조기 천장골염의 자기공명영상 소견

김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),심승철 ( Seung Cheol Shim ),장대국 ( Dae Kook Chang ),고회관 ( Hee Kwan Koh ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),전의용 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

목적: 천장골염의 유무가 척추 관절염의 진단에 중요한데 단순 골반 검사에서 변화가 없는 환자를 대상으로 MRI를 이용하여 천장골염의 조기변화 소견 및 MRI방법에 따른 장점을 비교하고자 하였다. 대상 및 방법: 단순 골반 검사에서 천장골염 유무가 확실하게 구분되지 않은 혈청 음성 척추 관절염 환자 26명을 대상으로 MRI를 시행하고 염증의 주침범위치를 천측과 장측, 관절의 상하로 구분하고, MRI방법에 따른 변화를 비교하였다. 결과: 모든 예에서 조영 증강되는 판누스를 관찰할 수 있었고, Grade I 이하에서는 장골측과 관절하부, 인대성 관절보다 활막성 관절을 더 많이 침범하였다. Grade II 이상에서도 장골측과 관절 하부에 더 많았으나 인대성 관절을 Grade I이하에서보다 더 많이 침범하였다. 관절 주변 지방 침착역시 장골측과 관절 하부에 더 주로 침범하였고 Grade II 이상에서 약간 더 많았다. 관절 주변 골염은 Grade 0에서는 없었고, Grade I에서는 주로 장골측과 관절 하부에서 92%가 양성이었고, Grade II에서는 93%에서, Grade III에서는 64%에서 양성으로, 장골측을 주로 침범하였으나 관절 상하부의 구분은 없었다. 인대성 천장골 관절은 Grade I 이하에서 38%, II 이상에서는 94%에서 침범하였다. 관절 주변 골염과 지방 침착, 그리고 판누스의 관찰에는 MPGR보다 스핀에코 영상이 좋았고, 관절면의 불규칙성 또는 관절강의 확대와 관절 강직여부의 관찰에는 스핀에코에 비해 MPGR 영상이 좋았고, 연골하 경화는 비슷하였다. 천장골염의 정도와 ESR, CRP와의 연관성은 없었다. 걸론: 천장골 관절에서 염증의 시작은 주로 장골 측과 관절의 하부에서 먼저 시작되고, 관절이 진행될수록 장골측에서 천골측까지로 범위가 확대 되었다. MRI방법에 의한 차이로 초기단계에는 스핀에코 영상이 관절염을 확인하는데 도움이 되고 관절면이 불규칙하게 되고 경화가 되어 병이 진행된 상태에서는 MPGR영상이 진단에 더 도움이 되었다. 염증성 배부 동통이 있는 경우 단순 골반 검사에서 이상이 없는 환자인 경우에도 MRI 검사를 시행하여 천장골염의 유무를 확인하는 것이 중요하다. Objective: The early detection of sacroiliitis on X-ray is important to diagnose spondyloarthropathy(SpA). The conventional radiography, bone scan, and computer tomogram have the problems of sensitivity, specificity, and side effects. We examined sacroiliitis using MR imaging in patients who had inflammatory back pain, but no definite changes in conventional radiogrphy. Other radiologic techniques were compared in detection of early sacroillitis. Methods: Twenty six patients with SpA were examined. The MRI findings of both sacroiliac joints were evaluated in every patients, such as pannus, periarticular osteitis and fat accumulation, subchondral sclerosis, and joint space changes(irregularity, ankylosis). Also we analyzed the changes of sacroiliac joints in sacroiliitis. Results: The predominant sites of involvement were upper aspect and iliac surface of sacroiliac joint in subchondral sclerosis, lower and iliac in pannus, periarticular fat accumulation, and iliac in periarticular osteitis. The MPGR images were superior to spin echo images in evaluation of joint space changes(irregularity, and ankylosis). Conclusions: Sacroiliitis is initiated in iliac side and lower portion of sacroiliac joints. MRI can detect early changes of sacroiliitis in patients with no conventional radiographic changes. MRI seems to be needed in patients with inflammatory back pain.

갑상선 기능저하성 근육병

장대국 ( Dae Kook Chang ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ),오영배 ( Young Bae Oh ),전재범 ( Jae Bum Jun ),고희관 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

Hypothyroidism may be accompanied by different rheumatic syndromes such as neuropathy, arthropathy and myopathy. Severe myopathy with high elevations of creatine kinase (CK) is rarely seen in hypothyroidism. Authors experinced a case of myopathy with hypothyroidism, similar to rheumatoid arthritis or polymyositis-like syndrome. We have treated with thyroid hormone replacement (Levothyroxine sodium 100ug/day) for 10 months. The initial serology resulted in: free T4 0.51ng/dl, TSH 110uIU/ml, LDH 465 units, and CK 4385 units. After treatment, we gained free T4 1.60ng/dl, TSH 0.14uIU/ml, LDH 110 units, and CK 80 units and musculoskeletal symptoms are much improved. We report this patient with a review of literatures.

CD40와 종양괴사인자 수용체에 의한 B림프구 Fas항원 발현과 세포사멸 유도에 관한 연구

장대국 ( Dae Kook Chang ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.1

Objective: CD40 and the TNFR belong to the NGF/TNFR supergene family. Ligation of CD40 on B cells induces activation signals leading to proliferation, Ig isotype class switching, germinal center formation but also induces Fas antigen expression. In addition, CD40 ligation induces pro-inflammatory cytokines including TNF-α and LT-α gene transcription by human B cell. TNF-α is a pleiotropic cytokine and also induces Fas antigen expression on various cells. Lately it has been known that TNF-α plays an important role in the pathogenesis of chronic inflammatory diseases, including rheumatoid arthritis, or chronic inflammatory bowel diseases. However there have been occurrence of autoantibodies, or autoimmune disease such as lupus after use of anti TNF-α blocking agents. In this report, we tested the relationship and biological significance of CD40 ligation and TNFR signaling with respect to Fas antigen expression on human B cells. Methods: Ramos Burkitt`s lymphoma B cell was used as a prototype of germinal center B lymphocyte, and R2G6 cell was utilized as a model of activated germinal center B cell. CD40 Igation was performed by the coculture with CD40 ligand bearing L-293 cells, or anti-CD40 monoclonal antibody, whereas control was obtained with CD-8-L-293 cells or control antibody. Expression of Fas antigen was determined with flow cytometer. Apoptosis assay was conducted by two ways. Alamar blue reduction assay after sIgM cross linking or anti-Fas anti-body, in the presence or absence of CD40 ligation or TNF-α In addition, DNA content assay was utilized to make sure the proportion of apoptotic Ramos B cells by various treatments. Results: 1) CD40 and TNF-α induced Fas antigen expression on Ramos B cell line cells and rendered them susceptible to Fas-mediated apoptosis. 2) CD40 and TNFR signaling upregulate Fas antigen independently. 3) Both TNFR and CD40 signaling rescue sIgM crosslink induced apoptosis of Ramos B cell line cells, only CD40, but not TNFR, signaling rescues Ramos cells from Fas-mediated apoptosis. Conclusion: Taken together, these results demonstrate that B cell signaling via two distinct members of the NGF/TNFR superfamily, CD40 and TNFR, independently engage the Fas pathway and provide mechanisms for eliminating B cells. Acting alone, both signals will ready B cells for Fas-mediated apoptosis. In concert with sIg signaling, the rescue effect provided uniquely by CD40 ligation assures the selective survival of only those B cells which have bound antigen and presented it to antigen-specific T(h) cells.

Early Valuable factors for identifying juvenile - onset ankylosing spondylitis from type 2 pauciarticular juvenile rheumatoid arthritis

장대국(Dae Kook Chang),김태환(Tae Hwan Kim),심승철(Seung Cheol Shim),고희관(Hee Kwan Koh),정자훈(Ja Hun Jung),송용호(Yong Ho Song),전재범(Jae Bum Jun),정성수(Sung Soo Jung),이인홍(In Hong Lee),배상철(Sang Cheol Bae),유대현(Dae Hyun Y 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

한국인에서 Adult Onset Still`s Disease의 임상상과 예후 인자에 관한 연구

조균석 ( Kyoon Seok Cho ),유대현 ( Dae Hyun Yoo ),윤형란 ( Hyung Ran Yun ),이명호 ( Myong Ho Lee ),이제경 ( Je Kyung Lee ),심승철 ( Seung Cheol Shim ),장대국 ( Dae Kook Chang ),유태석 ( Tae Seok Yoo ),고희관 ( Hee Kwan Koh ),김태 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objective: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still`s disease (AOSD) in Korea. Methods: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, intermittent, or chronic disease course. Results: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12(38%) patients. Anemia (Hb<10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3.5 g/dL) in 14 (52%) patients. Elevated ferritin (≥300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3-108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an intermittent or chronic disease group(p<0.05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. Conclusion: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.

류마티스 관절염 환자의 활막세포에서 TNF-α에 의해 활성화된 Nuclear Factor κB에 대한 N-(2-mercapto-2-methylpropanoyl)-L-Cysteine(bucillamine)의 효과

전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),이은영 ( Eun Young Lee ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),정자헌 ( Ja Hun Jung ),장대국 ( Dae Kook Chang ),배상철 ( Sang Cheol Bae ),최영길 ( Yong Keel Choi ),김성윤 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

Objective: Bucillamine(BUC) is a new disease-modifying anti-rheumatic drug, which is structurally similar to D-penicillamine. In type II collagen induced arthritis, BUC inhibited the proliferation of synovial lining cells. This study was designed to demonstrate whether BUC inhibits TNF-α-induced synovial cell proliferation or NF-κB activation in cultured synovial cells from patients with RA. Methods: The non-radioactive, colorimetric assay system was applied to cell proliferation assay. The activation of NF-κB was assessed by electrophoretic mobility shift assay. Results: Synovial cells proliferated in a dose-dependent manner in the presence of varying concentrations of TNF-α. The proliferative activity of synovial cells was inhibited in a dose-dependent fashion by BUC. Incubation of synovial cells with 20ng/ml TNF-α resulted in the appearance of shifted NF-κB bands. Control experiments indicated that these bands were eliminated by a 100-fold excess of unlabeled NF-κB probe, but not by a 100-fold excess of unrelated oct-1 probe. These findings represented that the binding between NF-κB and labeled probe is specific. Pretreatment with 30μg/ml BUC for 2 hours partially inhibited TNF-α-induced NF-κB activation in synovial cells. Conclusion: BUC inhibited the activation of NF-κB, which further explains the mechanism of action of this drug. Further studies on mechanism of inhibitory action of BUC on NF-κB activation are considered necessary.

류마티스 관절염 환자에서 미립체로 구성된 거대 견봉하 점액낭염

심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),장대국 ( Dae Kook Chang ),이제경 ( Je Kyung Lee ),유태석 ( Tae Seok Yoo ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Rice bodies are numerous small fibrinous, cartilaginous-like materials which were first described in tuberculous joints. Rice bodies are common findings in joints afflicted with rheumatoid arthritis or other seronegative arthropathy. But less commonly, those can be seen in periarticular bursae or at the sites of tendon or ligament insertion. Rice bodies, thought to be a nonspecific response to synovial inflammation, probably evolve from ischemia in a proliferative synovium. Some of these bodies contain a core of collagen with a mantle of fibrin, others contain only fibrin. Subacromial bursa are sometimes involved in the patients with rheumatoid arthritis and can reach impressive dimensions before becoming clinically detectable because significant constrain is lacking. Subacromial arthrography or magnetic resonance imaging accurately delineated the existence of cartilaginous loose bodies before surgical exision. We experienced a man with rheumatoid arthritis who had massive subacromial bursitis with rice bodies. His shoulder had been swollen since 5 years ago. He felt no pain and had only mild limitation of motion. Subacromial arthrography or magnetic resonance imaging of right shoulder showed multiple rice bodies in enlarged subacromial bursa. Operation finding showed a large encapsulated mass in the subacromial bursa, and hundreds of fibrinous rice bodies were revealed, which were resected. We report this patient with a review of literatures.

조기 류마티스 관절염 환자에서 수부 방사선학적 소견 및 진행의 의의 (意義)

송용호(Yong Ho Song),전재범(Jae Bum Jun),정자헌(Ja Hun Jung),장대국(Dae Kook Chang),심승철(Seung Cheol Shim),고희관(Hee Kwan Koh),김태환(Tae Hwan Kim),정성수(Sung Soo Jung),이인홍(In Hong Lee),배상철(Sang Cheol Bae),유대현(Dae Hyun Y 대한내과학회 1998 대한내과학회지 Vol.55 No.6

N/A Objectives: To evaluate the disease status in relation to the radiological findings of hands using some short term indices of disease activity and laboratory tests in early rheumatoid arthritis. Method: 136 patients with symptoms of rheumatoid arthritis for less than 2 years were studied by means of measuring erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anti-nuclear antibody. Of these, 71patients were performed the radiographies of hands at mean 1.3months after diagnosis, Also, 30 radiological films of hands were studied for measurement of intra- & inter-observer variations by well-trained rheumatologist and radiologist. All films were scored by the modified Sharps method. Results: The radiological features of hands showed that the carpal bone was involved more common in the bony erosion (5.7%) and the joint space narrowing (8.8%), and the radiological progression in the interval of 24 months was positively correlated with the disease duration(p<0.05). Also, the radiological lesions and progressions appeared more severe in high disease activity, C-reactive protein (r : 0.334, p : 0.004) and Ritchie index (r : 0.249, p : 0.01) at diagnosis. On the other hand, they were correlated negatively with the age of disease onset (r : -0.357, p : 0.002). The Spearman correlations of inter- & intra-observer varia1ians were signi5cant by 0.716 and 0.775. Conclusion: The development of radiological lesions in early rheumatoid arthritis is closely correlated with the duration of disease. The patients with early rheumatoid arthritis who had active arthritis at the time of diagnosis showed mare severe radiological progressions.

항인지질항체 증후군을 동반한 복합 교원성 질환

이제경 ( Je Kyung Lee ),정성수 ( Sung Soo Jung ),유태석 ( Tae Seok Yoo ),장대국 ( Dae Kook Chang ),심승철 ( Seung Chul Shim ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),이인홍,배상철 ( Sang Cheol Bae ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

The presence of antiphospholipid antibodies in systemic lupus erythematosus (SLE) and the primary antiphospholipid antibody syndrome(APS) are well-known risk factors for thrombosis. However, aCL associated with rheumatic diseases other than SLE or primary APS tend to be in low prevalence and low titer, and unassociated with clinical complications. We experienced a 31-year-old female patient with painful swelling, purpura, and intermittent claudication of both lower extremities, moderate thrombocytopenia, and persistent positive antiphospholipid antibodies(43 GPL of aCL, positive LAC). Four years prior to admission, she had been diagnosed at our hospital as a mixed connective tissue disease because of positive anti-nRNP, Raynaud`s phenomenon, swollen hands, polyarthritis, sclerodactyly. After anticoagulant therapy, she experienced remarkable symptomatic improvement. We report an unusual case of antiphospholipid antibody syndrome in mixed connective tissue disease with a review of the literature.

류마티스 관절염 환자에서 발생된 치골지와 천골의 부전형 피로 골절

정자헌 ( Ja Hun Jung ),전재범 ( Jae Bum Jun ),심승철 ( Seung Cheol Shim ),장대국 ( Dae Kook Chang ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Insufficiency fractures of the sacrum and pubic rami commonly occurs as a results of osteoporosis, usually without a history of trauma, especially in the patients with rheumatoid arthritis. In addition to rheumatoid arthritis and osteoporosis, the other predisposing factors for this condition were renal failure, prolonged corticosteroid therapy, pelvic irradiation, inflammatory diseases, malignancy and mechanical changes after hip surgery. The clinical presentation included progressive inguinal pain, limping, and inability to walk. If a high index of suspicion is not present, subtle findings on radiographs may be missed. Diagnosis of insufficiency fractures is difficult in the early stages. Because initial radiographs are not usually diagnostic, bone scintigraphy and computed tomography were necessary to confirm the diagnosis and detect additional fractures. In most patients, bed rest, non-weight bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up of this fractures shows usually benign outcome. So insufficiency fracture of the pelvic bone should be suspected in cases of unexplained inguinal or hip-area pain and inability to walk in the elderly. We present 3 patients with rheumatoid arthritis in our hospital who were found to have insufficiency fractures of sacrum and pubic rami in 2 patients and that of pubic rami on 1 patients with literature review.