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( Ji Ae Yang ),( Jae Hyun Lee ),( Eun Young Lee ),( Eun Bone Lee ),( Yeong Wook Song ),( Jin Kyun Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Clinical experiences suggest that gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response including fever, higher C-reactive protein(CRP) and erythrocyte sediment ratio(ESR) as compared those in younger patients. As such, it is often diffi cult to differentiate them from septic arthritis. To defi ne whether gout attacks in elderly patients have higher infi ammtory markers. Methods: In this retrospective study, medical records of patients who were evaluated for a possible gout attack between January 2000 and April 2014 were examined. The presence of fever (>37.8°), levels of CRP and ESR on attack were compared between young (=50 years), middle aged (51- 65 years) and elderly patients (>65 years). Results: Gout attacks were observed in 188 patients with 34 young, 54 middle aged and 100 elderly patients. Baseline characteristics of three groups differed; elderly patients had more comorbidities including diabetes mellitus (p<0.001), hypertension (p<0.001), coronary artery disease (p=0.015), cerebrovascular accident (p<0.001), and cancer (p=0.031) as compared other groups. The elderly patients had a low body mass index (BMI) (24.60 ± 4.65, 24.55 ± 3.30, 23.27 ± 3.12, p=0.041) and longer disease duration (2.76 ± 5.16, 4.20 ± 6.13, 6.58 ± 9.23 years, p=0.028 by ANOVA). Fever was more often present in the elderly patients (17.6% in young vs. 29.6% in middle aged vs. 50.0% in elderly, p=0.001 by chi-square test). Although numbers of involved joints during attacks did not differ between groups (p=0.656), CRP and ESR levels during gout attack increased signifi cantly with age (figure 1). Conclusions: Since gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response, often resembling sepsis or septic arthritis, it is crucial to correctly diagnose them as gout so that unnecessary invasive diagnostics including joint lavage and prolonged antibiotic treatment can be avoided.
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증례 : 류마티스 ; Methotrexate로 치료한 불응성 육아종성 유방염 1예
유종진 ( Jong Jin Yoo ),강은하 ( Eun Ha Kang ),이윤종 ( Yun Jong Lee ),김성원 ( Sung Won Kim ),최인아 ( In Ah Choi ),이은봉 ( Eun Bone Lee ),송영욱 ( Yeong Wook Song ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
Granulomatous mastitis (GM) is an uncommon chronic inflammatory disease of the breast that can mimic breast carcinoma or infection. The treatment options include expectant management, complete resection, and corticosteroid therapy, although no standard treatment has been established. Recently, several case reports have suggested that methotrexate is another effective treatment for GM. Here, we describe the first Korean case of recurrent GM successfully treated with low-dose weekly methotrexate and review the relevant literature. (Korean J Med 2012;82:386-391)
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