한국인 골관절염 환자에 대한 Celecoxib와 서방형 Diclofenac의 유효성 및 안전성 비교: 다기관 임상연구

안홍준 ( Hong Joon Ahn ),이찬희 ( Chan Hee Lee ),정성모 ( Sung Mo Chung ),이상헌 ( Sang Heon Lee ),이충기 ( Choong Ki Lee ),배성권 ( Sung Kwon Bae ),송정수 ( Jung Soo Song ),박원 ( Won Park ),배상철 ( Sang Cheol Bae ),유대현 ( Da 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Objective: Long-term use of the analgesic acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis is limited due to the lack of effectiveness and presence of side effects. Celecoxib is a selective inhibitor of cyclo-oxygenase (COX)-2 and expected to help NSAIDs in expressing the effective anti-inflammatory effect by not inhibiting COX-1. Thus, 200 mg of celecoxib and 100 mg of slow releasing diclofenac were compared for their effectiveness and safety in Korean patients with knee osteoarthritis. Methods: We administered 200 mg of celecoxib or 100 mg of slow releasing diclofenac in 223 randomly selected patients with knee osteoarthritis for 4 weeks. The effectiveness of these drugs on osteoarthritis was assessed by evaluating pain in each patient, making overall evaluation on osteoarthritis by the patient and his/her attending physician, and measuring the severity indices on osteoarthritis before treatment, and 2 weeks and 4 weeks after treatment. Moreover, safety and drug resistance were evaluated by assessing the rate of adverse effects, rate of withdrawal, laboratory tests, and vital signs. Results: The clinical symptoms of osteoarthritis were improved significantly by 4 weeks after treatment with celecoxib and diclofenac. According to the results of overall evaluation made by attending physicians 2 weeks after treatment, the rate of improvement was 49.5% in celecoxib group and 35.7% in diclofenac group, showing a statistically significant difference (p=0.023). Other than this difference, no other significant difference was present between the two groups with other variables used for the evaluation of effectiveness. The rate of adverse effects was significantly lower in celecoxib group compared with diclofenac group. According to laboratory findings, no abnormal figure was found in both groups but total bilirubin, SGOT, and SGPT were consistently higher in patients in diclofenac group. Thirteen patients dropped out of the study due to side effects (10 patients) and treatment failure (3 patients). Conclusion: Our findings from the clinical comparison of celecoxib and diclofenac in Korean patients with knee osteoarthritis were similar to those results found in previous studies. Although celecoxib showed similar effectiveness as diclofenac on knee osteoarthritis in the treatment of symptoms, it showed a lower rate of adverse effects; thus, we concluded that celecoxib is safer compared with diclofenac.

염증성 근병증에서 자기공명영상의 임상적 의의

고재현 ( Jae Hyun Koh ),홍석주 ( Suk Joo Hong ),안홍준 ( Hong Joon Ahn ),안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),안중모 ( Joong Mo Ahn ),김현숙 ( Hyun Sook Kim ),서연림 ( Yeon Lim Seo ),고은미 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.3

Objective: The purpose of the study is to describe the magnetic resonance imaging (MRI) findings and to investigate useful sequences of MRI in inflammatory myopathies. A third goal is to correlate MRI findings with the grade of histopathologic severity. Methods: Sixteen patients (13 women, 3 men), aged 21~74 years (median age of 49) with inflammatory myositis (examined with both MRI and muscle biopsy) were studied. Ten patients were diagnosed with polymyositis and 6 with dermatomyositis. Conventional T1-weighted (SE 366/12) and T2-weighted (SE 4766/90) fast spin-echo and fat-suppressed T1-weighted MR images with contrast enhancement (FSAT T1 CE) were obtained. Ratios between the signal intensities of a muscle and the signal intensities of subcutaneous fat in the same tomographic sections were calculated to objectively represent the degree of signal intensities. Semi-quantitative grading of severities in muscle biopsy specimen was examined based on invasion of inflammatory cells and necrosis, degeneration and regeneration of muscle fiber by a neuromuscular pathologist. Results: FSAT T1 CE could objectively describe the severity of involvement in inflammatory myopathies. The quadriceps muscle group, especially the vastus muscle tended to be most severely and frequently involved in inflammatory myositis with FSAT T1 CE (statistically insignificant). The vastus intermedius muscle was more severely involved in dermatomyositis than polymyositis. The signal intensity of abnormal muscle sampled by biopsy correlated positively with the grade of muscle biopsy. Conclusion: MRI shows promise in identifying pathologic muscle in patients suspected of having one of the inflammatory myopathies. The degree of signal intensity on MRI may reflect the severity of grade in muscle biopsy.

통풍환자에서 Benzbromarone의 효과에 관한 연구

한성훈 ( Seong Hoon Han ),안홍준 ( Hong Joon Ahn ),이윤우 ( Yun Woo Lee ),김동욱 ( Dong Wook Kim ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Objective: Benzbromarone is a most potent uricosuric agent which has been marketed in Europe. The purpose of this study was to evaluate the safety and efficacy of benzbromarone as a uric acid lowering agent in gouty patients in Korea. Method: Twenty-one patients with gout, who were lower excreter of uric acid and had no other complication of gout, were treated with benzbromarone for 6 months. In these patients we checked complete blood count, liver function test, BUN, creatinine, serum uric acid, 24 hour urine uric acid excretion and uric acid clearance before and after treatment with benzbromarone. Results: Significant improvements(p<0.01) were found in the serum uric acid level, 24h uric acid excretion and uric acid clearance. The mean serum uric acid decreased from 8.2mg/dl to 5.1mg/dl at the end of 6 months; mean urinary uric acid excretion increased from 425.9mg/day to 760.3mg/day; and the uric acid clearance increased from 3.5mL/min to 10.9mL/min. There are no clinical or laboratory side effects, except skin rash in the one patient. Conclusion: Benzbromarone was effective to control plasma uric acid concentration at doses ranging from 25 to 50mg/day.

정상인과 통풍 환자의 Hypoxanthine-Guanine Phosphoribosyltransferase 활성도 비교

이찬희 ( Chan Hee Lee ),안홍준 ( Hong Joon Ahn ),이지환 ( Ji Hwan Rhee ),박소진 ( So Jin Park ),윤보영 ( Bo Young Yoon ),한성훈 ( Seong Hoon Han ),이백락 ( Baek Rak Lee ),이윤우 ( Yun Woo Lee ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.2

Objective: It has been known that the enzyme deficiency associated with uric acid production is the minor cause of gout. The purpose of this study is to evaluate the role of hypoxanthine-guanine phosphoribosyltransferase (HGPRT) activity deficiency in the development of gout. Methods: Assay of HGPRT activity was performed on 38 gout patients and 107 controls compromising 82 men and 25 women. In the patients with gout, age of onset, sex, family history of gout, duration of disease, serum uric acid level, and uric acid concentration of 24-hour urine were analyzed. Results: In gout patients and control male group, the HGPRT activity was lowest in the age of forties. But, in female, there was no decreasing tendency with aging. In 4 gout patients, HGPRT activities were severely deficient and their ages of onset were less than 30 years old, and all have a family history of gout. Conclusion: In men, the lowest HGPRT activity in the age of forties could be one of the factors that make the onset of gout is highest in the fifth decade of age. The deficiency of HGPRT enzyme and family history of gout are the important factors in the pathogenesis of early onset gout.

통풍환자에서 Allopurinol 투여 후 나타난 간기능이상

서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),고광철 ( Kwang Cheol Koh ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

Objective: To investigate the incidence and clinical course of the patients who had liver function test abnormalities during treatment with allopurinol. Methods: 62 patients who were diagnosed as gout and were treated with allopurinol at Samsung Medical Center between 1995 and 1997 were reviewed. In these patients, liver function tests were checked before and during treatment for 6 months. The term of `abnormalities of liver function test` was defined when there was an increase of more than 1.5 times of upper limit of normal values or baseline values in anyone of bilirubin, asparate transaminase, alanine transaminase and alkaline phosphatase. Results: During treatment with allopurinol, 25 patients(40.2%) showed abnormalities of liver function test. 10(25.0%) of 40 patients who had normal liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68.2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. Conclusions: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.

Adult onset Still`s disease 환자에서 질환의 활동지표로서의 혈중 Ferritin의 역할

서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objective: Adult onset Still`s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. Methods: Seven patients who were diagnosed as adult onset Still`s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. Results: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml; normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively. There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. Conclusions: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.

슬관절 골관절염 환자에 대한 Meloxicam의 유효성 및 안전성 평가를 위한 Diclofenac과의 공개 비교 무작위 다기관 임상 시험

송정식 ( Jung Sik Song ),박용범 ( Yong Beom Park ),이수곤 ( Soo Kon Lee ),안홍준 ( Hong Joon Ahn ),이윤우 ( Yun Woo Lee ),이창근 ( Chang Keun Lee ),고재현 ( Jae Hyun Koh ),고은미 ( Eun Mi Koh ),이은영 ( Eun Young Lee ),이충기 ( Ch 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.4

Objective: To assess the clinical efficacy and safety of meloxicam 7.5mg versus diclofenac 100mg slow release (SR) in the Korean patients with osteoarthritis of the knee. Methods: Ninety-one patients of four university hospitals in 1999 were randomized to receive once daily oral meloxicam 7.5mg (N=45) or diclofenac 100mg SR (N=46) for 8 weeks. Clinical efficacy was evaluated using 100mm Visual Analogue Scale (VAS) for pain, Lequesne index after 4, 8 weeks of treatment as well as the physician`s and patient`s global assessment at the end of treatment. Evaluations for clinical safety were performed using the incidence of adverse events, physical examinations, laboratory finding and total ingestion of antacid during the treatment. Results: After 8 weeks of therapy, both groups had significant improvement in 100mm VAS and Lequesne index than baseline although the difference between two groups did not reach statistical significance. The physician`s and patient`s global assessment were similar in two groups. The incidence of gastrointestinal adverse events was significantly lower in meloxicam group (24.4%) than diclofenac group (50.0%) (p<0.05). Conclusion: Meloxicam 7.5mg is comparable to diclofenac 100mg SR in the treatment of Korean patients with osteoarthritis of the knee. Furthermore meloxicam 7.5mg was well tolerated for 8 weeks and has safe advantage of a significantly lower incidence of gastrointestinal adverse events.

전신성 괴사성 혈관염에서 다발성 단신경염의 임상적 고찰

김진석 ( Jin Seok Kim ),차훈석 ( Hoon Suk Cha ),서기현 ( Gi Hyun Seo ),안홍준 ( Hong Joon Ahn ),이창근 ( Chang Keun Lee ),고재현 ( Jae Hyun Koh ),김현숙 ( Hyeon Sook Kim ),최동철 ( Dong Chull Choi ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

Background: The vasculitides are heterogeneous clinical syndromes characterized by inflammation of blood vessels. There are no pathognomonic symptoms. Mononeuritis multiplex is an acute or subacute asymmetric sensory motor syndrome involving discrete peripheral nerves and is known to occur in many illnesses including certain types of systemic vasculitis. Our purpose was to evaluate the clinical manifestations and significance of mononeuritis multiplex in systemic necrotizing vasculitis. Patients & Methods: Eight patients who were diagnosed as systemic necrotizing vasculitis at Samsung Medical Center between 1995 and 1997 were reviewed. Vasculitis was diagnosed by ACR criteria for each vasculitis and microscopic polyangiitis was diagnosed by the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis. Three were diagnosed as Churg-Strauss syndrome, 3 as polyarteritis nodosa, and 2 as microscopic polyangiitis. In most cases, vasculitis was confirmed by a biopsy specimen showing infiltration of granulocytes, lymphocytes, and/or plasma cell into vessel walls. Occasionally, polyarteritis nodosa was confirmed by mesenteric or renal arteriography which showed microaneurysms. EMG/NCV was performed in seven patients who had neuropathy. Results: Seven of the eight patients presented with mononeuritis multiplex and one had no neuropathy. Four patients presented with neuropathy as the first symptom, and three developed neuropathy within 3 weeks after the onset of vasculitis symptoms. The peroneal nerve and sural nerve were involved in all seven patients. The median nerve, ulnar nerve and posterior tibial nerve were involved in four, two and six patients, respectively. All seven patients had lower extremity involvement. Two showed only lower extremity involvement and five had both lower and upper extremity involvement. Isolated upper extremity involvement was not seen. All patients with mononeuritis multiplex were improved by treatment with cyclophosphamide and steroid therapy. Conclusion: Mononeurtis multiplex is a common manifestation of vasculitis and occurs early in the course of systemic vasculitis. Prognosis of mononeuritis multiplex is excellent, although it may take up to one year to recover.

Paraplegia due to Herpes Zoster Myelitis in a Patient with Rheumatoid Arthritis

이상준 ( Sang Jun Lee ),한성훈 ( Seong Hoon Han ),안홍준 ( Hong Joon Ahn ),이윤우 ( Yun Woo Lee ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

초기 류마티스 관절염에서 적혈구 침강속도, 혈청 C-반응성 단백과 방사선학적 진행의 상관관계

고재현 ( Jay Hyun Koh ),김재형 ( Jae Hyung Kim ),이창근 ( Chang Keun Lee ),전찬홍 ( Chan Hong Jeon ),서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),안중모 ( Joong Mo Ahn ),고은미 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.4

Objective: To investigate the clinical usefulness of serial measurement of erythrocyte sediment rate(ESR) and C-reactive protein(CRP) for monitoring the radiological progression in early rheumatoid arthritis(RA). Methods: Thirty one patients with RA according to the 1987 ACR criteria, with joint symptoms for less than one year, and who had not previously received disease modifying antirheumatic drugs(DMARDs) were assessed from Oct. 1994 to Aug. 1998 in retrospective study. Area under curve(AUC) of ESR and CRP were calculated in these patients. Joint damage in the hands was assessed by modified Sharp`s method. Results: Male to female ratio was 1: 3.4. Median age of this group was 45.8±13.2 years. Patients who had positive rheumatoid factor were 82%. Mean duration until first visit was 271.9±145.8 days. At the first clinic visit, mean ESR and CRP were 50mm/hr and 2.0mg/dL. Mean erosions and joint space narrowing score by modified Sharp`s method were 55.2 and 12.4, respectively. Correlation analysis showed that ESR AUC and CRP AUC were significantly associated with radiologic progression. Conclusions: Elevated over-time ESR and CRP provide a convenient short term correlation with radiologic outcome(i. e. erosions). Elevated over-time ESR and CRP can be used as a guide for therapy.