In 1961, Dr. Lourdes Manahan, a young internist at the Philippine General Hospital, presented her paper entitled “Rheumatic disease in the Philippines” at the Australian Rheumatism Congress in Sydney.1 This was the first time an article on the Philippine rheumatology experience was presented at an international convention. It was, however, not Dr. Manahan’s first foray into research. In 1948, she was published in this very journal – a report on familial non-hemolytic jaundice, a syndrome which would later bear her name, the Rotor-Manahan-Florentin syndrome.2 Her interest soon shifted towards a new field of study centered on diseases referred to then as “rheumatism.” After training in the United States for a year, she established an arthritis clinic to serve Filipino rheumatic patients in the PGH dispensary. For over a decade, she cared for patients alone, painstakingly documenting her findings in pages of handwritten notes and tables. These pages turned into scientific publications, and Dr. Manahan became a pioneer in research in rheumatology in the region. She was the first to describe gout in the Philippines.3, 4 She authored the COPCORD (Community Oriented Program for Control of Rheumatic Diseases) studies, a joint effort by the World Health Organization and International League Against Rheumatism to measure the burden of arthritis and disability in the community.5,6 The Division of Rheumatology continues this legacy. Research in rheumatic diseases has been one of the core disciplines of the division over its now 50 years of existence. In celebration of our founder’s 100th birth anniversary, this special issue of ACTA MEDICA PHILIPPINA republishes three of Dr. Manahan’s earlier works. The first is a report of a family with Rotor-Manahan-Florentin syndrome. 7 While not a rheumatic disease, her encounter with this condition sparked her interest in scientific inquiry. Dr. Manahan also co-authored the first clinical and laboratory description of Chikungunya in the Philippines.8 She also was one of the first to investigate HLA antigens in Ankylosing Spondylitis in Filipinos.9 This special issue in rheumatology also presents interesting cases in rheumatic diseases and original studies by the faculty of the division and its graduates. The gout registry feasibility study emphasizes the importance of databases in collecting data over time to describe the clinical profiles and outcomes of Filipino patients with gout. Penserga and Penserga’s paper shines a spotlight on the unmet need to manage rheumatoid arthritis in the Philippines, where most patients do not have access to biological treatments. Finally, Villanueva-Misa et al. demonstrate the Knee Injury and Osteoarthritis Outcome Score (KOOS) to be a valuable tool for measuring disability in Filipino patients with osteoarthritis in clinical practice and research. As we honor the legacy of the first among us, we are reminded that the central focus of our work, both in research and clinical practice, is always in the service of the Filipino patient
Rheumatology

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet’s disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet’s disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.
Arthritis, Reactive ; Tuberculosis ; Rheumatology

Introduction: Behcet's disease (BD) sometimes called behcet's syndrome or silk road disease is an immunemediated systemic vasculitis. This condition remains a clinical challenge for physicians. There are many reports, mostly case series and nationwide surveys, on clinical manifestations of BD from different parts of the world. In the Philippines where BD is rare and underreported, physicians might not be familiar with the clinical manifestations of this disease. The aim of this research is to describe the disease presentation of BD among Filipinos to increase awareness and avoid delay in diagnosis which might pose a threat for the development of irreversible, sometimes fatal complications. Methods: A manual search was done for medical records with diagnosis of BD in the clinics of rheumatology staff of PGH. The diagnosis of BD was based on the 2006 International Criteria for BD. We noted the demographic data, clinical manifestations, results of ancillary procedures, treatment and outcomes. The study follows a descriptive design. Results: There were 31 patients with the diagnosis of BD found from the manual search. Most of them were female (77%). The mean age at diagnosis was 38.6 years ± 10.4 (SD) and the mean time duration from onset of first symptom to diagnosis was 41 months (range three to 180 months). Three patients had a family member who also had BD (10%). The most common features of the disease were oral ulcers (94%), ocular manifestation (68%), and cutaneous disease (65%). The pathergy test was positive in 17%.The most common treatments prescribed were oral steroids (74%), colchicine (58%), and NSAIDs (48%). There was symptom control or improvement in a third of patients but there were still symptom recurrence in some. Thirteen patients (42%) had recurrent oral ulcerations while 23% had recurrence of skin lesions. Two of the patients (six percent) developed blindness. There was no death recorded. Conclusion There is an average delay of three years in the diagnosis of BD that hinders appropriate early treatment. Moreover, BD remains to be a clinical challenge for physicians. While a third of the cohort had good outcomes, half still had symptom recurrences and the occurrence of blindness in two patients underlines the potential of the disease to disable. We recommend expansion of the cohort to include the BD patients of other rheumatologists in the Philippines to have an idea on the actual prevalence and incidence of how this uncommon disease in our locality, and to have a better understanding of its clinical presentation and disease management in our country.
Behcet Syndrome ; Rheumatology

Introduction: There are very few reported incidences of juvenile dermatomyositis in the Philippine setting. Case Summary: This is a case of a 9-year-old female from Batangas City, who came in with a 3-year history of multiple non- tender, non-pruritic erythematous papules which started on the dorsal aspect of the metacarpophalangeal (MCP) and interphalangeal joints of the hands, with some progressing into plaques on the face and extremities. No other associated symptoms such as fever, cough, colds or weakness were noted. Three months prior to consult, there was persistence of the above-mentioned lesions with body weakness described as difficulty getting out of bed and climbing stairs. Consult with a dermatologist and rheumatologist was done. A skin punch biopsy showed hyperkeratosis of the stratum corneum. There was focal vacuolar alteration of the basal cell layer with thickening of the basement membrane zone. The papillary dermis showed pigment-laden macrophages, a calcified nodule, fibrosis, and a sparse perivascular inflammatory infiltrate of lymphocytes. There was also thickening of the basement membrane zone on Periodic acid-Schiff stain. Both clinical and histopathological findings point to Juvenile Dermatomyositis. Conclusion Juvenile Dermatomyositis requires prompt diagnosis for proper treatment and prognostication. This entails extensive diagnostic procedures such as skin punch biopsy, muscle enzymes such as CK-MB and CK- MM, and blood tests. Co-management with a pediatric rheumatologist is highly advised for initiation and regulation of oral corticosteroids as well as vitamin supplementation.
Dermatomyositis ; Connective Tissue ; Rheumatology

OBJECTIVE: To evaluate the fate of abstracts presented at scientific meetings of the Korean College of Rheumatology (KCR). METHODS: This study examined the abstracts presented at annual meetings of the KCR from 2005 to 2014. Only original studies were selected, excluding case reports. A manual search was conducted using PubMed, KoreaMed, Cochrane Library, and Embase to track the published articles. The abstracts were considered to have been published if the authors, title, study design, and results were the same for a published article. In addition, they were considered published if the author and the study design matched, even if the results of the abstract and the results of the published articles were not identical. RESULTS: A total of 928 abstracts from 2005 to 2014 were analyzed. Of the 928 abstracts, 468 (50.43%) abstracts were published in a peer-reviewed journal and the mean time to publication was 19 months. Of the 468 abstracts, 414 were published in a science citation index extended (SCI[E]) journal, and 54 were published in non-SCI(E) journals. The proportion of SCI(E) articles increased annually. The average impact factor for the SCI(E) journals was 2.93. In subgroup analysis, the abstracts that were awarded the best oral or best poster presentation were more likely to be published as full-length articles with a higher impact factor than the abstracts not awarded. CONCLUSION: Half of the abstracts presented in the KCR annual meetings were published in a peer-reviewed journal. Approximately 90% of the articles were published in a SCI(E) journal.
Awards and Prizes ; Korea ; Publications ; Rheumatology*

Humans ; Rheumatology ; Rheumatic Diseases/therapy*

Systemic lupus erythematosus (SLE) is a multi-system, autoimmune disorder of unknown cause, characterized by the production of autoantibodies and wide ranging spectrum of clinical manifestations. SLE can involve any organ system of the body with constitutional symptoms, including musculoskeletal, skin, renal, neuropsychiatric, cardiovascular, respiratory and gastrointestinal system. American College of Rheumatology classifications criteria for SLE can be helpful when establishing the diagnosis of SLE. However, these criteria would not do for physicians to give a diagnosis of SLE because these were designed for classification for research purpose and not for diagnosis. The diagnosis of SLE remains largely clinical. Thus, increasing awareness of the clinical manifestations could lead to earlier diagnosis. The clinical manifestations and diagnosis of SLE are covered in this review.
Autoantibodies ; Lupus Erythematosus, Systemic ; Rheumatology ; Skin

OBJECTIVE: To investigate balance control according to the severity of knee osteoarthritis (OA) using clinical tests and Tetra-ataxiometric posturography (Tetrax(R)). METHOD: A total 80 patients with primary knee OA classified according to American College of Rheumatology criteria, and 40 age-matched controls were enrolled in this study. Of those with OA, 39 patients had mild OA (Kellgren-Lawrence [KL] grade 1, 2) and the other 41 had moderate to severe OA (KL grade 3, 4). The postural control capabilities of the subjects were assessed using the timed up and go test (TUG), Berg balance scale (BBS), and Tetrax(R), which utilizes two paired force plates to measure vertical pressure fluctuations over both heels and forefeet. The subjects were checked for their stability index (ST), Fourier index, weight distribution index (WDI), and synchronization index (SI) in eight positions using Tetrax(R). RESULTS: Patients with moderate to severe OA exhibited significantly higher stability indices in all positions than patients with mild OA. The Fourier index was also higher in patients with moderate to severe OA than in patients with mild OA. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different in the three groups. CONCLUSION: These findings suggest that patients with moderate to severe OA have more deficits in balance control than those with mild disease. Therefore, evaluation of balance control and education aimed at preventing falls would be useful to patients with knee OA.
Heel ; Humans ; Knee ; Osteoarthritis, Knee ; Rheumatology

OBJECTIVE: The authors created a new citation index of the Journal of the Korean Rheumatism Association (JKRA) and, based on the index, developed internal impact score, which can measure contribution to the development of the journal by manuscript, by author and by institute. Thus, we report the results in this paper. METHODS: For manuscripts published in the JKRA from Volume 1 No. 1 in 1994 to Volume 13 No. 4 in 2006, we built a database of the journals and their references, and created an index using the database. The citation index were analyzed using three indicators internal impact score for manuscript (IIS-M), internal impact score for author (IIS-A) and internal impact score for institute (IIS-I). RESULTS: The total number of references cited in the manuscripts was 7,341, and of the references, 80 (1.1%) had been published in the JKRA. The mean IIS-M of all the cited manuscripts was 0.46. The total number of authors participated in the cited manuscripts was 226. In IIS-A calculated in consideration of each author's participation and the weight of manuscripts, the highest score was 19.253. The number of institutes that had produced the cited manuscripts was 29. In IIS-I calculated in consideration of each organization's participation and the weight of manuscripts, the highest score was 92. CONCLUSION: If the indicators developed by the authors are used as tools for analyzing the citation indexes of journals, they can quantify the contribution of manuscripts, authors and institutes to each journal, and compensation based on the quantified contribution will promote the development of academic journals considerably.
Academies and Institutes ; Compensation and Redress ; Rheumatic Diseases ; Rheumatology

The introduction of new therapeutic agents in recent years has led the early diagnosis of rheumatoid arthritis (RA) increasingly important. Therapeutic intervention early in the disease course of RA allows earlier disease control and less joint damage. The 1987 American College of Rheumatology classification criteria for RA, however, does not reach full efficiency for providing clinicians to distinguish RA from other arthritides in the early phase of the disease. Therefore, diagnostic tools are needed to establish a reliable diagnostic criteria although the lack of an independent gold standard for RA makes it challenging in the evaluation of diagnostic studies. RA has no disease specific clinical, radiological or immunological features. This review describes the diagnostic values of medical history, physical examination, laboratory tests and imaging studies as well as the 1987 American College of Rheumatology classification criteria in the diagnosis of RA in its early phase.
Arthritis ; Arthritis, Rheumatoid ; Early Diagnosis ; Joints ; Physical Examination ; Rheumatology