Current Issue

  • Editorial 2024-04-01

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    Juvenile systemic sclerosis

    Young Dae Kim , M.D., Ph.D.

    J Rheum Dis 2024; 31(2): 65-67
  • Review Article 2024-04-01

    0 370 272

    Medical treatment of osteoarthritis: botanical pharmacologic aspect

    Junyong Park , M.D., Ph.D., Sung Won Lee , M.D., Ph.D.

    J Rheum Dis 2024; 31(2): 68-78
    Abstract

    Abstract : Osteoarthritis (OA) is the most common form of arthritis, and its prevalence is expected to further increase as our society ages. Despite many approaches to cure OA, no drugs are currently proven to modulate the progression of OA. Nowadays, new OA treatment options are holistically developed and one of the approaches of treatment option is botanical drugs. Some botanical drugs for OA have shown both therapeutic effect comparable to refined drugs in small studies and fewer side effects. Hence, there are various health functional foods which are known to relieve symptoms of OA. However, since there are many botanical products, clinicians are not familiar to the efficacy of each botanical product, making it challenging to use them appropriately in clinical practice. Here, we summarize the botanical products available for treating OA, including prescription botanical drugs and health functional foods available in Korea. Further studies and the purification of effective molecules from botanical products will be necessary in future.

  • Original Article 2024-04-01

    0 378 249

    Effect of recombinant human bone morphogenetic protein-2 and osteoprotegerin-Fc in MC3T3-E1 cells

    Sang-Hyon Kim , M.D., Ph.D., Hye-Jung Choi , Ph.D., Sang-Min Lee , Ph.D., Dae Sung Yoon , Ph.D., Chang-Nam Son , M.D., Ph.D.

    J Rheum Dis 2024; 31(2): 79-85
    Abstract

    Abstract : Objective: We compared the osteoblastogenesis by serially administrating recombinant human bone morphogenetic protein-2 (rhBMP-2) and osteoprotegerin-immunoglobulin Fc segment complex (OPG-Fc).
    Methods: The MC3T3-E1 preosteoblast cell line was differentiated for 1, 3, and 7 days with a treatment of OPG-Fc in 10~200 ng/mL concentration and the cell viability was evaluated by Cell Counting Kit-8 analysis. The level of differentiation from MC3T3-E1 cells to osteoblasts was determined by alkaline phosphatase activity. The level of runt domain-containing transcription factor 2 (Runx2) and osteopontin (OPN) manifestation, involved in osteoblast differentiation, was examined by real-time polymerase chain reaction and western blotting.
    Results: During MC3T3-E1 cell differentiation, the differentiation level was high with 1-day treatment using 100 ng/mL OPG-Fc. The treatment with 50 ng/mL rhBMP-2 for 7 days, followed by 1-day treatment with 100 ng/mL OPG-Fc produced the highest differentiation level, which was approximately 5.3 times that of the control group (p<0.05). The expression of Runx2 mRNA significantly increased, reaching 2.5 times the level of the control group under the condition of 7-day treatment with rhBMP-2 and 1-day treatment with OPG-Fc (p<0.001). The expression of Runx2 protein significantly increased to approximately 5.7 times that of the control group under the condition of 7-day treatment with rhBMP-2, followed by 1-day treatment with OPG-Fc (p<0.01). The expression of OPN protein showed no change from that of the control group under various conditions of rhBMP-2 and OPG-Fc combinations.
    Conclusion: These results imply that the treating preosteoblasts with rhBMP-2 first and then with OPG-Fc increased osteoblast differentiation efficacy.

  • Original Article 2024-04-01

    0 510 306

    Real-world effectiveness of a single conventional disease-modifying anti-rheumatic drug (cDMARD) plus an anti-TNF agent versus multiple cDMARDs in rheumatoid arthritis: a prospective observational study

    Min Wook So , M.D., Ph.D., Sang-Hyon Kim , M.D., Ph.D., Dong Wook Kim , M.D., Ph.D., Yoon-Kyoung Sung , M.D., Ph.D., MPH, Jung-Yoon Choe , M.D., Ph.D., Sang-Il Lee , M.D., Ph.D., Jin-Wuk Hur , M.D., Ph.D., Hye-Soon Lee , M.D., Ph.D., Sang-Heon Lee , M.D., Ph.D., Jin Ran Kim , PharmD

    J Rheum Dis 2024; 31(2): 86-96
    Abstract

    Abstract : Objective: The objective of this prospective, observational multicenter study (NCT03264703) was to compare the effectiveness of single conventional disease-modifying anti-rheumatic drug (cDMARD) plus anti-tumor necrosis factor (TNF) therapy versus multiple cDMARD treatments in patients with moderate-to-severe rheumatoid arthritis (RA) following cDMARD failure in the real-world setting in South Korea.
    Methods: At the treating physicians’ discretion, patients received single cDMARD plus anti-TNF therapy or multiple cDMARDs. Changes from baseline in disease activity score 28-joint count with erythrocyte sedimentation rate (DAS28-ESR), corticosteroid use, and Korean Health Assessment Questionnaire (KHAQ-20) scores were evaluated at 3, 6, and 12 months.
    Results: Of 207 enrollees, the final analysis included 45 of 73 cDMARD plus anti-TNF and 91 of 134 multiple-cDMARD recipients. There were no significant between-group differences (BGDs) in ANCOVA-adjusted changes from baseline in DAS28-ESR at 3, 6 (primary endpoint), and 12 months (BGDs −0.18, −0.38, and −0.03, respectively). More cDMARD plus anti-TNF than multiple-cDMARD recipients achieved a >50% reduction from baseline in corticosteroid dosage at 12 months (35.7% vs 14.6%; p=0.007). Changes from baseline in KHAQ-20 scores at 3, 6, and 12 months were significantly better with cDMARD plus anti-TNF therapy than with multiple cDMARDs (BGD −0.18, −0.19, and −0.19 points, respectively; all p≤ 0.024).
    Conclusion: In the real-world setting, relative to multiple cDMARDs, single cDMARD plus anti-TNF therapy significantly improved quality-of-life scores and reduced corticosteroid use, with no significant BGD in disease activity, in RA patients in whom previous cDMARD therapy had failed.

  • Original Article 2024-04-01

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    Machine learning models with time-series clinical features to predict radiographic progression in patients with ankylosing spondylitis

    Bon San Koo , M.D., Ph.D., Miso Jang , M.D., Ph.D., Ji Seon Oh , M.D., Ph.D., Keewon Shin , Ph.D., Seunghun Lee , M.D., Ph.D., Kyung Bin Joo , M.D., Ph.D., Namkug Kim , Ph.D., Tae-Hwan Kim , M.D., Ph.D.

    J Rheum Dis 2024; 31(2): 97-107
    Abstract

    Abstract : Objective: Ankylosing spondylitis (AS) is chronic inflammatory arthritis causing structural damage and radiographic progression to the spine due to repeated and continuous inflammation over a long period. This study establishes the application of machine learning models to predict radiographic progression in AS patients using time-series data from electronic medical records (EMRs).
    Methods: EMR data, including baseline characteristics, laboratory findings, drug administration, and modified Stoke AS Spine Score (mSASSS), were collected from 1,123 AS patients between January 2001 and December 2018 at a single center at the time of first (T1), second (T2), and third (T3) visits. The radiographic progression of the (n+1)th visit (Pn+1=(mSASSSn+1–mSASSSn)/(Tn+1–Tn)≥1 unit per year) was predicted using follow-up visit datasets from T1 to Tn. We used three machine learning methods (logistic regression with the least absolute shrinkage and selection operation, random forest, and extreme gradient boosting algorithms) with three-fold cross-validation.
    Results: The random forest model using the T1 EMR dataset best predicted the radiographic progression P2 among the machine learning models tested with a mean accuracy and area under the curves of 73.73% and 0.79, respectively. Among the T1 variables, the most important variables for predicting radiographic progression were in the order of total mSASSS, age, and alkaline phosphatase.
    Conclusion: Prognosis predictive models using time-series data showed reasonable performance with clinical features of the first visit dataset when predicting radiographic progression.

  • Original Article 2024-04-01

    0 431 257

    Urate-lowering therapy is associated with a reduced risk of arrhythmias: a systematic review and meta-analysis

    Palapun Waitayangkoon , M.D., Thiratest Leesutipornchai , M.D., Witina Techasatian , M.D., Noppawit Aiumtrakul , M.D., Manasawee Tanariyakul , M.D., Chinnawat Arayangkool , M.D., Tatchaya Kanthajan , M.D., Todd Nagamine , M.D., Jakrin Kewcharoen , M.D.

    J Rheum Dis 2024; 31(2): 108-115
    Abstract

    Abstract : Objective: While urate-lowering therapy (ULT) is linked to increased cardioprotective benefits on primary prevention of cardiovascular events such myocardial infarction or heart failure, little is known regarding their effects on arrhythmia risk. The purpose of this study was to investigate the relationship between incident arrhythmias and ULT.
    Methods: We searched MEDLINE and Embase from inception to May 2023. Included studies were randomized controlled trials and cohort studies that compared the risk of cardiac arrhythmias among ULT users with non-ULT users.
    Results: A total of 12,420 patients from five studies were analyzed, comprising 7,359 subjects in the ULT group and 5,061 subjects in the non-ULT group. Our results showed that ULT users had significant reductions in the risk of arrhythmias (pooled relative risk [RR] 0.82, 95% confidence interval [CI]: 0.74~0.92, p<0.001, I2=0.0%) compared to non-ULT users. Subgroup analysis did not show that ULT users had a significant reduced risk of atrial fibrillation (pooled RR 0.76, 95% CI: 0.54~1.05, p=0.096 with I2=15.4%) compared to non-ULT users.
    Conclusion: ULT is associated with lower risk of overall arrhythmias. Further studies are warranted to confirm our findings.

  • Case Report 2024-04-01

    0 277 237

    Lupus nephritis presenting with massive ascites and pleural effusion (pseudo-pseudo Meigs’ syndrome)

    Rabia Deniz , M.D., Ph.D., Gülşah Hacımurtazaoğlu-Demir, M.D., Bilgin Karaalioğlu , M.D., Duygu Sevinç Özgür, M.D., Gamze Akkuzu , M.D., Fatih Yıldırım , M.D., Cemal Bes , M.D.

    J Rheum Dis 2024; 31(2): 116-119
    Abstract

    Abstract : The triad of ascites, pleural effusion, and elevated cancer antigen-125 (CA-125) levels in the absence of ovarian malignancy in systemic lupus erythematosus patients is specifically named pseudo-pseudo Meigs’ syndrome (PPMS) or Tjalma syndrome. In this case we reported a 33 years female patient with pleural effusion lasting for 3 years and new onset progressive massive ascites and increased level of CA-125. After she was evaluated for an underlying benign and malign ovarian tumor or any other malignancies, serologic tests were requested with respect to progressive renal dysfunction, proteinuria, lymphopenia, anemia, and effusion. She was diagnosed with systemic lupus erythamatosus (SLE) and renal biopsy showed class-V lupus nephritis. Immunosuppressive treatment led to improvement in both SLE activity and components of PPMS, including massive ascites and pleural effusion and without the need of diuretics. Co-existence of unexplained CA-125 increase, pleural effusion, and ascites might be related to PPMS and detailed examination to exclude malignancy and early and effective treatment of SLE are the mainstay of management.

  • Case Report 2024-04-01

    0 280 168

    Piriformis syndrome as an overlooked cause of pain in a patient with axial spondyloarthritis: a case report

    Ezgi Akyildiz Tezcan , M.D., Kemal Erol , M.D., Ilknur Albayrak Gezer , M.D.

    J Rheum Dis 2024; 31(2): 120-124
    Abstract

    Abstract : Piriformis syndrome is a neuromuscular disorder characterized by hip, buttock, and leg pain. Axial spondyloarthritis is a rheumatic disease primarily affecting the sacroiliac joint and the spine. Due to their anatomical proximity, the potential relationship between piriformis syndrome and sacroiliitis has been discussed for some time. However, literature review revealed that there is no study on piriformis syndrome in individuals with axial spondyloarthritis. Here, we present the case of a 30-year-old female with axial spondyloarthritis who developed severe low back, hip, and buttock pain that persisted despite initial treatment for axial spondyloarthritis. We first re-evaluated her condition through physical examination, magnetic resonance imaging, and an injection test for piriformis syndrome. Following a comprehensive assessment, the patient was diagnosed with both axial spondyloarthritis and piriformis syndrome. Subsequently, a tailored treatment plan was devised, addressing both conditions, and after a 3-month course of treatment, we obtained significant reduction in pain of the patient. This is the first case report in literature, where we used injection test to confirm the diagnosis of the piriformis syndrome in a patient with axial spondyloarthritis. We therefore strongly advocate considering piriformis syndrome as a potential etiology for pain in individuals with axial spondyloarthritis consistently. This recognition is important as piriformis syndrome does not respond adequately to non-steroidal anti-inflammatory drugs and may lead to unnecessary use of biological disease-modifying antirheumatic drugs. Timely identification and intervention are imperative in ensuring optimal patient care.

  • Case Report 2024-04-01

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    Successful treatment of hemophagocytic lymphohistiocytosis in a patient with systemic lupus erythematosus with ruxolitinib: a case report

    Ji In Jung , M.D., Ju Yeon Kim , M.D., Mi Hyeon Kim , M.D., Jin Kyun Park , M.D., Ph.D., Eun Young Lee , M.D., Ph.D., Eun Bong Lee , M.D., Ph.D., Jun Won Park , M.D.

    J Rheum Dis 2024; 31(2): 125-129
    Abstract

    Abstract : Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hematological disorder characterized by uncontrolled activation of CD8+ T and natural killer cells, leading to a cytokine storm and severe organ dysfunction. Although secondary HLH related to autoimmune diseases usually demonstrates a good treatment response to immunosuppressive therapy for underlying conditions, there is no consensus regarding the treatment in case of unresponsiveness to the treatment. Herein, we present a case of HLH that was unresponsive to high-dose glucocorticoid and cyclosporine treatment in a patient with newly diagnosed systemic lupus erythematosus. The patient’s clinical features and laboratory abnormalities rapidly improved with ruxolitinib, an oral Janus kinase 1 and 2 (JAK1/2) inhibitor. This result suggests that blocking JAK-STAT pathway may be a potential treatment option in patients with refractory HLH secondary to autoimmune diseases.

  • Clinical Image 2024-04-01

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    Cerebral small vessel vasculitis triggered by neurotoxoplasma-related ETosis: histological and immunofluorescence observation of a case

    Gabriele Gaggero , M.D., Maria Bertolotto , Ph.D., Daniela Verzola , Ph.D., Jacopo Ferro , M.D., Pietro Fiaschi , M.D., Ph.D.

    J Rheum Dis 2024; 31(2): 130-132
JRD
Apr 01, 2024 Vol.31 No.2, pp. 108~96
COVER PICTURE
Schematic diagram for mechanism of botanical drugs and ingredients for health functional food for treatment of OA. OA: osteoarthritis, IL: interleukin, TNF-α: tumor necrosis factor-alpha, PGE2: prostaglandin E2, MMP: matrix metalloproteinase, VAS: visual analogue scale. (J Rheum Dis 2024;31:68-78)

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