A systematic review of the association of obesity with the outcomes of inflammatory rheumatic diseases

This was a systematic review of the literature on the association between obesity and the outcome of inflammatory rheumatic diseases. We conducted a literature search using PubMed®, Embase and PsycINFO®. Articles were classified into three categories based on the effects of obesity on the outcomes of inflammatory rheumatic diseases. The subject population, country, type of studies, number of patients, measurement of obesity and outcomes assessed were presented. Quality was appraised using Kmet et al's criteria. 4,331 articles were screened and 60 were relevant to the objective. Obesity had a negative, positive and neutral association with outcomes of inflammatory rheumatic diseases in 38 (63.3%) studies with 57,612 subjects, 11 (18.3%) studies with 3,866 subjects, and 11 (18.3%) studies with 3,834 subjects, respectively. In most studies, the disease population had been diagnosed with rheumatoid arthritis (RA). Tumour necrosis factor-α inhibitors were mostly associated with negative outcomes. More studies examining subjects outside Europe and North America and diseases other than RA are warranted.

Relapsing polychondritis in Singapore: a case series and review of literature

<p><b>INTRODUCTION</b>This study aimed to describe the clinical presentation, treatment and outcome of patients with relapsing polychondritis (RP) who were seen at a large tertiary-care academic medical institution in Singapore.</p><p><b>METHODS</b>The medical records of all patients diagnosed with RP at the Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, between 2005 and 2013 were reviewed. The diagnosis of RP was made using the modified McAdam criteria.</p><p><b>RESULTS</b>Ten patients were diagnosed with RP during the study period. Among these patients, five fulfilled the modified McAdam criteria and five were probable cases of RP. The most common clinical presentations were auricular chondritis (n = 9), episcleritis or scleritis (n = 5), and large airway involvement (n = 3). All of the patients received prednisolone. Five patients developed haematological disorders. Patients with both RP and haematological disorders had a longer duration of RP symptoms prior to diagnosis, compared to patients with RP who did not develop haematological disorders (average duration of symptoms 14.7 months vs. 4.2 months).</p><p><b>CONCLUSION</b>The high frequency of patients with haematological malignancies in this series was unexpected. Myelodysplastic syndrome has been reported, but other haematological malignancies are rarely associated with RP. As the association between haematological malignancies and RP is currently unclear, the threshold for haematological/lymphoproliferative screening should be lowered in patients with RP.</p>

Polyarthritis in four patients with chikungunya arthritis

The incidence of chikungunya infection in Singapore has been on the rise since the first reported case in 2006. Acute polyarthritis, a common manifestation among affected patients, may precede fever and present with debilitating arthritis to rheumatologists, orthopaedists, internists and primary care physicians. The diagnosis of chikungunya infection requires careful history taking and a high index of suspicion, with supporting evidence from the reverse transcription-polymerase chain reaction or the chikungunya IgM serology test. Treatment of chikungunya arthritis usually involves non-steroidal anti-inflammatory drugs. Rarely, polyarthritis in chikungunya may persist even after resolution of the acute infection, necessitating treatment with disease-modifying anti-rheumatic drugs. In this article, we present the different manifestations of chikungunya arthritis in our local setting and review the literature.

Junior doctors' attitudes towards older adults and its correlates in a tertiary-care public hospital

<p><b>INTRODUCTION</b>The medical community in Singapore is faced with a rapidly ageing demographic. This would result in an increase in the interaction between medical professionals and older adults. In anticipation of an increased exposure to elderly patients, we sought to determine the attitudes of our house officers (HO), medical officers (MO) and Registrars towards the elderly.</p><p><b>MATERIALS AND METHODS</b>A descriptive pilot study of junior doctors from the Division of Medicine carried out during a luncheon in the largest tertiary-care public hospital in Singapore. A validated self-administered structured questionnaire using Kogan's Old People (KOP) Scale was used to evaluate attitudes towards older adults and basic demographics and medical educational data were collected.</p><p><b>RESULTS</b>Fifty-one questionnaires were completed. The mean KOP score was 114.4, suggesting an overall positive attitude towards older people in this sample. The prevalence of negative attitude was 7.8%. There was no significant difference in attitudes among doctors with different designation, age, marital status, medical school attended, nationality, years in medical practice and living arrangement. Doctors who had previous exposure with a posting in Geriatric Medicine had higher KOP scores but were just out of significance (P = 0.098). Respondents who found treating older people unrewarding had significantly lower KOP score (P <0.001).</p><p><b>CONCLUSION</b>In this sample of junior doctors, overall attitudes towards older people as measured by the KOP scale were moderately positive. Exposure to a Geriatric Medicine posting during residency may positively influence a doctor's attitudes towards the older adults.</p>