Objective: Musculoskeletal ultrasound has gained recognition in early identification of crystal deposits in the joints and soft tissues. This study aims to validate the sonographic features of 1st metatarsophalangeal joints (MTPJs) in gout and asymptomatic hyperuricemia (AH). Methods Patients with gout (n=20) and AH (n=16) underwent a gray-scale ultrasound assessment of both 1st MTPJs on 3 positions (dorsal, medial, plantar) in longitudinal view. The static images were read by 2 blinded trained sonologists for the presence of double contour sign (DCS), erosions, and tophi.
Gout ; Validation Study

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.

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.

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.

Human ; Female ; Adult ; Lupus Erythematosus, Systemic ; Peripheral Nervous System Diseases ; Lower Extremity

OBJECTIVE: This paper describes the clinical experience in Filipinopatients with lupus nephritis who had used mycophenolate mofetil (MMF). METHODS: Retrospective case-cohort. Patients were obtained from database of Filipino patients who received MMF for lupus nephritis from January 2003 to June 2006. Data obtained included demographics, renal parameters including histology, SLE disease activity measures, corticosteroid dose and prior immunosuppressive drugs, dose, and duration of MMF, and adverse drug events. The attending rheumatologists assessed their patients' individual response to MMF treatment. RESULTS: There were 39 Filipino patients with lupus nephritis who had received MMF, of whom 97.4% were females. The mean age was 30.89 years. Of the 25 patients who had undergone renal biopsy, 4.0% had World Health Organization (WHO) Class II, 12.0% had Class II, 64% had class IV, and 24% had Class V. Mean dose of MMF was 1.2g/day with a mean duration of treatment of 14.77+_10.7 months. Mycophenolate mofetil was used as induction therapy in 8 patients and to maintain remission in 31 patients. Clinical response was improved in 21 patients, stable in 11 patients and worse in 7 patients. Adverse events were reported in 11 patients and were commonly gastrointestinal-related. SUMMARY: This clinical experience among Filipinos with SLE reiterates MMF as a reasonable option in lupus nephritis, with acceptable safety profile. Cognizant of the heterogeneity of individual clinical response to drug, it will be useful to further study the variables which may influence such treatment responses.