From March 1986 to June 1992, 100 primary total knee arthroplasties were done in 69 patients. The demographic data and complications were analysed in these 69 patients. The first 50 knees with a minimal follow-up of one year (range 1-6 years) were analysed in more detail according to the International Knee Society Rating System. Detailed radiological evaluation was also carried out to assess positioning of the components. There were 79 knees with osteoarthritis, 20 knees with rheumatoid arthritis and one with Systemic Lupus Erythromatosus (SLE). The knee score was poor in all knees pre-operatively. Post-operatively 78% had good to excellent score and the other 22% had fair knee score. However the functional score remained poor in 50% of the knees. Ideal tibio-femoral alignment was obtained in 68% of the knees. Twenty four percent of the knees had 0.4 degrees of varus and eight percent had 10-12 degrees valgus. Complication rate was low with 1% of infection (one knee). Overall early results were satisfactory.
Study site; University Hospital Kuala Lumpur (University Malaya Medical Centre)
Introduction:Tropical herbs are used as a medicine long before the introduction of modern medicine, especially by traditional healers. However, its’ scientific benefits are not widely investigated. There is a belief that the use of tradi-tional herbs potentially causing health deterioration due to its unknown mechanism of actions and interactions, and the nature of its unregulated processing as a health supplement. Parkia speciosa (local: petai) and Pithecellobium jir-inga (local: jering) are two tropical herbs from the Leguminosae family that are widely used raw as salads with many perceived health benefits and harms. We reviewed both species, looking into scientific pieces of evidence supporting the belief. Methods: The databases of MEDLINE, PubMed, EBSCOhost, and Google Scholars were systematically searched for both in vitro and in vivo effects of both species with no language restriction. Data were extracted using standardised fashioned. Results:P speciosa has pharmacological properties including antioxidant and anti-inflam-mation. It has shown to have antibacterial properties and glucose-lowering activity. P jiringa contains known an-tioxidant metabolites such as flavonoids, phenolics and terpenoids. It also contains antiangiogenic properties with potential use in retinopathy, cancer, and Rheumatoid arthritis. However, both herbs have potentially harmful effects which include liver injuries. Large consumption of P jiringa leads to acute kidney injury. Conclusion: Consumption of both P speciosa and P jiringa has medicinal properties as well as health harm. If taken as a supplement, rigorous clinical trials are needed to delineate benefit vs harm effect of both herbs.
Introduction: While sharing a common causal link, both rheumatoid arthritis (RA) and periodontitis (PD) manifest similar inflammatory responses. With the progression of severity, both diseases result in bone loss. Hence, Ca and Zn, as structural components of the bones, are expected to be altered in saliva and serum in PD and RA respectively. Zinc and calcium concentrations have been studied previously in patients with PD or RA, with PD patients exhibiting increased salivary Ca and decreased Zn concentrations in serum, while RA patients have been reported to express low plasma concentrations of both Zn and Ca. The aim of this study is to evaluate the saliva and serum levels of Ca and Zn in PD patients with or without RA. Methods: Serum and saliva samples were collected from 82 patients from the Faculty of Dentistry, University of Malaya and the University Malaya Medical Centre rheumatoid clinic. Patients were grouped according to their periodontal health and RA status (healthy n=21; PD n=21; RA n=21; RAPD n=19). Results: Zinc concentration in serum was significantly higher (p
Objective: The assay for anti-cyclic citrullinated peptide (anti-CCP) antibody is a recent test of interest due to low diagnostic specificity of rheumatoid factor in the diagnosis of rheumatoid arthritis. To determine the sensitivity and specificity of anti-CCP antibodies in rheumatoid arthritis patients using American College of Rheumatology (ACR) criteria as a gold standard.
Design: A cross sectional study was conducted from January 2008 to December 2008 on 100 patients with rheumatoid arthritis and 153 patients with arthritis or arthralgia but not fulfilling ACR criteria for rheumatoid arthritis.
Materials and Methods: Serum from each subject was tested for anti-CCP antibodies and IgM rheumatoid factor (IgM RF) by an enzyme linked immunosorbent assay (ELISA). Sensitivity and specificity of the tests were evaluated using the ACR criteria as the gold standard. Data was analyzed using SPSS version 12.0 software. The association between the two categorical variables were tested using chi-square test. The differences between the two groups were tested using independent t-test. Results: The sensitivity of anti-CCP antibodies was 71% with 94.8% of specificity. For rheumatoid factor the sensitivity was 85% and the specificity was 74.5%. Positive predictive value for anti-CCP antibodies was 89.9% whereas for rheumatoid factor it was 68.5%. The sensitivity of ACR criteria with inclusion of anti- CCP antibodies was 100% and specificity of 94.8% (95%CI: 91.3%, 98.2%).
Conclusion: Anti-CCP antibody has a higher diagnostic accuracy compared to the RF. Anti-CCP antibody is a useful laboratory marker to support the diagnosis of rheumatoid arthritis and to differentiate patients with rheumatoid arthritis from rheumatoid arthritis-like symptoms. Therefore, it is suggested that anti-CCP antibodies should be included as another laboratory supportive criterium besides RF test in ACR criteria in the diagnosis of RA.
Study site: family medicine clinic, rheumatology clinic and immunology laboratory of Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
Background: Rheumatoid arthritis (RA) is an inflammatory disease. Predictors of disease activity include presence of joint inflammation, blood investigations such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). ESR is said to be imprecise as it is affected by aging, female sex, obesity, pregnancy, anaemia and polycythaemia. But it is inexpensive and easy to perform. CRP is produced as an acute phase reactant by the liver in response to interleukin 6 and other cytokines. CRP is more specific but costs more than ESR. Both tests are done in the rheumatology clinic of Hospital Seremban. Objective: To compare the usefulness of ESR and CRP as a predictor of disease activity in rheumatoid arthritis (RA) patients. Method: This was a retrospective study. The medical records of 248 RA patients who attended the rheumatology clinic, Hospital Seremban between 1 January 2004 and 31 Dec 2004 were reviewed. The following data were obtained: joint swelling and tenderness, other clinical features which indicate inflammation secondary to infection or trauma and inflammation of soft tissue, ESR, CRP, FBC and UFEME. Results: Data was analysed and the results showed that a total number of 248 patients were seen. There were 13 defaulters. Of the 248 patients there were 929 patients' visits. Of the total number of patients' visits where patients clinically had active disease, 80.2% had raised ESR while 88.8% had raised CRP. As for visits where patients had quiescent disease clinically, 57.3% had normal ESR and 36.5% had normal CRP. Conclusion: CRP is more sensitive but less specific than ESR. This suggests that we still should use both tests as they complement each other. ESR can serve as a countercheck for CRP and vice versa.
Background: Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) is a new serological test for the diagnosis of rheumatoid arthritis (RA). It is an enzyme immunoassay (EIA) for the detection of antibodies directed toward citrullinated peptides. Studies show this test has an improved diagnostic value compared to rheumatoid factor (RF). Objective: To determine the sensitivity and specificity of anti-CCP in patients with rheumatoid arthritis and other rheumatic diseases. Method: 227 serum samples for rheumatology clinics (Putrajaya, Taiping, and Ipoh Hospital) were tested for the presence of anti-CCP and rheumatoid factor (RF). These included 171 patients diagnosed with RA and 56 from other rheumatic diseases. Patient demographic data, clinical diagnosis, radiographic information and other laboratory data were obtained from the patients' clinical notes. Results: Anti-CCP antibodies were detected in 76.6% (131/171) patients with RA and 17.9% (10/56) patients with other arthritis. The sensitivity and specificity of anti-CCP reactivity at the optimal cut off values were 66.1% and 87.5% respectively. The sensitivity of anti-CCP was higher than that for RF (41.8%). However, the presence of either anti-CCP or RF improved the sensitivity to 76.2%. Conclusion: The detection of anti-CCP alone maybe useful in the diagnosis of RA. However, when used concomitantly with RF, it can improve the diagnostic ability significantly.
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.
Epstein-Barr virus (EBV) is one of the common human herpesvirus types in the world. EBV is known to infect more than 95% of adults in the world. The virus mainly infects B lymphocytes and could immortalize and transform the cells into EBV-bearing lymphoblastoid cell lines (LCLs). Limited studies have been focused on characterizing the surface marker expression of the immortalized LCLs. This study demonstrates the generation of 15 LCLs from sixteen rheumatoid arthritis (RA) patients and a healthy volunteer using B95-8 marmoset-derived EBV. The success rate of LCL generation was 88.23%. All CD19+ LCLs expressed CD23 (16.94-58.9%) and CD27 (15.74-80.89%) on cell surface. Our data demonstrated two distinct categories of LCLs (fast- and slow-growing) (p<0.05) based on their doubling time. The slow-growing LCLs showed lower CD23 level (35.28%) compared to fast-growing LCLs (42.39%). In contrast, the slow-growing LCLs showed higher percentage in both CD27 alone and CD23+CD27+ in combination. Overall, these findings may suggest the correlations of cellular CD23 and CD27 expression with the proliferation rate of the generated LCLs. Increase expression of CD23 may play a role in EBV immortalization of B-cells and the growth and maintenance of the EBV-transformed LCLs while CD27 expression might have inhibitory effects on LCL proliferation. Further investigations are warranted to these speculations.
Introduction: Carpal collapse of wrist occurs in disorders like rheumatoid arthritis and Kienbock's disease. Three techniques have been described to measure carpal collapse. First, the carpal height ratio (CHR), measured by dividing carpal height by 3rd metacarpal length. Second, the revised carpal height ratio (RCH ratio), measured by dividing carpal height by length of capitate. Third, capitate radius distance (CR index), measured by shortest distance between distal edge of radius and the proximal edge of capitate. The index publications describe good reliability of all these but which method out of the three is best in terms of intra- and inter-observer variability is not known. The purpose of this study was to find out which method had the least inter- and intra-observer variability for determining carpal collapse. Materials and Methods: Fifty normal wrist postero-anterior radiographs were studied by three assessors who measured CHR, RCH ratio and CR index separately. The measurements were repeated after one month by all the three observers. The results were then statistically analysed. Results: The p-value was <0.001 in all the three assessors in CR index meaning that the intra-observer variability was least in CR index. For the inter-observer variability intra class coefficient of 0.9 indicated that the CR index has the least variability. Conclusion: CR index is the most reproducible method to measure carpal collapse. The method which provides accurate measurement of carpal collapse will allow better staging of carpal disorders.
Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAIDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods.
Rheumatoid arthritis (RA) is a chronic, autoimmune, systemic, inflammatory disorder that affects synovial joints, both small and large joints, in a symmetric pattern. This disorder usually does not directly cause death but significantly reduces the quality of life and life expectancy of patients if left untreated. There is no cure for RA but, patients are usually on long-term disease modifying anti-rheumatic drugs (DMARDs) to suppress the joint inflammation, to minimize joint damage, to preserve joint function, and to keep the disease in remission. RA is strongly associated with various immune cells and each of the cell type contributes differently to the disease pathogenesis. Several types of immunomodulatory molecules mainly cytokines secreted from immune cells mediate pathogenesis of RA, hence complicating the disease treatment and management. There are various treatments for RA depending on the severity of the disease and more importantly, the patient's response towards the given drugs. Early diagnosis of RA and treatment with (DMARDs) are known to significantly improve the treatment outcome of patients. Sensitive biomarkers are crucial in early detection of disease as well as to monitor the disease activity and progress. This review aims to discuss the pathogenic role of various immune cells and immunological molecules in RA. This review also highlights the importance of understanding the immune cells in treating RA and in exploring novel biomarkers.
Upon reviewing the literature, the prevalence of many systemic conditions such as diabetes,
hypertension, asthma and rheumatoid arthritis were reported to be high in Saudi Arabia. The relationship of these
conditions with tooth loss among Saudi population was not investigated. Therefore, the aim of the present study
is to explore the relationship between tooth loss and most common medical conditions among Saudi dental
patient. The study participants were 250 patients who were randomly selected from the College of Dentistry
database of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia.
Participants were requested to answer self-administered questionnaires related to their demographic as well as
general health questions concerned to the presence of systemic medical conditions. Missing teeth were
determined after examining the orthopantogram radiographs and reviewing the Romexis and SALUD databases.
Descriptive statistics, independent t-test and linear multiple regression model were performed using SPSS
software. The mean number of missing teeth among the study population was 5.8 teeth per person. The mean
number of missing teeth was higher among subjects with diabetes, hypertension, rheumatoid arthritis,
cardiovascular diseases, or osteoporosis compared to healthy individuals. A multiple linear regression analysis
model revealed that diabetes, hypertension and rheumatoid were significant predictors of missing teeth among
Saudi population. These results highlight the importance of the effect of medical conditions on oral health.
Curcuma longa or turmeric has long been used in traditional medicine by the local population in Malaysia as an antiinflammatory agent. It has been proven to contain natural antiarthritic compound called curcumin. Joints abnormality and destruction have been implicated in the pathogenesis of rheumatoid arthritis (RA) due to inflammatory reactions. In this study, collagen-induced arthritis (CIA) model was utilized to study the effects of curcumin on joint inflammation in Sprague-Dawley rats. Body weight measurement, arthritis score assessment and radiology score assessment were carried out at specific intervals throughout this study. The results showed that the mean arthritis and radiology scores for animal groups designated as CIA CurcuminC and CIA CurcuminT were significantly lower compared with the negative control (CIA OV) group respectively. The mean arthritis scores for CIA CurcuminC group is significantly lower compared with CIA CurcuminT group but there is no significant difference in the mean radiology scores between the CIA CurcuminC and CIA CurcuminT groups. In conclusion, the oral supplementation of curcumin at the dose of 110 mg/mL/kg/day has a potential to delay and improve joint abnormality and injury in Sprague-Dawley rats with CIA.
Pes anserine syndrome is a cause of inferomedial knee pain. It occurs in patients with diabetes mellitus, osteoarthritis, rheumatoid arthritis and in overweight patients. It is a challenge to identify the causes of knee pain following knee replacement surgery. We present a case report of pes anserine syndrome in a 79-year-old female who had undergone knee arthroplasty 13 years prior. She was pain free until one year ago when her knee pain resurfaced without any symptoms of infection or history of trauma. She was successfully treated with a combination of stretching exercise and steroid local steroid injection. We want to highlight that such common condition as pes anserine syndrome, could occur in total knee arthroplasty, and should be considered as one of the possible diagnosis.
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.
This short review provides an update of the anticancer and anti-inflammatory properties of casticin from Vitex species. Casticin is a polymethylflavone with three rings, an orthocatechol moiety, a double bond, two hydroxyl groups and four methoxyl groups. Casticin has been isolated from various tissues of plants in the Vitex genus: fruits and leaves of V. trifolia, aerial parts and seeds of V. agnus-castus and leaves of V. negundo. Studies have reported the antiproliferative and apoptotic activities of casticin from Vitex species. The compound is effective against many cancer cell lines via different molecular mechanisms. Studies have also affirmed the anti-inflammatory properties of casticin, with several molecular mechanisms identified. Other pharmacological properties include anti-asthmatic, tracheospasmolytic, analgesic, antihyperprolactinemia, immunomodulatory, opioidergic, oestrogenic, anti-angiogenic, antiglioma, lung injury protection, rheumatoid arthritis amelioration and liver fibrosis attenuation activities. Clinical trials and commercial use of the casticin-rich fruit extract of V. agnus-castus among women with premenstrual syndrome were briefly discussed.
The complement system plays a fundamental role in mediating the activity of rheumatoid arthritis (RA). Biologic therapy can reduce native complement component levels and its activation. We aimed to study the relation of Doppler ultrasound (US) synovitis versus clinical synovitis with changes in native complement component levels in RA patients on biologic therapy.
This review explores the effects of pomegranate on the pathogenesis of bone loss in osteoporosis, osteoarthritis and rheumatoid arthritis. A systematic review of the literature was conducted to identify the relevant studies on pomegranate and osteoporosis/osteoarthritis/rheumatoid arthritis. A comprehensive search was conducted in Medline and CINAHL for relevant studies published between the years 1946 to 2012. The main inclusion criteria were research articles published in English, studies had to report the association or effect of pomegranate and these bone and joint diseases: osteoporosis, osteoarthritis or rheumatoid arthritis. The literature search identified 35 potentially relevant articles, whereby 8 met the inclusion criteria. Two animal studies, two combinations of animal and in vitro studies, three in vitro studies and one human study were included in this review. All the studies reported positive effects of pomegranate extract or juice on osteoporosis, osteoarthritis and rheumatoid arthritis. This evidence-based review highlighted the potential of pomegranate extract being used for treating bone loss in osteoporosis, osteoarthritis and rheumatoid arthritis. Further studies are required to identify the active ingredients and molecular mechanisms before controlled human observational studies are conducted to provide stronger evidence.
OBJECTIVES: Dendritic cell immunoreceptor (DCIR) has been implicated in development of autoimmune disorders in rodent and DCIR polymorphisms were associated with anti-citrullinated proteins antibodies (ACPA)-negative rheumatoid arthritis (RA) in Swedish Caucasians. This study was undertaken to further investigate whether DCIR polymorphisms are also risk factors for the development of RA in four Asian populations originated from China and Malaysia.
METHODS: We genotyped two DCIR SNPs rs2377422 and rs10840759 in Han Chinese population (1,193 cases, 1,278 controls), to assess their association with RA. Subsequently, rs2377422 was further genotyped in three independent cohorts of Malaysian-Chinese subjects (MY_Chinese, 254 cases, 206 controls), Malay subjects (MY_ Malay, 515 cases, 986 controls), and Malaysian-Indian subjects (MY_Indian, 378 cases, 285 controls), to seek confirmation of association in various ethnic groups. Meta-analysis was preformed to evaluate the contribution of rs2377422 polymorphisms to the development of ACPA-negative RA in distinct ethnic groups. Finally, we carried out association analysis of rs2377422 polymorphisms with DCIR mRNA expression levels.
RESULTS: DCIR rs2377422 was found to be significantly associated with ACPA -negative RA in Han Chinese (OR 1.92, 95% CI 1.27-2.90, P=0.0020). Meta-analysis confirms DCIR rs2377422 as a risk factor for ACPA-negative RA across distinct ethnic groups (OR(overall) =1.17, 95% CI 1.06-1.30, P=0.003). The SNP rs2377422 polymorphism showed significant association with DCIR mRNA expression level, i.e. RA-risk CC genotype exhibit a significant increase in the expression of DCIR (P=0.0023, Kruskal-Wallis).
CONCLUSIONS: Our data provide evidence for association between DCIR rs2377422 and RA in non-Caucasian populations and confirm the influence of DCIR polymorphisms on RA susceptibility, especially on ACPA-negative RA.
The aim of our study is to describe the impact of tight control strategy on the care of RA patients in Sarawak General Hospital. We performed a prospective study of all patients with a diagnosis of RA who received treatment at the Rheumatology Clinic in Sarawak General Hospital over a 1-year period. Systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS 28-ESR <2.6) were carried out in the clinic over the 1-year period. Disease activity and treatment regimes of all 142 patients were collected for at baseline and 1 year later for statistical analysis. Our patients have a significantly lower DAS 28 with a mean of 2.99 ± 0.95 compared with baseline of 4.31 ± 1.34 (p < 0.000). More patients were in remission 1 year later compared to baseline (36.6% vs 11.3%). Tight control strategy has a positive impact on the care of RA patients in our centre. By optimising the care of RA through tight control strategy, RA can be better controlled in our centre.
Study site: Rheumatology clinic, Sarawak general hospital