Pulmonary arterial hypertension in Thai patients with systemic sclerosis.

OBJECTIVE: Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with systemic sclerosis (SSc), and compare these features between those with limited (lc) SSc and diffuse (dc) SSc. MATERIAL AND METHOD: The medical records of SSc patients attending the Division of Rheumatology, Chiang Mai University were reviewed. PAH was defined by pulmonary arterial systolic pressure (PASP) > 35 mmHg, determined by Doppler echocardiography. RESULTS: Among 275 patients with SSc, 66 had Doppler echocardiography measurement. Thirty-nine patients (59.1%) had PAH. Among the PAH-SSc patients, 36 (92.3%) presented with dyspnea on exertion, and 37 (94.8%) were in a New York Heart Association functional class of II and III. Twenty-four of 39 patients (61.5%) had interstitial lung disease. Diffuse SSc patients had a significantly higher proportion of males, and shorter disease duration between SSc and PAH diagnosis than lcSSc patients. CONCLUSION: PAH was not uncommon in Thai patients with SSc. Interstitial lung disease might have been the cause associated with over half of these cases. Annual routine Doppler echocardiography screening for PAH in patients with SSc may detect preclinical PAH, and lead to early management and improved functional outcome.

Inappropriate prescription of allopurinol in a teaching hospital.

BACKGROUND: Allopurinol is a drug that is widely used to treat hyperuricemia, but it is often prescribed inappropriately. OBJECTIVE: The authors conducted a study to look for the appropriate allopurinol prescription and diagnosis of gout in the out-patient clinics at a university hospital. MATERIAL AND METHOD: One hundred and forty-five patients who were newly prescribed allopurinol (128 males and 17 females, mean +/- SD age of 58.5 +/-14.1 years) were enrolled in this study. RESULT: Only 77 (53.1%) received allopurinol with appropriate indications. Thirty-eight patients (26.2%) did not have allopurinol dose adjustment according to the patients' creatinine clearance. Among 131 patients, prescribed allopurinol for the diagnosis of gout, only 55 (42.0%) were diagnosed in accordance with the American Rheumatism Association criteria. CONCLUSION: Inappropriate use of allopurinol (both the indication and prescribed dosage) and inappropriate diagnosis of gout are major problems even in a large teaching hospital. An educational campaign program is warranted for achieving appropriate diagnosis of gout, and eliminating the inappropriate use of allopurinol.

Community-acquired pneumonia in Thai patients with systemic lupus erythematosus.

Infection, particularly pneumonia, is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This study was performed to assess the prevalence, causative organisms, and outcomes of community-acquired pneumonia (CAP) in Thai SLE patients, and determine the predicting factors for death. A retrospective chart review of adult SLE patients, age >16 years, seen at the Division of Rheumatology, Chiang Mai University over an 18 year period was carried out. Cases diagnosed with CAP were selected for this study. Of 542 SLE patients, a total of 56 episodes of CAP occurred in 52 patients. Their mean age +/- SD and duration of SLE were 37.98 +/- 11.48 years and 34.99 +/- 54.53 months, respectively. Thirty-three CAP cases (58.9%) occurred within the first year of diagnosis with SLE. The causative organisms identifiable in 40 patients (71.5%) were Mycobacterium tuberculosis in 12, Nocardia spp in 6, Aspergillus spp in 5, Staphylococcus aureus in 3, Pneumocystis carinii, Haemophilus influenzae, Escherichia coli, and Pseudomonas aeruginosa in 2 each, and Acinetobactor baumanii, Burkholderia pseudomallei, and Strongyloides stercoralis in 1 each. The remaining 3 patients had mixed bacterial infection. The overall mortality rate was 26.8%. Use of high dose prednisolone (> or =15 mg/day), and ventilator support were significantly associated with death.

Physician's awareness of the prevention of corticosteroid induced osteoporosis.

BACKGROUND AND OBJECTIVE: Corticosteroid induced osteoporosis (CIO) is a preventable condition that is often not realized by physicians who prescribe corticosteroids. The present study was carried out to study the awareness of CIO prevention in a teaching hospital. MATERIAL AND METHOD: The medical records of patients who received corticosteroids equivalent to prednisolone of > or = 5 mg/day for a minimum of 3 months between 1 May 2004 and 30 June 2004 were reviewed. RESULTS: Four hundred and forty nine patients of 1,540 who received corticosteroids (29.1%) were included in the present study. Rheumatologists, nephrologists, and dermatologists were the top three specialists to prescribe corticosteroids in 189 (42.1%), 103 (23.0%), and 46 (10.2%) cases, respectively. Only 146 patients (32.5%) received calcium supplement. Rheumatologists and neurologists were the top two specialists to prescribe calcium supplementation in 100 of 189 (52.9%) and 13 of 36 (36.1%) cases, respectively. Bone mineral density measurement was determined in only 26 of the 449 patients (5.8%). CONCLUSION: Prevention of CIO is still neglected by internal medicine specialists, even in a teaching hospital. An educational campaign for physicians is warranted to improve the practice for the prevention of this treatable complication.

Ocular side effects of chloroquine in patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma.

OBJECTIVE: Ocular complication is a major long term adverse event of chloroquine. The present study was carried out to determine the ocular side effects of chloroquine in patients with rheumatic diseases. MATERIAL AND METHOD: Medical records of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl), who received chloroquine for their treatment, at the Division of Rheumatology, Faculty of Medicine, Chiang Mai University between 1 January 1992 and 31 August 2005 were reviewed. Only patients who were older than 16 years, had a clear total accumulative dose and duration of chloroquine therapy, and a regular ophthalmologic examination by ophthalmologists were included in the present study. RESULTS: One hundred and thirty-nine patients (54, 49, and 36 cases of RA, SLE and Scl, respectively) were studied. Forty-eight patients (34.5%) had ocular adverse effects (retinopathy in 37 and corneal deposition in 13 while two patients had both defects). There was no statistical difference in age, mean lean body weight adjusted daily dose, total dosage, and duration of treatment between those with and without ocular side effects. However those with ocular side effects had significantly lower creatinine clearance (66.9 +/- 26.9 vs 72.3 +/- 20.0 ml/min, p = 0.046). CONCLUSION: Ocular side effects of chloroquine were more common in patients with connective tissue diseases who had decreased creatinine clearance. The use of chloroquine in patients with impaired renal function should be of greater concern.

Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables.

This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl). The ocular symptoms and sign (the Schirmer's 1 test) and the oral sicca symptoms and sign (the Saxon's test) in each of 50 RA, SLE and Scl patients were compared with their age-matched controls. The correlation between the presence of sicca symptoms and signs with their clinical activity was also determined. Ocular sicca symptoms were found more common in patients with RA (38% vs 18%, p < 0.05), SLE (36% vs 14%, p < 0.05) and Scl (54% vs 16%, p < 0.01), and oral sicca symptoms were found more common in SLE (22% vs 0%, p < 0.01), and Scl (16% vs 4%, p < 0.05) than their controls. However, only RA patients had a significantly higher proportion of positive Schimer-1 test compared with their controls (p < 0.01). There was no strong correlation between sicca symptoms or signs and other clinical or laboratory variables (age, disease duration, disease activity, disease severity, and antibody to Ro and La antigens) in these three groups. In conclusion, sicca symptoms were seen significantly more common in Thai patients with connective tissue diseases, but the symptoms did not show a good correlation with the clinical and laboratory variables.

Validation of the Thai version of a screening questionnaire for detection of systemic lupus erythematosus.

OBJECTIVE: The present study was performed to assess the sensitivity and specificity of the translation questionnaire for Systemic Lupus Erythematosus (SLE) in Thai speaking populations. MATERIAL AND METHOD: The 10- item questionnaire was applied to out-patients at the rheumatology clinic of the Chiang Mai University Hospital. One hundred and thirty-nine SLE, 109 Rheumatoid Arthritis (RA), and 35 Scleroderma (Scl) patients, as well as 88 Healthy Controls (HC) were enrolled into the present study. RESULTS: All subjects completed the questionnaire within 2 minutes. A positive response to three or more questions of the questionnaire gave a sensitivity and specificity of 92.81% and 76. 39%, respectively, and was comparable to the original version. CONCLUSION: This Thai-version of the screening questionnaire should be applied in the general population to determine the prevalence of SLE.