미만성 폐포출혈을 동반한 전신성 홍반성 루푸스 환자에서 Plasmapheresis를 이용한 치험

고재현 ( Jay Hyun Koh ),송서영 ( Seo Young Song ),이창근 ( Chang Keun Lee ),서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),고은미 ( Eun Mi Koh ),송재훈 ( Jae Hoon Song ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.2

Pulmonary alveolar hemorrhage (PAH) is a rare and often fatal presenting feature of systemic lupus erythematosus (SLE) and enters the differential diagnosis of diffuse lung disease in patients with SLE. Reported mortality rates are extremely high, between 70 and 90 percents. Because death frequently occurs within the first several days of the hemorrhage, the diagnosis needs to be established promptly and treatment should be initiated immediately. Treatment of alveolar hemorrhage has included various combinations of corticosteroids, cytotoxic agents, and plasmapheresis, but survival rates have been extremely low despite aggressive therapy. We experienced a case of diffuse alveolar hemorrhage in a 29 year-old SLE male patient. PAH was diagnosed by hemoptysis, anemia, infiltration on chest X-ray and hemosiderin-laden macrophages in bronchoalveolar lavage. After high dose intravenous steroid, cyclophosphamide intravenous therapy and plasmapheresis, the condition of patient was markedly improved. He was discharged and received monthly intravenous pulse cyclophosphamide. He has done well since, showing no further pulmonary hemorrhage with steroid tapering.

초기 류마티스 관절염에서 적혈구 침강속도, 혈청 C-반응성 단백과 방사선학적 진행의 상관관계

고재현 ( Jay Hyun Koh ),김재형 ( Jae Hyung Kim ),이창근 ( Chang Keun Lee ),전찬홍 ( Chan Hong Jeon ),서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),안중모 ( Joong Mo Ahn ),고은미 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.4

Objective: To investigate the clinical usefulness of serial measurement of erythrocyte sediment rate(ESR) and C-reactive protein(CRP) for monitoring the radiological progression in early rheumatoid arthritis(RA). Methods: Thirty one patients with RA according to the 1987 ACR criteria, with joint symptoms for less than one year, and who had not previously received disease modifying antirheumatic drugs(DMARDs) were assessed from Oct. 1994 to Aug. 1998 in retrospective study. Area under curve(AUC) of ESR and CRP were calculated in these patients. Joint damage in the hands was assessed by modified Sharp`s method. Results: Male to female ratio was 1: 3.4. Median age of this group was 45.8±13.2 years. Patients who had positive rheumatoid factor were 82%. Mean duration until first visit was 271.9±145.8 days. At the first clinic visit, mean ESR and CRP were 50mm/hr and 2.0mg/dL. Mean erosions and joint space narrowing score by modified Sharp`s method were 55.2 and 12.4, respectively. Correlation analysis showed that ESR AUC and CRP AUC were significantly associated with radiologic progression. Conclusions: Elevated over-time ESR and CRP provide a convenient short term correlation with radiologic outcome(i. e. erosions). Elevated over-time ESR and CRP can be used as a guide for therapy.

류마티스 관절염 활막에서 종양단백질의 발현

김진석 ( Jin Seok Kim ),차훈석 ( Hoon Suk Cha ),고재현 ( Jay Hyun Koh ),서기현 ( Gi Hyun Seo ),이창근 ( Chang Keun Lee ),김병준 ( Byoung Joon Kim ),최화정 ( Hwa Jung Choi ),한정호 ( Joung Ho Han ),오원환 ( Won Hwan Oh ),고은미 ( E 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Objective: The synovium in rheumatoid arthritis(RA) is characterized by an increase in the thickness of lining layer and infiltration of cells into the sublining area. Histomorphologic studies of RA have indicated that initial destruction is more closely related to the presence of transformed appearing proliferating synovial cells than to the presence of subsynovial or periarticular inflammation. Based on the fact that synovial lining cells have some properties of transformed appearing cells, we examined the expressions of Fos, Jun and Myc oncoproteins in the synovial tissue from patients with rheumatoid arthritis and osteoarthritis. Methods: Synovial tissues from 15 patients with RA and 15 with osteoarthritis(OA) were studied by the immunohistochemical staining technique. Nine of 15 RA sped men were from arthroscopic synovectomy and the other 6 were from total knee replacement arthroplasty. Result: In all specimen studied, Myc and Fos were expressed in the synovial lining cells and Myc, Fos and Jun were expressed in the sublining cells, including lymphocytes, other inflammatory cells and blood vessels. Lymphocytes in the diffuse infiltrates showed increased expression of three oncoproteins compared to lymphocytes in the nodular aggregates. When oncoprotein expressions in RA were compared to OA, Fos and Myc expressions in the synovial lining cell layer were significantly higher in RA than in OA and Jun, Fos and Myc expressions in inflammatory cells were significantly higher in RA than in OA. The expressions of Fos and Myc were significantly correlated with the degree of synovial hypercellularity. In RA, the expressions of all three oncoproteins were increased in synovectomy group than joint replacement group. Conclusion: We observe that there are increased expressions of Myc, Fos and Jun in RA synovium than OA. These changes are more prominent in synovectomy group than joint replacement group, which suggest the differential expression of oncoproteins according to disease progression.

류마티스 관절염 환자에서 혈장 호모시스테인, 혈청 비타민 B12, 엽산 농도에 관한 연구

차훈석 ( Hoon Suk Cha ),전찬홍 ( Chan Hong Jeon ),고재현 ( Jay Hyun Koh ),이창근 ( Chang Keun Lee ),김진석 ( Jin Seok Kim ),김종원 ( Jong Won Kim ),강성욱 ( Seong Wook Kang ),송영욱 ( Yeong Wook Song ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Objective: Cardiovascular disease is the most frequent cause of death in rheumatoid arthritis(RA) patients and hyperhomocysteinemia is an independent risk factor for cardiovascular disease. We evaluated the status of homocysteine, vitamin B12 and folate in RA patients and the influence of the drugs used in RA on homocysteine and vitamin levels Methods: Fifty-six RA patients and 22 controls were studied. Plasma total homocysteine was measured by HPLC method and serum folate and vitamin B12 were measured by chemiluminescence immunoassay. In RA patients, age, sex, disease duration, medications and laboratory findings were analyzed. Results: Serum vitamin B12 level was significantly lower in RA patients compared to controls(p=0.033). No significant difference in serum folate level was found between RA patients and controls but plasma total homocysteine level was significantly higher in RA patients. There was no difference in plasma total homocysteine level between patients taking MTX with folate and controls, but plasma total homocysteine level was significantly higher in patients not taking MTX compared with controls(p=0.028). In RA patients taking only hydroxyl-chloroquine(HCQ) as a DMARD, there was significantly lower serum folate level(p=0.033) and higher plasma total homocysteine level(p=0.043) compared with controls. There was a significant negative correlation between plasma total homocysteine level and serum folate level in RA patients(r=-0.319, p=0.017). Conclusion: Plasma total homocysteine level was increased in RA patients but not in patients taking MTX and folate. These findings suggested that folate supplementation may be effective to prevent hyperhomocysteinemia in RA patients.

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.

한국인에서의 통풍의 임상양상에 관한 연구

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)