Upper Respiratory Tract Symptoms, Renal Involvement and Vasculitis: A Case Report and Review of Wegener Granulomatosis

Wegener’s Granulomatosis is a condition associated with systemic vasculitis which can present with upper respiratory tract symptoms initially. On September 2001, a 15-year-old girl presented with symptoms of nasal block for 3 weeks. She later developed joint pains and worsening renal status requiring dialysis. A renal biopsy was performed which showed pauci-immune cresentric glomerulonephritis. Her cANCA levels were positive. She was treated with oral cyclophosphamide and steroids and later responded

Septic Arthritis in Rheumatology: Review of Five Cases

This report illustrates five cases of patients admitted to medical ward in HUKM, diagnosed and treated as septic arthritis over the course of two months. Their age ranged from 32 to 67 years old with one patient had history of monoarticular pain and the other four had polyarticular pain. Two of these patients had pre-existing joint disease, namely gouty arthritis and rheumatoid arthritis, and another patient with background history of mixed connective tissue disease on long term steroid therapy. The diagnosis of septic arthritis was made mainly from clinical assessment, supported by synovial fluid assessment and blood investigations. All patients received minimum of two weeks intravenous antibiotic followed by one month course of antibiotic. All of them had arthrocentesis for diagnostic and therapeutic purposes and two had laparoscopic arthroscopy with wash out done

MEDICATION ADHERENCE STATUS AMONG RHEUMATOID ARTHRITIS PATIENTS

Objective: Rheumatoid arthritis (RA) is a common disease affecting about 5 in 1,000 people in Malaysia. Medication adherence among RA patients can be as low as 30% and non-adherence of disease modifying anti-rheumatic drugs (DMARD) may result in irreversible joint damage. This study aimed to assess adherence rates and to identify potential factors influencing adherence.Methods: A cross-sectional study was conducted at Rheumatology Clinic of a tertiary hospital for 8 w from May to June 2014. A total of 51 RA patients using DMARD were recruited in this study. Researcher-assisted questionnaires were utilized. The study assessed adherence by using Compliance Questionnaire on Rheumatology (CQR5) and data retrieved from pharmacy dispensing records which were measured using Medication Possession Ratio (MPR). Questionnaires to assess beliefs about medicines and satisfaction about medicine information were also used. Subsequently, associations between adherence and demographics, socioeconomics, medication, disease and patient-related factors were determined.Results: The response rate was 75%. Depending on the instruments used, 75% (CQR5) and 60% (MPR) of the patients were adherent to DMARD. Non-adherence was not associated with demographic, socioeconomic and clinical characteristics, satisfaction about medication information and medication concerns. Beliefs about the necessity of medication (r = 0.372; p = 0.007) and necessity-concerns differential (r = 0.439; p = 0.001) were moderately associated with adherence.Conclusion: Patient-related factor was associated with medication adherence in our study population. The necessity-concerns differential of medication beliefs may serve as a possible screening tool for non-adherence or target for adherence-improving intervention among RA patients.Keywords: Rheumatoid arthritis, Medication adherence, Medication beliefs, DMAR

Case Review of Sarcoidosis Resembling Sjogren's Syndrome

We would like to report a case of a 29-year-old male patient who presented with multiple lymphadenopathy and vague symptoms of low grade fever, cough, weight loss, rashes, vomiting, dry eyes and dry mouth. Physical examination revealed submandibular lymphadenopathy, vasculitic rashes over both lower limbs, and parotid gland enlargement. Blood investigations showed mild anemia with leukocytosis, predominantly eosinophilia and high erythrocyte sedimentation rate and C-reactive protein. Computed tomography of the neck, thorax and abdomen showed bilateral submandibular, submental adenopathy, mediastinal and para-aortic lymphadenopathy with generalized reticulonodular densities in both lower lobes. There were hepatomegaly and bilateral enlarged kidneys with renal cyst. Histopathological examination from the cervical lymph node later revealed non-caseating granuloma, consistent of sarcoidosis. Patient responded well to prednisolone 50 mg daily with subsequent reduction in the size of cervical lymphadenopathy and parotid swelling

Subclinical atherosclerosis among rheumatoid arthritis patients without overt cardiovascular risk factors

Objective. To determine the associated factors of subclinical atherosclerosis measured with carotid intima media thickness (CIMT) among rheumatoid arthritis (RA) patients without any overt traditional cardiovascular (CV) risk factors. Methods. Forty RA patients with matched age and gender healthy controls were recruited. Carotid ultrasound was performed to all subjects. CIMT was considered to be abnormally thickened if it was more than the 75th percentile matched for age and sex reference values. Univariate and multivariate analyses were performed to determine the association between the sociodemographics and disease characteristics of RA with thickened CIMT. Results. Abnormally thickened CIMT were observed in 11 RA patients (27.5%) and in 4 control subjects (10%), p = 0.04. It was highly prevalent among RA patients with active disease (54.5% vs 17.2%), p = 0.02. Patients with thickened CIMT also tend to have erosive disease, p = 0.06. Seropositive rheumatoid factor (RF) patients also had significantly higher CIMT values as compared with sero-negative patients, p = 0.03. Multivariable logistic regression analysis revealed that active disease was independently associated with thickened CIMT. Conclusions. RA patients are at risk for subclinical atherosclerosis despite absence of traditional CV risk co morbidities and active disease was the independent factor associated with it

Rheumatoid Arthritis: Refractory to Infliximab, a Tumor Necrosis Factor Inhibitor

Rheumatoid arthritis is one of the commonest autoimmune diseases. It is a chronic, progressive, systemic inflammatory disorder affecting the synovial joints and typically producing symmetrical arthritis. If left untreated, it leads to joint destruction and thus deformity and disability

Cardiovascular risks and primary interventions among treated rheumatoid arthritis patients: Experience from a tertiary care centre in Kuala Lumpur, Malaysia

Purpose: To investigate the cardiovascular risk among treated rheumatoid arthritis (RA) patients to predict the factors associated with high cardiovascular risk and to determine the presence of pharmacotherapy primary prevention among treated RA patients with high cardiovascular disease (CVD) risk.Methods: The study was a prospective cross-sectional study on adult patients diagnosed and treated for RA and without established heart disease/stroke. Cardiovascular risk scoring was based on Framingham Cardiovascular Disease 10-year risk prediction model (BMI model) x 1.5 factor while descriptive and inferential analyses were done using SPSS.Results: High CVD risk was defined as FRS-CVD cardiovascular risk categories (>20%) and 55.9% of patients were at high CVD risk. Use of Hydroxychloroquine (OR: 0.44; 95 % CI: 0.21- 0.92; p= 0.028) and COX-2 inhibitors (OR: 0.31; 95% CI:0.10- 0.95; p = 0.039) were found to be significantly associated with high CVD risk among treated RA patients. Significant number of high CVD risk patients did receive pharmacotherapy primary prevention (p = 0.001).Conclusion: Hydroxychloroquine and COX-2 inhibitors are independent negative risk predictors associated with high CVD risk among treated RA patients. Baseline cardiovascular risk data may be useful in rational use of medications to treat RA, considering that cardiovascular related mortality is the leading cause of death in RA

Impact of rheumatoid arthritis functional status on oral and periodontal health in a multi-ethnic population

Periodontal disease (PD) has both been associated with the pathogenesis of Rheumatoid Arthritis (RA) and is also a comorbidity of RA. The aim of this study was to investigate the impact of the functional status of RA on oral and periodontal health in a multi-ethnic population. This is a hospital-based, multi-ethnic, observational study. Duration of illness, Disease Activity Score (DAS28), seropositivity and other rheumatological parameters were obtained from the records of RA patients attending the Rheumatology Clinic. Oral health examination was conducted on the subjects. Their functional status was assessed using the Health Assessment Questionnaire (HAQ) which includes categories in ‘dressing’, ‘rising’, ‘eating’, ‘walking’, ‘hygiene’, ‘reach’, ‘grip’ and ‘usual activities’. Data were analysed using ANOVA or Kruskal-Wallis test and Pearson’s Correlation or Spearman’s Rank Correlation Test. The 63 RA patients recruited had a mean disease duration of 10.7 ± 9.85 years with a mean of 19.9 teeth (± 7.18). The severity of PD worsens the longer the patients were suffering from RA (p=0.028). A high frequency (70%) of PD with 27% moderate and 27% severe, was observed. A significant association (p=0.035) was found between the ‘eating’ category of the HAQ and the average periodontal pocket depth. This study shows that there is a higher prevalence and severity of PD among RA patients in the selected population. The impact of functional status on periodontal health is mostly in the ‘eating’ category of the HAQ where patients reporting a disability in eating had higher average periodontal pocket depth

Stigma and posttraumatic growth among COVID-19 survivors during the first wave of the COVID-19 pandemic in Malaysia: a multicenter cross-sectional study

BackgroundContracting COVID-19 can cause negative and distressing psychological sequelae, but traumatic stressors may also facilitate the development of positive psychological change beyond an individual’s previous level of adaptation, known as posttraumatic growth (PTG). As a result, studies have investigated the negative effects of COVID-19 on mental health, but data on PTG among patients who have recovered from COVID-19 remains limited. This study aims to evaluate the level of PTG and its associations with stigma, psychological complications, and sociodemographic factors among COVID-19 patients 6 months post-hospitalization.MethodA cross-sectional online survey of 152 COVID-19 patients was conducted after 6 months of being discharged from Hospital Canselor Tuanku Muhriz, MAEPS Quarantine Center, or Hospital Sungai Buloh, Malaysia. Patients completed a set of questionnaires on sociodemographic and clinical data. The Posttraumatic Growth Inventory (PTGI-SF) was used to assess the level of PTG, the Kessler Psychological Distress (K6) was used to measure the degree of psychological distress, the General Anxiety Disorder-7 (GAD-7) was used to evaluate the severity of anxiety symptoms, the Patient Health Questionnaire (PHQ-9) was used to assess the severity of depression symptoms, and the Explanatory Model Interview Catalog Stigma Scale (EMIC-SS) was used to record the degree of perceived stigma toward COVID-19.ResultsThe median PTGI SF score of the respondents was 40.0 (Interquartile range 16.0). Multivariable general linear model with bootstrapping (2,000 replications) revealed factors that significantly predicted PTG, which were at the higher level of the perceived stigma score, at 37 (B = 0.367, 95% CI = 0.041 to 0.691, p = 0.026), among the Malay ethnicity (B = 12.767, 95% CI 38 = 7.541 to 17.993, p < 0.001), retirees (B = −12.060, 95% CI = −21.310 to −2.811, p = 0.011), and those with a history of medical illness (B = 4.971, 95% CI = 0.096 to 9.845, p = 0.046).ConclusionExperiencing stigma contributed to patients’ PTG in addition to psychosocial factors such as ethnicity, history of medical illness, and retirement

Stigma, Sociodemographic Factors, and Clinical Factors Associated with Psychological Distress among COVID-19 Survivors during the Convalescence Period : A Multi-Centre Study in Malaysia

High rates of psychological distress among COVID-19 survivors and stigmatisation have been reported in both early and late convalescence. This study aimed to compare the severity of psychological distress and to determine the associations among sociodemographic and clinical characteristics, stigma, and psychological distress among COVID-19 survivors across two different cohorts at two different time points. Data were collected cross-sectionally in two groups at one month and six months post-hospitalisation among COVID-19 patient from three hospitals in Malaysia. This study assessed psychological distress and the level of stigma using the Kessler Screening Scale for Psychological Distress (K6) and the Explanatory Model Interview Catalogue (EMIC) stigma scale, respectively. At one month after discharge, significantly lower psychological distress was found among retirees (B = −2.207, 95% confidence interval [95% CI] = −4.139 to −0.068, p = 0.034), those who received up to primary education (B = −2.474, 95% CI = −4.500 to −0.521, p = 0.014), and those who had an income of more than RM 10,000 per month (B = −1.576, 95% CI = −2.714 to −0.505, p = 0.006). Moreover, those with a history of psychiatric illness [one month: (B = 6.363, 95% CI = 2.599 to 9.676, p = 0.002), six months: (B = 2.887, CI = 0.469–6.437, p = 0.038)] and sought counselling services [one month: (B = 1.737, 95% CI = 0.385 to 3.117, p = 0.016), six months: (B = 1.480, CI = 0.173–2.618, p = 0.032)] had a significantly higher severity of psychological distress at one month and six months after discharge from the hospital. The perceived stigma of being infected with COVID-19 contributed to greater severity of psychological distress. (B = 0.197, CI = 0.089–0.300, p = 0.002). Different factors may affect psychological distress at different periods of convalescence after a COVID-19 infection. A persistent stigma contributed to psychological distress later in the convalescence period