• Journal of Medicine and Life Science
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• v.20 no.1
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• pp.32-37
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• 2023

The demand for total knee arthroplasty (TKA) is rapidly increasing worldwide. The most common indication for TKA is osteoarthritis (OA); however, some patients with rheumatoid arthritis (RA) also undergo TKA. This study aimed to investigate the effects of RA on TKA. Our findings revealed that patients with RA underwent TKA at a younger age than did patients with OA. However, contrary to the findings of pre-21st century studies, the average age of TKA among patients with RA was not significantly different from that of patients with OA. Additionally, patients with RA had a 1.5-fold higher risk of undergoing TKA. Although not statistically significant, patients with RA had a higher revision TKA rate, a shorter time until revision TKA, and underwent more revision TKAs due to infections than did patients with OA. An analysis of factors that affect revision TKA revealed that the risk of revision increased if the erythrocyte sedimentation rate and C-reactive protein levels were increased at the time of TKA. This study showed that patients with RA have a slightly higher risk of undergoing TKA than did patients with OA. Furthermore, the presence of inflammation at the time of TKA increases the risk of revision; therefore, inflammation should be adequately controlled before performing TKA.

• Journal of Oral Medicine and Pain
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• v.41 no.4
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• pp.169-179
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• 2016

Purpose: This study is designed to analyse etiology and bone pattern at the first visit using cone-beam computed tomography (CBCT) and to evaluate the treatment outcome of conservative treatment in temporomandibular disorder (TMD) patients with rheumatoid arthritis (RA). Methods: One hundred condyles in 50 subjects with RA were chosen among the patients who presented to the Department of Oral Medicine of Pusan National University Dental Hospital, diagnosed as TMD. Condylar bone changes were classified by normal, erosive bony change, proliferative bony change and combined group (erosive bony change+proliferative bony change). They were treated conservatively with physical therapy, medication, behavioral therapy and/or occlusal stabilizing splint therapy. After 3 months on average, patients were re-evaluated with regards to subjective symptoms and the clinical findings were investigated. Results: TMD patients with RA have behavioral contributing factors such as parafunctional habit. The results that analyse bone pattern at the first visit using CBCT proliferative bony changes group (32.6%) were more common than erosive bony changes group (15.2%). In comparison between unilateral and bilateral bony change in temporomandibular joint, the ratio showed no significant differences. After 3 months of conservative treatments, pain, noise, limitation of motion (LOM) were markedly improved regardless of occlusal splint therapy. However only LOM was significantly improved through occlusal splint therapy during 3 months. Conclusions: TMD patients with RA had similar behavioral contributing factors and characteristics of CBCT images shown in general TMD patients and also similar response to conservative treatment so it is difficult to differentiate. Therefore when TMD patients show symptoms corresponding to clinical diagnostic criteria of RA at the first visit, serological testing should be conducted and through this, early diagnosis and treatment of RA should be initiated.

• Journal of Yeungnam Medical Science
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• v.28 no.1
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• pp.60-69
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• 2011

Due to its efficacy and tolerability, low dose oral methotrexate (MTX) therapy has been widely used for treatment of rheumatoid arthritis (RA). However, it can rarely cause serious, life-threatening hematologic toxicities, such as pancytopenia. We report here on two patients with chronic kidney disease (CKD), who developed severe pancytopenia after 5 years (cumulative dose 1,240 mg) and 4 years (cumulative dose 1,320 mg) of low dose MTX therapy for treatment of RA, respectively. Both patients presented with renal insufficiency, hypoalbuminemia, concurrent use of nonsteroidal anti-inflammatory drugs, and elevated mean corpuscular volume of red blood cells (RECs), all of which are known as risk factors of MTX-induced pancytopenia. Despite receiving treatment, which included REC and platelet transfusions, antibiotic therapy, granulocyte colony stimulating factor, and leucovorin rescue, one patient died of sepsis. Based on our case study, prompt investigation of risk factors associated with MTX toxicity is required for all patients receiving MTX therapy. MTX treatment, even at a low dose, should be discontinued in patients with advanced CKD.

• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.434-442
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• 2012

Purpose: The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). Methods: The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression. Results: Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables. Conclusion: Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.

• Journal of Physiology & Pathology in Korean Medicine
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• v.21 no.5
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• pp.1233-1242
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• 2007

Rheumatoid arthritis (RA) is a systemic autoimmune disease with chronic inflammation characterized by hyperplasia of synovial cells in affected joints, which might be mediated by the altered activation of Immune system, ultimately leading to the destruction of cartilage and bone. To examine effects of GHS on rheumatoid arthritis DBA/1J mice were immunized with bovine type II collagen to induced arthritis and then treated with GHS once a day for 7 weeks. Oral administration of GHS (200 mg/Kg) significantly suppressed the progression of CIA, which extend is comparable to that of methotrexate (MTX, 0.3 mg/Kg), a positive control. The severity of arthritis within the knee joints, which was evaluated by histological assessment of cartilage destruction and pannus formation, was also lowered by GHS. The production of TNF-and IL-6 in serum was significantly suppressed. The levels of IFN-g in the culture supernatant of splenocytes stimulated with CD3/CD28 or collagen were dramatically decreased, while those of IL-4 was increased. The levels of IgG and IgM RA factor were also decreased in the serum. FACS analysis indicated that B cells (in DLN), CD3+ T cells (in spleen, and paw joint), CD11b+Gr-1+ cells (in paw joint), CD3+CD49b(DX5) (in PBMC) were decreased and there was increased proportion of CD3+, CD4+, CD8+, CD4+CD25+ T cells in DLN. In conclusion, our results demonstrates that GHS significantly suppressed the progression of CIA and this action was characterized by the decreased production of TNF-a, IL-6, and rheumatoid factors, and modulations of immune cell populations.

• Nutrition Research and Practice
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• v.9 no.2
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• pp.186-191
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• 2015

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS: Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin $K_1$ as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS: There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS: Function of vitamin $K_1$ in lipid profile modification remains still controversial. This study showed that vitamin $K_1$ has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.

• Journal of Acupuncture Research
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• v.32 no.2
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• pp.65-75
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• 2015

Objectives : The purpose of this study was to investigate the effects of warm needling at $GB_{30}{\cdot}GB_{34}$ on Complete Freund's Adjuvant(CFA)-induced rheumatoid arthritis in rats. Methods : Arthritis was induced by injecting CFA subcutaneously into the left knee joint and paw. Acupuncture(AT) and warm needling(W-AT0.5, W-AT1.0) were injected at $GB_{30}{\cdot}GB_{34}$, every other day for a total of 5 times beginning on day 10 after the CFA injection. Thereafter, external shape, paw edema, serum aminotransferase and anti-inflammatory factors were assessed, and hematological and histological observations were made. Results : In paw edema volume all 3 groups(AT, W-AT0.5, W-AT1.0) showed significant decrease compared to the CFA control group. In TNF-${\alpha}$ and IL-6, all 3 groups showed significant decrease compared to CFA control group. In AST and ALT all 3 groups showed no significant change. In IL-$1{\beta}$, W-AT0.5 and W-AT1.0, groups showed significant decrease compared to the CFA control group. Leucocyte, erythrocyte and thrombocyte, all 3 groups showed no significant change. In histological observations, all 3 groups were similar to the intact group in terms of synoviocyte, cartilage lacuna and cartilage cells. Conclusions : The results suggest that warm needling at $GB_{30}{\cdot}GB_{34}$, has the effect of suppressing inflammation of CFA-induced rheumatoid arthritis in rats.

• Journal of Korean Academy of Nursing
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• v.30 no.5
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• pp.1333-1346
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• 2000

This study is a methodical research to develop a health behavior assessment scale for patients with rheumatoid arthritis, and to test the validity and reliability of the instrument. The research procedure was as follows; 1) The first step was to develop conceptual framework based on a comprehensive review of the literature, in-depth interviews patients with rheumatoid arthritis. This conceptual framework was organized in eight dimensions; pain management, exercise, rest, diet control, active committment, self-management, positive thinking, interpersonal maintenance. Initially 56 items were selected from 164 statement. 2) These items were reviewed by panel of eight specialists and the Index of Content validity (CVI) was calculated, and forty six items were selected which met more than 70% on the CVI. 3) 174 rheumatoid arthritis pateints were interviewed, and data was gathered from Jan. 25 to Feb. 18, 1999 for test reliabilities and validities of the scale. The item analysis was carried out and 40 items were selected. Factor analysis by varimax rotation was carried out to test construct validity. The internal consistency by chronbach's $\alpha$ was calculated. The findings were as follows; 1) Item analysis and factor analysis were carried out to test the validity of the health behavior assessment scale. The item analysis was based on the corrected item`s to total correlation coefficient (.30 or more), and information about the alpha estimate. However, this was only if this item was deleted from the scale. As a result of the item analysis, forty items were selected. Thirty items were selected by a initial factor analysis by varimax rotation, and ten items were deleted because of factor complexity. In the secondary factor analysis, eight factors were labled as 'positive thinking', 'exercise', 'rest', 'pain management', 'active committment', 'self-management', 'diet control', and 'interpersonal maintenance', each similar with the conceptual framework. 2) Chronbach's $\alpha$ coefficient to test reliability of the scale was. 903 for total the thirty items. The Scale for assessing health behavior developed in this study was identified to be a tool with a high degree of reliability and validity. Therefore this scale can be effectively utilized for assessment in the health behaviors of the patients with rheumatoid arthritis.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.10
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• pp.4588-4597
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• 2012

This study aimed to investigate pain, perceived exercise barriers, and related factors in arthritis patients. The study was conducted on 140 arthritis patients (89 rheumatoid arthritis patients and 51 osteoarthritis patients) who visited C University Hospital in Daejeon due to arthritis and agreed to participate in a survey. The self-administered survey was conducted from February 2011 to September 2011. The results are as follow. The perceived exercise barriers increased in both groups as the education level and monthly household income decreased. In the rheumatoid arthritis group, the pain became more intense as the self-rated health status became poorer while the perceived exercise barriers became more significant as the self-rated health status became poorer and the patients had other diseases besides arthritis. In the osteoarthritis group, the pain was greater as the duration of arthritis was longer and the self-rated health status became poorer. In both groups, the perceived exercise barriers became more significant as the exercise stage approached the pre-planning stage. The results of the multiple linear regression analysis showed that the most influential factor on pain in both groups was the 'very bad' self-rated health status. In the rheumatoid arthritis group, influential factors on the perceived exercise barriers were the exercise stage and the education level while for the osteoarthritis group, they were the exercise stage and the monthly household income. In conclusion, the results of this study showed that the pain and perceived exercise barriers of arthritis patients were associated with various factors such as the education level, monthly household income, self-rated health status, and exercise stage, which suggests that these factors should be considered in the planning of exercise programs.

• Journal of Korean Academy of Nursing
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• v.27 no.3
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• pp.614-626
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• 1997

The main purposes of the study were to develop and test a model which explains the dynamic relationship among factors reported as affecting to the quality of life of individuals with rheumatoid arthritis and to examine the relationship between self-help response and quaility of life. Data for the study were collected from March 1996 to December 1996 from 153 female patients who regularly visited a clinic for people with rheumatism. The patients were introduced to the investigators by nurses who worked at that clinic, and then the investigator interviewed the patients for 30 to 40 minutes to collect the data. Instruments used in the study were modified self-report questionaires from the ones which were already developed in previous studies or from related literature. Data analysis were performed using LISREL(Lineal Structural Relations) 8 program to test whether the proposed hypothesized model fit the collected data. To test the fitablity of the hypothesized model both a general fit measure and a detailed fit measure were used. Based on the test results from the various fit measures, the hypothesized model was found to be well suited to the real data. As characteristics related to illness becomes severe, the feasibility for these characteristics leading to the perception of uncertainty about the illness tend to increase, but, the direct effects from the illness characteristics(such as level of physical symptoms, sense of social-psychologic change, limitations of action) as they are related to the other intrinsic variables (self-efficacy or self-help behavior and quality of life), were found to be not significant. It was found that uncertainty had a direct effect on self-efficacy but did not have a direct effect on self-help behavior or quality of life. Also, it is noted that self-efficacy had a positive effect on self-help behavior and quality of life and there was a bilateral relationship between self-efficacy and self-help behavior. Lastly, the hypothesis proposed from the theoretical model in this study was supported basis of the results that self-help behavior provides both direct and positive effects to quality of life. Particularity, since a bilateral relationship was also found between self-help behavior and quality of life in the modified model, as self-help behavior increased, so did quality of life. And, reversely, as quality of life increased, so did self-help behavior. In conclusion, the results of this study suggest that focusing on both acquirement and reinforcement of adjustment factors or self-help behavior is more efficient than focusing on the characteristics of illness in establishing the stategies for improving quality of life of individuals with rheumatoid arthritis.