• Korean Journal of Clinical Pharmacy
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• v.25 no.1
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• pp.9-17
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• 2015

Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacy compared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. The objective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab with conventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under the condition of the reimbursement coverage criteria in Korea. Methods: A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesian outcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR was greater than one. Results: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR response rates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) for Golimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. In ACR50 and ACR70, the ORs did not present significant differences. Conclusion: Certolizaumab with cDMARD was more effective or comparable than other bDMARDs in patients who failed prior cDMARD treatment.

• The Journal of Pediatrics of Korean Medicine
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• v.24 no.1
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• pp.57-64
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• 2010

Objectives This study is to examine case that has an significant result on treating Polyarticular Type Juvenile Idiopathic Arthritis(JIA) the patient who did not response to DMARDs and NSAIDs with oriental medicine. JIA is the most common form of persistent arthritis in children before age 16. The symptoms of JIA is pain and edema of joints, fever, lethargy, reduced physical activity, and poor appetite. But the symptoms vary. Methods The patient felt pain and had limitation of mobility on his joints, but the DMARDs and NSAIDs were not effective. Therefore, he was treated with oriental medicine and withdrew from DMARDs and NSAIDs. The patient took DMARDs and NSAIDs from May 2007 to November 2008(He did not took DMARDs and NSAIDs from December 2007 to June 2008), and took oriental medicine from November 2008 until now. Results The patient's pain and limited mobility on his joints, edema, morning stiffness, fatigue was gone, and could maintain the condition. He doesn't have DMARDs or any other western medicine anymore. Conclusions This study shows that a Polyarticular Type Juvenile Idiopathic Arthritis patient who had ineffective response to DMARDs and NSAIDs can reach to the clinical remission by oriental medicine treatment. His morning stiffness, fatigue, pain of joints, edema was gone and ESR was in normal range with Oriental medicine treatment.

• Journal of Acupuncture Research
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• v.26 no.5
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• pp.151-160
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• 2009

Objectives : This study is to report five cases those have an important meaning as a result of treating female Rheumatoid Arthritis(RA) patients in the reproductive years with oriental medical treatment. The patients had problems of pregnancy because of their RA and DMARDs(disease-modifying antirheumatic drugs) before oriental medical treatment. Methods : These patients were treated by acupuncture, moxibution and herb medication. Results : The conditions of patients were improved with oriental medicine even if they had stopped DMARDs. And they became pregnant and the patients maintain their conditions. Conclusions : Oriental medical treatment was effective to improve the condition of RA patients and pregnancy. For more accurate studies, further studies would be needed with more cases.

• Korean Journal of Clinical Pharmacy
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• v.26 no.1
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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.

• The Journal of Pediatrics of Korean Medicine
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• v.27 no.4
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• pp.31-38
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• 2013

Objectives This study is to report a case that has an effective result to oligoarticular type juvenile idiopathic arthritis patient with the oriental medicine treatment. Methods We treated the patient with an oriental medicine and tapered down with the DMARDs and NSAIDs. We followed up the laboratory blood tests every four or five months and throughout the experiment. Results The symptoms of oligoarticular type juvenile idiopathic arthritis were vanished and the patient maintained her good health condition with oriental medicine treatment after discontinued all Disease-Modifying Antirheumatic Drugs (DMARDs) and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Her ESR, CRP levels were stable in normal and other blood test results were back to normal range. Her joint mobility and condition was back to normal. Now she is in clinical remission status. Conclusions According to the result, the oriental medicine treatment is considered to be effective on the oligoarticular juvenile idiopathic arthritis and further studies will be needed with more cases.

• Journal of Korea Association of Health Promotion
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• v.2 no.2
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• pp.154-159
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• 2004

Rheumatoid arthritis(RA) is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one percent of adults. Inflammation of the synovial membrane surrounding a joint leads to swollen, tender, and stiff joints RA has no known cure and the diagnosis is made based on clinical criteria and many different options exist for treatment. All of these factors magnify the importance of the patient-physician interaction and place a premium on the art rather than the science of medicine. The major goals of therapy for RA are to relive pain, swelling, and fatigue; improve joint function; stop joint daage, and prevent disability and disease-related morbidity. Some combination of nonsteroidal anti-inflammatory drugs(NSAIDs), steroids, and DMARDs is necessary in almost patients. In many combinations of different DMARDs or DMARDs plus biologicals are necessary for optimal control. Additionaly, all patients with RA should be educated about their disease and the therapies that will be used. Patient education is essentially early in the disease course and on going basis Much research is focused on the further development of biological agent for treatment of RA. Elucidation of the trigger or trigers for RA may allow us to begin to think about prevention of RA.

• Proceedings of the Korean Society of Applied Pharmacology
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• 2001.11a
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• pp.35-36
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• 2001

According to the recent epidemiological data, the numbers of patients of Reumatoid Arthritis(RA) in the world are reported to be 350mi11ion and 700,000 in the world and in Japan, respectively For the treatment of RA, NASIDs as the first choice drug have been widely used worldwide, and more than 50 NSAIDs have been in market up to today in Japan. Early 1990s, DMARDs as the new drug for RA treatment came into market, and the number of DMARDs has been increased every year. These drugs are recognized to have several advantages in treatment of RA, however, disadvantages are also reported, i.e., (1) high incidence of side effects, (2) high non-responder population, (3) decreased efficacy in chronic treatment, and (4) slow starting of the efficacy. For example, Methotrexate which has been widely used as the immunosuppressant has been recently used for treatment of Reumatoid. However, this drug has several disadvantages such as 60-70% improvement of the disease, 80% incidence of side effects, and 2-4 weeks to recognize the efficacy after treatment. In addition to these two.

• The Journal of Pediatrics of Korean Medicine
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• v.23 no.1
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• pp.73-83
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• 2009

Objectives This study is to report a case that has an important meaning as a result of treating Juvenile Rheumatoid Arthritis. We investigated a patient who had to maintain his life with western medicines such as DMARDs, NSAIDs and steroids for a long time. The patient has recovered from all symptoms and his ESR, CRP has been back to normal range with oriental medicine treatment. Methods The patient had fever, especially repeated fever during the afternoon, pain and swelling of joints, generalized skin eruption, anorexia, delayed growth, weight loss, fatigue. So we treated him with herbal medicine and reduced his western medicine. The aim of treatment was recovery from Juvenile Rheumatoid Arthritis after discontinuance of all western medicine. Results The symptoms of systemic type Juvenile Rheumatoid Arthritis was vanished and the patient maintains his condition with oriental medicine treatment after stopped all DMARDs such as MTX(methotrexate) and NSAIDs. His ESR and CRP levels were back to the normal range. After this treatment the patient's height and weight has been increased which showed a significant meaning in growth to the child. Conclusions This study showed that oriental medicine can elevate the Juvenile Rheumatoid Arthritis patient's quality of life with continuous health care and treatment for major problem. For more accurate studies, further studies would be needed with more cases.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.3
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• pp.135-146
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• 2009

Objectives : The purpose of this study is to report the effect of live leech(hirudo medicinalis) therapy with oriental medication on the patient with regional rheumatoid arthritis. The patient had resistant to DMARDs so she was in the debilitating condition and suffered from edema, pain, stiffness of joint and purpura before live leech(hirudo medicinalis) therapy. Methods : The regional rheumatoid arthritis patient had edema, pain, stiffness of joint and purpura on right foot. We treated the patient with live leech(hirudo medicinalis) therapy and oriental medicine. Results : The symptoms of regional rheumatoid arthritis was improved through live leech(hirudo medicinalis) therapy and oriental medicine. The patient maintains her condition with oriental medicine treatment after stopped all DMARDs such as MTX(methotrexate) and NSAIDs. After this treatment the patient's walking difficulty has been improved. Conclusions : This study shows that live leech(hirudo medicinalis) therapy and oriental medicine can elevate the regional rheumatoid arthritis patient's quality of life with continuous health care and treatment for major problem. For more accurate studies, further studies would be needed with more cases.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.506-510
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• 2004

Purpose: We investigated whether Tc-99m MIBI imaging is useful to predict the response of drug treatment in patients with rheumatoid arthritis. Materials and Methods: 24 patients (15 women and 9 men, age $49{\pm}12$ year) rheumatoid arthritis and treated with disease modifying antirheumatic drugs (DMARDs) were included in this study. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured, and Tc-99m MIBI scan was obtained before drug treatment. Quantitative analysis of uptake in diseased joints was performed and expressed as joint-to background ratio (J/B) and percent retention (%R) of Tc-99m MIBI. Clinical symptoms were evaluated and graded from 0 (no) to 3 (severe) regarding to presence of tenderness and swelling. Results: J/B of the diseased joints were significantly correlated with ESR and CRP (p<0.05). A highly significant correlation was found between the improvement of clinical symptoms and %R of Tc-99m MIBI (p<0.05). Conclusion: The results demonstrate that Tc-99m MIBI scan may be used to predict the therapeutic response in patients with rheumatoid arthritis.