2021 Asia-Pacific League of Associations for Rheumatology clinical practice guideline for treatment of gout.

BACKGROUND: Gout is the most prevalent inflammatory arthritis in the Asia-Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions. METHODS: Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi-sectoral consensus panel formulated the final recommendations. RESULTS: The Asia-Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate-lowering therapy (3 statements), urate-lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non-responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non-pharmacologic interventions (5 statements). CONCLUSION: Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.

Survey of rheumatologists on the use of the Philippine Guidelines on the Screening for Tuberculosis prior to use of Biologic Agents.

BACKGROUND: The use of biologic agents has become an important option in treating patients with rheumatoid arthritis. However, these drugs have been associated with an increased risk of tuberculosis (TB) reactivation. Local guidelines for TB screening prior to the use of biologic agents were developed to address this issue. AIM: This study is a survey describing the compliance of Filipino rheumatologists to these guidelines. METHOD: Eighty-seven rheumatologists in the Philippines were given the questionnaire and responses from 61 rheumatologists were included in the analysis. RESULTS: All respondents agree that patients should be screened prior to giving the biologic agents. Local guidelines recommend screening with tuberculin skin test (TST) and chest radiograph. However, cut-off values considered for a positive TST and timing of initiation of biologic agents after starting TB prophylaxis and treatment varied among respondents. In addition, screening of close household contacts were only performed by 41 (69.5%) respondents. There were 11 respondents who reported 16 patients developing TB during or after receiving biologic agents, despite adherence to the guidelines. CONCLUSION: This survey describes the compliance rate of Filipino rheumatologists in applying current local recommendations for TB screening prior to initiating biologic agents. The incidence of new TB cases despite the current guidelines emphasizes the importance of compliance and the need to revise the guidelines based on updated existing literature.

A Filipino with systemic lupus erythematosus-scleroderma overlap syndrome

BACKGROUND: Overlap syndrome is a large group of condition that manifests with symptoms from two or more autoimmune conditions and satisfies the diagnostic criteria of at least two connective tissue diseases in the same patient. This condition might be unrecognized by the primary care physician and underreported.CASE: A 30-year-old female had a 10-week history of non-pruritic erythematous macules on her face that gradually spread to her trunk, and upper extremities which progressed to hyperpigmented macules and tightening of the skin. There was note of hair loss, anemia, ulcerating wounds on distal extremities and finger tips. She then developed generalized body weakness and easy fatigability. Physical and laboratory examinations were consistent with SLE and scleroderma. 2D-echocardiogram showed a large pericardial effusion and pulmonary hypertension. She was treated with prednisone and azathioprine which in less than a week, diminished significantly the pericardial effusion. Patient also complained of a few day history of unilateral blurring of vision which turned out to be central retinal artery occlusion.CONCLUSION: Overlap syndrome is a disease entity to consider in patients with multiple symptoms that cannot be classified into one connective tissue disease. Treatment of this disease should be individualized and based on the connective tissue diseases involved.