염증류마티스질환에서의 예방접종

정청일 ( Chung Il Joung ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.4

Infection is a critical and challenging situation encountered in treatment of inflammatory rheumatic diseases (IRDs). It is associated with the disease activity itself and/or the immunosuppressant treatments. Vaccine preventable infections could be controlled by use of a timely vaccination protocol. Immunosuppressed situations observed in IRDs require some modification of the recommendation for the general population in each national society. Live attenuated vaccines are generally contraindicated in IRDs, except for varicella-zoster vaccination, which is solely permitted live vaccine and could be given on a case by case basis in autoimmune IRDs. Influenza and pneumococcal vaccines are strongly recommended due to increased mortality in patients with IRDs. The vaccination protocol reflects the current national medical environment and requirements; therefore, it could change with time. The Korean Rheumatology Society now requires that vaccination be recommended for patients with IRDs, with the possibility of both an adult and child version.

Osteitis Condensans Ilii를 동반한 반응성 관절염 1예

성상석 ( Sang Seokg Seong ),정청일 ( Chung Il Joung ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

류마티스 관절염 환자에서 MTHFR 유전자 다형성과 경동맥 죽상경화증과의 관계

박재홍 ( Jae Hong Park ),( Ahmed El Sohemy ),강태영 ( Tae Young Kang ),정청일 ( Chung Il Joung ),전석철 ( Seok Chol Jeon ),이혜순 ( Hye Soon Lee ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( D 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.3

Objective: Studies have suggested that the 5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation (alanine→valine) is a risk factor for atherosclerotic disease. We assessed the association between MTHFR gene polymorphism and carotid atherosclerosis in patients with rheumatoid arthritis (RA). Methods: Forty postmenopausal RA women (mean age: 58±5 years, mean duration of RA 14±5 years) treated with low dose methotrexate, other concurrent disease modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, steroid (prednisolone ≤5 mg/day) and folic acid (≥1 mg/day) were studied. The genetic polymorphism was detected by the polymerase chain reaction. We measured intima-media thickness (IMT) and plaques of the common carotid arteries by ultrasonography, and evaluated relations among the known risk factors for atherosclerosis, the genetic polymorphism, RA outcomes (Steinbrocker`s radiological stage and functional class defined by the ACR criteria) and markers of inflammation (erythrocyte sedimentation rate and C-reactive protein). Results: Among the 40 subjects, 12 had MTHFR genotype CC, 24 genotype CT, and 4 genotype TT. The frequencies of the MTHFR C and T allele were 0.6 and 0.4, respectively. Between the subjects with the CC genotype and those with the mutant T allele, there was no difference in age, body mass index, blood pressure (BP), lipid, duration of RA, RA outcome indices, rheumatoid factor, acute phase reactants and IMT. Carotid IMT was positively associated with age, systolic BP and antihypertensive drug use. There was no significant association between carotid IMT and the MTHFR C677T mutation. Conclusion: It is assumed that there was no significant relationship between the MTHFR C677T polymorphism and carotid atherosclerosis in Korean postmenopausal RA women.

다발성 폐공동을 형성한 베체트병

윤세희 ( Se Hee Yoon ),손지웅 ( Ji Woong Son ),정청일 ( Chung Il Joung ),최유진 ( Eu Gene Choi ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.1

Behcet`s disease is a systemic vasculitis of an unknown etiology involving the arteries and veins of all sizes. There are reports showing that a pulmonary artery aneurysm or thromboembolism and superior vena cava thrombosis are present in 5-10% of patients with Behcet`s disease and that lung parenchymal lesions are mainly airway consolidations resulting from hemorrhage or infarction. We encountered a patient with increasing pulmonary cavitary changes and localized aspergilloma. The patient was a 43-year-old man diagnosed with Behcet`s disease with a history of recurrent oro-genital ulceration and uveitis, and who was administered methotrexate, colchicines, prednisolone. During the follow up he developed progressive dyspnea upon exertion and finger clubbing. Therefore further evaluations were performed. Chest computed tomography showed more advanced consolidations and cavitations than the previous film with the previously known aspergilloma still observable. An open lung biopsy was carried out to determine the presence of malignant changes, which revealed nonspecific vasculitis. Azathioprine was added resultion in an improvement of symptoms. (Tuberc Respir Dis 2006; 61: 65-69)

증례 : 류마티스 ; 비장경색이 동반된 베체트병 1예

정장한 ( Jang Han Jung ),강민규 ( Min Kyu Kang ),이한나 ( Han Na Lee ),권미혜 ( Mi Hye Kwon ),정청일 ( Chung Il Joung ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

베체트병을 진단 받았거나, 의심되는 환자에서 왼쪽 옆구리통증이 동반될 경우, 혈전성 혈관염에 동반된 비장 경색을 감별해야 하겠다. Behcet`s disease is a multisystem autoimmune disease with vasculitic features, and major vascular involvement occurs in 7.7-60% of patients. Venous lesions are more common than arterial lesions and arterial thrombotic events are relatively rare. Wereport a patient with Behcet`s disease who developed a splenic infarct associated with splenic thrombotic arteritis. A 44-year-oldman who had been diagnosed with Behcet`s disease 5 years earlier presented with left flank pain lasting for 5 days. Laboratory tests revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Computed tomography (CT) and three-dimensional CT showed a wedge-shaped splenic infarct and thrombus in the splenic artery. We treated him with low-molecular-weight heparin and prednisolone. The symptoms improved within 6 days of hospitalization, after which we stopped the heparin and added methotrexate and azathioprine. Splenic infarct should be ruled out if patients with Behcet`s disease complain of new left-sided abdominal pain. (Korean J Med 2011;81:126-129

Methotrexate 치료를 받고 있는 활동성 류마티스 관절염 환자에서 etanercept의 유효성과 안전성에 관한 연구

최병렬,강태영,정청일,이혜순,엄완식,김태환,전재범,유대현,배상철 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 류마티스 관절염을 앓고 있는 한국인 중에 기존 DMARDs로 치료 실패하였고, 고정용량의 MTX를 복용하고 있는 환자들에 있어서 etanercept의 유효성과 안전성을 평가하고자 하였다. 방법 : 기존 DMARDs로 치료 실패한 활동성 류마티스 관절염 환자 76명을 대상으로 하여 단일군, 공개시험을 하였다. 대상 환자들은 고정용량의 MTX를 복용하면서 etanercept 25 mg을 1주일에 두 번 피하 주사하였으며 12주간 투여하였다. 유효성은 ACR 20, ACR 50,조조강직 시간으로 평가하였고, 약제의 안전성은 이상반응 등으로 평가하였다. 결과 : 대상 환자는 총 76명으로 평균 연령은 45.2세, 남자 5명, 여자 71명이었다. 84.4%인 54명이 12주째에 ACR 20을 만족하였고, 53.1%인 34명이 12주째에 ACR 50을 만족하였다. 조조 강직 시간은 치료 전 203.3분에서 치료 12주째 42.6분을 평균 74.5% 호전되었다. 가장 흔한 이상반응은 주사부위 반응이었다. 이외에도 상기도 감염, 오심, 안면부종 등이 발생하였으나 심각한 부작용은 없었다. 결론 : etanercept는 효과적이고, 안전한 류마티스 관절염 치료 방법이며 특히 MTX치료에도 불구하고 활동성인 류마티스 관절염에 기대되는 치료라고 할 수 있다. Background : This study was performed to investigate the efficacy and safety of etanercept in active rheumatoid arthritis patients with stable dose of methotrexate in Korean. Methods : In a 12 week, single arm, open trial, we assigned 76 patients with active rheumatoid arthritis who had an inadequate response to disease-modifying antirheumatic drugs. Patients received twice-weekly subcutaneous injections of etanercept 25 ㎎ while containing to receive methotrexate at a stable dose of 7.5~25 ㎎ per week. The clinical response was defined as the percent improvement in disease activity according to the criteria of the American Collage of Rheumatology (ACR) at 12 weeks. Results : Etanrecept led to significant improvements in disease activity and was safe and well tolerated. At 12 week, 84.4% of the patients receiving 25 ㎎ of etanercept achieved a 20% ACR response, and 53.1% of those receiving etanercept achieved a 50% ACR response. The most common adverse event was injection-site reaction. Other advanse events were upper respiratory infection, nausea, and facial edema, but there were no serious adverse events associated with etanercept. Conclusion : In active rheumatoid arthritis patients, etanercept was safe, well tolerated, and provided rapid clinical improvements.

말기 신질환과 혈액투석 환자의 담석증 유병률에 대한 고찰

한동수,이민호,이정익,김호중,최호순,윤병철,이오영,기춘석,함준수,은창수,전용철,이향락,손병관,정청일 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Background/Aims: Gallstone disease is one of the major cause of morbidity in adults. Hemodialysis (HD) has been found to increase risk of gallstone formation following increase in bile cholesterol and biliary saturation index. There are very few data about the prevalence of gallstone in hemodialysis patients and so, we performed this study. Methods: We compared the prevalence of gallstone disease in patients with end-stage renal disease (ESRD) treated with HD with that in 208 age- and sex-matched controls (non-uremic control group). Patients who had chronic liver disease, renal disease, and diabetes were excluded from the control group. Results: In our study, we found a prevalence of gallstone of 18.3% in patients with ESRD treated with HD, which was significantly higher than 5.3% in the non-uremic control group. In most of our HD patients, cholecystolithiasis was asymptomatic. HD patients with cholecystolithiasis were statistically significantly older than patients without gallstones. We did not find a difference in sex, duration of HD treatment between patients with and without gallstones. Conclusions: Our results suggest that the prevalence of gallstone disease is higher in patient with ESRD treated with HD than in non-uremic population in Korea.