Seong-Ryul Kwon, Tae-Hwan Kim, Tae-Jong Kim, Won Park, Seung Cheol Shim
Ankylosing spondylitis is a chronic inflammatory disorder characterized by inflammation of the axial skeleton and sacroiliac joints and to a lesser extent by peripheral arthritis and the involvement of some extra-articular organs. It is paramount for the provision of effective health care delivery to be familiar with the epidemiologic studies on prevalence, mortality, and disability. Furthermore, there is no systematic arrangement of studies related to the treatment of ankylosing spondylitis in Korea. In this review, we addressed Korean ankylosing spondylitis epidemiological studies related to prevalence, genetic factor especially human leucocyte antigen-B27, extra-articular manifestations, infections, mortality, radiologic progression, child-birth, and quality of life. Furthermore, we reviewed Korean ankylosing spondylitis treatment researches about treatment trend, patients' registration program called The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry project, biologics and biosimiliars, complications especially infections, and issues about bony progression. There would be value to further studying the epidemiology and treatment of Korean ankylosing spondylitis.
{"title":"The Epidemiology and Treatment of Ankylosing Spondylitis in Korea.","authors":"Seong-Ryul Kwon, Tae-Hwan Kim, Tae-Jong Kim, Won Park, Seung Cheol Shim","doi":"10.4078/jrd.22.0023","DOIUrl":"https://doi.org/10.4078/jrd.22.0023","url":null,"abstract":"<p><p>Ankylosing spondylitis is a chronic inflammatory disorder characterized by inflammation of the axial skeleton and sacroiliac joints and to a lesser extent by peripheral arthritis and the involvement of some extra-articular organs. It is paramount for the provision of effective health care delivery to be familiar with the epidemiologic studies on prevalence, mortality, and disability. Furthermore, there is no systematic arrangement of studies related to the treatment of ankylosing spondylitis in Korea. In this review, we addressed Korean ankylosing spondylitis epidemiological studies related to prevalence, genetic factor especially human leucocyte antigen-B27, extra-articular manifestations, infections, mortality, radiologic progression, child-birth, and quality of life. Furthermore, we reviewed Korean ankylosing spondylitis treatment researches about treatment trend, patients' registration program called The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry project, biologics and biosimiliars, complications especially infections, and issues about bony progression. There would be value to further studying the epidemiology and treatment of Korean ankylosing spondylitis.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/76/jrd-29-4-193.PMC10351411.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sang Jin Lee, Eon Jeong Nam, Man Hoon Han, Yong Jin Kim
Objective: To investigate the histopathological characteristics of patients with lupus nephritis in the 2018 revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification and assess the prognostic factors.
Methods: This study enrolled 92 patients with lupus nephritis, who had conventional treatment and renal biopsy. Each renal tissue was evaluated according to 2018 ISN/RPS classification, and quantified apoptotic regulator protein, the B-cell lymphoma-2 protein (Bcl-2), expressions in selected lymphocyte subsets were measured using novel computational approaches using multicolor confocal images. Histopathological characteristics and prognostic factors of end-stage renal disease (ESRD) and chronic kidney disease (CKD) were compared. Follow-up data were obtained, and survival analysis was conducted.
Results: During follow-up period (average 74.3 months), 16 and 18 patients progressed ESRD and CKD, respectively. Multivariable analysis of age, sex, disease activity and pathological features in ISN/RPS demonstrated the extent of interstitial inflammation (grade 0~3) was significantly associated with both ESRD and CKD. When interstitial inflammation was divided into mild (grade 0, 1) and severe (grade 2, 3), Cox regression analysis showed that patients with severe interstitial inflammation were significantly increased risk of both ESRD and CKD (hazard ratio 4.67 and 3.8, respectively). Bcl-2 expression in CD4+ and CD20 cells was significantly higher in the severe interstitial inflammation group compared to in mild interstitial inflammation patients (p=0.006 and 0.010, respectively).
Conclusion: The extent of interstitial inflammation can predict clinical renal outcomes. Significantly elevated Bcl-2 expression in both CD4+ and CD20 cells was found in severe interstitial inflammation compared with mild interstitial inflammation.
{"title":"Interstitial Inflammation in the ISN/RPS 2018 Classification of Lupus Nephritis Predicts Renal Outcomes and is Associated With Bcl-2 Expression.","authors":"Sang Jin Lee, Eon Jeong Nam, Man Hoon Han, Yong Jin Kim","doi":"10.4078/jrd.22.0011","DOIUrl":"https://doi.org/10.4078/jrd.22.0011","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the histopathological characteristics of patients with lupus nephritis in the 2018 revised International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification and assess the prognostic factors.</p><p><strong>Methods: </strong>This study enrolled 92 patients with lupus nephritis, who had conventional treatment and renal biopsy. Each renal tissue was evaluated according to 2018 ISN/RPS classification, and quantified apoptotic regulator protein, the B-cell lymphoma-2 protein (Bcl-2), expressions in selected lymphocyte subsets were measured using novel computational approaches using multicolor confocal images. Histopathological characteristics and prognostic factors of end-stage renal disease (ESRD) and chronic kidney disease (CKD) were compared. Follow-up data were obtained, and survival analysis was conducted.</p><p><strong>Results: </strong>During follow-up period (average 74.3 months), 16 and 18 patients progressed ESRD and CKD, respectively. Multivariable analysis of age, sex, disease activity and pathological features in ISN/RPS demonstrated the extent of interstitial inflammation (grade 0~3) was significantly associated with both ESRD and CKD. When interstitial inflammation was divided into mild (grade 0, 1) and severe (grade 2, 3), Cox regression analysis showed that patients with severe interstitial inflammation were significantly increased risk of both ESRD and CKD (hazard ratio 4.67 and 3.8, respectively). Bcl-2 expression in CD4+ and CD20 cells was significantly higher in the severe interstitial inflammation group compared to in mild interstitial inflammation patients (p=0.006 and 0.010, respectively).</p><p><strong>Conclusion: </strong>The extent of interstitial inflammation can predict clinical renal outcomes. Significantly elevated Bcl-2 expression in both CD4+ and CD20 cells was found in severe interstitial inflammation compared with mild interstitial inflammation.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/d2/jrd-29-4-232.PMC10351406.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9840786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aimed to assess the prevalence of pain in patients with RA in clinical remission and analyze the demographic and clinical characteristics of those who experienced persistent pain despite remission status.
Methods: Data from 1,891 patients with RA registered on the Korean College of Rheumatology Biologics and Targeted Therapy registry were obtained. Remission was defined as a Disease Activity Score of 28 joints-erythrocyte sedimentation rate (ESR) <2.6. Pain intensity was classified as severe (pain visual analog scale [VAS] ≥7), moderate (4≤VAS<7), or mild (VAS <4).
Results: Our analysis showed that 52.6% of patients complained of severe pain at the start of or during switching biological disease-modifying anti-rheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs). Despite having a 36.0% (n=680) remission rate after the use of bDMARDs or tsDMARDs at their 1-year follow-up, 21.5% (n=146) of these patients had moderate-to-severe pain, higher frequency of foot erosions, and comorbidities, such as mental illness, endocrine, renal, and neurological disorders, than patients with a milder degree of pain. The multivariable regression analysis showed that presence of foot erosions, neurological disorders, and use of corticosteroids were independently associated with moderate-to-severe pain in patients with RA despite being in remission. The level of ESR and use of Janus kinase inhibitors were inversely associated with moderate-to-severe pain.
Conclusion: Persistent pain and discomfort continue to be a problem for patients with RA in clinical remission. Continued research on insistent pain in patients with RA is warranted to better alleviate distress and improve the quality of life in patients.
{"title":"Implications of Persistent Pain in Patients With Rheumatoid Arthritis Despite Remission Status: Data From the KOBIO Registry.","authors":"Hyoun-Ah Kim, So Young Park, Kichul Shin","doi":"10.4078/jrd.22.0005","DOIUrl":"https://doi.org/10.4078/jrd.22.0005","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prevalence of pain in patients with RA in clinical remission and analyze the demographic and clinical characteristics of those who experienced persistent pain despite remission status.</p><p><strong>Methods: </strong>Data from 1,891 patients with RA registered on the Korean College of Rheumatology Biologics and Targeted Therapy registry were obtained. Remission was defined as a Disease Activity Score of 28 joints-erythrocyte sedimentation rate (ESR) <2.6. Pain intensity was classified as severe (pain visual analog scale [VAS] ≥7), moderate (4≤VAS<7), or mild (VAS <4).</p><p><strong>Results: </strong>Our analysis showed that 52.6% of patients complained of severe pain at the start of or during switching biological disease-modifying anti-rheumatic drugs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs). Despite having a 36.0% (n=680) remission rate after the use of bDMARDs or tsDMARDs at their 1-year follow-up, 21.5% (n=146) of these patients had moderate-to-severe pain, higher frequency of foot erosions, and comorbidities, such as mental illness, endocrine, renal, and neurological disorders, than patients with a milder degree of pain. The multivariable regression analysis showed that presence of foot erosions, neurological disorders, and use of corticosteroids were independently associated with moderate-to-severe pain in patients with RA despite being in remission. The level of ESR and use of Janus kinase inhibitors were inversely associated with moderate-to-severe pain.</p><p><strong>Conclusion: </strong>Persistent pain and discomfort continue to be a problem for patients with RA in clinical remission. Continued research on insistent pain in patients with RA is warranted to better alleviate distress and improve the quality of life in patients.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/07/jrd-29-4-215.PMC10351409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
www.jrd.or.kr Patients with rheumatoid arthritis (RA) tend to have more comorbidities than the general population, but remain at risk of insufficient rheumatological care despite high disease burden and poor outcomes [1]. As life expectancy increases, rheumatologists have more opportunities to see patients with co-morbidities. Although malignancy is a frequent cause of morbidity and mortality, information on the management of RA in patients with malignancy is scarce. In this respect, the study that Joo et al. [2] published in the previous issue of Journal of Rheumatic Diseases provides valuable information on current practice among such patients, suggesting the unmet clinical needs of this population. According to a recent meta-analysis that investigated the pooled data from previous cohort studies, the overall risk of developing malignancy is slightly increased in RA patients. Regarding site-specific risk, the risk of lymphoma and lung cancer was particularly increased [3,4], and it is postulated that a shared etiology such as smoking [5,6] or chronic persistent immune activation may play a role in the development of neoplasms [7,8]. Apart from the inherent risk of malignancy in RA patients, there have been concerns regarding the influence of diseasemodifying antirheumatic drugs (DMARDs) on the risk of developing malignancy. There is conflicting evidence about the relationship between TNF-α inhibitors (TNFis) and malignancy risk; some meta-analyses and patient registry studies have shown that the risk of malignancy is not increased in patients receiving TNFis, whereas other studies have reported increased risk of nonmelanoma skin cancer [9]. Non-TNFi biologics were not linked with increased risk of malignancy in some claimsbased studies and registry data [10,11]. As for new target synthetic DMARDs, Janus kinase inhibitors showed no effect on the overall incidence of malignancy from the general population or those taking biologic DMARDs, although the ageand sexmatched standard incidence ratio of lymphoma was higher than that of the general population [12]. Despite a few reports of increased malignancy risk related to cyclosporin and azathioprine, conventional synthetic DMARDs are generally considered not to increase malignancy risk [13]. There also are some theoretic concerns that concurrent DMARDs might suppress the immune system, thus increasing the risk of malignancy recurrence. However, recent meta-analyses of observational studies showed that the recurrence rate of malignancy in patients who are on DMARDs was not different from that in patients without DMARDs [14]. Drawing firm conclusions about the effects of DMARDs on malignancy risk is challenging. The data provided by randomized controlled studies (RCTs) regarding the risk of malignancy with DMARDs are quite limited; a history of prior malignancy is usually an exclusion criterion of those studies, and considering the long latency of malignancy, RCTs generally do not involve sufficient fo
{"title":"Rheumatoid Arthritis and Malignancy: What Should We Do With DMARDs?","authors":"Chan Hong Jeon","doi":"10.4078/jrd.22.0034","DOIUrl":"https://doi.org/10.4078/jrd.22.0034","url":null,"abstract":"www.jrd.or.kr Patients with rheumatoid arthritis (RA) tend to have more comorbidities than the general population, but remain at risk of insufficient rheumatological care despite high disease burden and poor outcomes [1]. As life expectancy increases, rheumatologists have more opportunities to see patients with co-morbidities. Although malignancy is a frequent cause of morbidity and mortality, information on the management of RA in patients with malignancy is scarce. In this respect, the study that Joo et al. [2] published in the previous issue of Journal of Rheumatic Diseases provides valuable information on current practice among such patients, suggesting the unmet clinical needs of this population. According to a recent meta-analysis that investigated the pooled data from previous cohort studies, the overall risk of developing malignancy is slightly increased in RA patients. Regarding site-specific risk, the risk of lymphoma and lung cancer was particularly increased [3,4], and it is postulated that a shared etiology such as smoking [5,6] or chronic persistent immune activation may play a role in the development of neoplasms [7,8]. Apart from the inherent risk of malignancy in RA patients, there have been concerns regarding the influence of diseasemodifying antirheumatic drugs (DMARDs) on the risk of developing malignancy. There is conflicting evidence about the relationship between TNF-α inhibitors (TNFis) and malignancy risk; some meta-analyses and patient registry studies have shown that the risk of malignancy is not increased in patients receiving TNFis, whereas other studies have reported increased risk of nonmelanoma skin cancer [9]. Non-TNFi biologics were not linked with increased risk of malignancy in some claimsbased studies and registry data [10,11]. As for new target synthetic DMARDs, Janus kinase inhibitors showed no effect on the overall incidence of malignancy from the general population or those taking biologic DMARDs, although the ageand sexmatched standard incidence ratio of lymphoma was higher than that of the general population [12]. Despite a few reports of increased malignancy risk related to cyclosporin and azathioprine, conventional synthetic DMARDs are generally considered not to increase malignancy risk [13]. There also are some theoretic concerns that concurrent DMARDs might suppress the immune system, thus increasing the risk of malignancy recurrence. However, recent meta-analyses of observational studies showed that the recurrence rate of malignancy in patients who are on DMARDs was not different from that in patients without DMARDs [14]. Drawing firm conclusions about the effects of DMARDs on malignancy risk is challenging. The data provided by randomized controlled studies (RCTs) regarding the risk of malignancy with DMARDs are quite limited; a history of prior malignancy is usually an exclusion criterion of those studies, and considering the long latency of malignancy, RCTs generally do not involve sufficient fo","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/cf/jrd-29-4-191.PMC10351408.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Hyoun Kim, Jeong Seok Lee, Byoong Yong Choi, Yun-Hong Cheon, Su-Jin Yoo, Ji Hyeon Ju, Kichul Shin, Eu Suk Kim, Han Joo Baek, Won Park, Yeong Wook Song, Woi-Hyun Hong, Yun Jong Lee
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.
目的:探讨孤立性结核性肌炎(ITBM)的临床特点和相关的潜在条件,ITBM是一种罕见的肺外结核(TB)。方法:采用系统的文献检索和多中心调查,采用三角测量法。从已识别的ITBM病例中提取数据并进行分析,以确定潜在条件、临床表现、治疗和结果。结果:基于系统评价,我们确定了58例ITBM,包括9例儿科,从1981年到2021年发表的文献中有25例(43.1%)免疫功能低下,33例(56.9%)非免疫功能低下。免疫功能低下的病例症状持续时间明显较短(中位30.0天vs. 75.0天),多房受累的患病率较高(20.8% vs. 0%)。在24例免疫功能低下的成人患者中,皮肌炎/多发性肌炎(DM/PM;n=10, 41.7%)是系统评价中发现的ITBM成人中最常见的基础疾病。在过去的20年里,在多中心调查中发现了11名患有ITBM的韩国成年人。7例免疫功能低下患者中,2例(28.6%)为DM/PM患者。在系统评价中发现的儿童和成人ITBM病例中,免疫功能低下患者的结核病死亡率分别为0.0%和5/23(21.7%),在调查中发现的ITBM病例中,免疫功能低下患者的结核病死亡率为3/7(42.9%)。结论:ITBM具有独特的临床表现,包括发热、压痛、局部肿胀、覆盖红斑、脓肿形成,并与严重的结果相关,特别是在免疫功能低下的宿主中。DM/PM在系统评价鉴定和调查鉴定的免疫功能低下ITBM患者中都是一种非常普遍的潜在疾病。
{"title":"Isolated Tuberculous Myositis: A Systematic Review and Multicenter Cases.","authors":"Ji Hyoun Kim, Jeong Seok Lee, Byoong Yong Choi, Yun-Hong Cheon, Su-Jin Yoo, Ji Hyeon Ju, Kichul Shin, Eu Suk Kim, Han Joo Baek, Won Park, Yeong Wook Song, Woi-Hyun Hong, Yun Jong Lee","doi":"10.4078/jrd.22.0014","DOIUrl":"https://doi.org/10.4078/jrd.22.0014","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical features and associated underlying conditions of isolated tuberculous myositis (ITBM), a rare extrapulmonary tuberculosis (TB).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/ba/jrd-29-4-243.PMC10351410.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9840778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dae Jin Park, Young Bin Joo, So-Young Bang, Jiyoung Lee, Hye-Soon Lee, Sang-Cheol Bae
Objective: To identify the predictive factors for renal response in patients with lupus nephritis (LN).
Methods: Patients and data were extracted from a prospective systemic lupus erythematosus cohort in Korea, in which clinical data were collected at 0, 3, 6, and 12 months after induction therapy. Treatment response of LN were evaluated as a complete response (CR), partial response (PR), or non-response (NR) at 3, 6, and 12 months, respectively. Predictive factors for CR at 6 months were evaluated using multivariable Poisson regression analysis.
Results: A total of 75 patients with LN who underwent biopsy was enrolled. The mean age at diagnosis of LN was 28.9±9.7 years, and 68 (90.7%) were female. The frequencies of classes III, IV, III+V, IV+V, and V were 20.0%, 44.0%, 16.0%, 12.0%, and 8.0%, respectively. Compared to relapsed LN, new-onset LN showed a lower percentage of glomerulosclerosis (45.5% vs. 76.2%, p=0.013). The overall proportions of CR, PR, and NR at 6 and 12 months were 52.0%, 26.7%, 21.3% and 50.7%, 24.0%, 25.3%, respectively. In multivariate analysis, age at enrollment (odds ratio [OR]=1.02, p=0.022), relapsed LN (OR=0.71, p=0.037), anti-Ro antibody (OR=0.67, p=0.014), and class III LN (OR=1.48, p=0.001) were associated with CR at 6 months.
Conclusion: In our prospective cohort, class III LN was a good predictive factor for CR at 6 months in patients with LN, whereas younger age, relapsed LN, and anti-Ro antibody were poor predictive factors.
{"title":"Predictive Factors for Renal Response in Lupus Nephritis: A Single-center Prospective Cohort Study.","authors":"Dae Jin Park, Young Bin Joo, So-Young Bang, Jiyoung Lee, Hye-Soon Lee, Sang-Cheol Bae","doi":"10.4078/jrd.22.0006","DOIUrl":"https://doi.org/10.4078/jrd.22.0006","url":null,"abstract":"<p><strong>Objective: </strong>To identify the predictive factors for renal response in patients with lupus nephritis (LN).</p><p><strong>Methods: </strong>Patients and data were extracted from a prospective systemic lupus erythematosus cohort in Korea, in which clinical data were collected at 0, 3, 6, and 12 months after induction therapy. Treatment response of LN were evaluated as a complete response (CR), partial response (PR), or non-response (NR) at 3, 6, and 12 months, respectively. Predictive factors for CR at 6 months were evaluated using multivariable Poisson regression analysis.</p><p><strong>Results: </strong>A total of 75 patients with LN who underwent biopsy was enrolled. The mean age at diagnosis of LN was 28.9±9.7 years, and 68 (90.7%) were female. The frequencies of classes III, IV, III+V, IV+V, and V were 20.0%, 44.0%, 16.0%, 12.0%, and 8.0%, respectively. Compared to relapsed LN, new-onset LN showed a lower percentage of glomerulosclerosis (45.5% vs. 76.2%, p=0.013). The overall proportions of CR, PR, and NR at 6 and 12 months were 52.0%, 26.7%, 21.3% and 50.7%, 24.0%, 25.3%, respectively. In multivariate analysis, age at enrollment (odds ratio [OR]=1.02, p=0.022), relapsed LN (OR=0.71, p=0.037), anti-Ro antibody (OR=0.67, p=0.014), and class III LN (OR=1.48, p=0.001) were associated with CR at 6 months.</p><p><strong>Conclusion: </strong>In our prospective cohort, class III LN was a good predictive factor for CR at 6 months in patients with LN, whereas younger age, relapsed LN, and anti-Ro antibody were poor predictive factors.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/39/jrd-29-4-223.PMC10351413.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9840781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4078/jrd.2022.29.3.181
Su Min Lee, Hyungwook Choi, Sungmin Lim, Jehee Shin, Ji-Man Kang, Jong Gyun Ahn
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.
{"title":"Pediatric Sarcoidosis Misdiagnosed as Hepatosplenic Abscesses: A Case Report and Review.","authors":"Su Min Lee, Hyungwook Choi, Sungmin Lim, Jehee Shin, Ji-Man Kang, Jong Gyun Ahn","doi":"10.4078/jrd.2022.29.3.181","DOIUrl":"10.4078/jrd.2022.29.3.181","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/a7/jrd-29-3-181.PMC10324926.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4078/jrd.2022.29.3.129
Dong-Jin Park
www.jrd.or.kr Rheumatoid arthritis (RA) is one of the most common autoimmune diseases and is characterized by synovial hypertrophy and joint inflammation and damage [1,2]. RA affects up to 2% of adults worldwide and often causes substantial functional impairment and decreased health-related quality of life, relative to the general population [3,4]. The conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (csDMARDs), including methotrexate and leflunomide, are still used as the first-line treatment for RA. However, the development of targeted treatments such as biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have shown great promise at improving the disease outcomes [5,6]. Radiographs of hands and feet evaluate the bone resorption as erosions and cartilage degradation as joint space narrowing. These images are used to assess the structural progression of damage in clinical research trials in patients with RA, aiming to provide the disease-modifying capacity of a drug [7]. Recent studies have reported that ongoing disease activities, as reflected by elevated erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP) or composite indices including the 28-joint disease activity score (DAS28), are associated with severe radiologic joint destruction [8]. The disease composite indices are largely applied to therapeutic targets for treat-to-target (T2T) strategy targeting remission or low disease activity (LDA), resulting in better disease outcomes and quality of life [9]. However, clinical trials of bDMARDs in established RA patients after inadequate response to csDMARDs have reported a subsequent disconnect between disease activity and radiographic progression [10]. Furthermore, recent real-world data demonstrate that approximately 20% of RA patients with sustained remission or LDA still show radiographic progression [11,12]. Similarly, Brown et al. [13] found that 60%~80% of RA patients who fulfilled the American College of Rheumatology (ACR) and DAS28 remission criteria had synovitis or subclinical joint inflammation on magnetic resonance imaging or musculoskeletal ultrasonography. Subsequently, they observed that subclinical joint inflammation detected by imaging techniques explains the structural deterioration in RA patients in clinical remission [14]. Additionally, there may be challenges in assessing disease activity when patients are treated with interleukin-6 inhibitors and other drugs that directly affect levels of CRP [15]. The level of CRP is a component of composite indices measuring RA disease activity (DAS28-CRP, simplified disease activity index [SDAI], and ACR/European Alliance of Associations for Rheumatology [EULAR] remission). Therefore, assessment of disease activity based on the prompt reduction in the level of CRP may not reflect the actual improvement of disease activity in patients receiving interleukin-6 inhibitors [15,16]. In conclusion, although T2T re
{"title":"Importance of Time-integrated Cumulative Parameters for Radiographic Progression Prediction of Rheumatoid Arthritis.","authors":"Dong-Jin Park","doi":"10.4078/jrd.2022.29.3.129","DOIUrl":"https://doi.org/10.4078/jrd.2022.29.3.129","url":null,"abstract":"www.jrd.or.kr Rheumatoid arthritis (RA) is one of the most common autoimmune diseases and is characterized by synovial hypertrophy and joint inflammation and damage [1,2]. RA affects up to 2% of adults worldwide and often causes substantial functional impairment and decreased health-related quality of life, relative to the general population [3,4]. The conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (csDMARDs), including methotrexate and leflunomide, are still used as the first-line treatment for RA. However, the development of targeted treatments such as biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) have shown great promise at improving the disease outcomes [5,6]. Radiographs of hands and feet evaluate the bone resorption as erosions and cartilage degradation as joint space narrowing. These images are used to assess the structural progression of damage in clinical research trials in patients with RA, aiming to provide the disease-modifying capacity of a drug [7]. Recent studies have reported that ongoing disease activities, as reflected by elevated erythrocyte sedimentation rate (ESR) and C-reactive proteins (CRP) or composite indices including the 28-joint disease activity score (DAS28), are associated with severe radiologic joint destruction [8]. The disease composite indices are largely applied to therapeutic targets for treat-to-target (T2T) strategy targeting remission or low disease activity (LDA), resulting in better disease outcomes and quality of life [9]. However, clinical trials of bDMARDs in established RA patients after inadequate response to csDMARDs have reported a subsequent disconnect between disease activity and radiographic progression [10]. Furthermore, recent real-world data demonstrate that approximately 20% of RA patients with sustained remission or LDA still show radiographic progression [11,12]. Similarly, Brown et al. [13] found that 60%~80% of RA patients who fulfilled the American College of Rheumatology (ACR) and DAS28 remission criteria had synovitis or subclinical joint inflammation on magnetic resonance imaging or musculoskeletal ultrasonography. Subsequently, they observed that subclinical joint inflammation detected by imaging techniques explains the structural deterioration in RA patients in clinical remission [14]. Additionally, there may be challenges in assessing disease activity when patients are treated with interleukin-6 inhibitors and other drugs that directly affect levels of CRP [15]. The level of CRP is a component of composite indices measuring RA disease activity (DAS28-CRP, simplified disease activity index [SDAI], and ACR/European Alliance of Associations for Rheumatology [EULAR] remission). Therefore, assessment of disease activity based on the prompt reduction in the level of CRP may not reflect the actual improvement of disease activity in patients receiving interleukin-6 inhibitors [15,16]. In conclusion, although T2T re","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/86/jrd-29-3-129.PMC10324923.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4078/jrd.2022.29.3.187
Seong-Ji Park, Chung-Il Joung, Seung Hyun Cheong, Han Young Ryu, Ga Hyun Lee, Gil Jae Pyo, Mihye Kwon
www.jrd.or.kr An 86-year-old female patient was diagnosed with seropositive rheumatoid arthritis (RA) in March 2019 and she also had approximately ten-year history of diabetes mellitus, hypertension, dyslipidemia, osteoporosis, and total knee replacement in her left knee joint in 2014. She had been treated with methotrexate, leflunomide, and prednisolone for RA, then tofacitinib was added for uncontrolled disease activity of RA in December 2019, symptoms and signs of arthritis subsided and she was treated on methotrexate, tofacitinib and methylprednisolone 2 mg daily thereafter. In April 2020, she developed erythematous papules, palpable purpura, and ulcers on the left lower leg, and visited the department of dermatology. There were no other systemic symptoms and signs, and laboratory tests were nonspecific. Suspicious of leukocytoclastic vasculitis (LCV), an al-
{"title":"A Case of Superficial Thrombo-occlusive Vascular Disease in a Patient With Rheumatoid Arthritis.","authors":"Seong-Ji Park, Chung-Il Joung, Seung Hyun Cheong, Han Young Ryu, Ga Hyun Lee, Gil Jae Pyo, Mihye Kwon","doi":"10.4078/jrd.2022.29.3.187","DOIUrl":"https://doi.org/10.4078/jrd.2022.29.3.187","url":null,"abstract":"www.jrd.or.kr An 86-year-old female patient was diagnosed with seropositive rheumatoid arthritis (RA) in March 2019 and she also had approximately ten-year history of diabetes mellitus, hypertension, dyslipidemia, osteoporosis, and total knee replacement in her left knee joint in 2014. She had been treated with methotrexate, leflunomide, and prednisolone for RA, then tofacitinib was added for uncontrolled disease activity of RA in December 2019, symptoms and signs of arthritis subsided and she was treated on methotrexate, tofacitinib and methylprednisolone 2 mg daily thereafter. In April 2020, she developed erythematous papules, palpable purpura, and ulcers on the left lower leg, and visited the department of dermatology. There were no other systemic symptoms and signs, and laboratory tests were nonspecific. Suspicious of leukocytoclastic vasculitis (LCV), an al-","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b9/f7/jrd-29-3-187.PMC10324927.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9904353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4078/jrd.2022.29.3.132
Hyun Ah Kim
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.
{"title":"Osteoarthritis - Insights From Recent Research.","authors":"Hyun Ah Kim","doi":"10.4078/jrd.2022.29.3.132","DOIUrl":"https://doi.org/10.4078/jrd.2022.29.3.132","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":56161,"journal":{"name":"Journal of Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/fa/jrd-29-3-132.PMC10324928.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10208255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}