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ObjectivesThis study investigates whether COVID-19 vaccines can elicit cross-reactive antibody responses against the Omicron variant in patients with autoimmune rheumatic diseases (ARDs).MethodsThis observational cohort study comprised 149 patients with ARDs and 94 healthcare workers (HCWs). Blood samples were obtained at enrolment, a median of 15 weeks after the second vaccine dose or 8 weeks after the third dose. The functional cross-neutralisation capacity of sera was measured using the Omicron variant receptor-binding domain-ACE2 binding inhibition assay. We assessed the incidence of breakthrough infections and the potential correlation with neutralising responses in participants after receiving third doses. The association of time-from-vaccine and neutralising responses in sera was predicted using linear regression analysis.ResultsThe mean cross-neutralising responses against the Omicron variant developed after the second dose was 11.5% in patients with ARDs and 18.1% in HCWs (p=0.007). These responses were significantly lower in patients with ARDs than in HCWs after the third dose (26.8% vs 50.3%, pConclusionsStriking antibody evasion manifested by the Omicron variant in patients with ARDs and current vaccine-induced immunity may not confer broad protection from Omicron breakthrough infection, highlighting the need for further research on vaccine effectiveness in patients with immune dysfunctions.

Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.

Objective. Although gout is the most common form of inflammatory arthritis, data on gout prevalence and management are sparse, especially in Korean populations. This study reevaluated the most recent prevalence and incidence of gout values in Korean people to update the findings from our previous study in 2011. Methods. We used the National Health Insurance Service-National Health Information Database (NHIS-NHID) to identify patients diagnosed with gout in South Korea during 2002∼2015. We selected patients with gout as principal diagnosis or 1st∼4th additional diagnosis. Results. The prevalence of gout increased 5.17-fold, from 0.39% in 2002 to 2.01% in 2015. This increase occurred in all age groups, but was stronger in those aged 80 years or older, with a 13.1-fold increase from 2002 to 2015. The prevalence of gout increased in all regions of South Korea. The prevalence of the disease was also related to income levels: in 2015, medical insurance subscribers with the highest income were twice more likely to have gout than those in the lowest income bracket. By contrast, the prevalence of gout in medical benefit recipients was 5.58- and 5.25-times higher than that of the general population and of those in the highest income bracket, respectively. Conclusion. The prevalence of gout has increased rapidly, although the degree of increase varied according to sex, age, region, and income group. This study sheds some light on the current prevalence of gout among national insurance subscribers in Korea, and will help educate patients and medical staff on the management of gout. (J Rheum Dis 2020;27:174-181)

In the present work, several specimens were obtained from microalloyed HP40Nb reformer tubes with the different serviced period. The creep tests were conducted at a temperature of 950 °C and under stress levels in the range 25–55 MPa. Results indicated that the degradation of the creep life was due to the increase of the serviced period. The microstructural degradation and creep voids were observed at the grain boundary regions, attributed to the main reason leading to the premature creep failure. The creep exponent started decreasing after the servicing and approached a constant value after 7.2 years. The creep coefficient was obtained to be a function of time when the creep exponent was constant. Norton’s creep power law equation was used to derive an equation describing the relationship between the diametrical expansion and serviced period of the reformer tubes. Larson-Miller curves were obtained from creep test data. Amount of carbides from the different serviced period was also calculated.

Background/Aims: The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheu matoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Se rial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was -19.0 in the bDMARD group and -12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, re spectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.

Background Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits. Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout., Graphical Abstract

Aims With the high prevalence of gout and associated cardiovascular (CV) diseases, information on the comparative CV safety of individual urate-lowering drugs becomes increasingly important. However, few studies examined the CV risk of uricosuric agents. We compared CV risk among patients with gout who initiated allopurinol vs. benzbromarone.Methods and results Using the Korean National Health Insurance claims data (2002–17), we conducted a cohort study of 124 434 gout patients who initiated either allopurinol (n = 103 695) or benzbromarone (n = 20 739), matched on propensity score at a 5:1 ratio. The primary outcome was a composite CV endpoint of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. To account for competing risk of death, we used cause-specific hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes comparing allopurinol initiators with benzbromarone. Over a mean follow-up of 1.16 years, 2258 patients developed a composite CV event. The incidence rate of the composite CV event was higher in allopurinol initiators (1.81 per 100 person-years) than benzbromarone (1.61 per 100 person-years) with a HR of 1.22 (95% CI 1.05–1.41). The HR for all-cause mortality was 1.66 (95% CI 1.43–1.93) among allopurinol initiators compared with benzbromarone.Conclusion In this large population-based cohort of gout patients, allopurinol was associated with an increased risk of composite CV events and all-cause mortality compared to benzbromarone. Benzbromarone may reduce CV risk and mortality in patients with gout, although more studies are necessary to confirm our findings and to advance our understanding of the underlying mechanisms.

Background Soluble urate has been shown to serve as an antioxidant, especially in the central nervous system. Although there are intriguing data suggesting that low levels of serum urate are associated with worse outcomes in neurodegenerative diseases, its impact on mental health has not been adequately assessed. Thus, we aimed to investigate the association between serum urate and depression using a large, nationally representative sample. Methods Information on participants’ socio-demographic characteristics as well as physical and mental health conditions were retrieved from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016 dataset. The Patient Health Questionnaire (PHQ)-9 was applied to identify depressive symptoms. Analyses were stratified by age: young adults (aged 19–39 years), middle-aged adults (aged 40–59 years), and older adults (aged 60 years and older). Results A total of 5332 participants were included. Serum urate concentrations were divided into sex-specific quartiles based on their distribution: ≤ 4.9 (Q1), 5.0–5.7 (Q2), 5.8–6.6 (Q3), and ≥ 6.7 (Q4) mg/dL in men and ≤ 3.7 (Q1), 3.8–4.3 (Q2), 4.4–4.9 (Q3), and ≥ 5.0 (Q4) mg/dL in women. There was a significant negative linear relationship between serum urate quartiles and PHQ-9 scores in older adults (p for trend = 0.020 in men and p for trend = 0.048 in women). Compared to high levels (Q3 and Q4) of serum urate, low levels (Q1 and Q2) were significantly associated with the overall burden of depression in older women (OR 1.78, 95% CI 1.21, 2.61) and clinically relevant depression in older men (OR 3.35, 95% CI 1.16, 9.70), even after adjustment. Conclusions Based on the KNHANES data, low levels of serum urate are associated with a higher prevalence of depression in older adults. This may have clinical implications for mental health.

Background We purposed to evaluate the seasonality and associated factors of the incidence of gout attacks in Korea. Methods We prospectively enrolled patients with gout attacks who were treated at nine rheumatology clinics between January 2015 and July 2018 and followed them for 1-year. Demographic data, clinical and laboratory features, and meteorological data including seasonality were collected. Results Two hundred-five patients (men, 94.1%) were enrolled. The proportion of patients with initial gout attacks was 46.8% (n = 96). The median age, body mass index, attack duration, and serum uric acid level at enrollment were 50.0 years, 25.4, 5.0 days, and 7.4 mg/dL, respectively. Gout attacks were most common during spring (43.4%, P < 0.001) and in March (23.4%, P < 0.001). A similar pattern of seasonality was observed in the group with initial gout attacks. Alcohol was the most common provoking factor (39.0%), particularly during summer (50.0%). The median diurnal temperature change on the day of the attack was highest in the spring (9.8°C), followed by winter (9.3°C), fall (8.6°C), and summer (7.1°C) (P = 0.027). The median change in humidity between the 2 consecutive days (the day before and the day of the attack) was significantly different among the seasons (3.0%, spring; 0.3%, summer; −0.9%, fall; −1.2%, winter; P = 0.015). One hundred twenty-five (61%) patients completed 1-year follow-up (51% in the initial attack group). During the follow-up period, 64 gout flares developed (21 in the initial attack group). No significant seasonal variation in the follow-up flares was found. Conclusion In this prospective study, the most common season and month of gout attacks in Korea are spring and March, respectively. Alcohol is the most common provoking factor, particularly during summer. Diurnal temperature changes on the day of the attack and humidity changes from the day before the attack to the day of the attack are associated with gout attack in our cohort., Graphical Abstract

Background The 24-hour uric acid excretion measurement is important in assessing disease status and helping to select the appropriate uric acid-lowering agent for patients with gout, however, it is inconvenient. The authors investigated the efficacy of the random urine uric acid-to-creatinine (UA/CR) ratio to screen the patients who under-secreted 24-hour urine uric acid. Methods This was a retrospective cross-sectional study. Ninety patients with gout, without undergoing uric acid-lowering treatment were enrolled. Twenty-four-hour urine and random urine samples were obtained on the same day. Six hundred mg of uric acid in the 24-hour urine sample was used as a standard for distinguishing between over and under-excretion groups. Results The random urinary UA/CR ratio showed positive correlation with 24-hour urine uric acid excretion (γ = 0.398, P < 0.001). All the patients with the random UA/CR less than 0.2 excreted less than 600 mg uric acid in 24-hour urine collection. When the random urine UA/CR ratio < 0.2 was regarded as a positive result, the positive predictive value, negative predictive value, sensitivity, and specificity in the uric acid under-excretion were 100% (8 of 8), 64.6% (53 of 82), 21.6% (8 of 37), and 100% (53 of 53), respectively. Conclusion There is a moderate positive correlation between the random urinary UA/CR ratio and 24-hour urine uric acid excretion, so that UA/CR ratio may not be a good predictor of 24-hour urine uric acid excretion. However, the random urine UA/CR ratio 0.2 can be a useful predictor to screen the gouty patients who need to be treated with uricosuric drugs., Graphical Abstract

Background Korea has recently attained the aged society status and the growth rate of the aging population will be among the most rapid worldwide. The objective of this study was to develop a credible list of potentially inappropriate medications (PIMs) for Korean older adults. Methods A new Korean PIMs list was produced through a comprehensive structured expert survey (modified Delphi method). To generate an expert panel, we invited the nomination of experts in geriatric medication from the Korean Geriatric Society, the Korean Academy of Clinical Geriatrics, the Korean Academy of Family Medicine, the Korean Association for Geriatric Psychiatry, and the Korean Association of Geriatric Hospitals. Based on their recommendation, the expert panel consisted of 14 geriatric specialists, including 10 geriatricians (7 family medicine doctors and 3 internal medicine doctors), 3 geriatric psychiatrists, and 1 clinical pharmacist. After 4 rounds, the new Korean PIMs list was finalized. Results Sixty-two drugs were classified as PIMs for older adults irrespective of comorbidities, including antipsychotics, tricyclic antidepressants, benzodiazepines, non-steroidal anti-inflammatory drugs, and first-generation antihistamines. Forty-eight drugs or drug categories were classified as PIMs for 18 specific conditions that older adults encounter frequently. The expert panel presented the rationale and comments including preferred therapeutic alternatives and exceptional situations for each item. Conclusion We presented a "user-friendly" PIMs list for Korean older adults. Further prospective studies to validate its usefulness in clinical settings and regular updating of the list are required. It is also important to disseminate this list to doctors who prescribe medication to older people.

Gout is a chronic systemic metabolic disease characterized by recurrent attacks of inflammatory arthritis resulting from the precipitation of monosodium urate crystals, which has various clinical and pathological manifestations. The disease is associated with multiple comorbidities, an impaired quality of life, and a heavy economic burden. The incidence and prevalence of gout is increasing in many developed and developing countries, as in Korea. Gout is diagnosed by confirming monosodium urate crystals in the synovial fluid or affected tissue. If crystal documentation is unavailable, new gout classification criteria presented by the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) in 2015 can be applied. There are many guidelines for managing gout published in the United States, Japan, and Europe. However, there are no guidelines for the tailored management of gout for Korean patients. This review describes a new classification for the diagnosis of gout and management guidelines. (Korean J Med 2018;93:344-350)

Failure analysis was conducted for a hydrogen fluoride pressure regulator. Hydrogen fluoride gas transformed into highly corrosive hydrofluoric acid owing to the presence of condensed moisture. On the surface of the Hastelloy diaphragm of the pressure regulator, corrosion pits and network-like corrosion structures were uncovered. Crack initiation from a corrosion pit caused the coalescence of cracks of neighboring pits and fatigue crack growth, and the fatigue crack penetrated the diaphragm and triggered gas leakage. The fatigue load was provided by the repeated bending of the diaphragm during pressure regulation. Mo, Ni, and Cr in Hastelloy contributed to the formation of a passivation film, and M6C carbide could have served as a crevice corrosion cell. The stress generated in the diaphragm during pressure regulation was analyzed using finite element analysis. In this paper, apart from a discussion of these observations, an explanation of the detailed results of a metallurgical investigation and energy dispersive X-ray spectroscopy analysis are explained.

Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a &ldquo, treat-to-target&rdquo, approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of &lt, 6 mg/dL was achieved (76.40 &plusmn, 18.81 mL/min/1.73 m2 vs. 80.30 &plusmn, 20.41 mL/min/1.73 m2, p &lt, 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (&minus, 0.35 &plusmn, 3.87 mL/min/1.73 m2 vs. 5.33 &plusmn, 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients &ge, 65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13&ndash, 0.75, p = 0.009). Conclusions: The &ldquo, approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

This study evaluated Superb Microvascular Imaging (SMI) technology for detection of active synovitis in patients with rheumatoid arthritis (RA). Between June 2015 and October 2016, 56 patients with RA (42 females; mean age, 53.2 years) underwent gray-scale ultrasound (US) imaging, power Doppler imaging (PDI), and SMI for synovitis of both wrists and hands (total 22 joints), scored for each joint from grades 0 to 3. The sum of grades for 22 joints was determined for gray-scale (SYN-sum), PDI (PDI-sum), and SMI (SMI-sum) according to clinical parameters. Follow-up US was performed in 17 patients (mean interval, 251.6 days). The SMI-sum (7.27 ± 4.56) was significantly higher than the PDI-sum (4.38 ± 3.09, p

Risk-based inspection (RBI) offers the most cost-effective operation and maintenance strategy for minimizing overall risks and making financial and safety improvements within a power plant. Risk assessment may also benefit decision-making with regards to plant design and equipment manufacturing processes. The purpose of this study is to propose a quantitative RBI methodology that can be applied to a high-energy piping system operating at elevated temperatures and high pressures in power plants. Three major steps involved are: (i) using generic mean time to failure (MTTF), specified as the expected lifetime of the equipment obtained from a theoretical equation; (ii) adding a modification factor that identifies the specific conditions that can influence the failure rate; and (iii) incorporating individual inspection locations as a factor in risk evaluation. Probability-of-failure (POF) assessment was conducted using a Weibull distribution with MTTF and the modification factor. In addition, consequence-of-failure (COF) assessment was conducted based on financial consequences in terms of downtime costs per day and the length of downtime due to failure. The main steam piping system in a thermal power plant was selected as the case study unit. The actual inspection locations where damage to components could frequently occur were defined as risk evaluation targets for the RBI. The generic MTTF for the main steam piping system was evaluated using the Larson-Miller parameter (LMP) equation for creep rupture time. Piping system stress analysis was conducted to obtain the stress applied to the LMP. An equation for the modification factor applied to the main steam piping system was also proposed based on five subfactors.

Failures in end caps of sprinkler firewater systems frequently occur due to the freezing of the water inside the sprinkler systems on cold winter days. In these failures, a flat top of an end cap of a sprinkler system fails and completely separates from the threaded body of the end cap. In this study, metallurgical investigations including fractography, metallography, EDS analysis, and hardness measurement were performed for the failure analysis of the end cap. Finite element analysis was employed to identify both the maximum stress location and the maximum stress magnitude resulting from the freezing of and interaction between the ice and end cap when temperature dropped below the freezing point. Microstructure observations confirmed the ferritic malleable cast iron of the end cap. The hardness of the end cap was significantly below the hardness range specified for standard ferritic malleable cast iron. Small cracks formed during the casting of the end cap and the low strength of the end cap caused the final fracture. Failure stress determined by finite element analysis simulating the freezing of the inside water could accurately predict the failure stress and failure temperature. High tensile stress and poor manufacturing quality caused the crack to propagate in the cleavage mode and at the final stage in the ductile mode.

The objectives of the study are to demonstrate the non-inferiority of PG201 (Layla®) 600 mg in comparison with celecoxib 200 mg for the treatment of symptomatic knee osteoarthritis (OA). In total, 309 patients were randomly assigned to receive either the test drug, PG201 600 mg (n = 154) or celecoxib 200 mg (n = 155). The primary efficacy variable was improvement in mean 100-mm pain VAS score from baseline to the final visit (week 8), and this value was compared between the 2 treatment groups. Secondary outcome variables included changes from baseline in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain VAS score and subscale score, patient’s global assessment of disease status quality of life (short form-36) and responder index at weeks 4 and 8. For safety assessment, adverse events were recorded at each clinical visit. At weeks 8, the 100-mm pain VAS scores were significantly decreased in patients receiving both PG201 600 mg (p

Our aim was to investigate the efficacy of monthly oral ibandronate in Korean women with rheumatoid arthritis and reduced bone mineral density (BMD) receiving long-term glucocorticoids.Patients (n = 167 women) were randomly assigned (1:1) to receive ibandronate 150 mg or placebo every 4 weeks. Patients had taken glucocorticoid (equivalent of daily prednisolone ≥5 mg) for 3 or more consecutive months before enrollment, and had a lumbar spine 1 to 4 (L1-L4) T-score of-1.0 and ≥ -2.5. Both groups were provided with daily calcium carbonate and cholecalciferol. The primary end point was the L1 to L4 BMD percent changes at 48 weeks compared with baseline.Baseline characteristics were comparable between the 2 groups. BMD percent changes in L1 to L4 at 48 weeks were significantly different between the ibandronate versus the placebo group (+3.7% [5.1%] vs -1.9% [4.4%], respectively; P0.0001). BMD percent changes at 48 weeks in femur neck and total hip also had similar results (P = 0.0073 and P = 0.0031, respectively). Decrease of serum type 1 collagen C-terminal telopeptide was significant at both 24 and 48 weeks in the ibandronate group. There was no incident of fragility fracture in both groups during the study period. Safety profiles, including adverse events, were comparable between the 2 groups.Monthly oral ibandronate for 48 weeks is well tolerated and effective in reducing bone mineral loss in women with rheumatoid arthritis on long-term glucocorticoid therapy. Longer follow-up studies are needed to investigate the benefit of ibandronate on fracture rate reduction in this subset of patients. ClinicalTrials.gov identifier: NCT01287533.

Objective.To determine whether levels of plasma-soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are elevated in patients with rheumatoid arthritis (RA) and whether levels are correlated with disease activity and other variables.Methods.Our study included 71 patients with RA and 50 age- and sex-matched healthy controls. Clinical characteristics and laboratory measures, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and 28-joint Disease Activity Score (DAS28) were assessed. Plasma levels of sTREM-1 and tumor necrosis factor-α (TNF-α) were measured by ELISA.Results.Patients with RA had significantly higher plasma sTREM-1 levels than healthy controls (170.10 ± 84.71 pg/ml vs 97.41 ± 40.64 pg/ml; p < 0.001). In patients with RA, plasma sTREM-1 levels were found to be correlated with DAS28, ESR, CRP, white blood cell counts, neutrophil counts, and plasma TNF-α levels (r = 0.329, p = 0.005; r = 0.241, p = 0.043; r = 0.314, p < 0.001; r = 0.261, p = 0.028; r = 0.278, p = 0.019; and r = 0.313, p = 0.009, respectively). Plasma sTREM-1 levels in patients with active disease status (DAS28 > 3.2) were significantly higher than in those with low disease status (DAS28 ≤ 3.2; 208.89 ± 100.14 pg/ml vs 150.29 ± 68.70 pg/ml; p = 0.005).Conclusion.Patients with RA had higher plasma sTREM-1 levels than healthy controls, and plasma sTREM-1 levels were correlated with disease activity measures, suggesting that plasma sTREM-1 could play a role in the inflammatory process associated with TNF-α, and that it may be a useful disease activity marker in RA.

Background: Combined tramadol/acetaminophen is used to treat pain related to osteoarthritis. However, adverse events (AEs) leading to discontinuation can occur. Dose titration may decrease the risk for AEs. Objective: The aim of this study was to assess the effect of tramadol/acetaminophen titration on the development of AEs leading to treatment discontinuation in patients with knee osteoarthritis. Methods: This 2-week, multicenter, randomized, double-blind, double-dummy, add-on study was conducted at 12 tertiary referral university hospitals in the Republic of Korea. Patients aged 35 to 75 years with knee osteoarthritis receiving a stable dose of NSAIDs and with a daily mean pain-intensity score of ≥4 on a numeric rating scale (NRS) (0 = no pain to 10 = worst pain) during the 48 hours prior to enrollment were eligible. Patients were randomly assigned to receive 1 tablet of tramadol/acetaminophen 37.5/325 mg QD and 1 placebo BID for 3 days, followed by 1 active tablet BID and 1 placebo QD for 4 days, followed by 1 active tablet TID for 7 days (titration group) or 1 tablet of combined tramadol 37.5 mg/acetaminophen 325 mg TID for 14 days (nontitration group). The primary outcome measure was the rate of treatment discontinuation due to AEs. Secondary outcome measures were time to discontinuation due to AEs, prevalences and characteristics of AEs, decrease from baseline in pain intensity as measured on the NRS, and change in the Korean version of the Western Ontario and McMaster Universities (K-WOMAC) index score (scale: 0 = best to 100 = worst). Results: A total of 250 patients were enrolled (92.0% female; mean [SD] age, 60.2 [7.8] years; mean [SD] weight, 60.0 [9.2] kg [range, 37.5-90.7 kg]; all Korean). The discontinuation rate was significantly lower in the titration group than in the nontitration group (10.5% vs 26.2%; P < 0.001). The Kaplan-Meier survival curve showed that the rates of discontinuation due to AEs were similar in the 2 groups up to day 2, but thereafter the discontinuation rate was significantly lower in the titration group. The most common AEs were nausea (12.1% and 24.6% in the titration and nontitration groups, respectively; P = 0.008), vomiting (4.0% and 17.2%; P < 0.001), and dizziness (9.7% and 22.1%; P = 0.005). No serious AEs were reported in either group. Tramadol/acetaminophen use was associated with a similar decrease from baseline in pain in both the titration and nontitration groups (mean [SD] Δ: NRS, -1.60 [1.62] vs -1.68 [1.58]; total K-WOMAC, -12.86 [13.73] vs -12.52 [16.58]). Conclusions: In this population of Korean patients with knee osteoarthritis pain managed with a stable dose of NSAIDs, titration of tramadol/acetaminophen over 12 days was associated with improved tolerability and a significantly lower discontinuation rate compared with nontitration. Both regimens significantly reduced from baseline associated with osteoarthritis.

Purpose Patients with gout are similar to those with bacterial infection in terms of the nature of inflammation. Herein we compared the differences in procalcitonin (PCT) levels between these two inflammatory conditions and evaluated the ability of serum PCT to function as a clinical marker for differential diagnosis between acute gouty attack and bacterial infection. Materials and Methods Serum samples were obtained from 67 patients with acute gouty arthritis and 90 age-matched patients with bacterial infection. Serum PCT levels were measured with an enzyme-linked fluorescent assay. Results Serum PCT levels in patients with acute gouty arthritis were significantly lower than those in patients with bacterial infection (0.096±0.105 ng/mL vs. 4.94±13.763 ng/mL, p=0.001). However, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels showed no significant differences between the two groups. To assess the ability of PCT to discriminate between acute gouty arthritis and bacterial infection, the areas under the curves (AUCs) of serum PCT, uric acid, and CRP were 0.857 [95% confidence interval (CI), 0.798–0.917, p

During the last ten years, the need has been increased for reducing maintenance cost for aged equipments and ensuring safety, efficiency and profitability of petrochemical and refinery plants. RBI (Risk Based Inspection) methodology is one of the most promising technologies satisfying the need in the field of integrity management. In this study, a user-friendly software, realRBl for RBI based on the API 581 code was developed. This software has modules for evaluating qualitative and semi-quantitative risk level, analyzing quantitative risks using the potential consequences of a failure of the pressure boundary, and assessing the likelihood of failure. A quantitative analysis was performed for 16 columns in a domestic NCC (Naphtha Cracking Center) plant whose operating time reaches about 12 years. Each column was considered as two equipment parts by dividing into top and bottom. Generic column failure frequencies were adjusted based on likelihood data. After determining release rate, release duration and release mass for each failure scenario, flammable/explosive and toxic consequences were assessed. Current risks for 32 equipment parts were evaluated and risk based prioritization were determined as a final result.

Aim To evaluate treatment patterns and clinical factors affecting gout flare in South Korea. Methods We retrospectively examined data from 401 patients seen at nine rheumatology multicenter clinics, under urate lowering therapy (ULT) more than 6 months after stopping prophylactic medication. Demographic data, clinical and laboratory features were collected at the initiation of ULT, upon stopping prophylaxis, and 6 months after. Results The mean age was 52.2 years and mean disease duration was 25.0 months. The male-to-female count was 387 : 14. The most common ULT starting agent was allopurinol 83.8%. Colchicine (62.3%) was the most commonly prescribed prophylactic agent. During ULT, 134 of the 401 patients (33.4%) experienced at least one gouty attack in the period from stopping prophylaxis to 6 months later. The duration of prophylaxis was different between those with serum uric acid levels below 6 mg/dL and those over 6 mg/dL (P = 0.001). Of the 179 patients (44.6%) who attained target serum uric acid (SUA) levels (6 mg/dL) at the end of prophylaxis, those taking

통풍은 퓨린대사의 이상으로 체내에 과잉축적된 요산이 결정화되면서 관절과 관절 주위 조직에 재발성 발작성 염증 을 일으키는 질환으로 심한 관절통과 관절의 변형으로 삶의 질을 저하시키는 만성전신성질환이다[1]. 통풍은 고통스런 관절염뿐만 아니라 고혈압, 이상지질혈증, 복부비만, 당뇨 병으로 특징지어지는 대사증후군과 관련이 높음이 입증되고 있으며 우리나라 통풍 환자들의 현실도 예외는 아니다[2,3]. 그에 따라 통풍 환자에게는 다양한 질병이 동반되고 많은 약 물이 복합적으로 사용되면서 질병에 의한 합병증과 약물에 의한 부작용으로 인해 수명이 단축될 수 있다는 보고가 나오 고 있다[4]. 또한 이에 따른 경제적인 부담도 다른 질병에 비 해 많이 소모되고 있으며 전 세계적으로 통풍 환자의 수가 증가하여 이제 미국에서는 통풍이 류마티스관절염을 제치고 가장 흔한 염증성관절염으로 등극되어 있는 것이 통계적으 로 증명되고 있다[5]. 통풍은 임상적으로나 병리학적으로 복 잡하고 심각한 질환이지만 그 치료와 예후의 중요성이 전 세 계적으로 저평가되고 있으며 우리나라에서도 제대로 치료를 받고 있는 통풍 환자들이 절반에도 미치지 못하고 있는 형편 이다[6]. 그러나 통풍은 적절히 치료를 받으면 통풍발작을 충분히 예방할 수 있고 통풍의 심각한 합병증도 줄이거나 늦 출 수 있다. 그러므로 의사와 환자들에게 통풍의 치료와 관 리에 대한 중요성이 더욱 강조되어야 한다. 여기에서는 통풍 의 치료에 대해 정리하여 소개하고자 한다. 통풍관리의 최신지견

Objective. Gout is known to be associated with cardiovascular disease (CVD), and hyperhomocysteinemia is one of the risk factors for CVD. We investigated the associations between the change of serum homocysteine (Hcy) level and those of the other parameters including serum uric acid level, renal function, and cholesterol profiles in chronic gout patients with longitudinal follow-up data. Methods. Ninety-one male patients with chronic gout and 97 age-matched healthy male control subjects were included in the previous study. Among them, 33 patients with gout and 39 healthy control subjects underwent follow-up tests for Hcy levels with an average of 24.00±9.12 months in this study. Results. The follow-up data showed that gout patients had significantly higher levels of Hcy in serum than control subjects (16.75±5.43 μmol/L vs. 13.17±3.83 μmol/L, p=0.002). In gout patients, the change of serum Hcy level after follow up showed positive correlation with the change of creatinine (γ=0.442, p=0.009) and negative correlation with estimated glomerular filtration rate (eGFR; γ=−0.528, p＜0.001). However, the change of serum Hcy level did not show correlation with the changes of uric acid level or the lipid profiles. Conclusion. Serum Hcy level was elevated in gout patients compared with control subjects. The change of serum Hcy level showed negative correlation with the change of eGFR. Hyperhomocysteinemia in gout patients was associated with decreased renal function, but not with serum uric acid or lipid profiles. (J Rheum Dis 2016;23:30-36)

Brain meningioma, the most common benign brain tumor, has been reported to account for 13-26% of all intracranial tumors, with a crude incidence rate of 2.3 per 100,000 persons for all types of meningiomas. The prevalence of neuropsychiatric lupus erythematosus is 15-91% and its clinical manifestations are diverse: from mild cognitive dysfunction to serious neurological or psychiatric symptoms. Here, we report the first Korean patient with brain meningioma and systemic lupus erythematosus who had undergone surgical tumor resection.

The quality of life (QoL) in systemic lupus erythematosus (SLE) patients may be affected by psychological features and disease status. We evaluated the QoL of SLE patients according to four subscales of QoL compared to healthy controls, and the association with affecting factors.108 patients with SLE and 52 healthy controls completed a psychological questionnaire. Depression, fatigue, and QoL were assessed with the Centre for Epidemiologic Studies Depression Scale, the Profile of Mood States Fatigue-Inertia Scale, and Functional Assessment Chronic Illness Therapy. Disease activity and damage index were measured by the SLE Disease Activity Index and SLE Collaborating Clinics/American College of Rheumatology.SLE patients showed higher degrees of depression (p=0.005) and a lower total QoL score than the controls (p=0.003). In the subscale analysis, physical well-being (PWB) and emotional well-being (EWB) were lower in the SLE group than the control group (p0.001 for both). Multivariate analysis identified correlations between the following factors: total QoL with depression and daily glucocorticoid dose; PWB with depression, fatigue, and daily glucocorticoid; EWB with depression and functional well-being (FWB) with depression.The QoL of SLE patients was lower than that of healthy controls. QoL subscales of the SLE patients were associated with daily glucocorticoid dose, depression, and fatigue rather than disease activity or damage. Comprehensive evaluation of psychological problems and appropriate management may improve the QoL of SLE patients, especially those using higher doses of glucocorticoids, even if disease activity and damage are not severe.

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 8 aout 2013

Systemic lupus erythematosus(SLE) is a prototypic autoimmune disease affecting various organ systems. Hypothermia is a rare manifestation of SLE. We experienced a case of SLE combined with hypothermia. A 36-year-old woman, who had been diagnosed as SLE 3 days before admission, admitted complaining of mental confusion. After admission, her body temperature, initially 36.1 degrees C, became 32.6 degrees C. Her core body temperature was less than 35.0 degrees C. Despite of warming with heating lamp and blankets, her core temperature did not reach 35.0 degrees C during 18 hours. Ten days later, her temperature exceeded 36.0 degrees C.

Objective.To find a measure that can predict the disease course in patients with adult onset Still’s disease (AOSD).Methods.We retrospectively investigated the medical records of 71 hospitalized patients with AOSD. Patients were divided according to chronic and nonchronic disease course. The initial laboratory results were defined as those at the time of admission, the extremely deviated laboratory results as the highest or the lowest results, and the adjusted laboratory results as area under the curve divided by the days of hospitalization. All measures were compared and the odds ratio (OR) for the chronic disease pattern was assessed.Results.The mean age was 39.7 ± 13.5 years and women accounted for 63 of the total 71 (88.7%). Thirty patients (42.3%) had self-limited disease, 9 (12.7%) intermittent disease, and 23 (32.4%) the chronic disease pattern (32.4%). Nine patients (12.7%) died. The initial levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and ferritin, the highest levels of lactate dehydrogenase (LDH) and ferritin, and the adjusted level of ferritin in patients with chronic disease were significantly higher than those with nonchronic disease. Among them, only the middle range of the adjusted ferritin level (784.1~4120.0 ng/ml) was found to have a significant predictive value for the chronic disease pattern (OR 81.7, p = 0.007).Conclusion.A novel measure, the adjusted level of ferritin during the first hospitalization, might be useful to predict progression to chronic disease in patients with AOSD.

The object of this study was to evaluate the seasonality of gout in Korea. We retrospectively examined data from 330 patients seen at nine rheumatology clinics, treated with urate lowering therapy (ULT) more than one year after stopping prophylactic medication. Demographic data, clinical and laboratory features, and seasonality of gout onset and flares were collected. Season was classified in three-month intervals. The mean age was 52.2 yr and mean disease duration was 26.8 months. The male to female count was 318:12. The onset of acute gouty attacks was obtained in 256 patients. Gout developed most commonly in summer season (36.7%) (P

To investigate the relationships of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), anthropometric variables, and lipid parameters, we measured serum TRAIL concentrations, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 207 healthy adults. There were no significant differences in serum TRAIL concentrations between men and women, nor between elderly persons and middle-aged subjects. However, men with TBF 16.4 kg (75th per centile) exhibited significantly higher serum TRAIL concentrations than those with TBF 11.2 kg (25th per centile) (69.7 +/- 15.1 pg/ml vs 50.2 +/- 14.3 pg/ml, p0.05). Serum TRAIL concentration averaged 76.2 +/- 16.1 pg/ml in women with low-density lipoprotein cholesterol (LDL-C) 165 mg/dl (75th per centile), which was significantly above the values (53.1 +/- 12.9 pg/ml, p0.05) in those with LDL-C 117 mg/dl (25th per centile), although no differences were observed on the basis of TBF (75th percentile vs 25th percentile). Serum TRAIL concentrations correlated significantlywithTBF (r = 0.31, p0.05) and lean body mass (r = -0.26, p0.05) in men and LDL-C (r = 0.32, p0.05) and total cholesterol (r = 0.21, p0.05) in women. In conclusion, serum TRAIL concentrations are associated with serum lipid levels and body adiposity in healthy adults, but are unrelated to a subject's age or gender.

Lipoma arborescens are rare lesions, typically located in the knee. They have a predilection for the suprapatellar pouch in the knee joint, but can also occur in any area of the knee joint. Magnetic resonance imaging of lipoma arborescens often reveals subchondral bone cyst and/or bone erosions, and there may appear to be a correlation between lipoma arborescens and osteoarthritis. We describe a case of histologically proven lipoma arborescens in the suprapatellar pouch and infrapatellar area of the knee with no damage to the posterior compartment and bone erosion in the proximal tibia without osteoarthritis.

To the Editor: Various musculoskeletal manifestations can develop in a patient receiving chemotherapy for malignancy1,2,3,4,5,6. We previously examined the occurrence and prognosis of chemotherapy-related arthropathy (CRA) in 18 patients with a variety of cancers with favorable responses after a mean of 3 months’ treatment with nonsteroidal antiinflammatory drugs (NSAID) and disease-modifying antirheumatic drugs (DMARD)7. However, that study was limited by the small number of enrolled patients and its retrospective design. Therefore, on the basis of our previous report, a multicenter randomized open-label pilot study was designed to evaluate whether adding hydroxychloroquine (HCQ) to NSAID modifies disease activity in CRA. Our study was conducted in accord with the ethical principles of the Declaration of Helsinki and was approved by the institutional review boards of the hospitals involved. We obtained written informed consent from all participants. We registered our trial in the database of the Clinical Research Information Service (http://ncrc.cdc.go.kr/cris: KCT0000160) as a randomized clinical trial (RCT). The open-labeled RCT was carried out at 7 tertiary hospitals from April 2007 to June … Address correspondence to Dr. C-H. Suh, Department of Rheumatology and BK21 Division of Cell Transformation and Restoration, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, South Korea 443-721. E-mail: chsuh{at}ajou.ac.kr

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and the destruction of bone and joints. It also has multiple systemic manifestations, resulting in functional disability and premature mortality. Since the introduction of various disease.modifying anti.rheumatic drugs and new biological agents, early diagnosis and treatment of this disease has become the most important therapeutic strategy. However, the existing classification criteria for RA, the 1987 revised American College of Rheumatology (ACR) classification criteria for RA, have limited diagnostic accuracy for early RA. Therefore, new classification criteria that include early RA are needed. Consequently, a joint working group of the ACR and European League Against Rheumatism (EULAR) was formed to develop a new approach to the classification for RA and developed the 2010 ACR/EULAR classification criteria. This review describes the content and clinical importance of these new classification criteria. (Korean J Med 2014;87:383-388)

Our study aimed to investigate whether serum leucine-rich alpha-2-glycoprotein (LRG) levels are elevated in patients with rheumatoid arthritis (RA). In addition, we assessed their correlation with disease activity parameters and pro-inflammatory cytokine, tumor necrosis factor-α (TNF-α). Our study included 69 patients with RA and 48 age- and sex-matched healthy controls. Serum concentrations of TNF-α and LRG were determined by enzyme-linked immunosorbent assay. Serum LRG concentrations were significantly elevated in patients with RA compared with those in healthy controls (30.8±14.4 vs. 22.2±6.1 ng/mL; P

out is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis involving, most commonly, the big toe, ankle, or other joints of the foot resulting from responses to the deposition of urate crystals from extracellular fluids supersaturated with urate. Middle aged men who are obese and drink alcohol regularly are the most susceptible. It is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints, and may cause joint des- truction, decreased kidney function, and kidney stones. It is associated with metabolic syndrome including dyslipidemia, hypertension, hyperglycemia, and obesity. Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at the base of the toes. A confir- mative diagnosis of gout requires demonstration of monosodium urate crystals in the synovial fluid, tophi, or tissues. Abstract