• Clinical and Experimental Pediatrics
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• 제53권11호
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• pp.936-941
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• 2010

The systematic approach to pharmacologic treatment is typically to begin with the safest, simplest, and most conservative measures. It has been realized that the more rapidly inflammation is under control, the less likely it is that there will be permanent sequelae. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of initial treatment for inflammation. In addition, the slow-acting antirheumatic drugs (SAARDs) and disease-modifying antirheumatic drugs (DMARDs) have efficacy of anti-inflammatory action in children with chronic arthritis. New therapeutic modalities for inflammation, such as etanercept and infliximab, promise even further improvements in the risk/benefit ratio of treatment. It is not typically possible at the onset of the disease to predict which children will recover and which will go on to have unremitting disease with lingering disability or enter adulthood with serious functional impairment. Therefore, the initial therapeutic approach must be vigorous in all children.

• 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.

• 한국임상약학회지
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• 제25권1호
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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.

• Journal of Acupuncture Research
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• 제26권5호
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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.

• 대한한방소아과학회지
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• 제24권3호
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• pp.68-75
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• 2010

Objectives: This study is to report a case that has an effective result to systemic type juvenile idiopathic arthritis patient with an oriental medicine treatment. Methods: We treated the patient with an oriental medicine and tapered down with the western medicine. We followed up the laboratory blood tests every two or three months and through telephone at least six days in a week. Results: The symptoms of systemic type juvenile idiopathic arthritis were vanished and the patient maintains his condition with oriental medicine treatment after discontinued all Disease-Modifying Antirheumatic Drugs(DMARDs). His ESR, CRP levels and other blood test results were back to normal range. Now he is in clinical remission status. Conclusions: According to the result, the oriental medicine treatment is considered to be effective on the systemic juvenile idiopathic arthritis and further studies will be needed with more cases.

• 대한한방소아과학회지
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• 제27권4호
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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.

• 대한핵의학회지
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• 제38권6호
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• pp.506-510
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• 2004

목적: Tc-99m MIBI 을 이용하여 류마티스관절염의 치료에 대한 약제반응을 알 수 있는지를 조사하였다. 대상 및 방법: Disease modifying antirheumatic drugs(DMARDs) 병합요법으로 치료를 시행하고 3개월 후에 추적관찰이 가능하였던 24명의 류마티스 관절염환자 환자들(여자 15명, 남자 9명, 평균연령: $49{\pm}12$)을 대상으로 하여, 치료 전 적혈구침강속도와 C-반응성단백질의 수치를 조사하고, Tc-99m MIBI 스캔을 얻어서, 치료전후 압통과 부종으로 임상증상의 호전정도를 조사하여 서로 비교하였다. Tc-99m MIBI스캔에서 병적관절의 활막 대 배후 방사능비 (J/B ratio)와 함께 Tc-99m MIBI의 저류율(%R)을 구하였다. 결과: Tc-99m MIBI의 3분, 10분, 180분의 활막 대 배후 방사능비는 혈구침강속도와 C-반응성단백질의 수치와 양의 상관관계를 보여 주었다. 관절의 압통과 부종의 정도를 점수화하여 평가된 임상증상의 호전정도와 3분과 180분사이와 10분과 180분사이의 저류율 각각의 상관계수가 -0.72와 -0.76으로 유의한 음의 상관관계를 나타내었다. 결론: Tc-99m MIBI가 류마티스 관절염의 약제 치료효과평가 및 관절염의 정도를 예측할 수 있는 영상방법의 가능성을 보여 주었지만, 이의 확립을 위해서는 추가적인 연구가 필요할 것으로 사료된다.

• 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.

• Journal of Acupuncture Research
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• 제21권4호
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• pp.177-196
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• 2004

Objective : Rheumatoid arthritis is an autoimmune disease that pathogenesis is not fully understood and one of the most intractable musculoskeletal diseases. The concern in the immunopathogenesis of rheumatoid arthritis has been increased since 1980's and many immunotherapeutic agents including disease-modifying antirheumatic drugs (DMARDs) were developed and became the mainstay of treatment of rheumatoid arthritis. However, the cure of the disease has hardly been achieved. In oriental medicine, rheumatoid arthritis is related to Bi-Zheng(痺證), that presents pain, swelling, andlor loss of joint function as major clinical manifestations, and also known to be deeply involved in suppression of immune function related to weakness of Jung-Ki(正氣). The herbal medicine, empirically used, could be a potential resource of development of new immunotherapeutic agents for rheumatoid arthritis. Methods : We developed a search strategy using terms to include "rheumatoid arthritis and herbal medicine" combined with "Chinese medicine" and/or "Oriental medicine". The search was focused on experimental studies of herbal medicine (January 1999 to May 2004), which is known to have effects on immune function of patients with rheumatoid arthritis. Computerized search used Internet databases including KISS and RISS4U (Korea), CNKI (China), MOMJ (Main Oriental Medicine Journal, Japan), and PubMed. The articles were selected from journals of universities or major research institutes. Results : The literature search for experimental studies on effects of herbal medicine on immunity of rheumatoid arthritis retrieved a total of 21 articles (Korea; 8, China ; 12, Japan ; 1). Of 21 articles, 10 were related to single-drug formula, 2 to drug interaction, and 9 to multi-drug formula. Single-drug formula was mainly used for aqua-acupuncture and researches on active components. Studies of drug interaction emphasized harmony of Ki-Hyul(氣血) and balance of Han-Yeul(寒熱). Multi-drug regimen was mainly found among formulas for Bo-Ki-Hyul(補氣血) and Bo-Sin(補腎). Conclusion : Studies on rheumatoid arthritis were performed both in vitro and in vivo in vitro study, LPS-stimulated splenocytes and synoviocytes were treated with herbal medicine, resulting in proliferation and activation of immune cells and suppression of cytokine activities in vivo study CIA animal model demonstrated that herbal medicine decreased antibody production and improved function of immune cells. In cellular and molecular study herbal medicine showed profound effects on the level of mRNA expression of certain cytokines related to immune function. This study revealed that herbal medicine has significant immune modulatory action and could be used for recovery of immune dysfunction of rheumatoid arthritis patients.

• Journal of Korean Medical Science
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• 제33권52호
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• pp.346.1-346.11
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• 2018

Background: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. Methods: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) ($2.6{\leq}DAS28$ < 3.2). Results: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (-0.38 vs. -0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). Conclusion: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.