WCIM 2014 SEOUL KOREA 229
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0702 Rheumatology
Psychosocial Impact of Rheumatoid Arthritis Patients on Their Family Members
Sang Wan CHUNG1, Ji Ae YANG2, Eun Ha KANG1, Yun Jong LEE1, You Jung HA1 Seoul National University Bundang Hospital, Korea1, Seoul National University Hospital, Korea2 Background: Rheumatoid arthritis is a chronic illness that affects people both physi- cally and psychologically. To date, many studies have been conducted for evaluation of the burden of caregivers in chronic disease such as stroke, dementia, however, RA has not been evaluated. A population-based study was conducted to evaluate the psycho- social impact of RA patients on their family members.
Methods: From the Fifth Korea National Health and Nutrition Examination Surveys (KNHANES V) (2010-2012) dataset, we identifi ed 452 RA patients and then selected family members of these patients who were aged 20 years or older (n=515). The con- trol group was sampled from members of families without RA patient with matching for sex and age (n=1,545). Serial conditional logistic regression models were used for comparison of characteristics between family members of RA patients and control group, and prediction of psychosocial impact, such as history of depression, of RA pa- tients on their family memebers.
Results: The mean age was 51.9±18.8 years. Family members of RA patients were more employed (63.6% vs. 60.2%, p = 0.037), and had higher household income (p=0.037) compared with sex and age-matched control subjects. No signifi cant dif- ferences in comorbidity between two groups. Family members of RA patients also had a signifi cantly higher level of stress (29% vs. 24.3%, p=0.046), history of depression (17.3% vs. 11.9%, p=0.004). The presence of a RA patient in the family showed an association with history of depression (odds ratio, 1.60; 95% confi dence interval, 1.19 to 2.16; p=0.002), after adjustment for household income, education level, and em- ployment status.
Conclusions: Our data shows that family members of RA patients are more susceptible to depression. We suggest that physicians or rheumatologists who treat RA patients should pay attention to psychosocial burden of family members of their patients.
PS 0703 Rheumatology
Remission of Sweet Syndrome Secondary to Rheuma- toid Arthritis Treated with Etanercept
Helena Lobo MARTINS1, Tomás Abrantes DA FONSECA2, Teresa SEQUEIRA2, Isabel ALMEIDA2, António MARINHO2, Carlos VASCONCELOS2
Centro Hospitalar Do Porto / Centro Hospitalar Do Baixo Vouga, Portugal1, Centro Hospitalar Do Porto, Portugal2
Sweet’s syndrome (SS) is the most common acute neutrophilic dermatosis (ND), often idiopathic although it is associated with a wide range of diseases, especially neoplas- tic, infl ammatory and infectious. We report the case of SS occurring on a 43-year-old woman with a known seronegative rheumatoid arthritis (RA) since 20 year-old. After diagnosis, was treated by NSAIDs, methotrexate (MTX) and gold salts with complete remission. Medication was suspended. In 2002, develops disabling symmetric polyar- thritis, unresponsive to corticosteroids, NSAIDs and sulfasalazine. MTX was avoided due to chronic cholestasis (autoantibodies to primary biliary cirrhosis were negative, IRM excluded primary sclerosing cholangitis and liver biopsy without cirrhosis or in- terface hepatitis). Initiated Anti-TNF alpha monotherapy (Adalimumab) in 2004 with complete remission. Suspended due to pregnancy in 2007 and stayed in remission without drugs until 2014. In 2012, she presented widespread painful mucocutaneous lesions involving the neck, trunk and upper limbs, with fever, arthralgia and deteri- oration of general condition, compatible with SS. Biopsy confi rmed diagnosis. Sys- tematically excluded tuberculosis, lympho/myeloproliferative and other autoimmune diseases. Executed corticotherapy unsuccessfully, having developed iatrogenic diabe- tes. Improvement of lesions with dapsone, maintaining tolerable oral lesions. In 2014, worsening cutaneous lesions and initiates cyclosporine without any benefit. Under cyclosporine, progression to disabling oral lesions, and severe polyarthritis with DAS 28 5.02 (high activity disease). The authors assumed SS secondary to RA and started anti-TNF alpha etanercept. Skin lesions improved within few days, with complete re- gression of all clinical and laboratory abnormalities. The authors argue the importance to consider SS in differential diagnosis of new mucocutaneus lesions in patients with known autoimmune diseases, including RA. The diagnosis should be based on clinical, laboratory and histological fi ndings of an acute febril neutrophilic dermatosis without vasculitis. In these cases, the treatment with anti-TNF alpha is an option.
PS 0704 Rheumatology
A Case of Seronegative Rheumatoid Arthritis Following Treated Adult-Onset Still’s Disease
Mi-Hye KWON1, Go-Eun LEE1, Yu-Mi JO1, Chung-Il JOUNG1 Konyang University Hosptial, Korea1
Adult-onset Still’s disease (AOSD) is an uncommon autoinfl ammatory disease. Typical features include high spiking fever, evanescent rash, and arthritis or arthralgia. Still’s disease is a facet of juvenile idiopathic arthritis, however AOSD and rheumatoid ar- thritis (RA) are considered unrelated because clinical presentations and hypothesized pathogenesis are different. To our knowledge a case of RA following AOSD has not been reported yet, and we experienced a case so we report it. A 54-year-old man was admitted for one month of fever. Fever was predominant in the afternoon one or two times a day, reaching 39~40℃ and accompanied with pain on ankles. Initial lab showed elevated ESR and CRP, and serum ferritin level was just above normal. With empiric antibiotics treatment, further evaluations for fever of unknown origin were performed. Bone marrow biopsy was negative, while several reactive lymph nodes were seen on PET CT. On 16th hospital day serum ferritin was elevated to 1725.91 ng/
mL and he had new skin rash on his lower legs, he was consulted for rheumatologic evaluation. RF, anti-CCP, ANA, and ANCA were all negative and he was diagnosed as AOSD. With steroid therapy the symptoms and signs were improved. Steroid was tapered and stopped uneventfully within 3 months. After 6 months of the last visit he revisited with painful swelling of both 2nd and 3rd MCP joints, left 2nd PIP joint, and both 3rd and 4th PIP joints. He had no fever or rash, ferritin level was normal. Insid- ious onset of joint symptoms, typical symmetrical polyarticular involvement of small joints of hands made us diagnose him as seronegative RA. He has been followed on methotrexate.
