The aim of this study was to determine the influence of HLA-DRB1 and HLA-DQB1 genes on the disease susceptibility and the disease severity in elderly onset rheumatoid arthritis (EORA) compared with young onset rheumatoid arthritis (YORA) in Korean patients. Genetic analysis of HLA-DRB1 and HLA-DQB1 alleles was performed in three groups. Group 1 included 63 patients who were diagnosed with (rheumatoid arthritis) RA after the age of 60 (EORA). Group 2 consisted of 109 patients who were diagnosed with RA before the age of 60 (YORA). Group 3 involved 133 normal controls. The shared-epitope-coding alleles included the members of the HLA-DRB1*04 allele group (*0401, *0404, *0405, *0408, *0410), HLA-DRB1*01 allele group (*0101,*0102), HLA-DRB1*1001, and HLA-DRB1*1402. The disease severity was assessed by the modified total sharp score (mTSS). The shared-epitope-coding alleles were more frequently observed in the RA patients than in the normal controls. The shared-epitope-coding alleles were less frequently found in EORA group than YORA group (31/63 (49.2 %) in group 1, 72/109 (66.1 %) in group 2, 45/133 (33.8 %) group 3, p = 0.02). Although the mTSS of the group 1 was higher than group 2 at symptom onset, the overall mean mTSS of the group 1 was lower than that of group 2 (26.8 vs. 57.5, p < 0.05). HLA-DQ*04 showed the higher frequency in the patients group than in normal controls (p < 0.001). And HLA-DQ*04 was less commonly found in the patients with EORA than YORA (p < 0.05). The influence of shared epitope and HLA-DQ*04 alleles may be less significant on disease susceptibility in EORA. The presence of shared-epitope-coding alleles did not appear to influence on disease severity in EORA patients as well as in YORA patients. Radiologic deterioration in EORA group was less severe than in YORA group. The presence of shared epitope and radiologic progression are less prominent in EORA patients than YORA patients.

Shared epitope and radiologic progression are less prominent in elderly onset RA than young onset RA

This study retrospectively investigated the efficacy and adverse events of applying a lower dose (0.5 g/m2) of monthly intravenous (IV) cyclophosphamide (CYC) for lupus nephritis in Korean patients. Adverse events occurred in 64 patients (61.5%) of 104 lupus nephritis patients who were treated with IV CYC, with the most common being those related to the gastrointestinal system, followed by infection, symptoms related to the hematopoietic system, skin and its appendages, reproductive system, and urinary system. Lower-dose IV CYC therapy resulted in renal remission or response in 76 patients (73.1%), which was as effective as the reported outcomes of higher-dose (0.75–1.0 g/m2) IV CYC regimens. Adverse events were more likely (with borderline statistical significance, p = 0.055) in those who achieved renal remission or response than in nonresponders.

Effect of lower dose intravenous cyclophosphamide on remission induction in Korean patients with lupus nephritis

Clinical Characteristics of Elderly Onset Rheumatoid Arthritis

Background : Elderly-onset rheumatoid arthritis (EORA) is considered to be different from younger-onset rheumatoid arthritis (YORA) in clinical manifestations, laboratory indices, and in prognosis. However, the differences between these two diseases have not been clearly defined. The aim of this study was to more clearly define the clinical characteristics of EORA. Methods : We retrospectively reviewed 50 EORA and 58 YORA patients who met the classification criteria established by the American College of Rheumatology (ACR). The two groups (EORA and YORA) were compared by three criteria. First, we considered the patterns of the joints involved and the presence of rheumatoid nodules. Second, we compared the disease activity indices and the level of auto-antibodies. Finally, we compared the use of medications. Results : The mean age-of-onset and the women-to-men ratio in the EORA group was 66.2±5.5 years and 2.1:1, respectively. There was more large joint involvement seen in the EORA group. The titer of disease activity indices (ESR, CRP) and positive rate of auto-antibodies (rheumatoid factor, ANA, but not anti-CCP antibody) were also higher in the EORA group. We found no differences in the prescribed medications between the two groups. Conclusions : From these studies, we believe that EORA has higher disease activity indices at onset and greater joint involvement, along with higher titers of auto-antibodies as compared to YORA.(Korean J Med 72:62-67, 2007)

The clinical characteristics of elderly onset rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease, in which permanent joint deformation is largely preventable with the timely introduction of appropriate treatment strategies. However, there is no consensus for patients with RA to monitor their progress and communicate it to the rheumatologist till the condition progresses to remission. In response to this unmet need, we proposed the design of a self-measuring device based on bioelectrical impedance analysis (BIA) for regular monitoring of inflammation levels. Twenty joints of both hands were measured to monitor trends in inflammation levels. Three electrodes were used to measure two joints of each finger. A central electrode was used for two consecutive measurements. A suitable form factor for the device was proposed for the vertical placement of the hand. To ensure the stability of measurements, an air cushion was incorporated into the back of the hand, hand containers were designed on both sides, and a mobile application was designed. We conducted a convergence-assessment experiment with five air pressures to validate the consistency and convergence of bioimpedance measurements. A heuristic evaluation of the usability around the product and mobile application was conducted in parallel by six subject matter experts and validated the design. This study underscores the significance of considering patients’ disease activity during intervals between hospital visits and introduces a novel approach to self-RA care.

Design of a Self-Measuring Device Based on Bioelectrical Impedance Analysis for Regular Monitoring of Rheumatoid Arthritis

Clinical Characteristics of Late-onset Rheumatoid Arthritis

The Effect of Early Diagnosis and Treatment on the Disease Activity and Joint Damages in Korean Patients with Rheumatoid Arthritis

Clinical Outcome and Predictive Factors for Remission and Relapse of Proliferative Lupus Nephritis after Intravenous Cyclophosphamide Pulse Therapy

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Papers

Clinical Characteristics of Late-onset Rheumatoid Arthritis

The Effect of Early Diagnosis and Treatment on the Disease Activity and Joint Damages in Korean Patients with Rheumatoid Arthritis

Clinical Outcome and Predictive Factors for Remission and Relapse of Proliferative Lupus Nephritis after Intravenous Cyclophosphamide Pulse Therapy