versus joint OA Radiographic OA prevalence PIP Age

골관절염 versus 류마티스관절염 joint는 OA 환자에서 흔히 침범되는 관절임. Radiographic OA prevalence (%) � PIP Age group http: //what-when-how. com/rheumatology; Osteoarthritis Cartilage 2006; 14(9): 953 -57.

조조경직감 RA에서만 나타나는 것이 아님. 807 arthralgi a 481 arthralgi a 353 arthralgi a No arthritis 435 (53. 9%) No arthritis 214 (44. 5%) No arthritis 172 (48. 7%) Arthritis 372 (46. 2%) Arthritis 267 (55. 5%) Arthritis 181 (51. 3%) 80 40 0 Sp. A or psoriatic arthritis ≥ 30 ≥ 60 ≥ 90 Leiden EARC Groningen EARC REACH 120 Reactive arthritis * * 160 Inflammatory OA 0% * 240 200 RS 3 PE 20% * 480 Sarcoidosis * 720 SLE arthritis * 40% Duration of morning stiffness (min) 60% 2010 RA � 조조경직감은 Arthritis Res Thera 2015; 17: 108;

Pain on usage versus Pain on resting � 활동에 따라 혹은 시간이 지나면서 호전되는 통증은 염 Inflammatory Biomechanics-based diseases Resting pain Non-inflammatory Usage pain Pain severity Inflammation nociception 증성 � 활동에 따라 악화되는 통증은 비염증성 In the AM Inflammatory arthropathy In the PM Medicine. 2010; 38(3): 129 -32.

초기 수지 골관절염에서 측부인대의 역 할 � 초기 혹은 잠복성 수지 골관절염에서 인대 두께 증가 및 음영증가가 흔히 관찰됨. Proportion of abnormal findings (%) Chronic OA Early OA Latent OA Normal 100 Bone cysts Erosions Bone edema Osteophytes Cartilage 20 Tendons Ligament insertion 60 Ligaments Volar plate Collateral ligament Rheumatology 2008; 47: 1278– 85; Arthritis Rheum 2005; 52(8): 2355 -65.

류마티스관절염의 활막염 소견 � RA에서는 전후면 및 측면의 전반적 압통 경향 Axial T 1 -weighted without contrast Axial T 1 -weighted with contrast Arthritis Rheum. 2012; 64(8): 2489 -98

Rheumatoid factor �A meta-analysis (24개 연구, 3695 RA 환자 포함한 8420 RF Anti-CCP RF & Anti. RF or Anti명) CCP � RF Sensitivity 71% 67% 57% 78% Specificity 83% 94% 96% 82% False positivity 17% 6% 4% 18% Positive LR 3. 96 9. 8 13. 8 4. 24 Negative LR 0. 37 0. 35 0. 46 0. 27 in UK primary care Clini Exp Rheumatol 2014; 32: 11 -21. Rheumatology 2015; 54: 18821889

Rheumatoid factor RA 분류기준 RF 양성 상황 Conditions Prevalence (%) RA 50 -90 SLE 15 -35 Sjögren's syndrome 75 -95 Systemic sclerosis 20 -30 Tuberculosis 8 Bacterial endocarditis 25 -50 Hepatitis B and C 20 -75 Viral infection 15 -65 Interstitial lung fibrosis 10 -50 Primary biliary cirrhosis 45 -70 Malignancy 5 -25 Age > 70 years 5 -25 Scand J Rheumatol 2012; 41: 85– 88

Rheumatoid factor � 240 Korean subjects positive HBs. Ag RA Oligoarthritis Arthralgia No joint Sx -0. 5 1. 5 2. 5 3. 5 4. 5 5. 5 Ln (RF titers) J Rheumatol 2009; 36: 712– 6.

류마티스관절염 발생과 RF 양성의 시 간적 순서 Development Cumulative incidence of RA • Median time from RF (+) to developing RA • RA 183 • Sjögren's syndrome 25 • SLE 16 • Systemic sclerosis 7 FU for up to 28 yrs 9, 712 white Danish subjects aged 20 -100 years with RF, but without RA Age (years) üRF < 25 IU/m. L, 15 yrs üRF 25~50 IU/m. L, 12 yrs üRF > 50 IU/m. L, 7 yrs RA patients who had been blood donors before the Sx onset BMJ. 2012 ; 345: e 5244. ; Arthritis Rheum. 2004 50(2): 380 -6.

ESR의 정상 상한범위 성별/나이 Simple rule for calculating normal ESR 4 95% upper limits 17 -50 세 10 mm/hr 51 -60세 12 mm/hr 61 -70세 14 mm/hr > 70 세 30 mm/hr ESR (mm/hr) 남성 0 3 0 2 0 1 0 0 98 percentile Female (n = 1, 076) ESR = (Age+10)/2 Mean 50 percentile 20~24 30~34 40~44 50~54 60~65 Age (yrs) 17 -50 세 12 mm/hr 51 -60세 19 mm/hr 61 -70세 20 mm/hr > 70 세 35 mm/hr ESR (mm/hr) 여성 4 0 3 0 2 0 1 0 0 Male (n = 26, 836) ESR = Age/2 98 percentile Mean 50 percentile 20~24 30~34 40~44 50~54 60~65 Age (yrs) Br Med J (Clin Res Ed). 1983; 286(6361): 266

“Three S factor” Stiffness � AM Swelling � Persistent Squeezing stiffness > 30 min swelling of one joint or more � Squeezing MCP and/or MTP joints is painful. Inflammatory arthropathy

Squeezing sign MCP joints MTP joints

Summary RA OA 특이 침범장 소 MCP/MTP > PIP DIP > PIP, 1 st MTP 조조경직감 > 30~60 min < 30 min 통증 양상 Resting pain Usage pain 압통 양상 More diffuse tenderness along the joint margins More localized tenderness along the joint margins 종창 양상 Soft swelling, Diffuse Bony swelling. Local 급성 반응 물 질 Tends to increase Within normal limits RF or anti. CCP Positive in most subjects Remarks AM stiffness duration이 중요. 염증 정도가 증가할 수록 증가 남: 98 percentile ESR = 나이/2 여: 98 percentile ESR = (나이 +10)/2 May be positive 자가항체 가양성 (esp, (esp. at the lower HBV/HCV 감염), RA 발생 전 양 titers) 성까지 고려하여 해석