Thai Journal of Rheumatology

Rheumatology Quiz (Eng)

Tippawan Onchan — 2025-09-05

A 65-year-old female with a medical history poorly controlled Type 2 diabetes mellitus with diabetic retinopathy and hypertension for the past 8 years presented with a two-day history of right foot edema, which developed subsequent to long-distance walking. She is currently taking metformin, glipizide, and pioglitazone. Her most recent hemoglobin A1C was 10.6%. She has no prior history of arthritis. Examination revealed a body temperature of 37.0 C, erythema, edema, and warmth of the right ankle without tenderness. A diabetic ulcer was present on the plantar surface of the foot. She also had symmetrically decreased pinprick sensation and a negative response on the monofilament test.

The X-ray findings are shown in Figures 1. and 2.

Questions:
1. What are the X-ray findings?
2. What is the diagnosis?

Prevalence of Antinuclear antibody positivity in Thai patients with Rheumatoid arthritis (Eng)

Thanaphop Karoon — 2025-09-05

Background: Antinuclear antibodies (ANA) are commonly detected in patients with rheumatoid arthritis (RA), although they are traditionally associated with other connective tissue diseases. The prevalence and clinical significance of ANA positivity in RA, particularly among Thai patients remain uncertain.

Objective: To investigate the prevalence of ANA positivity and its clinical associations in Thai patients diagnosed with RA.

Methods: A retrospective observational study was conducted at Thammasat University Hospital, including RA patients aged ≥18 years from 2014 to 2023. Data on demographics, laboratory parameters including ANA patterns, treatments, disease activity, complications and relapsed disease were collected. Patients were categorized based on ANA status, and comparisons were made between ANA-positive and ANA-negative groups.

Results: Among 118 RA patients, ANA positivity was identified in 88.1%. The most frequent ANA pattern was homogenous (50%), followed by fine speckled (34.62%). ANA-positive patients exhibited significantly higher C-reactive protein (CRP) levels (p = 0.002) and were higher prednisolone dosage (p < 0.001). Azathioprine and cyclosporineA usage was exclusive to ANA-positive individuals. No significant differences were observed in demographic characteristics, disease duration, disease activity, remission, relapsed, extra-articular manifestations, or adverse events. Data loss, particularly for ESR and CRP, was noted as a study limitation.

Conclusion: ANA positivity is highly prevalent among Thai RA patients and is associated with elevated inflammatory markers and increased immunosuppressive therapy. Further prospective studies are necessary to elucidate the prognostic role of ANA in RA and its potential impact on personalized treatment approaches.

Introduction

Editor-in-Chief — 2025-09-05

The Thai Journal of Rheumatology, Volume 2, Issue 3, 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, “Prevalence of Antinuclear Antibody Positivity in Thai Patients with Rheumatoid Arthritis,” which provides valuable data on ANA prevalence in Thai rheumatoid arthritis patients. A review article on “Advanced Imaging in Gout” offers insights into imaging techniques for diagnosis and disease monitoring. In addition, two noteworthy case reports, “Lichenoid Drug Eruption Induced by Rosuvastatin” and “Cryoglobulinemic Vasculitis with Multisystem Involvement,” highlight rare and challenging conditions. 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

Editor-in-Chief — 2025-09-05

1. Prevalence of Antinuclear antibody positivity in Thai patients with Rheumatoid arthritis.
Thanaphop Karoon, Pakpiengpen Sornwiboonsak
1 - 10

2. Advanced imaging in gout
Chutipan SaeJung
11 - 35

3. Lichenoid drug eruption induced by rosuvastatin, a case report and review literatures
Angkana Norasetthada
36 - 42

4. A 69-Year-Old Man with Progressive Dyspnea, Purpuric Rash, Bilateral Distal Lower Extremity Numbness, and Acute Kidney Injury
Kittipong Kaewkarnjanarat, Saitip Sangkamanowet
43 – 52

5. Rheumatology Quiz
Tippawan Onchan
53 – 55

Advanced imaging in gout (Thai)

Chutipan SaeJung — 2025-09-05

โรคเกาต์ (gout) เป็นโรคข้ออักเสบที่เกิดจากการสะสมผลึกเกลือโมโนโซเดียมยูเรต (monosodium urate) ในน้ำไขข้อและเนื้อเยื่อจากการมีระดับกรดยูริกในซีรัมสูง (hyperuricemia) เป็นระยะเวลานาน การ ตรวจวินิจฉัยโรคเกาต์ทำได้โดยการตรวจพบผลึกเกลือโมโนโซเดียมยูเรตในน้ำไขข้อของผู้ป่วยที่มีข้ออักเสบ หรือพบก้อนโทฟัส (tophus)^{1, 2} แต่ในบางกรณีเช่น ข้อขนาดเล็ก ตำแหน่งข้อลึก หรือไม่สามารถเจาะน้ำไขข้อมาตรวจได้ ส่งผลให้ไม่ได้รับการวินิจฉัยอย่างเฉพาะเจาะจงหรือเกิดความล่าช้า จึงมีการพัฒนาภาพถ่ายรังสีเพื่อใช้สำหรับช่วยการวินิจฉัย ในปัจจุบันเทคนิคภาพถ่ายรังสีในการวินิจฉัยโรคเกาต์ มีหลายเทคนิค ได้แก่ ภาพรังสีพื้นฐาน (plain radiography), อัลตราซาวนด์ (ultrasonography), เอกซเรย์คอมพิวเตอร์ความเร็วสูงสองพลังงาน (Dual energy computed tomography; DECT), เครื่องสร้างภาพด้วยสนามแม่เหล็กไฟฟ้า (Magnetic Resonance Imaging; MRI), เวชศาสตร์นิวเคลียร์ (Nuclear Medicine) เทคนิคแต่ละชนิดช่วยในการวินิจฉัยและมีข้อจำกัดที่แตกต่างกัน ดังกล่าวต่อไป

Lichenoid drug eruption induced by rosuvastatin, a case report and review literatures (Eng)

Angkana Norasetthada — 2025-09-05

Cutaneous drug reactions have a wide variety of clinical features. Lichenoid drug eruptions (LDE) are rare and it may be difficult to differentiate them from idiopathic lichen planus. Gold, quinine, quinidine and penicillamine are well-known inducers of such eruptions^1,2, but there are only a few reports of lichenoid eruption induced by 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors (statin)^2,3. I described a lichenoid eruption linked to atorvastatin and rosuvastatin. His clinical features, in addition to histological findings, helped to establish the diagnosis. The cutaneous eruption resolved one month after the cessation of rosuvastatin. and a proposed alternative regimen to reduce total cholesterol (TC) and LDL-C in a patient with atherosclerotic heart disease.
For this case study, the patient gave written informed consent.

A 69-Year-Old Man with Progressive Dyspnea, Purpuric Rash, Bilateral Distal Lower Extremity Numbness, and Acute Kidney Injury (Eng)

Kittipong Kaewkarnjanarat — 2025-09-05

Cryoglobulinemic vasculitis is a systemic disease that involves multiple organ systems but remains diagnostically challenging. We report the case of a 69-year-old man who presented with progressive dyspnea over 1 week, followed by the development of a purpuric rash, bilateral distal lower extremity numbness, and acute kidney injury (AKI). Extensive evaluation by a multidisciplinary team excluded malignancy and infectious causes. Further investigations revealed evidence of systemic vasculitis, consistent with a diagnosis of cryoglobulinemic vasculitis.