L. Tam | The Chinese University of Hong Kong (original) (raw)

Papers by L. Tam

Research paper thumbnail of Plasma DNA aberrations in systemic lupus erythematosus revealed by genomic and methylomic sequencing

Proceedings of the National Academy of Sciences of the United States of America, Jan 9, 2014

We performed a high-resolution analysis of the biological characteristics of plasma DNA in system... more We performed a high-resolution analysis of the biological characteristics of plasma DNA in systemic lupus erythematosus (SLE) patients using massively parallel genomic and methylomic sequencing. A number of plasma DNA abnormalities were found. First, aberrations in measured genomic representations (MGRs) were identified in the plasma DNA of SLE patients. The extent of the aberrations in MGRs correlated with anti-double-stranded DNA (anti-dsDNA) antibody level. Second, the plasma DNA of active SLE patients exhibited skewed molecular size-distribution profiles with a significantly increased proportion of short DNA fragments. The extent of plasma DNA shortening in SLE patients correlated with the SLE disease activity index (SLEDAI) and anti-dsDNA antibody level. Third, the plasma DNA of active SLE patients showed decreased methylation densities. The extent of hypomethylation correlated with SLEDAI and anti-dsDNA antibody level. To explore the impact of anti-dsDNA antibody on plasma DNA...

Research paper thumbnail of Predictors of functional deterioration in Chinese patients with Psoriatic arthritis: a longitudinal study

BMC Musculoskeletal Disorders, 2014

Background: Psoriatic arthritis (PsA) disease activities at baseline may determine physical funct... more Background: Psoriatic arthritis (PsA) disease activities at baseline may determine physical function over time. There is no longitudinal data on course of physical function in PsA patients from Asia. We aim to describe variables associated with a deterioration of physical function in PsA in Chinese over a 6-year period. Methods: 125 consecutive patients with PsA fulfilled the CASPAR criteria from a rheumatology outpatient center were recruited to give sociodemographic and clinical data in 2006 to 2008. Follow up interviews were conducted in 2012 to 2013 to assess physical function using Health Assessment Questionnaire (HAQ). Regression models were constructed to determine baseline variables that predict physical function on follow up. Results: A total of 97 patients completed the follow up survey, with mean follow up time of 6.2 (±0.7) years, response rate 77.6%. PsA patients had poor physical function and health related quality of life (HRQoL) compared to normal population. There were 33% who improved in disability status and 41.2% had persistent minimal disability by HAQ categories (HAQ 0-0.49) over time. There were 14.4% of the patients who had persistent moderate disability (HAQ 0.5-1.50) and 10.3% had deterioration in disability status. There were 17.5% of patients who had deterioration in physical function as defined by an increment of HAQ score of more than 0.2 at follow up survey. Age, physical function at baseline and the number of damaged joint were significantly related HAQ at follow up. Conclusion: Chinese patients with PsA had had poor physical function and quality of life. One fifth of patient experienced deterioration of physical function over time. Joint damage and baseline physical function were important factors associated with poor physical function in PsA over time.

Research paper thumbnail of Is combination rituximab with cyclophosphamide better than rituximab alone in the treatment of lupus nephritis?

Rheumatology, 2009

Objective. To assess if combination rituximab and cyclophosphamide is more effective than rituxim... more Objective. To assess if combination rituximab and cyclophosphamide is more effective than rituximab monotherapy as an induction therapy for proliferative lupus nephritis. Methods. A randomized open-label pilot study in which 9 patients received rituximab alone and 10 patients received two doses rituximab þ intravenous cyclophosphamide. The clinical, laboratory and renal histological changes were assessed after 48 weeks of treatment. Results. At week 48, four patients had a complete response, 11 patients achieved partial response, 2 patients remained the same or stable and 2 worsened. There were no statistical differences in the proportion of patients with complete or partial response between the two groups. None of the variables was an independent predictor of response at week 48. Nine patients had significant improvement in activity indices in renal biopsies, but there were no significant differences between the two groups. Overall, 18 out of 19 patients were found to have effective B-cell depletion. The median duration of complete B-cell depletion in all patients was 22 weeks. There were no statistically significant differences in the proportion of patients with complete depletion at weeks 4, 8, 24 and 48 between the two groups except at week 2. Conclusions. Rituximab monotherapy appears to be effective as induction therapy in lupus nephritis. The addition of cyclophosphamide offers no additional improvement in clinical, laboratory and renal histological assessment or the duration of B-cell depletion at 48 weeks. Large-scale studies with longer duration are needed to confirm these findings.

Research paper thumbnail of Estimation of glomerular filtration rate in patients with systemic lupus erythematosus

Lupus, 2006

The objective of this study was to compare the limit of agreement of creatinine clearance (CrCl) ... more The objective of this study was to compare the limit of agreement of creatinine clearance (CrCl) estimated by different equations with the CrCl measured by 24-hour urine collection in Hong Kong Chinese patients with systemic lupus erythematosus (SLE). Forty-three SLE patients with mild to moderate renal impairment (serum creatinine concentration 80 mol/L to 300 mol/L for females; and 106 mol/L to 300 mol/L for males) and not requiring renal replacement therapy were assessed. The estimated clearances were calculated by the Cockcroft-Gault (CG) equation, the Modification of Diet in Renal Disease (MDRD) study equation and the abbreviated MDRD (aMDRD) study equation. The estimated clearances were compared against the measured CrCl by 24- hour urine collection for their limit of agreement. Forty-three patients with mean (SD) age of 41.6 (8.4) years were assessed. As compared to the measured CrCl in patients with SLE, the clearances by CG equation, MDRD and aMDRD equations predicted a mea...

Research paper thumbnail of Decreased Expression of T Lymphocyte Co-Stimulatory Molecule CD26 on Invariant Natural Killer T Cells in Systemic Lupus Erythematosus

Immunological Investigations, 2009

CD26, a T cell co-stimulatory molecule and dipeptidyl peptidase IV for the degradation of interfe... more CD26, a T cell co-stimulatory molecule and dipeptidyl peptidase IV for the degradation of interferon-gamma-induced chemokine, participates in multiple immunopathological roles in leukocyte homing and inflammation. Decreased circulating concentration of soluble (s)CD26 in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis and murine model of arthritis and encephalomyelitis have been reported. In the present study, the plasma concentration of sCD26 and chemokines, and cell surface expression of CD26 on monocytes, CD4+T lymphocytes, CD8+T lymphocytes, CD19+B lymphocytes and invariant natural killer T (iNKT) lymphocytes were analyzed using ELISA and flow cytometry, respectively, in 23 SLE patients and 14 sex- and age-matched control subjects. Although there was no significant difference between plasma concentrations of soluble CD26 in SLE patients with controls (p > 0.05), there was significant elevated Th1 chemokines CXCL10 and CXCL9 but not Th2 chemokine CCL2, and down-regulation in iNKT lymphocytes number and cell surface expression of CD26 on CD4+T and iNKT lymphocytes of SLE patients compared with controls (all p < 0.05). Decreased circulating number of iNKT cells and CD26 on iNKT cells can be important for the immunopathogenesis by exacerbating Th1-related inflammation in SLE.

Research paper thumbnail of Activation profile of Toll-like receptors of peripheral blood lymphocytes in patients with systemic lupus erythematosus

Clinical and Experimental Immunology, 2010

Summary Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with aberr... more Summary Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with aberrant activation of T and B lymphocytes for the production of inflammatory cytokines and autoreactive antibodies. Animal studies of SLE have indicated that Toll-like receptors (TLR) are important in the pathogenesis of murine lupus. In the present clinical study, differential protein expressions of TLR-1–9 of monocytes and different lymphocyte subsets from patients with SLE and normal control subjects were determined by flow cytometry. Results showed that the expression of intracellular TLRs (TLR-3, -8, -9) and extracellular TLRs (TLR-1, -2, -4, -5, -6) were elevated in monocytes, CD4+ T lymphocytes, CD8+ T lymphocytes and B lymphocytes of SLE patients compared to control subjects (all P < 0·001). Moreover, cell surface expression of TLR-4 on CD4+ T lymphocytes and CD8+ T lymphocytes, and TLR-6 on B lymphocytes, were correlated positively with SLE disease activity index (SLEDAI) (TLR-4 ...

Research paper thumbnail of Expression of chemokine and fibrosing factor messenger RNA in the urinary sediment of patients with lupus nephritis

Arthritis & Rheumatism, 2004

Lupus nephritis is characterized by intrarenal inflammation. To assess the extent and severity of... more Lupus nephritis is characterized by intrarenal inflammation. To assess the extent and severity of disease activity and renal involvement, this study examined the expression of transforming growth factor beta (TGFbeta) and monocyte chemoattractant protein 1 (MCP-1) in the urinary sediment of patients with systemic lupus erythematosus (SLE). We studied 106 patients with SLE who were classified according to their disease status as those with active disease, those with disease in remission, and those with nonrenal SLE. Ten healthy subjects were used as controls. Lupus activity was assessed by the SLE Disease Activity Index (SLEDAI). If renal biopsy was performed, the histologic activity index and chronicity index were determined, and a morphometry analysis of renal scarring was performed. The urinary expresssion of TGFbeta and MCP-1 messenger RNA (mRNA) was studied by real-time quantitative polymerase chain reaction, and the corresponding protein concentrations of TGFbeta and MCP-1 in the urine were measured by enzyme-linked immunosorbent assay (ELISA). Expression of TGFbeta and MCP-1 mRNA in the urinary sediment was significantly elevated in the active disease group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 for both). These expression levels of TGFbeta and MCP-1 mRNA correlated with the SLEDAI score (TGFbeta r = 0.71, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; MCP-1 r = 0.72, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and also significantly correlated with the histologic activity index (TGFbeta r = 0.487, P = 0.004; MCP-1 r = 0.357, P = 0.038). The urinary protein concentration of MCP-1, but not of TGFbeta, correlated with the SLEDAI score (r = 0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, neither the protein concentration of TGFbeta nor that of MCP-1 as measured by ELISA in the urine correlated with the histologic activity index. The measurement of urinary mRNA expression may be a noninvasive method for the assessment of lupus disease activity and the severity of renal involvement in patients with lupus nephritis.

Research paper thumbnail of Tumour necrosis factor alpha blockade is associated with sustained regression of carotid intima-media thickness for patients with active psoriatic arthritis: a 2-year pilot study

Annals of the Rheumatic Diseases, 2010

Research paper thumbnail of Effect of treat-to-target strategies on bone erosion progression in early rheumatoid arthritis: An HR-pQCT study

Seminars in arthritis and rheumatism, Jan 3, 2018

To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease... more To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease activity score [SDAI] remission (SDAI ≤ 3.3) compared to DAS28 remission (DAS28 < 2.6) on progression of bone erosions in early rheumatoid arthritis (ERA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). This was an open-label study in which 80 early RA patients were randomized to receive 1-year of tight-control treatment. Group 1 (n = 37) aimed at SDAI ≤ 3.3 and group 2 (n = 43) aimed at DAS28-CRP < 2.6. The number and size of bone erosions, as well as the bone mineral density (BMD) surrounding bone erosion at the second metacarpophalangeal joint (MCP2), were measured at baseline and 12 months. After 12 months, images were analyzed in 63 patients. Changes in clinical parameters, number and size of bone erosions as well as the BMD surrounding bone erosion between the two treatment groups were similar. Therefore, a post-hoc analysis including al...

Research paper thumbnail of Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis

Rheumatology, 2008

Objective. To examine the involvement in care, participation in medical decision, satisfaction of... more Objective. To examine the involvement in care, participation in medical decision, satisfaction of health care and unmet needs in patients with PsA. To explore factors related to involvement and satisfaction with care. Methods. One hundred and five patients with PsA attending four regional hospital rheumatology outpatient clinics were invited and consented to self-administer questionnaires, including socio-demographic data, quality of life with SF-12, involvement in medical decision, satisfaction with care and unmet health care needs. Results. The overall perceived knowledge of disease was moderate. Good disease knowledge and good physical functioning were positively associated with involvement in care. Age, sex and pain scores were not associated with involvement in multivariate analysis. A low score in at least one question on involvement was the single independent negative predictor for satisfaction with health care. Only a minority (9%) was actively participating in medical decision-making. Among non-participants, 61.5% expressed the wish to participate. In aspects of education of disease, advice for exercise, psychological support and social support, respectively, 68.3, 73.3, 29.3 and 41.6% of the patients expressed unmet needs. Conclusion. Low involvement is negatively associated with satisfaction with health care in PsA. Good knowledge of disease and good physical functioning is positively associated with involvement. The current study supports patient education as an important factor associated with involvement of and satisfaction with care in PsA patients. Such patients have a high desire for information and numerous unmet health care needs. There is a need for improvement in the delivery of care to patients with PsA.

Research paper thumbnail of Psoriatic arthritis as a distinct disease entity

Journal of Postgraduate Medicine, 2007

and Geriatrics. Taipo Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease charac... more and Geriatrics. Taipo Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease characterized by joint inflammation associated Hospital, and *Division of Rheumatology, with cutaneous psoriasis. For many years, the amount of attention directed to PsA had been less than that for Department of Medicine various other arthropathies. With the advances in understanding its pathogensis, it is now recognized as a and Therapeutics, The distinct disease entity with characteristic features. Psoriatic arthritis has a greater tendency towards asymmetric Chinese University of oligoarticular involvement, distal interphalangeal involvement and spondylitis. Associated features such as

Research paper thumbnail of Impact of illness and variables associated with functional impairment in Chinese patients with psoriatic arthritis

Clinical and experimental rheumatology

To assess the impact of disease and functional outcomes in Chinese patients with psoriatic arthri... more To assess the impact of disease and functional outcomes in Chinese patients with psoriatic arthritis (PsA) and to identify variables associated with poor functional outcomes. A cross sectional study performed in 80 consecutive patients with PsA from a single center. Functional outcomes were assessed by the Health Assessment Questionnaire (HAQ) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical variables included social-demographic characteristics and clinical features. Linear regression analyses were performed to identify variables associated with functional impairment. Thirty-six men and 44 women with mean (+/-SD) age and duration of arthritis of 48.6 (+/-13.0) and 10.2 (+/-6.9) years were studied. One-third reported PsA related unemployment and change in job nature. Another third experienced a reduction of income due to PsA. The median (IQR) HAQ and BASFI were 0.44 (1.09) and 2.1 (4.38). These functional scores correlated highly with each other and with the pat...

Research paper thumbnail of Psoriatic arthritis in Hong Kong

Objectives: To study the clinical features and disease burden in patients with psoriatic arthriti... more Objectives: To study the clinical features and disease burden in patients with psoriatic arthritis (PsA) in Chinese. Methods: A cross-sectional study on clinical features, laboratory data and radiography in patients with PsA in rheumatology clinics. Results: One hundred and twenty seven patients studied with mean (±SD) duration of PsA 11.58 (±7.47) years. Symmetrical polyarthritis developing in the third decade with an equal male to female ratio was the commonest pattern of arthritis. Seventy percent of patients required disease modifying antirheumatic drugs (DMARDs) and 21.3% had used two or more DMARDs. at some time for control of joint disease. Clinical classification identified predominant axial disease (AD) and predominant peripheral disease (PD) in 11% and 89% respectively; while radiographical classification identified AD and peripheral disease PD in 36.2% and 63.8%. Radiographic sacroiliitis were asymptomatic in 43%. A third of patients (33%) stopped working because of the disease. Patients with PsA had severe impairment of quality of life as compared to the normal population in Hong Kong. Differentiation into axial or peripheral disease by either classification systems did not affect quality of life outcomes and disease burden. Conclusion: The commonest pattern of PsA in Chinese was symmetrical polyarthritis. Patients with PsA were associated with a high disease burden and poor quality of life. More studies should be done to find out the predictors for poor prognosis in order to improve the quality of life for these patients.

Research paper thumbnail of Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong

Scandinavian Journal of Rheumatology, 2002

To determine the risk factors associated with and to describe the clinical course of tuberculosis... more To determine the risk factors associated with and to describe the clinical course of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Clinical features of patients with TB during the 1-year period prior to the diagnosis of TB were compared with controls. Of the 526 SLE patients, 57 (11%) had TB. Extra-pulmonary or miliary TB occurred in 67%. Patients with TB were more likely to have organic brain syndrome, vasculitis, and nephritis: and they were also more likely to have received intravenous &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;pulse&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; methylprednisolone or high cumulative dose of prednisolone. The cumulative dose of prednisolone and presence of nephritis were independent risk factors for the development of TB using multivariate regression analysis. There is a high prevalence of TB, especially extra-pulmonary diseases, among SLE patients in Hong Kong. High cumulative dose of corticosteroid and lupus nephritis are important risk factors for the development of TB.

Research paper thumbnail of Serum and urinary free microRNA level in patients with systemic lupus erythematosus

Lupus, 2011

MicroRNAs circulating in body fluid have been suggested as biomarkers of various diseases. We stu... more MicroRNAs circulating in body fluid have been suggested as biomarkers of various diseases. We studied the serum and urinary level of several miRNA species (miR-200 family, miR-205 and miR-192) in patients with systemic lupus erythematosus (SLE). We studied 40 SLE patients. Serum and urinary miRNA levels were determined and compared with that of healthy controls. The serum levels of miR-200a, miR-200b, miR-200c, miR-429, miR-205 and miR-192, and urinary miR-200a, miR-200c, miR-141, miR-429 and miR-192 of SLE patients were lower than those of controls. Glomerular filtration rate (GFR) correlated with serum miR-200b (r = 0.411, p = 0.008), miR-200c (r = 0.343, p = 0.030), miR-429 (r = 0.347, p = 0.028), miR-205 (r = 0.429, p = 0.006) and miR-192 (r = 0.479, p = 0.002); proteinuria inversely correlated with serum miR-200a (r = -0.375, p = 0.017) and miR-200c (r = -0.347, p = 0.029). SLE disease activity index (SLEDAI) inversely correlated with serum miR-200a (r = -0.376, p = 0.017). Serum miR-200b (r = 0.455, p = 0.003) and miR-192 (r = 0.589, p &amp;amp;lt; 0.001) correlated with platelet count, while serum miR-205 correlated with red cell count (r = 0.432, p = 0.005) and hematocrit (r = 0.370, p = 0.019). These pilot results suggested that miRNA may take part in the pathogenesis of SLE. Further studies are needed to validate the role of serum miRNA as a biomarker of SLE.

Research paper thumbnail of Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus

Lupus, 2001

The aim of this study was to determine whether early damage accrued in SLE as measured by the SLI... more The aim of this study was to determine whether early damage accrued in SLE as measured by the SLICC/ACR Damage Index predicts mortality in an inception cohort of lupus patients that have been followed prospectively in a single centre. SLE patients from the University of Toronto Lupus Clinic presenting within 1 y of their diagnosis prior to 1988 were included. This enabled all patients to be potentially followed for at least 10 y. Yearly SLICC/ACR Damage Index scores were determined for each patient. Early damage was defined as a score 1 and no damage as a score of 0 at the initial assessment. Log rank test was used to compare the survival experience between those with and without damage, with all patients being censored at 10 y. Two-hundred and sixty-three patients were identified in this inception cohort who were followed for 10 y. One-hundred and ninety patients (72%) had a SLICC/ACR Damage Index score of 0 (no damage) while 73 patients (28%) had at least one SLICC/ACR Damage Inde...

Research paper thumbnail of Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus

Lupus, 2011

Disease activity 6 months before pregnancy of patients with systemic lupus erythematosus (SLE) as... more Disease activity 6 months before pregnancy of patients with systemic lupus erythematosus (SLE) associated with adverse maternal and fetal outcomes is not well studied. The aim of the study was to identify predictors of adverse maternal and fetal outcomes in pregnant SLE patients, based on patients’ background characteristics, clinical and laboratory data 6 months before pregnancy. Of 103 pregnancies, 55 pregnancies in 39 SLE patients were investigated. Clinical and laboratory data were recorded at regular intervals from 6 months before conception to 1 year after delivery. Primary outcomes included the predictors of combined adverse maternal and fetal outcomes. Potential explanatory variables included demographic, clinical and laboratory data 6 months before conception. Using logistic regression, history of nephritis ( p = 0.001, odds ratio [OR] 13.3, 95% confidence interval [CI] 2.7–65.1) and a high SLE Disease Activity Index (SLEDAI) score 6 months before pregnancy ( p = 0.015, OR ...

Research paper thumbnail of Increased arterial stiffness correlated with disease activity in systemic lupus erythematosus

Lupus, 2008

To evaluate the relationships between arterial stiffness, disease activity and end-organ damage i... more To evaluate the relationships between arterial stiffness, disease activity and end-organ damage in systemic lupus erythematosus (SLE), non-invasive vascular assessments were made on 32 female SLE patients and 32 female normal controls. The patients had significantly increased brachial-ankle pulse wave velocity (PWV) (13.06 ± 1.79 vs. 11.50 ± 1.00 m/s; P

Research paper thumbnail of Minimal Important Difference and Responsiveness to Change of the SF-36 in Patients with Psoriatic Arthritis Receiving Tumor Necrosis Factor-  Blockers

The Journal of Rheumatology, 2011

Research paper thumbnail of Neurotoxicity following the ingestion of a Chinese medicinal plant, Alocasia macrorrhiza

Human & Experimental Toxicology, 1995

1 A case of poisoning due to the raw root tuber of a Chinese medicinal plant, Alocasia macrorrhiz... more 1 A case of poisoning due to the raw root tuber of a Chinese medicinal plant, Alocasia macrorrhiza is pre sented. 2 The patient developed neurological (severe pain and numbness in the perioral area and throat) and gastro intestinal (nausea, vomiting, abdominal pain) symptoms immediately after eating the root tuber. 3 A. macrorrhiza has properties and morphology very similar to another medical plant, A. odora. The root tuber of the latter is known to contain a neurotoxin, sapotoxin.

Research paper thumbnail of Plasma DNA aberrations in systemic lupus erythematosus revealed by genomic and methylomic sequencing

Proceedings of the National Academy of Sciences of the United States of America, Jan 9, 2014

We performed a high-resolution analysis of the biological characteristics of plasma DNA in system... more We performed a high-resolution analysis of the biological characteristics of plasma DNA in systemic lupus erythematosus (SLE) patients using massively parallel genomic and methylomic sequencing. A number of plasma DNA abnormalities were found. First, aberrations in measured genomic representations (MGRs) were identified in the plasma DNA of SLE patients. The extent of the aberrations in MGRs correlated with anti-double-stranded DNA (anti-dsDNA) antibody level. Second, the plasma DNA of active SLE patients exhibited skewed molecular size-distribution profiles with a significantly increased proportion of short DNA fragments. The extent of plasma DNA shortening in SLE patients correlated with the SLE disease activity index (SLEDAI) and anti-dsDNA antibody level. Third, the plasma DNA of active SLE patients showed decreased methylation densities. The extent of hypomethylation correlated with SLEDAI and anti-dsDNA antibody level. To explore the impact of anti-dsDNA antibody on plasma DNA...

Research paper thumbnail of Predictors of functional deterioration in Chinese patients with Psoriatic arthritis: a longitudinal study

BMC Musculoskeletal Disorders, 2014

Background: Psoriatic arthritis (PsA) disease activities at baseline may determine physical funct... more Background: Psoriatic arthritis (PsA) disease activities at baseline may determine physical function over time. There is no longitudinal data on course of physical function in PsA patients from Asia. We aim to describe variables associated with a deterioration of physical function in PsA in Chinese over a 6-year period. Methods: 125 consecutive patients with PsA fulfilled the CASPAR criteria from a rheumatology outpatient center were recruited to give sociodemographic and clinical data in 2006 to 2008. Follow up interviews were conducted in 2012 to 2013 to assess physical function using Health Assessment Questionnaire (HAQ). Regression models were constructed to determine baseline variables that predict physical function on follow up. Results: A total of 97 patients completed the follow up survey, with mean follow up time of 6.2 (±0.7) years, response rate 77.6%. PsA patients had poor physical function and health related quality of life (HRQoL) compared to normal population. There were 33% who improved in disability status and 41.2% had persistent minimal disability by HAQ categories (HAQ 0-0.49) over time. There were 14.4% of the patients who had persistent moderate disability (HAQ 0.5-1.50) and 10.3% had deterioration in disability status. There were 17.5% of patients who had deterioration in physical function as defined by an increment of HAQ score of more than 0.2 at follow up survey. Age, physical function at baseline and the number of damaged joint were significantly related HAQ at follow up. Conclusion: Chinese patients with PsA had had poor physical function and quality of life. One fifth of patient experienced deterioration of physical function over time. Joint damage and baseline physical function were important factors associated with poor physical function in PsA over time.

Research paper thumbnail of Is combination rituximab with cyclophosphamide better than rituximab alone in the treatment of lupus nephritis?

Rheumatology, 2009

Objective. To assess if combination rituximab and cyclophosphamide is more effective than rituxim... more Objective. To assess if combination rituximab and cyclophosphamide is more effective than rituximab monotherapy as an induction therapy for proliferative lupus nephritis. Methods. A randomized open-label pilot study in which 9 patients received rituximab alone and 10 patients received two doses rituximab þ intravenous cyclophosphamide. The clinical, laboratory and renal histological changes were assessed after 48 weeks of treatment. Results. At week 48, four patients had a complete response, 11 patients achieved partial response, 2 patients remained the same or stable and 2 worsened. There were no statistical differences in the proportion of patients with complete or partial response between the two groups. None of the variables was an independent predictor of response at week 48. Nine patients had significant improvement in activity indices in renal biopsies, but there were no significant differences between the two groups. Overall, 18 out of 19 patients were found to have effective B-cell depletion. The median duration of complete B-cell depletion in all patients was 22 weeks. There were no statistically significant differences in the proportion of patients with complete depletion at weeks 4, 8, 24 and 48 between the two groups except at week 2. Conclusions. Rituximab monotherapy appears to be effective as induction therapy in lupus nephritis. The addition of cyclophosphamide offers no additional improvement in clinical, laboratory and renal histological assessment or the duration of B-cell depletion at 48 weeks. Large-scale studies with longer duration are needed to confirm these findings.

Research paper thumbnail of Estimation of glomerular filtration rate in patients with systemic lupus erythematosus

Lupus, 2006

The objective of this study was to compare the limit of agreement of creatinine clearance (CrCl) ... more The objective of this study was to compare the limit of agreement of creatinine clearance (CrCl) estimated by different equations with the CrCl measured by 24-hour urine collection in Hong Kong Chinese patients with systemic lupus erythematosus (SLE). Forty-three SLE patients with mild to moderate renal impairment (serum creatinine concentration 80 mol/L to 300 mol/L for females; and 106 mol/L to 300 mol/L for males) and not requiring renal replacement therapy were assessed. The estimated clearances were calculated by the Cockcroft-Gault (CG) equation, the Modification of Diet in Renal Disease (MDRD) study equation and the abbreviated MDRD (aMDRD) study equation. The estimated clearances were compared against the measured CrCl by 24- hour urine collection for their limit of agreement. Forty-three patients with mean (SD) age of 41.6 (8.4) years were assessed. As compared to the measured CrCl in patients with SLE, the clearances by CG equation, MDRD and aMDRD equations predicted a mea...

Research paper thumbnail of Decreased Expression of T Lymphocyte Co-Stimulatory Molecule CD26 on Invariant Natural Killer T Cells in Systemic Lupus Erythematosus

Immunological Investigations, 2009

CD26, a T cell co-stimulatory molecule and dipeptidyl peptidase IV for the degradation of interfe... more CD26, a T cell co-stimulatory molecule and dipeptidyl peptidase IV for the degradation of interferon-gamma-induced chemokine, participates in multiple immunopathological roles in leukocyte homing and inflammation. Decreased circulating concentration of soluble (s)CD26 in patients with systemic lupus erythematosus (SLE), rheumatoid arthritis and murine model of arthritis and encephalomyelitis have been reported. In the present study, the plasma concentration of sCD26 and chemokines, and cell surface expression of CD26 on monocytes, CD4+T lymphocytes, CD8+T lymphocytes, CD19+B lymphocytes and invariant natural killer T (iNKT) lymphocytes were analyzed using ELISA and flow cytometry, respectively, in 23 SLE patients and 14 sex- and age-matched control subjects. Although there was no significant difference between plasma concentrations of soluble CD26 in SLE patients with controls (p &amp;amp;gt; 0.05), there was significant elevated Th1 chemokines CXCL10 and CXCL9 but not Th2 chemokine CCL2, and down-regulation in iNKT lymphocytes number and cell surface expression of CD26 on CD4+T and iNKT lymphocytes of SLE patients compared with controls (all p &amp;amp;lt; 0.05). Decreased circulating number of iNKT cells and CD26 on iNKT cells can be important for the immunopathogenesis by exacerbating Th1-related inflammation in SLE.

Research paper thumbnail of Activation profile of Toll-like receptors of peripheral blood lymphocytes in patients with systemic lupus erythematosus

Clinical and Experimental Immunology, 2010

Summary Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with aberr... more Summary Systemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with aberrant activation of T and B lymphocytes for the production of inflammatory cytokines and autoreactive antibodies. Animal studies of SLE have indicated that Toll-like receptors (TLR) are important in the pathogenesis of murine lupus. In the present clinical study, differential protein expressions of TLR-1–9 of monocytes and different lymphocyte subsets from patients with SLE and normal control subjects were determined by flow cytometry. Results showed that the expression of intracellular TLRs (TLR-3, -8, -9) and extracellular TLRs (TLR-1, -2, -4, -5, -6) were elevated in monocytes, CD4+ T lymphocytes, CD8+ T lymphocytes and B lymphocytes of SLE patients compared to control subjects (all P < 0·001). Moreover, cell surface expression of TLR-4 on CD4+ T lymphocytes and CD8+ T lymphocytes, and TLR-6 on B lymphocytes, were correlated positively with SLE disease activity index (SLEDAI) (TLR-4 ...

Research paper thumbnail of Expression of chemokine and fibrosing factor messenger RNA in the urinary sediment of patients with lupus nephritis

Arthritis & Rheumatism, 2004

Lupus nephritis is characterized by intrarenal inflammation. To assess the extent and severity of... more Lupus nephritis is characterized by intrarenal inflammation. To assess the extent and severity of disease activity and renal involvement, this study examined the expression of transforming growth factor beta (TGFbeta) and monocyte chemoattractant protein 1 (MCP-1) in the urinary sediment of patients with systemic lupus erythematosus (SLE). We studied 106 patients with SLE who were classified according to their disease status as those with active disease, those with disease in remission, and those with nonrenal SLE. Ten healthy subjects were used as controls. Lupus activity was assessed by the SLE Disease Activity Index (SLEDAI). If renal biopsy was performed, the histologic activity index and chronicity index were determined, and a morphometry analysis of renal scarring was performed. The urinary expresssion of TGFbeta and MCP-1 messenger RNA (mRNA) was studied by real-time quantitative polymerase chain reaction, and the corresponding protein concentrations of TGFbeta and MCP-1 in the urine were measured by enzyme-linked immunosorbent assay (ELISA). Expression of TGFbeta and MCP-1 mRNA in the urinary sediment was significantly elevated in the active disease group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 for both). These expression levels of TGFbeta and MCP-1 mRNA correlated with the SLEDAI score (TGFbeta r = 0.71, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; MCP-1 r = 0.72, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and also significantly correlated with the histologic activity index (TGFbeta r = 0.487, P = 0.004; MCP-1 r = 0.357, P = 0.038). The urinary protein concentration of MCP-1, but not of TGFbeta, correlated with the SLEDAI score (r = 0.66, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, neither the protein concentration of TGFbeta nor that of MCP-1 as measured by ELISA in the urine correlated with the histologic activity index. The measurement of urinary mRNA expression may be a noninvasive method for the assessment of lupus disease activity and the severity of renal involvement in patients with lupus nephritis.

Research paper thumbnail of Tumour necrosis factor alpha blockade is associated with sustained regression of carotid intima-media thickness for patients with active psoriatic arthritis: a 2-year pilot study

Annals of the Rheumatic Diseases, 2010

Research paper thumbnail of Effect of treat-to-target strategies on bone erosion progression in early rheumatoid arthritis: An HR-pQCT study

Seminars in arthritis and rheumatism, Jan 3, 2018

To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease... more To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease activity score [SDAI] remission (SDAI ≤ 3.3) compared to DAS28 remission (DAS28 < 2.6) on progression of bone erosions in early rheumatoid arthritis (ERA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). This was an open-label study in which 80 early RA patients were randomized to receive 1-year of tight-control treatment. Group 1 (n = 37) aimed at SDAI ≤ 3.3 and group 2 (n = 43) aimed at DAS28-CRP < 2.6. The number and size of bone erosions, as well as the bone mineral density (BMD) surrounding bone erosion at the second metacarpophalangeal joint (MCP2), were measured at baseline and 12 months. After 12 months, images were analyzed in 63 patients. Changes in clinical parameters, number and size of bone erosions as well as the BMD surrounding bone erosion between the two treatment groups were similar. Therefore, a post-hoc analysis including al...

Research paper thumbnail of Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis

Rheumatology, 2008

Objective. To examine the involvement in care, participation in medical decision, satisfaction of... more Objective. To examine the involvement in care, participation in medical decision, satisfaction of health care and unmet needs in patients with PsA. To explore factors related to involvement and satisfaction with care. Methods. One hundred and five patients with PsA attending four regional hospital rheumatology outpatient clinics were invited and consented to self-administer questionnaires, including socio-demographic data, quality of life with SF-12, involvement in medical decision, satisfaction with care and unmet health care needs. Results. The overall perceived knowledge of disease was moderate. Good disease knowledge and good physical functioning were positively associated with involvement in care. Age, sex and pain scores were not associated with involvement in multivariate analysis. A low score in at least one question on involvement was the single independent negative predictor for satisfaction with health care. Only a minority (9%) was actively participating in medical decision-making. Among non-participants, 61.5% expressed the wish to participate. In aspects of education of disease, advice for exercise, psychological support and social support, respectively, 68.3, 73.3, 29.3 and 41.6% of the patients expressed unmet needs. Conclusion. Low involvement is negatively associated with satisfaction with health care in PsA. Good knowledge of disease and good physical functioning is positively associated with involvement. The current study supports patient education as an important factor associated with involvement of and satisfaction with care in PsA patients. Such patients have a high desire for information and numerous unmet health care needs. There is a need for improvement in the delivery of care to patients with PsA.

Research paper thumbnail of Psoriatic arthritis as a distinct disease entity

Journal of Postgraduate Medicine, 2007

and Geriatrics. Taipo Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease charac... more and Geriatrics. Taipo Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease characterized by joint inflammation associated Hospital, and *Division of Rheumatology, with cutaneous psoriasis. For many years, the amount of attention directed to PsA had been less than that for Department of Medicine various other arthropathies. With the advances in understanding its pathogensis, it is now recognized as a and Therapeutics, The distinct disease entity with characteristic features. Psoriatic arthritis has a greater tendency towards asymmetric Chinese University of oligoarticular involvement, distal interphalangeal involvement and spondylitis. Associated features such as

Research paper thumbnail of Impact of illness and variables associated with functional impairment in Chinese patients with psoriatic arthritis

Clinical and experimental rheumatology

To assess the impact of disease and functional outcomes in Chinese patients with psoriatic arthri... more To assess the impact of disease and functional outcomes in Chinese patients with psoriatic arthritis (PsA) and to identify variables associated with poor functional outcomes. A cross sectional study performed in 80 consecutive patients with PsA from a single center. Functional outcomes were assessed by the Health Assessment Questionnaire (HAQ) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Clinical variables included social-demographic characteristics and clinical features. Linear regression analyses were performed to identify variables associated with functional impairment. Thirty-six men and 44 women with mean (+/-SD) age and duration of arthritis of 48.6 (+/-13.0) and 10.2 (+/-6.9) years were studied. One-third reported PsA related unemployment and change in job nature. Another third experienced a reduction of income due to PsA. The median (IQR) HAQ and BASFI were 0.44 (1.09) and 2.1 (4.38). These functional scores correlated highly with each other and with the pat...

Research paper thumbnail of Psoriatic arthritis in Hong Kong

Objectives: To study the clinical features and disease burden in patients with psoriatic arthriti... more Objectives: To study the clinical features and disease burden in patients with psoriatic arthritis (PsA) in Chinese. Methods: A cross-sectional study on clinical features, laboratory data and radiography in patients with PsA in rheumatology clinics. Results: One hundred and twenty seven patients studied with mean (±SD) duration of PsA 11.58 (±7.47) years. Symmetrical polyarthritis developing in the third decade with an equal male to female ratio was the commonest pattern of arthritis. Seventy percent of patients required disease modifying antirheumatic drugs (DMARDs) and 21.3% had used two or more DMARDs. at some time for control of joint disease. Clinical classification identified predominant axial disease (AD) and predominant peripheral disease (PD) in 11% and 89% respectively; while radiographical classification identified AD and peripheral disease PD in 36.2% and 63.8%. Radiographic sacroiliitis were asymptomatic in 43%. A third of patients (33%) stopped working because of the disease. Patients with PsA had severe impairment of quality of life as compared to the normal population in Hong Kong. Differentiation into axial or peripheral disease by either classification systems did not affect quality of life outcomes and disease burden. Conclusion: The commonest pattern of PsA in Chinese was symmetrical polyarthritis. Patients with PsA were associated with a high disease burden and poor quality of life. More studies should be done to find out the predictors for poor prognosis in order to improve the quality of life for these patients.

Research paper thumbnail of Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong

Scandinavian Journal of Rheumatology, 2002

To determine the risk factors associated with and to describe the clinical course of tuberculosis... more To determine the risk factors associated with and to describe the clinical course of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Clinical features of patients with TB during the 1-year period prior to the diagnosis of TB were compared with controls. Of the 526 SLE patients, 57 (11%) had TB. Extra-pulmonary or miliary TB occurred in 67%. Patients with TB were more likely to have organic brain syndrome, vasculitis, and nephritis: and they were also more likely to have received intravenous &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;pulse&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; methylprednisolone or high cumulative dose of prednisolone. The cumulative dose of prednisolone and presence of nephritis were independent risk factors for the development of TB using multivariate regression analysis. There is a high prevalence of TB, especially extra-pulmonary diseases, among SLE patients in Hong Kong. High cumulative dose of corticosteroid and lupus nephritis are important risk factors for the development of TB.

Research paper thumbnail of Serum and urinary free microRNA level in patients with systemic lupus erythematosus

Lupus, 2011

MicroRNAs circulating in body fluid have been suggested as biomarkers of various diseases. We stu... more MicroRNAs circulating in body fluid have been suggested as biomarkers of various diseases. We studied the serum and urinary level of several miRNA species (miR-200 family, miR-205 and miR-192) in patients with systemic lupus erythematosus (SLE). We studied 40 SLE patients. Serum and urinary miRNA levels were determined and compared with that of healthy controls. The serum levels of miR-200a, miR-200b, miR-200c, miR-429, miR-205 and miR-192, and urinary miR-200a, miR-200c, miR-141, miR-429 and miR-192 of SLE patients were lower than those of controls. Glomerular filtration rate (GFR) correlated with serum miR-200b (r = 0.411, p = 0.008), miR-200c (r = 0.343, p = 0.030), miR-429 (r = 0.347, p = 0.028), miR-205 (r = 0.429, p = 0.006) and miR-192 (r = 0.479, p = 0.002); proteinuria inversely correlated with serum miR-200a (r = -0.375, p = 0.017) and miR-200c (r = -0.347, p = 0.029). SLE disease activity index (SLEDAI) inversely correlated with serum miR-200a (r = -0.376, p = 0.017). Serum miR-200b (r = 0.455, p = 0.003) and miR-192 (r = 0.589, p &amp;amp;lt; 0.001) correlated with platelet count, while serum miR-205 correlated with red cell count (r = 0.432, p = 0.005) and hematocrit (r = 0.370, p = 0.019). These pilot results suggested that miRNA may take part in the pathogenesis of SLE. Further studies are needed to validate the role of serum miRNA as a biomarker of SLE.

Research paper thumbnail of Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus

Lupus, 2001

The aim of this study was to determine whether early damage accrued in SLE as measured by the SLI... more The aim of this study was to determine whether early damage accrued in SLE as measured by the SLICC/ACR Damage Index predicts mortality in an inception cohort of lupus patients that have been followed prospectively in a single centre. SLE patients from the University of Toronto Lupus Clinic presenting within 1 y of their diagnosis prior to 1988 were included. This enabled all patients to be potentially followed for at least 10 y. Yearly SLICC/ACR Damage Index scores were determined for each patient. Early damage was defined as a score 1 and no damage as a score of 0 at the initial assessment. Log rank test was used to compare the survival experience between those with and without damage, with all patients being censored at 10 y. Two-hundred and sixty-three patients were identified in this inception cohort who were followed for 10 y. One-hundred and ninety patients (72%) had a SLICC/ACR Damage Index score of 0 (no damage) while 73 patients (28%) had at least one SLICC/ACR Damage Inde...

Research paper thumbnail of Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus

Lupus, 2011

Disease activity 6 months before pregnancy of patients with systemic lupus erythematosus (SLE) as... more Disease activity 6 months before pregnancy of patients with systemic lupus erythematosus (SLE) associated with adverse maternal and fetal outcomes is not well studied. The aim of the study was to identify predictors of adverse maternal and fetal outcomes in pregnant SLE patients, based on patients’ background characteristics, clinical and laboratory data 6 months before pregnancy. Of 103 pregnancies, 55 pregnancies in 39 SLE patients were investigated. Clinical and laboratory data were recorded at regular intervals from 6 months before conception to 1 year after delivery. Primary outcomes included the predictors of combined adverse maternal and fetal outcomes. Potential explanatory variables included demographic, clinical and laboratory data 6 months before conception. Using logistic regression, history of nephritis ( p = 0.001, odds ratio [OR] 13.3, 95% confidence interval [CI] 2.7–65.1) and a high SLE Disease Activity Index (SLEDAI) score 6 months before pregnancy ( p = 0.015, OR ...

Research paper thumbnail of Increased arterial stiffness correlated with disease activity in systemic lupus erythematosus

Lupus, 2008

To evaluate the relationships between arterial stiffness, disease activity and end-organ damage i... more To evaluate the relationships between arterial stiffness, disease activity and end-organ damage in systemic lupus erythematosus (SLE), non-invasive vascular assessments were made on 32 female SLE patients and 32 female normal controls. The patients had significantly increased brachial-ankle pulse wave velocity (PWV) (13.06 ± 1.79 vs. 11.50 ± 1.00 m/s; P

Research paper thumbnail of Minimal Important Difference and Responsiveness to Change of the SF-36 in Patients with Psoriatic Arthritis Receiving Tumor Necrosis Factor-  Blockers

The Journal of Rheumatology, 2011

Research paper thumbnail of Neurotoxicity following the ingestion of a Chinese medicinal plant, Alocasia macrorrhiza

Human & Experimental Toxicology, 1995

1 A case of poisoning due to the raw root tuber of a Chinese medicinal plant, Alocasia macrorrhiz... more 1 A case of poisoning due to the raw root tuber of a Chinese medicinal plant, Alocasia macrorrhiza is pre sented. 2 The patient developed neurological (severe pain and numbness in the perioral area and throat) and gastro intestinal (nausea, vomiting, abdominal pain) symptoms immediately after eating the root tuber. 3 A. macrorrhiza has properties and morphology very similar to another medical plant, A. odora. The root tuber of the latter is known to contain a neurotoxin, sapotoxin.