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매일 고통과 함께 눈을 뜨는 아침도,
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Bravo your well Life, Enbrel
엔브렐Ⓡ 제품설명서 전문의약품[원료약물의 분량] 프리필드시린지 중 에타너셉트 25㎎, 50㎎ [주성분] 에타너셉트(TNFR : Fc) [성상] 무색투명 또는 유백색내지 연한 황색의 액이 충진된 프리필드시린지 [효능·효과] •성인 : 1. 류마티스관절염 - 메토트렉세이트를 포함한 DMARDs (Disease-Modifying anti Rheumatic Drugs)에 반응이 적절하지 않은 중등도에서 중증의 성인 활동성 류마티스관절염에 단독 또는 메토트렉세이트와 병용투여. - 메토트렉세이트에 내약성이 없거나, 메토트렉세이트 치료를 지속하기 부적절한 경우 단독투여. - 이전에 메토트렉세이트로 치료받지 않은 중증의 활동성 및 진행성 류마티스관절염. – 류마티스관절염 환자에 단독 또는 메토트렉 세이트와의 병용투여시, X선으로 측정했을 때 질환과 관련된 구조적 손상 진행의 지연. 2. 건선성 관절염 - 이전에 DMARDs (Disease-Modifying anti Rheumatic Drugs)에 대한 반응이 적절하지 않은 활동성 및 진행성 건선성 관절염. 3. 축성 척추관절염 - 강직성 척추염 : 기존 치료에 대한 반응이 적절하지 않은 중증의 강직성 척추염. - 방사선상으로 확인되지 않는 축성척추관절염 : 방사선상으로 확인되지 않으나, CRP 상승 및/또는 MRI와 같은 객관적인 염증 징후를 보이는 중증 축성 척추관절염. 비스테로이드성 항염증 약물(NSAIDs)에 반응이 적절하지 않은 환자에게 사용. 4. 건선 – 싸이클로스포린, 메토트렉세이트 또는 PUVA를 포함한 전신 치료요법에 대해 반응이 없거나 금기이거나 내약성이 없는 중등도 또는 중증의 건선. • 소아 : 1. 소아 특발성 관절염 - 메토트렉세이트에 대한 반응이 적절하지 않거나 또는 내약성이 없는 2세 이상의 소아 및 청소년의 다수 관절염 (류마티스 인자 양성 또는 음성) 및 확장성 소수 관절염(Extended Oligoarthritis)- 메토트렉세이트에 대한 반응이 적절하지 않거나 또는 내약성이 없는 12세 이상의 청소년의 건선성 관절염 - 기존 치료요법에 반응이 적절하지 않거나 내약성이 없는 12세 이상의 청소년의 골부착부위염 관련 관절염 [용법·용량] ○ 성인(18세 이상): 1. 류마티스관절염, 건선성 관절염, 강직성 척추염 : 1회 25 mg을 주 2회 피하주사 하거나 1회 50 mg을 주 1회 피하주사한다. 2. 건선 : 1회 25㎎을 주 2회 피하 주사 하거나 1회 50㎎을 주 1회 피하주사한다. 또는, 1회 50㎎을 주 2회 12주까지 피하주사하고, 필요한 경우 그 이후에 1회 25㎎을 주 2회 피하주사하거나 1회 50 mg을 주 1회 피하주사한다. 이 약의 투여는 건선이 없어질 때까지(최대 24주까지) 계속되어야 한다. 일부 성인 환자에 있어, 24주 이상의 지속 치료가 적절할 수 있다. 12주 후에도 아무런 반응이 없는 환자의 경우에는 투약을 중단해야 한다. 이 약의 재투여가 필요한 경우, 투여기간에 대한 위의 지침을 따라야 하며, 1회 25 mg을 주 2회 피하주사하거나 1회 50 mg을 주 1회 피하주사한다. 환자는 의사의 판단과 개별 환자의 필요에 따라 연속적 또는 간헐적으로 치료받을 수 있다. 간헐적 치료 시, 최초 주기 이후 치료 주기에는 1회 25 mg을 주 2회 피하주사 하거나 1회 50㎎을 주 1회 피하 주사한다. ○ 소아 : 소아 환자에서 이 약의 투여 용량은 체중을 기준으로 한다. 체중이 62.5 kg 미만인 환자는 엔브렐주사 25 ㎎ /mL 제제를 사용하여 정확하게 ㎏당 투여용량(㎎ )을 투여해야만 한다. 체중이 62.5 kg 이상의 환자는 정해진 용량의 프리필드시린지를 사용할 수 있다. 1. 소아 특발성 관절염(2세-17세) : 1회 kg 당 0.4 mg (1회 최대 25㎎ 까지)을 주 2회(3-4일 간격으로) 피하주사하거나 1회 ㎏ 당 0.8 ㎎ (1회 최대 50 mg까지)을 주 1회 피하주사한다. 4개월 후에도 아무런 반응이 없는 환자의 경우에는 투약을 중단해야 한다. [사용상의 주의사항] 1. 경고 1)감염 : 이 약 사용으로 심각한 감염증, 패혈증, 결핵 및 다른 기회감염증이 보고되었다. 감염증 중 일부는 치명적이었다. 이는 박테리아, 미코박테리아, 진균, 바이러스 및 프로토조아를 포함한 기생충에 의한 것이었다. 2) 결핵 : 이 약을 포함하여 TNF 저해제를 투여제 받는 환자에서 파종성(속립) 결핵 및 폐외결핵(폐막, 림프절 등)이 보고되었다. 3) 아나킨라(Anakinra)와의 병용치료: 이 약과 아나킨라(Anakinra)를 병용투여한 24주간의 임상시험에서 두 약물을 병용투여한 환자의 7%에서 중증의 감염이 나타났으며 이 약 단독투여군에서는 나타나지 않았다. 4) 신경계 이상: 이 약 및 다른 TNF 저해제 투여 시 드물게 중추신경계(CNS) 탈수초성 질환의 발생 및 악화가 나타날 수 있으며 일부에서는 정신적 상태의 변화를 나타내었고 일부에서는 영구적인 불구가 나타났다. 5) 혈액학적 이상반응: 이 약을 투여 받은 환자에서 재생불량성 빈혈이 매우 드물게, 범혈구감소증은 드물게 보고되었다. 6) 악성 종양 및 림프구 증식질환: - 고형 및 조혈 악성종양(피부암 제외) : 이 약의 임상시험에서 대조군에 비해 TNF 저해제 투여군에서 더 많은 림프종이 발생하였다. – 피부암 : TNF 저해제를 사용한 환자들에게서 흑색종 및 비흑색종 피부암(NMSC)이 보고되었다. - 베게너씨 육아종증(Wegener's granulomatosis) : 180명의 베게너씨 육아종증 환자 대상 위약 대조 시험에서 89명이 표준요법(사이클로포스파미드, 메토트렉세이트, 고용량 스테로이드 포함)에 이 약을 추가하여 평균 25개월간 투여 받았으며, 위약을 투여 받은 환자보다 이 약을 투여 받은 환자에서 치료적 효과를 보여주지 못했다. 여러 가지 형태의 비 피부성 고형 악성종양의 발생빈도가 대조군보다 이 약을 투여 받은 환자군에서 높게 나타났다. 7) B형 간염 재활성화 : B형 간염 바이러스(HBV) 감염 기왕력이 있는 환자에서 이 약을 포함한 TNF 저해제 병용 투여시, B형 간염 바이러스 재활성화가 보고되었고, 일부는 치명적인 경우가 있었다. 8)울혈성 심부전 : 이 약을 투여받은 환자에서 확인할 수 있는 발생요인과 관계없이 울혈성 심부전을 악화시킨다는 보고가 시판 후 조사에서 보고되었다. 9) 주사기의 고무 마개는 라텍스(건조천연고무)를 함유하고 있으므로, 라텍스 과민성 또는 그 가능성이 있는 자가 다루거나 투여 받을 경우에는 과민반응을 유발할 수 있다. 2. 금기 1) 이 약 및 이 약 성분에 과민증 환자 2) 패혈증 또는 패혈증의 위험이 있는 환자 3) 결핵을 포함하여 만성 또는 국소 감염을 포함한 활성 감염이 있는 환자(이 약의 투여를 시작하지 않는다.) 3. 신중한 투여 1) 탈수초성 질환(다발성 경화증 등) 및 병력이 있는 환자 2) 울혈성 심부전 환자. 4. 유해사례 : 감염(상기도 감염, 기관지염, 방광염, 피부감염 포함), 주사부위 반응(홍반, 가려움, 통증, 종창, 출혈, 타박상 포함)이 임상시험에서 매우 흔하게(≥1/10) 보고되었다. 이 약과 위약을 비교하는 이중 눈가림 임상시험에서 주사부위 반응은 이 약 치료군에서 가장 흔한 유해사례였다. 제품설명서 개정년월일 : 2015. 08. 31
엔브렐은 타TNF* 제제와 비교 시 결핵 발생률이 가장 낮았습니다.2, a* Adalimumab, lnfliximab
엔브렐은 10여 년간의 축적된 임상 경험으로 지속적 효과와 우수한 내약성을 확인하였습니다.1
KENB-1510-05
[주요 안전성 정보] 엔브렐Ⓡ 투여 시 심각한 감염증, 패혈증, 결핵 및 다른 기회감염증이 보고되었습니다.3Study design a. 결핵 위험도가 중간인 지역에서 항 TNF 치료 후 결핵의 발생률, 약물과 질병 간 위험도를 비교하기 위해 실시된 연구. 한국의 건강보험심사평가원 데이터베이스를 이용하여 2005~2009년 TNF 억제제를 처방받은 환자 총 8,421명을 대상으로 함.
References 1. Weinblatt M, et al. Safety and efficacy of etanercept beyond 10 years of therapy in North American patients with early and longstanding rheumatoid arthritis. Arthritis Care Res 2011;63:373–382. 2. Jung SM, Ju JH, Park MS,et al. Risk of tuberculosis in patients treated with anti-tumor necrosis factor therapy: a nationwide study in South Korea, a country with an intermediatetuberculosis burden. Int J Rheum Dis. 2015 Mar;18(3):323-30. 3. 엔브렐(etanercept). 제품설명서. Pfizer Inc. Revised 26/1/2015.
Official Journal of Korean College of Rheumatology
Journal of Rheumatic Diseases
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Official Journal of Korean College of Rheumatology
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JOURNAL OF RHEUMATIC DISEASES
대한류마티스학회 임원명단
자문위원 김 기 용 (울산의대) 김 동 수 (연세의대) 김 동 집 (가톨릭의대)
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이 사 강 성 욱 (충남의대) 강 영 모 (경북의대) 공 현 식 (서울의대)
김 광 남 (한림의대) 김 진 석 (제주의대) 류 완 희 (전북의대)
민 준 기 (가톨릭의대) 박 시 복 (한양의대) 서 창 희 (아주의대)
이 영 호 (고려의대) 이 지 수 (이화의대) 이 창 근 (울산의대)
임 군 일 (동국의대) 정 원 태 (동아의대) 홍 승 재 (경희의대)
감 사 박 원 (인하의대) 배상철 (한양의대)
(가나다순)
pp
JOURNAL OF RHEUMATIC DISEASES
대한류마티스학회 위원회명단
총무이사 김 태 환 (한양의대)
총무위원 김 성 규 (대구가톨릭의대) 이 은 영 (서울의대) 최 성 재 (고려의대)
재무이사 이 상 헌 (건국의대)
재무위원 박 경 수 (가톨릭의대) 서 영 일 (한림의대) 주 지 현 (가톨릭의대)
편집이사 전 재 범 (한양의대)
편집간사 김 용 길 (울산의대)
편집위원 강 성 욱 (충남의대) 민 준 기 (가톨릭의대) 박 민 찬 (연세의대) 박 성 훈 (대구가톨릭의대)
박 용 욱 (전남의대) 이 영 호 (고려의대) 이 재 준 (성균관의대) 최 찬 범 (한양의대)
학술이사 차 훈 석 (성균관의대)
학술간사 곽 승 기 (가톨릭의대)
학술위원 문 영 완 (성균관의대) 박 민 찬 (연세의대) 성 윤 경 (한양의대) 이 명 수 (원광의대)
이 상 일 (경상의대) 이 윤 종 (서울의대) 이 창 근 (울산의대)
국제이사 김 완 욱 (가톨릭의대)
국제간사 김 인 제 (이화의대)
국제위원 김 기 조 (가톨릭의대) 김 성 수 (울산의대) 박 용 욱 (전남의대) 이 상 훈 (경희의대)
이 은 봉 (서울의대) 정 영 옥 (한림의대)
보험이사 김 현 아 (한림의대)
보험간사 윤 보 영 (인제의대) 홍 승 재 (경희의대)
보험위원 강 태 영 (연세대원주의대) 김 태 종 (전남의대) 김 현 숙 (순천향의대) 민 도 준 (민도준내과)
박 민 찬 (연세의대) 박 성 환 (가톨릭의대) 서 영 일 (한림의대) 심 승 철 (충남의대)
엄 완 식 (한양류마엄완식내과) 윤 종 현 (가톨릭의대) 이 성 원 (동아의대) 장 대 국 (장대국내과)
주 지 현 (가톨릭의대)
홍보이사 심 승 철 (충남의대)
홍보간사 최 찬 범 (한양의대)
홍보위원 강 은 하 (서울의대) 김 상 현 (계명의대) 박 경 수 (가톨릭의대) 박 동 진 (전남의대)
신 기 철 (서울의대) 이 명 수 (원광의대) 허 진 욱 (을지의대) 홍 승 재 (경희의대)
교육연구이사 유 빈 (울산의대)
교육연구간사 윤 종 현 (가톨릭의대)
교육연구위원 김 근 태 (고신의대) 김 상 현 (계명의대) 이 창 훈 (원광의대) 서 창 희 (아주의대)
송 정 수 (중앙의대) 이 상 일 (경상의대) 차 훈 석 (성균관의대)
임상연구이사 이 신 석 (전남의대)
임상연구간사 최 성 재 (고려의대)
임상연구위원 강 성 욱 (충남의대) 곽 승 기 (가톨릭의대) 김 성 규 (대구가톨릭의대) 김 현 아 (아주의대)
남 언 정 (경북의대) 박 용 범 (연세의대) 성 윤 경 (한양의대) 신 기 철 (서울의대)
이 재 준 (성균관의대) 이 창 훈 (원광의대) 전 찬 홍 (순천향의대)
정보이사 송 정 수 (중앙의대)
정보간사 권 성 렬 (인하의대)
정보위원 고 혁 재 (가톨릭의대) 김 성 수 (울산의대) 나 성 수 (순천향의대) 안 중 경 (성균관의대)
이 상 원 (연세의대) 이 승 근 (부산의대) 이 은 영 (서울의대) 이 창 근 (울산의대)
채 지 영 (분당제생병원) 최 상 태 (중앙의대) 허 진 욱 (을지의대)
의료정책이사 백 한 주 (가천의대)
의료정책간사 이 은 봉 (서울의대)
의료정책위원 김 건 우 (대구파티마병원) 문 기 원 (강원의대) 서 미 령 (가천의대) 성 윤 경 (한양의대)
유 종 진 (한림의대) 윤 종 현 (가톨릭의대) 이 지 수 (이화의대) 임 철 현 (국군수도병원)
(가나다순)
pp
JOURNAL OF RHEUMATIC DISEASES
List of Korean College of Rheumatology Executive Directors
Advisory Board Key-yong Kim (Univ. of Ulsan), Dong Soo Kim (Yonsei Univ.)
Dong-Jip Kim (Catholic Univ.), Mok-Hyun Kim (Hanyang Univ.)
Think-You Kim (Hanyang Univ.), Joong-Gon Kim (Seoul National Univ.)
Ho-Youn Kim (Ho Youn Kim’s Clinic), Myung-Sang Moon (Halla General Hosp.)
Hun-Ki Min (Seoul National Univ.), Byeong Mun Park (Gwangmyeong Seongae Hosp.)
Dae-Hyun Yoo (Hanyang Univ.), Myung-Chul Yoo (Kyung Hee Univ.)
Soo-Kon Lee (CHA Univ.), Yun-Woo Lee (Withus Medical Clinic)
Duke Whan Chung (Kyung Hee Univ.), Young Kil Choi (Kangnam CHA Hosp.)
Il-Yong Choi (Hanyang Univ.)
President Yeong-Wook Song (Seoul National Univ.)
Chairman of the Board Eun-Mi Koh (Sungkyunkwan Univ.)
Director of Planning Sung-Hwan Park (Catholic Univ.), Jung-Yoon Choe (Catholic Univ. of Daegu)
Executive Secretary Tae-Hwan Kim (Hanyang Univ.)
Director of Finance Sang-Heon Lee (Konkuk Univ.)
Director of Editorial Board Jae-Bum Jun (Hanyang Univ.)
Director of Academic Affairs Hoon-Suk Cha (Sungkyunkwan Univ.)
Director of International Cooperation Wan-Uk Kim (Catholic Univ.)
Director of Insurance Hyun Ah Kim (Hallym Univ.)
Director of Public Relation Seung-Cheol Shim (Chungnam National Univ.)
Director of Education & Research Bin Yoo (Univ. of Ulsan)
Director of Clinical Trials Shin-Seok Lee (Chonnam National Univ.)
Director of Medical Information Jung Soo Song (Chung-Ang Univ.)
Director of Health Policy Affairs Han-Joo Baek (Gachon Univ.)
Director at Large Young-Wan Moon (Sungkyunkwan Univ.), Young-Beom Park (Yonsei Univ.)
Gwan Gyu Song (Korea Univ.), Tae Seok You (YTS Rheumatology Clinic)
Eun Bong Lee (Seoul National Univ.)
Board Members Seong Wook Kang (Chungnam National Univ.), Young Mo Kang (Kyungpook National Univ.)
Hyun Sik Gong (Seoul National Univ.), Kwang-Nam Kim (Hallym Univ.)
Jinseok Kim (Jeju National Univ.), Wan-Hee Yoo (Chonbuk National Univ.)
Jun-ki Min (Catholic Univ.), Si-Bog Park (Hanyang Univ.)
Chang-Hee Suh (Ajou Univ.), Young-Ho Lee (Korea Univ.)
Jisoo Lee (Ewha Womans Univ.), Chang Keun Lee (Univ. of Ulsan)
Gun-Il Im (Dongguk Univ.), Won Tae Chung (Dong-A Univ.)
Seung-Jae Hong (Kyung Hee Univ.)
Auditor Won Park (Inha Univ.), Sang Cheol Bae (Hanyang Univ.)
pp
JOURNAL OF RHEUMATIC DISEASES
List of Korean College of Rheumatology Executive Directors
Executive Secretary Committee Tae-Hwan Kim (Hanyang Univ.) (Chairman)Seong-Kyu Kim (Catholic Univ. of Daegu), Eun Young Lee (Seoul National Univ.)Sung Jae Choi (Korea Univ.)
Finance Committee Sang-Heon Lee (Konkuk Univ.) (Chairman)Kyung-Su Park (Catholic Univ.), Young-Il Seo (Hallym Univ.)Ji Hyeon Ju (Catholic Univ.)
Editorial Committee Jae-Bum Jun (Hanyang Univ.) (Chairman)Yong-Gil Kim (Univ. of Ulsan) (Executive Secretary)Seong Wook Kang (Chungnam National Univ.), Jun-ki Min (Catholic Univ.)Min-Chan Park (Yonsei Univ.), Sung Hoon Park (Catholic Univ. of Daegu)Wong-Wook Park (Chonnam National Univ.), Young-Ho Lee (Korea Univ.)Jaejoon Lee (Sungkyunkwan Univ.), Chan-Bum Choi (Hanyang Univ.)
Academic Affairs Committee Hoon-Suk Cha (Sungkyunkwan Univ.) (Chairman)Seung-Ki Kwok (Catholic Univ.) (Executive Secretary)Young-Wan Moon (Sungkyunkwan Univ.), Min-Chan Park (Yonsei Univ.)Yoon-Kyoung Sung (Hanyang Univ.), Myeung Su Lee (Wonkwang Univ.)Sang-il Lee (Gyeongsang National Univ.), Yun-Jong Lee (Seoul National Univ.)Chang Keun Lee (Univ. of Ulsan)
International Cooperation Committee Wan-Uk Kim (Catholic Univ.) (Chairman)In Je Kim (Hallym Univ.) (Executive Secretary)Ki-Jo Kim (Catholic Univ.), Sung Soo Kim (Univ. of Ulsan)Wong-Wook Park (Chonnam National Univ.), Sang-Hoon Lee (Kyung Hee Univ.)Eun Bong Lee (Seoul National Univ.), Young-Ok Jung (Hallym Univ.)
Insurance Committee Hyun Ah Kim (Hallym Univ.) (Chairman)Bo-Young Yoon (Inje Univ.), Seung-Jae Hong (Kyung Hee Univ.) (Executive Secretary)Tae-Young Kang (Yonsei Univ., Wonju College of Medicine), Tae-Jong Kim (Chonnam National Univ.)Hyun-Sook Kim (Soonchunhyang Univ.), Do-June Min (Dr. Min Clinic)Min-Chan Park (Yonsei Univ.), Sung-Hwan Park (Catholic Univ.)Young-Il Seo (Hallym Univ.), Seung-Cheol Shin (Chungnam National Univ.)Wan-Sik Uhm (Uhm's Hanyang Rheumatism Clinic), Chong-Hyeon Yoon (Catholic Univ.)Sung Won Lee (Dong-A Univ.), Dae-Kook Chang (Dr. Chang's Rheumatism Clinic)Ji Hyeon Ju (Catholic Univ.)
Public Relation Committee Seung-Cheol Shim (Chungnam National Univ.) (Chairman)Chan-Bum Choi (Hanyang Univ.) (Executive Secretary)Eun Ha Kang (Seoul National Univ.), Sang-Hyun Kim (Keimyung Univ.)Kyung-Su Park (Catholic Univ.), Dong-Jin Park (Chonnam National Univ.)Kichul Shin (Seoul National Univ.), Myeung Su Lee (Wonkwang Univ.)Jin-Wuk Hur (Eulji Univ.), Seung-Jae Hong (Kyung Hee Univ.)
Education & Research Committee Bin Yoo (Univ. of Ulsan) (Chairman)Chong-Hyeon Yoon (Catholic Univ.) (Executive Secretary)Geun Tae Kim (Kosin Univ.), Sang-Hyon Kim (Keimyung Univ.)Chang Hoon Lee (Wonkwang Univ.), Chang-Hee Suh (Ajou Univ.)Jung-Soo Song (Chung-Ang Univ.), Sang-il Lee (Gyeongsang National Univ.)Hoon-Suk Cha (Sungkyunkwan Univ.)
Clinical Trials Committee Shin-Seok Lee (Chonnam National Univ.) (Chairman)Sung Jae Choi (Korea Univ.) (Executive Secretary)Seong Wook Kang (Chungnam National Univ.), Seung-Ki Kwok (Catholic Univ.)Seong-Kyu Kim (Catholic Univ. of Daegu), Hyoun-Ah Kim (Ajou Univ.)Eon Jeong Nam (Kyungpook National Univ.), Yong-Beom Park (Yonsei Univ.)Yoon-Kyoung Sung (Hanyang Univ.), Kichul Shin (Seoul National Univ.)Jaejoon Lee (Sungkyunkwan Univ.), Chang Hoon Lee (Wonkwang Univ.)Chan Hong Jeon (Soonchunhyang Univ.)
Medical Information Committee Jung Soo Song (Chung-Ang Univ.) (Chairman)Seong Ryul Kwon (Inha Univ.) (Executive Secretary)Hyeok-Jae Ko (Catholic Univ.), Sung Soo Kim (Univ. of Ulsan)Seong-Su Nah (Soonchunhyang Univ.), Joong Kyoung Ahn (Sungkyunkwan Univ.)Sang-Won Lee (Yonsei Univ.), Seung-Geun Lee (Pusan National Univ.)Eun Young Lee (Seoul National Univ.), Chang Keun Lee (Univ. of Ulsan)Ji Young Chai (Bundang Jasang General Hosp.), Sang Tae Choi (Chung-Ang Univ.)Jin-Wuk Hur (Eulji Univ.)
Health Policy Committee Han-Joo Baek (Gachon Univ.) (Chairman)Eun Bong Lee (Seoul National Univ.) (Executive Secretary)Gun-Woo Kim (Daegu Fatima Hosp.), Kiwon Moon (Kangwon National Univ.)Miryoung Seo (Gachon Univ.), Yoon-Kyoung Sung (Hanyang Univ.)Jongjin Yoo (Hallym Univ.), Chong-Hyeon Yoon (Catholic Univ.)Jisoo Lee (Ewha Womans Univ.), Churl Hyun Im (Korean Armed Forces Capital Hosp.)
•Date: May 20 (Fri)∼21 (Sat), 2016 •Venue: Nine Tree Convention Gwanghwamun, Seoul, Korea
PRO GRAM
May 20 (Fri), 2016
Grand Ballroom 1 + 2
09:00-09:50 Plenary Session I - International Free Paper Session (E) Chairs: Eun-Mi Koh (Sungkyunkwan Univ., Korea)
Seung-Cheol Shim (Chungnam National Univ., Korea)
O-20-01 Urinary Interleukin-6 as a Predictor of Radiographic
Progression in Rheumatoid Arthritis: A 3-Year EvaluationYune-Jung Park (The Catholic Univ., Korea)
O-20-02 Baseline Autoantibodies Preferentially Impact
Abatacept Efficacy in Patients with RA Who are Biologic Naïve: 6-Month Results from a Real-World, International, Prospective Study
Manuela Le Bars (Bristol-Myers Squibb, France)
O-20-03 The Effect of Medication on Development
of Cardiovascular Disease in Patients with Rheumatoid ArthritisSoo-Kyung Cho (Hanyang Univ., Korea)
O-20-04 Comorbidities of Rheumatoid Arthritis: Results from
the 2010-2012 Korean National Health and Nutrition Examination SurveyHyemin Jeong (Samsung Medical Center, Korea)
O-20-05 Impacts of Disease Activity and Serum Level
of Brain-derived Neurotrophic Factor on Depression in Patients with Rheumatoid Arthritis Yun Hong Cheon (Gyeongsang National Univ., Korea)
09:50-10:30 Plenary Session II - International Free Paper Session (E) Chairs: Sang Cheol Bae (Hanyang Univ., Korea)
Seung-Cheol Shim (Chungnam National Univ., Korea)
O-20-06 Does Rheumatoid Arthritis Affect Bisphosphonate-related
Atypical Femur Fracture? Jung Hee Koh (The Catholic Univ., Korea)
O-20-07 Targeting IL-23 Can Attenuate Progression
of Spinal Ankylosis in Ankylosing Spondylitis Bon San Koo (Konkuk Univ., Korea)
The 36th Korean College of Rheumatology
Annual Scientific Meeting and the 10th International Symposium
Vol. 23, Suppl. 1, May, 2016 (K): Korean Session (E): English Session
O-20-08 Impact of Dose Tapering of Tumour Necrosis
Factor-blockers on Radiographic Progression in the Ankylosing Spondylitis: A 4-year Prospective Follow up from Single-centre Cohort
Jun Won Park (Seoul National Univ., Korea)
O-20-09 Insulin Resistance is Associated with Digital Ulcer
in Patients with Systemic Sclerosis Eun-Kyoung Park (Pusan National Univ., Korea)
10:30-11:00 Coffee Break & Poster Viewing
11:00-12:30 Invited Lectures I (E) Chairs: Yeong-Wook Song (Seoul National Univ., Korea)Jae-Bum Jun (Hanyang Univ., Korea)
11:00-11:30 Treatment of Lupus Nephritis Bevra Hahn (UCLA School of Medicine, USA)
11:30-12:00 Mechanistic Role of ACPA in Treatment OutcomesWilliam Hewitt Robinson (Stanford Univ. School of Medicine, USA)
12:00-12:30 Hyperuricemia and Cardiovascular Disease RiskHyon K. Choi (Harvard Medical School, USA)
12:30-13:30 Luncheon Symposium and Lunch Break (E)Chair: Choongki Lee (Yeungnam Univ., Korea)
Tofacitinib, an Oral Janus Kinase Inhibitor, as Monotherapy or with Background Methotrexate, in Japanese Patients with Rheumatoid Arthritis: An Open-label, Long-term Extension Study
Hisashi Yamanaka (Tokyo Women’s Medical Univ., Japan)
Grand Ballroom 1
13:30-15:00 Issues in Clinic Session (K) Chairs: Soo-Kon Lee (CHA Univ., Korea)Sang-Heon Lee (Konkuk Univ., Korea)
13:30-13:50 Bisphosphonate and Hydroxychloroquine in Rheumatic Diseases 이창근 (울산의대)
13:50-14:20 Rheumatism as a Co-morbidity of Medication Related Osteonecrosis of the Jaws 권용대 (경희치대)
14:20-14:50 Screening for Hydroxychloroquine Retinopathy: Why and How?김상진 (성균관의대 안과학교실)
14:50-15:00 Q&A
15:00-15:30 Coffee Break
15:30-17:00 Healthcare Policy Symposium (K)Chairs: Jung-Yoon Choe (Catholic Univ. of Daegu, Korea)
Sung-Hwan Park (Catholic Univ., Korea)
15:30-16:00 2016년도 보건의료정책 방향과 과제 정통령 (보건복지부 보험급여과)
16:00-16:30 류마티스 및 근골격계 질환의 질병 부담과 질 평가 이은봉 (서울의대)
16:30-17:00 류마티스 관절염 질지표 개발과 적용 백한주 (가천의대)
17:00-17:30 젊은 연구자상 및 학술상 수상 및 수상자 강연
17:30-18:00 General Assembly
Grand Ballroom 2
13:30-14:10 REOPHARD Session (K) Chairs: Dae-Hyun Yoo (Hanyang Univ., Korea)Shin-Seok Lee (Chonnam National Univ., Korea)
13:30-13:40 REOPHARD의 연혁과 기준 데이터의 분석 전찬홍 (순천향의대)
13:40-13:50 1차 추적 관찰 데이터의 분석 강귀영 (가톨릭의대)
13:50-14:00 KORPAH Registry 데이터의 분석 최성재 (고려의대)
14:00-14:10 결체조직질환에 동반된 폐동맥고혈압의 악화인자와 그 결과 서미령 (가천의대)
14:10-15:00 Free Paper Session: Rheumatoid Arthritis Clinical Aspects I (K)Chairs: Won Tae Chung (Dong-A Univ., Korea)
Seong Wook Kang (Chungnam National Univ., Korea)
O-20-10 Baseline Profiles in Korean Patients with
Rheumatoid Arthritis When Initiating or Switching Biologic Agents: Results from the KOBIO Registry Dong-Jin Park (Chonnam National Univ., Korea)
O-20-11 Drug Survival of Biologic Agents in Rheumatoid Arthritis
Using 10 Years of Nationwide Data in Korea: A Population-based StudyJeong Seok Lee (Seoul National Univ., Korea)
O-20-12 Efficacy and Safety of Add-on Treatment of Tacrolimus
Versus Leflunomide in Rheumatoid Arthritis Patients with Inadequate Response to Methotrexate Kichul Shin (SMG-SNU Boramae Medical Center, Korea)
O-20-13 The Impact of Korean Red Ginseng on Disease Activity and
Improvement of Fatigue in Patients with Rheumatoid Arthritis: A Randomized, Double-blind, Crossover Study Soo-Kyung Cho (Hanyang Univ., Korea)
O-20-14 Remission of Rheumatoid Arthritis Judged by 2 Criteria
Sung Yeon Lee (Hallym Univ., Korea)
Terrace Hall
13:30-14:10 Free Paper Session: Systemic Lupus Erythematosus, Sjogren's Syndrome Basic Aspects (K) Chairs: Jun-ki Min (Catholic Univ., Korea)
Hye-Soon Lee (Hanyang Univ., Korea)
O-20-15 A Selective JAK1 Inhibitor, Filgotinib Ameliorates
Sjogren's Syndrome in Non Obese Diabetes Mice Via Suppression of BAFF and Chemokine Production of Salivary Gland Epithelial Cells
Jennifer Jooha Lee (The Catholic Univ., Korea)
O-20-16 Exosomes from Patients with Active Systemic
Lupus Erythematosus Induce a Strong Inflammatory ResponseJoo Youn Lee (Seoul National Univ., Korea)
O-20-17 Urinary Immunoglobulin Binding Protein-1 as a Biomarker
Related with Lupus Nephritis Activity Eun-Ju Lee (Asan Medical Center, Korea)
O-20-18 Fn14-Fc Suppresses Germinal Center Formation
and Pathogenic B Cells in a Lupus Mouse Model via Inhibition of the TWEAK/Fn14 Pathway Hong Ki Min (The Catholic Univ., Korea)
14:10-15:00 Free Paper Session: Osteoarthritis (K) Chairs: Gun-Il Im (Dongguk Univ., Korea)Sung Won Lee (Dong-A Univ., Korea)
O-20-19 DICAM Promote Proliferation and Hypertrophic Differentiation
of Chondrocyte Through Indian Hedgehog Signaling of Primary CiliaSeung-Woo Han (Daegu Fatima Hosp., Korea)
O-20-20 Fibronectin Fragment Suppresses Xylosyltransferase-1
Expression Through Modulating Sp1 and Sp3 Expression Via MAPK, AP-1, and NF-κB Signaling Pathways Mi-Hyun Lee (Hallym Univ., Korea)
O-20-21 Metabolic and Inflammatory Links to Rotator Cuff Tear
in Hand Osteoarthritis Young Sun Suh (Gyeongsang National Univ., Korea)
O-20-22 Association between Grip Strength and Hand and
Knee Radiographic Osteoarthritis in Older Adults: Data from the Dong-gu StudyLihui Wen (Chonnam National Univ., Korea)
O-20-23 The Prevalence and Risk Factor of Knee Pain
in Advacned Knee Osteoarthritis Kyeong Min Son (Hallym Univ., Korea)
15:00-15:30 Coffee Break
15:30-16:10 Free Paper Session: Spondylarthropathies, Epidemiology (K)Chairs: Hyung In Yang (Kyung Hee Univ., Korea)
Young-Il Seo (Hallym Univ., Korea)
O-20-24 The Incidence of Herpes Zoster Infection in Patients
with Ankylosing Spondylitis: Analysis from Korean National Health Insurance Service-Cohort Sample Database Doo-Ho Lim (Univ. of Ulsan, Korea)
O-20-25 Utilization of the PEST Questionnaire to Detect
Psoriatic Arthritis in Clinical Practice: Data from the VALidation of psORiatic Arthritis Screening Tool for Korean Psoriasis Patients (VALOR) Study
You-Jung Ha (Seoul National Univ. Bundang Hosp., Korea)
O-20-26 Increased 18F-fluoride Uptake Lesions at Vertebral
Corners on Positron Emission Tomography Predict New Syndesmophytes Development in Ankylosing Spondylitis
Seung-Geun Lee (Pusan National Univ., Korea)
O-20-27 Korean Rheumatology Workforce from 1992 to 2015:
Rapid Advance, being on the Rise of Regional Concentration, in MetropolitanChan Uk Lee (Catholic Univ. of Daegu, Korea)
16:10-16:50 Free Paper Session: Behcet's Disease, Myositis (K)Chairs: Jinseok Kim (Jeju National Univ., Korea)
Yun-Jong Lee (Seoul National Univ., Korea)
O-20-28 Serum CXCL10 Levels are Associated with
Clinical Manifestations and Disease Activity in Behçet's Disease: A Prospective Follow-up Study Sang Jin Lee (Seoul National Univ., Korea)
O-20-29 Optimal Surgical Method for Aortic Regurgitation
in Behcet Disease Byeongzu Ghang (Univ. of Ulsan, Korea)
O-20-30 Major Comorbidities of Idiopathic Inflammatory Myositis
Affecting Survival and Functional Impairment: A Population-based Study Using 11 Years of Follow-up from the National Health Insurance in Korea
Jeong Seok Lee (Seoul National Univ., Korea)
O-20-31 C-Reactive Protein to Albumin as a New Prognostic
Value and Clinical Significance in Patients with DermatomyositisJaehyung Hur (Seoul National Univ. Bundang Hosp., Korea)
May 21 (Sat), 2016
Grand Ballroom 1
08:30-09:30 Breakfast Symposium (K) Chair: Won Park (Inha Univ., Korea)
Seeking for the Right ‘Combination’ of Conventional DMARDs in Rheumatoid Arthritis: Options Beyond Triple Combination
Kichul Shin (SMG-SNU Boramae Medical Center)
09:30-10:20 류마티스학 연구재단 연구과제 결과 보고 (K) Chairs: Gwan Gyu Song (Korea Univ., Korea)Jung-Soo Song (Chung-Ang Univ., Korea)
09:30-09:45 환자 교육이 류마티스관절염 환자의 만족도에 미치는 영향 성윤경 (한양의대)
09:45-10:00 류마티스관절염환자 대상 교육용 앱개발과 환자교육중재가 약제순응도 및 치료결과에 미치는 효과 주지현 (가톨릭의대)
10:00-10:10 질환특이 역분화 줄기세포 유도 정승민 (연세의대)
10:10-10:20 류마티스질환에서 대상포진의 위험인자 류희정 (가천의대)
10:20-11:00 Special Lectures (K) Chairs: Young Mo Kang (Kyungpook National Univ., Korea)Chang-Hee Suh (Ajou Univ., Korea)
10:20-10:30 유도만능줄기세포의 연골세포 분화 및 Crispr/Cas9 유전자 가위 시스템의 확립 한승우 (대구파티마병원)
10:30-10:40 T Cell Receptor Stimulation with Microbeads 김진현 (충남의대)
10:40-10:50 Translational Research in Keio University, Japan 김 담 (한양의대)
11:00-11:20 Coffee Break & Poster Viewing
11:20-12:50 Invited Lectures II (E) Chairs: Bin Yoo (Univ. of Ulsan, Korea)Hyun Ah Kim (Hallym Univ., Korea)
11:20-11:50 Engineering New Biologic Therapies for OsteoarthritisFarshid Guilak (Washington Univ. in St. Louis, USA)
11:50-12:20 Pulmonary Arterial Hypertension in Connective Tissue Diseases Janet Pope (Univ. of Western Ontario and St. Joseph's Health Care, London Ontario, Canada)
12:20-12:50 Ultrasound in Rheumatology: Getting Closer to the Holy Grail?George AW Bruyn (MC Groep Hosp., Lelystad, The Netherlands)
12:50-13:10 Excellence Awards for Oral and Poster Presentation
Grand Ballroom 2
09:30-10:20 Free Paper Session: Rheumatoid Arthritis Basic Aspects (K)Chairs: Wan-Uk Kim (Catholic Univ., Korea)
Yong-Beom Park (Yonsei Univ., Korea)
O-21-01 Regulation of Autophagic Flux Alters Interleukin-17A-induced
Migration and Proliferation of Fibroblast-like Synoviocytes from the Patients with Rheumatoid Arthritis Ji-Min Kim (Keimyung Univ., Korea)
O-21-02 Interleukin-32 Exacerbates Synovial Inflammation and
Bone Destruction Via the Suppression of Raf Kinase Inhibitory ProteinHae Sook Noh (Gyeongsang National Univ., Korea)
O-21-03 NFAT5 Promotes Macrophage Survival by Inducing Chemokine Ligand 2
Susanna Choi (The Catholic Univ., Korea)
O-21-04 Autophagy Contributes to Celecoxib-induced Cell Death in Rheumatoid
Arthritis Fibroblast-like Synoviocytes Jihye Bang (Keimyung Univ., Korea)
O-21-05 Robust Therapeutic Efficacy of Matrix Metalloproteinase-2
Cleavable fas-1-RGD Peptide Complex on Chronic Inflammatory ArthritisEon Jeong Nam (Kyungpook National Univ., Korea)
10:20-11:00 Free Paper Session: Rheumatoid Arthritis Clinical Aspects II (K)Chairs: Chan-Hee Lee (NHIC Ilsan Hosp., Korea)
Eun Young Lee (Seoul National Univ., Korea)
O-21-06 Disease Characteristics and Change of Arthritis Activity
According to Treatment in Hepatitis B Surface Antigen Positive Rheumatoid Arthritis Patients YeongHee Eun (Samsung Medical Center, Korea)
O-21-07 Correlations Between Rheumatoid Arthritis Activity Indices and
Factors Affecting Acute Phase Reactants in Patients with Rheumatoid ArthritisIn Ah Choi (Chungbuk National Univ., Korea)
O-21-08 Achievement of Imaging Remission among Patients
with Rheumatoid Arthritis in Clinical Remission and Their CharacteristicsJi-Young Choi (Kyung Hee Univ., Korea)
O-21-09 HAQ Score is an Independent Predictor of Sustained Remission in
Patients with Rheumatoid Arthritis Kyung-Eun Lee (Chonnam National Univ., Korea)
11:00-11:20 Coffee Break & Poster Viewing
11:20-12:50 Research Society Session on Spondyloarthritis (K)
11:20-12:10 1부 - 강직성 척추염에서 TNF 길항제의 사용Chair: Tae-Hwan Kim (Hanyang Univ., Korea)
11:20-11:35 Drug Survival of Tumor Necrosis Factor α Inhibitors in Patients with Ankylosing Spondylitis in Korea 정혜민 (성균관의대)
11:35-11:50 Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the Treatment of Active Tuberculosis 김혜원 (연세의대)
11:50-12:05 Low Dose Etanercept Treatment for Maintenance of Clinical Remission in Ankylosing Spondylitis 박준원 (서울의대)
12:05-12:10 Q&A
12:10-12:50 2부 - 강직성 척추염 NEWs and Updates Chair: Han-Joo Baek (Gachon Unvi., Korea)
12:10-12:30 Clinical Update on Spondyloarthritis 이연아 (경희의대)
12:30-12:50 Basic Update on Spondyloarthritis 이상훈 (경희의대)
Terrace Hall
09:30-10:20 Free Paper Session: Systemic Lupus Erythematosus Clinical Aspects (K)Chairs: Eun Bong Lee (Seoul National Univ., Korea)
Chang Keun Lee (Univ. of Ulsan, Korea)
O-21-10 Effects of Risk Factors for Metabolic Syndrome and the Components
of Metabolic Syndrome on the Quality of Life of Patients with Systemic Lupus Erythematosus: A Structural Equation Modeling Approach
Jeong-Won Lee (Chonnam National Univ., Korea)
O-21-11 Factors Related to Blood Hydroxychloroquine Concentration in Patients
with Systemic Lupus Erythematosus Ji Yeon Lee (Catholic Univ., Korea)
O-21-12 Factors Influencing on Health-Related Quality of Life in Korean
Patients with Systemic Lupus Erythematosus Su-Jin Moon (The Catholic Univ., Korea)
O-21-13 Corticosteroids Dose after 6 Months of Induction Therapy is
Associated with Non-Renal Organ Damage in Patients with Lupus NephritisChan-Bum Choi (Hanyang Univ., Korea)
O-21-14 Improved Survival of Systemic Lupus Erythematosus Patients
with Rituximab Treatment Na Ri Kim (Kyungpook National Univ., Korea)
10:20-11:00 Free Paper Session: Osteoporosis, Gout, Cytokines (K)Chairs: Young-Ho Lee (Korea Univ., Korea)Chong-Hyeon Yoon (Catholic Univ., Korea)
O-21-15 Glucocorticoid Acts Differently on Vertebral and Hip Fractures
in Korean RA Patients Using National Healthcare Claims DatabaseDam Kim (Hanyang Univ., Korea)
O-21-16 Ebselen is a Potential Anti-Osteoporosis Agent by Suppressing
Receptor Activator of NF-kB Ligand-Induced Osteoclast Differentiation and LPS-Induced Inflammatory Bone Destruction
Changhoon Lee (Wonkwang Univ., Korea)
O-21-17 p62 is Responsible for Interleukin-1b Production at the Early
Phase Through Mitochondrial Apoptosis by Monosodium Urate CrystalsSeong-Kyu Kim (Catholic Univ. of Daegu, Korea)
O-21-18 SIRT-1 Regulates TGF-b Induced Dermal Fibroblast Migration Via
Modulation of Cyr61 Expression Eun-Jeong Kwon (Jeju National Univ., Korea)
•Date: May 20 (Fri)∼21 (Sat), 2016 •Venue: Nine Tree Convention Gwanghwamun, Seoul, Korea
CO NTENTS May 20 (Fri), 2016
Plenary Session I - International Free Paper Session (E)
O-20-01 Urinary Interleukin-6 as a Predictor of Radiographic Progression in Rheumatoid Arthritis: A 3-year Evaluation
Yune-Jung Park, Seung-Ah Yoo, Ga-Ram Kim, Chul-Soo Cho, Wan-Uk Kim ········ S3
O-20-02 Baseline Autoantibodies Preferentially Impact Abatacept Efficacy in Patients with RA Who are Biologic Naïve: 6-Month Results from a Real-World, International, Prospective Study
Rieke Alten, Hubert G Nüßlein, Mauro Galeazzi, Hanns-Martin Lorenz, Xavier Mariette, Alain Cantagrel, Melanie Chartier, Guillaume Desachy,
Coralie Poncet, Christine Rauch, Manuela Le Bars ········ S4
O-20-03 The Effect of Medication on Development of Cardiovascular Disease in Patients with Rheumatoid Arthritis
Soo-Kyung Cho, Dam Kim, Soyoung Won, Minkyung Han, Jiyoung Lee, Eun Jin Jang, Sang-Cheol Bae, Yoon-Kyoung Sung ········ S5
O-20-04 Comorbidities of Rheumatoid Arthritis: Results from the 2010-2012 Korean National Health and Nutrition Examination Survey
Hyemin Jeong, Sun Young Beak, Yeong Hee Eun, In Young Kim, Hyungjin Kim, Joong Kyong Ahn, Jaejoon Lee, Eun-Mi Koh, Hoon-Suk Cha ········ S6
O-20-05 Impacts of Disease Activity and Serum Level of Brain-derived Neurotrophic Factor on Depression in Patients with Rheumatoid Arthritis
Yun-Hong Cheon, Hyun-Ok Kim, Young Sun Suh, Sang-Hyon Kim, Ji-Min Kim, Chang-Nam Son, Seung-Geun Lee, Eun Kyoung Park, Sang-Il Lee ········ S7
Plenary Session II - International Free Paper Session (E)
O-20-06 Does Rheumatoid Arthritis Affect Bisphosphonate-related Atypical Femur Fracture? Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Wan-Uk Kim, Sung-Hwan Park, Ji Hyeon Ju ····· S11
O-20-07 Targeting IL-23 Can Attenuate Progression of Spinal Ankylosis in Ankylosing Spondylitis
Sungsin Jo, Bon San Koo, Il-Hoon Sung, Ye-Soo Park, Tae-Hwan Kim ····· S12
The 36th Korean College of Rheumatology
Annual Scientific Meeting and the 10th International Symposium
Vol. 23, Suppl. 1, May, 2016 (K): Korean Session (E): English Session
O-20-08 Impact of Dose Tapering of Tumour Necrosis Factor-blockers on Radiographic Progression in the Ankylosing Spondylitis: A 4-year Prospective Follow Up from Single-centre Cohort
Jun Won Park, Hyun Mi Kwon, Jin Kyun Park, Ja-Young Choi, Eun Bong Lee, Yeong Wook Song, Eun Young Lee ····· S13
O-20-09 Insulin Resistance is Associated with Digital Ulcer in Patients with Systemic Sclerosis
Eun-Kyoung Park, Seung-Geun Lee, Ji-Heh Park ····· S14
Invited Lectures I (E)
1. Treatment of Lupus Nephritis Bevra Hahn ····· S17
2. Sequencing Antibody Repertoires to Decipher Pathogenic Mechanisms in Rheumatoid Arthritis William Hewitt Robinson ····· S25
3. Hyperuricemia and Cardiovascular Disease Risk Hyon K. Choi ····· S26
Luncheon Symposium and Lunch Break (E)
1. Tofacitinib, an Oral Janus Kinase Inhibitor, as Monotherapy or with Background Methotrexate, in Japanese Patients with Rheumatoid Arthritis: An Open-label, Long-term Extension Study Hisashi Yamanaka ····· S31
Issues in Clinic Session (K)
1. BP & HCQ Uses in Rheumatic Diseases 이창근 ····· S35
2. Rhuematism as a co-morbidity of Medication Related Osteonecrosis of the Jaws (MRONJ) 권용대 ····· S42
3. Screening for Hydroxychloroquine Retinopathy: Why and How? 김상진 ····· S43
Healthcare Policy Symposium (K)
1. 2016년 의료질 평가 정통령 ····· S49
2. 류마티스 및 근골격계 질환의 질병 부담 및 질관리 현황 이은봉 ····· S56
3. 류마티스관절염 질지표 개발과 적용 백한주 ····· S57
REOPHARD Session (K)
1. REOPHARD: History of the Registry and Analysis of Baseline Data 전찬홍 ····· S61
2. Survival and Prognostic Factors in Patients with Connective Tissue Disease-associated Pulmonary Hypertension by Echocardiography: Results from a Korean Nationwide Registry 강귀영 ····· S62
3. KORPAH Registry 데이터의 분석 최성재 ····· S63
4. Progression and Outcomes in Patients with Pulmonary Artery Hypertension Associated with Systemic Rheumatic Diseases: Results from a Korean Nationwide Registry 서미령 ····· S65
Free Paper Session: Rheumatoid Arthritis Clinical Aspects I (K)
O-20-10 Baseline Profiles in Korean Patients with Rheumatoid Arthritis when Initiating or Switching Biologic Agents: Results from the KOBIO Registry
Dong-Jin Park, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee ····· S69
O-20-11 Drug Survival of Biologic Agents in Rheumatoid Arthritis Using 10 Years of Nationwide Data in Korea: A Population-based Study
Jeong Seok Lee, Jun Won Park, Eunyoung Emily Lee, Yeong Wook Song, Hee Young Lee, Eun Young Lee ····· S70
O-20-12 Efficacy and Safety of Add-on Treatment of Tacrolimus versus Leflunomide in Rheumatoid Arthritis Patients with Inadequate Response to Methotrexate
Kichul Shin, Han Joo Baek, Young Mo Kang, Hoon-Suk Cha, Seong Wook Kang, Sung-Hwan Park, Jae Bum Jun,
Yun Jong Lee, Yeong Wook Song ····· S71
O-20-13 The Impact of Korean Red Ginseng on Disease Activity and Improvement of Fatigue in Patients with Rheumatoid Arthritis: A Randomized, Double-blind, Crossover Study
Soo-Kyung Cho, DasomiYoo, Dam Kim, Yoon-Kyoung Sung ····· S72
O-20-14 Remission of Rheumatoid Arthritis Judged by 2 CriteriaSung Yeon Lee, Kyeong Min Son, Young Il Seo, Hyun Ah Kim ····· S73
Free Paper Session: Systemic Lupus Erythematosus, Sjogren's Syndrome Basic Aspects (K)
O-20-15 A Selective JAK1 Inhibitor, Filgotinib Ameliorates Sjogren's Syndrome in Non Obese Diabetes Mice Via Suppression of BAFF and Chemokine Production of Salivary Gland Epithelial Cells
Jennifer Lee, Jaeseon Lee, Seung-Ye Baek, Seung-Ki Kwok, Mi-La Cho, Sung-Hwan Park ····· S77
O-20-16 Exosomes from Patients with Active Systemic Lupus Erythematosus Induce a Strong Inflammatory Response
Joo Youn Lee, Jin Kyun Park, Eun Young Lee, Eun Bong Lee, Yeong Wook Song ····· S78
O-20-17 Urinary Immunoglobulin Binding Protein-1 as a Biomarker Related with Lupus Nephritis Activity
Eun-Ju Lee, Seokchan Hong, Bin Yoo, Chang-Keun Lee, Yong-Gil Kim ····· S79
O-20-18 Fn14-Fc Suppresses Germinal Center Formation and Pathogenic B Cells in a Lupus Mouse Model Via Inhibition of the TWEAK/Fn14 Pathway
Hong-Ki Min, Sung-Min Kim, Jin-Sil Park, Jae-Kyeong Byun, Jennifer Lee, Seung-Ki Kwok, Young-Woo Park, Mi-La Cho, Sung-Hwan Park ····· S80
Free Paper Session: Osteoarthritis (K)
O-20-19 DICAM Promote Proliferation and Hypertrophic Differentiation of Chondrocyte through Indian Hedgehog Signaling of Primary Cilia
Seung-woo Han, Min-Su Han, Hye-Ri Park, Eun-Ju Lee, Ji-Ae Jang, Gun-Woo Kim, Youn-Kwan Jung ····· S83
O-20-20 Fibronectin Fragment Suppresses Xylosyltransferase-1 Expression through Modulating Sp1 and Sp3 Expression Via MAPK, AP-1, and NF-κB Signaling Pathways
Mi Hyun Lee, Hyun Sook Hwang, Hyun Ah Kim ····· S84
O-20-21 Metabolic and Inflammatory Links to Rotator Cuff Tear in Hand OsteoarthritisYoung Sun Suh, Yun-Hong Cheon, Hyun-Ok Kim, Rock-Bum Kim,
Ki Soo Park, Hyung Bin Park, Jae-Bum Na, Sang-Il Lee ····· S85
O-20-22 Association between Grip Strength and Hand and Knee Radiographic Osteoarthritis in Older Adults: Data from the Dong-gu Study
Lihui Wen, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Dong-Jin Park, Tae-Jong Kim,
Yong-Wook Park, Sun-Seog Kweon, Young-Hoon Lee, Yong-Woon Yun, Min-Ho Shin, Shin-Seok Lee ····· S86
O-20-23 The Prevalence and Risk Factor of Knee Pain in Advacned Knee OsteoarthritisKyeong Min Son, Dong-Hyun Kim,
MyungHee Cho Paik, Dae Gyu Jang, Hyun Ah Kim ····· S87
Free Paper Session: Spondylarthropathies, Epidemiology (K)
O-20-24 The Incidence of Herpes Zoster Infection in Patients with Ankylosing Spondylitis: Analysis from Korean National Health Insurance Service-Cohort Sample Database
Doo-Ho Lim, Byeongzu Ghang, Seokchan Hong, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo ····· S91
O-20-25 Utilization of the PEST Questionnaire to Detect Psoriatic Arthritis in Clinical Practice: Data from the VALidation of psORiatic Arthritis Screening Tool for Korean Psoriasis Patients (VALOR) Study
You-Jung Ha, So Yeon Cho, Sang-Heon Lee, Yong Beom Choe, Tae-Hwan Kim, Joo Yeon Ko, Sung Jae Choi, Il-Hwan Kim, Sang Woong Youn, Kichul Shin ····· S92
O-20-26 Increased 18F-fluoride Uptake Lesions at Vertebral Corners on Positron Emission Tomography Predict New Syndesmophytes Development in Ankylosing Spondylitis
Seung-Geun Lee, Eun-Kyoung Park, Ji-Heh Park ····· S93
O-20-27 Korean Rheumatology Workforce from 1992 to 2015: Rapid Advance, being on the Rise of Regional Concentration, in Metropolitan
Chan Uk Lee, Sung-Hoon Park, Hwajeong Lee, Ji-Na Kim, Ji-Won Kim, Seong-Kyu Kim, Jung-Yoon Choe ····· S94
Free Paper Session: Behcet's Disease, Myositis (K)
O-20-28 Serum CXCL10 Levels are Associated with Clinical Manifestations and Disease Activity in Behçet’s Disease: A Prospective Follow-up Study
Sang Jin Lee, Eun Ha Kang, Byoong Yong Choi, Shin Eui Kang, Jin Kyun Park, Eun Young Lee, Eun Bong Lee, Yeong Wook Song ····· S97
O-20-29 Optimal Surgical Method for Aortic Regurgitation in Behcet DiseaseByeongzu Ghang, Suk Jung Choo, Ohchan Kwon, Wook Jang Seo,
Seokchan Hong, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo ····· S98
O-20-30 Major Comorbidities of Idiopathic Inflammatory Myositis Affecting Survival and Functional Impairment: A Population-based Study Using 11 Years of Follow Up from the National Health Insurance in Korea
Jeong Seok Lee, Min Jung Kim, Hee Young Lee, So Yeon Ahn, Yeong Wook Song, Eun Bong Lee,
Eun Young Lee, Yun Jong Lee, Eun Ha Kang ····· S99
O-20-31 C-Reactive Protein to Albumin as a New Prognostic Value and Clinical Significance in Patients with Dermatomyositis
Jaehyung Hur, Dong Jin Go, Sang Wan Chung, You-Jung Ha, Eun Ha Kang, Jin Kyun Park, Kichul Shin, Eun Young Lee,
Eun Bong Lee, Yeong Wook Song, Yun Jong Lee ··· S100
May 21 (Sat), 2016
Breakfast Symposium (K)
1. Seeking for the Right ‘Combination’ of Conventional DMARDs in Rheumatoid Arthritis: Options Beyond Triple Combination Kichul Shin ··· S103
류마티스학 연구재단 연구과제 결과 보고 (K)
1. Impact of Patient Education on Outcomes in RA Patients 성윤경 ··· S107
2. 류마티스관절염환자 대상 교육용 앱개발과 환자교육중재가 약제순응도 및 치료결과에 미치는 효과 주지현 ··· S112
3. 질환특이 역분화 줄기세포 유도 정승민 ··· S113
4. Risk Factors of Herpes Zoster in Patients with Rheumatic Diseases in Korea 류희정 ··· S114
Special Lectures (K)
1. 유도만능줄기세포의 연골세포 분화 및 Crispr/Cas9 유전자 가위 시스템의 확립 한승우 ··· S117
2. T Cell Receptor Stimulation with Microbeads 김진현 ··· S118
3. Change of Regulatory T Cells in RA Patients with Tocilizumab 김 담 ··· S119
Invited Lectures II (E)
1. Engineering New Biologic Therapies for Osteoarthritis Farshid Guilak ··· S123
2. Pulmonary Arterial Hypertension in the Connective Tissue Diseases Janet Pope ··· S124
3. Ultrasound in Rheumatology: Getting Closer to the Holy Grail? George AW Bruyn ··· S126
Free Paper Session: Rheumatoid Arthritis Basic Aspects (K)
O-21-01 Regulation of Autophagic Flux Alters Interleukin-17A-induced Migration and Proliferation of Fibroblast-like Synoviocytes from the Patients with Rheumatoid Arthritis
Ji-Min Kim, Jihye Bang, Hye-Jin Jeong, Chang-Nam Son, Sang-Hyon Kim ··· S131
O-21-02 Interleukin-32 Exacerbates Synovial Inflammation and Bone Destruction Via the Suppression of Raf Kinase Inhibitory Protein
Hae Sook Noh, Hye Song Lim, Sang Mi Yi, Min-Gyu Jeon, Beow Yong Park, Hee Young Cho, Young-Sool Hah, Yun-Hong Cheon, Sang-Il Lee ··· S132
O-21-03 NFAT5 Promotes Macrophage Survival by Inducing Chemokine Ligand 2Susanna Choi, Sungyong Yoo, Soo Youn Choi, H. Moo Kwon, Hyun-Sook Kim, Daehee Hwang, Chul-Soo Cho, Wan-Uk Kim ··· S133
O-21-04 Autophagy Contributes to Celecoxib-induced Cell Death in Rheumatoid Arthritis Fibroblast-like Synoviocytes
Jihye Bang, Hye-Jin Jeong, Chang-Nam Son, Ji-Min Kim, Sang-Hyon Kim ··· S134
O-21-05 Robust Therapeutic Efficacy of Matrix Metalloproteinase-2 Cleavable fas-1-RGD Peptide Complex on Chronic Inflammatory Arthritis
Eon Jeong Nam, Jin Hee Kang, Keum Hee Sa, Shijin Sung, Jeong Soo Eun, Na Ri Kim, Young Mo Kang ··· S135
Free Paper Session: Rheumatoid Arthritis Clinical Aspects II (K)
O-21-06 Disease Characteristics and Change of Arthritis Activity According to Treatment in Hepatitis B Surface Antigen Positive Rheumatoid Arthritis Patients
YeongHee Eun, In Young Kim, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Hoon-Suk Cha ··· S139
O-21-07 Correlations between Rheumatoid Arthritis Activity Indices and Factors Affecting Acute Phase Reactants in Patients with Rheumatoid Arthritis
In Ah Choi ··· S140
O-21-08 Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission and Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee ··· S141
O-21-09 HAQ Score is an Independent Predictor of Sustained Remission in Patients with Rheumatoid Arthritis
Kyung-Eun Lee, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Lihui Wen, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee ··· S142
Research Society Session on Spondyloarthritis (K) 1부 - 강직성 척추염에서 TNF 길항제의 사용
1. Drug Survival of Tumor Necrosis Factor α Inhibitors in Patients with Ankylosing Spondylitis in Korea 정혜민 ··· S145
2. Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the Treatment of Active Tuberculosis: A Retrospective Nationwide Registry of the Korean Society of Spondyloarthritis Research 김혜원 ··· S146
3. Low Dose Etanercept Treatment for Maintenance of Clinical Remission in Ankylosing Spondylitis 박준원 ··· S147
Research Society Session on Spondyloarthritis (K) 2부 - 강직성 척추염 NEWs and Updates
1. Clinical Update on Spondyloarthritis 이연아 ··· S151
2. 척추관절염 Update: Basic and Translational Research 이상훈 ··· S158
Free Paper Session: Systemic Lupus Erythematosus Clinical Aspects (K)
O-21-10 Effects of Risk Factors for Metabolic Syndrome and the Components of Metabolic Syndrome on the Quality of Life of Patients with Systemic Lupus Erythematosus: A Structural Equation Modeling Approach
Jeong-Won Lee, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Kyung-Eun Lee, Lihui Wen, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee ··· S165
O-21-11 Factors Related to Blood Hydroxychloroquine Concentration in Patients with Systemic Lupus Erythematosus
Ji Yeon Lee, Seung Ki Kwok, Ji Hyeon Ju, Kyung Su Park, Sung-Hwan Park ··· S166
O-21-12 Factors Influencing on Health-Related Quality of Life in Korean Patients with Systemic Lupus Erythematosus
Su-Jin Moon, Kwi Young Kang, Seung-Ki Kwok, Ji Hyeon Ju, Wan-Uk Kim, Yeon-Sik Hong, Sung-Hwan Park, Chan Hong Jeon,
Sang Tae Choi, Jung-Soo Song, Jun-Ki Min ··· S167
O-21-13 Corticosteroids Dose After 6 Months of Induction Therapy is Associated with Non-Renal Organ Damage in Patients with Lupus Nephritis
Chan-Bum Choi, Young Bin Joo, Soyoung Won, Sang-Cheol Bae ··· S168
O-21-14 Improved Survival of Systemic Lupus Erythematosus Patients with Rituximab Treatment
Na Ri Kim, Jung Su Eun, Jong Wan Kang, Eon Jeong Nam, Young Mo Kang ··· S169
Free Paper Session: Osteoporosis, Gout, Cytokines (K)
O-21-15 Glucocorticoid Acts Differently on Vertebral and Hip Fractures in Korean RA Patients Using National Healthcare Claims Database
Dam Kim, Soo-Kyung Cho, Byeongju Park, Eun Jin Jang, Sang-Cheol Bae, Yoon-Kyoung Sung ··· S173
O-21-16 Ebselen is a Potential Anti-Osteoporosis Agent by Suppressing Receptor Activator of NF-κB Ligand-Induced Osteoclast Differentiation and LPS-Induced Inflammatory Bone Destruction
Changhoon Lee, Jong Min Baek, Ju-Young Kim, Jaemin Oh, Myeung-Su Lee ··· S174
O-21-17 p62 is Responsible for Interleukin-1β Production at the Early Phase through Mitochondrial Apoptosis by Monosodium Urate Crystals
Seong-Kyu Kim, Jung-Yoon Choe, Ji Na Kim, Ji-Won Kim, Chan Uk Lee ··· S175
O-21-18 SIRT-1 Regulates TGF-β Induced Dermal Fibroblast Migration Via Modulation of Cyr61 Expression
Eun-Jeong Kwon, Eun-Jung Park, Moonjae Cho, Jinseok Kim ··· S176
Poster Presentation
1. The Synovial Fluid Concentrations of Cold-inducible RNA-binding Protein are Correlated with Disease Activity in Patients with Rheumatoid Arthritis
In Seol Yoo, Young Kim, Seong Wook Kang, Seung-Cheol Shim, Jinhyun Kim, Su-Jin Yoo, Sun Young Lee, Chan Keol Park ··· S179
2. A Role of Synovial Exosomes in Osteoclast Differentiation of Inflammatory ArthritisJi Eun Song, Ji Hye Shin, Ki Won Moon, Se Hui Shon, Ji Soo Park,
Eun Bong Lee, Yeong Wook Song, Eun Young Lee ··· S180
3. The Relationship between the Articular Surface Projection and Radiologic Laxity of the Trapeziometacarpal Joint
Jeong Hwan Kim, Hyun Sik Gong, Jihyeung Kim, Goo Hyun Baek ··· S181
4. Impact of Myofascial Pain Syndrome on Pain and Functional Status in Patients with Hand Osteoarthritis
Young Sun Suh, Yun-Hong Cheon, Hyun-Ok Kim, Rock-Bum Kim, Ki Soo Park, Hyung Bin Park, Jae-Bum Na, Sang-Il Lee ··· S182
5. The Value of High-sensitivity C-reactive Protein in Hand and Knee Radiographic Osteoarthritis: Data from the Dong-gu Study
Yi-Rang Yim, Lihui Wen, Ji-Hyoun Kang, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Sun-Seog Kweon,
Young-Hoon Lee, Yong-Woon Yun, Min-Ho Shin, Shin-Seok Lee ··· S183
6. Leptin Protects Rat Articular Chondrocytes from TNF-α Cytotoxicity Induced by Cyclohexamide
Sang Yeob Lee, Sung Won Lee, Won Tae Chung ··· S184
7. Association-heterogeneity Mapping Identifies an Asian-specific Association of the GTF2I Locus with Rheumatoid Arthritis
Kwangwoo Kim, So-Young Bang, Katsunori Ikari, Dae Hyun Yoo, Soo-Kyung Cho, Chan-Bum Choi, Yoon-Kyoung Sung, Tae-Hwan Kim, Jae-Bum Jun, Young Mo Kang,
Chang-Hee Suh, Seung-Cheol Shim, Shin-Seok Lee, Jisoo Lee, Won Tae Chung, Seong-Kyu Kim, Jung-Yoon Choe, Shigeki Momohara, Atsuo Taniguchi,
Hisashi Yamanaka, Swapan K Nath, Hye-Soon Lee, Sang-Cheol Bae ··· S185
8. Stauntonia Hexaphylla Extract Suppresses Expression of Pro-inflammatory Mediators, MMPs through Downregulating Akt, p38, JNK and NF-κB Activation in Rheumatoid Arthritis Fibroblast-like Synoviocytes
Hyung Jung Yoo, Jeong Yeon Kim, Shin Eui Kang, Ji Soo Park, Eun Young Lee, Eun Bong Lee, Yeong Wook Song ··· S186
9. Hypoxia Induce Slug Expression Via JAK/STAT3 Pathway in Rheumatoid Arthritis Fibroblast-like Synoviocytes
Hyungjin Kim, Hyemin Jeong, Jaejoon Lee, Hoon-Suk Cha, Eun-Mi Koh, Joong Kyong Ahn ··· S187
10. Pioneering Study about Expression of Programmed Death-1 (PD-1) with Its Ligands on Synoviocyte, Macrophage and Lymhpocyte in Synovial Fluid of Rheumatoid Arthritis
Sang Yeob Lee, Sung Won Lee, Won Tae Chung, Jae Ho Bae ··· S188
11. The Jak-2 Mutation in Rheumatoid Arthritis PathogenesisTaskin Senturk, Ikbal Akdam, Irfan Yavasoglu, Gohan Bozkurt ··· S189
12. Identification of Differential Expressions of NOD-like Receptors and Their Signaling Pathway in Rheumatoid FLS and Synovium
Ji-Yoen Moon, Byung Wook Park, Yong-Jin Kwon, Hye Won Kim, Min-Chan Park ··· S190
13. Histamine and Histamine H4 Receptor Promotes Osteoclastogenesis in Rheumatoid ArthritisHae-Rim Kim, Kyung-Ann Lee, Kyoung-Woon Kim, Bo-Mi Kim, Sang-Heon Lee ··· S191
14. Rheumatoid Arthritis is Associated with Low/mid Frequency Hearing Impairment: Results from the 2010-2012 Korean National Health and Nutrition Examination Survey
Hyemin Jeong, Young-Soo Chang, Sun Young Baek, Sun Woo Kim, Yeong Hee Eun, In Young Kim, Jaejoon Lee, Eun-Mi Koh, Hoon-Suk Cha ··· S192
15. High Fat Mass Predicts the Persistence/Progression of Musculoskeletal Pain in Community Residents
Hyun-Ah Kim, Seung Hun Lim, Nam Han Cho ··· S193
16. Biological Function Enriched Prediction of Severe Radiographic Progression in Rheumatoid Arthritis
Young Bin Joo, Yul Kim, Youngho Park, Kwangwoo Kim, Jeong Ah Ryu, Seunghun Lee, So-Young Bang, Hye-Soon Lee, Gwan-Su Yi, Sang-Cheol Bae ··· S194
17. A Korean Multicenter Observational Study of Disease Activity Changes in BIologic versus Non-biologic Users with Seropositive Rheumatoid Arthritis
Kichul Shin, Sung Soo Kim, Sang Heon Lee, Seung Jae Hong, Sung Jae Choi, Jung yoon Choe, Seung- Geun Lee, Hoon-Suk Cha, Eun Young Lee, Sung-Hwan Park,
Jin Wuk Hur, Sung Soo Na, Chang Hee Suh, So Min Wook, Seung Won Choi, Dong Hyuk Sheen, Won Park, Shin-Seok Lee, Myong Joo Hong, Jin Seok Kim,
Jung Soo Song, Hye Soon Lee, Seong Ho Kim, Dae-Hyun Yoo ··· S195
18. Seropositivity and Its Impact on Radiographic Damage in Korean Rheumatoid Arthritis Patients Starting Biologics
Kichul Shin, Seungjun Ha, Inkyung Jung, Hyoun-Ah Kim, Shin-Seok Lee ··· S196
19. Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission and Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee ··· S197
20. Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission and Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee ··· S198
21. Assessment of Liver Fibrosis Using Transient Elastography in Patients with Rheumatoid Arthritis Exposed to Long Term Methotrexate
Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Ji Hyeon Ju, Sung-Hwan Park ··· S199
22. The Effect of TNF Blockers on Bone Mineral Density in Rheumatoid Arthritis Patients Receiving Bisphosphonate
Doo-Ho Lim, Byeongzu Ghang, Seokchan Hong, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo ··· S200
23. A Rare Case of Branch Retinal Vein Occlusion Complicating Rheumatoid ArthritisMi-Hye Kwon, Younghoon Lee, Chung-Il Joung ··· S201
24. On Drug and Drug-Free Remission by Baseline Disease Duration: Abatacept Versus Methotrexate Comparison in Patients with Early Rheumatoid Arthritis
Vivian P. Bykerk, Gerd R. Burmester, Bernard G. Combe, Daniel E. Furst, Tom W.J. Huizinga, Dennis A. Wong, Paul Emery ··· S202
25. Abatacept Plus Methotrexate Can Effectively and Safely Regain the Target of Remission Following Re-treatment for Flares after Drug-Free Withdrawal in Patients with Early Rheumatoid Arthritis
Paul Emery, Gerd R. Burmester, Vivian P. Bykerk, Bernard G. Combe, Daniel E. Furst, Michael Maldonado, Thomas W. Huizinga ··· S203
26. Factors Associated with Hydroxychroloquine Retinal ToxicityJi-Won Kim, Chan Uk Lee, Ji-Na Kim, Se Eun Kim, Yun Young Kim,
Hwajeong Lee, Sung-Hoon Park, Seong-Kyu Kim, Jung-Yoon Choe ··· S204
27. Improvement of Morning Stiffness in Korean Rheumatoid Arthritis Patients after Treatment with a New Modified-release form of Prednisone
Kichul Shin, Sung-Soo Kim, Sung Jae Choi, Geun-Tae Kim, Sang-Hyon Kim, Myeong Soo Lee, Jin-Wuk Hur, Yun Sung Kim, Young Il Seo, Seong-Su Nah,
Hyun-Sook Kim, Eun Young Lee, Seung-Jae Hong ··· S205
WithdrawWithdrawWithdraw
WithdrawWithdrawWithdraw
28. Withdrawal of Nonsteroidal Anti-inflammatory Drugs in Rheumatoid Arthritis Patients with Low Disease Activity
Dong Jin Go, Kichul Shin, Han Joo Baek, Seong Wook Kang, Young Mo Kang, Jae Bum Jun, Yun Jong Lee, Sung Hwan Park, Yeong Wook Song ··· S206
29. Varicella-zoster Virus Specific Cell-mediated Immunity is Decreased in Patients with Rheumatoid Arthritis Receiving Varicella Vaccine
Jung-Hee Koh, Jennifer Lee, Seung-Ki Kwok, Ji Hyeon Ju, Wan-Uk Kim, Sung-Hwan Park ··· S207
30. Body Mass Index Does Not Influence the Efficacy of Abatacept in Patients with RA Who are Biologic-DMARD Naïve: 6-Month Results from a Real-World, International, Prospective Study
Rieke Alten, Hubert G Nüßlein, Mauro Galeazzi, Hanns-Martin Lorenz, Xavier Mariette, Alain Cantagrel, Melanie Chartier, Guillaume Desachy,
Coralie Poncet, Christine Rauch, Manuela Le Bars ··· S208
31. Safety of Biologics in Patients with Rheumatoid Arthritis and Hepatitis C Virus Infection: A Multicenter Retrospective Study
Hyun Mi Kwon, Kichul Shin, Shin-Seok Lee, Won Tae Chung, Jisoo Lee, Sang-Heon Lee, Seong-Wook Kang, Chang Hee Suh, Seung-Jae Hong,
Ran Song, Jung-Yoon Choe, Yeong Wook Song ··· S209
32. Baricitinib Versus Placebo or Adalimumab in Patients with Active Rheumatoid Arthritis and an Inadequate Response to Background Methotrexate Therapy: Results of a Phase 3 Study
Jieon Won, Peter C. Taylor, Edward C. Keystone, Désirée van der Heijde, Yoshiya Tanaka, Taeko Ishii, Kahaku Emoto, Lili Yang, Vipin Arora,
Carol Gaich, Terence Rooney, Douglas Schlichting, William L. Macias, Stephanie de Bono, Michael E. Weinblatt ··· S210
33. Evaluation of the Relationship between IL-10, IL-17, IL-23 Levels and Disease Activity of Systemic Lupus Erythematosus and Vitamin D Metabolism
Taskin Senturk, Beyza Cetin, Gokhan Sargin, Neriman Aydin ··· S211
34. Comparison of the Clinical, Serological, and Prognostic Differences among Juvenile-, Adult-, and Late-onset Lupus Nephritis in Korean Patients: A Case-control Study
Ji-Hyoun Kang, Dong-Jin Park, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee ··· S212
35. Body Mass Index, HDL Cholesterol, Taking NSAID, and Current Dose of Glucocorticoids Might Contribute to Subclinical Atherosclerosis in SLE Patients with Low Disease Activity
Ju-Yang Jung, Hyun-Ah Kim, Chang-Hee Suh ··· S213
36. Antiphospholipid Antibody Positivity and Related Clinical Characteristics in Korean Lupus Patients
Dam Kim, Soo-Kyung Cho, Kyung-Eun Lee, Dong-Jin Park, Shin-Seok Lee, Yoon-Kyoung Sung ··· S214
37. Lupus Nephritis is Associated with more Corticosteroid-associated Organ Damage but Less Corticosteroid Non-associated Organ Damage
Young Bin Joo, Soyoung Won, Chan-Bum Choi, Sang-Cheol Bae ··· S215
38. Comparison of Clinical and Serological Differences According to the Autoantibody Cluster in Women with Systemic Lupus Erythematosus: Results from the Korean Lupus Network (KORNET) Registry
Ji-Eun Kim, Dong-Jin Park, Ji-Hyoun Kang, Yi-Rang Yim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee ··· S216
39. Vitamin D and Bone Mineral Density in Rheumatoid Arthritis and Systemic Lupus Erythematosus
Ju-Yang Jung, Hyoun-Ah Kim, Chang-Hee Suh ··· S217
40. Salivary Proteomic Analysis in the Patients with Systemic Lupus Erythematosus Ju-Yang Jung, Hyun-Ah Kim, Jin-Young Nam and Chang-Hee Suh ··· S218
41. The Increase or Decrease of Serially Assessed anti ds-DNA Antibody Serum Level is Strong Relationship with Lupus Flare Up: Single Center Experience
Sang Yeob Lee, Sung Won Lee, Won Tae Chung ··· S219
42. Outcomes in Patients with Ischemic Stroke Regarding Titer and Persistence of Antiphospholipid Antibodies
Jung Yoon Pyo, Sang-Won Lee, Jason Jungsik Song, Yong-Beom Park ··· S220
43. Cytomegalovirus Reactivation in Patient with Active Lupus Nephritis Hyunae Lee, yeunmi Kang, Jihyun Han, Sangyoon Kim, In Je Kim, Jisoo Lee ··· S221
44. A Case of Systemic Lupus Erythematosus Presenting as Stevens-Johnson SyndromeMi-Hye Kwon, Chung-Il Joung ··· S222
45. Renal Microaneurysm in a Patient with Systemic Lupus ErythematosusJung Su Eun, Eun Song Lee, Jong Wan Kang, Na Ri Kim,
Sang Jin Lee, Young Mo Kang, Eon Jeong Nam ··· S223
46. A Case of Meningoencephalitis by Cryptococcus Neoformans in a Patient with Systemic Lupus Erythematosus
Do Sik Moon, Hyun-SooK Kim, Yun Sung Kim ··· S224
47. Long-term Outcomes of Autologous Peripheral Blood Stem Cell Transplantation for Refractory Rheumatic Diseases
Seung Lee, Jae-Bum Jun, Chan-Bum Choi, Sang-Cheol Bae ··· S225
48. Tuberculin Skin Test and Interferon Gamma Release Assay (IGRA) for Diagnosing Latent Tuberculosis Infection in Patients with Systemic Lupus Erythematosus
Hyoun-Ah Kim, Hundo Cho, Ye Won Kim, Ju-Yang Jung, Yoo-Jin Um, Jin-Hee Jung, Chang-Hee Suh ··· S226
49. Association of HLA Genes in Systemic Sclerosis with Interstitial Lung DiseaseHyun Mi Kwon, Eun Young Song, Ye Ji Lee, Jin Kyun Park,
Eun Young Lee, Yeong Wook Song, Eun Bong Lee ··· S227
50. Metabolomics for the Diagnosis of Systemic SclerosisKyong-Hee Jung, Sehyun Oh, Won Park, Mie Jin Lim, Seong Ryul Kwon, Sunghyouk Park ··· S228
51. Neutrophil/Lymphocyte Ratio (NLR) were Useful Marker in Prediction of Lung Involvement in Patient with Systemic Sclerosis
Won-Seok Lee, Yun-Jung Choi, Yu-Mi Lee, Wan-Hee Yoo ··· S229
52. Renal Involvement in Patients with Inflammatory Myopathies in KoreaHowook Jeon, Min Seok Choi, Jeniffer Lee, Sung-Hwan Park ··· S230
53. Renal Involvement in Polymyositis: A Case Report Yoon Jeong Oh, Eun Sung Park, Mi Jang, Jeong Hae Kie,
Jason Jungsik Song, YongBeoum Park, Chan Hee Lee, Jin Su Park ··· S231
54. Drug Survival of TNF Alpha Inhibitor in Spondyloarthropathies Using 10 Years of Nationwide Data in Korea: A Population-based Study
Eunyoung Emily Lee, Jeong Seok Lee, Yeong Wook Song, Hee Young Lee, Eun Young Lee ··· S232
55. Lateral Spine BMD Measurement and Trabecular Bone Score Can Represent a Bone Loss in Patients with Advanced Ankylosing Spondylitis
Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Sung-Hwan Park, Ji Hyeon Ju ··· S233
56. Quantitative Assessment of Bone Marrow Fat Using Magnetic Resonance Imaging in Patients with Spondyloarthritis
Bon San Koo, Yoonah Song, Kyung Bin Joo, Seunghun Lee, Tae-Hwan Kim ··· S234
57. Clinical Characteristics of Korean Psoriatic Arthritis Patients: Results from the Nationwide KOBIO Registry
Hyoun-Ah Kim, Seongjun Ha, Seoungjae Choi, Shin-seok Lee, Inkyung Jung, Kichul Shin ··· S235
58. Andersson Lesions of Whole Spine Magnetic Resonance Imaging Compared with Plain Radiography in Ankylosing Spondylitis
Seong-Kyu Kim, Kichul Shin, Yoonah Song, Seunghun Lee, Tae-Hwan Kim ··· S236
59. Estrogen is Associated with Radiographic Progression in Ankylosing SpondylitisHyemin Jeong, Eun Kyoung Bae, Yeong Hee Eun, In Young Kim,
Hyungjin Kim, Joong Kyong Ahn, Jaejoon Lee, Eun-Mi Koh, Hoon-Suk Cha ··· S237
60. Severe Bone Marrow Edema on Sacroiliac Joint MRI Increases the Risk of Low BMD in Patients with Axial Spondyloarthritis
Ha Neul Kim, Joon-Yong Jung, Yeon Sik Hong, Sung-Hwan Park, Kwi Young Kang ··· S238
61. A20 Expression and Bone Remodeling in Ankylosing SpondylitisMin Kyung Lee, Hee Jung Ryu, Mi Ryoung Seo, Hyo Jin Choi, Han Joo Baek ··· S239
62. Phlegmonous Gastritis in Ankylosing SpondylitisBo Young Kim, Shin Ok Jeong, Yoon-Ho Cho, Hyun-sook Kim ··· S240
63. Hypergammaglobulinemia is an Indicator of Extraglandular Manifestations in Patients with Primary Sjogren’s Syndrome
In Je Kim, Roo Min Jun, Jisoo Lee ··· S241
64. Diagnostic Value of Salivary Gland Ultrasonography in Primary Sjögren’s SyndromeJi-Won Kim, Chan Uk Lee, Ji-Na Kim, Jung-Kyu Kim,
Hwajeong Lee, Sung-Hoon Park, Seong-Kyu Kim, Jung-Yoon Choe ··· S242
65. Clinical Characteristics and Treatment outcomes of Patients with Behcet’s Disease with Vascular Involvement
In Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim, Hoon-Suk Cha ··· S243
66. Sleep Quality and Behcet’s DiseaseJi Min Lee, Hye-Jin Jeong, Chang-Nam Son, Ji-Min Kim, Sang-Hyon Kim ··· S244
67. Potential Laboratory Markers Associated with Disease Activity in Behcet’s DiseaseYunjung Choi, Won seok Lee, Wan-Hee Yoo ··· S245
68. Erosive Arthritis Resembling Osteomyelitis in Behcet’s Disease PatientJae Hyun Jung, Sung Jae Choi, Gwan Gyu Song,
Jong Dae Ji, Young Ho Lee, Jae-Hoon Kim, Young Ho Seo ··· S246
69. Risk Factors for Mortality in ANCA-Associated Vasculitides Gi Bum Bae, Jeong Soo Eun, Na Ri Kim, Eon Jeong Nam, Young Mo Kang ··· S247
70. Clinical Characteristics and Treatment Outcomes of Patients with Large Vessel Vasculitis Including Takayasu Arteritis
In Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim and Hoon-Suk Cha ··· S248
71. Clinical Characteristics and Treatment Outcomes of Patients with Chronic PeriaortitisIn Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim and Hoon-Suk Cha ··· S249
72. ANCA is Associated with the Clinical Manifestations of EGPADae-Sik Kim, Jung Yoon Pyo, Se-Jin Byun, Sung Soo Ahn,
Jungsik Song, Yong-Beom Park, Soo-Kon Lee, Sang-Won Lee ··· S250
73. Effect of Teriparatide in Patients with Osteoporosis and Rheumatoid Arthritis Sae Young Lee, Robin Dore, Kenneth Saag, Guillermo Valenzuela,
Kathleen Taylor, Qiu He, Jahangir Alam, Kelly Krohn ··· S251
74. Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Stage 4 Chronic Kidney Disease
Kwanghoon Lee ··· S252
75. The Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients Undergoing DialysisDoo-Ho Lim, Ji Seon Oh, Byeongzu Ghang, Seokchan Hong,
Yong-Gil Kim, Chang-Keun Lee, Seung Won Choi, Bin Yoo ··· S253
76. Identification of Subclinical Tophi in Patients with Gouty Arthritis: A Dual-energy Computed Tomography Study
In Je Kim, Ji Young Hwang, Jisoo Lee ··· S254
77. Clinical Features and Risk Factors of Gout Attacks Following Anti-tuberculous Treatment Sang Wan Chung, Eun Ha Kang, Yun Jong Lee, You Jung Ha ··· S255
78. Increased Carotid Intima-media Thickness was Related with Elevated Serum Homocysteine Level in Patients with Hyperuricemia
Ji Ho Park, Jung-Soo Song, Sang Tae Choi ··· S256
79. Insulin Resistance as an Independent Predictor of Erectile Dysfunction in Patients with GoutJi Hun Kim, Howook Jeon, Seo Hwa Kim, Haneul Kim,
Jihyung Yoo, Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Ji Yeon Lee, Seung-Ki Kwok, Ji Hyeon Ju, Sung-Hwan Park ··· S257
80. MTHFR C677T Polymorphism is Associated with Increase in Homocysteine but not with Uric Acid
Il Woong Sohn, Chan-Bum Choi, Young Seo Kim, Jae-Bum Jun ··· S258
81. Macrophage Migration Inhibitory Factor in GoutHae-Rim Kim, Kyung-Ann Lee, Kyoung-Woon Kim, Bo-Mi Kim, Sang-Heon Lee ··· S259
82. A Case of Cryopyrin Associated Periodic Fever Syndrome (CAPS) with Mutation of NLRP3 as Autoinflammatory Syndrome
Sooyeon Lim, Minji Son, Yumi Seo, Kumi Jeong, Kihwan Kim, Jungwoo Rhim, Seungbeom Han, Jinhan Kang, Myungshin Kim, Daechul Jeong ··· S260
83. Treatment Pattern and Its Cost of Vertebral Fracture among Elderly Patients in KoreaDam Kim, Jeonghoon Ahn, Yoon-Kyoung Sung ··· S261
84. Evaluation of the Inpatient Rheumatology Consultation Service: A Single Tertiary Center Experience
Chan Uk Lee, Sung- Hoon Park, Hwajeong Lee, Ji-Na Kim, Ji-Won Kim, Seong-Kyu Kim, Jung-Yoon Choe ··· S262
85. Utilization Patterns of Medication in Women with Rheumatoid Arthritis of Childbearing Age: Result from KORONA Cohort
Soo-Kyung Cho, Yoon-Kyoung Sung, Dam Kim, Soyoung Won, Hoon-Suk Cha, Jung-Yoon Choe, Chan-Bum Choi, Won Tae Chung,
Seung-Jae Hong, Jae-Bum Jun, Jinseok Kim, Tae-Hwan Kim, Eunmi Koh, Hye-Soon Lee, Jisoo Lee, Shin-Seok Lee, Sung Won Lee, Dae-Hyun Yoo, Sang-Cheol Bae ··· S263
86. The Effect of Rheumatoid Factor on All-cause, Cardiovascular and Cancer-cause Mortality in 296,581 Korean Subjects: A Kangbuk Samsung Health Study
Joong Kyong Ahn, Jiwon Hwnag, Seungho Ryu, Yoosoo Chang ··· S264
87. Prevalence and Incidence of RA and Medical Care Utilization in Elderly Onset RA Patients: An analysis of Korean National Health Insurance Claims Data
Soyoung Won, Soo-Kyoung Cho, Dam Kim, Minkyung Han, Jiyoung Lee, Hyuk Hee Kwon, Eun Jin Jang, Yoon-Kyoung Sung, Sang-Cheol Bae ··· S265
88. Medical Care Utilization among the Korean Patients with Systemic Lupus Erythematosus Seung Lee, Young Bin Joo, So-Yeon Park, Hyuk Hee Kwon,
Hye-soon Lee, Yoon-Kyoung Sung, Sang-Cheol Bae ··· S266
89. A Case of Serotonin Syndrome Following the Administration of Duloxetine in a Fibromyalgia Patient: Case Report and Review of Literature
Joon Sul Choi, Ji Hyun Lee ··· S267
90. Pattern Recognition Receptors in Adult Onset Still’s DiseaseHyoun-Ah Kim, Chang-Hee Suh, Ju-Yang Jung,
Hasan MD Sayeed, Ye Won Kim, Seonghyang Sohn ··· S268
91. TLR4 Endogenous Ligand S100A8/A9 Levels in Adult-onset Still’s Disease and Their Association with Disease Activity and Clinical Manifestations
Hyoun-Ah Kim, Jae Ho Han, Ju-Yang Jung, You-Sun Kim, Chang-Hee Suh ··· S269
92. Cytokine Profiles of Korean Patients with Adult Onset Still’s Disease Treated with Tumor Necrosis Factor Inhibitors
Seung Taek Song, SuMan Kang, Sung Won Lee, Seoung Wan Nam, Dae-Hyun Yoo ··· S270
93. Elevated High Mobility Group B1 Levels in Active Adult-onset Still’s Disease Associated with Systemic Score and Skin Rash
Hyoun-Ah Kim, Ju-Yang Jung, Chang-Hee Suh ··· S271
94. Unbiased Analysis of Fever Curves in Adult Onset of Still’s DiseaseEun Young Ahn, Hyun MI Kwon, Woochang Hwang, Eun Young Lee,
Eun Bong Lee, Yeong Wook Song, Jin Kyun Park ··· S272
95. Serum Uric Acid is Positively Associated with Pulmonary Function in Korean Health Screening Examinees: A Cross-Sectional Study
Jiwon Hwang, Jae-Uk Song, Joong Kyong Ahn ··· S273
96. Clinical Outcomes and Pathological Characteristics of Orbital IgG4-related Disease versus Orbital Inflammatory Pseudotumor
Hong Ki Min, Youn Soo Lee, Suk Woo Yang, Jennifer Lee, Seung-Ki Kwok, Ji Hyeon Ju, Wan-Uk Kim, Sung-Hwan Park ··· S274
97. Are High Levels of Serum B2 Mikroglobuline, Independent Inflammatory Markers from Renal Dysfunction in Geriatric Population?
Suleyman Ozbek, Ertugrul Bayram ··· S275
98. Coexistent Mixed Connective Tissue Disease and Papillary Thyroid Cancer in a Patient with Primary Biliary Cirrhosis: A Case Report
Ji-Heh Park, Seung-Geun Lee, Eun-Kyoung Park ··· S276
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Plenary Session I - International
Free Paper Session
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S3
Urinary Interleukin-6 as a Predictor of Radiographic Progression in Rheumatoid Arthritis: A 3-year Evaluation
Yune-Jung Park1,2, Seung-Ah Yoo2, Ga-Ram Kim2, Chul-Soo Cho2,3, Wan-Uk Kim2,4
1Department of Internal Medicine, Division of Rheumatology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, 2POSTECH-CATHOLIC Biomedical Engineering Institute, The Catholic University of Korea, Seoul, 3Department of Internal Medicine,
Division of Rheumatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 4Department of Internal Medicine, Division of Rheumatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Objectives: Previously, we demonstrated that the urine proteome signature of patients with rheumatoid arthritis (RA)
reflects inflammation-related cellular processes. Here, we measured interleukin (IL)-6, IL-8, and chemokine ligand 2
(CCL2) concentrations in the urine of RA patients and prospectively investigated their role in predicting RA activity and
prognosis.
Methods: One hundred seventy-three RA patients and 62 non-RA controls were consecutively recruited. RA activity
was determined based on assessment of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and 28-joint
disease activity score. Radiographic severity was evaluated using Sharp/van der Heijde score on X-rays of the hands and
feet at 1 and 3 years. Urinary IL-6, CCL2, and IL-8 at presentation were determined by enzyme-linked immunosorbent
assay.
Results: Urinary IL-6, CCL2, and IL-8 levels were elevated in RA patients and correlated well with disease activity.
Urinary IL-6 level at presentation was an independent risk factor of radiographic progression at 1 and 3 years. High uri-
nary IL-6 level increased the risk ratio of radiographic progression by 2.9-fold, which was comparable to high serum CRP.
Moreover, combination of urinary IL-6 and serum CRP measures synergistically increased the predictability of radio-
graphic progression. In a subgroup with normal ESR, patients with the highest tertile of urinary IL-6 were at 6.4-fold
greater risk of radiographic progression.
Conclusions: High urinary IL-6 level at presentation is an independent risk factor for radiographic progression of RA,
reflecting disease activity. Urinary IL-6 in combination with serum CRP may be a useful parameter for estimating RA
prognosis.
O-20-01
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S4
Baseline Autoantibodies Preferentially Impact Abatacept Efficacy in Patients with RA Who are Biologic Naïve: 6-Month
Results from a Real-World, International, Prospective Study
Rieke Alten1, Hubert G Nüßlein2, Mauro Galeazzi3, Hanns-Martin Lorenz4, Xavier Mariette5, Alain Cantagrel6, Melanie Chartier7, Guillaume Desachy8, Coralie Poncet9, Christine Rauch10, Manuela Le Bars10
1Schlosspark-Klinik University Medicine, Berlin, 2University of Erlangen, Erlangen, Germany, 3University of Siena, Siena, Italy, 4University Hospital Heidelberg, Heidelberg, Germany, 5Université Paris-Sud, Paris, 6Purpan Hospital, Toulouse, France,
7Chiltern International, Neuilly, 8Excelya, Biostatistician, Paris, 9Docs International, Nanterre, France, 10Bristol-Myers Squibb, Munich, Germany, 11Bristol-Myers Squibb, Rueil-Malmaison, France
Background: In a recent meta-analysis, neither RF nor anti-CCP status were associated with clinical response to an-
ti-TNF treatments. In contrast, anti-CCP positivity may be associated with increased abatacept (ABA) efficacy in prior
bDMARD failure and bDMARD-naïve pts.
Objective: The efficacy of ABA after 6 months' follow-up in bDMARD-naïve pts was compared in RF/anti-CCP positive
vs-negative pts enrolled in the ACTION study.
Methods: ACTION is a 2-year, international, prospective, observational study evaluating retention and effectiveness
of IV ABA in RA pts. Baseline characteristics and clinical outcomes were evaluated at 6 months and compared for
bDMARD naïve anti-CCP/RF-positive and negative pts using analysis of variance on ranks for quantitative variables and
Fisher exact tests for qualitative variables. EULAR response and CDAI was based on DAS28 (ESR or CRP).
Results: In 672 bDMARD-naïve pts, RF was reported in 577 (86%) pts (412 [71%] positive) and anti-CCP in 552
(82%) pts (364 [66%] positive); 308/511 (60%) pts were double positive and 127/511 (25%) pts were double negative.
Clinical outcomes at 6 months were more beneficial in pts who were RF or anti-CCP positive vs negative, including
EULAR good/moderate response vs no response (Figure); mean (95% CI) CDAI (RF: 10.8 [9.8, 11.8] vs 15.3 [13.4,
17.2]; p<0.001; anti-CCP: 10.9 [9.8, 12.0] vs 14.3 [12.4, 16.2]; p=0.002). Similarly, significant differences in clinical out-
comes were observed among pts who were
RF/anti-CCP single or double positive vs dou-
ble negative, respectively, including EULAR
good/ moderate response vs no response
(Figure); mean (95% CI) CDAI (11.1 [10.2,
12.1] and 10.5 [9.3, 11.6] vs 14.5 [12.3, 16.7];
p=0.003 and p=0.001, respectively).
Conclusion: This is the first prospective re-
al-world data showing superior efficacy of ABA
in bDMARD-naïve pts who are RF and/or an-
ti-CCP positive vs negative. The association be-
tween autoantibody status and clinical out-
comes with ABA may be linked to its’
mechanism.
O-20-02
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S5
The Effect of Medication on Development of Cardiovascular Disease in Patients with Rheumatoid Arthritis
Soo-Kyung Cho1,2, Dam Kim1,2, Soyoung Won2, Minkyung Han2, Jiyoung Lee2, Eun Jin Jang3, Sang-Cheol Bae1,2, Yoon-Kyoung Sung1,2
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, 3Department of Information Statistics, Andong National University, Andong, Korea
Objectives: To evaluate the impact of drugs on the development of cardiovascular disease (CVD) in patients with rheu-
matoid arthritis (RA)
Methods: A retrospective cohort of RA patients was established using Korean national healthcare claims database be-
tween Jan 2009 and Dec 2013. There was 6 months disease-free period of CVD to determine the incident cases. After ex-
cluding the patients with CVD history, patients were followed for the development of CVD or the last observational date
(Dec 31, 2013). We performed a nested case-control study of RA patients without previous CVD. Cases who developed
CVD were identified and matched with up to 4 controls without CVD. Controls were matched for age, gender, RA index
date, comorbidities including hypertension, diabetes, hyperlipidemia, chronic kidney disease, and drugs such as anti-
platelet agent, cholesterol lowering agent. Information on drugs exposure: non-steroidal anti-inflammatory drugs
(NSAIDs), disease modifying antirheumatic drugs (DMARDs), biologic DMARDs, corticosteroids, calcium which was
used more than 30 days during 1 year before CVD was collected. Using the multivariate regression model, we evaluate
the impact of drugs on the development of CVD after adjusting various confounding factors.
Results: We identified 7,102 cases and 17,018 controls identified. DMARDs (OR 0.79, 95%CI 0.73-0.85) were pro-
tective effect for CVD. Corticosteroids (OR 1.26, 95%CI 1.19-1.34) and NSAIDs (nonselective NSAIDs: OR 1.32, 95%CI
1.22-1.41, Cox-2 inhibitor: OR 1.31, 95%CI 1.18-1.45) were risk factors for CVD.
Conclusions: DMARDs showed protective effect for CVD, while corticosteroids and NSAIDs were risk factors for
CVD.
O-20-03
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S6
Comorbidities of Rheumatoid Arthritis: Results from the 2010-2012 Korean National Health
and Nutrition Examination Survey
Hyemin Jeong1, Sun Young Beak2, Yeong Hee Eun1, In Young Kim1, Hyungjin Kim1, Joong Kyong Ahn3, Jaejoon Lee1, Eun-Mi Koh1, Hoon-Suk Cha1
1Department of Medicine, Samsung Medical Center, 2Biostatic and Clinical Epidemiology Center, Samsung Medical Center, ³Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Abstract: To evaluate the prevalence of comorbidities in subjects with rheumatoid arthritis (RA) compared with sub-
jects without RA.
Method: The 2010-2012 Korea National Health and Nutrition Examination Survey (KNHANES), which assesses the
general health status of populations in South Korea using interviews and basic health assessment, was analyzed
retrospectively. Weighted prevalence and odds ratio (OR) of comorbidities were analyzed in subjects with RA compared
with subjects without RA.
Results: The overall weighted (n=37,453,158) prevalence of RA was 1.5%. Subjects with RA were older and more fe-
male predominant than subjects without RA. The prevalence of living in urban area, collage graduation, drinking and
smoking was lower in subjects with RA than subjects without RA. Subjects with RA had more comorbidities including
hypertension, dyslipidemia, myocardial infarction (MI) or angina, stoke, osteoarthritis, pulmonary tuberculosis, asthma,
diabetes, depression, thyroid disease and chronic kidney disease. After adjusting socioeconomic and lifestyle character-
istics, RA was associated with increased the prevalence of MI or angina (OR 1.86, 95% CI 1.17 to 2.96, p=0.009), pulmo-
nary tuberculosis (OR 1.95, 95% CI 1.24 to 3.09, p=0.004), asthma (OR 1.97, 95% CI 1.05 to 3.71, p=0.036), depression
(OR 2.38, 95% CI 1.47 to 3.85, p<0.001) and hepatitis B (OR 2.34, 95% CI 1.15 to 4.80, p=0.020). Prevalence of malig-
nancy was not significantly associated with RA.
Conclusions: RA was associated with increased risk of cardiovascular disease, pulmonary tuberculosis, asthma, hep-
atitis B and depression.
O-20-04
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S7
Impacts of Disease Activity and Serum Level of Brain-derived Neurotrophic Factor
on Depression in Patients with Rheumatoid Arthritis
Yun-Hong Cheon1, Hyun-Ok Kim1, Young Sun Suh1, Sang-Hyon Kim2, Ji-Min Kim2, Chang-Nam Son2, Seung-Geun Lee3, Eun Kyoung Park3, Sang-Il Lee1
1Department of Rheumatology, Internal Medicine, Gyeongsang National University School of Medicine, Jinju, 2Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu,
3Division of Rheumatology, Department of Internal Medicine, Pusan, Korea
Background: Rheumatoid arthritis (RA) and depression is closely associated with each other. The serum level of
brain-derived neurotrophic factor (BDNF) is related with the major depressive disorder (MDD). However, the impacts
of disease activity and BDNF on depression in RA have not well studied.
Objectives: To determine the risk factors for depression and to examine the effect of disease activity and BDNF on de-
pression in patients with RA.
Methods: This cross sectional study was conducted from Jan, 2014 to Jan, 2015 from 3 university hospitals.
Demographic and laboratory data were examined and routine assessment of patient index data 3 (RAPID 3) ques-
tionnaire and 28 joints disease activity score (DAS28-CRP) were assessed for disease activity. Depression was measured
by Korean version of the Beck Depression Inventory second edition (K-BDI II). Serum level of BDNF was assessed by
ELISA.
Results: A total of 507 RA patients were recruited. The prevalence of depression was 46.2% (n=234). RAPID 3 score
showed a significant association with depression in multivariate analysis (OR 1.2, 95% CI 1.1-1.4, P=0.006). The RA pa-
tients with DAS 28-CRP >3.2 (n=135) had more risk for depression than those with DAS 28-CRP<3.2 (n=361) in mul-
tivariate analysis (OR 1.8, 95% CI 1.2-2.8, p=0.006). We re-checked K-BDI II and DAS28-CRP for 29 patients after treat-
ment, and the disease activity and K-BDI II score were improved (ΔDAS28-CRP: -1.73±1.6, and ΔK-BDI II: -7.73±10.8,
P<0.001). In the case of BDNF, there was weakly negative correlation with K-BDI-II score (r=-0.229, P=0.006). The se-
rum level of BDNF was weakly predicted for depression after multiple linear regression analysis with adjustment for co-
variates (β=-0.51, P=0.023).
Conclusion: This study suggests that RAPID 3 score and DAS28-CRP were related with depression. The serum level
of BDNF is negatively related with the severity of depression in patients with RA.
O-20-05
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Plenary Session II - International
Free Paper Session
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S11
Does Rheumatoid Arthritis Affect Bisphosphonate-related Atypical Femur Fracture?
Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Wan-Uk Kim, Sung-Hwan Park, Ji Hyeon Ju
Division of Rheumatology, Department of Internal Medicine, St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
Backgrounds: Patients with rheumatoid arthritis (RA) are diagnosed with osteoporosis earlier than those without, and
are therefore exposed to Bisphosphonates (BP) for longer. However, the increasing use of BPs has raised concerns about
atypical femur fracture (AFF).
Objectives: To determine RA and other clinical factors are associated with an increased risk of BP-related AFF.
Methods: We conducted a retrospective case-control study in patients who have taken BPs for at least 1 year in Seoul
St. Mary’s Hospital, between 2008 and 2015. We identified patients with AFF by reviewing surgical and radiographic
records. Three age- and sex- matched controls without history of AFF were randomly selected to each patient with AFF.
Conditional logistic regression was used to estimate predictors of BP related AFF.
Results: In 35,104 patients who were prescribed BPs for at least a year during 8 year-period, 43 female patients (mean
age, 68.1±7.9 years) suffered AFF (0.12%). The mean length of BPs exposure for them was 7.3±2.7 years. Patients with
AFF had exposed to BPs longer and continued BP treatment without cessation. More patients with AFFs comorbided
with RA than controls did (28% and 7%, respectively, P<0.001). Use of glucocorticoids (GCs) and disease modifying an-
ti-rheumatic drugs (DMARDs) in prior 6 months was more frequently found in patients with AFF. Multivariate logistic
analyses identified prolonged BP exposure (per year, OR, 1.381; 95% CI, 1.168-1.633) without cessation (OR, 5.163;
95% CI, 1.553-17.165), GCs use (OR 13.868, 95% CI, 4.523-42.518), and higher BMI (per kg/m2, OR, 1.456, 95% CI,
1.218-1.743) as being associated with an increased risk of AFF.
Conclusions: Patients receiving long-term BPs without cessation, use of GCs and higher BMI are at higher risk of AFF
than matched control subjects. These patients should be carefully followed up with X-rays or dual energy bone densiom-
etry during BP treatment.
O-20-06
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S12
Targeting IL-23 Can Attenuate Progression of Spinal Ankylosis in Ankylosing Spondylitis
Sungsin Jo1*, Bon San Koo2*, Il-Hoon Sung3, Ye-Soo Park4, Tae-Hwan Kim1 1Department of Rheumatology, Hanyang University Hospital for Rheumatic Disease, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Konkuk University College of Medicine, Chungju, 3Department of Orthopaedic Surgery, Hanyang University Hospital for Rheumatic
Disease, Seoul, 4Department of Orthopaedic Surgery, Hanyang University Hospital for Rheumatic Disease, Guri, Korea*These two authors contributed equally.
Background/Objectives: The role of IL- 23 in AS pathogenesis has emerged as a therapeutic target. We investigated en-
doplasmic reticulum (ER) stress and IL-23 cytokine could play a role in human bone derived osteoblast cells and blocking
it leads to regulation of bone-related genes and/or preventing bone ankylosis in AS.
Methods: Primary human osteoblast cells were isolated from diced bones of facet joints which were taken from surgical
operation of 8 AS patients and 8 healthy controls (HC). Osteoblast differentiation- and ER stress-related genes were de-
termined by quantitative RT-PCR, immunoblotting, immunofluorescence, and immunohistochemistry. Osteoblast activ-
ity of all bones-derived osteoblast cells was confirmed by Alkaline Phosphatase activity (ALP) and Alizarin Red (ARS)
staining. The ER stress by BIX, selective BIP inducer X, in the regulation of IL-23 expression and secretion was evaluated.
Results: We found that elevated RUNX2, BIP, and IL-23 protein expressions were observed at osteoblast cells in human
AS compared to HC. In addition, mRNA levels of bone differentiation (ALP, BMP2, COL1A, RUNX2, C/EBPβ, OPG, and
OCN) and ER stress (BIP and CHOP)-related genes were highly expressed in human AS. In particular, IL-23 and RUNX2
expressions were significantly increased in AS. BIX-mediated ER stress stimulated induction of osteoblast activity and
IL-23 secretion via modulating RUNX2 and C/EBPβ genes. Intriguingly, RUNX2 Knockdown by shRNA impeded ER
stress induced effects. Moreover, osteoblast activity and RUNX2 expression in AS were significantly reduced by IL-23
blockers, but not TNFα blockers.
Conclusions: This is the first report to show that osteoblastic activity in AS were increased compared to HC, suggesting
that sustained ER stress induces osteoblast activity and IL-23 expression. Taken together, our results supported that
blocking IL-23 may represent a promising therapeutic target to assist and prevent bony progression in AS.
O-20-07
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S13
Impact of Dose Tapering of Tumour Necrosis Factor-blockers on Radiographic Progression in the Ankylosing Spondylitis: A 4-year Prospective Follow Up from Single-centre Cohort
Jun Won Park, MD1, Hyun Mi Kwon, MD1, Jin Kyun Park, MD1, Ja-Young Choi, MD, PhD2, Eun Bong Lee, MD, PhD1, Yeong Wook Song, MD, PhD1, Eun Young Lee, MD, PhD1
1Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
Background: Although dose tapering of tumour necrosis factor inhibitor (TNFi) in ankylosing spondylitis (AS) showed
a comparable clinical efficacy in some studies, its impact on radiographic progression remains uncertain.
Objectives: To investigate the impact of dose reduction of TNFi on radiographic progression in the AS over 4 years
Methods: One hundred sixty-five patients treated with etanercept or adalimumab were selected from single-centre,
prospective observational cohort based on the availability of cervical and lumbar radiographs at baseline and after 2-
and/or 4-years of the treatment. Radiographs were assessed by two blinded readers using modified Stokes AS Spinal
Score (mSASSS). Radiographic progression in patients treated with standard-dose TNFi (standard-dose group, n=49)
were compared with patients who tapered the dosage during the treatment (tapering group, n=116) using linear mixed
models.
Results: Baseline characteristics between two groups were comparable except for higher BASDAI (7.1 vs. 6.3,
p=0.003) in the standard-dose group. At 2 years after the treatment, mean dose quotient (SD) of the tapering group was
0.59 (0.17). During the follow up, rate of radiographic progression in overall patients was 0.90 mSASSS unit/year.
Radiographic progression between two treatment strategies was similar after the adjustment for baseline status.
However, in the subgroup of patients with baseline syndesmophyte, it occurred significantly faster in the tapering group
(1.30 vs. 1.82 mSASSS unit/year, p=0.008). It was concordant when radiographic progression was assessed by the num-
ber of newly developed syndesmophyte (0.52/year vs. 0.73/year, p=0.047). Sensitivity analysis after multiple imputation
of missing radiographs also showed similar result.
Conclusion: Dose tapering strategy of TNFi is associated with more rapid radiographic progression in AS patients who
have syndesmophyte at baseline.
O-20-08
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S14
Insulin Resistance is Associated with Digital Ulcer in Patients with Systemic Sclerosis
Eun-Kyoung Park, Seung-Geun Lee, Ji-Heh Park
Divsion of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
Background: Growing evidence supports the view that systemic sclerosis (SSc) is a vascular disease mediated by auto-
immunity and evolving into progressive tissue fibrosis. Several vascular biomarkers have been studied, but little is known
about the role of metabolic derangement in vasculopathy in SSc.
Objectives: To investigate the relationship between insulin resistance and digital ulcers (DUs) in patients with SSc.
Methods: Using a cross-sectional design, we recruited 73 consecutive female patients with SSc and 109 sex- and
age-matched healthy controls in South Korea from July 2014 to June 2015. The magnitude of insulin resistance was meas-
ured using the homeostatic model assessment of insulin resistance (HOMA-IR). DUs ever included active and healed
DUs and the extent of skin fibrosis was evaluated using the modified Rodnan skin score (MRSS).
Results: The HOMA-IR in patients with SSc was significantly higher than that in healthy controls (median 1.18 vs.
0.71, p<0.001). In SSc patients, 7 (9.6%) had active DUs and 14 subjects (19.2%) had healed DUs; thus, DUs ever were
observed in 21 cases (28.8%). SSc patients with DUs ever had significantly higher HOMA-IR and MRSS compared with
those without this feature (median, 2.05 vs. 0.99, p=0.001 and 14 vs. 9.5, p=0.011, respectively). After adjustment for
confounding factors using multivariable logistic regression analyses, the HOMA-IR showed a significant positive associa-
tion with the presence of DUs ever in patients with SSc (OR=1.43, 95% CI=1.01-2.05, p=0.048). In addition, higher
MRSS was significantly correlated with DUs ever (OR=1.11, 95% CI=1.02-1.21, p=0.015).
Conclusion: Insulin resistance was independently associated with the presence of DUs in patients with SSc and may
be a potential biomarker for SSc micro-vasculopathy. Moreover, our data also suggest a potential contribution of insulin
resistance to the pathogenesis of DUs.
O-20-09
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Invited Lectures I
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S17
Treatment of Lupus Nephritis
Bevra H Hahn, MD, UCLA
Professor of Medicine/Rheumatology, UCLA School of Medicine, USA
Bevra H Hahn: Treatment of Lupus Nephritis
S18 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Bevra H Hahn: Treatment of Lupus Nephritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S19
Bevra H Hahn: Treatment of Lupus Nephritis
S20 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Bevra H Hahn: Treatment of Lupus Nephritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S21
Bevra H Hahn: Treatment of Lupus Nephritis
S22 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Bevra H Hahn: Treatment of Lupus Nephritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S23
Bevra H Hahn: Treatment of Lupus Nephritis
S24 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S25
Sequencing Antibody Repertoires to Decipher Pathogenic Mechanisms in Rheumatoid Arthritis
William H. Robinson, MD, PhD
Stanford University School of Medicine, USA
We developed a method that utilizes cell barcodes to enable high-throughput sequencing of the paired heavy-chain and
light-chain immunoglobulin sequences and other co-expressed genes expressed by individual B cells. When applied to
peripheral blood plasmablasts, this approach enables us to generate phylogenetic trees of the acute affinity-matured auto-
antibody response, and thereby pinpoint the antibodies produced in immune responses. We are applying this method to
sequence the antibody repertoire in rheumatoid arthritis (RA). We identified clonal families of B cells that express anti-
bodies specific for citrullinated fibrinogen, citrullinated histones and rheumatoid factor. We characterized the binding
and functional properties of clonal family-derived recombinant antibodies using synovial antigen arrays, macrophage and
neutrophil functional assays, and in mouse models of RA. We identified anti-citrullinated fibrinogen antibodies that du-
al-stimulate macrophage to produce TNF, and anti-citrullinated histone 2B antibodies that form immune complexes that
induce neutrophil netosis. We demonstrate that these antibodies exacerbate the severity of arthritis in mouse models of
RA. Our results are defining novel pathogenic autoantibodies, and elucidating the mechanisms by which they mediate
synovitis and joint tissue destruction, in RA.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S26
Hyperuricemia and Cardiovascular Disease Risk
Hyon Choi, MD, DrPH
Professor of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Hyperuricemia and gout are strongly associated with cardiovascular (CV)-metabolic-renal comorbidities (e.g., hyper-
tension in 74%, metabolic syndrome in 63%, and obesity in 53% in the US1-4.) and their sequelae (e.g., myocardial in-
farction and premature death5,6). Despite these associations, the causal link between gout (or serum urate) and the risk
of these CV-renal-metabolic outcomes remains unresolved. Recently, with the expansion of genetic discovery through
GWAS, a stronger causal inference became feasible. However, Mendelian randomization studies, which take advantage
of the fact that alleles of an individual’s genotype are assigned randomly at meiosis to eliminate bias by confounding varia-
bles and reverse causation, are particularly relevant in the context of the gout-urate-CVD link as uric acid is associated
with many CV-metabolic risk factor traits. To date, the vast majority of Mendelian Randomization study findings have
been null, suggesting non-causal associations7. In terms of actual randomized controlled trials (RCTs), two RCTs among
adolescents with hyperuricemic prehypertension or stage-1 hypertension found that allopurinol or probenecid lowered
blood pressure with a magnitude of effect similar to the first line oral anti-hypertensive agent,8,9 whereas a similarly de-
signed trial among adults did not find such benefit.10 Importantly, these trials’ participants were not gout patients8-10;
thus, the generalizability of their results remains to be clarified.
Regardless of the question of causality, the high level of major comorbidities and sequelae of gout provide a strong ra-
tionale for serious consideration of these issues in gout care (e.g., choosing appropriate anti-gout therapy) and reducing
the overall disease burden of gout. Observational studies have suggested that allopurinol initiation is associated with a
lower risk of all-cause mortality11,12 and CV events13. A recent study found that the use of colchicine was also associated
with a lower risk of acute coronary syndrome14, unlike the well-established hazardous impacts of NSAIDs and
glucocorticoids.
Taken together, the optimal gout-limiting therapy approaches (pharmacologic, diet, and lifestyle measures) would
adopt a personalized treat-to-target paradigm to reduce both serum urate levels and CV-metabolic-renal complications.
The current low-purine dietary approach to gout offers limited efficacy, palatability, and sustainability, and promotes in-
creased consumption of refined carbohydrates and saturated fat that can actually worsen gout’s CV-metabolic comorbid-
ities by leading to insulin resistance and increased levels of plasma glucose, triglycerides, and LDL-C1,15. In contrast, there
are proven, effective dietary approaches to reduce CV-metabolic conditions (including obesity) that could also lower se-
rum uric acid levels and the risk of gout by lowering adiposity and insulin resistance (which inhibits uric acid excretion).
These existing measures could provide an ideal strategy to reduce both the risk of gout and its associated comorbidities.
For example, the Dietary Approaches To Stop Hypertension (DASH) diet could be investigated for hyperuricemic in-
dividuals with hypertension16, whereas diets against the metabolic syndrome15 could be further examined for obese hy-
peruricemic individuals who require better glycemic control and lipid effects, respectively.
Hyon Choi: Hyperuricemia and Cardiovascular Disease Risk
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S27
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1. Fam AG. Gout, diet, and the insulin resistance syndrome. J. Rheumatol. 2002;29(7):1350-1355.2. Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Ann Intern Med. 2005;143:499-516.3. Choi HK, Ford ES, Li C, Curhan G. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and
Nutrition Examination Survey. Arthritis Rheum. Feb 15 2007;57(1):109-115.4. Zhu Y, Pandya BJ, Choi HK. Comorbidities of Gout and Hyperuricemia in the US General Population - The National Health and
Nutrition Examination Survey 2007-2008. Am. J. Med. In Press.5. Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH. Long-term cardiovascular mortality among middle-aged men with
gout. Arch Intern Med. May 26 2008;168(10):1104-1110.6. Abbott RD, Brand FN, Kannel WB, Castelli WP. Gout and coronary heart disease: the Framingham Study. J. Clin. Epidemiol.
1988;41(3):237-242.7. Merriman TR, Choi HK, Do R, Robinson PC. Mendelian randomization : insights into rheumatological cause-effect relationships.
Nature reviews. Rheumatology. 2016 (in press).8. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension:
a randomized trial. Jama. Aug 27 2008;300(8):924-932.9. Soletsky B, Feig DI. Uric acid reduction rectifies prehypertension in obese adolescents. Hypertension. Nov 2012;60(5):1148-1156.
10. McMullan CJ, Borgi L, Curhan GC, Fisher NDL, Forman JP. Effect of Uric Acid Lowering on Ambulatory Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J. Am. Soc. Nephrol. 2015(26):43A.
11. Luk AJ, Levin GP, Moore EE, Zhou ZH, Choi HK. Allopurinol and Mortality in Hyperuricemic Patients. Rheumatology (Oxford). 2009;48(7):804-806.
12. Dubreuil M, Zhu Y, Zhang Y, et al. Allopurinol initiation and all-cause mortality in the general population. Ann Rheum Dis. Mar 24 2014.
13. Grimaldi-Bensouda L, Alperovitch A, Aubrun E, et al. Impact of allopurinol on risk of myocardial infarction. Ann Rheum Dis. Jan 6 2014.
14. Solomon DH, Liu CC, Kuo IH, Zak A, Kim SC. Effects of colchicine on risk of cardiovascular events and mortality among patients with gout: a cohort study using electronic medical records linked with Medicare claims. Ann Rheum Dis. Nov 18 2015.
15. Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J. Beneficial effects of weight loss associated with moderate calo-rie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000;59(7):539-543.
16. Juraschek SP, Gelber AC, Choi HK, Appel LJ, Miller ER, 3rd. Effects of the Dietary Approaches To Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid. Arthritis and Rheumatism (in press). 2016.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Luncheon Symposium and Lunch Break
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S31
Tofacitinib, an Oral Janus Kinase Inhibitor, as Monotherapy or with Background Methotrexate,
in Japanese Patients with Rheumatoid Arthritis: An Open-label, Long-term Extension Study
Hisashi Yamanaka1*, Yoshiya Tanaka2, Tsutomu Takeuchi3, Naonobu Sugiyama4*, Hirotoshi Yuasa4, Shigeyuki Toyoizumi4, Yosuke Morishima4, Tomohiro Hirose4, Samuel Zwillich5
1Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, 2The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, 3Department of Internal Medicine, Keio University, Tokyo,
4RA & Inflammation Medical Affairs, Pfizer Japan Inc, Tokyo, Japan, 5Pfizer Inc, Groton, Connecticut, USA
Background: Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Here, tofacitinib
safety and efficacy data from a long-term extension study in Japanese patients are presented.
Methods: Study A3921041 was a multi-centre, open-label, long-term extension study that included Japanese patients
who had participated in a prior Phase 2 or Phase 3 study of tofacitinib as monotherapy or with background methotrexate.
Patients received tofacitinib 5 mg twice daily (BID) or tofacitinib 10 mg BID. Dose adjustment of tofacitinib during treat-
ment period, and concomitant usage of disease-modifying antirheumatic drugs including methotrexate after week 12
were permitted. Primary endpoints were adverse events, laboratory parameters and vital signs. Secondary efficacy end-
points included American College of Rheumatology (ACR)20/50/70 response rates, Disease Activity Score (DAS)
28-4(erythrocyte sedimentation rate (ESR))<2.6 response rate (DAS-defined remission) and Health Assessment
Questionnaire-Disability Index (HAQ-DI) score. Safety and efficacy data were assessed throughout the study.
Results: A total of 486 patients were recruited and treated (1439.9 patient-years of exposure). 308 patients completed
the study. Median (range) duration of treatment in this extension study was 1185 (5-2016) days. 476 patients (97.9%)
experienced adverse events; the majority of which (97.8%) were of mild or moderate severity. The two most common
treatment-emergent adverse events were nasopharyngitis (n=293, 60.3%) and herpes zoster (n=94, 19.3%). For all tofa-
citinib-treated patients, the incidence rate (patients with events per 100 patient-years) was 10.7 for serious adverse
events, 3.3 for serious infections, 7.4 for herpes zoster (serious and non-serious) and 1.2 for malignancies (excluding
non-melanoma skin cancer). Mean changes from baseline(start of the index study) in laboratory parameters were con-
sistent with those seen in previously reported studies of tofacitinib. ACR20/50/70 response rates, DAS-defined re-
mission rates and HAQ-DI scores were sustained through to study completion.
Conclusions: Tofacitinib (with or without background methotrexate) demonstrated a stable safety profile and sus-
tained efficacy in Japanese patients with active rheumatoid arthritis. The risk of herpes zoster appears to be higher in
Japanese patients treated with tofacitinib than in the global population.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Issues in Clinic Session
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S35
BP & HCQ Uses in Rheumatic Diseases
이창근
울산대학교 의과대학 서울아산병원
이창근: BP & HCQ Uses in Rheumatic Diseases
S36 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이창근: BP & HCQ Uses in Rheumatic Diseases
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S37
이창근: BP & HCQ Uses in Rheumatic Diseases
S38 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이창근: BP & HCQ Uses in Rheumatic Diseases
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S39
이창근: BP & HCQ Uses in Rheumatic Diseases
S40 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이창근: BP & HCQ Uses in Rheumatic Diseases
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S41
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S42
Rhuematism as a co-morbidity of Medication Related Osteonecrosis of the Jaws (MRONJ)
Yong-Dae Kwon, DMD, MSD, PhD
Department of Oral & Maxillofacial Surgery, Center for Refractory Jawbone Diseases, Kyung Hee University Dental Hospital
Bisphosphonate has been regarded as one of the major risk factors of MRONJ and other medications like Denosumab
may be also a risk factor of ONJs. Although the incidence of MRONJ is still ambiguous, the incidence from oral bi-
sphosphonate is believed less than 0.01%.
MRONJ has really multifactorial etiology and is a consequence of local and systemic triggers. There are many etiologic
factors besides bisphosphonate. Many elderly ladies are suffering from rheumatism and osteoporosis. DMRADs are com-
prised of steroid, cytotoxic drugs and immunosuppressive agents. Long-term antirheumatic therapy may impair bony
healing. It is well known that long-term steroid can induce osteoporosis and this may lead to higher chance of bi-
sphosphonate therapy.
Oral cavity is basically contaminated area with various oral microbes and the mucosal barrier is quite thinner than that
of ordinary skin. Surgical procedures involving bone is commonly carried out in the alveolar bone. Long-term DMRADs
may hinder healing process when dental surgeries involving alveolar bone were performed.
Actually, there is a lack of evidence showing the direct relationship between MRONJ and RA but there are several possi-
ble hypotheses linking long-term DMRADs and ONJs. It is well-known that GDTC may play a role in an anti-
body-dependent cell-mediated cytotoxic reaction toward the epithelium of the oral mucosa, which may be a reason de-
layed soft tissue healing in MRONJ patients. In RA patients, pro-inflammatory cytokines are elevated and may reach jaw-
bone as well. The relationship between RA and periodontal disease (PD) has been widely investigated and it might be
postulated that ONJs may have a link to RA. PD can be one of the risk factors of ONJs but the microbiologic implication
of specific pathogens has not been confirmed.
It may be reasonable to expect an increased tendency in the number of MRONJ lesions in RA patients considering that
rheumatologists in many countries may be less familiar to this disease than bone specialists are and that BPs are the most
frequent prescribed drugs in rheumatologic practice. This is due to the high efficiency of BPs in the prevention and treat-
ment of osteoporosis, which is a common feature in RA.
Many dentists are aware of MRONJ and long-term bisphosphonate can be a risk of ONJs. However, many of them are
not aware that long-term antirheumatic therapy may also contribute to impaired bony healing after invasive dental sur-
gery such as dental implant placement and they often fails to deliver the informed consent that rheumatism and its treat-
ment may affect the outcome of a dental surgery involving alveolar bone.
In this presentation, rheumatism as one of risk of MRONJ will be discussed.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S43
Screening for Hydroxychloroquine Retinopathy: Why and How?
김상진
성균관대학교 의과대학 삼성서울병원 안과
김상진: Screening for Hydroxychloroquine Retinopathy: Why and How?
S44 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
김상진: Screening for Hydroxychloroquine Retinopathy: Why and How?
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S45
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Healthcare Policy Symposium
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S49
2016년 의료질 평가
정통령
보건복지부 보험급여과
정통령: 2016년 의료질 평가
S50 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
정통령: 2016년 의료질 평가
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S51
정통령: 2016년 의료질 평가
S52 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
정통령: 2016년 의료질 평가
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S53
정통령: 2016년 의료질 평가
S54 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
정통령: 2016년 의료질 평가
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S55
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S56
류마티스 및 근골격계 질환의 질병 부담 및 질관리 현황
이은봉
서울대학교 의과대학 내과학교실
류마티스 및 근골격계 질환은, 인체에서 가장 큰 기관을 침범하는 질환들로서, 다양한 질환을 포함한다. 세계보건기구 주관으로 진행
된, 대표적 질환에 대한 질병 부담 연구에 따르면, 근골격계 질환의 대표 질환인 요통은 장애로 인한 손실 년수 측면에서 전세계적으로
가장 질병 부담이 큰 질환이며, 국내에서도 요통의 생애 유병률은 50%를 상회한다. 퇴행성 관절염도, 노인인구에서 발생하는 흔한 질환
으로서 장애로 인한 손실 년수로 비교했을 때, 전세계적으로 11번째로 질병부담이 큰 질환이며, 국내에서의 유병률은 10% 이상에 달한
다. 이외에도 류마티스 관절염, 통풍 관절염, 견통 등 다양한 근골격계 질환들은 비교적 흔하게 발생하는 질환들로서, 이환된 환자에게
장기적인 장애를 유발해서, 질병부담을 가중시킨다. 특히 근골격계 질환의 대부분이, 완치가 불가한 질환들이어서, 인구고령화에 따라
근골격계 질환에 따른 질병부담은 점차 늘어날 것으로 예상된다. 류마티스 및 근골격계 질환이 적절하게 치료되고 있는지를 평가하기
위해서 객관화된 질 지표를 이용한 질 평가가 다양하게 시도되고 있다. 질 평가는 아직까지는 주로, 치료과정에 대한 평가를 중심으로
이루어지고 있으며, 류마티스 관절염의 경우 전체적으로 60% 내외, 퇴행성 관절염의 경우 40% 내외의 지표 달성률을 보인다. 따라서
근골격계 질환의 치료의 질은 아직도 개선할 여지가 많은 것으로 간주되고 있으며, 현재 치료의 질을 객관적으로 평가할 수 있는 도구의
개발과 현재 상황에 대한 객관적인 평가가 필요할 것으로 보인다.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S57
류마티스관절염 질지표 개발과 적용
백한주
가천대학교 의과대학
최근 국내외적으로 의료의 각 분야에서 진료의 질에 대한 문제제기 및 질 향상을 위한 논의가 이루어졌다. 류마티스 내과 전문의는
근골격계 환자에게 양질의 진료를 제공할 의무가 있다. 이를 위해서는 질 측정 및 평가, 질 향상을 위한 활동에 참여해야 한다.
류마티스관절염은 조기 진단과 적절한 치료로 질병의 비가역적 결과와 합병증을 막을 수 있을 가능성이 높은 질환이지만 외국의 여려
연구들에서 진단과 치료가 적절히 이루어지지 않는다는 점을 보여 주었다. 그래서 현재 외국에서는 다양한 류마티스관절염 질 지표가
각 국가의 의료체계 내에서 류마티스관절염의 질 측정에 적용하기 위해 새로이 개발되고 있다. 우리는 한국의 류마티스 관절염 진료의
질을 측정하기 위한 질 지표를 개발하고자 했다.
질 지표 개발은 RAND/University of California at Los Angeles appropriateness Method를 우리 실정에 맞게 수정하여 이용하
였다. 문헌 고찰을 통해 후보 질 지표를 선정하고 전문가 패널 토의를 통해 질 지표를 선정하였다. 후보 질 지표 선정에는 외국의 기존
질 지표 및 진료 지침, 한국의 류마티스관절염 진료 지침, 결핵 진료 지침 등을 참고하였다. 전문가 패널 토의는 두 차례에 걸쳐서 이루어
졌고 첫 번째 토의에서는 의학적 적절성에 대한 평가가 있었고 두 번째 토의에서는 질 지표의 적용성에 대한 평가가 있었다.
후보 질 지표는 70개가 선정되었고 첫 번째 전문가 패널 토의에서 56개의 후보 질 지표가 적절한 것으로 평가되었다. 두 번째 전문가
패널 토의에서는 첫 번째 토의에서 적절한 것으로 평가된 56개의 질 지표 후보와 그 측정을 적용성에 대해 평가하였고 15개의 질 지표
후보가 최종적으로 적합한 것으로 선정되었다. 향후 이 지표의 정확성과 재현성, 현장에서의 임상적 유용성에 대한 검증 및 확인이 필요
할 것이다.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
REOPHARD Session
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S61
REOPHARD: History of the Registry and Analysis of Baseline Data
전찬홍
순천향대학교 의과대학
Objectives: Registry of Pulmonary Arterial Hypertension associated with Rheumatic Disease (REOPHARD) was ini-
tiated to observe the characteristics of connective tissue disease (CTD) associated pulmonary arterial hypertension
(PAH) in Korean patients. The baseline data from the second year of the registry’s operation were described.
Methods: Patients with CTD who met the modified definition of the WHO group I PAH were enrolled. Hemodynamic
parameters and clinical data such as demographics, functional class, underlying disease, organ involvement, laboratory
tests and treatments were recorded. Baseline data collected from April 2008 to March 2010 were investigated.
Results: A total of 321 patients were enrolled. The mean age of the patients at registration was 51.9 years and 87.5%
were female. Most patients were diagnosed by echocardiography and only 24 patients (7.5%) underwent cardiac
catheterization. Exertional dyspnea was present in 63.6% of patients and 31.8% were New York Heart Association class
III or IV. Among the patients, systemic lupus erythematosus accounted for 35.3%, systemic sclerosis 28.3%, rheumatoid
arthritis 7.8%, overlap syndrome 9.0%, and mixed connective tissue disease 5.9%. There were no significant differences
in hemodynamics, functional class, diffusing capacity and N-terminal pro-brain natriuretic peptide levels between the
disease subgroups. Treatments consisted of calcium antagonists (57.0%), endothelin antagonists (32.7%), prostanoids
(27.1%), phosphodiesterase-5 inhibitors (14.3%) and combinations (37.4%).
Conclusions: REOPHARD was the first nation-wide survey of Korean patients with CTD-PAH. Compared with pre-
vious studies, the results showed some differences: underlying diseases, functional status and treatments.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S62
Survival and Prognostic Factors in Patients with Connective Tissue Disease-associated Pulmonary Hypertension by
Echocardiography: Results from a Korean Nationwide Registry
Kwi Young Kang1, Chan Hong Jeon2, Sung Jae Choi3, Bo Young Yoon4, Chan-Bum Choi5, Chang Hoon Lee6, Chang-Hee Suh7, Choong Won Lee8, Chul Soo Cho9, Eon Jeong Nam10, Eun-Mi Koh11, Ho-Youn Kim9, Hyo Jin Choi12, Hyoun-Ah Kim7, Jae-Bum Jun5, Jaejoon Lee11, Jinseok Kim13, Jong Dae Ji3,
Jun Ki Min9, Ki Jo Kim9, Kichul Shin14, Min Wook So15, Seong Ryul Kwon16, Seong-Kyu Kim17, Seong-Su Nah18, Seung-Ki Kwok9, Soo-Kon Lee19, Sung Won Lee20, Sung-Hwan Park9, Won Park16,
Yong-Beom Park19, Young Ho Lee3, Shin-Seok Lee21*, Dae Hyun Yoo5*1Department of Internal Medicine, Incheon Saint Mary’s Hospital, Catholic University of Korea, Incheon, 2Department of Internal Medicine,
Hospital Bucheon, Soonchunhyang University, Bucheon, 3Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, 4Departments of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang,
5Department of Internal Medicine, College of Medicine, Hanyang University, 6Departments of Internal Medicine, Wonkwang University College of Medicine, Iksan, 7Department of Rheumatology, Ajou University School of Medicine, Suwon, 8Department of Internal Medicine,
Wallace Memorial Baptist Hospital, Busan, 9Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 10Department of Internal Medicine, Kyungpook National University School of Medicine, 11Department of Internal Medicine, Sungkyunkwan University, 12Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center,
Incheon, 13Departments of Internal Medicine, Jeju National University School of Medicine, Jeju, 14Department of Internal Medicine, Seoul National University, Borame Hospital, 15Department of Internal Medicine, Asan Medical Center, University of Ulsan college of Medicine, Seoul,
16Departments of Internal Medicine, Inha University College of Medicine, Incheon, 17Department of Internal Medicine, Catholic University of Daegu, 18Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan,
19Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 20Department of Internal Medicine, College of Medicine, Dong-A University, Pusan, 21Department of Rheumatology, Chonnam National University Medical School, Kwangju, Korea
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 SLE, 50 with systemic sclerosis, 10 with mixed CTD, 22 with RA, and
31 with other CTDs) were diagnosed by Doppler echocardiography. Of these, 25 (14%) died during the 3.8±2.7 year fol-
low-up period after PH diagnosis. The 1 and 3 year survival rates were 90.7% and 87.3%, respectively. Compared to the
other CTD- PH s, RA- PH had the lowest survival rates (56% 3 year survival; p=0.022). Multiple regression analysis re-
vealed that low DLCO, pleural effusion, and diabetes mellitus were poor prognostic factors (p=0.008, 0.04, and 0.009,
respectively). Anti-UI-RNP 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 DLCO, pleural effusion, and dia-
betes 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.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S63
KORPAH Registry 데이터의 분석
최성재
고려대학교 의과대학
KORPAH REGISTRY
이 연구의 목적은 한국 폐동맥 고혈압 환자의 유병률, 증상, 성별, 나이, 병인과 치료 등을 알아보는 것으로 2008년부터 2011년까지
환자를 등록해 연구를 진행하였다.
심장내과, 류마티스내과, 호흡기내과, 소아청소년과 4분과의 625명 환자로 연구를 시작했다. 가장 많은 병인은 결합조직 질환으로
전체의 49.8%이고, 선천성 심장 질환은 25.4%, 특발성이거나 가족력에 의한 경우는 23.2%였다. 피험자의 평균나이는 47.6세, 성별
은 여자:남자 비율이 4:1 정도로 여자가 많았으며, 피험자의 특성이 세계 여러 나라의 registry의 피험자 특성과 비슷했다. 피험자의 분
류는 WHO-NYHA Class가 III와 IV 단계인 중증의 환자가 43.3%였다. 특발성 환자(IPAH)와 다른 질환과 관련된 환자(APAH)간
에 Class, 성비, 6MWD에서 차이가 없었지만, DLCO (폐확산능)이 낮은 폐 질환이 있는 환자는 APAH 환자 중 결합조직 질환과 관련
된 환자에게서 많았다. 표적 요법은 47% 환자가 받고 있었고 이 환자들이 주로 쓰는 약제는 bosentan으로 47%였다. WHO Class
III 혹은 IV인 환자 중 표적 요법으로 치료받은 환자는 62.8%이고 이 중 가장 많이 사용되는 약은 bosentan으로 35.7%였다. 진단 도구
는 심초음파가 60%, 우심도자술이 40%였다.
새로 발병한 환자들에 대한 특성
새로 발병한 환자 297명을 따로 비교했을 때, 한국의 유병률은 매년 백만명당 1.9명이 발병했고, 다른 나라 연구에서도 인구 백만명
당 2.0명이 발생하므로 우리나라 유병률과 비슷하다. 새로 발생한 환자들의 평균 나이(50세)와 성별(여성, 78.5%)도 전체 피험자와
거의 비슷했다. 이들의 병인은 결합조직 질환이 57.6%로 가장 많았고 Class도 II와 III가 전체의 74%를 차지했다. IPAH와 APAH를
비교했을 때, 결합조직 질환과 관련된 환자가 가장 많았고, 성별, 나이, Class나 수축기 혈압에서 두 군 간에 특별한 차이는 없었다. 단일
표적 치료는 52%, 병용 요법은 9%였으며, 가장 많이 투여한 제제는 bosentan이었고 병용요법에 가장 많이 쓰인 제제는 bosentan과
sildenafil이었다. 이 환자들의 진단 도구는 심초음파가 64.3%로 가장 많았고, 새로 발병한 환자 297명 중 우심도자술을 시행한 환자는
106명이었고 우심도자술을 시행한 환자 중 IPAH와 APAH 간에 큰 차이는 없었다.
생존율에 영향을 미치는 요인
297명 환자 중 1.7년 간 35명의 사망이 있어서 매년 100명 중 7명의 사망을 보였다. 결합조직 질환과 관련된 환자들이 가장 높은
사망률을 보였다. 생존율은 12개월에 90.8%, 24개월 87.8%를 보였다. 2010년의 REVEAL 연구의 12개월 생존율 90%와 비슷했고
이 연구에서도 IPAH 환자보다 APAH 환자들의 생존율이 더 낮았고 다른 나라 연구들도 이와 유사했다. 결합조직 질환과 관련된 환자와
WHO-NYHA Class III, IV 환자들의 누적 생존율이 가장 낮았다. 6분 보행검사 시 380 m 이하로 달린 환자와 NT-ProBNP가 797
ng/ml 이하인 환자의 생존율이 낮았다. 또한, 표적 치료를 받은 환자가 통상적 치료를 받은 환자보다 생존율이 높았다. Class 분류와
치료요법, NT Pro-BNP가 의미 있는 인자였으나 BNP나 pericardial effusion은 통계적으로 의미를 보이지 않았다. 생존율에 가장
영향을 미치는 인자는 Class 분류와 표적치료 여부였다.
최성재: KORPAH Registry 데이터의 분석
S64 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
결 론
가장 첫 번째로 이뤄진 전국적인 registry였고, 그 당시 임상 치료를 잘 반영했으며 다른 외국 연구 결과와 유사했다. 사망률은 매년
100명당 7명이었으며, 1년 생존율은 90.8%, 2년 생존율은 87.8%였으며, 생존율에 관련된 인자는 Class와 표적 치료 여부였다. 앞으
로 이 연구 결과를 기반으로 더욱 심층적인 국내 환자에 대한 연구 결과를 얻을 수 있겠다.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S65
Progression and Outcomes in Patients with Pulmonary Artery Hypertension Associated with Systemic Rheumatic Diseases:
Results from a Korean Nationwide Registry
MR Seo, HJ Ryu, HJ Choi, HJ Baek
Department of Internal Medicine, Division of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
Background: Pulmonary artery hypertension (PAH) is associated with mortality and morbidity in patients with rheu-
matic diseases.
Objectives: To investigate the progression and outcomes in patients with PAH associated with systemic rheumatic
diseases.
Methods: We used the data from the REgistry of Pulmonary Hypertension Associated with Rheumatic Disease
(REOPARD). The patients who had the results of systolic pulmonary artery pressure (sPAP) by echocardiography at the
time of diagnosis of PAH and at least one year later were enrolled.
Results: A total of 198 patients were included and female to male was 8:1. Age at the diagnosis of PAH was 46.9±14.8
years. The associated systemic rheumatic diseases were systemic sclerosis (32.8%), systemic lupus erythematosus
(32.8%) and others (34.3%). The sPAP at the time of diagnosis was 57.2±18.8 mmHg. Patients were classified into three
groups. The improvement group who sPAP was improved more than 30% were 57 patients (28.8%). The aggravating
group who sPAP was aggravated more than 30% were 40 patients (20.2%). The stationary group who were not both of
them were 101 patients (51.0%). The time intervals of echocardiography were 50.9±29.5 months in the improvement
group, 47.7±26.3 months in the stationary group, and 63.3±40.2 months in the aggravating group (p=0.02). The pa-
tients who died by any causes were 5.4% in the improvement group, 19.0% in the stationary group, and 43.2% in the ag-
gravating group (p<0.01). The patients with WHO-functional class III/IV were 22.2% in the improvement group, 47.4%
in the stationary group, and 81.1% in the aggravating group (p<0.01). The patients with home oxygen therapy were 1.8%
in the improvement group, 10.9% in the stationary group, and 22.5% in the aggravating group (p<0.01). The factors as-
sociated with deterioration of sPAP were systemic sclerosis, history of ischemic ulcers, and arrhythmia. The factors asso-
ciated with favorable outcomes of sPAP was history of pleural effusion (p<0.05).
Conclusion: The deterioration of sPAP was associated with worse outcomes in systemic rheumatic diseases patients
with PAH and it was associated with systemic sclerosis, history of ischemic ulcers, and arrhythmia.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Rheumatoid Arthritis
Clinical Aspects I
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S69
Baseline Profiles in Korean Patients with Rheumatoid Arthritis when Initiating or Switching Biologic Agents:
Results from the KOBIO Registry
Dong-Jin Park, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee
The Division of Rheumatology, The Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
Objective: Despite improved clinical outcomes for the majority of rheumatoid arthritis (RA) patients, RA patients fre-
quently experience treatment failure with one biologic agent, due to either inefficacy or adverse events, and switch to
another. This study investigated the pattern of biologic treatment and the reasons for switching biologics in Korean pa-
tients with RA
Methods: Patients with RA who had been started on a biologic agent or had switched to another biologic agent were
identified from the prospective observational Korean nationwide Biologics (KOBIO) registry. The KOBIO registry en-
rolled 1184 patients with RA at the time of initiation or switching of biologic agents. Patients were categorized according
to the chronological order of the introduction of biologic agents, and the reasons for switching of biologics were also
evaluated.
Result: Of the 1184 patients with RA, 801 patients started with their first biologic agent, 228 patients were first time
switchers, and 89 patients were second time or more switchers. Second or more switchers had lower rheumatoid factor
(RF) and anti-CCP positivity and higher disease activity scores (i.e., DAS28, SDAI, and CDAI score) at the time of enroll-
ment than the other groups. In these patients, tocilizumab was the most commonly prescribed biologic agent, followed
by adalimumab, and etanercept. The most common reason for switching biologics was inefficacy (76.2%), followed by
adverse events (14.5%), which included infusion reaction (6.2%), infection (2.5%), and skin eruption (1.8%).
Conclusion: In this registry, we found different baseline profiles based on the chronological order of biologic agents.
O-20-10
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S70
Drug Survival of Biologic Agents in Rheumatoid Arthritis Using 10 Years of Nationwide Data in Korea:
A Population-based Study
Jeong Seok Lee1, Jun Won Park1, Eunyoung Emily Lee1, Yeong Wook Song1, Hee Young Lee2, Eun Young Lee1*1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
2Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
Background: Since 2004, Korean national health insurance began to cover the cost of biologic agents in rheumatoid ar-
thritis (RA) patients experiencing treatment failure by conventional disease modifying antirheumatic agents. However,
real-world issues such as selecting or switching among biologic agents in clinical practice became more complicated as
types of the agents increased.
Objectives: To evaluate 1) first choice among biologic agents, 2) drug retention rate and duration of each biologic agent
in RA.
Methods: We used retrospective cohort data from the National Health Insurance Service in Korea, which consisted of
more than one million subjects representing whole Korean population followed from 2004 to 2013. All RA patients with
any experience of biologic agents were checked. We also compared with the independent cohort of biologic agent users
in Seoul national university hospital.
Results: One hudred and seventy three patients were found to experience any of TNFa inhibitors. Etanercept was the
most frequent choice as first TNFa inhibitor (43.4%). Among TNFa inhibitors, retention rates of etanercept at month 12
and 24 were significantly higher than adalimumab and infliximab (Fig. 1A-B). Mean duration of retention was almost
twice longer in etanercept than others (Fig. 1C-D).
Conclusions: This research can be a pilot study before analyzing nationwide population cohort encompassing whole
population of Korea. Conclusively, etanercept has been prescribed longer in general and the rate of retention till 2 years
was also better than adalimumab and infliximab for 10 years after national insurance coverage.
O-20-11
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S71
Efficacy and Safety of Add-on Treatment of Tacrolimus versus Leflunomide in Rheumatoid Arthritis
Patients with Inadequate Response to Methotrexate
Kichul Shin1, Han Joo Baek2, Young Mo Kang3, Hoon-Suk Cha4, Seong Wook Kang5, Sung-Hwan Park6, Jae Bum Jun7, Yun Jong Lee8, Yeong Wook Song9,10
1Division of Rheumatology, SMG-SNU Boramae Medical Center, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, 3Division of Rheumatology, Department of Internal Medicine, Kyungpook National University
Hospital, Daegu, 4Division of Rheumatology, Department of Internal Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, 5Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, 6Division of Rheumatology, Department of Internal Medicine, Catholic University of Korea, Seoul St Mary’s Hospital, Seoul, 7Division of Rheumatology, Department of
Internal Medicine, Hanyang University, Hospital for Rheumatic Disease, Seoul, 8Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 9Division of Rheumatology, Department of Internal Medicine, Seoul National University
Hospital, Seoul, 10Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
Background: Tacrolimus (TAC) is a disease modifying antirheumatic drug (DMARD) used for rheumatoid arthritis
(RA) treatment. Combination of TAC with methotrexate (MTX) was shown to be effective and safe in RA, yet com-
parative clinical studies are insufficient to date.
Objective: To investigate the efficacy and safety of TAC versus leflunomide (LEF) when combined with MTX in RA
patients.
Method: The PLATINUM-X study is a 24-week multi-center, double-blinded randomized non-inferiority (phase 4)
study targeting RA patients with moderate to active disease activity (DAS28(ESR)>3.2) who previously had an in-
adequate clinical response to MTX. Patients were randomized into the TAC or LEF (add-on to MTX) group. The initial
daily dose of TAC and LEF were 1.5 mg and 10 mg, respectively, for 4 weeks then increased to 3 mg, 20 mg per day until
the end of the study. Clinical and laboratory data were obtained at 4, 8, 16, and 24 weeks. The primary endpoint was to
compare DAS28 at 24 weeks. The per protocol set was used for statistical analysis.
Result: Eighty seven patients were screened in 9 centers, and 75 patents were randomized into 2 groups. Baseline dem-
ographics of patients were comparable with baseline DAS28 being 4.54±0.61 and 4.91±1.01 in the TAC and LEF group,
respectively. TAC was non-inferior to LEF in terms of reduction of DAS28 at 24 weeks (mean difference -0.0565, CI
-0.6513, 0.5384). Improvement of DAS28, K-HAQ throughout each visit was not statistically different between the 2
groups. Yet, reduction in tender joint count was significant in the TAC group compared with LEF (-5.97±4.89 versus
-3.08±5.55 at 24 weeks, p=0.0145). Six patients presented transaminitis in the LEF group compared with 2 in the TAC
group.
Conclusion: The efficacy of TAC plus MTX was non-inferior to LEF combined the MTX, with a reasonable safety profile
in RA patients with moderate to active disease activity.
O-20-12
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S72
The Impact of Korean Red Ginseng on Disease Activity and Improvement of Fatigue in Patients with Rheumatoid Arthritis:
A Randomized, Double-blind, Crossover Study
Soo-Kyung Cho, DasomiYoo, Dam Kim, Yoon-Kyoung Sung
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Background and Objective: Patients with rheumatoid arthritis (RA) suffer from fatigue, apart from pain and disability.
In this randomized, crossover clinical trial, we aimed to evaluate the impact of Korean Red Ginseng (KRG) on disease ac-
tivity and improvement of fatigue in RA patients.
Methods: Eighty of RA patients were randomly allocated to KRG (2 g/day, n=40) or placebo (n=40) groups for the
first 8 weeks, followed by crossover to the other arm for the final 8 weeks. Primary outcome was the disease flare rate
defined as worsening of disease activity using DAS 28. Secondary outcome was fatigue measured by Functional
Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-F, score range is 0-52 with lower scores representing
greater fatigue). Those were evaluated at baseline, 8 and 16 weeks. The changes of outcome were compared between KRG
and placebo period using paired t-test.
Results: Among total patients, 70 patients completed study periods. Female patients whose mean age was 51.9 years
were enrolled. The mean of FACIT-F at baseline was 22.0±6.6. Seventy eight patients (97.5%) have low or moderate dis-
ease activity (DAS28 mean 3.5±1.0). The disease fare rate was same as 3.7% (n=3) in both periods. Improvement of fa-
tigue was better in KRG group compared with placebo group (2.66±6.37 vs. 1.36±6.14 in FACIT-F, p=0.31), although
there were no statistical significance. These results were consistent in subgroup analyses for patients more than
pill-count 80%.
Conclusions: KRG did not associated with disease flare in RA patients. Fatigue tends to be improved with KRG, but
the differences were not statistically significant. Further study with increasing sample size will be required to adequately
address the effectiveness of KRG on improvement in fatigue of RA patients.
O-20-13
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S73
Remission of Rheumatoid Arthritis Judged by 2 Criteria
Sung Yeon Lee1, Kyeong Min Son2, Young Il Seo1, Hyun Ah Kim1
1Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 2Division of Rheumatology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
Objectives: To investigate the remission rate of rheumatoid arthritis (RA) and find out the clinical factors that are asso-
ciated with attaining remission measured by Disease Activity Score in 28 joints (DAS28) and ACR/EULAR Boolean
criteria.
Methods: Every RA patient, who first visited rheumatology clinics of Hallym University Sacred Heart Hospital from
August 2010 to December 2013, and started DMARD treatment, was evaluated with DAS28 every 3months. We calcu-
lated remission rate using DAS28 and Boolean criteria after 6 months of treatment. Logistic regression analyses was used
to identify clinical factors that were associated with remission.
Results: A total of 285 patients were included. The remission rates of RA were 26.3% in DAS28 and 8.1% in Boolean
criteria. Patients who achieved DAS28 remission were significantly younger age, and had lower tender joint count (TJC),
swollen joint count (SJC), baseline DAS28, and ESR compared to those who did not. Patients who achieved Boolean re-
mission had shorter disease duration, lower TJC, SJC, baseline DAS28, CRP, and were treated with lower starting dose
of glucocorticoids. Multivariate analysis showed lower starting dose of glucocorticoids as an independent predictor of
Boolean remission. Among 75 patients with DAS28 remission, 25.3% achieved Boolean remission. Patients failing
Boolean remission criteria despite achieving DAS28 remission had significantly longer disease duration compared to
those who achieved remission by both criteria.
Conclusion: The remission rate of RA in Boolean criteria was much lower than DAS28. Longer disease duration was
significantly associated with failing Boolean remission criteria despite achieving DAS28 remission.
O-20-14
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Systemic Lupus Erythematosus,
Sjogren's Syndrome Basic Aspects
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S77
A Selective JAK1 Inhibitor, Filgotinib Ameliorates Sjogren's Syndrome in Non Obese Diabetes Mice Via
Suppression of BAFF and Chemokine Production of Salivary Gland Epithelial Cells
Jennifer Lee1, Jaeseon Lee2, Seung-Ye Baek2, Seung-Ki Kwok1, Mi-La Cho2, Sung-Hwan Park1
1Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, 2Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, Korea
Background: Interferon (IFN) signatures are upregulated in patients with primary Sjogren’s syndrome (pSS) and inter-
ferons are considered to play a pathogenic role in pSS. Therefore, Janus kinase (JAK) which mediates interferon signaling
pathway may be a good therapeutic target.
Objective: To investigate whether a selective JAK1 inhibitor, filgotinib would ameliorate disease-related parameters in
non-obese diabetic (NOD) mice, an animal model SS.
Methods: Filgotinib (1.5 mg/kg) or vehicle (saline) was intraperitoneally injected three times per week from 8 weeks
after birth. Salivary flow rate (SFR) was addressed on 8, 12, 16 and 20 weeks. Histologic analysis was performed on 20
weeks. The effect of filgotinib on the expressions of B cell activating factor (BAFF) and chemokines (CXCL10 [IP-10],
CXCL3 [fractalkine], CCL-2 [MCP-1]) in human salivary gland epithelial cell (SGEC) line or primary epithelial cells of
patients with pSS was determined in vitro.
Results: The SFR of NOD mice in both groups decreased over time. Lymphocytic infiltration increased over time, espe-
cially marked B cell infiltration was noted. SFRs of filgotinib-treated mice were greater than those of controls. On histo-
logic evaluation, lymphocytic infiltration of salivary gland was markedly reduced in the mice treated with filgotinib.
Similarly, the expression of IFN-γ and TNF-α was lower in the salivary gland of filgotinib-treated mice. IFN-α treat-
ment induced BAFF and chemokine production both in SGECs and primary epithelial cells obtained from pSS patients,
which was abrogated by filgotinib treatment. Filgotinib suppressed STAT1 phosphorylation and the expression of IFN
signature genes in these cells.
Conclusion: Filgotinib inhibits IFN signaling and suppresses BAFF and chemokine expression of salivary gland epi-
thelial cells, which suppresses lymphocytic infiltration of salivary glands and alleviates the decrease of SFRs of NOD
mice. JAK1 inhibition may be a novel therapeutic approach for SS.
O-20-15
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S78
Exosomes from Patients with Active Systemic Lupus Erythematosus Induce a Strong Inflammatory Response
Joo Youn Lee1, Jin Kyun Park1,2, Eun Young Lee2, Eun Bong Lee2, Yeong Wook Song1,2
1Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Seoul National University, Seoul, Korea
Background: Exosomes are 60-150 nm membrane vesicles that are secreted by various cells into surrounding body flu-
ids including blood and urine. As vehicles for intercellular communication, they are involved in immune cell activation.
To date, the role of exosomes in pathogenesis of systemic lupus erythematosus (SLE) has not been fully elucidated.
Objectives: This study was aimed to investigate as to whether exosome formation is increased and whether they effec-
tively contribute to proinflammatory cytokine response in patients with SLE.
Methods: Serum samples from SLE patients, rheumatoid arthritis (RA) patients and healthy controls were obtained
at Seoul National University Hospital. Exosomes were isolated from sera using ExoQuick and quantified using EXOCET.
Healthy peripheral blood mononuclear cells (PBMCs) were stimulated with exosomes from SLE patients, RA patients or
healthy controls. After 24 hours, production of interferon (IFN)-α, interleukin (IL)-1β, IL-6, and tumor necrosis factor
(TNF)-α were measured using ELISA. Correlation between SLE disease activity index (SLEDAI) and exosome levels was
assessed by Spearman correlation.
Result: The purified exosomes were 60-150nm in size and had a membrane bilayer on electron microscopy. Exosomes
from SLE induced healthy PBMCs to produce high levels of IFN-α, IL-1β, IL-6, and TNF-α, whereas exosomes derived
from RA patients or healthy controls did not. Exosome-depleted SLE serum and SLE exosomes that were mechanically
disrupted fail to elicit any significant proinflammatory cytokine production. The serum levels of exosomes were sig-
nificantly higher in SLE patients than healthy controls and their levels correlated with SLEDAI in patients with SLE.
Conclusion: These data suggest that exosomes are generated and contribute to proinflammatory response in patients
with SLE. Exosomes might serve as a novel biomarker of disease activity. Treatment targeting exosome might offer a new
therapeutic option.
O-20-16
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S79
Urinary Immunoglobulin Binding Protein-1 as a Biomarker Related with Lupus Nephritis Activity
Eun-Ju Lee1,2, Seokchan Hong2, Bin Yoo2, Chang-Keun Lee2, Yong-Gil Kim2
1Asan Institute for Life Science, Asan Medical Center, Seoul, 2Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Background/Purpose: Systemic lupus erythematous (SLE) is a multisystem autoimmune inflammatory disease. Lupus
nephritis (LN) is one of the most serious complications in patients with SLE. Immunoglobulin binding protein-1 (IGBP1)
originally was discovered as a phosphoprotein associated with the immunoglobulin receptor in B cells. The objective of
the present study was to determine urinary IGBP1 levels in LN patients and identify any correlations between urinary
IGBP1 levels with other clinical variables and renal pathology.
Methods: The levels of IGBP1 were measured in urine of SLE patients with (n=40) or without (n=30) nephritis, and
healthy subjects (n=18). Correlation analyses between urinary IGBP1 levels and the diseases-related variables including
c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-double-stranded DNA antibody (anti-dsDNA), and
SLE Disease Activity Index (SLEDAI) were examined. In addition, we performed correlation analyses of urinary IGBP1
levels with activity index score or chronicity index score in renal biopsy samples. To define IGBP1 expression in renal
pathologies, immunohistochemical stainings were performed.
Results: Urinary levels of IGBP1 were significantly higher in LN than in SLE without nephritis and healthy individuals.
Among the diseases-related variables, SLEDAI scores, anti-dsDNA, and C3 were significantly correlated with the levels
of urinary IGBP1. Further, urinary IGBP1 levels represented a significant positive association with activity index score
(p=0.0072). In immunohistochemical staining results, IGBP1 was expressed mainly in tubules, especially in class III and
IV.
Conclusion: This study demonstrates that the levels of urinary IGBP1 were significantly higher in LN patients and were
correlated with disease activity and activity index score of renal pathology. Therefore, IGBP1 might be a valuable tool for
determining high disease activity in LN patients.
O-20-17
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S80
Fn14-Fc Suppresses Germinal Center Formation and Pathogenic B Cells in a Lupus Mouse Model Via Inhibition of the TWEAK/Fn14 Pathway
Hong-Ki Min1,2*, Sung-Min Kim1*, Jin-Sil Park1, Jae-Kyeong Byun1, Jennifer Lee1,2, Seung-Ki Kwok1,2, Young-Woo Park3, Mi-La Cho1§, Sung-Hwan Park1,2§
1Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 2Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
3Integrative Omics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
Background: Systemic lupus erythematosus (SLE) is an autoimmune-mediated chronic inflammatory disease. Half of
patients with SLE suffer from lupus nephritis, which is major cause of death in SLE. TNF-like weak inducer of apoptosis
(TWEAK)/fibroblast growth factor-inducible 14 (Fn14) interactions mediate inflammatory responses that are linked to
the pathogenesis of lupus nephritis. Blocking of the TWEAK/Fn14 pathway by Fn14-Fc was performed in a SLE mouse
model and the likely therapeutic mechanisms were investigated.
Methods: To investigate the impact of TWEAK on B-cell differentiation in SLE, the levels of AID, Blimp-1, and IRF4
messenger RNA were measured in CD19+ B cells extracted from the spleens of sanroque mice and cultured with
TWEAK. To identify the therapeutic effects of Fn14-Fc in SLE, sanroque mice were treated with Fn14-Fc or a control-Fc
for 3 weeks. Immunoglobulin (Ig) G, IgG1, IgG2a, and anti-dsDNA antibody (Ab) levels were measured in the sera of
each group. Spleens from each group were stained with antibodies against CD4, B220, GL-7, CD138, and PD-1. Kidneys
were stained with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS).
Results: Administration of TWEAK increased the mRNA levels of AID, Blimp-1, and IRF4. Treatment with Fn14-Fc
suppressed levels of IgG, IgG1, IgG2a, and anti-dsDNA Ab in sera and reduced numbers of B-, plasma-, and follicular
helper T-cells (Tfh) in spleens of sanroque mice. In addition, renal protective effects of Fn14-Fc were shown.
Conclusion: Fn14-Fc had beneficial effects in a SLE mouse model by repressing B cells, plasma cells, Tfh, and renal
damage. This suggested that Fn14-Fc represents a potential therapeutic agent for SLE.
O-20-18
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Osteoarthritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S83
DICAM Promote Proliferation and Hypertrophic Differentiation of Chondrocyte through
Indian Hedgehog Signaling of Primary Cilia
Seung-woo Han1,2, Min-Su Han1, Hye-Ri Park1, Eun-Ju Lee1, Ji-Ae Jang1, Gun-Woo Kim1,2, Youn-Kwan Jung1
1Laboratory for Arthritis and Bone Biology, Fatima Research Institute, 2Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
Background and Objectives: DICAM (dual Ig domain containing cell adhesion molecule) was originally cloned from
human chondrocyte cell-line, HCS-2/8 cells, but the role during endochondral bone formation and osteoarthritis has not
been elucidated.
Methods: Primary chondrocytes and tibia were isolated from limbs of C57BL/6 embryo (E15.5) and used in vitro study.
Cartilage-specific DICAM transgenic (Col2-DICAM-Tg) mice was constructed and the phenotype of E15.5 long bone was
compared with their wild type-littermates.
Results: DICAM mainly expressed in resting and proliferating chondrocytes in growth plate and it was increased by
Pthrp and BMP2 in primary chondrocytes. Gain-of function study with Col2-DICAM-Tg revealed that DICAM increased
length of long bones. Col2-DICAM-Tg showed an increased expression of chondrogenic, Col2a1 and proliferating mark-
er, PCNA in immunohistochemical analysis. In addition, early and late hypertrophic chondrocyte marker, Col10a1 and
MMP13, respectively, also increased in Col2-DICAM-Tg compared to wild-type. To elucidate a molecular mechanism of
DICAM, we checked the major signaling targets in chondrogenesis, which showed an increased expression of HHIP and
Zfp521, the target molecule of Ihh and Pthrp signaling, respectively. Other Ihh signaling molecules such as Ptch1, Gli1,
Gli2, Gli3 and Ihh itself were also increased by DICAM overexpression in primary chondrocytes. Mechanistically, DICAM
was co-localized with primary cilia of chondrocytes and increased a number of primary cilia and their adaptor molecule,
IFT88. Knock-down of IFT88 and hedgehog signaling antagonist, cyclopamine, attenuated the DICAM-mediated in-
crease of length in primary tibia organ culture.
Conclusion: DICAM was colocalized with primary cilia in resting and primary chondrocytes and modulated Ihh signal-
ing, which was responsible for a chondocyte proliferation and hypertrophic differentiation during endochodral bone
formation.
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Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S84
Fibronectin Fragment Suppresses Xylosyltransferase-1 Expression through Modulating Sp1 and Sp3 Expression
Via MAPK, AP-1, and NF-κB Signaling Pathways
Mi Hyun Lee1, Hyun Sook Hwang2, Hyun Ah Kim3
1Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kyunggi, 2Institute for Skeletal Aging, Hallym University, Chunchon, Korea
Background: Xylosyltransferase-1 (XT-1) is an essential anabolic enzyme in glycosaminoglycan chain synthesis. The
effect of fibronectin fragments (FN-fs), known as damage-associated molecular pattern (DAMP) molecules, on cartilage
metabolism was poorly characterized.
Objective: In this study we examined 29-kDa amino-terminal fibronectin fragment (29-kDa FN-f)-mediated XT-1 ex-
pression mechanism and its signaling pathway, determining the role of 29-kDa FN-f in cartilage matrix synthesis.
Methods: The relative levels of mRNA and protein for XT-1 and aggrecan were analyzed by real-time quantitative PCR
and immunoblotting. siRNAs were used to knock down Toll-like receptor (TLR)-2, Sp1, and Sp3. The signaling pathways
related with XT-1 expression was investigated by immunoblotting using pharmacological inhibitors
Results: The expression of aggrecan and XT-1 was significantly lower in human osteoarthritis cartilage compared to
normal cartilage. XT-1 expression in cultured primary articluar chondrocytes showed a periodic oscillation in both
mRNA and protein level. 29-kDa FN-f significantly suppressed the mRNA and protein levels of XT-1 as well as caused
the decreased Sp1 expression and increased Sp3 expression. Knockdown and overexpression experiments revealed that
29-kDa FN-f suppressed XT-1 expression through modulation of Sp1 and SP3 expression. Knockdown of TLR-2 using
siRNA revealed that the decrease of XT-1 expression by 29-kDa FN-f is mediated by TLR-2 signaling pathway. Inhibition
of MAPK and NF-κB signaling pathways restored 29-kDa FN-f-inhibited XT-1 expression. In addition, 29-kDa FN-f sup-
presses XT-1 expression through inducing translocation of phosphorylated the c-jun and c-fos into nucleus and sub-
sequently activating AP-1 signaling pathway.
Conclusion: These results demonstrated that 29-kDa FN-f plays a detrimental role in the regulation of cartilage ex-
tracellular matrix formation, including XT-1 expression, via the MAPK, AP-1, and NF-κB signaling pathways
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Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S85
Metabolic and Inflammatory Links to Rotator Cuff Tear in Hand Osteoarthritis
Young Sun Suh1, Yun-Hong Cheon2, Hyun-Ok Kim1, Rock-Bum Kim3, Ki Soo Park3, Hyung Bin Park4, Jae-Bum Na5, Sang-Il Lee2
1Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, 2Division of Rheumatology, Department of Internal Medicine, 3Preventive Medicine, 4Orthopedic Surgery, and 5Radiology,
Gyeongsang National University School of Medicine, Jinju, Korea
Background: Rotator cuff tear (RCT) and hand osteoarthritis (HOA) are commonly accompanied because they share
a similar pathogenesis. However, there was no previous study investigating the relationship between RCT and HOA.
Objectives: To estimate the prevalence of RCT and factors associated with development of RCT in patients with HOA.
Methods: We enrolled 1150 inhabitants in Gyeongnam province in Korea from June 2013 to December 2015. Physical
examinations of upper extremities, plain radiography of hands and magnetic resonance imaging (MRI) of shoulders were
performed in all participants. Serum levels of high sensitive C reactive protein (hsCRP) and high density lipoprotein
(HDL) were checked. RCT was diagnosed by clinical examination and MRI findings. Diagnosis of HOA was made by the
1990 American College of Rheumatology classification criteria.
Results: The prevalence of RCT was higher in participants with HOA group (192/307, 62.5%) than those without HOA
(410/827, 49.5%, p<0.001). Among 307 with HOA, people with RCT were older (62.69±7.04 vs. 59.11±7.69, p<0.001)
and showed higher hsCRP (1.51±3.78 vs. 0.67±0.70, p=0.004) and lower HDL levels (55.66±15.46 vs. 60.48±12.45,
p=0.003) compared to those without RCT. Multiple logistic regression analysis showed significant associations of age
(odds ratio [OR] 1.1; 95% confidence interval [CI] 1.021-1.098), serum levels of hsCRP (OR 1.4, CI 1.044-1.795), and
low HDL (male <40 mg/dL, female <50 mg/dL) (OR 2.1, CI 1.142-3.978) with RCT in HOA group. Stratified by age,
the low HDL (OR 3.8, C.I 1.310-10.937) and high hsCRP over 0.6 mg/L (OR 2.5, C.I 1.091-5.571) were significantly as-
sociated with RCT among participants under 60 years with HOA.
Conclusions: The prevalence of RCT is high and age and serum levels of hsCRP and HDL have predictive roles in the
development of RCT in HOA patients.
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Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S86
Association between Grip Strength and Hand and Knee Radiographic Osteoarthritis in Older Adults:
Data from the Dong-gu Study
Lihui Wen1, Ji-Hyoun Kang1, Yi-Rang Yim1, Ji-Eun Kim1, Jeong-Won Lee1, Kyung-Eun Lee1, Dong-Jin Park1, Tae-Jong Kim1, Yong-Wook Park1, Sun-Seog Kweon2,3,
Young-Hoon Lee4, Yong-Woon Yun5, Min-Ho Shin2, Shin-Seok Lee1
1Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, 2Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, 3Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital,
4Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, 5Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Objective: We assessed whether grip strength was related to various types of radiographic damage in older adults with
osteoarthritis (OA).
Methods: Data from 2,251 subjects enrolled in the Dong-gu study, who had no hand joint pain, were analyzed to inves-
tigate the relationship between grip strength and OA. Hand grip strength was measured using a hand-held dynamometer,
and radiographs of the hand and knee were scored according to a semi-quantitative grading system. Multiple linear re-
gressions were used to explore associations between grip strength and radiographic features of OA.
Results: Grip strength in men and women was negatively related to hand (both p<0.001) and knee (men, p<0.001;
women, p=0.010) OA after adjusting for confounders. Hand (men, p<0.001; women, p=0.001) and knee (both
p<0.001) joint space narrowing (JSN) showed the strongest associations with low grip strength, regardless of sex.
Moreover, the severity of hand osteophytes in women (p=0.001), knee osteophytes in men (p=0.006), hand malalign-
ment (men, p=0.008; women, p=0.041), and subchondral cysts (men, p<0.001; women, p=0.007) was correlated with
low grip strength in both sexes.
Conclusions: Among subjects without hand joint pain, low grip strength was associated significantly with hand and
knee radiographic OA, regardless of sex. Among all types of OA radiographic damage, low grip strength showed the stron-
gest association with JSN.
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Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S87
The Prevalence and Risk Factor of Knee Pain in Advacned Knee Osteoarthritis
Kyeong Min Son1, Dong-Hyun Kim2, MyungHee Cho Paik3, Dae Gyu Jang3, Hyun Ah Kim1
1Department of Internal Medicine, Hallym University Colleage of Medicine, 2Deparment of Social and Preventive Medicine, Hallym University College of Medicine,³Department of Statistics, Seoul National University
Background: Although osteoarthritis (OA) is predominantly considered as a disease of cartilage, articular cartilage is
an aneural tissue, and there is a consensus that the association between knee radiographic OA and knee pain is modest.
Objectives: To investigate the prevalence of asymptomatic subjects with advanced knee OA, we examined databases
obtained from 2 Korean community residents.
Methods: Subjects included were from Hallym Aging Study (HAS) or from the Korean National Health and Nutrition
Examination Survey (KNHANES, year 2010-2012). Participants in each study were asked knee-specific questions regard-
ing presence of knee pain. Each knee was graded for overall evidence of radiographic OA using the K-L grade. Advanced
knee OA was defined as K-L grade 4. Clinical factors associated with the presence of knee pain were evaluated with multi-
varitate logistic regression analysis.
Results: Included were 504 subjects from HAS and 8679 from KNHANES. Two hundred twenty five subjects (44.3%)
did not report any pain despite having K-L grade 4 OA. After multivariate association, female and osteoporosis was sig-
nificantly associated with the presence of knee pain. Advanced OA Subjects without knee pain had functional status eval-
uated with WOMAC and chair stand not different from that of non-OA subjects. General physical health, assessed with
the short-form (SF-12) method was not different between advanced OA subjects without knee pain and non-OA subjects
except physical functioning. MRI findings such as summary cartilage score, bone marrow lesion score, synovitis and effu-
sion of advanced OA subjects without knee pain was not different from those of advanced OA subjects with knee pain.
Conclusion: Our community study showed that a majority of subjects with K-L grade 4 OA was asymptomatic. The
guidance of therapeutic decision merely based on imaging study as well as treatment option focusing solely on cartilage
engineering should be viewed with caution.
O-20-23
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Spondylarthropathies,
Epidemiology
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S91
The Incidence of Herpes Zoster Infection in Patients with Ankylosing Spondylitis: Analysis from Korean National
Health Insurance Service-Cohort Sample Database
Doo-Ho Lim1, Byeongzu Ghang2, Seokchan Hong2, Yong-Gil Kim2, Chang-Keun Lee2, Bin Yoo2
1Division of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 2Division of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background: Herpes zoster (HZ) infection occurs more commonly in patients with underlying autoimmune disease,
partially due to immunosuppressive treatment. However, little is known about the incidence of HZ in patients with anky-
losing spondylitis (AS), especially who were treated with conventional disease modifying anti-rheumatic drugs
(cDMARDs) or TNF inhibitors.
Objectives: The aims of our study were to investigate the incidence of HZ in AS patients and to determine whether use
of cDMARDs or TNF inhibitors could increase the risk of HZ infection in AS patients.
Methods: We used database of the Korean National Health Insurance Service?Cohort Sample (1,025,340 individuals)
from 2002 to 2013. We evaluated HZ incidence among three groups (non-DMARD users, cDMARDs users and TNF in-
hibitor users) based on drug exposure episodes.
Results: Among 1,079 patients with AS, we identified 54 HZ infections. Crude incidence rates were 11.0 per 1000 pa-
tient-years (95% CI, 8.2-14.3) in all AS patients; 9.1 (95% CI, 6.2-12.8) in non-DMARD users, 16.7 (95% CI, 9.1-28.0)
in cDMARDs users and 14.1 (95% CI, 6.1-27.8) in TNF inhibitor users, respectively. Adjusted hazard ratio (HR) of HZ
infection was higher in cDMARDs users and TNF inhibitor users than in non-DMARD users. In subgroup analysis, TNF
inhibitor increased the risk of HZ infection more significantly in female (adjusted HR=8.01; 95% CI, 1.97-32.54) and pa-
tients older than 50-yr (adjusted HR=7.29; 95% CI, 1.88-28.21), but not in patients exposed to baseline corticosteroid
(95% CI, 0.53-32.84) compared to non-DMARD users.
Conclusions: The incidence of HZ in AS patients was 11.0 per 1000 patient-years which is similar to the previously re-
ported incidence in general Korean population. cDMARDs or TNF inhibitors increased the risk of HZ infection in AS pa-
tients, especially in female and older patients, which can be considered as target of HZ vaccination in AS population.
O-20-24
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S92
Utilization of the PEST Questionnaire to Detect Psoriatic Arthritis in Clinical Practice:
Data from the VALidation of psORiatic Arthritis Screening Tool for Korean Psoriasis Patients (VALOR) Study
You-Jung Ha1, So Yeon Cho2, Sang-Heon Lee3, Yong Beom Choe4, Tae-Hwan Kim5, Joo Yeon Ko6, Sung Jae Choi7, Il-Hwan Kim8, Sang Woong Youn9, Kichul Shin10
1Divsion of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 2Department of Dermatology, SMG-SNU Boramae Medical Center, 3Department of Dermatology, Konkuk University School of Medicine, 4Division of Rheumatology,
Department of Internal Medicine, Konkuk University School of Medicine, 5Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 6Department of Dermatology, Hanyang University College of Medicine, 7Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, 8Department of Dermatology, Korea University Ansan Hospital, 9Department of Dermatology, Seoul
National University Bundang Hospital, 10Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center
Background: Several questionnaires have been developed to help identify psoriatic arthritis (PsA) among psoriasis
(PsO) patients, but there is no screening tool yet tested through joint efforts by Dermatologists and Rheumatologists in
Korea. The PsO Epidemiology Screening Test (PEST) is a simple questionnaire that could be used without assistance.
Objectives: This study aimed to investigate the utility and validation of PEST for screening PsA in Korean PsO patients.
Methods: The PEST, consisted of 5 questions, was translated into Korean and then back-translated to English for
comparison. This form was tested on PsO patients visiting the Dermatology clinic at 5 hospitals in urban areas. Patients
who checked ‘yes' to 2 or more questions were referred to Rheumatology for further evaluation. Patients meeting the
CASAPR criteria were then confirmed to have PsA.
Results: Data of 191 PsO patients from 5 centers were analyzed. The mean age was 45.1 years, and male/female ratio
was 1.27. Among the 41 (21.5%) patients who checked 'yes' to 2 or more questions, 35 patients were eventually assessed
by a Rheumatologist. Of these subjects, 16 (45.7%) patients were diagnosed as PsA. When comparing baseline character-
istics between PsA and PsO-only patients, the proportion of female in the PsA group was significantly higher than that
the PsO-only group (68.8 vs. 41.4%, p=0.035). BSA of PsO and the % of nail involvement were also higher in PsA pa-
tients, but did not reach statistical significance. Using the known PEST cut-off score of 3, its specificity increased to
93.5%, but sensitivity dropped to 50%.
Conclusion: This study supports that PsO patients with musculoskeletal symptoms should be carefully evaluated for
PsA especially when patients are female, and have nail involvement and higher BSA of PsO. The Korean version of PEST
is a convenient tool for screening PsA, yet its peformance and utility in our region with a different PsA population need
to be further investigated.
O-20-25
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S93
Increased 18F-fluoride Uptake Lesions at Vertebral Corners on Positron Emission Tomography Predict New
Syndesmophytes Development in Ankylosing Spondylitis
Seung-Geun Lee, Eun-Kyoung Park, Ji-Heh Park
Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Korea
Background: 18F-fluoride uptake on positron emission tomography (PET) represents osteoblastic activity. But, longi-
tudinal studies that investigated the association between increased 18F-fluoride uptake lesions and future syndesmo-
phytes formation are lacking.
Objectives: To demonstrate that increased 18F-fluoride uptake lesions on PET predict the development of new
syndesmophytes.
Methods: In 12 patients with AS, 18F-fluoride PET-MRI (Philips Healthcare, Cleveland, OH, USA) was performed at
baseline and radiography was performed at baseline and 2 years. We recorded 18F-fluoride uptake lesions on PET, acute
(type A) and advanced (type B) corner inflammatory lesions (CILs) and fat lesions on MRI and syndesmophytes on
radiography. An increased 18F-fluoride uptake lesion was defined as an uptake greater than the uptake in the adjacent
normal vertebral body (Fig. 1).
Results: Of 231 anterior vertebral corners without syndesmophyte at baseline, 13 type A CILs (5.5%), 2 type B CILs
(0.9%) and 20 fat lesions (8.7%) on MRI and 6 increased fluoride uptake lesions (2.6%) on PET were observed. After 2
years, 16 new syndesmophytes (6.9%) in 8 AS patients (66.7%) occurred. New syndesmophytes developed significantly
more frequently in anterior vertebral corners with in-
creased 18F-fluoride uptake lesions (50%) or fat le-
sions (25%) at baseline, as compared with those
without either feature (5.8 % and 5.2%, respective-
ly). After adjusting within-patient correlation, base-
line increased 18F-fluoride uptake lesion signifi-
cantly predicted the development of new syndesmo-
phytes (OR=20.6 95% CI=2.7-156.1, p=0.003). Fat
lesions were also associated with new syndesmo-
phytes development, but this association was not ob-
served in CILs.
Conclusions: Our findings indicate that increased
18F-fluoride uptake lesions can predict future new
syndesmophytes formation of AS.
O-20-26
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S94
Korean Rheumatology Workforce from 1992 to 2015: Rapid Advance, being on the Rise
of Regional Concentration, in Metropolitan
Chan Uk Lee, Sung-Hoon Park, Hwajeong Lee, Ji-Na Kim, Ji-Won Kim, Seong-Kyu Kim, Jung-Yoon Choe
Medicine Catholic University of Daegu School of Medicine, Korea
Objective: Rheumatology of Korea has been rapidly advanced in a brief span of 36 years since the subspecialty board
certification program was established in 1992. The objectives of this investigation is to analyze the distribution of rheu-
matology practices in Korean in order to better understand the appropriate supply of the workforce.
Methods: Using a membership list of KCR (Korean College of Rheumatology), information of practicing rheumatolo-
gist was obtained. We mapped the ratios of rheumatologist to population and patient with rheumatologic disease, using
data of Statistics Korea and 2015 HIRA (Health Insurance Review & Assessment service).
Results: In 16 administrative districts of Korea, in 2015, there were 311 practicing rheumatologist in a list of member
of KCR. There were 218 members practicing in metropolitans and 93 members in provinces. In whole country, mean
number of rheumatologist per 100,000 populations was 0.60 and was 0.33 in provinces but was 0.92 in metropolitans.
In comparison that number of internal medicine specialist in 2014, difference of between provinces and metropolitans
was 1.5 times in internal medicine specialist but was 2.7 times in rheumatologist. And number of rheumatologist per pa-
tients that be practiced from 7 groups according to 2015 HIRA data, were 17.21(per 100,000 patients) in metropolitans
but were 6.57 in provinces.
Conclusion: Because of uneven distribution of rheumatologist, some patients with chronic rheumatic conditions likely
have limited access to rheumatology care. So newly policy based approach need to be taken into account to alleviate a
disparity.
Keywords: Rheumatologist, Distribution, KCR, Concenturation
O-20-27
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Behcet's Disease,
Myositis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S97
Serum CXCL10 Levels are Associated with Clinical Manifestations and Disease Activity in Behçet’s Disease:
A Prospective Follow-up Study
Sang Jin Lee1,2, Eun Ha Kang3, Byoong Yong Choi4, Shin Eui Kang2, Jin Kyun Park1,2, Eun Young Lee1, Eun Bong Lee1, Yeong Wook Song1,2
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 2Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center,
Seoul National University, 3Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, 4Division of Rheumatology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
Background: It remains to be investigated which chemokines are important in Behçet’s disease (BD). The objective of
this study was to investigate serum levels of CXC chemokines in BD patients and their association with clinical manifes-
tations and disease activity.
Methods: Blood samples were collected from 109 BD patients and 36 age- and sex-matched healthy controls (HCs).
Twenty-two follow-up blood samples were collected in BD patients. Serum CXC chemokines were assayed for neutrophil
chemoattractants (CXCL1, CXCL8, CXCL9, CXCL10, CXCL12, CXCL13 and CXCL16) using a multiplex assay. Cell sur-
face maker expression (CD3, CD4 and CXC chemokine receptor 3 (CXCR3)) in peripheral blood mononuclear cells
(PBMCs) was investigated by flow cytometry. Clinical features including disease activity, laboratory tests and current
medication were evaluated at the time of blood collection. CXCR3 and CD45 expression in skin and intestinal lesions
from BD patients and HCs was assessed via immunohistochemistry.
Results: Serum levels of CXCL8, CXCL10 and CXCL12 were significantly higher in BD patients than in HCs. Serum
CXCL10 levels were correlated with disease activity in terms of both Behçet’s Disease Current Activity Form (BDCAF)
and Behçet’s Syndrome Activity Score (BSAS) (rho=0.336, p<0.001 and rho=0.253, p=0.009, respectively). In fol-
low-up BD patients, changes in serum CXCL10 levels were correlated with those of BDCAF. CXCR3 expression was sig-
nificantly increased in CD3-positive cells versus CD3-negative cells in PBMCs from both BD patients and HCs.
Percentages of CXCR3 expression in CD3-positive cells were inversely correlated with serum CXCL10 levels in BD
patients. By immunohistochem-
istry, the number of CXCR3-
positive mononuclear cells was
higher in skin lesions of BD pa-
tients than in those of HCs.
Conclusions: These results
suggest that the CXCL10/CXCR3
axis contributes to the patho-
genesis of BD, particularly mu-
cocutaneous lesions.
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Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S98
Optimal Surgical Method for Aortic Regurgitation in Behcet Disease
Byeongzu Ghang1, Suk Jung Choo2, Ohchan Kwon1, Wook Jang Seo3, Seokchan Hong1, Yong-Gil Kim1, Chang-Keun Lee1, Bin Yoo1
Division of 1Rheumatology, Department of Internal Medicine, and 2Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 3Seoul Veterans Hospital, Seoul, Korea
Background/Objectives: Aortic regurgitation (AR) in Behcet disease is a rare but very fatal condition. Many patients
required a second or third operation after simple aortic valve replacement (AVR) as a result of prosthetic valve
dehiscence. Recently, a few case series have been published aortic root replacement (ARR) have shown favorable out-
come but they have not suggested yet as an effective surgical method because of lack of evidence. Thus, we compare
long-term outcome between isolated AVR and ARR after first operation.
Methods: From January 1996 through December 2015, 31 patients with AR caused by Behcet disease have been surgi-
cally treated. AVR was performed in 14 cases and ARR in 17 cases. According to the definition of the event; aortic
valve/graft problem, infective endocarditis, cerebral infarction cased by thromboembolism or re-operation of aortic valve;
we compared events after first operation between two groups. The duration of follow-up was 164.7±63.3 months (AVR
group) and 74.4±55.4 months (ARR group).
Results: In the 14 patients with isolated AVR, events occurred in 12 patients (39.3±43.8 months after operation) and
re-operations were performed in 17 cases. In the 17 patients with ARR, events occurred in 6 patients (56.2±52.4 months
after operation), necessitating re-operations in 5 cases (AVR group vs. ARR group; p=0.006). Kaplan-Meier curves dis-
played higher event free rate in ARR group compared to AVR group (p=0.027). Overall mortality was 12.9% (4 of 14 pa-
tients in AVR group, 0 of 17 patients in ARR group, p=0.032). As post operational medications, steroid was used more
frequently in patients with ARR than AVR group (4 patients vs 15 patients, p=0.028).
Conclusion: In patients with AR related with Behcet disease, the rate of event and mortality was lower in patients with
ARR compared to those with isolated AVR.
O-20-29
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S99
Major Comorbidities of Idiopathic Inflammatory Myositis Affecting Survival and Functional Impairment:
A Population-based Study Using 11 Years of Follow Up from the National Health Insurance in Korea
Jeong Seok Lee1, Min Jung Kim1, Hee Young Lee2, So Yeon Ahn3, Yeong Wook Song1, Eun Bong Lee1, Eun Young Lee1, Yun Jong Lee4, Eun Ha Kang4
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 2Center for Preventive Medicine and Public health, Seoul National University Bundang Hospital, Seongnam,
3Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, 4Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Background: Patients with idiopathic inflammatory myositis (IIM) suffer from comorbidities such as interstitial lung
disease (ILD), cancer, and infections related to immunosuppressive agents.
Objectives: To evaluate 1) incidence rate ratio (IRRs) of major comorbidities in IIM compared to non-IIM Koreans, and
2) impact of the comorbidities on survival and functional impairment.
Methods: A retrospective cohort study was performed using the 2002-2013 National Health Insurance Service (NHIS)
database of weighted probability sampled one million cohort. IIM was identified by at least two visits to the tertiary hospi-
tals under ICD9 code of IIM. Age- and sex-matched twenty subjects per patient were included as the unexposed.
Results: Ninety-one patients were newly diagnosed as IIM from 2003 to 2013. Most patients (>90%) defined as such
were found to have muscle biopsy, electromyogram, or multiple laboratory examinations on muscle enzymes. Their in-
cidence rate of the above outcomes was significantly elevated (Table); IRRs of ILD 31.8 [95% confidence interval:
13.2-76.7], cancer 2.36 [1.61-3.48], herpes zoster 1.75 [1.20-2.54], tuberculosis 2.08 [1.15-3.77], severely disabled sta-
tus 4.79 [2.55-9.01], and mortality 3.47 [1.96-6.12]. Among IIM patients, the presence of ILD or cancer greatly deterio-
rated survival; mortality IRR of 73.2 [9.58-559.9] in ILD and 63.2 [17.6-226.7] in cancer. The occurrence of zoster and
tuberculosis did not influence on the mortality. ILD and cancer also worsened functional impairment of IIM patients; IRR
of 12.0 [2.64-54.9] for severely disabled status in ILD and 13.2 [4.19-41.6] in cancer.
Conclusions: This is the first report of the nation-wide population based evaluation of IIM in Korea. The incidence of
ILD, cancers, zoster, and tuberculosis was exceptionally higher in IIM than non-IIM. ILD and cancers significantly af-
fected prognosis of IIM.
Table. Incidence rate and incidence rate ratios of major comorbidities, severely disabled, and death in patients with idiopathic inflammatory myositis versus the matched control
Incidence Rate (# of cases/1,000 person-year) Incidence Rate Ratio[95% Confidence interval]Myositis (n=91) Control (n=1820)
Interstitial lung disease 33.0 (13/394.3) 1.04 (8/7714.3) 31.8 [13.2-76.7]Cancer 73.6 (29/394.3) 31.1 (240/7714.3) 2.36 [1.61-3.48]Herpes zoster 76.1 (30/394.3) 43.6 (336/7714.3) 1.75 [1.20-2.54]Tuberculosis 30.4 (12/394.3) 14.6 (113/7714.3) 2.08 [1.15-3.77]Severely disabled 30.4 (12/394.3) 6.35 (49/7714.3) 4.79 [2.55-9.01]Death 35.5 (14/394.3) 10.2 (79/7714.3) 3.47 [1.96-6.12]
O-20-30
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S100
C-Reactive Protein to Albumin as a New Prognostic Value and Clinical Significance in Patients with Dermatomyositis
Jaehyung Hur1, Dong Jin Go2, Sang Wan Chung1, You-Jung Ha1, Eun Ha Kang1, Jin Kyun Park2, Kichul Shin3, Eun Young Lee2, Eun Bong Lee2, Yeong Wook Song2,4, Yun Jong Lee1,2
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 2Department of Internal Medicine, Seoul National University Hospital, Seoul, 3Division of Rheumatology,
Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, 4WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea
Background: Recent studies have suggested that C-reative protein to albumin (CRP/Alb) ratio could be an emerging
predictive marker of mortality in patients with sepsis or malignancies.
Objective: This study was aimed to evaluate the clinical significance and prognostic value of CRP/Alb ratio in patients
with dermatomyositis.
Methods: We retrospectively reviewed 158 patients with newly diagnosed dermatomyositis between August 2003 and
January 2016. We investigated the association of the CRP/Alb ratio with clinical characteristics. Using the receiver oper-
ating characteristics curves, the cut-off value of CRP/Alb ratio for predicting survival was calculated. Univariate and mul-
tivariate analyses using Cox proportional hazard model were performed to identify associated factors with survival.
Results: The optimal cut-off value of the CRP/Alb ratio was 0.073 for overall survival. According to the cut-off value
of 0.073, we classified 57 patients (36.1%) into the low CRP/Alb ratio group and 101 patients (63.9%) into the high
CRP/Alb ratio group. The higher CRP/Alb ratio group was associated with older age (≥50) (p=0.031), the lower per-
centage of DLco (p=0.006), overlap syndrome (p=0.018) and death (p=0.009). The CRP/Alb ratio was significantly cor-
related with muscle enzymes (creatine kinase: γ=0.248, p=0.002; lactate dehydrogenase γ=0.360, p<0.001; and aldo-
lase γ=0.170, p=0.048, respectively). In univariate analyses, high CRP/Alb ratio, old age, and the presence of inter-
stitial lung disease (ILD) were identified as significant factors for death. The higher CRP/Alb ratio and age >50 were
found to independently lower risk of survival by multivariate analysis (p=0.041 and p=0.006, respectively).
Conclusion: Our results demonstrated that higher level of the CRP/Alb ratio was associated with worse overall surviv-
al and the CRP/Alb ratio may play a role as an independent prognostic marker in patients with dermatomyositis.
O-20-31
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Breakfast Symposium
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S103
Seeking for the Right ‘Combination’ of Conventional DMARDs in Rheumatoid Arthritis:
Options Beyond Triple Combination
Kichul Shin
Division of Rheumatology, SMG-SNU Boramae Medical Center
Early disease control in rheumatoid arthritis (RA) is not an optional, but an essential task for rheumatologists.
Especially, upfront combination of conventional disease modifying anti rheumatic drugs (cDMARDs) is recommended
in RA patients with poor prognosis. Preference of combination strategies vary among clinicians, and such regimens have
evolved since the introduction DMARDs. Triple therapy (methotrexate (MTX), hydroxychloroquine, sulfasalazine
(SSLZ)) or MTX plus SSLZ has been well studied, and is one of the mainstay regimens for combination therapy.
Alternatives, on the basis of MTX, have been published in the literature and are applied or often modified, in daily clinical
practice. Tacrolimus and leflunomide are relatively new agents used in combination with MTX. Results of both combina-
tion strategies respectively show reasonable efficacy and safety profiles in clinical studies. Now with a longer list of
cDMARDs at hand, the quest is to select the proper regimen for RA patients individually, understanding the known possi-
ble adverse events of each agent, and when it is combined with one another.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
류마티스학 연구재단 연구과제 결과 보고
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S107
Impact of Patient Education on Outcomes in RA Patients
Yoon-Kyoung Sung, MD, PhD, MPH
Hanyang University Hospital for Rheumatic Diseases
Yoon-Kyoung Sung: Impact of Patient Education on Outcomes in RA Patients
S108 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Yoon-Kyoung Sung: Impact of Patient Education on Outcomes in RA Patients
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S109
Yoon-Kyoung Sung: Impact of Patient Education on Outcomes in RA Patients
S110 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
Yoon-Kyoung Sung: Impact of Patient Education on Outcomes in RA Patients
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S111
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S112
류마티스관절염환자 대상 교육용 앱개발과 환자교육중재가 약제순응도 및 치료결과에 미치는 효과
Seung In Baek, Ji Hoon Kim, Seung Min Jung, Ji Hyeon Ju, Sung-Hwan Park
가톨릭대학교 의과대학
Objective: This study was to measure alleviating effect of professional-led education on disease activity, and the param-
eters of assessment tools in rheumatoid arthritis (RA). Furthermore, we aimed to develop a cellular phone-based applica-
tion program which was specialized for educating patients with rheumatoid arthritis.
Methods: RA patients with disease activity of DAS28>3.2 were recruited in this research. Patients were randomly allo-
cated into two groups- one is education intervention group and the other is control group. Patients were systemically edu-
cated by the experienced professionals. The strategy of “Treat to target” was mainly used for educating patients. Patients
of education group were asked to fill up the forms showing target achievement at routine follow up periods. Disease activ-
ity, pain, dysfunction, fatigue, drug compliance, and quality of life were assessed at 0, 3 months, 6 months and 9 months
after study initiation. 2 sample t-test, Wilcoxon rank sum test, chi-square test or fisher’s exact test were used for stat-
istical analysis.
Results: Disease activity was more effectively controlled in education intervention group (DAS28 2.63 vs 3.34,
P=0.02). Visual analogue scale revealed at lower score (1.97 vs 4.06, P=0.02). Fatigue was improved in education group
by FACIT scale (42.39 vs 36.61, P=0.01). Illness perception score was better (22.5 vs 40.0, P<0.0001). Quality of life
shown by SF36 was also better (50.6 vs 47.1, P=0.01). However, Korean HAQ score and drug adherence score (MMAS-4)
was not significantly affected by educational intervention.
Conclusion: Subjective parameter such as fatigue and illness perception was improved by appropriate education led
by healthcare professional. Furthermore, purpose-driven education was objectively effective in controlling disease activ-
ity and improving quality of life. Patient education may need to vigorously be incorporated into the routine rheumatology
practice.
*For better educational support, smart phone-based application is under development. This content is temporarily
available by capturing QR code below or typing the internet address in smartphone internet window.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S113
질환특이 역분화 줄기세포 유도
정승민
연세대학교 의과대학 류마티스내과
역분화 줄기세포는 성체의 체세포를 이용하여 만들어진 전분화능을 갖는 세포로서, 배아줄기세포와는 달리 윤리적인 문제에서 비교
적 자유롭고, 중간엽 줄기세포보다 자가 복제 및 분화 능력이 뛰어나다는 장점을 갖고 있다. 특히 환자로부터 유래한 역분화 줄기세포는
질환과 유사한 환경을 조성하여 병인 연구에 이용되거나, 자가세포를 이용하여 이식의 거부반응을 최소화한 이식 재료로 활용될 수 있
다. 환자유래 역분화 줄기세포를 이용하는 연구에 있어서 중요한 점은 특징적인 환자군에서 수집한 검체를 이용하여 양질의 역분화 줄
기세포를 유도하고, 이로부터 신뢰성 있는 표적세포를 만드는 것이라고 할 수 있다. 역분화 줄기세포를 이용한 병인 연구는 주로 유전적
인 이상 소견을 갖는 환자에서 우선적으로 시도되었으나, 최근에는 유전적 소인을 갖는 만성 질환자에서도 질환 특성을 파악하는 데에
도움이 될 것으로 기대되고 있다. 환자의 역분화 줄기세포에서 유래한 표적세포는 정상인 또는 비교 질환군의 역분화 줄기세포에서 유
래한 세포와 형질 비교를 하게 되며, 그 차이는 일부 질환의 특성을 반영할 것으로 생각된다. 그러나 환자 개인의 특성에 의해서도 형질의
차이가 나타날 수 있으므로, 결과 해석에 유의를 요한다. 역분화 줄기세포를 이용한 재생 치료 연구에 있어서는, 무엇보다도 안전한 방법
으로 양직의 표적세포 또는 표적기관을 만들어내는 것이 중요하다고 할 수 있다. 또한 재생 치료를 위해 사용될 조직은 질환의 병태 생리
를 보이지 않으면서 조직의 특성상 낮은 면역원성을 갖는 것이 바람직하다. 최근 근골격계 질환 및 자가면역 질환에서도 역분화 줄기세
포를 이용한 연구가 점차 확대되고 있다. 성공적인 연구 수행을 위해서는, 환자에서 유래된 질환특이 역분화 줄기세포의 품질을 지속적
으로 관리하고, 역분화 줄기세포로부터 표적 세포로의 분화 효율을 높이면서 분화된 세포가 안정적인 형질을 갖도록 유지하는 것이 필
수적이라고 할 수 있을 것이다.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S114
Risk Factors of Herpes Zoster in Patients with Rheumatic Diseases in Korea
Hee Jung Ryu1, Jin-Ok Han2, Mi Ryoung Seo1, Hyo Jin Choi1, Kwang-Pil Ko2, Han Joo Baek1
1Department of Rheumatology Gachon University Gil Medical Center, 2Department of Preventive Medicine, Gachon University School of Medicine, Incheon, Korea
Background: Herpes zoster (HZ) is caused by the reactivation of latent varicella zoster virus infection and is associated
with a risk of disseminated infection and often considerable pain and morbidity. Older age and immunosuppressive medi-
cations are known as the established risk factors for HZ and other potential risk factors for HZ include ethnicity, generic
susceptibility, rheumatic diseases, trauma, and psychological stress. And the immunosuppressive medications and rheu-
matic diseases such as RA and SLE contribute to increase risk of HZ, however the comparative risk of HZ among different
immunosuppressive medications and different rheumatic diseases are unclear.
Objective: We performed this nationwide cohort study to determine the risk factors of HZ in patients with rheumatic
diseases in Korea.
Patients and Methods: We used the database of the Health Insurance Review & Assessment Service of Korea and ana-
lyzed the data of patients aged ≥18 years who had visited hospital more than two times with rheumatic diseases (RA,
SLE, Behçet’s disease, vasculitis, spondyloarthropathy, and other connective tissue diseases) as a principal diagnosis
from Jan 2009 to Oct 2013. HZ was identified as ICD-10 codes related to HZ with prescription of antiviral agents.
Demographic data, comorbidities (Hematologic malignancy, solid malignancy, diabetes, hypertension, heart diseases,
chronic lung diseases, chronic liver diseases, chronic renal diseases) and medications were analyzed as the risk factors
by using Cox proportional hazards models.
Results: The cumulative incidence of HZ in the patients with rheumatic diseases was 0.65%. The incidence rate (IR)
of period (per 10,000 person-years) was highest in RA (26.4) and followed the order in spondyloarthropathy (19.9), oth-
er connective tissue diseases (10.2), Behçet’s disease (6.2), SLE (5.1) and vasculitis (0.9). Compared with the reference
group of RA, HZ occurred more frequently in patients with SLE (hazard ratio [HR] 4.3, 95% CI 3.5-5.3) and Behçet’s dis-
ease (HR 4.5, 95% CI 3.7-5.6). And female, hematologic malignancy, hypertension, diabetes, chronic lung diseases, and
use of methotrexate, steroid, cyclosporine and TNF antagonists were independently associated with the development of
HZ. There was no apparent association of HZ with older age, spondyloarthropathy, and sulfasalazine in the patients with
rheumatic diseases.
Conclusion: Risk factors for HZ in patients with rheumatic diseases included SLE, Behçet’s disease, use of steroid and
immunosuppressive medications, and several comorbid medical conditions. Older age was not the independent risk fac-
tor in the patients with rheumatic diseases, unlike in general population.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Special Lectures
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S117
유도만능줄기세포의 연골세포 분화 및 Crispr/Cas9 유전자 가위 시스템의 확립
한승우
대구파티마 병원
골관절염은 대표적인 퇴행성 질환으로 연골세포의 비대화에 동반된 자멸사와 MMP13이나 ADAMTS 등의 효소에 의한 세포외기
질의 파괴가 핵심 병리 기전임. 그러나 이를 억제하여 골관절염을 예방하려는 시도는 골관절염의 느린 진행 경과로 인해 장기간의 치료
를 요하며, 골관절염으로 인해 증상이 발생하려면 관절연골의 손상이 일정 정도 이상 진행되어야 한다는 점에서 한계를 가짐. 이로 인해
손상된 연골을 중간엽 줄기세포나 자가 연골세포를 이용하여 복구하려는 시도들이 있어왔으나 대부분의 연구에서 만족스러운 결과를
얻지 못함. 연골세포는 증식능이 거의 없고, 일반적인 조건에서 배양할 경우 탈분화되어 연골세포의 성질을 잃게 됨. 일반적으로 손상된
연골의 수복을 위해서는 107개 이상의 많은 연골세포가 필요하나 이런 제한된 연골세포의 증식능으로 인해 치료에 충분한 연골세포를
얻기가 힘듬. 본 연구진은 혈관내피세포에 야마나카 인자를 도입하여 유도만능줄기세포로 분화 및 증식시키고, 이를 중간엽 세포 단계
를 거쳐 연골세포로 분화시키는 연구를 진행 중임. 이를 통해 충분한 수의 연골세포 확보가 가능하며, 골관절염의 치료에 적용하려고
함. 본 연구진이 진행 중인 두 번째 골관절염의 치료적 접근법은 Crispr/Cas9 유전자 가위 시스템을 이용하여 골관절염의 진행에 중요
한 타겟 단백을 결손시키는 방법임. 면역 반응이 없고, DNA에 삽입되지 않는 아데노연관 바이러스 시스템에 Crispr/Cas9 유전자 가위
시스템을 결합하여 관절연골에서 특정 단백을 결손하려함. 타겟 단백으로 제 2형 BMP 수용체나 Hif2a를 고려하고 있으며 동물실험을
통해 효과를 검증하려 함.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S118
T Cell Receptor Stimulation with Microbeads
김진현
충남대학교 의과대학
Triggering of the T cell receptor (TCR) by antigen presenting cells activates signaling networks. The signal trans-
duction will lead to transcriptional activation, proliferation, and differentiation of T cells that will ultimately result in an
immune response. Defects in signal cascades may lead to either T-cell hyper or hyporesponsiveness, which results in au-
toimmunity or immunodeficiency, respectively. Thus, the study of how TCR signaling is initiated, transduced, and con-
verted to a cellular response is important for the understanding physiology of T cells and the molecular mechanisms of
immunologic disease.
To assess signaling events during TCR activation, soluble stimuli such as agonistic antibodies against the TCR/CD3
complex and/or CD28 are still largely used. However, soluble stimuli fail to induce T-cell proliferation or appropriate
functional responses. Thus, it is questionable whether TCR signaling induced upon stimulation with soluble antibodies
reflects the physiologic signaling in T-cell responses. Alternative method of T-cell stimulation is based on microbeads
coated with the same antibodies against TCR complex and has been used mainly to expand T cells ex vivo. It is generally
believed that soluble antibodies and immobilized antibodies on microbeads have different functional properties.
However, a comprehensive biochemical characterization of antibody-coated microbeads stimulation in human T cells in
vitro has not yet been performed. Therefore, an analysis of the signaling signatures such as CD247, SLP76, Akt and
Erk1/2 was performed by antibodies against the TCR complex immobilized on microbeads.
The graded stimulation with anti-CD3- and anti-CD28-coated microbeads can provoke variable phosphorylation in
signaling molecules. The phosphorylation of proximal molecules like SLP76 and CD247 demonstrated positively corre-
lated response by graded TCR stimulation. However, the phosphorylation of distal molecules such as ERK1/2 and AKT
revealed initial increase with weak stimuli but steady state or even less phosphorylation with stronger TCR stimulation.
Between old and young persons, there was also a difference in the naïve T cell signal transduction. In old persons the
proximal signal molecule showed more phosphorylation than in young people whereas the distal molecule featured less
phosphorylation than in young persons.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S119
Change of Regulatory T Cells in RA Patients with Tocilizumab
Dam Kim
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases
Background/Objectives: Various immune cells are considered to be involve in the pathogenesis of rheumatoid arthritis
(RA). The anti-interleukin (IL)-6 receptor antibody tocilizumab (TCZ), which is one of effective treatments against RA,
is supposed to affect proportions of peripheral blood cells by blocking the IL-6 signaling. We aimed to identify the effect
of TCZ treatment on proportion of peripheral blood cell population during 2 years of treatment.
Methods: Among RA patients who met the 1987 ACR classification of RA or the 2010 ACR/EULAR classification, con-
secutive patients at Keio University Hospital who commenced TCZ as their first biologic agent were enrolled. The pa-
tients were administered 8 mg/kg TCZ every 4 weeks, either with or without conventional DMARDs. Peripheral blood
mononuclear cells were obtained at baseline, at week 24, 52, and 104 of TCZ treatment. The proportion of several subsets
of peripheral cells with their levels of expression of differentiation markers, activation markers and costimulatory mole-
cules were measured sequentially from baseline to week 104 by flow cytometry analysis.
Results: Twenty two RA patients who completed 2 years of TCZ treatment were enrolled in this study. Among them,
17 patients achieved simple disease activity index (SDAI) remission at week 104 of TCZ therapy. The proportion of
CD4+CD25+CD127low Treg cells increased during week 52 and maintained from week 52 to week 104. Comparing pa-
tients with remission and non-remission at week 104, proportions of Treg cells were slightly higher in patients with re-
mission, but it was not statistically significant. In addition, proportion of HLA-DR+ Treg cells was increased during week
52 to 104.
Conclusion: TCZ affected proportions of circulating immune cells in patients with RA. The proportion of Treg cells
among CD4+ T cells increased with TCZ treatment.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Invited Lectures II
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S123
Engineering New Biologic Therapies for Osteoarthritis
Farshid Guilak, PhD
Center of Regenerative Medicine and Shriners Hospitals for Children - St. Louis, Departments of Orthopaedic Surgery, Developmental Biology, and Biomedical Engineering, Washington University, St. Louis MO
Osteoarthritis is a painful and debilitating disease of the joints that is characterized by progressive degeneration of the
articular cartilage that lines the joint surfaces. The etiology of osteoarthritis is poorly understood, although it is now well
accepted that biomechanical factors play an important role in the onset and progression of this disease. The primary goal
of our lab has been to determine the mechanisms by which mechanical loading affects the physiology of the joints. Using
a hierarchical approach to span different systems, ranging from clinical studies and in vivo animal models to studies at
the tissue, cellular, and subcellular scale, we have identified specific mechanical signaling pathways that regulate cartilage
physiology, pathology, and mechanically-induced regeneration. These pathways provide novel pharmacologic targets for
the modification of cartilage degeneration in osteoarthritis. Additionally, our studies have focused on tissue engineering
approaches for repairing cartilage damage with osteoarthritis. Using textile processes that allow weaving of biomaterial
fibers in three dimensions, we have created cell-instructive bioactive scaffolds that can recreate many of the complex bio-
mechanical properties and anatomic features of articular cartilage as a cell-based approach for complete resurfacing of os-
teoarthritic joint surfaces. In recent years, the advent of synthetic biology and gene-editing methods such as CRISPR/
Cas9 has allowed for precise modifying gene networks that control cell behavior. We have applied a combination of princi-
ples from these fields to rewire cellular gene circuits in a manner that allows us to create a unique, custom-designed cell
type that can sense and respond to its biochemical environment in a pre-programmed way to developed engineered tis-
sues with the ability for tunable, inducible, or feedback-controlled, auto-regulated biological responses. In addition to re-
capitulating the biochemical and biomechanical properties of the tissue, these “smart” constructs can provide controlled
drug delivery and immunomodulatory responses to the joint to enhance the success of engineered tissue replacements.
Taken together, these studies emphasize the important role of biomechanics and mechanobiology in the health, disease,
and regeneration of the joint.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S124
Pulmonary Arterial Hypertension in the Connective Tissue Diseases
Janet Pope, MD, MPH, FRCPC
Univ. of Western Ontario and St. Joseph's Health Care, London Ontario, Canada
Pulmonary arterial hypertension (PAH) can be a complication of connective tissue diseases (CTDs) where it is most
often occurring in systemic sclerosis (SSc). Routine screening in all CTDs is not recommended but it is recommended
in SSc and CTDs with SSc features such as those with overlaps including SSc and many with mixed connective tissue
disease. PAH must always be diagnosed with right heart catheterization. In CTDs, there are multiple reasons for dyspnea
so investigations have to be done as clinically indicated to determine if there is heart or lung involvement in someone with
shortness of breath and CTD.
PAH IN SYSTEMIC SCLEROSIS
Development of PAH in SSc is lethal with shorter survival than idiopathic PAH. It occurs in 8 to 15% of patients. Years
prior to diagnosis, there may be changes such as a decreasing diffusing capacity on pulmonary function testing and cardiac
exercise abnormalities, so screening of PAH in SSc is recommended. Research may aid in determining who has the great-
est chance of developing PAH. Those who are older with long standing disease, and a low, worsening diffusing capacity
seem to be at highest risk. When screening SSc patients (with annual echocardiography and/or pulmonary function tests
(diffusing capacity), patients are detected at earlier functional class and if treated early, they can have less worsening.
Therapies of PAH have reduced clinical worsening and improved mortality. Drugs used for PAH do result in sustained
clinical and hemodynamic improvements. Major classes of pharmacotherapeutics recommended for treatment of PAH in
SSc include: ERAs (macitentan bosentan, ambrisentan), PDE5 inhibitors (sildenafil, tadalafil), IV prostanoids
(epoprostenol, iloprost, treprostinil), and Riociguat (a soluble guanylate cyclase (sGC) stimulator). These drugs were
traditionally used as monotherapy; however, recent studies have shown benefit in combination therapy and further re-
search is ongoing in this respect. The standard of care for PAH is to add another treatment if initial treatment goals are
not reached with monotherapy and some expert centers initiate combination therapy as first-line. Trends have been to
treat PAH earlier with positive data from treatment of less symptomatic patients (Functional Class II).
In the class of ERAs, macitentan has improved relevant end points such as less hospitalizations and survival in PAH
where approximately 1/3 of patients had connective tissue disease (especially systemic sclerosis). ERA agents are also
being studied in combination therapies with PDE5 inhibitors. Sildenafil and tadalafil have shown clinical improvements
in patients with PAH as monotherapies.
Epoprostenol, an intravenous (IV) prostanoid, is considered the most effective. However, it is a synthetic compound
with a half-life of 5 minutes; thus, requiring an indwelling catheter and continuous infusion. Iloprost has been studied
in inhalation formulations in the setting of PAH. Current treatment recommendations include both inhalational and IV
forms. Treprostinil has been studied in IV, subcutaneous, inhalational and oral routes of administration in PAH, and is
Janet Pope: Pulmonary Arterial Hypertension in the Connective Tissue Diseases
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S125
usually given by chronic subcutaneous administration.
Riociguat is a soluble guanylate cyclase (sGC) stimulator, which is responsible for synthesis of cGMP that acts on the
cGMP-dependent protein kinase pathway, ultimately leading to vasodilation with improvement in the 6 minute walk test,
functional class, pulmonary vascular resistance and time to clinical worsening.
Data are lacking with respect to what order and which combination to use in each SSc patient with PAH. There is no
high level data in SSc with respect to the use of anticoagulation in PAH, although primary PAH (i.e. not associated with
SSc) treatment recommendations have suggested warfarin may be beneficial. Future trends include screening for PAH
early, determining if SSc patients who do not have symptoms should be treated if they have proven PAH and under-
standing the natural history of those who do not meet criteria for PAH but have abnormal pulmonary artery pressure and
normal wedge pressure (sometimes called borderline PAH). There are no definitive data that immune suppression in SSc
will treat PAH.
PAH IN SLE
PAH in SLE is treated similarly to SSc but also immune suppression is added. Always other causes of PH must be ruled
out. Patients with SLE are at higher risk than the general population of pulmonary emboli if they have antiphospholipid
antibodies. Patients need to have a ventilation perfusion lung scan and possibly a spiral CT chest looking for thrombi. The
prognosis of PAH in SLE is better than SSc.
CONCLUSIONS
PAH should be suspected in someone with CTD and unexplained dyspnea. A systematic approach is needed and in SSc
or SSc-like CTDs, screening for PAH is needed due to the high prevalence and because screening allows for earlier inter-
vention and a better prognosis.
SELECTED REFERENCES
1. Murdaca G, Spano F, Puppo F. Current therapies for the treatment of systemic sclerosis-related pulmonary arterial hypertension: efficacy and safety. Expert Opin Drug Saf. 2014 Mar;13(3):295-305.
2. Muangchan C, Baron M, Pope J. The 15% rule in scleroderma: the frequency of severe organ complications in systemic sclerosis. A systematic review. J Rheumatol. 2013 Sep;40(9):1545-1556.
3. Pulido T, Adzerikho I, Channick R, et al. Macitentan and morbidity and mortality in pulmonary arterial hypertension. N Engl J Med. 2013;369(9):809-818.
4. Ghofrani HA, Galie N, Grimminger F, Grunig E, Humbert M, Jing ZC, et al. Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med. 2013 Jul 25;369(4):330-340.
5. Rubin LJ, Galie N, Grimminger F, Grunig E, Humbert M, Jing ZC, et al. Riociguat for the treatment of pulmonary arterial hyper-tension: a long-term extension study (PATENT-2). Eur Respir J. 2015 May;45(5):1303-1313.
6. Olsson KM, Delcroix M, Ghofrani HA, Tiede H, Huscher D, Speich R, et al. Anticoagulation and survival in pulmonary arterial hy-pertension: results from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA). Circulation. 2014 Jan 7;129(1):57-65.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S126
Ultrasound in Rheumatology: Getting Closer to the Holy Grail?
GAW Bruyn, MD, PhD
Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
By 2016, musculoskeletal ultrasound (US) can no longer be considered as controversial in rheumatology but on the
contrary, thrives as an established imaging modality for the investigation and management of chronic inflammatory
arthritis. The main advantage of US in the evaluation and monitoring of patients with rheumatoid arthritis (RA) is based
particularly on its greater sensitivity compared to clinical examination for detecting synovitis in RA signature joints. Yet,
the development of US as a tool for the clinical rheumatologist has come a long way. The several milestones set in stand-
ardizing the use of US in rheumatic disease over the last decade and the contribution of US in understanding muscu-
loskeletal diseases will be presented in this lecture, that will focus on RA.
More or less arbitrarily, we may state that the start of a data-driven development of US as a research instrument was
designed in 2004. At the OMERACT conference of 2004, a Special Interest Group (SIG) dedicated to ultrasound was
founded by a group of international rheumatologists/experts in ultrasound, with the aim of exploring the metric proper-
ties of musculoskeletal US. At this infant stage, a systematic review of the musculoskeletal US literature in rheumatoid
arthritis (RA) had dissected the various gaps in existing knowledge, particularly underscoring the lack of US definitions
of rheumatic pathology, instrument reliability, and instrument validity. Unfortunately, research resources of the SIG were
very limited and so, efforts had to be strictly prioritized. The very first publication of the group reported on a core set of
practical US definitions for inflammatory elementary lesions including synovitis, tenosynovitis, and erosions. In consid-
ering which best strategy to employ, dauntless exercises on synovitis in RA patients were carried out during the
2004-2010 era. Standardization of detection and acquisition of synovitis in metacarpophalangeal (MCP) joints in RA us-
ing the OMERACT definition for synovitis, i.e. a combination of effusion and synovital hypertrophy, was considered the
first objective. Subsequent iterative exercises tested and retested interobserver and intraobserver reliability for both the
reading and acquisition of images of the MCP joint, including a freshly introduced semi-quantitative scoring system at
the joint level that combined together power Doppler (PD), effusion and synovial hypertrophy. The B-mode semi-
qauntitative scoring system included 4 steps (grades 0-3), the PD scoring system also included 4 grades (0-3). These data
showed that the OMERACT ultrasound definitions and scoring system of synovitis combined with a standardized acquis-
ition protocol provided good intra- and interobserver reliability.
Subsequently, the definitions and scoring system of synovitis were evaluated on other joints commonly involved in RA,
including proximal interphalangeal joints (PIPJ), wrist, metatarsophalangeal joints (MTPJ), and knee joints. Two should-
er reliability studies were also conducted to compare ultrasound with magnetic resonance imaging for the detection of
inflammatory and mechanical pathologies and to assess the intra- and inter-observer reliability of ultrasound for detect-
ing these lesions. All data were published in peer-reviewed journals, and showed that the developed PDUS scoring of
MCP synovitis was useful for detection and scoring of synovitis in other joints.
In the last phase, the objectives changed from joint level to patient level. This project was called the OMERACT ultra-
GAW Bruyn: Ultrasound in Rheumatology: Getting closer to the Holy Grail?
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S127
sound global synovitis score at the patient level (US-GLOSS) using the combined PDUS score in an extended set of joints.
The ultimate goal of an ultrasound scoring system at patient level is permitting physicians objectively follow patients un-
der treatment in clinical practice and research by using a feasible and economical tool which we would expect to be more
representative of RA disease activity than conventional clinical measures. The US-GLOSS has been used in various clin-
ical trials, but fails to show a consistent correlation with several clinical and functional instruments. At this moment, it
is still unclear how many joints we have to scan in order to get a validated reflection of the disease activity, neither is there
consensus on the scanning technique of the various joints. These issues are still under investigation.
In conclusion, collaborative work over the years, by an international group of rheumatologists/US experts has yielded
considerable progress in developing a valuable instrument that can be used in a both in daily clinical practice and in rheu-
matology trials.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Rheumatoid Arthritis
Basic Aspects
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S131
Regulation of Autophagic Flux Alters Interleukin-17A-induced Migration and Proliferation of Fibroblast-like Synoviocytes
from the Patients with Rheumatoid Arthritis
Ji-Min Kim1, Jihye Bang2, Hye-Jin Jeong1, Chang-Nam Son1, Sang-Hyon Kim1
1Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, 2Keimyung University Graduate School of Medicine, Daegu, Korea
Background: Interleukin-17A (IL-17A) plays a critical role in the pathogenesis of rheumatoid arthritis (RA).
Autophagy is required to ensure cellular homeostasis. Here, we hypothesized that IL-17A might have an impact on auto-
phagic flux and that aberrant autophagy might be involved in expansion of synovial fibroblasts in the patients with RA.
Objectives: The aims of this study were (1) to evaluate whether IL-17A influences on autophagic flux in the synovium
of the patients with RA and (2) to investigate whether the modulation of autophagy can regulate migration and pro-
liferation of fibroblast-like synoviocytes (FLS) from the patients with RA (RA-FLS) under inflammatory milieu.
Methods: Synovial tissue was obtained from the patients with RA or osteoarthritis (OA). FLS was cultured with
IL-17A, autophagy inducer or inhibitor. The expression of marker proteins for autophagic flux and the formation of auto-
phagolysosome were analyzed by western blot. A migration scratch assay was used to assess FLS migration in response
to stimulation with IL-17A. Proliferation of FLS was determined by the viable cell count using trypan blue. Bafilomycin
was used for inhibiting autophagic flux.
Results: The expression of autophagy markers (LC3B, Beclin1, Atg5) was increased in the synovium of the patients
with RA than in that of the patients with OA. Autophagy was also enhanced in RA-FLS compared with OA-FLS. IL-17A
upregulated the expression of LC3B, Atg5, Beclin1, LAMP1 in RA-FLS. In particular, IL-17A-induced accumulation of
p62 was prominent in RA-FLS. Migration and proliferation of FLS stimulated by IL-17A was suppressed by the inhibition
of autophagy.
Conclusion: This study reveals that IL-17A stimulates autophagic flux and that intervention of autophagy can control
IL-17A-induced migration and proliferation of FLS. Our results also provide additional evidence for a significant role of
autophagy in the pathogenesis of RA.
O-21-01
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S132
Interleukin-32 Exacerbates Synovial Inflammation and Bone Destruction Via the Suppression
of Raf Kinase Inhibitory Protein
Hae Sook Noh1, Hye Song Lim1, Sang Mi Yi1, Min-Gyu Jeon1, Beow Yong Park2, Hee Young Cho2, Young-Sool Hah2, Yun-Hong Cheon1, Sang-Il Lee1
1Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Gyeongnam, 2Clinical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongnam, Korea
Background: IL-32 is a newly described pro-inflammatory cytokine and play pathogenetic role in RA by stimulating
TNF-a production and activation of NF-kB and ERK pathways. Raf kinase inhibitory protein (RKIP) has been reported
to be an inhibitory protein for the NF-kB and ERK pathways. However, there was no study about the interaction of IL-32
and RKIP in RA.
Objective: The purpose of present study was to investigate the interaction of IL-32 and RKIP in RA.
Methods: Arthritis development was examined in IL-32 transgenic (TG) and wild-type of C57/BL6 (WT) mice using
the K/BxN serum transfer arthritic model. Fibroblast-like synoviocytes (FLS) and bone marrow-derived osteoclast were
isolated and cultured from IL-32 TG and WT mice. Synovium and FLS from RA patients were also used. Quantitive
RT-PCR, immunohistochemistry, ELISA, western blotting, TRAP and safranin-O staining, migration and invasion assay
were performed.
Reasults: IL-32 TG mice displayed significantly increased arthritis severity as assed by measurements of ankle swel-
ling, joint inflammation, and bone and cartilage erosions in the K/BxN serum-transfer model. TNF-a levels were sig-
nificantly increased in the serum and ankle of IL-32 TG mice than WT. RKIP expressions were decreased in the ankles,
FLS, and bone marrow-derived osteoclast of the IL-32 TG mice than WT. Additionally, RKIP expression was also de-
creased in the synovium and FLS from RA patients than osteoarthritis. The migration of FLS and osteoclastogenesis of
bone marrow-derived osteoclast of the IL-32 TG mice were increased than WT.
Conclusion: These results suggest pro-inflammatory role of IL-32 is, in part, RKIP-dependent. Thus, further studies
on the potential involvement of IL-32-RKIP axis will be beneficial in better understanding the pathogenesis of RA.
Keyword: IL-32, RKIP, Rheumatoid arthritis, Fibroblast-like synoviocytes, Osteoclastogenesis
O-21-02
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S133
NFAT5 Promotes Macrophage Survival by Inducing Chemokine Ligand 2
Susanna Choi1, Sungyong Yoo2, Soo Youn Choi3, H. Moo Kwon3, Hyun-Sook Kim4, Daehee Hwang5, Chul-Soo Cho1,6, Wan-Uk Kim1,6
1POSTECH-Catholic BioMedical Engineering Institute, The Catholic University of Korea, Seoul, Korea, 2Department of Surgery and Biomedical Sciences, Cancer Biology Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA,
USA, 3School of Nano-Bioscience and Chemical Engineering, Ulsan National Institute of Science and Technology, Ulsan, 4Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, 5Center for Systems Biology of Plant Senescence
and Life History, Institute for Basic Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu, 6Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Apoptotic death of activated macrophages is important for controlling chronic inflammation and its defect in these
cells has been implicated in the pathogenesis of rheumatoid arthritis (RA). However, the molecular signatures defining
apoptotic resistance of RA macrophages have not been fully understood. Here, global transcriptome profiling of RA mac-
rophages revealed that nuclear factor of activated T-cells 5 (NFAT5), an osmoprotective transcription factor, is one of the
critical regulators for a wide range of pathologic processes of synovial macrophages, including cell cycle, apoptosis, and
proliferation. Analysis of transcriptomes in NFAT5-deficient macrophages demonstrated the molecular networks defin-
ing cell survival and proliferation. Proinflammatory M1 polarizing stimuli and hypoxic conditions were responsible for
enhanced NFAT5 expression in RA macrophages. An in vitro functional study demonstrated that NFAT5-deficient mac-
rophages were more susceptible to apoptotic death. Interestingly, chemokine (C-C motif) ligand 2 (CCL2) was secreted
in an NFAT5-dependent fashion and it bestowed RA macrophages apoptotic resistance. Mice with NFAT5 hap-
loinsufficiency (NFAT5+/-) had a lower severity of IL-1β-induced arthritis than their wild type littermates. Moreover,
in mice, NFAT5-deficient macrophages were more susceptible to apoptosis and were less efficient in promoting joint de-
struction than NFAT5-sufficient macrophages when injected intra-articularly. Conclusively, NFAT5 regulates macro-
phage survival by inducing CCL2 secretion. Our results provide the first evidence that NFAT5 expression in macrophages
enhances chronic arthritis by conferring apoptotic resistance to activated macrophages and thereby plays a central role
in the pathogenesis of macrophage-dependent chronic inflammatory diseases, including RA.
O-21-03
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S134
Autophagy Contributes to Celecoxib-induced Cell Death in Rheumatoid Arthritis Fibroblast-like Synoviocytes
Jihye Bang1, Hye-Jin Jeong2, Chang-Nam Son2, Ji-Min Kim2, Sang-Hyon Kim2*1Keimyung University Graduate School of Medicine, Daegu, 2Division of Rheumatology, Department of Internal Medicine,
Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
Background: An aggressive proliferation of synovium is the hallmark of rheumatoid arthritis (RA). Previous studies
suggested that resistance of fibroblast-like synoviocytes (FLS) to apoptosis is involved in synovial hyperplasia in the pa-
tients with RA. Recently, the possibilities that autophagy regulates apoptosis resistance and hyperplasia of FLS were also
presented. Selective cyclooxygenase-2 (COX-2) inhibitor, celecoxib, has been reported to affect apoptosis or autophagy
in various cancer cells.
Objectives: The aim of this study is to investigate the influence of celecoxib on viability of RAFLS and to reveal how
celecoxib affects the viability of RAFLS.
Methods: RA synovial tissue was obtained from patients during total knee replacement surgery or arthroscopy. FLS
was cultured with celecoxib, caspase inhibitor (z-VAD-fmk) or autophagy inhibitor (3-methyladenine; 3-MA, bafilomy-
cin A1; bafi A1, chloquine; CQ). Cell viability was measured by MTS assay and by cell count using trypan blue staining.
The expression of autophagy flux (LC3, p62) and apoptosis related protein (caspase3 and poly (ADP-ribose) polymerases
(PARP)) was analyzed by western blot.
Results: Celecoxib dose-dependently decreased cell viability (mean IC50 of 120μM) of RAFLS. Activation of Caspase
3 and PARP cleavage were observed in RAFLS after the treatment with celecoxib. Combination treatment with caspase
inhibitor and celecoxib increased cell viability than a single treatment with celecoxib. Celecoxib also increased the ex-
pression of LC3II and p62 in RAFLS. Treatment with autophagy inhibitor (3-MA, bafi A1, CQ) restored viability of RAFLS
which was decreased by celecoxib.
Conclusion: This study demonstrates that both apoptosis and autophagy contribute to celecoxib-induced cell death in
RAFLS. Further studies to identify the effects of celecoxib on chronological sequence of autophagy and apoptosis in
RAFLS are need.
O-21-04
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S135
Robust Therapeutic Efficacy of Matrix Metalloproteinase-2 Cleavable fas-1-RGD Peptide
Complex on Chronic Inflammatory Arthritis
Eon Jeong Nam*, Jin Hee Kang, Keum Hee Sa, Shijin Sung, Jeong Soo Eun, Na Ri Kim, Young Mo Kang
Department of Internal Medicine, Kyungpook National University School of Medicine, (Rheumatology) Daegu, Korea
Background: Therapeutic agents that are transformable via introducing cleavable linkage by locally enriched MMP-2
within inflamed synovium would enhance therapeutic efficacy on chronic inflammatory arthritis. Transforming growth
factor-β-inducible gene-h3 (βig-h3), which consists of fas-1 domains and an Arg-Gly-Asp (RGD) motif, intensifies in-
flammatory processes by facilitating adhesion and migration of fibroblast-like synoviocyte in the pathogenesis of rheu-
matoid arthritis (RA).
Objectives: To investigate whether MMP-2 cleavable peptide complex consisted of fas-1 domain and RGD peptide
blocks the interaction between βig-h3 and resident cells and leads to the amelioration of inflammatory arthritis.
Methods: We designed βig-h3-derivatives, including the fourth fas-1 domain truncated for H1 and H2 sequences of
mouse (MFK00) and MMP-2-cleavable peptide complex (MFK902). MMP-2 selectivity was examined by treatment with
a series of proteases. MFK902 efficacy was determined by the adhesion and migration assay with NIH3T3 cells in vitro
and collagen-induced arthritis (CIA) model in vivo.
Results: MFK902 was specifically cleaved by active MMP-2 in a concentration-dependent manner, and βig-h3-me-
diated adhesion and migration were more effectively inhibited by MFK902, compared with RGD or MFK00 peptides. The
arthritis activity of murine CIA, measured by clinical arthritis index and incidence of arthritic paws, was significantly
ameliorated after treatment with all dosages of MFK902 (1, 10, and 30 mg/kg). MFK902 ameliorated histopathologic de-
terioration and reduced the expression of inflammatory mediators simultaneously with improvement of clinical features.
Conclusions: The present study reveals that the MMP-2-cleavable peptide complex, based on βig-h3 structure, was
a potent therapeutic agent for chronic inflammatory arthritis and provides a reliable evidence for the MMP-2-cleavable
mechanism as a tissue-targeted strategy to treat RA.
O-21-05
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Rheumatoid Arthritis
Clinical Aspects II
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S139
Disease Characteristics and Change of Arthritis Activity According to Treatment in Hepatitis B Surface Antigen
Positive Rheumatoid Arthritis Patients
YeongHee Eun, In Young Kim, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Hoon-Suk Cha
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
Background: Rheumatoid arthritis (RA) treatment may differ according to hepatitis B state and consequently bring
about different outcome of arthritis. However, it has not yet been elucidated whether hepatitis B affects treatment out-
come such as disease activity.
Objective: We investigated possible differences in change of arthritis activity between RA patients according to con-
comitant hepatitis B virus infection.
Methods: A retrospective analysis of 40 hepatitis B surface antigen (HBsAg)-positive RA patients and 112 HBsAg-neg-
ative RA patients was conducted. The longitudinal relationship between HBsAg-positivity and RA activity/medication
use was analyzed using generalized estimating equations in regression models.
Results: In regression analysis, RA activity showed time-dependent improvement. We observed significant interaction
between time and HBsAg-positivity for disease activity score in 28 joints with 3 variables (DAS28-3; P=0.026), that
means the degree of decrease in DAS28-3 with time influenced by HBsAg-positivity. But this interaction did not remain
significant after adjustment. For tender joints, erythrocyte sedimentation rate and C-reactive protein levels, there were
no interaction between time and HBsAg-positivity, while swollen joints showed significant interaction (P=0.017). The
time-association and group differences were not observed in alanine aminotransferase (ALT) level. Over all visits,
HBsAg-positive patients were less likely to receive methotrexate (OR 0.09 [95% CI 0.04-0.19], P<0.0001) and more like-
ly to receive sulfasalazine (OR 3.67 [95% CI 1.94-6.95], P<0.0001).
Conclusion: There were no significant differences over time in DAS28-3, tender joints and inflammatory markers ac-
cording to HBsAg-positivity, while swollen joints showed significant difference over time. ALT level did not showed
time-association and group differences. HBsAg-positive RA patients were less likely to receive methotrexate and more
likely to receive sulfasalazine.
O-21-06
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S140
Correlations between Rheumatoid Arthritis Activity Indices and Factors Affecting Acute Phase Reactants
in Patients with Rheumatoid Arthritis
In Ah Choi
Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
Background: Assessment of disease activity is a key part of clinical decision in rheumatology care.
Objectives: We compared the DAS28ESR and DAS28CRP to other RA activity measures and were to find confounding
factors affecting acute phase reactants to patients with RA to find best tool to access RA disease activity.
Methods: A cross-sectional study was conducted in 1120 patients with RA, using initial registration data from Korean
Biologics Registry (KOBIO).
Results: DAS28CRP showed excellent correlation with SDAI (r=0.926, p<0.001) and CDAI (r=0.901 p<0.001).
DAS28ESR also showed good correlation with SDAI (r=0.875, p<0.001) and CDAI (r=0.886, p<0.001). CRP showed
low but significant correlation with SJC (r=0.132, p<0.001), TJC (r=0.087, p=0.004), SDAI (r=0.441, p<0.001) and
CDAI (r=0.134, p<0.001). ESR also showed significant correlation with SJC (r=0.132, p<0.001), TJC (r=0.063,
p=0.035), SDAI (r=0.233, p<0.001) and CDAI (r=0.145, p<0.001). In correlation analysis using CDAI as controlled
variable, ESR increased with age (r=0.110, p<0.001) and serum RF (r=0.105, p=0.001) but was not correlated with
BMI, disease duration, and anti-CCP antibody titer. There was no difference in ESR according to the gender, smoking sta-
tus, presence of diabetes mellitus, obesity (BMI ≥ 30) or low body weight (BMI<18.5). In the same analysis, CRP was
not correlated with age, BMI, disease duration, RF and anti-CCP antibody. It was higher in male compared to female
(p=0.001) and higher in ever-smoker compared to never-smoker (p=0.027). There was no difference in CRP according
to the presence of diabetes mellitus, obesity or low body weight.
Conclusion: Both DAS28CRP and DAS28ESR were well correlated with other activity indices. ESR increased with age
but was less susceptible to gender or smoking status compared to CRP, suggesting DAS28ESR to be a more useful marker
for inter-patient-comparison of RA disease activity.
O-21-07
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S141
Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission and
Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee
Division of Rheumatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
Background & Object: Therapeutic goal of rheumatoid arthritis (RA) is to achieve disease remission. However, several
remission criteria have not always equated to the complete absence of true inflammation. Power Doppler
Ultrasonography (PDUS) has been demonstrated to detect subclinical synovitis. The aim of this study was to elucidate
the achievement rates of imaging remission and examine characteristics associated with achievement status among RA
patients in clinical remission.
Methods: This study was conducted in 46 RA patients who attained clinical remission, defined by DAS28-ESR re-
mission criteria. PDUS was performed in 16 joints and 2 tendons and graded on the basis of a dichotomous assessment
(presence/absence). Imaging remission was defined by absence of PD on US examination. The clinical and laboratory da-
ta of patients with imaging remission were compared with those of patients with only clinical remission.
Results: Twenty one patients (45.7%) with RA in clinical remission had PDUS-defined active synovitis. PD was de-
tected most frequently in right RC joint (n=12, 26.1%). Six patients complained of pain in other joints that were not in-
cluded in US assessments. All those joint were PDUS positive. PDUS negative patients had lower evaluator global assess-
ment score (P<0.001), and simplified disease activity index score, SDAI (P=0.005). They use less nonsteroidal anti-in-
flammatory drug (NSAID) (n=15 vs 19 pa-
tients, p=0.019). Overall, imaging remission
was related with less tender and swollen joint
count, lower patient global assessment score,
higher health assessment questionnaire (HAQ)
score and lower clinical disease activity score.
Conclusion: Achievement rate of imaging
remission was 54.3% in RA patients with clin-
ical remission. Patients who were in imaging
remission tend to have lower disease activity,
lower pain score and less frequent use of
NSAIDs, compared to patients with only clin-
ical remission.
O-21-08
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S142
HAQ Score is an Independent Predictor of Sustained Remission in Patients with Rheumatoid Arthritis
Kyung-Eun Lee, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Lihui Wen, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee
Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Korea
Objective: We compared remission rates, according to different definitions of remission in rheumatoid arthritis (RA)
and investigated the potential predictors of sustained remission at the 2-year follow-up.
Methods: We obtained data on 291 RA outpatients, seen from July 2009 to September 2012. Sociodemographic data
and answers to questionnaires were collected in face-to-face interviews. Remission was defined according to the Disease
Activity Score in 28 joints (DAS28)-ESR, DAS28-CRP, Simplified Disease Activity Index (SDAI), Clinical Disease Activity
Index (CDAI), and ACR/EULAR Boolean definition. Sustained remission was defined as when the patient continued in
remission at two consecutive annual assessments. Predictors of sustained remission according to the DAS28-CRP were
assessed by univariate and multivariate analyses.
Results: For the 291 RA patients, the remission rates of RA were 17.9% (DAS28-ESR), 54.3% (DAS28-CRP), 10.3%
(SDAI), 10.0% (CDAI), and 5.8% (Boolean). On follow-up for 2 years, the sustained remission rates of RA were 46.5%
(DAS28), 55.0% (DAS28-CRP), 37.5% (SDAI), 32.0% (CDAI), and 30.8% (Boolean). RA patients who achieve sus-
tained remission according to the DAS28-CRP were younger, and had more education, higher monthly income, lower
Health Assessment Questionnaire (HAQ) score, lower physician global assessment, lower patient global assessment,
lower patient pain assessment, and higher EQ-5D. In multivariate analysis, only the HAQ score predicted sustained re-
mission according to DAS28-CRP (OR=0.257, 95% CI 0.067-0.980, p=0.047).
Conclusion: The remission rates of RA patients differed according to the definition of remission, and the highest sus-
tained remission rate was classified by the DAS28-CRP. A lower HAQ score was an independent predictor of sustained
remission over 2 years, according to the DAS28-CRP.
O-21-09
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Research Society Session on Spondyloarthritis
1부 - 강직성 척추염에서 TNF 길항제의 사용
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S145
Drug Survival of Tumor Necrosis Factor α Inhibitors in Patients with Ankylosing Spondylitis in Korea
Hyemin Jeong1, Yeong Hee Eun1, In Young Kim1, Hyungjin Kim1, Joong Kyong Ahn2, Jaejoon Lee1, Eun-Mi Koh1, Hoon-Suk Cha1
1Department of Medicine, Samsung Medical Center, 2Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Objectives: To evaluate drug survival of the tumor necrosis factor-α inhibitors (TNFi) and risk factors for the drug dis-
continuation in patients with ankylosing spondylitis (AS).
Methods: We retrospectively evaluated 487 AS patients at a single tertiary hospital. Among the TNFi users, drug sur-
vival and risk factors of TNFi discontinuation were investigated.
Results: Among 487 patients, 128 AS patients were treated with at least one TNFi. Patients who were treated with
TNFi were younger at disease onset, had more peripheral manifestations, and had higher level of acute phase reactants
and BMI than those of TNFi non-users at baseline. Of 128 patients, 28 (21.9%) patients discontinued first TNFi therapy
during the follow-up period of 65.1±27.9 months. In the multivariable analysis, female (HR 6.08, 95% CI 2.27-16.27,
p=0.003), hip involvement (HR 2.52, 95%CI 1.08-5.87, p=0.033) and a high CRP (HR 1.10, 95%CI 1.00-1.21, p=0.044)
were risk factors for drug discontinuation. Etanercept showed better survival rate than infliximab. The main reason for
discontinuation of TNFi was inefficacy.
Conclusions: TNFi discontinuation rate of Korean patients with AS seems to be similar to those with the European
patients. Female sex, hip involvement, CRP, and the type of TNFi were associated with TNFi discontinuation.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S146
Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the
Treatment of Active Tuberculosis: A Retrospective Nationwide Registry of the Korean Society of Spondyloarthritis Research
Hye Won Kim1, Seong Ryul Kwon2, Kyong-Hee Jung2, Seong-Kyu Kim3, Han Joo Baek4, Mi Ryung Seo4, So-Young Bang5, Hye-Soon Lee5, Chang-Hee Suh6, Ju Yang Jung6, Chang-Nam Son7, Seung Cheol Shim8,
Sang-Hoon Lee9, Seung-Geun Lee10, Yeon-Ah Lee11, Eun Young Lee12, Tae-Hwan Kim13*, Yong-Gil Kim14*, and for the members of Korean Society of Spondyloarthritis Research
1Department of Internal Medicine, Yonsei University College of Medicine. Division of Rheumatology, Gangnam Severance Hospital, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, 3Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu,
4Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, 5Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, 6Division of Rheumatology, Department of Internal Medicine, Ajou
University Hospital, Suwon, 7Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, 8Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, 9Department of
Rheumatology, Center of Arthritis and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, 10Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, 11Division of Rheumatology, Department of Internal Medicine,
Kyung Hee University Medical center, Seoul, 12Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 13Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 14Division of Rheumatology,
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Backgrounds: Patients who develop an active tuberculosis infection during tumor necrosis factor (TNF) inhibitor
treatment typically discontinue TNF inhibitor and receive standard anti-tuberculosis treatment. However, there is cur-
rently insufficient information on patient outcomes following resumption of TNF inhibitor treatment during ongoing an-
ti- tuberculosis treatment. Our study designed to investigate the safety of resuming TNF inhibitors in ankylosing spondy-
litis (AS) patients who developed tuberculosis as a complication of the use of TNF inhibitors.
Methods: Through the nationwide registry of the Korean Society of Spondyloarthritis Research, 3929 AS patients who
were prescribed TNF inhibitors were recruited between June 2003 and June 2014 at fourteen referral hospitals. Clinical
information was analyzed about the patients who experienced tuberculosis after exposure to TNF inhibitors. The clinical
features of resumers and non-resumers of TNF inhibitors were compared and the outcomes of tuberculosis were sur-
veyed individually.
Findings: Fifty-six AS patients were treated for tuberculosis associated with TNF inhibitors. Among them, 23 patients
resumed TNF inhibitors and these patients were found to be exposed to TNF inhibitors for a longer period of time and
experienced more frequent disease flare up after discontinuation of TNF inhibitors compared with those who did not
resume. Fifteen patients resumed TNF inhibitors during anti-tuberculosis treatment (early resumers) and 8 after com-
pletion of anti-tuberculosis treatment (late resumers). Median time to resuming TNF inhibitor from tuberculosis was 3.3
and 9.0 months in the early and late resumers, respectively. Tuberculosis was treated successfully in all resumers and did
not relapse in any of them during follow-up (median 33.8 (IQR; 20.8-66.7) months).
Conclusions: Instances of tuberculosis were treated successfully in our AS patients, even when given concomitantly
with TNF inhibitors. We suggest that early resuming TNF inhibitors in AS patients could be safe under effective coverage
of the tuberculosis.
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S147
Low Dose Etanercept Treatment for Maintenance of Clinical Remission in Ankylosing Spondylitis
박준원
서울대학교 의과대학
Objective: To investigate the efficacy and safety of low-dose etanercept treatment after clinical remission of ankylosing
spondylitis (AS) in the real world.
Methods: Data on 134 AS patients who were treated with etanercept for more than 12 months and achieved clinical
remission (BASDAI<4 and CRP<0.5 mg/dL) were extracted from a large single center registry. Drug survival and in-
cidence of adverse events in 100 patients who reduced the dose during follow up (low-dose group) were compared with
34 patients who maintained the initial dose (standard-dose group). For minimization of selection bias between the two
groups, the same analyses were performed in a propensity score-matched population.
Results: Both groups showed similar BASDAI score and CRP levels during the follow-up. Drug survivals between the
two groups were also comparable up to 4 years (vs. standard-dose group, adjusted HR=0.472, 95% CI 0.155-1.435). The
same analysis performed after propensity score-matching showed concordant result. The incidence of injection site re-
actions in the low-dose group was significantly lower, and the incidence of other adverse events showed no differences
between the two groups. In the low-dose group, dose reduction after more than 24 weeks of standard-dose treatment was
associated with longer drug survival (adjusted HR=0.261, 95% CI 0.084-0.809).
Conclusion: Low-dose etanercept treatment after achieving clinical remission can be an alternative treatment option
in terms of its comparable long-term efficacy and favorable safety in AS. More than 24 weeks of standard-dose treatment
before dose reduction may be beneficial for longer drug survival in this strategy.
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Research Society Session on Spondyloarthritis
2부 - 강직성 척추염 NEWs and Updates
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S151
Clinical Update on Spondyloarthritis
이연아
경희대학교 의과대학 류마티스내과
이연아: Clinical Update on Spondyloarthritis
S152 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이연아: Clinical Update on Spondyloarthritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S153
이연아: Clinical Update on Spondyloarthritis
S154 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이연아: Clinical Update on Spondyloarthritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S155
이연아: Clinical Update on Spondyloarthritis
S156 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이연아: Clinical Update on Spondyloarthritis
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S157
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S158
척추관절염 Update: Basic and Translational Research
이상훈
강동경희대병원 류마티스내과
이상훈: 척추관절염 Update: Basic and Translational Research
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S159
이상훈: 척추관절염 Update: Basic and Translational Research
S160 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
이상훈: 척추관절염 Update: Basic and Translational Research
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016 S161
이상훈: 척추관절염 Update: Basic and Translational Research
S162 Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Systemic Lupus
Erythematosus Clinical Aspects
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S165
Effects of Risk Factors for Metabolic Syndrome and the Components of Metabolic Syndrome on the Quality of Life of Patients with Systemic Lupus Erythematosus:
A Structural Equation Modeling Approach
Jeong-Won Lee, Ji-Hyoun Kang, Yi-Rang Yim, Ji-Eun Kim, Kyung-Eun Lee, Lihui Wen, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee
Devision of rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
Objectives: This study assessed 1) relationships among risk factors for metabolic syndrome (MS), components of MS,
and health related quality of life (HRQOL), and 2) the effects of these variables on HRQOL in a hypothesized causal mod-
el using structural equation modeling (SEM) in Korean patients with systemic lupus erythematosus (SLE).
Methods: Of the 505 patients with SLE enrolled in the Korean Lupus Network (KORNET registry), we investigated
244 patients with sufficient data to assess the components of metabolic syndrome at the time of cohort entry. We eval-
uated the education, income, corticosteroid dose, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI),
Physicians Global Assessment (PGA), depression, components of metabolic syndrome, and HRQOL at the time of cohort
entry. SEM was used to test the structural relationships of the model using AMOS software ver. 23.
Results: The 244 patients had an average age of 40.7±11.8 years and included 228 (93.4%) women. The SEM results
supported the good fit of the model (χ2=71.629, df=56, p=0.078, RMSEA 0.034, CFI 0.972). The final model showed
that higher education and income had a direct negative effect on MS and higher disease activity had a positive indirect
effect on MS as mediated by the corticosteroid dose. Higher education and income had indirect effects on HRQOL, and
higher disease activity had a direct negative effect on HRQOL. MS had no direct impact on HRQOL, but an indirect neg-
ative impact on HRQOL as mediated by depression.
Conclusion: In our causal model, risk factors for MS were related to MS, directly and indirectly. MS had a negative in-
direct impact on HRQOL as mediated by depression. Therefore, clinicians should consider socioeconomic status, medi-
cation, and depression and try to modify the disease activity and metabolic syndrome, to improve the HRQOL of SLE
patients.
O-21-10
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S166
Factors Related to Blood Hydroxychloroquine Concentration in Patients with Systemic Lupus Erythematosus
Ji Yeon Lee, Seung Ki Kwok, Ji Hyeon Ju, Kyung Su Park, Sung-Hwan Park
Division of Rheumatology, Department of Medicine, Catholic University of Korea, Seoul St.Mary’s Hospital, Seoul, Korea
Objective: To identify factors associated with blood concentrations of hydroxychloroquine (HCQ) and its major metab-
olite, N-desethylhydroxychloroquine (DHCQ), in patients with systemic lupus erythematosus (SLE) receiving
long-term oral HCQ treatment.
Methods: SLE patients who had been taking HCQ for more than 3 months were recruited. Various clinical character-
istics, laboratory values, and SLE disease activity index (SLEDAI) scores were examined. The concentration of HCQ and
DHCQ ([HCQ] and [DHCQ]) was measured by liquid chromatography-mass spectrometry, and the relationship be-
tween [HCQ], [DHCQ], and the ratio of the two to various factors was investigated.
Results: In total, 189 SLE patients on long-term HCQ treatment were included in the analysis. The mean [HCQ] was
589.3±360.7 ng/ml, the mean [DHCQ] was 460.5±299.9 ng/ml, and the value for [HCQ]/[DHCQ] was 1.45±0.7.
[HCQ] was closely associated with [DHCQ] (r=0.88, p<0.0001). The weight-adjusted oral HCQ dose was strongly asso-
ciated with both [HCQ] (p<0.001) and [DHCQ] (p<0.001). Unadjusted and adjusted models revealed no significant as-
sociation between renal function and [HCQ] or [DHCQ]. Additional use of immunosuppressants increased [DHCQ] af-
ter adjusting for possible confounders (p=0.04). The prednisolone dose was associated with a higher [HCQ]/[DHCQ]
value (p=0.02-0.03), and the lower SLEDAI score was significantly related to higher [HCQ] after adjusting for con-
founders (p=0.002-0.008).
Conclusion: Various factors affect [HCQ], [DHCQ], or the [HCQ]/[DHCQ] value in the blood of SLE patients on
long-term oral HCQ treatment. Notably, a higher [HCQ] was associated with a lower SLEDAI score, even when [HCQ]
was less than 1,000 ng/ml.
O-21-11
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S167
Factors Influencing on Health-Related Quality of Life in Korean Patients with Systemic Lupus Erythematosus
Su-Jin Moon1, Kwi Young Kang1, Seung-Ki Kwok1, Ji Hyeon Ju1, Wan-Uk Kim1, Yeon-Sik Hong1, Sung-Hwan Park1, Chan Hong Jeon2, Sang Tae Choi3, Jung-Soo Song3, Jun-Ki Min1
1Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 3Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
Background: Health-related quality of life (HRQoL) among SLE patients is reduced, because SLE can significantly im-
pact both physiological and psychological functioning. With the advent of new treatment and better understanding of the
disease, survival has improved in recent decades. However, this has not translated into improvement in HRQoL. To im-
prove the HRQoL in SLE patients, it might be the clinically important and constructive theme to investigate that which
is the most important factor among the fibomyalgia, depression, sleep quality, SLE activity and SLE duration.
Objectives: To evaluate the contributing factors for reduced HRQoL for reduced HRQoL in Korean female patients with
SLE.
Methods: Subjects were selected from the five affiliated hospitals in South Korea. This prospective study included 152
Korean female patients with SLE and 139 age, and sex-matched healthy controls.
Results: SLE patients fared significantly worse than age matched controls. Forty-one patients with SLE had
fibromyalgia. The education level was lower in FMS group (p value<0.05). The overall quality of life was lower in patients
that had FMS. Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). Global PSQI was also higher,
indicating the poorer sleep quality in SLE patients with FMS, as compared with those without FMS. SLE disease activity
as assessed by SELENA-SLEDAI score was significantly higher in FMS group, whereas SLICC-ACR damage index did not
differ between the two groups. SLE disease duration and mean steroid dose did not show statistical significance between
the two groups. In SLE patients without FMS, fatigue severity and poor perceived sleep quality negatively influence qual-
ity of life in patients with SLE. In SLE patients with FMS, fatigue severity and SLE disease damage index independently
influence the decreased quality of life.
Conclusion: The poorer quality of life in SLE patients can be improved by fatigue manage and improving sleep quality.
O-21-12
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S168
Corticosteroids Dose After 6 Months of Induction Therapy is Associated with Non-Renal Organ Damage in Patients with Lupus Nephritis
Chan-Bum Choi1, Young Bin Joo1, Soyoung Won2, Sang-Cheol Bae1
1Hanyang University Hospital for Rheumatic Diseases, 2Clinical Research Center for Rheumatoid Arthritis, Seoul, Korea
Background: Lupus nephritis (LN) is one of the most common and serious organ involvement and long-term cortico-
steroids, especially at high doses, used for its treatment can cause organ damage. Failure to taper can cause increase in
damage either by high disease activity preventing the taper or the corticosteroids itself.
Objectives: We investigated the relationship between the corticosteroids dose after 6 months of induction therapy and
organ damage.
Methods: Corticosteroids dose at 6 months after induction were assessed in patients with LN. Patients who tapered
the corticosteroids to ≤10 mg/d and those who failed to taper to 10 mg/d were compared on demographic characteristics
and SLE-related characteristics..
Results: A total of 166 patients, including 66 patients with corticosteroids dose tapered to ≤10 mg/d at 6 months after
induction and 100 patients who failed to taper to 10mg/d were analyzed. There were no significant differences in baseline
demographic and SLE-related characteristics. Patients who failed to taper corticosteroids to 10 mg/d after 6 months of
induction therapy were on higher doses of corticosteroids, had higher proportion of patients with SDI ≥1, and higher
cumulative SDI score. Patients who failed to taper were more likely to have both renal and non-renal organ damage (renal
damage OR 2.38, 95% CI 1.16-4.85; non-renal damage OR 16.0, 95% CI 1.99-128.1). In multivariate regression analysis
adjusted for age, sex, disease duration, AMS, and induction treatment regimen, corticosteroids dose of >10 mg at 6
months of induction therapy was associated with non-renal damage (OR 112.15, 95% CI 4.04-99.9), but not with renal
damage (OR 2.13, 95% CI 0.95-4.77).
Conclusion: Failing to taper corticosteroids to ≤10 mg at 6 months of induction therapy is associated with non-renal
organ damage in patients with lupus nephritis.
O-21-13
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S169
Improved Survival of Systemic Lupus Erythematosus Patients with Rituximab Treatment
Na Ri Kim, Jung Su Eun, Jong Wan Kang, Eon Jeong Nam, Young Mo Kang*
Division of Rheumatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations in
multiple organ systems. Although two recent randomized controlled trials of rituximab in SLE showed no significant
beneficial effects, rituximab has proven optimistic results in several open label trials.
Objectives: We report a retrospective study to evaluate the efficacy of rituximab in the treatment of moder-
ately-to-severely active SLE.
Methods: We enrolled 46 SLE patients treated with immunosuppressive regimen including rituximab. The control
group consisted of 46 SLE Disease Activity Index (SLEDAI)-matched patients who had not received rituximab treatment.
Clinical and laboratory measures of disease activity, immunosuppressive regimen, infection and survival rates were
assessed.
Results: Baseline disease activity and organ involvement were similar in the rituximab and control groups with mean
SLEDAI score of 23.8 and 23.0, respectively at baseline and 3.2 and 4.5, respectively at 36 months of follow-up. Although
the infection rates were lower in the rituximab group (50.0% vs. 82.2% in control group, P=0.002), a significant differ-
ence was not observed in severe infection rates (50.0% vs. 67.4%, P=0.138). Steroid sparing effect was shown in ritux-
imab group (P=0.007). The survival rates were significantly higher in the rituximab group compared with control group
(91.3% vs. 72.7%, P=0.028).
Conclusion: Rituximab have superior efficacy in reducing steroid dosage and improving mortality in moderate to se-
vere SLE patients compared with immunosuppressive regimen without rituximab. A prospective study evaluating the
outcome of rituximab treatment in moderately-to-severely active SLE is warranted.
O-21-14
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Free Paper Session: Osteoporosis, Gout,
Cytokines
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S173
Glucocorticoid Acts Differently on Vertebral and Hip Fractures in Korean RA Patients Using
National Healthcare Claims Database
Dam Kim1,2, Soo-Kyung Cho1,2, Byeongju Park3, Eun Jin Jang4, Sang-Cheol Bae1,2, Yoon-Kyoung Sung1,2
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, 3Department of Statistics, Kyungpook National University, Daegu,
4Department of Information Statistics, Andong National University, Andong, Korea
Background: Fracture in rheumatoid arthritis (RA) patient is more frequent than general population. One of the im-
portant reasons is use of glucocorticoid (GC) for treatment of RA.
Objectives: In this study, we aimed to identify the effect of GC on fracture of different site.
Methods: Among RA patients ≥19 years, we established a retrospective cohort using Korean national healthcare
claims database from Jan 2010 to Dec 2010, and then followed up until Dec 2013. RA patients who experienced fracture
in year 2009 were excluded. Fractures were identified on the basis of selected ICD-10 codes and information about clinic
visit until last visit. Information about oral GC use was collected until incidence of fracture or last visit. In multivariable
logistic regression analysis, each of variables such as duration, mean dose, and highest daily dose of GC were adjusted
for age, gender, payer type, type of institution, physician’s specialities, comorbidities and medication.
Results: The 11,599 fractures in 9,964 RA patients were observed among total of 138,240 RA patients. The 68.19%
of patients used oral GC more than 3 months. Mean dose of GC was 6.1±4.7 mg and their highest daily dose was
16.20±15.8 mg. In adjusted analysis, duration of GC≥6 months (OR 1.36, p<0.01 for total fracture; OR 1.76, p<0.01
for vertebral fracture), mean dose of GC≥2.5 mg (OR 1.17-1.34, p<0.01 in total fracture; OR 1.37-1.71, p<0.01 in verte-
bral fracture) and highest daily dose of GC≥10 mg (OR 1.22-1.33, p<0.01 in total fracture; OR 1.23-1.75, p<0.03 in ver-
tebral fracture) increased the risk of total and vertebral fracture. However, in hip fracture, neither duration nor dose of
oral GC increased the risk.
Conclusion: Use of oral GC increased the risk of total and vertebral fracture, however, it did not increase the risk of
hip fracture in RA patients.
O-21-15
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S174
Ebselen is a Potential Anti-Osteoporosis Agent by Suppressing Receptor Activator of NF-κB Ligand-Induced
Osteoclast Differentiation and LPS-Induced Inflammatory Bone Destruction
Changhoon Lee1, Jong Min Baek2, Ju-Young Kim2, Jaemin Oh2, Myeung-Su Lee1
1Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital, 2Department of Anatomy, School of Medicine, Wonkwang University, Iksan, Korea
Ebselen is a non-toxic seleno-organic drug with anti-inflammatory and antioxidant properties.
We investigated the effects of ebselen on RANKL-induced differentiation of osteoclasts and their functions and the un-
derlying molecular mechanisms. Furthermore, we determined the effects of ebselen on LPS-induced bone erosion in
vivo.To generate osteoclasts from BMMs, we cultured BMMs for 4 days pretreated with ebselen. The cells were then
stained with rhodamine-conjugated phalloidin for F-actin ring labeling and DAPI solution to detect apoptotic body
formation. The change of F-actin ring on mature osteoclasts induced by ebselen was quantified by calculating the ratio
of actin ring positive (AR+) osteoclasts versus AR-. To detect the formation of apoptotic osteoclasts, we performed
TUNEL assay. ICR mice were divided into phosphate-buffered saline-treated (control) group, ebselen only-treated
group, LPS only-treated group, and LPSand ebselen-treated group. Micro-computed tomography data containing 3D im-
ages and bone parameters and histological data were acquired. Ebselen suppressed the formation of multinucleated cells
by regulating the ratio of RANKL/osteoprotegerin. Ebselen treatment in the early stage inhibited osteoclastogenesis by
decreasing the phosphorylation of IκB, PI3K, and Akt in early signaling pathways. Ebselen induced apoptosis of osteo-
clasts in the late stage.Ebselen treatment suppressed filamentous actin ring formation and bone resorption activity.
Administration of ebselen recovered bone loss and its μ-CT parameters in LPS-mediated mouse model. Histological
analysis confirmed that ebselen prevented trabecular bone matrix degradation and osteoclast formation in the bone
tissues. Finally, it was proved that the anti-osteoclastogenic action of ebselen is achieved through targeting N-meth-
yl-D-aspartate receptor.
O-21-16
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S175
p62 is Responsible for Interleukin-1β Production at the Early Phase through Mitochondrial Apoptosis
by Monosodium Urate Crystals
Seong-Kyu Kim, Jung-Yoon Choe, Ji Na Kim, Ji-Won Kim, Chan Uk Lee
Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center Catholic University of Daegu School of Medicine, Daegu, Korea
Objective: The aim of this study was to clarify the role of p62-dependent mitochondrial apoptosis in the initiation of
monosodium urate (MSU) crystal-induced inflammation in macrophages.
Methods: The induction of mitochondrial apoptosis in RAW 264.7 murine macrophages by MSU crystals was meas-
ured using western blotting and quantitative real-time polymerase chain reaction for Bax, caspase-3, caspase-9, or
PARP1, and by flow cytometric analysis. Immunoprecipitation and western blotting was applied to detect ubiquitination
of p62, TRAF6, and caspase-9. Mitochondrial apoptosis, reactive oxygen species (ROS) generation, and cell proliferation
were assessed in cells transfected with p62 siRNA.
Results: Treatment of RAW 264.7 cells with MSU crystals induced activation of Bax, caspase-3, caspase-9, and PARP1
at the early phase, in addition to enhancing IL-1β expression, but these findings were attenuated at the late phase. MSU
crystals induced ubiquitination of p62, followed by ubiquitination of TRAF6 and caspase-9, which were significantly re-
versed by ascorbic acid. RAW 264.7 cells transfected with p62 siRNA showed attenuated expression of Bax, caspase-3,
caspase-9, and PARP1, decreased ROS and IL-1β production, and increased cell proliferation, compared to controls. The
antioxidant ascorbic acid inhibited p62, caspase-9, and IL-1β expression increased by MSU crystals.
Conclusion: p62 may be a crucial mediator for the mitochondrial apoptosis pathway in MSU crystal-induced in-
flammation, which is linked to the acute inflammatory response during the early phase of gout.
O-21-17
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S176
SIRT-1 Regulates TGF-β Induced Dermal Fibroblast Migration Via Modulation of Cyr61 Expression
Eun-Jeong Kwon1, Eun-Jung Park2, Moonjae Cho3, Jinseok Kim1,2*1Department of Medicine, Jeju National University School of Medicine, 2Departmnet of Internal Medicine,
3Department of Biochemistry, Jeju National University School of Medicine, Jeju, Korea
Background: SIRT1 is a NAD-dependent protein deacetylase that participate in cellular regulation. A key feature for
activation of fibroblast is increased migration and uncontrolled activation of fibroblasts lead to produce pathologic con-
dition such as systemic sclerosis, kidney fibrosis and idiopathic pulmonary fibrosis. The role of SIRT1 in human dermal
fibroblasts (HDFs) migration remains unknown.
Objectives: The aim of this study was to establish the role of SIRT1 in HDFs migration and explore a target of SIRT1
for HDF migration.
Methods: Levels of SIRT1 expression were analysed in HDFs by RT-PCR and western blotting before and after stim-
ulation with TGF-β and resveratol (RSV). HDFs were transfected with active SIRT1 expression vectors or with siRNA
targeting SIRT1 or were treated with nicotinamide (NAM). Cyr61 expression analysis was performed by western blotting
to study the role of SIRT1 on cell migration. The wound healing assay was performed due to analyze migration of HDFs.
Results: SIRT1 and Cyr61 was expressed in HDFs and the stimulation of TGF-β further induced expression levels of
SIRT1 and Cyr61. Treatment of RSV, SIRT1 agonist or overexpression of SIRT1 also promoted expression of SIRT1 and
Cyr61 in HDFs, whereas inhibition of SIRT1 activity by NAM or knock down of SIRT1 down-regulated Cyr61 basal level
as well as TGF-β or RSV-induced Cyr61expression. Blocking of ERK signaling by PD98509 reduced TGF-β or RSV-in-
duced Cyr61 expression. SIRT-1-dependent β-catenin also modulated Cyr61 expression. RSV increased migration and
NAM attenuated RSV-induced migration of HDFs. Furthermore, SIRT1 overexpression promoted cell migration whereas
blocking Cyr61 attenuated SIRT1-stimulated migration of HDFs.
Conclusion: We suggested a role of SIRT1 in HDFs migration. SIRT1 increased cell migration by stimulated Cyr61 ex-
pression for their target through the ERK and β-catenin/Wnt signaling. SIRT1-induced Cyr61 production is important
for HDFs migration.
O-21-18
(2010. 1. 1∼2010. 12. 31)
The 36th Korean College of Rheumatology Annual Scientific Meeting and the 10th International Symposium
Poster Presentation
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S179
The Synovial Fluid Concentrations of Cold-inducible RNA-binding Protein are Correlated with Disease Activity in
Patients with Rheumatoid Arthritis
In Seol Yoo, Young Kim, Seong Wook Kang, Seung-Cheol Shim, Jinhyun Kim, Su-Jin Yoo, Sun Young Lee, Chan Keol Park
Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
Background: The cold-inducible RNA-binding protein (CIRP) is 18 kDa protein of the glycine-rich RNA binding pro-
tein (GRP) family, and is upregulated during mild hypothermia, UV exposure and hypoxia. In recent studies, extracellular
CIRP is a recently identified endogenous proinflammatory mediator and damage-associated molecular pattern molecules
(DAMP) that triggers inflammatory responses in sepsis and inflammatory bowel disease.
Objectives: This study was planned to investigate the relationship between CIRP and rheumatoid arthritis.
Methods: Peripheral blood and synovial fluid were collected from 15 patients with rheumatoid arthritis (RA) and 16
patients with osteoarthritis (OA). The concentration of CIRP was measured by sandwich ELISA.
Results: The concentration of serum CIRP was significantly elevated in RA patients group (RA patients=26.39±10.48
pg/ml, OA patients=17.14±7.24 pg/ml, p=0.009). Furthermore, the RA patients group showed significantly higher
CIRP concentration than the OA patients group in synovial fluid (153.56±108.93 pg/ml vs. 23.63±16.18 pg/ml,
p<0.001) (Fig. 1). The mean concentration of synovial fluid CIRP was significantly higher than that of serum in RA pa-
tients group (Serum concentration=26.39±10.48 pg/ml, Synovial fluid=153.56±108.93 pg/ml, p<0.001). Also, the
synovial concentration of CIRP was significantly increased in the treatment-naïve group (treatment-naïve group=
223.22±52.05, DMARDs treatment-experienced group=107.13±114.06, p=0.02) (Fig. 2). DAS28-ESR and DAS28-
CRP were positively correlated with synovial fluid concentration of CIRP (DAS28-ESR: r=0.582, p=0.023, DAS28-CRP:
r=0.541, p=0.037).
Conclusion: The serum and synovial concentration of CIRP in RA patients was increased compared to OA patients.
Also synovial concentration of CIRP in RA patients correlated well with the disease activity, i.e. the DAS28-ESR/CRP.
Based on these results, the CIRP mediates the inflammation and is potential marker for synovial inflammation.
Poster 1
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S180
A Role of Synovial Exosomes in Osteoclast Differentiation of Inflammatory Arthritis
Ji Eun Song1, Ji Hye Shin1, Ki Won Moon2, Se Hui Shon1, Ji Soo Park3, Eun Bong Lee3, Yeong Wook Song1,3, Eun Young Lee3*
1Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, 2Department of Internal Medicine, Kangwon National University Hospital, Chuncheon,
3Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Background: Exosomes are small membrane vesicles (40-150 nm) of endocytic origin secreted by many types of cells
and engage in cell-to-cell communication by transferring proteins, microRNAs, and lipid to recipient cells. Exosomes are
also identified in various biological fluids. Until now, the role of exosomes from synovial fluid (SF) on human osteoclasto-
genesis is unknown.
Objectives: We aimed to identify the characteristics of synovial exosomes and evaluate the effects on human
osteoclastogenesis.
Methods: Synovial exosomes were isolated from SF of rheumatoid arthritis (RA), osteoarthritis (OA), ankylosing
spondylitis (AS), and gout patients using ExoQuick. Monocytes were isolated from human peripheral blood mono-
nuclear cell and were differentiated into macrophages. Then, macrophages were incubated with synovial exosomes for
9-10 days. Osteoclast differentiation was evaluated by tartrate resistant acid phosphatase stain. Exosomes from RA
(n=11), OA (n=5), AS (n=6), and gout (n=6) patients were quantified by measuring acetylcholinesterase activity.
Results: We found that exosomes are abundant in SF of RA, AS, and gout patients compared to OA patients.
Interestingly, the number of exosomes from AS SF was significantly higher than exosomes from OA SF (p=0.0476).
Exosomes isolated from SF induced proliferation and osteoclast formation without macrophage colony-stimulating fac-
tor and receptor activator of nuclear factor kappa-B ligand. Noticeably, exosomes from RA SF had higher potential on os-
teoclast differentiation than other three diseases.
Conclusions: Our results suggest that exosomes from SF of various inflammatory diseases might have differential
functional roles in osteoclast differentiation and the number of exosomes may be associated with inflammatory
conditions.
Poster 2
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S181
The Relationship between the Articular Surface Projection and Radiologic Laxity of the Trapeziometacarpal Joint
Jeong Hwan Kim1, Hyun Sik Gong2, Jihyeung Kim2, Goo Hyun Baek2
1Department of Orthopedic Surgery, Seoul Medical Center, Seoul, 2Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
Background: Trapeziometacarpal joint (TMCJ) osteoarthritis is a common disorder related with the aging process, with
reported prevalence of 25% in postmenopausal women and 94~100% in women older than 80 years. And hypermobility
of the TMCJ is considered as one of the causes of TMCJ osteoarthritis.
Objectives: We aimed to determine whether the articular surface projection was associated with hypermobility of the
TMCJ.
Methods: We evaluated 108 women without TMCJ osteoarthritis or generalized ligament laxity which was defined by
the scores of ≥4 in the Beighton and Horan scale. We assessed the first metacarpal base articular slope and the trapezial
tilt in radiographs. And we assessed the radiologic laxity of TMCJ using the subluxation ratio in a TMCJ stress view. We
compared radiologic laxity of the TMCJ using subluxation ratio with regard to the metacarpal slope or the trapezial tilt.
Results: The mean trapezial tilt was 38 degrees and the mean metacarpal base articular slope was 82 degrees. And the
mean subluxation ratio was 0.27. After dividing the subjects into four subsets according to metacarpal slope, there was
a statistically significant difference in the mean subluxation ratio those in the upper and lower quartiles of the metacarpal
slope (0.24 vs 0.32, P=0.013). However, there was no difference in the subluxation ratio with regard to the trapezial tilt
(0.29 vs 0.24, P=0.189).
Conclusion: This study suggests that a steeper articular slope of the first metacarpal base could be associated with the
radiologic laxity of the TMCJ. Further longitudinal studies are necessary to determine whether this anatomic difference
represents a risk factor for later development of TMCJ osteoarthritis.
Poster 3
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S182
Impact of Myofascial Pain Syndrome on Pain and Functional Status in Patients with Hand Osteoarthritis
Young Sun Suh1, Yun-Hong Cheon2, Hyun-Ok Kim1, Rock-Bum Kim3, Ki Soo Park3, Hyung Bin Park4, Jae-Bum Na5, Sang-Il Lee2
1Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, 2Division of Rheumatology, Department of Internal Medicine, 3Preventive Medicine, 4Orthopedic Surgery, 5Radiology,
Gyeongsang National University School of Medicine, Jinju, Korea
Background: Various upper extremity musculoskeletal diseases (MSDs) can affect pain and disability in patients with
hand osteoarthritis (HOA). However, there was no previous study investigating the relationship between upper ex-
tremity MSDs and HOA.
Objectives: To explore the influence of major upper extremity MSDs on pain severity and functional status of patients
with HOA.
Methods: We enrolled 1150 inhabitants in Gyeongnam province in Korea from June 2013 to December 2015. Physical
examinations were performed by rheumatologists, orthopedists, and rehabilitation specialists. Grip powers of both
hands also were evaluated. Plain radiography, a nerve conduction velocity (NCV) examination, and magnetic resonance
imaging (MRI) of shoulders were performed. The Australian/Canadian Osteoarthritis Hand Index (AUSCAN) was used
to assess pain severity and functional status of hand joints. The diagnosis of HOA was made by the 1990 American
College of Rheumatology classification criteria. Carpal tunnel syndrome (CTS) was confirmed by NCV findings, and rota-
tor cuff tear (RCT) was diagnosed by MRI findings. Myofascial pain syndrome (MPS) was diagnosed by palpations of my-
ofascial trigger points.
Results: Of 1150 participants, 307 were diagnosed with HOA. Among HOA patients, 151 (49.7%), 192 (62.5%), and
249 (80.1%) patients had CTS, RCTs, and MPS, respectively. HOA patients with MPS showed significantly higher
AUSCAN scores (350.4±285.0 vs 200.4±201.8, p<0.001) and decreased grip power of a dominant hand (22.5±9.8 vs.
26.2±9.8, p=0.011) compared with HOA without MPS. Linear regression analysis also showed that MPS was associated
with AUSCAN scores after adjustment for age and gender (β=0.21, p=0.001). The existence of CTS or RCT did not in-
fluence on AUSCAN scores and grip power.
Conclusions: Therefore, management of coexisting MPS is the better way to improve pain and function of hand joints
in patients with HOA.
Poster 4
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S183
The Value of High-sensitivity C-reactive Protein in Hand and Knee Radiographic Osteoarthritis:
Data from the Dong-gu Study
Yi-Rang Yim, Lihui Wen, Ji-Hyoun Kang, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Dong-Jin Park, Tae-Jong Kim, Yong-Wook Park, Sun-Seog Kweon, Young-Hoon Lee, Yong-Woon Yun, Min-Ho Shin, Shin-Seok Lee
Department of Rheumatology, Chonnam National University Hospital & Medical School, Gwangju, Korea
Objective: We evaluated whether high-sensitivity C-reactive protein (hs-CRP) was related to various radiographic
findings in older adults with osteoarthritis (OA) because of the inconsistent association between hs-CRP and OA.
Methods: This cross-sectional study recruited 2,376 participants from the population-based Dong-gu cohort. The
scores of radiographic features in OA on x-rays of the knees and hands were computed using a semi-quantitative grading
system. The hs-CRP levels were measured using a particle-enhanced immunonephelometry assay. Correlations showing
the relationship between hs-CRP and OA were calculated using multiple linear correlation analysis.
Results: The hs-CRP levels were significantly higher in older subjects (p<0.001), those with a higher Body Mass Index
(BMI) (p<0.001), current smokers (p<0.001), current alcohol drinkers (p=0.014), those who engaged in less physical
activity (p=0.003), and those with a lower level of education (p=0.040). After adjusting for BMI and other confounders,
the total OA scores (knee, p=0.048; hand, p=0.010), erosion scores (knee, p=0.035; hand, p=0.031), and sclerosis
(knee, p=0.021; hand, p=0.029) in the knees and hands were all significantly positively correlated with hs-CRP. A sig-
nificant association was also observed between hs-CRP and the hand malalignment score (p=0.012).
Conclusions: In this large cross-sectional study, the hs-CRP level was a significant predictor of radiographic OA. Of the
types of OA radiographic damage, erosion, sclerosis, and malalignment showed significant associations with hs-CRP.
Poster 5
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S184
Leptin Protects Rat Articular Chondrocytes from TNF-α Cytotoxicity Induced by Cyclohexamide
Sang Yeob Lee, Sung Won Lee, Won Tae Chung
Department of Rheumatology, Division of Internal Medicine, Dong-A Uiversity
Objective: Although leptin appears to be an important local and systemic factor influencing cartilage homeostasis, the
role of leptin in chondrocyte death is largely unknown. Tumor necrosis factor a (TNF-a) is a pro-inflammatory cytokine
that plays a central role in the pathogenesis of articular diseases. This study examines whether leptin modulates
TNF-a-induced articular chondrocyte death.
Methods: Primary rat articular chondrocytes were isolated from knee joint cartilage slices. To induce cell death, the
chondrocytes were treated with TNF-a. To examine whether leptin modulates the extent of TNF-a-mediated chondrocyte
death, the cells were pretreated with leptin for 3 h before TNF-a treatment followed by viability analysis. To examine the
mechanism by which leptin modulates the extent of TNF-a-mediated chondrocyte death, we utilized mitochondrial
membrane potential (MMP) measurements, flow cytometry, nuclear morphology observation, co-immunoprecipitation,
western blot analysis and confocal microscopy.
Results: We demonstrated that leptin suppresses TNF-a induced chondrocyte death. We further found that apoptosis
partially contributes to TNF-a induced chondrocyte death while necroptosis primarily contributes to TNF-a induced
chondrocyte death. In addition, we observed that leptin exerts anti-TNF-a toxicity via c-jun N-terminal kinase (JNK) in
rat articular chondrocytes.
Conclusion: Based on our findings, we suggest that the leptin present in the articular joint fluid protects articular chon-
drocytes against cumulative mechanical load and detrimental stresses throughout a lifetime, delaying the onset of degen-
erative changes in chondrocytes. We can further hypothesize that leptin protects articular chondrocytes against destruc-
tive stimuli even in the joints of osteoarthritis (OA) patients.
Poster 6
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S185
Association-heterogeneity Mapping Identifies an Asian-specific Association of the GTF2I Locus
with Rheumatoid Arthritis
Kwangwoo Kim1, So-Young Bang1, Katsunori Ikari2,3, Dae Hyun Yoo1, Soo-Kyung Cho1, Chan-Bum Choi1, Yoon-Kyoung Sung1, Tae-Hwan Kim1, Jae-Bum Jun1, Young Mo Kang4, Chang-Hee Suh5, Seung-Cheol Shim6,
Shin-Seok Lee7, Jisoo Lee8, Won Tae Chung9, Seong-Kyu Kim10, Jung-Yoon Choe10, Shigeki Momohara2, Atsuo Taniguchi2, Hisashi Yamanaka2, Swapan K Nath11, Hye-Soon Lee1, Sang-Cheol Bae1
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, 2Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, 3Core Research for Evolutional Science and Technology (CREST), Japan Science and Technology Agency (JST), Tokyo, Japan, 4Division of Rheumatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, 5Department of Rheumatology, Ajou University School of Medicine, Suwon, 6Division of Rheumatology, Daejeon Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, 7Division of Rheumatology, Department of Internal Medicine, Chonnam National University
Medical School and Hospital, Gwangju, 8Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, 9Division of Rheumatology, Department of internal medicine, Dong-A University, Busan, 10Division of Rheumatology,
Department of Internal Medicine, Arthritis & Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea, 11Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
Background: Genetic association studies using multiple ancestral cohorts have revealed a large overlap of rheumatoid
arthritis (RA)-risk alleles among different ancestries, but there are some exceptional loci showing heterogenic associa-
tion among populations.
Objectives: Here we investigated genetic variants with distinct effects on the development of RA in Asian and
European populations.
Methods: Ancestry-related association heterogeneity was examined using the association data from large Korean
(n=9,299) and European (n=45,790) rheumatoid arthritis cohorts with Immunochip and genome-wide SNP array data.
Novel disease associations detected in Koreans were validated using two independent Asian cohorts (n=5,166) and a
meta-analysis.
Results: We identified significant heterogeneity between the two ancestries for the common variants in the GTF2I lo-
cus and showed that this heterogeneity is due to an Asian-specific association effect (PHeterogeneity=9.6×10-9 at rs73366469
[ORMeta=1.37 and PMeta=4.2×10-13 in Asians; ORMeta=1.00 and PMeta=1.00 in Europeans]) in RA. Trans-ancestral com-
parison and bioinfomatics analysis revealed a plausibly causal SNP (rs117026326; linked to rs73366469), whose minor
allele is common in Asians but rare in Europeans.
Conclusion. We identified the largest effect on Asian RA across human non-HLA regions at GTF2I by heterogeneity
mapping followed by replication studies, and pinpointed a possible causal variant.
Poster 7
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S186
Stauntonia Hexaphylla Extract Suppresses Expression of Pro-inflammatory Mediators, MMPs through Downregulating Akt, p38, JNK and NF-κB Activation in
Rheumatoid Arthritis Fibroblast-like Synoviocytes
Hyung Jung Yoo1,2, Jeong Yeon Kim1,2, Shin Eui Kang1,2, Ji Soo Park2, Eun Young Lee2, Eun Bong Lee2, Yeong Wook Song1,2
1Department of Molecular Medicine and Biopharmaceutical Science, Medical Research Center, Graduate School of Convergence Science and Technology and College of Medicine, Seoul National University, Seoul,
2Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Natural plants, including common vegetables and fruits, have been recognized as essential sources for drug discovery
and the development of new, safe, and economical medicaments. Stauntonia hexalphylla (Lardizabalaceae) is widely dis-
tributed in Korea, Japan and China, and is a popular herbal supplement in Korean and Chinese folk medicine owing to
its analgesic, sedative, and diuretic properties. However, the exact pharmacological effects of S. hexaphylla extract, partic-
ularly its effect on inflammation, are not known.
We investigated the suppressive effect of S. hexaphylla extract, YRA-1909 on lipopolysaccharide (LPS) - induced ex-
pression of pro-inflammatory mediators and the molecular mechanisms underlying these activity in rheumatoid arthritis
fibroblast-like synoviocytes (RA-FLS). YRA-1909 inhibited the production of pro-inflammatory cytokines, chemokines
and matrix metalloproteinases (MMPs) including tumor necrosis factor-α, interleukin-6 (IL-6), IL-17A, CXCL8,
CXCL10, MMP-1, 2, 3, 9 and 13 in RA-FLSs. Moreover, YRA-1909 suppressed LPS-induced nitric oxide reduced the ex-
pression of cyclooxygenase-2, as well as a reduction in MMP-2 gelatinolytic activity in RA-FLSs. YRA-1909 suppressed
LPS-induced phosphorylation Akt and mitogen-activated protein kinases (MAPKs), including JNK1/2, and p38
signaling. Furthermore, YRA-1909 inhibited LPS-induced nuclear factor kappa B (NF-κB) activation by reducing the
phosphorylation of p65 at Ser468 and Ser536. YRA-1909 also suppressed nucleus translocation of p65.
These observations suggest that S. hexaphylla might be useful for the development of new anti-inflammatory agents.
Poster 8
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S187
Hypoxia Induce Slug Expression Via JAK/STAT3 Pathway in Rheumatoid Arthritis Fibroblast-like Synoviocytes
Hyungjin Kim1, Hyemin Jeong1, Jaejoon Lee1, Hoon-Suk Cha1, Eun-Mi Koh1, Joong Kyong Ahn2
1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 2Department of Internal Medicine, Division of Rheumatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: Accumulating evidence implicates hypoxia in the pathogenesis of RA. The effect of hypoxia on the ex-
pression of Slug, a transcriptional repressor that impairs apoptosis of RA FLS, remains unknown.
Objectives: The aim of this study is to investigate the role of hypoxia in the expression of Slug in RA FLS and to delin-
eate the signaling pathway involved in the process.
Methods: After RA FLS were exposed to hypoxia, expression of HIF1-α and phosphorylation of ERK, JNK, and STAT3
were analyzed by Western blot. The experiment was repeated with RA FLS pretreated with WP1066, an inhibitor of the
JAK/STAT pathway. RT-PCR was performed to measure HIF-1α mRNA and Slug mRNA expressions in RA FLS under
hypoxia. RA FLS was transfected with HIF-1α cDNA to investigate the effect of overexpression of HIF-α on Slug
expression. Immunohistochemistry was used to assess the presence HIF-1α and Slug in RA synovial tissue. Microarray
analysis was performed to investigate the change in Slug gene expression when FLS were exposed to hypoxia. Finally, the
effect of TNF-α on Slug and HIF-1α expressions under normoxic conditions was assessed in RA FLS by Western blot.
Results: Hypoxia induced the expression of HIF-1α and phosphorylation of STAT3, but not JNK and ERK in RA FLS.
Pre-treatment of RA FLS with WP1066 inhibited the expression of p-STAT and HIF-1α under hypoxia. Hypoxic con-
ditions induced Slug mRNA expression, and overexpression of HIF-1α in RA FLS reproduced enhanced Slug expression.
Microarray analysis revealed a significantly up-regulated Slug expression. Immunohistochemical staining showed that
HIF-1 α and Slug were co-localized in the lining area of RA synovium. Stimulation of FLS with TNF-α alone without hy-
poxia resulted in increased expression of HIF-1α and Slug.
Conclusion: Our study demonstrates that HIF-1α expression from RA FLS induced by hypoxia or TNF-α alone is
mediated through JAK/STAT3 signaling pathway, which ultimately leads to the expression of Slug.
Poster 9
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S188
Pioneering Study about Expression of Programmed Death-1 (PD-1) with Its Ligands on Synoviocyte, Macrophage and
Lymhpocyte in Synovial Fluid of Rheumatoid Arthritis
Sang Yeob Lee1, Sung Won Lee1, Won Tae Chung1, Jae Ho Bae2
1Department of Rheumatology. Division of Internal Medicine. Dong-A Uiversity, Busan, 2Biochemistry, Pusan National University, Yong -San, Korea
Introduction: Programmed death 1 (PD-1) plays a key role in the negative regulation of the immune response and plays
a key role in the induction of immune tolerance in the cancer microenvironment. PD-1 ligand expressing cancer cells
evaded from PD-1 expressed antigen-specific T cells. In this study, we investigated the expression of PD-1 and PD-1 li-
gand on synoviocyte, macrophage and lymphocyte in RA synovial fluid.
Methods: Eight RA patients were enrolled. They were high disease activity {mean DAS (CRP)=3.8}. RA synoviocyte,
macrophage and monocyte cultured from the synovial fluid of the knee joint of each subject, were used for experiments.
Percentage of PD-1+ and PD-1 + ligand cells were measured by flow cytometry.
Results: PD-1 expression was significantly increased synoviocyte, macrophage and lymphocyte in RA (p=0.002 and
p<0.001, respectively) Similarly, PD-1 Ligand was also upregulated in synoviocyte, macrophage and lymphocyte in RA.
Conclusion: PD-1 and PD-1 ligand were expressed in RA synoviocytes, macrophage and monocyte. These dates sug-
gested that RA was very complex immune disease and the role of PD-1 and PD-1 ligands in PA were needed more
experiments.
Poster 10
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S189
The Jak-2 Mutation in Rheumatoid Arthritis Pathogenesis
Taskin Senturk1, Ikbal Akdam1, Irfan Yavasoglu2, Gohan Bozkurt3
Departments of 1Rheumatology, 2Hematology and 3Genetics, Adnan Menderes University, Aydin, Turkey
Background: The Janus kinases, Jaks, constitutively associate with the cytoplasmic region of cytokine receptors and
play an important role in a multitude of biological processes. The JAK2 gene provides instructions for making a protein
that promotes the growth and division (proliferation) of cells. This protein is an important intracellular mediator of cyto-
kine signaling by JAK/STAT pathway and mutations has been implicated in myeloproliferative diseases and leukemia.
Aberrant JAK activity is also associated with immune diseases such as rheumatoid arthritis (RA). We aim to investigate
relationship between Jak-2 V617F mutation and pathogenesis of rheumatoid arthritis.
Objective: To investigate Jak-2 V617F mutation in patients with RA.
Method: Diagnosed by 2010 ACR/EULAR classification criteria of 27 seropositive, 22 seronegative RA patients and
22 healthy controls were included in this study. Jak-2 V617F mutations studied Real-time quantitative PCR methods in
all groups. DNA was isolated from 200μL whole blood.
Results: In healthy controls, only one heterozygous Jak-2 V617F mutation detected (%0.04), but in all RA patients het-
erozygous or homozygous mutations not detected (%0.00).
Conclusion: We concluded that there was no relationship between RA and JAK-2 V617 mutation. The hematopoietin
family of cytokines, which includes several postulated to have roles in RA (e.g., interferons, IL-6, IL-2, IL-7, IL-12, IL-15)
bind to Type I and II cytokine receptors and signal through the janus kinase-signal transducers and activators of tran-
scription (Jak-STAT) pathway. Otherwise, JAK have been identified like as Jak1,Jak2, Tyk2, and Jak3. Accordingly, all gene
mutations of JAK should be investigated for pathogenesis of rheumatoid arthritis.
Poster 11
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S190
Identification of Differential Expressions of NOD-like Receptors and Their Signaling Pathway
in Rheumatoid FLS and Synovium
Ji-Yoen Moon1, Byung Wook Park2, Yong-Jin Kwon1, Hye Won Kim1, Min-Chan Park1
1Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 2Chadwick International School, Songdo, Incheon, Korea
Objectives: This study was performed to investigate the differential gene expressions and protein productions of nu-
cleotide oligomerization domain (NOD)-like receptors (NLRs) in RA and to identify their dominant signaling pathways.
Methods: Gene expressions and protein productions of proinflammatory NLRs, including NLRP1, NLRP3, NLRC1,
and NLRC2, and anti-inflammatory NLRs, including NLRP12, NLRX1, and NLRC3, were determined in FLS and syno-
vium from patients with RA or OA using real-time quantitative RT-PCR, immunohistochemistry and Western blot
analysis. The effects of their gene regulations on inflammatory gene expressions and caspase-1 were assessed using real
time PCR and on TRAF6, NF-κB, and IKK productions were analyzed using Western blot analysis after RNAi plasmid
or E.coli vector encoding NLRs treatments.
Results: Gene expressions and protein productions of NLRP1, NLRP3, NLRC1, NLRP12, and NLRC3 did not show any
differences between RA and OA samples. Expression and production of NLRC2 were increased, and those of NLRX1
were decreased in RA, compared to those from OA samples. Proinflammatory gene expressions of TNF-α, IL-1β, IL-6,
and COX-2 were increased in NLRC2 RNAi plasmid-transfected RA FLS, and transfection with E.coli vectors encoding
NLRX1 induced reductions in those levels. The expressions of caspase-1 were increased by NLRC2 RNAi plasmids treat-
ment and were decreased by adenoviral vectors encoding NLRX1. Regulations of NLRC2 and NLRX1 gene expression
did not alter TRAF6, NF-κB, and IKK levels.
Conclusion: We found that proinflammatory NLRC2 is increased and anti-inflammatory NLRX1 is decreased in RA
FLS and synovium and that their main action mechanisms are mediated by caspase-1, rather than NF-κB signaling
pathways. To our knowledge, this study is the first to show the presence and differential expressions of NLRs in RA syno-
vial tissues and can our data suggest that NLRs might be involved in pathogenesis of RA.
Poster 12
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S191
Histamine and Histamine H4 Receptor Promotes Osteoclastogenesis in Rheumatoid Arthritis
Hae-Rim Kim1, Kyung-Ann Lee1, Kyoung-Woon Kim2, Bo-Mi Kim1,2, Sang-Heon Lee1
1Department of Rheumatology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 2Concersant Research Consortium in Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Objective: The biological function of histamine is mediated through four types of histamine H1~H4 receptors.
Histamine H4 receptor (H4R) has immune-modulatory and chemotaxic effects and various immune cells express H4R.
This study aimed to determine the osteoclastogenic role of H4R in rheumatoid arthritis (RA).
Methods: The expression of H4R in RA synovial fluid mononuclear cells (SFMCs), synovial fibroblasts and peripheral
blood mononuclear cells (PBMCs) using real-time polymerase chain reaction (PCR). After RA SFMCs and PBMCs were
treated with histamine, Th17 cytokines, such as IL-17, IL-21 and IL-22, and H4R antagonist (JNJ7777120), the gene ex-
pression and protein production of H4R and RANKL were determined by real-time PCR and ELISA. Osteoclastogenesis
was assessed by counting tartrate-resistant acid phosphatase-positive multinucleated cells in peripheral blood CD14+
monocytes cultured with histamine, Th17 cytokines and JNJ7777120.
Results: The synovial fluid and serum concentration of histamine was higher in RA, compared with osteoarthritis and
healthy controls, respectively. The expression of H4R was increased in RA PBMCs compared with healthy controls.
Histamine, IL-17, IL-21 and IL-22 stimulated the expression of H4R and RANKL in PBMCs and JNJ7777120 reduced the
histamine and Th17 cytokine-induced RANKL expression. Histamine and Th17 cytokines also induced the osteoclast dif-
ferentiation from peripheral blood monocytes and JNJ7777120 decreased the osteoclastogenesis.
Conclusion: H4R mediates RANKL expression and osteoclast differentiation induced by histamine and Th17
cytokines. The blockage of H4R could be a new therapeutic modality for prevention of bone destruction in RA.
Poster 13
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S192
Rheumatoid Arthritis is Associated with Low/mid Frequency Hearing Impairment: Results from the 2010-2012 Korean
National Health and Nutrition Examination Survey
Hyemin Jeong1, Young-Soo Chang2, Sun Young Baek3, Sun Woo Kim3, Yeong Hee Eun1, In Young Kim1, Jaejoon Lee1, Eun-Mi Koh1, Hoon-Suk Cha1
1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 2Department of otorhinolaryngology, The Armed Forces Daejeon Hospital, Daejeon, 3Biostatic and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
Introduction: To evaluate the association between rheumatoid arthritis (RA) and hearing impairment in the Korean
adult population.
Method: Audiometric and laboratory test data from the 2010-2012 Korean National Health and Nutrition Examination
Survey (KNHANES) were used for analysis. Logistic regression were performed to adjust various possible factors asso-
ciated with hearing impairment. We defined hearing impairment for 2 categories of frequency (low/mid, high): Low/mid
frequency, average of 0.5, 1.0, and 2.0 kHz and high frequency, average of 3.0, 4.0, and 6.0 kHz.
Results: A total of 15,598 subjects completed the audiometric tests. The overall weighted (n=32,898,665) prevalence
of RA was 1.5%. Subjects with RA were older and showed lower education level and demonstrated high prevalence of
hypertension, diabetes, and chronic kidney disease than subjects without RA. Frequency of hearing impairment was
higher in subjects with RA than subjects without RA in both Low/mid and high frequency (22.0 vs 7.8%, p<0.001 and
43.3 vs. 26.4%, p<0.001, respectively). In multivariable logistic analysis, RA (OR 1.54, 95% CI 1.07 to 2.22, p=0.021)
was independent risk factor for low/mid frequency hearing impairment along with age (OR 1.12, 95% CI 1.11 to1.13,
p<0.001), college graduation (OR 0.51, 95% CI 0.38 to 0.69, p<0.001), and occupational exposure (OR 1.46, 95% CI
1.19 to 1.81, p<0.001). In the analysis of high frequency hearing impairment, RA did not show any association with hear-
ing impairment.
Conclusion: This study first demonstrated that RA was associated with the low/mid frequency hearing impairment af-
ter adjustment with various known risk factors.
Poster 14
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S193
High Fat Mass Predicts the Persistence/Progression of Musculoskeletal Pain in Community Residents
Hyun-Ah Kim1, Seung Hun Lim2, Nam Han Cho3
1Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 2Department in Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
Objective: Previously we reported that fat mass, muscle mass, and fat/muscle mass ratio as well as body mass index
(BMI), and musculoskeletal (MS) pain was significantly correlated (JJ Yoo et al. AR, 2014). The objective of the present
study was to evaluate the influence of BMI, fat mass, muscle mass, and fat/muscle mass ratio on the persistence and pro-
gression of MS pain after 3 years in community residents.
Methods: In the Korean Health and Genome Study, 1325 participants completed pain questionnaire and underwent
dual x-ray absorptiometry calculating body composition in year 2007 and 2010. Widespread pain was defined as pain
above the waist, below the waist, on both sides of the body and in the axial region. Three other categories of pain in these
analyses were pain in two or more regions that did not meet the criteria for widespread pain, pain in one region, and no
pain. After 3 years of follow-up, subjects were categorized into non-progressor and persistence/progressor. Tests for a lin-
ear trend across categories of pain constellations were performed using Mantel-Haenszel chi-square tests for categorical
variables and the F-statistics from linear regression models for continuous variables.
Result: Among persistence/progressor, the proportion of females was significantly higher and the mean age was sig-
nificantly older. BMI, fat mass, and fat mass/muscle mass ratio was significantly higher among persistence/progressor.
After multivariate logistic regression analysis, female gender, obesity and self-reported hand and knee arthritis were sig-
nificantly associated with persistence/progression of MS pain. Fat mass and fat/muscle mass ratio was significantly cor-
related with persistence/progression of MS pain only among female. The prevalence of metabolic syndrome did not affect
persistence/progression of MS pain in either normal or high BMI group.
Conclusion: High Fat mass, and fat/muscle mass ratio predicts the persistence/progression of MS pain in female
subjects.
Poster 15
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S194
Biological Function Enriched Prediction of Severe Radiographic Progression in Rheumatoid Arthritis
Young Bin Joo1, Yul Kim2, Youngho Park3, Kwangwoo Kim3, Jeong Ah Ryu4, Seunghun Lee4, So-Young Bang3, Hye-Soon Lee3, Gwan-Su Yi2, Sang-Cheol Bae3
1Department of Rheumatology, St Vincent's Hospital, The Catholic University of Korea, 2Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, 3Department of Rheumatology,
Hanyang University Hospital for Rheumatic Diseases, 4Department of Radiology, Hanyang University Hospital
Background: Although radiographic damage in rheumatoid arthritis (RA) is highly heritable, genetic information is
still lack for prediction of radiographic damage. More reliable prediction could be established from biological function en-
riched analysis.
Objectives: To find out a biological relevant set of single nucleotide polymorphisms (SNPs) for prediction of radio-
graphic progression in RA patients using genome-wide association study (GWAS) combined with bioinformatics
analysis.
Methods: We obtained genome-wide SNP data for 374 RA patients using Illumina HumanOmni2.5Exome-8 arrays.
Significant SNPs for radiographic progression from GWAS were mapped on the functional genes and re-ranked in order
of higher RA correlation scores. Based on this post-GWAS analysis, an optimal set of SNPs for prediction of radiographic
progression was selected using support vector machine (SVM). Prediction accuracy of our model was compared with oth-
er models obtained by GWAS and SPOT, one of the post-GWAS analyses, using wilcoxon signed-rank test. Pathway en-
richment analysis was done using DAVID.
Results: A total, 36,091 significant SNPs with p-value<0.05 from GWAS were reprioritized using post-GWAS analysis.
In 10-fold cross-validation using SVM classifier, the best average accuracy was 0.6342 with 120 SNPs and increased to
0.7565 as combined with clinical information. As compared the prediction accuracy of our model with GWAS or SPOT,
0.7827 of AUC in our model was superior to those obtained by GWAS (AUC 0.5969, p-value 0.0019) and SPOT (AUC
0.6737, p-value 0.0371). Top-ranked 120 SNPs associated with radiographic progression in post-GWAS analysis were en-
riched in cytokine-cytokine receptor interaction, pathways in cancer, Jak-STAT signaling pathway, and chronic myeloid
leukemia (all FDR<0.05).
Conclusion: We identified an optimal set of SNPs to predict radiographic progression in patients with early RA, which
showed outstanding prediction accuracy than GWAS or other post-GWAS.
Poster 16
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S195
A Korean Multicenter Observational Study of Disease Activity Changes in BIologic versus Non-biologic Users with
Seropositive Rheumatoid Arthritis
Kichul Shin1, Sung Soo Kim2, Sang Heon Lee3, Seung Jae Hong4, Sung Jae Choi5, Jung yoon Choe6, Seung- Geun Lee7, Hoon-Suk Cha8, Eun Young Lee9, Sung-Hwan Park10, Jin Wuk Hur11, Sung Soo Na12,
Chang Hee Suh13, So Min Wook14, Seung Won Choi15, Dong Hyuk Sheen16, Won Park17, Shin-Seok Lee18, Myong Joo Hong19, Jin Seok Kim20, Jung Soo Song21, Hye Soon Lee22, Seong Ho Kim23, Dae-Hyun Yoo24
1Division of Rheumatology, SMG-SNU Boramae Medical Center, Division of Rheumatology, 2Gangreung Asan Hospital, 3Division of Rheumatology, Konkuk University Medical Center, 4Division of Rheumatology, KyungHee University Hospital, 5Division of Rheumatology, Korea University Ansan Hospital, 6Division of Rheumatology, Daegu Catholic University Medical Center, 7Division of Rheumatology, Pusan National University Hospital, 8Division of Rheumatology, Samsung Medical Center, 9Division of Rheumatology, Seoul National University Hospital, 10Division of Rheumatology, Catholic University of Korea, Seoul St. Mary's Hospital, 11Division of Rheumatology, Eulji Generall
Hospital, 12Division of Rheumatology, Soonchunghyang University Cheonan Hospital, 13Division of Rheumatology, Ajou University Hospital, 14Division of Rheumatology, Pusan National University Yangsan Hospital, 15Division of Rheumatology, Ulsan University Hospital, 16Division of Rheumatology, Deajun Eulji University Hospital, 17Division of Rheumatology, Inha University Hospital, 18Division of Rheumatology, Chonnam National University Hospital, 19Division of Rheumatology, Chonbuk National University Hospital, 20Division of Rheumatology, Jeju National
University Hospital, 21Division of Rheumatology, Chung-Ang University Hospital, 22Division of Rheumatology, Hanyang University Guri Hospital, 23Division of Rheumatology, Inje University Haeundae Paik Hospital, 24Division of Rheumatology, Hanyang University Hospital
Background: Biologic disease modifying anti-rheumatic drugs (DMARDs) have become an important arsenal for rheu-
matoid arthritis (RA) treatment. However, studies comparing outcomes of biologic (b) DMARD versus non-biologic
(nb) DMARD use in Korean RA patients are limited to date.
Objective: To follow the changes of the simplified disease activity index (SDAI) of seropositive RA patients in daily clin-
ical practice.
Methods: KOSDAI is a multicenter observational study that was launched in Jan 2012 in 24 secondary or tertiary cen-
ters nationwide. Seropositive patients who met the 2010 ACR/EULAR classification criteria for RA, and had ³ 3 tender
and ³ 2 swollen joints, and abnormal inflammatory markers were enrolled consecutively. Disease activity including SDAI,
laboratory findings and patient reported outcomes were obtained at baseline, 6 months, and 12 months. Serial SDAI
changes and the 2011 ACR/EULAR clinical remission rate at 12 months were assessed.
Results: Eight hundred and fifty patients participated in this study. The retention rate of DMARDs at 12 months was
82.3%. Mean SDAI score at baseline was higher in the bDMARD group than the nb DMARD group (32.08±12.98 vs
25.69±10.97, p<0.0001). The reduction of the SDAI score was significant (12 months-baseline) in both groups; mean
SDAI reduction -19.0 in the bDMARD group, -12.6 in the nbDMARD group. Patient’s global assessment, Korean HAQ
at 12 months also improved accordingly in both groups. Clinical remission rate in the bDMARD an nbDMARD group at
12 months were 15.4%, 14.6%, respectively. A multivariate logistic regression model showed that baseline KHAQ score
was the most notable factor determining remission in this study.
Conclusion: The KOSDAI study indicates that Korean Rheumatologists are succesfully treating RA patients with prop-
er selection of DMARDs. Attaining higher clinical remission rates is an essential, reachable objective in our daily practice.
Poster 17
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S196
Seropositivity and Its Impact on Radiographic Damage in Korean Rheumatoid Arthritis Patients Starting Biologics
Kichul Shin1, Seungjun Ha1, Inkyung Jung2, Hyoun-Ah Kim3, Shin-Seok Lee4
1Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, 2Department of Biostatistics, Yonsei University College of Medicine, 3Department of Rheumatology, Ajou University School of Medicine,
4Department of Rheumatology, Chonnam University Medical School
Background: High titers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACCP) are poor
prognostic factors for rheumatoid arthritis (RA) patients. Only few studies have investigated the clinical subtypes based
on seropositivity; double (RF/ACCP), RF or ACCP positive (+), double negative (-ve) (seronegative, SN) and its impact
on RA disease status.
Objective: To analyze the demographic and clinical data in active RA patients based on seropositivity.
Method: Patients were selected from the Korean College of Rheumatology Biologics Registry (KOBIO), a nationwide
inception cohort operating since 2013. Data regarding demographics, comorbidity, disease activity, medication, imaging
and laboratory tests were analyzed by a biostatistician (HS). After adjusting for gender, age, and disease duration, odd
ratio (OR, with 95% confidence interval [95% CI]) of RF, ACCP was calculated for predicting prevalent erosions at
baseline.
Results: Total 1198 RA patients who were to start a biologics was analyzed. Mean age was 57.2 years, and mean disease
duration was 8.3 years. Mean DAS28-CRP was 4.99, and erosion in hands or feet were found in 40.1% of patients.
ACCP+ was associated with prevalent erosions (OR 1.69 [95% CI 1.13-2.52] p=0.0096), better than RF+ (OR 1.03
p=0.83) but no superior than RF/ACCP (OR 2.19 [95% CI 1.19-4.01] p=0.012). Of note, ACCP+ only (RF-ve) was
strongly associated with presence of erosions (OR 4.93 [95% CI 2.29-10.61], p<0.0001) in our analysis. Other baseline
clinical characteristics were comparable between RF/ACCP, RF+, ACCP+, and the SN group at the time point of starting
biologics, yet C-reactive protein was significantly higher in the SN group.
Conclusion: Our data corroborate the significance of ACCP+ in predicting radiographic damage in active RA patients.
In particular, the subgroup of ACCP+/RF-ve active RA patients would need further attention to achieve early disease
control.
Poster 18
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S197
Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission
and Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee
Division of Rheumatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
Background & Object: Therapeutic goal of rheumatoid arthritis (RA) is to achieve disease remission. However, several
remission criteria have not always equated to the complete absence of true inflammation. Power Doppler
Ultrasonography (PDUS) has been demonstrated to detect subclinical synovitis. The aim of this study was to elucidate
the achievement rates of imaging remission and examine characteristics associated with achievement status among RA
patients in clinical remission.
Methods: This study was conducted in 46 RA patients who attained clinical remission, defined by DAS28-ESR re-
mission criteria. PDUS was performed in 16 joints and 2 tendons and graded on the basis of a dichotomous assessment
(presence/absence). Imaging remission was defined by absence of PD on US examination. The clinical and laboratory da-
ta of patients with imaging remission were compared with those of patients with only clinical remission.
Results: Twenty one patients (45.7%) with RA in clinical remission had PDUS-defined active synovitis. PD was de-
tected most frequently in right RC joint (n=12, 26.1%). Six patients complained of pain in other joints that were not in-
cluded in US assessments. All those joint were PDUS positive. PDUS negative patients had lower evaluator global assess-
ment score (P<0.001), and simplified disease activity index score, SDAI (P=0.005). They use less nonsteroidal anti-in-
flammatory drug (NSAID) (n=15 vs 19 patients, p=0.019). Overall, imaging remission was related with less tender and
swollen joint count, lower patient global assessment score, higher health assessment questionnaire (HAQ) score and
lower clinical disease activity score.
Conclusion: Achievement rate of imaging remission was 54.3% in RA patients with clinical remission. Patients who
were in imaging remission tend to have lower disease activity, lower pain score and less frequent use of NSAIDs, com-
pared to patients with only clinical remission.
Poster 19
Withdraw
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S198
Achievement of Imaging Remission among Patients with Rheumatoid Arthritis in Clinical Remission
and Their Characteristics
Ji-Young Choi, Seung-Jae Hong, Hyung-In Yang, Sang-Hoon Lee, Ran Song, Yeon-Ah Lee
Division of Rheumatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
Background & Object: Therapeutic goal of rheumatoid arthritis (RA) is to achieve disease remission. However, several
remission criteria have not always equated to the complete absence of true inflammation. Power Doppler
Ultrasonography (PDUS) has been demonstrated to detect subclinical synovitis. The aim of this study was to elucidate
the achievement rates of imaging remission and examine characteristics associated with achievement status among RA
patients in clinical remission.
Methods: This study was conducted in 46 RA patients who attained clinical remission, defined by DAS28-ESR re-
mission criteria. PDUS was performed in 16 joints and 2 tendons and graded on the basis of a dichotomous assessment
(presence/absence). Imaging remission was defined by absence of PD on US examination. The clinical and laboratory da-
ta of patients with imaging remission were compared with those of patients with only clinical remission.
Results: Twenty one patients (45.7%) with RA in clinical remission had PDUS-defined active synovitis. PD was de-
tected most frequently in right RC joint (n=12, 26.1%). Six patients complained of pain in other joints that were not in-
cluded in US assessments. All those joint were PDUS positive. PDUS negative patients had lower evaluator global assess-
ment score (P<0.001), and simplified disease activity index score, SDAI (P=0.005). They use less nonsteroidal anti-in-
flammatory drug (NSAID) (n=15 vs 19 patients, p=0.019). Overall, imaging remission was related with less tender and
swollen joint count, lower patient global assessment score, higher health assessment questionnaire (HAQ) score and
lower clinical disease activity score.
Conclusion: Achievement rate of imaging remission was 54.3% in RA patients with clinical remission. Patients who
were in imaging remission tend to have lower disease activity, lower pain score and less frequent use of NSAIDs, com-
pared to patients with only clinical remission.
Poster 20
Withdraw
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S199
Assessment of Liver Fibrosis Using Transient Elastography in Patients with Rheumatoid Arthritis
Exposed to Long Term Methotrexate
Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Ji Hyeon Ju, 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
Background: Methotrexate (MTX) has been recommended for the first line therapy of rheumatoid arthritis (RA), ei-
ther alone or in combination with other DMARDs such as leflunomide. Although MTX is thought to have long term safe-
ty, there is still controversy whether long term use of MTX and its cumulative dose causes liver fibrosis (LF) in RA
patients.
Objectives: This study was performed to assess the degree of LF among the RA patients treated with MTX by transient
elastography (TE), and to identify associated factors with LF in those patients.
Methods: We restrospectively reviewed the medical records of 160 patients with RA taking MTX over 3 years, and who
had LF examination using TE. LF was defined as liver stiffness value over 5.3 kPa. The duration, cumulative doses of med-
ications including MTX and leflunomide, and serologic markers related to LF were analyzed by comparing 2 groups with
and without LF.
Results: The mean disease duration of patients was 10.7±5.1 years, and the median liver stiffness value was 4.5±2.7
kPa. Twenty one (13.1%) patients showed LF while only 1 (0.01%) patient progressed to liver cirrhosis. The cumulative
dose of MTX and leflunomide showed no significant difference between 2 groups. A history of taking LFNM and con-
comitant medications did not affect to the development of LF. Patients with LF had higher glucose, aspirate amino-
transferase (AST), and alkaline phosphate (ALP) level with a tendency of longer treatment duration with MTX. The dura-
tion of MTX (odds ratio [OR] 1.245, P=0.011), serum glucose level (OR 6.089, P=0.022), and AST level (OR 1.054,
P=0.015) were related with LF in multivariate analysis.
Conclusion: Long term use of low dose MTX and combination of leflunomide in patients with RA were relatively safe
in terms of severe LF measured by TE. RA patients with risk factors such as impaired glucose tolerance should be more
carefully monitored for development of LF in long term use of MTX.
Poster 21
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S200
The Effect of TNF Blockers on Bone Mineral Density in Rheumatoid Arthritis Patients Receiving Bisphosphonate
Doo-Ho Lim1, Byeongzu Ghang2, Seokchan Hong2, Yong-Gil Kim2, Chang-Keun Lee2, Bin Yoo2
1Division of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 2Division of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background: Osteoporosis is more frequently observed in patients with rheumatoid arthritis (RA) than in general
population. Bisphosphonate (BP), which suppresses bone resorption by inhibiting osteoclast activation, has been most
commonly used for treatment of osteoporosis. Previous studies demonstrated that anti-TNF therapy has a beneficial ef-
fect on bone loss possibly through anti-inflammatory effects as well as its inhibitory effects on osteoclast activation.
However, there have been few studies assessing the role of TNF blocker for osteoporosis in RA patients under con-
comitant treatment with BP.
Objectives: We performed a retrospective longitudinal study to investigate the changes in bone loss in RA patients re-
ceived BP with or without TNF blockers.
Methods: One hundred and seven RA patients who were diagnosed with osteoporosis and treated with BP between
Jan. 2005 and Dec. 2013, were reviewed retrospectively. Bone mineral density (BMD) (g/cm2) of the lumbar spine, femur
neck, trochanter and total femur was measured by dual-energy X-ray absorptiometry. Last follow-up BMD was obtained
at 4.62±2.9 years after initial acquisition of BMD. The rate of change in the BMD was expressed as the annualized per-
centage change of BMD between initial measurement and subsequent measurement.
Results: Among RA patients receiving BP with (n=19) and without TNF blockers (n=88), 19 (100.0%) and 80
(90.9%) were women, respectively. The mean ages at initial BMD for these subjects were 67.4±10.3 years and 66.1±8.3
years, respectively (p=0.569). The annualized changes of BMD in femur neck was significantly different between RA pa-
tients receiving BP with or without TNF blockers (1.25±6.0 vs. -0.72±3.0 %/year, respectively [p=0.038]), while there
were no differences in other sites.
Conclusion: In RA patients with osteoporosis even receiving BP, TNF blockers might have additional benefit for bone
loss in femur neck, possibly lowering hip fracture.
Poster 22
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S201
A Rare Case of Branch Retinal Vein Occlusion Complicating Rheumatoid Arthritis
Mi-Hye Kwon1, Younghoon Lee2, Chung-Il Joung1
Departments of 1Internal Medicine, 2Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
Branch retinal vein occlusion (BRVO) is an ophthalmic disease that the distal retinal venous system is occluded by con-
ditions such as thrombosis. Patients with BRVO may be asymptomatic, or experience decreased vision depending on the
location, extent of lesion and complications such as macular edema or vitreous hemorrhage. Risk factors for developing
retinal vein occlusion (RVO) are HTN, DM, smoking, obesity, and hypercoagulable state. In rheumatic disorders,
Behçet’s disease, lupus, and antiphospholipid syndrome have been reported as complicated by retinal vessel diseases in-
cluding RVO. While, rheumatoid arthritis (RA) is hardly associated with RVO, rather more with keratoconjunctivitis sic-
ca, episcleritis or scleritis. We report a RA patient complicated by BRVO treated with intravitreal bevacizumab.
A 65-year-old woman presented with painful swelling of metatarsophalangeal joints for a few weeks and was diag-
nosed as having seropositive RA in May 2013. She was prescribed with methotrexate, then sulfasalazine was added for
increased activity of RA in Oct 2014, and celecoxib was intermittently prescribed for joint pain. RA disease activity had
been minimal thereafter, suddenly she developed decreased vision in the left eye and visited department of ophthalmol-
ogy and was diagnosed as BRVO in the supratemporal vein with hemorrhage (Fig. 1A) and macular edema (Fig. 1B).
Ophthalmologist performed intravitreal injection of bevacizumab, an off-label treatment for anti-VEGF. Her vision has
improved gradually and hemorrhage completely absorbed (Fig. 2A) although mild cystic macular edema sustained (Fig.
2B). We searched for known risk factors for BRVO in this patient but she did not have HTN, DM, obesity, smoking history,
hypercoagulable state, nor another rheumatic disease. We experienced a rare case of BRVO in a RA patient, and report
it here.
Fig. 1.
Fig. 2.
Poster 23
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S202
On Drug and Drug-Free Remission by Baseline Disease Duration: Abatacept Versus Methotrexate Comparison
in Patients with Early Rheumatoid Arthritis
Vivian P. Bykerk1, Gerd R. Burmester2, Bernard G. Combe3, Daniel E. Furst4, Tom W.J. Huizinga5, Dennis A. Wong6, Paul Emery7
1Department of Rheumatology, Weill Cornell Medical College-Cornell University, United States, 2Department of Rheumatology, Charité - University Medicine Berlin, 3Department of Rheumatology, Montpellier-Nimes University, France, 4Division of Rheumatology,
University of California Los Angeles, United States, 5Department of Rheumatology, Leiden University Medical Center, Netherlands, 6Bristol-Myers Squibb, United States, 7Department of Rheumatology, University of Leeds, United Kingdom
Background: Patients with RA and longer disease duration generally do not respond as well to treatment with
DMARDs as patients with a shorter disease duration. Earlier use of biologic (b) DMARDs can improve disease control.
Objectives: This AVERT trial post-hoc analysis examines outcomes in patients with varying degrees of early disease
duration in which the definition for disease duration is well defined across groups.
Methods: Patients with early active RA (persistent symptoms for ≤2 years and DAS28 [CRP] ≥3.2), and who were an-
ti-CCP2 positive, were randomized to SC abatacept (ABA) + MTX, SC ABA alone or MTX alone for 12 months. All RA
treatment was removed after 12 months in patients with DAS28<3.2. In this post hoc analysis, proportions of patients
achieving protocol-defined remission (DAS28<2.6) were assessed by ≤3 months', >3 to ≤6 months' or >6 months' dis-
ease duration (defined as the duration of persistent symptoms at baseline) and treatment group.
Results: Patients were randomized and treated with ABA+MTX (n=119) or MTX (n=116): 36 and 48 with ≤3
months'; 34 and 29 with >3 to ≤6 months'; 49 and 39 with >6 months' disease duration, respectively. No systematic dif-
ferences were seen in baseline demographics and clinical characteristics for patients grouped by disease duration.
Irrespective of baseline disease duration, a higher proportion of ABA+MTX-treated patients achieved Month 12 and sus-
tained (Month 18) remission, compared with MTX alone. A higher proportion of ABA+MTX-treated patients with dis-
ease duration ≤3 months maintained remission following all treatment withdrawal compared with longer disease dura-
tions and MTX alone. ABA+MTX-treated patients with ≤3 months' disease duration also had the fastest onset of re-
sponse (Fig. 1).
Conclusion: Disease duration of ≤3 months was associated with faster onset of clinical response and the ability to ach-
ieve higher rates of drug-free remission following treatment with ABA+MTX in AVERT.
Poster 24
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S203
Abatacept Plus Methotrexate Can Effectively and Safely Regain the Target of Remission Following
Re-treatment for Flares after Drug-Free Withdrawal in Patients with Early Rheumatoid Arthritis
Paul Emery1, Gerd R. Burmester2, Vivian P. Bykerk3, Bernard G. Combe4, Daniel E. Furst5, Michael Maldonado6, Thomas W. Huizinga7
1University of Leeds, United Kingdom, 2Charité - University Medicine Berlin, Germany, 3Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA, 4Department of Rheumatology, Service d’ Immuno-Rheumatologie,
Montpellier, France, 5Department of Medicine, University of California Los Angeles, Los Angeles, USA, 6Bristol-Myers Squibb, New Jersey, Princeton, USA, 7Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
Background: AVERT was a Phase IIIb, randomized, active controlled study to evaluate efficacy and safety of abata-
cept(ABA) over three treatment phases: treatment, following therapy withdrawal, and re-exposure.
Objective: Assess treatment outcomes during treatment withdrawal and re-exposure periods.
Methods: MTX-naïve, anti-CCP-positive pts with early RA (onset of symptoms ≤2 yrs) were initially randomized to
12 months of weekly SC ABA+MTX, ABA mono or MTX alone (treatment period). Pts with DAS28 (CRP)<3.2 at Month
12 then entered a 12 month withdrawal period with no treatment. All pts with protocol-defined flare after Month 15
could receive open-label ABA+MTX (re-exposure period) for 6 months.
Results: Most pts could not remain treatment-free after complete withdrawal, due to worsening disease activity
(172/225; 76.4%) during the 12 month withdrawal period. Of those who entered withdrawal, rates of pts maintaining
DAS28<2.6 free of drugs at 24 months were 14.0, 12.3 and 11.3% for ABA+MTX, ABA mono and MTX alone,
respectively. A total of 146 pts entered the re-exposure period and 140 completed. The mean (SD) DAS28 at re-exposure
period entry was 5.47 (1.27) and at the end of the re-exposure period was 2.43 (0.95). A total of 62% (78/126) of evalu-
able pts were in DAS28 remission on Day 169 of re-exposure period. Over the 12 months withdrawal period, the num-
bers(%) of serious AEs were 2 (2.4), 0 (0) and 5 (6.7), respectively. In the re-exposure period, no pts discontinued due
to AEs and no serious infections were reported (292.2 pt-yrs). The overall infection rates were 8.9 and 16 (incidence
rate/100 pt-yrs) in the withdrawal and re-exposure periods, respectively.
Conclusion: Re-treatment with ABA+MTX can effectively recapture prior remission following flare after complete
therapy withdrawal. There were fewer infection events in the combined withdrawal and re-exposure and only 1 serious
infection during withdrawal and treatment period, suggesting re-treatment is well tolerated.
Poster 25
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S204
Factors Associated with Hydroxychroloquine Retinal Toxicity
Ji-Won Kim1, Chan Uk Lee1, Ji-Na Kim1, Se Eun Kim2, Yun Young Kim2, Hwajeong Lee1, Sung-Hoon Park1, Seong-Kyu Kim1, Jung-Yoon Choe1
1Division of Rheumatology, Department of Internal Medicine, 2Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
Background: Hydroxychloroquine (HCQ) is widely used drug in autoimmune diseases, and is known to cause retinal
toxicity. Since several studies investigated risk factors for HCQ retinal toxicity, there were limited data in Korea.
Objective: This study was designed to investigate factors which increase the risk of HCQ retinal toxicity in Korean
patients.
Methods: Twenty-seven patients of rheumatoid arthritis or systemic lupus erythematosus, who were using or had used
HCQ, were enrolled in our study and sent to an ophthalmologist. Several tools including spectral domain optical coher-
ence tomography, fundus autofluorescence, and visual field test were used to screen retinal toxicity. Retrospective chart
review of all patients was done. Logistic regression analysis was performed to identify factors associated with HCQ reti-
nal toxicity.
Results: We identified 4 patients (14.8%) of HCQ retinal toxicity among 27 patients. Of the 4 patients with retinal tox-
icity, 2 patients had pericentral pattern of retinal toxicity and the other 2 patients had mixed pattern of retinal toxicity.
Total HCQ dose (odds ratio 1.40, 95% Cl 1.03-1.89 for Total HCQ dose in 100-g increments) and duration of HCQ use
(odds ratio 1.60, 95% Cl 1.05-2.43 for HCQ duration in 1-year increments) increased the risk of retinal toxicity.
Conclusion: HCQ retinal toxicity was associated with total HCQ dose and duration of HCQ use. In addition, further
investigation of other risk factors including genetic factor is needed.
Keywords: Hydroxychloroquine, Retina, Toxicity, Risk factors
Poster 26
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S205
Improvement of Morning Stiffness in Korean Rheumatoid Arthritis Patients after Treatment with
a New Modified-release form of Prednisone
Kichul Shin1, Sung-Soo Kim2, Sung Jae Choi3, Geun-Tae Kim4, Sang-Hyon Kim5, Myeong Soo Lee6, Jin-Wuk Hur7, Yun Sung Kim8, Young Il Seo9, Seong-Su Nah10, Hyun-Sook Kim10, Eun Young Lee11, Seung-Jae Hong12
1Division of Rheumatology, SMG-SNU Boramae Medical Center, 2Division of Rheumatology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 3Division of Rheumatology, Korea University College of Medicine, Korea University Ansan Hospital, 4Division of
Rheumatology, Kosin University College of Medicine, 5Division of Rheumatology, Keimyung University Dongsan Medical Center, 6Division of Rheumatology, Wonkwang University Hospital, 7Division of Rheumatology, Eulji University College of Medicine, 8Division of Rheumatology,
Chosun University College of Medicine, 9Division of Rheumatology, Hallym University College of Medicine, 10Division of Rheumatology, Soonchunhyang University College of Medicine, 11Division of Rheumatology, Department of Internal Medicine, Seoul National University
College of Medicine, 12Division of Rheumatology, Department of Internal Medicine, Kyunghee University College of Medicine
Background: The Circadian Administration of Prednisone in Rheumatoid Arthritis Study (CAPRA-1 and -2) provided
further insights that chronotherapy with modified-release prednisone (MR) can improve morning stiffness (MS) and
benefit patients with active rheumatoid arthritis (RA). Never has MS been the primary endpoint in a large-scale trial in
Korea.
Objective: To investigate changes in MS and safety after 12 weeks of MR in Korean RA patients.
Methods: The K-IMPROvE study was a 12 week single-arm, open-label, phase 4 study conducted in 13 centers
(ClinicalTrial.gov NCT02072200). Patients had 1) duration of MS ≥ 45 minutes and<6 hours, 2) DAS28-ESR ≥ 3.2 and
3) pain visual analog scale (VAS) ≥30/100 mm. Patients could switch from prednisolone to an equivalent dose of MR,
or start MR 10 mg daily at enrollment. Duration/severity of MS, pain VAS, Korean HAQ, EQ-5D, DAS28, and laboratory
tests were obtained. Primary endpoint was the % change in duration of MS (12 week-baseline) in the full analysis
population. A revised ‘Pre-screening’ of MS was adopted early after initiating the study.
Results: One hundred sixty-four patients were screened, and 145 patients were enrolled in this study. 46.7% of pa-
tients were on the 5 mg MR dosage on study completion. The mean changes of MS duration in all patients was -17%
(p<0.0995). Patients who undergone the pre-screening process resulted in -34% reduction of MS duration at 12 weeks
(n=85, p<0.002). Secondary endpoints including reduction of MS severity (-44%), pain VAS (-32%), DAS28 (-24%) and
improvement of HAQ (+18.5%), EQ-5D (+36%) were all statistically significant. Adverse events (AE) did not differ
from the known profile of low-dose oral corticosteroids.
Conclusion: This open-label study supports that MR can improve MS duration and severity, as well as other clinical
parameters in Korean RA patients. A standardized method for obtaining MS information (Korean) is warranted for future
studies.
Poster 27
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S206
Withdrawal of Nonsteroidal Anti-inflammatory Drugs in Rheumatoid Arthritis Patients with Low Disease Activity
Dong Jin Go1,2, Kichul Shin3, Han Joo Baek4, Seong Wook Kang5, Young Mo Kang6, Jae Bum Jun7, Yun Jong Lee8, Sung Hwan Park9, Yeong Wook Song1,2
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 2Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research
Institute, Seoul National University, Seoul, 3Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Borame Medical Center, Seoul, 4Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon,
5Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, 6Division of Rheumatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu,
7Division of Rheumatology, Department of Internal Medicine, Hanyang University, Hospital for Rheumatic Disease, Seoul, 8Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
9Division of Rheumatology, Department of Internal Medicine, Catholic University of Korea, Seoul St Mary’s Hospital, Seoul, Korea
Background: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving joint pain in rheuma-
toid arthritis (RA) patients, long-term use of NSAIDs can cause adverse effects.
Objectives: To examine the patient-reported outcome (PRO) and its associated clinical factors in RA patients with low
disease activity (LDA) after discontinuing NSAIDs.
Methods: This study was a 16-week, multi-center prospective open-label trial. RA patients who achieved LDA
(28-joint Disease Activity Score [DAS28]<3.2) who were on NSAIDs for more than a month discontinued the NSAIDs.
Acetaminphen (AAP) was used as the rescue medication. Changes of DAS28 and PRO including pain visual analogue
scale (pain-VAS) and Routine Assessment of Patient Index Data 3 (RAPID-3) score were assessed. NSAID was restarted
when patient’s pain was intolerable with AAP. The endpoint was to analyze the group of patients who continued to with-
draw NSAID. Patients were further classified to have “sustained effectiveness” who met the following: 1) pain-VAS ≤30
mm at week16 or increase less than 25% from baseline and 2) RAPID-3 score ≤6 at week16 or increase less than 25%
from baseline.
Results: A total of 109 RA patients with LDA were enrolled in the study. At the end of the study, 89 (84.8%) patients
had remained without restarting NSAID. In these patients, there was a difference in pain-VAS between baseline and week
16 (P=0.010). However, changes in RAPID-3 and DAS28 were insignificant (P=0.128 for RAPID-3 and P=0.638 for
DAS28) Moreover, 66 patients ended up to show sustained effectiveness without restarting NSAID. After adjustments
of covariables, we found out joint swelling was the detrimental factor in NSAID withdrawal (odd ratio [OR] 0.150, 95%
confidence interval [CI] 0.034-0.666, P=0.013) and sustained effectiveness (OR 0.312, 95% CI 0.101-0.964, P=0.043).
Conclusion: NSAIDs can be
attempted to discontinue in
RA patients with LDA, espe-
cially in patients without joint
swelling.
Poster 28
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S207
Varicella-zoster Virus Specific Cell-mediated Immunity is Decreased in Patients with
Rheumatoid Arthritis Receiving Varicella Vaccine
Jung-Hee Koh, Jennifer Lee, Seung-Ki Kwok, Ji Hyeon Ju, Wan-Uk Kim, Sung-Hwan Park
Division of Rheumatology, Department of Internal Medicine, St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
Backgrounds: Response to varicella vaccine in rheumatoid arthritis (RA) patients is thought to be impaired due to the
immunological alterations generated by the disease and disease modifying anti-rheumatic drugs (DMARDs).
Objective: To evaluate humoral and cellular immunity against the live attenuated varicella vaccine in the patients with
RA.
Methods: We performed a prospective study of the varicella vaccine in 38 RA patients without biologic DMARDs and
a comparison of 19 patients with OA who had not taken DMARDs and oral glucocorticoids. Peripheral blood mono-
nuclear cells were collected before receiving varicella vaccine and after 12 weeks of vaccination and then analyzed using
VZV-specific interferon gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay. The level of VZV IgG antibodies
was measured at the baseline and 12 weeks.
Results: No patients developed varicella zoster after vaccination during follow-up period (mean 13.8±2.5 months).
RA patients and controls in baseline and 12 weeks were similar in Levels of VZV IgG. However, RA patients showed less
baseline and follow-up Spot-forming cells (SFC) counts in the IFN-γ ELISPOT assay than controls did (2 and 11 in base-
line; P=0.046, 4.5 and 30 in 12 weeks; P=0.001, respectively). SFC counts increased from baseline after vaccination in
both RA patients and controls. The level of acute phase reactant and disease activity index 28 (DAS28) were similar in
baseline and 12 weeks after vaccination in patients with RA. Few participants reported mild adverse event (7%). Four pa-
tients with RA were experienced worsening of disease activity (median disease activity score 28 in 12 weeks, 3.2 [IQR,
2.9-3.6]).
Conclusions: Patients with RA significantly reduced VZV-specific cellular immunity, while humoral immunity is sim-
ilar after VZV vaccination. Although cellular immune response was not sufficient, vaccination seems to be effective in
the prevention of varicella zoster clinically, without major adverse event.
Poster 29
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S208
Body Mass Index Does Not Influence the Efficacy of Abatacept in Patients with RA Who are Biologic-DMARD Naïve:
6-Month Results from a Real-World, International, Prospective Study
Rieke Alten1, Hubert G Nüßlein2, Mauro Galeazzi3, Hanns-Martin Lorenz4, Xavier Mariette5, Alain Cantagrel6, Melanie Chartier7, Guillaume Desachy8, Coralie Poncet9, Christine Rauch10, Manuela Le Bars10
1Schlosspark-Klinik University Medicine, Berlin, 2University of Erlangen-Nuremberg, Nuremberg, 3University of Siena, Siena, Italy, 4University Hospital of Heidelberg, Heidelberg, Germany, 5Université Paris-Sud, Paris, France, 6Purpan Hospital, Toulouse,
7Chiltern International, Neuilly, 8Excelya, Biostatistician Group, Paris, 9Docs International, Nanterre, 10Bristol-Myers Squibb, France
Background: In RA, obesity may negatively affect clinical response to anti-TNFs. In contrast, real-world data show aba-
tacept (ABA) efficacy and retention are unaffected by BMI in patients(pts) with prior bDMARD failure.
Objective: 6 months treatment response was assessed, according to BMI, in bDMARD-naïve pts in the ACTION study.
Methods: ACTION is a 2-year, international, prospective, observational study evaluating retention and effectiveness
of IV ABA in RA pts. In this 6-month analysis of bDMARD-naïve pts, baseline characteristics and clinical response were
compared by BMI subgroup: underweight/normal (<25 kg/m2), overweight (25-<30 kg/m2) and obese (≥30 kg/m2).
Time to ABA discontinuation was estimated using Kaplan-Meier survival analysis and compared using log-rank tests.
Results: BMI was reported in 643/672(96%) pts of which 41%, 35%, 24%, were underweight/normal, overweight and
obese, respectively. Higher baseline BMI was associated with more active disease (mean [95% CI], DAS28-CRP, 4.6 [4.5,
4.7], 4.8 [4.7, 5.0] and 5.1 [4.9, 5.2] for BMI<25, 25-<30 and ≥30 kg/m2, respectively) and more women (74, 66 and
81%), more metabolic disorders (22, 29 and 46%), fewer RF positive (77, 68 and 67%) and anti-CCP positive (71, 63 and
63%) pts (for BMI<25, 25-<30 and ≥30 kg/m2, respectively). Overall retention rates at 6 months (K-M analysis) did not
differ across groups(84, 89 and 87%, for BMI<25, 25<30 and ≥30 kg/m2, respectively; log-rank p=0.290); no significant
differences between groups were observed in discontinuation rates due to safety (log-rank p=0.683) or efficacy (log-rank
p=0.516). After adjustment for baseline characteristics, BMI was still not a discontinuation risk factor (BMI<25 kg/m2;
HR [95% CI] 0.46 [0.22, 0.99] and 0.69 [0.34, 1.41] for BMI 25-<30 and ≥30 kg/m2, respectively; FIGURE).
Conclusion: Unlike anti-TNFs, high BMI does not impact ABA clinical response in bDMARD-naïve RA. These results
are similar to real-world results in pts with prior bDMARD failure.
Poster 30
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S209
Safety of Biologics in Patients with Rheumatoid Arthritis and Hepatitis C Virus Infection: A Multicenter Retrospective Study
Hyun Mi Kwon1†, Kichul Shin2, Shin-Seok Lee3, Won Tae Chung4, Jisoo Lee5, Sang-Heon Lee6, Seong-Wook Kang7, Chang Hee Suh8, Seung-Jae Hong9, Ran Song10, Jung-Yoon Choe11, Yeong Wook Song1
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 2Division of Rheumatology, SMG-SNU Boramae Medical Center, 3Chonnam National University Hospital, 4Dong-A University Hospital, 5Ewha Womans University Mokdong Hospital,
6Konkuk University Hospital, 7Chungnam National University Hospital, 8Ajou University Hospital, 9Kyung-Hee University Hospital, 10Kyung Hee University Hospital at Gangdong, 11Catholic University Hospital of Daegu
Background: The natural course or clinical outcome in Korean rheumatoid arthritis (RA) patients with hepatitis C vi-
rus (HCV) infection is poorly understood. Biologic disease modifying anti-rheumatic drugs (bDMARDs) are effective for
the treatment of RA, however concerns remain regarding the safety of bDMARDs in patients with concurrent HCV
infection.
Objective: To investigate the outcomes of HCV-infected Korean RA patients who were treated with bDMARDs
Methods: A multicenter retrospective observational study was conducted at 12 university hospitals between
November 2014 and November 2015. Seventy-eight patients who met the 2010 ACR/EULAR classification criteria for
RA, and with HCV infection were identified. Baseline and longitudinal data including HCV genotype, viral load, treat-
ment, extrahepatic manifestations were obtained. The safety profile and changes of liver fuction/viral RNA titer were
evaluated. HCV reactivation was defined as having both viral and biochemical breakthrough.
Results: Mean age (SD) of diagnosis of RA was 56.2 (11.2) years, mean disease duration was 7.8 (5.0) years, and 60
patients were female (76.9%). Seventeen (21.8%) patients were treated with bDMARDs; 2 infiliximab, 8 adalimumab,
8 etanercept, 2 tocilizumab, and 1 abatacept. The mean treatment duration of bDMARDs were 9.3 months for infliximab,
30.2 months for adalimumab, 29.2 months for etanercept, 13.4 for tocilizumab, 3.8 months for abatacept. At start-up,
conventional DMARD and anti-viral therapy was concomitantly used in 11 (64.7%), 1 (9.6%) patient(s), respectively.
During the study period, one patient experienced mild elevation of HCV RNA titer. However, there was no case of HCV
reactivation.
Conclusion: Our data suggests that RA patients with HCV infection can tolerate bDMARDs without increased risk of
HCV reactivation. This contrasts with other study results in bDMARD users infected with hepatitis B virus.
Poster 31
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S210
Baricitinib Versus Placebo or Adalimumab in Patients with Active Rheumatoid Arthritis and an Inadequate
Response to Background Methotrexate Therapy: Results of a Phase 3 Study
Jieon Won1, Peter C. Taylor2, Edward C. Keystone3, Désirée van der Heijde4, Yoshiya Tanaka5, Taeko Ishii6, Kahaku Emoto6, Lili Yang6, Vipin Arora6, Carol Gaich6, Terence Rooney6, Douglas Schlichting6, William L. Macias6, Stephanie de Bono6, Michael E. Weinblatt7
1Presenting on behalf of Eli Lilly and Company, Indianapolis, USA, 2Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK,
3The Rebecca MacDonald Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, 4Leiden University Medical Center, Leiden, The Netherlands, 5School of Medicine, University of Occupational & Environmental Health, Kitakyushu, Japan,
6Eli Lilly & Company, Indianapolis, USA, 7Brigham and Women’s Hospital, Boston, USA
Background: In phase 3 studies, baricitinib (bari) improved disease activity in patients (pts) with active rheumatoid
arthritis (RA) and an inadequate response to conventional synthetic or biologic disease-modifying antirheumatic drugs
(DMARDs).
Objective: The primary endpoint was ACR20 response at Wk 12 for bari vs placebo (PBO). Major secondary endpoints
included comparisons of bari vs adalimumab (ADA) for ACR20 and change in DAS28-CRP at Wk 12.
Methods: Pts with active RA despite stable background methotrexate (MTX) were randomized 3:3:2 to PBO, bari 4mg
once daily, or ADA 40 mg biweekly, stratified by region and baseline joint erosion status. Nonresponders were rescued
from Wk 16. At Wk 24, pts on PBO switched to bari.
Results: Of 1305 randomized pts, 89%, 94%, and 93% completed Wk 24 in PBO, bari, and ADA groups, respectively.
Rescue rates were 26%, 7%, and 12% for PBO, bari, and ADA, respectively. ACR20 response at Wk 12 was higher for bari
vs PBO (70% vs 40%, p≤.001). Compared to ADA, bari was superior with respect to measures including ACR20 re-
sponse and improvement in DAS28-CRP at Wk 12. Compared to PBO, daily diary measures of morning joint stiffness
duration and severity, worst tiredness, and worst joint pain were significantly improved in pts receiving bari from as early
as Wk 1. Rates of treatment-emergent adverse events, including infections, were higher for bari and ADA compared to
PBO. Compared to PBO, serious adverse event rates were similar for bari and lower for ADA; serious infection rates were
similar across groups. Two deaths occurred (bari):1 pneumonia and 1 duodenal ulcer hemorrhage. Five malignancies
were reported:2 bari and 3 PBO. There were no gastrointestinal perforations. Lab abnormalities were consistent with oth-
er phase 3 studies;few led to discontinuation.
Conclusion: Despite background MTX, once-daily bari was associated with significant clinical improvements com-
pared to PBO and ADA, with an acceptable safety and tolerability profile.
Poster 32
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S211
Evaluation of the Relationship between IL-10, IL-17, IL-23 Levels and Disease Activity of
Systemic Lupus Erythematosus and Vitamin D Metabolism
Taskin Senturk1, Beyza Cetin2, Gokhan Sargin1, Neriman Aydin3
Departments of 1Rheumatology, 2Internal Medicine and 3Clinical Microbiology, Adnan Menderes Universty, Aydin, Turkey
Background: SLE is a chronic, autoimmune, inflammatory disease and the prototype of multisystem autoimmune
diseases. Several cytokines such as interleukin (IL)-10, IL-17, IL-23, and vitamin D have been suspected in the patho-
genesis of SLE. However, the association between these cytokines, vitamin D and disease activity is unknown.
Objectives: We aimed to determine the association between IL-10, IL-17, IL-23, vitamin D and SLE disease activity in-
dex (SLEDAI) score.
Methods: We included 40 patients with SLE (mean age: 35.5±13.41 years, 95% female) and 20 healthy controls (mean
age: 36.1±14.76 years, 70% female) in the study. Clinical and laboratory parameters and, SLEDAI score were evaluated.
Serum IL-10, IL-17 and IL-23 were measured by nephelometry and vitamin D by HPLC (high-performance liquid chro-
matography). Mann-Whitney U and Kolmogorov-Smirnov test were used for statistical analysis. P<0.05 was accepted as
statistically significant.
Results: The level of vitamin D was significantly lower (p=0.003), and IL-23 was significantly higher (p=0.001) in SLE
patients compared to healthy controls. There was no significant difference for IL-10 and IL-17 between both group
(p>0.05). However, a significant correlation between vitamin D and disease duration (p=0.02), and between IL-23 and
vitamin D (p=0.019) were found among SLE patients. Vitamin D levels were correlated with SLEDAI score and IL-23 in
patients group.
Conclusions: Although there are studies suppporting the role of IL-10 and IL-17 in the pathogenesis of SLE in the liter-
ature, there was no significant difference between patients and healthy controls in our study. IL-23 levels were sig-
nificantly higher, whereas vitamin D levels were significantly lower in SLE patients than in the control group. Also vita-
min D levels were negative correlated with duration of disease and IL-23. Levels of IL-23 may be used to evaluated the
disease activity, or may be a promising therapeutic approach for SLE patients.
Poster 33
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S212
Comparison of the Clinical, Serological, and Prognostic Differences among Juvenile-, Adult-, and Late-onset Lupus
Nephritis in Korean Patients: A Case-control Study
Ji-Hyoun Kang, Dong-Jin Park, Yi-Rang Yim, Ji-Eun Kim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee*
The Division of Rheumatology, The Department of Internal Medicine and Chonnam National University Medical School, Gwangju, Korea
Objectives: SLE patients present with different clinical and serological manifestations according to the age at disease
onset. However, it is not known that the association between disease onset age and the clinical presentation of lupus
nephritis (LN). We investigated whether LN patients could be distinguished based on the time of disease onset and the
groups differed in their clinical, serologic features and prognosis in Korean patients.
Methods: We enrolled 117 SLE patients with available data at the time of renal biopsy for LN from the lupus cohort
at Chonnam National University Hospital. We divided the LN patients according to the age at LN diagnosis into three
groups [juvenile-onset LN (JLN), adult-onset LN (ALN), and late-onset LN (LLN)] and compared the baseline demo-
graphic, clinical, histologic, and laboratory findings. We also compared the treatment and long-term prognosis of LN.
Results: Of the 114 LN patients, 20 (17.5%), 84 (71.8%), and 13 (11.1%) had JLN, ALN, and LLN, respectively. LLN
patients were less educated than ALN and JLN patients (p<0.001). HTN and DM at the onset of LN were more common
in LLN patients than ALN or JLN patients (p<0.001 and 0.037). LLN patients had a higher WBC count and lower eGFR
than ALN or JLN patients (p<0.011 and 0.002). Histologically, LLN patients had more chronicity indices and a higher
chronic score. Anti-Ro antibodies were found less frequently in JLN (p=0.024) and lower complement levels were more
common in JLN and less common in LLN (p<0.011 and 0.002). During a mean follow-up of 76.5 months, the develop-
ment of chronic kidney disease and death from any cause were higher in LLN patients than in JLN and ALN patients
(p=0.028 and 0.038).
Conclusions: LLN patients had more chronicity at the time of renal biopsy, and more deterioration of kidney function
and death on long-term follow-up, than JLN and ALN patients. Therefore, LLN patients should be monitored and man-
aged carefully to avoid poor outcomes.
Poster 34
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S213
Body Mass Index, HDL Cholesterol, Taking NSAID, and Current Dose of Glucocorticoids Might Contribute
to Subclinical Atherosclerosis in SLE Patients with Low Disease Activity
Ju-Yang Jung, Hyun-Ah Kim, Chang-Hee Suh
Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
Background: Systemic lupus erythematosus (SLE) patients have increased risk of advanced atherosclerosis and car-
diovascular disease. While the mechanism is not completely understood, immunologic deterioration and traditional risk
factors such as overweight and dyslipidemia have been regarded to contribute.
Objectives: We tried to look for change of subclinical atherosclerosis in SLE patients and analyze the risk factors of
CVD and SLE-related characteristics with the variations.
Methods: We assessed carotid artery intima-media thickness (cIMT) and carotid artery plaque by Doppler ultra-
sonography among sixty-one female SLE patients who were enrolled in the study with subclinical atherosclerosis 4 years
ago.
Results: The mean cIMT of the patients was 0.39±0.09 mm and 11 patients had carotid plaques, which were not sig-
nificantly different with the previous study. Twenty one patients had the increased cIMT, and new carotid plaque was de-
veloped in 7 patients. The patients with increased cIMT had lower body mass index (BMI), longer disease duration, more
rarely took non-steroidal anti-inflammatory drugs (NSAID), and higher cumulative glucocorticoids dose compared with
those not. The patients with new carotid plaque development had lower high density lipoprotein (HDL) cholesterol and
higher doses of glucocorticoids. On multiple regression analysis, BMI (r=0.62, p=0.01), HDL cholesterol (r=0.94,
p=0.02), and taking NSAID (r=0.16, p=0.03) were related with cIMT increment, and current glucocorticoids dose
(r=1.14, p=0.04) were associated with plaque development.
Conclusion: The follow up study for SLE patients with low disease activity showed low BMI, low HDL cholesterol, and
not taking NSAID were associated with cIMT increment. Moreover, current glucocorticoids dose was associated with pla-
que development. Considered that mean BMI was lower than other studies, obesity paradox in cardiovascular disease risk
might support it.
Poster 35
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S214
Antiphospholipid Antibody Positivity and Related Clinical Characteristics in Korean Lupus Patients
Dam Kim1, Soo-Kyung Cho1, Kyung-Eun Lee2, Dong-Jin Park2, Shin-Seok Lee2, Yoon-Kyoung Sung1
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by recurrent throm-
bosis and/or pregnancy morbidities in the presence of antiphospholipid antibodies (aPL). Systemic lupus erythematosus
(SLE) is the most common cause of secondary APS, however, the information about APS in SLE patients is scarce.
Objectives: In this study, we aimed to identify the prevalence of aPL and related clinical characteristics in Korean SLE
patients.
Methods: Among 505 SLE patients from KORean lupus NETwork (KORNET), we selected 469 patients who under-
went aPL tests within 2 years of enrollment. They were classified into two groups: 1) aPL (+) group as patients with at
least one aPL which includes anticardiolipin antibody (aCL), anti-ß2 glycoprotein I (anti-ß2GPI) and lupus anticoagulant
(LAC), and 2) aPL (-) groups as patients without aPL. We compared the demographic and clinical characteristics between
two groups, and clinical symptoms of thrombosis and obstetric complications were compared according to patterns of
aPL.
Results: The prevalence of aPL was 25.4% and all 3 aPL were positive in 1.7% among Korean lupus patients. Although
age, sex and autoantibody profile such as ANA and anti-dsDNA antibody were not different between two groups, ever
smokers (19.3% vs. 8.6%, p<0.01) were more common in aPL (+) group and 37.8% of aPL (+) patients were using
aspirin. More patients in aPL (+) group underwent stroke than aPL (-) group (6.7% vs. 0.9%, <0.01), whereas no differ-
ent was found in history of ischemic heart disease or spontaneous abortion.
Conclusion: Twenty five percent of patients had aPL in Korean SLE patients. In addition, stroke was more common in
patients with aPL (+) SLE patients.
Poster 36
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S215
Lupus Nephritis is Associated with more Corticosteroid-associated Organ Damage but Less
Corticosteroid Non-associated Organ Damage
Young Bin Joo, MD, PhD1,2, Soyoung Won, PhD3, Chan-Bum Choi, MD, PhD1,3, Sang-Cheol Bae, MD, PhD1,3
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Department of Rheumatology, St Vincent's Hospital, The Catholic University of Korea, Suwon, 3Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
Background: Lupus nephritis (LN) has been suggested to be a predictor of organ damage accrual. Since patients with
LN are more exposed to immunosuppressive agents including corticosteroid, and also have high inflammatory burdens,
they might be more vulnerable to organ damage than patients without LN.
Objective: To investigate the association of LN on organ damage and mortality.
Methods: A total of 1,112 patients with systemic lupus erythematosus (SLE) were investigated. LN was defined as a
proteinuria as represented by the 1997 American college of rheumatology (ACR) criteria. Damage was assessed using
the SLICC/ACR Damage Index (SDI). The associations of LN with overall, non-renal, corticosteroid-associated, and
non-associated damage were analyzed using logistic regression. The age-adjusted and sex-adjusted standardized mortal-
ity ratio (SMR) was evaluated in patients with vs without LN.
Results: The prevalence of LN was 46.3%. After a mean follow-up of 7.6 years, patients with LN had a higher percent-
age of overall damage than patients without LN (51.5% vs. 35.7%, p<0.001). The odds ratio was 1.40 after adjusting for
age at SLE diagnosis, sex, disease duration, anti-malarial agents, immunosuppressive agents, and cumulative cortico-
steroid dose. However, LN was not associated with non-renal damage (p=0.551). The odds of corticosteroid-associated
damage were higher (2.06, 95% CI 1.43-2.96), whereas the odds of non-associated damage were lower (0.50, 95% CI
0.35-0.75) in patients with LN. The age-adjusted and sex-adjusted SMRs of patients with vs without LN were 5.17 (95%
CI 3.49-7.38) and 2.32 (95% CI 1.47-3.48), respectively.
Conclusion: LN was associated with more overall organ damage but not more non-renal organ damage. Patients with
LN had more corticosteroid-associated damage, but less corticosteroid non-associated damage compared with patients
without LN. Additionally, the SMR of patients with LN was significantly higher than the SMR of patients without LN.
Poster 37
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S216
Comparison of Clinical and Serological Differences According to the Autoantibody Cluster in Women
with Systemic Lupus Erythematosus: Results from the Korean Lupus Network (KORNET) Registry
Ji-Eun Kim, Dong-Jin Park, Ji-Hyoun Kang, Yi-Rang Yim, Jeong-Won Lee, Kyung-Eun Lee, Lihui Wen, Tae-Jong Kim, Yong-Wook Park, Shin-Seok Lee
Department of Rheumatology, Chonnam National University Medical School & Hospital Gwangju, Korea
Objectives: Individual autoantibodies are associated with the clinical features in patients with systemic lupus eryth-
ematosus (SLE). However, few studies have investigated differences in disease presentation based on autoantibody pro-
files in Asian patients with SLE. This study evaluated autoantibody clusters and compared the clinical and serological pre-
sentation and clinical outcome in Korean SLE patients.
Methods: The Korean Lupus Network (KORNET) is a nationwide multicenter, hospital-based registry, set up to pro-
spectively assess outcomes in Korean SLE patients. Of the 505 SLE patients enrolled in the KORNET registry from July
2014 to November 2015, the study group comprised 339 consecutive female SLE patients. Seven autoantibodies
(anti-dsDNA, anti-Sm, anti-RNP, anti-Ro, anti-La, lupus anticoagulant (LAC), and anti-cardiolipin antibody [aCL]) were
selected for cluster analysis using the K-means cluster analysis procedure.
Results: Three distinct autoantibody clusters were identified: cluster 1, anti-dsDNA and anti-Ro; cluster 2, anti-RNP;
and cluster 3, anti-RNP, anti-Ro, and anti-La. Compared with patients in clusters 2 (n=99) and 3 (n=85), patients in clus-
ter 1 (n=155) had a shorter symptom duration before SLE diagnosis and higher incidence of biopsy-proven lupus
nephritis. Patients in cluster 3 had a higher incidence of discoid rash, central nervous system involvement, lupus pan-
creatitis, pulmonary arterial hypertension, Raynaud’s phenomenon, and premature gonadal failure. In addition, patients
in cluster 3 had the lowest proportion of mean prednisolone>7.5 mg/day in the medication history.
Conclusion: Autoantibody clusters were associated with the clinical features in women with SLE. Clustering autoanti-
bodies could be a valuable approach for differentiating between various clinical subsets of SLE, and may help to guide pre-
diction of the subsequent clinical course and organ damage in these patients.
Poster 38
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S217
Vitamin D and Bone Mineral Density in Rheumatoid Arthritis and Systemic Lupus Erythematosus
Ju-Yang Jung, Hyoun-Ah Kim, Chang-Hee Suh
Department of Rheumatology, Ajou University School of medicine, Suwon, Korea
Background: Vitamin D (VitD) has been revealed to involve immunologic pathogenesis in rheumatoid arthritis (RA)
and systemic lupus erythematosus (SLE). Moreover, Vit D plays a pivotal role in bone formation which tends to be vulner-
able in RA and SLE.
Objectives: We studied the effects of clinical features and VitD on bone mineral densities (BMD) in RA and SLE
patients.
Methods: Age matched 94 female patients with SLE and 92 female patients with RA were recruited. The medical data
including levels of 25-OH-VitD from March to May and BMD were measured by dual energy X-ray absorptiometry were
collected.
Results: The L-spine and hip T-scores were not different between RA and SLE patients, and the T-scores were not dif-
ferent between the patients with VitD deficiency and those without. In SLE, the patients with osteoporosis had higher
erythrocyte sedimentation rate (ESR) than those without osteoporosis (31.4±23.9 vs 16.4±11.9, p=0.008). Among the
patients taking VitD replacement, RA patients had lower levels of 25-OH-VitD than SLE patients (19.83±8.07 vs
24.33±10.45, p=0.011), and L-spine and hip T-scores in RA patients were lower than those in SLE patients. On multiple
regression analysis, age (r=-0.131, p<0.001), disease duration (r=-0.082, p=0.017), vitamin D replacement (r=-0.787,
p=0.003) and glucocorticoids dose (r=-0.111, p=0.024) were associated with lowest T-score of L-spines in RA patients,
while age (r=-0.058, p=0.028) and ESR (r=-0.025, p=0.005) were associated with lowest T-score of L-spines in SLE
patients.
Conclusions: There was no difference of BMD between RA and SLE, and according to VitD deficiency. In RA patients,
age, disease duration, vitamin D replacement, and glucocorticoids dose might be contributing factors for BMD. Also, age
and ESR could influence in spinal BMD in SLE.
Poster 39
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S218
Salivary Proteomic Analysis in the Patients with Systemic Lupus Erythematosus
Ju-Yang Jung, Hyun-Ah Kim, Jin-Young Nam and Chang-Hee Suh
Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
Background: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by patho-
genic autoantibodies and uncontrolled inflammatory response. As symptoms and activities changes with time, the pa-
tients with SLE need to take blood sampling to measure disease activity.
Objectives: We try to find a salivary protein composition and seek for what difference helps to discriminate and eval-
uate patients with SLE with more convenient way.
Methods: Total 80 patients with SLE and 40 healthy controls (HCs) participated, and all collected saliva in the morning
with fasting condition. Same amount of protein of two groups were prepared with pooling 10 samples from SLE patients
and HCs, and subjected to 1 and 2-dimensional gel electrophoresis (DE). The spots with more than 2 fold alteration in
expression were identified by matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spec-
trometer (MS) analysis.
Results: Three hundreds eighty proteins were detected in 1 DE analysis, 13 spots were up-regulated, and 14 spots were
down-regulated in SLE than in HCs. Epidermal growth factor receptor kinase substrate 8-like protein 2 was detected only
in HCs, and galectin-7, putative helicase and transaldolase were detected only in SLE. By 2-DE analysis, 20 spots of pro-
tein were differently detected in SLE compared in HCs. Immunoglobulin gamma-3 chain C region, protein S100, Zinc-al-
pha-2-glycoprotein, BPI fold containing family a member 2 showed significantly different concentration between SLE and
HCs (p<0.05).
Conclusion: Current proteomic analysis using electrophoresis and MS analysis is accurate to detect tiny amounts of
proteins. From 1-DE and 2-DE analysis, several proteins in saliva were differently detected in SLE and HCs, suggested
that salivary protein might be useful biomarkers for SLE.
Poster 40
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S219
The Increase or Decrease of Serially Assessed anti ds-DNA Antibody Serum Level is Strong Relationship
with Lupus Flare Up: Single Center Experience
Sang Yeob Lee, Sung Won Lee, Won Tae Chung
Department of Rheumatology, Division of Internal Medicine, Dong-A Uiversity
Introduction: Patients with Systemic Lupus Erythematosus (SLE) may experience flare of disease activity. The aim of
this study was to assess flares clinical features, focusing on the relationship with serially assessed anti-double stranded
DNA antibodies (anti-dsDNA) serum levels by Farr assay, through the analysis of a monocentric cohort of SLE patients
and a literature review.
Methods: We analyzed 159 patients who visited outpatients or admitted to Dong-a university hospital between march
2012 and march 2015. They were diagnosed to SLE, according to the revised 1997 ACR criteria and serillay assessed se-
rum anti-dsDNA every three months. Among subjects, 62 subjects were excluded because of drop-out. So 97 patients
were enrolled and section to three groups. The one group, 29 patients were showed significant increase or decrease serum
anti-dsDNA level, the other group, 33 patients who maintained high level anti-ds-DNA, another group, 35 patients were
maintained lower level anti-ds-DNA. Informed consents were obtained from all individual participants included in the
study.
Results: The mean SLEDAI score was 4.21 (±4.63) in 29 patients who were showed significant increase or decrease
serum anti-dsDNA level. On the contrary, mean SLEDAI score was low in no change anti-ds-DNA level group {0.47
(±5.33) in high keeping anti-ds-DNA group (p=0.000), 0.51 (±2.03) in low keeping anti-ds-DNA group (p=0.00)}. The
14 patient who were increased serum anti-dsDNA level, had hematologic and cardiopulmonary exasperation. 15 pa-
tients, who were decreased serum anti-dsDNA level, had worsened musculoskeletal and mucocutaneous manifestation.
Conclusion: The increased SlEDAI score is associated with change anti ds-DNA antibody level and increased an-
ti-ds-DNA level subjects had more severe clinical manifestation than decreased anti-ds-DNA level subjects.
Poster 41
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S220
Outcomes in Patients with Ischemic Stroke Regarding Titer and Persistence of Antiphospholipid Antibodies
Jung Yoon Pyo, Sang-Won Lee, Jason Jungsik Song, Yong-Beom Park
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Background: Stroke and transient ischemic attack (TIA) are the most common neurologic manifestation of anti-
phospholipid syndrome (APS). The international consensus criteria for APS classification require persistent anti-
phospholipid antibodies (aPL) positivity and medium or high titer for anticardiolipin antibody (aCL) associated with
clinical manifestations[1]. However, significance of persistence and titer of aPL on the clinical relevance is not identified.
Objectives: To evaluate the effect of persistent and medium or high titer of aPL positivity on recurrence in patients with
ischemic stroke/TIA.
Methods: We reviewed medical records of 99 patients with ischemic stroke/TIA who had at least one or more positive
aPL (ie, positivity for aCL, β2-GPI, LA). We divided these patients into two groups according to the most recent revised
classification (Sydney consensus conference), and designated as “definite APS” who fulfilled the laboratory criteria, and
“aPL carriers” who had transient or low titer aPL. We compared the subsequent ischemic stroke/TIA events between the
two groups.
Results: Of the 99 patients, 46 (46%) were classified as definite APS and 53 (54%) as aPL carriers. There was no in-
creased risk of subsequent ischemic/TIA events in definite APS group compared with aPL carriers group. The overall
event was 14 (30.4%) in APS group and 16 (30.2%) in aPL carriers group during 60.4 months and 43.8 months follow
up period respectively. 38 patients were having anticoagulation for treatment and 60 patients were on anti-platelet treat-
ment without anticoagulation, but there was no difference on recurrence events regarding the treatment.
Conclusions: Diagnosing definite APS does not predict increased risk for subsequent ischemic stroke/TIA.
Anticoagulation does not reduce the risk of recurrence compared with anti-platelet agents in patients with ischemic
stroke/TIA with positive aPL.
Poster 42
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S221
Cytomegalovirus Reactivation in Patient with Active Lupus Nephritis
Hyunae Lee, yeunmi Kang, Jihyun Han, Sangyoon Kim, In Je Kim, Jisoo Lee
Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
Cytomegalovirus (CMV) infection can be life-threatening in immunocompromised patients. There are only a few re-
ports on CMV reactivation in systemic lupus erythematosus (SLE). We report a rare case of CMV reactivation, which de-
veloped after immunosuppressive therapy in a 26-year-old woman with severe lupus nephritis. This patient who was on
high-dose prednisolone and cyclophosphamide induction therapy developed high fever, dyspnea, and diarrhea. CMV an-
tigen was positive, and she was diagnosed with CMV pneumonia and CMV colitis. Clinical improvement was observed
after ganciclovir treatment. Despite the improvement of disease activity, she again presented with fever and
pancytopenia. Rising CMV titers were detected and it was considered as CMV reactivation. Clinical course of lupus neph-
ritis should be carefully monitored for development of CMV infection. CMV titer in a SLE patient with fever and pan-
cytopenia may be a useful marker for early detection of CMV infection, even after first remission of it.
Poster 43
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S222
A Case of Systemic Lupus Erythematosus Presenting as Stevens-Johnson Syndrome
Mi-Hye Kwon, Chung-Il Joung
Department of Internal medicine, Konyang University College of Medicine, Daejeon, Korea
Systemic lupus erythematosus has myriads of clinical manifestations, the skin involvement is known as the second
common form of disease. Among diverse skin manifestations, acute cutaneous lupus erythematosus (ACLE) is usually
observed in the area exposed to the light, such as face, but rarely, generalized distribution may occur. A hyper-acute form
of ACLE can simulates Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis.
A 33-year-old man presented with erythematous eroded papules and patches on head, neck and upper chest for more
than 2 months (Fig. 1). He also presented hemorrhagic erosion with crust on lips, buccal and nasal mucosa accompanied
by conjunctival injection. Skin biopsy showed mild degree of vacuolar alteration and thickening of basement membrane,
perivascular and periadnexal lymphohistiocytic infiltration and stromal mucin deposition (Fig. 2). On direct immuno-
fluorescence, there were Ig G and Ig M deposition along the basement membrane zone. Laboratory findings demon-
strated pancytopenia, and positivity for ANA, Anti-dsDNA, and anti-Ro. The patient was diagnosed SLE according to
clinical, histological, and laboratory findings. He was treated with oral methylprednisolone 0.5mg/kg/day and hydroxy-
chloroquine, all the skin manifestations had subsided in 2 months. He later developed proteinuria and was diagnosed as
lupus nephritis class V by renal biopsy. Herein we report a rare case of SLE presenting as SJS.
Poster 44
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S223
Renal Microaneurysm in a Patient with Systemic Lupus Erythematosus
Jung Su Eun, Eun Song Lee, Jong Wan Kang, Na Ri Kim, Sang Jin Lee, Young Mo Kang, Eon Jeong Nam
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
Systemic lupus erythematosus (SLE) is a complex, heterogeneous disease characterized by autoantibody production
and potential involvement of nearly every organ system. Although vasculitis usually confined to small vessels is a fairly
common feature of SLE, necrotizing vasculitis with aneurysm is an uncommon feature. Especially, renal arterial aneur-
ysm has been very rarely reported in patients with SLE. We experienced a case of renal microaneurysm in a patient with
SLE.
Case: A 41-year old woman who was previously diagnosed with hypertension, hypertensive retinopathy admitted to
our hospital with both foot metatarsophalangeal (MTP) joint pain. She did not complain of flank pain. On physical ex-
mination, both MTP joint revealed mild swelling and tenderness. Fundoscopic examination showed small hard exudates
in the left retina. Laboratory examination revealed the following : lymphocyte 1330/mm3, immunoglobulin G 2354
mg/dl (700-1600), serology for antinuclear antibodies, anti-double-stranded DNA, anti-β2-glycoprotein were positive.
Serum complement levels and urinalysis were normal. She was diagnosed with SLE based on clinical feature (arthritis)
and laboratory findings. Additionally, abdominal computed tomographic (CT) scan showed multiple wedge-shaped areas
on both kidney. She underwent a renal angiography which demonstrated bilateral multiple reanl artery microaneurysms.
Renal biopsy was done to check for renal parenchyma. Renal biopsy revealed well-demarcated parenchymal atrophic
change without glomerular proliferation or sclerosis that suggests ischeminc nephropathy. For treatment of renal vasculi-
tis with microaneurysm, she was treated with high dose glucocorticoid and mycophenolate mofetil. Six months later,
there was improvement of hypertension, hypertensive retinopaty, arthritis. She is scheduled to be examined abdominal
CT and renal angiography soon.
Conclusions: We suggest that visceral vasculitis should be included in the work-up of patients with SLE.
Poster 45
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S224
A Case of Meningoencephalitis by Cryptococcus Neoformans in a Patient with Systemic Lupus Erythematosus
Do Sik Moon1, Hyun-SooK Kim2, Yun Sung Kim1
1Department of Internal Medicine, Chosun University College of Medicine, Gwanju, 2Department of Internal Medicine, Sunchun Hyang University College of Medicine, Seoul, Korea
Invasive fungal infection can be a lethal complication in systemic lupus erythematosus (SLE).
Crytococcus neoformans, as one of the most common pathogenic species worldwide, can cause infection disease in
human. The central nervous system (CNS) is a common site for cryptococcal infection which usually presents crypto-
coccal meningitis. The cryptococcal meningitis is a recognized complication of SLE, with high mortality rates, particularly
in those treated with immunosuppressive agents. However, it is difficult to differentiate infectious meningitis and neuro-
psychiatric lupus because of the clinical manifestations are unspecific and frequently are confused with lupus activity. So
a early diagnosis and treatment is very important for its significant mortality and morbidity. We report the case of fatal
meningoencephalitis by Cryptococcus neoforman in a 44 years old patient with SLE
Poster 46
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S225
Long-term Outcomes of Autologous Peripheral Blood Stem Cell Transplantation for Refractory Rheumatic Diseases
Seung Lee, Jae-Bum Jun, Chan-Bum Choi, Sang-Cheol Bae
Hanyang University Hospital for Rheumatic Diseases
Objectives: We investigated long-term outcomes of autologous peripheral blood stem cell transplantation (PBSCT) for
treatment of refractory rheumatic diseases.
Methods: Patients who underwent PBSCT for refractory rheumatic diseases at our hospital between 2002 and 2005
were assessed for outcomes including treatment response in disease activity at, damage, adverse events, and survival at
6 months and either July 2015, last follow-up, or at death.
Results: A total of 11 patients including 6 systemic lupus erythematosus (SLE), 4 systemic sclerosis (SSc), and 1 Still's
disease were treated with PBSCT. Lupus nephritis and neuropsychiatric lupus were the manifestations refractory to con-
ventional treatments requiring PBSCT in the SLE patients. At 6 months, complete response was observed in 2 patients,
partial response in 2, and 2 patient expired. One patient who expired showed a complete response at 2 months after trans-
plantation but discontinued all treatment at the patient’s discretion and expired at 6 months due to flare. Long-term out-
comes showed 2 patients in remission without organ damage, 1 in remission with organ damage, and 1 in low disease
activity with organ damage. Of the 4 patients with SSc, 2 showed complete response, 1 partial response, and 1 trans-
plantation-related death at 6 months. In the long-term, 2 remained in remission without relapse, 1 expired and 1 was lost
to follow up. The Still’s diseases patient showed partial response at 6 months and was in remission in long-term
assessment.
Conclusion: At 6 months after PBSCT for refractory rheumatic diseases, 5 patients showed complete response, 4 parti-
al response, and 3 expired. Four patients showed relapse in the long-term. 2 of them went back in remission and 1 patient
expired. Ten year survival rate was 70% with 40% recurrence rate and 20% treatment-related mortality rate.
Poster 47
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S226
Tuberculin Skin Test and Interferon Gamma Release Assay (IGRA) for Diagnosing Latent Tuberculosis Infection in Patients
with Systemic Lupus Erythematosus
Hyoun-Ah Kim, Hundo Cho, Ye Won Kim, Ju-Yang Jung, Yoo-Jin Um, Jin-Hee Jung, Chang-Hee Suh
Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
Objective: We investigated the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB Gold
(QFT-G) assay in the diagnosis of latent tuberculosis infection (LTBI) in patients with systemic lupus erythematosus
(SLE). Furthermore, we evaluated the factors associated with indeterminate results in the QFT-G assay in patients with
SLE.
Methods: We enrolled 136 patients with SLE prospectively, and compared them to 66 patients with rheumatoid arthri-
tis (RA). In addition to the TST, QFT-G assay, patients’ medications, and Bacillus Calmette-Guérin (BCG) vaccination
status were also investigated. A positive TST or QFT-G assay result without an active tuberculosis lesion on chest x-ray
was considered to indicate a diagnosis of LTBI.
Results: The prevalence of LTBI was 26.5% in patients with SLE and 30.3% in patients with RA. The agreement be-
tween the TST and QFT-G assay was fair in SLE patients, but, poor in RA patients. BCG vaccination was one factor asso-
ciated with discordance between TST and QFT-G. Older age and higher SLE Disease Activity Index (SLEDAI) score were
associated with a negative TST/positive QFT-G result in patients with SLE. Higher SLEDAI score and increased gluco-
corticoid dose were associated with an indeterminate result in the QFT-G assay for patients with SLE.
Conclusions: Agreement between the QFT-G assay and TST in patients with SLE was found to be fair. However, BCG
vaccination status, age, and SLEDAI score are all factors that could result in discordance between the two tests.
Indeterminate results from the QFT-G assay may be caused by a higher SLEDAI score or increased glucocorticoid dose.
Poster 48
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S227
Association of HLA Genes in Systemic Sclerosis with Interstitial Lung Disease
Hyun Mi Kwon1*, Eun Young Song2*, Ye Ji Lee3, Jin Kyun Park1, Eun Young Lee1, Yeong Wook Song1, Eun Bong Lee1
1Division of Rheumatology, Department of Internal Medicine, 2Department of Laboratory Medicine, 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Background: Interstitial lung disease (ILD) is related to significant morbidity and mortality in systemic sclerosis (SSc).
Many studies have reported the association of human leukocyte antigen (HLA) alleles with SSc, but few have focused on
SSc subpopulation with ILD.
Objectives: The aim of this study was to investigate the association of HLA class I and HLA class II with ILD in Korean
SSc cohort.
Methods: A total of 170 SSc patient were enrolled at Seoul National University Hospital from 1988 to 2014. Two hun-
dred one1 healthy participants from Korean Marrow Donor Program (KMDP) were recruited as controls. SSc patients
were characterized for demographic information, clinical skin subset (limited vs. diffuse), SSc-specific autoantibodies
(anti-topoisomerase I (ATA), anti-centromere (ACA), anti-ribonucleoprotein (RNP)), and internal organ involvement
(ILD, pulmonary arterial hypertension, gastrointestinal, renal involvement). One hundred five SSc patients with ILD and
65 without ILD were identified based on the findings of the chest computed tomography. HLA-A, -B, -C, -DQB1, -DRB1,
and -DPB1 typing were performed PCR amplification with directly sequencing from extracted genomic DNA.
Results: HLA-B*52:01, C*12:02, DRB1*15:02, DPB1*09:01, and DPB1*13:01 alleles were more frequently found in
SSc patients with ILD than healthy controls. However, the frequencies of these genes did not show significant difference
between SSc patients with and without ILD (Table). ATA positive SSc was associated with HLA-B*52:01, C*12:02,
DRB1*15:02, DPB1*09:01, and DPB1*13:01 alleles compared to ATA negative SSc and DPB1*09:01 showed the highest
odds ratio for ATA (OR=23.08).
Conclusion: SSc patients with ILD have several specific HLA genes compared with healthy controls and the frequencies
of these HLA genes were significantly higher in ATA-positive SSc. These results suggest shared genetic origin of HLA
class I and II between ILD and ATA positivity in SSc patients.
Table 1. HLA frequencies in patient with systemic sclerosis with ILD and without ILD compared to healthy controls
HLA allelesSSc_Total (N=170)
ILD(+)SSc (n=105)
ILD(-)SSc (n=65)
Control (N=201)
SSc Total vs. Control ILD(+)SSc vs. Control ILD(-)SSc vs. Control
Pc Pc Pc
B*52:01 23 (13.5) 20 (19.0) 3 (4.6) 9 (4.5) 0.076 <0.001 1.000 C*12:02 23 (13.5) 20 (19.0) 3 (4.6) 9 (4.5) 0.046 <0.001 1.000 DRB1* 15:02 29 (17.1) 24 (22.9) 5 (7.7) 14 (7.0) 0.074 <0.001 1.000 DPB1* 09:01 22 (12.9) 18 (17.1) 4 (6.2) 9 (4.5) 0.045 <0.001 1.000 DPB1* 13:01 52 (30.6) 38 (36.2) 14 (21.5) 25 (12.4) <0.001 <0.001 1.000
Abbreviation: HLA, human leukocyte antigen; SSc, systemic sclerosis; ILD, interstitial lung disease; OR, odds ratio; Pc, corrected P by Bonferroni correction.Pc of ILD(+)SSc vs. ILD(-)SSc: HLA-B*52:01 (Pc=0.304), C*12:02 (Pc=0.184), DRB1*15:02 (Pc=0.407), DPB1*09:01 (Pc=0.570), DPB1*13:01 (Pc=0.660).
Poster 49
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S228
Metabolomics for the Diagnosis of Systemic Sclerosis
Kyong-Hee Jung1*, Sehyun Oh2, Won Park1, Mie Jin Lim1, Seong Ryul Kwon1, Sunghyouk Park2*1Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon,
2College of pharmacy, Seoul National University, Seoul, Korea
Background: Systemic sclerosis (SSc) is a complex multi-organ autoimmune disease that is caused by inflammation,
vasculopathy and fibrosis. Clinical heterogeneity, unpredictable course, high mortality and resistance to treatment make
physicians still frustrated. Recently, there are unmet needs of useful biomarkers for diagnosis, disease activity and se-
verity of SSc. Metabolomics is expected to be a useful tool for the identification of biomarkers and new therapeutic
targets. Several researchers have applied metabolomics to autoimmune diseases such as systemic lupus erythematosus,
and rheumatoid arthritis.
Objective: To identify the biomarker candidates for the diagnosis of SSc using metabolomic analysis.
Methods: Fifty-five patients (48 females (87 %); mean age 59.30±11.44 years; disease duration 6.92±4.36 years; 11
diffuse cutaneous SSc, 44 limited cutaneous SSc) and thirty age, gender matched healthy controls (HCs) were enrolled.
Serum samples after 8 h of fasting were stored at -80oC and analysed using nuclear magnetic resonance (NMR)-based
metabolomics.
Results: Multivariate analysis showed metabolic differences between SSc and HCs using partial least squares discrim-
ination analysis (PLS-DA: R2Y=0.654, Q2=0.482) and orthogonal partial least squares discrimination analysis
(OPLS-DA: R2Y=0.83, Q2=0.674). We identified nine discriminatory metabolites (p<0.05): isopropanol, lactate, 2-ox-
oisocaproate, glucose, and formate were increased and pyruvate, glutamate, methylguanidine, and methanol were de-
creased in SSc compared with those in the HCs. Using these metabolites for diagnosis of SSc, sensitivity was 96.36% and
specificity was 80% by Leave-one-out analysis.
Conclusion: There are considerable differences in the serum metabolomic characteristics between SSc and HCs. We
expect that metabolomic analysis can be a useful tool for identification of potential diagnostic biomarkers of SSc.
Poster 50
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S229
Neutrophil/Lymphocyte Ratio (NLR) were Useful Marker in Prediction of Lung Involvement
in Patient with Systemic Sclerosis
Won-Seok Lee, Yun-Jung Choi, Yu-Mi Lee, Wan-Hee Yoo
Division of Rheumatology, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
Background: Both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) are reported to be in-
creased in various inflammatory diseases, but there clinical significance in systemic sclerosis (SSc) remains unclear.
Objective: The aim of the study is to evaluate usefulness of neutrophil to lymphocyte ratio in diagnosis of systemic scle-
rosis and in prediction of lung involvement such as pulmonary fibrosis.
Method: The medical records of 88 SSc patients and 50 healthy controls were retrospectively reviewed. NLR, PLR be-
tween SSc patients and healthy controls were compared, and correlation between these indexes and lung involvement
were analyzed. Exclusion criteria included active infection and/or the presence of any hematological, cardiovascular or
metabolic disorder.
Results: The NLR and PLR were found to be significantly higher in SSc patients when compared to the healthy control
(NLR: 3.95±6.59 vs 2.00±1.07, p<0.01, PLR: 163.87±101.12 vs 126.33±42.31, p<0.05). SSc patients with lung in-
volvement had higher NLR and PLR levels than those without lung involvement (p<0.01, p<0.05). NLR was negatively
correlated with forced vital capacity (FVC)(r=-0.341, p<0.01) but not diffusing capacity for carbon monoxide (DLCO).
Receiver-operating characteristics analysis (ROC) of NLR to predict lung involvement in SSc showed that the area under
the curve (AUC) was 0.763. The cut-off NLR value for prediction of lung involvement was determined as 2.59.
(sensitivity, 0.700;specificity, 0.729; p<0.01)
Conclusion: NLR may be a promising marker that reflects lung involvement in patients with SSc and values greater
than 2.59 were useful in prediction of lung involvement
Poster 51
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S230
Renal Involvement in Patients with Inflammatory Myopathies in Korea
Howook Jeon, Min Seok Choi, Jeniffer Lee, Sung-Hwan Park
Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Background: Renal involvement in patients with inflammatory myopathies (IM) is previously thought to be
uncommon. But recently some studies suggest that two types of renal involvement occur in nealy 20% patients, one is
acute kidney injury (AKI) at diagnosis and the other is chronic kidney disease (CKD). And some possible risk factors are
proposed.
Objectives: To investigate the incidence and prognosis of renal involvement Korea, patients with IM include dermato-
myositis (DM) and polymyositis (PM)
Methods: Clinical and laboratory data of 50 patients diagnosed with IM in our rhematology clinic between 2005 and
2015 were investigated. These data were obtained from medical records and studied retrospectively. AKI was defined as
an acute doubling of serum creatinine level, and CKD as decreased GFR less than 60 ml/min/1.73m2 over 3 months. And
other renal involvement such as proteinuria more than 300 mg/day or microscopic hematuria were evaluated.
Results: The incidence and clinical manifestations of renal involvement our patients were distinguished from previous
other countries' studies. There were no patients with AKI at initial diagnosis and also no one progressed to CKD. But 16%
of patients were showed proteinuria or hematuria, suspicious of chronic glomerulonephritis and they have no other pos-
sible causes for renal involvement. We tried to conduct renal biopsy for patients with proteinuria over 1g/day, but un-
fortunately, no one agreed for procedure so we did not identify the causes of renal involvement. And we conducted stat-
istical analysis to identify risk factors for renal involvement, but all of variables - age at IM onset, sex, type of IM, under-
lying disease, various muscle enzyme levels - had no statistical significance.
Conclusion: We found that there were many patients with renal involvement presenting proteinuria or hematuria. So
when treat the patients with DM/PM, we have to monitor renal function and urinalysis, and consider renal biopsy.
Poster 52
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S231
Renal Involvement in Polymyositis: A Case Report
Yoon Jeong Oh1, Eun Sung Park1, Mi Jang2, Jeong Hae Kie3, Jason Jungsik Song1, YongBeoum Park1, Chan Hee Lee4, Jin Su Park4
1Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 2Department of Pathology, Yonsei University College of Medicine, Seoul, 3Department of Pathology, NHIS Ilsan Hospital, Goyang,
4Division of Rheumatology, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang, Korea
Polymyositis (PM) is a chronic inflammatory disorder that mainly involves muscles. The systemic organ involvements
of PM including the respiratory and gastrointestinal tracts are frequently observed, however, renal involvement is rare.
Herein, we report a rare case of PM combined with immunoglobulin A (IgA) nephropathy.
A 56-year-old woman presented with a 1-month history of pruritus, weight gain (3 kg for a month), grade II bilateral
pretibial pitting edema and generalized myalgia. Laboratory tests revealed creatinine kinase (CK)=8,493 IU/L, albu-
min=2.5 g/dL and the spot urine protein/creatinine ratio=2066.9 mg/g. She was suspected as a polymyositis based on
clinical and biochemical tests, and it was confirmed on muscle biopsy (Fig. 1). Renal biopsy was also performed to eval-
uate the proteinuria. Light and immunofluorescence microscopic findings were compatible to IgA nephropathy (Haas'
subclass II) (Fig. 2). Although she has been initially treated with oral prednisolone 60 mg/day, CK showed no signs of
normalization and the severity of proximal muscle weakness worsened from grade IV to grade II.
Even though methylprednisolone pulse therapy (1 g/day, 3 times) and then cyclophosphamide pulse therapy were tak-
en, her muscle weakness persisted. Intravenous immunoglobulin was adopted in a dose of 2 g/kg for 5 days for the control
of refractory PM. After that, the patient’s proximal muscle strength has gradually improved from grade II to grade IV and
muscle enzyme was reduced (CK=780 IU/L). In addition, the amount of proteinuria was decreased. She was maintained
with oral prednisolone and regularly followed up.
Poster 53
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S232
Drug Survival of TNF Alpha Inhibitor in Spondyloarthropathies Using 10 Years
of Nationwide Data in Korea: A Population-based Study
Eunyoung Emily Lee1, Jeong Seok Lee1, Yeong Wook Song1, Hee Young Lee2, Eun Young Lee1*1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
2Center for Preventive Medicine and Public health, Seoul National University Bundang Hospital, Seongnam, Korea.
Background: Tumor necrosis factor-alpha inhibitors (TNFi) have consistent efficacy in controlling disease activity of
spondyloarthropathies (SpA). However, real-world issues in clinical practice remain unresolved especially selecting or
switching TNFi for individual patient.
Objectives: To describe patterns of prescribing TNFi in SpA patients, we used the national health insurance claim data
of Korea from 2004 to 2013. We aimed to evaluate 1) the first choice 2) drug retention rate and duration and 3) switching
rate and duration before switching of each TNFi.
Methods: We used retrospective cohort data by the National Health Insurance Service in Korea, which consisted of
more than one million subjects representing whole Korean population followed from 2004 to 2013. All SpA patients with
any experience of TNFi were involved.
Results: One-hundred and sixty patients were found to experience any of TNFi. Etanercept was the most frequent
choice as first TNFi (39.4%). Retention rate was consistently higher for etanercept than others till 24 months (Fig 1A).
Etanercept and infliximab had longer duration of use than adalimumab. Switching rate of etanercept (8.8%) was lower
than adalimumab (11.9%) and infliximab (13.3%). Etanercept users (1.67 years) had longer duration of use before
switching than adalimumab (0.82 years, p=0.013).
Conclusions: This research can be a pilot study before analyzing nationwide cohort encompassing whole population
of Korea. Conclusively, in the aspect of drug survival of TNFi, etanercept was prescribed longer in general and the rate
of retention till 2 years was also higher than adalimumab and infliximab for 10 years after national insurance coverage.
Poster 54
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S233
Lateral Spine BMD Measurement and Trabecular Bone Score Can Represent a Bone Loss in Patients
with Advanced Ankylosing Spondylitis
Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Seung-Ki Kwok, Sung-Hwan Park, 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
Backgrounds: It is well known that osteoporosis is paradoxically common in patients with ankylosing spondylitis (AS)
in spite of their new bone formation and extraosseous calcification. However, some features of advanced disease such as
syndesmophyte can influence in the result of bone marrow density (BMD) according to the measurement methods.
Objective: The aim of this study was to identify suitable BMD measurement methods reflecting bone mass loss in pa-
tients with AS.
Methods: Fifty-four patients with AS (38 males, 16 females) who assessed BMD using dual-energy X-ray absorptiom-
etry (DXA) were retrospectively reviewed. BMD was measured by anterior-posterior (AP) L1-L4, lateral (Lat) L2, L3, and
proximal femur projection. Trabecular bone score (TBS) L2-L4 was calculated as an indicator of vertebral fracture risk.
Radiologic variables including Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s) score, modified
Stroke Ankylosing Spondylitis Spine Score (mSASSS), and the presence of syndesmophyte were determined. AS patients
were divided into mild, moderate, and advanced stages according to each radiologic variables, and the BMD measured by
different methods were compared among those 3 groups using ANOVA.
Results: Radiologic progression of AS patients represented by BASRI-s, mSASSS, and the number of syndesmophyte
was negatively correlated with Lat-L3 BMD (r=-0.431, r=-0.364, r=-0.464) and with TBS (r=-0.352, r=-0.355,
r=-0.382). Moreover, patients in advanced stage (BASRI-s≥3, mSASSS≥10, syndesmophyte≥1, respectively) showed
significantly lower Lat-L3 BMD (P=0.047, P=0.012, P=0.006) and TBS (P=0.050, P=0.014, P=0.090) compared with
those in mild stage, while they displayed no difference in conventional BMD from AP and femur DXA.
Conclusions: The Lat-L3 BMD and TBS have higher potency to mirror a bone loss in AS patients independent of their
radiologic changes. Further studies evaluating TBS cutoff value for expecting vertebral fracture are needed.
Poster 55
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S234
Quantitative Assessment of Bone Marrow Fat Using Magnetic Resonance Imaging in Patients with Spondyloarthritis
Bon San Koo1*, Yoonah Song2*, Kyung Bin Joo2, Seunghun Lee2, Tae-Hwan Kim3 1Division of Rheumatology, Department of Internal Medicine, Konkuk University College of Medicine, Chungju,
2Department of Radiology and ³Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea*These two authors contributed equally.
Background/Objectives: Fat metaplasia in the bone marrow is an indicator of disease progression in spondyloarthritis
(SpA). This study sought to evaluate the degree of bone marrow fat metaplasia in patients with SpA. In order to do so,
we used two-point mDIXON fat-water separation sequences on MRI to measure the fat fraction (FF) and identify the FF
changes according to disease progression.
Methods: A total of 140 patients with SpA who had undergone pelvic MRI between September 2014 and March 2015
were retrospectively evaluated. Fat metaplasia was quantified on the FF maps using the two-point mDixon technique.
Based on the fat deposition signal on T1- and T2 weighted images, we defined three groups with high fat deposition, as
follows: 1) postinflammatory fat deposition; 2) normal marrow fat; and 3) active inflammatory area (or those with bone
marrow edema).
Results: The mean patient age was 32.2±11.6 years. A total of 84 were male (65%). The mean right and left SI joint
grades on the radiograph were 1.7±1.3 and 1.8±1.3, respectively. The mean FF of postinflammatory fat deposition area
was 82.6%±9.6% in the right and 82.2%±9.8% in the left. The mean FF of the normal marrow area was 50.4%±10.1%
in the right and 51.9%±10.4 % in the left. The mean FF of the active inflammatory edema area was 15.8±6.7 in the right
and 14.0±6.3 in the left. There was a significant correlation between the postinflammatory fat deposition areas in the SI
joint grades on the radiographs (r=0.298, p=0.005 in right and r=0.417, p=<0.001 in left). However, no correlation was
found between the FFs of the normal fat marrow area, the active inflammatory edema area, and the SI joint grade on the
radiographs.
Conclusion: The postinflammatory FF of the bone marrow increased in SpA patients who demonstrated chronic radio-
graphic changes of the SI joint. Quantitative assessment of the FF using MRI might represent a useful technique to eval-
uate SpA progression.
Poster 56
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S235
Clinical Characteristics of Korean Psoriatic Arthritis Patients: Results from the Nationwide KOBIO Registry
Hyoun-Ah Kim1, Seongjun Ha2, Seoungjae Choi3, Shin-seok Lee4, Inkyung Jung5, Kichul Shin2
1Department of Rheumatology, Ajou University School of Medicine, 2Division of Rheumatology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, 3Division of Rheumatology, Department of Internal Medicine, Korea University College of Medicine,
4Divison of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, 5Department of Biostatistics and Medical Informatics, Yonsei University College of Medicine
Background: Although the clinical characteristics and manifestations of psoriatic arthritis (PsA) have been vastly stud-
ied in western countries, clinical research on Korean PsA patients are scarce. The aim of this study was to investigate the
clinical characteristics of PsA patients enrolled in the nationwide KOBIO registry.
Methods: This was an observational study of patients with PsA registered in KOBIO between 2013 and 2015. Clinical
characteristics at enrollment, previous medications before using biologics, imaging and laboratory data were obtained in
34 patients. We also compared the results with data from anklyosing spondylitis (AS) patients (n=1058) enrolled in
KOBIO during the same period. AS patients with psoriasis (PSO) and PsA with SpA were grouped as SpA with PsO for
subanalysis.
Results: Fifteen PsA patients (44.1%) were female, and the mean age was 53.3 years. Their disease duration was
4.7±5.6 years. Seven PsA patients (20.6%) had HLA-B27. Symmetric polyarthritis was the most common manifestation
(35.3%), followed by SpA (29.4%) and others. Commonly used drugs before biologics were methotrexate (88.6%), sulfa-
salazine (64.7%), and hydroxychloroquine (14.7%). We then compared clinical characteristics in PsA with SpA (n=16),
PsA without SpA (n=18), and AS with PsO (n=29). HLA-B27 was positive in PsA without SpA (16.7%) and PsA with
SpA (25.0%), lower than AS with PsO (86.2%) as expected. Positivity of HLA-B27 in AS without PsO was even higher
(91.4%). Peripheral joint involvement and dactylitis were greater in SpA with PsO than without PsO (p=0.0114 and
0.0002, respectively). Yet, the grade for sacroiliitis, if present, was lower in SpA with PsO than without PsO (p=0.0396).
Conclusion: The clinical characteristics of PsA patients in KOBIO are similar to what we see in the literature. SpA is
not an infrequent manifestation of PsA in Korea. However, the degree of sacroiliitis is largely lower than AS, thus could
be overlooked.
Poster 57
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S236
Andersson Lesions of Whole Spine Magnetic Resonance Imaging Compared with Plain Radiography
in Ankylosing Spondylitis
Seong-Kyu Kim1, Kichul Shin2, Yoonah Song3, Seunghun Lee3, Tae-Hwan Kim4
1Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, 2Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
3Department of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 4Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Objective: The objective of this study was to identify the characteristics of Andersson lesions in ankylosing spondylitis
(AS) using whole spine magnetic resonance imaging (MRI).
Methods: A total of 62 patients with AS who had undergone whole spine MRI and plain radiography were retro-
spectively enrolled in this study. We compared the number of discovertebral units (DVUs) with Andersson lesions with
clinical and radiographic indices such as erythrocyte sediment rate (ESR), C-reactive protein (CRP), the Bath Ankylosing
Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and modified
Stoke Ankylosing Spondylitis Spine Score (mSASSS).
Results: Fifty-three patients (85.5%) by whole spine MRI and 23 patients (37.1%) by plain radiography had at least
one Andersson lesion. We found 129 DVUs with Andersson lesions (9.0%) by MRI and 35 DVUs by plain radiography
over all the spine levels. Andersson lesions by MRI were most commonly detected at the lower thoracic spine (from T7-8
to T12-L1). Among the 151 total Andersson lesions by whole spine MRI, 41 were identified as central disc type, 26 as
anterior peripheral disc type, 44 as posterior peripheral disc type, and 40 as diffuse disc type. However, the number of
Andersson lesions did not correlate with ESR, CRP, BASDAI, BASFI, or mSASSS (p>0.05 for all).
Conclusion: Our study indicates that the presence of Andersson lesions in patients with AS is clearly underestimated.
MRI is a superior technique for detecting early Andersson lesions compared with plain radiography.
Poster 58
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S237
Estrogen is Associated with Radiographic Progression in Ankylosing Spondylitis
Hyemin Jeong1, Eun Kyoung Bae2, Yeong Hee Eun1, In Young Kim1, Hyungjin Kim1, Joong Kyong Ahn3, Jaejoon Lee1, Eun-Mi Koh1, Hoon-Suk Cha1
1Department of Medicine, Samsung Medical Center, 2Samsung Biomedical Research Institute, 3Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Introduction: This study aimed to evaluate the role of estrogen in the radiographic spinal progression in patients with
ankylosing spondylitis (AS).
Method: One hundred and two patients with AS were included in this study. Radiographs both at baseline and at the
end of the study were scored using modified the Stoke AS Spine score (mSASSS). A rate of 1≥ unit/year was defined as
radiographic progression. Serum estrogen, dickkopf-1 (DKK1), leptin levels were detected by enzyme-linked im-
munosorbent assay (ELISA) at specific times. Blood samples of 31 patients were assessed by flow cytometry to detect fre-
quencies of Th1, Th2 and Th17 cells. Body mass index (BMI) and other clinical and laboratory characteristics were retro-
spectively collected.
Results: The mean age was 38.8±11.3 years old, and 17 (16.7%) patients were female. In the univariable analysis, es-
trogen serum level (OR 1.01, 95% CI 1.00 to 1.03, p=0.026), BMI (OR 1.35, 95% CI 1.15 to 1.59, p<0.001), initial
mSASSS (OR 1.11 95% CI 1.05 to 1.18, p<0.001), CRP (OR 1.16, 95% CI 1.02 to 1.31, p=0.026), DKK1 (OR 0.99, 95%
CI 0.99 to 1.00, p=0.045), female (OR 0.21, 95% CI 0.04 to 0.98, p=0.047) and disease duration (OR 1.01, 95% CI 1.00
to 1.02, p=0.013) were associated with radiographic progression. In the multivariable analysis, estrogen, BMI, DKK1 and
CRP were associated radiographic progression. In the flow cytometry, frequency of Th17 was significantly increased in
progressors compared with non-progressors (2.7±1.9 vs. 1.0±0.9%, p=0.041). Estrogen level was positively correlated
with the frequency of Th1 and Th17 (r=0.55, p=0.001 and r=0.38, p=0.036, respectively).
Conclusions: Estrogen is associated with radiographic spinal progression in AS patients. Further study is warranted
to clarify the role of estrogen in the pathogenesis of AS.
Poster 59
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S238
Severe Bone Marrow Edema on Sacroiliac Joint MRI Increases the Risk of Low BMD in Patients with Axial Spondyloarthritis
Ha Neul Kim1, Joon-Yong Jung2, Yeon Sik Hong1,3, Sung-Hwan Park1, Kwi Young Kang1,3
1Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 2Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, 3Division of Rheumatology,
Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
Background: Patients with axSpA have an increased risk of low bone mass. A recent study showed that nr-axSpA pa-
tients show significantly greater bone loss than patients with mechanical back pain.
Objective: To determine the association between inflammatory and structural lesions on sacroiliac joint (SIJ) MRI and
bone mineral density (BMD) and to identify risk factors for low BMD in patients with axial spondyloarthritis (axSpA).
Methods: 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 scor-
ed using the SPondyloArthritis Research Consortium of Canada method. Laboratory tests and assessment of radio-
graphic and disease activity were performed at the time of MRI. The association between SIJ MRI findings and BMD was
evaluated. Multivariate logistic regression analysis identified predictors of low BMD.
Results: 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. There was no association be-
tween structural lesions and BMD. The deep BME score correlated with expression of bone resorption markers
(p=0.009). 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).
Conclusion: Acute inflammatory lesions on SIJ MRI were associated with low BMD. 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.
Poster 60
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S239
A20 Expression and Bone Remodeling in Ankylosing Spondylitis
Min Kyung Lee, Hee Jung Ryu, Mi Ryoung Seo, Hyo Jin Choi, Han Joo Baek
Department of Rheumatology, Gachon University Gil Medical Center, Incheon, Korea
Background: A20, an inhibitor of TNF-a-induced apoptosis, has been reported the associations with inflammation by
inhibition of NF-κB activation. And recently A20 deficient mice showed to develop ankylosing spondylitis (AS) and en-
thesitis and A20 was reported to be appeared important in the control of bone resorption in LPS-generated osteoclast.
We investigated the expression of A20 and its correlation with the bone remodeling markers and mSASSS in AS.
Methods: Nine-teen AS patients and 19 healthy controls were enrolled and the expressions of A20 in their PBMCs were
measured by quantitative RT-PCR. The level of Dickkopf-1(Dkk-1) and osteoprotegerin (OPG) as bone remodeling
markers were measured by ELISA. ESR, CRP and mSASSS were checked. Mann Whitney U-test for the comparison of the
expression of A20 and the levels of bone remodeling markers between both group and Spearman analysis for the correla-
tions between the expression of A20 and the level of bone remodeling markers, mSASSS, ESR and CRP were used.
Results: The expression of A20 significantly decreased in AS patients (mean±SEM, 0.44±0.11) compared with in
healthy controls (1.90±0.52, p=0.0026). The mean of mSASSS was 5.63±1.63 and there did not find any correlation
with A20 expression. Dkk-1 and OPG levels in AS patients were not different from in healthy controls. A20 expression
tended to be positively correlated with Dkk-1 in AS patients (r=0.527). OPG levels in AS was not correlated with A20
expression.
Conclusion: The patients with AS showed a significant decreased A20 expression. The deficiency of A20 in AS also
showed the tendency of correlation with decreased Dkk-1, even if it was not statistically significant. This suggests that
the deficiency of A20 might be associated with the pathogenesis of AS and bone remodeling related with Dkk-1 in AS.
Poster 61
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S240
Phlegmonous Gastritis in Ankylosing Spondylitis
Bo Young Kim, Shin Ok Jeong, Yoon-Ho Cho, Hyun-sook Kim
Department of Internal medicine, Division of Rheumatology, Soonchunhyang university college of medicine, Seoul, Korea
Phlegmonous gastritis is a rare, rapidly progressive, and potentially fatal bacterial infection. However, because of the
rarity of this disease, the diagnosis and choice of appropriate treatment is difficult. Predisposing factors recognized are
mucosal injury, achlorhydria, and an immunocompromised state. A fifty one-year old man, with a 2-year history of
Ankylosing spondylitis was brought to the emergency room. He presented with nausea and vomiting. Upon examination,
the bowel sounds were hypoactive, the diffuse abdomen was tender to palpation. His blood pressure was 130/80 mmHg,
his heart beat was 88 beats per minute, and his body temperature 37.5oC. He was treated with infliximab from July 2015
to January 2016 and received the treatment in the last two weeks before. The patient underwent aggressive fluid re-
suscitation and was administered prophylactic broad-spectrum antibiotics. He was to keep fasting state. A characteristic
feature of Phlegmonous gastritis is the thickening of the gastric wall on cut section, most marked in the submucosa.
Compared with a computed tomographic (CT) scanning performed one month ago, CT revealed diffuse edematous wall
thickening in entire stomach. In contrast, there was no other specific findings in the colon. One week later, the patient
underwent an esophagogastroduodenoscopy (EGD) that showed edematous, reddish, mucosal change and multiple ul-
cerative lesions on the upper body, lower body greater curvature of the stomach. And diffuse ulcerative lesion on the fun-
dus of stomach was also detected. The patient was diagnosed as a phlegmonous gastritis based on CT and endoscopic
findings. EGD was performed again 10 days later, it was confirmed that the improvement of phlegmonous gastritis. After
a few days, he was able to cosume a diet. This is first reported case of phlegmonous gastritis occurred in AS patients who
received treatment with infliximab. Early recognition and aggressive therapy are important for survival.
Poster 62
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S241
Hypergammaglobulinemia is an Indicator of Extraglandular Manifestations in Patients with Primary Sjogren’s Syndrome
In Je Kim1, Roo Min Jun2, Jisoo Lee1
1Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, 2Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Seoul, Korea
Background: Sjögren’s syndrome (SS) is a systemic autoimmune disease characterized by lymphocytic infiltration of
exocrine glands. The most common serologic finding is hypergammaglobulinemia which contain several autoantibodies.
Objective: To evaluate the clinical significance of hypergammaglobulinemia in patients with primary SS (pSS).
Methods: Medical records of patients with pSS were retrospectively reviewed and patients with concomitant con-
nective tissue disease were excluded. Demographic, clinical, and serological data were evaluated. Disease activity was as-
sessed using the EULAR Sjögren’s Syndrome Patients Reported Index (ESSPRI). Objective measures of dryness included
Schirmer’s test and measurement of salivary gland function. Patients were grouped according to baseline serum im-
munoglobulin G (IgG) levels; normal IgG (≤1600), mild IgG (1600-2000),and high IgG (>2000).
Results: Of 80 patients (75 female) with pSS, the mean age at diagnosis was 48.6±13.4 years, and the median disease
duration was 2.5 (0.1-14) years. Dry eyes and mouth, and glandular swelling were present in 91.3% and 22.5% of pa-
tients, respectively, and extraglandular manifestations were detected in 85% of patients. Of all patients, 28.8%, 31.2%,
and 40% had normal IgG, mild IgG, and high IgG, respectively. Patients with elevated IgG levels were significantly more
likely to have glandular swelling and extraglandular manifestations including anemia and purpura compared to patients
with normal IgG. Rheumatoid factor positivity, mean number of autoantibodies present, and rate of hypo-
complementemia were significantly higher in patients with elevated IgG. Schirmer’s test results, mean ejection fraction
values of salivary gland scan, and mean total ESSPRI scores were not significantly different between 3 groups.
Conclusions: Hypergammaglbulinemia is very common (72.5%) in patients with pSS. Glandular swelling and extra-
glandular manifestations are more prevalent in pSS patients with hypergammaglbulinemia.
Poster 63
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S242
Diagnostic Value of Salivary Gland Ultrasonography in Primary Sjögren’s Syndrome
Ji-Won Kim1, Chan Uk Lee1, Ji-Na Kim1, Jung-Kyu Kim2, Hwajeong Lee1, Sung-Hoon Park1, Seong-Kyu Kim1, Jung-Yoon Choe1
1Division of Rheumatology, Department of Internal Medicine, 2Otorhinolaryngology, Catholic University of Daegu School of Medicine, Daegu, Korea
Background: Serologic, histopathological tests and clinical aspects are used in diagnosing primary Sjögren’s Syndrome.
Recently, ultrasonography has introduced as a simple, noninvasive method to detect salivary gland involvement in pri-
mary Sjögren’s Syndrome. Limited data are available for diagnostic value of salivary gland ultrasonography (SGUS) in
Korea.
Objective: The purpose of this study was to evaluate diagnostic value of SGUS in primary Sjögren’s syndrome, com-
pared to minor salivary gland biopsy or other serologic tests.
Methods: Total 62 patients suspected as Sjögren’s syndrome were enrolled in our study. The SGUS was performed, and
parenchymal echogenicity was graded from 0 to 4. Serologic tests and histopathologic findings of minor salivary gland
were collected retrospectively. Diagnostic accuracy of SGUS was determined by receiver operating characteristic (ROC)
curve analysis.
Results: Forty-seven patients of primary Sjögren’s syndrome were diagnosed by American College of Rheumatology
classification criteria of 2012. The remaining 15 patients constituted control group, which included patients of idiopathic
sicca syndrome or secondary Sjögren’s syndrome. Sum of SGUS grades, from 0 to 16, exhibited better diagnostic value
for primary Sjögren’s syndrome than maximal grade of SGUS. The optimal cutoff value for sum of SGUS grades was 8
with 81% of sensitivity and 73% of specificity.
Conclusion: SGUS had lower sensitivity than minor salivary gland biopsy, but specificity was equal to minor salivary
gland biopsy. SGUS can be used as an additional diagnostic method for primary Sjögren’s syndrome.
Keywords: Sjögren’s Syndrome, Ultrasonography, Salivary Glands, Diagnosis
Poster 64
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S243
Clinical Characteristics and Treatment outcomes of Patients with Behcet’s Disease with Vascular Involvement
In Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim, Hoon-Suk Cha
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: Vascular manifestations have been reported in up to 50% of patients with Behcet’s disease (BD), most
commonly as venous thrombosis, but all types of vessels can be involved.
Objectives: The aim of this study is to investigate characteristics and treatment outcomes of patients with vascular BD.
Methods: A retrospective review was performed on 2,496 patients who visited our center between 2004 and 2014.
Patients who were suspected to have BD and vascular involvement were enrolled.
Results: 83 patients with clinical features of BD and vascular involvement were identified. Although less than half sat-
isfied the classic International Study Group (ISG) criteria, greater proportion fulfilled the International Criteria for BD
(ICBD), and all of the patients satisfied at least “suspected BD” according to the Japanese criteria. 50 patients had arterial
lesions including 34 with aorta involvement. Another 33 patients had venous thrombosis without arterial lesions.
Patients showed a male predominance (87%) and a predilection of young age with the median of 42 years old. The most
prominent type of arterial lesions was aneurysm (80%) with a high frequency of pseudoaneurysms. Among the aorta, the
thoracic aorta was most commonly involved and 18 patients had aortic valve regurgitation. 75 (90%) patients received
glucocorticoids with a median initial dose of prednisolone of 30 mg per day and 68 (82%) received immunosuppressants.
Half of the patients had more than one relapse after stabilization of the first vascular event. During the course, 44 patients
underwent surgery and/or endovascular treatment and 60% of these patients had repeated treatment for the relapse.
These included 31 aortic valve replacement on 13 patients.
Conclusion: Patients with vascular BD showed a predilection of young male with frequent aneurysmal change and
relapse. Further studies into a practical and specialized diagnostic tool for vascular BD and optimal treatment strategies
are required.
Poster 65
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S244
Sleep Quality and Behcet’s Disease
Ji Min Lee, Hye-Jin Jeong, Chang-Nam Son, Ji-Min Kim, Sang-Hyon Kim
Division of Rheumatology, Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
Background: Behcet's disease is a chronic, systemic vasculitis. Sleep disturbance is one of the most particular concerns
in patients with Behcet’s disease. It has been known that the disease activity of rheumatoid arthritis and ankylosing spon-
dylosis is associated with the sleep quality. However, studies about the sleep quality of patients with Behcet’s disease in
Korean population are limited.
Objectives: The purpose of this study was to find out the effects of sleep quality on Behcet’s disease in Korean
population. We also investigated the relationship between depression, quality of life and the clinical findings of Behcet’s
disease.
Methods: The study was performed by cross-sectional design. Sleep quality was assessed by the Korean version of
Pittsburgh sleep quality index (PSQI). Disease activity of Behcet's disease was evaluated by Behcet's disease current activ-
ity form (BDCAF). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2).
Quality of life was assessed by the Korean version of the Leeds Behcet’s Disease Quality of Life Measure (BDQoL).
Results: Among 100 patients, median age was 51 [44.5-56.0] years, median disease duration was 77.5 [24.0-136.0]
months and 31% were male. The frequency of poor sleep quality (PSQI>5) was 67%. Patients with poor sleep quality
tend to have higher BDI-2, BDCAF and pain VAS score (P<0.001, P=0.028, and P=0.011). Female rate was higher, and
BDQoL was lower in poor sleeper group (P=0.004 and P<0.001). Among 7 PSQI components, daytime dysfunction was
higher in patients with high disease activity (P=0.03). Total PSQI score were strongly correlated with BDCAF score,
BDI-2 score, BDQoL score, and pain VAS score (P=0.02, P<0.001, P<0.001, and P<0.001, respectively).
Conclusions: The low sleep quality is associated with disease activity, depression and quality of life in Korean patients
with Behcet’s disease. Better disease control will improve the sleep quality.
Poster 66
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S245
Potential Laboratory Markers Associated with Disease Activity in Behcet’s Disease
Yunjung Choi, Won seok Lee, Wan-Hee Yoo*
Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
Background: Behcet’s disease (BD) is a rare autoimmune disorder of unknown etiology characterized by involving
multi-organ system. Because there is not a specific test which can reflect disease activity, it is challenging to assess disease
activity and determine treatment strategy based on laboratory parameters.
Objectives: To investigate the laboratory markers as an indicator of disease activity and the correlation between these
parameters and clinical manifestations, retrospectively.
Methods: A total of 115 patients diagnosed with BD based on the criteria of the International Study Group for Behcet’s
Syndrome (ICBS) were enrolled. 65 of whom were active and 50 inactive, according to clinical findings. The neutrophil,
lymphocytes, platelet counts, mean platelet volume (MPV), erythrocyte sedimentation rate (ESR), C-reactive protein
(CRP), complement 3 (C3), complement 4 (C4), and lipoprotein (a) were recorded, and the neutrophil to lymphocyte
ratio (NLR), platelet to lymphocyte ratio (PLR) were calculated from these parameters.
Results: NLR, PLR, ESR, and CRP were significantly higher in patients with active BD group compared with inactive
BD group (all p<0.05). C3 and C4 were higher during the active period than during the inactive phase without statistical
significance. NLR significantly positively correlated with C3 (r=0.54, p<0.01) and C4 (r=0.36, p=0.01). Any laboratory
markers were not associated with oral, genital mucosal ulcer, uveitis, gastrointestinal or vascular lesion in BD. Multiple
Logistic regression analysis revealed that NLR to be an independent factor related to BD activity. (OR=1.41, p=0.04).
NLR showed good accuracy for prediction of disease activity, AUC of 0.706 with cutoff value of 2.7 (sensitivity: 47.7%,
specificity: 86.0%).
Conclusions: NLR, PLR, ESR and CRP might be helpful as biomarkers associated with severity of BD. Especially NLR
can be a simple tool with satisfactory power in predicting the disease activity of patients with BD.
Poster 67
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S246
Erosive Arthritis Resembling Osteomyelitis in Behcet’s Disease Patient
Jae Hyun Jung, Sung Jae Choi, Gwan Gyu Song, Jong Dae Ji, Young Ho Lee, Jae-Hoon Kim, Young Ho Seo
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Description: A 48-year-old woman, diagnosed with Behcet's disease (BD), visited to the clinic of reccurent both feet
pain persisted for about 2 years. She received corticosteroids, sulfasalazine, colchicine, and non-steroidal anti-in-
flammatory drugs. After about 2.5 years from first visit, her right foot pain was aggravated. Initially we suspected cellulitis
and started levofloxacin, but after 10 days there was no clinical improvement and MRI of the foot suggested osteomyelitis
with myositis. Bone scans revealed active inflammatory lesions in the right tarsal and left ankle joint areas that resembled
septic arthritis with combined osteomyelitis. Her colonoscopy revealed Behcet's colitis and we added azathioprine. Her
right foot pain improved but she developed left ankle pain. The left ankle and foot pain continued and despite to admin-
istration of levofloxacin for 3 weeks. She did not have infectious signs, so we suspected BD-related arthritis rather than
septic arthritis. We doubled the dose of corticosteroids and sulfasalazine. MRI of the left foot showed joint space narrow-
ing at the tibiotalar joint and suspicious bone erosion at the medial tibia that suggested BD-related arthritis with reactive
bone marrow edema rather than infectious arthritis with osteomyelitis. We started treatment with methotrexate, and
ceased azathioprine and sulfasalazine, and her joint symptoms improved.
Conclusions: Behcet’s arthritis should be considered in the differential diagnosis of BD patients with articular manifes-
tations that may be septic arthritis, especially when there is no response to antibiotics and negative culture study. After
septic arthritis is excluded, treatment of BD could improve joint symptoms. The long-term management strategy for
these patients should involve careful assessment of articular consequences and regular follow-up to assess changes, in-
cluding radiographic evidence of joint damage.
Poster 68
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S247
Risk Factors for Mortality in ANCA-Associated Vasculitides
Gi Bum Bae*, Jeong Soo Eun, Na Ri Kim, Eon Jeong Nam, Young Mo Kang
Department of Internal Medicine (Rheumatology), Kyungpook National University School of Medicine, Daegu, Korea
Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) has a high mortality rate,
although the introduction of cyclophosphamide and corticosteroids has changed the natural history of disease. However,
reported causes of death (COD) and risk factors for mortality vary between studies.
Objectives: To investigate the COD and risk factors for mortality in patients with AAV.
Methods: A retrospective study was conducted in 44 patients with microscopic polyangiitis (MPA) and 12 gran-
ulomatosis with polyangiitis (GPA) from January 1999 to December 2011. We reviewed medical records of patients in-
cluding demographic characteristics, clinical features, treatment agents, and causes of death.
Results: The mortality rate was 41.1% (23/56) with 5 deaths in patients with GPA and 18 with MPA. Among the sig-
nificant risk factors for mortality on univariate analysis, which include diffuse alveolar hemorrhage (DAH), renal involve-
ment, ≥4 organ involvements, ≥2 five factor score, and ≥4 treatment modalities, a multivariate regression analysis iden-
tified DAH as an independent predicting factor (OR, 10.28; 95% CI, 2.58-40.56; p<0.001). In an analysis of COD, nine-
teen deaths (82.6%) were related to infection. The most common COD was pneumonia (73.9%) which, in turn, was asso-
ciated with DAH (OR, 27.18; 95% CI, 4.30-171.80; p<0.001) and ≥4 organ involvement (OR, 7.62; 95% CI, 1.54-37.71;
p=0.013) as independent risk factors. Bacteria were the most frequent microorganisms causing pneumonia (68.2%), fol-
lowed by fungi (12.7%) and Pneumocyctis jirovecii (11.1%). Most frequently isolated bacteria were Acinetobacter bau-
manii (6 cases), and Staphylococcus aureus (6 cases). There were no significant difference in the mean number of patho-
gens between patients who survived and dead.
Conclusions: This study implicated that early intervention of pulmonary infection may be critical to increase survival
rates in AAV patients with DAH or severe manifestations.
Poster 69
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S248
Clinical Characteristics and Treatment Outcomes of Patients with Large Vessel Vasculitis Including Takayasu Arteritis
In Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim and Hoon-Suk Cha
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: Large vessel vasculitis is a disease that affects aorta or its major branches with the two major variant of
Takayasu arteritis (TA) and giant cell arteritis (GCA).
Objectives: This study aimed to investigate clinical features and outcomes of patients with large vessel vasculitis.
Methods: A retrospective review was performed on 2,496 patients who visited our center between 2004 and 2014.
After exclusion of other diseases, patients with primary large vessel vasculitis were further classified by age of onset and
disease activity. Patients whose ages of onset were younger than 50 years or those who had been diagnosed as inactive
disease at any age were classified as “TA” considering the natural course of TA. Patients with symptom onset older than
50 years with active disease were classified as “non-TA”. The term “GCA” was avoided in this study, since it is uncertain
whether non-TA is truly accord with GCA.
Results: 229 TA and 16 non-TA patients were identified. The majorities were females and 90% of TA patients met the
classic ACR criteria. TA patients had more headache and visual disturbance, while non-TA patients had higher frequency
of arthritis and polymyalgia rheumatica. The major locations of lesion were the aorta and primary branches of arch with
no difference between groups. Stenosis were more frequent in TA patients (99% vs. 63%). 94% of non-TA patients re-
ceived glucocorticoids compared to only 37% of TA patients. Immunosuppressant was given to 15% of TA and 50% of
non-TA patients. 50% of TA patients showed chronic inactive disease course, while 70% of non-TA patients showed sus-
tained activity. However, the overall clinical course of patients with initially active TA was not significantly different from
that of non-TA patients.
Conclusion: We reviewed 245 patients with large vessel vasculitis and classified patients into TA vs. non-TA according
to the onset age and disease activity. Further studies for diagnosis, treatment and monitoring are needed.
Poster 70
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S249
Clinical Characteristics and Treatment Outcomes of Patients with Chronic Periaortitis
In Young Kim, Yeonghee Eun, Hyemin Jeong, Hyungjin Kim, Jaejoon Lee, Eun-Mi Koh, Duk-kyung Kim and Hoon-Suk Cha
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: Chronic periaortitis (CP) is characterized by a fibroinflammatory periaortic cuff in image and adven-
titia-predominant fibrosis in histology. CP encompasses idiopathic retroperitoneal fibrosis and inflammatory abdominal
aortic aneurysm (AAA), and recent studies have documented overlap between CP and IgG4-related disease (IgG4-RD).
Objectives: This study aimed to investigate clinical characteristics and treatment outcomes of patients with CP.
Methods: Overall 2,496 patients who visited our center between 2004 and 2014 were screened, and patients compat-
ible with CP were enrolled based on imaging findings for a retrospective review. Patients were further classified into two
subgroups: IgG4-related and non IgG4-related according to the diagnostic criteria for IgG4-RD proposed by a Japanese
study.
Results: A total of 61 CP patients were identified. Patients showed a male predominance (70%) with the median age
of 61 at diagnosis. The abdominal aorta was most commonly involved (84%), and the thoracic aorta was involved in 46%
of patients. Only 2 patients had stenosis of the aorta, while 19 patients had aneurysmal changes. Ureteral obstruction was
found in 30%. 49 (80%) patients received glucocorticoids and 19 (31%) patients received immunosuppressants. 9 pa-
tients underwent surgery including 7 cases of AAA repair, 2 cases of aortic valve replacements and 4 patients underwent
endovascular AAA repair. 60% of patients achieved remission without relapse during the course. When the Japanese cri-
teria for IgG4-RD were applied, 10 patients were classified as IgG4-related and 25 as non IgG4-related. There was no sig-
nificant difference in clinical features, treatment outcomes between groups, with the exception of older age, higher serum
globulin, IgG and IgG4 levels and greater pancreas involvement in IgG4-related patients.
Conclusion: We identified 61 CP patients including ten IgG4-related cases. Further studies for pathogenesis and treat-
ment strategies are warranted.
Poster 71
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S250
ANCA is Associated with the Clinical Manifestations of EGPA
Dae-Sik Kim, Jung Yoon Pyo, Se-Jin Byun, Sung Soo Ahn, Jungsik Song, Yong-Beom Park, Soo-Kon Lee, Sang-Won Lee
Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Background: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg Strauss syndrome, is clas-
sified among the small and medium-sized vessel vasculitis associated with antineutrophil cytoplasmic antibody (ANCA).
During the course of the disease, various symptoms and inflammatory feature of organ can occur.
Objectives: The objective of this study was to determine the relationship between clinical features and ANCA in EGPA.
Methods: We retrospectively reviewed medical records of thirty patients, who had been first classified as EGFA at
Yonsei University Health System, from January 2010 to December 2014. All patients were categorized according to the
six American College of Rheumatology (ACR) classification criteria.
Results: The median age of 71 SLE patients was 50.3 (37.0-56.0) and the proportion of female gender was 60.0%.
Among the ACR criteria, eosinophilia was the most commonly satisfied factor (86.7%). ANCA was measured in 28 pa-
tients and was positive in fourteen (50.0%) (p-ANCA : 39.3% vs c-ANCA : 10.7%). The most common clinical feature
was asthma (83.3%) followed by sinusitis (76.7%) and pulmonary infiltrates (60.0%). Neuropathy was diagnosed in 17
(56.7%) of the patients, 2 (6.7%) of whom had both peripheral neuropathy and central nervous system manifestations.
ANCA positive patients had significantly more frequent renal and neurologic involvement than ANCA negative patients
(Renal involvement: 6 (43.9%) vs 1 (7.1%), p=0.029, Neurologic involvement: 12 (85.7%) vs 4 (28.6%), p=0.002). In
ANCA negatie patients, Lung infiltrates was more frequent than in ANCA positive, but the differences were not statisti-
cally significant (Fig. 1). Treatment response was not significantly different between ANCA positive and negative (Table 1).
Conclusions: The clinical manifestations of EGPA patients differ according to their ANCA status. ANCA positive pa-
tients showed more frequent renal and neurologic involvement.
Poster 72
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S251
Effect of Teriparatide in Patients with Osteoporosis and Rheumatoid Arthritis
Sae Young Lee1*, Robin Dore2, Kenneth Saag3, Guillermo Valenzuela4, Kathleen Taylor5, Qiu He5, Jahangir Alam5, Kelly Krohn5
1Lilly Korea, on behalf of Eli Lilly and Company, Indianapolis, IN, 2University of California, Los Angeles, CA, 3The University of Alabama at Birmingham, Birmingham, AL, 4Integral Rheumatology and Immunology Specialists, Plantation, FL,
5Eli Lilly and Company LLC, Indianapolis, IN, USA
Background: A common complication in rheumatoid arthritis (RA) is osteoporosis (OP) with increased incidence of
fragility fractures.
Objectives: The effect of teriparatide (TPTD) on clinical vertebral (VERT) and nonvertebral (NV) fragility fractures,
BMD and safety was examined in the subgroup of OP patients with RA enrolled in the open-labeq,prospective,ob-
servational DANCE trial.
Methods: Patients were treated with TPTD 20 g/day for ≤2 years and followed for up to 2 more years. Mixed model
repeated measures analysis was used to evaluate BMD changes over 18 months. New clinical VERT or NV fragility frac-
tures after 6-24 mo vs 0-6 mo of TPTD therapy and time to new NV fragility fracture were compared.
Results: Of 4085 patients who received ≥1 dose of TPTD, 544 had documented RA. Patients with vs without RA at
baseline had similar age but significantly more history of prior NV fractures, higher L1-L4 T-scores, more baseline clinical
conditions, more glucocorticoid use. Mean TPTD exposure was similar. Over 18 mo, bone density in the spine, femoral
neck,and total hip increased similarly in patients with vs without RA. Incident rates of new VERT or NV fragility fractures
decreased in mo 6-24 vs mo 0-6. There was no significant difference in the decrease in fracture incidence in mo 6-24 vs
mo 0-6in the patients with vs without RA, regardless of the type of fracture. There was no difference in the time to a new
NV fragility fracture by RA status. NV fracture incidence rates/100 patient-years decreased vs reference baseline during
treatment and stayed down. TPTD was well tolerated overall, and no new significant safety findings were observed.
Conclusion: Patients with RA receiving TPTD showed similar increases in BMD at the spine, femoral neck, and total
hip, and similar reduction in the incidence of NV fractures compared with patients without RA. The incidence of NV frac-
tures remained down after drug cessation.
Poster 73
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S252
Effect of Urate Lowering Therapy on Renal Disease Progression in Hyperuricemic Patients with Stage 4 Chronic Kidney Disease
Kwanghoon Lee
Department of Internal Medicine, Dongguk University Ilsan Hospital
Objective: To determine whether urate lowering therapy (ULT) delays renal disease progression in hyperuricemic pa-
tients with stage 4 chronic kidney disease (CKD) and whether the baseline stage of CKD affects renal outcomes in ULT
treatment.
Methods: One hundred and forty three patients (53 treated with ULT and 90 with conventional treatment only) with
both hyperuricemia and stage 4 CKD were retrospectively reviewed. Several renal outcomes including the proportion of
patients with renal disease progression were compared between the 2 groups (Non-ULT vs. ULT). In order to evaluate
the implication of baseline stage of CKD, we combined the data of current study with that of our previous one, which dealt
with patients with stage 3 CKD, and performed binary logistic regression analysis for factors associated with renal disease
progression.
Results: We found no significant difference between the 2 groups in terms of the proportion of patients with renal dis-
ease progression (55/90 (61.1%) vs. 33/53 (62.3%), P=1.000), the proportion of patients who started dialysis (31/90
(34.4%) vs. 23/50 (43.4%), P=0.291) and the mean change of eGFR value from baseline (-8.0±10.0 vs. -8.3±10.4,
P=0.878). Binary logistic regression analysis revealed that baseline stage of CKD (3a, 3b and 4) was independently asso-
ciated with renal disease progression (P for trend<0.001).
Conclusion: ULT did not show any benefit on renal disease progression in hyperuricemic patients with stage 4 CKD.
The effect of ULT decreased as the renal disease progressed.
Poster 74
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S253
The Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients Undergoing Dialysis
Doo-Ho Lim1, Ji Seon Oh2, Byeongzu Ghang3, Seokchan Hong3, Yong-Gil Kim3, Chang-Keun Lee3, Seung Won Choi1, Bin Yoo3
1Division of Rheumatology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 2Division of Rheumatology, National Medical center, Seoul, 3Division of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background: Febuxostat is metabolized mainly in the liver and is excreted through both urine and feces, suggesting
that it may be an alternative choice for the treatment of hyperuricemia and gout in chronic kidney disease (CKD) patients.
However, there are insufficient data on the use of febuxostat in patients undergoing dialysis.
Objectives: The aims of our study were to investigate the efficacy and tolerability of febuxostat in hyperuricemic pa-
tients on dialysis.
Methods: We retrospectively reviewed clinical and laboratory data from two tertiary referral centers from January 2012
to December 2015. We included 49 patients with underlying CKD on dialysis who started febuxostat treatment in the
two hospitals.
Results: The mean age of the study patients was 54.4±12.5 year and follow-up duration was 12.7±10.2 months. Thirty
six patients (73.5%) were also diagnosed with gout. Among 41 patients who were treated with febuxostat for over 3
months, the mean serum uric acid level at 3 months after treatment (4.97±1.84 mg/dL) was significantly reduced com-
pared with the pretreatment level (9.61±2.18 mg/dL) (p<0.001). And the serum uric acid level stayed significantly lower
for 12 months without deterioration in eGFR. Of the 49 patients, only 2 stopped the medication due to adverse event.
The two patients who stopped taking febuxostat were on peritoneal dialysis.
Conclusions: Febuxostat is efficacious and well tolerated in hyperuricemic patients undergoing dialysis. Close ob-
servation for adverse events might be needed for patients on peritoneal dialysis.
Poster 75
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S254
Identification of Subclinical Tophi in Patients with Gouty Arthritis: A Dual-energy Computed Tomography Study
In Je Kim1, Ji Young Hwang2, Jisoo Lee1
1Division of Rheumatology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, 2Department of Radiology,Ewha Womans University School of Medicine, Seoul, Korea.
Background: Tophi are generally considered as manifestations of chronic gout, but subclinical tophi in intra- and ex-
tra-articular structures have been shown to occur in early gout and asymptomatic hyperuricemia. Since occurrence of to-
phi is linked to joint destruction, it is important to detect tophi early before clinical detection.
Objective: The aim of our study was to evaluate the utility of dual-energy CT (DECT) in detecting subclinical tophi in
patients with gouty arthritis.
Methods: DECT scans of feet in 71 patients with gout without apparent clinical tophi were evaluated for presence of
tophi. Plain X-ray of feet, clinical and laboratory data were obtained simultaneously at the time of the DECT evaluation.
Total volumes of tophi in both feet were quantified using an automated software program of DECT.
Results: The mean age of gout patients was 47.3±14.8 years, and median disease duration was 2.6 (range 0-20) years.
Subclinical tophi were detected in 70 (98.6%) patients and in 793 (39.9%) joints, and median 9 (0 to 26) joints per patient
were positive for tophi. The most common sites for tophi were first metatarsophalangeal joints (17.8%), followed by an-
kle joints (11.0%). Tophi in Achilles tendons were present in 10.8% of patients. Patients with early gout (disease dura-
tion<2 years) had tophi in 99 (13.6%) joints. Mean number and volume of tophi were not significantly different between
early gout and chronic gout.
Conclusions: Tophi frequently occur in both intra- and extra-articular structures of gouty arthritis patients despite ab-
sence of clinically apparent tophi. DECT is an excellent imaging modality for detecting subclinical tophi.
Poster 76
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S255
Clinical Features and Risk Factors of Gout Attacks Following Anti-tuberculous Treatment
Sang Wan Chung1, Eun Ha Kang1, Yun Jong Lee1,2, You Jung Ha1
1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Background: Taking some anti-tuberculous (TB) drugs is known to induce hyperuricemia and trigger gout attack.
However, there have been no well-described studies for gout during anti-TB therapy.
Objective: The aim of this study was to investigate the clinical features and risk factors of gout attacks following anti-TB
treatment.
Methods: We conducted the case-control study including 20 patients who developed gout attack following anti-TB
medications and 60 age-sex matched TB controls without gout attack. Demographics, clinical features and laboratory
findings of patients with gout attacks following anti-TB therapy were analyzed and compared to those of controls in order
to establish risk factors associated with gout attack during anti-TB treatment.
Results: The mean age was 62.7±15.5 years and 10 patients were male (80%). 11 patients had a previous history of
gout. The mean time interval to develop gout attack was 3.7±5.3 months from the initiation of anti-TB therapy. The at-
tacks tended to involve lower extremity joints (18/20, 90%), especially the ankle joint (10/20, 50%). Patients with gout
attack were treated with rifampin (n=17), isoniazid (n=14), ethambutol (n=14), pyrazinamide (n=10), or others
(n=15). Patients who developed gout following anti-TB medication have higher body mass index (23.8 vs 21.3 kg/m²,
p=0.024), more decreased renal function (eGFR 58.8 vs 83.9 mL/min/1.73m2, p=0.039) and higher pre-treatment se-
rum urate levels (8.3 vs 5.3 mg/dl, p<0.001). An elevated pre-treatment serum urate level was found to be an in-
dependent risk factor for gout attack following anti-TB treatment (OR 2.04, 95% CI 1.32-3.16, p=0.001).
Conclusion: Patients who developed gout attack following anti-TB therapy had higher pre-treatment serum urate level.
We suggest that physicians who start anti-TB therapy in TB patients with high pre-treatment serum urate level should
pay attention to the development of gout attack and educate the patients.
Poster 77
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S256
Increased Carotid Intima-media Thickness was Related with Elevated Serum Homocysteine Level
in Patients with Hyperuricemia
Ji Ho Park, Jung-Soo Song, Sang Tae Choi
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
Background: Hyperuricemia and hyperhomocysteinemia are known to be associated with metabolic syndrome and car-
diovascular disease. However, there was no report about the relationship between Hcy and atherosclerosis in patients
with hyperuricemia.
Objectives: We investigated whether carotid intima-media thickness (IMT) was increased in patients with
hyperuricemia. We also evaluated the correlation between serum homocysteine (Hcy) level and carotid IMT in hyper-
uricemic patients.
Methods: This study includes 1,228 patients who visited the Health Promotion Center of Chung-Ang University
Hospital from January 2013 to August 2015. Serum Hcy level was measured by a competitive immunoassay using direct
chemiluminescent. Carotid IMT was measured by B-mode carotid ultrasonography. Hyperuricemia and hyper-
homocysteinemia were defined as the serum uric acid>7.0 mg/dL, and as the serum Hcy>15.0μmol/L.
Result: Patients with hyperuricemia showed significantly higher levels in serum Hcy than normouricemic individuals
(13.65±4.47μmol/L vs 11.68±3.65μmol/L, p<0.001). Carotid IMT in hyperuricemia group was significantly thicker
than that in normouricemia group (1.13±0.66 mm vs 1.03±0.53, p=0.029). In patients with hyperuricemia, carotid IMT
was correlated with serum Hcy level (γ=0.209, p=0.007), estimated glomerular filtration rate (eGFR), serum BUN and
Cr levels (γ=-0.318, p<0.001; γ=0.229, p=0.003; γ=0.311, p<0.001, respectively). In multiple linear analyses, car-
otid IMT was affected by eGFR (β=-0.289, p=0.001), however, it was not influenced by glucose level and cholesterol
profiles in patients with hyperuricema.
Conclusions: Carotid IMT was higher in patients with hyperuricemia than in those with normouricemia, and it was
correlated with serum Hcy level in patients with hyperuricemia. This study suggests that decreased renal function in pa-
tients with hyperuricemia leads to elevated serum Hcy level, which in turn leads to atherosclerosis.
Poster 78
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S257
Insulin Resistance as an Independent Predictor of Erectile Dysfunction in Patients with Gout
Ji Hun Kim, Howook Jeon, Seo Hwa Kim, Haneul Kim, Jihyung Yoo, Min Kyung Chung, Jung Hee Koh, Jennifer Lee, Ji Yeon Lee, Seung-Ki Kwok, Ji Hyeon Ju, Sung-Hwan Park
Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Objectives: Gout is linked with a number of metabolic disorders. Recent studies have reported that erectile dysfunction
(ED) is increased in patients with gout and has been linked with similar comorbidities of gout. The aim of the present
study was to identify independent predictor of ED in patients with gout.
Methods: From August 2014 to August 2015, outpatients who were men and treated for gout in our rheumatology clin-
ic were enrolled. Healthy males without any history of inflammatory disease were included as control group. ED was as-
sessed by using the five-item version of the International Index of Erectile Function questionnaire in participants. Insulin
resistance (IR) was measured by homeostatic model assessment (HOMA). Logistic regression analysis was performed
to estimate the effect of variables on presences of ED on all of the study subjects and patients with gout.
Results: We analyzed 80 patients with gout and 70 healthy controls. The median age of patients with gout was 52 years
and median disease duration was 120 months. Gout patients had more ED compared to controls (55.3% vs. 41.4%,
P<0.047). After adjustment of compounding factors, only HOMA-IR was significantly associated with ED (OR: 1.82,
95% CI: 1.05-3.15). Older age (P<0.001), higher HOMA-IR (P=0.048) and lower glomerular filtration rate (GFR)
(P=0.038) were observed in patients with gout with presence of ED than without ED in gout patients. Multivariate logis-
tic regression analysis showed that HOMA-IR was an independent predictor for the presence of ED (OR: 1.62, 95% CI:
1.03-2.82) in gout patients.
Conclusion: In our study, IR was an independent predictor of ED in patients with gout.
Poster 79
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S258
MTHFR C677T Polymorphism is Associated with Increase in Homocysteine but not with Uric Acid
Il Woong Sohn1, Chan-Bum Choi2, Young Seo Kim3, Jae-Bum Jun2
1Department of Rheumatology, Hanil General Hospital, Seoul, 2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 3Department of Neurology, Hanyang University Hospital, Seoul, Korea
Background: Hyperhomocysteinemia is reportedly associated with high serum uric acid (sUA) levels. MTHFR C677T
polymorphism is associated with increase in serum homocysteine (sHcy). Some studies have suggested a positive corre-
lation between MTHFR C677T polymorphism and sUA, but it remains unclear.
Objectives: We aimed to evaluate the association between sHcy and sUA as well as MTHFR C677T polymorphism and
sUA.
Methods: Hyperuricemia was defined as >7.0 mg/dl for male and >5.6 mg/dl for female. Hyperhomocysteinemia was
defined as >15μmol/l. Clinical laboratory examinations and genotyping for MTHFR C677T polymorphism was
performed. Statistical analyses were performed using chi-square, Pearson’s correlation coefficients, and ANOVA.
Results: Data from 861 subjects(264 male and 597 female) were analyzed. The mean age was 73.2±11.3 years in male
and 75.3±10.3 years in female. Subjects with elevated sHcy levels had an odds ratio (OR) of 2.7 (95% CI 1.4-5.4) in male
and 2.0 (95% CI 1.4-3.1, p=0.001) in female for hyperuricemia. The genotype frequency of MTHFR C677T was 32.8%
(n=282) for CC, 49.8% (n=429) for CT, and 17.4% (n=150) for TT. TT genotype showed association with hyper-
homocysteinemia when both gender were analyzed (p<0.001, ANOVA). MTHFR C677T polymorphism was not asso-
ciated with sUA level (Table 1).
Conclusion: TT genotype of the MTHFR C677T was associated with hyperhomocysteminema. A positive association
was observed between sHcy levels and sUA levels for both males and females which is in agreement with previous
studies. MTHFR C677T polymorphism is not associated with sUA level, which is inconsistent with recent studies.
Poster 80
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S259
Macrophage Migration Inhibitory Factor in Gout
Hae-Rim Kim1, Kyung-Ann Lee1, Kyoung-Woon Kim2, Bo-Mi Kim1,2, Sang-Heon Lee1
1Department of Rheumatology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 2Concersant Research Consortium in Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Objective: Macrophage migration inhibitory factor (MIF) is proinflammatory, angiogenic and tissue degrading
cytokine. This study aimed to determine monosodium urate (MSU)-induced MIF production and the role of MIF in gouty
arthritis.
Methods: Peripheral blood and clinical data were obtained from 98 patients (31 patients with acute gouty arthritis and
67 patients with intercritical gout). Synovial fluid (SF) was obtained from patients with acute gouty arthritis and SF white
blood cells and neutrophils were counted. SF and serum levels of MIF, interleukin (IL)-1, IL-8 and leukotriene B4, were
measure using enzyme-linked immunosorbent assay (ELISA) and their relationship was analyzed. Peripheral blood mon-
onuclear cells (PBMC) were isolated and cultured with MSU crystal, the production of MIF was determined.
Results: SF MIF level was higher in acute gouty arthritis than osteoarthritis. Serum MIF was higher in patients with
intercritical gout than patients with acute gouty arthritis or healthy volunteers. SF MIF level was positively correlated
with SF WBC and neutrophil counts, IL-1β and IL-8 levels in acute gouty arthritis. Serum MIF level was correlated with
IL-1b and IL-8 levels in patients with intercritical gout. MSU crystal induced MIF production in PBMC with maximal ef-
fect at 100 mg/ml.
Conclusion: MIF was highly produced in gouty arthritis and MSU induced MIF production. MIF could be involved in
early inflammatory process in acute gouty arthritis.
Poster 81
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S260
A Case of Cryopyrin Associated Periodic Fever Syndrome (CAPS) with Mutation of NLRP3
as Autoinflammatory Syndrome
Sooyeon Lim1, Minji Son1, Yumi Seo1, Kumi Jeong1, Kihwan Kim1, Jungwoo Rhim1, Seungbeom Han1,3, Jinhan Kang1,3, Myungshin Kim2, Daechul Jeong1,3
1Department of Pediatrics, 2Catholic Genetic Laboratory Center, 3Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea
Cryopyrin-associated periodic syndrome(CAPS) is a group of autoinflammatory disorders characterized by mutations
in genes encoding the NLRP3 inflammasome. Affected patients develop episodic fevers, urticaria, and arthralgias. We re-
port a case of CAPS presenting with fevers, rash and arthralgia.
A 13-month-old boy was hospitalized for evaluation of fever and standing difficulty during 1 day. He had urticarial rash
since 1 month after birth, and presented with episodes of prolonged fever. Fever was partially controlled by NSAID and
urticarial rash persisted in spite of anti-histamine and steroid treatment. His physical examination for this admission re-
vealed no significant finding except abnormal skin rash. There was no swelling on any joint and no focus of fever. On labo-
ratory study, there were leukocytosis, high ESR and CRP. Allergy tests including MAST, IgE, and eosinophilic cationic pro-
tein and immunologic tests including serum immunoglobulin were within normal range. Bone scan and auditory brain
response were normal. We evaluated genetic study for CAPS because of uncontrollable fever and persistent urticarial
rash. Gene analysis showed a point mutation on exon 5 (c.932T>C) in NLRP3. There is no serious organ damage like
as neurologic abnormality, hearing loss, joint abnormality or secondary amyloidosis until 13 months of age. Standing and
walking were improved after low dose steroid and NSAID. We must be close observation and monitoring after treatment
with anti-IL1 inhibitor.
Fever with rash is common symptoms due to infection in children. We have to consider autoinflammatory disease in
child with repeated fever and skin manifestations in the absence of definite infections.
Poster 82
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S261
Treatment Pattern and Its Cost of Vertebral Fracture among Elderly Patients in Korea
Dam Kim1, Jeonghoon Ahn2, Yoon-Kyoung Sung1
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
Background: Vertebral fracture (VF) is a hallmark of osteoporosis, and it increases morbidity, mortality and large
amount of medical cost.
Objectives: In this study, we aimed to describe the treatment pattern and estimate the cost of VF among elderly pa-
tients in Korea.
Methods: Using Korean national healthcare claims database, we analyzed a 2% sample of patients aged ≥50 years be-
tween years of 2008 and 2012. New VF was identified on the basis of selected ICD-10 codes in patients who did not have
VF in past 1 year, and medical cost includes in-hospital and outpatient medication cost. After estimating incidence of VF,
treatment pattern and medical cost in first and second year in VF were compared according to age and gender.
Results: The incidence of VF was much higher in female (616 and 1,597 per 100,000 in male and female, respectively).
The 14% of patients underwent vertebroplasty or kyphoplasty, 42% of patients needed hospitalization for pain control,
the other 43% were treated without hospitalization. Patients aged 50-59 years showed lowest proportion for verte-
broplasty or kyphoplasty (1.8% in male and 8.2% in female), the proportion was increased with the age (7.9% in male
and 12.2% in female aged 60-69 years; 16.7% and 17.5% in 70-79 years; 20.0% and 17.7% ≥80 years). Patients under-
went vertebroplasty or kyphoplasty paid the largest medical cost in first year (w1,973×103 in male and w1,950×103 in
female), followed by hospitalization (w981×103 and w885×103) and without hospitalization (w393×103 and
w338×103). In addition, medical cost according to age group did not show significant trend, whereas proportion of medi-
cal cost in second year was increased with age.
Conclusion: In Korean patients with VF, 14% of patients underwent vertebroplasty or kyphoplasty, and the proportion
was increased with age. In addition, older patients tend to pay more medical cost for longer period.
Poster 83
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S262
Evaluation of the Inpatient Rheumatology Consultation Service: A Single Tertiary Center Experience
Chan Uk Lee, Sung- Hoon Park, Hwajeong Lee, Ji-Na Kim, Ji-Won Kim, Seong-Kyu Kim, Jung-Yoon Choe
Division of Rheumatology, Department of Internal Medicine Catholic University of Daegu School of Medicine, Korea
Background/Objectives: Consultation is an important aspect of rheumatology fellowship training and an essential
service provided by academic rheumatology divisions. The objective of this investigation is to profile the spectrum of dis-
ease which might be encountered in the consultation service.
Methods: The medical records of all patient consults during the year 2015 at a university hospital were reviewed with
regard to reason for consult, demographic data, and final rheumatologic diagnosis and consequences.
Result: A total of 478 consultations regarding 374 patients were seen on medical center consult service in 2015. Mean
age of patients was 57.7 year-old, and 242 (65%) patients were female. There were 190 patients related rheumatoid dis-
ease and 184 patients not related. Among patients with rheumatic disease, 115 (30.7%) patients were previously diag-
nosed to rheumatic disease and 75 (20.0%) patients were newly diagnosed during hospitalization. The 6 major disease
entities of newly diagnosed patient were crystal arthropathy, systemic lupus erythematous, vasculitis, adult onset still`s
disease, and rheumatoid arthritis. Two main reasons for consultation were laboratory abnormalities (anti-nuclear anti-
body, anti-neutrophil cytoplasmic antibody, anti CCP antibody, rheumatoid factor, etc.) and musculoskeletal symptom
(arthralgia and/or fever), or mixture them. Among patients with newly diagnosed as a rheumatic diseases, 67 (17.9%)
patients were consulted from division of infectious diseases followed by division of cardiology, neurology, and pulmonary
diseases.
Conclusion: There were a significant number of patients newly diagnosed with rheumatic diseases by consultation
service during hospitalization period. We need to be more cautious to patients with an important symptom and sign, es-
pecially arthralgia and/or fever.
Keywords: Consultation, Rheumatology, Hospitalization
Poster 84
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S263
Utilization Patterns of Medication in Women with Rheumatoid Arthritis of Childbearing Age:
Result from KORONA Cohort
Soo-Kyung Cho1,2, Yoon-Kyoung Sung1,2, Dam Kim1,2, Soyoung Won2, Hoon-Suk Cha3, Jung-Yoon Choe4, Chan-Bum Choi1,2, Won Tae Chung5, Seung-Jae Hong6, Jae-Bum Jun1, Jinseok Kim7, Tae-Hwan Kim1, Eunmi Koh3,
Hye-Soon Lee8, Jisoo Lee9, Shin-Seok Lee10, Sung Won Lee5, Dae-Hyun Yoo1, Sang-Cheol Bae1,2
1Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, 3Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 4Catholic University of Daegu School of Medicine, Daegu,
5Dong-A University Hospital, Busan, 6Kyung Hee University Hospital, Seoul, 7Jeju National University Hospital, Jeju, 8Hanyang University Guri Hospital, Guri, 9Ewha Womans University Mokdong Hospital, Seoul, 10Chonnam National University Hospital, Gwangju, Korea
Objectives: This study aimed to compare the disease activity between the women RA with childbearing age who were
planning a pregnancy and who were not planning a pregnancy, and identify the difference in their utilization of the medi-
cines for RA.
Methods: We included 1,440 women with RA of childbearing age from the KORONA cohort. The patients were catego-
rized into those with a pregnancy plan (n=596) and without a pregnancy plan (n=844). The disease activity calculated
by disease activity score 28 ESR (DAS28ESR) and the patterns of DMARDs, and corticosteroids use were compared be-
tween two groups using the Chi-square test.
Result: The women patients with a pregnancy plan had significantly lower age at 37.3 compared to those without a
pregnancy plan at 43.2 (p<0.001). The DAS28 ESR was similar between two groups (3.65±1.33 for the patients with
a pregnancy plan vs. 3.60±1.32 for the patients without a pregnancy plan, p=0.51). The proportion of the patients with
remission was higher in patients with a pregnancy plan at 25.0% than at 23.3% in patients without a pregnancy plan, but
there was not statistically significant (p=0.38). In the utilization of medication, the methotrexate and leflunomide use
were lower in the patients with a pregnancy plan than those of the patients without a pregnancy plan (80.0 % vs. 87.3%,
p<0.001 in methotrexate, 26.5% vs. 33.7% in leflunomide, p=0.005). On the other hand, the corticosteroid and biologic
DMARDs use were higher in the patients with a pregnancy plan than those of the patients without a pregnancy plan
(74.0% vs. 68.8%, p=0.04 in corticosteroid, 8.7% vs. 4.5%, p=0.002 in biologic DMARDs).
Conclusion: The disease activity of the women RA with childbearing age who had pregnancy plan was similar to that
of the patients without a pregnancy plan. In the use of medicine, the patients with pregnancy plan used less methotrexate
and leflunomide and more corticosteroid and biologic DMARDs compared to the patients without pregnancy plan.
Poster 85
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S264
The Effect of Rheumatoid Factor on All-cause, Cardiovascular and Cancer-cause Mortality in 296,581 Korean Subjects:
A Kangbuk Samsung Health Study
Joong Kyong Ahn1, Jiwon Hwnag2, Seungho Ryu3, Yoosoo Chang3
1Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 2Division of Rheumatology, Department of Internal Medicine, National Police Hospital, Seoul, 3Department of Occupational and
Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: The presence of rheumatoid factor (RF) in patients with rheumatoid arthritis (RA) associates with an in-
creased overall mortality. However, the clinical effect of RF are incompletely known, particularly in general populations.
Objective: The aim of this study was to determine the association of RF with mortality due to all-causes, cardiovascular
disease (CVD), and cancer in Koreans.
Methods: Among 295,581 participants of a health-screening program between 2002 and 2012, the risk of death from
all-causes, CVD, and cancer was calculated based on the presence or titers of RF. Vital status and confirmation of the
cause of death were based on the analysis of death certificate records from the National Death Index.
Results: The prevalence rate of RF positivity (RF>20 IU/L) was 4.4 %. During 1,449,464.9 person-years of follow-up,
1,404 participants died. The mortality risk due to all-cause and cancer-cause significantly increased in RF-positive sub-
jects compared to RF-negative subjects, respectively (HR 1.34, 95% CI 1.12-1.61; HR 1.35, 95% CI 1.05-1.74). All-cause
mortality risk significantly increased about two-fold in subjects in the 2nd quartile (20-49 IU/mL) compared with
RF-negative subjects after adjusting confounding factors (HR 1.96, 95% CI 1.38-2.78). The HR for cancer-cause mortal-
ity linearly increased as RF increased. In particular, cancer-cause mortality risk significantly increased in subjects with RF
>100 IU/L (HR 2.04, 95% CI 1.29-3.21). However, the HR for cardiovascular mortality was not higher in RF-positive
subjects than RF-negative subjects (HR 0.94, 95% CI 0.52-1.71).
Conclusions: Mortality risk from all-causes and cancer significantly increased in RF-positive subjects compared with
RF-negative subjects. The HR for cancer-cause mortality linearly increased depending on RF titer.
Poster 86
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S265
Prevalence and Incidence of RA and Medical Care Utilization in Elderly Onset RA Patients:
An analysis of Korean National Health Insurance Claims Data
Soyoung Won1, Soo-Kyoung Cho1,2, Dam Kim1,2, Minkyung Han1, Jiyoung Lee1, Hyuk Hee Kwon2, Eun Jin Jang3, Yoon-Kyoung Sung2, Sang-Cheol Bae1,2
1Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, 2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 3Department of Information Statistics, Andong National University, Andong, Korea
Objects: To identify the prevalence and incidence rates of RA and to investigate the pattern of medical care and drug
utilization in Korea.
Methods: We used Korean National Health Insurance claims data. In 2009-2012, RA was defined by having a medical
claim with RA, prescription of DMARDs within one year after the claim. RA patients identified in 2010 claims with no
codes or prescription for RA during the previous one year and continuous treatment for RA in 2011-2013 were defined
as the incident cases in 2010, and classified into 2 groups: elderly onset RA patients (EORA, ≥60 years) and young onset
RA patients (YORA, ≥19 and <60 years). The patterns of medical care and drug utilization were compared.
Results: The prevalence of RA increased every year (0.28 to 0.32%), and the incidence of RA was 28 per 100,000 per-
son-years. Among the prevalent cases, the use of biologic DMARDs increased (2.3 to 4.1%). Hydroxychloroquine (HCQ)
(57.5-62.5%) was most commonly used non-biologic DMARDs, followed by methotrexate (MTX) (50.0-51.9%). The use
of leflunomide (15.2 to 18.5%) and taclorimus (1.5 to 4.4%) increased, while use of HCQ (62.5 to 57.5%) and sulfasala-
zine (SSZ) (25.5 to 22.4%) decreased. The number of outpatient visit (14.5 vs 13.8) and the frequency of hospitalization
with RA code (18.8 vs 11.3%) were higher in EORA. Use of biologic DMARDs (1.4 vs 2.4%) was less frequently, while
NSAIDs (98.2 vs 97.7%) was used more frequently in EORA than YORA. Use of any non-biologic DMARDs was similar
between the 2 groups. HCQ was more frequently used in EORA (75.0 vs 72.1%), but MTX (55.2 vs 59.3%) and SSZ (28.0
vs 32.7%) were used less frequently than YORA.
Conclusions: Prevalence of RA is in increase in Korea. Use of medical care utilization was higher in EORA. The use
of biologic DMARDs were low in both groups and EORA receiving even less biologic DMARDs than YORA. The use of
non-biologic DMARDs similar between 2 groups, but EORA used more HCQ and less MTX and SSZ than YORA.
Poster 87
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S266
Medical Care Utilization among the Korean Patients with Systemic Lupus Erythematosus
Seung Lee1, Young Bin Joo1, So-Yeon Park2, Hyuk Hee Kwon1, Hye-soon Lee1, Yoon-Kyoung Sung1, Sang-Cheol Bae1
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, 2Department of Rheumatology, Myongii Hospital, Goyang, Korea
Background: This study aimed to investigate the medical utilization in SLE patients using Korean National Health
Insurance (NHI) claims database covering almost all Korean population.
Methods: The distribution of the number of patients who used medical care were evaluated according to the type of
medical service, medical institutions, specialty of doctors and medications among the prevalent SLE patients between
January and December in 2010.
Results: The prevalent SLE patients in 2010 were 13,047 and their rate per 100,000 was 26.5(95% CI 26.0-27.0). Mean
age was 39.7±14.6 years and female was 85.7%. As investigated the type of medical service, 84.8% of the patients had
outpatient visits with mean visit frequencies of 9.7. 39.2% of the patients had one or more than hospitalization service
with mean hospitalization duration of 14.9 days. 15.7% of patients visited an emergency room and 8.7% of patents under-
went surgery. In the type of medical institution, tertiary hospital was the most commonly visited institution (67.0%), fol-
lowed by general hospital (20.9%), community hospitals/clinics (11.5%). Disease of the connective tissue (79.9%), pep-
tic ulcer (29.6%)and chronic lung disease (25.5%)were the top three common causes of visits. The most frequent spe-
cialty of prescribing doctor was internal medicine (80.8%, the proportion of rheumatology was 72.2% within internal
medicine), followed by orthopedics (6.8%), pediatrics (2.9%). The percentage of prescribed medication was cortico-
steroids (72.9%), anti-malarial agents (64.2%) and immunosuppressants (34.4%).
Conclusion: About 88% of SLE patients have used large teaching (tertiary or general) hospitals and only 11.5% of them
have used small hospital/clinics. Rheumatologists were responsible for about 58% of patients with SLE.
Poster 88
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S267
A Case of Serotonin Syndrome Following the Administration of Duloxetine in a Fibromyalgia Patient:
Case Report and Review of Literature
Joon Sul Choi, Ji Hyun Lee
Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
Serotonin syndrome is an adverse drug reaction that is a consequence of excess serotonergic agonism of central nerv-
ous system receptors and peripheral serotonergic receptors. Large numbers of drugs and drug combinations have been
associated with the serotonin syndrome, and generally occur in cases that have ingested drugs that synergistically in-
crease synaptic serotonin. These include monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin re-
uptake inhibitors, opioid analgesics, antibiotics, antiemetics, and herbal products. Serotonin-norepinephrine reuptake
inhibitor-induced serotonin syndrome is reported to be very rare. It is often described as a clinical triad of mental status
changes, autonomic hyperactivity, and neuromuscular abnormalities, but not all of these findings are present in all pa-
tients and signs of excess serotonin range from tremor and diarrhea in mild cases to delirium, neuromuscular rigidity, and
hyperthermia in life-threatening cases. No laboratory test can confirm SS. Diagnosis is made based on the symptoms and
patient’s history, and several diagnostic criteria have been developed. Management involves the removal of the precipitat-
ing drugs, the provision of supportive care, the control of agitation, the administration of 5-HT2A antagonists, the control
of autonomic instability, and the control of hyperthermia. We experienced a rare case of fibromyalgia accompanied by
tremer, hyperreflexia, spontaneous clonus, muscle rigidity and diaphoresis after 10 days of single use of duloxetine 30mg.
Serotonin syndrome occurred by duloxetine has been reported once in Korea, but that case was reported to occur with
the co-administration of fluoxetine. We report here on this case along with a review of the relevant literature.
Poster 89
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S268
Pattern Recognition Receptors in Adult Onset Still’s Disease
Hyoun-Ah Kim1, Chang-Hee Suh1, Ju-Yang Jung1, Hasan MD Sayeed3, Ye Won Kim1, Seonghyang Sohn2
Departments of 1Rheumatology, 2Microbiology, 3Biomedical Science, Ajou University School of Medicine, Suwon, Korea
Objective: Several pattern recognition receptors (CD11b, CD11c, CD32, CD206, CD209, and dectin-1) were quanti-
fied in peripheral blood from AOSD patients, rheumatoid arthritis (RA) patients, and HC using cell surface staining and
flow cytometry analysis. The correlations between the frequencies of several pattern recognition receptors and disease
activity were investigated in AOSD patients.
Methods: Thirteen AOSD patients, 19 RA patients as a disease control, and 19 healthy controls (HC) were included
in the study. Follow-up samples were collected form 5 patients after resolution of disease activity.
Results: Significantly higher mean frequencies of surface stained cells presenting CD11b from whole blood were ob-
served in patients with AOSD than in patients with RA and in HC. Also, significantly higher frequencies of surface stained
cells presenting CD32 from whole blood were observed in patients with AOSD than in patients with RA and in HC.
CD11b frequencies from whole cells correlated with systemic score, lactate dehydrogenase (LDH) levels, aspartate trans-
aminase levels, interleukin-23 (IL-23) levels, and IL-18. The frequencies of CD209 from granulocyte correlated positively
with systemic scores, and the levels of ESR, CRP, ferritin, LDH, IL-23, and IL-18. The frequencies of CD206 from whole
blood cells were increased in patients with active AOSD than them with inactive AOSD. The frequencies of CD209 from
whole blood cells were increased in active AOSD patients than inactive AOSD patients.
Conclusion: In conclusion, the CD11b and CD32 circulating cells were higher in patients with AOSD compared to the
RA and HC, and CD11b cells were correlated with several disease activity markers. CD209 circulating granulocytes were
correlated with systemic scores, ESR, CRP, ferritin, LDH, IL-23, and IL-18. Also, the frequencies of CD206 and CD209
from whole blood cells were increased in patients with active AOSD than them with inactive AOSD.
Poster 90
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S269
TLR4 Endogenous Ligand S100A8/A9 Levels in Adult-onset Still’s Disease and Their Association with Disease Activity and Clinical Manifestations
Hyoun-Ah Kim1, Jae Ho Han2, Ju-Yang Jung1, You-Sun Kim3, Chang-Hee Suh1
Departments of 1Rheumatology, 2Pathology, and 3Biochemistry and Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, Korea
Objective: S100A8/A9 has been suggested as a biomarker of disease activity in patients with systemic juvenile idio-
pathic arthritis and adult-onset Still’s disease (AOSD). We investigated the clinical significance and the pathogenic role
of this marker in AOSD.
Methods: Serum samples were collected prospectively from 20 active AOSD patients, and 20 healthy controls (HCs).
Furthermore, S100A8/A9 expression levels in biopsy specimens obtained from 26 AOSD patients with skin rashes and
8 AOSD patients with lymphadenopathy were investigated via immunohistochemistry. Peripheral blood mononuclear
cells (PBMCs) from active AOSD and HC were evaluated for interleukin-1β (IL-1β) release and S100A8/A9 cell signals.
Results: S100A8/A9, IL-1β and tumor necrosis factor-α (TNF-α) levels in active AOSD patients were higher than
those of HCs. Serum S100A8/A9 levels correlated with IL-1β, TNF-α, ferritin, and C-reactive protein. The grade of in-
flammatory cells expressing S100A8/A9 ranged from 1 to 3 in skin and lymph node biopsies of active AOSD patients. The
grading and strength of staining of cells positive for S100A8/A9 was more intense in the skin lesions with karyorrhexis,
mucin deposition, and neutrophil infiltration. S100A9 was a strong inducer of IL-1β expression in PBMCs from HCs and
AOSD patients. Like LPS, S100A8/A9 induced phosphorylation of c-jun amino-terminal kinase and p38 in PBMCs, sug-
gesting that S100A8/A9 activates TLR4 signaling pathways.
Conclusions: These data suggest that S100A8/A9 may contribute to the inflammatory response by induction of in-
flammatory cytokines in AOSD, and serve as a clinicopathological marker for the assessment of disease activity in AOSD.
Poster 91
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S270
Cytokine Profiles of Korean Patients with Adult Onset Still’s Disease Treated with Tumor Necrosis Factor Inhibitors
Seung Taek Song1, SuMan Kang2, Sung Won Lee2, Seoung Wan Nam2, Dae-Hyun Yoo2
1Cheongju St. Mary's Hospital, Cheongju, 2Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
Background: Adult onset Still’s disease (AOSD) is a rare inflammatory disorder of unknown etiology. Several studies
have reported that pro-inflammatory cytokines are involved in the pathogenesis of AOSD.
Objectives: To investigate predictors for therapeutic response of biologic drugs in refractory AOSD.
Methods: 22 AOSD patients treated with anti-TNFα agents were recruited from a university hospital for rheumatic
diseases in Korea. The dosages of anti-TNFα (infliximab in 18 patients, etanercept in 4, and adalimumab in 3) were same
as rheumatoid arthritis. Serum cytokines (TNFα, IL-1β, IL-6, IL-8, IL-17α, and INF-γ) and IL-2 receptor α in were ana-
lyzed by multiplex flowcytometry. A good response was defined as decreased modified Pouchot score more than 2 score
compared to initial treatment of anti-TNFα inhibitors. A no response was defined as no decrease of modified Pouchot
score. We used the Wilcoxon signed rank test for continuous variable and Fisher’s exact test for categorical variables.
Results: 6 (27.3%) patients showed good response to anti-TNFα inhibitors and 3 (13.6%) patients showed partial
response. 13 (59.1%) patients did not respond to anti-TNFα inhibitors. At starting time point of anti-TNFα inhibitors,
levels of ferritin, TNFα, IL-1β, IL-6, and IFNγ in no responders (mean±SD 4,142.0±7,128.6 ng/mL, 13.8±24.3 pg/mL,
8.7±16.9 pg/mL, 77.1±157.8, and 69.3±146 pg/mL, respectively) seemed to be higher than in good responders
(566.4±633.0 ng/mL, 6.9±10.5 pg/mL, 2.6±2.9 pg/mL, 16.9±18.7 pg/mL, and 13.2±9.1 pg/mL, respectively), but
without statistically significant differences between the 2 groups. We didn’t raise the dosage of infliximab in no res-
ponders, in whom tocilizumab was used as second biologic therapy.
Conclusion: This study showed that AOSD patients who were refractory to anti-TNFα inhibitors might have distinct
cytokine profiles. Therefore, dosage of anti-TNF agents in AOSD patients might be individualized according to pre-treat-
ment cytokine profiles.
Poster 92
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S271
Elevated High Mobility Group B1 Levels in Active Adult-onset Still’s Disease Associated with Systemic Score and Skin Rash
Hyoun-Ah Kim, Ju-Yang Jung, Chang-Hee Suh
Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
Objective: High mobility group box-1 (HMGB1) is a nuclear protein and such prototypical damage-associated molec-
ular patterns mediate the immune response in the noninfectious inflammatory response. Adult-onset Still’s disease
(AOSD) is a systemic inflammatory disorder involved in the dysregulation of innate immunity. We investigated the se-
rum HMGB1 level in patients with AOSD and evaluated its clinical significance.
Method: Blood samples were collected from 40 patients with active AOSD and 40 healthy controls (HC). Of the pa-
tients with AOSD, follow-up samples were collected from 16 patients after a resolutionof AOSD disease activity.
Results: Serum HMGB1 levels in patients with AOSD were higher than those of the HC(10.0±5.85 vs. 5.15±1.79
ng/ml, p<0.001). Serum HMGB1levels were found to be correlated with C-reactive protein (CRP)and the systemic score.
The AOSD patient who had a sore throat showed a higher serum HMGB1 level than those patients who did not, and the
patient with a skin rash had higher levels than the patients without. In addition, the serum HMGB1 levels were decreased
after the resolution of disease activity in the AOSD patients who were followed-up.
Conclusions: The serum HMGB1levels were elevated in AOSD patients compared to the HC, and were correlated with
both CRP and the systemic score. The HMGB1 levels were associated with skin rash and a sore throat in AOSD patients.
After the resolution of disease activity, serum HMGB1 levels were found to have decreased
Poster 93
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S272
Unbiased Analysis of Fever Curves in Adult Onset of Still’s Disease
Eun Young Ahn1, Hyun MI Kwon1, Woochang Hwang2, Eun Young Lee1, Eun Bong Lee1, Yeong Wook Song1, Jin Kyun Park1
1Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, 2Data Science for Knowledge Creation Research Center, Seoul National University, Seoul, Korea
Background: Adult onset of Still’s disease (AOSD) is a systemic inflammatory disease characterized by fever, arthritis,
rash and elevated inflammatory markers. The classical fever of AOSD is intermittent with a quotidian or double-quo-
tidian pattern. However, it remains unclear as to whether the certain fever pattern is associated with specific clinical
manifestations.
Objective: To investigate the association between fever pattern and clinical characteristics in patients with AOSD.
Methods: A total of 70 patients with AOSD who were treated as inpatient at Seoul National University Hospital from
2004 through 2015 were enrolled. Fever curves on days 2, 3 and 4 during were grouped using hierarchical clustering.
Results: Patients were clustered into 2 groups based on the fever curves. The 14 patients in the group 1 had a higher
mean temperature (38.1±0.4oC vs. 37.2±0.5oC, p<0.001) with wider daily variation (2.7±0.9oC vs 1.9±0.7oC,
p<0.001) as compared to 56 patients in the group 2. The group 1 tended to by younger (38.4±14.7 years vs. 46.1±17.6
years, p=0.141). Fever, arthritis, arthralgia and rash did not differ between them. Group 1 had significantly lower Plt
count (198,900±68,000/μl vs. 312,900±156,900/μl, p<0.001), higher LDH (816.6±376.4 IU/L vs. 477.5±327.1
IU/L, p=0.002) and higher mean level of ferritin (27,004.1±48,891.5 ug/mL vs 6,852±10,628.2 ug/mL, p=0.072) as
compared to group 2, whereas WBC, CRP did not differ between them. Group 1 tended to require longer time to a clinical
remission (455.5±850 days vs. 9.4±115.7 days, p=0.137).
Conclusion: The systemic analysis of fever curves reveals the presence of at least 2 distinctive fever patterns associated
with AOSD. Spiking fever with higher daily variation was associated with more higher inflammatory markers and re-
quired longer duration until remission. Thus, fever pattern in AOSD might be a prognostic factor.
Poster 94
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S273
Serum Uric Acid is Positively Associated with Pulmonary Function in Korean Health Screening Examinees:
A Cross-Sectional Study
Jiwon Hwang1, Jae-Uk Song2, Joong Kyong Ahn2
1Division of Rheumatology, Department of Internal Medicine, National Police Hospital, Seoul, 2Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: The double-edged characteristics of SUA and mixed results from previous studies have complicated de-
termination of whether serum uric acid (SUA) plays a pulmonary-protective or pulmonary-destructive role.
Objectives: The aim of this study was to determine whether level of SUA, a potent antioxidant, is linked to pulmonary
function in health screening examinees.
Methods: We performed a cross-sectional study on 69,928 Koreans (30,572 men) without overt medical conditions
who underwent a health examination in 2010.
Results: Percent predicted forced vital capacity (FVC%) and forced expiratory volume in 1 s (FEV1%) were positively
correlated with SUA in both genders (FVC%: r=0.361; FEV1%: r=0.314 in males and FVC%: r=0.413; FEV1%: r=0.382
in females, all P<0.001). When quartiles 2, 3 and 4 were compared to quartile 1 (the reference group, highest quartile)
of FVC% by regression analysis, the adjusted ORs for hyperuricemia in men were 0.876 (95% CI, 0.809-0.949), 0.631
(0.574-0.695), and 0.311 (0.278-0.349), respectively. The adjusted ORs for hyperuricemia when quartiles 2, 3 and 4 were
compared to quartile 1 of FEV1% in men were 0.791 (95% CI, 0.729-0.859), 0.565 (0.513-0.623), and 0.302
(0.270-0.337), respectively (P for trend<0.001). Similarly, the adjusted OR of having hyperuricemia in women decreased
significantly across FEV1% and FVC% quartile groups compared to the reference group (P for trend<0.001).
Conclusion: SUA was positively associated with FVC% and FEV1% in a healthy population, supporting the hypothesis
that hyperuricemia protects against impaired lung function.
Poster 95
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S274
Clinical Outcomes and Pathological Characteristics of Orbital IgG4-related Disease versus Orbital
Inflammatory Pseudotumor
Hong Ki Min1, Youn Soo Lee2, Suk Woo Yang3, Jennifer Lee1, Seung-Ki Kwok1, Ji Hyeon Ju1, Wan-Uk Kim1, Sung-Hwan Park1
1Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, 2Department of Hospital Pathology, School of Medicine, The Catholic University of Korea, Seoul,
3Department of Ophthalmology, School of Medicine, The Catholic University of Korea, Seoul, Korea
Objective: This study investigated the clinical and pathological features of orbital immunoglobulin G4-related disease
(IgG4-RD). To clarify the features, we compared the clinical characteristics and pathological findings of orbital IgG4-RD
and orbital inflammatory pseudotumor.
Materials and Methods: We retrospectively reviewed the medical records of 103 patients who were initially diagnosed
with orbital inflammatory pseudotumor at our tertiary-care medical center in South Korea between January 2008 and
December 2014. We identified 16 cases in which the diagnosis was based on surgical biopsy and for which data in medical
records were sufficient for analysis. Immunohistochemical staining of pathological specimens for IgG and IgG4 was
performed. The Mann-Whitney U-test, chi-squared test, Fisher’s exact test, Kaplan-Meier curves, and log-rank tests were
used for comparisons.
Results: The orbital IgG4-RD group had more IgG4-positive plasma cells and a higher IgG4/IgG plasma cell ratio than
the orbital inflammatory pseudotumor group. Storiform fibrosis and lacrimal gland involvement were significantly more
frequent in the orbital IgG4-RD group. Dense lymphocyte infiltration, obliterative phlebitis, and bilateral lesions were
more frequent in orbital IgG4-RD, but the differences were not significant. The eosinophil count was significantly higher
in the orbital IgG4-RD group. The recurrence-free rate was lower in the orbital IgG4-RD group (P=0.035).
Conclusion: The location of the lesion (lacrimal gland), bilateral involvement, and storiform fibrosis aid the diagnosis
of orbital IgG4-RD in patients with idiopathic orbital mass-like lesions. In addition, maintenance therapy should be con-
sidered in patients with orbital IgG4-RD to prevent recurrence.
Poster 96
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S275
Are High Levels of Serum B2 Mikroglobuline, Independent Inflammatory Markers
from Renal Dysfunction in Geriatric Population?
Suleyman Ozbek, Ertugrul Bayram
Cukurova University College of Medicine, Adana, Turkey
Object: This study was to aim to determine the microglobulin level of serum B2 in geriatric patient population as an
inflammatory marker and to compare with other inflammatory markers in order to determine its effectiveness, reliability
and whether it is brittleness marker or not.
Materials and Methods: In order to evaluate the relationship between inflammation and Serum B2 microglobulin level,
totally 81 participants were attended as 20 patients with rheumatoid arthritis (chronic inflammatory disease), 20 pa-
tients with osteoarthritis (chronic non-inflammatory disease), 22 patients with acute infection and 19 control groups
(healthy individuals). Malignancy, grade 3-4 congestive heart failure, renal disfunction, chronic liver disease, obesity, au-
toimmune disease, antiinflammatory, antibiotic and immunosuppressive drug therapy which affect the inflammatory
markers and people who are except from geriatric population and under 65 years of age could not have attended to this
study.
Symptoms: 29 (35.8 %) men and 52(64.2%) women patients have attended. Average of B2 microglobin level of all
groups have been determined as 3.8±1.3 mg/L (1.24-7.9 mg/L). Significant difference was determined as statistically be-
tween groups and B2 Microglobulin level. B2 microglobulin was determined as high in both acute infection and rheuma-
toid arthritis. According to the quality of CFS and SF36; Score of quality of life is the lowest in acute infections. And in-
creased values have been seen in Rheumatoid arthritis, osteoarthritis and healthy individuals. We have determined in-
directly related between Serum B2 Microglobulin level and quality of life. B2 Microglobulin has positive correlation with
age, CRP, sedime, procalcitonin, WBC, ferritin, HES, IL-6, TNF alpha, CFS. Otherwise, it has negative correlation with
hemoglobin, htc, Fe/TİBC (TSAT), D-vitamine, HDL, albumen and SF-36. In the case of acute infectious, the level of D
vitamine, T.cholesterol, HDL, LDL and TG are decreased.
Poster 97
Journal of Rheumatic Diseases Vol. 23, Suppl. 1, May, 2016
S276
Coexistent Mixed Connective Tissue Disease and Papillary Thyroid Cancer in a Patient with Primary Biliary Cirrhosis:
A Case Report
Ji-Heh Park, Seung-Geun Lee, Eun-Kyoung Park
Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Korea
Case Description: A 40-year-old woman who was diagnosed with primary biliary cirrhosis (PBC) 5 years ago, visited
our hospital complaining of muscle weakness since 8 months, arthralgia, and skin hardening. On physical examination,
all bilateral proximal interphalangeal joints of hands were swollen and tender. Raynaud’s phenomenon (RP) was accom-
panied by telangiectasia and sclerosis on bilateral fingertips. Laboratory results revealed the increased level of creatine
kinase (CK, 4206.2 U/L) and myoglobin (444.9 ng/mL). Electromyographic findings of the upper and lower limbs were
compatible with the active myopathy and histological examination of specimens obtained from the right tibialis anterior
muscle showed inflammatory myositis. ANA was positive and anti-RNP antibody level was 200 U/mL. Anti-cyclic cit-
rullinated peptide antibody, anti-double-stranded DNA, anti-centromere antibody, anti-Scl-70, and anti-Jo-1 antibody
were absent. Therefore, we confirmed mixed connective tissue disease (MCTD) using Alarcon-Segovia criteria based on
positive anti-RNP antibody, synovitis, sclerosis of skin, RP, and myositis. On thyroid ultrasonography, two thyroid nod-
ules in both lobes were founded and histological examination of needle aspiration biopsy specimens revealed nodular hy-
perplasia and papillary thyroid cancer (PTC) in right and left lobes, respectively. Treatment began with intravenous pulse
methylprednisolone of 500 mg for 3 days, followed by 1 mg/kg/day of prednisolone; azathioprine was administered be-
cause of active myositis. After 6-month treatment with glucocorticoids and azathioprine, CK levels declined to 492 U/L
and muscle strength improved significantly. Then, the patient underwent total thyroidectomy.
Conclusion: This is the first report of coexistent MCTD and PTC in a patient with PBC. This case report highlights the
possible association between MCTD and thyroid cancer and suggests that MCTD, similar to other autoimmune diseases,
is associated with PBC.
Poster 98
pp
JOURNAL OF RHEUMATIC DISEASES
Journa l o f R heum atic D iseases
Vol. 23, Suppl. 1, May, 2016
2016년 5월 13일 인쇄 2016년 5월 20일 발행
발행인:송 영 욱 편집인:전 재 범 기획인:차 훈 석
발 행: 대한류마티스학회(우: 04376) 서울특별시 용산구 새창로 213-12한강현대하이엘 803호 Tel: 02-794-2630, Fax: 02-794-2631E-mail: [email protected]: www.rheum.or.kr
편집제작:(주)더 위드인(우: 04208) 서울특별시 마포구 만리재로 93 (공덕동 108-1) 비퍼스B/D 2FTel: 02-6959-5333, Fax: 070-8677-6333E-mail: [email protected]
<pISSN 2093-940X><eISSN 2233-4718>
Publisher:Yeong-Wook Song Editor in Chief:Jae-Bum Jun
Published byKorean College of Rheumatology
Office of Executive Secretary803 Hangang Hyundai HYEL, 213-12, Saechang-ro,
Yongsan-gu, Seoul 04376, Korea Tel:82-2-794-2630, Fax:82-2-794-2631 E-mail : [email protected] Homepage : www.rheum.or.kr
이 발표논문집은 2016년도 정부재원(과학기술진흥기금 및 복권기금)으로 한국과학기술단체총연합회의 지원을 받아 발간되었음.
This work was supported by the Korean Federation of Science and
Technology Societies (KOFST) grant funded by the Korean Government.
본 학술대회는 한국내과학연구지원재단의 일부 후원으로 개최하였음.