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엄완식 ( Wan Sik Uhm ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.3
In Korea, Resource-Based Relative Value Scale (RBRVS) was developed in 1997 and introduced in 2001 for the alternative of Korean Medical Fee Schedule. The RBRVS measures physician resource inputs to construct relative values for services and procedures. The RBRVS, as an administered price system, would need to be updated periodically. Changes in practice costs and practice patterns, and the rapid evolution of technology will require that relative values be adjusted over time. The Relative Value Scale Update Committee (RUC) in Korean Medical Association (KMA) is under updating annual review and 5-year review of Korean Relative Value Scale (RVS). The Korean RVS is estimated less balanced and rational in general, and furthermore there was no update after base-line study. So, it is the reason why this update of RVS is important. We, rheumatologists, are specialists for rheumatic diseases and are unfamiliar and unconcerned with health care system and medical insurance fee schedule, but this attitude is not appropriate to improve our specialized medical situation. This article reviewed the history of Korean medical insurance, development and update procedure of Korean RVS, and the current insurance problems in rheumatic diseases briefly. In Korea, RVS of medical services including rheumatology is relatively less compensated than the other invasive and imaging services. Therefore, Korean RVS update should be changed to more balanced and reasonable one for the medical service including rheumatology.
건강검진자의 혈청 Rheumatoid Factor 양성률과 간염바이러스 감염의 관계에 대한 연구
엄완식(Wan Sik Uhm),조재근(Jae Kun Cho),정두련(Doo Ryeon Chung),최승원(Seung Won Choi),이무송(Moo Song Lee),유빈(Bin Yoo),문희범(Hee Bom Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: To estimate the prevalence of rheumatoid factor(BF) positivity in adult Korean population and to investigate the association between viral hepatitis infection and rheumatoid factor positivity. Methods: The database from 21,907 subjects who visited general health screening center of Asan Medical Center during 1 year's period were surveyed. RF was tested using a commercial latex test kit(RapiTex® RF Test; Behringwerke). Results : 1) The prevalence of I4F was 2.9%(male 3.1%, female 2.7%) and increased along with the higher age groups. 2) The prevalence of HF in HBsAg(+) subjects was higher(13.3%) than that of RF in HBsAg(-) subjects(2.2%). 3) The prevalence of RF in anti-HCV(+) subjects was higher(6.1%) than that of BF in anti-HCV(-) subjects(2.8%). 4) HBsAg positivity was highly associated the presence of RF than age, anti-HCV, or abnormnl AST/ALT. Conclusion : The prevalence of RF in healthy Korean adults can be estimated as 3% and shows high association with hepatitis B and C virus infection.
한국인 관절염의 본인인지 유병률과 역학적 특성: 『1998 국민건강,영양조사』
엄완식 ( Wan Sik Uhm ),윤정이 ( Jeong E Yun ),박용욱 ( Yong Wook Park ),김혜련 ( Hye Ryun Kim ),남정자 ( Jung Ja Nam ),이혜순 ( Hye Soon Lee ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Ch 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.2
Objective: The aim of our study was to define the prevalence, demographic data, selection of the medical services and disability of the patients with self-reported arthritis which were based on the data of National Health and Nutrition Survey (NHNS) conducted by Korea Institute for Health and Social Affairs (KIHASA) and Ministry of Health and Welfare in 1998. Methods: By a stratified multistage probability sampling method, 200 sample districts which consisted of total 13,523 households were selected all over the country. The investigation started with a basic household survey which was completed in 12,189 households with exclusion of non-kinship family. The Health Interview Survey was subdivided to 5 parts including the basic household survey (n=39,060), the diseases survey (n=26,448), and the disability survey (n=694). Results: An estimated 8.0% of Koreans had some form of self-reported arthritis in 1998 and this proportion was higher than that of other chronic medical conditions such as peptic ulcer disease, hypertension, and diabetes mellitus (DM) -7.0%, 4.5%, and 2.2%, respectively. Arthritis was more prevalent among people with female, increasing age, lower income (less than 500 thousand ₩ per month), lower educational attainment (less than 9 years), and lower standard of living. Especially, arthritis ranked first in prevalence as the cause of the chronic disease in the population aged over 45 years, with the prevalence rate of 22.6%. People with arthritis were more likely to report functional limitations such as activities of daily living (ADL) and instrumental activities of daily living (IADL) (5.4%), compared with people who had other musculoskeletal diseases, such as low back pain (3.8%), and herniated intervertebral disc (2.8%). The loss of productivity from arthritis was estimated to reach 0.25% of gross domestic product (GDP) amounts to ₩ 1,133 billion per year which was remarkably higher than that of cardiovascular diseases or cancers. Conclusion: Arthritis has a major impact on the health profile of our population. High burden of arthritis in our society should be considered as an important factor in planning health care services and setting research priorities.
엄완식 ( Wan Sik Uhm ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Primary antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) constitute a group of small vessel vasculitides that includes Wegener`s granulomatosis, microscopic polyangiitis and Churg-Strauss syndrome. Recently, many in vitro and in vivo studies have highlighted the role of ANCA as the main pathophysiological factor in the development of AAV. Two remarkable studies on ANCA pathogenesis were recently reported. One study examined anti-lysosomal membrane protein-2, which supports the `shared epitope` theory. The other examined the neutrophil extracellular trap that is released by neutrophils primed by ANCA. Each disease of AAV shows a broad spectrum of the clinical features and severities, which makes it difficult to diagnose and treat them. Considerable effort has been made in the past decades to improve the treatment outcomes, reduce the incidence of relapse and avoid drug toxicity. This review describes the current understanding of AAV along with a few Korean reports.
엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),박용욱 ( Yong Wook Park ),장대국 ( Dae Kook Chang ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김성윤 ( S 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3
Behcet`s disease can elicit serious vascular complications such as thrombophlebitis, arterial occlusion, and arterial aneurysm. The most common cause of death in Behcet`s disease is secondary to vascular complication. The treatment for abdominal aortic aneurysm which was frequently complicated by fatal rupture (60%) is mainly a surgical management. If surgical treatment is not possible due to various causes, alternative medical therapy such as immunosuppressives and steroid would be recommended. We report here the case of medically controlled abdominal aortic aneurysm in a 47-year-old patient with Behcet`s disease who refused to undergo surgical treatment. Immunosuppressive therapy and steroid could be an alternative treatment of aneurysmal manifestations in Behcet`s disease.
김윤정 ( Yun Jung Kim ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Hwan Kim ),이창우 ( Chang Woo Lee ),박찬금 ( Chan Kum Park ),전재범 ( Jae Bum Jun ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.1
Panniculitis is an inflammation within adipose tissue and most commonly affects the subcutaneous fat. Frequently, the panniculitis is associated with certain drugs and systemic diseases, such as various rheumatologic diseases, idiopathic Weber-Christian disease, infection and malignancy. Panniculitis in dermatomyositis (DM) is most commonly an incidental histopathologic finding that less commonly manifests a clinical component. We report the case of a woman with DM who presented with panniculitis as a clinical finding. A 51-year-old woman was admitted to our hospital with diffuse nodular, indurated, painful erythematous plaques on buttocks, back and chest. 18-months ago, she had been diagnosed DM at our hospital. Her medication on admission was azathioprine. High-dose glucocorticoid was prescribed after the diagnosis of lobular panniculitis confirmed by skin biopsy. After then, the patient was getting better and discharged with the medication tapered.
류마티스 관절염 환자에서 외안근 마비증상을 동반한 안부대상포진
이혜순 ( Hye Soon Lee ),전재범 ( Jae Bum Jun ),엄완식 ( Wan Sik Uhm ),서정철 ( Jeong Cheol Seo ),김주한 ( Ju Han Kim ),고명규 ( Myung Kyoo Ko ),변정원 ( Jung Won Byeon ),유대현 ( Dae Hyun Yoo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.2
There have been many reports about infections in patients with rheumatoid arthritis (RA) being more frequent than general population. Increased susceptability to infections in RA could be related to disease itself, comorbid conditions, and use of immunosuppressive drugs and steroid. Herpes zoster viral infections also have been reported to be more frequent in RA. We describe a case of 60-year-old woman with RA presented with ophthalmoplegia associated with herpes zoster ophthalmicus. Initially she complained of right orbital and periorbital pain. Six days later, she noted a cutaneous herpes zoster eruption involving the right 1st division of trigeminal nerve. Three days after developing skin eruption, she developed a right ptosis with external ophthalmoplegia and pupil dilatation resulting from the 3rd and 6th cranial nerve involvement. She was placed on intravenous acyclovir for 7days. Eight weeks after the onset of ophthalmoplegla, she recovered nearly completely.
오동호 ( Dong Ho Oh ),김태환 ( Tae Hwan Kim ),지종대 ( Jong Dae Ji ),엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),천병철 ( Byung Chul Chun ),김채기 ( Chae Gi Kim ),송용호 ( Yong H 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3
Objective: Depression is common in the patients with rheumatoid arthritis (RA). Estimates of the prevalence of depression in the patients with RA have ranged from 14 to 46%, depending on the criteria used and the patient subgroups studied. Our objectives were to show how frequently depression occur among patients with RA, to compare depression in RA and osteoarthritis (OA) patients, and to identify the disease and sociodemographic variables with which depression are associated. Methods: Subjects included in this study were 119 RA patients, and 140 OA patients. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. The Korean health assessment questionnaire (KHAQ) was used to assess physical function in patients with RA. The associations of sociodemographic variables, disability, severity and other variables with CES-D score were evaluated by multiple regression analysis. Results: When CES-D cut-off score of 25 was used, 54 (50.9%) of 106 RA patients, and 32(23.5%) of 122 OA patients had scores suggestive of depression, and the difference was still significant after adjusting age, sex, disease duration, pain scale and fatigue scale (p<0.05). RA patients had higher mean scores on CES-D than OA patients after adjusting above variables, too (p<0.05). The bivariate analysis showed that age, sex, education level, fatigue scale, pain scale, KHAQ-disability score, WBC, ESR were significantly associated with CESD scores in RA patients; and the duration of disease, pain scale and fatigue scale were associated with those in OA patients (p<0.05). By stepwise selection in multiple logistic regression model, the age, pain scale and KHAQ-disability score were selected as significant independent variables in RA patients. In OA patients, the duration of disease and pain scale were selected as significant independent variables. Conclusion: RA patients are significantly more depressed than OA patients, and the associated factors with depression are patient`s age, pain scale and KHAQ disability score in RA.
치료 불응성 루푸스 신염 환자에 대한 Rituximab 치료
염지연 ( Ji Youn Youm ),성윤경 ( Yoon Kyoung Sung ),엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4
Objective: To determine preliminary evidence for the safety and efficacy of B lymphocyte depletion therapy in refractory systemic lupus erythematosus (SLE). Methods: Four female lupus nephritis patients who had been refractory to steroid and one or more immunosuppressive therapy were treated on an open-label basis. During a 4-week period, each patient received two 500-mg infusions of rituximab and two 750-mg infusions of cyclophosphamide. Results: Patient 1, 2, and 3 were responded with rituximab treatment with improvements in SLEDAI and laboratory parameters such as C3/C4 and 24 hour urine protein. However, patient 4 had not improved with rituximab. The variation in the level of anti-double-stranded DNA antibody was different in individual patients. No significant adverse events were observed during follow-up. Conclusion: This study provides an evidence for the safety and possible efficacy of B lymphocyte depletion therapy in refractory lupus nephritis. However a further randomized trial is needed to confirm the efficacy and durability of remission.
이지현 ( Ji Hyun Lee ),유대현 ( Dae Hyun Yoo ),정윤호 ( Yoon Ho Chung ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),김인순 ( In So 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3
The myelodysplastic syndrome (MDS) is a heterogeneous group of refractory anemia resulting from a clonal abnormality in the pleuripotent stem cell. A variety of immunologic abnormalities have been reported in patients with MDS, and various rheumatic diseases, including rheumatoid arthritis, lupus, Sjogren`s syndrome, vasculitis, have been reported in association with MDS. Inflammatory arthritis is a rare complication of MDS. Here we report a patient with refractory anemia with excess blasts with unusual manifestation of inflammatory arthritis, with a review of the literature.