Lydia Say Lee Pok

Objective: Advanced therapies have revolutionized the treatment landscape for rheumatoid arthritis. However, concerns exist regarding the risk of serious infections among patients receiving these therapies. This study aimed to determine the incidence of serious infections and identify predictive factors associated with serious infections in patients with rheumatoid arthritis receiving advanced therapies. Methods: This single-center retrospective cohort study reviewed patients with rheumatoid arthritis who attended the rheumatology clinic and/or ward at Universiti Malaya Medical Centre between January 2006 and December 2023. Patient demographic and clinical data, as well as data on treatment with advanced therapies, were collected. Logistic regression analyses were used to identify predictors of serious infections. Results: Of the 423 patients with rheumatoid arthritis identified, 87% were female. The mean age was 61.0 (SD: 13.8) years, and 80 (18.9%) received at least one advanced therapy. Sixteen (20%) patients developed serious infections, with a total of 23 serious infection episodes reported. The overall incidence rate of serious infections was 3.75 per 100 patient-years. Respiratory infections were the most common (52.2%), and tumor necrosis factor inhibitors had the highest incidence rate (4.25/100 patient-years) among the various classes of advanced therapies. Diabetes mellitus (odds ratio = 4.508, 95% confidence interval: 1.246–16.316; p = 0.022) and lung disease (odds ratio = 4.554, 95% confidence interval: 1.056–19.637; p = 0.042) were independent predictors of serious infections. Conclusion: Serious infections may develop among patients with rheumatoid arthritis receiving advanced therapy, with lung disease and diabetes mellitus identified as independent risk factors. This study may help improve clinicians’ awareness of the real-world risks associated with initiating advanced therapy. Future studies with a larger sample size are warranted to expand upon these findings.

Purpose: To assess health-related quality of life (HR-QoL) and the clinical associations in patients with Rheumatoid Arthritis (RA). Methods: A cross-sectional study on multi-ethnic RA patients was performed. Disease activity was assessed using DAS28-ESR. HR-QoL was measured by EQ5D, functional disability by HAQ-DI and fatigue by FACIT-F. Results: A total of 214 predominantly female (86.9 %) patients were recruited. Median age was 62 years; Inter-quartile range (IQR): 53 – 68 years. Median and mean EQ-5D scores were 0.793 (IQR: 0.647 – 0.879) and 0.752 (SD: 0.165) respectively. Median EQ-5D scores for patients in remission, low, moderate, and high disease activity were 0.879 (IQR: 0.742 – 0.933), 0.795 (IQR: 0.645 – 0.880), 0.742 (IQR: 0.564 – 0.818) and 0.653 (IQR: 0.323 – 0.775) respectively. Median EQ-5D scores for patients with mild to moderate, moderate to severe, and severe to very severe disability were 0.795 (IQR: 0.714 – 0.933), 0.728 (IQR: 0.564 – 0.818) and 0.554 (IQR: 0.287 – 0.765) respectively. DAS28-ESR, HAQDI, ethnicity and FACIT-F correlated with HR-QoL. EQ-5D scores were lowest in patients requiring biologic disease- modifying anti-rheumatic drugs (DMARDs) compared to none or conventional DMARDs, although this was not significant. Conclusion: HR-QoL declined as RA disease activity and disability increased. Treat-to-target strategies and preventing joint destruction may improve health-related outcomes of RA patients. It is recommended that future studies be conducted in multiple health centers across Malaysia to capture variations in HR-QoL of RA patients nationally.

Objective: We aimed to analyze the clinical characteristics of patients with psoriasis and determine the predictive factors of psoriatic arthritis (PsA). Methods: This retrospective cohort study was performed among patients with psoriasis. Demographic and clinical data were collected. Psoriasis treatment was categorized as topical agents, phototherapy, oral therapy, and biologics. Predictive factors of PsA development were determined using logistic regression analyses. Results: We included 330 patients with psoriasis, and 83 (25%) patients developed PsA. Thirty-eight (45.8%) patients who developed PsA were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. The mean age of patients with PsA was 54.2 (±15.8) years, and the duration from diagnosis of psoriasis to diagnosis of PsA was 36 (3.5–114) months. Predictive factors for developing PsA were female sex (odds ratio [OR] = 3.33, 95% confidence interval [CI] 1.78–6.22), presence of nail involvement (OR = 5.36, 95% CI 2.50–11.51), severe psoriasis (OR = 27.41, 95% CI 7.58–99.11), and oral systemic therapy prior to PsA diagnosis (OR = 4.09, 95% CI 2.04–8.22). Conclusion: Patients with psoriasis who are female, have nail involvement, severe skin psoriasis, and require oral systemic therapy for psoriasis may have an increased risk of developing PsA.

Introduction: Fatigue is an important yet infrequently evaluated component in patients with rheumatoid arthritis (RA) and may have a major impact on quality of life.Objectives: To evaluate fatigue, identify factors associated with fatigue and assess the effect of fatigue on health‐related quality of life (HRQoL) in a multi‐ethnic cohort of RA patients.Methods: A cross‐sectional study was performed in patients who fulfilled European League Against Rheumatism/ American College of Rheumatology 2010 criteria for RA. Functional Assessment of Chronic Illness Therapy ‐ Fatigue (FACIT‐F) questionnaire was used to assess fatigue. Potential factors for fatigue were categorized into RA‐related (gender, seropositivity [rheumatoid factor and/or anti‐citrullinated protein antibody], disease duration, visual analog scale pain score, Disease Activity Score of 28 joints – erythrocyte sedimentation rate [DAS28‐ESR], ESR, hemoglobin level, functional disability [Health Assessment Questionnaire ‐ Disability Index, HAQ‐DI score], EQ‐5D‐3L, concomitant prednisolone use and number of conventional synthetic disease‐modifying anti‐rheumatic drugs [csDMARDs] used) and non‐RA‐related (age, body mass index, ethnicity and number of co‐morbidities).Results: A total of 214 patients (86.9% female) were included; the median age was 62 (25‐91) years and 67.3% were seropositive. Seventy‐six (33.5%) patients had moderate disease activity, 12 (5.6%) had high disease activity and 152 (71%) patients had mild difficulties to moderate disability HAQ‐DI scores. Median of total FACIT‐F score was 113.2 (36.3‐160.0). Joint factors of younger age, longer disease duration, higher HAQ score (increased functional disability), and lower EQ‐5D (poorer HRQoL) were significantly associated with higher levels of fatigue (all P < .02).Conclusion: Fatigue was associated with functional disability and has a significant impact on HRQoL in RA. Fatigue assessment should be considered in routine clinical practice for RA patients.

Aim: To determine the incidence and direct costs of NSAID‐induced upper GI adverse events in Malaysian rheumatology patients.Methods: A retrospective, multi‐centre, cohort study of rheumatology patients on long‐term NSAIDs was conducted. Clinical data of patients treated between 2010 and 2013 were collected for a 24‐month follow‐up period. The costs of managing upper GI adverse events were based on patient level resource use data.Results: Six hundred and thirty‐four patients met the inclusion criteria: mean age 53.4 years, 89.9% female, diagnosis of rheumatoid arthritis (RA; 59.3%), osteoarthritis (OA; 10.3%) and both RA and OA (30.3%). Three hundred and seventy‐one (58.5%) patients were prescribed non‐selective NSAIDs and 263 (41.5%) had cyclo‐oxygenase‐2 inhibitors. Eighty‐four upper GI adverse events occurred, translating into a risk of 13.2% and an incidence rate of 66.2 per 1000 person‐years. GI adverse events comprised: dyspepsia n = 78 (12.3%), peptic ulcer disease (PUD) n = 5 (0.79%) and upper GI bleeding (UGIB) n = 1 (0.16%). The total direct healthcare cost of managing adverse events was Malaysian Ringgit (MR) 37 352 (US dollars [USD] 11 419) with a mean cost of MR 446.81 ± 534.56 (USD 136.60 ± 163.42) per patient, consisting mainly of GI pharmacotherapy (33.8%), oesophagoduodenoscopies (23.1%) and outpatient clinic visits (18.2%). Mean cost per patient by GI events were: dyspepsia, MR 408.98 ± 513.29 (USD125.03 ± 156.92); PUD, MR 805.93 ± 578.80 (USD 246.39 ± 176.95); UGIB, MR 1601.94 (USD 489.74, n = 1).Conclusion: The economic burden of GI adverse events due to long‐term NSAIDs use in Malaysian patients with chronic rheumatic diseases is modest.