( Kowoon Joo ),천웅 ( Ung Chon ),이정일 ( Jung Il Lee ),정석 ( Seok Jeong ),이돈행 ( Don Haeng Lee ),김영수 ( Young Soo Kim ),민경선 ( Kyung Sun Min 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1

저자들은 75세 여자 환자에서 국내 처음으로 발생한 alverine citrate에 의한 약인성 간염 1예를 경험하였으며 이를 문헌고찰과 함께 보고하고자 한다. Alverine citrate is one of the most commonly used antispasmodic drugs for patients with irritable bowel syndrome. Alverine-citrate-induced hepatotoxicity is extremely rare, with only a few cases having been reported worldwide. We present a case of a 75-year-old female patient who experienced complicated jaundice and abdominal discomfort after taking alverine citrate. Other causes of hepatitis were ruled out and the results of the liver function test returned to normal after ceasing the drug. This is the first case report in Korea of alverine-citrate-induced hepatotoxicity. (Korean J Hepatol 2010;16:75-78)

SAPHO 증후군에서 경구 Alendronate로 치료한 1예

심현익 ( Hyun Ik Shim ),박원 ( Won Park ),김여주 ( Yeo Ju Kim ),정경희 ( Kyong Hee Jung ),백지현 ( Ji Hyeon Baek ),임미진 ( Mie Jin Lim ),주고운 ( Kowoon Joo ),권성렬 ( Seong Ryul Kwon ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

본 저자들은 손가락의 골절과 감염이 동반된 SAPHO 증후군에서 경구 bisphosphonate로 성공적으로 치료하였기에 이를 보고하는 바이다. SAPHO syndrome, characterized by synovitis, acne, pustulosis, hyperostosis, and osteitis is rare compared to other spondyloarthropathies. It is also difficult to diagnose, and treatment methods have not yet been fully identified. Approximately 72% of patients are diagnosed with at least one other disease before a final diagnosis of SAPHO syndrome. In addition, SAPHO syndrome is subject to a delayed diagnosis period of 4.5 to 9.1 years. Medications such as non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and tumor necrosis factor inhibitors are used in treatment of SAPHO syndrome. Bisphosphonate is also used for refractory SAPHO syndrome; however, most reports on this relate to intravenous injection of medication. The authors experienced and subsequently reported on a case involving a patient with SAPHO syndrome accompanied by fracture and infection of the left second finger who was treated with the oral biphosphonate, alendronate. (J Rheum Dis 2015;22:313-316)