BACKGROUND: Chikungunya virus (CHIKV) is a mosquito- borne  alphavirus  of  the  family  Togaviridae  transmitted  to humans by the Aedes spp. mosquitoes, causing Chikungunya   Fever  (CHIKF).
OBJECTIVE: This study aims to describe the course and outcome of musculoskeletal (MSK) manifestations in patients  with  CHIKF  seen  over  a   three-month     period.
DESIGN: This is a prospective descriptive  study.  Seventy  patients  with  fever,  rash,  and  arthritis  seen   at the University of the Philippines-Philippine General Hospital  and  private  arthritis  clinics  were  collected from August - December 2012.  Demographics  and course   of   arthritis   were  described.
RESULTS:  Seventy   patients,   53   (68.6%)   female,   with  a mean age  of  39.2  ±13.50  were  diagnosed  with CHIKF. All cases were from the Metropolitan  Manila area. Of these, 15 (21.4%) had  family  members  affected. Twenty-four patients (34.3%) were either employed or students. The most common presenting symptoms were fever (94.3%), arthritis or athralgia  (98.6%), and rash (87.1%).  The  most  common  joint  areas involved were the ankles  (60.0%),  the  wrists (40.0%) and the small joints of the hand (51.4%). Twenty-seven (47.3%) had symmetric  arthritis.  Thirty- seven   cases   (52.9%)   had   arthralgia   or   arthritis    for at least  six  weeks.  By  the  end  of  the  follow-up  period, only four (5.7%) had persistent musculoskeletal symptoms. Age and  sex  were not  found to  be  factors in  determining  chronicity  of  arthritic  symptoms  (p   =   0.104   and   p=0.58  respectively). Of the seventy patients, 31 (44. 3%) were confirmed  cases  of  CHIKF--  29 had  (+)   CHIKV  IgM   by ELISA,  and  two   had   (+)   CHIKV   PCR.   Twenty-  one (67.7%) had  persistent  arthritis  of  at least  six  weeks. Treatment  consisted  of continuous  NSAIDs  for  at  least  two   weeks   and   some   received   steroids.  In this subgroup, age and sex were not shown to  correlate with chronic arthritis (p=0.47 and p=0.05 respectively).
CONCLUSION: This report on a recent outbreak of CHIKF showed the classic triad of fever, rash,  and  arthritis.  There  was  no  correlation  between  age  and  chronicity of  arthritic  symptoms.  Sex,  likewise,  did  not  appear   to influence chronicity. The disease occurred in family clusters. Patients required continuous treatment with NSAIDs and  some  had  to  be given  steroids.  Most cases   resolved   by   12 weeks.

Human ; Male ; Female ; Middle Aged ; Adult ; Chikungunya Fever ; Chikungunya Virus ; Togaviridae ; Anti-inflammatory Agents, Non-steroidal ; Arthralgia ; Arthritis ; Exanthema ; Enzyme-linked Immunosorbent Assay

BACKGROUND:  Methylprednisolone  Pulse  Therapy  (MPPT)  is standard of care in the management of severe systemic lupus erythematosus (SLE). This treatment, though,  is considered   a   double-edged   sword   due to its life-threatening adverse  effects.  Renal  disease,  liver disease and high dose of the drug are factors proposed to adversely affect outcomes of patients treated  with  MPPT.   Despite   the   widely   accepted use of MPPT, there are no reports describing the outcomes   from   its   use   among   Filipinos   with SLE.
OBJECTIVE: To determine the in-hospital outcomes of patients with SLE treated with MPPT and to identify  factors   associated   with   adverse  outcomes.
GENERAL STUDY DESIGN:  Retrospective
POPULATION:  Adult  patients  with  SLE  who  were  admitted  in Philippine General  Hospital  and  underwent  MPPT from   January   2008   to   December  2012.
METHODS: Patient demographics,  disease  characteristics  on admission, indications for MPPT and in-hospital outcomes   were  extracted.
ANALYSIS: Chi-square test and Fisher's exact  test  were  used  to  elicit  association  of  population  characteristics  to  outcomes.
RESULTS: Forty-two patients  with  SLE  who  underwent MPPT were included. Majority are females  (98%)  and  most (60%) underwent MPPT within one year of SLE diagnosis.  High   disease   activity   is   seen   at   the time
of MPPT with a mean Mex-SLEDAI score  of  14.69. Infection (83%) is the most common comorbidity.  Anemia, hypoalbuminemia and significant  proteinuria  are the most common  laboratory  abnormalities.  The  top indication for MPPT is nephritis (83.3%). The dose received  by the  majority  (66.7%)   is   one   gram/day for   three   days,   which   is   a   high  dose.
Improvement rate is 76% but the in-hospital complication  rate  is  64%  and  mortality  rate   is   21%. Patients with in-hospital complications have significantly lower absolute lymphocyte count (p=0.013), serum albumin (p=0.04) and greater 24-hour proteinuria (p=0.04) at baseline. High-dose MPPT is significantly associated with in-hospital complications (p=0.04) but not mortality. Nephritis (p= 0.04) and low platelet counts at baseline  (p=0.01)  are  associated with  mortality.
CONCLUSION:  In this  population,  there  is   a   high  rate   of  improvement  of   lupus  disease  activity  when  MPPT   is used but there is a corresponding high rate of in-hospital  complications  and   mortality.   High   dose  of MPPT seems to be associated with increased in-  hospital complication, while nephritis and low platelet count showed a probable association with mortality. Further studies  on  a  larger  cohort  are  needed.  For  now, the findings of this study may be helpful in developing guidelines on the use  of  MPPT  among Filipino   patients   with  SLE.

Human ; Male ; Female ; Adult ; Hypoalbuminemia ; Serum Albumin ; Lupus Erythematosus, Systemic ; Nephritis ; Kidney Diseases ; Proteinuria ; Anemia ; Liver Diseases ; Lymphocyte Count ; Methylprednisolone

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