Calf pain as a prominent feature of Behçet's Disease

Objective@#This study aimed to present four cases of Behçet's disease (BD) wherein recurrent calf pain was the first and prominent symptom experienced by the patients. @*Methodology@#The case series described the clinical features, disease development, management, and outcomes of these patients. Written consent was obtained from each participant for the review and publication of their case. @*Results@#All cases presented with chronic and recurrent calf pain, three of whom were bilateral. All four had skin changes on the lower extremities that may have contributed to leg pain. Only probing was a history of oral ulcers reported in all four; none had genital ulcers, eye abnormality, or sensory or motor deficits. All presented with elevated acute phase reactants. Based on the 2013 International Criteria for Behçet’s Disease (ICBD), a diagnosis of possible BD was made due to the presence of oral ulcers, skin lesions, and absence of other findings pointing to another connective tissue disease or systemic vasculitides. All four cases were given oral corticosteroids and colchicine, but two required the addition of methotrexate and azathioprine for control of symptoms. @*Conclusion@#A complaint of recurrent calf pain warrants inquiry and examination of the skin lesions over the affected area and other areas like the oral cavity and genital area. It also warrants consideration of a vasculitic process, especially in the background of oral ulcers and skin changes. In such cases, BD is the right differential diagnosis to be considered.

A Philippine Tertiary Hospital cross-sectional and registry feasibility study: Gout clinical case scenario

Background@#Gout is one of the most common arthritides affecting Filipinos; yet, there is a lack of updated local data and Clinical Practice Guidelines. @*Objective@#To describe Clinical Case Scenario (CCS) of Filipino patients with gout in a tertiary referral hospital seen over a year. @*Design@#Cross-sectional study. @*Methods@#Patients’ characteristics, risk factors, disease course, management, and CCS were obtained by a rheumatologist using a questionnaire. Descriptive statistics were used. @*Results@#One hundred eight patients were included with a median age of 58 (range 26–80) years. 106 were male (98%); and, 2 were female (2%) who were menopause and had chronic kidney disease (CKD). Most prevalent CCS were stages 9 (29%), 1 (16%), and 2 (15%). The majority of cases had tophi and belonged to CCS 4-9 (62%). This signifies that most patients had advanced gout. Consistent with international and local data: almost half had hypertension (46%), a third had CKD (36%). Most were ethanol drinkers (65%) and smokers (57%). Unexpectedly, not many were obese (10%) or had metabolic syndrome (2%). The initial joint involved was the ankle (52%) rather than the first metatarsophalangeal joint (40%). Almost half of the patients presented with two or more joint involvement (46%) than monoarthritis (54%). Patients with acute flare were most commonly prescribed NSAIDs (77%), followed by colchicine (62%). Most were prescribed allopurinol (44%) compared with febuxostat (37%) for urate-lowering therapy. Only 16% received patient education. Medication compliance was 65%, but follow-up compliance was less than 18%. Comparing the Filipino clinical profile to historical data suggests an increased incidence of gout in the young and an increase in comorbidity prevalence. @*Conclusion@#This study reports a cohort of Filipino gout patients. Comorbidities are similar to world figures but differ in the low incidence of obesity and metabolic syndrome. It also differs from literature in having the ankle as the most common initial joint presentation. Management and compliance were also described. As a pilot study for a registry, this study can be implemented at different institutions to broaden and monitor the ever-changing Filipino gout profile. @*Recommendation@#A larger sample size and a more extended observation period are recommended to estimate gout CCS prevalence, flare risk factors, and treatment response more accurately. Other outcomes that can be measured are mortality rates and etiologies for each CCS.

Disease knowledge and functional disability of a cohort of rheumatoid arthritis in a tertiary government hospital in Manila, Philippines

Background@#Rheumatoid arthritis (RA) is a chronic and progressive disease resulting in disability and poor quality of life. Patients’ knowledge (PxK) of disease can contribute to better disease control, reduced disability, and improved quality of life. @*Objective@#The objective of this study was to determine the disease knowledge and functional disability of a cohort of patients with RA. @*Methods@#We conducted a cross-sectional study among patients with RA at the University of the Philippines - Philippine General Hospital Arthritis Clinic. The subjects were recruited using convenience sampling over three months in 2019. We obtained demographic and disease characteristics, clinic attendance, patient knowledge, and functional status through chart review, a questionnaire, and a disability index. Descriptive statistics, 2-sample T-test, Pearson’s correlation, analysis of variance (ANOVA), and multiple linear regression analysis were used for data analysis. Informed consent was obtained before participation in the study. @*Results@#Eighty percent (57/71) of recruited patients participated in the study. All were female, and the mean age was 51.6 years (±12.9). Most participants completed secondary education, were employed, had an average duration of RA of 8 (±6.8) years, had been consulting at the Arthritis Clinic for an average of 4.8 years (±3.8), and had moderate disease activity (49.1%). Most patients had American College of Rheumatology (ACR) class I or II functional status (50/57, 88%). The usual source of the patients' knowledge about RA was their physician. The mean knowledge score was 5.10 (±0.93) out of a perfect score of 9. Most patients were aware of their disease diagnosis and the non-communicable nature of RA. There was low awareness of the need for self-monitoring for disease flares or treatment adverse events and the extra-articular involvement in RA. The mean functional disability score was 6.65 ± 5.33, and the mean functional disability index (FDI) was 0.83 (±0.66). These correspond to mild functional disability (FD). There was no significant relationship between the total knowledge score and age, duration of disease, number of consultations in the past year, level of education, employment status, perceived level of disease knowledge, or the practice of asking their physician about illness. Perception of overall health status was associated with functional disability (p=0.001). @*Conclusion@#Most of the patients in our cohort of RA patients had a mild functional disability and low knowledge scores. The study identified the gaps in our patients’ knowledge of disease and its management. A re-evaluation of existing educational and treatment strategies will be beneficial to enhance disease knowledge and improve health outcomes.

Clinical factors associated with inadequate treatment response to methotrexate among patients with rheumatoid arthritis in a tertiary referral hospital

Objective@#The study aimed to determine patient-related factors associated with inadequate treatment response of patients with rheumatoid arthritis (RA) to methotrexate (MTX). @*Methodology@#We reviewed the medical records of patients with RA seen at the rheumatology outpatient clinic of Philippine General Hospital; dichotomized into those with adequate and inadequate treatment response to MTX. Clinical data including age, gender, comorbidities, smoking status, tender joint counts, disease activity score-28 (DAS28), and rheumatoid factor (RF) positivity were compared between the two groups. We used univariate binary logistic regression to determine whether these clinical factors were significantly associated with inadequate treatment response. @*Results@#Majority (47/77 or 61%) of patients have inadequate treatment response to MTX. There were no significant differences between the two study groups in terms of age, tender joint count, DAS28, sex, smoking status and RF positivity. These factors also failed to show significant association with inadequate treatment response. @*Conclusion@#Age, sex, smoking status, duration of disease, initial DAS28, RF positivity and tender joint counts are not significantly associated with inadequate treatment response. A larger sample size is needed to estimate the prevalence of inadequate treatment response to MTX and derive a predictive model for treatment response.