통풍성 관절염의 임상 양상에 관한 연구

백한주(Han Joo Baek),이은봉(Eun Bong Lee),유창달(Chang Dal Yoo),김현아(Hyun An Kim),송영욱(Yeong Wook Song),임용성(Yong Seong Lim) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. Methods: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. Results: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3±14.5 years(range 11-83 years); the mean duration of disease 6.5±7.0 years(range 0-30 years); the mean duration of gouty attack 7.2±5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. Conclusion: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.

강직척추염 환자에서의 수면장애

백한주 ( Han Joo Baek ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.6

건선 관절염의 빈도 및 임상 양상에 관한 연구

백한주 ( Han Joo Baek ),유창달 ( Chang Dal Yoo ),신기철 ( Ki Chul Shin ),이윤종 ( Yun Jong Lee ),강성욱 ( Seong Wook Kang ),이은봉 ( Eun Bong Lee ),한창완 ( Chang Wan Han ),김현아 ( Hyun Ah Kim ),송영욱 ( Yeong Wook Song ),윤재일 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Objective: To evaluate the prevalence of psoriatic arthritis(PsA) in Korean patients with psoriasis and to determine the clinical features of PsA. Methods: We examined 356 patients with psoriasis who visited dermatology clinic in Seoul National University Hospital between January 1 and April 28, 1997. Thirty-two patients were determined to have PsA. Nineteen cases of PsA, who were diagnosed in rheumatology clinic of the same hospitial from January 1983 to November 1997, were added to these patients and total 51 cases of PsA were analysed for clinical, laboratory and radiologic features. Results: The prevalence of PsA among patients with psoriasis was 9%(32/356). Male to female ratio of psoriatic arthritis was 1.1:1. Median age at onset of psoriatic arthritis was 34.5 years(range 9-63 years) and mean duration of psoriatic arthritis was 5.8±6.0 years. Psoriasis preceded arthritis in 73.5% of subjects, arthritis preceding psoriasis in 14.3%. Silmultaneous onset of both joint and skin disease was found in 12.2% of subjects. Nail changes, dactylitis and enthesopathy were detected in 37.1%, 21.6% and 33.3% of patients with PsA, respectively. Frequently involved joints in PsA were sacroiliac joints(51%), knees(49%), proximal interphalangeal joints of hands(33.3%), ankles(25.5%). About thirteen percent of patients with PsA were in ACR functional class III/IV. Patients with PsA were older than those with psoriasis alone(39 vs 35 [years], p=0.034). There were no significant differences between patients with PsA and those with psoriasis alone in age at onset of psoriasis, duration, family history, nail involvement, initial extent or type of psoriasis. Higher prevalence of anemia, leukocytosis, and increased ESR was found in patients with PsA compared to psoriasis alone(26% vs 6.3%, 28% vs 5%, and 40% vs 10.3%, p<0.001, respectively). ANA positivity and radiologic sacroiliitis were more frequent in patients with PsA than those with psoriasis alone(35.7% vs 16.7%, p=0.015 and 45.5% vs 1.1%, p=0.001, respectively). Patterns of PsA according to Moll and Wright criteria were as follows: spondylitis was present in 54.9% of patients; oligoarthritis in 25.5%, polyarthritis in 9.8%, predominant DIP involvement in 5.9%. Three cases of SAPHO syndrome were also found in our series. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group(23 vs 30 and 28 vs 44 [years], p<0.05, respectively). HLA-B27 was more prevalent in patients with PsA and spondylitis group compared to normal Koreans(19.5% vs 5.7%, p=0.024 and 29.2% vs 5.7%, P=0.0027, respectively), but HLA-B27 was not increased in non-spondylitis group. Conclusions: The clinical features of PsA in our series showed some differences from previous reports. Spondylitis was the commonest pattern of PsA. Nail changes and enthesopathy were less common compared to previous reports. Anemia, leukocytosis, increased ESR, ANA positivity, and radiologic sacroiliitis were more frequent in patients with PsA than in those with psoriasis alone. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group. The prevalence of HLA-B27 was increased in patients with PsA, especially in spondylitis group.

신(新)의료전문가주의

백한주 ( Han Joo Baek ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.6

Etanercept 치료 중 발생한 류마티스성 결절

한우진 ( Woo Jin Han ),이종록 ( Jong Rok Lee ),윤규현 ( Kyu Hyun Yoon ),최효진 ( Hyo Jin Choi ),백한주 ( Han Joo Baek ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.3

Etanercept is a recombinant human tumor necrosis factor (TNF) receptor fusion protein, which inhibits the biological activity of TNF-α. The common side effects of TNF-α inhibitors are injection site reactions, infusion reactions and infection. Rheumatoid nodules are the most common extraarticular manifestation of rheumatoid arthritis. Drugs such as methotrexate were reported to be associated with rheumatoid nodules, but etanercept-related nodules were uncommonly observed. We report the new formation of cutaneous rheumatoid nodules in a 58-year-old man during anti-TNFα therapy with etanercept. He had 2-year history of seropositive rheumatoid arthritis, and been treated with methotrexate, hydroxychloroquine, sulfasalazine, prednisolone and nonsteroidal anti-inflammatory drugs before etanercept regimen. Rheumatoid nodules developed on the palmar surface of fingers 4 month after treatment of etanercept, although his disease activity was maintained low. One month later, we decided to stop etanercept because his nodulosis extended to elbow. Since then, he has been followed up without any progression of rheumatoid nodules or aggravation of arthritis.

류마티스 관절염 환자에서 발생한 카포시육종

이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),강성욱 ( Seong Wook Kang ),이윤종 ( Yun Chong Lee ),신기철 ( Ki Chul Shin ),송영욱 ( Yeong Wook Song ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Kaposi`s sarcoma is a soft tissue sarcoma characterized by proliferation of endothelial cells and fibroblasts and is frequently associated with immunosuppresed status of the patients. It is rarely complicated in a patient with rheumatoid arthritis. We report a case of Kaposi`s sarcoma in a patient with longstanding rheumatoid arthritis. A 50 year-old man was admitted to this hospital because of tingling sensation on both arms and elevated purpuric rash in both lower legs. Eighteen years prior to admission, he was diagnosed as rheumatoid arthritis and has taken prednisolone for 6 years and methotrexate for 2 years. One month prior to admission, he found multiple round elevated purpuric rash in both lower legs and dorsum of feet, which were found to be Kaposi`s sarcoma on skin biopsy.

류마티스 관절염 환자에서 Piroxicam Patch(TRAST(R))의 임상적 효능에 관한 연구

한창완 ( Chang Wan Han ),김현아 ( Hyun Ah Kim ),임용성 ( Yong Sung Lim ),이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),송영욱 ( Yeong Wook Song ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objective: To evaluate the effects of piroxicam patch(Trast(R)) in rheumatoid arthritis patients with knee joint pain and swelling and to determine the concentration of plasma and synovial fluid following patch application. Methods: Twenty-two patients with rheumatoid arthritis participated in a double-blind, placebo-controlled study. The patients were instructed to apply piroxicam or placebo patch at one knee and re-apply it every other day for 2 weeks. They had washout period for 2 weeks and then applied the other patch for 2 weeks at the same joint. The patients recorded knee joint pain using visual analog scale. Knee joint swelling and tenderness were assessed before and after application of piroxicam and placebo patch. Complete blood count, AST, ALT, BUN, creatinine, joint fluid analysis were also done. Piroxicam concentration in plasma and synovial fluid were measured by high performance liquid chromatography(HPLC) after 2 weeks of piroxicam patch application. Results: Knee joint pain improved significantly after the application of piroxicam patch for 2 weeks(visual analog scale, 56.2±5.9mm vs 48.2±5.7mm, p=0.03 by Wilcoxon signed rank test). There was no significant change in white cell count of synovial fluid, peripheral blood cell count, chemistry, C-reactive protein and erythrocyte sedimentation rate. In terms of adverse effects, mild gastrointestinal disturbance(8/21 cases, 38%) and local side effects such as pruritus and erythema(3/21 cases, 14%) were developed, which were insignificant compared with control groups(30%, 15% respectively). Piroxicam concentrations in plasma and synovial fluid after the application of piroxicam patch were 0.129±0.04μg/ml(mean±SE) and 0.644±0.202μg/ml respectively. Conclusions: Piroxicam patch is a safe and effective therapeutic modality for knee joint pain in patients with rheumatoid arthritis. Mild adverse effects such as gastrointestinal disturbance and local side effects were noted. Piroxicam concentration was higher in synovial fluid than in plasma following the application of piroxicam patch.

척추관절염의 개념 및 개관

서미령 ( Mi Ryoung Seo ),백한주 ( Han Joo Baek ) 대한내과학회 2013 대한내과학회지 Vol.85 No.3

척추관절염은 천장관절염/척추염, 소수관절염, 부착부염같은 근골격 증상과 포도막염, 건선, 장점막 질환 및 HLA-B27유전자와의 연관성을 공유하고 있는 만성 염증성 류마티스질환이다. 척추관절염의 진단기준은 없지만 다양한 분류기준이 진단에 도움을 줄 수 있다. 최근 ASAS는 방사선학적 천장관절염이 보이지 않는 단계를 포함하여 포괄적이고 체계적으로 척추관절염을 분류할 수 있는 축형 및 말초형 척추관절염 분류기준을 제안하였다. 척추관절염은 유전 요소가 지배적인 질환이며 가장 강력한 연관 유전자는 HLA-B27이다. 최근 MHC 유전자 자리 바깥에 위치한 질환 감수성 유전자로 ERAP1, IL23R 등이 발견되었다. 척추관절염의 주요병리는 부착부의 염증과 골생성이다. 척추관절염의 염증 발생을 설명하기 위해 HLA-B27과 관련된 여러 기전이 제안 되었다. HLA-B27 이외의 질환 감수성 유전자 생성물들은 HLA-B27 분자의 과정이나 시토카인 경로에 관여할 것으로 추정된다. 한편 척추관절염의 골생성을 조절하는 염증 과정과는 완전히 혹은 부분적으로 분리된 기전이 존재한다. The spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases in association with HLA-B27. They share the clinical features including sacroiliitis, spondylitis, oligoarthritis, enthesitis and extra-articular involvement. Recently ASAS proposed new classification criteria sets of axial and peripheral SpA. They were designed to include non-radiographic SpA, thus can guide the early diagnosis of disease before the structural damage occurs. SpA has a strong genetic predisposition. Non-MHC genes, such as IL23R and ERAP1, as well as HLA-B27 were confirmed as susceptibility genes through several GWAS. Major pathology in SpA is entheseal inflammation and new bone formation. Intrinsic ability of HLA-B27 to trigger innate immune response and several proinflammtory cytokines may contribute to the inflammation in SpA. New bone formation could be explained by a mechanism, partly or completely independent of the inflammatory process. (Korean J Med 2013;85:229-239)

만성질환 관리사업 보건지표 조사 결과를 이용한 인천 지역의 근골격계 및 류마티스 질환의 유병률 및 특성

최효진 ( Hyo Jin Choi ),한우진 ( Woo Jin Han ),임정수 ( Jeong Soo Im ),백한주 ( Han Joo Baek ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4

Objective: To estimate the prevalence of musculoskeletal diseases in Incheon. Methods: This study was based on data from chronic disease management surveys of Incheon. The surveys were conducted from 12 Sept 2005 to 7 Oct 2005 on 5,144 households using proportional stratified sampling methods. Three questionnaires were performed on all study subjects. All analyses were done using SPSS version 11.5. Results: Out of 16,623 subjects, the mean age was 34.5±20.2 (years, ±SD). The crude prevalence rate of musculoskeletal diseases were as follows: osteoarthritis 3.2%, rheumatoid arthritis 1.1%, spondyloarthropathy 0.3%, gouty arthritis 0.1%, Behcet`s disease 0.04%, herniated disc 1.1%, and osteoporosis 0.8%. Age-standardized prevalence of rheumatoid arthritis was 1.6%, and osteoarthritis 5.2%. The prevalence of rheumatoid arthritis and osteoarthritis tended to be higher among older age groups, low socioeconomic/education state, and homemakers. The age-standardized prevalence of arthritis was higher in rural than in urban area. There were more concurrent chronic diseases such as hypertension or diabetes mellitus in the arthritis group than in the whole population. Questionnaires were performed on subjects with musculoskeletal disease. It revealed chronic arthralgia at 3%, spine arthralgia 2.5%, and chronic myalgia 2.8%. Conclusion: The crude prevalence of rheumatoid arthritis and osteoarthritis were 1.1% and 3.2% (age-standardized, 1.6% and 5.2%), respectively. The prevalence of musculoskeletal diseases in Incheon is much lower than previously-reported data indicate. These differences should be confirmed by further epidemiological survey. The prevalence of arthritis is higher in populations of old age, low socioeconomic state, and rural areas.

한국인 베체트병 환자에서 T-bet 유전자 다형성에 관한 연구

김진현 ( Jin Hyun Kim ),이윤종 ( Yun Jong Lee ),황재희 ( Jae Hee Hwang ),백한주 ( Han Joo Baek ),강성욱 ( Seong Wook Kang ),배영덕 ( Young Deok Bae ),송승택 ( Seung Taek Song ),최효진 ( Hyo Jin Choi ),송주경 ( Ju Kyoung Song ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.4

Objective: Behcet`s disease (BD) is a chronic systemic inflammatory disease with unknown etiology. A number of clinical and laboratory findings suggest a strongly polarized Th1 immune response in BD. T-bet is a newly identified Th1 specific T-box transcription factor selectively expressed in Th1 cells. However, it is not yet clear whether the T-bet protein is involved in the proposed Th1-mediated pathogenesis of BD at the transcriptional level. Therefore, this study investigated the potential associations of two single nucleotide polymorphisms (SNPs) at positions -99 (C/G) and -1993 (T/C) in the exon and promoter regions of the TBX21 gene with susceptibility to BD in the Korean population. Methods: 105 patients with BD and 105 healthy controls were studied. All subjects were genotyped using restriction fragment length polymorphism analysis. The genotypes of the two groups were compared with the chi-square or Fisher`s exact tests. Results: The genotypic and allelic distributions of the two SNPs did not differ significantly between the two groups. Furthermore, no associations between the polymorphisms and clinical manifestations were found, except a central nervous system manifestation and arthritis. Furthermore, no associations between the polymorphisms and severity were identified. Conclusion: TBX21 gene polymorphisms were not associated with susceptibility, clinical manifestations, or severity of BD in the Korean population.