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Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis
백한주,임미진,박원,박성환,심승철,유대현,김현아,이수건,이윤종,박영은,차훈석,송영욱 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4
Background/Aims: To investigate the efficacy and safety of tocilizumab (TCZ) humanized anti-interleukin-6 receptor monoclonal antibody, in Korean patients with active rheumatoid arthritis (RA) refractory to conventional disease modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX). Methods: The main study was a 24-week, randomized, double-blind, controlled trial that was followed by a 48-week, open-labeled, extension phase. TCZ (8 mg/kg) or placebo was intravenously administered every 4 weeks. Results: Those treated with TCZ showed more favorable outcomes in terms of 20% according to the American College of Rheumatology response criteria (ACR20) and ACR50 responses, individual parameters of ACR core set, disease activity score in 28 joints (DAS28) remission, and European League Against Rheumatism (EULAR) response at week 24. These improvements were maintained or increased during the extension period. DAS28 remission at week 72 was associated with EULAR good response at week 12. The patients who experienced any adverse event (AE) were more frequent in the TCZ group compared to the placebo group. Most AEs were mild or moderate in intensity, although TCZ therapy had possible AEs including serious infection, abnormal liver function, and atherogenic lipid profile. Conclusions: TCZ infusion add-on is highly efficacious and well-tolerated in Korean patients with active RA refractory to conventional DMARDs including MTX. EULAR good response at week 12 could predict DAS28 remission at week 72.
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.
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.