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특집: 전신 홍반 루푸스의 최신지견 : 전신 홍반 루푸스의 임상 소견과 진단
안중경 ( Joong Kyong Ahn ) 대한내과학회 2010 대한내과학회지 Vol.78 No.4
Systemic lupus erythematosus (SLE) is a multi-system, autoimmune disorder of unknown cause, characterized by the production of autoantibodies and wide ranging spectrum of clinical manifestations. SLE can involve any organ system of the body with constitutional symptoms, including musculoskeletal, skin, renal, neuropsychiatric, cardiovascular, respiratory and gastrointestinal system. American College of Rheumatology classifications criteria for SLE can be helpful when establishing the diagnosis of SLE. However, these criteria would not do for physicians to give a diagnosis of SLE because these were designed for classification for research purpose and not for diagnosis. The diagnosis of SLE remains largely clinical. Thus, increasing awareness of the clinical manifestations could lead to earlier diagnosis. The clinical manifestations and diagnosis of SLE are covered in this review. (Korean J Med 78:409-415, 2010)
결체 조직 질환에서 조직학적으로 확진된 통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상상과 흉부 HRCT 소견의 비교 및 방사선학적 변화와 임상적 지표와의 연관성
안중경 ( Joong Kyong Ahn ),고은미 ( Eun Mi Koh ),이유선 ( You Sun Lee ),차훈석 ( Hoon Suk Cha ),정만표 ( Man Pyo Chung ),한정호 ( Jung Ho Han ),오대근 ( Dae Kun Oh ),이경수 ( Kyung Soo Lee ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.3
Objective: The purpose of this study is to assess the clinical characteristics and the serial changes of high resolution CT (HRCT) findings and to correlate those with the results of clinical parameters in biopsy proven nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) with connective tissue diseases (CTD). Methods: Retrospective analysis was made of forty patients with CTD diagnosed of NSIP and UIP from a single tertiary hospital between January 1996 and February 2006. Results: UIP was common in rheumatoid arthritis, systemic sclerosis and Sjogren`s syndrome, while NSIP was frequent in polymyositis/dermatomyositis. No significant difference was found in the clinical characteristics of patients with NSIP and UIP. In initial HRCT findings, extents of honeycombing and reticulation pattern were significantly more in UIP-CTD than in NSIP-CTD. In bronchoalveolar lavage (BAL) results, proportion of alveolar macrophages was significantly higher in NSIP-CTD than in UIP-CTD. In NSIP-CTD, significant increment in the extent of reticulation and honeycombing was noted in the serial HRCT findings despite the aggressive treatment. Significant correlation was found between leukocytosis and honeycombing change in NSIP-CTD. Despite no significant difference of survival between two groups, patients with UIP-CTD seem to have a higher mortality than those with NSIP-CTD. Conclusion: It is suggested that chest HRCT and BAL fluid analysis may be helpful in the differential diagnosis of NSIP- and UIP-CTD and leukocytosis in initial blood test might be predictive of honeycombing progression in NSIP-CTD. Further study will be required to compare with the prognosis of NSIP- and UIP-CTD.
미만성 기관, 기관지 침범으로 발현한 재발다발연골염 1예
유경모 ( Kyung Mo Yoo ),황지원 ( Jiwon Hwang ),안중경 ( Joong Kyong Ahn ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.6
Relapsing polychondritis is a rare autoimmune disease involving the cartilaginous structures of the whole body. Its diagnosis can be difficult when the typical clinical features such as auricular chondritis are absent. Here, we report on a case of a 51-year-old female who presented with cough, dyspnea, and polyarthritis. Chest computed tomography showed the diffuse involvement of tracheobronchial cartilage. According to Damiani`s criteria, she was diagnosed as relapsing polychondritis even though there was no unique involvement of auricular cartilage, and high dose steroid and immunosuppressive therapy were then started. This case indicated that patients who have tracheobronchial cartilage involvement without definite auricular chondritis should be considered for relapsing polychondritis as a differential diagnosis. (J Rheum Dis 2015;22:374-377)
증례 : 류마티스 ; 전신홍반루푸스 환자에서 발생한 부착부위염
김형진 ( Hyung Jin Kim ),이재준 ( Jae Joon Lee ),안중경 ( Joong Kyong Ahn ),황지원 ( Ji Won Hwang ),노정원 ( Jung Won Noh ),고은미 ( Eun Mi Koh ),차훈석 ( Hoon Suk Cha ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2
We present the first case of enthesitis in the lumbar spine in a woman with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Enthesopathy is defined as pathological alterations at the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. In particular, enthesitis is the universal hallmark of seronegative spondyloarthropathies (SpA), including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and spondyloarthropathies associated with inflammatory bowel diseases. A 36-year-old female SLE patient with a history of lupus nephritis and thrombosis from APS presented with low back pain that had been gradually worsening for several months. She reported no previous episodes of trauma. Plain radiography indicated sclerosis at the anterior superior bodies of L3 and L5. Magnetic resonance imaging (MRI) showed low-intensity lesions on T1-weighted images and high-intensity lesions on T2-weighted images at the anterior superior bodies of L3, L4, and L5, consistent with osteitis or enthesitis. A nonsteroidal antiinflammatory drug (NSAID) was used as the first-line therapy in this patient, which improved her symptoms. This is the first report of enthesitis in the context of SLE. Although the possibility of coincidental occurrence of SpA and SLE cannot be excluded, the observations in this case suggest that enthesitis may be one of the manifestations of SLE. (Korean J Med 2011;80:243-246)
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)
증례 : 류마티스 ; 치료 불응성 성인형 스틸병: 아나킨라 사용 후 임상 호전을 보인 증례 보고
오지민 ( Ji Min Oh ),김형진 ( Hyung Jin Kim ),이재준 ( Jae Joon Lee ),안중경 ( Joong Kyong Ahn ),이유선 ( You Sun Lee ),고은미 ( Eun Mi Koh ),차훈석 ( Hoon Suk Cha ) 대한내과학회 2012 대한내과학회지 Vol.82 No.4
Adult-onset Still`s disease (AOSD) is a systemic inflammatory disorder with variable clinical features. The interleukin (IL)-1 receptor antagonist anakinra has been proposed as an alternative effective treatment in refractory AOSD. We report, for the first time in Korea, two cases of refractory AOSD in which anakinra treatment produced a clinical response. The first patient had frequent clinical flare-ups with fever, sore throat, myalgia, and pleuritic chest pain despite treatment with methotrexate and etanercept. In the second patient, treatments with various immunosuppressive agents failed to control the disease activity. Treatment with anakinra 100 mg/day was initiated in both cases. A complete clinical remission and improvement in the laboratory parameters were observed. The steroid dose was tapered without further clinical flare-ups. Anakinra appears to be an effective alternative treatment modality in patients with AOSD refractory to conventional disease-modifying anti-rheumatic drugs and corticosteroid therapy. (Korean J Med 2012;82:520-524)
심한 지방간과 심낭 삼출을 동반한 Weber-Christian병
김응호 ( Eung Ho Kim ),신성철 ( Sung Chul Shin ),김형진 ( Hyung Jin Kim ),안중경 ( Joong Kyong Ahn ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.2
Weber-Christian disease (WCD) was first described by Pfeifer in 1892, and more clearly defined by Weber and Christian in the 1920s. It is a process of unknown etiology characterized by recurrent fever and inflammation of the adipose tissue. Pathological studies disclose areas of fat necrosis with an inflammatory infiltrate showing a lobular pattern and the usual presence of macrophages with foamy cytoplasm. The clinical signs include tender, palpable nodules, located mainly in the extremities, and fever, abdominal pain, arthritis and arthralgia and hepatosplenomegaly have also been reported. We present a case of Weber-Christian disease in which the presence of multiple subcutaneous nodules, enophthalmos, fatty liver, pericardial effusion was noticed. Biopsy of the skin showed mixed panniculitis in the subcutaneous fat layer. She responded well to glucocorticoid, colchicine and hydroxychloroquine.
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.
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
강직척추염 환자에서 TNF-α 억제제 사용 후 악화된 건선
오지민 ( Ji Min Oh ),고은미 ( Eun Mi Koh ),김형진 ( Hyung Jin Kim ),이재준 ( Jae Joon Lee ),안중경 ( Joong Kyong Ahn ),차훈석 ( Hoon Suk Cha ),이주흥 ( Joo Heung Lee ),장기택 ( Kee Taek Jang ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
TNF-α antagonists have been successfully utilized in the treatment of autoimmune diseases, including psoriasis and psoriatic arthritis. Paradoxically, new onset or exacerbation of psoriatic lesions during treatment with TNF-α antagonists have been reported. It has been postulated that TNF-α blockade may cause disruption in the balance between TNF-α and type 1 interferon (IFN)-α, which are the key players in the pathogenesis of psoriasis. We report a case of psoriasis exacerbation during TNF-α antagonist therapy in a 53-years-old man with ankylosing spondylitis. The patient has been treated with etanercept for 3 years and 7 months when he developed accelerated deterioration of psoriasis. His condition was previously under control solely by local treatment. Physical examination revealed vigorous desquamative lesions with silvery scale in both lower legs. Deterioration of psoriasis was attributed to etanercept therapy and was subsequently discontinued. Clinical improvement of psoriasis has been observed 2 months following cessation of etanercept.