Hyun-Sook Kim

Immunogenicity of anti-tumour necrosis factor therapy in Korean patients with rheumatoid arthritis and ankylosing spondylitis

The aim of this study was to investigate the prevalence of antidrug antibodies (ADAs) against tumour necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). ADAs were detected in 18 (9.8%) patients with RA and in 18 (10.2%) patients with AS of the 360 patients. Development of ADAs was significantly associated with treatment failure in RA patients (P=0.003). When classified by drugs, the prevalence of immunogenicity in descending order was 17 (28.8%) patients treated with infliximab, 17 (10.4%) with adalimumab, and 2 (1.4%) with etanercept. After adjustment for disease and duration of anti-TNF therapy, the odds ratio as a reference of adalimumab-treated patients was 9.159 (95% confidence interval [CI] 2.005-41.845) for infliximab and 0.280 (95% CI 0.128-0.611) for etanercept. The immunogenicity of anti-TNF therapy was highest in the infliximab-treated group and significantly lower in the etanercept-treated group.

Determinants of quality of life in patients with fibromyalgia: A structural equation modeling approach

Objective Health-related quality of life (HRQOL) in patients with fibromyalgia (FM) is lower than in patients with other chronic diseases and the general population. Although various factors affect HRQOL, no study has examined a structural equation model of HRQOL as an outcome variable in FM patients. The present study assessed relationships among physical function, social factors, psychological factors, and HRQOL, and the effects of these variables on HRQOL in a hypothesized model using structural equation modeling (SEM). Methods HRQOL was measured using SF-36, and the Fibromyalgia Impact Questionnaire (FIQ) was used to assess physical dysfunction. Social and psychological statuses were assessed using the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), the Arthritis Self-Efficacy Scale (ASES), and the Social Support Scale. SEM analysis was used to test the structural relationships of the model using the AMOS software. Results Of the 336 patients, 301 (89.6%) were women with an average age of 47.9±10.9 years. The SEM results supported the hypothesized structural model (χ2 = 2.336, df = 3, p = 0.506). The final model showed that Physical Component Summary (PCS) was directly related to self-efficacy and inversely related to FIQ, and that Mental Component Summary (MCS) was inversely related to FIQ, BDI, and STAI. Conclusions In our model of FM patients, HRQOL was affected by physical, social, and psychological variables. In these patients, higher levels of physical function and self-efficacy can improve the PCS of HRQOL, while physical function, depression, and anxiety negatively affect the MCS of HRQOL.

Polymorphisms of the TRPV2 and TRPV3 genes associated with fibromyalgia in a Korean population

OBJECTIVEnResearchers continue to gather evidence that transient receptor potential vanilloid (TRPV) channels contribute towards pain signalling pathways. However, it is unknown whether polymorphisms of the TRPV gene are associated with FM. For the first time, we investigated the association between the polymorphisms of the TRPV2 and TRPV3 genes, FM susceptibility and the severity of the symptoms.nnnMETHODSnA total of 409 patients with FM and 423 controls were enrolled from 10 medical centres that participated in the Korean nationwide FM survey. The alleles and genotypes at three positions [rs3813768(C > G), rs8121(C > T) and rs1129235(C > A)] in the TRPV2 gene and two positions [rs7216486 (G > A) and rs395357(C > T)] in the TRPV3 gene were genotyped.nnnRESULTSnThe frequencies of the alleles and genotypes of individual TRPV2 and TRPV3 genes were not significantly associated with FM susceptibility. However, the GTA haplotype of TRPV2 showed a defence against FM susceptibility (P = 0.035). In addition, polymorphisms of TRPV3 were associated with symptom severity in FM patients. The single nucleotide polymorphism rs395357 of TRPV3 was associated with the scores of the Brief Fatigue Inventory (P = 0.017) in FM patients. Furthermore, haplotypes of TRPV3 were associated with the Brief Fatigue Inventory and the 36-item Short-Form Health Survey mental health summary scores (P = 0.036).nnnCONCLUSIONnThis study was the first to evaluate the associations of TRPV gene polymorphisms with FM. Our results suggest that certain TRPV2 haplotypes may have a protective role against FM and that some genotypes and haplotypes of TRPV3 contribute towards the symptoms of FM.

IgG4-related disease presenting as hypertrophic pachymeningitis and compressive optic neuropathy

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 8 avril 2016

Phlegmonous gastritis in an ankylosing spondylitis patient treated with infliximab

A 51-year old man, with a 2-year history of ankylosing spondylitis (AS), was hospitalized for severe nausea and vomiting. On physical examination, his temperature was 37.5°C and his blood pressure was 138/86 mmHg. His laboratory findings were as follows: white blood cell count, 15,200/ mm3 (neutrophils, 81.6%); hemoglobin, 9.4 g/dL; platelet count, 400,000/mm3; erythrocyte sedimentation rate, 74 mm/hr; and C-reactive protein, 4.00 mg/dL. He had been treated with infliximab beginning 6 months earlier and had last received it 2 weeks earlier. Abdominal computed tomography (CT) showed diffuse edematous submucosal wall thickening throughout the stomach and no specific findings in the colon (Fig. 1A and 1B). A characteristic feature of phlegmonous gastritis is the isolated thickening of the gastric wall, most marked in the submucosa. Esophagogastroduodenoscopy showed edematous, reddish mucosal change, and multiple ulcerative lesions on the greater curvature of the stomach. Diffuse ulcerative lesions on the fundus of the stomach were also detected (Fig. 1C). Phlegmonous gastritis was diagnosed based on CT and endoscopy findings. No phlegmonous gastritis pathogen was identified from cultures of blood, gastric aspirates, or tissue. The patient was treated conservatively with fluid resuscitation, a proton pump inhibitor, and broad-spectrum antibiotics including vancomycin and piperacillin/tazobactam for 3 weeks. Within a few days, the patient was afebrile and able to eat. Phlegmonous gastritis is a rare, rapPhlegmonous gastritis in an ankylosing spondylitis patient treated with infliximab

Unusual osteoporotic stress fracture: adjacent bilateral pedicle fractures

Dear Editor, A 77-year-old woman was admitted to our institute with 2 months’ severe back and buttocks pain progressively worsened with no history of trauma. She had undergone anterior lumbar interbody fusion with bone cement-augmented screw fixation at the L5–S1 level under a diagnosis of foraminal stenosis 4 years previously (Fig. 1a). Physical examination revealed no motor weakness or sensory changes, but significant tenderness was present in the low back area that motion was limited, especially in extension. Plain radiographs showed irregularity of the L4 pedicle, suggesting L4 pedicle fracture (Fig. 1b). Computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral pedicle fractures through L4 (Fig. 2a–c). Bone densitometry indicated severe osteoporosis, with a mean spinal T-score of –3.8 on D dual-energy X-ray absorptiometry (DEXA). She was treated with posterior lumbar interbody fusion of L4–S1 with a rigid screw. Follow-up 8 months later, revealed no residual low back pain and she had returned to normal activities with weekly bisphosphonate, calcium and vitamin D supplementation for her osteoporosis. Bilateral pedicle fractures in the spine are uncommon, even in elderly patients. The pedicle has great intrinsic strength and a short moment arm that can resist greater cyclic shear forces. Bilateral pedicle stress fractures at adjacent cephalad levels after instru-

Intracranial Migration of Intravitreal Silicone Oil: A Case Report

A 51-year-old woman with a history of diabetes mellitus for 20 years developed traction retinal detachment in the left eye. The detachment was treated using intravitreal SiO as an endotamponade agent. However, the intraocular pressure of the affected eye increased up to 49 mmHg on postoperative day 2, decreased to 30 mmHg 7 days later, and reached normalized pressure 18 days after intraocular tamponade. After 9 months following retinal surgery, the patient had to undergo a second surgery for vitreous hemorrhaging of the contralateral eye. In route to the operating room, the patient suddenly presented dizziness; her blood pressure was 200/100 mmHg. Pre-contrast CT scan showed a high-density nodular lesion in the optic chiasm and the left optic nerve that resembled a small subarachnoid hemorrhage in the suprasellar cistern (Fig. 1). From a brain CT angiography, a tiny aneurysm was found in the distal internal carotid artery at the inferior aspect to the left ophthalmic artery origin. The patient underwent a transfemoral carotid angiography; an aneurysm was confirmed. A brain MRI, including the orbits, revealed a foreign substance extending to the left side of the optic chiasm, along the left intraorbital and intracranial optic nerve (Fig. 2a–c). The substance had an intermediate signal intensity with a prominent chemical shift artifact in T2-WI and a low signal intensity in T1and T2-fat saturation images, identical to the properties presented by SiO in a phantom study. We performed CT and MR imaging on SiO and PFCL phantoms. SiO shows a high attenuation in CT scans and a high signal intensity with a prominent chemical shift artifact in T1-WI, an intermediate signal intensity in T2-WI with prominent chemical shift artifact, and a low signal intensity in fat-saturated MR images. PFCL shows a high attenuation Introduction

Dysphagia Caused by Ossificaion of the Cervical Anterior Longitudinal Ligament

Degeneative changes in the cervical spine can produce osteophytes and other hypertrophic abnormalities including ossification of the anterior longitudinal ligament (OALL). Cervical osteophytes including OALL are common whereas asymptomatic in the aging population. Dysphagia resulted from cervical OALL, although uncommon, is an important and treatable cause of dysphagia that must be identified. This report describes a rare case of dysphagia which was attributed to C2-C7 OALL and non symptomatic cervical ossification of posterior longitudinal ligament(OPLL) with successful symptomatic improvement after ostectomy. The medical literature concerning this unusual case of dysphagia is reviewed.

Performance of the 2016 ACR-EULAR classification criteria for primary Sjogren’s syndrome in a Korean cohort

This study compared the performance of the newly proposed 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria to the 2002 American–European Consensus Group (AECG) and 2012 ACR classification criteria for primary Sjogren’s syndrome (pSS) in well-characterized Korean patients. Patients with pSS from 12 university-affiliated hospitals in Korea were enrolled from October 2013 to January 2017. Clinical and laboratory data were reviewed. For the validation set, patients who underwent evaluation tests to rule out pSS at Seoul St. Mary’s hospital from November 2016 to December 2017 were analyzed. Baseline registry data were available in 458 patients, and 328 patients had sufficient data to determine the fulfillment of each criteria set. All three sets of criteria were met by 307 patients (93.6%). The newly proposed 2016 ACR/EULAR criteria were met by 325 patients (99.1%). The 2002 AECG and 2012 ACR criteria were met by 325 (99.1%) and 310 patients (94.5%), respectively. In a validation cohort consisting of 161 patients with pSS-related symptoms/signs, the sensitivity and specificity of the 2016 ACR/EULAR criteria were 100% [95% confidence interval (CI), 96.11–100.00] and 81.8% [95% CI, 76.15–94.26], respectively. Agreement between the 2016 criteria and 2012 or 2002 criteria was high (Cohen’s kappa 0.736 and 0.769, respectively). The newly proposed 2016 ACR/EULAR criteria were met by most patients diagnosed with pSS according to previous criteria and showed higher sensitivity and lower specificity compared with both previous criteria sets.

Association between brain-derived neurotrophic factor gene polymorphisms and fibromyalgia in a Korean population: a multicenter study

BackgroundSeveral lines of evidence imply that brain-derived neurotrophic factor (BDNF) is involved in the pathophysiology of fibromyalgia (FM); in this regard, patients with FM have altered blood and cerebrospinal fluid levels of BDNF. In this study, we explored the association between BDNF gene polymorphisms and FM susceptibility and the severity of symptoms.MethodsIn total, 409 patients with FM and 423 healthy controls in 10 medical centers were enrolled from the Korean nationwide FM survey. The alleles and genotypes at 10 positions in the BDNF gene were genotyped.ResultsThe allele and genotype frequencies of BDNF rs11030104 differed significantly between the patients with FM and the controls (Pu2009=u20090.031). The GG genotype of rs11030104 had a protective effect against FM (Pu2009=u20090.016), and the G allele of rs11030104 was negatively associated with the presence of FM compared with the A allele (Pu2009=u20090.013). In comparison, although the allele and genotype frequencies of BDNF rs12273539 did not differ between the two groups, the TT genotype of BDNF rs12273539 was associated with susceptibility to FM (Pu2009=u20090.038). Haplotype analyses implied that some BDNF haplotypes have a protective effect against FM. Finally, several genotypes and haplotypes of the BDNF gene contributed to specific symptoms of FM.ConclusionsThis study is the first to evaluate the associations between BDNF gene polymorphisms and FM. Our results imply that some BDNF single-nucleotide polymorphisms and haplotypes are associated with susceptibility to, and contribute to the symptoms of, FM.