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Ma M, Santosa A, Kong KO, Xu C, Xiang JTG, Teng GG, Mak A, Tay SH, Ng VWW, Koh JZE, Fong W, Chew LC, Low A, Law A, Poh YJ, Yeo SI, Leung YY, Goh WR, Yu CT, Roslan NE, Angkodjojo S, Phang KF, Arkachaisri T, Sriranganathan M, Tan TC, Cheung P, Lahiri M. POS0200 POST-mRNA VACCINE FLARES IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES: INTERIM RESULTS FROM THE CORONAVIRUS NATIONAL VACCINE REGISTRY FOR IMMUNE DISEASES SINGAPORE (CONVIN-SING). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPublished data suggest no increased rate of flare of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination; however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys).ObjectivesTo study flares of AIIRD within three months of the first dose of an anti-SARS-COV2 mRNA vaccine.MethodsA retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfizer/BioNTech or Moderna) vaccine. Data were censored at the first post-vaccine clinic visit when the patient had flared or if ≥ three months had elapsed since the first dose of the vaccine, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis and time to flare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1).Figure 1.Nelson-Aalen curve of flares over timeResults2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfizer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/ targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection.Table 1.Patient characteristicsBaseline characteristicsNo flares(n = 1887, %)Flares within 0—3 months of 1st vaccine dose (n= 272, %)Flares outside of 0 – 3 months after 1st vaccine dose (n = 180, %)Age (median years, IQR)64 (53, 71)61 (50, 69)65 (55, 71)RaceChinese1386 (73)206 (76)129 (72)Malay193 (10)28 (10)20 (11)Indian195 (10)27 (10)26 (14)GenderFemale1367 (72)200 (74)117 (65)Vaccine typePfizer/BioNTech1713 (92)239 (90)160 (90)Moderna149 (8)28 (10)18 (10)DiagnosisRheumatoid Arthritis831 (44)139 (51)93 (52)Systemic Lupus Erythematosus269 (14)20 (7)9 (5)Psoriatic Arthritis225 (12)42 (15)29 (16)Spondyloarthropathies141 (7)21 (7)17 (9)Sjogren’s Syndrome114 (6)15 (6)8 (4)Systemic sclerosis94 (5)4 (1)6 (3)Baseline Physician Disease ActivityRemission1007 (53)99 (36)63 (35)Low Disease Activity731 (39)128 (47)97 (54)Moderate Disease Activity134 (7)40 (15)20 (11)High Disease Activity15 (1)5 (2)0452 (19%) flares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients flared within the 3-month period of interest and 180 (7.7%) flared outside of the 3-month period (Table 1). Median (IQR) time-to-flare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who flared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine.On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to flare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with inflammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to flare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively]ConclusionThere was a moderately high rate of AIIRD flares after mRNA vaccination; however, there was no clustering of flares in the immediate post-vaccine period to suggest causality. Older patients were less likely to flare, while those with inflammatory arthritis and active disease at baseline were more likely to flare.Disclosure of InterestsMargaret Ma Grant/research support from: Support grant from multiple companies for the Singapore Biologics registry, Amelia Santosa Speakers bureau: Amgen Talk, Consultant of: Pfizer ad board, Kok Ooi Kong: None declared, Chuanhui Xu: None declared, Johnston Tang Gin Xiang: None declared, Gim Gee Teng Speakers bureau: Boehringer Ingleheim, Anselm Mak Speakers bureau: J&J and GSK, Grant/research support from: GSK - the supported studies programme, Sen Hee Tay: None declared, Victoria Wei Wen Ng: None declared, Joshua Zhi En Koh: None declared, Warren Fong Speakers bureau: speaker for Abbvie, DKSH, GSK, Novartis, Li-Ching Chew Speakers bureau: pfizer and Abbvie, Consultant of: Pfizer and Abbvie Advisory Board meeting, Grant/research support from: Abbvie educational grant for ultrasound conference, Andrea Low Speakers bureau: Boehringer Ingeilheim, Consultant of: Consultant/steering group committee for BI and J&J, annie law: None declared, Yih Jia Poh: None declared, Siaw Ing Yeo Grant/research support from: Multiple pharmaceutical companies for the support of the National Biologics Registry, Ying Ying Leung Speakers bureau: Abbvie, DKSH, Jassen, Novartis and Pfizer, Wei-Rui Goh: None declared, Chuah Tyng Yu: None declared, Nur Emillia Roslan: None declared, Stanley Angkodjojo Speakers bureau: Boehringer Ingeilheim, Consultant of: Abbvie and DKSH, Kee Fong Phang: None declared, Thaschawee Arkachaisri: None declared, Melonie Sriranganathan: None declared, Teck Choon TAN: None declared, Peter Cheung Consultant of: Ad board for Boehringer Ingleheim, novartis, janssen and abbvie, Grant/research support from: Novartis, Manjari Lahiri Speakers bureau: J&J, DSKH, Consultant of: DSKH, Gilead, Grant/research support from: Multiple pharma companies contributed to the Singapore Biologics registryNovartis
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Liu ZL, Wang WH, Liu Y, Wu T, Teng GG. [Elafin-expressing probiotic Escherichia coli Nissle 1917 protects against experimental colitis]. Zhonghua Yi Xue Za Zhi 2021; 101:3819-3824. [PMID: 34895424 DOI: 10.3760/cma.j.cn112137-20210318-00689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To construct the gene modified probiotic Escherichia coli nissle1917 (EcN) which can express human Elafin protein and to explore its protective effect on the acute colitis in mice. Methods: The recombinant plasmid with human Elafin gene was constructed and then transferred to EcN. Western blot results confirmed that the engineered probiotic expressed Elafin successfully in vitro. C57/BL6J mouse was used in this study and were randomly divided into 4 groups according to different treatment: PBS gavage (PBS group); DSS administrated (DSS group); DSS administrated with wild-type EcN (EcN-WT) gavage (EcN-WT group); DSS administrated with EcN-Elafin gavage (EcN-Elafin group). Body weight and disease activity index (DAI) were measured every day. The length of mice colons in each group were measured after euthanasia. The degree of inflammation of intestinal mucosa in each group was measured through histopathological scoring. The proportion of neutrophils and macrophages infiltrated into colon lamina propria was detected by flow cytometry. The protein expression levels of pro-inflammatory cytokines TNF-α, IL-6 and chemokine CXCL-1 in colonic tissue were quantified by enzyme-linked immunosorbent assay. Results: Elafin protein could be detected in the supernatant of EcN-Elafin culture medium and EcN-Elafin homogenates. Compared with DSS group, the weight loss and DAI score of EcN-Elafin group and EcN-WT group were both significantly improved. The colon length of EcN-Elafin group was significantly longer than that of DSS group. The histological score of colitis in EcN-Elafin group was significantly lower than that in DSS group (5.3±2.3 vs 9.3±1.4, P<0.05). In EcN-Elafin group, the proportion of neutrophils[(8.65±1.49)% vs (17.60±2.16)%, P<0.01]and macrophages[(3.79±0.26)% vs (5.73±0.45)%, P<0.01]infiltrated into the colon lamina propria was significantly decreased compared with DSS group. The protein expression levels of TNF-α, IL-6 and CXCL-1 in EcN-Elafin group and EcN-WT group were significantly lower than those in DSS group. Conclusion: Elafin-expressing EcN can protect against DSS-induced acute colitis in mice and may have provided an effective and cost-efficient method for the treatment of IBD.
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Affiliation(s)
- Z L Liu
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - W H Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Y Liu
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - T Wu
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - G G Teng
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
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Zhang JL, Teng GG, Wu T, Chen GW, Wang PY, Jiang Y, Wu YC, Sun L, Liu T, Zuo S, Pan YS, Wang X. [Clinical analysis of 554 patients with colorectal diverticulosis]. Zhonghua Wei Chang Wai Ke Za Zhi 2021; 24:1008-1014. [PMID: 34823302 DOI: 10.3760/cma.j.cn441530-20200306-00125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: Most patients with asymptomatic colorectal diverticulosis are easily overlooked. However, some of diverticulosis become diverticulitis, bleeding and even perforation, which cause extensive harm to patients. The purpose of this study is to analyze the incidence, clinical features, diagnosis and treatment of colorectal diverticulosis in order to improve the clinical understanding of diverticulosis and its related complications. Methods: A descriptive cohort study was carried out. Clinical data of 554 patients with colorectal diverticulosis confirmed by CT, colonoscopy, digestive tract radiography or operation in Peking University First Hospital from January 2009 to June 2019 were retrospectively analyzed. Patients with malignant tumors, autoimmune diseases, long term use of immunosuppressive drugs, chronic liver diseases and renal diseases, and mental disorders were excluded. The analysis parameters included gender, onset age, clinical symptoms, location of diverticulitis, treatment and prognosis. According to the criteria established by the World Society of Emergency Surgery (WSES), acute diverticulitis was divided into 5 stages based on the extension of the infectious process. Stage 0 was simple diverticulitis and stage 1-4 was complicated diverticulitis. Results: Among the 554 patients with colorectal diverticulosis, 358 (64.6%) were males, the median onset age was 63 years; 191 patients (34.5%) had various digestive symptoms, of whom 113 (20.4%) had chronic constipation and abdominal distension, 78 (14.1%) had chronic diarrhea and abdominal pain; the other 363 patients had no obvious abdominal symptoms. Four hundred and six patients were found by colonoscopy and 465 patients were found by CT. Twenty-five patients were diagnosed by lower gastrointestinal tract radiography and 3 were confirmed during operation. There were 339 patients with multiple diverticula (61.2%) and 215 patients with single diverticulum (38.8%). 76.5% (424/554) of diverticula were located in colon, 37.0% (205/554) in ascending colon, 21.3% (118/554) in multiple sites, and 2.2% (12/554) in rectum. The median diameter of diverticulum was 7 mm, and 78 cases (14.1%) was ≥30 mm. Forty-nine patients (8.8%) developed acute diverticulitis, including 13 patients with simple diverticulitis and 36 patients with complicated diverticulitis. Among 36 patients with complicated diverticulitis, 29 (80.6%) were males, 27 (75.0%) had recurrent abdominal pain and fever before onset; diverticula of 25 cases were located in sigmoid colon; 11 cases in ascending colon. Nine cases developed sigmoid colon perforation and 8 cases developed vesicocolonic fistula, and these 17 patients underwent surgical treatment. The other 19 cases with complicated diverticulitis developed gastrointestinal bleeding, of whom 18 cases were male, 11 cases were located in ascending colon; 13 cases were healed after conservative treatment, 4 cases received endoscopic hemostatic intervention, and 2 cases underwent surgery. Conclusions: Colorectal diverticulosis is more common in male patients, and CT and colonoscopy are main diagnostic methods. The symptoms of complicated colonic diverticulitis are related to the location of diverticulum. In addition to symptomatic treatment, surgical procedures are the most important treatments.
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Affiliation(s)
- J L Zhang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - G G Teng
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - T Wu
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - G W Chen
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - P Y Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Y Jiang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Y C Wu
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - L Sun
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - T Liu
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - S Zuo
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Y S Pan
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - X Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
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Sek KSY, Tan ATH, Yip AWJ, Boon EME, Teng GG, Lee C. Singapore's experience in ensuring continuity of outpatient care during the COVID-19 pandemic. Int J Clin Pract 2020; 74:e13573. [PMID: 32500951 PMCID: PMC7300471 DOI: 10.1111/ijcp.13573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Kathleen S. Y. Sek
- Chronic ProgramAlexandra HospitalNational University Hospital SystemSingaporeSingapore
- Division of EndocrinologyUniversity Medicine ClusterNational University HospitalSingaporeSingapore
| | - Andre T. H. Tan
- Chronic ProgramAlexandra HospitalNational University Hospital SystemSingaporeSingapore
- Division of EndocrinologyUniversity Medicine ClusterNational University HospitalSingaporeSingapore
| | - Alexander W. J. Yip
- Fast ProgramAlexandra HospitalNational University Hospital SystemSingaporeSingapore
| | - Eve M. E. Boon
- Department of Ambulatory OperationsAlexandra HospitalNational University Hospital SystemSingaporeSingapore
| | - G. G. Teng
- Chronic ProgramAlexandra HospitalNational University Hospital SystemSingaporeSingapore
- Division of RheumatologyUniversity Medicine ClusterNational University HospitalSingaporeSingapore
- Department of MedicineYong Loo Lin School of MedicineNational UniversitySingaporeSingapore
| | - Chun‐Tsu Lee
- Chronic ProgramAlexandra HospitalNational University Hospital SystemSingaporeSingapore
- Department of MedicineYong Loo Lin School of MedicineNational UniversitySingaporeSingapore
- Department of Haematology‐OncologyNational University Cancer Institute SingaporeNational University HospitalSingaporeSingapore
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Goh Y, Yeo L, Quek A, Teng GG, Tan C, Wang S, Lim A. Kikuchi-Fujimoto disease associated with intracranial large-vessel vasculitis and recurrent cranial neuropathies. Scand J Rheumatol 2020; 50:80-82. [PMID: 32878510 DOI: 10.1080/03009742.2020.1771764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Y Goh
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Lll Yeo
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Aml Quek
- Division of Neurology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - G G Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System , Singapore, Singapore
| | - Cwt Tan
- Department of Ophthalmology, National University Hospital, National University Health System , Singapore, Singapore
| | - S Wang
- Department of Pathology, National University Hospital, National University Health System , Singapore, Singapore
| | - Ayn Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System , Singapore, Singapore
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Liu Y, Teng GG, Wang WH, Wu T, Hu FL. [Protective effects of sucralfate on gastric mucosal injury induced by Helicobacter pylori and its effects on gastrointestinal flora in mice]. Zhonghua Yi Xue Za Zhi 2019; 99:1546-1552. [PMID: 31154720 DOI: 10.3760/cma.j.issn.0376-2491.2019.20.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of sucralfate suspension gel (SC) on Helicobacter pylori (H.pylori) colonization, H.pylori-induced gastric mucosal injury and gastrointestinal microecology in mice. Methods: C57BL/6J mice were randomly divided into 3 groups, including normal control (NC) group, H.pylori model (HP) group, and SC prevention (HP+SC) group. H.pylori infection mouse model was established by gavage with H.pylori Sydney strain (SS1). And HP+SC group was also administered with SC for 14 days. After mice were sacrificed, the gastric mucosa was taken for HE staining, immunohistochemical (IHC) staining [H.pylori, zonula occludens-1 (ZO-1), Occludin, interleukin (IL)-8, IL-10 and tumor necrosis factor-α (TNF-α)], qPCR (IL-8, IL-10, TNF-α) . And cell ultrastructure was observed by electron microscopy. Microbiota communities in the gastric mucosa or fecal were investigated using 16S ribosomal RNA (rRNA) gene sequencing. The detection of H.pylori in IHC staining or Giemsa staining was defined as H.pylori infection. Results: The H.pylori positive rate of HP group was 91.67%, and that of HP+SC group was 50.00%. The EDS of HP group were significantly higher than those of the NC group [(3.42±0.19) vs (1.17±0.17), P<0.05], while EDS of HP+SC group (2.42±0.29) were significantly lower than that of HP group (P<0.05). The mRNA levels and immunostaining scores of IL-8, IL-10 and TNF-α in HP group was higher than NC group (all P<0.05). Compared with HP group, mRNA levels and IHC scores of IL-8 significantly decreased (all P<0.05) in HP+SC group, while those of IL-10 and TNF-α was similar between two groups (all P>0.05). The IHC scores of ZO-1 and Occludin in HP group was significantly lower than NC group (all P<0.05), and that of ZO-1 and Occludin in the HP+SC group increased compared with HP group [(2.00±0.26) vs (1.17±0.48), P>0.05; (3.50±0.43) vs (2.33±0.21), P<0.05]. Compared with NC group, the diversity of gastric microbiota in HP group was significantly lower, and diversity of gut microbiota decreased insignificantly. There was no significant difference between HP+SC group and HP group in gastric or gut microbiota. Conclusion: SC reduces H.pylori colonization, protects H.pylori-induced gastric mucosal injury, decreases H.pylori-induced IL-8 expression, enhances Occludin. However, its effects on H.pylori-induced gastrointestinal microbiota disorders are limited.
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Affiliation(s)
- Y Liu
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
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Teng GG, Leung YY, Ang LW, Yuan JM, Koh WP. Gout and risk of knee replacement for severe knee osteoarthritis in the Singapore Chinese Health Study. Osteoarthritis Cartilage 2017; 25:1962-1968. [PMID: 28757187 PMCID: PMC9237815 DOI: 10.1016/j.joca.2017.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/15/2017] [Accepted: 07/19/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE While cross-sectional and retrospective case-control studies suggest that gout is associated with knee osteoarthritis (KOA), no prospective study has evaluated the risk of total knee replacement (TKR) for KOA in association with gout. We prospectively evaluated the association between gout and the risk of TKR due to severe KOA. DESIGN We used data from the Singapore Chinese Health Study (SCHS), a prospective cohort with 63,257 Chinese adults aged 45-74 years at recruitment (1993-1998). Self-report of physician-diagnosed gout was enquired at follow-up I interview (1999-2004) from 52,322 subjects. TKR cases for KOA after follow-up I were identified via linkage with nationwide hospital discharge database through 31 December 2011. Multivariable Cox proportional hazards regression model was applied with adjustment for potential risk factors of KOA. RESULTS Among 51,858 subjects (22,180 men and 29,678 women) included in this analysis, after average 9.7 follow-up years, there were 1,435 cases of TKR. Gout was associated with 39% higher risk of TKR in women [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.08-1.79] but not in men (HR 0.78; 95% CI 0.49-1.23). The positive gout-TKR association in women remained after excluding participants with self-reported history of arthritis (HR 1.57; 95% CI 1.04-2.37). This association was stronger in women who were lean (body mass index [BMI] < 23 kg/m2) (HR 2.17; 95% CI 1.30-3.64) compared to their heavier counterparts (Pinteraction = 0.016). CONCLUSION Gout is associated with risk of severe KOA, especially in lean women, suggesting the crystal arthritis may play a role in the pathogenesis or progression of OA.
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Affiliation(s)
- G G Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
| | - Y Y Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School Singapore, Singapore.
| | - L-W Ang
- Epidemiology & Disease Control Division, Ministry of Health, Singapore.
| | - J-M Yuan
- Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - W-P Koh
- Duke-NUS Medical School Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Zhang W, Teng GG, Tian Y, Wang HH. [Expression of elafin in peripheral blood in inflammatory bowel disease patients and its clinical significance]. Zhonghua Yi Xue Za Zhi 2017; 96:1120-3. [PMID: 27095781 DOI: 10.3760/cma.j.issn.0376-2491.2016.14.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To quantify the expression of elafin mRNA in peripheral blood in patients with inflammatory bowel disease (IBD) and to explore its value in assessment of the activity and severity of IBD. METHODS From July 1 2015 to August 15 2015, 23 patients with IBD admitted to Peking University First Hospital were selected, including 15 cases with ulcerative colitis (UC) and 8 cases with Crohn's disease (CD). Among those, 5 cases were in remission (UC 3, CD 2), 6 cases were mild active (UC 3, CD 3), 3 cases were moderate active (UC 1, CD 2), and 9 cases were severe active (UC 8, CD 1). A total of 21 healthy individuals were selected as the control group. Peripheral blood samples of IBD patients and healthy controls were collected. The expression of elafin mRNA in peripheral blood leukocytes was detected by fluorescence quantitative real-time PCR. Mann-Whitney test was performed for comparison between the two groups. The correlation between the expression of elafin mRNA in peripheral blood and IBD activity score was analyzed by Pearson correlation analysis after transformation of variables. RESULTS The median expression of elafin mRNA in peripheral blood leukocytes in IBD group and control group was 0.005 8 (0.000 2, 0.043 5) and 0.015 3 (0.002 1, 0.175 8), respectively, with no significant difference (P>0.05). However, in the active IBD patients it was lower than that in the controls (0.004 6 (0.000 2, 0.034 8) vs 0.015 3 (0.002 1, 0.175 8), P<0.05) and also lower than that in the remission patients(0.004 6 (0.000 2, 0.034 8) vs 0.023 1 (0.012 6, 0.043 5), P<0.05); in the active UC patients it was lower than that in the controls(0.003 7 (0.000 2, 0.027 0) vs 0.015 3 (0.002 1, 0.175 8), P<0.05). The expression of elafin mRNA in peripheral blood was negatively correlated with modified Mayo score in UC patients (r=-0.513, P<0.05) and with the Crohn's Disease Activity Index (CDAI) of Best score in CD patients (r=-0.889, P<0.05). CONCLUSION The expression of elafin mRNA in peripheral blood in active IBD patients is decreased, which may be correlated with the activity of IBD, and negatively correlated with corresponding disease activity score, suggesting that it may play a protective role in IBD and may be helpful in predicting disease activity.
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Affiliation(s)
- W Zhang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
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Santosa A, Tan CS, Teng GG, Fong W, Lim A, Law WG, Chan G, Ng SC, Low AHL. Lung and gastrointestinal complications are leading causes of death in SCORE, a multi-ethnic Singapore systemic sclerosis cohort. Scand J Rheumatol 2016; 45:499-506. [DOI: 10.3109/03009742.2016.1153141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - CS Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - GG Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - A Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WG Law
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - G Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - SC Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
| | - AHL Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
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Tan CSL, Teng GG, Chong KJ, Cheung PP, Lim AYN, Wee HL, Santosa A. Utility of the Morisky Medication Adherence Scale in gout: a prospective study. Patient Prefer Adherence 2016; 10:2449-2457. [PMID: 27980395 PMCID: PMC5144895 DOI: 10.2147/ppa.s119719] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The outcomes of any chronic illness often depend on patients' adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand. OBJECTIVE We set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT). METHODS This cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test-retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36-0.88). CONCLUSION MMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.
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Affiliation(s)
- CSL Tan
- University Medicine Cluster, Division of Rheumatology, National University Health System
| | - GG Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - KJ Chong
- Department of Medicine, Yong Loo Lin School of Medicine
| | - PP Cheung
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - AYN Lim
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
| | - HL Wee
- Department of Pharmacy, Faculty of Science
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System
- Department of Medicine, Yong Loo Lin School of Medicine
- Correspondence: A Santosa, University Medicine Cluster, Division of Rheumatology, National University Health System, Level 10 Tower Block, 1E Lower Kent Ridge Road, Singapore 119228, Singapore, Fax +65 6872 4130, Email
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Lee W, Teo FSW, Santosa A, Teng GG. Eosinophilic Granulomatosis with Polyangiitis preceding allergic bronchopulmonary aspergillosis. Eur Ann Allergy Clin Immunol 2015; 47:228-231. [PMID: 26549342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 61-year-old Chinese man with long-standing, stable Eosinophilic Granulomatosis with Polyangiitis (EGPA) and asthma, presented with acute hypoxemia and declining obstructive pulmonary function. Elevated serum IgE levels, positive Aspergillus fumigatus specific IgE and CT findings of central bronchiectasis with small airway mucoid impaction confirmed new development of Allergic Bronchopulmonary Aspergillosis (ABPA). The maintenance therapy for EGPA, azathioprine, was discontinued. Prednisolone 0.5 mg/kg/day and Itraconazole improved his symptoms and IgE levels. To our knowledge, ABPA occurring in a patient with EGPA has not been reported. Differentiation of EGPA with asthmatic flare vs ABPA vs asthma with aspergillus hypersensitivity is discussed. Heightened Th2 immunity where eosinophils play a central role may link these conditions.
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Affiliation(s)
- W Lee
- University Medicine Cluster, Internal Medicine Residency, National University Health System, Singapore
| | - F S W Teo
- University Medicine Cluster, Division of Respiratory and Critical Care Medicine, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - A Santosa
- University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - G G Teng
- University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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Santosa A, Ng PSL, Teng GG. Traditional Chinese medication for rheumatoid arthritis: more than what meets the eye. Rheumatol Int 2014; 35:383-4. [PMID: 25037898 DOI: 10.1007/s00296-014-3092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
There is an increasing interest in the role of traditional Chinese medicine (TCM) in rheumatoid arthritis (RA), as evidenced by recent trials comparing their efficacy against established disease-modifying antirheumatic drugs. While the TCM in these trials seem to support a favorable cost-benefit ratio, many products are marketed under the guise of TCM, potentially exposing the user to unpredicted adverse events. We present the case of a patient with RA, who developed side effects from treatment with adulterated TCM. While TCM may be of value in the treatment of rheumatic diseases, their application in routine care continues to warrant careful consideration of safety and reliability.
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Affiliation(s)
- Amelia Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10 Tower Block, Singapore, 119228, Singapore,
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Teng GG, Chong KJ, Lim A, Wee HL. THU0534 Validity and Reliability of the Gout Impact Scale in a Multi-Ethnic Asian Population. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lim AYN, Shen L, Tan CH, Lateef A, Lau TC, Teng GG. Achieving treat to target in gout: a clinical practice improvement project. Scand J Rheumatol 2012; 41:450-7. [DOI: 10.3109/03009742.2012.689325] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
We performed a retrospective study of 10 patients with refractory systemic lupus erythematosus treated with rituximab to determine the efficacy, safety and impact on hospitalization days. Patients received rituximab according to a standardized protocol, all achieved B-cell depletion with clinical improvement in nine patients. At 12 months, BILAG scores improved significantly from a median of 13.5 (range 3-20) at baseline to 1 (range 0-27) (p < 0.05). There was significant reduction in urinary total protein excretion with stabilization of renal function in patients with nephritis. Two out of three patients with thrombocytopenia had normalization of platelet counts. The median duration of B-cell depletion was 6 months (range 6-18). Two patients required retreatment and responded well. There were no adverse outcomes following rituximab therapy. Patients with lupus nephritis spent a median of 17.1 days per year (range 1.9-49) in hospital on conventional treatment which was reduced to 0 days (range 0-14.8, p = 0.027) post-rituximab treatment. The cost of hospitalization was 5989 Singapore dollars per patient-year while on conventional treatment and 5792 Singapore dollars per patient-year post-rituximab. This study adds to the growing literature of rituximab efficacy with potential cost saving in lupus nephritis.
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Affiliation(s)
- A Lateef
- Division of Rheumatology, Department of Medicine, National University Health System, Singapore.
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Mak A, Ho RCM, Tan JYS, Teng GG, Lahiri M, Lateef A, Vasoo S, Boey ML, Koh DR, Feng PH. Atherogenic serum lipid profile is an independent predictor for gouty flares in patients with gouty arthropathy. Rheumatology (Oxford) 2008; 48:262-265. [DOI: 10.1093/rheumatology/ken471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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