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한국인 일차성 쇼그렌 증후군 환자의 선외 임상상의 분석
최병용 ( Byoong Yong Choi ),유종진 ( Jong Jin Yoo ),오혜진 ( Hye Jin Oh ),장유진 ( Yu Jin Jang ),이윤종 ( Yun Jong Lee ),송영욱 ( Yeong Wook Song ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.3
Objectives. To investigate the clinical findings upon initial diagnosis and extraglandular manifestations in Korean patients with primary Sjogren``s syndrome (pSS). Methods. We collected clinical and laboratory data from 238 pSS patients enrolled at Seoul National University Hospital, Seoul National University Bundang Hospital and Seoul Medical Center from March 2011 to December 2014. All patients met the American-European Consensus Group criteria for pSS. Results. Upon initial diagnosis, sicca symptoms (xerophthalmia or xerostomia) as the chief complaint were only observed in 129 (54.2%) pSS patients, while extraglandular manifestation was more common as the chief complaint in male patients or those with younger age (<40 years) than female or older patients (both p<0.05). Extraglandular manifestations were found in 178 (74.8%) patients, with musculoskeletal manifestations being most common (53.8%). Peripheral neuropathy in pSS patients was associated with Raynaud phenomenon and elevated serum total immunoglobulin G (IgG) levels (both p<0.05). Serum β2-microglobulin (β2-M) levels were significantly correlated with European League against Rheumatism (EULAR) Sjogren``s syndrome disease activity index, erythrocyte sedimentation rate and serum total IgG (all p<0.001), and were higher in patients with extraglandular manifestations than those without (p<0.05). Serum C3 levels were decreased in patients with extraglandular manifestation, compared to those without (p<0.05). Malignant lymphoma was found in Korean pSS patients (1.7%) and associated with elevated serum β2-M levels (p<0.0001). Conclusion. Extraglandular manifestations were common in pSS patients and may be a diagnostic tool for male or younger pSS patients. Serum β2-M levels can be useful markers for monitoring pSS patients. (J Rheum Dis 2015;22:167-174)
증례 : 류마티스 ; 만성 염증성 탈수초성 다발신경병증과 헤노흐-쇤라인 자반증을 동반한 강직성 척추염 1예
최병용 ( Byoong Yong Choi ),권현미 ( Hyun Mi Kwon ),성정준 ( Jung Jun Sung ),박성혜 ( Seong He Park ),송영욱 ( Yeong Wook Song ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
Peripheral nervous system dysfunction is a rare complication in Henoch-Schonlein purpura, but it tends to recover spontaneously without treatment. A 78-year-old man who had ankylosing spondylitis presented with Henoch-Schonlein purpura associated with progressive sensorimotor polyneuropathy. He was diagnosed with chronic inflammatory demyelinating polyneuropathy, which did not improve despite intravenous immunoglobulin therapy. We describe a case of Henoch-Schonlein purpura, accompanied by chronic inflammatory demyelinating polyneuropathy in a patient with ankylosing spondylitis. (Korean J Med 2012;83:538-542)
( Hyun Suk Lee ),( Jun Ho Lee ),( Yong Seok Lim ),( Eui Chang Kim ),( Hyun Mi Kwon ),( Seong-he Park ),( Byoong Yong Choi ) 대한류마티스학회 2017 대한류마티스학회지 Vol.24 No.1
Polyarteritis nodosa (PAN) has a broad spectrum of clinical presentation, since it affects small and medium-sized muscular arteries with microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction. Although skeletal muscle involvement is well documented in patients with PAN, it can mimic more common diseases, and cause confusion and delays in diagnosis. PAN muscular involvement may have limited or early systemic forms with a benign course and excellent clinical response to corticosteroid therapy. Herein, we describe the clinical course and outcome of four unusual cases of PAN manifested by acute onset of pain and pitting edema in both lower extremities; in addition, we reviewed the relevant literature. (J Rheum Dis 2017;24:48-54)
정희원 ( Hee Won Chung ),유종진 ( Jong Jin Yoo ),최병용 ( Byoong Yong Choi ),조현정 ( Hyun Jung Cho ),강은하 ( Eun Ha Kang ),송영욱 ( Yeong Wook Song ),이윤종 ( Yun Jong Lee ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.5
Primary Sjogren`s syndrome (pSS) is characterized by chronic inflammation and dysfunction in exocrine organs; however, it also has protean clinical features, including neuropsychiatric symptoms. A major neurological manifestation is peripheral neuropathy and involvement of the central nervous system is uncommonly described in pSS. A 52-year-old female was admitted because of depression, dysarthria, gait abnormality, and memory disturbance, which had developed over two months, and was diagnosed as pSS. She was treated successfully with high-dose glucocorticoid and cyclophosphamide pulse therapy without recurrence during the follow-up period of two years. Herein, we describe the first Korean case of pSS presenting with rapidly progressive cognitive impairment along with a review of the literature.
Heart Rate Variability for Quantification of Autonomic Dysfunction in Fibromyalgia
Jin Ho Kang,Jong Kyu Kim,Seok Hyun Hong,Chang Hyun Lee,Byoong Yong Choi 대한재활의학회 2016 Annals of Rehabilitation Medicine Vol.40 No.2
Objective To quantify autonomic dysfunction in fibromyalgia patients compared to healthy controls using heart rate variability (HRV).Methods Sixteen patients with fibromyalgia and 16 healthy controls were recruited in this case control study. HRV was measured using the time-domain method incorporating the following parameters: total heartbeats, the mean of intervals between consecutive heartbeats (R-R intervals), the standard deviation of normal to normal R-R intervals (SDNN), the square root of the mean squared differences of successive R-R intervals (RMSSD), ratio of SDNN to RMSSD (SDNN/RMSSD), and difference between the longest and shortest R-R interval under different three conditions including normal quiet breathing, rate controlled breathing, and Valsalva maneuver. The severity of autonomic symptoms in the group of patients with fibromyalgia was measured by Composite Autonomic Symptom Scale 31 (COMPASS 31). Then we analyzed the difference between the fibromyalgia and control groups and the correlation between the COMPASS 31 and aforementioned HRV parameters in the study groups.Results Patients with fibromyalgia had significantly higher SDNN/RMSSD values under both normal quiet breathing and rate controlled breathing compared to controls. Differences between the longest and shortest R-R interval under Valsalva maneuver were also significantly lower in patients with fibromyalgia than in controls. COMPASS 31 score was negatively correlated with SDNN/RMSSD values under rate controlled breathing.Conclusion SDNN/RMSSD is a valuable parameter for autonomic nervous system function and can be used to quantify subjective autonomic symptoms in patients with fibromyalgia.
Case Reports : Successful Infliximab Therapy in a Patient with Refractory Takayasu`s Arteritis
( Jin Young An ),( Yeon Sil Yu ),( Suhyeon Lee ),( Hyun Suk Lee ),( Byoong Yong Choi ) 대한류마티스학회 2016 대한류마티스학회지 Vol.23 No.1
Takayasu’s arteritis (TA), a granulomatous vasculitis, affects the aorta and its major branches. Glucocorticoids are an effective treatment for patients with active TA, but some patients fail to achieve or maintain remission with the conventional therapy, and side effects resulting from long-term glucocorticoid therapy are potentially serious. Anti-tumor necrosis factor-α agents, such as infliximab, may be efficient in patients with refractory TA. We report on a 24-year-old female patient with refractory TA who was treated successfully with infliximab. Clinical remission was induced as determined by repeated 18F-fluoro-2-deoxy- D-glucose positron emission tomography scans combined with assay of serological inflammatory markers. (J Rheum Dis 2016;23:71-75)
TNF-like ligand 1A is a promising biomarker of disease activity in rheumatoid arthritis
( Yoo Jin Hong ),( Yun Jong Lee ),( Ki Chul Shin ),( Byoong Yong Choi ),( Sung Hae Chang ),( Hae Won Kim ),( In Ah Choi ),( Eun Young Lee ),( Eun Bong Lee ),( Yeong Wook Song ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of multiple joints. TN -like ligand 1A (TL1A), a ligand belonging to the TNF superfamily, is expressed by endothelial cells, lymphocytes, monocytes and plasma cells. These are also the key cell lineages participating in the pathogenesis of RA. Moreover, TL1A is up-regulated by proinflammatory cytokines TNF- and IL-1. We thereby examined the serum and synovial fluid levels of TL1A in patients with RA. In addition, we investigated the relationship between serum TL1A concentration and clinical parameters in RA patients. Methods: Serum samples were obtained from 232 patients with RA and 29 with osteoarthritis (OA). Thirty-eight and 27 synovial fluid (SF) samples were collected from respective group of patients. Additional 45 serum samples before and after (14 weeks) anti-TNF- treatment were collected from RA patients. TL1A concentrations were measured by ELISA. Clinical parameters were acquired at the time of sampling. Results: Serum concentrations of TL1A in RA patients were significantly higher than those in OA patients (mean±SD, 1327.4±3858.8 pg/ml vs. 150.3±269.6 pg/ml, p<0.0001). The SF levels of TL1A were elevated in patients with RA compared with those in OA (965.7±1617.2 vs. 271.4±238.9, p=0.013). Levels of TL1A were significantly increased in SF than serum in matched samples (RA; p=0.006, OA; p<0.0001). Serum levels of TL1A decreased substantially with anti-TNF- treatment (p=0.002). Serum levels of TL1A correlated well with DAS28-ESR (r=0.170, p=0.021), DAS28-CRP (r=0.166, p=0.037), SDAI (r=0.201, p=0.016), CDAI (r=0.195, p=0.011) and rheumatoid factor positivity (r=0.876, p=0.044). Conclusion: Serum and SF levels of TL1A were significantly increased in RA patients compared with OA patients, and correlated well with clinical parameters representing disease activity.Our results support that TL1A could be a potential biomarker in assessing disease activity and treatment response in RA patients.
Depression and Quality of Life in Patients with Systemic Lupus Erythematosus
( Sung Hae Chang ),( Ja Hyun Cho ),( Na Hee Shin ),( Hye Jin Oh ),( Byoong Yong Choi ),( Myeong Jae Yoon ),( Eun Young Lee ),( Eun Bong Lee ),( Yun Jong Lee ),( Tae Jin Lee ),( Bong Jin Hahm ),( Young 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.6
Objective. The objective of this study is to examine the prevalence of depression and its related factors including quality of life, brain-derived neurotrophic factor (BDNF), and vitamin D in patients with systemic lupus erythematosus (SLE). Methods. Depression was assessed using the center for epidemiologic studies depression (CES-D) scale. Disease activity, disease-related organ damage, the EuroQol-5 dimensions (EQ-5D), sociodemographic features, and laboratory tests including serum vitamin D level were surveyed. Serum BDNF was measured using an enzyme-linked immunosorbent assay. Results. Depression was observed in 22.8% of 180 SLE patients (n=41). Patients with marital status of single/divorced/separated/widowed, a higher patient global assessment (PGA) score, and extreme pain/discomfort showed significant association with depression. The EQ-5D index showed negative correlation with CES-D score (r=-0.56, p<0.05). In each EQ-5D dimension, depression showed significant association with moderate to severe problems in self-care and usual activities, and extreme pain/discomfort. Serum BDNF levels were not associated with depression (p=0.75) but associated with SLE disease activity index (SLEDAI; r=-0.21, p<0.05). Serum vitamin D levels were not associated with depression (p=0.60) but showed negative correlation with SLEDAI (r=-0.23, p<0.05) and mean glucocorticoid dose over the previous 3 months (r=-0.21, p<0.05) after adjustment for use of vitamin D supplement. Conclusion. Depression was prevalent in patients with SLE and was associated with low quality of life, and a higher PGA but not with SLEDAI. Serum BDNF and vitamin D levels were not associated with depression but showed negative correlation with SLEDAI. (J Rheum Dis 2015;22:346-355)