류마티스 관절염의 임상 증상 및 진단

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that mainly affects the diarthrodial joint. Morning stiffness and symmetric swelling of the wrists, PIPs and MCPs constitue the typical history for rheumatoid arthritis. Extra-articular manifestations in RA include constitutional symptoms, distinct organ manifestations and severe multiorgan disease. The presence of rheumatoid factor and the anti-cyclic citrullinated peptide antibody, which is more specific to RA, are helpful in RA diagnosis. Although conventional radiographs remain the initial imaging modality in patients with RA, other imaging modalities such as MRI or ultrasound have demonstrated increased sensitivity to detecting early erosive change. To the present day, there is no single test that confirms RA. Early diagnosis of RA is essential because there is substantial evidence that early therapeutic intervention with non-biologic/biologic disease-modifying antirheumatic drugs leads to a better outcome. Although the 1987 American College of Rheumatology (ACR) classification criteria for RA have been used as the gold standard in clinical studies, these criteria are misleading early in the disease course. The ACR/European League Against Rheumatism (EULAR) is scheduled to release the new classification criteria for RA soon. This review describes clinical manifestations of RA, diagnostic tools, as well as the classification criteria in the diagnosis of RAope

Benign Lymphoepithelial Lesion of Parotid Gland and Secondary Amyloidosis as Concurrent Manifestations in Sjögren's Syndrome

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Clinical Images: Osteoporotic calcaneal stress fractures mistaken for aggravation of rheumatoid arthritis

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Overlap Syndrome of Antisynthetase Syndrome and Rheumatoid Arthritis: A Case Report

The antisynthetase syndrome is characterized by anti-Jo-1 antibody production, interstitial lung disease, inflammatory muscle disease, and, in many cases, fever, polyarthritis, Raynaud’s phenomenon, and mechanic’s hands. Joint signs and symptoms occur in up to 90% of patients with antisynthetase syndrome, occasionally as the initial manifestations. Although visual inspection of the hands shows changes that are highly suggestive of rheumatoid arthritis, notable differences exist. Antisynthetase syndrome is a predominantly nonerosive arthropathy with subluxations of the distal interphalangeal joints. It manifests as overlap syndrome with other connective tissue diseases. However, overlap syndrome of antisynthetase syndrome and rheumatoid arthritis is rare. We treated a 51-year-old male patient with overlap syndrome of antisynthetase syndrome and rheumatoid arthritis, and report the case with a review of the literatureope

A Case of Wegener’s Granulomatosis Presenting with Cerebral Infarction and Intracerebral Hemorrhage

Wegener’s granulomatosis is a multisystem necrotizing vasculitis that primarily involves the upper and lower respiratory tract and kidneys but can affect almost any organ, including the central nervous system. Cerebral infarction and intracerebral hemorrhage are rare neurologic complications of Wegener’s granulomatosis. We report on a 52-year-old male patient with Wegener’s granulomatosis presenting with a cerebral infarction and subsequent intracerebral hemorrhage. He was successfully treated with high dose corticosteroid and cyclophosphamideope

A Case of Dermatomyositis Showing Vesicular Lesion Associated with Ovarian Cancer

Dermatomyositis is a rare inflammatory myopathy with characteristic skin manifestations and accompanied by muscular weakness. Vesicle formation in dermatomyositis is rare. We report a case of dermatomyositis associated with ovarian cancer in a 62-year-old woman who had vesicles and bullae on her arms. She had erythema and edema on the face, chest, abdomen, and shoulder for 2 months. Diagnosis of dermatomyositis was established by clinical manifestations, muscle enzyme elevation, and a characteristic electromyogram. She was successfully treated with cyclosporin and high doses of steroidsope

A Case of Escherichia Coli Sternoclavicular Septic Arthritis

Septic arthritis of the sternoclavicular joint is a rare condition. The predisposing risk factors include intravenous drug abuse, subclavian vein catheter placement, diabetes mellitus and trauma. Delayed or inadequate management can lead to irreversible joint damage with subsequent disability, even death. We report a 48-year-old female patient who presented with right sternoclavicular joint swelling and right shoulder pain. Magnetic resonance imaging of the sternum showed swelling of the right sternoclavicular joint with gadolinium enhancement. Synovial fluid and bone tissue culture revealed Escherichia coli (E.coli), and confirmed the diagnosis of sternoclavicular septic arthritis. She was successfully treated with surgical debridement and ciprofloxacin without recurrence. This is the first case report of E.coli sternoclavicular septic arthritis in Koreaope

A case of hepatocellular carcinoma confirmed histologically in primary biliary cirrhosis

Primary biliary cirrhosis is a chronic cholestatic autoimmune liver disease characterized by progressive bile duct injury caused by portal and periportal inflammation, resulting in fibrosis and eventual cirrhosis in a significant proportion of patients. Little is known of the incidence, survival, and risk factors of hepatocellular carcinoma in patients with primary biliary cirrhosis. We report the case of a 68-year-old male with primary biliary cirrhosis who developed hepatocellular carcinoma without hepatitis B or C virus infection. Histological analysis revealed well-differentiated hepatocellular carcinoma. He was treated successfully with percutaneous radiofrequency ablation and has regular follow-up evaluations without recurrence. This is the first case report of hepatocellular carcinoma in primary biliary cirrhosis diagnosed with a liver biopsy in Koreaope

Retroperitoneal fibrosis in 27 Korean patients: single center experience

Retroperitoneal fibrosis (RPF) is a rare disease with unclear etiology, which is characterized by chronic non-specific inflammation of the retroperitoneum. This study was performed to investigate the clinical characteristics, laboratory findings, radiologic findings, treatment and outcome in Korean patients with RPF. We retrospectively reviewed medical records of 27 RPF patients who were admitted to Yonsei University Medical Center between 1998 and 2009. Twenty-two patients (81%) were male. The mean age at diagnosis was 56 yr. Nine patients had identifiable risk factors of RPF and three patients had combined autoimmune diseases. Acute phase reactants were elevated in most patients. Rheumatoid factor was positive in 3 of 16 patients (19%) and antinuclear antibody in 4 of 17 (24%). Five of 6 patients who were taken positron-emission tomography showed positive uptake. Glucocorticoids were used in 16 patients (59%) and four of them received combination therapy with azathioprine. After immunosuppressive treatment, the levels of acute phase reactants dropped, and the size of mass also decreased in most patients. In conclusion, the clinical characteristics of RPF in Korean patients are similar with other series except for higher proportion of male. Some patients with RPF have autoimmune features. The effect of immunosuppressive treatment on RPF is good.ope

Clinical Manifestations of Korean Adult Patients with Henoch-Schonlein Purpura

OBJECTIVE: We investigated the clinical data and analyzed the significant prognostic factors for outcomes in Korean adult patients with Henoch-Schonlein Purpura (HSP). METHODS: We retrospectively reviewed the medical records of 52 patients over 20 years-old, who visited the Yonsei University Severance Hospital from December 1999 to November 2009, and fulfilled the classification criteria for HSP. We investigated the epidemiologic data, clinical features, renal biopsy findings, laboratory results and disease outcomes. RESULTS: The median age was 43.5 (20~83) years old and 29 out of 52 patients (55.8%) were male. HSP exhibited seasonal variation and most frequently developed in winter (42.3%), followed by spring (25.0%). Upper respiratory infection was the most common known preceding event for HSP development. Skin manifestations were observed in all subjects, followed by kidney (80.8%), gastro-intestine (57.7%) and joints (26.9%). After a median follow-up period 14.5 (1~227) months, 12 patients experienced HSP relapse (23.1%), and 7 patients had chronic renal failure (13.4%). Univariate analysis showed that renal insufficiency (p=0.002) and nephritic syndrome (p=0.026) at diagnosis were significantly related to the development of chronic renal failure. Of the two parameters, only initial renal insufficiency was found to be a significant predictive value for chronic renal failure (OR=28.7, p=0.001, 95% confidential interval 3.6~225.3). CONCLUSION: Renal insufficiency at diagnosis may be a useful predictive factor for progression to chronic renal failure in Korean adult patients with HSP.ope