Muscular polyarteritis nodosa.

We present an unusual case of a 26-year-old man with muscular polyarteritis nodosa (PAN) with severe calf pain and gait disturbance. Magnetic resonance imaging of the lower limbs demonstrated highly increased signal intensity in both soleus muscles and the lateral head of the left gastrocnemius muscle. Biopsies of the soleus muscle showed acute necrotizing arteritis. The calf pain and limited range of motion of ankle dorsiflexion subsided from day 1 on administration of oral corticosteroid at high dosage and were completely resolved by 4 months. After tapering corticosteroid to 10 mg, symptoms recurred. A combined regimen of immunosuppressants was found to maintain symptomatic relief.Muscular PAN should be included in the differential diagnosis of a patient presenting with symptoms of acute or subacute calf pain. Although this muscular PAN was so far been benign, complete remission of the underlying process may be difficult to achieve.

Association of STAT4 polymorphism with rheumatoid arthritis and systemic lupus erythematosus: a meta-analysis.

STAT4 is a transcription factor that has been implicated in the pathogenesis of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Recently, several reports has documented that a STAT4 haplotype is associated with RA, SLE and Sjogren's syndrome. To summarize and review these findings, we conducted a meta-analysis of all relevant reports published before September 2008. Studies on STAT4 rs7574865 single nucleotide polymorphism (SNP) of RA and SLE were identified using PubMed. Meta-analyses were performed for 15,609 patients with RA and 15,793 controls from 14 published studies and for 2,478 patients with SLE and 5,058 controls from 8 published studies. Meta-odds ratios (ORs) and 95% confidence intervals (CIs) based on random effects models were calculated for all available studies. The overall ORs for the minor T allele of STAT4 rs7574865 SNP were 1.27 (95% CI 1.20-1.34) in RA and 1.57 (95% CI 1.44-1.71) in SLE. Asian controls have significantly higher allele frequency (32%) for the minor T allele of STAT4 rs7574865 SNP than population of European origin (22%), however, there was no significant difference of ORs for RA and SLE by ethnicity. No apparent effect of anti-CCP positivity was found in stratified analysis. The risk of STAT4 genotype for SLE was significantly higher than for RA in populations of European origin and Asian. The results of our meta-analysis demonstrated that STAT4 rs7574865 SNP is significantly associated with RA and SLE. In addition to specific alleles of HLA-DRB1, the minor T allele of STAT4 rs7574865 SNP is a common RA risk factor in populations of European origin and Asian.

Associations between osteoprotegerin polymorphisms and bone mineral density: a meta-analysis.

Associations between polymorphisms of the osteoprotegerin gene (OPG) and bone mineral density (BMD) have been studied by several research groups, but results are mixed. Accordingly, the authors performed a meta-analysis on studies of associations between OPG polymorphisms and BMD. Appropriate studies were identified using MEDLINE and by manual searching. A total of eight separate comparisons were considered in this meta-analysis. Individuals with the GG genotype of G1181C were found to have a significantly lower mean lumbar BMD than subjects with the CC genotype (WMDs -0.051 g/cm(2), 95% confidence interval -0.079--0.023, P < 0.001), and similar results were obtained in European and Asian populations. In contrast to G1181C, no association was found between the A163G and T950C polymorphisms and lumbar BMD. In terms of femoral neck BMD, the GG genotype of G1181C was associated with a significantly lower BMD than the CC genotype in Europeans but not in Asians. Total hip BMD was lower for the GG genotype of G1181C than for the CC or GC genotypes in Europeans. A difference in total hip BMD was found between the AG and GG genotypes of the A163G polymorphism by meta-analyses in Europeans, but no differences were found between the genotypes of the T950C polymorphism and total hip BMD in Europeans. Summarizing, the present study demonstrates that the OPG G1181C polymorphism is associated with lumbar BMD in Europeans and Asians, and with femoral neck and total hip BMD in Europeans only.

Fc receptor-like 3 -169 C/T polymorphism and RA susceptibility: a meta-analysis.

The Fc receptor-like 3 (FCRL3) -169 C/T polymorphism has been reported to be associated with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), but with inconsistent results. The aim of this study was to explore whether the FCRL3 -169 C/T polymorphism confers susceptibility to RA and SLE. The authors conducted a random effect meta-analysis on the associations between the C/C (recessive effect) or C/C + C/T (dominant effect) genotype or the allele C of the FCRL3 -169 polymorphisms and RA or SLE in different populations. In total, 15 separate comparisons, 12 for RA and 3 for SLE, drawn from nine European and six Asian population samples were included in this meta-analysis. No association between RA and the FCRL3 C allele was found for all study subjects (OR = 1.064, 95% CI = 0.987-1.146, p = 0.107). However, stratification by ethnicity indicated that the FCRL3 C allele was significantly associated with RA in Asians (OR = 1.203, 95% CI = 1.097-31.319, p < 0.001). Conversely, no association was detected for this allele and RA in Europeans (OR = 0.997, 95% CI = 0.931-1.068, p = 0.933). The ORs for the C/C + C/T and C/C genotypes in these ethnic groups showed the same trends as the FCRL3 C allele. An association between SLE and the FCRL3 -169 A allele was found in all study subjects (OR = 1.115, 95% CI = 1.003-1.240, p = 0.043), but meta-analysis excluding studies with controls not in HWE did not show the association. This meta-analysis suggests that the FCRL3 -169 C/T polymorphism is a significant risk factor for RA in Asians, but not in Europeans.

Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis.

The aim of this study was to assess the structural efficacies of daily glucosamine sulfate and chondroitin sulfate in patients with knee osteoarthritis (OA). The authors surveyed randomized controlled studies that examined the effects of long-term daily glucosamine sulfate and chondroitin sulfate on joint space narrowing (JSN) in knee OA patients using the Medline and the Cochrane Controlled Trials Register, and by performing manual searches. Meta-analysis was performed using a fixed effect model because no between-study heterogeneity was evident. Six studies involving 1,502 cases were included in this meta-analysis, which consisted of two studies on glucosamine sulfate and four studies on chondroitin sulfate. Glucosamine sulfate did not show a significant effect versus controls on minimum JSN over the first year of treatment (SMD 0.078, 95% CI -0.116 to -0.273, P = 0.429). However, after 3 years of treatment, glucosamine sulfate revealed a small to moderate protective effect on minimum JSN (SMD 0.432, 95% CI 0.235-0.628, P < 0.001). The same was observed for chondroitin sulfate, which had a small but significant protective effect on minimum JSN after 2 years (SMD 0.261, 95% CI 0.131-0.392, P < 0.001). This meta-analysis of available data shows that glucosamine and chondroitin sulfate may delay radiological progression of OA of the knee after daily administration for over 2 or 3 years.

Association between the rs7574865 polymorphism of STAT4 and rheumatoid arthritis: a meta-analysis.

The aim of this study was to determine whether the rs7574865 polymorphism of STAT4 (signal transducers and activators of transcription 4) confers susceptibility to rheumatoid arthritis (RA) in populations with different ethnicities. A meta-analysis was conducted on the T allele of the STAT4 rs7574865 polymorphism in 15 studies containing 16,088 RA patients and 16,509 normal control subjects. Meta-analysis revealed an association between RA and the STAT4 rs7574865 T allele in all subjects (OR = 1.271, 95% CI = 1.197-1.350, P < 0.001). Furthermore, the STAT4 rs7574865 T allele was found to be significantly associated with RA in Europeans and Asians (OR = 1.300, 95% CI = 1.195-1.414, P < 0.001; OR = 1.216, 95% CI = 1.135-1.303, P < 0.001). Stratification of RA patients according to the presence of anti-CCP antibody revealed a statistically significant association between the T allele and RA in both anti-CCP-positive and -negative RA patients versus controls. Europeans had the lowest (21.4%) and Asians had the highest (32.0%) prevalence of the T allele among the populations studied. In conclusion, this meta-analysis confirms that the STAT4 rs7574865 polymorphism is associated with RA susceptibility in different ethnic groups, and that its prevalence is ethnicity dependent.

Association between the A1330V polymorphism of the low-density lipoprotein receptor-related protein 5 gene and bone mineral density: a meta-analysis.

The association between the A1330V polymorphism of the low-density lipoprotein receptor-related protein 5 gene (LRP5) with bone mineral density (BMD) has been studied, but results have been mixed. Accordingly, the authors performed a meta-analysis on studies on the association between the A1330V LRP5 polymorphism and BMD. Appropriate studies were identified using MEDLINE and by manual searching. A total of 7 separate comparisons were considered in this meta-analysis. Individuals with the AA genotype showed significantly higher lumbar BMD than those with the AV/VV or VV genotype. Weighted mean differences (WMDs) were 0.147 g/cm(2) (95% confidence interval [CI] 0.069-0.224, P < 0.001) and 0.182 g/cm(2) (95% CI 0.024-0.340, P = 0.024) without between-study heterogeneity for AA versus AV/VV and AA versus VV, respectively. Six studies analyzed femur neck (FN) BMD. Individuals with the AA genotype had a significantly higher FN BMD than those with the AV/VV genotype (WMD = 0.165 g/cm(2), 95% CI = 0.087-0.215, P < 0.001), without between-study heterogeneity. Trochanter BMD was measured in three studies. Results showed that subjects with the AA genotype tended to have higher BMD than patients with the AV or VV genotype (WMD = 0.136 g/cm(2), 95% CI = -0.002 to 0.274, P = 0.053). In conclusion, this meta-analysis shows that the LRP5 A1330V polymorphism is associated with BMD, and that individuals with the AA genotype have a higher BMD than those with the AV/VV or VV genotype.

Selective oxidation on metallic carbon nanotubes by halogen oxoanions.

Chlorine oxoanions with the chlorine atom at different oxidation states were introduced in an attempt to systematically tailor the electronic structures of single-walled carbon nanotubes (SWCNTs). The degree of selective oxidation was controlled systematically by the different oxidation state of the chlorine oxoanion. Selective suppression of the metallic SWCNTs with a minimal effect on the semiconducting SWCNTs was observed at a high oxidation state. The adsorption behavior and charge transfer at a low oxidation state were in contrast to that observed at a high oxidation state. Density functional calculations demonstrated the chemisorption of chloro oxoanions at the low oxidation state and their physisorption at high oxidation states. These results concurred with the experimental observations from X-ray photoelectron spectroscopy. The sheet resistance of the SWCNT film decreased significantly at high oxidation states, which was explained in terms of a p-doping phenomenon that is controlled by the oxidation state.

Association between serum uric acid and the Adult Treatment Panel III-defined metabolic syndrome: results from a single hospital database.

Hyperuricemia is known to be associated with various metabolic abnormalities of the metabolic syndrome, but its precise contribution is not well defined. We have investigated the effects of serum uric acid on the metabolic syndrome as defined by the Adult Treatment Panel (ATP) III criteria and tested its independent association. This was a cross-sectional study consisting of 1686 Korean subjects (821 men and 865 women) from a health promotion center. Clinical data and the presence of the metabolic syndrome were assessed, and serum uric acid was tested for its independent contribution to the metabolic syndrome using 2 multiple logistic regression models. The metabolic syndrome was defined by the original ATP III criteria and the modified ATP III criteria that include a reduced waist circumference. The general age-adjusted prevalence of the metabolic syndrome was 4.4% in men and 6.8% in women; hyperuricemic subjects tended to have a higher prevalence of the metabolic syndrome and more metabolic abnormalities than normouricemic subjects. The prevalence of the metabolic syndrome increased as normouricemia (2.9%) progressed to hyperuricemia (8.9%) and to gout (43.6%) in men. Multivariate analysis showed that serum uric acid was a significant factor for the development of the metabolic syndrome as defined by the original ATP III criteria only in one model for women (odds ratio, 1.51; 95% confidence interval, 1.11-2.05; P = .009). Serum uric acid is closely linked to and may even be independently associated with the metabolic syndrome as defined by the ATP III criteria, but only in women.

Effects of low-dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis: a meta-analysis.

BACKGROUND: : The effects of long-term high-dose corticosteroids on bone mineral density (BMD) are clear, but the effects of low-dose corticosteroids in patients with rheumatoid arthritis (RA) remain controversial. The aim of this study was to assess the effects of low-dose corticosteroids on BMD in patients with RA. METHODS: : The authors surveyed randomized controlled studies that examined the effects of low-dose corticosteroids on BMD in patients with RA using MEDLINE and the Cochrane Controlled Trials Register and by performing manual searches. Data were collected on BMD (end-of-period or change-from-baseline) after longest recorded treatment durations. Meta-analysis was performed using a random effects model; outcomes are presented as standardized mean differences (SMDs). RESULTS: : Seven studies were included in this meta-analysis, which included 7 studies on lumbar BMD meta-analysis and 6 studies on femur BMD meta-analysis. Corticosteroids resulted in a moderate worsening in lumbar BMD compared with controls (SMD = -0.483; 95% confidence interval [CI], -0.815 to -0.151, P = 0.004), whereas the femoral BMD differences were not siginificant (SMD = -0.224; 95% CI, -0.663 to 0.215, P = 0.318). Subgroup analysis of BMD data performed on a change-from-baseline basis showed that corticosteroids had a clear effect on both lumbar and femoral BMDs (SMD = -0.354; 95% CI, -0.620 to -0.088, P = 0.009; SMD = -0.488; 95% CI, -0.911 to -0.065, P = 0.024, respectively). CONCLUSIONS: : This meta-analysis shows BMD loss after low-dose corticosteroid treatment in patients with RA. These findings have practical implications for the long-term management of patients with RA on low-dose corticosteroids.

Spatial control of quantum sized nanocrystal arrays onto silicon wafers.

Monolayer arrays of monodispersed nanocrystals (<10 nm) onto three dimensional (3D) substrates have considerable potential for various engineering applications such as highly integrated memory devices, solar cells, biosensors and photo and electro luminescent displays because of their highly integrated features with nanocrystal homogeneity. However, most reports on nanocrystal arrays have focused on two dimensional (2D) flat substrates, and the production of wafer-scale monolayer arrays is still challenging. Here we address the feasibility of arraying nanocrystal monolayers in wafer-scale onto 3D substrates. We present both metal (Pd) and semiconductor (CdSe) nanocrystals arrayed in monolayer onto trenched silicon wafers (4 inch diameter) using a facile electrostatic adsorption scheme. In particular, CdSe nanocrystal arrays in the trench well showed superior luminescent efficiency compared to those onto the protruded trench flat, due to the densely arrayed CdSe nanocrystals in the vertical direction. Furthermore, the surface coverage controllability was investigated using a 2D silicon substrate. Our approach can be applied to generate highly efficient displays, memory chips and integrated sensing devices.

Acute arthritis of carpal bones secondary to metastatic gastric cancer.

A 39-year-old woman presented with acute onset of arthralgia in both wrists. Although her primary gastric cancer was in remission after previous treatment, carcinomatous arthritis was suggested by the osteolytic radiographic findings and refractoriness to nonsteroidal anti-inflammatory drugs, which was then confirmed by synovial fluid cytopathology. In view of the high incidence of gastric cancer in Korea, gastric cancer involving the carpal bones should be considered when we encounter a patient presenting with inflammatory peripheral joint arthritis, which might be the first sign of recurrence.

A new onset of systemic lupus erythematosus developed after bee venom therapy.

Lupus is a systemic autoimmune disease of an unknown origin, and systemic lupus erythematosus (SLE) can be triggered by numerous stimuli. Bee venom therapy is an alternative therapy that is believed to be effective for various kinds of arthritis. We present here a case of a 49-year-old female who experienced a new onset lupus after undergoing bee venom therapy, and this looked like a case of angioedema. The patient was successfully treated with high dose steroids and antimalarial drugs. We discuss the possibility of bee venom contributing to the development of SLE, and we suggest that such treatment should be avoided in patients with lupus.

Vitamin D receptor TaqI, BsmI and ApaI polymorphisms and osteoarthritis susceptibility: a meta-analysis.

OBJECTIVE: Genetic factors may play a role in the development of osteoarthritis (OA), and vitamin D receptor (VDR) polymorphisms have been associated with several common diseases including OA by some studies. The aim of this study was to explore whether the VDR polymorphisms confer susceptibility to OA. METHODS: We conducted meta-analyses on the associations between the VDR TaqI, BsmI, ApaI polymorphisms and OA using: (1) allele contrast, (2) the recessive model, (3) the dominant model, and (4) contrast of homozygotes, using fixed and random effects models. RESULTS: A total of 10 relevant studies on VDR polymorphisms and OA were included in this meta-analysis, which involved in total 1591 OA patients and 1781 controls. Nine studies were performed on VDR TaqI polymorphisms, 6 on VDR BsmI polymorphisms, 5 on VDR ApaI polymorphisms. Accordingly, to our meta-analysis of VDR TaqI polymorphisms, no association was found between OA and the VDR TaqI T allele among in all study subjects (OR=0.841, 95% CI=0.663-1.067, p=0.155). Stratification by ethnicity yielded no association between the VDR TaqI T allele and OA in Europeans or Asians. Moreover, no association was found between OA and the VDR TaqI polymorphisms by the meta-analyses of recessive and dominant models, and contrast of homozygotes. No association was found between OA and the VDR polymorphisms with respect to the BsmI and ApaI polymorphisms by meta-analyses. CONCLUSIONS: No association was found between the VDR TaqI, BsmI, or ApaI polymorphisms and OA susceptibility by this meta-analysis, which included 3372 subjects.

Meta-analysis of the combination of TNF inhibitors plus MTX compared to MTX monotherapy, and the adjusted indirect comparison of TNF inhibitors in patients suffering from active rheumatoid arthritis.

This present study was designed to examine (1) whether a combination therapy of TNF (tumor necrosis factor) blockers and methotrexate (MTX) is better than MTX monotherapy, and (2) if the TNF inhibitors such as etanercept, infliximab and adalimumab are all same for treating patients with active rheumatoid arthritis (RA). We performed meta-analysis of a combination therapy of TNF-blockers and MTX compared to MTX monotherapy and we performed adjusted indirect comparison of the TNF-blocking agents for their efficacy and toxicity. Three studies met the inclusion criteria for the analysis. Meta-analysis showed that the combination of MTX with anti-TNF inhibitors was more effective than MTX monotherapy and this indicated that combination therapy of anti-TNF inhibitors and MTX was comparable with MTX monotherapy in terms of withdrawal due to the side effects (RR: 1.05, 95% CI: 0.52-2.09, P = 0.86). The adjusted indirect comparison did not show any differences between infliximab and adalimumab. However, there was a significant difference for clinical efficacy and side effects between etanercept, adalimumab and infliximab. The RRs for achieving ACR20, ACR50 and ACR70 responses and withdrawal due to the side effect in the etanercept group were lower when compared with the adalimumab group. The RR for achieving an ACR20 response in the etanercept group was lower when compared with the infliximab group. The adjusted indirect comparison analysis suggests that the TNF-blocking agents all are not the same with respect to effectiveness and toxicity for the treatment of active RA.

PADI4 polymorphisms and rheumatoid arthritis susceptibility: a meta-analysis.

We conducted a comprehensive meta-analysis with all available data on the association of allele and genotype of peptidylarginine deiminases 4 (PADI4) polymorphisms with RA overall and in each ethnic population to explore whether the PADI4 polymorphisms confer susceptibility to RA. Nine comparisons, three Asians and six Europeans, from eight studies were included in this meta-analysis. Overall meta-analysis shows a significant association of PADI4_94, 104 and 90 with RA (OR = 1.20, 1.17, 1.35, P = 0.001, <0.0001, 0.006, respectively). There was a significant association with all of the PADI4 polymorphisms with RA in people of Asian descent. However, there was no significant association of PADI4 polymorphisms with RA in people of European descent, except for PADI_94. The presence of 2/2 genotype of the PADI4 significantly increased the risk for RA in European populations (OR = 2.10, 95% CI, 1.66-2.66, P < 0.0001) without between-study heterogeneity (I (2) = 44.3, P = 0.15). In conclusion, this meta-analysis demonstrates that the PADI4 polymorphisms may represent a significant risk factor for RA in Asians and Europeans and may play a larger role in susceptibility to RA in Asian than in European populations. Further studies are needed to see if the PADI4 gene confers a risk of RA in other ethnic groups.

The association between hyperuricemia and the Trp64Arg polymorphism of the beta-3 adrenergic receptor.

The object of this study was to determine the association of Trp64Arg polymorphism with hyperuricemia. This study is an age-matched, case-controlled study of 203 hyperuricemic and 203 normouricemic men. The frequency of genotypes was compared between the two groups. Possible confounding metabolic variables were included in a multiple logistic regression model for multivariate adjustment. The genotype frequencies of Trp64Trp, Trp64Arg, and Arg64Arg in hyperuricemic and normouricemic groups are respectively 130, 69, and 4 (64.0%, 34.0%, 2.0%) and 154, 45, and 4 (75.9%, 22.2%, 2.0%) (P = 0.029, Chi-square test). Simple logistic regression analysis indicated that the Trp64Arg genotype is significantly associated with hyperuricemia (OR = 1.816, 95% CI (1.167-2.827), P = 0.008). Multivariate analysis for controlling metabolic effects also showed a significant association with the occurrence of hyperuricemia (OR = 1.937, 95% CI (1.149-3.266), P = 0.013). Trp64Arg polymorphism of the beta-3 adrenergic receptor may be independently associated with hyperuricemia in males.

Scleroderma associated with ANCA-associated vasculitis.

We have recently reported on two cases of scleroderma patients with ANCA-associated vasculitis for the first time in Korea. In order to explore the nature of this disease combination, we pooled together all the previously known cases and statistically analyzed them. Out of the 50 selected cases, survival analysis was done for comparison of the scleroderma disease period and the clinical factors associated with ANCA-associated vasculitis (AAV). Kaplan-Meier analysis revealed that patients having anti-topoisomerase antibody (anti-Scl-70) and, probably, PR-3 ANCA are at a higher risk for developing AAV than patients without both anti-topoisomerase antibody and anti-centromere antibody (ACA), and patients with MPO-ANCA. Multivariate Cox regression analysis revealed having anti-topoisomerase antibody as a risk factor for developing AAV [OR 3.1 (95% CI 1.11-8.55), P=0.031]. We suggest that having anti-topoisomerase antibodies may play a role among scleroderma patients in developing AAV.

Scleroderma associated with ANCA-associated vasculitis.

Scleroderma and ANCA-associated vasculitides (AAV), such as microscopic polyangiitis, are distinct disease entities, but are rarely known to coexist with each other. We have reported on two cases of scleroderma patients for the first time in Korea, and these patients were initially known to have only limited type scleroderma with pulmonary fibrosis, but eventually they were found to be ANCA-positive with the associated clinical features of vasculitis. Both were treated with high-dose steroids and cyclophosphamide and remitted without major sequelae. When scleroderma patients exhibit atypical features such as normotensive renal failure with signs of active inflammation, the possibility of AAV should always be considered.