Thai Journal of Rheumatology

Introduction

Editor-in-Chief — Mon, 17 Feb 2025 00:00:00 +0700

Welcome to the Thai Journal of Rheumatology, now entering its second year with this inaugural issue of Volume 2, Issue 1. This journal remains dedicated to serving as a reliable academic resource and platform for knowledge exchange in the field of rheumatology, committed to delivering high-quality content to enhance the understanding of diseases and improve patient care.

In this second year, we are proud to present articles covering significant topics. In the research section, we feature the link between the psoriatic arthritis comorbidity index and clinical characteristics in patients with psoriatic arthritis. Additionally, we provide a comprehensive review on immune-mediated necrotizing myopathy and an intriguing case report titled Sertraline-induced vasculitis and The Seroconversion for Anti-melanoma differentiation-associated protein5 (Anti-MDA5), which offers valuable insights for patient care. Furthermore, this issue includes an academic quiz designed to stimulate knowledge and engage our readers.

On this occasion, we would like to express our sincere gratitude to the editorial team, authors, and contributors who made this journal possible. We hope that readers find the articles in this journal beneficial and inspiring.

Editor-in-Chief — Mon, 17 Feb 2025 00:00:00 +0700

1. The link between psoriatic arthritis comorbidity index and clinical characteristics in patients with psoriatic arthritis
Ping Seung Ong, Nor Aini Abdullah, Wahinuddin Sulaiman
1 - 8

2. Immune-Mediated Necrotizing Myopathy
Paijit Asavatanabodee
9 - 36

3. Sertraline induced Leukocytoclastic Vasculitis, a Case Report, and Review Literature
Angkana Norasetthada
37 – 43

4. Seroconversion for Anti-melanoma differentiation-associated protein5 (Anti-MDA5)
Thanaporn Theerasetthumrong
44 – 48

5. Rheumatology Quiz
Patnarin Pongkulkiat
49 – 51

Immune-Mediated Necrotizing Myopathy (Thai)

Paijit Asavatanabodee — Mon, 17 Feb 2025 00:00:00 +0700

Immune-mediated necrotizing myopathy (IMNM) หรือ necrotizing autoimmune myopathy (NAM) เป็นโรคหนึ่งในกลุ่ม idiopathic inflammatory myopathies (IIM) พบร้อยละ 20-38 ของ IIM ทั้งหมด มีการดำเนินโรครุนแรงและรวดเร็ว อาการสำคัญคือ กล้ามเนื้อต้นขาและต้นแขนอ่อนแรง (proximal muscle weakness) อย่างรุนแรงและเฉียบพลันภายใน 6 สัปดาห์ หรือรองเฉียบพลันภายใน 6 เดือน พร้อมกับมีเอนไซม์กล้ามเนื้อในซีรัม (serum creatine kinase, CK) สูง ผู้ป่วยสองในสามมี autoantibodies จำเพาะต่อโรคได้แก่ anti-signal recognition particle (SRP) และ anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) autoantibodies พยาธิสภาพของกล้ามเนื้อที่เป็นมาตรฐานสำคัญสำหรับวินิจฉัยโรคคือ มีใยกล้ามเนื้อตาย (myofiber necrosis) อย่างรุนแรงเป็นวงกว้าง โดยพบการอักเสบน้อยมากหรือไม่พบเลย (scanty or no inflammatory cell infiltration) การวินิจฉัยโรคและการรักษาอย่างถูกต้องตั้งแต่ระยะแรกจะทำให้ผู้ป่วยรอดชีวิตและมีคุณภาพชีวิตที่ดีเหมือนคนทั่วไป

Sertraline induced Leukocytoclastic Vasculitis, a Case Report, and Review Literature (Eng)

Angkana Norasetthada — Mon, 17 Feb 2025 00:00:00 +0700

A rare secondary small vessel vasculitis characterized by inflammation of blood vessels caused by various drugs, including antibiotics, anti-tumor necrosis factor-alpha agents, immunotherapeutic drugs, and psychoactive agents. The skin is most commonly affected, but other tissues and organs, such as the subcutis, kidneys, or lungs, may also be involved. Systemic disease develops only in a minority of patients, typically when treated with the causative drug over a prolonged period of time. Presenting signs and symptoms include skin rash, myalgia, arthralgia, fever, and malaise.¹

Drug-induced vasculitis is a diagnosis of exclusion. There is no laboratory diagnostic tool for drug-induced vasculitis. Eosinophil count may be raised, this is seen more frequently in the case of systemic involvement. A comprehensive drug history of prescribed and over-the-counter medicine is paramount. Tissue biopsy can be beneficial in confirming the diagnosis.¹ The disease entity ranges from relatively benign symptoms requiring supportive care to life-threatening episodes requiring intensive care.The etiologies of vasculitis include autoimmune syndromes, infectious agents, and medications.^2,3.The association of drug therapy with development of cutaneous vasculitis is recognized with numerous therapeutic agents. In fact, it has been estimated that 10–20% of dermal reactions to drugs are vasculitic reactions. Systemic manifestations have been less well reported, even though patients have commonly described nonspecific symptoms such as fever, arthralgia, malaise, and lymphadenopathy.⁴

In the treatment of the major depressive disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder, sertraline is one of the most widely used selective serotonin reuptake inhibitors (SSRIs) and one of the best-tolerated antidepressants.⁵ Here, I present a patient with depressive disorder who developed severe cutaneous vasculitis after using sertraline. For this case study, the patient gave written informed consent.

Seroconversion for Anti-melanoma differentiation-associated protein5 (Anti-MDA5) (Eng)

Thanaporn Theerasetthumrong, Panupong Kongkiatsin, Sungchai Angthararak — Thu, 06 Mar 2025 00:00:00 +0700

A sixty-six-year-old Thai female presented with progressive dyspnea and non-productive cough. She was diagnosed with MDA-5 dermatomyositis with rapidly progressive interstitial lung disease (RP-ILD) from UIP pattern in her high-resolution computed tomography-chest (HRCT-chest) and anti-MDA5 strongly positive in her myositis profile. After one year of treatment with steroid and immunosuppressive therapy, follow-up testing of anti-MDA-5 became negative in result.

Rheumatology Quiz (Eng)

Patnarin Pongkulkiat — Mon, 17 Feb 2025 00:00:00 +0700

A 60-year-old male presented with a 1-month history of severe bone pain in the fingers and legs, worse at night, and unintentional weight loss. The examination showed digital clubbing without arthritis. The X-ray is shown in Figures 1 and 2.

What unique features can you observe?
What is the diagnosis?

The link between psoriatic arthritis comorbidity index and clinical characteristics in patients with psoriatic arthritis (Eng)

Ping Seung Ong , Nor Aini Abdullah, Wahinuddin Sulaiman — Mon, 17 Feb 2025 00:00:00 +0700

Objectives: Psoriatic arthritis comorbidity index (PsACI) was developed specifically to assess comorbidity in psoriatic arthritis (PsA) patients. This study aimed to investigate the association between PsaCI and clinical characteristics in patients with PsA

Methods: This is a cross sectional study including PsA patients who visited the Rheumatology Clinic at Hospital Raja Permaisuri Bainun. Their clinical characteristics and comorbidities were recorded.

Results: This study population consisted of 172 patients with PsA. There were 77 males (44.8%) and 95 females (55.2%). Hypertension (59.9%) was the most common comorbidity, followed by dyslipidemia (46.5%) and diabetes mellitus (36.1%). The PsACI score was significantly associated with age and obesity (p<0.001). Further analysis revealed that both the age of onset for psoriasis and the age of onset for PsA exceeding 45 years were positively correlated with higher PsACI scores. PsACI did not correlate with the multiple domains of PsA, the site of psoriasis or treatment regimen given.

Conclusions: The findings underscore the critical importance of managing comorbid conditions in PsA patients, especially among those with an earlier age of psoriasis onset, older patients with PsA, and those with obesity. The results showed the overall comorbidity burden may be influenced more by patient-specific factors rather than disease-specific factors. Further research is needed to better understand the interplay between comorbidities and PsA.