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대한류마티스학회> Journal of Rheumatic Diseases(구 대한류마티스학회지)> Korean College of Rheumatology: Forty Years of Excellence

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Korean College of Rheumatology: Forty Years of Excellence

Jung-yoon Choe , Tae-hwan Kim
  • : 대한류마티스학회
  • : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권2호
  • : 연속간행물
  • : 2022년 04월
  • : 71-74(4pages)
Journal of Rheumatic Diseases(구 대한류마티스학회지)

DOI


목차

LAUNCH PHASE
PROGRESS PHASE
DEVELOPMENT PHASE
MEETING THE CHALLENGES AND FUTURE PERSPECTIVES
FUNDING
CONFLICT OF INTEREST
AUTHOR CONTRIBUTIONS
ORCID
REFERENCES

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UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • :
  • : 계간
  • : 2093-940X
  • : 2233-4718
  • : 학술지
  • : 연속간행물
  • : 1994-2022
  • : 1428


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1Importance of Time-integrated Cumulative Parameters for Radiographic Progression Prediction of Rheumatoid Arthritis

저자 : Dong-jin Park

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 129-131 (3 pages)

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2Osteoarthritis - Insights From Recent Research

저자 : Hyun Ah Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 132-139 (8 pages)

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Osteoarthritis (OA) is the most common form of arthritis and is a growing public health concern in the aging society. In rapidly aging societies such as in Korea, the increasing prevalence of OA may present serious new health issues. There is no treatment for OA that can either prevent or slow the progression of joint damage. For the development of effective therapeutics, precise understating of its pathogenesis is important. In this review, the current evidence of etiopathogenesis of OA is discussed. First, while epidemiologic study of OA are still dominated by reports from Western countries, findings from Korean epidemiologic studies are highlighted. Then, recent progresses in genetics, especially in the field of genome wide association study and mendelian randomization studies, are reviewed with focus on Asian population. Lastly, sex difference in pain etopathogenesis is reviewed. Studies of OA pathogenesis including epidemiology, genetics, animal model and pain signaling will aid in progress towards treatment of OA.

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3The Mechanism of the NLRP3 Inflammasome Activation and Pathogenic Implication in the Pathogenesis of Gout

저자 : Seong-kyu Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 140-153 (14 pages)

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The NACHT, LRR, and PYD-domains-containing protein 3 (NLRP3) inflammasome is an intracellular multi-protein signaling platform that is activated by cytosolic pattern-recognition receptors such as NLRs against endogenous and exogenous pathogens. Once it is activated by a variety of danger signals, recruitment and assembly of NLRP3, ASC, and pro-caspase-1 trigger the processing and release of pro-inflammatory cytokines including interleukin-1β (IL-1β) and IL-18. Multiple intracellular and extracellular structures and molecular mechanisms are involved in NLRP3 inflammasome activation. Gout is an autoinflammatory disease induced by inflammatory response through production of NLRP3 inflammasome-mediated proinflammatory cytokines such as IL-1β by deposition of monosodium urate (MSU) crystals in the articular joints and periarticular structures. NLRP3 inflammasome is considered a main therapeutic target in MSU crystal-induced inflammation in gout. Novel therapeutic strategies have been proposed to control acute flares of gouty arthritis and prophylaxis for gout flares through modulation of the NLRP3/IL-1 axis pathway. This review discusses the basic mechanism of NLRP3 inflammasome activation and the IL-1-induced inflammatory cascade and explains the NLRP3 inflammasome-induced pathogenic role in the pathogenesis of gout.

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4Modified Body Mass Index at Diagnosis is a Useful Predictor of Mortality in Patients With Antineutrophil Cytoplasmic Antibody-associated Vasculitis

저자 : Jung Yoon Pyo , Sung Soo Ahn , Jason Jungsik Song , Yong-beom Park , Sang-won Lee

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 154-161 (8 pages)

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Objective: We investigated whether modified body mass index (mBMI) at diagnosis could predict all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
Methods: The medical records of 203 AAV patients with BMI ≥18.5 kg/m2 were reviewed. mBMI was calculated using an equation: mBMI=BMI (kg/m2)×serum albumin (g/L). All-cause mortality was considered as a poor outcome, and the follow-up duration based on all-cause mortality was defined as the period from AAV diagnosis to death for deceased patients, and the period from AAV diagnosis to the last visit for surviving patients.
Results: The median age was 59.0 years (35.5% were male). The median BMI and mBMI were 22.8 kg/m2 and 813.2 kg · g/m2 · L. Twenty-five patients (12.3%) died. mBMI was well correlated with age, BVAS, FFS, erythrocyte sedimentation rate and C-reactive protein at diagnosis. Deceased patients exhibited significantly lower mBMI at diagnosis compared to surviving patients. AAV patients mBMI ≤570.1 kg · g/m2 · L showed a significantly higher frequency of all-cause mortality (38.5% vs. 8.5%), and furthermore, exhibited a significantly higher risk for all-cause mortality than those with mBMI >570.1 kg · g/m2 · L (RR 6.750). mBMI ≤570.1 kg · g/m2 · L showed a significantly lower cumulative patients' survival rate than those with mBMI >570.1 kg · g/m2 · L. In the multivariable Cox hazards model analysis, either serum albumin or mBMI was significantly associated with all-cause mortality in AAV patients.
Conclusion: In conclusion, mBMI ≤570.1 kg · g/m2 · L at diagnosis may be a useful predictor of all-cause mortality during followup additionally to serum albumin in AAV patients.

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5Use of Disease-modifying Antirheumatic Drugs After Cancer Diagnosis in Rheumatoid Arthritis Patients

저자 : Young Bin Joo , Seung Min Jung , Yune-jung Park , Ki-jo Kim , Kyung-su Park

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 162-170 (9 pages)

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Objective: There is no recommendation for the use of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who developed cancer. We examined changes in the DMARDs prescription patterns associated with cancer diagnosis in RA patients.
Methods: We reviewed the medical records of 2,161 RA patients who visited rheumatology clinic between January 2008 and February 2017 and found 40 patients who developed cancer during RA treatment. In these patients, we examined DMARDs prescription patterns before and right after cancer diagnosis and at recent outpatient clinic visits.
Results: Before cancer diagnosis, methotrexate (MTX)-combined conventional synthetic DMARDs (csDMARDs) were most commonly prescribed (22, 55.0%) and biological DMARDs (biologics) in nine patients (22.5%). For cancer treatment, 19 patients received chemotherapy (including adjuvant chemotherapy) and 21 patients had surgery only. Right after cancer diagnosis, changes in the DMARDs prescription patterns were similar in discontinuation (13, 32.5%), switching (14, 35.0%), and maintenance (13, 32.5%). DMARDs were discontinued more frequently in the chemotherapy group (9/19, 47.4%) than the surgery only group (4/2, 19.0%) (p<0.05). Among the 13 patients who discontinued DMARDs, nine (69.2%) resumed DMARDs after a median of 5.5 months (interquartile range [IQR] 2.9, 18.3) due to arthritis flare. At a median of 4.6 years (IQR 3.3, 6.7) after cancer diagnosis, 25 patients were evaluated at recent outpatient clinic visits. Four patients received no DMARD, three MTX monotherapies, 11 csDMARDs combination therapies, and seven biologics.
Conclusion: A significant number of RA patients who developed cancer during RA treatment were still receiving DMARDs including biologics after cancer diagnosis.

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6Clinical Implications of Shared Epitope and Anti-citrullinated Peptide Antibody in Patients With Rheumatoid Arthritis

저자 : Seung Min Jung , Yune-jung Park , Kyung-su Park , Ki-jo Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 171-180 (10 pages)

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Objective: The shared epitope (SE) and anti-citrullinated peptide antibody (ACPA) are involved in the pathogenesis of rheumatoid arthritis (RA). This study evaluated the clinical implications of SE and ACPA in terms of disease manifestation and response to biologic disease modifying anti-rheumatic drugs (DMARDs).
Methods: Patients with identified human leukocyte antigen (HLA)-DRB1 alleles were included to compare the clinical characteristics and drug survival rate of tumor necrosis factor (TNF) inhibitors or abatacept based on the presence of SE and ACPA.
Results: Of the 533 patients with identified HLA-DRB1 alleles, 329 patients (61.7%) with SE alleles showed higher disease activity and erosive changes compared to patients without SE alleles. SE-positive patients were more likely to start biologic (b-) or targeted synthetic DMARDs (tsDMARDs) within the first 5 years (p=0.020). The presence of SE, smoking, dyslipidemia, and higher erythrocyte sedimentation rate were independently associated with the initiation of b- or tsDMARDs (p=0.016, 0.028, 0.031, and 0.001, respectively). The presence of SE and ACPA did not affect the drug survival rate of TNF inhibitors, whereas the abatacept retention rate was higher in ACPA-positive patients (p=0.024).
Conclusion: The presence of SE affected disease characteristics and prognosis in Korean patients with RA without a significant impact on drug survival rate of TNF inhibitors and abatacept. ACPA positivity was associated with abatacept drug retention, suggesting that abatacept may be helpful in ACPA-positive patients than in ACPA-negative patients.

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7Pediatric Sarcoidosis Misdiagnosed as Hepatosplenic Abscesses: A Case Report and Review

저자 : Su Min Lee , Hyungwook Choi , Sungmin Lim , Jehee Shin , Ji-man Kang , Jong Gyun Ahn

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 181-186 (6 pages)

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Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by granuloma formation. Due to the limited incidence of sarcoidosis in pediatric patients, little is known about the clinical course of this disease. A combination of clinical, radiologic, and pathologic examination is necessary to exclude other differential diagnoses (i.e., infection and granulomatous inflammatory disorder) and establish a diagnosis of sarcoidosis. Here, we report a case of histologically confirmed sarcoidosis initially misdiagnosed as hepatosplenic abscesses in an 11-year-old male. Treatment with corticosteroids improved his symptoms and resolved his skin and hepatosplenic lesions. A three-year follow-up was uneventful. This study emphasizes the importance of considering sarcoidosis in children presenting with findings of multi-organ involvement in the presence of histologic evidence of granuloma.

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8A Case of Superficial Thrombo-occlusive Vascular Disease in a Patient With Rheumatoid Arthritis

저자 : Seong-ji Park , Chung-il Joung , Seung Hyun Cheong , Han Young Ryu , Ga Hyun Lee , Gil Jae Pyo , Mihye Kwon

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 3호 발행 연도 : 2022 페이지 : pp. 187-189 (3 pages)

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1Rituximab can Decrease Proteinuria in Refractory Lupus Nephritis

저자 : Chang-hee Suh

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 59-60 (2 pages)

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2Recent Advances in Basic and Clinical Aspects of Rheumatoid Arthritis-associated Interstitial Lung Diseases

저자 : Hanna Lee , Sang-il Lee , Hyun-ok Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 61-70 (10 pages)

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Rheumatoid arthritis (RA) is a common autoimmune disease that mainly affects the joints and systemic organs, such as the skin, eyes, heart, gastrointestinal tract, and lungs. In particular, among various pulmonary involvements, interstitial lung disease (ILD) is closely related to the selection of anti-rheumatic drugs and the long-term prognosis of patients with RA. Although the exact pathogenesis of RA-ILD is not well defined, several mechanistic pathways, similar to those of idiopathic pulmonary fibrosis, have been elucidated recently. Conversely, RA-related autoantibodies, including anti-cyclic citrullinated peptide antibody, are detectable in circulation and in the lungs, even in the absence of articular symptoms. RA-ILD can also predate years before the occurrence of joint symptoms. This evidence supports the fact that local dysregulated mucosal immunity in the lung causes systemic autoimmunity, resulting in clinically evident polyarthritis of RA. Because the early diagnosis of RA-ILD is important, imaging tests, such as computed tomography and pulmonary function tests, are being used for early diagnosis, but there is no clear guideline for the early diagnosis of RA-ILD and selection of optimal disease-modifying anti-rheumatic drugs for the treatment of patients with RA with ILD. In addition, the efficacy of nintedanib, a new anti-fibrotic agent, for RA-ILD treatment, has been investigated recently. This review collectively discusses the basic and clinical aspects, such as pathogenesis, animal models, diagnosis, and treatment, of RA-ILD.

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3Korean College of Rheumatology: Forty Years of Excellence

저자 : Jung-yoon Choe , Tae-hwan Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 71-74 (4 pages)

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4The Korean College of Rheumatology: 40 Years of Public Health Influence

저자 : Jisoo Lee , Yoon-kyoung Sung , Myeung-su Lee , Han Joo Baek

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 75-78 (4 pages)

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5Assessment on Treatments With Conventional Synthetic Disease-modifying Drugs Before Initiating Biologics in Patients With Rheumatoid Arthritis in Korea: A Populationbased Study

저자 : Min Jung Kim , Eun Hye Park , Anna Shin , You-jung Ha , Yun Jong Lee , Eun Bong Lee , Han Joo Baek , Eun Ha Kang

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 79-88 (10 pages)

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Objective: To assess pre-biologic treatments with conventional synthetic disease-modifying drugs (csDMARDs) prior to biologics initiation among patients with rheumatoid arthritis (RA).
Methods: Using Korea National Health Insurance database, we examined pre-biologic treatments of RA patients on the following four items: whether 1) initial methotrexate (MTX) therapy was given, 2) MTX dose was escalated up to ≥15 mg/week within 1-year post-diagnosis, 3) prednisone-equivalent glucocorticoid was used at a dose of ≤7.5 mg/day, and 4) glucocorticoid was discontinued within 6 months of treatment. Multivariable logistic regressions identified predictors of items 2) and 4) fulfillment.
Results: Among 6,986 biologics initiators with RA, 54.9% used MTX as the 1st csDMARD. Within 1-year post-diagnosis, 85.2% used MTX with half of them achieving a dose of ≥15 mg/week. The majority (75.2%) of patients used glucocorticoids initially and 64.5% were still on glucocorticoids at 6 months, mostly at a dose of ≤7.5 mg/day. csDMARD combination was observed in 85.7%. Item 2) fulfillment was associated with males, younger age, glucocorticoid, combination therapy, cyclo-oxygenase-2 inhibitors, and viral hepatitis. Item 4) fulfillment was associated with males, MTX dose of ≥15 mg/week, combination therapy, viral hepatitis, and hospitalizations.
Conclusion: RA patients in Korea were predominantly treated with MTX-based csDMARD combination plus glucocorticoids before initiating biologics, without sufficient MTX dose escalation or glucocorticoid discontinuation. Items 2) and 4) fulfillments were associated with patient age and gender, concomitant treatments, and comorbidities.

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Objective: This study aims to evaluate the change in serum metalloproteinase-3 (MMP-3) following the management of active rheumatoid arthritis (RA) and define the relationships between MMP-3 and disease activity indices.
Methods: Data from a previously reported a 24-week, randomized controlled trial to investigate efficacy of tocilizumab in active RA refractory to methotrexate were analyzed. The serum level of MMP-3 were measured at week 0, 12, 20, and 24. The changes in MMP-3, and the relationship between MMP-3 and clinical parameters was assessed based on treatment group, methotrexate with or without tocilizumab.
Results: A total of 95 patients were included in this study. The serum MMP-3 significantly decreased and showed similar pattern with other disease activity indices during treatment period in both treatment groups (p<0.001). The MMP-3 was positively correlated with ESR, CRP, DAS28, SDAI, and CDAI for 302 visits throughout 24 weeks (p<0.001). In another correlation analysis to evaluate the treatment effect at 24 week time point, methotrexate group showed significant correlation between serum markers: MMP-3 (r=0.321, p=0.043); ESR (r=0.450, p=0.002); and CRP (r=0.536, p< 0.001), with DAS28, but tocilizumab group didn't show meaningful correlation between serum markers and DAS28 (p >0.05).
Conclusion: Serum MMP-3 showed positive correlation with disease activity indices in active RA patients. Furthermore, serum MMP-3 significantly decreased from baseline to week 20. As there is no single serum marker that can represent the disease activity particularly in tocilizumab treatment, MMP-3 might be a useful adjunct indicator to evaluate the treatment response in active RA patients.

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7Time-integrated Cumulative Parameters Predictive of Radiographic Progression of Rheumatoid Arthritis: Real-world Data From a Prospective Single-center Cohort

저자 : Youngjae Park , Mei-ling Li , Ji-won Kim , Jung Hee Koh , Yune-jung Park , Wan-uk Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 98-107 (10 pages)

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Objective: With many chronic inflammatory diseases, outcomes are determined by assessing both disease activity at presentation and cumulative activity over time. Here, we investigated whether cumulative activity better reflects the radiographic progression (RP) of rheumatoid arthritis (RA) than measurement of activity at a single time point.
Methods: From a prospective cohort of RA patients, most of whom were treated with anti-rheumatic drugs, we selected 117 subjects for whom laboratory, clinical, and radiographic parameters potentially influencing RP were monitored serially for more than 1 year. X-ray images of both hands and both feet were scored using the van der Heijde modified total Sharp score (mTSS). In addition to cross-sectional values at baseline, longitudinal and cumulative values for each parameter were calculated in a timeintegrated and averaged manner.
Results: Among the values measured at baseline, mTSS, but not the baseline erythrocyte sedimentation rate (ESR) or C-reactive protein level, was associated with RP. By contrast, multivariate analyses identified cumulative values such as the cumulative ESR, cumulative tender joint count, cumulative swollen joint count (SJC), and cumulative Disease Activity Score 28-ESR as major determinants of RP. In particular, the cumulative SJC showed the best predictive performance for RP.
Conclusion: This study highlights the importance of cumulative indices for predicting progression of RA. Specifically, dynamic and cumulative values of RA activity-related factors, particularly the cumulative SJC, may be the major determinants of RP in the current practice.

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8Differential Diagnosis of Inflammatory Arthropathy Accompanying Active Tuberculosis Infection

저자 : Youjin Jung , Byoong Yong Choi

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 108-115 (8 pages)

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Objective: The study aimed to ascertain the clinical manifestations of inflammatory arthritis accompanying tuberculosis (TB) for the differential diagnosis.
Methods: We retrospectively reviewed patients with active TB who presented with inflammatory arthropathy at Seoul Medical Center. Among 2,872 patients with active TB infection, 47 had inflammatory arthropathy: 14 had crystal-induced arthropathy; 12, TB arthritis; 12, Poncet's disease (PD); 8, Rheumatoid arthritis (RA); and 1, septic arthritis. The clinical characteristics and laboratory and radiographic findings of each group were analyzed.
Results: In TB arthritis, weight-bearing joints were more commonly affected than the elbow and wrist joints. When compared to TB arthritis, PD demonstrated a significantly higher proportion of polyarthritis and involved both large and small-to-mediumsized joints. The duration of arthritis symptoms after anti-TB treatment was significantly shorter in patients with PD (56 days vs. 90 days, p=0.028). When compared to PD, RA flares during active TB infection involved only small-to-medium-sized joints rather than a mixed distribution (62.5% vs. 16.7%, p=0.035). Patients with PD more commonly had fever at onset and showed a good response to nonsteroidal anti-inflammatory drugs alone or were in remission within 3 months after anti-TB treatment. The presence of rheumatoid factor or anti-cyclic citrullinated peptide and radiographic progression after 12 months was frequently observed in patients with RA flares.
Conclusion: The differential diagnosis of inflammatory arthritis accompanying active tuberculosis infection is challenging. Comprehensive history taking and physical examination, synovial fluid analysis, and a high level of clinical suspicion are essential to avoid delayed diagnosis and to reduce the significant morbidity involved.

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9Idiopathic Inflammatory Arthritis in the Auditory Canal in a Patient With Hearing Impairment: A Case Report and Literature Review

저자 : So Hye Nam , Gi Hwan Kim , Hong Ju Park , Yong-gil Kim

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 116-122 (7 pages)

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Inflammatory arthritis can affect the auditory system during the disease course. Although most cases show asymptomatic hearing impairment, it can result in hearing loss. Here we describe the case of a 70-year-old female with hearing impairment associated with idiopathic inflammatory arthritis in her auditory system. She had suffered from hearing difficulties for decades; however, the causes of her hearing impairment had not been evaluated. Pure tone audiometry showed severe sensorineural hearing loss requiring a cochlear implant. The workup for the cochlear implant revealed erosive changes in the incudomalleolar and incudostapedial joints with soft tissue swelling on temporal bone computed tomography. Bone pathology revealed plasmacytic infiltration and granulomatous inflammation. Laboratory examinations showed elevated levels of inflammatory markers; otherwise, she had negative results for all autoantibodies. In patients with idiopathic hearing loss, inflammatory arthritis of the middle ear without peripheral arthritis can provide a clue regarding the cause of the hearing loss.

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10A Case of Macrophage Activation Syndrome During the Treatment of Adult-onset Still's Disease With Tocilizumab

저자 : Ju Ho Lee , You-jung Ha , Eun Ha Kang , Sung Hae Chang , Yun Jong Lee

발행기관 : 대한류마티스학회 간행물 : Journal of Rheumatic Diseases(구 대한류마티스학회지) 29권 2호 발행 연도 : 2022 페이지 : pp. 123-128 (6 pages)

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Macrophage activation syndrome (MAS) is a fatal complication of adult-onset Still's disease (AOSD). Although anti-cytokine agents have been recommended for refractory AOSD or complicated with MAS, MAS cases have been rarely reported during anticytokine treatment. Herein, we describe the first AOSD case complicated with MAS during the treatment with tocilizumab in Korea. Two years after tocilizumab maintenance therapy, high fever and hypertransaminasemia recurred. MAS was diagnosed based on hyperferritinemia, elevated soluble IL-2 receptor levels, and the presence of hemophagocytic histiocytes in the bone marrow. However, she had normal white blood cell counts and acute phase reactant levels. High-dose glucocorticoid and anakinra therapies were not effective, but her disease improved with etoposide. This case shows that tocilizumab may not prevent MAS development and can modify clinical features making it challenging to diagnose. Cytotoxic therapy such as etoposide may be required in MAS cases that develop during anti-cytokine therapy.

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