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Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy
Lee Eunyoung Emily,Jun Jong Kwan,Lee Eun Bong 대한의학회 2021 Journal of Korean medical science Vol.36 No.4
Antiphospholipid syndrome (APS), which is characterized by the presence of antiphospholipid antibodies (aPL), is associated with increased risk of thrombosis and obstetric complications, including preterm delivery and recurrent pregnancy losses. APS shows diverse clinical manifestations and the risk of complications varies among clinical subtypes. Although these patients are usually treated with aspirin and anticoagulants, the optimal treatment in various clinical settings is unclear, as the risk of complications vary among clinical subtypes and the management strategy depends on whether the patient is pregnant or not. Also, there are unmet needs for the evidence-based, pregnancy- related treatment of asymptomatic women positive for aPL. This review focuses on the management of positive aPL or APS in pregnant and postpartum women, and in women attempting to become pregnant. For asymptomatic aPL positive women, no treatment, low dose aspirin (LDA) or LDA plus anticoagulants can be considered during antepartum and postpartum. In obstetric APS patients, preconceptional LDA is recommended. LDA plus low molecular weight heparin is administered after confirmation of pregnancy. Vascular APS patients should take frequent pregnancy test and receive heparin instead of warfarin after confirmation of pregnancy. During pregnancy, heparin plus LDA is recommended. Warfarin can be restarted 4 to 6 hours after vaginal delivery and 6 to 12 hours after cesarean delivery. Most importantly, a tailored approach and patient-oriented treatment are mandatory.
S-701 항인지질증후군을 동반한 루프스 환자에서 hydroxychloroquine을 중단한 후 발생한 대뇌경색 증례보고
( Eunyoung Emily Lee ),( Yeong Wook Song ),( Eun Bong Lee ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
서론: Anti-phospholipid antibodies are known to increase the risk of thrombosis in SLE patients. Hydroxychloroquine is recommended to be continued during pregnancy to decrease the risk of thrombosis and to improve pregnancy outcome. We present a case that supports hydroxychloroquine as thrombo-protective agent in APS. 증례: A 33-year old woman was admitted in 2014, because of left side weakness. Six years ago, the patient was diagnosed with SLE and lupus anti-coagulant was positive at that time. Prednisolone was slowly tapered to 2.5mg/day with hydroxychloroquine 100mg/day. However 2 months before admission, she discontinued the medications by herself for planning a baby. Muscle strength of left arm was decreased to 4/5 and showed hypoesthesia. C3 and C4 were decreased to 59mg/dl and 7mg/dl and anti dsDNA titer was increased to 9.2IU/ml from 6.1IU/ml. Anti-cardiolipin IgG and anti-b2-Glycoprotein I IgG were positive. CRP and ESR were in normal range. After OBGY exam she was found to be pregnant at 6 weeks. Brain MRI showed acute infarction involving right precentral and postcentral gyrus. The diagnosis of thromboembolic stroke associated with antiphospholipid syndrome was made. Aspirin and LMWH (1 mg/kg bid) plus 300mg of hydroxychloroquine were prescribed. Weakness was completely recovered and at 12 week of gestation, routine examination showed fetal and maternal well-being. However at 22th gestational weeks, fetal death in utero was discovered. 결론: This is the first case of cerebrovascular event after discontinuation of hydroxychloroquine in SLE patient with APS. Studies have shown that SLE is most likely to flare when antimalarial drugs are discontinued and hydroxychloroquine can be used as prophylactic treatment for thrombosis event is SLE and APS patients. Therefore, it can be postulated that the patient in this case underwent cardiovascular event due to lupus flare following discontinuation of hydroxychloroquine. Since SLE, in the presence of anti-phospholipid antibody, can lead to thrombosis and obstetric morbidities, it is important to keep adequate medication including hydroxychloroquine during pregnancy.
( Eunyoung Emily Lee ),( Min Jung Kim ),( Yeong Wook Song ),( Jin Kyun Park ) 대한류마티스학회 2020 대한류마티스학회지 Vol.27 No.2
The treatment of adult-onset Still’s disease (AOSD) aims to control systemic inflammation and prevent organ damage. Systemic inflammation can be controlled with corticosteroid (CS) monotherapy in most cases. However, symptoms often flare as CS is tapered, often requiring long-term CS treatment, with its associated risks of infection, cardiovascular disease, and osteoporosis. Disease-modifying antirheumatic drugs (DMARDs) are often used as CS-sparing agents; however, the choice of DMARD has been largely empirical. Methotrexate (MTX) is recommended as the first-line steroid-sparing drug due to its well-known efficacy and safety in rheumatoid arthritis (RA). When MTX treatment is unsuccessful in AOSD, the choice of a second-line drug has not been established. In RA, leflunomide (LEF) has been used as an alternative to or in combination with MTX. To date, there has been no adequate assessment of the combination of LEF and MTX in AOSD. Here, we report a case of refractory chronic AOSD successfully treated with the MTX-LEF combination.
( Youjin Jung ),( Eunyoung Emily Lee ),( Jina Yeo ),( Mi Hyeon Kim ),( Se Rim Choi ),( Yeong Wook Song ) 대한류마티스학회 2021 대한류마티스학회지 Vol.28 No.4
Mixed cryoglobulinemic vasculitis (CV) is occasionally caused by autoimmune diseases including systemic sclerosis. Multiorgan involvement such as skin, kidney, and peripheral nerve involvement is common in mixed CV. However, central nervous system (CNS) involvement is extremely rare. Here, we report a case of overlap syndrome of limited cutaneous systemic sclerosis and mixed cryoglobulinemic vasculitis with CNS involvement. The neurologic deficits and systemic symptoms improved promptly after steroid and cyclophosphamide therapy. (J Rheum Dis 2021;28:242-246)
Sang Hyun Joo,Jin Kyun Park,Eunyoung Emily Lee,Yeong Wook Song,Sung-Soo Yoon 대한혈액학회 2016 Blood Research Vol.51 No.3
BackgroundSince cell turnover in the hematopoietic system constitutes a major source of uric acid (UA) production, we investigated whether hematopoietic stem cell transplantation (HSCT) is associated with significant changes in serum UA levels in patients with hemato-logical disorders. MethodsPatients who underwent HSCT at our institution between 2001 and 2012 were retro-spectively enrolled. Serum UA levels at 3 months before, 1 week before, and 3 months and 1 year after HSCT were examined. ResultsComplete clinical and laboratory information including data regarding UA levels was avail-able for 93 patients. At baseline, the mean UA level was 4.9±2.1 mg/dL, with an overall prevalence of hyperuricemia of 15% (defined as serum UA>6.8 mg/dL). Mean UA levels tended to be higher in patients with acute myeloid leukemia (4.8±2.0 mg/dL) and non-Hodgkin lymphoma (5.1±2.3 mg/dL) and lower in patients with aplastic anemia (mean, 4.2±1.8 mg/dL). UA levels dropped during myeloablative conditioning, reaching a nadir on the day of HSCT (3.27±1.4 mg/dL). Over the 3 months following HSCT, UA levels rose sharply (5.0±2.1 mg/dL) and remained stable up to 1 year after HSCT (5.5±1.6mg/dL). UA levels in HSCT recipients at 12 months correlated with those of their respective graft donors (Pearson r=0.406, P=0.001).ConclusionHSCT is associated with significant changes in uric acid levels in patients with hematologic disorders.
최인아,김지현,이윤종,강은하,하유정,신기철,이정석,Eunyoung Emily Lee,박진균,이은영,이은봉,송영욱 대한의학회 2019 Journal of Korean medical science Vol.34 No.22
Background: We aimed to assess the performance of the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for gout in Korean patients with acute arthritis and to compare the performance of the ACR/ EULAR criteria to that of other sets of criteria for gout classification. Methods: Patients with acute arthritis who underwent diagnostic arthrocentesis at one of the four participating rheumatology clinics were consecutively enrolled between February and December 2017. Crystal-proven gout was diagnosed upon confirming the presence of monosodium urate (MSU) crystals in patients with a clinical impression of gout as judged by the rheumatologist. The performance of the ACR/EULAR and other gout classification criteria, including the Rome, New York, American Rheumatism Association (ARA), Mexico, and Netherlands criteria, was analyzed regardless of the presence/absence of MSU crystals. Results: The study enrolled 118 gout patients (all crystal-proven) and 95 non-gout patients. According to the area under the curve, the diagnostic performance was the highest for the ACR/EULAR classification criteria (sensitivity, 80.5%; specificity, 95.8%; area under the curve, 0.966), followed by the Netherlands, Rome, ARA, New York, and Mexico criteria. All six sets of criteria demonstrated lower sensitivity in patients exhibiting the first episode of acute arthritis. Conclusion: In Korean patients with acute arthritis, the ACR/EULAR classification criteria outperformed other sets of gout classification criteria even in the absence of information regarding the presence of MSU crystals. However, to enhance diagnostic sensitivity, synovial fluid analysis should be considered in patients with the first episode of acute arthritis.