Disease activity and functional changes of RA patients receiving different DMARDs in clinical practice.

The aim of this study was to compare the effectiveness of different disease-modifying anti-rheumatic drugs (DMARDs) in improving disease activity and functional status in patients with rheumatoid arthritis (RA). One hundred and fifty-two Thai RA patients treated with at least one DMARD were enrolled in this 1-year cohort. Demographic characteristics, baseline and end-of-study data on disease activity and Health Assessment Questionnaire (HAQ) Disability Index of the subjects were compared among different DMARD options. Predictors of HAQ score were investigated using regression analysis. The results showed that the studied patients had established RA with mild to moderate activity. More than 85% were prescribed methotrexate (MTX) as single or combined DMARDs. At 1 year, improvement in most activity measures was experienced. However, all patients had functional declines. Patients taking antimalarial agents had the maximal rate of functional deterioration. Patients taking MTX-based DMARDs had significantly lower rate of functional decline than patients taking DMARDs without MTX (p=0.018). Only patients receiving MTX-based DMARDs had clinically meaningful improvement in HAQ score. The predictors of HAQ score at 1 year included baseline HAQ score and patient global assessment at end of study. In conclusion, although DMARD treatment was shown to improve disease activity in RA patients, functional deterioration was evident in our cohort. Thus, measures of functional status are more appropriate than measures of disease activity to evaluate treatment effects of DMARDs in established RA in clinical practice. MTX-based DMARDs should be prescribed where possible in RA patients with persisting activity due to their ability to delay functional deterioration.

The efficacy of combined low dose of Allopurinol and benzbromarone compared to standard dose of Allopurinol in hyperuricemia.

OBJECTIVE: To compare the efficacy of combined low dose of hypouricemic drugs (Allopurinol 100 mg and benzbromarone 20 mg; Allomaron) and standard dose 300 mg of allopurinol in hyperuricemia. MATERIAL AND METHOD: A prospective, open study of 94 hyperuricemic patients was done at King Chulalongkorn Memorial Hospital. Each group of 47 patients was given a combined low dose of hypouricemic drugs (Allopurinol 100 mg and benzbromarone 20 mg; Allomaron) and a standard dose 300 mg of allopurinol. Serum uric acid was measured before and 4 weeks after receiving the drugs. The efficacy was measured from the difference of the level of serum uric acid before and after receiving the drugs. RESULTS: The patients receiving the combined low dose of hypouricemic drugs and standard dose of allopurinol showed a mean reduction of serum uric acid of 2.5+/-3.4 mg/dl and 4.1+/-2.7 mg/dl consecutively. There was a statistically significant difference between the 2 groups (P = 0.010). CONCLUSION: This study demonstrates that the efficacy of standard dose 300 mg of allopurinol is superior to a combined low dose of allopurinol and benzbromarone in lowering the level of serum uric acid level.

Four years follow-up of bone mineral density change in premenopausal women with systemic lupus erythematosus.

OBJECTIVE: To measure the change in bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) during 4 years of follow-up, and to identify the role of glucocorticoid and disease related variables. METHOD: Premenopausal women with SLE were clinically evaluated and underwent BMD measurement of the lumbar spine, femoral neck and trochanter by dual energy x-ray absorptiometry. RESULTS: 106 SLE patients were evaluated with a mean age of 31.7 +/- 7.5 years, duration of SLE 2.5 +/- 2.6 years, mean daily dose 17.1 +/- 14 mg/d, duration of prednisolone treatment 16.3 +/- 19.9 months during 4 years of follow-up. There was no significant change in BMD at the lumbar spine (1.051 +/- 0.15 vs 1.052 +/- 0.14 vs 1.056 +/- 0.17 vs 1.056 +/- 0.19; p = 0.27), femoral neck (0.861 +/- 0.12 vs 0.867 +/- 0.12 vs 0.846 +/- 0.12 vs 0.844 +/- 0.12, p = 0.28) and trochanter (0.718 +/- 0.12 vs 0.726 +/- 0.13 vs 0.717 +/- 0.13 vs 0.709 +/- 0.14; p = 0.26) at the baseline, first, second and fourth year follow-up study. Furthermore, annual percentage BMD changes were not significant in lumbar BMD (p = 0.37), femoral neck BMD (p = 0.65) and trochanteric BMD (p = 0.47) during the 4 years follow-up study. The average annual percentage change of BMD was not significantly associated with change in age, body mass index (BMI), disease activity, disease severity, disease duration and prednisolone treatment. In addition, there were no significant bone changes between subgroups treated with < or = 7.5 mg and > 7.5 mg daily dose of prednisolone as indicated by BMD at the lumbar spine, femoral neck and trochanter as well as annual percentage BMD changes over the study period. CONCLUSION: There was no significant change of lumbar spine, femoral neck or trochanteric BMD in premenopausal SLE women treated with corticosteroid. These findings suggest that low dose prednisolone may not be detrimental to bone in premenopausal women with SLE during longterm treatment.

Infection in Thai patients with systemic lupus erythematosus: a review of hospitalized patients.

Infection is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The authors conducted retrospective review of 488 admissions at King Chulalongkorn Memorial Hospital during a 5-year period (1994-1999) to determine the infectious complications in these patients. One hundred ninety-one patients with SL2 were admitted because of infection. Lower respiratory tract infection was the most commonly found in these patients (24.6%) followed by infections of the urinary tract (15.7%), skin (15.7%), septicemia (13.6%) and the musculoskeletal system (11.5%). The most common pathogens were Salmonella spp (12.6%), while Escherichiae coli (9.9%) and Mycobacterium tuberculosis (8.4), respectively.

DRB1*04 subtype in Thai patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) in a Thai population is significantly associated with HLA-DR4. The frequency of DR4 was 43 per cent in RA patients and 20 per cent in the healthy controls (p = 0.00008, OR = 3.06, 95% CI = 1.71, 5.52). To analyze which DR4 alleles were associated with the disease, the authors subtyped 52 DR4-positive RA patients compared to 28 DR4-positive healthy controls by amplification with DR4-specific primers followed by direct sequencing. Six DR4 alleles (DRB1*0401, *0403, *0404, *0405, *0406, and *0410) were found in the RA patient group while 5 alleles (DRB1*0401, *0403, *0405, *0406, and *0407) were found in the control group. Both groups were predominated by DRB11*0405, but there was a significant increase in the frequency of DRB1*0405 in DR4+ RA patients compared to DR4+ healthy controls (84.6% vs 46.4%, p = 0.0008, OR = 6.35, 95% CI = 1.96, 21.08). DR4 which shared epitope alleles (DRB1*0401, *0404, *0405) were observed in 47 (90.3%) DR4+ patients and 15 (53.5%) DR4+ controls (p = 0.0005, OR = 8.15, 95% CI = 2.29, 33.2). In addition, the authors found that DRB1*0403 was significantly decreased in DR4+ RA patients compared to controls (p = 0.0065, OR = 0.07, 95% CI = 0, 0.67).

Efficacy of benzbromarone compared to allopurinol in lowering serum uric acid level in hyperuricemic patients.

This study was aimed to evaluate the efficacy of benzbromarone compared to allopurinol in lowering serum uric acid level in hyperuricemic patients with normal renal function (serum creatinine < or = 1.5). The authors conducted a crossover study consisting of two four-week treatment periods of allopurinol 300 mg/day and benzbromarone 100 mg/day separated by a four-week washout period. Fourteen patients with mean age and duration of hyperuricemia of 60.78 +/- 8.62 and 6.93 +/- 3.69 years, respectively, were recruited and all completed our study protocol. This study was a crossover design consisting of two four-week treatments of allopurinol and benzbromarone separated by a four-week washout period. The serum uric acid level was reduced from 9.89 +/- 1.43 mg/dl to 5.52 +/- 0.83 mg/dl and from 9.53 +/- 1.48 to 4.05 +/- 0.87 mg/dl by allopurinol and benzbromarone, respectively. The efficacy of benzbromarone in lowering serum uric acid level was significantly superior to allopurinol (p=0.005). No patient reported clinical side effects during treatment with either drug. In conclusion, the authors have shown that benzbromarone is more effective than allopurinol in the reduction of serum uric acid levels in hyperuricemic patients with normal renal function.