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BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal fibrosis. Recently, there have been increasing reports of PPFE, and PPFE might coexist with other interstitial lung diseases in the lower lobe and upper lobe. However, cases of unilateral PPFE are scarce. CASE SUMMARY A 75-year-old Korean male presented to our hospital with chronic dry cough and exertional dyspnea. The patient’s symptoms started 6 mo previously and had been gradually worsening. At the time of presentation, he felt dyspnea when walking at his own pace. Radiologic findings suggested PPFE, but the lesion was localized in the upper lobe of the right lung. After multidisciplinary discussion, a transbronchial lung biopsy in the right upper lobe revealed collapsed alveoli with parenchymal fibroelastosis, and elastic van Gieson staining demonstrated septal elastosis with intra-alveolar collagenosis, which met the histopathologic criteria of definite PPFE. After multidisciplinary discussion in an experienced interstitial lung disease center, we confirmed the diagnosis of unilateral PPFE. Furthermore, we confirmed the progression of PPFE on radiologic findings during the follow-up period. CONCLUSION Clinicians should consider PPFE, even in cases with unilateral, predominantly upper lung involvement in interstitial lung disease patients through multidisciplinary discussion.

In December 2019, numerous coronavirus disease 2019 (COVID-19) cases were reported in Wuhan, China, which has since spread throughout the world. However, its impact on rheumatoid arthritis (RA) patients is unknown. Herein, we report a case of COVID-19 pneumonia in a 61-year-old female RA patient who was receiving conventional disease-modifying antirheumatic drugs (cDMARDs). The patient presented with a 4-day history of myalgia and febrile sensation. COVID-19 was confirmed by real-time polymerase chain reaction (PCR). Chest X-ray showed increased opacity on the right lower lung area, and C-reactive protein level was slightly elevated. The patient was treated with antiviral agents (lopinavir/ritonavir), and treatment with cDMARDs was discontinued except hydroxychloroquine. Her symptoms and laboratory results gradually improved. Three weeks later, real-time PCR for COVID-19 showed negative conversion, and the patient was discharged without any complications.

Background/aims To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea. Methods A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made. Results The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the rightside second and third MCP joints were 0.55 and 0.55 mm, and those of the leftside joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology. Conclusion We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

Objective As the heritability of hyperuricaemia remains largely unexplained, we analysed the association between parental and offspring hyperuricaemia at the phenotype level. Methods This cross-sectional study included data on 2373 offspring and both-parent pairs from the seventh Korean National Health and Nutrition Examination Survey. Logistic regression and generalised estimating equation analysis were used to evaluate the association between offspring and parental hyperuricaemia adjusting for metabolic risk factors and alcohol intake. Results Both maternal and paternal hyperuricaemia were associated with offspring hyperuricaemia among teenagers, but from the age of 20 years, a strong association was observed between offspring and paternal, rather than, maternal hyperuricaemia, and this could not be explained by metabolic risk factors such as obesity. However, there was a positive interaction between offspring alcohol intake and parental hyperuricaemia, and there was a stronger association between terciles of offspring alcohol intake and hyperuricaemia in the presence of parental hyperuricaemia: T1 (reference), T2 odds ratio (OR) 1.1 (0.3–4.6), and T3 OR 3.3 (1.4–7.9) (P for trend .017) vs. T1 (reference), T2 OR 0.7 (0.3–1.9), and T3 OR 1.1 (0.6–2.2) (P for trend .974). Conclusion These results suggest a gene–environment interaction, especially with respect to alcohol intake for hyperuricaemia in Korean adults.

Background Interstitial lung diseases (ILDs) are chronic, parenchymal lung diseases with a variable clinical course and a poor prognosis. Within various clinical courses, acute exacerbation (AE) is a devastating condition with significant morbidity and high mortality. The aim of this study was to investigate the role of interleukin-6 (IL-6) to predict AE and prognosis in patients with ILD. Methods Eighty-three patients who were diagnosed with ILD from 2016 to 2019 at the Haeundae Paik Hospital, Busan, South Korea, were included and their clinical data were retrospectively analyzed. Results The median follow-up period was 20 months. The mean age was 68.1 years and 65.1% of the patients were men with 60.2% of patients being ever-smokers. Among ILDs, idiopathic pulmonary fibrosis was the most common disease (68.7%), followed by connective tissue disease-associated ILD (14.5%), cryptogenic organizing pneumonia (9.6%), and nonspecific interstitial pneumonia (6.0%). The serum levels of IL-6 were measured at diagnosis with ILD and sequentially at follow-up visits. During the follow-ups, 15 (18.1%) patients experienced an acute exacerbation (AE) of ILD and among them, four (26.7%) patients died. In the multivariable analysis, high levels of IL-6 (OR 1.014, 95% CI: 1.001–1.027, p = 0.036) along with lower baseline saturations of peripheral oxygen (SpO2) were independent risk factors for AE. In the receiver operating characteristic curve analysis, the area under the curve was 0.815 (p < 0.001) and the optimal cut-off value of serum IL-6 to predict AE was 25.20 pg/mL with a sensitivity of 66.7% and specificity of 80.6%. In the multivariable Cox analysis, a high level of serum IL-6 (HR 1.007, 95% CI: 1.001–1.014, p = 0.018) was only an independent risk factor for mortality in ILD patients. Conclusions In our study, a high level of serum IL-6 is a useful biomarker to predict AE and poor prognosis in patients with ILD.

Background The main barrier to the effective rheumatoid arthritis (RA) therapy is poor adherence. Coronavirus disease 2019 (COVID-19) pandemic have led to a significant change in the pattern and the number of medical visits. We assessed changing patterns of medical visits and no-show, and identified factors associated with no-show in patients with RA during COVID-19 pandemic. Methods RA patients treated with disease-modifying antirheumatic drugs at least 6 months who had been in remission or those with mild disease activity were observed for 6 months from February to July 2020. No-show was defined as a missed appointment that was not previously cancelled by the patient and several variables that might affect no-show were examined. Results A total of 376 patients and 1,189 appointments were evaluated. Among 376 patients, 164 patients (43.6%) missed appointment more than one time and no-show rate was 17.2% during COVID-19 pandemic. During the observation, face-to-face visits gradually increased and no-show gradually decreased. The logistic regression analysis identified previous history of no-show (adjusted odds ratio [OR], 2.225; 95% confidence interval [CI], 1.422–3.479; P < 0.001) and fewer numbers of comorbidities (adjusted OR, 0.749; 95% CI, 0.584–0.961; P = 0.023) as the independent factors associated with no-show. Conclusion Monthly analysis showed that the no-show rate and the pattern of medical visits gradually changed in patients with RA during COVID-19 pandemic. Moreover, we found that previous history of no-show and fewer numbers of comorbidities as the independent factors associated with no-show., Graphical Abstract

The association of dietary and nutritional factors with hyperuricemia and gout is well-known in Western populations. The present study aimed to examine the association of dietary and nutritional factors with hyperuricemia among Korean adults.This cross-sectional study included 10,175 participants from the seventh Korean National Health and Nutrition Examination Survey 2016-2017. Dietary information was collected using a single 24-hour recall method, and nutritional information was derived from the 9th Korean Food Composition Table. The associations between serum uric acid and intake of meat, seafoods, nuts, and legumes, sugar-sweetened products, dairy products, alcohol, sodium, vitamin A, vitamin B1, vitamin C, and dietary fiber were analyzed using linear regression analysis adjusting for confounding variables. The association with hyperuricemia was analyzed using logistic regression analysis. All analyses were weighted by the sampling design.Alcohol intake was associated with serum uric acid in both men and women. In men, the highest quartile of alcohol intake was associated with a 1.5-times higher prevalence of hyperuricemia (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.16-1.95), while vitamin C and dietary fiber intakes were found to be inversely associated with hyperuricemia. For vitamin C and dietary fiber intake, the ORs for a quartile increase were 0.93 (95% CI 0.86-0.99) and 0.92 (95% CI 0.85-0.99), respectively.The associations between vitamin C, dietary fiber and alcohol intakes and hyperuricemia in men support the Dietary Approach to Stop Hypertension (DASH)-based approach and attention to alcohol intake for managing hyperuricemia in Korean men.

The aerial parts of Tetrastigma hemsleyanum (APTH) have been used as a functional tea in China. The purpose of the current study was to identify the bioactive constituents with inhibitory activity against soluble epoxide hydrolase (sEH) and inducible nitric oxide synthase (iNOS), which are jointly considered potential therapeutic targets for vascular system diseases. In the present study, 39 compounds (1–39) were isolated from the APTH. Among them, compounds 8, 10, 12, 16, 17, 19, and 32 displayed potential activities, with IC50 values ranging from 4.5 to 9.5 µM, respectively, and all in non-competitive inhibition mode. Compounds 5, 10, 12, 19, and 32 displayed potent iNOS inhibitory effects, with IC50 values ranging from 15.6 to 47.3 µM. The results obtained in this work contribute to a better understanding of the pharmacological activities of T. hemsleyanum and its potential application as a functional food.

Milnacipran is a reuptake inhibitor of both serotonin and noradrenaline, used in the treatment of fibromyalgia with severe depression. However, few studies have been conducted on the efficacies of milnacipran drug on the functional connectivity of the neural network. The authors aimed to find the correlation between the drug efficacy and the changes in neural network in fibromyalgia patients. Resting-state-functional magnetic resonance imaging (rs-fMRI) were obtained before and after milnacipran drug administration. Graph theory indexes and small-worldness were calculated using preprocessed blood-oxygen-level-dependent signals from the rs-fMRI scans of 14 brain regions-of-interest. Statistical analyses were conducted to compare the topological network parameters. Significant changes in the neural network indexes appeared in three of the 14 brain regions-of-interest. In the pain network, the average path length on the left side of Brodmann area 32 was shortened. In the default mode network, functional connectivity changes were observed in the left lateral parietal cortex and medial prefrontal cortex. In the left lateral parietal cortex, the degree and betweenness centrality increased, whereas the clustering coefficient decreased. In the medial prefrontal cortex, local efficiency decreased. The small-worldness declined after milnacipran medication. The present results demonstrate that functional connectivity indexes in the brains of female fibromyalgia patients obtained from rs-fMRI data can be used as potential prognosis markers of milnacipran drug treatment.

To assess adherence (compliance and persistence) and factors that might contribute to nonadherence to urate-lowering therapies (ULT) in patients with gout in a routine clinical setting.This prospective observational cohort study was conducted in the rheumatology center of a local tertiary hospital. A total of 132 male adults aged 75 years or younger who were incidentally diagnosed with gout were included. Adherence to ULT was assessed by the clinic nurses through pill counts.Of the 132 patients, 94 (71.2%) was compliant and 81 (61.4%) was persistent with ULT. The logistic regression analysis revealed that the absence of chronic kidney disease (CKD) and the previous history of non-persistence with ULT are the independent factors associated with noncompliance and the absence of CKD is an independent factor associated with non-persistence. The average serum urate levels of the noncompliant (p = 0.001) and non-persistent (p = 0.002) patients were significantly higher than those of the compliant and persistent patients.The absence of CKD and the previous history of non-persistence of ULT that are correlated with poor adherence and easily assessed can be used to identify patients at a particular risk of poor adherence.

Objectives: To assess long-term adherence and persistence to febuxostat (FBX) and factors that might contribute to non-adherence and non-persistence to FBX in male patients with gout during a 3-year period. Methods: Adherence to FBX was assessed by the clinic nurses through pill counts at the scheduled visits and non-adherence was defined as less than 80% of the prescribed dose taken. Non-persistence was defined as discontinuation of FBX longer than 60 days. Results: A total of 220 patients were recruited. The percentage of adherence and persistence was 71.8% and 80.9% at 1 year, 65.5% and 68.2% at 2 years and 58.2% and 56.4% at 3 years, respectively. The logistic regression analysis identified high income status, current smoking, absence of hypertension and previous history of non-persistence with urate-lowering therapy (ULT) as the independent factors associated with non-adherence, and the unmarried, absence of hypertension and previous history of non-persistence with ULT as the independent factors associated with non-persistence. Conclusion: Variable risk factors that are correlated with poor adherence or persistence and easily assessed can be used to identify patients at a particular risk of poor adherence or persistence.

Background Obesity and metabolic abnormalities are important risk factors for knee osteoarthritis (KOA). Recent epidemiologic studies have found that a high glycemic index (GI) and glycemic load (GL) diet are associated with a higher risk for metabolic complications and cardiovascular mortality. Objective We aimed to examine the association between dietary GI, dietary GL, and KOA among Korean adults. Design This was a cross-sectional study that analyzed data obtained from the Korean National Health and Nutrition Examination Survey 2010-2012. Participants/setting A total of 9,203 participants (5,275 women) aged ≥50 years were included. Main outcome measures KOA was defined as the presence of radiographic features of Kellgren-Lawrence grade ≥2. Chronic knee pain was defined as the presence of knee pain for more than 30 days during the past 3 months. Dietary information was collected using a single 24-hour recall method. Statistical analyses performed The association between the quintiles of dietary GI and dietary GL and knee conditions was analyzed using a multinomial logistic regression analysis adjusting for age, physical activity, obesity, hypertension and diabetes, serum low-density lipoprotein, and total energy intake. Results Among the women, the association between dietary GI and symptomatic KOA was: quintile 1: 1.00 (reference); quintile 2: 1.29 (95% CI 0.87 to 1.92); quintile 3: 1.59 (95% CI 1.11 to 2.28); quintile 4: 1.74 (95% CI 1.21 to 2.51); and quintile 5: 1.77 (95% CI 1.20 to 2.60) ( P =0.001). Chronic knee pain without KOA was associated with dietary GI; however, this association was not linear across quintiles. There was no significant association between dietary GI and asymptomatic KOA. Among the men, no significant association was found between dietary GI and any knee conditions. There was no significant association between dietary GL and KOA in both men and women. Conclusions There was a significant positive association between dietary GI and symptomatic KOA in women.

Aim Although there have been regional population-based studies on the prevalence of knee osteoarthritis (KOA) and its risk factors in South Koreans, those studies in common had limited external validity. This study aims to estimate the national prevalence of KOA and its risk factors using a complex sampling design. Methods This was a cross-sectional study including 9512 participants aged ≥ 50 years of The Fifth Korean National Health and Nutrition Examination Survey, who were selected using two-step stratified clustered equal-probability systematic sampling. Radiographic KOA (RKOA) was defined as a Kellgren–Lawrence grade of ≥ 2. Symptoms of KOA were evaluated through a health interview. Obesity was defined as a body mass index ≥ 27.5 kg/m2. Quality of life was measured by the Korean version of European Quality of Life Questionnaire (EQ-5D). Results The prevalence of RKOA was 21.1% (95% CI: 19.6–22.8%) in men, and 43.8% (42.0–45.6%) in women. The prevalence of symptomatic RKOA (SRKOA) was 4.4% (3.8–5.2%) and 19.2% (17.9–20.6%) in men and women, respectively. The EQ-5D index was lower in participants with KOA. When plotted against mean age and prevalence of obesity, regions with a higher mean age and prevalence of obesity had higher prevalence of KOA, which was also observed at the individual level. The prevalence of SRKOA was 36.6% (29.7–44.1%) in women in Jeju province. Conclusion The prevalence of SRKOA in women reached 36.6% in high-risk groups accompanied by low quality of life. The results suggest that the disease burden of KOA is high in South Korea.

For high-quality flexible devices from printing processes based on Roll-to-Roll (R2R) systems, overlay alignment during the patterning of each functional layer poses a major challenge. The reason is because flexible substrates have a relatively low stiffness compared with rigid substrates, and they are easily deformed during web handling in the R2R system. To achieve a high overlay accuracy for a flexible substrate, it is important not only to develop web handling modules (such as web guiding, tension control, winding, and unwinding) and a precise printing tool but also to control the synchronization of each unit in the total system. A R2R web handling system and reverse offset printing process were developed in this work, and an overlay between the 1st and 2nd layers of ±5μm on a 500 mm-wide film was achieved at a σ level of 2.4 and 2.8 (x and y directions, respectively) in a continuous R2R printing process. This paper presents the components and mechanisms used in reverse offset printing based on a R2R system and the printing results including positioning accuracy and overlay alignment accuracy.

This study aimed to analyze the association between knee osteoarthritis and four body size phenotypes defined by the presence or absence of metabolic abnormality and obesity.This was a cross-sectional study using data from 1,549 female participants of the Fifth Korean National Health and Nutrition Examination Survey. Knee osteoarthritis was defined as a Kellgren-Lawrence grade of ≥ 2. Metabolically abnormal state was defined as presence of more than one abnormality among five metabolic risk factors. Obesity was defined using body mass index. Participants were grouped into one of the four body size phenotypes: metabolically healthy normal weight (MHNW), metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO).The distribution of each body size phenotype was as follows: MHNW 54.7%, MANW 30.7%, MHO 4.3%, and MAO 10.3%. Prevalence of symptomatic knee osteoarthritis was higher in MANW than in MHNW, and in MAO than in MHO. In multivariable analysis, the association between symptomatic knee osteoarthritis and the body size phenotypes was as follows (OR [95% CI]): MHNW 1.00 (reference), MANW 1.54 (1.15-2.07), MHO 1.61 (0.83-3.13), and MAO 3.47 (2.35-5.14).Obesity showed closest association with knee osteoarthritis when accompanied by metabolic abnormality.

PurposeTo assess the efficacy of pregabalin by showing differences in the neuronal activities of fibromyalgia (FM) patients before and after longitudinal treatment using functional magnetic resonance imaging (fMRI).Materials and methodsIn total, 21 female patients with FM and 11 age- and gender-matched healthy controls participated. FM patients underwent fMRI at baseline and following pharmacological therapy with pregabalin to diminish their pain. Pressure-pain stimuli were delivered on the subject's thumbnail bed during fMRI scans. Brain activation regions in fMRI were evaluated for longitudinal changes using a paired t-test. Changes in clinical features were also assessed with the Fibromyalgia Impact Questionnaire (FIQ), Brief Fatigue Inventory (BFI), Beck Depression Inventory (BDI), Widespread Pain Index (WPI), Symptom Severity Scale Score (SSS), and State-Trait Anxiety Inventory (STAI).ResultsClinical scores were reduced significantly following therapy with five of the six clinical tests (FIQ, BFI, BDI, WPI, SSS; p < 0.05). Brain activation post-treatment was significantly lower than that pre-treatment in 13 regions of the brain (p < 0.001).ConclusionsOur findings confirm that pregabalin influences aspects of the whole pain matrix, using fMRI, inducing longitudinal changes in neuronal activity during the pain state, and that it reduces pain and other core symptoms of FM. This method could be applied to other longitudinal clinical trials of pharmacological treatments for FM.

This study aimed to evaluate the relationship between radiographic knee osteoarthritis and vertebral fractures (VFs) in an Asian population.This cross-sectional study involved data from 1,829 participants of the Fifth Korean National Health and Nutrition Examination Survey. Radiographic knee osteoarthritis was defined as Kellgren-Lawrence (KL) grades ≥ 2. Prevalent VF was defined as a loss of ≥ 4 cm of height from the peak height. BMD was measured using dual-energy X-ray absorptiometry, in the lumbar spine and femoral neck.In both sexes, the prevalence of VFs increased with age, and was higher in the knee osteoarthritis group than in the control group (in men 13.2 % in osteoarthritis group and 7.9 % in control group; in women 27.7 % in osteoarthritis group and 14.7 % in control group). Age-adjusted BMD at the lumbar spine and femoral neck was significantly higher in the knee osteoarthritis group. In multivariable analysis, KL grade 4 was significantly associated with vertebral fractures in men. In women, there was a significant trend for a positive association between KL grades and vertebral fractures.Despite high systemic BMD, knee osteoarthritis was positively associated with VFs. These results suggest that bone quality, and consequently bone strength, may be decreased at the systemic level in knee osteoarthritis.

Objective Sarcopenic obesity is a body composition category in which obesity is accompanied by low skeletal muscle mass, offsetting the increase in body weight caused by increased adipose tissue. The purpose of this study was to analyze the association between knee osteoarthritis (OA) and 4 different categories of body composition: normal, sarcopenic nonobesity, nonsarcopenic obesity, and sarcopenic obesity. Methods This was a cross-sectional study using the data from 2,893 participants in the Fifth Korean National Health and Nutrition Examination Survey. Radiographic knee OA was defined as a Kellgren/Lawrence grade of ≥2. Appendicular skeletal muscle mass (ASM) and whole-body fat mass were measured using dual x-ray absorptiometry. Sarcopenia was defined as a skeletal muscle mass index (ASM/body weight [%]) below –2SD of the value in sex-matched young reference groups. Nonsarcopenic obesity was defined as a body mass index (BMI) ≥27.5 kg/m2. Results The prevalence of each body composition category was as follows: 83.5% normal, 4.3% sarcopenic nonobesity, 9.2% nonsarcopenic obesity, and 3.0% sarcopenic obesity. Compared with nonsarcopenic obesity participants, participants with sarcopenic obesity were significantly older, had lower ASM, higher whole-body fat mass, and higher waist circumference. However, there was no significant difference in body weight or BMI. In multivariate analysis, sarcopenic obesity was more closely associated with radiographic knee OA (OR 3.51 [95% confidence interval (95% CI) 2.15–5.75]) than was nonsarcopenic obesity (OR 2.38 [95% CI 1.80–3.15]). Sarcopenic nonobesity showed no significant association with knee OA. Conclusion Sarcopenic obesity was more closely associated with knee OA than was nonsarcopenic obesity, although both groups had equivalent body weight. This finding supports the importance of the systemic metabolic effect of obesity in knee OA.

Sexual dysfunction is a common problem among patients with ankylosing spondylitis (AS). This study was an open-label study without placebo to assess sexual dysfunction in male patients with AS, and to determine whether sexual function might improve with the use of tumor necrosis factor (TNF)-alpha blockers. Twenty-two males with AS (age, 29-48 years) were treated for 3 months with TNF-alpha blockers. Before and after treatment, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was measured, and all patients completed the International Index of Erectile Function (IIEF) questionnaire, a self-administered measure of sexual dysfunction with five domains: erectile function (EF), intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD) and overall satisfaction (OS). There were significant improvements in BASDAI after treatment with TNF-alpha blockers (P

The efficacy of anti-TNF-α antibodies including infliximab and adalimumab for refractory intestinal Behcet`s disease has recently been demonstrated in a series of case reports. The efficacy of switching to a different kind of anti-TNF-α agent in the face of refractoriness to one kind of anti-TNF- α agent, a common practice of proven efficacy in rheumatoid arthritis, has yet not been reported for intestinal Behcet`s disease. In the present study, we report a case of 52-year-old female patient with intestinal Behcet`s disease, who lost initial good response to infliximab, and was refractory to subsequent administrations of adalimumab. Her recent relapse of intestinal lesions could be successfully treated with etanercept. This case suggests that switching to etanercept might be a reasonable therapeutic option in case of intestinal Behcet`s disease with secondary non-response to anti-TNF-α antibodies that is most likely to be mediated by anti-drug antibody.