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류마티스관절염 환자에서 혈관염을 동반하여 발병한 다발성 골수종 1예
손경민 ( Kyeong Min Son ),김자경 ( Ja Kyung Kim ),김현아 ( Hyun Ah Kim ),박혜림 ( Hye Rim Park ),박은주 ( Eun Ju Park ),오지민 ( Ji Min Oh ),서영일 ( Young Ll Seo ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.1
류마티스관절염 환자에서 피부 병변을 주소로 내원하여 다발성 골수종을 진단한 경험을 하였기에 문헌고찰과 함께 보고하는 바이다. Paraneoplastic vasculitis is a part of secondary vasculitis, the hematological neoplasm, such as lymphoma or myelodysplastic syndrome, which is most frequently observed. However, in multiple myeloma, cutaneous vasculitis is a rare complication, particularly as an initial clinical symptom. We report one case where a purplish reticulated patch on the lower extremity and an ear lobe skin necrotic change developed in a rheumatoid arthritis patient. He was diagnosed with multiple myeloma and cutaneous vasculitis.
손경민 ( Kyeong Min Son ),서영일 ( Young Il Seo ),김인제 ( In Je Kim ),배영덕 ( Young Deok Bae ),정영옥 ( Young Ok Jung ),차명진 ( Myeong Jin Cha ),김현아 ( Hyun Ah Kim ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Objective: Gout is crystal-induced arthritis with hyperuricemia. Uric acid lowering agent (UALA) is the maintenance drug of its treatment. Drug adherence is an important factor that influences treatment outcome. The purpose this study was to examine the drug adherence to UALA of 303 gouty patients and to analyze the factors associated with compliance. Methods: We retrospectively assessed adherence to UALA in 303 patients who visited three hospitals affiliated with Hallym University. Patients were diagnosed as gout and used UALA with at least 6 month follow-up. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <70% was considered poor adherence and factors associated with poor adherence were examined. Results: Among the 303 patients, 283 (93.4%) were male. Mean age was 55.4±13.7 years. Comorbidities included hypertension in 117 (38.6%), diabetic mellitus in 108 (35.6%), angina in 107 (35.3%), myocardial infarction in 108 (35.6%), and heart failure in 113 (37.3%). The mean PDC was 65.8% with 63.4% of patients considered poorly compliant over the study period. Mean treatment duration before an extended break occurred was 203.5 days. Factors associated with good adherence included hypertension and prescription from rheumatologist. Conclusion: In our study, adherence to UALA in gouty patient was poor. Understanding the factors associated with adherence to UALA and proper education of gouty patients to improve drug adherence are needed.
TNF-α 길항제가 적응이 되는 류마티스관절염 환자들의 임상양상
손경민 ( Kyeong Min Son ),정영옥 ( Young Ok Jung ),김인제 ( In Je Kim ),김범준 ( Bum Jun Kim ),이성연 ( Seung Yun Lee ),문소영 ( So Young Mun ),서영일 ( Young Il Seo ),김현아 ( Hyun Ah Kim ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.6
Objective. The aim of this study was to examine clinical characteristics of Korean rheumatoid arthritis (RA) patients with clinically indications for TNF-α blocker, and to compare their clinical parameters with the Korean National Health Insurance reimbursement criteria. Methods. Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym University affiliated hospitals. Among patients who were previously prescribed DMARDs for more than three months, rheumatologists selected patients clinically indicated for TNF-a blocker. The clinical characteristics at the time TNF-α blocker use was deemed indicated were examined. Radiographic damage was quantified by Modified Sharp van der Heijde score in hand and foot simple AP radiograph. Results. From August 2010 to January 2013, five rheumatologists in four hospitals selected 109 patients clinically indicated for TNF-α blocker. When TNF-α blocker was considered, mean DAS28 was 5.2 (range 2.1∼8.05), mean swollen joint count was 6 (range 0∼22), mean tender joint count was 10.6 (range 0∼28), mean ESR was 43.2 mm/hr (range 1∼140) and mean CRP was 2.5 mg/dL (range 0.1∼18.3). The mean total modified Sharp van der Heijde score was 32.72 (range 0∼240). Eighty one percent of subjects did not have enough active joints to satisfy the Korean National Health Insurance reimbursement standard. Conclusion. Our results show that patients with clinically indications for TNF-α blocker had a broad range of disease activity and clinical parameters, and the majority did not meet the Korean National Health Insurance reimbursement criteria
증례 : 류마티스 ; 말단 괴저를 주소로 내원하여 진단된 전신홍반루푸스 1예
손경민 ( Kyeong Min Son ),임수경 ( Soo Kyung Lim ),전의용 ( Eui Yong Jeon ),김현아 ( Hyun Ah Kim ),서영일 ( Young Il Seo ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1
전신홍반루푸스에서 말단 괴저는 드물며 첫 임상증상으로 나타나는 환자의 보고가 국내에는 없었다. 저자들은 오른쪽 손가락 및 발가락의 말단괴저를 주소로 내원하여 전신홍 반루푸스를 진단받은 환자를 경험하여 1예를 보고하는 바이다. Although digital gangrene is an uncommon clinical feature, it may lead to serious complications, such as amputation. Therefore, it requires prompt evaluation and treatment. Digital gangrene is often seen in systemic sclerosis, but is rare in systemic lupus erythematosus (SLE). In SLE, digital gangrene results from vasculitis, vasospasm, and thromboembolism. Here, we report a 15-year-old male SLE patient who initially presented with digital gangrene, and present a review of the relevant literature. (Korean J Med 2013;84:141-144)
증례 : 류마티스 ; Creatine kinase 증가가 없었던 다발성근염 1예
박민선 ( Min Sun Park ),권오경 ( Oh Kyung Kwon ),김효선 ( Hyo Sun Kim ),신원재 ( Won Jae Shin ),한상학 ( Sang Hak Han ),홍명선 ( Myung Sun Hong ),손경민 ( Kyeong Min Son ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2
환자는 CK의 상승 없이 상, 하지 근무력감을 주소로 내원하여 초기에는 류마티스 다발성 근통으로 진단하였으나 추후 증상 호전을 보이지 않아 근육 조직 검사를 통하여 다발성 근염으로 진단되었다. CK 등의 근육 수치의 증가가 없더라도 임상적으로 염증성 근염이 의심되는 경우에는 근육 조직 검사를 포함한 자기공명검사, 근전도 검사 등의 적극적인 검사를 통하여 염증성 근염 여부를 반드시 감별할 필요가 있겠다. Proximal muscle weakness can be induced by many diseases, such as muscular dystrophies, inflammatory muscle diseases, and polymyalgia rheumatica. Differential diagnosis of these diseases is important. The patient had proximal muscle weakness with a normal creatine kinase (CK) level. Our initial diagnosis was polymyalgia rheumatica because the CK level was normal. The patient was treated with low-dose corticosteroid. However, the muscle weakness did not improve. The diagnosis of polymyositis was confirmed by a muscle biopsy. We suggest that if the patient has typical symptoms with normal CK, then evaluations for inflammatory muscle diseases are essential. (Korean J Med 2014;86:258-262)
알레르기 비염 치료제로서 녹차, 구아바잎, 장미꽃잎 추출 복합물의 효과: 무작위 이중맹검 시험
김성열 ( Seong Yeol Kim ),강혜련 ( Hye Ryun Kang ),김주희 ( Joo Hee Kim ),손경민 ( Kyeong Min Son ),정종문 ( Jong Moon Jeong ),박성훈 ( Sung Hoon Park ),황용일 ( Yong Il Hwang ),장승훈 ( Seung Hoon Jang ),김동규 ( Dong Gyu Kim 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.2
Background: Allergic rhinitis causes itching, sneezing, profuse watery rhinorrhea, and nasal congestion. There is no medication to cure allergic rhinitis so far except for allergen immunotherapy which can be performed in limited patients. Therefore, people with allergic rhinitis cannot be away from their medication for their lives once the condition developed. BENDU381, a nutraceutical composed of extracts from green tea (Camellia sinensis), guajava leaves (Psidium guajava), and rose petals (Rosa hybrida), was proved to improve allergic inflammation through several in vitro and in vivo trials. Objective: This study was performed to evaluate the therapeutic effect of BENDU381 on allergic rhinitis. Method: Sixty three patients with perennial allergic rhinitis were received two capsules of BENDU381 (200 mg/capsule) or placebo, twice every day, for four weeks. Nasal symptom score and quality of life (QoL) related with rhinitis were monitored to evaluate the effect of BENDU381 on allergic rhinitis. Result: BENDU381 showed significant improvements in symptoms related with allergic rhinitis (itching, sneezing, and watery rhinorrhea) over placebo. In addition, BENDU381 reduced skin reactivity to sensitized perennial allergens. QoL related with rhinitis also remarkably improved with the treatment of BENDU381. Conclusion: BENDU381 was proved to be helpful in relieving rhinitis symptoms and improving QoL without noticeable side effects. (Korean J Asthma Allergy Clin Immunol 2009;29:89-95)
증례 : 알레르기 ; 종합비타민 정주투여 후 발생한 과민반응 4예
이인정 ( In Joung Lee ),김소연 ( So Yeon Kim ),안정선 ( Jung Sun An ),손경민 ( Kyeong Min Son ),이서희 ( Seo Hee Lee ),한보람 ( Bo Ram Han ),강혜련 ( Hye Ryun Kang ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
종합비타민 주사제에 의한 아나필락시스 반응 4예를 경험하였고, 피부반응 검사로 과민반응을 확인하였다. 또한 종합비타민제에 대한 유해반응이 드물지 않게 발생하므로 적절한 적응증 없이 불필요하게 비타민제재를 투여하는 것은 피하도록 하여야겠다. Parenteral vitamin supplements are frequently used in normal subjects and patients with vitamin deficiencies. The incidence rate of an allergic reaction to a multivitamin is less than 0.1%. We recently experienced four young patients who showed severe immediate allergic reactions after administration of an intravenous multivitamin. A 21-year-old male who was admitted for diarrhea suddenly felt chest tightness, shortness of breath, high fever, and generalized pruritus with facial flushing within a few minutes after beginning a dextrose fluid drip mixed with a multivitamin solution. The patient`s symptoms subsided in 20 minutes after fluid administration stopped. The patient showed positive response to intradermal tests using a multivitamin, vitamin B-complex, and thiamine solution. We also observed similar responses to a multivitamin in three other young patients, and all of them showed positive reactions on a skin test using a multivitamin solution. Including the above-described patients, we have experienced 17 cases of potential multivitamin-induced hypersensitivity reactions over the past year. Based on our experience, multivitamin-related allergic reactions are not rare. Therefore, more attention to vitamins as a cause of severe allergic adverse reaction is required. (Korean J Med 77:S1347-S1351, 2009)