• Journal of Korean Academy of Nursing
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• v.30 no.3
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• pp.619-631
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• 2000

This study was conducted to test whether a comprehensive health promotion program for promotion strategies and knowledge about the disease, thus leading to the improvement of health status by using repeated measure of quasi- experiment design. Eighteen RA patients who visited the RA clinic of an university hospital located in Inchon were invited to participate in the CHPPRA. According to the study results, it was shown that the CHPPRA had significant effects on the patients' health status such as pain, depression, and functional disability. Also, that the improvement of health status was achieved by a positive change in the four health promotion strategies, which consisted of goal setting, positive thinking, exercise, and knowledge about the disease. Goal setting, positive thinking, and knowledge about the disease could also affect the patients' depression. Thus it can be interpreted that the improvement of these strategies may result in a remarkable decrease of depression. In addition, alleviation of functional disability may be due to increase of exercise. However although the strategies which were directly associated with pain management were not significantly improved, pain was significantly reduced. On the other hand, the study result showed that the other health promotion strategies included in CHPPRA such as pain management, positive thinking, stress management, asking for assistance and communication were not significantly increased. although the health status such as pain, depression, and functional disability, which are final goals of the program, were significantly improved through the exposition of patients to those health promotion strategies.

• Women's Health Nursing
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• v.29 no.2
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• pp.91-103
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• 2023

Purpose: This study aimed to construct a structural equation model to explain and predict factors affecting the health-related quality of life (QoL) in female rheumatoid arthritis (RA) patients based on the health-related QoL model by Ferrans et al. (2005) and a literature review. Methods: Patients (N=243) who were either registered members of an internet cafe composed of patients with RA or rheumatology outpatients at two tertiary general hospitals in Busan, Korea, were recruited via convenience sampling. Data were collected from July 2 to September 9, 2021, and the survey was conducted using a web-based questionnaire. The data were analyzed by SPSS and AMOS 26.0. Results: The goodness-of-fit statistics of the final model exhibited good results (χ²/degree of freedom=2.68, Turker-Lewis index=.94, comparative fit index=.96, standardized root mean-squared residual=.04, root mean- square error of approximation=.08), and 11 out of 14 paths of the model were supported. The squared multiple correlation, which reflected the explanatory power of the environmental characteristics, symptoms, functional status, and perceived health status on health-related QoL, was 80%. In the hypothesis model, 10 paths had significant direct effects, 6 paths had significant indirect effects, and 12 paths had significant total (direct and indirect) effects. Conclusion: Considering that factors directly affecting the health-related QoL of female patients with RA were social support, symptoms (fatigue and depression), resilience, and perceived health status, and that resilience was the most influential factor, clinicians can encourage resilience. Hence, to improve the health-related QoL of female patients with RA, continuing management is necessary, using various intervention methods that focus on enhancing resilience from the early stage to the end of treatment for RA.

• The Journal of Korean Physical Therapy
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• v.19 no.1
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• pp.57-66
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• 2007

Purpose: We investigated the effects of the combined therapy in rats with rheumatoid arthritis induced by type II collagen for 28 days, which consisted of the oral administration of the AR and EA applied to zusanli acupoint(ST36). Methods: Normal group was oral administered with 0.9% NaCl $0.5\;m{\ell}/day$ to normal rats. Control group was oral administered with 0.9% NaCl $0.5\;m{\ell}/day$ to arthritic rats. Group I was oral administered with AR 500 mg/kg $0.5\;m{\ell}/day$ to arthritic rats. Group II was given 2 Hz EA of ST36 in the test group for 30 min/day to arthritic rats. Group III was oral administered with AR 500 mg/kg $0.5\;m{\ell}/day$ and 2 Hz EA of ST36 in the test group for 30 min/day to arthritic rats. We Observed effect of the histopathological changes by H&E stain of liver, kidney, knee joint and ELSIA of cytokines($TNF-{\alpha}$). Results: 1. The vacuolization of liver tissue was decreased in group I, II, III comparing with control group. 2. The glomerular sclerosis of kidney tissue was decreased in group I, II, III comparing with control group. 3. The erosion of arthritic site of knee joint tissue was decreased group I, II, III comparing with control group. In particular group III was the most effective comparing with group I, II on the histopathological view. 4. In the ELSIA test of $TNF-{\alpha}$ concentration, Control group significantly increased in the concentration more than group I, II, III. The rate of increase in concentration slowed down in group III more than group I, II(p<0.05). Conclusion: It is concluded that 500 mg/kg of AR extracts and EA have clear therapeutic effect on the rheumatoid arthritis.

• IMMUNE NETWORK
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• v.11 no.5
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• pp.258-267
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• 2011

Background: Current management strategies attempt to diagnose rheumatoid arthritis (RA) at an early stage. Transcription profiling is applied in the search for biomarkers for detecting early-stage disease. Even though gene profiling has been reported using several animal models of RA, most studies were performed after the development of active arthritis, and conducted only on the peripheral blood and joint. Therefore, we investigated gene expression during the initial phase of collagen-induced arthritis (CIA) before the arthritic features developed in the thymus in addition to the peripheral blood and synovium. Methods: For gene expression analysis using cDNA microarray technology, samples of thymus, blood, and synovium were collected from CIA, rats immunized only with type II collagen (Cll), rats immunized only with adjuvant, and unimmunized rats on days 4 and 9 after the first immunization. Arrays were scanned with an Illumina bead array. Results: Of the 21,910 genes in the array, 1,243 genes were differentially expressed at least 2-fold change in various organs of CIA compared to controls. Among the 1,243 genes, 8 encode T-cell receptors (TCRs), including CD3${\zeta}$, CD3${\delta}$, CD3${\varepsilon}$, CD8${\alpha}$, and CD8${\beta}$ genes, which were down-regulated in CIA. The synovium was the organ in which the genes were differentially expressed between CIA and control group, and no difference were found in the thymus and blood. Further, we determined that the differential expression was affected by adjuvant more than Cll. The differential expression of genes as revealed by real-time RT-PCR, was in agreement with the microarray data. Conclusion: This study provides evidence that the genes encoding TCRs including CD3${\zeta}$, CD3${\delta}$, CD3${\varepsilon}$, CD8${\alpha}$, and CD8${\beta}$ genes were down-regulated during the initial phase of CIA in the synovium of CIA. In addition, adjuvant played a greater role in the down-regulation of the CD3 complex compared to CII. Therefore, the down-regulation of TCR gene expression occurred dominantly by adjuvant could be involved in the pathogenesis of the early stage at CIA.

• Journal of muscle and joint health
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• v.7 no.2
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• pp.241-257
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• 2000

Rheumatoid arthritis as one of the chronic illness requiring management in long period of time puts great burden to patients, their family and society. For patients with chronic illnesses, providing a social support is important and the most important source comes from spouses. Therefore we assessed burden of husbands of female rheumatoid arthritic patients and also found out the factors affecting burden. The sample of study was 107 female rheumatoid arthritic patients and their spouses. The tool of assessing spouses' burden was the revised version of subjective and objective parameters developed by Montgomery et al.(1985). The results are as follows: 1. General characteristics of patients and spouses: The mean age of the patients was 48 years. Educational level of patients was high school 41.1%. The mean age of the spouses was 51years. Educational level of spouses was mostly high school(40.2%) and college(29.9%) graduate. The mean marital period was 23.4years. Average income per month was 1,609,000 won. The average duration since diagnosis was 9.4years. As a therapy, 67.3% chose standard drug therapy. Average rating of discomfort by patient was 3.05(range 1-5) and that of severity was 3.48 and that of dependency was 2.58. The husband's rating of their spouses disease severity was 3.68. 2. Husbands' burden: The average burden in subjective items was 21.61(range 6-36) and objective items was 35.24(range 10-60). The average of total burden was 56.59(range 16-96). 3. Husband's total burden correlated with patient's age, educational level of patients, therapy method, patient's level of discomfort, patient's severity, patient's level of dependence, husband's recognition of level of severity in statistical level. Husband's objective burden correlated with patient's age, educational level of patient, patient's level of discomfort, husband's recognition of level of severity. Husband's subjective burden correlated with patient's age, educational level of patients, therapy method, patient's severity, patient's level of dependence, husband's recognition of level of severity. 4. Linear correlation analysis on burden: The husbands' total burden is explained in 37 7% by husband's recognition of level of severity and husband's age. The husbands' objective burden is explained in 31.2% by patient's level of dependence, husband's age, husband's recognition of level of severity. The husbands' subjective burden is explained in 26.7% by husband's recognition of level of severity and patient's age. In conclusion, husbands' level of burden is affected by many factors and therefore nursing strategy for relieving burden of middle aged husbands should be individualized taking these factors into consideration.

• Journal of Physiology & Pathology in Korean Medicine
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• v.21 no.2
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• pp.425-431
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• 2007

The purpose of this study was to observe the effects of Achyranthes Radix(AR) and electroacupuncture(EA) in rats with rheumatoid arthritis induced by type II collagen for 28 days. Control group was daily administered 0.9% NaCl 0.5 $m{\ell}$, Group I was daily administered 0.9% NaCl 0.5 $m{\ell}$ to arthritic rats, Group II was orally administered with Achyranthes Radix 500 mg/kg 0.5 $m{\ell}$ to arthritic rats. Group III was given 2 Hz EA of chok samni acupoint(ST36) in the test group for 30 min/days to arthritic rats. Group IV was daily orally administered with Achyranthes Radix 500 mg/kg 0.5 $m{\ell}$ and 2 Hz EA of chok samni acupoint(ST36) in the test group for 30 min/days to arthritic rats. This studies have been designed to evaluate the hind paw edema, assessment of arthritis indices, analgetic effects by analysis of blood chemistry(WBC, CRP, ALP, AST). In each group, histologic observations, Safranin O-fast green stain were observed and analyzed. The following results were obtained. Group II, III, IV were significantly decreased arthritis indices and the rate of paw edema compared with Group I . Especially group IV was the most significantly decreased. The WBC, CRP, AST, ALT was that Group II, III, IV were significantly decreased compared with Group I . In conclusion, Achyranthes Radix and Ea contribute to the improvement of blood chemistry and change in safranin O-fast green by knee joint of arthritic rats.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3403-3410
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• 2014

Context: Interest exits in whether TNF-alpha antagonists increase the risk of breast cancer and total malignancies in patients with rheumatoid arthritis (RA). Objectives: To analyze the risk of malignancies, especially breast cancer, in patients with RA enrolled in randomized control trials (RCTs). Methods: A systematic literature search for RCTs from 1 January 1998 to 1 July 2013 from online databases, such as PubMed, WILEY, EMBASE, ISI web of knowledge and Cochrane Library was conducted. Studies included RCTs that compared the safety of at least one dose of the five TNF-${\alpha}$ antagonists with placebo or methotrexate (MTX) (or TNF-${\alpha}$ antagonists plus MTX vs placebo plus MTX) in RA patients for more than 24 weeks and imported all the references into document management software EndNote${\times}6$. Two independent reviewers selected studies and extracted the data about study design, patients' characteristics and the type, number of all malignancies. Results: 28 RCTs from 34 records with 11,741 patients were analyzed. Of the total, 97 developed at least one malignancy during the double-blind trials, and breast cancer was observed in 17 patients (17.5% of total malignancies). However, there was no statistically significant increased risk observed in either the per protocol (PP) model (OR 0.65, 95%CI [0.22, 1.93]) or the modified intention to treat (mITT) model (OR 0.75, 95%CI [0.25, 2.21]). There were also no significant trend for increased risk of total malignancies on anti-TNF-${\alpha}$ therapy administered at approved doses in either model (OR, 1.06, 95%CI [0.64, 1.75], and OR, 1.30, 95%CI [0.80, 2.14], respectively). As to the two models, modified intention to treat model analysis led to higher estimation than per protocol model analysis. Conclusions: This study did not find a significantly increased risk of breast cancer and total malignancies in adults RA patients treated with TNF-${\alpha}$ antagonists at approved doses. However, it cannot be ignored that more patients developed malignancies with TNF-${\alpha}$ antagonists therapy compared with patients with placebo or MTX, in spite of the lack of statistical significance, so that more strict clinical trials and long-term follow-up are needed, and both mITT and PP analyses should be used in such safety analyses.

• IMMUNE NETWORK
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• v.24 no.1
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• pp.10.1-10.17
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• 2024

In this review, we will explore the intricate roles of cytokines and vascular endothelial growth factors in autoimmune diseases (ADs), with a particular focus on rheumatoid arthritis (RA) and multiple sclerosis (MS). AD is characterized by self-destructive immune responses due to auto-reactive T lymphocytes and Abs. Among various types of ADs, RA and MS possess inflammation as a central role but in different sites of the patients. Other common aspects among these two ADs are their chronicity and relapsing-remitting symptoms requiring continuous management. First factor inducing these ADs are cytokines, such as IL-6, TNF-α, and IL-17, which play significant roles in the pathogenesis by contributing to inflammation, immune cell activation, and tissue damage. Secondly, vascular endothelial growth factors, including VEGF and angiopoietins, are crucial in promoting angiogenesis and inflammation in these two ADs. Finally, placental growth factor (PlGF), an emerging factor with bi-directional roles in angiogenesis and T cell differentiation, as we introduce as an "angio-lymphokine" is another key factor in ADs. Thus, while angiogenesis recruits more inflammatory cells into the peripheral sites, cytokines secreted by effector cells play critical roles in the pathogenesis of ADs. Various therapeutic interventions targeting these soluble molecules have shown promise in managing autoimmune pathogenic conditions. However, delicate interplay between cytokines, angiogenic factors, and PlGF has more to be studied when considering their complementary role in actual pathogenic conditions. Understanding the complex interactions among these factors provides valuable insights for the development of innovative therapies for RA and MS, offering hope for improved patient outcomes.

• Journal of Acupuncture Research
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• v.22 no.2
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• pp.33-41
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• 2005

Objective : The effect of Ulmus davidiana Planch(UD), which has long been known to have anti-inflammation and protective effects on damaged tissue, inflammation and bone among other functions, on the development of type II collagen (CII)-induced arthritis (CIA) in rats was studied. Methods : Male rats were immunized with an emulsion of $200\;{\mu}g$ of CII and complete Freund's adjuvant (CFA). The rats were then given intraperitoneal stimulation of Ulmus davidiana Planch herbal acupuncture(UDHA)or saline during the experiment. When compared with rats treated with saline as control, UDHA at doses of more than $20{\mu}g/100\;g$ rat once a day for 7 days inhibited the ability of inguinal lymph node cells to produce T cell cytokines interleukin-2, interleukin-6, $IFN-{\gamma}$ when the cells were obtained from rats 14 days after immunization and cultured in vitro with CII. Results : When rats were injected intraperitoneally, UD -treated group and control group rats did not differ significantly when low doses of UD was given to rats. Conclusion : The recommended dose of UD in the management and treatment of rat CIA will be more than $20{\mu}g/100\;g$, which is two-firth of human therapeutic dose. From the results, it was concluded that the effect of UDHA is dependent of dosage.

• Journal of muscle and joint health
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• v.6 no.1
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• pp.100-135
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• 1999

Typical symptoms of rheumatic disease affect overall daily living and cause severe stress. Individuals afflicted with rheumatic disease have many illness-related stresses. Pain was the predominantly perceived stress followed by limitation in mobility, difficulties in carrying out activities of daily living. helplessness, dependency on others, threat to self-esteem, interference in social activity, interference in family relationships. difficulties performing at work, and discomfort of the treatment. Patients with chronic arthritis are subjected to long periods of continuous stress, which may require the management by the health care provider. In these cases, the purpose of the nursing is helping to promote health through supporting patient's coping. Therefore, for the nursing intervention to be effective, it is critical to build a theoretical framework that describes stress-coping for chronic arthritis. Thus, the purpose of this dissertation is to present a theoretical framework which describes the stress-coping processes and to empirically test pathos of this framework for the people with chronic arthritis. The foundation upon which this framework is built in the Erickson, Tomlin, and Swain(1983) theory of Modeling and role-Modeling. The subjects were 275 patients with rheumatoid arthritis or osteoarthritis who visited the outpatient clinic. A hypothetical model of stress-coping was tested by covariance structure analysis with PC-LISREL 8.12 program. As a result, the overall fit was good(Chi-square=94.49, P=0.00, RMR=0.067, GFI=0.95, AGFI=0.91, NNFI=0.93, NFI=0.91) for the hypothetical model. The results of hypothesis testing were as follows : Basic need satisfaction had a statistically significant influence on illness-related experience, emotional stress and coping resources. Internal health locus of control had a statistically significant influence on coping resources. However, independent variables(basic need satisfaction, internal health locus of control, illness-related experience, emotional stress and coping resource) did not have significantly influence on coping. And then, the hypothetical model was modified by considering both the theoretical implication and statistical significance of the parameter estimates. The revised model had a better fit to the data(Chi-square=83.11(P=0.00), RMR=0.061, GFI=0.96, AGFI=0.92, NNFI=0.95, NFI=0.92). Hypothesis emerged from the revised model was tested. The results of hypothesis testing were as follows : Basic need satisfaction had a statistically significant influence on illness-related experience, emotional stress and coping resources. Internal health locus of control had a statistically significant influence on illness-related experience and coping resources. Internal health locus of control, illness-related experience, emotional stress and coping resources had a significantly influence on coping. According to the results of this dissertation, basic need satisfaction and internal health locus of control play a central role in appraisal of illness-related experience and coping resources. And illness related-experience, emotional stress, and coping resources affect on coping activities. In summary, nursing interventions to enhance basic need satisfaction and internal health locus of control will decrease illness related experience and emotional stress and increase coping resources. Increased coping resources will prompt coping activities.