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Papers by Nuntana Kasitanon

International Journal of Rheumatic Diseases

Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia-Paci... more Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia-Pacific region. The prognosis of SLE remains unsatisfactory in some Asian countries because of delayed diagnosis, limited access to medications, increased complications and issues of tolerability and adherence to treatment. The Asia-Pacific League of Associations for Rheumatology SLE special interest group has recently published a set of consensus recommendations on the management of SLE for specialists, family physicians, specialty nurses, and other healthcare professionals in the Asia-Pacific region. This article reports a systematic literature review of the infective complications of SLE in Asia and evidence for prevention of these infections by pre-emptive antimicrobial therapy and vaccination.

Objective Complementary and alternative medicine (CAM) is commonly used by patients with joint sy... more Objective Complementary and alternative medicine (CAM) is commonly used by patients with joint symptoms. Its effect on the disease progression is by Thai patients with rheumatoid arthritis (RA). Methods Fifty-three consecutive RA patients, seen during January-May 2002, were interviewed. Types of CAM used were assessed, and their uses were correlated with medical, socioeconomic and educational status. Results Thirty-four patients (64.1%) had used at least one kind of CAM before they were seen by us. The forms of CAM used by these patients were massage (with or without herbs) in 55.9%, oral Thai herbs in 29.4%, oral Chinese herbs in 23.5%, sauna with herbs in 23.5% and others in 35.3%. Forty-one percent had used more than one modality of CAM, with an average of 1.9 modalities/patients. Fifty-nine percent were advised to use CAM by their relatives or neighbors. Regarding their belief in this remedy, 47.1% of the users wanted to try it, 29.4% partially believed that CAM was effective, a...

International Journal of Neuroscience, 2020

Free Radical Research, 2019

(2019): Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients ... more (2019): Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients via reducing brain activity and mitochondrial dysfunction, Free Radical Research,

International Journal of Rheumatic Diseases, 2017

AimIn June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation f... more AimIn June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation for the use of biologic disease‐modifying anti‐rheumatic drugs (bDMARDs) and targeted synthetic (tsDMARD) in the treatment of rheumatoid arthritis (RA) to cover those currently available in Thailand (etanercept, infliximab, golimumab, rituximab, tocilizumab, abatacept and tofacitinib).MethodA search of the literature was performed between January 2000 and June 2015. Existing RA recommendations, in relation to the use of bDMARDs and tsDMARD, were identified and evaluated by the AGREE II instrument prior to their use as a ‘guide’ for developing this TRA recommendation. An additional literature search was performed in order to answer specific clinical questions that could not be found in existing guidelines.ResultThirteen recommendations were developed. They covered the use of RA classification criteria, the aim of RA treatment, when to initiate bDMARDs/tsDMARD or taper or switch them to oth...

Annals of the Rheumatic Diseases, 2016

Results: A total of 1728 images were analyzed and patients were divided into 4 subsets, on the ba... more Results: A total of 1728 images were analyzed and patients were divided into 4 subsets, on the basis of the extent of the SP. In subset 1 (6 patients, 11.2%) the extent was less than 25%, in subset 2 (5 patients, 9.2%) the extent was between 25-50%, in subset 3 (16 patients, 29.6%) between 50-75%, in subset 4 (27 patients, 50%) was more than 75%. Subsets 1 and 2 showed no significant relationship with any of the variables considered. Patients of subset 3 had a significant correlation with the presence of DU (p=0.007). The subset 4 showed a significant correlation with disease severity (p=0.03), history of DU (p=0.04) and the presence of DU (p≤0.0001). SP without reduction of the capillary density was correlated with the presence of lung fibrosis (p=0.04). The SP with avascular areas showed a significant relationship with disease severity (p=0.001), lung fibrosis (p=0.01), gastrointestinal involvement (p=0.01), skin involvement (p=0.03), history of DU (p=0.04), and DU (p=0.001). No association was found between patterns and disease duration. Conclusions: The correlation observed between the presence of DU and/or history of DU both with the extent of the SP and the avascular areas represent a relevant data, confirming the hypothesis of a strong relationship between the fingertip blood perfusion and the integrity of the nailfold microvasculature. Unexpectedly, lung fibrosis showed a significant association both with the SP without reduction in capillary density and with the avascular areas. This fact leads us to consider the possibility of the multifactorial nature of pulmonary involvement, not only determined by a reduced number of capillaries. The lack of correlation between type and extent of the scleroderma pattern with the disease duration supports the concept that the severity of microangiopathy is not a characteristic of the late stages of the SSc. References: [1] De Angelis R, et al. A growing need for capillaroscopy in rheumatology.

Journal of Herbal Medicine, 2017

Cryptolepis buchanani oil formulation versus indomethacin solution as a topical therapy for osteo... more Cryptolepis buchanani oil formulation versus indomethacin solution as a topical therapy for osteoarthritis of the knee: A randomized controlled trial Abstract Aim: This study aimed to compare the efficacy of a topical Cryptolepis buchanani oil formulation (CBO) with indomethacin, a topical non-steroidal anti-inflammatory drug, in the symptomatic treatment of osteoarthritis (OA) of the knee. Study Design: This study was a randomized, double-blind, active-controlled trial. Methods: One hundred and sixty-nine patients with OA of the knee were randomly assigned to receive either a 1% indomethacin solution or CBO formulation, which were applied topically, four times a day for a period of four weeks. Clinical assessments included a visual analog scale (VAS) assessment of joint pain, VAS assessment of stiffness, Lequesne's functional index (LI), time taken to climb up 10 steps, and patient's and physician's opinions of overall improvement. Results: After four weeks of treatment, there were no statistically significant differences between the two groups in mean changes from baseline of the VAS assessment of total pain (p = 0.92), VAS assessment of total stiffness (p = 0.57), LI (p = 0.44), and time taken to climb up 10 steps (p = 0.61). Additionally, the mean VAS of patient's and physician's opinions of overall improvement did not differ significantly (p = 0.77 and p = 0.77, respectively). The percentages of responders in the CBO and the indomethacin groups were also comparable (67.44% versus 69.88%, p = 0.86). Treatments were generally well tolerated, with reports of pruritus and rash at the application site occurring significantly more frequently in the indomethacin than CBO group (28.92% versus 10.47%, p = 0.005 and 21.69% versus 8.14%, p = 0.024, respectively). Conclusion: CBO was as effective as indomethacin solution for the symptomatic treatment of OA of the knee, but had a significantly lower rate of adverse skin reactions.

JCR: Journal of Clinical Rheumatology, 2015

The aim of this study was to determine the effect of antituberculous drugs on serum uric acid (SU... more The aim of this study was to determine the effect of antituberculous drugs on serum uric acid (SUA), urine uric acid (UUA) excretion, and renal function. Methods: Patients with tuberculosis requiring a 6-month treatment course of antituberculous drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampicin for a further 4 months) were included in this study. Serum uric acid, 24-hour UUA excretion, uric acid clearance (UACl), serum creatinine, and creatinine clearance were determined at baseline and at the end of the second week, second month, and fourth month. Results: Sixteen of 50 patients completed the study. Their mean ± SD baseline SUA and UACl was 4.44 ± 1.72 mg/dL and 8.77 ± 7.03 mL/min per 1.73 m 2 , respectively. At the second week, a significant increase in SUA (9.78 ± 3.21 mg/dL, P < 0.001) and significant decrease in UACl (3.50 ± 2.50 mL/min per 1.73 m 2 , P = 0.001) were noted. These changes persisted through the second month, but returned to baseline value at the fourth month. Thirteen patients (81.25%) had hyperuricemia. The 24-hour UUA followed the same pattern as that of UACl but showed no statistical significance. There were no changes in serum creatinine or creatinine clearance. One patient had arthralgia, and another developed tuberculous arthritis. Conclusions: The hyperuricemic effect of pyrazinamide and ethambutol was due primarily to a decrease in UACl, which was reversible, and had no negative effect on the renal function. Arthralgia was uncommon and required no specific treatment.

An 82 year-old woman with gouty arthritis developed acute diarrhea, vomiting, myalgia and general... more An 82 year-old woman with gouty arthritis developed acute diarrhea, vomiting, myalgia and generalized muscle weakness after she had mistakenly increased the dose of colchicine (0.6 mg/tablet) from once a day to three times/day for 1 week. She was found to have pancytopenia, proximal muscle weakness and elevated serum muscle enzymes. A clinical diagnosis of colchicine myotoxicity and hematotoxicity was made. Despite aggressive therapy, she died on the 5th hospital day. This patient represented another case of the rare side effect of colchicine, and the risk factors involved in the occurrence

Annals of the Rheumatic Diseases, 2014

Background: Vasculopathy and progressive disease status such as digital ulcer, pulmonary arterial... more Background: Vasculopathy and progressive disease status such as digital ulcer, pulmonary arterial hypertension and interstitial lung disease (ILD) deteriorate the quality of life as well as survival rate in patients with systemic sclerosis (SSc). Angiogenesis and fibrotic process appear to be dysregulated in patients with SSc. Objectives: We have explored the surrogate indices to reflect vascular damage and disease progression in patients with SSc using reactive hyperemia index assessed by EndoPAT and circulating biomarkers. Methods: Fifty-two patients with SSc (limited type; 40 patients, diffuse type; 12 patients) were enrolled. All the patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. They were examined by Chest X-ray or CT, echocardiography, respiratory function test, blood test including autoantibodies and NT-proBNP, endothelial function test by EndoPAT (RHI; Reactive Hyperemia Index), skin assessment by modified Rodonan Skin Score (mRSS) at the same day. Serum levels of placenta growth factor (PlGF) and vascular endothelial growth factor (VEGF) and plasma levels of growth differentiation factor (GDF)-15 and pentraxin (PTX)-3 were measured by ELISA. Results: The mean of age was 61.5 y.o. and that of disease duration was 5.2 years. Twenty patients complicated with ILD, 4 patients with pulmonary hypertension including border line, and 9 patients with digital ulcer. Anti-Tpo-1 antibodies were positive in 10 patients, anti-centromere antibodies in 26 patients, anti-U1-RNP antibodies in 5 patients, and anti-RNA polymerase III antibodies in 3 patient, respectively. The mean of mRSS was 6.3 points. The mean of RHI was 1.68, which was low as compared with healthy controls. In contrast, higher concentrations of PlGF, VEGF, GDF-15 and PTX-3 were found in SSc patients. The RHI inversely correlated with mRSS (r=-0.32, p<0.05). The significant high concentrations of PlGF, GDF-15 and PTX-3 were noted in diffuse type as compared with limited type. With regard to the analysis by coexistence of tissue damages, these biomarkers were also significantly higher in the tissue damagespositive group as compared with tissue damages-negative group (PlGF, GDF-15 and PTX-3 in digital ulcer-positive group, PlGF and GDF-15 in ILD-positive group). Conclusions: Low RHI and high circulating level of placenta growth factor, growth differentiation factor-15 and pentraxin-3 may reflect the presence of vasculopathy as well as progressive disease status in patients with SSc. References: [1] Kawashiri SY, et al. Improvement of plasma endotheline-1 and nitric oxide in patients with systemic sclerosis by bosentan therapy. Rheumatol Int. in press.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

The urate levels and the correlations of urate levels between the serum and synovial fluid (SF) o... more The urate levels and the correlations of urate levels between the serum and synovial fluid (SF) of many arthritic diseases have not been well described. Compare urate levels in the serum and SF of gouty arthritis, calcium pyrophosphate dihydrate deposition disease (CPPD), rheumatoid arthritis (RA), septic arthritis, ankylosing spondylitis (AS), and osteoarthritis (OA) patients. Paired samples of serum and SF from 95 patients comprised of 33 patients with gout, 22 with CPPD, 18 with RA, nine with septic arthritis, three with AS, and 10 with OA were collected simultaneously for urate measurement by photometric test. Ninety-five patients, including 53 males, with mean (SD) age of 64.1 (15.3) years were recruited. In gout, serum and SF urate levels were significantly higher than those of CPPD, RA, septic arthritis, AS, and OA ( p 0..01). In all the study population, the serum/SF ratios of urate levels of gout were not different across all groups. However, after excluding 24 patients wit...

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014

The objective of this study was to investigate the hypouricemic effects of green tea extract (GTE... more The objective of this study was to investigate the hypouricemic effects of green tea extract (GTE) in healthy individuals. This study comprised 1-week control, 2-week interventional, and 1-week follow-up periods. Participants were assigned randomly at the interventional period to consume GTE at 2 (GTE2), 4 (GTE4), or 6 (GTE6) g/d. Levels of serum uric acid (SUA), uric acid clearance, and serum antioxidant power (using trolox equivalent antioxidant capacity assay) were measured at both ends of each study period. Of 30 participants, 11, 11, and 8 received GTE2, GTE4, and GTE6, respectively. After 2 weeks of consumption, the mean SUA level tended to decrease in all groups, with no statistical significance. Serum uric acid reduction was greatest in GTE2 (from 4.81 ± 0.81 mg/dL to 4.64 ± 0.92 mg/dL, 3.53%). Uric acid clearance decreased significantly in GTE2 (from 11.37 ± 6.41 mL/min per 1.73 m to 7.44 ± 2.74 mL/min per 1.73 m, 34.56%, P < 0.05) and GTE4 (from 8.36 ± 3.41 mL/min per 1...

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014

Invasive Streptococcus agalactiae infection in nonpregnant women has been reported increasingly w... more Invasive Streptococcus agalactiae infection in nonpregnant women has been reported increasingly worldwide. This study reports the clinical features and outcome of S. agalactiae septic arthritis in Thai patients. The medical records of cases with septic arthritis seen between July 1990 and December 2010 were reviewed. Only those with S. agalactiae were included in this study. From 244 cases of septic arthritis, 38 (15.57%, 13 men and 25 women) were caused by S. agalactiae, with 34 of them (89.48%) occurring between 2008 and 2010. Their mean age was 52.89 (SD, 18.95) years. Twenty-four of the 38 patients (63.16%) had 1 or more underlying disease that might predispose to joint infection. Fever and joint pain were the most common symptoms presented. Eleven cases (28.95%) presented monoarthritis, 15 (39.47%) oligoarthritis, and 12 (31.58%) polyarthritis, with a mean joint involvement of 3.34 (SD, 2.35) joints (range, 1-8). Cellulitis was seen in 27 cases (71.05%). Blood cultures were pos...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008

Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with system... more Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with systemic sclerosis (SSc), and compare these features between those with limited (lc) SSc and diffuse (dc) SSc. The medical records of SSc patients attending the Division of Rheumatology, Chiang Mai University were reviewed. PAH was defined by pulmonary arterial systolic pressure (PASP) > 35 mmHg, determined by Doppler echocardiography. Among 275 patients with SSc, 66 had Doppler echocardiography measurement. Thirty-nine patients (59.1%) had PAH. Among the PAH-SSc patients, 36 (92.3%) presented with dyspnea on exertion, and 37 (94.8%) were in a New York Heart Association functional class of II and III. Twenty-four of 39 patients (61.5%) had interstitial lung disease. Diffuse SSc patients had a significantly higher proportion of males, and shorter disease duration between SSc and PAH diagnosis than lcSSc patients. PAH was not uncommon in Thai patients with SSc. Interstitial lung disease might...

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2006

This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai pa... more This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl). The ocular symptoms and sign (the Schirmer's 1 test) and the oral sicca symptoms and sign (the Saxon's test) in each of 50 RA, SLE and Scl patients were compared with their age-matched controls. The correlation between the presence of sicca symptoms and signs with their clinical activity was also determined. Ocular sicca symptoms were found more common in patients with RA (38% vs 18%, p < 0.05), SLE (36% vs 14%, p < 0.05) and Scl (54% vs 16%, p < 0.01), and oral sicca symptoms were found more common in SLE (22% vs 0%, p < 0.01), and Scl (16% vs 4%, p < 0.05) than their controls. However, only RA patients had a significantly higher proportion of positive Schimer-1 test compared with their controls (p < 0.01). There was no strong correlation between sicca symptoms or ...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006

The present study was performed to assess the sensitivity and specificity of the translation ques... more The present study was performed to assess the sensitivity and specificity of the translation questionnaire for Systemic Lupus Erythematosus (SLE) in Thai speaking populations. The 10- item questionnaire was applied to out-patients at the rheumatology clinic of the Chiang Mai University Hospital. One hundred and thirty-nine SLE, 109 Rheumatoid Arthritis (RA), and 35 Scleroderma (Scl) patients, as well as 88 Healthy Controls (HC) were enrolled into the present study. All subjects completed the questionnaire within 2 minutes. A positive response to three or more questions of the questionnaire gave a sensitivity and specificity of 92.81% and 76. 39%, respectively, and was comparable to the original version. This Thai-version of the screening questionnaire should be applied in the general population to determine the prevalence of SLE.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003

The clinical features of 567 patients with crystal proven gout (489 males, 78 females) seen in a ... more The clinical features of 567 patients with crystal proven gout (489 males, 78 females) seen in a University Hospital in northern Thailand was reviewed. The mean age at onset and mean duration of disease was 60.0 +/- 11.7 years and 5.2 + 4.8 years, respectively. Recurrent attacks accounted for 94 per cent. The knee and ankle were the 2 most common joints affected during the first attack and each one was seen in 55.6 per cent of cases. During a recurrent attack, the ankle, knee and first metatarsophalangeal joint were the 3 most common joints affected and were seen in 94.5 per cent, 81.2 per cent and 80.2 per cent of cases, respectively. Thirty-six per cent of the patients had tophi. Hypertension, hyperlipidemia, diabetes mellitus and ischemic heart disease were commonly associated diseases. Thirty-five per cent had renal calculi, and fifty-four per cent had renal insufficiency. Of 59 patients who tested with normal renal function, twelve per cent were hyperexcretor. The clinical feat...

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2002

Various musculoskeletal syndromes have been well described in patients infected with the human im... more Various musculoskeletal syndromes have been well described in patients infected with the human immunodeficiency virus (HIV). Surprisingly, erythema nodosum, an inflammation of the adipose tissue of the skin, has rarely been described. We report a 24-year-old known case of HIV infection, who developed fever and multiple tender subcutaneous nodules that were proven to be erythema nodosum. The patient also had polymyositis. She responded well to a high dose of corticosteroids. Erythema nodosum should be listed as possible the rheumatic manifestation of HIV infection.

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2002

From a cohort study of 349 Thai patients (337 females [F] and 12 males [M]) with systemic lupus e... more From a cohort study of 349 Thai patients (337 females [F] and 12 males [M]) with systemic lupus erythematosus (SLE), 52 patients (51 F, 1 M) died. Their 5- and 10-year survival rates were 84.0% and 74.9%, respectively. Seventy-nine percent of deaths occurred within the first year of diagnosis. Infection contributed to 27 deaths (51.9%). The lung and the urinary system were the 2 most common sites of infection. There were 18 SLE-related deaths (34.6%), and 7 non-SLE related deaths (13.5%). In a multivariate analysis of all causes of death, serositis, hematologic abnormality, central nervous system (CNS) and renal involvement were significantly associated with poor survival, while photosensitivity and arthritis were significantly associated with longer survival. Among SLE-related death, serositis and CNS involvement were significantly associated with poor survival, and arthritis was associated with longer survival. In conclusion, infection was the most common cause of death in Thai SL...

Seminars in Arthritis and Rheumatism, 2003

To present a case of Pythium insidiosum arteritis and review reported cases of human pythiosis. M... more To present a case of Pythium insidiosum arteritis and review reported cases of human pythiosis. Methods: Search of MEDLINE (PubMed) and the Thai Index Medicus was performed using the words "pythiosis" and "pythium." Search of abstracts from a scientific meeting also was performed. Only reported cases in the English or Thai language, with enough clinical information for analysis, were included. Results: There were a total of 32 cases of human pythiosis, with 31 identified in the literature. Twenty-five cases were Thai. Twenty of 21 patients with known occupations were farmers. There was ocular infection in 9 cases, subcutaneous infection in 5 cases, arterial infection in 17 cases, and cardiopulmonary infection in 1 case. Thalassemia was a common associated finding. In addition to systemic antifungal therapy, surgery was required in most cases. The highest mortality rate was seen in the arteritic form, particularly in patients with arterial lesions proximal to the superficial femoral artery. Conclusions: Human pythiosis is rare. Physicians should be suspicious of pythiosis in individuals, particularly farmers in Thailand, who develop nonhealing cutaneous ulcers or keratitis, which do not respond to conventional treatment. P insidiosum infections should be listed as a rare cause of infectious arteritis.

International Journal of Rheumatic Diseases

Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia-Paci... more Systemic lupus erythematosus (SLE) is a more common autoimmune rheumatic disease in the Asia-Pacific region. The prognosis of SLE remains unsatisfactory in some Asian countries because of delayed diagnosis, limited access to medications, increased complications and issues of tolerability and adherence to treatment. The Asia-Pacific League of Associations for Rheumatology SLE special interest group has recently published a set of consensus recommendations on the management of SLE for specialists, family physicians, specialty nurses, and other healthcare professionals in the Asia-Pacific region. This article reports a systematic literature review of the infective complications of SLE in Asia and evidence for prevention of these infections by pre-emptive antimicrobial therapy and vaccination.

Objective Complementary and alternative medicine (CAM) is commonly used by patients with joint sy... more Objective Complementary and alternative medicine (CAM) is commonly used by patients with joint symptoms. Its effect on the disease progression is by Thai patients with rheumatoid arthritis (RA). Methods Fifty-three consecutive RA patients, seen during January-May 2002, were interviewed. Types of CAM used were assessed, and their uses were correlated with medical, socioeconomic and educational status. Results Thirty-four patients (64.1%) had used at least one kind of CAM before they were seen by us. The forms of CAM used by these patients were massage (with or without herbs) in 55.9%, oral Thai herbs in 29.4%, oral Chinese herbs in 23.5%, sauna with herbs in 23.5% and others in 35.3%. Forty-one percent had used more than one modality of CAM, with an average of 1.9 modalities/patients. Fifty-nine percent were advised to use CAM by their relatives or neighbors. Regarding their belief in this remedy, 47.1% of the users wanted to try it, 29.4% partially believed that CAM was effective, a...

International Journal of Neuroscience, 2020

Free Radical Research, 2019

(2019): Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients ... more (2019): Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients via reducing brain activity and mitochondrial dysfunction, Free Radical Research,

International Journal of Rheumatic Diseases, 2017

AimIn June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation f... more AimIn June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation for the use of biologic disease‐modifying anti‐rheumatic drugs (bDMARDs) and targeted synthetic (tsDMARD) in the treatment of rheumatoid arthritis (RA) to cover those currently available in Thailand (etanercept, infliximab, golimumab, rituximab, tocilizumab, abatacept and tofacitinib).MethodA search of the literature was performed between January 2000 and June 2015. Existing RA recommendations, in relation to the use of bDMARDs and tsDMARD, were identified and evaluated by the AGREE II instrument prior to their use as a ‘guide’ for developing this TRA recommendation. An additional literature search was performed in order to answer specific clinical questions that could not be found in existing guidelines.ResultThirteen recommendations were developed. They covered the use of RA classification criteria, the aim of RA treatment, when to initiate bDMARDs/tsDMARD or taper or switch them to oth...

Annals of the Rheumatic Diseases, 2016

Results: A total of 1728 images were analyzed and patients were divided into 4 subsets, on the ba... more Results: A total of 1728 images were analyzed and patients were divided into 4 subsets, on the basis of the extent of the SP. In subset 1 (6 patients, 11.2%) the extent was less than 25%, in subset 2 (5 patients, 9.2%) the extent was between 25-50%, in subset 3 (16 patients, 29.6%) between 50-75%, in subset 4 (27 patients, 50%) was more than 75%. Subsets 1 and 2 showed no significant relationship with any of the variables considered. Patients of subset 3 had a significant correlation with the presence of DU (p=0.007). The subset 4 showed a significant correlation with disease severity (p=0.03), history of DU (p=0.04) and the presence of DU (p≤0.0001). SP without reduction of the capillary density was correlated with the presence of lung fibrosis (p=0.04). The SP with avascular areas showed a significant relationship with disease severity (p=0.001), lung fibrosis (p=0.01), gastrointestinal involvement (p=0.01), skin involvement (p=0.03), history of DU (p=0.04), and DU (p=0.001). No association was found between patterns and disease duration. Conclusions: The correlation observed between the presence of DU and/or history of DU both with the extent of the SP and the avascular areas represent a relevant data, confirming the hypothesis of a strong relationship between the fingertip blood perfusion and the integrity of the nailfold microvasculature. Unexpectedly, lung fibrosis showed a significant association both with the SP without reduction in capillary density and with the avascular areas. This fact leads us to consider the possibility of the multifactorial nature of pulmonary involvement, not only determined by a reduced number of capillaries. The lack of correlation between type and extent of the scleroderma pattern with the disease duration supports the concept that the severity of microangiopathy is not a characteristic of the late stages of the SSc. References: [1] De Angelis R, et al. A growing need for capillaroscopy in rheumatology.

Journal of Herbal Medicine, 2017

Cryptolepis buchanani oil formulation versus indomethacin solution as a topical therapy for osteo... more Cryptolepis buchanani oil formulation versus indomethacin solution as a topical therapy for osteoarthritis of the knee: A randomized controlled trial Abstract Aim: This study aimed to compare the efficacy of a topical Cryptolepis buchanani oil formulation (CBO) with indomethacin, a topical non-steroidal anti-inflammatory drug, in the symptomatic treatment of osteoarthritis (OA) of the knee. Study Design: This study was a randomized, double-blind, active-controlled trial. Methods: One hundred and sixty-nine patients with OA of the knee were randomly assigned to receive either a 1% indomethacin solution or CBO formulation, which were applied topically, four times a day for a period of four weeks. Clinical assessments included a visual analog scale (VAS) assessment of joint pain, VAS assessment of stiffness, Lequesne's functional index (LI), time taken to climb up 10 steps, and patient's and physician's opinions of overall improvement. Results: After four weeks of treatment, there were no statistically significant differences between the two groups in mean changes from baseline of the VAS assessment of total pain (p = 0.92), VAS assessment of total stiffness (p = 0.57), LI (p = 0.44), and time taken to climb up 10 steps (p = 0.61). Additionally, the mean VAS of patient's and physician's opinions of overall improvement did not differ significantly (p = 0.77 and p = 0.77, respectively). The percentages of responders in the CBO and the indomethacin groups were also comparable (67.44% versus 69.88%, p = 0.86). Treatments were generally well tolerated, with reports of pruritus and rash at the application site occurring significantly more frequently in the indomethacin than CBO group (28.92% versus 10.47%, p = 0.005 and 21.69% versus 8.14%, p = 0.024, respectively). Conclusion: CBO was as effective as indomethacin solution for the symptomatic treatment of OA of the knee, but had a significantly lower rate of adverse skin reactions.

JCR: Journal of Clinical Rheumatology, 2015

The aim of this study was to determine the effect of antituberculous drugs on serum uric acid (SU... more The aim of this study was to determine the effect of antituberculous drugs on serum uric acid (SUA), urine uric acid (UUA) excretion, and renal function. Methods: Patients with tuberculosis requiring a 6-month treatment course of antituberculous drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampicin for a further 4 months) were included in this study. Serum uric acid, 24-hour UUA excretion, uric acid clearance (UACl), serum creatinine, and creatinine clearance were determined at baseline and at the end of the second week, second month, and fourth month. Results: Sixteen of 50 patients completed the study. Their mean ± SD baseline SUA and UACl was 4.44 ± 1.72 mg/dL and 8.77 ± 7.03 mL/min per 1.73 m 2 , respectively. At the second week, a significant increase in SUA (9.78 ± 3.21 mg/dL, P < 0.001) and significant decrease in UACl (3.50 ± 2.50 mL/min per 1.73 m 2 , P = 0.001) were noted. These changes persisted through the second month, but returned to baseline value at the fourth month. Thirteen patients (81.25%) had hyperuricemia. The 24-hour UUA followed the same pattern as that of UACl but showed no statistical significance. There were no changes in serum creatinine or creatinine clearance. One patient had arthralgia, and another developed tuberculous arthritis. Conclusions: The hyperuricemic effect of pyrazinamide and ethambutol was due primarily to a decrease in UACl, which was reversible, and had no negative effect on the renal function. Arthralgia was uncommon and required no specific treatment.

An 82 year-old woman with gouty arthritis developed acute diarrhea, vomiting, myalgia and general... more An 82 year-old woman with gouty arthritis developed acute diarrhea, vomiting, myalgia and generalized muscle weakness after she had mistakenly increased the dose of colchicine (0.6 mg/tablet) from once a day to three times/day for 1 week. She was found to have pancytopenia, proximal muscle weakness and elevated serum muscle enzymes. A clinical diagnosis of colchicine myotoxicity and hematotoxicity was made. Despite aggressive therapy, she died on the 5th hospital day. This patient represented another case of the rare side effect of colchicine, and the risk factors involved in the occurrence

Annals of the Rheumatic Diseases, 2014

Background: Vasculopathy and progressive disease status such as digital ulcer, pulmonary arterial... more Background: Vasculopathy and progressive disease status such as digital ulcer, pulmonary arterial hypertension and interstitial lung disease (ILD) deteriorate the quality of life as well as survival rate in patients with systemic sclerosis (SSc). Angiogenesis and fibrotic process appear to be dysregulated in patients with SSc. Objectives: We have explored the surrogate indices to reflect vascular damage and disease progression in patients with SSc using reactive hyperemia index assessed by EndoPAT and circulating biomarkers. Methods: Fifty-two patients with SSc (limited type; 40 patients, diffuse type; 12 patients) were enrolled. All the patients gave their informed consent to be subjected to the protocol that was approved by the Institutional Review Board of Nagasaki University. They were examined by Chest X-ray or CT, echocardiography, respiratory function test, blood test including autoantibodies and NT-proBNP, endothelial function test by EndoPAT (RHI; Reactive Hyperemia Index), skin assessment by modified Rodonan Skin Score (mRSS) at the same day. Serum levels of placenta growth factor (PlGF) and vascular endothelial growth factor (VEGF) and plasma levels of growth differentiation factor (GDF)-15 and pentraxin (PTX)-3 were measured by ELISA. Results: The mean of age was 61.5 y.o. and that of disease duration was 5.2 years. Twenty patients complicated with ILD, 4 patients with pulmonary hypertension including border line, and 9 patients with digital ulcer. Anti-Tpo-1 antibodies were positive in 10 patients, anti-centromere antibodies in 26 patients, anti-U1-RNP antibodies in 5 patients, and anti-RNA polymerase III antibodies in 3 patient, respectively. The mean of mRSS was 6.3 points. The mean of RHI was 1.68, which was low as compared with healthy controls. In contrast, higher concentrations of PlGF, VEGF, GDF-15 and PTX-3 were found in SSc patients. The RHI inversely correlated with mRSS (r=-0.32, p<0.05). The significant high concentrations of PlGF, GDF-15 and PTX-3 were noted in diffuse type as compared with limited type. With regard to the analysis by coexistence of tissue damages, these biomarkers were also significantly higher in the tissue damagespositive group as compared with tissue damages-negative group (PlGF, GDF-15 and PTX-3 in digital ulcer-positive group, PlGF and GDF-15 in ILD-positive group). Conclusions: Low RHI and high circulating level of placenta growth factor, growth differentiation factor-15 and pentraxin-3 may reflect the presence of vasculopathy as well as progressive disease status in patients with SSc. References: [1] Kawashiri SY, et al. Improvement of plasma endotheline-1 and nitric oxide in patients with systemic sclerosis by bosentan therapy. Rheumatol Int. in press.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

The urate levels and the correlations of urate levels between the serum and synovial fluid (SF) o... more The urate levels and the correlations of urate levels between the serum and synovial fluid (SF) of many arthritic diseases have not been well described. Compare urate levels in the serum and SF of gouty arthritis, calcium pyrophosphate dihydrate deposition disease (CPPD), rheumatoid arthritis (RA), septic arthritis, ankylosing spondylitis (AS), and osteoarthritis (OA) patients. Paired samples of serum and SF from 95 patients comprised of 33 patients with gout, 22 with CPPD, 18 with RA, nine with septic arthritis, three with AS, and 10 with OA were collected simultaneously for urate measurement by photometric test. Ninety-five patients, including 53 males, with mean (SD) age of 64.1 (15.3) years were recruited. In gout, serum and SF urate levels were significantly higher than those of CPPD, RA, septic arthritis, AS, and OA ( p 0..01). In all the study population, the serum/SF ratios of urate levels of gout were not different across all groups. However, after excluding 24 patients wit...

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014

The objective of this study was to investigate the hypouricemic effects of green tea extract (GTE... more The objective of this study was to investigate the hypouricemic effects of green tea extract (GTE) in healthy individuals. This study comprised 1-week control, 2-week interventional, and 1-week follow-up periods. Participants were assigned randomly at the interventional period to consume GTE at 2 (GTE2), 4 (GTE4), or 6 (GTE6) g/d. Levels of serum uric acid (SUA), uric acid clearance, and serum antioxidant power (using trolox equivalent antioxidant capacity assay) were measured at both ends of each study period. Of 30 participants, 11, 11, and 8 received GTE2, GTE4, and GTE6, respectively. After 2 weeks of consumption, the mean SUA level tended to decrease in all groups, with no statistical significance. Serum uric acid reduction was greatest in GTE2 (from 4.81 ± 0.81 mg/dL to 4.64 ± 0.92 mg/dL, 3.53%). Uric acid clearance decreased significantly in GTE2 (from 11.37 ± 6.41 mL/min per 1.73 m to 7.44 ± 2.74 mL/min per 1.73 m, 34.56%, P < 0.05) and GTE4 (from 8.36 ± 3.41 mL/min per 1...

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2014

Invasive Streptococcus agalactiae infection in nonpregnant women has been reported increasingly w... more Invasive Streptococcus agalactiae infection in nonpregnant women has been reported increasingly worldwide. This study reports the clinical features and outcome of S. agalactiae septic arthritis in Thai patients. The medical records of cases with septic arthritis seen between July 1990 and December 2010 were reviewed. Only those with S. agalactiae were included in this study. From 244 cases of septic arthritis, 38 (15.57%, 13 men and 25 women) were caused by S. agalactiae, with 34 of them (89.48%) occurring between 2008 and 2010. Their mean age was 52.89 (SD, 18.95) years. Twenty-four of the 38 patients (63.16%) had 1 or more underlying disease that might predispose to joint infection. Fever and joint pain were the most common symptoms presented. Eleven cases (28.95%) presented monoarthritis, 15 (39.47%) oligoarthritis, and 12 (31.58%) polyarthritis, with a mean joint involvement of 3.34 (SD, 2.35) joints (range, 1-8). Cellulitis was seen in 27 cases (71.05%). Blood cultures were pos...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008

Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with system... more Study the clinical features of pulmonary arterial hypertension (PAH) in Thai patients with systemic sclerosis (SSc), and compare these features between those with limited (lc) SSc and diffuse (dc) SSc. The medical records of SSc patients attending the Division of Rheumatology, Chiang Mai University were reviewed. PAH was defined by pulmonary arterial systolic pressure (PASP) > 35 mmHg, determined by Doppler echocardiography. Among 275 patients with SSc, 66 had Doppler echocardiography measurement. Thirty-nine patients (59.1%) had PAH. Among the PAH-SSc patients, 36 (92.3%) presented with dyspnea on exertion, and 37 (94.8%) were in a New York Heart Association functional class of II and III. Twenty-four of 39 patients (61.5%) had interstitial lung disease. Diffuse SSc patients had a significantly higher proportion of males, and shorter disease duration between SSc and PAH diagnosis than lcSSc patients. PAH was not uncommon in Thai patients with SSc. Interstitial lung disease might...

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2006

This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai pa... more This study was performed to determine the prevalence of ocular and oral sicca symptoms in Thai patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl). The ocular symptoms and sign (the Schirmer's 1 test) and the oral sicca symptoms and sign (the Saxon's test) in each of 50 RA, SLE and Scl patients were compared with their age-matched controls. The correlation between the presence of sicca symptoms and signs with their clinical activity was also determined. Ocular sicca symptoms were found more common in patients with RA (38% vs 18%, p < 0.05), SLE (36% vs 14%, p < 0.05) and Scl (54% vs 16%, p < 0.01), and oral sicca symptoms were found more common in SLE (22% vs 0%, p < 0.01), and Scl (16% vs 4%, p < 0.05) than their controls. However, only RA patients had a significantly higher proportion of positive Schimer-1 test compared with their controls (p < 0.01). There was no strong correlation between sicca symptoms or ...

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006

The present study was performed to assess the sensitivity and specificity of the translation ques... more The present study was performed to assess the sensitivity and specificity of the translation questionnaire for Systemic Lupus Erythematosus (SLE) in Thai speaking populations. The 10- item questionnaire was applied to out-patients at the rheumatology clinic of the Chiang Mai University Hospital. One hundred and thirty-nine SLE, 109 Rheumatoid Arthritis (RA), and 35 Scleroderma (Scl) patients, as well as 88 Healthy Controls (HC) were enrolled into the present study. All subjects completed the questionnaire within 2 minutes. A positive response to three or more questions of the questionnaire gave a sensitivity and specificity of 92.81% and 76. 39%, respectively, and was comparable to the original version. This Thai-version of the screening questionnaire should be applied in the general population to determine the prevalence of SLE.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2003

The clinical features of 567 patients with crystal proven gout (489 males, 78 females) seen in a ... more The clinical features of 567 patients with crystal proven gout (489 males, 78 females) seen in a University Hospital in northern Thailand was reviewed. The mean age at onset and mean duration of disease was 60.0 +/- 11.7 years and 5.2 + 4.8 years, respectively. Recurrent attacks accounted for 94 per cent. The knee and ankle were the 2 most common joints affected during the first attack and each one was seen in 55.6 per cent of cases. During a recurrent attack, the ankle, knee and first metatarsophalangeal joint were the 3 most common joints affected and were seen in 94.5 per cent, 81.2 per cent and 80.2 per cent of cases, respectively. Thirty-six per cent of the patients had tophi. Hypertension, hyperlipidemia, diabetes mellitus and ischemic heart disease were commonly associated diseases. Thirty-five per cent had renal calculi, and fifty-four per cent had renal insufficiency. Of 59 patients who tested with normal renal function, twelve per cent were hyperexcretor. The clinical feat...

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2002

Various musculoskeletal syndromes have been well described in patients infected with the human im... more Various musculoskeletal syndromes have been well described in patients infected with the human immunodeficiency virus (HIV). Surprisingly, erythema nodosum, an inflammation of the adipose tissue of the skin, has rarely been described. We report a 24-year-old known case of HIV infection, who developed fever and multiple tender subcutaneous nodules that were proven to be erythema nodosum. The patient also had polymyositis. She responded well to a high dose of corticosteroids. Erythema nodosum should be listed as possible the rheumatic manifestation of HIV infection.

Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2002

From a cohort study of 349 Thai patients (337 females [F] and 12 males [M]) with systemic lupus e... more From a cohort study of 349 Thai patients (337 females [F] and 12 males [M]) with systemic lupus erythematosus (SLE), 52 patients (51 F, 1 M) died. Their 5- and 10-year survival rates were 84.0% and 74.9%, respectively. Seventy-nine percent of deaths occurred within the first year of diagnosis. Infection contributed to 27 deaths (51.9%). The lung and the urinary system were the 2 most common sites of infection. There were 18 SLE-related deaths (34.6%), and 7 non-SLE related deaths (13.5%). In a multivariate analysis of all causes of death, serositis, hematologic abnormality, central nervous system (CNS) and renal involvement were significantly associated with poor survival, while photosensitivity and arthritis were significantly associated with longer survival. Among SLE-related death, serositis and CNS involvement were significantly associated with poor survival, and arthritis was associated with longer survival. In conclusion, infection was the most common cause of death in Thai SL...

Seminars in Arthritis and Rheumatism, 2003

To present a case of Pythium insidiosum arteritis and review reported cases of human pythiosis. M... more To present a case of Pythium insidiosum arteritis and review reported cases of human pythiosis. Methods: Search of MEDLINE (PubMed) and the Thai Index Medicus was performed using the words "pythiosis" and "pythium." Search of abstracts from a scientific meeting also was performed. Only reported cases in the English or Thai language, with enough clinical information for analysis, were included. Results: There were a total of 32 cases of human pythiosis, with 31 identified in the literature. Twenty-five cases were Thai. Twenty of 21 patients with known occupations were farmers. There was ocular infection in 9 cases, subcutaneous infection in 5 cases, arterial infection in 17 cases, and cardiopulmonary infection in 1 case. Thalassemia was a common associated finding. In addition to systemic antifungal therapy, surgery was required in most cases. The highest mortality rate was seen in the arteritic form, particularly in patients with arterial lesions proximal to the superficial femoral artery. Conclusions: Human pythiosis is rare. Physicians should be suspicious of pythiosis in individuals, particularly farmers in Thailand, who develop nonhealing cutaneous ulcers or keratitis, which do not respond to conventional treatment. P insidiosum infections should be listed as a rare cause of infectious arteritis.