Impact of Osteoarthritis on Household Catastrophic Health Expenditures in Korea

Kim, Hyoungyoung,Cho, Soo-Kyung,Kim, Daehyun,Kim, Dalho,Jung, Sun-Young,Jang, Eun Jin,Sung, Yoon-Kyoung The Korean Academy of Medical Sciences 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.21

<P><B>Background</B></P><P>Osteoarthritis (OA) is a disease of old age whose prevalence is increasing. This study explored the impact of OA on household catastrophic health expenditure (CHE) in Korea.</P><P><B>Methods</B></P><P>We used data on 5,200 households from the Korea Health Panel Survey in 2013 and estimated annual living expenses and out-of-pocket (OOP) payments. Household CHE was defined when a household's total OOP health payments exceeded 10%, 20%, 30%, or 40% of the household's capacity to pay. To compare the OOP payments of households with OA individuals and those without OA, OA households were matched 1:1 with households containing a member with other chronic disease such as neoplasm, hypertension, heart disease, cerebrovascular disease, diabetes, or osteoporosis. The impact of OA on CHE was determined by multivariable logistic analysis.</P><P><B>Results</B></P><P>A total of 1,289 households were included, and households with and without OA patients paid mean annual OOP payments of $2,789 and $2,607, respectively. The prevalence of household CHE at thresholds of 10%, 20%, 30%, and 40% were higher in households with OA patients than in those without OA patients (<I>P</I> < 0.001). The presence of OA patients in each household contributed significantly to CHE at thresholds of 10% (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16–1.87), 20% (OR, 1.29; 95% CI, 1.01–1.66), and 30% (OR, 1.37; 95% CI, 1.05–1.78), but not of 40% (OR, 1.17; 95% CI, 0.87–1.57).</P><P><B>Conclusion</B></P><P>The presence of OA patients in Korean households is significantly related to CHE. Policy makers should try to reduce OOP payments in households with OA patients.</P>

A Case of Stress Cardiomyopathy Complicated by Torsades de Pointes in a Patient with Acute Colitis: A Case Report

Hyoungyoung Kim,Gi Byoung Nam,Sang Jin Lee,Hyun Kee Lee,Yoonki Hong,Kee Joon Choi,You Ho Kim Korean Society of Critical Care Medicine 2007 Acute and Critical Care Vol.22 No.2

A 67-year old woman, hospitalized for the management of infectious colitis, developed acute congestive heart failure. Two-dimensional echocardiography revealed left ventricular apical akinesia (ballooning) and basal hyperkinesis, which was compatible with stress cardiomyopathy. A marked QT prolongation and T wave inversion followed by nonsustained polymorphic ventricular tachycardia was noted in the electrocardiogram. Intravenous administration of magnesium completely suppressed the ventricular tachycardia. After recovery from the colitis, the follow-up ECG and echocardiogram were normalized. There was no evidence of ischemic heart disease in the coronary angiography or perfusion scan. Takotsubo cardiomyopathy is one of the most important causes of acquired QT prolongation in ICU (intensive care unit) patients.. A careful monitoring of the QT interval in these patients is warranted particularly when drugs causing QT prolongation are used.

Epidemiology of Rheumatoid Arthritis in Korea

( Hyoungyoung Kim ),( Yoon-kyoung Sung ) 대한류마티스학회 2021 대한류마티스학회지 Vol.28 No.2

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetrical involvement of the joints, associated extra-articular manifestations and functional disability. In Korea, several epidemiologic studies reporting prevalence and incidence rates of RA have been conducted using large databases such as claims databases, national surveys, prospective cohort databases or electronic health records; according to these data sources, the estimated prevalence ranged from 0.27% to 1.85%. The prevalence of extra-articular manifestations such as interstitial lung disease (ILD) and Sjögren’s syndrome (SS) were also reported, but an issue of external validity of the study results persisted. In this review, we detail the epidemiology of Korean RA patients, focusing on the prevalence of RA and the frequency of systemic extra-articular manifestations including ILD and SS reported in previous studies. In addition, we discuss the current methodological issues which are inherent in Korean epidemiologic studies for patients with RA with understanding of the characteristics of each database. (J Rheum Dis 2021;28:60-67)

루푸스 신염에서 동반된 Rhupus syndrome 1예

( Hyoungyoung Kim ),( Seonghoon Han ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

서론: Rhupus syndrome (RS)은 전신성 홍반성 루푸스(SLE)와 류마티스 관절염(RA)의 임상적, 병리학적, 면역학적 특징들이 모두 나타나는 질환이다. RS에서 관찰되는 루푸스는 전신증상 및 혈액학적 이상소견이 주로 나타나며 신장을 침범한 경우는 매우 드물게 보고되고 있다. 이에 저자들은 루푸스 신염(Lupus nephritis)에서 동반된 RS 1예를 경험하여 보고하고자 한다. 증례: 특이병력이 없는 46세 여자환자가 내원 6개월 전부터 시작된 다발성 관절통으로 내원하였다. 신체진찰에서 체온은 38.2℃였고, 안면 발진, 하지 부종이 있었다. 양측 손가락 및 발가락 관절에 다발성 관절종창 및 압통이 있었으나 관절변형은 없었다. 혈액검사에서 백혈구 2,880/μL, 혈소판 450,000/μL, 혈색소 5.0 g/dL이었고 혈중요소질소/크레아티닌 42.9/1.79 mg/dL, 총 단백질/알부민 6.1/2.5 mg/dL로 소변검사에서 요단백 2+, 24시간 요단백은 10,383 mg이었다. 면역혈청학적 검사에서 ANA, anti-dsDNA Ab, anti-Sm Ab는 모두 양성이었고 C3 31 mg/dL로 감소되어 있었다. RF는 음성이었으나, anti-CCP Ab는 양성이었다. 혈액학적 검사에서 Direct, indirect coombs’ 검사는 모두 양성이었다. 흉부 방사선 사진에서 심비대가 있었고, 심장 초음파에서 심낭삼출이 있었다. 양 손과 발의 방사선 사진에서는 이상이 없었으나 관절초음파검사에서 다수의 중수지절관절, 중족지절관절에서 윤활막염 소견과 골미란이 관찰되었다. 신장조직검사에서는 diffuse global endocapillary proliferative glomerulonephritis (Class IV)가확인되었다. 환자는류마티스 관절염과 루푸스의 진단기준을 각각 만족하여 RS로 진단하였으며, cyclophosphagmide와 methylprednisolone를 투약하였다. 이후 발열 및 관절통 등의 증상은 호전되었고 신기능도 회복되어 외래 추적 진료 중이다. 결론: RS는 RA가 발현된 이후 SLE를 동반하는데, 이 때 신장을 침범한 RS가 발견되는 빈도는 매우 낮다. 따라서 RS를 적극적으로 치료하기 위해서는 이를 정확하게 진단할 수 있는 자가면역 항체와 영상검사에 대한 추가 연구가 필요하다.

내시경 점막하 박리술로 치료한 크기가 증가한 위 염증성 섬유양 용종

김형영 ( Hyoungyoung Kim ),최정민 ( Jeongmin Choi ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.6

A Case of Hepatic Inflammatory Pseudotumor Occurred in a Patient with Lupus Nephritis

( Min Jung Kim ),( Hyoungyoung Kim ),( Yeo-jin Song ),( Soo-kyung Cho ),( Yoon-kyoung Sung ) 대한류마티스학회 2019 대한류마티스학회지 Vol.26 No.2

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease affecting various organs. Among its manifestations, inflammatory pseudotumor (IPT) is an extremely rare disease about which no case has been reported of it occurring in the liver. We present a case of a SLE patient with hepatic IPT (hIPT) successfully treated with immunosuppressants. A 16-year-old male with elevated liver enzymes visited our clinic and was diagnosed as SLE. Although no lesion was observed in the initial abdomen ultrasonography, the abdominal CT on hospital day 7 revealed a new hepatic mass resembling an abscess. Despite 5 weeks of antibiotics treatment, the hepatic mass remained, and was re-diagnosed as hIPT secondary to SLE with an abdominal MRI. After high dose prednisolone and mycophenolate mofetil treatment, lupus activity subsided and hIPT disappeared in the follow- up CT. This case suggests that hIPT should be considered as a differential diagnosis among hepatic mass in SLE patients. (J Rheum Dis 2019;26:137-141)

Comparative effectiveness of JAK inhibitors and biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis

Soo-Kyung Cho,Hyoungyoung Kim,Yeo-Jin Song,Hye Won Kim,Eunwoo Nam,Shin-Seok Lee,Hye-Soon Lee,Sung-Hoon Park,Yeon-Ah Lee,Min-Chan Park,Sung Hae Chang,Hyoun-Ah Kim,Seung-Ki Kwok,Hae-Rim Kim,Hyun-Sook Ki 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.4

Background/Aims: We aimed to compare the effectiveness and safety of Janus kinase inhibitors (JAKi) vs. biologic disease-modifying antirheumatic drugs (bDMARD) in Korean patients with rheumatoid arthritis (RA) who had an inadequate response to conventional synthetic DMARDs. Methods: A quasi-experimental, multi-center, prospective, non-randomized study was conducted to compare response rates between JAKi and bDMARDs in patients with RA naïve to targeted therapy. An interim analysis was performed to estimate the proportion of patients achieving low disease activity (LDA) based on disease activity score (DAS)–28– erythroid sedimentation rate (ESR) (DAS28-ESR) at 24 weeks after treatment initiation and to evaluate the development of adverse events (AEs). Results: Among 506 patients enrolled from 17 institutions between April 2020 and August 2022, 346 (196 JAKi group and 150 bDMARD group) were included in the analysis. After 24 weeks of treatment, 49.0% of JAKi users and 48.7% of bDMARD users achieved LDA (p = 0.954). DAS28-ESR remission rates were also comparable between JAKi and bDMARD users (30.1% and 31.3%, respectively; p = 0.806). The frequency of AEs reported in the JAKi group was numerically higher than that in the bDMARDs group, but the frequencies of serious and severe AEs were comparable between the groups. Conclusions: Our interim findings reveal JAKi have comparable effectiveness and safety to bDMARDs at 24 weeks after treatment initiation.

Incidence and Prevalence of Idiopathic Inflammatory Myopathies in Korea: a Nationwide Population-based Study

Cho, Soo-Kyung,Kim, Hyoungyoung,Myung, Jisun,Nam, Eunwoo,Jung, Sun-Young,Jang, Eun Jin,Yoo, Dae-Hyun,Sung, Yoon-Kyoung KOREAN ACADEMY OF MEDICAL SCIENCE 2019 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.34 No.8

<P><B>Background</B></P><P>This study aimed to estimate the incidence and prevalence of idiopathic inflammatory myopathies (IIM) and associated comorbidities in Korea from 2006 to 2015.</P><P><B>Methods</B></P><P>IIM between 2004 to 2015 were identified using the Korean National Health Insurance Service medical claim database. The case definition required more than one visit based on diagnostic codes including juvenile dermatomyositis (JDM), dermatomyositis (DM), or polymyositis (PM) and registration in the Individual Copayment Beneficiaries Program (ICBP) for rare and intractable diseases. IIM patients with a disease-free period of 24 months before the index date were defined as incident cases. The Elixhauser comorbidity score was calculated.</P><P><B>Results</B></P><P>Using the base case definition, 1,150 prevalent patients with IIM (117 JDM, 521 DM, 512 PM) were recorded in 2006 and 2,210 (130 JDM, 1,101 DM, 869 PM) in 2015. The prevalence was estimated at 2.3–4.0 (0.9–1.2 for JDM, 1.2–2.7 for DM, 1.4–2.1 for PM)/100,000 person-year (PY). We identified 218 incident cases of IIM in 2006 (18 JDM, 98 DM, 102 PM) and 191 cases (7 JDM, 83 DM, 101 PM) in 2015. The incidence was estimated at 2.9–5.2 (0.7–1.9 for JDM, 1.8–4.0 for DM, 1.6–3.0 for PM)/1,000,000 PY. The mean age (± standard deviation) of prevalent patients with IIM was 51.2 (± 16.9) years, and the percentage of women was 72.1%. More than two-thirds of patients (70.7%) had more than two comorbidities. Twenty percent of patients had interstitial lung diseases.</P><P><B>Conclusion</B></P><P>In Korea, the incidence and prevalence of IIM were 2.9–5.2/1,000,000 PY and 2.3–4.0/100,000 PY, respectively.</P>

Developing the Korean Educational Needs Assessment Tool (Korean ENAT) in rheumatoid arthritis: cross-cultural validation using Rasch analysis

( Yoon-kyoung Sung ),( Hyoungyoung Kim ),( Sung Joo Cha ),( Sae-hyung Kim ),( Mwidimi Ndosi ),( Soo-kyung Cho ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.4

Background/Aims: This study was performed to undertake cross-cultural adaptation and validation of the Educational Needs Assessment Tool (ENAT) in rheumatoid arthritis (RA) for use in Korea. Methods: The study involved two main phases: cross-cultural adaptation of the ENAT from English into Korean, and validation of the Korean ENAT. The first phase followed the established process of cross-cultural adaptation of self-report measures, and in the second phase, the Korean ENAT data were analyzed using the Rasch measurement model. Fit to the model was determined using the observed data infit and outfit statistics. Additional tests of validity included unidimensionality and internal consistency. Results: Adequate conceptual equivalence was achieved following the adaptation process. A total of 123 patients completed the Korean ENAT. The mean age was 46.7 ± 12.3 years and the majority of patients (81.3%) were female. Thirty-five of the 39 items gave good fit to the model. The four items deviating from the model had infit and outfit > 1.50. The item separation index (5.26) and item reliability index (0.97) provided evidence for good reliability of items. All seven domains of the Korean ENAT fit the Rasch model. The internal consistency of the Korean ENAT was high, and unidimensionality was confirmed (person separation index, 3.41; reliability index, 0.92; item separation index, 16.82; reliability index, 1.00). Conclusions: Using the standard procedure for cross-cultural adaptation, the ENAT has been adapted into Korean, and Rasch analysis has confirmed the construct validity, reliability, and unidimensionality of the Korean ENAT.

Nonsteroidal Anti-inflammatory Drugs-sparing Effect of Symptomatic Slow-acting Drugs for Osteoarthritis in Knee Osteoarthritis Patients

( Soo-kyung Cho ),( Hyoungyoung Kim ),( Ha-rim Park ),( Wooseok Choi ),( Seongmi Choi ),( Sun-young Jung ),( Eun Jin Jang ),( Yoon-kyoung Sung ) 대한류마티스학회 2019 대한류마티스학회지 Vol.26 No.3

Objective. To evaluate the nonsteroidal anti-inflammatory drugs (NSAID)-sparing effect of symptomatic slow-acting drugs for osteoarthritis (SYSADOA) in knee osteoarthritis (OA) patients. Methods. A retrospective study was conducted on a cohort of knee OA patients who visited a single academic referral hospital from 2013 to 2014. Among all patients, NSAID users in their first visit were extracted and divided into SYSADOA users and SYSADOA non-users. All patients were observed from their first visit with knee OA to their last visit, NSAID discontinuation, or the date of data collection, July 2017 (mean observational periods: 369.1 days). To evaluate the NSAID-sparing effect of SYSADOA, Cox regression analysis was performed after adjusting for confounding factors. Results. Patients for this study (n=212) were divided into SYSADOA users (n=57) and SYSADOA non-users (n=155). The mean age (68.8 vs. 66.6 years old, p=0.31) and the number of comorbidities (p=0.73) were comparable between the two groups. The SYSADOA users showed higher Kellgren-Lawrence (KL) grade (66.7% of patients with more than KL grade 3) than SYSADOA non-users (42.6% of patients with more than KL grade 3) (p=0.02). In treatment, the frequency of intra-articular injection was higher in the SYSADOA user group than the SYSADOA non-user group (33.3% vs. 9.0%, p<0.01). In Cox regression analysis, SYSADOA use contributed to NSAID discontinuation in knee OA patients (hazard ratio 2.97, 95% confidential interval 1.42∼6.22). Conclusion. This real-world analysis demonstrated that SYSADOA use combined with NSAIDs had a significant effect on NSAID discontinuation in patients with knee OA. (J Rheum Dis 2019;26:179-185)