Interstitial pneumonitis associated with infliximab therapy in a rheumatoid arthritis patient / 대한내과학회지

Tumor necrosis factor (TNF)-alpha inhibitors are well-established biological agents for the treatment of a wide variety of chronic autoimmune diseases and inflammatory conditions, including rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis. Although these drugs have been noted to have good safety profiles, some important side effects, including infection, injection site reactions, lupus-like syndrome, congestive heart failure, and malignancies have been reported. Therefore, utilization of TNF-alpha inhibitors demands caution. Interstitial pneumonitis is a very rare complication of TNF-alpha inhibitors. We report here a 71-year-old man with RA who developed interstitial pneumonitis after the third infusion of infliximab.

Associations between TBX21 Gene Polymorphisms and Korean Patients with Behcet's Disease / 대한류마티스학회지

OBJECTIVE: Behcet's disease (BD) is a chronic systemic inflammatory disease with unknown etiology. A number of clinical and laboratory findings suggest a strongly polarized Th1 immune response in BD. T-bet is a newly identified Th1 specific T-box transcription factor selectively expressed in Th1 cells. However, it is not yet clear whether the T-bet protein is involved in the proposed Th1-mediated pathogenesis of BD at the transcriptional level. Therefore, this study investigated the potential associations of two single nucleotide polymorphisms (SNPs) at positions -99 (C/G) and -1993 (T/C) in the exon and promoter regions of the TBX21 gene with susceptibility to BD in the Korean population. METHODS: 105 patients with BD and 105 healthy controls were studied. All subjects were genotyped using restriction fragment length polymorphism analysis. The genotypes of the two groups were compared with the chi-square or Fisher's exact tests. RESULTS: The genotypic and allelic distributions of the two SNPs did not differ significantly between the two groups. Furthermore, no associations between the polymorphisms and clinical manifestations were found, except a central nervous system manifestation and arthritis. Furthermore, no associations between the polymorphisms and severity were identified. CONCLUSION: TBX21 gene polymorphisms were not associated with susceptibility, clinical manifestations, or severity of BD in the Korean population.

A Case of Avascular Necrosis of Bone as the Initial Manifestation of Polyarteritis Nodosa / 대한류마티스학회지

We describe a 28-year old man in otherwise apparently good health, in whom pain in his left knee joint caused by avascular necrosis led to a diagnosis of polyarteritis nodosa (PAN). The angiogram showed multiple microaneurysmal and thrombotic lesions, notably in the renal, mesenteric and tibial arteries. A skin biopsy of the upper dermis of the left thigh with an erythematous skin rash showed the infiltration of mononuclear leukocytes in the perivascular area. During hospitalization, he was diagnosed with chronic hepatitis B, and was treated with lamivudine, and corticosteroid, azathioprine to control the PAN. The knee joint pain improved progressively, and the patient could walk normally after several months. This case is an unusual presentation because the initial manifestation of PAN was avascular necrosis.

Acute lymphoblastic leukemia initially presenting with polymyalgia rheumatica / 대한내과학회지

Polymyalgia rheumatica (PMR) is a clinical syndrome of unknown etiology characterized by aching and stiffness in the shoulder girdle, pelvic girdle, and neck that occurs in people over the age of 50 years. New-onset proximal muscle pain and stiffness in subjects older than 50 are the most common symptoms of PMR, but polymyalgic pain can also be present in patients with malignant neoplasms. The musculoskeletal system may be involved in malignancy either directly or indirectly, particularly in cases involving hematological malignancies. Only a few cases of cancer-associated PMR have been reported worldwide, and this is the first in Korea. We report the case of a 58-year-old man diagnosed with PMR associated with acute lymphoblastic leukemia.

Association between Macrophage Migration Inhibitory Factor Gene Polymorphism and Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Rheumatoid arthritis (RA) is characterized by the interaction of multiple mediators, especially cytokines. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine and has been shown to be involved in RA. This study explored the association of the MIF gene polymorphism with RA in Korean. METHODS: 114 patients with RA, and 114 age and gender matched healthy controls were studied. Patients and controls were genotyped for a single nucleotide polymorphism (SNP) in the 5'-flanking region at position -173 of the MIF gene. RESULTS: No significant differences in MIF gene polymorphism were observed in RA compared to healthy controls. No association with disease severity was detected for the MIF gene polymorphism. CONCLUSION: MIF -173 G/C polymorphism did not appear to be associated with genetic susceptibility and disease severity in Korean RA patients.

A Case of Idiopathic Thrombocytopenic Purpura in a Patient with Behcet's Disease / 대한류마티스학회지

In Behcet's disease, thrombocytopenia has rarely been reported in association with the hemolytic uremic syndrome, thrombotic thrombocytopenic purpura or in association with cyclosporine or chlorambucil in the treatment of ocular inflammatory disease and meningoencephalitis. In this paper we report a case of thrombocytopenia in a 33-year-old female with Behcet's disease who has taken no medications for three years. After history taking, physical examination, routine laboratory and bone marrow examination, we diagnosed her case as idiopathic thrombocytopenic purpura (ITP). She recovered with high dose steroid treatment. To our knowledge, this is the first report having ITP in a patient with Behcet's disease.