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Jung SM, Kim MY, Hong YS, Park SH, Kang KY. Costovertebral joint involvement in patients with axial spondyloarthritis. Joint Bone Spine 2023; 90:105546. [PMID: 36796582 DOI: 10.1016/j.jbspin.2023.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To evaluate costovertebral joint involvement in patients with axial spondyloarthritis (axSpA) and to assess its association with disease features. METHODS We included 150 patients from the Incheon Saint Mary's axSpA observational cohort who underwent whole spine low-dose computed tomography (ldCT). Costovertebral joint abnormalities were scored by two readers on a scale of 0-48 based on the presence or absence of erosion, syndesmophyte, and ankylosis. The interobserver reliability of costovertebral joint abnormalities was assessed using intraclass correlation coefficients (ICCs). Associations between costovertebral joint abnormality scores and clinical variables were evaluated using a generalized linear model. RESULTS Two independent readers found costovertebral joint abnormalities in 74 (49%) patients and 108 (72%) patients. The ICCs of scores for erosion, syndesmophyte, ankylosis, and total abnormality were 0.85, 0.77, 0.93, and 0.95, respectively. For both readers, total abnormality score was correlated with age, symptom duration, Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath AS functional index (BASFI), CT syndesmophyte score (CTSS), and number of bridging spines. Multivariate analyses showed age, ASDAS, CTSS to be independently associated with total abnormality scores in both readers. The frequency of ankylosed costovertebral joint was 10.2% (reader 1) and 17.0% (reader 2) in patients without radiographic syndesmophytes (n=62), and 10.3% (reader 1) and 17.2% (reader 2) in patients without radiographic sacroiliitis (n=29). CONCLUSIONS Costovertebral joint involvement was common in patients with axSpA, even in the absence of radiographic damage. LdCT is recommended for evaluating structural damage in patients with clinically suspected costovertebral joint involvement.
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Affiliation(s)
- Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Lee BW, Jung JY, Kim MY, Hong YS, Park SH, Kang KY. Prevalence and Associated Factors of Facet Joint Ankylosis in Patients With Axial Spondyloarthritis. J Rheumatol 2023:jrheum.220749. [PMID: 36642426 DOI: 10.3899/jrheum.220749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate the prevalence of facet joint ankylosis in the whole spine in axial spondyloarthritis (axSpA) using low-dose computed tomography (LDCT), and to identify factors associated with facet joint ankylosis. METHODS Whole spine LDCT images from 161 patients with axSpA were examined, and the presence of facet joint ankylosis was assessed (right and left, C2-S1) by 2 readers. Facet joint ankylosis was scored from 0 to 46. Structural damage of vertebral body was assessed using CT Syndesmophyte Score (CTSS). Factors associated with ankylosed facet joint scores for the whole spine were identified using a generalized linear model with a negative binomial distribution. RESULTS Seventy-nine patients (49%) and 70 patients (43%; reader 1 and reader 2, respectively) had ≥ 1 ankylosed facet joint. Facet joint ankylosis was most common in the thoracic spine. The mean score of facet joint ankylosis for the whole spine was 6.6 (SD 11.2) in reader 1 and 4.2 (SD 8.4) in reader 2. Whole spine facet joint ankylosis score positively correlated with Ankylosing Spondylitis Disease Activity Score (ASDAS) and CTSS. In multivariable analysis, the ankylosed facet joint score was associated with ASDAS, sacroiliitis, CTSS, and a history of uveitis in both readers. Uveitis history, ASDAS, and CTSS were associated with whole spine facet joint ankylosis score in subgroup analysis of only radiographic axSpA. CONCLUSION The prevalence of ankylosed facet joints is high in axSpA, especially in the thoracic segment. The whole spine ankylosed facet joint score is significantly associated with a history of uveitis, ASDAS, sacroiliitis, and syndesmophyte score.
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Affiliation(s)
- Bong-Woo Lee
- B.W. Lee, MD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Joon-Yong Jung
- J.Y. Jung, MD, PhD, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Young Kim
- M.Y. Kim, MD, Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Sik Hong
- Y.S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- S.H. Park, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- K.Y. Kang, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Min HK, Kim HR, Lee SH, Hong YS, Kim MY, Park SH, Kang KY. Clinical efficacy of alternative TNF inhibitor and secukinumab between primary non-responder and secondary non-responder of prior TNF inhibitor in ankylosing spondylitis. Mod Rheumatol 2023; 33:194-201. [PMID: 35107167 DOI: 10.1093/mr/roac005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 12/25/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To compare the drug retention times and clinical efficacy of alternative tumour necrosis factor inhibitors (TNFi) and secukinumab in primary and secondary non-responders with ankylosing spondylitis (AS). METHODS AS patients treated with biologics and enrolled in the Korean College of Rheumatology Biologics registry were examined. Patients who did not respond to previous TNFi treatment were defined as primary and secondary non-responders. Data regarding drug discontinuation and clinical efficacy were collected after 1 year. Kaplan-Meier and Cox regression analyses were performed to compare drug survival and associated factors. Logistic regression analyses were conducted to compare the clinical efficacy secukinumab with that of alternative TNFi. RESULTS In total, 124 patients (83 receiving alternative TNFi and 41 receiving secukinumab) had biologic changes due to clinical inefficacy. Drug retention rates in the alternative TNFi and secukinumab groups were similar (P = 0.096). However, subgroup analyses including only secondary non-responders revealed that secukinumab users showed a higher hazard ratio (HR) for drug discontinuation (HR = 3.77, P = 0.045). In addition, secukinumab was negatively associated with achieving BASDAI50 or a major improvement in the ASDAS. CONCLUSION Alternative TNFi showed better drug retention and clinical efficacy in AS patients experiencing previous TNFi failure, in secondary non-responders. Therefore, alternative TNFi may be a more suitable treatment for secondary non-responders.
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Affiliation(s)
- Hong Ki Min
- Department of Internal Medicine, Division of Rheumatology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Hae-Rim Kim
- Department of Internal Medicine, Division of Rheumatology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Sang-Heon Lee
- Department of Internal Medicine, Division of Rheumatology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Yeon Sik Hong
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Moon-Young Kim
- Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Division of Rheumatology, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
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Kim MY, Hong YS, Park SH, Kang KY. Physical activity is associated with physical and global function in patients with axial spondyloarthritis, independent of disease activity. Semin Arthritis Rheum 2022; 56:152067. [PMID: 35849891 DOI: 10.1016/j.semarthrit.2022.152067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether physical activity is independently associated with physical and global function in patients with axial spondyloarthritis (axSpA), and to analyse the relationship between subtypes of physical activity (work, transport, and recreation) and functional impairment. METHODS One-hundred-and-eighty-five patients were included. Physical function was assessed using BASFI, and global function was assessed using the ASAS health index (HI). Physical activity was measured using the Global Physical Activity Questionnaire. Levels of physical activity were categorised as low, moderate or high. The associations between levels of physical activity and the BASFI and ASAS HI scores were analysed using multivariate regression analysis. RESULTS Of the 185 patients, 46, 63 and 76 reported low, moderate and high levels of physical activity, respectively. There was a negative correlation between the BASFI and total physical activity. Multivariate linear regression analysis revealed that a high level of physical activity was independently associated with BASFI after adjusting for age, ASDAS. sacroiliitis and syndesmophyte number (ß (95% CI) =-0.88 (-1.49--0.26); p=0.006). One-hundred-and-forty-six had good global functioning (ASAS HI≤5). Multivariate logistic regression analysis revealed that moderate physical activity was independently associated with good global functioning (OR (95% CI) = 2.82 (1.02-7.86); p = 0.047). Recreational activity, but not work- and transport-related activity, showed a significant relationship with ASAS HI scores (ß (95% CI) =-0.55 (-1.02-0.08); p = 0.023). CONCLUSIONS Physical activity in those with axSpA is associated independently with physical and global functioning. Among the subtypes of physical activity, recreational activity is related to global functioning.
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Affiliation(s)
- Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
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Min HK, Kim HR, Lee SH, Kang KY, Park SH, Kwok SK. Time-averaged DAS28 and HAQ predict cardiovascular disease in patients with rheumatoid arthritis: data from KORONA registry. Joint Bone Spine 2022; 89:105401. [PMID: 35513231 DOI: 10.1016/j.jbspin.2022.105401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the predictive role of time-averaged disease activity score (DAS)28 and Health Assessment Questionnaire (HAQ) on cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA). METHODS Patients with RA were recruited from 23 tertiary hospitals. Baseline and annual follow-up data of demographic, laboratory, questionnaire, RA-associated parameters, and occurrence of CVD were collected. Patients were divided into three groups according to time-averaged DAS28: 1) remission (<2.6), 2) low (2.6-3.2), 3) moderate (3.2-5.1), and 4) high (>5.1). Kaplan-Meier curves was performed to compare the cumulative probability of CVD. Hazard ratios of each factor on the occurrence of CVD were obtained using Cox regression analyses. RESULTS A total of 4,034 RA patients with 826 for remission, 938 for low, 2,002 for moderate, and 268 for high time-averaged DAS28 groups were included. Baseline age, disease duration, ESR, CRP, DAS28, and HAQ scores were higher in the high time-averaged DAS28 group. The incidence rate of CVD was 2.86, 2.71, 3.53, and 8.13 events per 1,000 person-years for the remission, low, moderate, and high time-averaged DAS28 groups, respectively. The incidence rate ratio of CVD in the high time-averaged DAS28 group were 3.01 (95% CI 1.20-8.50) when compared to low time-averaged DAS28 group. The cumulative hazard for CVD in the high time-averaged DAS28 group was significantly high (log-rank P<0.01). In multivariate Cox regression analysis, age, high time-averaged DAS28, and time-averaged HAQ>0.5, were positively associated with CVD events in RA patients. CONCLUSIONS In patients with RA, time-averaged DAS28 and HAQ could predict the occurrence of CVD. TRIAL REGISTRATION Clinical Research Information Service of South Korea https://cris.nih.go.kr: KCT0000086, registered May 26, 2009.
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Min HK, Kim HR, Lee SH, Park S, Park M, Hong YS, Kim MY, Park SH, Kang KY. Increased risks of aortic regurgitation and atrial fibrillation in radiographic axial spondyloarthritis patients: a 10-year nationwide cohort study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221088094. [PMID: 35368372 PMCID: PMC8972938 DOI: 10.1177/1759720x221088094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background: To compare the incidences of aortic regurgitation, atrial fibrillation (AF), and atrioventricular (AV) block II–III between radiographic axial spondyloarthritis (r-axSpA) patients and the general population (GP). Methods: National Health Insurance Services data were used. R-axSpA patients (N = 8877) and the age- and sex-matched GP (N = 26,631) were followed from August 2006 to December 2019. Incidence rates and standardized incidence ratios (SIRs) of aortic regurgitation, AF, and AV block II–III were compared between these groups. Ten-year incidence rates and hazard ratios (HRs) were calculated by the Kaplan–Meier method and Cox regression analysis. Results: Incidence rates of aortic regurgitation, AV block II–III, and AF in the r-axSpA group were 0.42, 0.21, and 4.0 per 1000 person-years (PYs), respectively. In the r-axSpA group, the SIR for aortic regurgitation was highest among 40- to 49-year-old men (4.11). Incidence rates of aortic regurgitation and AF were higher in the r-axSpA group than in the GP group (0.42 versus 0.18 per 1000 PYs 4.00 versus 3.13 per 1000 PYs, both p < 0.001, respectively), whereas the difference was insignificant for AV block II–III (0.21 versus 0.14 per 1000 PYs, p = 0.222). In multivariate analysis, r-axSpA was associated with a higher hazard (risk) for the development of aortic regurgitation and AF [HR (95% confidence interval) = 2.55 (1.49–4.37) and 1.20 (1.04–1.39), respectively], but the difference was insignificant for AV block II–III [HR (95% confidence interval) = 1.17 (0.59–2.31)]. Conclusions: Compared with the GP, r-axSpA patients are at increased risk of aortic regurgitation and AF, but not AV block II–III. These patients should be carefully monitored for occurrence of aortic regurgitation and AF.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Minae Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #56 Dongsu-Ro, Bupyung-Gu, Incheon KS006, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul KS013, South Korea
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Kang KY, Jung YE, Jang H, Kim MD, Bahk WM. Relationship between Handgrip Strength and Low-grade Inflammation in Older Adults with Depression. Clin Psychopharmacol Neurosci 2021; 19:721-730. [PMID: 34690127 PMCID: PMC8553523 DOI: 10.9758/cpn.2021.19.4.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/08/2023]
Abstract
Objective The relationship among physical functional decline, low-grade inflammation, and depression remains unclear. The aim of this study was to examine the association between hand grip strength (HGS) and high-sensitivity C-reactive protein (hs-CRP) in a large sample with depression. Methods This study used data obtained from a representative Korean sample of 9,402 people who participated in the seventh Korean National Health and Nutrition Examination Survey. Physical function was assessed using a digital grip strength dynamometer. Depression was identified using a cutoff of 5 on the Patient Health Questionnaire-9 (PHQ-9), and high hs-CPR level was defined as ≥ 3.0 mg/L. Results In older adults (≥ 60 years) with depression, 43.8% of those with high hs-CRP levels had low HGS, compared to 21.8% of those with hs-CRP levels < 3.0 mg/L (p = 0.002). Multivariate analysis revealed that, after adjustments for potentially confounding factors, high hs-CRP was independently associated with lower HGS (B = −2.25; 95% confidence interval = −4.49 to −0.02) in older adults with depression, but not in younger or middle-aged adults with depression. Conclusion These findings suggest a significant correlation between physical functional decline and low-grade inflammation in older adults with depression.
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Affiliation(s)
- Kwi Young Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young-Eun Jung
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Hwan Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon-Doo Kim
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Min HK, Kim HR, Lee SH, Kang KY, Park SH, Shin K, Kim J, Kwok SK. Biologic retention rate and efficacy in patients with cluster-based phenotypes of ankylosing spondylitis: data from a Korean national biologics registry. Clin Exp Rheumatol 2021; 40:1701-1707. [DOI: 10.55563/clinexprheumatol/9yfunq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kishul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jinhyun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Park EA, Kang KY, Lee JH, Lee JY, Kim HS, Choi HS, Song GY, Moon EH, Shiin MY, Hur YJ, Yu EJ, Kim R, Koong MK, Lee KA, Kim MJ. P–153 Comparison outcome of vitrified human embryos stored in vapor phase liquid nitrogen (LN2) and direct LN2. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is vapor cryopreserved LN2 storage beneficial for clinical outcomes of vitrified human embryos that are frozen compared to vitrified human embryos having direct contact with LN2.
Summary answer
There are no significant differences compared to clinical outcomes of human embryos stored in LN2 vapor and direct store in LN2.
What is known already
There has been concerned about potential cross-contamination and biohazard issues of embryos for long term storage using direct LN2. This study aimed to compare clinical outcomes of human embryos transfer between vapor phase and liquid LN2.
Study design, size, duration
The embryo has undergone vitrification for long term storage with vapor or direct contact in LN2. After the thawing of the embryo, we checked on the survival rates. We transferred only one or two embryos per patient and kept analyzing the implantation and pregnancy rates
Participants/materials, setting, methods
This retrospective study was carried out from January 2018 to December 2019 with 3272cycles 4713embryos; vitrified for long term storage in vapor phase or direct contact with LN2. We compared the clinical outcomes of frozen embryo transfer cycles using vitrified for long term storage in vapor phase and direct contact with LN2. Clinical outcomes monitored were embryo survival, subsequent implantation and pregnancy after single or double embryo transfer
Main results and the role of chance
A total of 4713 fertilized human embryos are vitrified and then stored in LN2 vapor (n = 2520 cycles) or direct contact LN2 (n = 752 cycles). The study showed that the blastocyst stored in vapor able to retain full development. Survival was 97.8% (vapor) and 97.6% (direct contact LN2), and the vapor storage of human embryos had no significant difference in survival rates after a long term storage. For single blastocyst transfer, pregnancy and implantation rates were 51.5%, 52.4% in vapor, 54.6%, 54.9% in direct LN2; respectively (p=NS). In double blastocyst transfer, the pregnancy and implantation rates were 61.8%, 42.0% in vapor and 64.7%, 44.5% in direct LN2; respectively (p=NS). There were also no significant differences between two groups.
Limitations, reasons for caution
The study showed that the blastocyst stored in vapor can retain full development. A vapor storage system thus is safe and effective for long term vapor storage of vitrified human embryos.Within the limits of this study, there was no detection of an adverse effect of vapor storage.
Wider implications of the findings: Vapor storage systems thus represent a useful alternative for safe and effective long-term storage of vitrified human embryos that can avoid cross contamination chances from having direct contact with LN2.
Trial registration number
Not applicable
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Affiliation(s)
- E A Park
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - K Y Kang
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - J H Lee
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - J Y Lee
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - H S Kim
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - H S Choi
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - G Y Song
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - E H Moon
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - M Y Shiin
- CHA Fertility Center Seoul Station, Fertility laboratory, Seoul, Korea- South
| | - Y J Hur
- CHA Fertility Center Seoul Station, Department of Obstetrics and Gynecology, Seoul, Korea- South
| | - E J Yu
- CHA Fertility Center Seoul Station, Department of Obstetrics and Gynecology, Seoul, Korea- South
| | - R Kim
- CHA Fertility Center Seoul Station, Department of Obstetrics and Gynecology, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, Department of Obstetrics and Gynecology, Seoul, Korea- South
| | - K A Lee
- CHA University, Department of Biomedical Science- College of Life Science, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, Department of Obstetrics and Gynecology, Seoul, Korea- South
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Choi KH, Kim YJ, Kang KY, Park EA, Kim YS, Kim MJ, Kim HO, Koong MK, Kim YS, Yoon TK, Ko JJ, Lee JH. P–657 Prostaglandin D2 is correlated with follicles development and a reliable marker of ovarian reserve of poor ovarian responder patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the prostaglandin D2 (PGD2) associated with growing follicles and ovarian reserve of poor ovarian responders?
Summary answer
PGD2 is correlated with ovarian stimulation activity and follicle growth. Especially, poor ovarian responders show a significant decrease in the level of follicular fluid.
What is known already
Prostaglandins (PGs) are involved in the female reproductive process, mainly ovulation, fertilization, and implantation.
Study design, size, duration
We investigated the PGD2 level in the follicular fluid of poor ovarian responders. The collection of human follicular fluid was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. Follicular fluid was collected from patients with normal ovarian response and patients with POR.
Participants/materials, setting, methods
We studied whether prostaglandin has related to POR in the clinical key factor by measuring human follicular fluid. Follicular fluid was collected from patients with normal ovarian response and patients with POR. The concentration of PGD2 in follicular fluid was determined with ELISA kits following the manufacturer’s protocol.
Main results and the role of chance
We analyzed the level of PGD2 in the follicular fluid of patients with normal ovarian response and patients with POR using an ELISA. The PGD2 concentration was significantly lower in the follicular fluid of patients with POR than in the follicular fluid of young and old patients with normal ovarian response.
Limitations, reasons for caution
This study has an identification of biomarker of the clinical samples as POR criteria patients. Therefore, further investigations aimed at specific recovery of low PGD2 metabolic activity in the CCs during control ovarian stimulation.
Wider implications of the findings: Until now there is no specific biomarker of POR. AMH is just an ovary reserve marker for an indication of ovary function. PGD2 is one of the metabolites in steroid metabolism in the ovary. Therefore, we can find some cure through further study for improved PGD2 production to POR patients.
Trial registration number
none
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Affiliation(s)
- K H Choi
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y J Kim
- CHA Medical Group, Advanced Research Division of Reproductive Medicine, Seoul, Korea- South
| | - K Y Kang
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - E A Park
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - H O Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - T K Yoon
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - J J Ko
- CHA University, Biomedical Science, Pocheon-si, Korea- South
| | - J H Lee
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
- CHA University, Biomedical Science, Pocheon-si, Korea- South
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11
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Kim YJ, Choi KH, Kang KY, Park EA, Kim YS, Kim MJ, Kim HO, Koong MK, Kim YS, Yoon TK, Ko JJ, Lee JH. P–658 Lovastatin promotes the expression of LDL receptor and enhances E2 production in the cumulus cells. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
Lovastatin enhanced E2 productive ratios in the cumulus cells through promoted expression of Low-density lipoprotein receptor (LDLR).
Summary answer
Lovastatin up-regulated gene expression of LDLR in the CCs. And the high expression of LDLR promoted E2 productive ratios from CCs.
What is known already
We already reported that the up-regulation of LDLR correlated with clinical pregnancy. Therefore, we found lovastatin as an up-regulator of LDLR expression of clinical pregnancy.
Study design, size, duration
This is an expended study of LDLR to enhance steroidogenesis regarding the effect of lovastatin in the CCs. The collection of human cumulus cells was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. The CCs were collected from 12 patients with normal ovarian response after oocyte denudation for ICSI.
Participants/materials, setting, methods
We studied whether lovastatin has up-regulated LDLR expression in human CCs. Cumulus cells were collected from patients with young (∼ 36) and old aged patients (37 ∼). After culturing human CCs, they were treated lovastatin for one day. The concentration of E2 in culture medium was measured using Chemiluminescence immunoassay. The mRNA isolated from CCs was analyzed gene expression level through real time-PCR.
Main results and the role of chance
The concentration of E2 was significantly increased in the culture medium treated with lovastatin. The CCs treated with lovastatin increased the expression of LDLR and StAR which are components of the steroidogenesis pathway.
Limitations, reasons for caution
We have found that the role of lovastatin promotes the E2 production by increasing the ldlr gene of CCs. Therefore, further investigations aimed at lovastatin effect on human oocytes embryo whether enhanced quality of oocytes or not.
Wider implications of the findings: Previous data show that high activation of LDLR and StAR was associated with embryo quality and clinical pregnancy in infertile women. Our data suggest that lovastatin is stimulated LDLR expression to enhanced pregnancy ratios of IVF patients.
Trial registration number
none
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Affiliation(s)
- Y J Kim
- CHA Medical Group, Advanced Research Division of Reproductive Medicine, Seoul, Korea- South
| | - K H Choi
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - K Y Kang
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - E A Park
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - H O Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - T K Yoon
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - J J Ko
- CHA University, Biomedical Science, Pocheon-si, Korea- South
| | - J H Lee
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
- CHA University, Biomedical Science, Pocheon-si, Korea- South
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12
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Ki Min H, Kim HR, Lee SH, Hong YS, Kim MY, Park SH, Kang KY. Retention rate and effectiveness of secukinumab vs TNF inhibitor in ankylosing spondylitis patients with prior TNF inhibitor exposure. Rheumatology (Oxford) 2021; 60:5743-5752. [PMID: 33725088 DOI: 10.1093/rheumatology/keab245] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The choice of second-line biologics for ankylosing spondylitis (AS) patients previously treated with a tumour necrosis factor inhibitor (TNFi) remains unclear. Here, we compared drug retention and clinical efficacy between AS patients who switched biologics to secukinumab and those who switched to a different TNFi. METHODS AS patients enrolled in the Korean College of Rheumatology BIOlogics registry were included, and patients with non-radiographic axial spondyloarthritis were excluded. Patients with previous TNFi exposure were divided into the secukinumab group and the TNFi switching group. Drug retention and clinical efficacy (BASDAI50, ASAS20, ASAS40, ASDAS <2.1, ASDAS clinically important improvement, and ASDAS major improvement) were assessed at the 1 year follow-up. Propensity score (PS)-matched and covariate-adjusted logistic regression analyses were performed. RESULTS 246 had available 1 year follow-up data. Secukinumab as third- or later-line biologics was more frequent than alternative TNFi (54% vs 14%). PS-matched and multiple covariate-adjusted analyses showed that the odds ratio (OR) for drug discontinuation was comparable between the secukinumab and TNFi switching groups (OR = 1.136; 95% CI, 0.843-1.531 and OR = 1.000; 95% CI, 0.433-2.308, respectively). The proportion of patients who achieved BASDAI50 was also comparable between the two groups (OR = 0.833; 95% CI, 0.481-1.441 in PS-matched analysis). Other clinical efficacy parameters were also comparable. In the subgroup analysis of AS patients with previous TNFi discontinuation due to ineffectiveness, all clinical efficacy parameters were comparable between the two groups. CONCLUSION In AS patients with previous exposure to a TNFi, switching biologics to secukinumab and switching to an alternative TNFi resulted in comparable drug retention and clinical efficacy.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
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13
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Lim MJ, Kang KY. A Contemporary View of the Diagnosis of Osteoporosis in Patients With Axial Spondyloarthritis. Front Med (Lausanne) 2020; 7:569449. [PMID: 33363182 PMCID: PMC7759657 DOI: 10.3389/fmed.2020.569449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/13/2020] [Indexed: 01/31/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the axial joints. Altered bone metabolism associated with chronic inflammation leads to both new bone formation in the spine and increased bone loss. It is known that patients with axSpA have a high prevalence of osteoporosis and fractures. However, there is no consensus on which imaging modality is the most appropriate for diagnosing osteoporosis in axSpA. Bone mineral density measurement using dual-energy X-ray absorptiometry is the primary diagnostic method for osteoporosis, but it has notable limitations in patients with axSpA. This method may lead to the overestimation of bone density in patients with axSpA because they often exhibit abnormal calcification of spinal ligaments or syndesmophytes. Therefore, the method may not provide adequate information about bone microarchitecture. These limitations result in the underdiagnosis of osteoporosis. Recently, new imaging techniques, such as high-resolution peripheral quantitative computed tomography, and trabecular bone score have been introduced for the evaluation of osteoporosis risk in patients with axSpA. In this review, we summarize the current knowledge regarding imaging techniques for diagnosing osteoporosis in patients with axSpA.
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Affiliation(s)
- Mie Jin Lim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
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14
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Kim SH, Kang KY. A 2 years longitudinal data of bone health in adolescent patients with axial spondyloarthritis. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Jung JY, Kim MY, Hong YS, Park SH, Kang KY. Trabecular bone loss contributes to radiographic spinal progression in patients with axial spondyloarthritis. Semin Arthritis Rheum 2020; 50:827-833. [PMID: 32896695 DOI: 10.1016/j.semarthrit.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate the longitudinal relationship between trabecular bone loss and spinal progression in axial spondyloarthritis (axSpA). METHODS Patients enrolled in the Incheon Saint Mary's axSpA prospective observational cohort were evaluated. The number of syndesmophytes was assessed by two trained readers at baseline and at 2 and 4 years follow-up. Trabecular bone loss was assessed using the trabecular bone score (TBS). Disease activity measures included the BASDAI, ASDAS, CRP, and ESR. The relationship between trabecular bone loss and radiographic damage was investigated using generalized estimating equation models with 2 year time lags. RESULTS Of the 245 patients included (80% males; mean (SD) age, 37 (12) years), 26 (11%) had mild trabecular bone loss (1.23-1.31) and 25 (10%) had severe trabecular bone loss (≤1.23) at baseline. Trabecular bone loss was associated with longitudinal radiographic spinal progression. Those with severe trabecular bone loss at baseline had an average 0.42 more syndesmophytes/2 years than those with normal TBS. Multivariate analysis revealed that severe trabecular bone loss compared with normal TBS resulted in an additional 0.4 syndesmophytes over 2 years. Adjusting for significant clinical factors revealed that both mild and severe trabecular bone loss were independent risk factors for new syndesmophyte formation over the next 2 years (OR [95% CI] = 2.4 [1.1-5.1]) and OR [95% CI] = 4.0 [1.6-9.7], respectively). CONCLUSIONS Trabecular bone loss is longitudinally associated with spinal progression of axSpA. The more severe the trabecular bone loss, the stronger the effect on the progression of the spine.
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Affiliation(s)
- Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
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16
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Kang KY, Park SH, Hong YS. Relationship between faecal calprotectin and inflammation in peripheral joints and entheses in axial spondyloarthritis. Scand J Rheumatol 2020; 49:397-404. [PMID: 32657633 DOI: 10.1080/03009742.2020.1748707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: To compare faecal calprotectin levels according to the type of manifestation and to investigate factors associated with increases in faecal calprotectin in patients with axial spondyloarthritis (axSpA). Method: The study enrolled 190 patients fulfilling the imaging arm of the Assessment of SpondyloArthritis international Society axSpA criteria. Faecal calprotectin levels were measured in an enzyme-linked immunosorbent assay. Systemic inflammatory markers and the Ankylosing Spondylitis Disease Activity Score (ASDAS) were also assessed. Peripheral joint involvement was assessed using the 44-joint examination and Spondyloarthritis Research Consortium of Canada Enthesitis Index. Results: Of 190 patients, 34 (18%) had increased faecal calprotectin levels. These patients were more likely to have ongoing peripheral arthritis and enthesitis (p = 0.016 and 0.001, respectively). A history of psoriasis and uveitis, or current uveitis symptoms, had no bearing on faecal calprotectin levels. Faecal calprotectin levels increased along with ASDAS-C-reactive protein (CRP), and correlated with ASDAS-erythrocyte sedimentation rate (ESR) (r = 0.240, p = 0.001), ASDAS-CRP (r = 0.162, p = 0.025), ESR (r = 0.228, p = 0.002), and CRP levels (0.258, p < 0.001). Tender joint and swollen joint counts also correlated with faecal calprotectin levels (r = 0.252 and 0.205, p < 0.001 and p = 0.005, respectively). Faecal calprotectin levels were higher in patients with current peripheral symptoms (p = 0.003). Peripheral symptoms were independently associated with increased faecal calprotectin levels (odds ratio = 4.083; 95% confidence interval 1.580-10.556). Conclusions: Faecal calprotectin levels in axSpA patients were associated with disease activity. Subclinical gut inflammation (assessed by measuring faecal calprotectin) in axSpA is more closely related to peripheral joint inflammation than to axial joint inflammation.
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Affiliation(s)
- K Y Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea , Incheon, Republic of Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Y S Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea , Incheon, Republic of Korea
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17
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Kang KY, Jung JY, Lee SK, Min HK, Hong YS, Park SH, Ju JH. Trabecular bone score value is associated with new bone formation independently of fat metaplasia on spinal magnetic resonance imaging in patients with ankylosing spondylitis. Scand J Rheumatol 2020; 49:292-300. [PMID: 32314620 DOI: 10.1080/03009742.2019.1704053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the association between trabecular bone score (TBS) and new bone formation in ankylosing spondylitis (AS) patients, and to investigate whether TBS is independently associated with new bone formation. METHOD Sixty-eight patients with AS underwent spinal magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry of the lumbar spine to measure TBS and bone mineral density at baseline. Lateral radiographs of the cervical and lumbar spine (baseline and 2 years) were assessed for new bone formation (syndesmophyte formation and/or growth combined), and spinal MRIs were assessed for the presence or absence of fat metaplasia (FM) at the first to fourth lumbar vertebrae. The factors associated with new bone formation were analysed at the patient level and the vertebral level. RESULTS New bone formation had developed in 17 patients (25%) at 2 year follow-up. Patients with new bone formation had a higher prevalence of FM and lower TBS at baseline than patients without new bone formation (p = 0.013 and p = 0.041). At the patient level, FM on MRI and low TBS (< 1.23) were significantly associated with new bone formation. At the vertebral level, new bone formation had developed in 25 out of 231 vertebrae (11%) after 2 years. Vertebrae with both FM on MRI and low TBS tended to have more new bone formation (p < 0.001). Syndesmophytes and low TBS (< 1.23) independently increased the risk of new bone formation at the level of individual vertebrae. CONCLUSION At both patient and individual vertebral levels, low TBS was associated with new bone formation independently of FM on MRI.
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Affiliation(s)
- K Y Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea , Incheon, Republic of Korea
| | - J-Y Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - S K Lee
- Department of Radiology, Dongguk University Ilsan Hospital , Gyenggi-do, Republic of Korea
| | - H K Min
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Y S Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea , Incheon, Republic of Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - J H Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
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18
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Kim YJ, Kang KY, Shin J, Jun Y, Kim SI, Kim YR. Trabecular bone scores in young HIV-infected men: a matched case-control study. BMC Musculoskelet Disord 2020; 21:94. [PMID: 32041580 PMCID: PMC7011600 DOI: 10.1186/s12891-020-3092-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background Screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) is recommended for male HIV-infected patients only above the age of 50. Recently, trabecular bone score (TBS) has been introduced as a novel tool to assess bone microarchitecture using DXA of the lumbar spine. Few studies have reported TBS values in HIV-infected individuals younger than 50 years of age. This study compared TBS values in young males infected with HIV and matched controls, and investigated the associations between TBS and demographic parameters, clinical parameters, and bone mineral density (BMD) scores. Methods A cross-sectional study of BMD and TBS in HIV-infected men (n = 80) aged between 18 and 50 years and age- and sex-matched controls (n = 80) was conducted. Results The proportion of patients with low BMD (Z-score ≤ − 2) was significantly greater among HIV-infected patients than among matched controls (21.3% [17/80] vs. 8.8% [7/80], p = 0.027). Mean TBS values were significantly lower in HIV-infected patients than in controls (1.41 ± 0.07 vs. 1.45 ± 0.07, p = 0.008). In both groups, TBS values were positively correlated with BMD at the lumbar spine, femoral neck, and total hip (p < 0.001); however, TBS was not correlated with body mass index. In the HIV group, TBS was negatively correlated with the duration of tenofovir disoproxil fumarate(TDF) exposure (p = 0.04). Conclusion Young men infected with HIV had abnormal bone trabecular microarchitecture, as assessed by both TBS and BMD. TBS values were correlated with both BMD and the duration of TDF exposure.
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Affiliation(s)
- Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Donsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Donsu-Ro, Bupyung-Gu, Incheon, South Korea.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Juyoung Shin
- Health Promotion Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoonhee Jun
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpodong, Seochogu, 137-701, Seoul, Republic of Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpodong, Seochogu, 137-701, Seoul, Republic of Korea.
| | - Yang Ree Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Chonboro 271, Uijeongbu, South Korea
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19
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Kang KY, Ju JH, Park SH, Hong YS. Longitudinal Association Between Trabecular Bone Loss and Disease Activity in Axial Spondyloarthritis: A 4-year Prospective Study. J Rheumatol 2019; 47:1330-1337. [PMID: 31732556 DOI: 10.3899/jrheum.190749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate whether trabecular bone loss is longitudinally associated with disease activity measures in patientswith axial spondyloarthritis (axSpA). METHODS Data from patients enrolled in the Incheon Saint Mary's axSpA prospective observational cohort were evaluated. Trabecular bone loss was assessed using the trabecular bone score (TBS). The relationship between TBS and disease activity measures [Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)] was investigated using generalized estimating equation (GEE) models. RESULTS Four-year followup data from 240 patients (80% males, mean age 37 ± 12 yrs) were evaluated. At baseline, higher disease activity according to ASDAS-ESR and ASDAS-CRP showed a trend toward lower TBS (p = 0.003 and p = 0.016, respectively). Univariate GEE analyses showed a significant association between TBS and disease activity measures over time, with the exception of BASDAI. Univariate analysis showed a longitudinal association between TBS and age, smoking, and spinal structural damage. In multivariate GEE analysis, ASDAS-ESR, ASDAS-CRP, ESR, and CRP were longitudinally associated with TBS after adjustment for confounding factors. ASDAS scores and inflammatory markers were longitudinally associated with TBS in patients with ankylosing spondylitis (AS; 79%), but not in patients with nonradiographic axSpA (nr-axSpA). BASDAI scores showed no relationship with TBS in either the AS or nr-axSpA groups. CONCLUSION Trabecular bone loss in patients with axSpA, assessed using the TBS, showed a longitudinal association with ASDAS scores and inflammatory markers.
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Affiliation(s)
- Kwi Young Kang
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,K.Y. Kang, MD, PhD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Ju, College of Medicine, The Catholic University of Korea, St. Mary's Hospital; S.H. Park, Seoul St. Mary's Hospital; Y.S. Hong, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Ji Hyeon Ju
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,K.Y. Kang, MD, PhD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Ju, College of Medicine, The Catholic University of Korea, St. Mary's Hospital; S.H. Park, Seoul St. Mary's Hospital; Y.S. Hong, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,K.Y. Kang, MD, PhD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Ju, College of Medicine, The Catholic University of Korea, St. Mary's Hospital; S.H. Park, Seoul St. Mary's Hospital; Y.S. Hong, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,K.Y. Kang, MD, PhD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Ju, College of Medicine, The Catholic University of Korea, St. Mary's Hospital; S.H. Park, Seoul St. Mary's Hospital; Y.S. Hong, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Jung YE, Kang KY. Elevated hs-CRP level is associated with depression in younger adults: Results from the Korean National Health and Nutrition Examination Survey (KNHANES 2016). Psychoneuroendocrinology 2019; 109:104397. [PMID: 31377557 DOI: 10.1016/j.psyneuen.2019.104397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Reports on the association between the level of circulating high-sensitivity C-reactive protein (hs-CRP) and depression have been inconsistent. The aim of this study was to examine the association between hs-CRP and depression in a large sample. METHODS This study used data obtained from a representative Korean sample of 5447 people who participated in the first (2016) year of the seventh Korean National Health and Nutrition Examination Survey (KNHNES VII-1). Depression was identified using a cutoff of 5 on the Patient Health Questionnaire-9 (PHQ-9), and high hs-CPR level was defined as ≥ 3.0 mg/L. FINDINGS Participants with a high CRP levels had a significantly higher rate of depression than did those with a low hs-CRP levels (25.1% vs. 19.8%, p = 0.007). Serum hs-CRP was independently associated with the PHQ-9 total score after adjusting for potentially confounding factors (B = 0.014; 95% CI = 0.008-0.020). After controlling for body mass index (BMI), smoking, alcohol use problems, hypertension, diabetes, dyslipidemia, chronic illness related hs-CRP, and metabolic syndrome. Furthermore, elevated hs-CRP level was significantly associated with an increased risk of depression (adjusted OR = 1.44; 95% CI = 1.01-2.07) in younger adults, but no significant association was observed among older adults. CONCLUSION These findings suggest a significant correlation between high hs-CRP levels and depression in younger adults. Further studies are necessary to investigate the age-specific association and the biological mechanism involved.
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Affiliation(s)
- Young-Eun Jung
- Department of Psychiatry, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon, Republic of Korea.
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Yoon HE, Kim Y, Shin SJ, Hong YS, Kang KY. Factors associated with low trabecular bone scores in patients with end-stage kidney disease. J Bone Miner Metab 2019; 37:475-483. [PMID: 29956021 DOI: 10.1007/s00774-018-0938-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/23/2018] [Indexed: 12/30/2022]
Abstract
The trabecular bone score (TBS) is a textural index that indirectly assesses bone trabecular microarchitecture using lumbar spine images obtained by dual-energy X-ray absorptiometry (DXA). This study compared the TBS of patients with end-stage kidney disease (ESKD) with that of matched controls to identify risk factors associated with a low TBS. TBS and bone mineral density (BMD) were assessed in ESKD patients (n = 76) and age- and sex-matched control subjects (n = 76) using DXA. The TBS of both groups was then compared, and risk factors associated with a low TBS (defined as ≤ 1.31) were evaluated. The mean TBS in the ESKD group was significantly lower than that in the control group (1.34 ± 0.15 vs. 1.43 ± 0.08, respectively; p < 0.001). More subjects in the ESKD group had a low TBS [34.2% (ESRD) vs. 5.3% (controls); p < 0.001]. The TBS was negatively correlated with age, alkaline phosphatase and C-reactive protein levels, and dialysis vintage, and positively correlated with BMD at the lumbar spine, femoral neck, and hip. Multivariate analysis identified lower estimated glomerular filtration rate and increased C-reactive protein levels as being significantly associated with a low TBS. In conclusion, ESKD patients had abnormal bone microarchitecture (as assessed by the TBS). The TBS was positively correlated with BMD. Renal function and inflammatory marker levels were independently associated with a low TBS. Thus, TBS may be a useful clinical tool for assessing cancellous bone connectivity in ESKD patients.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Yaeni Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Yeon Sik Hong
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea.
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Lee J, Hong YS, Park SH, Kang KY. High serum uric acid level is associated with greater handgrip strength in the aged population. Arthritis Res Ther 2019; 21:73. [PMID: 30867037 PMCID: PMC6417193 DOI: 10.1186/s13075-019-1858-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of serum UA level with muscle strength assessed by handgrip strength (HGS) in a large Korean adult population. METHODS Cross-sectional data were obtained from the seventh Korea National Health and Nutrition Examination Survey (KNHANES) 2016. The KNHANES 2016 study included 8150 subjects, of whom 4230 subjects were analyzed in this study. The association between serum UA level and HGS was investigated with adjustment for confounding factors. RESULTS Serum UA was divided into sex-specific tertiles After adjustment for potential confounding factors, HGS was significantly greater in the high serum UA group (the third tertile) than in the low UA group (the first tertile) in the elderly (age ≥ 60 years) population (coefficient β [95% confidence interval (CI)] = 1.017 [0.115-1.920]). When the elderly population was subdivided according to the presence of metabolic syndrome (metS), the impact of UA remained significant only in individuals with metS. In the aged population, high serum UA level reduced the risk for low HGS (OR, 95% CI = 0.69, 0.48-0.98, p = 0.041) only in male subjects. CONCLUSIONS A population-based cross-sectional survey in Korea revealed that high serum UA level is associated with increased HGS in the aged population. The antioxidant property of UA may enhance muscle strength, especially in the elderly population.
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Affiliation(s)
- Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea.
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Kim HR, Hong YS, Park SH, Ju JH, Kang KY. Low bone mineral density predicts the formation of new syndesmophytes in patients with axial spondyloarthritis. Arthritis Res Ther 2018; 20:231. [PMID: 30326956 PMCID: PMC6235222 DOI: 10.1186/s13075-018-1731-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
Background This study aimed to investigate whether the presence of low bone mineral density (BMD) in patients with axial spondyloarthritis (axSpA) predicts formation of new syndesmophytes over 2 years. Methods One hundred and nineteen patients fulfilling the imaging arm of the Assessment of SpondyloArthritis International Society axSpA criteria were enrolled. All patients were under 50 years of age. The modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) was assessed by two trained readers blinded to the patients’ data. BMD (lumbar spine, femoral neck or total hip) at baseline was assessed using dual-energy absorptiometry. Low BMD was defined as Z score ≤ − 2.0. Spinal radiographic progression was defined as worsening of the mSASSS by ≥ 2 points over 2 years. Logistic regression analyses were performed to identify predictors associated with development of new syndesmophytes and spinal radiographic progression. Results At baseline, 19 (16%) patients had low BMD. New syndesmophytes had developed in 22 (21%) patients at 2-year follow-up. New syndesmophyte formation after 2 years occurred more in patients with low BMD than in those with normal BMD (p = 0.047). In the multivariable analysis, current smoking, existing syndesmophytes and low BMD at baseline were associated with spinal radiographic progression (OR (95% CI) 3.0 (1.1, 7.7), 4.6 (1.8, 11.8) and 3.6 (1.2, 11.2), respectively). The presence of syndesmophytes at baseline and low BMD were predictors of new syndesmophytes over the following 2 years (OR (95% CI) 5.5 (2.0, 15.2) and 3.6 (1.1, 11.8), respectively). Conclusions Low BMD and existing syndesmophytes at baseline were independently associated with the development of new syndesmophytes in young axSpA patients.
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Affiliation(s)
- Hyoung Rae Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea.
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Jung JY, Han SH, Hong YS, Park SH, Ju JH, Kang KY. Inflammation on spinal magnetic resonance imaging is associated with poor bone quality in patients with ankylosing spondylitis. Mod Rheumatol 2018; 29:829-835. [DOI: 10.1080/14397595.2018.1510877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul
| | - Seung Hee Han
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
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Choi S, Lee K, Jung H, Park N, Kang J, Nam KH, Kim EK, Ju JH, Kang KY. Kruppel-Like Factor 4 Positively Regulates Autoimmune Arthritis in Mouse Models and Rheumatoid Arthritis in Patients via Modulating Cell Survival and Inflammation Factors of Fibroblast-Like Synoviocyte. Front Immunol 2018; 9:1339. [PMID: 29997611 PMCID: PMC6030377 DOI: 10.3389/fimmu.2018.01339] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/29/2018] [Indexed: 01/23/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes mild to severe joint inflammation. During RA pathogenesis, fibroblast-like synoviocytes (FLS) acquire a tumor-like phenotype and mediate cartilage destruction both directly and indirectly by producing proinflammatory cytokines and matrix metalloproteinases (MMPs). Kruppel-like factor (KLF) 4, a member of the KLF family, plays significant roles in cell survival, proliferation, and differentiation. A recent study reported increased expression of KLF4 in synovial tissue from RA patients. However, its precise role in RA in different models, including mouse autoimmune disease models, remains unclear. In this study, we examined the role of KLF4 during development of autoimmune arthritis in mouse models. To do this, we used KLF4 knockout mice rendered by ribonucleic acid (RNA)-guided endonuclease (RGEN) and performed collagen antibody-induced arthritis (CAIA). We found that deletion of KLF4 reduces inflammation induced by CAIA. In addition, we assessed collagen-induced arthritis (CIA) in control mice and KLF4-overexpressing mice generated by a minicircle vector treatment. Severity of CIA in mice overexpressing KLF4 was greater than that in mice injected with control vector. Finally, we verified the inflammatory roles of KLF4 in CIA by treating Kenpaullone which is used as KLF4 inhibitor. Next, we focused on human/mouse FLS to discover the cellular process involved in RA pathogenesis including proliferation, apoptosis, and inflammation including MMPs. In FLS, KLF4 upregulated expression of mRNA encoding proinflammatory cytokines interleukin (IL)-1β and IL-6. KLF4 also regulated expression of matrix metallopeptidase 13 in the synovium. We found that blockade of KLF4 in FLS increased apoptosis and suppressed proliferation followed by downregulation of antiapoptotic factor BCL2. Our results indicate that KLF4 plays a crucial role in pathogenesis of inflammatory arthritis in vivo, by regulating apoptosis, MMP expression, and cytokine expression by FLS. Thus, KLF4 might be a novel transcription factor for generating RA by modulating cellular process of FLS.
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Affiliation(s)
- Seungjin Choi
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- School of Biological Sciences, Institute of Molecular Biology and Genetics, Seoul National University, Seoul, South Korea
- Department of Cancer Biomedical Science, Research Institute, National Cancer Center, Goyang, South Korea
| | - Kijun Lee
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyerin Jung
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Narae Park
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jaewoo Kang
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Hoan Nam
- Laboratory Animal Resource Center, Korea Research Institute of Bioscience & Biotechnology (KRIBB), Cheongju, South Korea
| | - Eun-Kyeong Kim
- Laboratory Animal Resource Center, Korea Research Institute of Bioscience & Biotechnology (KRIBB), Cheongju, South Korea
| | - Ji Hyeon Ju
- CiSTEM Laboratory, Catholic iPSC Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
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Moon SJ, Kang KY, Kwok SK, Ju JH, Hong YS, Park SH, Jeon CH, Choi ST, Song JS, Min JK. Differences in quality of life determinants according to the presence of fibromyalgia in middle-aged female patients with systemic lupus erythematosus: a multicenter, cross-sectional, single-ethnicity cohort. Int J Rheum Dis 2018; 21:1173-1184. [DOI: 10.1111/1756-185x.13320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Su-Jin Moon
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Kwi Young Kang
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Seung-Ki Kwok
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Ji Hyeon Ju
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Yeon-Sik Hong
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Chan Hong Jeon
- Division of Rheumatology; Department of Internal Medicine; Soonchunhyang University Bucheon Hospital; Bucheon Korea
| | - Sang Tae Choi
- Division of Rheumatology; Department of Internal Medicine; Chung-Ang University College of Medicine; Seoul Korea
| | - Jung-Soo Song
- Division of Rheumatology; Department of Internal Medicine; Chung-Ang University College of Medicine; Seoul Korea
| | - Jun-Ki Min
- Division of Rheumatology; Department of Internal Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
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Kang KY, Goo HY, Park SH, Hong YS. Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: a case-control study. Rheumatology (Oxford) 2018; 57:462-469. [PMID: 29471485 DOI: 10.1093/rheumatology/kex377] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 12/27/2022] Open
Abstract
Objectives To compare the trabecular bone score (TBS) between patients with axial spondyloarthritis (axSpA) and matched normal controls and identify risk factors associated with a low TBS. Methods TBS and BMD were assessed in the two groups (axSpA and control) using DXA. Osteoporosis risk factors and inflammatory markers were also assessed. Disease activity and radiographic progression in the sacroiliac joint and spine were evaluated in the axSpA group. Multivariate linear regression analysis was performed to identify risk factors associated with TBS. Results In the axSpA group, 248 subjects were enrolled; an equal number of age- and sex-matched subjects comprised the control group. The mean TBS was 1.43 (0.08) and 1.38 (0.12) in the control and axSpA groups, respectively (P < 0.001); BMD at the lumbar spine did not differ between the two groups. The TBS was negatively correlated with ESR and CRP levels in the axSpA group only (P < 0.001 and P = 0.007, respectively). Syndesmophytes in the axSpA group was associated with lower TBS (P < 0.001) but higher lumbar BMD (P = 0.021) vs controls. In the multivariate analyses, ESR, CRP and spinal radiographic progression were significantly associated with TBS. Conclusion TBS assessments revealed poor bone quality in patients with axSpA compared with the matched controls. In axSpA, systemic inflammatory markers were negatively correlated with TBS and spinal radiographic progression and inflammatory markers were independently correlated with low TBS. TBS may, therefore, be a useful clinical tool to identify the risk of osteoporosis in patients with axSpA.
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Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Hye Yeon Goo
- Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
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Kang KY, Kim IJ, Park SH, Hong YS. Associations between trabecular bone score and vertebral fractures in patients with axial spondyloarthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Incheon St Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
| | - In Je Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Incheon St Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
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Kang KY, Goo HY, Park SH, Hong YS. Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: a case-control study. Rheumatology (Oxford) 2018; 57:587. [PMID: 29088407 DOI: 10.1093/rheumatology/kex431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Hye Yeon Goo
- Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
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Kang KY, Chung MK, Kim HN, Hong YS, Ju JH, Park SH. Severity of Sacroiliitis and Erythrocyte Sedimentation Rate are Associated with a Low Trabecular Bone Score in Young Male Patients with Ankylosing Spondylitis. J Rheumatol 2018; 45:349-356. [DOI: 10.3899/jrheum.170079] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/25/2022]
Abstract
Objective.To examine factors related to a low trabecular bone score (TBS) and the association between TBS and vertebral fractures in patients with ankylosing spondylitis (AS).Methods.One hundred patients (all male, aged < 50 yrs) who fulfilled the modified New York criteria for the classification of AS were enrolled. The TBS and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry. Clinical variables, inflammatory markers, and the presence of vertebral fractures were also assessed. Sacroiliitis grade and spinal structural damage were measured using the modified New York criteria and the Stoke Ankylosing Spondylitis Spine Score (SASSS).Results.The mean TBS was 1.38 ± 0.13. The TBS showed a positive correlation with BMD at the lumbar spine, femoral neck, and total hip. TBS negatively correlated with SASSS, whereas BMD at the lumbar spine showed a positive correlation. A significant decrease in TBS values was observed in patients with spinal structural damage (p = 0.001). Univariate analysis identified disease duration, erythrocyte sedimentation rate (ESR), sacroiliitis grade, and SASSS as being associated with TBS. Multivariate analysis identified ESR and sacroiliitis grade as being independently associated with TBS (p = 0.006 and p < 0.001, respectively). Ten patients had morphometric vertebral fractures. The mean TBS was lower in patients with vertebral fractures than in age-matched patients without fractures (p = 0.028). Lower TBS predicted vertebral fractures (area under curve = 0.733, cutoff = 1.311).Conclusion.The TBS in young male patients with AS is associated with the ESR and severity of sacroiliitis. The TBS may be useful as a tool for assessing osteoporosis in AS.
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Kim IJ, Kang KY. Low Skeletal Muscle Mass is Associated with the Risk of Low Bone Mineral Density in Urban Dwelling Premenopausal Women. Calcif Tissue Int 2017; 101:581-592. [PMID: 28828511 DOI: 10.1007/s00223-017-0314-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022]
Abstract
To evaluate the relationship between skeletal muscle mass and bone mineral density (BMD) and to determine the association between low skeletal muscle mass and low BMD in urban dwelling young adults. This study was based on data from the 2008-2011 Korea National Health and Nutrition Examination Surveys. The subjects were 1702 20-49-year-old men and 2192 premenopausal women (age 20-55 years). BMD at the lumbar spine, femoral neck, and total hip and the appendicular skeletal muscle mass (ASM) were measured by dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was defined as weight-adjusted ASM. Mildly and severely low muscle skeletal mass were defined as SMI that was 1-2 and >2 standard deviations below the sex-specific mean ASM of young adults, respectively. Low BMD was defined as T score of less than -1.0 at the lumbar spine, femoral neck, and/or total hip. After adjusting for confounders, skeletal muscle mass was positively associated with BMD at the lumbar spine, femoral neck, and total hip in both men and women. Mildly and severely low skeletal muscle mass increased the risk of low BMD in premenopausal women [OR (95% CI) = 1.4 (1.1-1.9) and 2.4 (1.2-4.6), respectively] but not men. In women, low skeletal muscle mass independently was associated with the risk of low BMD at the femoral neck and total hip but not the lumbar spine. Skeletal muscle mass was independently associated with BMD in urban dwelling young men and women, but low skeletal muscle mass was associated with the risk of low BMD in premenopausal women only.
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Affiliation(s)
- In Je Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, #56, Dongsu-Ro, Bupyung-Gu, Incheon, South Korea.
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Kang KY, Jung JY, Hong YS, Ju JH, Park SH. Positive correlation between inflammation on sacroiliac joint MRI and serum C-terminal telopeptide of type-I collagen in ankylosing spondylitis but not in non-radiographic axial spondyloarthritis. Clin Exp Rheumatol 2017; 35:415-422. [PMID: 27974096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To identify the clinical disease activity scores and laboratory markers that best reflect magnetic resonance imaging (MRI)-determined sacroiliac joint (SIJ) inflammation in ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). METHODS This cross-sectional study included all consecutive patients who presented with axial spondyloarthritis in 2013-2015. All underwent SIJ MRI. The bone marrow oedema in the inflammatory lesions on MRI was scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Bone-specific alkaline phosphatase (BALP), serum C-terminal telopeptide of type-I collagen (sCTX-I), and inflammatory markers were measured. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) were assessed. The correlations between the MRI-determined SIJ inflammation scores and disease activity scores and laboratory variables were evaluated. RESULTS Of the 81 patients with axSpA, 45 had AS and 36 had nr-axSpA. The AS and nr-axSpA groups did not differ in terms of disease activity scores, physical functional index, or MRI-determined SIJ inflammation. Erythrocyte sedimentation rate, C-reactive protein, and ASDAS correlated with MRI inflammatory scores in nr-axSpA but not in AS. sCTX-I correlated with MRI-determined SIJ inflammatory scores in AS only. BASDAI and BALP levels did not associate with MRI inflammatory scores in either group. Multivariate analysis showed that sCTX-I associated independently with MRI inflammatory score in AS (β=17.047, p=0.038). CONCLUSIONS Inflammatory markers and ASDAS correlated with active sacroiliitis on MRI in nr-axSpA only. In AS, only sCTX-I correlated with active inflammation on SIJ MRI. sCTX-I may be useful as a marker of objective inflammation in AS.
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Affiliation(s)
- Kwi Young Kang
- Div. of Rheumatology, Dept. of Internal Medicine, College of Medicine, The Catholic University of Korea; and Div. of Rheumatology, Dept. of Internal Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon, Seoul, South Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- Div. of Rheumatology, Dept. of Internal Medicine, College of Medicine, The Catholic University of Korea; and Div. of Rheumatology, Dept. of Internal Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Lee JY, Yim HB, Kang KY, Lee NY. Associations between Intraocular Pressure and Systemic Parameters according to the KNHNES 2008-2011. J Korean Ophthalmol Soc 2017. [DOI: 10.3341/jkos.2017.58.4.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ji Young Lee
- Department of Ophthalmology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Bin Yim
- Department of Ophthalmology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Young Lee
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yoon HE, Nam Y, Kang E, Hwang HS, Shin SJ, Hong YS, Kang KY. Gender-Specific Associations between Low Skeletal Muscle Mass and Albuminuria in the Middle-Aged and Elderly Population. Int J Med Sci 2017; 14:1054-1064. [PMID: 29104458 PMCID: PMC5666535 DOI: 10.7150/ijms.20286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/24/2017] [Indexed: 12/21/2022] Open
Abstract
Objective This study assessed gender-specific associations between low muscle mass (LMM) and albuminuria. Methods Data from the Korea National Health and Nutrition Examination Survey 2011 were employed. The study consisted of 1,087 subjects (≥50 years old). Skeletal muscle index (SMI) was defined as the weight-adjusted appendicular skeletal muscle mass. Mild LMM and severe LMM were defined as SMI that were 1-2 and >2 standard deviations below the sex-specific mean appendicular skeletal muscle mass of young adults, respectively. Increased albuminuria was defined as albumin-to-creatinine ratio ≥30mg/g Results Men with mild and severe LMM were significantly more likely to have increased albuminuria (15.2% and 45.45%, respectively) than men with normal SMI (9.86%, P<0.0001), but not women. Severe LMM associated independently with increased albuminuria in men (OR=7.661, 95% CI=2.72-21.579) but not women. Severe LMM was an independent predictor of increased albuminuria in hypertensive males (OR=11.449, 95% CI=3.037-43.156), non-diabetic males (OR=8.782, 95% CI=3.046-25.322), and males without metabolic syndrome (MetS) (OR=8.183, 95% CI=1.539-43.156). This was not observed in males without hypertension, males with diabetes or MetS, and all female subgroups. Conclusion Severe LMM associated with increased albuminuria in men, especially those with hypertension and without diabetes or MetS.
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Affiliation(s)
- Hye Eun Yoon
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Yunju Nam
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Eunjin Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital
| | - Seok Joon Shin
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.,Department of Internal Medicine, Incheon St. Mary's Hospital
| | - Yeon Sik Hong
- Department of Internal Medicine, Incheon St. Mary's Hospital.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Kwi Young Kang
- Department of Internal Medicine, Incheon St. Mary's Hospital.,Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
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Kang KY, Kim IJ, Yoon MA, Hong YS, Park SH, Ju JH. Correction: Fat Metaplasia on Sacroiliac Joint Magnetic Resonance Imaging at Baseline Is Associated with Spinal Radiographic Progression in Patients with Axial Spondyloarthritis. PLoS One 2016; 11:e0151443. [PMID: 26954447 PMCID: PMC4782987 DOI: 10.1371/journal.pone.0151443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kim HN, Jung JY, Hong YS, Park SH, Kang KY. Severe bone marrow edema on sacroiliac joint MRI increases the risk of low BMD in patients with axial spondyloarthritis. Sci Rep 2016; 6:22158. [PMID: 26931505 PMCID: PMC4773924 DOI: 10.1038/srep22158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022] Open
Abstract
To determine the association between inflammatory and structural lesions on sacroiliac joint (SIJ) MRI and BMD and to identify risk factors for low BMD in patients with axial spondyloarthritis (axSpA). Seventy-six patients who fulfilled the ASAS axSpA criteria were enrolled. All underwent SIJ MRI and BMD measurement at the lumbar spine, femoral neck, and total hip. Inflammatory and structural lesions on SIJ MRI were scored. Laboratory tests and assessment of radiographic and disease activity were performed at the time of MRI. The association between SIJ MRI findings and BMD was evaluated. Among the 76 patients, 14 (18%) had low BMD. Patients with low BMD showed significantly higher bone marrow edema (BME) and deep BME scores on MRI than those with normal BMD (p < 0.047 and 0.007, respectively). Inflammatory lesions on SIJ MRI correlated with BMD at the femoral neck and total hip. Multivariate analysis identified the presence of deep BME on SIJ MRI, increased CRP, and sacroiliitis on X-ray as risk factors for low BMD (OR = 5.6, 14.6, and 2.5, respectively). The presence of deep BME on SIJ MRI, increased CRP levels, and severity of sacroiliitis on X-ray were independent risk factors for low BMD.
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Affiliation(s)
- Ha Neul Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
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Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Kang KY, Jung JY, Ju JH, Park SH, Hong YS. Platelet Indices Are Associated with Disease Activity Scores and the Severity of Sacroiliitis on Magnetic Resonance Imaging in Axial Spondyloarthritis Patients. J Rheum Dis 2016. [DOI: 10.4078/jrd.2016.23.5.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon-Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
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Kang KY, Her YH, Ju JH, Hong YS, Park SH. Radiographic progression is associated with increased cardiovascular risk in patients with axial spondyloarthritis. Mod Rheumatol 2015; 26:601-6. [DOI: 10.3109/14397595.2015.1119348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea and
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Youn Hee Her
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea and
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea and
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea and
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Kang KY, Lee SH, Jung SM, Park SH, Jung BH, Ju JH. Downregulation of Tryptophan-related Metabolomic Profile in Rheumatoid Arthritis Synovial Fluid. J Rheumatol 2015; 42:2003-11. [PMID: 26329338 DOI: 10.3899/jrheum.141505] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Synovial fluid (SF) is one of the most important materials that reflect the pathophysiological process of arthritis. A metabolomic and lipidomic study of SF was performed with the aim of identifying tentative diagnostic markers or therapeutic candidates for rheumatoid arthritis (RA). METHODS SF was aspirated from 10 patients with RA and 10 patients with osteoarthritis (OA). RA SF and OA SF were collected and analyzed by ultraperformance liquid chromatography quadruple time-of-flight mass spectrometry. Associations among clinical variables, laboratory results, and metabolic profiles were investigated. RESULTS The metabolic pathways for carnitine, tryptophan, phenylalanine, arachidonic acid, and glycophospholipid were significantly upregulated in OA SF. The metabolic pathways for taurine, cholesterol ester, and the β-oxidation of pristine acid, linolenic acid, and sphingolipid were activated more in RA SF than in OA SF. In particular, the tryptophan pathway, which comprises kynurenine, indoleacetic acid, indole acetaldehyde, and N'-formylkynurenine, was downregulated. Interestingly, the levels of tryptophan metabolites kynurenine and N'-formylkynurenine, which are involved in immune tolerance, were significantly lower in RA SF compared with OA SF (p < 0.05), but the opposite pattern was observed for erythrocyte sedimentation rate (p < 0.01) and the levels of C-reactive protein (CRP; p < 0.01), rheumatoid factor (p < 0.01), and anticyclic citrullinated peptide antibody (p < 0.05). Kynurenine concentration correlated inversely with CRP concentration in RA SF but not in OA SF (r -0.65, p < 0.05). CONCLUSION Advances in metabolomic techniques enabled us to delineate distinctive metabolic and lipidomic profiles in RA SF and OA SF. RA SF and OA SF showed distinct metabolic profiles.
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Affiliation(s)
- Kwi Young Kang
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Soo Hyun Lee
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Seung Min Jung
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Sung-Hwan Park
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Byung-Hwa Jung
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.
| | - Ji Hyeon Ju
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon; Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University, Chungnam; Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul; Division of Biological Chemistry, University of Science and Technology, Daejeon, South Korea.K.Y. Kang, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, The Catholic University of Korea; S.H. Lee, PhD, Department of Medical Records and Health Information Management, College of Nursing and Health, Kongju National University; S.M. Jung, MD; S.H. Park, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea; B.H. Jung, PhD, Molecular Recognition Research Center, Korea Institute of Science and Technology, Division of Biological Chemistry, University of Science and Technology; J.H. Ju, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.
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Kang KY, Kwok SK, Ju JH, Hong YS, Park SH. Assessment of fracture risk in patients with axial spondyloarthritis: a case–control study using the fifth Korean National Health and Nutrition Examination Survey (KNHANES V). Scand J Rheumatol 2015; 45:23-31. [DOI: 10.3109/03009742.2015.1039574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kang KY, Kim IJ, Yoon MA, Hong YS, Park SH, Ju JH. Fat Metaplasia on Sacroiliac Joint Magnetic Resonance Imaging at Baseline Is Associated with Spinal Radiographic Progression in Patients with Axial Spondyloarthritis. PLoS One 2015; 10:e0135206. [PMID: 26271099 PMCID: PMC4535979 DOI: 10.1371/journal.pone.0135206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/19/2015] [Indexed: 12/22/2022] Open
Abstract
Objective To study the relationship between inflammatory and structural lesions in the sacroiliac joints (SIJs) on MRI and spinal progression observed on conventional radiographs in patients with axial spondyloarthritis (axSpA). Methods One hundred and ten patients who fulfilled the ASAS axSpA criteria were enrolled. All underwent SIJ MRI at baseline and lumbar spine radiographs at baseline and after 2 years. Inflammatory and structural lesions on SIJ MRI were scored using the SPondyloArthritis Research Consortium of Canada (SPARCC) method. Spinal radiographs were scored using the Stoke AS Spinal Score (SASSS). Multivariate logistic regression analysis was performed to identify predictors of spinal progression. Results Among the 110 patients, 25 (23%) showed significant radiographic progression (change of SASSS≥2) over 2 years. There was no change in the SASSS over 2 years according to the type of inflammatory lesion. Patients with fat metaplasia or ankyloses on baseline MRI showed a significantly higher SASSS at 2 years than those without (p<0.001). According to univariate logistic regression analysis, age at diagnosis, HLA-B27 positivity, the presence of fat metaplasia, erosion, and ankyloses on SIJ MRI, increased baseline CRP levels, and the presence of syndesmophytes at baseline were associated with spinal progression over 2 years. Multivariate analysis identified syndesmophytes and severe fat metaplasia on baseline SIJ MRI as predictive of spinal radiographic progression (OR, 14.74 and 5.66, respectively). Conclusion Inflammatory lesions in the SIJs on baseline MRI were not associated with spinal radiographic progression. However, fat metaplasia at baseline was significantly associated with spinal progression after 2 years.
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Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Medical College, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - In Je Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Min A Yoon
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, Medical College, The Catholic University of Korea, Seoul, South Korea
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Medical College, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Medical College, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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Koh JH, Jung SM, Lee JJ, Kang KY, Kwok SK, Park SH, Ju JH. Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis. PLoS One 2015; 10:e0135409. [PMID: 26247204 PMCID: PMC4527732 DOI: 10.1371/journal.pone.0135409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 07/21/2015] [Indexed: 01/01/2023] Open
Abstract
Objective The relationship between mechanical stress and radiographic progression in rheumatoid arthritis (RA) is unclear. The assumption is that mechanical stress is greater in the dominant hand. Therefore, the aim of the present study was to compare the presence and progression of erosions and joint space narrowing (JSN) in the dominant and non-dominant hand. Methods Data from 194 patients recently diagnosed with seropositive RA, and with hand radiographs taken at the time of diagnosis and at 2-year follow-up, were analyzed retrospectively. Radiographs were scored using the van der Heijde-modified Sharp Score (HSS) method. Each joint group within each hand was rated separately by two independent examiners in a double-blinded manner. Results One hundred and ninety-four patients were enrolled (80% female, 88% positive rheumatoid factor, 92% positive anti-citrullinated protein antibody, and 95.4% right-handed). The baseline, follow-up erosion and JSN HSS were significantly higher in the dominant hand than in the non-dominant hand. The annual rate of radiographic progression was also higher in the dominant hand. The erosive progression in the wrist joints varied significantly according to handedness, but the erosion in the proximal interphalangeal joints and metacarpophalangeal joints was similar in both hands. The radiographic progression was associated with the dominant hand, an abnormal baseline C-reactive protein level, and joint damage at baseline. There was no significant difference in bone mineral density between the right and left hands. Conclusion Radiological damage was worse and progressed faster in the dominant hand, suggesting that mechanical stress is associated with radiographic joint damage in early and active RA.
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Affiliation(s)
- Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- * E-mail:
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Kang KY, Jeon CH, Choi SJ, Yoon BY, Choi CB, Lee CH, Suh CH, Lee CW, Cho CS, Nam EJ, Koh EM, Kim HY, Choi HJ, Kim HA, Jun JB, Lee J, Kim J, Ji JD, Min JK, Kim KJ, Shin K, So MW, Kwon SR, Kim SK, Nah SS, Kwok SK, Lee SK, Lee SW, Park SH, Park W, Park YB, Lee YH, Lee SS, Yoo DH. Survival and prognostic factors in patients with connective tissue disease-associated pulmonary hypertension diagnosed by echocardiography: results from a Korean nationwide registry. Int J Rheum Dis 2015. [PMID: 26214170 DOI: 10.1111/1756-185x.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is a major cause of mortality in connective tissue disease (CTD). The survival rates and mortality-predictive factors of a nationwide registry of Korean patients with CTD-PH measured by echocardiography were determined. METHODS Patients with CTD-PH were enrolled between April 2008 and December 2012. Hemodynamic parameters and clinical data (WHO-functional class [FC], organ involvement, laboratory tests and treatment agents) were recorded. Survival rates were calculated by using the Kaplan-Meier method. Mortality-associated factors were examined by Cox proportional hazards regression analysis. RESULTS In total, 174 incident PH cases (61 with systemic lupus erythematosus, 50 with systemic sclerosis, 10 with mixed CTD, 22 with rheumatoid arthritis (RA) and 31 with other CTDs) were diagnosed by Doppler echocardiography. Of these, 25 (14%) died during the 3.8 ± 2.7 year follow-up period after PH diagnosis. The 1- and 3-year survival rates were 90.7% and 87.3%, respectively. Compared to the other CTD-PHs, RA-PH had the lowest survival rates (56% 3 year survival; P = 0.022). Multiple regression analysis revealed that low diffusion capacity of carbon monoxide (DLCO), pleural effusion and diabetes mellitus were poor prognostic factors (P = 0.008, 0.04 and 0.009, respectively). Anti-UI-RNP (ribonucleoprotein) antibody positivity was protective (P = 0.022). In patients with WHO-FC III/IV, patients who received vasodilators had lower mortality than those who did not (P = 0.038). CONCLUSIONS In Korean patients with CTD-PH, the 3-year survival rate was 87%. Low diffusion capacity of carbon monoxide (DLCO), pleural effusion and diabetes mellitus were independent poor prognostic factors. Anti-UI-RNP antibody was protective. Prompt PAH-specific vasodilator therapy may improve the survival of patients with severe CTD-PH.
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Affiliation(s)
- Kwi Young Kang
- Department of Internal Medicine, Incheon Saint Mary's Hospital, Catholic University of Korea, Incheon, Korea
| | - Chan Hong Jeon
- Department of Internal Medicine, Hospital Bucheon, Soonchunhyang University, Bucheon, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Bo Young Yoon
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Chan-Bum Choi
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Hoon Lee
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Choong Won Lee
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea
| | - Chul Soo Cho
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eon Jeong Nam
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eun-Mi Koh
- Department of Internal Medicine, Sungkyunkwan University, Seoul, Korea
| | - Ho-Youn Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jaejoon Lee
- Department of Internal Medicine, Sungkyunkwan University, Seoul, Korea
| | - Jinseok Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Jun Ki Min
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Jo Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kichul Shin
- Department of Internal Medicine, Borame Hospital, Seoul National University, Seoul, Korea
| | - Min Wook So
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Ryul Kwon
- Departments of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seong-Kyu Kim
- Department of Internal Medicine, Catholic University of Daegu, Daegu, Korea
| | - Seong-Su Nah
- Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo-Kon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Won Lee
- Department of Internal Medicine, College of Medicine, Dong-A University, Pusan, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Park
- Departments of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yong-Beom Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School, Kwangju, Korea
| | - Dae Hyun Yoo
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Kang KY, Hong YS, Park SH, Ju JH. Low levels of serum uric Acid increase the risk of low bone mineral density in young male patients with ankylosing spondylitis. J Rheumatol 2015; 42:968-74. [PMID: 25834199 DOI: 10.3899/jrheum.140850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Uric acid (UA) has antiosteoporotic effects in postmenopausal women. This study investigated the association between serum UA levels and bone mineral density (BMD) in young male patients with ankylosing spondylitis (AS). METHODS One hundred fifty patients who fulfilled the modified New York criteria for the classification of AS were analyzed. All patients were male and under 50 years of age. BMD, serum UA concentrations, clinical variables, and radiographic progression were assessed. The associations between UA and BMD at the lumbar spine and hip were evaluated using multiple linear regression analysis. Multivariate logistic regression analyses were performed to identify risk factors associated with low BMD. RESULTS Mean serum UA concentration in the 150 patients with AS was 5.5 ± 1.3 mg/dl. BMD at the lumbar spine, but not at the total hip and femoral neck, increased with increasing serum UA tertiles (p = 0.033). The significant positive association between serum UA and BMD at the lumbar spine remained after adjustment for confounding factors (β = 0.185, p = 0.014, adjusted R(2) = 0.310). Multiple logistic regression analyses showed that lower UA concentrations (OR 4.02, 95% CI 1.34-12.3) and body mass index and increased erythrocyte sedimentation rate were independently associated with the risk of low BMD. CONCLUSION Lower serum UA levels are associated with lower BMD in young male patients with AS. UA may be a novel predictive marker or therapeutic target in patients with AS.
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Affiliation(s)
- Kwi Young Kang
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; and the Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, Incheon, South Korea.K.Y. Kang, MD, PhD; Y.S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital; S.H. Park, MD, PhD; J.H. Ju, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Yeon Sik Hong
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; and the Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, Incheon, South Korea.K.Y. Kang, MD, PhD; Y.S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital; S.H. Park, MD, PhD; J.H. Ju, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Sung-Hwan Park
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; and the Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, Incheon, South Korea.K.Y. Kang, MD, PhD; Y.S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital; S.H. Park, MD, PhD; J.H. Ju, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
| | - Ji Hyeon Ju
- From the Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; and the Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital, Incheon, South Korea.K.Y. Kang, MD, PhD; Y.S. Hong, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, and Division of Rheumatology, Department of Internal Medicine, College of Medicine, Incheon Saint Mary's Hospital; S.H. Park, MD, PhD; J.H. Ju, MD, PhD, Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea.
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Min HK, Lee JH, Jung SM, Lee J, Kang KY, Kwok SK, Ju JH, Park KS, Park SH. Pulmonary hypertension in systemic lupus erythematosus: an independent predictor of patient survival. Korean J Intern Med 2015; 30:232-41. [PMID: 25750566 PMCID: PMC4351331 DOI: 10.3904/kjim.2015.30.2.232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We investigated whether transthoracic echocardiography-suspected pulmonary hypertension (PH) affects survival in systemic lupus erythematosus (SLE) patients and examined factors associated with PH occurrence and survival. METHODS This retrospective single-center study included 154 Korean SLE patients fulfilling the American College of Rheumatology criteria (January 1995 to June 2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-rank tests were used for comparisons. RESULTS A total of 35 SLE patients with PH (SLE/PH+) and 119 without PH (SLE/PH-) were analyzed. Higher percentages of interstitial lung disease, Raynaud's phenomenon (RP), World Health Organization functional classification III/IV, and cardiomegaly were found in SLE/PH+ compared to SLE/PH-. Furthermore, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was significantly higher in SLE/PH+ (2.46 ± 1.245 vs. 1.00 ± 1.235), whereas survival rates were significantly higher in SLE/PH- in log-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazard ratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated a higher percentage of lupus nephritis in the SLE/PH+ patients who died (p = 0.039) and low complement-3 levels (p = 0.007). In univariate analysis, the mortality HR for SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RP decreased the mortality risk in multivariate analysis; adjusted HR, 0.10. CONCLUSIONS PH is an independent factor predicting survival in SLE patients. The presence of lupus nephritis resulted in an increased trend for mortality, whereas coexistence of RP was associated with a better survival prognosis in SLE/PH+ patients.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kang KY, Kwok SK, Ju JH, Park KS, Park SH, Hong YS. The predictors of development of new syndesmophytes in female patients with ankylosing spondylitis. Scand J Rheumatol 2014; 44:125-8. [DOI: 10.3109/03009742.2014.938693] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kang KY, Kim IJ, Jung SM, Kwok SK, Ju JH, Park KS, Hong YS, Park SH. Incidence and predictors of morphometric vertebral fractures in patients with ankylosing spondylitis. Arthritis Res Ther 2014; 16:R124. [PMID: 24935156 PMCID: PMC4095597 DOI: 10.1186/ar4581] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/02/2014] [Indexed: 01/22/2023] Open
Abstract
Introduction Ankylosing spondylitis (AS) is associated with an increased incidence of vertebral fractures (VFs); however the actual incidence and predictors of morphometric VFs are unknown. The present study examined the incidence and predictors of new VFs in a large AS cohort. Methods In total, 298 AS patients who fulfilled the modified New York criteria were enrolled and spinal radiographs were evaluated biennially. Clinical and laboratory data and radiographic progression were assessed according to the Bath AS Disease Activity Index, erythrocyte sedimentation rate, C-reactive protein (CRP), and the Stoke AS spine score (SASSS). VF was defined according to the Genant criteria. The incidence of VFs at 2 and 4 years was evaluated using the Kaplan-Meier method. The age-specific standardized prevalence ratio (SPR) for AS patients in comparison with the general population was calculated. Results Of 298 patients, 31 (10.8%) had previous VFs at baseline. A total of 30 new VFs occurred in 26 patients over 4 years. The incidence of morphometric VFs was 4.7% at 2 years and 13.6% at 4 years. Multivariate logistic regression analysis showed that previous VFs at baseline and increased CRP levels at 2 years were predictors of new VFs (odds ratio (OR) =12.8, 95% confidence interval (CI) = 3.6-45.3 and OR = 5.4, 95% CI = 1.4–15.9). The age-specific specific standardized prevalence ratio of morphometric VFs in AS was 3.3 (95% CI 2.1–4.5). Conclusions The incidence of morphometric VFs increased in AS. Previous VFs and increased CRP levels predicted future VFs. Further studies are needed to identify the effects of treatment interventions on the prevention of new VFs.
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Ju JH, Yoon SH, Kang KY, Kim IJ, Kwok SK, Park SH, Kim HY, Lee WC, Cho CS. Prevalence of systemic lupus erythematosus in South Korea: an administrative database study. J Epidemiol 2014; 24:295-303. [PMID: 24857955 PMCID: PMC4074634 DOI: 10.2188/jea.je20120204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a rare autoimmune disease for which a population-based survey on the prevalence of the disease in South Korea has not yet been conducted. Our goal was to estimate the nationwide prevalence of SLE. Methods The International Classification of Diseases, Tenth Revision (ICD-10) code for SLE diagnosis—M32—was tentatively given when patients were suspected to have SLE before 2009. As such, the positive predictive value (PPV) of the M32 code shown in medical bills reflecting true SLE was uncertain. We attempted to estimate the prevalence of SLE in South Korea using national administrative database data from 2004–2006. We approximated the actual number of SLE patients by analyzing a list of SLE-coded patients provided by the National Health Insurance (NHI) and Health Insurance Review and Assessment Service. Prevalence was estimated by multiplying the PPV of the M32 diagnostic code by the number of patients receiving the code. The PPV was determined by three methods: direct investigation of the medical records of patients randomly selected from the SLE-coded patients list; assessment of all SLE patients treated at 56 selected hospitals in South Korea; and extrapolation from sub-groups at a single institute to the sub-groups of the national NHI data. Results The estimated number of national SLE cases was between 9000 and 11 000, depending on the method of ascertainment, corresponding to a prevalence of 18.8–21.7 per 100 000 people. Conclusions This is the first report of a nationwide prevalence survey of SLE in South Korea. National databases may serve as a resource for epidemiologic studies of rare autoimmune diseases like SLE.
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Affiliation(s)
- Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
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Kim HH, Kim JY, Kim SJ, Park ES, Shin SJ, Kang KY, Hong YS, Yoon HE. Overflow proteinuria as a manifestation of unrecognized polymyositis. Int Med Case Rep J 2014; 7:71-4. [PMID: 24729735 PMCID: PMC3979789 DOI: 10.2147/imcrj.s60885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Polymyositis is a rare and gradually progressive autoimmune disease of skeletal muscle. Two main types of renal involvement have been described: acute tubular necrosis related to rhabdomyolysis and glomerulonephritis. However, cases of overflow proteinuria related to polymyositis have rarely been reported. Herein, we report a case of a 41-year-old male who presented with edema of both lower extremities. Laboratory studies revealed elevated creatine phosphokinase level, hypoalbuminemia, and a moderate amount of proteinuria, although albuminuria was not dominant. Urine electrophoresis showed an abnormally restricted zone in the β-fraction, which suggested overflow proteinuria of non-glomerular origin. Despite intravenous hydration, his serum creatine phosphokinase level did not decrease and his symptoms did not improve. Electromyography showed myopathy, and muscle biopsy revealed findings consistent with polymyositis. After corticosteroid therapy, his creatine phosphokinase level and proteinuria decreased and his clinical symptoms improved. This case demonstrates an atypical presentation of polymyositis manifested by overflow proteinuria.
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Affiliation(s)
- Hyun Ho Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Jae Young Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Sung Jun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea ; Division of Nephrology, Department of Internal Medicine, Incheon St Mary's Hospital, Republic of Korea
| | - Eun Su Park
- Department of Pathology, Incheon St Mary's Hospital, Republic of Korea
| | - Seok Joon Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea ; Division of Nephrology, Department of Internal Medicine, Incheon St Mary's Hospital, Republic of Korea
| | - Kwi Young Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea ; Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, Incheon, Republic of Korea
| | - Yeon Sik Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea ; Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, Incheon, Republic of Korea
| | - Hye Eun Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Republic of Korea ; Division of Nephrology, Department of Internal Medicine, Incheon St Mary's Hospital, Republic of Korea
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