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Immunoglobulin G4–related disease (IgG4-RD) is a chronic inflammatory condition that has been suggested to increase cancer risk, but the incidence and types of associated malignancies remain unclear. This study aimed to evaluate the cancer risk in patients with IgG4-RD using a nationwide population-based cohort. We identified 2,150 patients newly diagnosed with IgG4-RD between January 2012 and December 2020 from the Korean National Health Insurance Service database. Patients were followed until the occurrence of cancer, death, or December 31, 2021. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated to compare cancer incidence in IgG4-RD patients with that in the general population. Subgroup analyses were conducted based on sex, age at diagnosis, follow-up duration, and use of immunosuppressive agents. Patients with IgG4-RD had a significantly increased risk of overall cancer (SIR 4.12, 95% CI 3.48–4.85), including solid tumors (SIR 3.33, 95% CI 2.74–4.02) and hematologic malignancies (SIR 15.31, 95% CI 10.17–22.13). Among solid tumors, the highest risks were observed for pancreatic cancer (SIR 14.54, 95% CI 8.31–23.62), central nervous system cancer, and biliary tract cancer. Myelodysplastic syndrome and non-Hodgkin lymphoma were the most frequent hematologic cancers. Cancer risk was higher in female patients. The risk peaked within the first year after IgG4-RD diagnosis (SIR 7.13, 95% CI 5.65–8.89). Patients with IgG4-RD have a significantly elevated risk of developing cancer, particularly myelodysplastic syndrome, non-Hodgkin lymphoma, pancreatic cancer, and biliary tract cancer. Close surveillance for malignancy is warranted, especially during the first year after diagnosis.

Vaccination is a cornerstone for reducing the risk of COVID-19 infection during a pandemic. Although the currently used COVID-19 vaccine is considered safe, some concerns persist regarding the likelihood of flares of rheumatic diseases. Still’s disease is a rare auto-inflammatory disorder of unknown etiology, and the data on the flare of Still’s disease following COVID-19 vaccination are limited. Therefore, we hereby present the case of a 34-year-old female patient with Still’s disease who experienced a flare after a ChAdOx1 nCoV-19 vaccination. The patient visited the emergency department complaining of fever, arthralgia, myalgia, pleuritic chest pain and macular salmon-pink rash on her back for the past 2 days. She had maintained low Still’s disease activity with etanercept and low-dose glucocorticoid for 14 years. She received the ChAdOx1 nCoV-19 vaccine 7 days before the flare. Laboratory investigations revealed leucocytosis and elevated serum levels of erythrocyte sedimentation rate, C-reactive protein, and ferritin. Computed tomography showed no specific findings. She received methylprednisolone pulse therapy, etanercept, and methotrexate for treating the Still’s disease flare. However, her symptoms were not fully controlled, and she developed pericarditis, pleuritis, fever and macular rashes expanding to her extremities. After excluding infectious conditions by blood culture and pleural fluid analysis, we administered tocilizumab with methotrexate and prednisolone. Her symptoms and laboratory findings improved significantly, and she was discharged without symptoms 7 days later. Although rare, this case of a patient with Still’s disease undergoing a flare following vaccination suggests that close observation of disease activity is warranted following COVID-19 vaccination.

Osteoarthritis (OA) is a prevalent degenerative joint disorder with varying clinical and radiological presentations. This study aimed to investigate the relationship between pro-inflammatory mediators in serum and synovial fluid (SF) and osteophyte size in patients with end-stage knee OA. Forty-four patients (58 knees) who underwent total knee arthroplasty were included. Serum and SF levels of matrix metalloproteinase-1 (MMP-1), interleukin-8 (IL-8), and interleukin-18 (IL-18) were measured using enzyme-linked immunosorbent assay. Radiographic parameters, including osteophyte size, were assessed using on standing anteroposterior knee X-rays. Pearson’s and partial correlation analyses were used to evaluate associations. A positive correlation was found between serum and SF IL-18 levels ( r  = 0.64, P  < 0.001) and between SF MMP-1 and IL-8 levels ( r  = 0.28, P  = 0.03). A significant positive correlation was found between patient age and femur osteophyte size ( r  = 0.32, P  = 0.02). SF IL-18 levels positively correlated with both femur ( r  = 0.36, P  = 0.005) and tibia ( r  = 0.28, P  = 0.04) osteophyte sizes. The partial correlation between SF IL-18 and femur osteophyte size remained significant after adjusting for age ( r  = 0.3, P  = 0.02) and body mass index ( r  = 0.38, P  = 0.003). Elevated SF IL-18 levels were associated with increased osteophyte size in patients with end-stage knee OA, suggesting a potential role for IL-18 in osteophyte formation. Elevated SF IL-18 levels may reflect underlying inflammatory activity in OA and could serve as a potential biomarker or therapeutic target in advanced disease.

Depression is a prevalent mental health concern in aging populations and is associated with increased morbidity and reduced quality of life. While psychosocial and biochemical factors have been widely studied, the role of muscle mass, particularly abdominal muscle mass, in depression remains unclear. This study aimed to investigate the association between abdominal muscle mass, as measured by computed tomography (CT), and depression in middle-aged and older Korean men. This retrospective cross-sectional study included 2,877 men aged ≥ 40 years who underwent both abdominopelvic CT and the Beck Depression Inventory (BDI) as part of a general health examination. Abdominal muscle mass was quantified using the total abdominal muscle area (TAMA) at the L3 vertebral level. Depression was defined as a BDI score ≥ 16. Multivariable logistic regression analyses were performed to examine the association between TAMA and depression, adjusting for age, body mass index, lifestyle factors, comorbidities, and biochemical markers. The prevalence of depression decreased across increasing TAMA quartiles ( = 0.018). Higher TAMA was independently associated with a lower risk of depression. In the fully adjusted model, participants in the highest TAMA quartile had a significantly reduced odds of depression compared to those in the lowest quartile (adjusted OR, 0.534; 95% CI, 0.297-0.958; = 0.035). Greater abdominal muscle mass, as assessed by CT, was significantly associated with a lower prevalence of depression in middle-aged and older Korean men. These findings suggest that abdominal muscle mass may be a marker of mental health during aging.

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.

In contrast to experimental studies indicating the neuroprotective role of uric acid (UA), recent clinical studies have shown that increased UA is associated with a risk of acute hemorrhagic stroke. However, the association of UA with intraventricular hemorrhage (IVH) has not been adequately evaluated. In this study, we determined the relationship between UA and IVH in patients with intracerebral hemorrhage (ICH). We included 721 patients with ICH who were admitted to a tertiary hospital in South Korea. The patients were stratified into quartiles based on their UA levels. IVH decreased continuously across all quartiles of UA. After adjusting for confounding factors, the odds ratio (OR) for IVH was significantly lower in the fourth quartile compared with that in the first quartile (OR: 0.713; 95% CI: 0.546–0.934; P=0.045). In conclusion, UA is independently associated with IVH, suggesting its protective role against IVH in patients with ICH.

Gallstones are a prevalent gastrointestinal disorder influenced by metabolic factors and obesity. Visceral adiposity is metabolically active and proinflammatory, yet the role of the relative distribution of visceral and subcutaneous fat, quantified as the visceral-to-subcutaneous fat ratio (VSR), in gallstone formation remains unclear. This study aimed to investigate the association between VSR, measured by computed tomography (CT), and the prevalence of gallstones in Korean men. This retrospective cross-sectional study included 4,914 Korean men who underwent both abdominopelvic CT and ultrasonography as part of routine health examinations. Visceral and subcutaneous fat areas were quantified at the L3 vertebral level using CT images, and participants were categorized into quartiles based on the VSR. Logistic regression analyses were conducted to evaluate the association between VSR and the prevalence of gallstones, adjusting for age, body mass index (BMI), lifestyle factors, comorbidities, and biochemical markers. The mean age and BMI were 52.3 ± 9.3 years and 24.6 ± 2.9 kg/m , respectively. Gallstone prevalence increased progressively across VSR quartiles, from 4.0% in the lowest quartile to 7.6% in the highest (  < 0.001). In fully adjusted models, men in the highest VSR quartile had 1.6-fold higher odds of having gallstones compared to the lowest quartile (OR 1.596, 95% CI 1.074-2.373,  = 0.021). A higher VSR, reflecting a predominance of visceral over subcutaneous fat, was independently associated with an increased risk of gallstones in Korean men. These findings highlight the importance of abdominal fat distribution, beyond overall obesity, in gallstone pathogenesis. The VSR may serve as a valuable imaging biomarker for identifying men at elevated risk of developing gallstones.

Background: Uric acid (UA) may influence bone health through its antioxidant and pro-oxidant properties. While previous studies have investigated the relationship between serum UA levels and bone mineral density (BMD), their findings have been conflicting. This study aimed to examine the impact of serum UA levels on BMD in peri- and postmenopausal Korean women. Methods: We evaluated 3,566 women aged 50–80 years who voluntarily underwent laboratory tests and BMD measurements as part of a general health examination between March 2014 and March 2020. Participants were stratified into quartiles according to their serum UA levels. Univariate and multivariate analyses were performed to assess the association between serum UA levels and BMD. Results: The mean age of the participants was 56.9±5.8 years. BMD at the lumbar spine and hip was significantly higher in women with elevated serum UA levels, showing a continuous increase across the quartiles. Furthermore, after adjusting for covariates, the mean total lumbar spine BMD increased from 0.892 g/cm² (95% CI: 0.884–0.900) in the lowest UA quartile to 0.918 g/cm² (95% CI: 0.909–0.927) in the highest quartile (P<0.001). Similarly, the adjusted total hip BMD was higher in the highest UA quartile at 0.847 g/cm² (95% CI: 0.840–0.854) compared with 0.828 g/cm² (95% CI: 0.821–0.834) in the lowest quartile (P=0.001). Conclusion: Our results suggest that elevated serum UA levels are associated with higher BMD in peri- and postmenopausal Korean women, indicating a potential protective role in bone metabolism.

Background To develop an inflammation-related immunohistochemistry marker-based algorithm that confers higher diagnostic ability for idiopathic inflammatory myopathies (IIMs) than IIM-related histopathologic features. Methods Muscle biopsy tissues from 129 IIM patients who met the 2017 EULAR/ACR criteria and 73 control tissues from patients with non-inflammatory myopathies or healthy muscle specimens were evaluated for histological features and immunostaining results of CD3, CD4, CD8, CD20, CD68, CD163, MX1, MHC class I, MHC class II, and HLA-DR. Diagnostic algorithms for IIM were developed based on the results of the classification and regression tree (CART) analysis, which used immunostaining results as predictor variables for classifying patients with IIMs. Results In the analysis set (IIM, n  = 129; control, n  = 73), IIM-related histopathologic features had a diagnostic accuracy of 87.6% (sensitivity 80.6%; specificity 100.0%) for IIMs. Notably, muscular expression of CD163 (99.2% vs. 20.8%, p  < 0.001) and MHC class I (87.6% vs. 23.1%, p  < 0.001) was significantly higher in the IIM group than in controls. Based on the CART analysis results, we developed an algorithm combining CD163 and MHC class I expression that conferred a diagnostic accuracy of 95.5% (sensitivity 96.1%; specificity 94.5%). In addition, our algorithm was able to correctly diagnose IIM in 94.1% (16/17) of patients who did not meet the 2017 EUALR/ACR criteria but were diagnosed as having IIMs by an expert physician. Conclusions Combination of CD163 and MHC class I muscular expression may be useful in diagnosing IIMs.

Background Gout is the most common inflammatory arthritis. Current urate-lowering therapies have limitations, such as adverse drug reactions or limited efficacy. Epaminurad is a novel selective human urate transporter 1 (hURAT1) inhibitor that has been shown to reduce serum urate (sUA) levels in healthy volunteers and patients with gout. The aims of the current study were to evaluate the urate-lowering efficacy and safety of epaminurad compared with placebo in patients with gout, and to determine the optimal dose. Methods This multicenter, randomized, double-blind, placebo-controlled, dose-finding phase 2b clinical trial, which incorporated a standard-treatment reference arm, enrolled patients aged 19–70 years with gout and sUA level ≥ 0.42 mmol/L. Participants received gout prophylaxis and followed therapeutic lifestyle changes, and were randomized to receive epaminurad 3 mg, 6 mg or 9 mg, or febuxostat 80 mg, or matching placebo, once daily for 12 weeks. The primary efficacy endpoint was the proportion of patients with sUA level < 0.36 mmol/L at week 4 after initiation of study treatment. Statistical comparisons were performed between the epaminurad and placebo groups. Results Overall, 169 patients received study medication (99.40% male, mean ± SD age 48.26 ± 13.15 years, sUA level 0.53 ± 0.09 mmol/L). Mean adherence to treatment was > 90% in all groups. The proportion of patients with sUA < 0.36 mmol/L at week 4 was significantly higher in each epaminurad group (9 mg, 88.89%; 6 mg, 71.79%; 3 mg, 54.05%) compared with placebo (0.00%) (all p  < 0.0001). The response rate in the febuxostat group was 84.21%. The proportion of patients who achieved sUA < 0.30 mmol/L, and mean percent and absolute change in sUA, were also significantly greater in all epaminurad groups versus placebo at week 4. Outcomes were consistent at weeks 8 and 12. The adverse event rate did not differ between epaminurad groups and placebo, and most events were mild. There were no significant differences in mean serum creatinine levels or liver function parameters between the epaminurad groups and placebo. Conclusions Epaminurad was effective at reducing sUA levels in patients with gout. The study also confirmed the safety and tolerability profile during 12 weeks of treatment. Trial registration ClinicalTrials.gov NCT04804111 (registered on 15 November 2020).