Fariz Yahya

Aim: To develop and undertake preliminary psychometric validation of the Gout Knowledge, Attitudes and Practices (G‐KAP) Questionnaire for patients with gout in multiple Asia‐Pacific clinical settings. Methods: Six development experts and nine relevance experts reviewed the English 56‐question instrument. Analyses included 312 baseline participants from 10 countries and 117 paired assessments; 149 participants formed an additional recruitment‐wave subset. Language assistance involved oral explanation without a fixed translation script. We evaluated content relevance, keyed knowledge reliability, item‐level stability, and exploratory structure using explicit coding and missing‐data rules. Results: S‐CVI/Ave was 0.998 across 68 rated rows. The 19‐indicator knowledge score averaged 56.1% ± 20.3%; KR‐20 was 0.770 and common‐factor omega 0.764. Absolute‐agreement single‐measure ICC was 0.763 (95% bootstrap CI 0.635–0.857); mean retest increase was 2.34 percentage points ( p = 0.037). Numeric attitude ICCs ranged 0.345–0.838. Among 303 complete cases for 38 exploratory indicators, full‐matrix and common‐factor parallel analyses suggested 7 and 11 dimensions. The seven‐factor comparison model included two weak two‐item factors and ambiguous cross‐loadings. Conclusion: The English G‐KAP shows strong expert‐rated relevance and encouraging preliminary knowledge‐score reliability. Oral‐assistance variability, unequal recruitment and uncertain dimensionality limit interpretation. Cross‐cultural validity, measurement invariance, attitude/practice composite scores and clinical effectiveness are unestablished. Standardized administration, linguistic adaptation and independent confirmatory evaluation are needed before cross‐country comparison or subscale development.

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.

Objective: To evaluate diagnostic delay, referral pathways, presenting symptoms, and clinical characteristics among patients with axial spondyloarthritis (axSpA) managed at a Malaysian tertiary rheumatology centre. Methods: This retrospective observational study included adults with consultant-confirmed axSpA attending the Rheumatology Clinic, Universiti Malaya Medical Centre. Demographics, axSpA subtype, diagnostic delay, presenting symptoms, laboratory profiles, HLA‑B27 status, referral pathways, and treatments before and 6 months after diagnosis were recorded. Results: A total of 141 adults were included. This consisted of 87 males (61.7%) and was predominantly Chinese (n=83, 58.9%), followed by Malay (n=45, 31.9%), Indian (n=12, 8.5%), and other ethnicities (n=1, 0.7%). Radiographic axSpA and non‑radiographic axSpA accounted for 103 (73.0%) and 38 (27.0%) patients, respectively. Median age at symptom onset and diagnosis were 28 and 35 years. Median diagnostic delay was 48 months, and radiographic patients experienced longer delays (60 vs 36 months). Back pain was the commonest presenting symptom, with subtype‑specific variations in neck, shoulder, and peripheral joint involvement. External referrals had longer delays than internal referrals. Before diagnosis, 76.5% received NSAIDs, and 31.2% commenced biologic therapy within six months. Conclusion: In this Malaysian tertiary-care cohort, axSpA was associated with a median diagnostic delay of 48 months, with longer delays observed in radiographic disease and external referrals. Delayed recognition may reflect non-classical presentations and pathway-level barriers in referral coordination and specialist access. Greater awareness among primary care and non-rheumatology specialties, supported by structured referral criteria, minimum referral datasets, shared imaging pathways, and streamlined external referral processes, may improve timely rheumatology assessment.

Background/Objectives: Systemic lupus erythematosus (SLE) is a heterogeneous disease with substantial variability in clinical manifestations and outcomes, influenced by ethnic and geographical diversity. Remission is the optimal treatment target, while low lupus disease activity state is an accepted alternative goal. Although sustained remission has been associated with reduced organ damage, the impact of early attainment of treatment targets on subsequent damage accrual in SLE remains incompletely defined. To explore a potential window of opportunity, this study aimed to identify factors associated with achieving remission or low lupus disease activity state within the first year of SLE diagnosis and to examine their associations with organ damage. Methods: This retrospective study was conducted across 22 rheumatology centres in Malaysia and included patients with systemic lupus erythematosus (SLE) who had complete follow-up from diagnosis until attainment of treatment targets. Treatment targets were defined as achieving either early remission or a low disease activity state (LDAS). Given the retrospective nature of the study and the unavailability of complete Physician’s Global Assessment data, the definitions of early remission and LDAS were modified by excluding this component. Accordingly, treatment targets were defined as attainment of a clinical SLE Disease Activity Index (cSLEDAI) score of 0 with oral prednisolone doses of ≤5 mg/day and ≤7.5 mg/day, respectively, within 12 months of SLE onset. Multivariable Cox proportional hazards regression and logistic regression analyses were performed to determine factors associated with early remission and organ damage, respectively. Results: A total of 1599 patients were included, the majority of whom were female (92.5%). The cohort was predominantly Malay (68.7%), followed by Chinese (17.4%), Indigenous groups (10.8%) and Indian (3.0%). Early attainment of treatment targets was achieved in 45.7% of patients, while 54.3% experienced delayed attainment. In the multivariable cox regression model, the Malay and Chinese ethnic group demonstrated a significantly lower likelihood of achieving early remission compared to the Indigenous ethnic group. Patients with longer SLE duration, low C4 levels, presence of haematological and renal manifestations at the initial presentation, were identified as additional adverse factors associated with lower likelihood of early remission. Overall, 16.9% of patients accrued organ damage. Independent factors associated with organ damage included Indian ethnicity [OR 5.75, 95% CI 1.39–23.81, p = 0.02], delayed remission [OR 2.97, 95% CI 1.51–5.83) and absence of baseline hydroxychloroquine therapy [OR 4.13, 95% CI 1.21–14.07; p = 0.020]. Conclusions: Ethnic disparities were observed in the early attainment of the treatment targets, as well as in organ damage accrual within the Malaysian multi-ethnic SLE cohort. The significant association between the delay in achieving the treatment targets and organ damage underscores the importance of adopting an early treat-to-target approach in SLE management.

Objectives: Under the auspices of the Asia‐Pacific League of Associations for Rheumatology (APLAR), we aimed to develop broad, evidence‐ and consensus‐based guidelines to aid health professionals managing patients with psoriatic arthritis (PsA) in the region.Methods: A working group of 35 members comprising rheumatologists, dermatologists, and patient research partners from 18 APLAR countries was convened. The working group conducted systematic literature reviews to derive the quality of evidence via GRADE methods in supporting the efficacy and safety of classes of therapeutic agents for the management of active PsA, its comorbidities, and screening for specific infection concerns in the region. Recommendation statements on the principles of management and the best use of therapeutic drugs were developed. Consensus within the working group was achieved. An external voting panel, five from each of the 18 APLAR countries, was convened to confirm further agreement on the recommendation statements.Results: The main literature review included 178 articles from clinical trials for PsA. Additional articles on the evidence for managing comorbidities, uveitis, inflammatory bowel disease, and screening for chronic hepatitis B and latent tuberculosis were reviewed. The working group discussed and reached consensus on eight management principles and 16 recommendation statements for managing PsA. Endorsement from an external voting panel (n = 90, response rate 80%) was achieved.Conclusion: These first recommendations for the management of PsA patients in the APLAR regions were developed based on the best available evidence and region‐specific considerations through discussion among rheumatologists, dermatologists, and patients, with strong agreement from an external expert panel.

Objectives: This study explores the correlation between volunteer demographics with enthesis stiffness and intra- and interobserver agreements using shear wave elastography (SWE). Methods: Ninety-eight healthy volunteers were recruited. SWE was performed on quadriceps, suprapatellar, infrapatellar, and Achilles entheses. The stiffness measurements were measured in shear wave velocity (SWV). Results: Mann-Whitney test revealed insignificant difference in SWV among gender. Wilcoxon signed-rank test showed significant difference in SWV between left and right Achilles entheses. Spearman correlation test revealed moderate negative correlation between SWV and age group in quadriceps (ρ, −0.45, P < .01), and weak negative correlation in suprapatellar (ρ, −0.31, P < .01), and left Achilles (ρ, −0.29, P < .01). Multiple linear regression analysis showed subjects’ demographic significantly predicted quadriceps, suprapatellar, and left Achilles entheses stiffness with only age statistically significantly to the prediction (P < .05). Kruskal-Wallis showed significant differences in SWV for quadriceps (P = .01), suprapatellar (P = .03), and left Achilles (P = .01) among different age groups. Good interobserver [0.79-0.86 (95% CI, 0.32-0.94)] and interobserver agreement [0.78-0.89 (95% CI, 0.62-0.95)] were found in all the entheses. Conclusion: SWE emerges as a reproducible method for entheses stiffness quantification, with the study highlighting age as a significant factor impacting SWV in quadriceps, suprapatellar, and left Achilles entheses. Among the studied entheses, SWV for Achilles enthesis is the highest in all age groups. Advances in knowledge: The study significantly contributes to the understanding of enthesis stiffness by exploring the influence of gender, BMI, and age.

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.

Objective To establish the scanning protocol for 2-dimensional shear wave elastography (SWE) on normal entheses by investigating the possible confounding factors that may increase the variability of measured elasticity. Material and methods 30 normal quadriceps entheses were scanned using SWE to compare the stiffness and coefficient variation by changing the ultrasonic coupling gel thickness, knee position, region of interest size, and scanning plane. Results No significant difference in median shear wave velocity (SWV) was observed in different coupling gel thicknesses. The median SWV was higher in the knee flexion position than in the extended position (p < 0.001). Increased knee flexion led to stiffer quadriceps enthesis and higher SWV (ρ = 0.8, p < 0.001). The median SWV was higher when the diameter region of interest was 4.0 mm than 2.0 mm (p = 0.001). The median SWV was higher in the transverse plane than in the longitudinal plane (p < 0.001). Strong correlation was found between SWV and the degree of the shear wave to muscle fiber direction (ρ = 0.8, p < 0.001). The coefficient variation was lower in a gel thickness of 2.5 cm, with an extended knee, a region of interest of 2.0 mm, and a longitudinal plane (p > 0.05). For interobserver reliability for the proposed protocol, the intraclass correlation coefficients was 0.763. Conclusion In this study, we determined supine position with the knee extended; using 2.0 mm diameter region of interest and image acquisition at the longitudinal plane with thicker layer coupling gel seems most appropriate to reliably image healthy quadriceps entheses with SWE.

This is a study which looked at the prevalence of MSK diseases across rural regions in East Africa, In general, this is an interesting study which would raise the awareness and highlighting the challenges in diagnosing and managing these conditions a...