WCIM 2014 SEOUL KOREA 247
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
most effective drugs in the treatment of symptomatic sarcoidosis. The same, it is use- ful to change the clinical course of the disease and improve prognosis.
PS 0767 Rheumatology
Arthritis in Older Man: Don’t Forget Paraneoplastic Syndromes
Helena 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 - Hospital Geral De Santo António, Portugal2
The association of rheumatic manifestations with cancer is now well established.
There are various rheumatological diseases that can be manifested as paraneoplastic syndromes, i.e. precede or occur simultaneously with different types of tumors, with- out local evidence of malignancy and regress after effective treatment of the tumor.
In fact, the recognition of rheumatic symptoms as the fi rst translation of malignancy is essential for early treatment of the underlying tumor. The authors present a case of a 66 year-old man with no history of relevant disease nor family history of psoriasis or rheumatic diseases, with initial manifestation of chronic oligoarticular frame of the knees with severe systemic infl ammatory component associated with B symptoms, which evolved into symmetric inflammatory polyarthritis and morning stiffness.
Analytically, without anemia or lymphopenia, increased inflammatory parameters, hemosedimentation velocity and C-reactive protein; Negative immunological study, including RF and anti-CCP, interpreted as probable seronegative rheumatoid arthritis.
Excluded tuberculosis. Initially treated with NSAIDs, corticosteroids and methotrexate (MTX) without much articular benefi t, subsequently conducted infi ltrations and began salazopyrin (SSZ), with some clinical improvement. Onset of oral ulcers, whose biopsy revealed epidermoid carcinoma. Tumor with lymph node metastasis, requiring dissec- tion, radiotherapy and chemotherapy, with clear improvement of the arthritis after- wards. Assumed paraneoplastic arthritis. Disease currently in remission, sporadically medicated only with NSAIDs. The relationship between malignancy and rheumatic manifestations is not simple. It is often diffi cult to identify the underlying tumor if not thinking about it, since the rheumatic paraneoplastic syndromes mimic well the idiopathic situations. On the other hand, the exhaustive search for a neoplasm in the initial assessment of rheumatic diseases is not recommended unless it is a high risk patient. Additionally, paraneoplastic arthritis may have independent natural history of tumors, thus the diagnosis is always a challenge.
PS 0447 Infectious Diseases
Prevalence of Multi-Drug Resistant Gram Negative Bacteria Caused Bacteremia from Internal Ward, Dr.
Soetomo Hospital Surabaya, Indonesia
Bramantono SOEKARMAN1 Airlangga University, Indonesia1
The use of antibiotics in hospitals in line with the emergence of microbes resistant to antibiotics. The resistant microbes may cause infection in patients for example that bacteremia. Bacteremia is condition that found bacteria on the blood fl ow, and these conditions can be threatening. The purpose of the study was to determine the prevalence of gram-negative bacteria causing bacteremia in internal medicine wards along sensitivity of antibiotic. The study shows a change in the prevalence of gram- negative bacteremia especially. Three species of germs most in 2010 was Klebsiella spp, E coli and Acinetobacter spp, Acinetobacter spp in 2012 were , E coli and Pseu- domonas. 2013 is A baumannii, E coli and P aeruginosa. And 2014 is A baumannii, K pneumoniae, and E cloacae Antibiotics for MDR cases with high sensitivity, among others, Amikacin, imipenem, meropenem, Piperacillin and tazobactam. Conclusion The prevalence of MDR gram-negative change each year, with dominance by Acinetobac- ter baumannii. Some Antimicrobial still has a high sensitivity
Keywords: Multi-drug Resistant, Gram negative bacteria, Bacteremia
PS 1627 Infectious Diseases
Musculoskeletal Ultrasound in Rheumatology in Korea – TUI Survey: Ultrasound Use in Rheumatology in Korea
Seoung-Wan Nam1, Richard J. Wakefi eld2, Paul Emery2, Taeyoung Kang1
Department of Rheumatology, Yonsei University Wonju College of Medicine, Korea1, Division of Rheu- matic and Musculoskeletal Disease and NIHR Leeds Musculoskeletal Biomedical Research Unit (LMB- RU), University of Leeds, United Kingdom2
Background: The use of musculoskeletal ultrasound (US) in rheumatology has rapidly advanced over the past decade, demonstrating its usefulness in the diagnosis and as- sessment of arthritis. Targeted Ultrasound Initiative (TUI) is an international research network which aims to promote US as a standard outcome measure in patients with rheumatoid arthritis. In collaboration with the TUI, to conduct the fi rst study in Korea to investigate current practices in US use among Korean rheumatologists.
Methods: We translated the global TUI survey into Korean and augmented it to ascertain the current status and use of US by Korean rheumatologists. In February 2013, we sent e-mails to all Korean College of Rheumatology (KCR) members; survey ran from March until June 2013; paper surveys sent to KCR members who did not respond to the e-mail survey.
Results: This study enrolled 108 rheumatologists which covered about a half of the total Korean rheumatologists. Rheumatologists in hospitals and private clinics use US to examine between one to fi ve patients daily; they use US for diagnosis more than moni- toring and receive compensation of about US$30–50 per patient. There are marked dif- ferences in the rates of US usage between rheumatologists who work in private practice compared with tertiary hospitals. Korean rheumatologists not currently using US in their practice appear eager to do so. Most current US users reported using it primarily for diagnosing either suspected arthritis (77.8%) or undifferentiated arthritis (64.4%). The most commonly cited barrier was insuffi cient time for examination.
Conclusions: This survey provides important insights into the current status of US in rheumatology in Korea and highlights several priorities; specifi cally, greater provision of formal training, standardization of reporting, and accrual of greater experience among US users. If these needs are addressed, all rheumatology departments in Korea are likely to use US or have access to it in the future.
