The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 45
Slide Session
OS-RHEU-08 Rheumatology
Minimally-Invasive Biopsy of Minor Salivary Glands in Internal Medicine: Searching for Systemic Infi ltrative Diseases
Pilar BRITO ZERÓN2, Marta PEREZ DE LIS NOVO1, Soledad RETAMOZO2, Lluisa ALÓS3, Albert BOVÉ2, Hoda GHEITASI2, Belchin KOSTOV4, Antoni SISÓ ALMIRALL4, Roberto PÉREZ ALVAREZ5, Manuel RAMOS CASALS2
CHUVI, Spain1, Hospital Clinic, Spain2, Hospital Clinic, Spain3, Les Corts CEPSE, Spain4, Meixoeiro Hos- pital, Spain5
Background: To analyze the safety and utility of minor lip biopsy by using the min- imally invasive technique, performed in the Department of internal medicine, in pa- tients presenting with immunonegative sicca syndrome.
Methods: Prospective analysis of 122 patients (100 women, mean age 60 years) with sicca syndrome and negative anti-Ro/La antibodies in which minimally invasive biopsy of minor salivary glands was performed.
Results: The most common histopathological feature consisted of lymphoplasmacytic infi ltration in 57 (47%) patients, followed by fi brosis in 46 (38%) and acinar atrophy in 32 (26%); the type of lymphoplasmacytic infi ltrate was detailed in 53 patients (21 lymphocytic, 20 plasmacytic, and 12 lymphoplasmacytic). According to the lympho- cytic classifi cation of Chisholm and Mason, 53 (44%) were classifi ed as normal, 42 (35%) grade I, 11 (9%) grade II, 8 (7%) grade III and 7 (6 %) grade IV. Histopathologic diagnosis were: normal in 46 patients, non-specifi c sialadenitis in 42, primary Sjögren’s syndrome in 26 (15 as the fi nal diagnosis, 11 and probable), and other diagnoses in 6 (fat infi ltration in 5, systemic amyloidosis in 1); no cases of infi ltration by granulomas or IgG4+ were found. The presence of fi brosis was detected more frequently in women (43% vs 14%, p=0.014); the existence of fi brosis (67.70 vs 55.76 years) and acinar atrophy (69.50 vs 56.71 years) correlated with increasing age. No correlation between the degree of infi ltration and diagnostic or immunological features was found. Only 8%
patients reported transient adverse events.
Conclusions: In 21% of patients with an immunonegative sicca syndrome, a diagnosis of primary SS was confi rmed by minimally invasive biopsy, whereas 35% of patients disclosed a non-specifi c chronic sialadenitis, which could refl ect a “mild” SS that have no place in the current classifi cation criteria of this disease.
OS-RHEU-09 Rheumatology
Serum Uric Acid as an Independent Risk Factor on Progression of Chronic Kidney Disease in Gout Patients with Uric Acid Lowering Agent
Eun-Jung PARK, Seulkee LEE, Hemin JEONG, Hyungjin KIM, Jinseok KIM, Jaejoon LEE, Hoon-Suk CHA, Eun-Mi KOH
Department of Medicine, Jeju National University Hospital, Jeju University School of Medicine, Korea1, Depart- ment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea2 Background: Hyperuricemia as a risk factor for renal outcomes of chronic kidney disease (CKD) is debated. This aim of study was to evaluate long-term effect of serum uric acid (SUA) level on progression of CKD in gout patients with uric acid lowering treatment.
Methods: All patients who had a fi rst visit for gout with CKD at Samsung Medical Center between 1995 and 2003, and follow-up until December 2012 or expired during follow-up period were included and retrospective analyzed. All serum creatinine and matched SUA taken during follow-up period were analyzed by using Mixed effect model to determine the effect of SUA level on renal outcome.
Results: One-hundred eleven gout patients with CKD were observed. The mean age of the patients at diagnosis of gout was 51.3 and mean follow-up duration was 13 years. Baseline eGFR and serum creatinine were 47.7 mL/min/1.73m2 and 1.62 mg/
dL, respectively. Maintaining the SUA below 6 mg/dL showed protective effect on serum creatinine and eGFR compared with SUA more than 6 mg/dL (p < 0.0001 and p = 0.02, respectively). Mixed effect model demonstrated the protective effect on renal outcome with maintaining the SUA below 6 mg/dL was statistically signifi cant after adjusting baseline age, follow-up time, hypertension, diabetes mellitus, history of cardiovascular disease, obesity, and intrinsic renal disease (p < 0.0001). Hypertension, diabetes mellitus and follow-up time were independently associated with progression of chronic kidney disease (p < 0.001, p < 0.001 and p < 0.001, respectively).
Conclusions: Our long term follow-up data demonstrated the SUA level was associat- ed with progression of CKD in gout patients. Maintaining of SUA level below 6 mg/dL would be essential to protect renal function in gout patients with CKD.
OS-RHEU-11 Rheumatology
Prevalence of Knee Osteoarthritis and Its Risk Factors in South Korea: The Fifth Korean National Health and Nutrition Examination Survey
Sunggun LEE1, Seong-Ho KIM1, Seon-Jeong KIM2
Department of Internal Medicine, Inje University Haeundae Paik Hospital, Korea1, Department of Radiol- ogy, Inje University Haeundae Paik Hospital, Korea2
Background: Although there have been reports on prevalence of knee osteoarthritis and its risk factors in South Koreans, those studies in common had limited external validity. This study aimed to estimate prevalence of knee osteoarthritis and its risk factors using complex sampling design.
Methods: This was a cross-sectional study including 9,512 participants of The Fifth Korean National Health and Nutrition Examination Survey, who were selected using two-step stratifi ed cluster equal-probability systematic sampling, and represented es- timated population of 14,586,766 adults aged = 50 in South Korea. Radiographic knee osteoarthritis was defi ned as a Kellgren-Lawrence grade of =2. Symptoms of knee osteoarthritis was evaluated through health interview. Obesity was defi ned as a body mass index (BMI, kg/m2) = 27.5.
Results: The prevalence of radiographic knee osteoarthritis was 21.1% (95% confi - dence interval: 19.6% – 22.8%) in men, and 43.8% (42.0% – 45.6%) in women. The prevalence of symptomatic radiographic knee osteoarthritis was 4.4% (3.8% – 5.2%) and 19.2% (17.9% – 20.6%) in men and women, respectively. The mean age and prev- alence of obesity was 62 (standard error: 0.2) years and 9.7% (8.6% - 10.9%) in men, and 63 (0.2) years and 14.7% (13.5% - 15.9%) in women. When plotted against age and prevalence of obesity, regions with higher mean age and prevalence of obesity had higher prevalence of knee osteoarthritis, prevalence of symptomatic and radiographic knee osteoarthritis being 36.6% in women in Jeju-do.
Conclusions: The prevalence of symptomatic knee osteoarthritis in women reached 36.6% in regions with high mean age and prevalence of obesity. The results show the burden of knee osteoarthritis as prevalence of obesity increases in aging population of South Korea.
OS-RHEU-12 Rheumatology
Clinical Characteristics and Prognosis of Malignancies Associated with Active Myositis
Sang Jin LEE1, Eun Ha KANG1, Yun Jong LEE1, Eun Young LEE1, Yeong Wook SONG1 Seoul National University Hospital, Korea1
Background: To examine the clinical features and prognosis of cancers associated with active myositis and to compare them with cancers found in patients with myosi- tis but unrelated to myositis activity.
Methods: Medical records of 289 patients who had been diagnosed as having pri- mary myositis according to Bohan and Peter criteria were reviewed to identify fi fty two cancer cases. Cancers were defi ned to be associated with active myositis if they were present during active phase of myositis (group A). If cancers were not detectable during active phase of myositis, they were defi ned to be unrelated to myositis activity (group B).
Results: Thirty patients were included in group A. Twenty two patients in group B.
Group A tended to be male (p=0.077) and had an older age at myositis diagnosis compared with group B (p=0.022). Group A patients had shorter intervals between the diagnoses of myopathy and cancer (5.4±9.0 vs 71.6±46.6 months, p<0.001).
Muscle power grades and enzyme levels were not signifi cantly different between the two groups at baseline. Dysphagia was more frequent (p=0.002) and interstitial lung disease less frequent (p=0.001) in group A. Notably, stages at cancer diagnosis were far advanced in group A (stage 3 and 4, 24/29 vs 7/22, p<0.001). Group A patients showed poor survival compared to group B patients (hazard ratio for mortality [95%
confi dence interval], 7.4 [2.6-21.2], p<0.001).
Conclusions: In patients with myositis, clinical features of cancers associated with ac- tive myositis were distinctive from those of cancers unrelated to myositis activity. The former were found to develop within 1year of myositis in contrast to the latter, and to be more advanced at diagnosis. Patients who had cancers associated with active my- ositis showed poor survival compared to those who had cancers unrelated to myositis activity.
