BACKGROUND

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. Comorbidities are highly prevalent in patients with RA, in particular cardiovascular disease (CVD), which is responsible for over 50% of premature deaths. This study aimed to describe cardiovascular diseases and their risk factors among patients with rheumatoid arthritis in the Philippine General Hospital (PGH).

To describe cardiovascular (CV) diseases and their risk factors among patients with rheumatoid arthritis.

A retrospective descriptive cross-sectional study was done in the University of the Philippines – Philippine General Hospital (UP-PGH) inpatient and outpatient services. The study included patients 18 years old and above diagnosed with RA and fulfills the 1987 American College of Rheumatology or 2010 American College of Rheumatology-European League Against Rheumatism (ACR/EULAR) classification criteria with no overlap features with other autoimmune connective tissue diseases and with complete records of the information required for the study from January 2019-December 2022. The primary outcomes of interest were the prevalence of CV diseases and CV risk factors. Descriptive statistics were used to summarize the data.

There were 123 patients in the study, 93.4% outpatients, and 95.1% females, with a mean age and disease duration of 51.3 and 9.8 years, respectively. Disease activity was moderate in 35% and high in 9.7%, based on disease activity score (DAS 28) or clinical disease activity index (CDAI) scores. Methotrexate (54%) was the most commonly used conventional synthetic disease-modifying antirheumatic drug (csDMARD). Glucocorticoid use was observed in 51.2%. None of the patients were receiving a biologic DMARD. There were 24 (19.5%) patients with CV diseases, namely myocardial infarction, heart failure, and stroke. There were 87 (70%) patients with at least one CV risk factor and 62 (50.4%) with multiple risk factors. The risk factors identified were: dyslipidemia (43.1%), hypertension (40.7%), elevated body mass index (35.7%), and diabetes mellitus (15.4%). There were f ive deaths in the hospitalized patients (4%), one due to a myocardial infarction.

The majority (70%) in our cohort had at least one CV risk factor, 19.5% had an identified CV disease, and one died from a myocardial infarction. Dyslipidemia was the most common CV risk factor. The high proportion of patients with CV disease and CV risk factors highlights the need to add the screening and management of CV diseases and risk factors as a priority among patients with rheumatoid arthritis.

Rheumatoid arthritis is a multisystem disorder that affects not only the musculoskeletal system but also other vital organ systems. This report tackles a case of a Filipino adult female with a 28-year history of rheumatoid arthritis on chronic DMARD and steroid use who developed symptoms of heart failure. This report will review the perioperative implications of a patient with rheumatoid arthritis for triple valve surgery.
Arthritis, Rheumatoid

Objective To investigate the relationship between interleukin-1β (IL-1β) and miR-185-5p in the process of joint injury in acute gouty arthritis (AGA). Methods The serum miR-185-5p levels of 89 AGA patients and 91 healthy volunteers were detected by real-time quantitative PCR. The correlation between miR-185-5p expression level and VAS score or IL-1β expression level was evaluated by Pearson correlation coefficient method. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of miR-185-5p in AGA. THP-1 cells were induced by sodium urate (MSU) to construct an in vitro acute gouty inflammatory cell model. After the expression level of miR-185-5p in THP-1 cells was upregulated or downregulated by transfection of miR-185-5p mimics or inhibitors in vitro, inflammatory cytokines of THP-1 cells, such as IL-1β, IL-8 and tumor necrosis factor α (TNF-α), were detected by ELISA. The luciferase reporter gene assay was used to determine the interaction between miR-185-5p and the 3'-UTR of IL-1β. Results Compared with the healthy control group, the expression level of serum miR-185-5p in AGA patients was significantly reduced. The level of serum miR-185-5p was negatively correlated with VAS score and IL-1β expression level. The area under the curve (AUC) was 0.905, the sensitivity was 80.17% and the specificity was 83.52%. Down-regulation of miR-185-5p significantly promoted the expression of IL-1β, IL-8 and tumor necrosis factor (TNF-α), while overexpression of miR-185-5p showed the opposite results. Luciferase reporter gene assay showed that IL-1β was the target gene of miR-185-5p, and miR-185-5p negatively regulated the expression of IL-1β. Conclusion miR-185-5p alleviates the inflammatory response in AGA by inhibiting IL-1β.
Humans ; 3' Untranslated Regions ; Arthritis, Gouty/genetics* ; Interleukin-1beta/genetics* ; Interleukin-8 ; Luciferases ; MicroRNAs/genetics* ; Tumor Necrosis Factor-alpha

Humans ; Arthritis, Psoriatic/drug therapy* ; Interleukin-17 ; Interleukin Inhibitors ; Antirheumatic Agents/therapeutic use* ; Tumor Necrosis Factor-alpha/therapeutic use* ; Interleukin-23/therapeutic use*

INTRODUCTION

Oral isothretinoin is the treatment of choice in moderate to severe acne vulgaris. The most common adverse effect is mild mucocutaneous symptoms and the most seious risk is related to teratogenecity. Hyperuricemia and gouty arthritis are rarely associated with isotretinoin therapy.

We report a case of a 26-year-old female patient with no known comorbidities who was started on isotretinoin therapy for acne vulgaris. The patient presented with baseline hyperuricemia with no joint pains or swelling. Two and a half weeks later after initiation of isotretinoin therapy, the patient developed pain and swelling on the left wrist, hence was started on urate-lowering medications and maintained on isotretinoin tharapy. The patient had no recurrence of joint pains and remains symptom-free for six months later.

After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

Psoriasis may manifest as severe hyperkeratotic lesions resembling an oyster shell called ostraceous psoriasis. This type of psoriasis is extremely rare and is often associated with psoriatic arthritis. Psoriatic arthritis is a chronic inflammatory disease of the joints presenting with pain, stiffness, swelling, tenderness, and limited movements. This is a case of a 16-year-old Filipino female presenting with pruritic erythematous plaques topped with thick adherent ostraceous scales associated with bilateral knee and elbow pains. Laboratory tests and biopsy were done. Histopathology is consistent with psoriasiform dermatitis and psoriatic arthritis is established through Early Psoriatic Arthritis (EARP) Screening Questionnaire and Classification Criteria for Psoriatic Arthritis (CASPAR). Patient was started on potent topical corticosteroids and Narrow-band Ultraviolet B (NB-UVB) phototherapy with minimal improvement. Hence, Secukinumab was initiated which showed significant improvement on the skin lesions and joint pains 7 days after the first dose of Secukinumab. Ostraceous psoriasis is rarely found in pediatric population. It is commonly associated with psoriatic arthritis that should be screened during routine consult. Its characteristic firmly adherent thick scales are resistant to topical treatments. One of the therapeutic options is Secukinumab, an IL-17A selective inhibitor targeting the release of proinflammatory cytokines, chemokines and mediators of tissue damage. It demonstrates immediate effect, significant and sustained improvement in the skin lesions, minimal adverse reactions, as well as improved quality of life and physical function. It is therefore a preferred treatment for patients with moderate to severe psoriasis and psoriatic arthritis requiring rapid clearance.

Introduction: Chinese medicine (CM) external therapy is commonly used to treat rheumatoid arthritis (RA) in combination with conventional drug. This study aims to provide a comprehensive synthesis on the efficacy of CM external therapy combined with conventional drug treatment in RA. Methods: Randomised controlled trials (RCTs) experimenting the efficacy of CM external therapy (acupuncture, moxibustion and CM fumigation) combined with conventional drug in comparison with conventional drug only in RA patients were collected from PubMed, Medline, Cochrane Central of Controlled Trials (CENTRAL), ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Quality was assessed using the Cochrane Risk of Bias Tool. The outcome measures which include Disease Activity Score-28 (DAS28), Visual Analogue Scale (VAS), Swollen Joint Count (SJC), Tumour Necrosis Factor (TNF-α), serum levels of C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were analysed using Review Manager 5.4.1 and GRADEpro GDT online software. Results: Fifty RCTs fulfilling the criteria were included. Although some level of efficacy was statistically noted on the use of CM external therapies, their certainty levels are mixed, ranging only in between moderate and low. Conclusions Mixed levels of certainty has hindered the drawing of conclusion. The addition of CM external therapies to conventional drug treatment may provide some benefits in RA. Further clinical trials with considerations in minimising the risk of bias are recommended to provide more high-quality evidence in the effect of CM external therapies as a complementary treatment in RA.
Medicine, Chinese Traditional ; Fumigation ; Meta-Analysis [Publication Type] ; Moxibustion ; Arthritis, Rheumatoid ; Systematic Review [Publication Type]

Child ; Humans ; Arthritis, Juvenile/drug therapy* ; Macrophage Activation Syndrome/etiology* ; Antibodies, Monoclonal, Humanized/therapeutic use*

Humans ; Arthritis, Juvenile/genetics* ; Intracellular Signaling Peptides and Proteins/genetics* ; Genetic Predisposition to Disease