Sleep quality in rheumatoid arthritis, and its association with disease activity in a Korean population

손창남,최고,이소연,이지민,이태한,정혜진,정창규,김지민,조용원,김상현 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.3

Background/Aims: The aim of this study was to compare the sleep quality between rheumatoid arthritis (RA) patients and healthy controls; and to evaluate the relationship between RA disease activity and sleep quality in Korea. Methods: A total of 130 RA patients and 67 age- and sex-matched healthy controls were enrolled in a comparative study of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Age, gender, concomitant medication, erythrocyte sedimentation rate, serum C-reactive protein, Beck Depression Inventory second edition (BDI-II), 28 joints disease activity score (DAS28), pain visual analog scale (VAS), and PSQI were analyzed as covariates. We also analyzed the sleep quality of RA patients according to the disease activity (DAS28 ≤ 3.2, 3.2 < DAS28 < 5.1, and DAS28 ≥ 5.1, respectively). Results: The total PSQI score and the frequency of poor sleep quality, were higher in the RA patients (5.62 ± 4.19, 38.5%) than in the control subjects (3.57 ± 2.17, 13.4%). The patients with poor sleep quality (PSQI > 5) were older and had a higher BDI-II and VAS score than the patients without sleep disturbance (PSQI ≤ 5). The score in subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, total PSQI, and frequency of poor sleep quality were increased when RA activity was high. Conclusions: Sleep disturbance was observed in RA patients (38.5%), and high RA disease activity was associated with poor sleep quality in Korea.

Follow-up Testing of Interferon-Gamma Release Assays Are Useful in Ankylosing Spondylitis Patients Receiving Anti-Tumor Necrosis Factor Alpha for Latent Tuberculosis Infection

손창남,전재범,김종헌,성일훈,유대현,김태환 대한의학회 2014 Journal of Korean medical science Vol.29 No.8

We evaluated the utility of follow-up interferon-gamma release assays (IGRAs) for thediagnosis of reactivation of latent tuberculosis infection (LTBI) or new tuberculosis inankylosing spondylitis (AS) patients receiving anti-tumor necrosis factor alpha (anti-TNFα). The study participants (n = 127) had a negative IGRA screening before receiving anti-TNFαand were evaluated by follow-up IGRA. We retrospectively examined data of the subjectsaccording to age, gender, tuberculosis prophylaxis, concomitant medications, IGRAconversion and anti-TNFα, including type and treatment duration. The median duration ofanti-TNFα was 21.5 months, and the median age was 35.3 yr. Of the 127 patients, IGRAconversion was found in 10 patients (7.9%). There was no significant variation betweenIGRA conversion rate and any risk factors except for age. IGRA conversion rate was notsignificantly different between AS and rheumatoid arthritis (P = 0.12). IGRA conversionwas observed in AS patients receiving anti-TNFα in Korea. A follow-up IGRA test can behelpful for identifying LTBI or new tuberculosis in AS patients receiving anti-TNFα.

당뇨 특화도시 육성 전략

손창남 한국약용작물학회 2016 한국약용작물학술대회 발표집 Vol.2016 No.05

Caspase-1 Level in Synovial Fluid Is High in Patients with Spondyloarthropathy but Not in Patients with Gout

손창남,방소영,김지혜,최찬범,김태환,전재범 대한의학회 2013 Journal of Korean medical science Vol.28 No.9

Activation of caspase-1 by NALP3 inflammasomes has been shown to be important in initiating acute gouty arthritis. The objectives of this study were to measure the levels of caspase-1 in synovial fluid in gout and various arthritides, and to elucidate the clinical significance of caspase-1 levels in synovial fluid. Caspase-1, IL-1β, IL-18, and uric acid were measured in synovial fluid from 112 patients with gout and other arthritides, such as rheumatoid arthritis, osteoarthritis, and spondyloarthropathy. Caspase-1 in synovial fluid from patients with crystal-induced arthritis, inflammatory arthritis, osteoarthritis, and spondyloarthropathy was 35.9 ± 86.7, 49.7 ± 107.7, 2.1 ± 7.0, and 152.6 ± 155.7 pg/mL, respectively. The mean level and the frequency of high levels (≥125 pg/mL) of caspase-1 in spondyloarthropathy were significantly higher than those in the other arthritides including gout. Caspase-1 was detectible in the synovial fluid of patients with the various arthritides. Contrary to our hypothesis, the caspase-1 level in the synovial fluid of patients with gout was not higher than in that of other arthritides. High levels of caspase-1 may be helpful in differentiating spondyloarthropathy from other arthritides.

S-718 인격변화 및 인지 장애로 발현된 재발성 다발연골염 뇌수막염 1예

손창남,이소연,김지민,김상현 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

재발성 다발 연골염은 병인이 명확치 않은 드문 질환으로, 주로 귀연골염, 청력손상 등 전정 기관증상이 흔하게 발생하며, 관절염 및 후두, 기관연골침범, 혈관염까지 광범위하게 침범한다. 신경계 침범은 흔하지는 않지만 뇌혈관염, 뇌신경침범, 뇌수막염을 일으킬 수 있으며 경우에 따라서는 치명적 일 수 있다. 저자들은 인격변화와 인지 장애를 주소로 내원하여 뇌수막염을 첫 증상으로한 재발성 다발연골염을 진단하고 성공적으로 치료하였기에 보고하는 바이다. 특이병력이 없는 63세 남자가 내원 3일전부터 시작된 인지장애 및 성격변화로 내원하였다. 내원 10일전부터 발열이 발생하였고, 내원 3일전부터 밥을 먹으라고 하면 ‘어’, ‘어’라고 말하는 등 말을 알아듣는 것 같지 않았고 직장에 가서도 차를 올바른 위치에 주차 하지 않는 등의 지남력 저하소견이 있었다. 또한 특정한 것에 집중하면 고집을 꺽지 않으려 하고 화내를 내는 등 충동적인 모습을 보였다. 환자는 급성병색소견을 보이고, 체온은 39.1℃였다. 신체진찰에서 양측귀의 통증, 열감, 종창소견을 보였으며, 경부 및 서혜부 림프절은 만져지지 않았다. 말초 혈액검사에서 총 백혈구 1460/μL, 혈색소 12.8g/dL, 혈소판은 219000/μL 이었다. C-반응단백 14.49 mg/dL, 적혈구침강속도 110 mm/hr으로 상승되어 있었다. 면역 혈청 검사상 인플루엔자 항체, 류마티스 인자, 항CCP항체, 항핵항체 모두 음성이었다. 뇌척수액 검사상 총백혈구 39개(호중구 5%, 림프구 95%) 당 69 mg/dL, 단백질 206.5 mg/dL, adenosine deaminase 4.5 U/L, 배양검사 및 크립토코구스 항원은 음성이었다. 뇌자기공명영상에서 연수막의 조영증가와 양측 바깥귀의 크기 증가 및 조영증가소견이 관찰되었다. 따라서 무균성 뇌수막염 진단하였고, 추가로 감각신경성 난청 및 우안의 포도막염을 확인하였으며 귀이개염에 대해 연골조직검사를 시행하여 최종적으로 재발성 다발연골염을 진단하였다. 3일간의 스테로이드 충격요법후 고용량의 경구 스테로이드를 투여하였고 이후 발열, 인지저하, 청력저하 소견 호전되며, 적혈구침강속도, C-반응단백 수치도 감소하였다. 이후 외래에서 경과 관찰을 하였고 5개월 후 인격도 이전 상태로 돌아왔고 양측 귀이개염도 호전을 보여 현재 저용량의 스테로이드와 메토트렉세이트로 유지치료 중이다. 본 증례에서처럼 인지장애와 인격변화를 보이는 환자에서 무균성 뇌수막염의 원인으로 재발성 다발연골염의 가능성을 생각하고 적극적인 진단 및 치료가 필요하겠다.

Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis

손창남,김태은,박경민,황준현,김성규 대한의학회 2016 Journal of Korean medical science Vol.31 No.3

The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman’s rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.

글루코코르티코이드 유발 골다공증의 이해

손창남 계명대학교 의과대학 2021 계명의대학술지 Vol.40 No.2

Glucocorticoids are effective for many inflammatory diseases, but long-term use can lead to osteoporosis and resulting fractures. An initial evaluation of fracture risk should be done within six months of starting glucocorticoid use, and fracture risk should be evaluated every 12 months after long-term use. Adequate calcium and vitamin D administration are required when taking 2.5 mg prednisolone daily for more than three months. Bisphosphonates, teriparatide, and denosumab can be used when there is a moderate or higher fracture risk due to glucocorticoid-induced osteoporosis.

특집 : 평신도 전문인 선교사 시대를 열어라 ; 평신도 전문인 선교는 시대적 요청

손창남 기독교대한성결교회 활천사 2009 활천 Vol.664 No.-

통풍의 약물치료

손창남 대한의사협회 2021 대한의사협회지 Vol.64 No.11

Background: Gout is a common disease that is mainly caused by hyperuricemia. Although it is relatively easy to treat, adherence to drug treatment and the rate at which treatment targets are met is low. Current Concepts: For the treatment of acute gout attack, colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids can be used alone or in combination depending on the severity of symptoms. To prevent gout attacks, patients are started on colchicine prior to or concurrent with treatment with uric acid–lowering drugs. The treatment is maintained until serum uric acid levels have returned to normal, and the patient has had no acute attacks for three to six months. Ultimately, the symptoms of gout are controlled in the long term by treating the patient’s hyperuricemia. For this purpose, allopurinol, febuxostat, and benzbromarone are used, and the side effects and contraindications for each drug should be checked. The goal for the treatment of chronic gout is to maintain a serum uric acid concentration below 6.0 mg/dL. Discussion and Conclusion: Patients visit the emergency departments of hospitals for sudden gout attacks. However, gout is a chronic disease that requires the lifelong use of uric acid–lowering agents. Therefore, it is necessary to educate patients on a serum urate-based treat-to-target approach.

충주 당뇨바이오 사업추진 현황

손창남 한국약용작물학회 2016 한국약용작물학회 학술대회논문집 Vol.2016 No.1