ANCA-associated vasculitis

최찬범 ( Chan-bum Choi ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

한국인에서 EQ-5D를 이용한 건강 관련 삶의 질 측정

성상석 ( Sang Seokg Seong ),최찬범 ( Chan Bum Choi ),성윤경 ( Yoon Kyoung Sung ),박용욱 ( Yong Wook Park ),이혜순 ( Hae Soon Lee ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Whan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),이오 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3

Objective: There has been no data on health related quality of life (HRQOL) in general Korean population. Assessing factors affecting HRQOL in Koreans is fundamental in HRQOL research. The objective of this study is to assess HRQOL in Korean using Korean version of EQ-5D (KEQ-5D). Methods: HRQOL was assessed using KEQ-5D from 1,044 randomly selected population representing general Korean population with telephone interview Result: The mean KEQ-5D utility score in Korean was 0.88 (range: -0.59∼1.00). Sociodemographic data showed relatively higher score in male, younger, well educated, higher income, and white color people. Among a variety of diseases, gastric ulcer/gastritis, arthritis, hypertension diabetes, low back pain were common in Korea. The most significant chronic diseases influencing Koreans were gastrointestinal disorder and arthritis. Conclusion: This paper suggests basic information on HRQOL in Korean and can be a useful parameter in comparison in the future research.

흡연과 베체트병의 임상증상 발현과의 관련성 고찰

이신석 ( Shin Seok Lee ),최찬범 ( Chan Bum Choi ),이은경 ( Eun Kyoung Lee ),박성훈 ( Sung Hoon Park ),최정윤 ( Jung Yoon Choe ),김성규 ( Seong Kyu Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

목적: 베체트병의 임상양상 및 질병 경과에서 흡연의 역할에 대한 이견이 있어 왔다. 본 연구는 한국인 베체트병 환자의 임상양상 발현과 흡연과의 관련성을 평가하고자 하였다. 방법: 1990년 제정된 International Study Group 기준에 합당한 베체트병 환자 131명을 대상으로 하였다. 베체트병의 임상양상인 구강 궤양, 음부 궤양, 안구 질환, 관절염, 혈관병변, 장 병변, 중추신경계 증상과 흡연 습관, 질환의 유병기간, HLA-B51 양성 여부를 의무기록 분석과 환자 면담을 통하여 조사하였다. 통계 분석은 Chi-square, Fisher`s Exact, 또는 student t 검정을 시행하였다. 결과: 흡연자의 혈관과 장 병변의 발생 빈도가 비흡연자에 비해 상당히 증가 되어 있었다(p=0.040, OR=3.341, 95% CI 1.083-10.305; p=0.012, OR=3.878, 95% CI 1.379-10.906). 혈관 질환의 발생에 있어 남성 흡연자가 여성 또는 남성 비흡연자에 비해 통계적으로 관련성을 보였다(p=0.025, OR=3.896, 95% CI 1.245-12.196). 그리고 흡연, 남성, HLA-B51양성이 베체트병의 장 병변 발생의 위험인자로 나타났다. 남성 흡연자의 경우 이외의 환자에 비해 정맥 혈관질환의 빈도가 통계적으로 유의하게 높게 나타났다(p=0.038). 결론: 흡연은 한국인 베체트병 환자에서의 혈관 및 장 병변 발생과 관련되어 있는 것으로 나타났다. 향후 더 많은 환자를 대상으로 흡연과 베체트병의 임상 증상 발현과의 상관관계 연구가 필요할 것으로 사려된다. Background/Aims: There is controversy related to the role of smoking in affecting the clinical features of patients with Behcet`s disease (BD). The aim of this study was to investigate the effect of smoking on clinical manifestations in Korean BD patients. Methods: We enrolled 131 patients with BD who fulfilled the International Study Group (ISG) criteria of 1990. The disease-related clinical features of BD―oral ulcers, genital ulcers, ocular lesions, arthritis, vascular lesions, gastrointestinal lesions―and central nerve lesions, smoking history, disease duration, and the presence of HLA-B51 were retrospectively assessed through medical record reviews and patient interviews. Statistical analysis was performed using Chi-square, Fisher`s exact, or student t-test, if appropriate. Results: The frequencies of vascular and gastrointestinal lesions in smokers were significantly increased compared to those in non-smokers (p=0.040, OR=3.341, 95% CI 1.083-10.305; p=0.012, OR=3.878, 95% CI 1.379-10.906, respectively). Male smokers developed vascular lesions more frequently compared to female smokers, male non-smokers, and female non-smokers (p=0.025, OR=3.896, 95% CI 1.245-12.196). Moreover, smoking, male sex, and positive HLA-B51 may be risk factors for the development of gastrointestinal lesions in BD. Venous lesions were more frequently found in male smokers compared with other patients (p=0.038). Conclusions: Smoking may be associated with the development of vascular and gastrointestinal lesions in Korean BD patients. A large population prospective assessment of the clinical effect of smoking on BD is needed. (Korean J Med 75:202-209, 2008)

국민건강영양조사를 이용한 한국인 관절염의 유병률 현황과 연도별 변화

허남욱 ( Nam Wook Hur ),최찬범 ( Chan Bum Choi ),엄완식 ( Wan Sik Uhm ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.1

Objective: To estimate the prevalence of musculoskeletal diseases, especially osteoarthritis, rheumatoid arthritis, osteoporosis and lumbar disc herniation, in Korean adults. For arthritis and total musculoskeletal diseases, trend of the age-standardized prevalence rates were evaluated. Methods: This study was based on the data obtained from the Korea National Health and Nutrition Examination Surveys (KNHANES) I, II and III, conducted in 1998, 2001 and 2005, respectively. KNHANES is a nationwide cross-sectional study using a stratified, multistage probability sampling design for the selection of household units. Annual self-reported prevalence and its confidence interval were estimated in adults aged over 19, using Health Interview Survey in KNHANES. All analyses were done using SAS 9.1 with survey procedure except for age-standardized prevalence rates for comparison prevalence rates of each survey. Age-standardized prevalence rates were calculated using a direct-method. Results: The prevalence of musculoskeletal diseases was 144.6, 140.0 and 197.2 and the annual self-reported prevalence of arthritis was 117.9, 109.2 and 146.4 per 1,000 population in 1998, 2001 and 2005, respectively. In KNHANES III, osteoarthritis was the most prevalent disease of the musculoskeletal diseases for both sex. Fifty-eight percent of the over 65 year-old population had at least one musculoskeletal disease and it was higher in women with 73%. Conclusion: The prevalence of musculoskeletal diseases was high in Koreans with arthritis being the most prevalent. The prevalence of musculoskeletal disease correlated with low sociodemographic status.

한국인 류마티스관절염 환자의 특성-단일 기관 코호트 연구

김윤정 ( Yun Jung Kim ),최찬범 ( Chan Bum Choi ),성윤경 ( Yoon Kyoung Sung ),이혜선 ( Hye Seon Lee ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.3

Objective: The aim of this study is to describe the general characteristics and potential susceptibility genes of a large cohort of Korean rheumatoid arthritis (RA) patients. Methods: After giving consent, the patients were invited to undergo a structured interview and clinical examination that were performed by rheumatologists and a specially trained research nurse. When appropriate, the information obtained by interview was supplemented by information from the patient`s medical record. We reviewed the genetic studies for the subjects in the Hanyang RA cohort to investigate the genetic characteristics of Korean RA patients. Results: The mean age of the Hanyang RA cohort was 51.6±12.4 years, and 88.1% were women. The unemployment rate was 19.6%, and 52.2% of the patients had limitation of everyday life or their work life. The mean age at the time of disease onset was 41.0±12.9 years and the duration from disease onset to initiation of treatment was 23.6±57.1 months. The smoking rate of the Hanyang RA cohort was 16.8%, and 30.8% of the patients were exposed to passive smoking. Total joint arthroplastys were performed in 158 (10.3%) patients, and the most common operation site was the knee. On the review of the genetic studies for the Hanyang RA cohort, the representative susceptibility genes for the development of RA were HLA-DRB1, PADI4, STAT4 and TRAF1-C5. Conclusion: This data of Korean RA patients can be used as the preliminary data for important studies. Establishment of a large prospective, multicenter cohort is imperative to determine the characteristics of Korean RA, and the Hanyang RA cohort is expected to play a lead role for this.

류마티스관절염에서 DAS28에 근거한 보험급여기준 적용시 항 TNF제제 대상 환자 예측

원소영 ( Soyoung Won ),성윤경 ( Yoon-Kyoung Sung ),조수경 ( Soo-Kyung Cho ),최찬범 ( Chan-Bum Choi ),고은미 ( Eun-Mi Koh ),김성규 ( Seong-Kyu Kim ),김진석 ( Jinseok Kim ),김태환 ( Tae-Hwan Kim ),김현아 ( Hyoun Ah Kim ),나성수 ( Se 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.2

Objective. The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria. Methods. Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement. Results. Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP). Conclusion. Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.

한국인 류마티스관절염 환자에서 항 TNF 제제의 지속성에 관한 연구

조수경 ( Soo Kyung Cho ),성윤경 ( Yoon Kyoung Sung ),최찬범 ( Chan Bum Choi ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.3

류마티스관절염 환자에서 의료보험 급여지침 변화가 생물학적 제제 단기 지속율에 미치는 영향

이주현 ( Joo Hyun Lee ),조수경 ( Soo Kyung Cho ),최찬범 ( Chan Bum Choi ),성윤경 ( Yoon Kyoung Sung ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.4

Objective. We aimed to investigate whether persistence rates of Tumor necrosis factor (TNF) blockers in the early period was affected by the change in reimbursement guideline of Rheumatoid Arthritis (RA) using Korean National Health Insurance (NHI) claims database. Methods. We identified patients with a diagnosis code of RA between January 2007 to December 2009 and who were 16 years of age or older, in a Korean NHI claims database. A subgroup RA patients who had recently started TNF blockers with 6 months of washout period in June 2007 (n=40), June 2008 (n=60), January 2009 (n=52) and June 2009 (n=68) were selected to compare the 6 months persistence rate. Also, we analyzed a change in prescriptions of TNF blockers in patients with RA for each 6 month period between 2007 and 2009. Results. The persistence rates of TNF blockers during 6 months in each group was not statistically significant (67.5%, 75.0%, 73.1%, and 79.4%, p=0.22). However, when we compared the frequency of new patients started on TNF blockers in June 2009 to those in the same months in 2008 and 2007; there was a tendency to increase. During change in TNF blocker prescriptions between 2007 and 2009, the overall utilization of TNF blockers increased. Conclusion. The persistence rate of TNF blockers in the early period was not affected by change of reimbursement guidelines of RA. However, long-term design and multivariate analysis will be needed to identify the impact of change in reimbursement guideline on the persistence of TNF blockers.

항 Tumor Necrosis Factor 제제 사용 전 잠복결핵 진단 전략에 따른 결핵 발생률

성윤경 ( Yoon Kyoung Sung ),조수경 ( Soo Kyung Cho ),원소영 ( Soyoung Won ),최찬범 ( Chan Bum Choi ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.4

Objective. To compare the incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients using tumor necrosis factor (TNF) inhibitors following two strategies for latent tuberculosis infection (LTBI) screening: Tuberculin skin test (TST) only vs. TST plus Qauntiferron-TB gold in tube (QFT-GIT). Methods. Data was extracted from a retrospective cohort of Korean RA patients who used biologic agents. Of the 406 RA patients who underwent TST before starting TNF inhibitor, we selected 355 patients who strictly followed LTBI screening and treatment strategies. Two hundred and twenty-two patients were classified as TST only group and the remaining 133 patients as TST plus QFT-GIT group. We calculated the standardized incidence ratio of TB in the entire sample and compared the TB incidence between groups. Results. Among the patients who received the TST only strategy (n=222, 538.6 person-year [PY]), two patients developed TB during anti-TNF therapy, while of those who followed the TST plus QFT-GIT strategy, none developed TB (n=133, 108.8 PY). The overall crude incidence of TB in RA patients using TNF inhibitors was 314 per 100,000 PY. Compared with the general population, the overall age standardized incidence of TB in TNF inhibitor users who followed management guideline for LTBI was 3.9. Conclusion. Despite following screening and management guidelines for LTBI, TB incidence for RA patients during anti-TNF therapy is higher than in the general population. Combining QFT-GIT with TST as a screening for LTBI might be reduce the risk of TB. (J Rheum Dis 2015;22:223- 230)

원저 : 피부근육염/다발근육염에서 발생한 자발 종격동기종의 임상적 의미

김진주 ( Jin Ju Kim ),김담 ( Dam KIm ),김은경 ( Eun Kyoung Kim ),손일웅 ( Il Woong Sohn ),정경희 ( Kyong Hee Jung ),최찬범 ( Chan Bum Choi ),성윤경 ( Yoon Kyoung Sung ),전재범 ( Jae Bum Jun ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae H 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2

Objective: Pneumomediastinum (PnM), a rare complication of dermatomyositis and polymyositis (DM/PM), is sporadic and has an unclear pathogenesis. PnM is almost always associated with interstitial lung disease (ILD), and is a poor prognostic factor in inflammatory myositis patients. We studied the prevalence of PnM in Korean DM/PM and its clinical significance. Methods: We retrospectively studied the medical records of 161 patients diagnosed with DM/PM meeting Bohan-Peter`s criteria at Hanyang University Hospital for Rheumatic Diseases from 1995 to 2010. We collected following findings; demographic data, diagnosis, lung involvement, cause of death, and duration from diagnosis to death. Results: One hundred nineteen patients (73.9%) were DM and 42 patients (26.1%) were PM. Eighty three patients (51.6%) developed ILD at diagnosis or during follow up. Eighteen patients (11.2%) died because of ILD aggravation, infection, or malignancy. The mean duration from diagnosis to death was 11.5 months, with 10 patients (6.2%) dying from from ILD aggravation but none with spontaneous PnM. 6 patients (3.7%) presented with PnM, and it was associated with ILD worsening in all cases. PnM resolved with O2 inhalation, corticosteroids, and/or immunosuppressive agents after 11 weeks (mean) of therapy Conclusion: PnM is rare but associates with DM and aggravation of ILD. PnM does not usually cause fatalities and can be cured by appropriate therapy.