Heselynn Hussein

Risk of tuberculosis with anti-tumor necrosis factor-α therapy: substantially higher number of patients at risk in Asia

To assess the potential risk of tuberculosis (TB) in patients treated with anti‐tumor necrosis factor‐alpha (TNF‐α) agents in Asia.

A cross‐sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity

Aims:  The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction.

A study of intima media thickness and their cardiovascular risk factors in patients with Psoriatic arthritis

INTRODUCTION Psoriatic Arthritis (PsA) is an inflammatory arthritis associated with Psoriasis. Its recognition as an inflammatory disease distinct from Rheumatoid Arthritis has put forward for consideration several questions regarding its specific CVS mortality and morbidity (9, 11, 16, 26). Carotid intima media thickness is a useful surrogate and sensitive marker to determine atherosclerosis even in its subclinical stages (6, 14, 22, 27, 32). OBJECTIVE Prevalence of carotid intima media thickness in patients with Psoriatic arthritis is unknown in Asian population. We aim to identify the presence of subclinical atherosclerosis in patients with psoriatic arthritis and disease activity association and its predictors in a series of patients with PsA attended to the rheumatology clinic, tertiary hospitals. METHODS A total of 63 patients with PsA who fulfilled the CASPAR criteria were recruited from UKM Medical Centre and Hospital Putrajaya. Common carotid intima media thickness (IMT) was measured in both right and left carotid artery by using high resolution B-mode ultrasound. This was a cross sectional study first done in Malaysia for PsA patients. RESULTS The positive IMT (IMT > 1.00 mm) among PsA was observed in 10 out of 63 patients (15.9 %) regardless of background cardiovascular risk. The mean +/- SD of IMT was 0.725 +/-0.260 mm for this study. Variables significantly associated with positive IMT (p < 0.05) included age at the time of study (p = 0.005), waist circumference (p = 0.001), Hypertension (p = 0.007), Diabetes (p = 0.002) and Metabolic syndrome (p = 0.001) and not associated with gender, ethnicity, duration of PsA disease, pattern of PsA, disease activity and severity. Above all, only age had positive IMT independent predictor (p = 0.032), with OR 1.116; 95 % CI (1.010-1.234). CONCLUSIONS There was a significant association between CVS risk and positive Intima Media Thickness in Psoriatic Arthritis patients. Otherwise, there was no association in disease activity, disease severity and DMARDS therapy with positive Intima Media Thickness in Psoriatic Arthritis patients. The study was approved by Research and Ethics Committee of the faculty of medicine, Universiti Kebangsaan Malaysia with project code FF-114-2008 and by Community Research Center (CRC) of National Institutes of Health (NIH) for the case study in Hospital Putrajaya with the project code NMRR-08-970-2125.

Case Review of Sarcoidosis Resembling Sjogren’s Syndrome

UNLABELLED We would like to report a case of a 29-year-old male patient who presented with multiple lymphadenopathy and vague symptoms of low grade fever, cough, weight loss, rashes, vomiting, dry eyes and dry mouth. Physical examination revealed submandibular lymphadenopathy, vasculitic rashes over both lower limbs, and parotid gland enlargement. Blood investigations showed mild anemia with leukocytosis, predominantly eosinophilia and high erythrocyte sedimentation rate and C-reactive protein. Computed tomography of the neck, thorax and abdomen showed bilateral submandibular, submental adenopathy, mediastinal and para-aortic lymphadenopathy with generalized reticulonodular densities in both lower lobes. There were hepatomegaly and bilateral enlarged kidneys with renal cyst. Histopathological examination from the cervical lymph node later revealed non-caseating granuloma, consistent of sarcoidosis. Patient responded well to prednisolone 50 mg daily with subsequent reduction in the size of cervical lymphadenopathy and parotid swelling. KEYWORDS Lymphadenopathy; Granuloma; Sjogren; Sarcoidosis.

Cross-cultural adaptation and validation of the Malay health assessment questionnaire for use in rheumatoid arthritis

Objective:  To validate the Malay version of the Health Assessment Questionnaire (Malay‐HAQ) for use in Malay‐speaking rheumatoid arthritis (RA) patients in the Malaysian setting. The HAQ – Disability Index has been validated in several languages, but not in Malay.

Multicentre survey of rheumatoid arthritis patients from Ministry of Health Rheumatology Centers in Malaysia

Aim:  This is a rheumatoid arthritis (RA) descriptive study, the first of its kind carried out in Malaysia.

Damage in the multiethnic Malaysian systemic lupus erythematosus (SLE) cohort: Comparison with other cohorts worldwide

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and despite the improvement in the survival in the past few decades, the morbidity due to disease damage remains significant. The objectives of this study were to investigate the disease damagepattern and determine the associated factors of damage in the multi-ethnic Malaysian SLE patients. We consecutively 424SLE patients who attended a consistent follow-up at the National University of Malaysia Medical Centre and Putrajaya Hospital were recruited. Disease damage was assessed using the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index (SDI) scores. Information on their demographics and disease characteristics were obtained from the clinical record. Univariate analysis was performed and the best model of independent predictors of disease damage was determined by multivariate logistic regression analysis. A total of 182 patients (42.9%) had disease damage (SDI ≥1). A significantly higher number of Indian patients had disease/organ damage and they predominantly developed steroid-induced diabetes mellitus (SDM). Patients with corticosteroid-induced osteoporosis (CIOP) were more likely to be Malayswhile majority of patients who developed malignancy were Chinese (p<0.05). In the univariate and multivariate analyses, disease damage was significantly associated with age, Indian ethnicity, lower mean cumulative C3 level, neuropsychiatry lupus (NPSLE), and antiphospholipid syndrome (APLS). Patients who had ever and early treatment with hydroxychloroquine(HCQ)were less likely to develop disease damage while more patients who had received oral prednisolone ≥1mg/kg daily over 2 weeks had disease damage (p<0.05). In conclusion, there were inter-ethnic differences in the damage pattern and risks among SLE patients.

Risk of upper gastrointestinal adverse events in Malaysian rheumatic patients on long-term non-steroidal antiinflammatorydrugs

Background: Non-steroidal anti-inflammatory drug (NSAID)-induced upper gastrointestinal (GI) adverse events are well-described in the Western population but data is lacking in Asian patients. This study aims to describe the incidence and predictive factors for NSAID-induced upper GI complications in a cohort of multi-ethnic patients in Malaysia. Methods and Findings: A retrospective cohort study was conducted in adult patients with rheumatoid arthritis (RA) and/or osteoarthritis (OA) from 2010-2013 in four main rheumatology centres in Malaysia with computerized clinical and pharmaceutical records. Clinical, pharmaceutical and demographic data over a 24-months follow-up period were analysed in subjects who were prescribed long-term NSAID therapy (defined as a minimum duration of four weeks). 634 patients were included in the final analysis with the following characteristics: mean age 53.4 ± 12.5 years, 89.9% female, diagnosis: RA 59.5%, OA 10.2% and RA/OA combination 30.3%. 371 (58.5%) patients received non-selective NSAIDs and 263 (41.5%) patients received COX-2 inhibitors. There were a total of 84 GI adverse events during the period of study, giving an incidence rate of 66.2 per 1000 person-years and a risk of 13.2%. The majority of upper GI adverse events was dyspepsia (92.9%), and only 7.1% with peptic ulcer disease/ upper GI bleeding. Multivariate analysis showed that the only independent predictive factor of upper GI adverse event in this cohort was a history of upper GI disease (O.R. 2.073, 95% C.I. 1.029 – 4.176). COX-2 inhibitor showed a trend towards, but not independently predictive of, GI protection in this analysis (OR 0.643; 95% C.I. 0.397 – 1.043). Conclusion: Malaysian rheumatic patients on long-term NSAID therapy, managed at referral centres, have a 13.2% risk of upper GI adverse events, with dyspepsia being the commonest complication. Patients with a history of upper GI disease were twice as likely to develop further upper GI adverse events with the use of long-term NSAIDs.

AB0275 The correlation of cartilage oligomeric matrix protein with sonographic knee cartilage thickness and disease characteristics in rheumatoid arthritis

Background Cartilage Oligomeric Matrix Protein (COMP) is an extracellular protein which is primarily found in the cartilage and to a lesser extent in ligaments, meniscus, tendons and synovium. Experimental models of rheumatoid arthritis (RA) and osteoarthritis have pointed out that serum COMP levels are reflective of the cartilage turnover rate. Objectives To investigate the correlation of serum COMP levels with the articular cartilage damage based on sonographic knee cartilage thickness (KCT) and disease characteristics in RA. Methods A total of 61 RA patients and 27 healthy controls were recruited in this study. Serum samples were obtained from all subjects to determine the COMP levels. All subjects had bilateral ultrasound scan of their knees performed by a single radiologist; who was blinded to the details of the subjects. The KCT was based on the mean of measurements at 3 sites; the medial condyle, lateral condyle and intercondylar notch (Figure 1). Besides, the RA patients were assessed for their disease activity based on DAS 28. Results Serum COMP concentrations were significantly elevated in the RA patients compared to the controls (p=0.001). The serum COMP levels had an inverse relationship with bilateral KCT in RA subjects and the healthy controls. However, the association was statistically insignificant for bilateral knees in the control arm. COMP correlated significantly with disease activity based on DAS 28 (r =0.299, p=0.010), disease duration (r =0.439,p = <0.05) and mean left KCT (r = -0.285,p=0.014) in RA (Table 1). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) which are the traditional markers of inflammation; demonstrated a significant positive correlation with the DAS 28 scores (r =0.372, p=0.003 for ESR; r =0.305, p=0.017 for CRP) comparable to the serum COMP. However, neither ESR nor CRP had a significant association with the KCT, as opposed to the serum COMP.Table 1. Correlation of Serum COMP levels with Clinical Parameters in RA Parameter r p value Age 0.214 0.094 BMI 0.122 0.259 DAS 28 0.299 0.010 ESR 0.065 0.311 CRP 0.027 0.418 Disease duration 0.439 <0.05 Mean Right KCT -0.177 0.088 Mean Left KCT -0.285 0.014 KCT: knee cartilage thickness. Conclusions The serum COMP is a promising biomarker in RA which reflects disease activity and damage to the articular cartilage. Serum COMP appeared superior to the traditional markers in RA i.e ESR and CRP in predicting sonographic KCT. References Andersson ML, Svensson B, Petersson IF, et al. Early increase in serum-COMP is associated with joint damage progression over the first five years in patients with rheumatoid arthritis. BMC Musculoskelet Disord. 2013;14:229. Happonen KE, Saxne T, Aspberg A, et al. Regulation of complement by cartilage oligomeric matrix protein allows for a novel molecular diagnostic principle in rheumatoid arthritis. Arthritis Rheum. 2010;62:3574–83. Happonen KE, Saxne T, Geborek P, et al. Serum COMP-C3b complexes in rheumatic diseases and relation to anti-TNF-alpha treatment. Arthritis Res Ther. 2012;14:R15. Disclosure of Interest None declared

Clinical significance of SLC2A9/GLUT9 rs11722228 polymorphisms in gout.

The main objective of this study is to elucidate the clinical significance of the SLC2A9/GLUT9 rs11722228 polymorphism among male gout patients.