WCIM 2014 SEOUL KOREA 227
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
the bronchoalveolar lavage were negative. CT guided lung biopsy was carried out and demonstrated the presence of granulomas with histiocytic cells and giant multinucle- ated cells, with neither necrosis nor caseum.
Conclusion: Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF antagonist. It is important for clinicians to be aware of this potential and uncommon complication of TNF antagonist.
PS 0696 Rheumatology
Infl ammatory Bullous Skin Disease in a Patient with Rheumatoid Arthritis after Tocilizumab Treatment
Sang Hyun JOO1, Jeong Seok LEE1, Yeong Wook SONG1, Eun Young LEE1 Seoul National University Hospital, Korea1
Introduction: Rheumatoid arthritis (RA) is a chronic systemic infl ammatory disorder with a prevalence of up to 1%. In the absence of adequate treatment, progressive joint deformity and loss of function occurs with associated premature cardiovascular morbidity. Tocilizumab (TCZ), a humanized anti IL-6 receptor antibody, has been shown to be effi cacious and well tolerated in several large randomized controlled trials of RA. Several adverse events associated to TCZ have been reported, including infections, neutropenia, hepatic toxicity, and bowel complications. Although there were some reports of drug-related skin disease after TCZ treatment such as pustulosis palmo- plantaris, diffuse pruritic erythema, halo naevus and secondary ulcerative skin lesions, autoimmune bullous skin disease was not reported.
Case description: The patient was 51-year-old woman with seropositive RA with interstitial lung disease, whose disease duration of 6 years. Because her disease ac- tivity was not controlled with oral disease modifying antirheumatic drugs including methorexate or infl iximab, TCZ was started. After third dosage of TCZ, she admitted due to infl ammatory bullous skin eruption on extensor surface of elbow joints, fi nger joints, toes, and lateral malleolar surface of ankles. Herpes simplex virus infection was suspected at fi rst, but there was no evidence of herpes simplex virus infection or vas- culitis at skin biopsy or serology. Stopping TCZ treatment lead marked improvement of bullous skin lesions.
Conclusion: We report a case of infl ammatory bullous skin disease associated with TCZ treatment.
PS 0697 Rheumatology
Comparison of the Disease Activity Score Using Eryth- rocyte Sedimentation Rate and C-Reactive Protein in Koreans with Rheumatoid Arthritis
Kyeong Min SON1, Young Il SEO1, Suk Yeon KIM1, Hyun Ah KIM1 Hallym University College of Medicine, Korea1
Background: The disease activity scored based on 28 joints (DAS28) has been widely used in clinical practice and research studies of rheumatoid arthritis (RA). Also, Korean National Health Insurance reimbursement criteria for biologic treatment of RA was recently revised based on disease activity measured with DAS28. The objective of this study was to evaluate discordance between DAS28 based on erythrocyte sedimenta- tion rate (ESR) versus C-reactive protein (CRP) in patients with RA.
Methods: From August to December 2011, 201 RA patients who visited 2 rheumatol- ogy clinics affi liated to Hallym University and had at least one DAS28 evaluation were examined.
Results: The mean age of the included patients was 52 years, and 84% were female.
The mean durations of disease was 32±46 months and the mean duration from fi rst treatment to measurement of DAS28 was 15 months. The mean swollen and tender joint counts for the 28 joints at the time were 1.2±2.6 (range 0-18) and 5.4±6.3 (range 0-26). The mean DAS28-ESR was higher than DAS28-CRP (3.59 vs 3.28; p<0.000).The number of patients who satisfi ed the criteria of remission was 50(24.9%) in DAS28- ESR versus 68 (33.8%) in DAS28-CRP and the number of patients with high disease activity was 33(16.4%) versus 14(7%) for DAS28-ESR and DAS28-CRP, respectively.
There was a signifi cantdifference in the rate of patients reaching remission and low disease activity between the two measures (p<0.001).
Conclusions: There was discordance between the ESR based and CRP based DAS28, a situation that could affect clinical treatment decisions for Korean RA patients.
PS 0698 Rheumatology
An Effect of Methotrexate on Carotid Intima-Media Thickness(CIMT) in Patients with Rheumatoid Arthritis
Min-Jung KIM1, Hyunje KIM1, Seung-Il BAE1, Choong-Ki LEE1 Yeungnam University Mecical Center, Korea1
Background: The purpose of this study is to assess the risk of developing cardiovas- cular disease (CVD) by comparing the carotid artery intima media thickness (CIMT) among the group of healthy control and rheumatoid arthritis (RA) patients treated with or without methotrexate (MTX).
Methods: This study is designed as a case control, included 44 female patients (22 patients with MTX and 22 patients without MTX) of RA and age- and sex-matched 22 healthy controls. All of the persons were negative history of smoking, and other cardiovascular disease, dyslipidemia, hypertension, diabetes, malignancy, active infec- tions. All subjects were examined by B-mode ultrasound to measure the intima-media thickness at the far wall of the both sides of common carotid artery and carotid inti- ma-media thickness(CIMT)s were calculated as mean of both sides.
Results: CIMTs in RA patients was signifi cantly thicker than that of healthy control (0.705±0.198 mm, 0.611±0.093 mm, respectively, p<0.05) (table 1). Analyses on the clinical factors and CIMTs according to the use of DMARD(disease modifying anti- rheumatic drugs) in RA revealed that CIMT was signifi cantly thicker in RA without MTX than with MTX(table 2) and correlation with age in RA without MTX ( r=0.389, p<0.05) (table 3). The change of CIMT in regards to the DMARDs was consistent only with the use of MTX in RA, and a multiple linear regression analysis to adjust for other CVD risk factors demonstrated associations of each 1 mg increase in MTX mainte- nance dosage with a 0.029 mm decrease in the CIMT value (p<0.01) (Table 4).
Conclusions: Among the DMARDs, steroid and NSAIDs are not helpful to reduce the cardiovascular risk in RA patients. But, MTX has the atheroprotective effect that pro- tecting vessel from atherosclerosis.
228 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0699 Rheumatology
Lung Disease of Rheumatoid Arthritis Patients in Korea
Hwajeong LEE1, Jung-Yoon CHOE1, Seong-Kyu KIM1, Sung-Hoon PARK1 Daegu Catholic University Medical Center, Korea1
Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease. Pulmonary involvement is one of the extra-articular manifestations of RA and manifest as a vari- ety of clinical signs such as pleural disease, pulmonary nodules, interstitial lung disease (ILD), and airway disease(AD). This study aimed to evaluate characteristics of lung disease of RA patients in Korea and compare clinical risk factors for ILD and AD.
Methods: We reviewed high-resolution computed tomography(HRCT) images and clinical data of 853 patients(male n=181,female n=672 ) met 1987 Criteria for the Classifi cation of Rheumatoid Arthritis. The diagnosis of ILD and AD was based on HRCT fi ndings. When we evaluated clinical characteristics and risk factors for ILD and AD, we enrolled defi nite ILD or AD patients and exclude patients with pulmonary tubercu- losis or pulmonary infection or lung cancer.
Results: HRCT results were abnormal in 601 (70%) patients. Pulmonary abnormalities involve the following: pleural nodule (n=14, 1%), pleural effusion (n=12, 1%), pleural thickening(n=9, 1%), bronchiectasis (n=154, 18%), bronchiolitis(n=47, 5%), ILD(n=43, 5%), nonspecific fibrosis(n=17, 1%), nodule(n=36, 4%), granuloma(n=51, 5%), in- fection(n=27, 3%), drug induced pneumonitis(n=7, 0.8%), lung cancer(n=3,0.3%), stable pulmonary tuberculosis(n=32, 3%), active pulmonary tuberculosis(n=11,1%).
Unadjusted multinomial logistic regression analysis indicated an association of AD with age(>65; RR 2.67; 95% CI 1.696 - 4.398), high titers of anti-CCP(>90 IU/ml; RR 1.793, 95% CI 1.175- 2.737). In case of ILD patients, age (>65; RR 3.856; 95% CI 1.86- 7.995),male sex (RR 5.388;95% CI 2.227- 13.036), smoking(RR 5.323; 95% CI 1.681- 16.857), high titers of anti-CCP(>90 IU/ml; RR 2.788; 95% CI 1.308- 5.942) were associated. Adjusted analysis showed age(>65) was only associated with AD( RR 2.545;
95% CI 1.473- 4.398) and ILD(RR 3.07; 95% CI 1.02- 9.24).
Conclusions: HRCT of RA patients showed various abnormalities. Old age was associ- ated with lung disease in RA.
PS 0700 Rheumatology
The Effects of Tai Chi on Endothelial Function and Arterial Stiffness in Middle-Aged Women with Rheu- matoid Arthritis
So-Young BANG1, Jeong Hun SHIN2, Soon Gil KIM2, Hye-Soon LEE1
Department of Rheumatology, Hanyang University Guri Hospital, Korea1, Department of Cardiology, Hanyang University Guri Hospital, Korea2
Background: Rheumatoid arthritis (RA) is associated with increased risk of cardiovas- cular disease, and levels of early preclinical markers of atherosclerosis, such as those that refl ect increased arterial stiffness, are commonly found to be higher in RA pa- tients than healthy individuals. The aim of this study was to investigate the effects of Tai Chi exercise on endothelial function and arterial stiffness in middle-aged women with RA.
Methods: The total of 44 female patients with RA were allocated to either a Tai Chi exercise group, receiving a 3 months Tai Chi exercise intervention, once a week, or controls receiving only information about the benefits of exercise. Assessment of endothelial function and arterial stiffness were performed by using fl ow-mediated dil- atation (FMD) and brachial-ankle pulse wave velocity (baPWV), respectively. Data were collected at baseline and at the end of the intervention (3 months).
Results: The demographic, clinical characteristics as well as baPWV and FMD were similar between both groups at baseline. Mean (±SD) baseline and 14-week DAS28 scores for the tai chi group were 3.58 ± 0.95 and 2.96 ± 0.54, respectively (change from baseline; P = 0.01). After 14-weeks of Tai Chi exercise, FMD (p=0.008) and baP- WV (p=0.025) were signifi cantly improved in the Tai Chi exercise group versus the control group.
Conclusions: Practicing Tai Chi exercise can improve the endothelial dysfunction and arterial stiffness of middle-aged women with RA. Therefore, Tai Chi exercise can be safely recommended to patients with RA as a complementary medical approach to improve cardiovascular risk. The potential long-term benefi cial effects of Tai Chi exer- cise at reducing cardiovascular risk in RA patients merit further exploration.
PS 0701 Rheumatology
Factors Infl uencing Physician Global Assessment of Rheumatoid Arthritis Disease Activity in Usual Clinical Practice
Hyesun LEE1, Sung-Hoon PARK1, Hwajeong LEE1, Seong-Kyu KIM1, Jung-Yoon LEE1 Daegu Catholic University Medical Center, Korea1
Background: Patient global assessment (PATGL) and physician global assessment (PhGL) of disease status are 2 of the 7 rheumatoid arthritis (RA) core data set. Varia- tion in PhGL appears to be explained by different factors in discordant patient group comparing with concordant group. To analyze variation in PhGL by examination of possible associations with all RA core data set measures, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), in patients monitored in usual care in a Korean rheumatology setting.
Methods: A cross-sectional study was conducted of patients with RA seen by 4 rheu- matologists in a Korean usual care setting. All core data set measures, as well as RF and ACPA, are collected in each RA patient. All study population was divided in three groups : positive discordance ; PATGL-PhGL>1, no discordance ; -1=PATGL-PhGL=1, negative discordance ; PATGL-PhGL<-1. In each group, correlations of all core data set measures, as well as RF and ACPA, with PhGL were analyzed using Spearman’s rho.
Univariate and multivariate regressions were performed for each measure with PhGL as the dependent variable, and core data set measures and laboratory tests as inde- pendent variables.
Results: PhGL was correlated signifi cantly with all 7 core data set measures (Spear- man’s rho 0.236-0.356, p<0.001). PhGL was not correlated signifi cantly with RF and ACPA. 270 patients (53.8%) were positively discordant and median disease activity score (DAS)28 was 3.9. TJC28, pain, PATGL, PhGL, DAS28 was signifi cantly different between 3 groups. By multivariate regression, PhGL was associated independently with TJC28, PATGL and ESR in positive discordance group.
Conclusions: PhGL is correlated signifi cantly with RA core data set. In multivariate regressions, PhGL was associated signifi cantly with TJC28, PATGL, ESR and RF, but not with SJC28, physical function or pain.
