Immunoglobulin G4 (IgG4) related lung disease is an emerging entity. We report a case of a 42-year-old man presented with fever and cough with minimal sputum. Chest X-ray revealed diffuse reticulonodular shadows. Extensive investigations were performed, including video-assisted thoracoscopic lung biopsy, which confirmed the diagnosis of IgG4-related disease (IgG4-RD) with lung involvement. This case report aims to illustrate that IgG4-related lung involvement can present as diffuse lung nodules and can affect different pulmonary structures. IgG4-RD should always be considered when a similar scenario is encountered.
Axial spondyloarthritis (SpA) is a spectrum of chronic inflammatory rheumatologic diseases commonly presenting with symptoms of inflammatory back pain, peripheral joint pain, and fatigue. When compared to the general population, patients with SpA have higher prevalence of depression and anxiety symptoms. Poor psychological status is associated with worse disease activity, poorer functional status, poor treatment adherence, and unhealthy lifestyle choices such as cigarette smoking. The Chinese-bilingual Hospital Anxiety and Depression Scale (HADS) is a validated tool to screen depression and anxiety in patients with axial SpA. The cytokine theory of depression may explain emerging evidence on the mutually beneficial effects of antidepressants on disease outcomes and anti-tumor necrosis factor α (TNFα) therapy on psychological status.
Majority of rheumatic diseases are complex and multifactorial in etiology. Emerging studies has suggested that the change of human microbiota, especially in the gut, play a pivotal role in its pathogenesis. Dysequilibrium of the gut microbiota triggers the imbalance between pro- and anti- inflammatory immune responses and results in different rheumatic manifestations, such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). In this article, current and future role of the human gut microbiota in rheumatic diseases are discussed.
Ho So, Tak-Lung Wong, Hin Ting Pang, Weng Nga Lao and Man-Lung Yip
We report a case of 50-year-old female patient with adult-onset Still’s disease (AOSD) complicated by macrophage-activation syndrome (MAS). After initial control of the disease with high-dose parenteral corticosteroids, tocilizumab (TCZ) therapy aided in maintaining the remission with rapid tapering of steroid dose. TCZ may be useful for MAS complicating AOSD.
Rheumatoid arthritis (RA) is the most common rheumatic disease being managed by the rheumatologists. With the emergence of the biologic and targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs), the prognosis of RA has improved substantially. However, these novel agents are associated with high cost and untoward effects. International consensus statements for the drug management of RA have been published to guide the practice of rheumatologists. In this article, updates from the 2016 EULAR management recommendations for RA are reviewed and discussed within the context of our local situation in Hong Kong.
Though ANA is a common test requested in several settings, one may not be aware of the potential traps for interpretation. Nowadays, there is a trend for autoantibodies diagnostics to move from traditional time honored manual methods to high throughput automated platforms. Nevertheless, the clinical significance and assay performance characteristics may be different from those “historical” methods. Though indirect immunofluorescence is the gold standard method for ANA tests, different laboratories vary in the slides (from different cell lines and commercial source, e.g., Hep 2, Hep 2000, etc.), screening dilutions, terminology, reporting format and expertise. Hence, discrepancy in results among different laboratories is not uncommon and could be confusing. Knowing the assay characteristic and limitations helps proper results interpretation and facilitate patient’s management. Indeed, the titer and pattern by indirect immunofluorescence do provide valuable information in screening patients. In particular, DFS pattern with the associated anti-DFS70 antibodies has been shown to have a role to risk stratify cases referred for suspected autoimmune rheumatic disease.
Primary Sjogren’s syndrome (SS) is a systemic autoimmune disease that primarily affects the exocrine glands, resulting in dryness of the mucosal membranes, particularly of the eyes and mouth. Considerable advance has been made for the classification and treatment of primary SS in the past few years. This article reviews the recent classification criteria for primary SS and briefly discusses the conventional and novel therapies of the disease.
Chi Chiu Mok, Hoon-Suk Cha, Emmanuel C Perez, Gregory J Tsay and Kam Hon Yoon
To estimate the prevalence of impaired morning function (IMF) in rheumatoid arthritis (RA), and to understand physicians’ and patients’ perceptions on the impact of IMF and treatment in selected Asian countries.
A survey on the impact of IMF was conducted in Asia on rheumatologists and patients with moderate-to-severe RA who experienced IMF for ≥3 mornings a week. Participants underwent comprehensive face-to-face interviews using structured questionnaires.
Sixty physicians and 300 patients from Hong Kong, Philippines, Singapore, South Korea, and Taiwan were surveyed. Rheumatologists estimated that two-thirds of patients with RA experienced IMF and believed that the prevalence of IMF increased with RA severity (present in 42%, 73%, and 87% of patients with mild, moderate, and severe disease, respectively). Patients’ survey revealed that, on an average, patients with RA experienced IMF 5 days a week for 2 h each day. Thirty-eight percent of patients with RA considered a reduction in morning stiffness as an important treatment goal, but this was agreed by only 3% of rheumatologists. Only 22% of rheumatologists modified the treatment regimen specifically for IMF. Physicians considered prednisolone and other glucocorticoids (GCs) to be the most effective medication for the treatment of IMF. Fifty-one percent of patients with RA did not find their current medication effective in relieving IMF, and as a result, they reported negative emotions such as frustration, defeat, and anger, and 56% had missed work because of this symptom.
IMF is prevalent in RA and significantly affects patients’ quality of life (QoL). A higher proportion of patients compared to physicians view the reduction of morning stiffness as an important goal. More should be done to address the dissonance between physicians’ and patients’ views on IMF.