Thai Journal of Rheumatology

Drug Therapy in Knee Osteoarthritis (Thai)

2025-12-09T11:00:38+07:00

โรคข้อเสื่อม (osteoarthritis, OA) เป็นโรคข้อที่พบบ่อยที่สุดในผู้สูงอายุ ประมาณการว่าทั่วโลกมีผู้ป่วยโรคข้อเสื่อมมากกว่า 500 ล้านคน และมีแนวโน้มเพิ่มขึ้นอย่างต่อเนื่องตามโครงสร้างประชากรโลกที่กำลังเข้าสู่สังคมผู้สูงวัยโดยสมบูรณ์¹ โรคข้อเสื่อมเป็นสาเหตุสำคัญที่ทำให้ผู้ป่วยมีคุณภาพชีวิตลดลง เกิดความพิการและต้องพึ่งพาผู้อื่น มีผลกระทบถึงครอบครัว สังคม และเศรษฐกิจของประเทศ²

Leaky gut and silent kidneys – a challenging presentation in systemic lupus erythematosus – What, Why and How? (Eng)

2025-12-09T11:19:45+07:00

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease predominantly affecting young females. Its presentation varies from mild musculoskeletal, muco-cutaneous involvement to life and organ threatening manifestations like renal failure, diffuse alveolar haemorrhage, hemophagocytic lymphohistiocytosis (HLH) and organic brain syndrome. Even though it is a female predominant disease, males tend to be higher severity, more renal involvement, higher mortality and delay in diagnosis. Acute presentation of gastroenteritis with renal failure have differentials like infections causing pre-renal azotemia, hemolytic uremic syndrome, systemic vasculitis and certain toxins, poisonings or drugs. We present case of a young male with diarrhea and acute renal failure, later diagnosed and managed as systemic lupus erythematosus.

Spinal rheumatoid meningitis: Clinicopathological Insights of rheumatoid nodule beyond the joint (Eng)

2025-12-09T11:38:44+07:00

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA), characterized by pachymeningitis and/or leptomeningitis. Cranial RM were more common, while spinal involvement is very rare, particularly in seronegative RA. We described a 56-year-old Thai woman with seronegative RA who presented with acute bilateral leg weakness, gait instability, and urinary retention. MRI revealed circumferential spinal dural thickening and enhancement, consistent with hypertrophic pachymeningitis and leptomeningitis. Histopathology confirmed a rheumatoid nodule with mixed inflammatory patterns. Corticosteroid therapy led to complete clinical and radiological resolution. This case highlights an unusual presentation of spinal pachymeningitis as a neurological manifestation of seronegative RA, which may mimic other meningitides. RM should be considered in RA patients with unexplained myelopathy, regardless of serostatus, as early diagnosis and prompt immunosuppression can result in excellent outcomes.

Rheumatology Quiz (Eng)

2025-12-09T11:52:33+07:00

A 37-year-old healthy female with a history of surgically repaired right index finger fracture 2 years ago presented with a 17-month history of right forearm pain. She reported recurrent episodes of redness, swelling, warmth, and burning pain that began in her right index finger and gradually progressed to involve the right hand, forearm and elbow. Symptoms worsened with heat exposure and improved with cooling. Examination revealed erythema, mild edema, moist skin, and warmth over the right fingers and forearm (Figure 1). There was tenderness at the proximal interphalangeal joints and metacarpophalangeal joints with a flexion deformity of the index finger. The pain was disproportionate to light palpation and did not improve after a complete course of antibiotics. The physical findings and hand radiographs are shown in Figures 1 and 2, respectively.

Effectiveness of a Drug Reminder Application on Adherence to Uric Acid-Lowering Therapy in Gout Patients: A Randomized Trial (Eng)

2025-12-09T10:51:05+07:00

Introduction: Almost half of gout patients fail to achieve target serum uric acid (SUA) levels due to poor adherence to urate-lowering therapy (ULT), leading to adverse outcomes and increased healthcare costs. Mobile health applications (apps) have become effective tools for improving medication adherence in patients with chronic diseases.

Objectives: This study aimed to evaluate the effectiveness of a drug reminder mobile app in improving adherence to ULT in gout patients with poor adherence.

Methods: We conducted an open-label, randomized controlled trial involving 54 gout patients with SUA > 6 mg/dL and poor adherence to ULT. Patients were randomly assigned to either the "Drug Diary" reminder app group (N=25) or the "Roo-Rak-Koh" patient education app group (N=29). Co-primary outcomes included ULT adherence (measured by the MTB-T questionnaire), pill count adherence, and the proportion of patients achieving the SUA target (<6 mg/dL). A stable ULT dose was maintained throughout the study.

Results: At 12 weeks, the proportion of patients with high ULT adherence and pill count adherence were higher in the drug reminder app group (63% vs 37%, p=0.102 for MTB-T and 96% vs 93%, p=0.615 for pill count). SUA target achievement was similar in both groups (48% vs 47.8%, p=0.89). However, SUA reduction was significantly greater in the drug reminder app group (-1.63 ± 1.18 vs -0.76 ± 1.24, p=0.01).

Conclusions: Mobile health applications, including drug reminder and patient education apps, may improve medication adherence. The integration of both apps could offer complementary benefits in gout management

Introduction

2025-12-09T11:54:32+07:00

The Thai Journal of Rheumatology, Volume 2, Issue 4, presents a collection of academic articles in the field of rheumatology. This issue aims to disseminate new knowledge and enhance understanding of essential topics in rheumatology practice.

The content includes an original article, “Effectiveness of a Drug Reminder Application on Adherence to Uric Acid-Lowering Therapy in Gout Patients: A Randomized Trial,” which provides important evidence on improving medication adherence among gout patients through digital health interventions. A review article, “Drug Therapy in Knee Osteoarthritis,” summarizes current pharmacologic approaches and offers practical perspectives for patient management. In addition, several compelling case reports are featured in this issue. These include “Leaky Gut and Silent Kidneys – A Challenging Presentation in Systemic Lupus Erythematosus – What, Why and How?”, which discusses a complex and atypical SLE manifestation, and “Spinal Rheumatoid Meningitis: Clinicopathological Insights of Rheumatoid Nodule Beyond the Joint,” highlighting a rare extra-articular complication of rheumatoid arthritis. To further engage readers, a Rheumatology Quiz is also included to encourage knowledge review and self-assessment.

The editorial board sincerely hopes that this issue will be academically enriching and practically helpful for all readers. We also extend our gratitude to all authors for their valuable contributions in maintaining the quality and relevance of the journal.

Editor-in-Chief

2025-12-09T12:00:09+07:00

1. Effectiveness of a Drug Reminder Application on Adherence to Uric Acid-Lowering Therapy in Gout Patients: A Randomized Trial.
Nattharadee Phutthinart, Wanwisa Chanapai,
Wanruchada Katchamart
1 – 11

2. Drug Therapy in Knee Osteoarthritis
Paijit Asavatanabodee
12 – 51

3. Leaky gut and silent kidneys – a challenging presentation in systemic lupus erythematosus – What, Why and How?
Debasish Mishra, Mathew Vadukoot Lazar, Abeesh Pillai,
Abdurrahman K Alabdulsalam, Sahithi Surapaneni, Ashraf Talat,
Priyanka Gupta, Muhammad Ali
52 - 62

4. Spinal rheumatoid meningitis: Clinicopathological Insights of rheumatoid nodule beyond the joint
Pimchanok Palawisut, Boonnam Bunda, Porntip Intapiboon
63 – 71

5. Rheumatology Quiz
Tippawan Onchan
72 – 76