• 한국임상약학회지
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• 제26권1호
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• pp.59-69
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• 2016

Background: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. Methods: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. Results: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. Conclusion: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.

• Journal of Periodontal and Implant Science
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• 제51권2호
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• pp.124-134
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• 2021

Purpose: The aim of this study was to assess the association between the clinical status of rheumatoid arthritis (RA) and periodontitis (PD) in patients diagnosed with PD and to evaluate the impact of RA treatment on the severity of PD. Methods: The study included 148 participants with PD, of whom 64 were also diagnosed with RA (PD+RA group), while 84 age-matched participants were rheumatologically healthy (PD-only group). PD severity was assessed by the following periodontal parameters: clinical attachment loss, probing pocket depth (PPD), bleeding on probing (BOP), alveolar bone loss, and number of missing teeth. RA disease characteristics and impact of disease were evaluated by the Disease Activity Score 28 using C-reactive protein, disease duration, RA treatment, the RA Impact of Disease tool, and the Health Assessment Questionnaire. Outcome variables were compared using parametric and non-parametric tests and associations were evaluated using regression analysis with the calculation of odds ratios (ORs). Results: Participants in the PD+RA group had higher mean PPD values (2.81 ± 0.59 mm vs. 2.58 ± 0.49 mm, P=0.009) and number of missing teeth (6.27±4.79 vs. 3.93±4.08, P=0.001) than those in the PD-only group. A significant association was found between mean PPD and RA (OR, 2.22; 95% CI, 1.16-4.31; P=0.016). Within the PD+RA group, moderate to severe periodontal disease was significantly more prevalent among participants with higher RA disease activity (P=0.042). The use of biologic disease-modifying antirheumatic drugs (bDMARDs) was associated with a lower BOP percentage (P=0.016). Conclusions: In patients with PD, RA was associated with a higher mean PPD and number of missing teeth. The severity of PD was affected by the RA disease clinical activity and by treatment with bDMARDs, which were associated with a significantly lower mean BOP percentage.

• 근관절건강학회지
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• 제28권2호
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• pp.200-208
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• 2021

Purpose: The purpose of this study was to establish the foundations for the application of appropriate programs for pain reduction in patients with rheumatoid arthritis. Methods: The literature on patients with rheumatoid arthritis were found on an electronic search site for South Korean academic papers. The search terms "rheumatism" and "rheumatoid arthritis" were used independently. The combined terms "rheumatism and pain" and "rheumatoid arthritis and pain" were also used. For the meta-analysis, the R version 3.5.1 program was utilized. Results: The meta-analysis of eight papers showed a large effect size of -4.11. The programs were most effective in the order of aquatic exercise, aromatherapy, self-help education, muscle strength exercises, and tai chi. Conclusion: This study could provide the basis for presenting appropriate programs for pain management in patients with rheumatoid arthritis.

• 근관절건강학회지
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• 제5권1호
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• pp.110-119
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• 1998

In an effort to obtain preventive, diagnostic and therpeutic medical and exercise training information of rheumatoid arthritis as well as to provide pertinent data to be used in development of exercise program for the management of rheumatoid arthritis, this study was conducted by using literature review. Because RA is a disease that involves both joints and muscles, its activity in the different functional classes influences the patient's ability to exercise. A patient in Functional Class 1 may perform any type of exercise because the disease involvement has not yet reached major importance. Exceptions may include hard physical exercise, running, and individual racket sports. In almost all cases, bicycle exercise is possible. Patients in Functional Class 2 and a few in Class 3 can perform most types of exercise (especially cycling, walking, heated pool exercise and even jogging) in low activity phases of RA. Although a few patients in Functional Class 3 can walk, jog, and perform similar types of exercise, most persons in this class can swim or exercise on a bicycle if the type of exercise, its intensity, and its range of motion are modified according to the patient's anatomic and pathologic conditions. Most patients in Functional Class 4 are not able to carry out complicated movements. We conclude that physical training for persons with RA has physical, psychological, and social consequences that are clearly beneficial. We recommend training be one part of the many involved in the complicated treatment of RA.

• 대한정형외과학회지
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• 제55권6호
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• pp.472-486
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• 2020

류마티스 관절염은 만성 경과를 보이는 전신 질환이지만 최근 약물 치료의 비약적 발전으로 인해 많은 환자들이 질병 활성 조절을 얻고 있다. 이에 따라 손과 손목에 시행하던 수술이 예전에 비해 줄어드는 추세를 보이고 있지만 안타깝게도 약물 치료에 반응하지 않는 환자는 여전히 존재하고 있고, 그들에게 수술은 약물과 함께 필요한 필수적 치료 방법이다. 관절이 파괴 및 변형되고, 근력 저하가 발생한 환자의 손과 손목을 수술하기 위해서 집도의는 환자마다 각기 다른 양상으로 진행되는 류마티스 관절염의 병리를 이해해야 한다. 특히 류마티스 관절염은 동시에 여러 관절을 침범하여 문제가 발생하는 경우가 빈번하여 한 가지의 수술만 하기 보다는 여러 가지의 수술을 함께 시행하는 경우가 많으므로 류마티스 관절염 환자의 손과 손목에서 발생하는 문제들에 대해 종합적인 이해가 필요하겠다. 이번 종설에서 저자는 30여 년간 류마티스 관절염에 대한 수술을 하면서 중요하게 생각하였던 개념을 정리하였고, 각 수술의 임상 결과를 문헌 고찰과 함께 기술하였다.

• Journal of Ginseng Research
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• 제42권2호
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• pp.144-148
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• 2018

Background: Panax ginseng is a well-known immune modulator, and there is concern that its immune-enhancing effects may negatively affect patients with rheumatoid arthritis (RA) by worsening symptoms or increasing the risk of adverse effects from other drugs. In this randomized, crossover clinical trial, we evaluated the impact of Korean Red Ginseng (KRG) on disease activity and safety in RA patients. Methods: A total of 80 female RA patients were randomly assigned to either the KRG (2 g/d, n = 40) treatment or placebo (n = 40) groups for 8 wk, followed by crossover to the other treatment group for an additional 8 wk. The primary outcome was the disease flare rate, defined as worsening disease activity according to the disease activity score 28 joints-erythrocyte sedimentation rate (DAS28-ESR). The secondary outcomes were development of adverse events (AEs) and patient reported outcomes. Outcomes were evaluated at baseline and 8 wk and 16 wk. The outcomes were compared using the Chi-square test. Results: Of the 80 patients, 70 completed the full study. Their mean age was 51.9 yr, and most exhibited low disease activity (mean DAS28-ESR $3.5{\pm}1.0$) at enrollment. After intervention, the flare rate was 3.7% in each group. During KRG treatment, 10 AEs were reported, while five AEs were developed with placebo; however, this difference was not statistically significant (p = 0.16). Gastrointestinal- and nervous system-related symptoms were frequent in the KRG group. Conclusion: KRG is not significantly associated with either disease flare rate or the rate of AE development in RA patients.

• IMMUNE NETWORK
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• 제15권4호
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• pp.177-185
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• 2015

Although rheumatoid arthritis (RA) is the most common chronic inflammatory autoimmune disease, diagnosis of RA is currently based on clinical manifestations, and there is no simple, practical assessment tool in the clinical field to assess disease activity and severity. Recently, there has been increasing interest in the discovery of new diagnostic RA biomarkers that can assist in evaluating disease activity, severity, and treatment response. Proteomics, the large-scale study of the proteome, has emerged as a powerful technique for protein identification and characterization. For the past 10 years, proteomic techniques have been applied to different biological samples (synovial tissue/fluid, blood, and urine) from RA patients and experimental animal models. In this review, we summarize the current state of the application of proteomics in RA and its importance in identifying biomarkers and treatment targets.

• 근관절건강학회지
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• 제6권1호
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• pp.51-72
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• 1999

The purpose of this study is to compar self-reported fatigue and fatigue-regulating behaviors of rheumatoid arthritic patients and normal persons. This study collected the data from 75 rheumatoid arthritic patents visited the departments of internal medicine or orthopedics of four general hospitals T-city and K-city by means of direct interview and questionnaires. in this study also collected data from 75 normal persons who had not been exposed to any other disease in T-city and K-city by means of direct interviews anti questionnaires which were conducted by two trained nurses. This experiment was conducted from August 1, 1998 to October 15, 1998. This study used both MAP(Multi-Dimentional Assessment of Fatigue) developed by Belza(1995) to measure fatigue and the measurement developed by Kwon, Young-Eun to investigate fatigue regulating behaviors. The collected materials were analyzed by means of descriptive statistics, t-test, and the ANCOVA according to the SPSS PC+ program. The findings are as follows : 1. There was the statistically significant difference(t =5.07, p=.000), between rheumatoid arthritic patients(32.76 points) and normal persons(25.81 points) in t-test comparison by group about fatigue. A fatigue degree of rheumatoid arthritic patient group was high in five kinds of lower realms such as common fatigue degree, fatigue severity to be experienced, distress due to fatigue, daily fatigue degree, and fatigue timing at the last week by dimension. 2. There was the significant difference in the number of fatigue-regulating behaviors between rheumatoid of fatigue arthritic patients(9.37 times) and normal persons (8.15 times), but there wasn't any significant difference in the efficiency between rheumatoid arthritic patients(2.85 points) and normal persons (2.78 points) This research suggests two kinds of things as follows : 1. It is necessary to develop an educational program for improving efficiency of fatigue-regulating behaviors as well as some nursing arbitration measures for reducing fatigue of rheumatoid arthritic patients. 2. It is necessary for the future studies to continuously grasp characteristics of fatigue by gender variable by selecting more rheumatoid arthritic male patients.

• Childhood Kidney Diseases
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• 제9권2호
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• pp.231-236
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• 2005

소아기 류마티스 관절염에서의 극소면역성 반월상 사구체신염은 매우 드문 신질환으로 국내에서는 보고된 바가 없다. 이 신질환의 발병에 소아기 류마티스 관절염이 어떻게 작용하였는지를 명확히 밝혀져 있지 않지만, 여러 가지 면역학적 기전이 작용할 것으로 생각한다. 저자들은 3년 전에 소아기 류마티스 관절염을 진단받고 치료중인 15세 남아가 혈뇨와 신기능 저하로 내원하여 시행한 신생검소견과 혈청학적 검사를 통해 p-ANCA 양성을 보인 극소면역싱 반월상 사구체신염을 진단받고 면역억제제 치료후 신기능 회복을 보인 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Advances in Traditional Medicine
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• 제5권4호
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• pp.251-261
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• 2005

Rheumatoid arthritis (RA) is an autoimmune/inflammatory disorder with a complex genetic component. RA is characterized by chronic inflammation of the synovial membrane in the joint, which leads to the progressive destruction of articular cartilage, ligament and bone. Several cytokines such as tumor necrosis $factor-{\alpha}\;TNF-{\alpha}\;and\;interleukin-1{\beta}\;(IL-1{\beta})$ and interleukin-6 (IL-6) have been implicated in the pathological mechanisms of synovial tissue proliferation, joint destruction and programmed cell death in rheumatoid joint. Genome wide screening of subjects suffering from autoimmune diseases especially arthritis revealed linkage to inflammatory molecules like $TNF-{\alpha},\;IL-1{\beta}$ and IL-6, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), nuclear factor-kappaB $(NF-{\kappa}B)$ and human leucocyte antigen/major histocompatibility complex (HLA/MHC) locus. The status of the pharmacological mechanism of herbal drugs in the light of genome wide screening results has been discussed to reinforce the therapeutic potential and the pharmacological basis of the herbal drugs.