The aim of this study was to analyse the clinical characteristics of patients with rheumatoid arthritis receiving biologics therapy and investigate the association between types of biologics and tuberculosis (TB) infections in 13 tertiary hospitals in Malaysia.
Abstract FBN1 gene encodes for the connective tissue protein fibrillin‐1 which can also regulate the profibrotic cytokine transforming growth factor (TGF)‐ß1. Mutations in the FBN1 gene cause Marfan syndrome (MFS), a genetic condition with defective connective tissues. FBN1 haplotypes and single nucleotide polymorphisms have also been reported to be associated with systemic sclerosis (SSc), a connective tissue disease characterized by fibrosis of multiple organs. Furthermore, the duplication of the Fbn1 gene causes a SSc‐like disease in the TsK1 mouse model. To the best of our knowledge, there are no reports of MFS and SSc co‐existing in a patient. Here, we describe a 46‐year‐old woman who presented with cardiac failure. She had a family history of MFS. Physical examination revealed marfanoid habitus and scleroderma features. Echocardiography demonstrated dilated cardiomyopathy with aortic root dilatation, aortic regurgitation and mitral regurgitation. Cardiac magnetic resonance imaging was consistent with dilated cardiomyopathy, mid‐wall fibrosis at basal septal wall and dilated aortic root. Extractable nuclear antigen panel detected anti‐Scl 70. She fulfilled Ghent criteria for MFS and satisfied American College of Rheumatology/ European League Against Rheumatism classification criteria for SSc. Although we do not have the FBN1 sequence in our patient, the co‐existence of MFS and SSc in this patient raises the possibility of co‐existence of distinct mutations in the FBN1 gene that could affect TGF‐β signaling differently, resulting in divergent pathologic consequences – loss of structural integrity in MFS versus increased extracellular matrix deposition in SSc, and different clinical manifestations.
Ankylosing spondylitis (AS) is a chronic spinal inflammatory disorder which leads to progressive fusion and deformity. The loss of spinal mobility is recognised as an important clinical sign. The BASMI, a composite index of spinal mobility is used internationally in clinical practice and research. However, the interpretation of BASMI has been impeded by the absence of normative values.
Objectives
We aimed to attain the normative values for BASMI in Malaysian healthy individuals.
Methods
BASMI data of 142 healthy individuals and 187 AS patients were analysed. Each BASMI component was assessed, using the 10-point scoring system, where zero is no mobility and 10 is very severe limitation. Measurements were performed by the rheumatologists and trained researchers following a designated protocol. Data were summarised and analysed according to sex and age groups.
Results
The total BASMI scores ranged from 0.2 to 4.2 and 0.6 to 9.6 in the healthy individuals and the AS cases, respectively. There was no significant difference for the BASMI median score between healthy men and women (men=1.2, women=1.6, p>0.05). The estimated median score for healthy individuals aged 15–19 years was 1.2, increasing with age to 2.7 for healthy individuals aged ≥60 years. In AS cases, the estimated median score was 5.4 and 5.8 for men and women, respectively (p>0.05). We observed significant increase of estimated median score between AS patients aged 15–19 years (BASMI score=2.0) and AS patients aged ≥60 years (BASMI score=6.4) (p<0.05).
Conclusions
Our data suggest that it is uncommon for healthy individuals to score zero on the BASMI. The magnitude of increase in BASMI score is apparent with increasing age, but not sex in the healthy individuals. Establishment of normative values may aid baseline measurement and monitor change of spinal mobility in AS patients over time, as well as help assess the impact of clinical interventions.
To determine the prevalence, correlates and independent predictors of self-reported depression, anxiety and stress in Rheumatoid arthritis (RA) patients in Hospital Melaka.This was a cross-sectional survey using convenient sampling of 192 RA patients who attended the Rheumatology Clinic outpatient appointment, Hospital Melaka from June 2013 to December 2013. Depression, Anxiety and Stress Scale (DASS21) questionnaire was used to evaluate symptoms of depression, anxiety and stress. RA disease activity was assessed using the DAS28-ESR formula. Functional status was assessed via the Health Assessment Questionnaire Disability Index (HAQ-DI).Out of 189 completed questionnaires, 46%(n=86) patients reported psychological distress symptoms, and 25%(n=48) experienced more than one negative emotional states. The prevalence of depression, anxiety and stress among our patients were 23.3%(n=44), 42.3%(n=80) and 20.1%(n=38) respectively. There were significant positive correlations (p<0.05) between these psychological symptoms with disease activity, number of tender joints, general health, pain and HAQ score. Age was inversely correlated with depression, anxiety and stress. Higher number of swollen joints correlated positively with depression but not with anxiety and stress. HAQ was the only independent predictor for depression (Odds Ratio [OR]=2.07; 95%CI: 1.19 to 3.61) and anxiety (OR=1.81; 95%CI: 1.1 to 3.0) whilst pain was found to be independent predictor for stress (OR=1.04; 95%CI: 1.0 to 1.1).The incidence of depression and anxiety in our Malaysian sample of RA patient was comparable to that observed in Caucasian populations. Functional status was an independent predictor of depression and anxiety, whereas pain was an independent predictor of stress.
Abstract Aim: This is a rheumatoid arthritis (RA) descriptive study, the first of its kind carried out in Malaysia. Methods: This descriptive study involved 1084 RA patients’ epidemiological and clinical data taken from Selayang, Putrajaya, Taiping and Seremban hospitals from June 2004 to December 2005. Results: One thousand and eighty‐four RA patients'data were analysed; 960 (88.6%) patients were female and 124 (11.4%) were male, approximately 8 : 1 M : F ratio. The majority of the patients were Indian (591; 54.5%), followed by the Malays (340; 31.4%), Chinese (126; 11.6%), indigenous (13; 1.2%) and others (14; 1.3%). Mean age was 49.6 ± 11.8 years with the youngest being 15 years and the oldest 88 years of age. Mean age for males was 52.0 ± 12.0 and females 49.3 ± 11.7 years ( P = 0.017). Most of these patients were housewives (565; 52.1%), followed by paid workers (266; 24.5%), retired patients (80; 7.4%), unemployed (76; 7.0%) and others (97; 8.9%). Mean duration of illness was 8.4 ± 6.7 years; 805 (74.3%) patients were relatively new patients (≤ 2 years illness duration) and 279 (25.7%) patients had illness duration > 2 years. Eight hundred and six (74.4%) were seropositive RA patients and 385 (35.5%) had presence of deformity. The majority of patients were treated with methotrexate (178; 16.4%), followed by combination of methotrexate, sulfasalazine and hydroxychloroquine (143; 13.2%), leflunomide (140; 12.9%), sulfasalazine (133; 12.3%) and combination of methotrexate and sulfasalazine (108; 10%). Conclusion: In the above study, the majority of patients were female (960; 88.6%), Indian (591; 54.5%), had a mean age of 49.6 ± 11.8 years, most were housewives with a mean duration of illness of 8.4 ± 6.7 years and were treated with methotrexate (178; 16.4%). The results of the study may help Malaysian rheumaologists to understand their patients better and treat RA holistically.
Ankylosing Spondylitis (AS) is a chronic, progressive inflammatory
disorder that results in ankylosis of the vertebral column and sacroiliac
joints.
More than 30% of patients with AS carry a heavy burden of disease
and have a decreased quality of life.
The HLA-B*27 is a well known genetic risk variant for ankylosing
spondylitis (AS).
However, the degree of association varies for different subtypes and
depends on ethnicity.
Malaysia is a multi-ethnic country comprises Malays as the largest
ethnic group, followed by Chinese, Indians and mixed-ethnicities.
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