Pub Date : 2021-07-23DOI: 10.1142/S2661341721300032
Tang Hoi San, Shirley Ying King Yee
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is associated with significant morbidity and mortality. Management of AAV is divided into induction of remission and maintenance of remission. Management of AAV has evolved with the aim of improving treatment outcomes and minimizing treatment toxicities. In this article, we will review the latest evidence on the treatment of AAV.
{"title":"Update of Management of ANCA-Associated Vasculitis","authors":"Tang Hoi San, Shirley Ying King Yee","doi":"10.1142/S2661341721300032","DOIUrl":"https://doi.org/10.1142/S2661341721300032","url":null,"abstract":"Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is associated with significant morbidity and mortality. Management of AAV is divided into induction of remission and maintenance of remission. Management of AAV has evolved with the aim of improving treatment outcomes and minimizing treatment toxicities. In this article, we will review the latest evidence on the treatment of AAV.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44712487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-05-04DOI: 10.1142/S2661341721300019
U. Rathore, A. Aggarwal
Pregnancy and fetal outcomes in patients suffering from systemic lupus erythematosus or antiphospholipid syndrome have been well described, as these are more common diseases and associated with frequent maternal and fetal complications. The data is scant about pregnancy-related morbidity and its outcome among less common rheumatic diseases like inflammatory myositis, systemic sclerosis (SSc), and vasculitis. Inflammatory myositis, vasculitis, and SSc are associated with higher risk of spontaneous abortions, preterm delivery, and intrauterine growth restriction (IUGR). Conception during active disease is associated with poor pregnancy outcomes, hence good control of disease is important. These diseases also increase risk of maternal complications like hypertension, preeclampsia, and antepartum hemorrhage. Due to rarity of these diseases, the individual experience of a physician is limited, thus it requires a collaborative team approach to have best outcome.
{"title":"Outcome of Pregnancy in Less Common Rheumatic Diseases: Inflammatory Myositis, Systemic Sclerosis and Vasculitis","authors":"U. Rathore, A. Aggarwal","doi":"10.1142/S2661341721300019","DOIUrl":"https://doi.org/10.1142/S2661341721300019","url":null,"abstract":"Pregnancy and fetal outcomes in patients suffering from systemic lupus erythematosus or antiphospholipid syndrome have been well described, as these are more common diseases and associated with frequent maternal and fetal complications. The data is scant about pregnancy-related morbidity and its outcome among less common rheumatic diseases like inflammatory myositis, systemic sclerosis (SSc), and vasculitis. Inflammatory myositis, vasculitis, and SSc are associated with higher risk of spontaneous abortions, preterm delivery, and intrauterine growth restriction (IUGR). Conception during active disease is associated with poor pregnancy outcomes, hence good control of disease is important. These diseases also increase risk of maternal complications like hypertension, preeclampsia, and antepartum hemorrhage. Due to rarity of these diseases, the individual experience of a physician is limited, thus it requires a collaborative team approach to have best outcome.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41249591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-29DOI: 10.1142/S2661341721400010
Hoch So, C. Mok, R. Yip
Patients with autoimmune rheumatic diseases are potentially at risk of more serious Coronavirus Disease 2019 (COVID-19) infection and increased mortality due to immunosuppressive therapies and disease-related medical comorbidities. Uncertainty about the safety and efficacy of the COVID-19 vaccines is a major deterrent for patients to participate in the vaccination program. The Hong Kong Society of Rheumatology took the lead to publish a set of consensus statements for COVID-19 vaccination in adult patients with autoimmune rheumatic diseases through a Delphi exercise that involved the senior members of the Society. This serves as a guide to rheumatologists and other specialists, nurses, healthcare professionals, and public regarding COVID-19 vaccination in autoimmune rheumatic diseases.
{"title":"The Hong Kong Society of Rheumatology Consensus Recommendations for COVID-19 Vaccination in Adult Patients with Autoimmune Rheumatic Diseases","authors":"Hoch So, C. Mok, R. Yip","doi":"10.1142/S2661341721400010","DOIUrl":"https://doi.org/10.1142/S2661341721400010","url":null,"abstract":"Patients with autoimmune rheumatic diseases are potentially at risk of more serious Coronavirus Disease 2019 (COVID-19) infection and increased mortality due to immunosuppressive therapies and disease-related medical comorbidities. Uncertainty about the safety and efficacy of the COVID-19 vaccines is a major deterrent for patients to participate in the vaccination program. The Hong Kong Society of Rheumatology took the lead to publish a set of consensus statements for COVID-19 vaccination in adult patients with autoimmune rheumatic diseases through a Delphi exercise that involved the senior members of the Society. This serves as a guide to rheumatologists and other specialists, nurses, healthcare professionals, and public regarding COVID-19 vaccination in autoimmune rheumatic diseases.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43944610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.1142/s2661341720300062
C. Ho, C. Mok
Systemic lupus erythematosus (SLE) is an autoimmune disease with involvement of multiple systems. Despite the therapeutic advances in the past few decades, refractory SLE causing organ damage and life-threatening complications still poses a therapeutic challenge. Therapeutic plasma exchange is considered as one of the rescue therapies used in refractory SLE. However, the level of evidence supporting its use is low. This article reviews the current evidence of the application of plasmapheresis in the treatment of SLE.
{"title":"Therapeutic Plasma Exchange in Patients with Systemic Lupus Erythematosus","authors":"C. Ho, C. Mok","doi":"10.1142/s2661341720300062","DOIUrl":"https://doi.org/10.1142/s2661341720300062","url":null,"abstract":"Systemic lupus erythematosus (SLE) is an autoimmune disease with involvement of multiple systems. Despite the therapeutic advances in the past few decades, refractory SLE causing organ damage and life-threatening complications still poses a therapeutic challenge. Therapeutic plasma exchange is considered as one of the rescue therapies used in refractory SLE. However, the level of evidence supporting its use is low. This article reviews the current evidence of the application of plasmapheresis in the treatment of SLE.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43470293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-05DOI: 10.1142/s2661341720300037
P. Li, C. Lau
Patients with rheumatological or immunological conditions, such as systemic lupus erythematosus (SLE), are particularly vulnerable to infections either due to the underlying immunological aberrations of the disease itself or treatment-related/iatrogenic immunosuppression. Infections remain the leading cause of morbidity and mortality in SLE patients and appropriate vaccination is of paramount importance. Despite clear guidance for the most common vaccinations, the greatest barrier to appropriate vaccinations likely remains with physician awareness or willingness for recommendation. To address this, we review the current evidence regarding the impact of the most commonly recommended vaccinations on SLE.
{"title":"Efficacy and Safety of Vaccinations in Systemic Lupus Erythematosus","authors":"P. Li, C. Lau","doi":"10.1142/s2661341720300037","DOIUrl":"https://doi.org/10.1142/s2661341720300037","url":null,"abstract":"Patients with rheumatological or immunological conditions, such as systemic lupus erythematosus (SLE), are particularly vulnerable to infections either due to the underlying immunological aberrations of the disease itself or treatment-related/iatrogenic immunosuppression. Infections remain the leading cause of morbidity and mortality in SLE patients and appropriate vaccination is of paramount importance. Despite clear guidance for the most common vaccinations, the greatest barrier to appropriate vaccinations likely remains with physician awareness or willingness for recommendation. To address this, we review the current evidence regarding the impact of the most commonly recommended vaccinations on SLE.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46725513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-30DOI: 10.1142/s2661341720300025
H. So, C. Mok
On March 12, 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic. The rapidly increasing number of cases and deaths have overwhelmed the health care system worldwide. We aimed to provide a narrative review on some practical issues of COVID-19 and rheumatic diseases with the limited data to the date of April 26, 2020.
{"title":"COVID-19 and Rheumatic Diseases: Practical Issues","authors":"H. So, C. Mok","doi":"10.1142/s2661341720300025","DOIUrl":"https://doi.org/10.1142/s2661341720300025","url":null,"abstract":"On March 12, 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic. The rapidly increasing number of cases and deaths have overwhelmed the health care system worldwide. We aimed to provide a narrative review on some practical issues of COVID-19 and rheumatic diseases with the limited data to the date of April 26, 2020.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46116634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.1142/S2661341719710019
P. Wong
A SLE patient with persistent small hand joint pain for 2 years despite on different disease modifying anti-rheumatic drugs. Ultrasound of the hands was performed and the diagnosis and management of the condition was revised.
{"title":"A SLE Patient with Small Hand Joint Pain","authors":"P. Wong","doi":"10.1142/S2661341719710019","DOIUrl":"https://doi.org/10.1142/S2661341719710019","url":null,"abstract":"A SLE patient with persistent small hand joint pain for 2 years despite on different disease modifying anti-rheumatic drugs. Ultrasound of the hands was performed and the diagnosis and management of the condition was revised.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1142/S2661341719710019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43502977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.1142/S2661341719300015
D. Kang, C. Mok
Manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Acute psychosis is an uncommon but well-recognized manifestation of NPSLE. With no specific biomarkers to date, the diagnosis of NPSLE relies on clinical acumen for circumstantial evidence and exclusion of important differential diagnoses. The attribution of psychosis to NPSLE is facilitated by the application attribution models. In particular, the American College of Rheumatology nomenclature, Systemic Lupus International Collaborating Clinics attribution models and Italian algorithm for the attribution of psychosis to NPSLE are revisited. The mainstay of treatment for psychosis attributable to NPSLE is immunosuppression and symptomatic control. In refractory cases, immunomodulatory and emerging biological agents may be considered. This article reviews the diagnostic dilemma, pathogenic mechanisms and treatment of psychosis in SLE patients.
{"title":"Management of Psychosis in Neuropsychiatric Lupus","authors":"D. Kang, C. Mok","doi":"10.1142/S2661341719300015","DOIUrl":"https://doi.org/10.1142/S2661341719300015","url":null,"abstract":"Manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Acute psychosis is an uncommon but well-recognized manifestation of NPSLE. With no specific biomarkers to date, the diagnosis of NPSLE relies on clinical acumen for circumstantial evidence and exclusion of important differential diagnoses. The attribution of psychosis to NPSLE is facilitated by the application attribution models. In particular, the American College of Rheumatology nomenclature, Systemic Lupus International Collaborating Clinics attribution models and Italian algorithm for the attribution of psychosis to NPSLE are revisited. The mainstay of treatment for psychosis attributable to NPSLE is immunosuppression and symptomatic control. In refractory cases, immunomodulatory and emerging biological agents may be considered. This article reviews the diagnostic dilemma, pathogenic mechanisms and treatment of psychosis in SLE patients.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1142/S2661341719300015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43116860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.1142/S2661341719300027
Carrel Ka Lung Yu, C. Mok
Allopurinol is an effective urate lowering agent but may lead to rare but life-threatening severe cutaneous adverse reactions (SCAR). Genetic predisposition, age, sex, renal function, dosage and concomitant diuretic use are known risk factors of allopurinol related SCAR. Among these factors, HLA-B[Formula: see text]58:01 confers the highest risk. Frequency of the HLA-B[Formula: see text]58:01 allele varies significantly across different ethnic groups. Although the usefulness of HLA-5801 genotyping before initiation of allopurinol has been confirmed by clinical studies, its positive predictive value for SCAR is low because of the low prevalence of HLA-5801 in some localities. Thus, health economic analysis does not consistently show cost-effectiveness of universal screening of HLA-5801 before initiation of allopurinol. However, screening of this genotype in high-risk subjects, including those with renal impairment or advanced age, should be considered on individual basis.
{"title":"Clinical Usefulness of HLA-B∗58:01 Genotyping in Gouty Arthritis","authors":"Carrel Ka Lung Yu, C. Mok","doi":"10.1142/S2661341719300027","DOIUrl":"https://doi.org/10.1142/S2661341719300027","url":null,"abstract":"Allopurinol is an effective urate lowering agent but may lead to rare but life-threatening severe cutaneous adverse reactions (SCAR). Genetic predisposition, age, sex, renal function, dosage and concomitant diuretic use are known risk factors of allopurinol related SCAR. Among these factors, HLA-B[Formula: see text]58:01 confers the highest risk. Frequency of the HLA-B[Formula: see text]58:01 allele varies significantly across different ethnic groups. Although the usefulness of HLA-5801 genotyping before initiation of allopurinol has been confirmed by clinical studies, its positive predictive value for SCAR is low because of the low prevalence of HLA-5801 in some localities. Thus, health economic analysis does not consistently show cost-effectiveness of universal screening of HLA-5801 before initiation of allopurinol. However, screening of this genotype in high-risk subjects, including those with renal impairment or advanced age, should be considered on individual basis.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1142/S2661341719300027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48346584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-17DOI: 10.1142/S2661341719500019
P. Li, H. Chung, Chun-sing Wong, H. Tsang, V. Lau, Grace Ho, Xiaopei Xu, C. Lau, K. Ma
Objective: To investigate the associations between age and clinical and radiological disease activities in axial SpA. Methods: One hundred and twenty-one patients fulfilling the Assessment of SpondyloArthritis International Society Classification Criteria for axial SpA were included in analyses. Patient demographics, disease activity and radiographic scores, as well as magnetic resonance imaging (MRI) with diffusion weighted imaging derived apparent diffusion coefficient values (DWI(ADC)), were compared between patients aged > 40 and [Formula: see text] 40 years at a cross-sectional level. Variables with significant differences in univariate analyses were used as dependent variables in multivariate linear regression models adjusted for potential confounding/contributing factors. Results: Multivariate analysis showed that increasing age was significantly associated with higher Bath Ankylosing Spondylitis Functional Index (B = 0.04, p < 0.01) and Bath Ankylosing Spondylitis Metrology Index scores (B = 0.04, p < 0.01); as well as higher modified Stoke Ankylosing Spondylitis Spine Score (B = 0.41, p < 0.01). On MRI, increasing age was associated with a lower DWI(ADC) (B = (-0.01), p < 0.01) of the SI joints, but higher DWI(ADC) values of the axial spine (B = 0.01, p = 0.01). Conclusion: Increasing age in SpA was associated with greater functional impairment and structural damage, more inflammation of the axial spine, but less inflammation of the SI joints. Our findings are consistent with the traditional belief that SpA is an “ascending disease” and highlights the importance of different modalities of MRI in the diagnosis and disease monitoring of SpA.
{"title":"The Association Between Age and Clinical and Radiological Activity in Axial Spondyloarthritis","authors":"P. Li, H. Chung, Chun-sing Wong, H. Tsang, V. Lau, Grace Ho, Xiaopei Xu, C. Lau, K. Ma","doi":"10.1142/S2661341719500019","DOIUrl":"https://doi.org/10.1142/S2661341719500019","url":null,"abstract":"Objective: To investigate the associations between age and clinical and radiological disease activities in axial SpA. Methods: One hundred and twenty-one patients fulfilling the Assessment of SpondyloArthritis International Society Classification Criteria for axial SpA were included in analyses. Patient demographics, disease activity and radiographic scores, as well as magnetic resonance imaging (MRI) with diffusion weighted imaging derived apparent diffusion coefficient values (DWI(ADC)), were compared between patients aged > 40 and [Formula: see text] 40 years at a cross-sectional level. Variables with significant differences in univariate analyses were used as dependent variables in multivariate linear regression models adjusted for potential confounding/contributing factors. Results: Multivariate analysis showed that increasing age was significantly associated with higher Bath Ankylosing Spondylitis Functional Index (B = 0.04, p < 0.01) and Bath Ankylosing Spondylitis Metrology Index scores (B = 0.04, p < 0.01); as well as higher modified Stoke Ankylosing Spondylitis Spine Score (B = 0.41, p < 0.01). On MRI, increasing age was associated with a lower DWI(ADC) (B = (-0.01), p < 0.01) of the SI joints, but higher DWI(ADC) values of the axial spine (B = 0.01, p = 0.01). Conclusion: Increasing age in SpA was associated with greater functional impairment and structural damage, more inflammation of the axial spine, but less inflammation of the SI joints. Our findings are consistent with the traditional belief that SpA is an “ascending disease” and highlights the importance of different modalities of MRI in the diagnosis and disease monitoring of SpA.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1142/S2661341719500019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49465948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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