ABSTRACT
BACKGROUND: Mixed connective tissue disease (MCTD) is a distinct autoimmune disease with overlapping features of different connective tissue diseases and a broad spectrum of presentation and prognosis. Our aim is to present the clinical profile of a cohort of Filipinos with MCTD.METHODS: Charts with diagnosis of MCTD based on the Alarcon-Segovia Criteria from the Philippine General Hospital Adult Rheumatology clinic from January 1999 to December 2011 were reviewed for demographics, clinical presentation, and management. Descriptive statistics were applied.RESULTS: Fourteen patients were identified to have MCTD. All were females. The median age at symptom onset, and at diagnosis, was 30.5, and 31.5 years, respectively, with two having juvenile onset of symptoms. Mean interval from symptom onset to diagnosis is two years. Patients are being followed up for the past mean of 3.5 years.All eight women who wanted children were able to conceive, and among them only two had fetal losses but were negative for antiphospholipid antibodies. Chief complaint was most commonly joint pain (67%) followed by skin tightness (13%). Systemic lupus erythematosus (SLE) was the most frequent initial diagnosis (43%). Majority had initial constitutional symptoms with generalized weakness and fatigue being the most frequent (93%). Most common physical findings in different body systems are as follows: musculoskeletal - arthritis (100%); vascular - Raynaud's phenomenon (93%); cutaneous- skin tightness (71%); gastrointestinal - dental caries (57%); hematologic - anemia of chronic disease (50%); cardiopulmonary - accentuated pulmonary component of the second heart sound and right ventricular hypertrophy (21% each); neurologic - peripheral neuropathy (21%); renal - proteinuria (21%); endocrine - autoimmune thyroiditis (21%).Half have anemia of chronic disease. Only three (21%) have proteinuria and were below nephrotic range. Twelve out of 12 have elevated sedimentation rates. For serologic studies, all have speckled ANA and very high titers of anti-U1RNP;six of six patients have normal rheumatoid factor(RF) titers; one out of two have positive anti-Ro;two out of four have anti-Ds DNA; none of two have anti-SCL70.Majority of the chest x-rays,electrocardiograms,echocardiographs were normal.Three have pulmonary hypertension. One out of four has restrictive lung disease on pulmonary function test. Most are in remission and are on low-dose prednisone (79%), hydroxychloroquine (50%), nifedipine (36%) and methotrexate (21%).CONCLUSION: This is the first study that detailed clinical and laboratory features of Filipinos with MCTD diagnosed using the Alarcon-Segovia criteria. Most clinical features, disease activity, and management are concordant with international data. Possible peculiarities include fewer interstitial lung disease, esophageal dysmotility, thrombocytopenia and leucopenia, and RF titers. We intend to add newly diagnosed patients and pursue this cohort for us to better understand the course of MCTD in Filipinos that could translate to better patient care.
Subject(s)
Humans , Female , Adult , Mixed Connective Tissue Disease , Hydroxychloroquine , Hypertrophy, Right Ventricular , Thyroiditis, Autoimmune , Lupus Erythematosus, Systemic , Antibodies, Antiphospholipid , Raynaud DiseaseABSTRACT
OBJECTIVE: The study aimed to evaluate the relationships between disease activity, functional capacity, and health-related quality of life (HRQoL) in Filipino patients with ankylosing spondylitis (AS).METHODS: Filipino AS patients gathered from the Rheumatology Clinic of the Philippine General Hospital (PGH) and from selected tertiary hospitals in Metro Manila who have been diagnosed via the Revised New York Criteria were included. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), while functional capacity and HRQoL were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and Short Form (SF)-36, respectively. Pearson's correlation was used to analyze the relationship between BASDAI and BASFI, and between BASDAI and SF-36.RESULTS: Twenty-four patients entered the study. Mean age was 38.75 ± 12.7 years and mean age at diagnosis was 31 ± 12.29 years. Symptoms occurred for a mean of 9.0 ± 6.97 years with mean duration of symptom onset to diagnosis of 3.38 ± 5.14 years. Study subjects had mild to moderate disease activity. Functional capacity was most impaired in performing a full day's activities at home or at work. HRQoL was highest in vitality and lowest in emotional role, with mental health components generally showing higher scores than physical health components. Pearson's correlation showed moderate positive correlation between BASDAI and BASFI (r=0.6016, p=0.0012) and moderate negative correlation between BASDAI and the physical health domain (r= -0.6916, p=0.0001) and mental health domain (r= -0.3575, p=0.0863) of SF-36. However, only the first two correlations were statistically significant.CONCLUSION: Filipino AS patients with higher disease activity have more functional disability and poorer physical HRQoL.
Subject(s)
Humans , Male , Female , Adult , Spondylitis, Ankylosing , Mental Health , Tertiary Care Centers , Quality of Life , Rheumatology , Physical ExaminationABSTRACT
BACKGROUND: Chikungunya virus (CHIKV) is a mosquito- borne alphavirus of the family Togaviridae transmitted to humans by the Aedes spp. mosquitoes, causing Chikungunya Fever (CHIKF).OBJECTIVE: This study aims to describe the course and outcome of musculoskeletal (MSK) manifestations in patients with CHIKF seen over a three-month period.DESIGN: This is a prospective descriptive study. Seventy patients with fever, rash, and arthritis seen at the University of the Philippines-Philippine General Hospital and private arthritis clinics were collected from August - December 2012. Demographics and course of arthritis were described.RESULTS: Seventy patients, 53 (68.6%) female, with a mean age of 39.2 ±13.50 were diagnosed with CHIKF. All cases were from the Metropolitan Manila area. Of these, 15 (21.4%) had family members affected. Twenty-four patients (34.3%) were either employed or students. The most common presenting symptoms were fever (94.3%), arthritis or athralgia (98.6%), and rash (87.1%). The most common joint areas involved were the ankles (60.0%), the wrists (40.0%) and the small joints of the hand (51.4%). Twenty-seven (47.3%) had symmetric arthritis. Thirty- seven cases (52.9%) had arthralgia or arthritis for at least six weeks. By the end of the follow-up period, only four (5.7%) had persistent musculoskeletal symptoms. Age and sex were not found to be factors in determining chronicity of arthritic symptoms (p = 0.104 and p=0.58 respectively). Of the seventy patients, 31 (44. 3%) were confirmed cases of CHIKF-- 29 had (+) CHIKV IgM by ELISA, and two had (+) CHIKV PCR. Twenty- one (67.7%) had persistent arthritis of at least six weeks. Treatment consisted of continuous NSAIDs for at least two weeks and some received steroids. In this subgroup, age and sex were not shown to correlate with chronic arthritis (p=0.47 and p=0.05 respectively).CONCLUSION: This report on a recent outbreak of CHIKF showed the classic triad of fever, rash, and arthritis. There was no correlation between age and chronicity of arthritic symptoms. Sex, likewise, did not appear to influence chronicity. The disease occurred in family clusters. Patients required continuous treatment with NSAIDs and some had to be given steroids. Most cases resolved by 12 weeks.
Subject(s)
Humans , Male , Female , Middle Aged , Adult , Chikungunya Fever , Chikungunya virus , Togaviridae , Anti-Inflammatory Agents, Non-Steroidal , Arthralgia , Arthritis , Exanthema , Enzyme-Linked Immunosorbent AssayABSTRACT
INTRODUCTION: Treatment of rheumatoid arthritis (RA) has evolved over the past 20 years, aiming at remission with the use of disease modifying drugs (DMARDs) and recently with biologic agents. Treatment of Filipino patients with RA has so far, not been described in literature. The University of the Philippines-Philippine General Hospital (UP-PGH) Rheumatology Section established the rheumatoid arthritis database and registry (RADAR) to better understand RA as it affects the Filipino patient.OBJECTIVE: To describe the treatment received by a cohort of Filipino patients with RA seen in the UP-PGH and entered in the RADAR over three time periods from 1996 to 2000.MATERIALS AND METHODS:This is a review of data on treatment of all cases entered into the RADAR diagnosed with rheumatoid arthritis by the 1987 ACR Criteria, between 1996 to 2010. Cases were grouped into three five-year periods: 1996-2000 (Period 1), 2001-2005 (Period 2), and 2006-2010 (Period3)based on initial prescription of the drugs. DMARDs given were listed and trend in the rate of use was extracted. These were then compared across the three time periods. Descriptive statistics using ratios and proportions was employed on the data.RESULTS: Two-hundred-twenty-four (224) cases were entered into the RADAR at the time of this study and all received DMARDs. Methotrexate (MTX) was the most common DMARD used (89%). Of these, 75% were on MTX monotherapy. Hydroxychloroquine was given in 25%, with 11% on HCQ monotherapy. Combination treatment with MTX and HCQ was used in 14% of cases. There was an increasing rate of MTX use across Periods 1-3 (87%, 89% and 90%, respectively). On the other hand, a decreasing rate in the use of HCQ was noted (43% in Period 1, 24% in Period 2, and 21% in Period 3). Only 9% of patients received biologic agents in combination with MTX.CONCLUSION: This study reports the use of DMARDS in a cohort of patients entered in the UP-PGH RADAR. Methotrexate monotherapy was the most common treatment used, and this increase continued over the three observation time periods. Hydroxychloroquin was used in one fourth of patients, and its use declined over the three time periods. Biologic DMARDS was rarely used, and when given, it was combined with MTX.
Subject(s)
Humans , Male , Female , Antirheumatic Agents , Hydroxychloroquine , Methotrexate , Arthritis, Rheumatoid , Registries , Combined Modality Therapy , Prescriptions , Biological ProductsABSTRACT
BACKGROUND: Polyangiitis overlap syndrome (POS),a systemic vasculitis not classifiable into well-defined syndromes, is diagnosed based on combined characteristics of two or more primary systemic vasculitides, such as Takayasu arteritis and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but not two AAVs. Our objective is to present such, with associated multiple infections.CASE: A 25-year-old Filipino female had six years of recurrent purpura, debilitating joint pains, hemoptysis, rhinorrhea, epistaxis, eye redness, dyspnea, and abdominal cramps. She was cachectic, had oral ulcers, bibasal crackles, polyarthritis, and generalized purpura. Work-up showed anemia, eosinophilia excluding parasitism, elevated inflammatory markers, and positive cytoplasmic (c)-ANCA and anti-proteinase 3. There was chronic sinusitis on rigid rhinoscopy, middle to lower lung field interstitial infiltrates on radiographs, pulmonary vasculitis on chest CT, moderate pulmonary hypertension on echocardiography, but normal spirometry. Skin biopsy showed leukocytoclastic vasculitis without necrotizing granulomas.Serology showed chronic hepatitis B infection. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus grew from bronchial washings and nasal swabs, respectively. ASO titer was high. Human immunodeficiency virus infection was ruled out. She was diagnosed with POS,with features of two AAVs- limited granulomatosis with polyangiitis (GPA) and Churg-Strauss syndrome (CSS), associated with multiple infections, and was given naproxen and culture-guided antibiotics (ciprofloxacin, clindamycin, penicillin),with partial resolution of symptoms. Prednisone 10 mg once a day (OD) was started two weeks after hepatitis B reactivation prophylaxis with lamivudine 100mg OD. Complete resolution of skin lesions and upper airway symptoms and inflammatory marker improvement were observed after 12 weeks. She is maintained on prednisone 5.0 mg daily.CONCLUSION AND RECOMMENDATIONS: This is the first reported case of POS involving two AAVs - limited GPA and incomplete CSS, associated with multiple pathogens.Identifying POS is important; inability to classify patients into well-recognized vasculitic syndromes delays treatment. The infections likely perpetuated the vasculitis, and both antimicrobials and immunosuppression were necessary to induce disease remission