MyMedR

Comment on: Multicentre survey of rheumatoid arthritis patients from Ministry of Health rheumatology centres in Malaysia

Yeap SS

Int J Rheum Dis, 2009 Jul;12(2):177-8; author reply 179.

PMID: 20374340 DOI: 10.1111/j.1756-185X.2009.01403.x

Comment on: Shahrir M, Shahdan M, Shahid M, Sulaiman W, Mokhtar AM, Othman M, et al. Multicentre survey of rheumatoid arthritis patients from ministry of health rheumatology centers in malaysia. Int J Rheum Dis. 2008;11(3):287-92. doi:10.1111/j.1756-185X.2008.00379.x;

Rheumatoid arthritis in paintings: a tale of two origins

Yeap SS

Int J Rheum Dis, 2009 Dec;12(4):343-7.

PMID: 20374373 DOI: 10.1111/j.1756-185X.2009.01434.x

Rheumatoid arthritis (RA) is thought to be a 'recent' disease in that descriptions of it were only noted in the 17th century. However, a study of paintings would suggest that RA could have been present as early as the 15th century, when artists started to paint the human body accurately rather than figuratively. Thus, it was possible to deduce from their paintings the occurrence of various medical conditions. If present, RA with its typical finger deformities should be apparent. This review discusses the known occurrences of RA-type deformities in paintings and places this in the context of the origins of the disease.

Fulltext We are all different: insights from osteoporosis research in Asia

Yeap SS

Int J Rheum Dis, 2008;11:323-326.

DOI: 10.1111/j.1756-185X.2008.00404.x

Osteoporosis only became a 'disease' entity in the 20th century. After the initial observations and definitions of osteoporosis based on Caucasian populations, systematic research in Asian populations started in the 1980s. Significant variations between different ethnic groups with respect to the rate of osteoporotic fractures, bone mineral density and disease risk factors emerged from the data; this article highlights some of the earlier important findings and the dissimilarities. Osteoporosis is therefore not a homogeneous disease across the world.

Fulltext The use of bisphosphonates in osteoporosis: a review

Yeap SS

JUMMEC, 1998;3(1&2):13-17.

Bisphosphonates are synthetic analogues of pyrophosphate. Their main pharmacological effect is to iuhibit bone resorption by a variety of mechanisms, not all of which are clearly understood. The activity of the bisphosphonates varies depending on the compound. In clinical trials, they have been shown to stop postmenopausal bone loss and increase bone density, with a concomitant reduction in fracture rate with some agents. This article reviews the currently known mechanisms of action of the bisphosphonates and the evidence that they are useful in the treatment of osteoporosis.

Current DMOAD options for the treatment of osteoarthritis

Yeap SS

Clin Exp Rheumatol, 2020 03 05;38(4):802.

PMID: 32141438

Amyopathic dermatomyositis and pulmonary fibrosis

Chow SK, Yeap SS

Clin Rheumatol, 2000;19(6):484-5.

PMID: 11147762

'Amyotrophic dermatomyositis' (ADM) is used to describe a small subgroup of patients with the typical skin rash associated with dermatomyositis but without muscle involvement. Lung involvement in ADM is rare. We report on the management of a patient with ADM associated with pulmonary fibrosis at presentation, and her response to corticosteroid treatment.

Management of corticosteroid-induced osteoporosis

Yeap SS, Hosking DJ

Rheumatology (Oxford), 2002 Oct;41(10):1088-94.

PMID: 12364625 DOI: 10.1093/rheumatology/41.10.1088

Corticosteroid (CS) therapy is widely used in the treatment of rheumatic diseases. Osteoporosis remains one of its major complications. The risk of low bone mineral density (BMD) and fracture may be already increased in some of the rheumatic diseases, regardless of CS therapy. However, in spite of this, preventative treatment for osteoporosis in patients on CS remains low. Patients on or about to start CS use for more than 6 months are at risk of corticosteroid-induced osteoporosis (CIOP). The pathogenesis of CIOP differs from post-menopausal osteoporosis in that bone formation is said to be more suppressed compared with bone resorption. The diagnosis of CIOP can be made on clinical risk factors and may not require measurement of BMD. Many agents used in post-menopausal osteoporosis such as activated vitamin D products, hormone replacement therapy, fluoride, calcitonin and the bisphosphonates have been shown to maintain or improve BMD in CIOP. However, there are few data on the reduction in fracture rates in CIOP, but the bisphosphonates seem the most promising in this regard.

Fulltext Osteoporosis in South-East Asian Countries

Thambiah SC, Yeap SS

Clin Biochem Rev, 2020 Feb;41(1):29-40.

PMID: 32158060 DOI: 10.33176/AACB-19-00034

Osteoporosis (OP) is a condition where there is low bone density and microarchitectural deterioration which can predispose to fragility fractures. There is a wealth of literature on OP from the developed countries, but less so from Asia. This review will explore the field of OP research in South-East Asia with regard to the epidemiology, the diagnosis of OP and the role of laboratory tests in the management of OP, with emphasis on 25-dihydroxyvitamin D and bone turnover markers.

Gout: why is this curable disease so seldom cured?

Yeap SS, Gun SC

Ann Rheum Dis, 2013 May;72(5):e5.

PMID: 23328940 DOI: 10.1136/annrheumdis-2012-203161

Comment on: Doherty M, Jansen TL, Nuki G, et al. Gout: Why is this curable disease so seldom cured? Ann Rheum Dis 2012;71:1765–70.

Fulltext Management of postmenopausal osteoporosis

Yeap SS, Hew FL, Chan SP

Malays Fam Physician, 2013;8(2):36-40.

PMID: 25606280 MyJurnal

Characteristics of Malaysian systemic lupus erythematosus (SLE) patients seen in a public and private hospital. [Abstract]

Yeap SS, Das Gupta E, Gun SC

Int J Rheum Dis, 2010;13:121.

DOI: 10.1111/j.1756-185X.2010.01502.x

BACKGROUND: In Malaysia, patients have a choice of attending a public (fully subsidised bygovernment) hospital (PUBH) or a private (fee-paying) hospital (PRIH) for their healthcare.The aim of this study was to, firstly, provide an overview of the characteristics of MalaysianSLE patients attending rheumatology clinics, and secondly, to ascertain if there were any dif-ferences between patients attending PUBH and PRIH.
METHODS:A standardised questionnaire was administered to all SLE patients attendingrheumatology clinics in a PRIH in Selangor state and a PUBH in Negeri Sembilan state dur-ing the months of September to December 2009.
RESULTS:One hundred and thirty patients were included in the study. There were 55(42.3%) patients from PRIH and 75 (57.7%) from PUBH. 93.8% were female. 61.5% wereChinese, 29.2% Malay and 7.7% Indians. The majority of patients completed secondaryschooling (46.9%) with significantly less PUBH patients going onto higher education(P = 0.001). 53.8% were in fulltime employment with 37.7% housewives/unemployed.There were significantly more unemployed patients in PUBH (45.3%) versus PRIH (27.2%)(P = 0.05). 33.8% of patients were single, 60.8% married and 3.8% divorced. Average ageat SLE diagnosis was 29.8510.17 years. At diagnosis, the most common presenting symp-tom was related to the mucocutaneous system 70.8%, followed by joints 55.3%, haemato-logical 46.9% and renal 23.1%. Significantly more patients had renal involvement atdiagnosis in PUBH (33.3%) versus PRIH (9.1%) (P = 0.001). At the time of survey, therewere 12 (9.2%) patients in remission. Of those still symptomatic, 48.5% related to themucocutaneous system, 32.3% joints, 27.7% haematological, 22.3% renal, with significantlymore current renal disease in PUBH (30.7%) versus PRIH (10.9%) (P = 0.008). The mostfrequently prescribed drug was prednisolone in 83.1% of patients, followed by hydroxychlo-roquine 68.5% and azathioprine 23.1%. Only 64.8% of patients on prednisolone were onbone protective agents. More patients in PRIH were on prednisolone (90.9%) versus PUBH(77.3%) (P = 0.04), but more patients were on activated vitamin D in PUBH (72%) versusPRIH (29.1%) (P < 0.001).
CONCLUSION:The demographics and clinical characteristics of SLE patients attending PUBHand PRIH are significantly different. This has important implications when considering edu-cational and treatment strategies

A brief history of the Malaysian Society of Rheumatology

Yeap SS, Veerapen K, Lim KKT

APLAR Journal of Rheumatology, 2005;8:229-231.

DOI: 10.1111/j.1479-8077.2005.00157.x

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.

Fulltext Sarcopenia and vertebral fracture

Hew FL, Chan SP, Yeap SS

Osteoporos Sarcopenia, 2018 Dec;4(4):151.

PMID: 30775560 DOI: 10.1016/j.afos.2018.11.086

Fulltext Reply on "Combined orthogeriatric and fracture liaison service for improved postfracture patient care"

Yeap SS, Hew FL, Chan SP

Osteoporos Sarcopenia, 2017 Sep;3(3):160.

PMID: 30775523 DOI: 10.1016/j.afos.2017.07.003

Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids

Yeap SS, Othman AZ, Zain AA, Chan SP

Int J Rheum Dis, 2012 Feb;15(1):17-24.

PMID: 22324943 DOI: 10.1111/j.1756-185X.2011.01653.x

AIM: To determine if baseline vitamin D levels would influence the gain in bone mineral density (BMD) in female systemic lupus erythematosus (SLE) patients on corticosteroids (CS) taking bone-active medication.

METHOD: Premenopausal SLE patients participating in a trial assessing the efficacy of calcium alone, calcitriol and calcium, and alendronate and calcium, on BMD in patients on CS, were studied. Patients were randomly allocated to the treatment groups at the start of the study and followed up for 2 years. Serum 25-hydroxy vitamin D [25(OH)D] was measured at baseline.

RESULTS: Thirty-eight patients were studied. One (2%) patient had osteoporosis, nine (24%) had osteopenia and all others had normal BMD. The mean baseline 25(OH)D levels were 21.6 ± 4.6 ng/mL (± 1 SD). Twelve (32%) patients had vitamin D deficiency [25(OH)D < 20 ng/mL]. There was a significant negative correlation between SLEDAI scores and 25(OH)D levels, that is, patients with high SLEDAI scores had significantly lower 25(OH)D levels (P = 0.033). Left femoral neck BMD was significantly lower in the deficient compared to insufficient group (P = 0.042). There was a trend toward better BMD gain at 2 years in the vitamin D insufficient compared to the deficient group, which did not reach statistical significance.

CONCLUSION: This study showed that in female SLE patients, low vitamin D levels are associated with higher disease activity and suggests that patients who have higher vitamin D levels have a better BMD response during treatment with bone-active agents.

A survey on the management of gout in Malaysia

Yeap SS, Goh EM, Gun SC

Int J Rheum Dis, 2009 Dec;12(4):329-35.

PMID: 20374371 DOI: 10.1111/j.1756-185X.2009.01431.x

AIM: The aim of this study was to ascertain the management of gout by doctors in Malaysia.
METHODS: A cross-sectional questionnaire survey was carried out among doctors attending rheumatology post-graduate courses, where gout was not a lecture topic.
RESULTS: A total of 128 questionnaires were analyzed, of which the majority (67: 52.3%) were general practitioners. In the treatment of acute gout, 68.0% use non-selective non-steroidal anti-inflammatory drugs (NSAIDs), 53.9% use selective COX-2 inhibitors (coxibs), 66.4% use colchicine and 10.2% use allopurinol (ALLO). In the treatment of chronic gout, 36.7% use NSAIDs, 44.5% use coxibs, 19.5% use colchicine and 93% use ALLO. In both acute and chronic gout, corticosteroids (CS) are not used by over 90% of respondents. Fifty percent would stop ALLO during an acute attack. 95.3% do not start ALLO during an acute attack; 87.5% would start ALLO after the attack, with a median of 14 days afterwards. Once ALLO was started, 54.7% would continue indefinitely. Regarding target urate levels while on treatment, 10.9% would be satisfied with a high normal range, 21.9% middle of the range, 18.0% low normal range and 45.3% anywhere within the normal range. Fifteen percent would treat asymptomatic hyperuricemia.
CONCLUSIONS: In Malaysia, anti-inflammatory agents are most commonly used for the treatment of acute and chronic gout, with corticosteroid usage at a low level. However, there are areas of concern regarding the diagnosis of gout and the usage of ALLO which are not consistent with current guidelines

Fulltext Mortality patterns in Malaysian systemic lupus erythematosus patients

Yeap SS, Chow SK, Manivasagar M, Veerapen K, Wang F

Med J Malaysia, 2001 Sep;56(3):308-12.

PMID: 11732075

A retrospective analysis of the case records of 494 systemic lupus erythematosus (SLE) patients under follow-up at University Hospital, Kuala Lumpur during 1976-1990 was performed. Overall mortality was 20.2% (100 patients). The causes of death were infection (30%), renal (15%), respiratory (14%), neurological (5%), cardiovascular (7%), other causes (2%) and unknown (27%). Active SLE was a contributing factor in 19% of the deaths. The patients who died had significantly more renal disease, neurological disease, serositis or thrombocytopenia by the end of the first year of disease compared to the survivors. As in other series, infection and active SLE remain important causes of death.

HLA-DRB1 genes and susceptibility to rheumatoid arthritis in three ethnic groups from Malaysia

Kong KF, Yeap SS, Chow SK, Phipps ME

Autoimmunity, 2002 Jul;35(4):235-9.

PMID: 12482190

Worldwide population studies have generally agreed that rheumatoid arthritis (RA) is associated with a group of HLA-DRB1 alleles which share a common amino acid sequence at residues 70-74. This represents the first study to investigate the association of HLA-DRB1 genes with susceptibility to RA amongst Malay, Chinese and Indian ethnic groups in Malaysia. One hundred and thirty three RA patients and one hundred and sixty seven healthy controls were recruited. The HLA-DRB1 alleles were studied using the Phototyping method. The subtypes of HLA-DR4 were detected by "high resolution" PCR-SSP DRB1*04 typing techniques. The prevalence of HLA-DRB1*0405 was significantly higher in Malay patients with RA than in healthy controls (28.9 vs. 8.3%, p = 0.0016, OR = 4.48, 95% CI = 1.26-16.69). Similarly, DRB1*0405 was more common in Chinese RA patients than in controls (30.0 vs. 6.7%, p = 0.0029, OR = 6.00, 95% CI = 1.67-23.48). In addition, DRB1*0901 was a predisposing factor (32.0 vs. 6.7%,p = 0.0015, OR = 6.59, 95% CI = 1.85-25.64) and *0301/04 had a protective role (4.0vs. 25.0%, p = 0.00562, OR = 0.13, 95% CI = 0.02-0.62) in Malaysian Chinese RA. RA in Indians was associated with DRB1*1001 (51.1 vs. 8.5%,p = 0.00002, OR = 11.24, 95% CI = 3.13-44.18). DRB1*0701 (13.3 vs. 42.6%,p = 0.0022, OR = 2.73, 95% CI = 1.40-5.37) may have a protective effect. Therefore, in the Malaysian population, RA is primarily associated with the QRRAA motif, and we suggest that genetic factors play a crucial role in the pathogenesis of RA, compared to environmental factors.

Rheumatological publications from Malaysia: a bibliometric study

Teng CL, Chew WZ, Das Gupta E, Yeap SS

Clin Rheumatol, 2020 Feb;39(2):547-552.

PMID: 31784864 DOI: 10.1007/s10067-019-04839-0

OBJECTIVES: To assess the content, authorship and study design of rheumatological publications written by Malaysian authors or about rheumatological conditions in Malaysia.

METHODS: The Malaysian Medical Repository (MyMedR), a web-based database of Malaysian health and medical publications, and Scopus were searched to retrieve rheumatological publications from Malaysia, for the period 1950 until 30 June 2019. The type and number of publications in each rheumatological subject area and the overall trend of publication numbers and citations were analysed.

RESULTS: 547 publications were found for the time period studied. There was a 27-fold increase in the number of publications from the period up to 1980 compared to 2010-2019. The median number of citations per paper was 5, but unlike the number of publications, there was only a slight increase in the number of citations with time. 84.5% of the papers were cited at least once. The top 3 conditions generating the most publications were systemic lupus erythematosus, 36.7%, followed by rheumatoid arthritis, 17.0%, and osteoporosis, 13.9%.

CONCLUSIONS: The number of rheumatological publications in Malaysia have increased over time, especially in the last decade. However, the average number of citations per publications remains low and the majority of publications are in journals with low impact factors. Thus, the quality of rheumatological publications from Malaysia can be further improved.Key Points• There have been only a limited number of bibliometric analysis of rheumatology publications from Asia.• In Malaysia, the number of rheumatology publications has increased over time.• However, there is still room for improvement in terms of the quality of the publications.

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