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  • EditorialJanuary 1, 2024

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  • Review ArticleJanuary 1, 2024

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    Radiologic approach and progressive exploration of connective tissue disease-related interstitial lung disease: meeting the curiosity of rheumatologists

    Hyeji Jeon , M.D., Bo Da Nam , M.D., Chong-Hyeon Yoon , M.D, Ph.D., Hyun-Sook Kim , M.D, Ph.D.

    J Rheum Dis 2024; 31(1): 3-14
    Abstract

    Abstract : Interstitial lung disease (ILD) is often observed in connective tissue diseases (CTDs), frequently in rheumatoid arthritis, systemic sclerosis, primary Sjögren’s syndrome, and inflammatory myositis. Early detection of ILDs secondary to rheumatic diseases is important as timely initiation of proper management affects the prognosis. Among many imaging modalities, high-resuloution computed tomography (HRCT) serves the gold standard for finding early lung inflammatory and fibrotic changes as well as monitoring afterwards because of its superior spatial resolution. Additionally, lung ultrasound (LUS) and magnetic resonance imaging (MRI) are the rising free-radiation imaging tools that can get images of lungs of CTD-ILD. In this review article, we present the subtypes of ILD images found in each CTD acquired by HRCT as well as some images taken by LUS and MRI with comparative HRCT scans. It is expected that this discussion would be helpful in discussing recent advances in imaging modalities for CTD-ILD and raising critical points for diagnosis and tracing of the images from the perspective of rheumatologists.

  • Original ArticleJanuary 1, 2024

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    Clinical and immunological responses to COVID-19 vaccination in rheumatoid arthritis patients on disease modifying antirheumatic drugs: a cross-sectional study

    Madhavi Eerike , M.D., Vijaya Prasanna Parimi , M.D., D.M., Anand Pyati , M.D., Ph.D., Raja Sundaramurthy , M.D., Varadharajan Sakthivadivel , M.D., Aswini Bramarambika Pidugu , Pharm.D., Bhavana Surapareddy , M.D., Naga Tejaswini Ramineni , M.D., Rekha Priyadarshini , M.D., Parag Parshuram Patil , M.D.

    J Rheum Dis 2024; 31(1): 15-24
    Abstract

    Abstract : Objective: This study was conducted to investigate the immunological and clinical response to COVID-19 vaccination in rheumatoid arthritis (RA) patients receiving disease modifying antirheumatic drugs (DMARDs).
    Methods: A cross-sectional study was conducted among RA patients who received two doses of COVID-19 vaccine within 6 months to one year. Demographic information, comorbidities, vaccination details, and past COVID-19 infection details were collected. Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were estimated. Disease Activity Score-28 (DAS-28) was calculated for RA patients. Anti-spike antibody (ASA) concentrations were measured, and compared with a healthy control population. Correlations of ASA with age, sex, disease parameters, medication use, and comorbidities were assessed.
    Results: A total of 103 RA patients and 185 controls were included in the study. RA patients had higher mean age, lower mean Hb, higher ESR, and elevated IL-6 levels. Both groups showed positive results for anti-spike antibodies, with a higher percentage in controls. Among RA patients majority had low DAS-28 score. The number of DMARDs used showed a negative correlation with antibody levels. There was a slight positive correlation between ASA concentration and DAS-28 score. Comorbidities did not significantly influence antibody concentration. No significant differences were found in antibody levels based on the type of COVID-19 vaccine or previous COVID-19 infection or booster dose vaccination among RA patients.
    Conclusion: The study revealed that RA patients showed a reduced antibody response following COVID-19 vaccination compared to the control group and potentially influenced by immunosuppressive treatments and disease-related factors.

  • Original ArticleJanuary 1, 2024

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    Clinical characteristics of juvenile systemic sclerosis in Korea: 31-year single-center study

    Ji Eun Jeong , M.D., Seong Heon Kim , M.D.

    J Rheum Dis 2024; 31(1): 25-32
    Abstract

    Abstract : Objective: To evaluate the clinical and laboratory characteristics, therapeutic drugs, and prognosis of juvenile systemic sclerosis (JSSc) at a single center in Korea.
    Methods: This study was a retrospective analysis of patients with JSSc aged <16 years at disease onset and who were treated at our hospital between January 1992 and April 2023. All patients met the Pediatric Rheumatology European Society/American College of Rheumatology/European League against Rheumatism provisional classification criteria for JSSc, and those with localized scleroderma (morphea) were excluded.
    Results: Among the 13 patients, proximal skin sclerosis (100%), Raynaud’s phenomenon (RP) (84.6%), and sclerodactyly (69.2%) were present at the time of diagnosis. The most common symptom before diagnosis was RP, which was present in 10 patients (76.9%), whereas proximal skin sclerosis was observed in only five patients (38.5%). Thirteen patients had positive anti-nuclear antibody (ANA). At the time of diagnosis, five individuals had findings suggestive of interstitial lung disease (ILD) on a pulmonary function test (PFT) or chest computed tomography (CT), two of whom were asymptomatic. During follow-up, three patients developed ILD, one developed renal dysfunction, one developed heart disease, and none died.
    Conclusion: This study was the first descriptive analysis of clinical features of JSSc in South Korea. Clinical suspicion is essential for diagnosing JSSc in patients with RP, especially if ANA is positive; however, proximal skin sclerosis, which is crucial for diagnosing JSSc, was unrecognized in the early phase of the disease. PFT should be considered even if a patient is asymptomatic or has normal chest CT.

  • Original ArticleJanuary 1, 2024

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    Preoperative patient’s expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery

    Sung-Jae Kim , M.D., Ph.D., Young-Woon Gil , M.D., Il-Hoon Sung , M.D., Ph.D.

    J Rheum Dis 2024; 31(1): 33-40
    Abstract

    Abstract : Objective: To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD).
    Methods: Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient’s expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson’s correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction.
    Results: Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient’s expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient’s expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction.
    Conclusion: Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient’s expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.

  • Original ArticleJanuary 1, 2024

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    Impact of anti-tumor necrosis factor treatment on lipid profiles in Korean patients with ankylosing spondylitis

    Inbeom Kwon , M.D., Nayeon Choi , M.S., Ji Hui Shin , M.S., Seunghun Lee , M.D., Ph.D., Bora Nam , M.D.,Ph.D., Tae-Hwan Kim , M.D., Ph.D.

    J Rheum Dis 2024; 31(1): 41-48
    Abstract

    Abstract : Objective: To investigate the effects of anti-tumor necrosis factor (TNF) treatment on lipid profiles and identify risk factors for an increase in total cholesterol (TC) after the anti-TNF treatment in ankylosing spondylitis (AS) patients.
    Methods: This retrospective cohort study analyzed AS patients who received the first-line anti-TNF treatment. Patients with at least nine months of follow-up were included; those who were under 18 years or on any lipid-lowering agent were excluded. A linear mixed model was used to assess the impact of anti-TNF inhibitors on disease activity and lipid profile (TC, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides [TG]). Univariable and multivariable linear regression were used to identify risk factors for an increase in TC after 3 months of anti-TNF treatment.
    Results: A total of 315 AS patients were enrolled (78.1% male, median age 32.0 [26.0~41.0]). TC, HDL, and TG levels significantly increased particularly within the first 3 months of anti-TNF treatment, while LDL level did not show significant changes. Changes in inflammatory markers and lipid particles (TC, LDL, TG) were correlated over time, but HDL showed no significant correlation. Older age, higher baseline erythrocyte sedimentation rate, and lower baseline LDL level were related to an increase in TC after 3 months of the anti-TNF treatment.
    Conclusion: In AS patients, anti-TNF treatment has been found to increase lipid particles, potentially due to its anti-inflammatory effects. Future research should explore the underlying mechanism and the clinical implications of dyslipidemia, particularly the occurrence of cardiovascular events, following anti-TNF treatment in AS patients.

  • Case ReportJanuary 1, 2024

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    Macrophage activation syndrome in neonatal lupus presenting with fever and rash

    Ji Yoon Yu , M.D., Tae Hwan Kim , M.D., Ye Ji Kim , M.D., Hyun Mi Kang , M.D. Ph.D., In Hyuk Yoo , M.D. Ph.D., Jung Woo Rhim , M.D., Ph.D., Soo Young Lee , M.D., Ph.D., Dae Chul Jeong , M.D., Ph.D.

    J Rheum Dis 2024; 31(1): 49-53
    Abstract

    Abstract : Neonatal lupus can occur in infants born to mother with autoimmune disorders through transplacental auto-antibodies. Clinical manifestations in neonatal lupus include cutaneous lesions and hematologic or hepatobiliary findings resembling those seen in systemic lupus erythematosus. In autoimmune state, macrophage activation syndrome (MAS) represent a critical and potentially fatal complication that can result in mortality if not immediately identified and managed with the appropriate care. Here we present a 33-day-old girl diagnosed with neonatal lupus and serious MAS. She was delivered by a primipara mother who did not exhibit any autoimmune symptoms. The patient visited the hospital due to fever and pancytopenia. Laboratory data were compatible with MAS, including pancytopenia, high level of ferritin, soluble interleukin-2, and decreased natural killer cell activity. In addition, autoimmune study showed positive results for anti-nuclear antibody (ANA), anti-Sjogren syndrome antigen A (SSA), and SSB, The autoimmune study for mother also showed positive results for ANA, anti-SSA, and SSB. The patient recovered after she received high dose steroid and supportive care. Our case indicates that neonatal lupus should be taken into consideration when fever, erythematous skin rash, and pancytopenia are observed in infants, even if their mothers have no prior history of autoimmune conditions.

  • Case ReportJanuary 1, 2024

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    Immunoglobulin G4-related hypertrophic pachymeningitis with an isolated scalp mass mimicking a brain tumor: a case report and literature review

    Jina Yeo , M.D., Gi Taek Yee , M.D., Ph.D., Jaedeok Seo , M.D., Mi Ryoung Seo , M.D., Han Joo Baek , M.D., Ph.D., Hyo-Jin Choi , M.D., Ph.D.

    J Rheum Dis 2024; 31(1): 54-58
    Abstract

    Abstract : Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder associated with fibroinflammatory conditions that can affect multiple organs. Hallmark histopathological findings of IgG4-RD include lymphocytic infiltration of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. However, little is known about central nervous system involvement of IgG4-RD. Hypertrophic pachymeningitis (HP) has recently been reported as a manifestation of IgG4-RD, which may have previously been demonstrated in a significant percentage of idiopathic cases. Herein, we report a rare case of a 63-year-old male who presented with a scalp mass that mimicked a brain tumor. He was diagnosed with IgG4-related HP (IgG4-RP) after surgery. This case suggests that awareness of a possibility of IgG4-RP in patients with isolated scalp masses, even in the absence of systemic symptoms, is crucial. A combination of careful history taking, evaluation of serum IgG4-levels and imaging as an initial work-up, followed by tissue biopsy, is important for the differential diagnosis of IgG4-RP, malignancy, and other infectious diseases.

  • Letter to the EditorJanuary 1, 2024

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    Insights from the COVID-19 pandemic: underscoring the paramount value of patient education and counseling for rheumatic diseases

    Byoong Yong Choi , M.D., Myeung-Su Lee , M.D., Ph.D., Geun Tae Kim , M.D., Ph.D., Seung-Jae Hong , M.D., Ph.D., Eun Bong Lee , M.D., Ph.D., Han Joo Baek , M.D., Ph.D

    J Rheum Dis 2024; 31(1): 59-61
  • CorrigendumJanuary 1, 2024

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    Corrigendum: Korean treatment recommendations for patients with axial spondyloarthritis

    Mi Ryoung Seo, M.D., Jina Yeo, M.D., Jun Won Park, M.D., Yeon-Ah Lee, M.D., Ph.D., Ju Ho Lee, M.D., Eun Ha Kang, M.D., Ph.D., Seon Mi Ji, M.D., Ph.D., Seong-Ryul Kwon, M.D., Ph.D., Seong-Kyu Kim, M.D., Ph.D., Tae-Jong Kim, M.D., Ph.D., Tae-Hwan Kim, M.D., Ph.D., Hye Won Kim, M.D., Ph.D., Min-Chan Park, M.D., Ph.D., Kichul Shin, M.D., Ph.D., Sang-Hoon Lee, M.D., Ph.D., Eun Young Lee, M.D., Ph.D., Hoon Suk Cha, M.D., Ph.D., Seung Cheol Shim, M.D., Ph.D., Youngim Yoon, RN, Seung Ho Lee, Jun Hong Lim, Han Joo Baek , M.D., Ph.D., on behalf of the Korean Society of Spondyloarthritis Research

    J Rheum Dis 2024; 31(1): 62-63
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)

Archives

Journal of Rheumatic Diseases

pISSN 2093-940X
eISSN 2233-4718
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