INTRODUCTION: Treatment  of  rheumatoid  arthritis  (RA) has evolved over the past  20  years, aiming at  remission with the use of disease modifying drugs (DMARDs) and recently with biologic agents. Treatment  of  Filipino  patients  with   RA   has   so   far, not  been  described  in literature.   The   University   of the Philippines-Philippine General Hospital (UP-PGH) Rheumatology Section established the rheumatoid arthritis database and registry (RADAR) to better understand   RA   as   it   affects   the   Filipino patient.
OBJECTIVE: To  describe   the   treatment   received   by a cohort of Filipino  patients  with  RA  seen  in the UP-PGH and entered in the RADAR over three time  periods   from   1996   to  2000.
MATERIALS AND METHODS:This   is   a   review   of   data  on treatment of all cases entered into the RADAR diagnosed   with   rheumatoid   arthritis    by    the  1987  ACR  Criteria,  between  1996   to   2010.   Cases were grouped into three five-year periods: 1996-2000 (Period  1),   2001-2005  (Period  2),   and   2006-2010  (Period
3)based on initial prescription of the  drugs.  DMARDs  given were listed and trend in the rate of use was extracted. These were  then  compared  across  the three time periods.  Descriptive  statistics  using  ratios and   proportions   was   employed   on   the  data.
RESULTS: Two-hundred-twenty-four (224) cases were entered  into  the  RADAR  at the  time  of  this  study   and  all  received  DMARDs.  Methotrexate (MTX)  was  the  most  common  DMARD  used  (89%).   Of   these,   75% were on MTX  monotherapy.  Hydroxychloroquine was given in 25%, with 11% on HCQ monotherapy. Combination  treatment  with  MTX  and  HCQ  was  used  in 14%  of  cases.  There  was  an   increasing   rate   of MTX use across Periods 1-3 (87%, 89% and 90%, respectively).  On the  other  hand,  a  decreasing  rate   in the  use  of  HCQ  was   noted   (43%   in   Period   1,  24%   in   Period   2,   and   21%   in   Period   3).   Only   9% of patients received biologic  agents  in combination with  MTX.
CONCLUSION: This  study   reports  the   use   of   DMARDS  in a cohort of patients entered in the UP-PGH RADAR. Methotrexate monotherapy was the most common treatment used, and this increase  continued  over  the  three  observation  time   periods.   Hydroxychloroquin was used in one fourth of  patients,  and  its  use declined over the three time periods. Biologic DMARDS was rarely used, and when given, it was combined   with  MTX.

Human ; Male ; Female ; Antirheumatic Agents ; Hydroxychloroquine ; Methotrexate ; Arthritis, Rheumatoid ; Registries ; Combined Modality Therapy ; Prescriptions ; Biological Products

Occupational acro-osteolysis pertains to bone resorption of the distal phalanges of the hands and feet among workers with vinyl chloride exposure. We report the case of a Filipino man with osteolysis of the distal phalanges of the hands initially considered to have systemic sclerosis. The patient had gradual shortening of the fingers, thickening of the skin over the extremities, and hypopigmented patches over a span of more than 20 years. His lower extremities presented with non-pitting edema, skin thickening, and neuropathy, without shortening of the digits. Difficulty of ambulation was apparent due to the development of feet inversion. Radiographic findings of the hands and feet included resorption of distal phalanges, erosive and sclerotic changes, and narrowed joint spaces. Other conditions considered were Hansen’s disease, skeletal tuberculosis, and diabetic neuropathic arthropathy, which were eventually ruled out. The final diagnosis was occupational acro-osteolysis secondary to vinyl chloride exposure. The patient underwent serial total contact casting of the bilateral lower extremities to relieve bipedal edema and to reposition the feet. This case emphasizes the significance of investigating a patient’s occupational history and highlights a rare sequela of exposure to a commonly used chemical agent in the manufacture of polyvinyl chloride products.
bone resorption ; vinyl chloride ; Filipino