Comparison of MR Findings between Patients with Septic Arthritis and Acute Gouty Arthritis of the Knee

Su Young Yun,Hye Jung Choo,Hae Woong Jeong,Sun Joo Lee 대한영상의학회 2022 대한영상의학회지 Vol.83 No.5

Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher’s exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.

海桐皮藥鍼이 Collagen-induced Arthritis 억제 및 면역조절에 미치는 영향

김영화,이현 대한침구의학회 2007 대한침구의학회지 Vol.24 No.5

Objectives : The purpose of this study was to analyze the effects of Erythrinae Cortex herbal- acupuncture solution(EC-HAS) at the Joksamni(ST36) of mice with collagen II-induced arthritis(CIA). Methods : The author performed several experimental procedures to observe the effects of the EC-HAS at the arthritis. The severity of arthritis, changes of cytokine level and antibody level, histological changes of the CIA mouse joint were analyzed. Results : 1. The incidence of arthritis and arthritis index were significantly decreased in the cases which were treated with the EC-HA. 2. Cartilage destruction and synovial cell proliferation were reduced, and the expression of the collagen fibers was similar with that of the normal group. 3. The levels of IL-6, IFN-γ, TNF-α, IL-1β in serum of the CIA mice which were treated with the EC-HA were significantly decreased compared with those of the normal group. 4. The levels of IgG, IgM and anti-collagen Ⅱ in serum of CIA mice when they treated with the EC-HA were significantly decreased compared with those of the normal group. 5. The expression ratio of CD4+ to CD8+ cells in the EC-HA treated mice were maintained as much as the normal group of the lymph nodes in the CIA mice. 6. The CD3e+CD69+ and CD11b+Gr-1+ cell populations in the knee joint were significantly decreased in the EC-HA treated group. Conclusions : These results suggest that the EC-HA at the ST36 may be responsible roles to control on the synovial cell proliferation and to prevent the cartilage destruction in rheumatoid arthritis. These results will be important supporting evidence for the practical use of the EC-HA at rheumatoid arthritis clinic in the future. Objectives : The purpose of this study was to analyze the effects of Erythrinae Cortex herbal- acupuncture solution(EC-HAS) at the Joksamni(ST36) of mice with collagen II-induced arthritis(CIA). Methods : The author performed several experimental procedures to observe the effects of the EC-HAS at the arthritis. The severity of arthritis, changes of cytokine level and antibody level, histological changes of the CIA mouse joint were analyzed. Results : 1. The incidence of arthritis and arthritis index were significantly decreased in the cases which were treated with the EC-HA. 2. Cartilage destruction and synovial cell proliferation were reduced, and the expression of the collagen fibers was similar with that of the normal group. 3. The levels of IL-6, IFN-γ, TNF-α, IL-1β in serum of the CIA mice which were treated with the EC-HA were significantly decreased compared with those of the normal group. 4. The levels of IgG, IgM and anti-collagen Ⅱ in serum of CIA mice when they treated with the EC-HA were significantly decreased compared with those of the normal group. 5. The expression ratio of CD4+ to CD8+ cells in the EC-HA treated mice were maintained as much as the normal group of the lymph nodes in the CIA mice. 6. The CD3e+CD69+ and CD11b+Gr-1+ cell populations in the knee joint were significantly decreased in the EC-HA treated group. Conclusions : These results suggest that the EC-HA at the ST36 may be responsible roles to control on the synovial cell proliferation and to prevent the cartilage destruction in rheumatoid arthritis. These results will be important supporting evidence for the practical use of the EC-HA at rheumatoid arthritis clinic in the future.

한국인에서 류마토이드 관절염과 제 2 형 조직적합항원과의 연관성에 관한 연구

유대현(Dae Hyun Yoo),서정대(Jeong Dai Suh),배상철(Sang Cheol Bae),김성윤(Seong Yoon Kim),김목현(Mok Hyun Kim),김신규(Thin Kyou Kim),주경빈(Kyung Bin Joo) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Rheumatoid arthritis is a chronic inflammatory disease characterized as destructive polyarthritis and has evidence of immunogenetic and environmental elements in its etiologic factors. Many studies document that one of the key genetic elements is closely linked to the class II major histocompatibility complex located in chromosome 6. Although it is not. known precisely how HLA genes contribute to disease susceptibility, many studies document a close association between rheumatoid arthritis and the specific histocompatibility marker, HLA-DR4. However, studies of HLA-DR4 in disease severity have yielded conflictiing results. Association between HLA- DR4 and the rheumatoid factor, earlier age of onset, increased general disease severity and more erosive radiographic changes have been reported, but these associations have not been confirmed in other studies. In addition, there has been no report regarding the association between rheumatoid arthritis and class II MHC in Koreans. Therefore this is the first epidemiologic study regarding the association between rheumatoid arthritis and class II MHC. The disrtibution of class II major histocompatibility complex and association between HLA- DR4 and disease severity were analyzed in 206 Korean patients with rheumatoid arthritis in this study. The results were as follows: 1) HLA-DR4 was associated with rheumatoid arthritis in 61.6% of the patients studied. The relative risk and etiologic fraction of HLA-DR4 were 2.47 and 0.367, respectively. HLA-DR1 was positive in 11.1% and the etiologic fraction of HLA-DR1 was 0.008. Therefore HLA-DR4 was associated strongly with rheumatoid arthritis in Koreans, similar to other ethnic populations, but HLA-DR1 was not associated with rheumatoid arthritis in Koreans. 2) HLA-DR2 was positive in 19.9% and the preventive fraction of HLA-DR2 was 0.205. HLA-DR7 was positive in 4.3% and the preventive fraction of HLA- DR7 was 0.011. Hence HLA-DR2 was the most preventive class II MHC against the development of rheumatoid arthritis in this study. 3) HLA-Dgw3 was positive in 62.1% and the relative risk of HLA-DQw3 was 1.65, HLA-DQw7, which was known as HLA-DQw3.1, was positive in 20.5% and HLA-DR4 Dgw7 haplotype was positive in 15% of the total number of patients. 4) HLA-DR4 was significantly associated with a more advanced ARA anatomical grade and more severe radiographic changes, including bony erosion, joint space, narrowing and total radiographic score. 5) The rheumatoid facor was positive in 84.3% of the HLA-DR4 positive patients and positive in 82.3% of the HLA-DR4 negative patients. HLA-DR4 v as positive in 62.2% of the 172 seropositive patients and positive in 58.8% of the 34 seronegative patients. Therefore HLA-DR4 was not associated significantly with the presence of a rheumatoid factor in this study. 6) HLA-DR4 was not associated significantly with joint count (Ritchie index), ARA functional class, ESR, C-reactive protein or other demographic data. HLA-DR4 was not associated significantly with the positive rate of ANA, cryoglobulin. 7) Homozygous HLA-DR4 patients were 31 out of 127 DR4-positive patients and showed more advanced ARA anatomical stage and radiographic changes than heterozygous DR4 patients, but the difference was statistically insignificant. In summary, HLA-DR4 was significantly associated with rheumatoid arthritis in Koreans, similar to other ethnic populations, Also HLA-DR4 was significantly associated with more destructive arthritis, but not associated with rheumatoid factor positivity and the parameters representing disease activity of rheumatoid arthritis.

건강보험 청구자료를 이용한 한국인 염증성 관절염 환자의 뇌졸중 발생 분석

Kijeong Lee,Jung-Kyu Choi,Jin-su Park,Jung Yoon Pyo,Minkyung Han,Jun Hong Lee 대한임상노인의학회 2022 대한임상노인의학회지 Vol.23 No.2

Background: Inflammation is an important mechanism in stroke. To a considerable extent, the pathophysiology of inflammatory arthritis is influenced by inflammatory cells and cytokines. We compared the risk of stroke between patients with inflammatory arthritis and matched controls, using data from the National Health Insurance Service. Methods: Using a combination of primary diagnosis and V codes for rare incurable diseases, we defined the patients with ankylosing spondylitis, seropositive rheumatoid arthritis, and psoriatic arthritis and enteropathic spondyloarthropathy. The control group was defined by 1:5 propensity score-matching for each disease. Newly developed stroke was identified in the patients with the primary diagnosis of (I60-64) and 1) brain imaging or 2) a prescription of stroke medication or related intervention. Results: The occurrence of stroke was more frequently associated with seropositive rheumatoid arthritis in both the patient population and the seropositive rheumatoid arthritis control group (hazard ratio 1:11, 95% CI 1.02-1.20, P=0.012). In this study, the frequency of stroke occurrence was not associated with the diagnosis of ankylosing spondylitis nor psoriatic arthritis or enteropathic spondyloarthropathy. Furthermore, the use of biologic agents was not associated with the occurrence of stroke, using multivariable analyses in the three different types of inflammatory arthritis and their respective control groups. Conclusion: Seropositive rheumatoid arthritis was a predictor of frequent stroke occurrences. The patients with seropositive rheumatoid arthritis must be cautious with regard to the occurrence of a comorbid stroke. Further studies with long-term follow-ups of clinical outcomes are warranted to explain the underlying correlation between inflammatory arthritis and the risk of stroke.

류마티스 관절염에 동반된 양측성 화농성 슬관절염

김성수 ( Sung Soo Kim ),박원 ( Won Park ),배성권 ( Sung Kwon Bae ),송정수 ( Jeong Soo Song ),문경호 ( Kyung Ho Moon ),이정윤 ( Joung Yoon Lee ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.2

Septic arthritis is a disease that causes a rapid joint destruction by various kinds of bacteria such as Staphylococcus aureus. It affects more frequently the patients with rheumatoid arthritis, diabetes, immunocompromised patients, and chronic steroid users. In patients with rheumatoid arthritis, 1 to 12% of patients are affected by septic arthritis. In these patients, it is very difficult to distinguish between an acute exacerbation of rheumatoid arthritis and a development of septic arthritis if the latter affects more than one joint. Septic arthritis usually affects single joint, especially the knee joint. If the diagnosis and treatment are delayed, it would cause sepsis resulting in high mortality and morbidity. Thus early diagnosis by arthrocentesis, prompt drainage, and antibiotics therapy are essential. We experienced a 46 years-old woman with rheumatoid arthritis who abused the steroids for 10 years and complaining recent aggravation of bilateral knee joint swelling, warmth, and tenderness. Large amount of pus from both knees showed Gram positive cocci. The immediate open surgical drainage of both knees was done. The patient recovered from septic arthritis after 6 weeks of antibiotics therapy. The synovial fluid microbiology study should be done in all joints of the patients with the risk factors of joint infection.

류마티스 관절염에 대한 한약의 면역학적 연구동향

최도영,이재동,백용현,이송실,유명철,한정수,양형인,박상도,유미현,박은경,박동석,Choi, Do-young,Lee, Jae-dong,Back, Yong-hyeon,Lee, Song-shil,Yoo, Myung-chul,Han, Chung-soo,Yang, Hyung-in,Park, Sang-do,Ryu, Mi-hyun,Park, Eun-kyung,Park, 대한침구의학회 2004 대한침구의학회지 Vol.21 No.4

Objective : Rheumatoid arthritis is an autoimmune disease that pathogenesis is not fully understood and one of the most intractable musculoskeletal diseases. The concern in the immunopathogenesis of rheumatoid arthritis has been increased since 1980's and many immunotherapeutic agents including disease-modifying antirheumatic drugs (DMARDs) were developed and became the mainstay of treatment of rheumatoid arthritis. However, the cure of the disease has hardly been achieved. In oriental medicine, rheumatoid arthritis is related to Bi-Zheng(痺證), that presents pain, swelling, andlor loss of joint function as major clinical manifestations, and also known to be deeply involved in suppression of immune function related to weakness of Jung-Ki(正氣). The herbal medicine, empirically used, could be a potential resource of development of new immunotherapeutic agents for rheumatoid arthritis. Methods : We developed a search strategy using terms to include "rheumatoid arthritis and herbal medicine" combined with "Chinese medicine" and/or "Oriental medicine". The search was focused on experimental studies of herbal medicine (January 1999 to May 2004), which is known to have effects on immune function of patients with rheumatoid arthritis. Computerized search used Internet databases including KISS and RISS4U (Korea), CNKI (China), MOMJ (Main Oriental Medicine Journal, Japan), and PubMed. The articles were selected from journals of universities or major research institutes. Results : The literature search for experimental studies on effects of herbal medicine on immunity of rheumatoid arthritis retrieved a total of 21 articles (Korea; 8, China ; 12, Japan ; 1). Of 21 articles, 10 were related to single-drug formula, 2 to drug interaction, and 9 to multi-drug formula. Single-drug formula was mainly used for aqua-acupuncture and researches on active components. Studies of drug interaction emphasized harmony of Ki-Hyul(氣血) and balance of Han-Yeul(寒熱). Multi-drug regimen was mainly found among formulas for Bo-Ki-Hyul(補氣血) and Bo-Sin(補腎). Conclusion : Studies on rheumatoid arthritis were performed both in vitro and in vivo in vitro study, LPS-stimulated splenocytes and synoviocytes were treated with herbal medicine, resulting in proliferation and activation of immune cells and suppression of cytokine activities in vivo study CIA animal model demonstrated that herbal medicine decreased antibody production and improved function of immune cells. In cellular and molecular study herbal medicine showed profound effects on the level of mRNA expression of certain cytokines related to immune function. This study revealed that herbal medicine has significant immune modulatory action and could be used for recovery of immune dysfunction of rheumatoid arthritis patients.

사상체질에 따른 류마티스 관절염의 위해요인 및 TNF-α(G308A) 유전자 다형성간의 연관성 연구

김수영,전형준,이두익,이윤호,최도영,유용구,이재동 대한침구의학회 2007 대한침구의학회지 Vol.24 No.1

Objectives : The purpose of this study is to examine the risk factors and the genetic polymorphism of TNF-alpha associated with rheumatoid arthritis by Sasang constitution Methods : This study was planned to detect the susceptibility of the patients diagnosed by rheumatoid arthritis to Sasang Constitution and to examine the risk factor such as life style and environmental stress (smoking, environmental tobacco smoke, alcohol intake and so on). The genetic polymorphism of TNF-alpha (G308A) were analyzed by PCR-RFLP in rheumatoid arthritis patients and controls. Rheumatoid arthritis patients and matched controls are assessed with QSCCⅡ question for Sasang Typology. Then the genetic polymorphism of patients by Sasang constitution are compared to those of control, which are statistically analyzed and adjusted by age, sex, smoking status, alcohol intake, BMI, and econocmic status. Results : Differential effect of passive smoking on the association between Sasang constitution and rheumatoid arthritis risk was found. This study showed that the genetic polymorphism (TNF-α(G308A)) of rheumatoid arthritis patients and controls associated with the susceptibility to rheumatoid arthritis by sasang constitution was analyzed. Differential effects of TNF-α(G308) genetic polymorphism on the association between rheumatoid arthritis risk and Sasang constitution were found. Conclusion : It is suggested that the genetic polymorphism correlated with susceptibility to rheumatoid arthritis by specific sasang constitution used as its susceptibility marker and further as basic data to prevent the risk factors for rheumatoid arthritis. But larger studies will be needed to confirm these preliminary findings.

Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

이광훈,최상태,이수경,이주현,윤보영 대한의학회 2015 Journal of Korean medical science Vol.30 No.6

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more ‘high’, and less ‘low’ probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis. Keywords: Gout; Arthritis

足三里 桑枝藥鍼이 Collagen-induced arthritis에 미치는 영향

정영돈,임윤경,이현진 대한침구의학회 2006 대한침구의학회지 Vol.23 No.6

Objectives : The purpose of this study is to observe the effects of Mori Ramulus herbal-acupuncture solution(MR-HAS) on arthritis of mice induced by Collagen Ⅱ at Joksamni(St36). Methods : The author performed several experimental items. First, it is the cell survival rate of mice lung fibroblasts. Second, it is the incidence rate of arthritis and arthritis index of CIA. Third, it is the levels of IL-6, TNF-α, IFN-γ, IL-1β, IgG, IgM and anti-collagen Ⅱ in serum and the level of IFN-γ, IFN-γ/IL-4 ratio in CIA mouse spleen cell culture. Fourth, it is histological analysis of the mice joint. Fifth, it is expression ratio of CD3e+ to CD19+ cell, CD4+ to CD8+ cell, CD69+/CD3e+ cells, CD11a+/CD19+ cells and CD11b+/Gr-1+ cells and CD4+/CD25+ cells.Results : 1. In the MR-HA, the incidence of arthritis and the arthritis index were significantly decreased.2. In MR-HA, the levels of IL-6, IFN-γ, TNF-α, IL-1β, IgG, IgM and anti-collagen Ⅱ in serum of CIA mice and the level of IFN-γ, IL-4, IFN-γ/IL-4 ratio in CIA mouse spleen cell culture were significantly decreased.3. In histology, the cartilage destruction and synovial cell proliferation were decreased in the MR-HA, and the collagen fiber expressions in the MR-HA were similar with that of the Normal group.4. In the MR-HA, the expression ratio of CD3e+ to CD19+ cell and CD4+ to CD8+ cell were similarly maintained as Normal group in lymph nodes, and CD69+/CD3e+ cells and CD11a+/CD19+ cells were decreased in lymph nodes, and CD11b+/Gr-1+ cells and CD4+/CD25+ cells were decreased in synovium.Conclusion : These results suggest that MR-HA at St36 has an effect to control synovial cell proliferation and cartilage destruction in rheumatoid arthritis, as well as prophylaxis is important to treat rheumatoid arthritis in clinic.

Clinical and Sociodemographic Factors and Arthritis in a Nationally Representative Sample of Korean Adults

Hyo Young Kim,Miran Kim,Minjeong An 한국성인간호학회 2021 성인간호학회 학술대회 Vol.2021 No.8

Aim(s): Social determinants of health are known to affect to health. However, the association between arthritis and social determinants of health remains undetermined. This study aimed to examine whether clinical and sociodemographic factors were associated with arthritis in a nationally representative sample of Korean adults. Method(s): Data from the Korea Community Health Survey from 2017 were obtained and analyzed. The participants of this study (n = 216,467; age = 52.9 years) were adults aged 19 and over who responded to arthritis related items. Descriptive statistics were performed to describe sample and clinical (i.e., hypertension, diabetes, dyslipidemia) and sociodemographic characteristics (i.e., age, sex, marital and education status, income, residential area). Logistic regression analysis were performed to determine which social determinants of health had relevance with arthritis. Result(s): More than half were female (53.9%) and married (68.5%) and lived in urban area (57.5%). Approximately a fourth were obese (27.5%) and hypertensive (26.4%). Overall, 14.9% of adults had doctor-diagnosed arthritis. Age, sex, marital and education status, household income, residential area (all ps < .001) were significant determinants and these variables explained 24.14% of the variance in arthritis. Additionally, persons who slept less than 6 hours (p<.001) and were obese, hypertensive, and depressed (all ps < .001) with smoking habits (p=.014) were more likely to have arthritis, and these explained additional 1.7% of the variance. Conclusion(s): Some social determinants of health were strong indicators of arthritis in Korean adults. More attention should be given in the relationship between arthritis and the clinical and sociodemographic factors identified in the result to reduce arthritis prevalence.