Gitelman's Syndrome Associated with Chondrocalcinosis

Gitelman's syndrome (GS), a hereditary disease characterized by hypokalemia, hypomagnesemia, and hypocalciuria, is a salt-losing renal tubulopathy. Herein, we describe a case of a 28-year-old woman diagnosed with atypical GS accompanying chondrocalcinosis. One year ago, she presented with vomiting, hypokalemic metabolic alkalosis, and hypocalciuria, and was tested by diuretic challenge test. As a result, she was diagnosed with atypical GS with normomagnesemia and treated with spironolactone and potassium supplementation. Meanwhile, acute arthritis of the right 1st metatarsophalangeal joint occurred. On the radiographies of the knees, chondrocalcinosis was observed. To the best of our knowledge, this is the first report in Korea of GS with chondrocalcinosis. Antialdosterone therapy or magnesium supplementation is effective in preventing the progression of chondrocalcinosis; thus, early diagnosis and treatment of GS are important.

SKI306X inhibition of glycosaminoglycan degradation in human cartilage involves down-regulation of cytokine-induced catabolic genes

BACKGROUND/AIMS: SKI306X, a mixed extract of three herbs, Clematis mandshurica (CM), Prunella vulgaris (PV), and Trichosanthes kirilowii (TK), is chondroprotective in animal models of osteoarthritis (OA). The objectives of this study were to investigate its effect on interleukin (IL)-1beta-induced degradation of glycosaminoglycan (GAG) and the basis of its action in human OA cartilage, as well as to screen for the presence of inhibitors of matrix metalloproteinase (MMP)-13 and a disintegrin and metalloprotease with thrombospondin motifs (ADAMTS)-4 in SKI306X and its component herbs, as well as in fractions from SKI306X. METHODS: Human OA chondrocytes and cartilage explants were obtained during total knee replacements and incubated with IL-1beta +/- oncostatin M with or without SKI306X or its component herb extracts. GAG degradation was assayed in cartilage explants using a commercial kit. Expression of genes involved in cartilage destruction was measured by real-time polymerase chain reaction using chondrocyte RNA. SKI306X was fractionated by preparative liquid chromatography to test for the presence of inhibitors of MMP-13 and ADAMTS-4. RESULTS: SKI306X and PV inhibited IL-1beta-induced GAG release from cartilage explants, and SKI306X, CM, PV, and TK inhibited IL-1beta-induced MMP gene expression. Unexpectedly, SKI306X greatly stimulated IL-1beta + oncostatin M-induced ADAMTS-4 gene expression, probably due to its TK component. Some fractions of SKI306X also inhibited ADAMTS-4 activity. CONCLUSIONS: SKI306X and its herbal components inhibit GAG degradation and catabolic gene expression in human OA chondrocytes and cartilage explants. SKI306X likely also contains one or more ADAMTS-4 inhibitor.

A case of hypophosphatemic osteomalacia associated with low-dose adefovir dipivoxil treatment / 대한내과학회지

Adefovir dipivoxil (ADV) effectively inhibits lamivudine-resistant hepatitis B virus replication. Hypophosphatemia and elevated serum creatinine are ADV-related nephrotoxicity caused by high-dose ADV. Hypophosphatemic osteomalacia is very rare and is induced by low-dose ADV. A 61-year-old man suffering from chronic hepatitis B manifested with generalized myalgia and bone pain, especially in both ankles and knees. He had been administered ADV for 56 months, since lamivudine-resistant HBV was detected. He developed severe hypophosphatemia and elevated serum alkaline phosphatase levels with a high bone fraction. Bone densitometry and a whole-body bone scan revealed osteoporosis and multiple hot uptake lesions. Blood chemistry and clinical symptoms improved after discontinuing the ADV.

Complementary and Alternative Medicine Use and Its Usefulness in Patients with RA / 대한류마티스학회지

OBJECTIVE: The use of Complementary and Alternative Medicine (CAM) is common especially among patients with chronic conditions. The aim of this study was to investigate the percentage and characteristics of patients who make use of CAM and analyse the effect of CAM in RA. METHODS: Two hundreds and twelve patients with RA were interviewed by a trained nurse according to structured questionnaire about sociodemographic features and type, effect and cost of CAM which was used. RESULTS: Among 212 patients with RA, 73 patients had used CAM (34.4%). There was no difference in sociodemographic features between the user and non-user of CAM. The chinese medicine containing herbal medicine and acupuncture (43.8% and 24.7%) was most commonly used. There was no difference in the score of Korean Health Assessment Questionnaire (KHAQ) between the user and non-user of CAM. In the user group, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. The average yearly cost for CAM was 790,000 Won/person and it was about 67.5% of the one for hospital services. CONCLUSION: In patients with RA, the percentage of using CAM was 34.4%. Herbal medicine was most commonly used. CAM did not affect the outcome of the patients with RA. However, the scores of the subjective effect and satisfaction for CAM were higher than those for the hospital services. For the proper management of patients with RA, it is necessary to know further data about the effectiveness and side effects of CAM through experimental and clinical research.

Human adjuvant disease manifesting as SLE / 대한내과학회지

Human adjuvant disease means the autoimmune disease or autoimmune disease like syndrome developed after plastic surgery using foreign body implantation. After first report of HAD by Miyoshi at 1964, a number of cases have been reported especially from Japan. Silicone has been known as biologically inert material, but a couple of side reaction and experimental data argue against such conventional idea. It is impossible to identify the exact role of implanted substance in the occurrence of autoimmune disease, but there are a few indirect evidences for adjuvant effect of silicone. The spectrum of HAD are as follows: unclassifiable connective disease like syndrome, rheumatoid arthritis, SLE, polymyositis, adult Still's disease, ITP, Hashimoto's thyroiditis, etc. We experienced two cases of HAD manifesting as SLE who had been injected with silicone fluid with for augmentation mammoplasty and report this with a review of the literature.