WCIM 2014 SEOUL KOREA 245
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0759 Rheumatology
Epidemiology of Polymyalgia Rheumatica in Korea
In Young KIM1, Gi Hyeon SEO2, Seulkee LEE1, Hyemin JEONG1, Hyungjin KIM1, Jeajoon LEE1, Eun-Mi KOH1, Hoon-Suk CHA1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Korea1, Health Insurance Review and Assessment Service, Korea2
Background: Polymyalgia rheumatica (PMR) is a chronic infl ammatory disease affect- ing people older than 50 years of age. The diagnosis is made based on clinical features, and the current standard of treatment is low-dose glucocorticoids. PMR is more com- monly reported in Caucasians and females. However, epidemiological studies in Asia are scarce, and no such studies have been conducted in Korea. We estimated incidence and prevalence of PMR in Korea.
Methods: This study was conducted by reviewing National Health Insurance and Health Insurance Review and Assessment databases. We verifi ed all claims data for population aged over 50 years between 2007 and 2012. PMR cases were defi ned by diagnostic and prescription codes. Cases were included when the PMR ICD-10 code (M 35.3) was recorded more than twice, and glucocorticoids were prescribed for more than 30 days.
Results: We identifi ed 1,463 newly diagnosed cases of PMR during the 5 years. Among them, 992 (67.8%) were female, and mean age at diagnosis was 66.9 years old. The sex and age adjusted annual incidence rate was estimated to be 2.06 per 100,000 individuals aged over 50 years. The prevalence rate was 8.21 per 100,000 individuals in 2012. Incidence and prevalence appeared to increase with age, peaking at about 70 years old. Prednisolone was the most commonly prescribed glucocorticoid. In half of the patients, the starting dose was 5-15 mg daily. Of the 1,453 PMR cases, only 1.2%
had a diagnostic code for giant cell arteritis simultaneously.
Conclusions: This is the fi rst study to investigate the epidemiology of PMR in Korea.
The incidence and prevalence of PMR appeared to be considerably lower than those in Western populations. Both genetic and environmental factors might infl uence disease occurrence. The actual incidence may have been underestimated due to a lack of awareness of PMR in clinical practice.
PS 0760 Rheumatology
Fever, Cough and Confusion as Clinical Expression of Giant Cell Arteritis
Joao Gomes PEREIRA1, Julio FERNANDES2
C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal1, C. Hosp. Lisboa Norte - Hospital De Santa Maria, Portugal2
Introduction: Giant cell arteritis (GCA) is the most common primary vasculitis in the elderly with predominance for the superfi cial temporal artery (ATS) and usual clinical expression of headache and elevation of infl ammatory parameters. The involvement of other organs is less common. 75 year old man with a history of bipolar disorder and severe headache in the 2 months prior to admission motivated by non-productive cough, fever and mental confusion, with no complaints of headache at this stage. On examination we revealed time-space disorientation, incoherent speech, bibasilar fervor and fever (38.2 ° C). Laboratory tests: ESR 120 mm/1h, CRP 19.7 mg / dL, normochro- mic normocytic anemia, AST 78U / L, ALT 94U / L GGT 81U / L, 69 mmHg pO2. Chest radiograph without parenchymal abnormalities. We assumed acute tracheobronchitis and started amoxicillin / clavulanic acid and azithromycin, which obtained a week of apyrexia. After suspending the antibiotics headache and fever restarted, while main- taining cough. Etiological investigation, including lumbar puncture was negative for infectious pathology. ATS Doppler showed bilateral stenosis suggestive of atheroma- tous disease without evidence of sonographic halo. By keeping clinical suspicion and elevation of infl ammatory parameters a right ATS biopsy was made that confi rmed the diagnosis of GCA. The patient began therapy with prednisolone 75mg/day (1mg/
kg) with clinical and analytical resolution of the picture.
Conclusion: This case allows us to call attention to cough and confusion as clinical expression of GCA, which can diffi culty in diagnosis for its atypical presentation. We highlight the importance of a high index of suspicion for this entity in an elderly pa- tient in the context of less common clinical expressions.
PS 0761 Rheumatology
Homonymous Hemianopia in a Patient with Behcet’s Disease
Won-Seok LEE1, Yun-Hong CHEON1, Myong-Joo HONG2, Wan-Hee YOO1
Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University Hospital-Chonbuk Nation, Korea1, Division of Rheumatology, Department of Internal Medicine, Presbysterian Medical Center, Korea2 Introduction: Homonymous hemianopia is a specifi c visual disturbance induced by the lesions of the retrochiasmal visual pathways, including the optic tract, lateral genicu- late body, parietotemporal radiation, and occipital cortex. The most frequent cause is apoplexy, followed by trauma, neoplasm, brain surgery, and other less common mech- anisms. Here, we report a homonymous hemianopia in a patient with Behçet’s disease who was visualized as lesions in lateral geniculate bodies on magnetic resonance image (MRI).
Case presentation: A 49-year old man presented to our department with sudden visual fi eld defect in both eyes when waking. Ten years Previouly, we diagnosed Beh- cet’s disease upon observation of oral ulceration, genital ulceration, positive pathergy test and multiple peripheral joint arthralgia. Laboratory data revealed increased serum levels of CRP (1.3mg/dL) and accelerated blood sedimentation rate (47 mm/hr). Visual fi eld and fundal examinations were conducted in the Department of Ophthalmology.
A right homonymous hemianopia detected in the Humphrey visual fi eld test, but no abnormal fi ndings was identifi ed on fundal examination. Magnetic resonance imaging (MRI) was performed due to the clinical suspicion of homonymous hemianopsia, and showed high-intensity lesions in left lateral geniculate bodies. From these results, he was diagnosed as having an acute relapsing phase of neuro-Behcet disease and he re- ceived steroid pulse therapy (1g/day) for 3 days. Immediately after steroid pulse ther- apy, he received high dose prednisolone (1mg/kg/day) and cyclophosphamide (750mg/
day). The lesions in the lateral geniculate bodies had reduced on MRI images taken 2 weeks after treatment, but homonymous hemianopia remained nearly unchanged.
Conclusion: Clinicians should be aware that hemianopia in behcet’s disease represent neu- ro-behcet’s disease, and early brain evaluation and proper treatment must be performed.
PS 0762 Rheumatology
Causes of Hospitalisation Among BehÇet’s Syndrome Patients in a Rheumatology Center in Turkey
Yesim OZGULER1, Vedat HAMURYUDAN2, Gulen HATEMI3, Ayse Selcen PALA4, Sebahattin YURDAKUL5, Hasan YAZICI6
Cerrahpasa Medical Faculty, University of Istanbul, Turkey1, Cerrahpasa Medical Faculty, University of Is- tanbul, Turkey2, Cerrahpasa Medical Faculty, University of Istanbul, Turkey3, Cerrahpasa Medical Faculty, University of Istanbul, Turkey4, Cerrahpasa Medical Faculty, University of Istanbul, Turkey5, Cerrahpasa Medical Faculty, University of Istanbul, Turkey6
Background: We surveyed the causes and outcome of hospitalisations among Behçet Syndrome (BS) patients in a dedicated center.
Methods: The records of all inpatients in our clinic between 2002-2011 were ret- rospectively reviewed to identify patients hospitalised with a diagnosis of BS. We reviewed both the inpatient and outpatient charts to identify the demographic and clinical features, causes of hospitalisation and outcome. We also contacted the pa- tients to determine their current condition.
Results: 178 BS patients (74% men, mean age 42.9±11.3) had been hospitalised for a total of 211 times during the last ten years. We were able to contact 104(58%) of them. The reasons for hospitalisation were directly related to BS organ involvement in 118(56%) and to complications in 93(44%). The most common BS related reasons were vascular involvement in 74/118(63%) (including 21 patients with pulmonary artery aneurysms, 10 with peripheral artery aneurysms and 11 with serious venous thrombosis such as vena cava superior and Budd-Chiari syndrome), neurologic involvement in 14/118(12%), gastrointestinal involvement in 6/118(5%) and eye in- volvement in 6/118(5%). Hospitalisations caused by complications of BS were infections in 39/93(42%), and other drug related adverse events in 15/93(16%). Neoplasias were diagnosed in 5 patients. Among the 178 patients, 16(9%) had died. Most common causes of death were vascular involvement (n=5), infections (n=4) and malignancies (n=4).
Conclusions: Vascular involvement is the leading cause of hospitalisation among BS patients, followed by infections related to therapy. Adverse events related to immuno- suppressives are problematic. The predominance of men among hospitalized patients underlines the more severe course of BS in this sex. The relatively low frequency of gastrointestinal involvement among hospitalisations is in line with our previous obser- vation that this type of involvement is rare in our BS patients.
