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Fulltext Klebsiella pneumoniae sacroiliac septic arthritis: First case report

Chee YC, Lim CH

IDCases, 2018;14:e00459.
PMID: 30386726 DOI: 10.1016/j.idcr.2018.e00459

Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting it as one of the important etiologies of infective sacroiliitis especially among diabetics.

Matched MeSH terms: Arthritis, Infectious
Hyaluronic acid, an efficient biomacromolecule for treatment of inflammatory skin and joint diseases: A review of recent developments and critical appraisal of preclinical and clinical investigations

Chen LH, Xue JF, Zheng ZY, Shuhaidi M, Thu HE, Hussain Z

Int J Biol Macromol, 2018 Sep;116:572-584.
PMID: 29772338 DOI: 10.1016/j.ijbiomac.2018.05.068

Hyaluronic acid (HA) plays multifaceted role in regulating various biological processes and maintaining homeostasis into the body. Numerous researches evidenced the biomedical implications of HA in skin repairmen, cancer prognosis, wound healing, tissue regeneration, anti-inflammatory, immunomodulation. The present review was aimed to summarize and critically appraise the recent developments and efficacy of HA for treatment of inflammatory skin and joint diseases. A thorough analysis of the literature revealed that HA based formulations (i.e., gels, creams, autologous graft, thin sheets, soaked gauze, gauze pad, tincture, injection) have shown remarkable efficacy in treating a wide range of inflammatory skin diseases. The safety, tolerability, and efficacy of HA (as intra-articular injection) have also been well-documented for treatment of various types of joint disease including knee osteoarthritic, joint osteoarthritis, canine osteoarthritis, and meniscal swelling. Intra-articular injection of HA produces remarkable reduction in joint pain, synovial inflammation, and articular swelling. A remarkable improvement in chondrocyte density, territorial matrix appearance, reconstitution of superficial amorphous layer of the cartilage, collagen remodelling, and regeneration of meniscus have also been evident in patients treated with HA. Conclusively, we validate that the application/administration of HA is a promising pharmacotherapeutic regimen for treatment of inflammatory skin and joint diseases.

Matched MeSH terms: Arthritis*
Fulltext Brief Report: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled, Multiple-Dose Study to Evaluate AMG 557 in Patients With Systemic Lupus Erythematosus and Active Lupus Arthritis

Cheng LE, Amoura Z, Cheah B, Hiepe F, Sullivan BA, Zhou L, et al.

Arthritis Rheumatol, 2018 07;70(7):1071-1076.
PMID: 29513931 DOI: 10.1002/art.40479

OBJECTIVE: To evaluate the safety and potential efficacy of AMG 557, a fully human antibody directed against the inducible T cell costimulator ligand (ICOSL) in patients with systemic lupus erythematosus (SLE) with arthritis.
METHODS: In this phase Ib, randomized, double-blind, placebo-controlled study, patients received AMG 557 210 mg (n = 10) or placebo (n = 10) weekly for 3 weeks, then every other week for 10 additional doses. The corticosteroid dosage was tapered to ≤7.5 mg/day by day 85, and immunosuppressants were discontinued by day 29. Primary end points on day 169 were safety, immunogenicity, the Lupus Arthritis Response Index (LARI; defined by a reduction in the tender and swollen joint counts), ≥1-letter improvement in the musculoskeletal domain of the British Isles Lupus Assessment Group (BILAG) index, and medication discontinuation. The secondary/exploratory end points were changes in the tender and swollen joint counts, BILAG index scores (musculoskeletal, global), and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).
RESULTS: The incidence of adverse events, most of which were mild, was similar between groups. LARI responses occurred in 3 of 10 patients receiving AMG 557 and 1 of 10 patients receiving placebo (P = 0.58). More patients in the AMG 557 group achieved a ≥4-point improvement in the SLEDAI score on day 169 (7 of 10 patients) compared with the placebo group (2 of 10 patients) (P = 0.07). Patients treated with AMG 557 (versus placebo) had greater improvements from baseline in the global BILAG index scores (-36.3% versus -24.7%) and the SLEDAI score (-47.8% versus -10.7%) and in tender (-22.8% versus -13.5%) and swollen (-62.1% versus -7.8%) joint counts on day 169.
CONCLUSION: AMG 557 showed safety and potential efficacy, supporting further evaluation of the clinical efficacy of ICOSL blockade in patients with SLE.

Matched MeSH terms: Arthritis/drug therapy*; Arthritis/immunology; Arthritis/pathology
Fulltext Chronic Inflammatory Diseases at Secondary Sites Ensuing Urogenital or Pulmonary Chlamydia Infections

Cheok YY, Lee CYQ, Cheong HC, Looi CY, Wong WF

Microorganisms, 2020 Jan 17;8(1).
PMID: 31963395 DOI: 10.3390/microorganisms8010127

Chlamydia trachomatis and C. pneumoniae are members of the Chlamydiaceae family of obligate intracellular bacteria. The former causes diseases predominantly at the mucosal epithelial layer of the urogenital or eye, leading to pelvic inflammatory diseases or blindness; while the latter is a major causative agent for pulmonary infection. On top of these well-described diseases at the respective primary infection sites, Chlamydia are notoriously known to migrate and cause pathologies at remote sites of a host. One such example is the sexually acquired reactive arthritis that often occurs at few weeks after genital C. trachomatis infection. C. pneumoniae, on the other hand, has been implicated in an extensive list of chronic inflammatory diseases which include atherosclerosis, multiple sclerosis, Alzheimer's disease, asthma, and primary biliary cirrhosis. This review summarizes the Chlamydia infection associated diseases at the secondary sites of infection, and describes the potential mechanisms involved in the disease migration and pathogenesis.

Matched MeSH terms: Arthritis, Reactive
Fulltext Determinants of comorbidity in rheumatoid arthritis: influence of demographic and duration of illness

Chin SN, Abdullah N, Poh LP

Journal of Advanced Research Design, 2015;22(1):13-22.
MyJurnal

Rheumatoid arthritis (RA) is a chronic, disabling autoimmune disease which affects about 5 in 1000 people in Malaysia. Patients with RA are at increased risk of developing comorbid conditions. This research aims at determining these relationships between demographic, duration of illness and comorbidity in RA via a multiple binary logistic (MBL) regression analysis based on the 102 patients’ information (23 males; 79 females) obtained from the rheumatoid clinic of the Queen Elizabeth Hospital in Kota Kinabalu. The relationship of the RA patients with comorbid conditions was studied with focus on the demographic and duration of illness. The variables obtained for analysis were the comorbid conditions namely, hypertension and hyperlipidemia, age, duration of illness, gender, ethnicity, household income and education level. From six independent variables, two were quantitative would be analyzed, while four were categorical, and would be transformed into dummy variables. Four phases in a model-building approach were executed where two models were formed where Model I predicted the probability of occurrence of hypertension with age of patients and first order interaction between duration of illness before diagnosis and household income of less than RM1000 had positive effects on the model, while Model II predicted the occurrence of hyperlipidemia among the RA patients with age of patients and first order interaction variable between gender(female) and age were the contributing factors.
Study site: Rheumatoid clinic, Queen Elizabeth Hospital (QEH), Kota Kinabalu, Sabah, Malaysia

Matched MeSH terms: Arthritis, Rheumatoid
Osteonecrosis with renal damage in HIV patients undergoing HAART

Chitra P, Bakthavatsalam B, Palvannan T

Biomed Pharmacother, 2014 Sep;68(7):881-5.
PMID: 25194446 DOI: 10.1016/j.biopha.2014.07.017

Rheumatoid arthritis in HIV patients undergoing HAART is associated with increased risk of side effect. Elevation of uric acid (UA) is important in tissue damage, deposition of crystal in joints leads to the development of rheumatoid arthritis in the HAART complaint group. This study was carried out to investigate the relationship of uric acid, RA factor, ANA, ESR, cystatin C, urea and creatinine in the HAART complaint group. Moreover; the ratio of uric acid/cystatin C, uric acid/urea and uric acid/creatinine were also studied. To analyze the progression of HIV, the immunological parameters were correlated with uric acid. Our result showed a statistically high significant increase in uric acid, RA factor, ANA, ESR, cystatin C, urea and creatinine in the HAART complaint group when compared to HAART non-complaint group, early stage and control. The ratio of uric acid/cystatin C, uric acid/urea, uric acid/creatinine were significantly increased in the HAART complaint group. Statistically significant positive correlation was observed between uric acid and cystatin C, urea, creatinine, absolute CD4 and CD8 count. The increased level of uric acid, RA factor, ANA, ESR, cystatin C and increased ratio of uric acid/cystatin C in the HAART complaint group might conclude the mechanism underlying the increased risk for rheumatoid arthritis in the HAART complaint group which may relate to the combined effects of low-grade inflammation and renal dysfunction.

Study done in India

Matched MeSH terms: Arthritis, Rheumatoid/chemically induced; Arthritis, Rheumatoid/metabolism
Rheumatoid arthritis management in the APLAR region: Perspectives from an expert panel of rheumatologists, patients and community oriented program for control of rheumatic diseases

Chopra A, Lin HY, Navarra SV, Saeed MA, Sockalingam S, Thongpooswan S, et al.

Int J Rheum Dis, 2021 Sep;24(9):1106-1111.
PMID: 34375036 DOI: 10.1111/1756-185X.14185

Rheumatoid arthritis (RA) is a major health burden in Asia Pacific affecting the quality of life of patients and consuming healthcare resources. According to recent estimates from the World Health Organization-International League Against Rheumatism-Community Oriented Program for Control of Rheumatic Diseases, prevalence is around 0.3%-0.5%. Management guidelines have helped to improve treatment across this diverse region. To gain better insight into current real-world management applications in view of these guidelines, virtual meetings were conducted in mid-2020 to explore perspectives of rheumatologists and patients, as well as discuss the impact of coronavirus disease 2019 on RA management. Patients and rheumatologists from Hong Kong, Malaysia, Singapore, the Philippines, Thailand, India, Pakistan, and Taiwan were included, representing a diverse mix of healthcare systems, wealth, ethnicity and culture. Despite many countries having prospered in recent years, similar challenges in RA diagnosis and treatment were identified. The daily impact and patient experience of RA were also similar across countries, marked by "silent" pain and disability, and universal misunderstanding of the disease. Late diagnosis and treatment, and barriers to access to appropriate treatment, remain problematic. The experience shared by Taiwan offers a glimmer of hope, however, wherein patient advocacy groups have succeeded in being included in policy-making decisions and securing access to advanced treatment. Real-world solutions that pay heed to the unique local needs and diversity of Asia Pacific are required to improve RA management, which will take time. In the interim, help can be sought from the trained, non-rheumatologist community to reduce some of the disease burden.

Matched MeSH terms: Arthritis, Rheumatoid/diagnosis; Arthritis, Rheumatoid/drug therapy*; Arthritis, Rheumatoid/epidemiology
Prevalence and correlates of self-reported depression in Malaysian patients with rheumatoid arthritis

Chow SK, Guan YK, Chong HY, Zainal NZ, Yeap SS

Malaysian Journal of Psychiatry, 2002;10(2):9-14.

Objectives: To determine the prevalence of self-reported depression among Malaysian patients with rheumatoid arthritis (RA) and to study the correlates and independent predictors for depression. Methods: The Hospital Anxiety and Depression Scale (HADS) questionnaire wasused to assess depressive symptoms. Disease activity was determined by theduration of morning stiffness, visual analogue scale for pain and fatigue, numberof swollen/tender joint and the modified disease activity score (DAS). The Health Assessment Questionnaire (HAQ) was used to assess the patients' functionalstatus. Results: Depression was recorded in 17.2% of the 93 patients. Painful joints(p<0.001), active disease (p<0.001) and poor joint function (p<0.001) correlatedsignificantly with depression. Poor functional status assessed by the HAO was themost significant Independent predictor for depression in RA patients, (OR=5.4,p=0.028). Conclusion: The prevalence of depression In this cohort of Asian RA patients was17.2%. Painful joints and functional disability were associated with a higherIncidence of depression. RA Patients with severe functional disability should beassessed for depression that may need to be treated Independently.

Matched MeSH terms: Arthritis, Rheumatoid
Fulltext Musculoskeletal disorders presenting to the primary care department at University Malaya Medical Centre

Chow SK, Yew KC, Yeap SS

Family Physician, 2003;12(1):33-34.

Musculoskeletal complaints are one of the most common presenting symptoms to primary care physicians. However, in Malaysia, there has been no prospective survey to look at this problem. This was a descriptive study to look at the prevalence of non-traumatic musculoskeletal complaints presenting to the primary care clinic at University Malaya Medical Center, Kuala Lumpur. Over a 3-week period, there were 408/4201 patients (9.7%) with non-traumatic musculoskeletal disorders. The most common regional problem was backache and the most commonly made diagnosis was non-specific musculoskeletal pain. In conclusion, musculoskeletal disorders form a significant proportion of primary care consultations and thus should be included in the curriculum for the primary care physician training. Keywords: musculoskeletal disorders, arthritis, primary care
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

Matched MeSH terms: Arthritis
Fulltext A novel de novo mutation in COL2A1 gene associated with fetal skeletal dysplasia

Chu FC, Hii LY, Hung TH, Lo LM, Hsieh TT, Shaw SW

Taiwan J Obstet Gynecol, 2021 Mar;60(2):359-362.
PMID: 33678343 DOI: 10.1016/j.tjog.2021.01.017

OBJECTIVE: Skeletal dysplasias, caused by genetic mutations, are a heterogenous group of heritable disorders affecting bone development during fetal life. Stickler syndrome, one of the skeletal dysplasias, is an autosomal dominant connective tissue disorder caused by abnormal collagen synthesis owing to a genetic mutation in COL2A1.
CASE REPORT: We present the case of a 38-year-old multipara woman whose first trimester screening showed a normal karyotype. However, the bilateral femur and humerus length symmetrically shortened after 20 weeks. Next-generation sequencing for mutations in potential genes leading to skeletal dysplasia detected a novel de novo mutation (c.1438G > A, p.Gly480Arg) in COL2A1, causing Stickler syndrome type 1. This pathogenic mutation might impair or destabilize the collagen structure, leading to collagen type II, IX, and XI dysfunction.
CONCLUSION: We identified a novel de novo mutation in COL2A1 related to the STL1 syndrome and delineated the extent of the skeletal dysplasia disease spectrum.

Matched MeSH terms: Arthritis/diagnosis*; Arthritis/embryology; Arthritis/genetics*
Fulltext Recognizing rheumatoid arthritis: oncoprotein survivin opens new possibilities: a population-based case-control study

Chun-Lai T, Murad S, Erlandsson MC, Hussein H, Sulaiman W, Dhaliwal JS, et al.

Medicine (Baltimore), 2015 Jan;94(4):e468.
PMID: 25634192 DOI: 10.1097/MD.0000000000000468

Survivin is a biomarker of cancer known for its anti-apoptotic and cell-cycle regulating properties. In the context of non-cancer pathology, high levels of survivin may be measured in blood and synovial fluid of patients with rheumatoid arthritis (RA) and associate with early joint damage and poor therapy response. The aim of the study was to investigate the value of survivin measurements in blood for diagnosis of RA in the frame of the Malaysian epidemiological investigation of rheumatoid arthritis (MyEIRA) study. The study enrolled RA patients from eight rheumatology centres in Peninsular Malaysia. The healthy controls matched by age, gender and ethnicity were recruited on the community basis from the residential area of the patients. Levels of survivin were measured in blood of RA patients (n = 1233) and controls (n = 1566) by an enzyme-linked immuno-sorbent assay (ELISA). The risk for RA was calculated as odds ratio (OR) and 95% confidence intervals in the individuals with high levels of survivin. The risk was calculated in relation to antibodies against cyclic citrullinated peptides (ACPA), detected by ELISA and HLA-DRB1 shared epitope (SE) alleles, identified by the polymerase chain reaction using sequence specific oligonucleotide method. High levels of survivin were detected in 625 of 1233 (50.7%) RA cases and in 85 of 1566 (5.4%) controls, indicating its high specificity for RA. Survivin was association with an increase in RA risk in the patients having neither SE-alleles nor ACPA (OR = 5.40, 95% CI 3.81-7.66). For the patients combining survivin, SE, and ACPA, the estimated risk for RA was 16-folds higher compared to the survivin negative patients with SE and ACPA(OR = 16.21, 95% CI 5.70-46.18). To conclude, detection of survivin in blood provides a simple test to improve diagnostic and to increase predictability for RA.

Matched MeSH terms: Arthritis, Rheumatoid/blood*; Arthritis, Rheumatoid/diagnosis*; Arthritis, Rheumatoid/genetics
Fulltext Osteoimmunology: Major and Costimulatory Pathway Expression Associated with Chronic Inflammatory Induced Bone Loss

Crotti TN, Dharmapatni AA, Alias E, Haynes DR

J Immunol Res, 2015;2015:281287.
PMID: 26064999 DOI: 10.1155/2015/281287

The field of osteoimmunology has emerged in response to the range of evidences demonstrating the close interrelationship between the immune system and bone metabolism. This is pertinent to immune-mediated diseases, such as rheumatoid arthritis and periodontal disease, where there are chronic inflammation and local bone erosion. Periprosthetic osteolysis is another example of chronic inflammation with associated osteolysis. This may also involve immune mediation when occurring in a patient with rheumatoid arthritis (RA). Similarities in the regulation and mechanisms of bone loss are likely to be related to the inflammatory cytokines expressed in these diseases. This review highlights the role of immune-related factors influencing bone loss particularly in diseases of chronic inflammation where there is associated localized bone loss. The importance of the balance of the RANKL-RANK-OPG axis is discussed as well as the more recently appreciated role that receptors and adaptor proteins involved in the immunoreceptor tyrosine-based activation motif (ITAM) signaling pathway play. Although animal models are briefly discussed, the focus of this review is on the expression of ITAM associated molecules in relation to inflammation induced localized bone loss in RA, chronic periodontitis, and periprosthetic osteolysis, with an emphasis on the soluble and membrane bound factor osteoclast-associated receptor (OSCAR).

Matched MeSH terms: Arthritis, Rheumatoid/metabolism
Evaluation of antiarthritic activity of nimbolide against Freund's adjuvant induced arthritis in rats

Cui X, Wang R, Bian P, Wu Q, Seshadri VDD, Liu L

Artif Cells Nanomed Biotechnol, 2019 Dec;47(1):3391-3398.
PMID: 31394949 DOI: 10.1080/21691401.2019.1649269

Nimbolide, a triterpenoid isolated from flower of neem tree possess various therapeutic properties. The objective of the study was to assess the anti-arthritic activity of nimbolide in arthritis induced rats. Nimbolide (20 mg/kg per day) was given orally to arthritic rats induced with Complete Freund's Adjuvant and changes in paw volume, body weight, organ indices (thymus and spleen), arthritic score, biochemical parameters and proinflammatory cytokines levels were determined. Histopathological analysis was also performed. Western blot analysis was also performed. Rats treated with nimbolide displayed marked reduction in arthritic score, organ indices, volume of paw, edema formation, along with substantial enhancement in body weight. Histopathological findings showed significant reduction in destruction of joints and inflammation following nimbolide treatment. The protective action of arthritic rats treated with nimbolide was also substantiated by molecular and biochemical studies. The results of the study show that nimbolide treatment has markedly enhanced health and reduced inflammation via lessening the proinflammatory cytokines expression in arthritic rats. Hence, nimbolide may be used as a potent therapeutic drug in treating rheumatoid arthritis.

Matched MeSH terms: Arthritis, Experimental/drug therapy*; Arthritis, Experimental/metabolism; Arthritis, Experimental/pathology
Fulltext Isolation of Mycoplasma hyosynoviae from pneumonic lung of swine

Dahlia H, Tan LJ, Zarrahimah Z, Maria J

Trop Biomed, 2009 Dec;26(3):341-5.
PMID: 20237449 MyJurnal

The isolation of Mycoplasma hyosynoviae from a piglet with severe pneumonia is described. This is the first report of M. hyosynoviae isolation in the country. The lung sample where the isolation was made was severely consolidated, suppurative and pleurisy. The pathogenicity of the M. hyosynoviae isolated has yet to be determined.

Matched MeSH terms: Arthritis, Infectious/diagnosis; Arthritis, Infectious/microbiology; Arthritis, Infectious/veterinary
Fulltext Interleukin-23 and its correlation with disease activity, joint damage, and functional disability in rheumatoid arthritis

Dalila AS, Mohd Said MS, Shaharir SS, Asrul AW, Low SF, Shamsul AS, et al.

Kaohsiung J. Med. Sci., 2014 Jul;30(7):337-42.
PMID: 24924839 DOI: 10.1016/j.kjms.2014.02.010

The purpose of this study was to compare the serum interleukin (IL)-23 levels between rheumatoid arthritis (RA) patients and healthy controls and to determine the correlation of IL-23 levels with disease activity, joint damage and functional disability in RA. Serum samples were obtained from 45 patients with RA and 45 healthy controls. The enzyme-linked immunosorbent assay method was used for quantitative analysis of IL-23. All the RA patients were assessed for disease activity based on the 28-joint disease activity score, joint damage based on modified Sharp score, and functional ability using the Health Assessment Questionnaire-Disability Index. The mean serum IL-23 level was much higher among the RA patients (24.50 ± 13.98 pg/mL) compared to the controls (5.98 ± 3.40 pg/mL; p < 0.01). There was a significant positive relationship between IL-23 levels and disease activity and questionnaire scores (p = 0.003 and 0.020, respectively). On logistic regression analysis, IL-23 levels were significantly higher in patients with moderate to high disease activity (p = 0.008, odds ratio = 1.073, 95% confidence interval = 1.019-1.130) and patients with significant functional disability (p = 0.008, odds ratio = 1.085, 95% confidence interval = 1.021-1.153). RA patients have significantly higher levels of serum IL-23. The IL-23 levels correlate well with disease activity and functional disability but not with radiographic joint damage.

Study site: Rheumatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Arthritis, Rheumatoid/blood*; Arthritis, Rheumatoid/physiopathology; Arthritis, Rheumatoid/radiography
Fulltext Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies

Das B

Biomed Imaging Interv J, 2007 Oct;3(4):e45.
PMID: 21614297 DOI: 10.2349/biij.3.4.e45

Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.

Matched MeSH terms: Arthritis; Arthritis, Rheumatoid
Fulltext Predictors of frequent oral analgesic use in rheumatoid arthritis

Das Gupta E, Tee HS, Sakthiswary R

Pak J Med Sci, 2014 Sep;30(5):976-81.
PMID: 25225510 DOI: 10.12669/pjms.305.5112

Objective: The main objective of this study was to determine the predictors of frequent oral analgesic use among Rheumatoid Arthritis (RA) patients who were prescribed with the above medication on an ‘as needed’ basis.
Methods: Patients with RA were recruited consecutively from the Rheumatology outpatient clinics in this cross-sectional study. The sociodemographic data, frequency of oral analgesic intake, Patient Global Assessment (PGA) scores and HAQ (Health Assessment Questionnaire) scores were determined by interviewing the subjects. Subjects were divided into 2 groups; frequent users (3 days and above in a week) and less frequent users (less than 3 days in a week).
Results: In a total of 112 subjects, 39 (34.8%) were frequent analgesic users. Both the HAQ and PGA scores were significantly higher among the frequent users (p < 0.05). Using multivariate analysis, the HAQ scores (p=0.015, odds ratio 3.161 [95% confidence interval of 1.246-8.015]) and PGA scores (p=0.039 odds ratio 1.291 [95% confidence interval of 1.012-1.646]) were found to be independent predictors of frequent analgesic use.
Conclusions: Our study confirms that the frequency of analgesic intake in Rheumatoid Arthritis has a significant relationship with patient-reported functional capacity and well being.
KEY WORDS: Analgesic, Rheumatoid arthritis.

Study site: Rheumatology clinic, Hospital Tunku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Arthritis, Rheumatoid*
Fulltext Early referral of newly diagnosed rheumatoid arthritis

Das Gupta E, Gun SC, Abdul Rahman YR

Family Physician, 2003;12(1):16-8.

1. Revised ARA criteria (1987) the diagnosis of RA requires presence of at least 4 of the following 7 features: 1) morning stiffness> 1 hour 2) swelling of 2 or more joints (of 6 weeks duration) 3) symmetrical joint involvement 4) arthritis of more than 1 hand joints (of at least 6 weeks duration) 5) positive rheumatoid factor, 6) presence of rheumatoid nodule 7) X-ray changes. 2. Use of DMARD should start early, along with pain control by non steroidal anti inflammatory drugs (NSAID) 3. Early referral to rheumatologists is the current recommendation 4. Indications for early referral include: i. Early morning stiffness (EMS) of 30 mins ;- ii. Metatarsophalangeal (MTP) / metacarpophalageal (Mep) involvement. iii. 2 or more swollen joints.

Matched MeSH terms: Arthritis, Rheumatoid
Fulltext Acute gonococcal sacro-iliitis--a case report

Deshmukh RG

Med J Malaysia, 1995 Dec;50(4):411-4.
PMID: 8668065

Acute infective sacro-iliitis is a rare condition. Though gonococcal arthritis is not uncommon, this organism does not appear to have been isolated from the sacro-iliac joint. The first proven case of gonococcal sacro-iliitis is reported here. Difficulties in correct diagnosis of infective sacro-iliitis are highlighted. Management of gonococcal sacro-iliitis is described. With the increase in number of gonococcal infections, a case can be made for routine culture of joint material N. Gonorrhoeae in cases of septic arthritis in patients at high risk.

Matched MeSH terms: Arthritis, Infectious/etiology*
Fulltext The difficult rheumatology diagnosis

Devaraj NK

Ethiop J Health Sci, 2018 Jan;28(1):101-102.
PMID: 29622913 DOI: 10.4314/ejhs.v28i1.13

Background: Rheumatoid arthritis is a devastating condition. More so, the diagnosis of seronegative rheumatoid arthritis is often fraught off with much uncertainty and that leads to further suffering to the unfortunate patient.

Case Details: This is a case of Madam A, who presented with many non-specific symptoms and signs involving many systems which was finally diagnosed as seronegative rheumatoid arthritis. This case explores the challenges in reaching this uncommon diagnosis and how anti-inflammatory drugs can bring a miraculous relief to the patient's suffering.

Conclusion: The diagnosis of seronegative rheumatoid arthritis often presents a real challenge to the medical practitioner and often requires multiple visits and/or shared multidisciplinary care for confirmation of the diagnosis. Once diagnosed and treated with disease modifying anti- rheumatic drugs, often there is a miraculous relief to the patient's suffering.

Matched MeSH terms: Arthritis, Rheumatoid/diagnosis*; Arthritis, Rheumatoid/drug therapy

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