Hsiang-g Chen

Usefulness of human leucocyte antigen-B27 subtypes in predicting ankylosing spondylitis: Taiwan experience

Background:  Genetic factors are clearly attributed to the susceptibility of ankylosing spondylitis (AS). The human leucocyte antigen (HLA)‐B27 proved to be the very useful marker for diagnosing AS. The aim of this study was to determine the prevalence of HLA‐B27 subtypes in Taiwan and to investigate whether these subtypes may be of help in predicting the diagnosis of AS.

Systemic lupus erythematosus with simultaneous onset of Kikuchi-Fujimoto’s disease complicated with antiphospholipid antibody syndrome: a case report and review of the literature

Histiocytic necrotizing lymphadenitis, called Kikuchi-Fujimoto’s disease (KFD), is an idiopathic, self-limited condition rarely associated with systemic lupus erythematosus (SLE). The cause of concomitant KFD and SLE is still unknown. We describe a 19-year-old man simultaneously diagnosed with both KFD and SLE complicated with deep vein thrombosis (DVT). To the best of our knowledge, this is the first case report of KFD associated with SLE complicated with antiphospholipid antibody syndrome (APS). Our patient was successfully treated with intravenous pulse methylprednisolone, anticoagulation with heparin, oral hydroxychloroquine, azathioprine, and low-dose aspirin.

A Comparison of the Diagnostic Sensitivity and Specificity of Two Anti-cyclic Citrullinated Peptides (CCP1 and CCP2) Tests for Rheumatoid Arthritis

The detection of anti-cyclic citrullinated peptide (CCP) autoantibodies has been considered a useful tool to identify rheumatoid arthritis (RA) patients. Here, we examined the sensitivity and specificity of two detection methods, namely the ELISA-based (anti-CCP1) and the EliA-based (anti-CCP2) for anti-CCP in 40 RA patients. Methods. Anti-CCP1 and anti-CCP2 antibody tests were performed on 79 patients with arthropathy. The sensitivity, specificity, positive predictive value, and negative predictive value for-discriminating between rheumatoid arthritis (RA) and non-RA were calculated for both tests. Results. Both anti-CCP1 and anti-CCP2 shared very similar specificities (97.4%) toward diagnosing RA. However, there was no significant associations between the titer of anti-CCP1 and anti-CCP2. Conclusion. Anti-CCP test was more sensitive and specific than traditional IgM-RF. However, anti-CCP2 was not significantly better than anti-CCP1 in the diagnosis of RA.

Life Threatening Pancytopenia with Azathioprine in a Systemic Lupus Erythematosus Patient

Severe and rapidly evolving pancytopenia due to toxicity from low dosage (＜3 mg/kg/day) azathioprine (AZA) in patients with autoimmune diseases is uncommon. We describe a 38-year-old woman with systemic lupus erythematosus (SLE) who developed pancytopenia 5 week after low-dose AZA (0.75 mg/kg/day) was started as a corticosteroid – sparing agent. After cessation of AZA, the clinical and hematologic abnormalities resolved. We report here a case of early and severe myelosuppression associated with AZA and review similar cases reported in the literature.

The Taiwan Rheumatology Association Consensus Recommendations for hepatitis B virus screening contributes to lower mortality from hepatitis B reactivation in rheumatic patients: a local medical center study

目的：評估自「2012年風濕病醫學會免疫風濕病患接受生物製劑治療B型肝炎篩檢與防治共識建議」發布後，本院風濕疾病患者使用biological originator disease-modifying antirheumatic drugs（boDMARDs）或targeted synthetic disease-modifying antirheumatic drugs（tsDMARDs）之B型肝炎篩檢率及B型肝炎再活化（reactivation）事件是否有改善。方法：統計自2006年1月起至2015年12月止，本院有215位類風溼性關節炎、僵直性脊椎炎或乾癬性關節炎患者使用boDMARDs，包括了etanercept, adalimumab, golimumab, tocilizumab, rituximab,abatacept或是使用tsDMARD tofacitinib，計算其B型肝炎篩檢率以及B型肝炎再活化之事件發生率。結果：經過篩選，共207位病患納入此研究。類風濕性關節炎患者之B型肝炎表面抗原篩檢率由原本的21.5%提升至77.8%；然而僵直性脊椎炎及乾癬性關節炎患者之B型肝炎表面抗原篩檢率並無顯著差異。B型肝炎再活化之事件/病患-年發生率，在經過遵行防治共識建議後由0.125降至0.056，其中，死亡率由25%降至0%。結論：由於台灣是B型肝炎高盛行率之國家，因此B型肝炎防治是非常重要的衛生議題。經由此次研究統計可觀察到在經由遵行「2012年風濕病醫學會免疫風濕病患接受生物製劑治療B型肝炎篩檢與防治共識建議」之後，病患的B型肝炎篩檢率提高且B型肝炎再活化之事件發生率及死亡率降低。建議應謹遵其行。

Diagnostic Validity of Computed Tomography for HLA-B27 Negative Ankylosing Spondylitis: A Retrospective Study of 209 Patients

Objective: Radiographic sacroiliitis is considered the hallmark of ankylosing spondylitis (AS). However, large interobserver variations make plain radiographic diagnosis of sacroiliitis notoriously difficult. The heterogeneity of HLA-B27 negative AS makes its diagnosis even more challenging. Several reports have shown that sacroiliitis tends to be underestimated using radiography, and that computed tomography (CT) facilitates AS diagnosis in patients with suspected spondyloarthritis. However, no studies have stressed the clinical utility of CT, particularly in the diagnosis of HLA-B27(-) AS. Methods: We retrospectively evaluated 209 HLA-B27(-) patients with chronic lower back pain and suspected AS. Radiography and CT reports were examined and outcomes were compared. Results: Among 408 sacroiliac (SI) joints examined using both radiography and CT, there was agreement between the two methods in the sacroiliitis grading of 82 (20.1%) SI joints. However, sacroiliitis grade using CT was higher in 276 (67.6%) SI joints and lower in 50 (12.3%) SI joints. CT evaluation of SI joints showed that 78.9% of patients met the radiographic sacroiliitis criteria of the modified New York criteria, while only 26% of patients satisfied the criteria for plain radiography. Surprisingly, 117 patients (57.3%), who did not meet the modified New York AS diagnosis criteria for plain radiography met the criteria for CT. Conclusion: CT was sensitive and useful in providing evidence for the diagnosis of AS. We suggest that HLA-B27(-) patients with equivocal plain radiography results and chronic inflammatory lower back pain be examined using CT.