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.

Case Reports : Injectable Gold - Induced Hepatitis and Neutropenia in Rheumatoid Arthritis

Wan Sik Uhm,Dae Hyun Yoo,Ji Hyun Lee,Tae Hwan Kim,Jae Bum Jun,In Hong Lee,Sang Cheol Bae,Seong Yoon Kim 대한내과학회 2000 The Korean Journal of Internal Medicine Vol.15 No.2

Gold salts have been used for many years in the treatment of rheumatoid arthritis. The common side effects are mucocutaneous reactions, but hepatotoxic reaction and isolated neutropenia are rare complications. We report a 62-year-old woman with rheumatoid

Cross-cultural adaptation and validation of Korean version of EQ-5D in patients with rheumatic diseases

( Wan Sik Uhm ),( Myoung Hee Kim ),( Hye Soon Lee ),( Tae Hwan Kim ),( Jae Bum Yun ),( Dae Hyun Yoo ),( Sang Cheol Bae ) 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

류마티스영역을 중심으로 분석한 상대가치수가제도 현황

엄완식 ( Wan Sik Uhm ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.3

In Korea, Resource-Based Relative Value Scale (RBRVS) was developed in 1997 and introduced in 2001 for the alternative of Korean Medical Fee Schedule. The RBRVS measures physician resource inputs to construct relative values for services and procedures. The RBRVS, as an administered price system, would need to be updated periodically. Changes in practice costs and practice patterns, and the rapid evolution of technology will require that relative values be adjusted over time. The Relative Value Scale Update Committee (RUC) in Korean Medical Association (KMA) is under updating annual review and 5-year review of Korean Relative Value Scale (RVS). The Korean RVS is estimated less balanced and rational in general, and furthermore there was no update after base-line study. So, it is the reason why this update of RVS is important. We, rheumatologists, are specialists for rheumatic diseases and are unfamiliar and unconcerned with health care system and medical insurance fee schedule, but this attitude is not appropriate to improve our specialized medical situation. This article reviewed the history of Korean medical insurance, development and update procedure of Korean RVS, and the current insurance problems in rheumatic diseases briefly. In Korea, RVS of medical services including rheumatology is relatively less compensated than the other invasive and imaging services. Therefore, Korean RVS update should be changed to more balanced and reasonable one for the medical service including rheumatology.

한국인 관절염의 본인인지 유병률과 역학적 특성: 『1998 국민건강,영양조사』

엄완식 ( Wan Sik Uhm ),윤정이 ( Jeong E Yun ),박용욱 ( Yong Wook Park ),김혜련 ( Hye Ryun Kim ),남정자 ( Jung Ja Nam ),이혜순 ( Hye Soon Lee ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Ch 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.2

Objective: The aim of our study was to define the prevalence, demographic data, selection of the medical services and disability of the patients with self-reported arthritis which were based on the data of National Health and Nutrition Survey (NHNS) conducted by Korea Institute for Health and Social Affairs (KIHASA) and Ministry of Health and Welfare in 1998. Methods: By a stratified multistage probability sampling method, 200 sample districts which consisted of total 13,523 households were selected all over the country. The investigation started with a basic household survey which was completed in 12,189 households with exclusion of non-kinship family. The Health Interview Survey was subdivided to 5 parts including the basic household survey (n=39,060), the diseases survey (n=26,448), and the disability survey (n=694). Results: An estimated 8.0% of Koreans had some form of self-reported arthritis in 1998 and this proportion was higher than that of other chronic medical conditions such as peptic ulcer disease, hypertension, and diabetes mellitus (DM) -7.0%, 4.5%, and 2.2%, respectively. Arthritis was more prevalent among people with female, increasing age, lower income (less than 500 thousand ￦ per month), lower educational attainment (less than 9 years), and lower standard of living. Especially, arthritis ranked first in prevalence as the cause of the chronic disease in the population aged over 45 years, with the prevalence rate of 22.6%. People with arthritis were more likely to report functional limitations such as activities of daily living (ADL) and instrumental activities of daily living (IADL) (5.4%), compared with people who had other musculoskeletal diseases, such as low back pain (3.8%), and herniated intervertebral disc (2.8%). The loss of productivity from arthritis was estimated to reach 0.25% of gross domestic product (GDP) amounts to ￦ 1,133 billion per year which was remarkably higher than that of cardiovascular diseases or cancers. Conclusion: Arthritis has a major impact on the health profile of our population. High burden of arthritis in our society should be considered as an important factor in planning health care services and setting research priorities.

건강검진자의 혈청 Rheumatoid Factor 양성률과 간염바이러스 감염의 관계에 대한 연구

엄완식(Wan Sik Uhm),조재근(Jae Kun Cho),정두련(Doo Ryeon Chung),최승원(Seung Won Choi),이무송(Moo Song Lee),유빈(Bin Yoo),문희범(Hee Bom Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4

N/A Objectives: To estimate the prevalence of rheumatoid factor(BF) positivity in adult Korean population and to investigate the association between viral hepatitis infection and rheumatoid factor positivity. Methods: The database from 21,907 subjects who visited general health screening center of Asan Medical Center during 1 year's period were surveyed. RF was tested using a commercial latex test kit(RapiTex® RF Test; Behringwerke). Results : 1) The prevalence of I4F was 2.9%(male 3.1%, female 2.7%) and increased along with the higher age groups. 2) The prevalence of HF in HBsAg(+) subjects was higher(13.3%) than that of RF in HBsAg(-) subjects(2.2%). 3) The prevalence of RF in anti-HCV(+) subjects was higher(6.1%) than that of BF in anti-HCV(-) subjects(2.8%). 4) HBsAg positivity was highly associated the presence of RF than age, anti-HCV, or abnormnl AST/ALT. Conclusion : The prevalence of RF in healthy Korean adults can be estimated as 3% and shows high association with hepatitis B and C virus infection.

면역억제제로 치료한 베체씨병에 의한 복부대동맥류

엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),박용욱 ( Yong Wook Park ),장대국 ( Dae Kook Chang ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( S 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3

Behcet`s disease can elicit serious vascular complications such as thrombophlebitis, arterial occlusion, and arterial aneurysm. The most common cause of death in Behcet`s disease is secondary to vascular complication. The treatment for abdominal aortic aneurysm which was frequently complicated by fatal rupture (60%) is mainly a surgical management. If surgical treatment is not possible due to various causes, alternative medical therapy such as immunosuppressives and steroid would be recommended. We report here the case of medically controlled abdominal aortic aneurysm in a 47-year-old patient with Behcet`s disease who refused to undergo surgical treatment. Immunosuppressive therapy and steroid could be an alternative treatment of aneurysmal manifestations in Behcet`s disease.

항호중구세포질항체연관혈관염

엄완식 ( Wan Sik Uhm ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2

Primary antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) constitute a group of small vessel vasculitides that includes Wegener`s granulomatosis, microscopic polyangiitis and Churg-Strauss syndrome. Recently, many in vitro and in vivo studies have highlighted the role of ANCA as the main pathophysiological factor in the development of AAV. Two remarkable studies on ANCA pathogenesis were recently reported. One study examined anti-lysosomal membrane protein-2, which supports the `shared epitope` theory. The other examined the neutrophil extracellular trap that is released by neutrophils primed by ANCA. Each disease of AAV shows a broad spectrum of the clinical features and severities, which makes it difficult to diagnose and treat them. Considerable effort has been made in the past decades to improve the treatment outcomes, reduce the incidence of relapse and avoid drug toxicity. This review describes the current understanding of AAV along with a few Korean reports.

가족형 폐유육종증

엄완식,임채만,김우성,김동순,김원동 대한결핵학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.6

Incidence of Tuberculosis Among Korean Patients with Ankylosing Spondylitis Who Are Taking Tumor Necrosis Factor Blockers

KIM, EUN-MI,UHM, WAN-SIK,BAE, SANG-CHEOL,YOO, DAE-HYUN,KIM, TAE-HWAN The Journal of Rheumatology 2011 The Journal of rheumatology Vol.38 No.10

<B>Objective.</B><P>To assess the incidence and relative risk of new tuberculosis (TB) infections in Korean patients with ankylosing spondylitis (AS) and patients with AS who are undergoing treatment with tumor necrosis factor (TNF) blockers.</P><B>Methods.</B><P>New cases of TB were identified by reviewing the medical records of 919 patients with AS not treated with TNF blockers and those of 354 patients with AS treated with adalimumab (n = 66), infliximab (n = 78), or etanercept (n = 210) between 2002 and 2009. Reference data were obtained from the Korean National Tuberculosis Association.</P><B>Results.</B><P>The mean incidence rate of TB was 69.8 per 100,000 person-years (PY) in the general population, 308 per 100,000 PY in the TNF blocker-naive AS cohort, and 561 per 100,000 PY in the TNF blocker-exposed AS cohort. The incidence rate of TB in the infliximab-treated AS cohort (540 per 100,000 PY) was higher than that in the adalimumab-treated AS cohort (490 per 100,000 PY). No cases of TB occurred in the etanercept-treated AS cohort. Comparing the relative risks of TB infections between the TNF blocker-exposed AS cohort and the TNF blocker-naive AS cohort, no statistically significant difference was identified (risk ratio 0.53; 95% CI 0.144-1.913).</P><B>Conclusion.</B><P>The risk of TB was higher in the TNF blocker-naive AS cohort than it was in the general population. However, the risk of TB was not increased in the TNF blocker-exposed AS cohort compared with the TNF blocker-naive AS cohort. Among patients with AS, etanercept is associated with a lower risk of TB compared with monoclonal antibodies.</P>