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박보형 ( Bo Hyoung Park ),민정요 ( Jeong Yo Min ),여창동 ( Chang Dong Yeo ),오수성 ( Soo Seong Oh ),허기훈 ( Ki Hoon Hur ),허성은 ( Sung Eun Hur ),김진수 ( Jin Soo Kim ),김원철 ( Won Chul Kim ),김완욱 ( Wan Uk Kim ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.3
Adult onset Still`s disease (AOSD) is a multi-systemic inflammatory disorder characterized by several distinguished manifestations including high spiking fever, evanescent salmon-colored skin rash, arthralgia/arthritis, hepato-splenomegaly, lymphadenopathy, sore throat, serositis, and leukocytosis. The frequently noticed cardiopulmonary manifestation is pleuritis, pneumonitis, and pericarditis. Diffuse myocardial dysfunction is uncommon in AOSD, but it may be the cause of life-threatening heart failure. We have experienced a case of AOSD with acute heart failure in 20-year-old female complained of high fever and skin rash. On echocardiogram, the wall motion of left ventricle was globally decreased with a marked diminished ejection fraction (<25%). Two weeks after treatment with high dose steroid and intravenous immunoglobulin, her symptoms and cardiac function on echocardiogram was completely resolved. To our knowledge, this is the first case of AOSD with acute heart failure reported in Korea.
박보형 ( Bo Hyoung Park ),박원 ( Won Park ),이용환 ( Yong Hwan Lee ),김성수 ( Sung Soo Kim ),김훈수 ( Hoon Soo Kim ),곽이경 ( Yee Gyung Kwak ),송정수 ( Jung Soo Song ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.2
Overlap syndrome is a combination of major features of more than one rheumatic disease present in the same patient and often defined by a specific serologic test. Overlap syndrome consistent with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) has been reported in a few cases. Overlap syndrome with SSc and SLE combined with Sjogren`s syndrome (SS) is rarely reported worldwide. In Korea, this is the first case report. A 33 year-old female visited our rheumatology clinic complaining of Raynaud`s phenomenon. She was diagnosed as SSc 6 years ago. Clinical and laboratory finding revealed that she has affected by SLE. She also complained dry mouth and dry eye. Finally, she was diagnosed as overlap syndrome consistent with SSc and SLE combined with SS. The authors report a case of overlap syndrome consistent with SSc, SLE, and SS with relevant literatures.
박보형 ( Bo Hyoung Park ),송정수 ( Jung Soo Song ),박근호 ( Geun Ho Park ),이충훤 ( Chung Hwon Lee ),박원 ( Won Park ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.4
Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic changes can be assessed by USG. This study was aimed to compare the radiographic and ultrasonographic findings in osteoarthritis (OA) of the knee joint and to evaluate the usefulness of each modality to evaluate the disease early and determine the severity of the arthritis. Methods: Fifty osteoarthritis patients classified by the American College of Rheumatology (ACR) clinical criteria from December 2002 to April 2003 were included in the study. Routine radiography (standing anteroposterior, lateral, skyline view) and systemic USG examination of both knee were performed. We compared the incidence of the radiographic and ultrasonographic abnormality related to the pathologic change of the knee OA and suggesting the severity of the OA which would help to decide the therapeutic modality. Results: In patient with knee OA, plain radiography showed abnormal findings in 37/50 (74%) patients, but USG showed at least five abnormal findings in all 50 patients. The abnormal findings detected only by plain radiography were subchondral sclerosis and subchondral cyst (14% and 4% each). But, the thinning of cartilage (94%), Baker`s cyst (94%), cartilage degeneration (54%), meniscal protrusion (44%), meniscal tear (34%), meniscal cyst (32%), and the pannus (22%) were detected only by USG. Among the findings shared by both method, joint space narrowing was detected better by plain radiography than USG, but fluid accumulation, spur, meniscal calcification and osteochondroma were detected more frequently by USG. Conclusion: USG is more sensitive to find the pathologic changes related to the knee OA and to diagnose OA than the plain radiography. But each of the plain radiography and USG have their own unique value for the evaluation of OA in the knee. So the USG supplements the plain radiography in the examination of the knee OA.
박윤정 ( Yun Jung Park ),박보형 ( Bo Hyoung Park ),민도준 ( Do June Min ),김완욱 ( Wan Uk Kim ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
To determine the degree and risk factors for decreased bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE). Methods. One hundred and one patients with SLE and 57 age-and gender-matched healthy controls were enrolled in this study. The BMD was measured by dual energy X-ray absorptiometry (DXA). The laboratory findings and clinical variables evaluated in the SLE patients consisted of disease duration, SLE disease activity index (SLEDAI), and medications, including mean and cumulative dose of glucocorticoid. At the time of the clinical and laboratory assessment, the levels of serum osteocalcin, serum FSH/ LH, urine deoxypyridinoline (DPD), and serum cytokines, such as IL-6 and soluble receptor activator of NF-kB ligand (RANKL), were determined in SLE patients using a enzyme-linked immunosorbent assay. Results. The BMD T score decreased in patients with SLE compared to the healthy controls (-1.11 versus -0.41, p=0.001 at lumbar spine, -0.84 versus -0.01, p<0.001 at femur neck, -1.20 versus -0.45, p<0.001 at total hip, respectively). Osteoporosis and osteopenia was present in 16.8% and 46.5% of patients, respectively. Multiple regression analysis revealed a low BMD in the lumbar spine to be associated with increased FSH, low BMI and cumulative glucocorticoid dose. A low BMD in the hip and femur neck was associated with increased FSH, low BMI, and duration of glucocorticoid. On the other hand, the levels of osteocalcin, deoxypyridinoline (DPD), IL-6, and soluble RANKL were similar in patients with a low BMD and those with normal BMD. Conclusion. Osteoporosis and osteopenia are more common in young Korean SLE patients than in control subjects. Elevated FSH, low BMI, and the use of glucocorticoid are independent risk factors linked to a decreased BMD in Korean patients with SLE.
송정수 ( Jung Soo Song ),박보형 ( Bo Hyoung Park ),김은아 ( Eun Ah Kim ),김려섭 ( Ryuh Sup Kim ),박선원 ( Sun Won Park ),박원 ( Won Park ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.2
This report describes a patient with lipoma arborescens presenting as hemarthrosis of a knee with intraosseous lesions. A 44-year old woman complained of pain and swelling of left knee. Arthrocentesis resulted in bloody effusion. Magnetic resonance images showed villous projecting frondlike fatty soft tissue proliferation in the suprapatellar pouch and ovoid intraosseous lesions in proximal tibia. The soft tissue mass was removed through arthroscopic synovectomy and the biopsy of the mass confirmed the diagnosis. The intraosseous lesions were not considered as a cause of hemarthrosis. We failed to find the exact cause of hemarthrosis. The patient remained asymptomatic after removal of the mass for 10 months. As far as we know, this is the first report of hemarthrosis associated with lipoma arborescens in korea.
다발성 결절동맥염 환자에서 경막하 혈종으로 오인된 급성 경수막염
이충훤 ( Chung Hwon Lee ),박인서 ( In Suh Park ),박원 ( Won Park ),박보형 ( Bo Hyoung Park ),임명관 ( Myung Kwan Lim ),김기창 ( Gi Chang Kim ),송정수 ( Jung Soo Song ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.4
The pathymeningitis is a very rare neurologic manifestation of PAN. We report a case of pathymeningitis misdiagnosed as subdural hematoma by brain CT in a patient with PAN. A 45-year old man who diagnosed as PAN through arteriography and skin biopsy in the ischemic finger 6 months ago. He complained of sudden headache, nausea, and diplopia 3 days before admission. In emergency room, noncontrast brain CT findings suggested small amount of subdural hematoma. But subsequent MRI findings revealed pachymeningitis of bilateral paratentoria and falx. He was treated with high-dose steroid and cyclophosphamide pulse therapy. Thereafter, his symptoms were gradually resolved. As far as we know, this is the first report of a case of pachymeningitis complicating PAN in Korea.
임희정 ( Hee Jung Lim ),박원 ( Won Park ),박보형 ( Bo Hyoung Park ),김현정 ( Hyun Jeong Kim ),김성수 ( Sung Soo Kim ),이용환 ( Yong Hwan Lee ),송정수 ( Jung Soo Song ),진희승 ( Hee Seung Jin ),최원식 ( Won Sick Choe ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.1
Wegener`s granulomatosis (WG) is a syndrome characterized by necrotizing granulomatosis lesions in the upper and lower respiratory tracts, glomerulonephritis, and generalized vasculitis involving both arteries and veins. This syndrome usually affects the upper and lower respiratory tract and the kidneys. Some patients with WG have cardiac involvement such as pericarditis, myocarditis, valvulitis, arrhthymia, coronary arteritis, and rarely cardiomyopathy. Ocular manifestations include keratitis, conjuntivitis, scleritis, retro-orbital granuloma with proptosis. Uncommonly, blindness may occur due to retinal vasculitis and optic neuritis. We report a 45-year-old female patient with WG who had sinusitis and lung nodules. She complained of sudden chest pain. Electocardiography and nuclear myocardial perfusion study suggested transient myocardial ischemia. During the active course of the disease, she complained of severe pain in the right eye-ball with decreased visual acuity. Subsequently, she developed monocular blindness probably due to retinal vasculitis.
서주현 ( Ju Hyun Suh ),박원 ( Won Park ),박보형 ( Bo Hyoung Park ),김성수 ( Sung Soo Kim ),이용환 ( Yong Hwan Lee ),송정수 ( Jung Soo Song ),최원식 ( Won Sick Choe ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4
Systemic lupus erythematosus (SLE) is a multisystemic inflammatory autoimmune disease caused by various autoantibodies and immune complexes. Splenic involvement in SLE includes hypersplenism, splenic atrophy, and splenic infarction, which has rarely been reported. We report a case of SLE with isolated splenic infarction. A 20-year-old female patient was admitted complaining of general weakness, malar rash, and easy fatigue. She was diagnosed as having SLE with thrombocytopenia and received steroid treatment. On the 7th hospital day, she complained of severe left upper abdominal pain with sudden-onset. While abdominal ultrasonography showed only mild splenomegaly, abdominal CT and 99mTc-RBC splenic scintigraphy revealed segmental splenic infarction. She had no evidence of additional thrombotic event or hemorrhage. After administration of high dose steroid, abdominal pain subsided and splenic infarction was resolved.
류마티스 관절염 환자에서 저용량 스테로이드 용법이 골대사에 미치는 영향
이용환 ( Yong Hwan Lee ),박원 ( Won Park ),김성수 ( Sung Soo Kim ),박보형 ( Bo Hyoung Park ),송정수 ( Jung Soo Song ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.3
Objective: This study was performed to evaluate the influence of low dose corticosteroid (CS) on bone turnover and osteoporosis in patients with rheumatoid arthritis (RA). Methods: Bone mineral density (BMD), erythrocyte sedimentation rate, C-reactive protein, serum osteocalcin, and urinary deoxypyridinoline were measured in 63 patients with RA. According to daily prednisolone dose, patients were divided into low dose DI (≤5.0 mg) and medium dose DII (7.5∼20.0 mg) groups. According to cumulated prednisolone dose, patients were divided into CI (<5.0 gm) and CII (>5.0 gm) groups. Then we analyzed each groups in relation to several indicators. Results: Most RA patients had low BMD. BMD of DI and DII groups were low without significant difference. Urinary excretion of deoxypyridinoline was high in DI and DII group while serum osteocalcin level was normal in both groups. It suggested patients with RA have an imbalance between bone absorption and bone formation contributing the development of osteoporosis, even though low dose steroid therapy. Conclusion: Patients with low dose CS had significantly high urinary deoxypyridinoline excretion, normal serum osteocalcin, and low BMD, as well as patients with medium dose CS. Even though low dose CS use, intensive prevention and treatment for generalized osteoporosis are recommended in patients with RA.