섬유조직염(섬유근육통 증후군) 환자의 임상 양상 및 사회적, 환경적 요인과의 연관성

황관표 ( Kwan Pyo Hong ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.2

Objective: To investigate the clinical characteristics of fibromyalgia syndrome and to determine the usefulness of visual analogue scale (VAS) in global pain as predictor of symptoms and functional disabilities of daily activities and to evaluate the relationship between social environmental factors and fibromyalgia syndrome. Method: Fourth-three patients with fibromyalgia syndrome who have met 1990 ACR criteria and 30 control patients with rheumatoid arthritis were included in the study. Clinical features, functional disabilities, VAS and psychological impact due to life stress by criteria and 30 control patients with rheumatoid arthritis were included in the study. Clinical features, functional disabilities, VAS and psychological impact due to life stress by social environmental factors were studied by direct interviews and questionnaires. Result: The mean age of the patients with fibromyalgia syndrome was 48±11 years old. The physical findings revealed that tender points were 15.5±1.4 and skin fold tenderness presented in 59% of patients. The most frequent symptoms with scores and ratio of symptom presented were fatigue (2.2, 93%), morning stiffness (2.2, 80%), arthralgia (2.1, 90%), lower back pain (2.1, 98%), depression (1.6, 95%). The majority of functional disabilities in fibromyalgia group were less severe than those of rheumatoid arthritis group. The VAS in global pain had correlationship with age, arthralgia, fatigue, hurt all over, morning stiffness, tender points as well as the majority of functional disabilities of daily activities. Although living together mother-in-law was not different significantly from each other groups, the duration of living together was longer in fibromyalgia group. There were more histories and frequencies of artificial abortions in patients with fibromyalgia syndrome. Conclusion: The patients with fibromyaliga showed various symptoms. The visual analogue scale in global pain have had significant correlation with some symptoms and functional disabilities in daily activities. Fibromyalgia patients revealed more social and obstetrical life stress which may suggest more psychological impact.

근모세포(Myoblast) 분리배양에 관한 연구

이인홍 ( In Hong Lee ),황관표 ( Kwan Pyo Hong ),김동욱 ( Dong Yook Kim ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

Objectives: To isolate and culture of human muscle cells by manipulating culture conditions. Methods: Muscle samples were obtained during total hip replacement or bedside muscle biopsy. We isolated myoblasts from freshly obtained human muscle tissue by trypsin and collagenase digesion. Results: Selective isolation of myoblasts was identified through histologic examination by light-microscope. We identified monoclonal antibodies (Leu-19) as molecular markers in human skeletal muscle were expressed. Conclusions: This study demonstrated that it had been possible to culture morphologically and immunologically identifiable myoblasts isolated from human skeletal muscle tissue.

류마티스 관절염 환자에서 혈청 creatine kinase의 활성도

전재범 ( Jae Bum Jun ),황관표 ( Kwan Pyo Hong ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),주경빈 ( Kyung Bin Joo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.1

Objective: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. Methods: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). Results: Serum CK activity was significantly reduced in RA (mean±SD: 45.7±24.2 IU/L) compared to controls (81.3±33.9 IU/L) (p<0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: -0.31, p<0.01; -0.45, p<0.001; -0.42, p<0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant. Conclusion: Serum CK activity is significantly reduced in RA. Serum CK activity correlates well with various indices of disease activity for rheumatoid arthritis. So, Inflammatory activity seems to play the major role in this phenomenon. Multiple regression analysis showed that CRP, but not steroids, was the major independent factor influencing CK activity.

류마티스 관절염 환자의 T세포 수용체 Vβ 유전자 레퍼토리 분석

정성수 ( Sung Soo Jung ),황관표 ( Kwan Pyo Hong ),김동욱 ( Dong Yook Kim ),김태환 ( Tae Hwan Kim ),이인홍 ( In Hong Lee ),전재범 ( Jae Bum Jun ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ),이은영 ( 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

목적: 류마티스 관절염(rheumatoid arthritis; RA)의 병인에 있어 중추적인 역할을 하는 것으로 알려진 T세포에 관한 연구가 최근에 관심의 초점이 되고 있으나, 현재까지 한국인을 대항으로 시행된 보고는 없다. 한국인 류마티스 관절염 환자의 관절병변부위에서 T세포 수용체(TCR)의 Vβ유전자 사용의 빈도를 검색하여 한국인 류마티스 관절염 환자에서 사용되는 빈도가 높은 유전자계를 찾는데 목적을 두었다. 방법: 이에 저자는 T세포에 관한 연구의 일환으로 류마티스 관절염 환자 3명과 정상인 4명을 대상으로 말초 혈액과 활액 T세포로부터 추출한 RNA를 이용하여 cDNA를 합성한뒤 cDNA를 주형을 Vβ family specific oligonucleotide를 시발체(primer)로하여 반정량적 역전사 연쇄중합반응(semiquantative RT-PCR)을 시행하여 T세포 수용체(T cell receptor; TCR) Vβ 레퍼토리를 분석하여 다음과 같은 결과를 얻었다. 결과: 1. 정상인 4명의 말초혈액에서 T세포 수용체 Vβ유전자 평균사용빈도는 Vβ7(8.68±3.20%), Vβ3(7.83±2.03%), Vβ(6.74±1.43%)의 순서로 빈도가 높았으며, HLA-DR4 양성군(3명)에서는 Vβ8(7.39±1.71%), Vβ2(7.31±2.30%), Vβ1(7.22±1.54%)의 순서로 빈도가 높았고, HLA-DR4 음성(1명)에서는 Vβ3(17.79%), Vβ4(11.41%), Vβ24(9.8%)의 순서로 사용빈도가 높았다. 2. 류마티스 관절염환자 3명의 말초 혈액에서는 Vβ16(6.90±1.81%), Vβ18(6.89±0.80%), Vβ14(6.58±0.65%)의 순서로 빈도가 높았다. HLA-DR4 양성 환자군에서는 Vβ16(7.52±2.06%), Vβ14(6.96±0.04%), Vβ22(6.78±0.18%)의 순서로 빈도가 높았다. 각각 환자의 결과를 보면 첫번째 환자(HLA-DR4 양성)는 Vβ16(8.98%), Vβ14(6.99%), Vβ22(6.91%)의 순서로 빈도가 높았고, 두번째 환자(HLA-DR13 양성)는 Vβ18(7.79%), Vβ20(5.98%), Vβ24(5.90%)의 순서로 빈도가 높았다. 이를 종합해 보면 류마티스 관절염 환자의 말초혈액에서 Vβ16, Vβ20, Vβ14, Vβ18유전자계가 제한되어 사용되었다. 3. 류마티스 관절염환자의 활액의 T세포에서 Vβ유전자 평균발현빈도는 Vβ20(7.39±1.77%), Vβ18(5.60±1.31%), Vβ12(5.56±1.77%)순으로 높았으며, HLA-DR4양성인 환자군에서는 Vβ12(6.56±0.58%), Vβ20(6.44±0.94%), Vβ4(5.30±0.49%)순으로 빈도가 높았으며, HLA-DR4음성 환자에서는 Vβ20(9.29%), Vβ19(7.57%), Vβ18(7.07%)의 순서로 빈도가 높았다. 각각 환자의 결과를 보면 첫번째 환자(HLA-DR4 양성)는 Vβ12(6.15%), Vβ20(5.77%), Vβ7(5.74%)의 순서로 빈도가 높았고, 두번째 환자(HLA-DR4 양성)는 Vβ20(7.10%), Vβ12(6.98%), Vβ24(5.83%)의 순서이었고, 세번째 환자(HLA-DR13 양성)는 Vβ20(9.29%), Vβ19(7.57%), Vβ18(7.06%)의 순서로 빈도가 높았다. 활액 T세포에서는 Vβ20, Vβ12유전자계가 제한되어 사용되었다. 4. 말초 혈액에 비해 활액 T세포에서 TCR Vβ유전자 사용빈도가 1.5배 이상인 경우는 Vβ5.2, Vβ9, Vβ23 이었으나, 이들 유전자계가 활액 T세포 전체에서 차지하는 사용빈도에 있어서는 각각 Vβ5.2는 1.07±1.26%, Vβ9는 2.17±1.42%, Vβ23는 3.84+1.97%로 낮은 수치를 나타내었다. 각각 환자에서 비교했을때에 첫번째 환자(HLA-DR4 양성)는 Vβ23(3.69%:1.12%), Vβ5.1(3.51%:1.40%), Vβ12(6.15%:3.29%), Vβ6(3.35%:2.10%), Vβ2(5.74%:3.73%)의 유전자계에서, 두번째 환자(HLA-DR4 양성)는 Vβ9(3.58%:0.74%), Vβ19(4.67%:1.52%), Vβ5.2(2.52%:0.87%), Vβ10(4.25%:1.75%), Vβ1(5.74%:2.35%)의 유전자계에세, 세번째 환자(HLA-DR13 양성)는 Vβ6(2.68%:0.15%) Vβ9(2.17%:0.73%), Vβ11(2.30%:1.10%), Vβ20(9.29%:5.98%)의 유전자계에서 활액에서 말초혈액보다 1.5배이상 증가되어 사용됨을 볼수 있었다. 즉 활액에서 말초혈액보다 의미 있게 편향되어 사용되는 Vβ 유전자계는 각각 환자마다 다른 결과를 나타내었다. 5. 류마티스 관절염환자의 말초 혈액과 정상인의 말초 혈액의 T세포의 Vβ 유전자 사용빈도를 비교했을때 류마티스 관절염 환자의 말초혈액 T세포에서 Vβ16(6.90±1.81%:3.23±1.21%), Vβ18(6.89±0.80%:2.72±0.70%) 유전자계가 2배 이상으로 빈도가 높았고, HLA-DR4양성군만 비교하였을때도 Vβ16(7.52±2.06%:3.69±1.46%), Vβ18(6.45±0.28%:2.61±0.86%) 유전자계가 2배 이상 사용이 많았다. 결론: 이상의 성적으로 미루어 보아 류마티스 관절염 각각 환자마다 다른 Vβ 유전자계의 제한적 사용과 편향됨을 볼 수 있었으나, 공통된 유전자계의 증식은 볼 수 없었다. 이러한 결과는 다른 연구보고와는 다른 결과를 보였고, 이것은 대상 환자의 질병의 유병기간이 다르고, 또 유전적인 배경, 생존 환경, 적용된 방법의 차이로 기인한다고 하는 기존의 보고와 부합된다고 사료되는데 질병의 진행단계에 따라 주로 면역반응을 일으키는 항원의 에피토프가 달라짐에 따라 여기에 대항하는 T세포들의 수용체도 이들 에피토프에 반응할 수 있는 수용체를 가진 코론들이 증식하게 된다는 epitope spreading theory에 부합되며, 이는 아주 초기에 질병을 시작하게 유도하는 항원의 특성을 규명하기 위해서는 환자선택이 연구결과에 결정적인 역할을 할 것으로 사료된다. 또 다른 가능성은 각각 환자마다 다른 Vβ유전자계의 증식된 클론들의 CDR3 연기 서열을 규명하여 비록 유전자 서열이 다를 지라도 항원과 결합하는 같은 성상을 갖는 아미노산 motif를 가질 가능성에 대해서도 연구가 필요하리라 사료된다. Objectives: Polymerase chain reaction (PCR) technology was eamine synovial fluid and peripheral T cells in patients with rheumatoid arthritis (RA) to determine the preferential usage of the T cell receptor(TCR) variable region (V) gene. Methods: Oligonucleotide primers specific for individual TCR Vβ gene families were used to amplify the TCR gene products in a semiquantitative assay of their relative utilization in unselected T cell populations. Results: The result of Vβ utilization was generally heterogenous, similar with previous reports. However, the mean expression of Vβ16 and Vβ18 in RA was more preferentially utilized compared to normal donors. The usage of Vβ in peripheral blood from 3 patients with RA demonstrated restrictions in Vβ16, Vβ20 and Vβ18 genes, respectively. Analyses of synovial fluid resulted in restriction in β12, Vβ20 and Vβ20, respectively. Although there was no significant pattern of skewed Vβ gene mean usage when comparing the synovial fluids with the peripheral blood T cells from RA patients, there were significant biased Vβ genes, Vβ12, Vβl and Vβ20, each 3 patients. As the HLA type is a determining factor in shaping TCR repertoire of peripheral T cells, we compared the Vβ utilization in HLA-DR4 expressing groups that have susceptibility and gene dosage effect in disease progression. It was a little different that comparing the pattern of Vβ usage in peripheral blood and synovial fluid from RA patients between HLA-DR4 positive and negative group. Conclusion: The results were consistent with the conclusion that the increased Vβ family T cells infiltrate synovium and are dependent on each patient and may be involved in inducing and maintaining the synovitis that characterizes RA The different outcome of each patient may be due to the difference in disease duration, genetic background and geographic region. A more important factor may be the stage of disease, because epitope induced immune reaction may change over time. Therefore, selecting patients early in the course of disease may be important and may facilitate the need for more in-depth TCR analysis in the future.

SAPHO 증후군 2예

윤형란 ( Hyun Ran Yun ),정성수 ( Sung Soo Jung ),고희관 ( Hee Kwan Koh ),유태석 ( Tae Seok Yoo ),이제경 ( Je Kyung Lee ),황관표 ( Kwan Pyo Hong ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),이인홍 ( In Hong Lee ),배상철 ( Sang 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.2

SAPHO(synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. It`s fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome: A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, Pustulosis.