베체트병 환자에서 발생한 Azathioprine에 의한 재발성 급성 췌장염

김상현 ( Sang Hyon Kim ),이승환 ( Seung Hwan Lee ),고윤석 ( Yoon Seok Koh ),김성동 ( Sung Dong Kim ),김해림 ( Hae Rim Kim ),윤종현 ( Chong Hyun Yoon ),이상헌 ( Sang Heon Lee ),박성환 ( Sung Hwan Park ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.1

Acute pancreatitis is a serious disease with a fatality rate of up to 15%. Drugs are considered a rare cause of acute pancreatitis and azathioprine has been linked to subsequent acute pancreatitis in several case reports. We present a 48-year-old female who developed abdominal pain and elevation of serum amylase and lipase levels following azathioprine treatment for Behcet`s disease. Abdominal CT scan reveals diffuse enlarged pancreas and large amount of fluid collection at peritoneal cavity. She was recovered with conventional therapy for acute pancreatitis and withdrawal of azathioprine. When the patient erroneously took the drug once again, acute pancreatitis was more rapidly developed than initial attack.

류마티스 관절염 환자의 활액 내 항GPI 항체의 임상적 유용성

김상현 ( Sang Hyon Kim ),김성동 ( Sung Dong Kim ),김해림 ( Hae Rim Kim ),박성환 ( Sung Hwan Park ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.1

Objective: Autoantibody against glucose-6-phosphate isomerase (GPI) has been shown to be present in both the serum and synovial fluid (SF) of patients with rheumatoid arthritis (RA). The purpose of this study was to evaluate whether GPI serves as a specific autoantigen in the SF of patients with RA and to investigate the relationship of anti-GPI antibody with clinical parameters of RA. Methods: SF was collected from 34 patients with RA and 34 patients with osteoarthritis (OA). The samples were tested by enzyme-linked immunosorbent assay (ELISA) using human recombinant GPI as antigen. Patients with RA were classified according to rheumatoid factor (RF) positivity, the presence of RA shared epitope, the presence of extraarticular manifestations, and evidence of bony erosive changes. Results: SF levels of anti-GPI antibody were higher in patients with RA than in patients with OA (631.12±534.02 AU versus 112.38±90.45 AU, p<0.001). In RA, there was no significant difference in SF anti-GPI antibody levels according to RF positivity, the presence of extraarticular manifestations, and evidence of bony erosive changes. Conclusion: Autoantibodies to GPI in SF have more related with patients with RA compared with those with OA. In patients with RA, autoantibodies to GPI in SF are not associated with the poor prognostic factors and disease activity of RA.

섬유근통 증후군의 정신과적 접근

김상현 ( Sang Hyon Kim ),정성원 ( Sung Won Jung ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.4

섬유근통 증후군은 매우 다양한 증상들을 나타내는 복합 증후군이다. 따라서 하나의 치료방법으로 모든 것을 치료하기가 어렵다. 환자가 경험하는 다양한 증상을 고려하여 여러 가지 치료방법을 적용할 필요가 있다. 섬유근통 증후군은 단순한 내과질환이기 보다는, 심리적인 영향을 많이 받을 수 있는 질환임을 명심하여야 한다. 따라서 단순히 치료목표가 되는 증상에 대해 약물을 처방하는 것 이상의 치료방법이 필요하며, 약물에 대한 교육, 운동, 인지행동치료, 이완요법과 같은 비약물학적인 치료가 환자의 신체적 증상에 영향을 줄 수 있다는 것을 이해하여야 한다. Fibromyalgia is a disease that occurs frequently. However, people do not know much about this disease and many doctors find it difficult to diagnose such patients. Symptoms of fibromyalgia may not only include pain, but also sleep disorder, fatigue, melancholia, and other mood disorders. Pain is one of the major symptoms of many diseases and may greatly impede the quality and functionof an individual`s life. Yet many clinicians have trouble treating chronic pain in part because they focus on the pain itself, which is merely one of the causes, and not on the evaluation and treatment of problems incidental to pain. It is noted that pain may be accompanied by not only physical suffering, but also emotional problems, such as melancholia and other secondary problems. The causes for fibromyalgia syndrome have not yet been clearly revealed but it is known that mental factors contribute to the occurrence and progress of the symptoms, and that the evaluation of or therapeutic interventions for the mental causes may be due to physical effects. Therefore, based on adequate psychiatric knowledge, clinicians should understand and treat the patients accordingly. It may be that more effective medical services are needed through intensive treatments in multidisciplinary teams for the patients. This article is aimed at investigating the psychological issues that fibromyalgia patients encounter. It also considers the psychiatric drugs and psychosocial treatment that are applied to the disease.

베체트병 환자에서 혈청 대식세포 유주 억제 인자 (Macrophage Migration Inhibitory Factor, MIF)의 상승

김성동 ( Sung Dong Kim ),김상현 ( Sang Hyon Kim ),김해림 ( Hae Rim Kim ),박미경 ( Mi Kyung Park ),윤종현 ( Chong Hyeon Yoon ),김완욱 ( Wan Uk Kim ),이상헌 ( Sang Heon Lee ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3

Objective: Macrophage migration inhibitory factor (MIF) has emerged recently as an important regulator of inflammatory and immune responses. This work was undertaken to evaluate serum levels of MIF and in vitro MIF production by whole blood cells in patients with Behcet`s disease and investigate the relationship between serum levels of MIF and clinical manifestations. Methods: Sixty-five patients with Behcet`s disease and forty-eight healthy controls were studied to evaluate serum levels of MIF. Six patients with Behcet`s disease and Five healthy controls were studied for evaluating the production of MIF by whole blood cells. Serum and culture supernatant levels of MIF were measured by enzyme-linked immuno-sorbent assay (ELISA). The production of MIF by whole blood cells was investigated by culturing peripheral blood cells in the absence or presence of Concanavalin A (Con A). Results: Serum levels of MIF were higher in patients with Behcet`s disease than in healthy controls. Serum levels of MIF were changed in each patient with Behcet`s disease according to clinical disease activity (higher at active state). The MIF production by Con A-stimulated peripheral blood cell culture was higher in patients with Behcet`s disease than in healthy controls. Conclusion: Circulating levels of MIF are higher in patients with Behcet`s disease than in healthy controls and the levels of MIF may be associated with clinical disease activity. MIF may play an important role as a mediator of inflammation in Behcet`s disease and provide opportunity for the development of anti-MIF strategy for the treatment of patients with Behcet`s disease.

루푸스 신염의 치료에 있어 Mycophenolate Mofetil의 효과와 안전성

김해림 ( Hae Rim Kim ),김상현 ( Sang Hyon Kim ),김성동 ( Sung Dong Kim ),박경수 ( Kyung Soo Park ),윤종현 ( Chong Hyeon Yoon ),김완욱 ( Wan Uk Kim ),홍연식 ( Youn Sik Hong ),이상헌 ( Sang Heon Lee ),박성환 ( Sung Hwan Park ),조철 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.3

Objective: To determine the therapeutic effect of mycophenolate mofetil (MMF) and the adverse effects associated with MMF in patients with lupus nephritis. Methods: We studied 51 patients with lupus nephritis, who had received MMF for more than 3 months. The efficacy was assessed as renal profiles, SLE disease activity index (SLEDAI), serum cytokine levels and oral corticosteroid dose. The adverse effects were evaluated by medical records and interview of each patient. Serum cytokine levels of IL-10, IFN-α and IFN-γ were determined by sandwich ELISA at starting MMF and at 12 months after MMF therapy. Results: MMF treatment resulted in complete remission 52.9%, partial remission 25.5% and treatment failure 21.6%. There was no difference of MMF efficacy between WHO class IV and V in 32 patients with biopsy-proven nephritis. The renal profiles and parameters for disease activity were improved, as assessed by increased serum albumin and C3 level, decreased proteinuria, cyturia, ESR, SLEDAI and oral corticosteroid doses. Serum IL-10 decreased after MMF therapy in class IV group, but not in class V group. Serum IFN-α, IFN-γ level and IFN-γ/IL-10 ratio also tended to decrease after MMF therapy. GI troubles including dyspepsia, nausea, vomiting and diarrhea were the most common adverse effects of MMF as 54.9%, followed by hair loss, leukopenia, anemia, infection, but there was no serious adverse effect. Conclusion: MMF is an effective and well tolerable immunosuppressant for both class IV and V lupus nephritis, even not responding or intolerable to conventional immunosuppressive therapy.

루푸스 신염의 활동성 예측 척도로서 혈청 C1q-Circulating Immune Complexes의 유용성

박성환 ( Sung Hwan Park ),김상현 ( Sang Hyon Kim ),김주연 ( Ju Youn Kim ),김해림 ( Hae Rim Kim ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.4

Objective: The purpose of this study was to evaluate whether serum C1q-circulating immune complexes (C1q-CIC) serve as a predictive marker for renal flares in patients with lupus nephritis. Methods: Twenty-five patients with lupus nephritis and 24 healthy controls were enrolled. Patients with lupus nephritis had their serum C1q-CIC titers and other serologic parameters such as serum C3, C4, anti-dsDNA antibody, and erythrocyte sedimentation rate measured simultaneously. The systemic lupus erythematosus disease activity index (SLEDAI) was also checked. Results: Serum C1q-CIC titers were higher in patients with lupus nephritis than in healthy controls (109.33±53.79 μg/mL vs. 75.28±22.91 μg/mL, p=0.008). A statistically significant association was found between serum C1q-CIC titers and C3 (p=0.011), C4 (p=0.027), and anti-dsDNA antibody (p=0.014). SLEDAI was also correlated with serum C1q-CIC titers (p=0.022). Conclusion: Serum C1q-CIC appears to be related to renal disease activity in patients with lupus nephritis. These results suggest that serum C1q-CIC is a predictive marker for renal flares in patients with lupus nephritis.

관절통의 감별진단 및 노인에서 진통제 선택

정혜진(Hye Jin Jeong),김상현(Sang Hyon Kim) 대한임상노인의학회 2018 대한임상노인의학회지 Vol.19 No.1

In Korea, the prevalence of joint disease among chronic diseases of the elderly is increasing as it enters the aging society. Therefore, appropriate differential diagnosis should be made when a patient complains of joint symptoms. Depending on the position of the joint itself or the surrounding structures, it is possible to distinguish the cause of joint symptoms. We can also make a differential diagnosis based on the range and distribution of joints, the number of joints with symptoms, the duration of symptoms, and the pattern of pain. In order to improve joint symptoms, the first agent to use is analgesic, which is very diverse, therefore important to take according to proper prescription. The types of analgesic drugs are classified into non-opioid and opioid analgesics. Among non-opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used when the arthralgia is not controlled by acetaminophen. However, a variety of side effects, such as nephrotoxicity and gastrointestinal toxicity of NSAIDs, should be noted for elderly patients. Opioid agents have the advantage of increasing the analgesic effect in proportion to the dose, however, there are several side effects including nausea, vomiting, sedation, respiratory depression, and constipation. Because of the characteristics of the elderly population, it is difficult to predict the appropriate dose, concentration and side effects of the drugs; further there is a lack of guidance on these drugs. When using analgesics for the treatment of arthralgia, we should try to understand the characteristics of the elderly and choose the safest and most effective drugs.

항핵항체의 올바른 해석

손창남 ( Chang-nam Son ),김상현 ( Sang-hyon Kim ) 대한내과학회 2021 대한내과학회지 Vol.96 No.4

Anti-nuclear antibodies (ANAs) are autoantibodies against nuclear substances or other cellular components. ANA tests are used in the diagnostic process to screen patients with suspected rheumatic or autoimmune diseases. ANA-associated diseases are characterized by a high titer of antinuclear antibodies and include systemic lupus erythematosus, systemic sclerosis, and mixed connective tissue diseases. ANA test results must be cautiously interpreted as they can be positive not only in infections and oncological diseases but also for the healthy general population. The ANA test mainly uses the indirect immunofluorescence test, and the results are expressed in terms of the final titer and pattern. The ANA test can increase diagnostic value when used in conjunction with the evaluation of disease-related clinical symptoms. (Korean J Med 2021;96:337-340)

류마티스관절염 환자의 혈청 내 항GPI 항체의 임상적 의의

변유미 ( Yu Mi Byeon ),김상현 ( Sang Hyon Kim ),박성환 ( Sung Hwan Park ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.4

Objective: Anti-glucose-6-phosphate isomerase (GPI) antibody (Ab) is known to be arthritogenic in K/BxN mice. Anti-GPI Ab is present in some patients with rheumatoid arthritis (RA), but their clinical manifestations are not clearly elucidated. The purpose of this study was to evaluate whether GPI serves as a specific autoantigen in patients with RA and to investigate the relationship of anti-GPI Ab with clinical parameters of RA. Methods: Sera were collected from 54 patients with RA, 15 patients with osteoarthritis (OA) and 28 healthy controls. The samples were tested by enzyme-linked immunosorbent assay (ELISA) using human recombinant GPI as antigen. Patients with RA were classified according to rheumatoid factor (RF) positivity, the presence of RA shared epitope (SE), the presence of extraarticular manifestations, and evidence of bony erosive changes. Results: Serum levels of anti-GPI Ab were higher in patients with RA than controls (1599.46±1022.48 versus 344.82±223.16 AU, p<0.001), and the levels of patients with OA were also higher than controls (1161.47±917.44 versus 344.82±223.16 AU, p<0.01). In RA, there were no significant difference in anti-GPI Ab levels according to RF positivity, the presence of RA SE, the presence of extraarticular manifestations, and evidence of bony erosive changes. Conclusion: Our results suggest that anti-GPI Ab may not be RA specific Ab and not related to the severity of RA.

루푸스 환자에서 예방접종

손창남 ( Chang-nam Son ),김상현 ( Sang-hyon Kim ) 대한내과학회 2020 대한내과학회지 Vol.95 No.3

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects various organs. SLE patients have an increased risk of infection compared to the general population. Immunosuppressive agents commonly used in SLE increase the risk of infection. Vaccination is a good way to reduce the risk of infection. However, some SLE patients are concerned that vaccination may worsen lupus disease activity or cause side effects. The latest SLE patient vaccination data were reviewed in this study, which focused on the safety, immunogenicity, and efficacy of influenza, pneumococcal, tetanus, hepatitis A, herpes zoster, and human papillomavirus vaccines. Korean immunization recommendations were also compared to those of other countries. (Korean J Med 2020;95:170-175)