통풍성 관절염의 임상 양상에 관한 연구

백한주(Han Joo Baek),이은봉(Eun Bong Lee),유창달(Chang Dal Yoo),김현아(Hyun An Kim),송영욱(Yeong Wook Song),임용성(Yong Seong Lim) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. Methods: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. Results: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3±14.5 years(range 11-83 years); the mean duration of disease 6.5±7.0 years(range 0-30 years); the mean duration of gouty attack 7.2±5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. Conclusion: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.

건선 관절염의 빈도 및 임상 양상에 관한 연구

백한주 ( Han Joo Baek ),유창달 ( Chang Dal Yoo ),신기철 ( Ki Chul Shin ),이윤종 ( Yun Jong Lee ),강성욱 ( Seong Wook Kang ),이은봉 ( Eun Bong Lee ),한창완 ( Chang Wan Han ),김현아 ( Hyun Ah Kim ),송영욱 ( Yeong Wook Song ),윤재일 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Objective: To evaluate the prevalence of psoriatic arthritis(PsA) in Korean patients with psoriasis and to determine the clinical features of PsA. Methods: We examined 356 patients with psoriasis who visited dermatology clinic in Seoul National University Hospital between January 1 and April 28, 1997. Thirty-two patients were determined to have PsA. Nineteen cases of PsA, who were diagnosed in rheumatology clinic of the same hospitial from January 1983 to November 1997, were added to these patients and total 51 cases of PsA were analysed for clinical, laboratory and radiologic features. Results: The prevalence of PsA among patients with psoriasis was 9%(32/356). Male to female ratio of psoriatic arthritis was 1.1:1. Median age at onset of psoriatic arthritis was 34.5 years(range 9-63 years) and mean duration of psoriatic arthritis was 5.8±6.0 years. Psoriasis preceded arthritis in 73.5% of subjects, arthritis preceding psoriasis in 14.3%. Silmultaneous onset of both joint and skin disease was found in 12.2% of subjects. Nail changes, dactylitis and enthesopathy were detected in 37.1%, 21.6% and 33.3% of patients with PsA, respectively. Frequently involved joints in PsA were sacroiliac joints(51%), knees(49%), proximal interphalangeal joints of hands(33.3%), ankles(25.5%). About thirteen percent of patients with PsA were in ACR functional class III/IV. Patients with PsA were older than those with psoriasis alone(39 vs 35 [years], p=0.034). There were no significant differences between patients with PsA and those with psoriasis alone in age at onset of psoriasis, duration, family history, nail involvement, initial extent or type of psoriasis. Higher prevalence of anemia, leukocytosis, and increased ESR was found in patients with PsA compared to psoriasis alone(26% vs 6.3%, 28% vs 5%, and 40% vs 10.3%, p<0.001, respectively). ANA positivity and radiologic sacroiliitis were more frequent in patients with PsA than those with psoriasis alone(35.7% vs 16.7%, p=0.015 and 45.5% vs 1.1%, p=0.001, respectively). Patterns of PsA according to Moll and Wright criteria were as follows: spondylitis was present in 54.9% of patients; oligoarthritis in 25.5%, polyarthritis in 9.8%, predominant DIP involvement in 5.9%. Three cases of SAPHO syndrome were also found in our series. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group(23 vs 30 and 28 vs 44 [years], p<0.05, respectively). HLA-B27 was more prevalent in patients with PsA and spondylitis group compared to normal Koreans(19.5% vs 5.7%, p=0.024 and 29.2% vs 5.7%, P=0.0027, respectively), but HLA-B27 was not increased in non-spondylitis group. Conclusions: The clinical features of PsA in our series showed some differences from previous reports. Spondylitis was the commonest pattern of PsA. Nail changes and enthesopathy were less common compared to previous reports. Anemia, leukocytosis, increased ESR, ANA positivity, and radiologic sacroiliitis were more frequent in patients with PsA than in those with psoriasis alone. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group. The prevalence of HLA-B27 was increased in patients with PsA, especially in spondylitis group.

강직척추염 환자에서의 수면장애

백한주 ( Han Joo Baek ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.6

신(新)의료전문가주의

백한주 ( Han Joo Baek ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.6

Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases

김지현,이정석,최병용,천윤홍,유수진,주지현,신기철,김의석,백한주,박원,송영욱,홍외현,이윤종 대한류마티스학회 2022 대한류마티스학회지 Vol.29 No.4

Objective: To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB). Methods: A systematic literature search and a multicenter survey were performed using a triangulation strategy. Data from the identified ITBM cases were extracted and analyzed to determine the underlying conditions, clinical presentations, treatments, and outcomes. Results: Based on the systematic review, we identified 58 ITBM, including 9 pediatric, cases in the literature published from 1981 to 2021: 25 (43.1%) immunocompromised and 33 (56.9%) non-immunocompromised patients. Immunocompromised cases had a significant shorter symptom duration (median 30.0 vs. 75.0 days) and a higher prevalence of multilocular involvement (20.8% vs. 0%). Among 24 immunocompromised adult patients, dermatomyositis/polymyositis (DM/PM; n=10, 41.7%) were the most common underlying diseases in adults with ITBM identified in the systematic review. Over the past 20 years, 11 Korean adults with ITBM were identified in the multicenter survey. Of 7 immunocompromised cases, two (28.6%) were DM/PM patients. TB death rate of immunocompromised patients was 0.0% and 5/23 (21.7%) in the pediatric and adult ITBM cases identified in the systematic review, respectively, and 3/7 (42.9%) in survey-identified ITBM cases. Conclusion: ITBM has a unique clinical presentation including fever, tenderness, local swelling, overlying erythema, abscess formation and was associated with a grave outcome, especially in immunocompromised hosts. DM/PM was a highly prevalent underlying disease in both systematic review-identified and survey-identified immunocompromised ITBM patients.

류마티스 관절염 환자에서 Piroxicam Patch(TRAST(R))의 임상적 효능에 관한 연구

한창완 ( Chang Wan Han ),김현아 ( Hyun Ah Kim ),임용성 ( Yong Sung Lim ),이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),송영욱 ( Yeong Wook Song ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objective: To evaluate the effects of piroxicam patch(Trast(R)) in rheumatoid arthritis patients with knee joint pain and swelling and to determine the concentration of plasma and synovial fluid following patch application. Methods: Twenty-two patients with rheumatoid arthritis participated in a double-blind, placebo-controlled study. The patients were instructed to apply piroxicam or placebo patch at one knee and re-apply it every other day for 2 weeks. They had washout period for 2 weeks and then applied the other patch for 2 weeks at the same joint. The patients recorded knee joint pain using visual analog scale. Knee joint swelling and tenderness were assessed before and after application of piroxicam and placebo patch. Complete blood count, AST, ALT, BUN, creatinine, joint fluid analysis were also done. Piroxicam concentration in plasma and synovial fluid were measured by high performance liquid chromatography(HPLC) after 2 weeks of piroxicam patch application. Results: Knee joint pain improved significantly after the application of piroxicam patch for 2 weeks(visual analog scale, 56.2±5.9mm vs 48.2±5.7mm, p=0.03 by Wilcoxon signed rank test). There was no significant change in white cell count of synovial fluid, peripheral blood cell count, chemistry, C-reactive protein and erythrocyte sedimentation rate. In terms of adverse effects, mild gastrointestinal disturbance(8/21 cases, 38%) and local side effects such as pruritus and erythema(3/21 cases, 14%) were developed, which were insignificant compared with control groups(30%, 15% respectively). Piroxicam concentrations in plasma and synovial fluid after the application of piroxicam patch were 0.129±0.04μg/ml(mean±SE) and 0.644±0.202μg/ml respectively. Conclusions: Piroxicam patch is a safe and effective therapeutic modality for knee joint pain in patients with rheumatoid arthritis. Mild adverse effects such as gastrointestinal disturbance and local side effects were noted. Piroxicam concentration was higher in synovial fluid than in plasma following the application of piroxicam patch.

Etanercept 치료 중 발생한 류마티스성 결절

한우진 ( Woo Jin Han ),이종록 ( Jong Rok Lee ),윤규현 ( Kyu Hyun Yoon ),최효진 ( Hyo Jin Choi ),백한주 ( Han Joo Baek ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.3

Etanercept is a recombinant human tumor necrosis factor (TNF) receptor fusion protein, which inhibits the biological activity of TNF-α. The common side effects of TNF-α inhibitors are injection site reactions, infusion reactions and infection. Rheumatoid nodules are the most common extraarticular manifestation of rheumatoid arthritis. Drugs such as methotrexate were reported to be associated with rheumatoid nodules, but etanercept-related nodules were uncommonly observed. We report the new formation of cutaneous rheumatoid nodules in a 58-year-old man during anti-TNFα therapy with etanercept. He had 2-year history of seropositive rheumatoid arthritis, and been treated with methotrexate, hydroxychloroquine, sulfasalazine, prednisolone and nonsteroidal anti-inflammatory drugs before etanercept regimen. Rheumatoid nodules developed on the palmar surface of fingers 4 month after treatment of etanercept, although his disease activity was maintained low. One month later, we decided to stop etanercept because his nodulosis extended to elbow. Since then, he has been followed up without any progression of rheumatoid nodules or aggravation of arthritis.

증례 : 류마티스 ; 만성 통풍결절 환자에서 발생한 위장관 아밀로이드증 1예

김세현 ( Sei Hyun Kim ),윤규현 ( Kyu Hyun Yoon ),한우진 ( Woo Jin Han ),한재준 ( Jae Jun Han ),최효진 ( Hyo Jin Choi ),백한주 ( Han Joo Baek ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

저자 등은 체중감소, 구역, 구토, 설사, 손발의 종창으로 내원한 70세 만성 결절통풍 환자에서 발생한 이차성 위장관 아밀로이드증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. 통풍 환자에서 아밀로이드증의 발생은 매우 드물지만, 조절되지 않은 만성 통풍결절 관절염 환자에서 지속적인 설사, 저알부민혈증이나 부종이 있는 경우 감별 진단으로 고려되어야 할 것으로 여겨진다. Secondary amyloidosis is associated with infectious, inflammatory, or neoplastic disorders. Gouty arthritis, unlike other forms of chronic inflammatory arthritis, is not usually associated with amyloidosis. A 70-year-old man was admitted because of generalized edema, anorexia, and diarrhea. He had been diagnosed with gouty arthritis 12 years earlier and took over-the-counter medication during acute attacks. The physical examination revealed multiple tophi on his ears, right hand, and right foot. No evidence of amyloidosis involving the heart or bone marrow was detected. Biopsy of the antrum, duodenum, ileum, and descending colon showed green birefringence with Congo red stain. Immunohistochemistry was strongly positive for amyloid A. We diagnosed him as having secondary gastrointestinal amyloidosis AA with chronic tophaceous gouty arthritis. Allopurinol was administered and oral prednisolone was increased. However, he died from septic shock 25 days after admission. (Korean J Med 77:531-535, 2009)

서울 시내 PC방(Internet Cafe)의 세균분포와 항생제 내성 양상

윤지희,백한주,진한주,손예원,곽선영,양환진,홍은경,최성숙,하남주,Yun Ji-Hee,Back Han-Joo,Jin Han-Joo,Son Ye-Won,Kwak Sun-Young,Yang Hwan-Jin,Hong Eun-Kyung,Choi Sung-Suk,Ha Nam-Joo 한국미생물학회 2005 미생물학회지 Vol.41 No.3

본 연구는 PC방의 세균 오염 실태를 조사하기 위한 목적으로 2004년 7월${\~}$12월까지 서울시내에 있는 PC방(Internet Cafe)들 중에서 34곳을 표본으로 선정하여 연구를 수행하였다. 총 세균수를 측정한 결과, 키보드에서는 $9.0{\times}10^4$ CFU/ml, 마우스에서는 $2{\times}10$ CFU/ml, 그리고 화장실 손잡이에서는 $5{\times}10^3$ CFU/ml의 세균이 검출되었다. 이는 화장실 손잡이보다 키보드와 마우스에서 세균에 대한 오염정도가 더 심한 것을 의미한다. PC방에서 항생제에 대한 내성을 지닌 7개의 균주를 분리해 내었는데, 2개의 균주는 methicillin과 erythromycin에 대한 내성을 나타내었고, 5개의 균주는 gentamicin, ampicllin, cefotaxim, chloramphenicol에 대해서 내성을 나타내었다. 이들 균주들을 동정한 결과, 2 균주는 Staphylococcus aureus로 동정되었고, 4 균주는 Actinobacillus ureae로 동정되었으며. 나머지 1개의 균주는 Pasteurella multocida로 동정되었다. Pasteurella multocida와 Actinobacillus ureae는 잠재적인 병원균으로 이전에 Pasteurella ureae로 알려졌던 Actinobacillus ureae는 인간의 상부 호흡기에 드물게 공생하는 것으로 알려졌으며, Pasteurella multocida는 많은 가축의 비인두강 안에 존재하는 평범한 정상 균총을 구성하는 세균인 것으로 알려졌다. 항생제 내성에 대한 연구 결과 Staphylococcus aureus는 erythromycin과 methicillin의 혼합제에 대해서 $100\;{\mu}g/ml$ 이상의 높은 항생제 내성을 나타내었고, Pasteurella multocida와 Actinobacillus ureae는 gentamicin, ampicillin 에 대하여 $100\;{\mu}g/ml$ 이상의 높은 항생제 내성이 있음을 알 수 있었다. This study was performed to investigate the hygiene condition of PC room(internet cafe) in Seoul Korea. From July 2004 to December, 34 samples were collected, there's an average of $9.0{\times}10^4$ CFU/ml on keyboards, $2{\times}10$ CFU/ml on mouse and $5{\times}10^3$ CFU/ml on door konbs toilets, suggesting that keyboards and mouse are more contaminated than toilet door knobs. Seven antimicrobial resistant strains were isolated from PC Rooms. Two isolates were resistant to methicillin and erythromycin, while five isolates were resistant to gentamicin, ampicllin, cefotaxim, and chloramphenicol. By identification, these strains were identified as Staphylococcus aureus (2 strains). Actinobacillus ureae (4 strains) and Pasteurella multocida (1 strain), respectively. Pasteurella multocida and Actinobacillus ureae are potentially pathogenic bacteria. Actinobacillus ureae, formerly, known as Pasteurella ureae, is an uncommon of the upper respiratory tract in humans. Pasteurella multocida is a part of the normal flora in the nasopharynx of many domestic animals. We concluded that Staphylococcus aureus is highly resistant to erythromycin and methicillin over $100\;{\mu}g/ml$, while Pasteurella multocida and Actinobacillus ureae is highly resistant to gentamicin, ampicillinover over $100\;{\mu}g/ml$.

척추관절염의 개념 및 개관

서미령 ( Mi Ryoung Seo ),백한주 ( Han Joo Baek ) 대한내과학회 2013 대한내과학회지 Vol.85 No.3

척추관절염은 천장관절염/척추염, 소수관절염, 부착부염같은 근골격 증상과 포도막염, 건선, 장점막 질환 및 HLA-B27유전자와의 연관성을 공유하고 있는 만성 염증성 류마티스질환이다. 척추관절염의 진단기준은 없지만 다양한 분류기준이 진단에 도움을 줄 수 있다. 최근 ASAS는 방사선학적 천장관절염이 보이지 않는 단계를 포함하여 포괄적이고 체계적으로 척추관절염을 분류할 수 있는 축형 및 말초형 척추관절염 분류기준을 제안하였다. 척추관절염은 유전 요소가 지배적인 질환이며 가장 강력한 연관 유전자는 HLA-B27이다. 최근 MHC 유전자 자리 바깥에 위치한 질환 감수성 유전자로 ERAP1, IL23R 등이 발견되었다. 척추관절염의 주요병리는 부착부의 염증과 골생성이다. 척추관절염의 염증 발생을 설명하기 위해 HLA-B27과 관련된 여러 기전이 제안 되었다. HLA-B27 이외의 질환 감수성 유전자 생성물들은 HLA-B27 분자의 과정이나 시토카인 경로에 관여할 것으로 추정된다. 한편 척추관절염의 골생성을 조절하는 염증 과정과는 완전히 혹은 부분적으로 분리된 기전이 존재한다. The spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases in association with HLA-B27. They share the clinical features including sacroiliitis, spondylitis, oligoarthritis, enthesitis and extra-articular involvement. Recently ASAS proposed new classification criteria sets of axial and peripheral SpA. They were designed to include non-radiographic SpA, thus can guide the early diagnosis of disease before the structural damage occurs. SpA has a strong genetic predisposition. Non-MHC genes, such as IL23R and ERAP1, as well as HLA-B27 were confirmed as susceptibility genes through several GWAS. Major pathology in SpA is entheseal inflammation and new bone formation. Intrinsic ability of HLA-B27 to trigger innate immune response and several proinflammtory cytokines may contribute to the inflammation in SpA. New bone formation could be explained by a mechanism, partly or completely independent of the inflammatory process. (Korean J Med 2013;85:229-239)