• Journal of Rheumatic Diseases
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• 제24권4호
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• pp.227-235
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• 2017

Objective. Failure of first-line anti-tumor necrosis factor (TNF) agents in in rheumatoid arthritis patients leads to decisions among second-line biologic agents. To better inform these decisions, the therapeutic effectiveness of rituximab is compared with other second-line biologic agents in this observational study. Methods. Between November 2011 and December 2014, study subjects were observed for 12 month periods. Patients with an inadequate response to initial anti-TNF agent received either rituximab or alternative anti-TNF agents (adalimumab/etanercept/infliximab) based on the preference of patients and physicians. The efficacy end point of this study was the change in 28-joint count Disease Activity Score (DAS28) at six and 12 months from baseline. Safety data were also collected. Results. Ninety patients were enrolled in the study. DAS28 at six months did not change significantly whether the patients were treated with rituximab or alternative anti-TNF agents in intention-to-treat analysis (n=34, $-1.63{\pm}0.30$ vs. n=31, $-2.05{\pm}0.34$) and standard population set analysis (n=31, $-1.51{\pm}0.29$ vs. n=24, $-2.21{\pm}0.34$). Similarly, the change in DAS28 at 12 months did not reach statistical significance ($-1.82{\pm}0.35$ in the rituximab vs. $-2.34{\pm}0.44$ in the alternative anti-TNF agents, p=0.2390). Furthermore, the incidences of adverse events were similar between two groups (23.5% for rituximab group vs. 25.8% for alternative anti-TNF agents group, p=0.7851). Conclusion. Despite the limitations of our study, switching to rituximab or alternative anti-TNF agents after failure of the initial TNF antagonist showed no significant therapeutic difference in DAS28 reduction.

• 한방재활의학과학회지
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• 제31권1호
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• pp.33-46
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• 2021

Objectives The aim of this study is to evaluate anti-inflammatory and anti-arthritic effects of Sogyunghwalhyel-tang-gamibang (SGHHTGB) in cell and animal models and also to suggest one of putative mechanisms underlying its anti-arthritic effects. Methods Enzyme-linked immunosorbent assay was applied to measure the concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and prostaglandin E2 (PGE2) in culture medium and blood serum and nitric oxide (NO) was assayed by Griess reagent. The expressions of inducible NO synthase (iNOS) and cyclooxygenase-2 (COX-2) were analyzed by Western blot method. Results In a cell model using RAW264.7 macrophages stimulated with the endotoxin lipopolysaccharide (LPS), the drug, at its non-cytotoxic concentrations, inhibited the production of the pro-inflammatory cytokine TNF-α, IL-1β and IL-6. In addition, it suppressed the expression of the inflammatory enzyme iNOS and COX-2, and reduced the synthesis of the enzyme product NO (as stable nitrite) and PGE2 in activated macrophages. Meanwhile, in an animal model using rheumatic arthritis (RA) mice induced with injection of type II collagen antibody (CAb) and LPS, the drug improved clinical symptom of arthritis and reduced paw thickness and inflammatory cell infiltration. In blood of RA mice, the drug reduced serum levels of TNF-α, IL-1β, IL-6, nitrite, and PGE2, all inflammatory mediators produced by activated macrophages. Conclusions SGHHTGB may ameliorate CAb and LPS-induced RA in mice, presumably by inactivating macrophages that are capable of initiating joint inflammation by producing pro-inflammatory cytokines and expressing inflammatory enzymes.

• 여성건강간호학회지
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• 제5권1호
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• pp.111-132
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• 1999

This correlational descriptive study sought to define the relationship between the experience of Sanhujori, Korean tradition non-professional postpartal care after delivery and abortion and present physical symptom distress of arthritis female who visited to outpatient clinic of rheumatic internal medicine at three hospital located in Seoul, Pusan, Chongju, Korea. Data from a convenience sample of 98 women who orally agreed to be respondent were collected from September 1, 1998 to October 31, 1998 for two months by way of interview with semi-structured questionnaire. Data analysis consisted of frequency, percentage, mean, S. D., Pearson Correlation Coefficient, t-test, ANOVA and Scheffe test as a post hoc by SPSS. The results of the study were as follows ; Mean age of participants as 52.8 years and mean number of children 3.3. Mean frequency of child birth was 3.1 times per woman, 67.4% of respondents had menopause, 57.0% did not have Sunhujori after abortion. The health status implies the subjective health status women perceived, which came from the three points of view of the present, comparative with other of same age and changed after delivery. The respondents of 76.1% perceived them as unhealthy and the main sites of physical symptom distress were upper & lower extremities including knee and hand 34.8%, shoulder 26.5%, waist 22.4%. Women perceived the etiology of the arthritis as 'did Sanhujori wrongly' 36.7%, 'aging process' 24.5%, 'stress' 16.3%, 'overwork' 15.3%, 'Immunocompromize' & 'physical constitution' 7.1% respectively, 'character' 3.1%, 'genetic' 2.0%, 'malnutrition' 1.0%. The mean period of Sanhujori after delivery was 20.4 at the first child and 18.1 at the second child. The higher frequency of child birth, the shorter period of Sanhujori. For the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori well' was the highest rank in the first child and the rate of 'did not particularly Sanhujori well' was the highest rank in the last child. There was a significant positive correlation between physical function disability and rheumatoid arthritis symptom at the level of 1% of significance statistically(r=.406). And a positive correlation between physical function disability and Sanhubyung symptom at the level of 5% of significance statistically(r=.224). There was a significant positive correlation among rheumatoid arthritis symptom, Sanhubyung symptom and menopause symptom at the level of 1%-5% of significance statistically. Most of all, the correlation between Sanhubyung symptom and menopause symptom was the higher than others. There was a negative correlation between the present physical symptom distress and experience of Sanhujori(r=.-130), however it was not significant statistically. However, there was a positive correlation between subjective health status and experience of Sanhujori at the level of 1% of significance statistically(r=.328). In conclusion, this finding reconfirmed the positive relationship between the perceived health status and experience of Sanhujori after delivery among women of arthritis. It provides a challenge to the professional care givers to study further on the effects of Sanhuiori after abortion or delivery on the physical symptom distress from the variouis aspects through the cross-sectional and longitudinal research. The strategy for the development of the appropriate intervention for primary prevention of sequele after childbirth and quality of care for desirable health outcomes for postpartal women with considering deeply on the relationship between women's health and postapartal care.

• Archives of Pharmacal Research
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• 제22권5호
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• pp.485-490
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• 1999

The mechanism of action of fish oil (FO), currently used in different chronic inflammatory conditions such as rheumatoid arthritis (RA), is not completely understood, although it is thought that it could alter the metabolism of endogenous autacoids. In addition, we hypothesized that the known capability of fatty acids (FA) of stabilizing serum albumin and perhaps other proteins, may be of pharmacological relevance considering that it is shared by other anti-rheumatic agents (e.g. nonsteroidal antiinflammatory drugs). Thus, we studied the effect of oral administration of FO and corn oil (CO), a vegetable oil with a different composition, on the stability of rat serum proteins, evaluated buy a classical in vitro method based on heat-induced protein denaturation. FO, and, to a lower extent, CO inhibited heat-induced denaturation of rat serum (RS): based on the inhibitory activity (EC50) of the major fatty acids against heat-induced denaturation of RS in vitro, it was possible to speculate the in vivo effects of palmitic acid (C16:0) and eicosapentaenoic acid (EPA, C20:5, n-3) may be more relevant than that of linolenic acid (C18:2). To better investigate this phenomenon, we extracted albumin from the serum of animals treated or not with FO with a one-step affinity chromatography technique, obtaining high purity rat serum albumin preparations (RSA-CTRL and RSA-FO), as judged by SDS-PAGE with Coomassie blue staining. When these RSA preparations were heated at $70^{\circ}C$ for 30 min, it was noted that RSA-FO was much more stable than RSA-CTRL, presumably due to higher number of long chain fatty acids (FA) such as palmitic acid or EPA. In conclusion, we provided evidences that oral administration of FO in the rat stabilizes serum albumin, due to an increase in the number of protein bound long chain fatty acids (e.g. palitic acid and EPA). We speculate that the stabilization of serum albumin and perhaps other proteins could prevent changes of antigenicity due to protein denaturation and glycosylation, which may trigger pathological autoimmune responses, suggesting that this action may be involved in the mode of action of FO in RA and other chronic inflammatory diseases.

• IMMUNE NETWORK
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• 제5권2호
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• pp.78-88
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• 2005

Background: Collagen-induced arthritis (CIA) in mice is animal model of autoimmune disease known as rheumatic arthritis in human. We investigated CII-specific CD4+ T cell receptor usage in CIA mice. Methods: In CIA model, draining lymph node (dLN) CD4+ T cells and splenocytes at $3^{rd},\;5^{th},\;8^{th}$ week, we investigated CII-specific T cell proliferation, production of IL-17, IFN-${\gamma}$, TNF-${\alpha}$, IL-4 and IL-10. And we also performed anti-CII IgG Ab measurements in serum level, TCRV ${\beta}$ usage and T cell clonality with RT-PCR-SSCP analysis. Also, we performed proliferative response against CII when CII-specific T cell subset is deleted. Results: CIA mice showed more increase in the serum level of anti-CII IgG than normal mice after induction of arthritis. And the level of anti-CII IgG2a in CIA mice was increased after $3^{rd}$ week after primary immunization, while anti-CII IgG1 was decreased. Draining LN CD4+ T cells have proliferated against CII stimulation at $3^{rd}$ week after $1^{st}$immunization. CD4+T cells derived from dLN of CIA mice produced proinflammatory cytokine IFN-${\gamma}$, IL-17 etc. Draining LN CD4 T cells of CIA presented higher proportion of CD4+V ${\beta}3$+subset compared to those of normal mice at $3^{rd}$ week after $1^{st}$ immunization, and they were increased in proportion by CII stimulation. Draining LN CD4+ T cells without TCRV ${\beta}3+/V{\beta}8.1/8.2+/V{\beta}$10b+cells were not responsive against CII stimulation. But, CII-reactive response of TCRV ${\beta}3-/V{\beta}8.1/8.2-/V{\beta}$10b- T cells was recovered when $V{\beta}3+$ T cells were added in culture. Conclusion: Our results indicate that CD4+$V{\beta}3+$ T cells are selectively expanded in dLN of CIA mice, and their recovery upon CII re-stimulation in vitro, as well as the production Th1-type cytokines, may play pivotal role in CIA pathogenesis.

• 여성건강간호학회지
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• 제4권2호
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• pp.217-230
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• 1998

The purpose of this descriptive correlational study was to define the relationship between the experience of Sanhuujori, Korean traditional non-professional postpartal care after delivery and abortion and present health status of chronic arthritis female patient who visited to outpatient clinic of rheumatic internal medicine at a hospital located in Seoul, Korea. A convenience sample of 64 women who orally agreed to be a participant and data were collected form October 1996 to May, 1997 for sis months by way of interview with semistructured questionnaire. The data were analyzed by the SPSS pc program using t-test, ANOVA and Scheffe test as a post hoc and Pearson Correlation Coefficient. The results of the study were as follows ; Mean age of participants was 53.2 years and mean number of children was 3.1. Mean frequency of abortion was 2.1 times per woman. Seventy four percentage of respondents did not have Sanhujori after abortion. The mean period of Sanhujori after delivery was 17.7, 15.2, 13.8 days from the first child to third child and shorter than that of general woman such as 20.0, 19.0, 17.3 days in the previous study. On the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori wrongly' was the highest rank in each child where as general woman 'did Sanhujori well' at the first child, 'moderate' at the second and third child and 'did Sanhujori wrongly' at the 4th and fifth child. The health status implies both subjective health status women perceived and the rate of complaints of physical symptom distress women are experiencing presently. The respondents of 82.5% perceived them as unhealthy or sick and 68.9% of women complained more than two symptoms. Mean number of physical symptom distress women complained was 2.33. The main sites of physical symptom distress were upper & lower extremities 69.1% including knee and hand, whole body 19.1%, neck 3.7%, waist & shoulders 2.7% respectively. The characteristics of the symptoms were mostly pain 60%, swelling 19.8%, rigidity & deformity 7.9% respectively, sensation of heat 6.8% and weakness 1.7%. Women perceived the etiology of the chronic arthritis as stress 25.8%, 'did Sanhujori wrongly' & overwork 23.4% respectively, genetic 12.9%, malnutrition, 4.8%, and aging process 3.2%. There were significant positive correlation between subjective health status and the period of Sanhujori after delivery of the second child(r=-0.22) and negative correlation with the number of child at the level of 5% of significance statistically(r=0.27). There were significant negative correlation between the rate of complaints of physical symptom distress and the subjective evaluation whether she did Sanhujori well or not at the level of 5% of significance statistically(r=-0.23). And the rate of complaints of physical symptom distress in the group of women who experienced abortion was significantly higher than that of women who did not experience it at the level of 5% significance statistically(t=2.00) In conclusion, this finding reconfirmed the possible relationship between health status of chronic arthritis female patient and the experience of Sanhujori after delivery & abortion. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the crosssectional and longitudinal research for the refinement of the reality of not only as cultural phenomenon but as conceptual model for the appropriateness of intervention and quality of care for desirable health outcomes.

• 대한간호학회지
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• 제20권2호
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• pp.185-194
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• 1990

The purpose of this study was to investigate the correlation of discomfort. self - esteem. personality and life - satisfaction in persons with rheumatoid arthritis and to provide basic data to help them attain a better quality of life. From Jan. 27 to Feb. 24, 1988, 53 patients, registered at a rheumatic clinic at one general hospital in Seoul, were accepted as subjects for this study. The instruments used for this study were a discomfort scale and life- satisfaction scale developed by the researcher, Rosenberg's Self - esteem Scale and Wallston and Wallston's Multidimensional Health Locus of Control (MEILC) Scale. The reliability of the scales were tested by Cronsbach's alpha. The collected data were analyzed by the SAS program using unpaired t-test, ANOVA, and Pearson's Correlation Coefficients. The results were as follows : 1. There was a significant difference in the subjects perceived discomfort level(t＝-3.49, p＝ .0010) between the onset of the disease(14.87$\pm$9.02) and the present(19.87$\pm$8.44). 2. There was a significant correlation between the MHLC - internal score and the MHLC -chance score (r＝-.4366, p＝ .0011). 3. The findings related to the demographic variables regarding the MHLC scores were as follows : 1) Regarding sex, there was a significant difference for the MHLC -internal score(t＝4.2572, df＝15.2, p＝ .0007) between male(32.13$\pm$2.47) and female(27.56$\pm$4.17). But the MHLC-chance score for male(15.13$\pm$2.85) was lower(t＝3.1539, df＝21.8, p$\pm$ .0047) than for female(19.47$\pm$6.29). 2) Regarding educational background, the MHLC - chance score for the below - high school group(20.52$\pm$5.81) was higher(t＝2.5450, df＝51.0, p＝ .0140) than the college graduate group(16.41$\pm$5.76). 4. The average Self - esteem score was 26.87 (S.D.＝5.29) and there was a significant correlation between the Self- esteem score and the MHLC - chance score (r＝ .3122, p＝ .0026). 5. It was found that the subjects' Discomfort score was correlated with the Self -esteem score(r＝-.3788, p＝ .0051) and the Life - satisfaction score(r＝-3570, p＝ .0087). It was also found that subjects' Self - esteem score was correlated with the Life-satisfaction score(r＝ .4474, p＝ .0008).

• 대한간호학회지
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• 제21권3호
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• pp.323-338
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• 1991

This study investigated the effect of supportive nursing care including modified guided imagery on the discomfort, self- esteem, erythrocyte semdimentation rate(ESR) and quality of life(Q. L.) in persons with rheumatoid arthritis (R. A.). The purpose was to contribute to the development of theoretical nursing care to enhance the Q. L. of persons with chronic illness. From Nov. 22, 1990 to May 2, 1991, 49 patients registered at a rheumatic clinic at one general hospital in Seoul, were accepted according to the research criteria as subjects for this study. Among these, 26 were selected for an experimental group to he treated with an interpersonal interview and modified guided imagery, the other 23 became the control group not treated for the purpose of measuring and comparing the effect of the treatment. Statistical analysis was done by a SAS program for X$^2$-test, unpaired t -test, Pearson correlation coefficients and factor analysis. The results were as follows : 1. The pre-experimental discomfort level of the total subject group averaged 25.42(S. D. ＝8.77), and the difference between the pre /post experimental discomfort levels of the two groups was not statistically significant. 2. The pre - experimental self- esteem scores of the total subject group averaged 27.48(S. D. ＝3.95), and the difference between the pre /post experimental self -esteem scores of the two groups was not statistically significant. 3. The pre - experimental Q. L. scores of the total subject group averaged 28.70(S. D. ＝5.99), and the difference between the pre /post experimental Q. L. score of the two groups was statistically significant (t＝2.1748, df＝47, p＝ .0347), 4. The pre - experimental mean of the ESR of the total subject group was 34.48(S. D. ＝19.50) mm, and the difference between the pre /post expeimental ESR scores of the two groups was not statistically significant. 5. The Family support scores of the total subject group averaged 41.28(S. D. ＝10.27). 6. The total subject group 0.L. score was correlated with self-exteem score (r＝ .3984, p＝ .0046). In this study, supportive nursing care including modified guided imagery increased the quality of life scores for this group of persons with R. A. significantly. So the concept of supportive nursing care of this study may be effective in enhancing the quality of life persons with chronic illness. Further investigations related to the methodology and with other groups of clients was recommended.

• Journal of Acupuncture Research
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• 제19권3호
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• pp.77-87
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• 2002

Like acupuncture, magnetic therapy has been known to yield effectiveness when it is applied to relieve from fatigue, musculoskelectal diseases, sore sites, rheumatic arthritis and chronic pain syndromes. However, combined application of acupuncture and magnet has not yet been studied. This study is designed to investigate effectiveness of acupuncture therapy when in the magnetic field for the pain relief. Magnetic field was made by magnetic ring ($7{\psi}{\times}2.3{\psi}{\times}1.5mm$). Twenty-one male swimmers with latent muscular pain at the GB21 area in the university course of physical education in Daegu were chosen and divided into three groups; 1) acupuncture treatment group (n=7), 2) acupuncture treatment with iron ring group (n=7), 3) acupuncture treatment with magnetic ring group (n=7). Manual Acupuncture was given to the GB21 point for 20 minutes. The degree of pressure pain threshold (PPT, $kg/cm^2$) in GB21 was measured with algometer. Before acupuncture treatment, the PPT values were $6.08{\pm}1.69$, $6.39{\pm}1.72$ and $5.59{\pm}1.11$ in acupuncture treatment group, acupuncture treatment with iron ring group, acupuncture treatment with magnetic ring group, respectively. After acupuncture treatment, the PPT values were $6.48{\pm}2.33$, $6.31{\pm}1.31$ and $6.59{\pm}1.80$, respectively. Pressure threshold was significantly increased in the acupuncture treatment with magnetic ring group compared to the other groups. Based on these results, acupuncture treatment with magnetic ring produced better effects on pain threshold, and these effects can be considered to be associated with the currents or voltages induced by the acupuncture needle and magnetic ring at present.

• Journal of Pharmaceutical Investigation
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• 제36권6호
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• pp.355-361
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• 2006

Intraarticular corticosteroid injections for therapy of rheumatic arthritis are administered with the aim of optimal local anti-inflammatory effect at the injection site. Since the side effects of corticosteroidal drug, dexamethasone(DEX), administered at hish dose limited the therapeutic efficacy, there was a need to design a new drug delivery system for controlled release of dexamethasone. As a prodrug for continuous therapeutic efficacy, dexamethasone-21-palmitate(DEX-PAL) was prepared via esterification of palmitoyl chloride and dexamethasone. DEX-PAL was identified by NMR and MASS analysis. DEX-PAL or DEX was entrapped in lipid nanosphere which could be prepared by using a self emulsification-solvent evaporation method. Physicochemical characteristics such as mean particle diameter, zeta potential and drug loading efficiency of the lipid nanospheres were investigated with variation of either the kind of lipid or the lipid composition. The lipid nanospheres had a mean diameter $83{\sim}95$ nm and DEX-PAL loading efficiency of up to 95%. The drug loading efficiency increased with the increase of aliphatic chain length attached to the phospholipid. The incorporation of cationic lipid was very efficient for both reducing particle size of lipid nanospheres and enhancing drug loading efficiency. The lipid nanospheres containing DEX-PAL may be a promising novel drug carrier for the controlled release of the poorly water-soluble drugs.