INTRODUCTION: Rheumatoid arthritis (RA) is one of systemic chronic progressive inflammatory disorders based on immunological disharmonies. Poorly controlled systemic inflammation in RA often leads to renal diseases such as secondary amyloidosis. CASE PRESENTATION: A 30-year-old man complained of swelling and tenderness of multiple joints gradually worsened the past 7 years. His laboratory examination showed anemia, positive rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA). C-reactive protein (CRP) was 48.7 mg/L (Normal value is <5 mg/L), increase in serum creatinine and protein was +3 in urine. His estimated glomerular filtration rate (e-GFR) was 58.3 mL/min/1.73 m2 Radiologic examinations of joints revealed features that support the diagnosis of rheumatoid arthritis. Renal biopsy was done revealed amyloid deposit. He was diagnosed with rheumatoid arthritis and secondary renal amyloidosis. CONCLUSION: Early proper diagnosis of RA is important and immunosuppressive drugs might slow disease progression by controlling the inflammatory process We discussed the importance of early diagnosis and the use of better treatment in managing RA to prevent renal amyloidosis.
Amyloidosis ; Arthritis, Rheumatoid ; Early Diagnosis

Background: Fibromyalgia is a difficult-to-treat chronic musculoskeletal pain and tenderness syndrome. It is considered due to augmented pain processing in central nervous system. Interest in antiepileptic drugs, included pregabalin, for treatment of fibromyalgia is currently growing. This study aimed to investigate the effectiveness of pregabalin for fibromyalgia. Methods: We conducted the study according to the meta-analysis PRISMA guideline. Relevant randomized controlled trials (RCTs) were identified from a search of PubMed and Cochrane databases. Quality of selected studies was assessed using Jadad score for randomized placebo-controlled trials (RCT). Primary outcome was pain score reduction (30% and 50% reduction) and secondary outcome was patient global impression of change. Statistical analysis was performed using Review Manager 5.3. Results: Six international, multicenter, high-quality RCTs with 8-15 weeks duration of treatment met inclusion criteria. Four studies used different fixed dose (300 mg/d, 450 mg/d, 600mg/d) and 2 studies used titrated dose in evaluating the efficacy of pregabalin. There was statistically significant benefit of pregabalin over placebo in mean pain score reduction [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.56-2.10 p < 0.00001 in fixed dose pregabalin 30% pain reduction; OR 2.06 95% CI 1.66-2.56 p < 0.00001 in fixed dose pregabalin 50% pain reduction; OR 1.53 95% CI 1.10-2.13 p 0.01 in titrated dose pregabalin 30% pain reduction; OR 1.80 95% CI 1.12-2.88 p 0.01 in titrated dose pregabalin 50% pain reduction]. Pregabalin also demonstrated significantly better patient global impression of change than placebo. No heterogeneity was seen in most groups. No publication bias was observed. Conclusion Our study showed pregabalin monotherapy was effective for pain treatment associated with fibromyalgia. Further studies with longer treatment duration are needed to confirm the long-term effectiveness of pregabalin for fibromyalgia treatment.
Fibromyalgia ; Pregabalin ; Meta-Analysis

Synopsis: this is the case of a 24 year old female with a strong family history of SLE who presented with autoimmune hepatitis and was eventually diagnosed to have SLE . Clinical presentation : two months history of intermittent jaundice , tea colored urine , anorexia easy fatigability pruritus, colicky right upper quadrant pain , intermittent diarrhea . Physical findings : Normal vital signs , fever of 38.8 degree C, jaundice facial and bipedal edema , some tenderness over the right upper abdomen no organomegaly. Significance : The case illustrates SLE presenting as automimmune hepatitis . Recommendations: SLE should be considered in hepatitis when viral etiology has been ruled out .

OBJECTIVE: To determine the practice of Filipino physicians in the management of gout

METHODS: A random survey was done at the rheumatology round-table discussions (RTD) and lecture symposia in Metro Manila and key cities in the Philippines, from March to August 2007. A set of questionnaires directed along clinical management of gout was asked to the physicians/trainees attending the rheumatology symposia or RTD.

RESULT: Of the 412 questionnaires distributed, 287 (69.7 percent) were available for evaluation. There were 112 (39.0 percent) internists/family physicians, 18 (6.3 percent) allied specialties, 117 (40.7 percent) general practitioners, 22 (7.7 percent) medical students/interns, and 18 (6.3% ) who did not indicate their fields of practice. Mean age of respondents was 44.3 +_ 12.6 years. Mean duration of practice was 14.6 +_ 11.6 years.

Generally, 150 (52.3 percent) respondents would prescribe urate lowering drug (ULD) during asymptomatic hyperuricemia, 94 (32.7 percent) after the first gouty attack, while 18 (6.3 percent) after at least 2-4 episodes of gout flares. For confirmatory diagnosis of gout, 173 (60.3 percent) respondents would want synovial fluid be examined in patients suspected for gout, 160 (55.7 percent) of them agreed to examine it once. For the management of acute gouty arthritis in an otherwise healthy patient, 136 (47.4 percent) chose colchicine, 57 (19.8 percent) non-steroidal anti-inflammatory drugs (NSAIDs), and 80 (27.9 percent) allopurinol. While for acute gout patients with renal impairment, 35 (12.2 percent) chose corticosteroid, 57 (19.9 percent) allopurinol, 44 (15.3 percent) NSAIDs.

For the dosage and frequency of colchicine during acute gout flare, 45 (15.7 percent) would give it t.i.d. daily for 3 days, one tablet hourly until pain relief in 44 (15.3 percent), one tablet hourly until abdominal toxicity occurs in 46 (16 percent), one tablet until maximum of 6 tablets/day in 72 (25 percent).

Ninety six (33.4 percent) preferred to initiate ULD 1-2 weeks after acute gouty flare, while 85 (29.6 percent) during acute flare of gout. In chronic gouty arthritis, 95 (33.1 percent) chose to use colchicine for prophylaxis while NSAIDs in 124 (43.2 percent). Ninety eight (34.1 percent) would discontinue prophylaxis soon after achieving a normal serum uric acid in a patient without evident tophi, while 90 (31.4 percent) would discontinue in 1-3 weeks, 51 (17.8 percent) in 1-6 months. Thirteen (4.5 percent) respondents would give ULD for life, while majority [148 (51.6 percent)] would discontinue it when serum uric acid normalizes.

Eighty-six respondents (30%) would request follow up SUA level once a month, 33 (11.5 percent) every 2 months, 120 (41.8 percent) every 3-6 months. One hundred forty seven (51.2 percent) would set < 5mg/dl while 95 (33.1 percent) chose < 6.0 mg/dl as the target SUA level in gout management.

CONCLUSION: This survey evidently shows the various inconsistent practices among physicians in the clinical management of gout. An efficient educational program should be designed in order to improve physicians' skills in the survey, hyperuricemia diagnosis and clinical management of gout.

OBJECTIVE:

To describe the clinical manifestations of PsA among Filipino patients seen in a tertiary care hospital.

ABSTRACT:

Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. The disease patterns vary among patients, with only very limited data describing such patterns among Asians. This study aimed to describe the clinical manifestations of PsA among Filipino patients seen in a tertiary care hospital. The data of 55 PsA patients (25, 45.5 percent males and 30, 54.5 percent females) were included. The mean age of onset of psoriasis was 36.5 +/- 14.5 years (range 3 - 70 years), and psoriatic arthritis was 40.6 +/- 14.4 years (range 12-76 years). Arthritis preceded the skin lesion in 8 (15.0 percent) patients by a mean interval of 36.6 +/- 44.1 months (range 1-108 months) and skin lesion antedated arthritis in 47 (85.0 percent) patients by a mean interval of 63.3 +/- 71.4 months (range 0-240 months). At disease onset, monoarthritis was found in 12 (22.0 percent), oligoarthritis in 36 (65.0 percent) and polyarthritis in 7 (13.0 percent) patients. Conclusion: Psoriatic arthritis in a Filipino group of patients affected both genders almost equally, with features typically that of an asymmetric oligoarthritis. Skin involvement preceded arthritis in the majority of patients.