<p style="text-align: justify;" data-mce-style="text-align: justify;">Axial Spondyloarthritis (SpA) is a chronic inflammatory disease of the spine associated with the gene HLA-B27.Non-radiographic spondyloarthritis (nr-SpA), an early stage of axial SpA often goes unrecognized in many settings including the Philippines. We describe five Filipinos from a tertiary health care facility who fulfill the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria for non-radiographic SpA with the aim of increasing awareness of this disease in the Philippines. All five patients presented with chronic low back pain. There were two women and three men in this series. All had varying degrees of inflammatory back pain. Uveitis was diagnosed in four. HLA-B27 was positive in four patients. MRI findings confirmed sacroiliitis where plain radiographs of the sacroiliac joints were interpreted as normal. Treatment included non-steroidal anti-inflammatory drugs (NSAIDs), biologic disease-modifying anti-rheumatic drugs (DMARDs), anti-tumor necrosis factor (TNF), and anti-interleukin-17 (IL-17) antibodies. Among Filipinos, we recommend that in both male and female patients with symptoms of inflammatory low back pain and uveitis, evaluation for Spondyloarthritis particularly non-radiographic SpA should be undertaken. Early diagnosis and treatment will potentially prevent long-term irreversible joint and bone damage and disability of the spine and improve quality of life.
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Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult: 25-44 Yrs Old ; Spondylitis ; Sacroiliitis

Background: Gout is one of the most common arthritides affecting Filipinos; yet, there is a lack of updated local data and Clinical Practice Guidelines. Objective: To describe Clinical Case Scenario (CCS) of Filipino patients with gout in a tertiary referral hospital seen over a year. Design: Cross-sectional study. Methods: Patients’ characteristics, risk factors, disease course, management, and CCS were obtained by a rheumatologist using a questionnaire. Descriptive statistics were used. Results: One hundred eight patients were included with a median age of 58 (range 26–80) years. 106 were male (98%); and, 2 were female (2%) who were menopause and had chronic kidney disease (CKD). Most prevalent CCS were stages 9 (29%), 1 (16%), and 2 (15%). The majority of cases had tophi and belonged to CCS 4-9 (62%). This signifies that most patients had advanced gout. Consistent with international and local data: almost half had hypertension (46%), a third had CKD (36%). Most were ethanol drinkers (65%) and smokers (57%). Unexpectedly, not many were obese (10%) or had metabolic syndrome (2%). The initial joint involved was the ankle (52%) rather than the first metatarsophalangeal joint (40%). Almost half of the patients presented with two or more joint involvement (46%) than monoarthritis (54%). Patients with acute flare were most commonly prescribed NSAIDs (77%), followed by colchicine (62%). Most were prescribed allopurinol (44%) compared with febuxostat (37%) for urate-lowering therapy. Only 16% received patient education. Medication compliance was 65%, but follow-up compliance was less than 18%. Comparing the Filipino clinical profile to historical data suggests an increased incidence of gout in the young and an increase in comorbidity prevalence. Conclusion: This study reports a cohort of Filipino gout patients. Comorbidities are similar to world figures but differ in the low incidence of obesity and metabolic syndrome. It also differs from literature in having the ankle as the most common initial joint presentation. Management and compliance were also described. As a pilot study for a registry, this study can be implemented at different institutions to broaden and monitor the ever-changing Filipino gout profile. Recommendation A larger sample size and a more extended observation period are recommended to estimate gout CCS prevalence, flare risk factors, and treatment response more accurately. Other outcomes that can be measured are mortality rates and etiologies for each CCS.
Gout ; Classification ; Comorbidity ; Registries

<p style="text-align: justify;"> OBJECTIVE: Gout is the most prevalent form of arthritis afflicting Filipinos. The diagnosis and overall management need further improvement especially among medical practitioners. Our study aims to develop evidence-based guidelines for general medical practitioners on the management of uncomplicated gout with the overall goal of improving the standard of care of patients with gouty arthritis.p><p style="text-align: justify;"> METHODOLOGY: The Technical Review Committee (TRC) of the Philippine Rheumatology Association (PRA) Gout Special Interest Group (S1G) conducted a literature search relating to management issues on all phases of gout from years 1980 to 2007 using databases including Medline, Ovid, Lilacs, Cochrane Central Register of Controlled Trials (CENTRAL). The GRADE system in rating quality of evidence and strength of recommendation was used. A multidisciplinary panel voted and approved the final recommendations during an en bane meeting.p><p style="text-align: justify;"> RESULTS: Nine recommendations for the management of uncomplicated gouty arthritis were developed based on evidence from the literature and consensus among experts and key stakeholders. Concerns regarding the initiation and maintainance of urate lowering therapy, target serum uric acid levels, treatment of acute gout, lifestyle and dietary modifications, comorbidities associated with gout such as cardiovascular disease were addressed.p>
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