A spectrum of immune dysregulation has been described following SARS-CoV-2 infections—from the cytokine storm in the acute phase, to hyperinflammatory syndromes that occur after the resolution of the initial infection.1 Multisystem inflammatory syndrome (MIS) was first reported in children in April 2020 as a hyperinflammatory syndrome with features similar...

The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and skin manifestations, to a potentially life-threatening complex condition of multiple organ involvement. In the recent decade, the discovery and addition of novel autoantibody profiles including...

Dear Editor, Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC). In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...

Early inpatient rehabilitation therapy has been known to have beneficial impact on physical function and mobility, psychological status and cognitive function of patients following an acute medical event requiring hospitalisation.1 Following an acute hospital care, those who have been identified to have potential for functional improvements are often transferred...

New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the pathophysiology and clinical features of phaeochromocytoma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Children with rheumatological disease form a small but important proportion of the ill paediatric population. Most of the published data available are based on studies on Caucasian, Black or Hispanic children with relatively little information on Asian children including Chinese and Malays. This article is available only as a PDF....

Breast cancer is the most common cancer among women in Singapore with age-standardised incidence rates increasing markedly from 26.8 to 38.7 per 100 000 per year over the last decade. While many recognised risk factors exist for the development of breast cancer such as demographic factors (personal and family...

Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter. The first documentation of familial systemic disease was by Orabona and Albano who reported its occurrence in two sisters some five years later. This article is...

The acronym SAPHO refers to a syndrome characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. In 1961, a link between acne conglobata and arthritis was first described by Windom et al. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Rheumatoid arthritis is a systemic disease characterised by remissions and exacerbations that vary in severity and timing among people. Its chronic and degenerative course makes it imperative that a philosophy of maintaining the patient’s physical, psychological, and functional abilities as long as possible through an ongoing carefully planned treatment...

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on the upper gastrointestinal tract (GIT) are well known and well described. This article is available only as a PDF. Please click on “Download PDF” on top...

Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg and lower back. There was no antecedent trauma. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Locally injected intra-synovial corticosteroids are useful to target selected joint, tendon sheath or bursal inflammation in children with pauciarticular or polyarticular juvenile chronic arthritis (JCA). Inflammation is decreased locally and with minimal systemic side effects. This article is available only as a PDF. Please click on “Download PDF” on top...

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased risk of fracture. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval gout), followed in about 10% of patients by chronic tophaceous gouty arthritis. Gout is one of the better understood of the arthritic disorders, and certainly...

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of whom 18 homozygotes of Type II hyperlipidaemia were identified. Ten of these patients experienced a migratory polyarthritis resembling rheumatic fever. This article is available only as...

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which is occasionally associated with extraarticular manifestations. Although the first good clinical description was by Landre-Beauvais in 1800, the term rheumatoid arthritis was first used only in 1878 by Alfred Garrod. This article is available only as a PDF. Please click on...

Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...

Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment. This article is available only as a...

Phospholipids (PLs) are components of cell membranes. Their function is not only to maintain the structure of the membranes but also to modify the function of proteins present on cell surface. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

In 1982, Davies and co-workers in Melbourne described the presence of a serum factor that stained the cytoplasm of neutrophil leukocytes by indirect immunofluorescence in 8 patients with generalised illness associated with segmental necrotising glomerulonephritis. This was followed two years later by a report by Hall and co-workers of...

Immunologic tolerance is a hallmark of the immune system whereby immune cells are tolerant of self antigen. Historically, this tolerance was thought to be secondary to the removal of self-reactive T cells during development and maturation in the thymus of the immune cells - clonal deletion. This article is available...

Systemic lupus erythematosus (SLE) is a chronic rheumatic disease characterised by protean clinical manifestations as well as the presence of multiple autoantibodies. Tissue deposition of autoantibodies and immune complexes can lead to tissue injury. This article is available only as a PDF. Please click on “Download PDF” on top to...

Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations as well as a plethora of autoantibodies in the sera of patients. The clinical features of SLE vary in different population groups. Ethnic and genetic...

The complex and non organ-specific nature of systemic lupus erythematosus (SLE) has made it difficult for researchers to unravel the genetic defects and pathogenic mechanisms underlying this disease. Over the past 30 years, several mouse models of lupus bearing differing sets of phenotypes and genotypes, have collectively contributed a...

The fact that there is an increasing and growing need in societies for care of sufferers of rheumatic conditions can be shown from national statistics. In Australia, for example, arthritic and related musculoskeletal diseases may not dominate mortality statistics but they figure in the top three causes of acute...

The presence of multiple autoantibodies is the hallmark of systemic lupus erythematosus (SLE). Many of these autoantibodies target nuclear antigens e.g. histones, Sm, RNP, SSA, SSB and dsDNA may give rise to a positive antinuclear antibody (ANA) test. This article is available only as a PDF. Please click on “Download...

Although George Still first described systemic onset juvenile rheumatoid arthritis (JRA) comprising fever, arthritis, lymphadenopathy and splenomegaly in 1897, it was not until 1971 that its nosologic entity presenting in adulthood was recognised by Eric Bywaters. Since then, well over 300 cases have been reported in the literature worldwide. This...

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship between the risk of this disease with birth weight and gestational age had been well-documented, in particular, in infants with birth weight ≤1500 g (very...

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...

Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies. This article is available only as a PDF. Please click on “Download PDF” on top...

The spondyloarthropathies (SpA) comprise a heterogenous group of conditions that include ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis/Reiter’s syndrome, arthritis associated with inflammatory bowel disease and pauciarticular, late-onset juvenile chronic arthritis. Undifferentiated forms of the disease are also present. This article is available only as a PDF. Please click on...

Voiding dysfunction is a relatively common problem in hospitalised older patients. Up to one-third of hospitalised elderly were reported to have post-void residual urine volume (PRUV) of more than 50 mL. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare of their autoimmune disease or from complications of treatment, at times requiring intensive care. This article is available only as a PDF. Please click on “Download...

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications. This article is available only as a PDF....

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by symmetrical inflammatory arthritis. Most patients exhibit a chronic course. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cyclooxygenase inhibitors are non-steroidal anti-inflammatory drugs (NSAIDs). They have been used in the treatment of rheumatic diseases for several decades. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965 when I joined the then Thomson Road General Hospital as his senior registrar. This article is available only as a PDF. Please click on “Download PDF”...

In the early 1700s, Lady Mary Wortley Montagu, wife of the British ambassador to Turkey, introduced the practice of variolation against smallpox into Western Europe. This act of immunisation had since been better understood. This article is available only as a PDF. Please click on “Download PDF” on top to...

The past decade has seen a rapid increase in the number of patients being referred for investigation for the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Indeed, in many centres, possible OSAHS is now the most common respiratory referral and OSAHS is the most common outpatient respiratory diagnosis. This article is available...

Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many chronic illnesses. With improvements in survival, patients’ perceptions of health are increasingly being recognised as an important outcome in clinical medicine, especially in illnesses where...

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1). This article is available only as a PDF. Please click on “Download PDF” on...

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers. This article is available only as a PDF. Please click on “Download...

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative. This article...

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of reactive arthritis and acute dermatitis-arthritis syndrome. We describe a case of PMA and meningococcal endophthalmitis occurring together. This article is available only as a PDF. Please...

Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or secondary endpoint in clinical research and is essential in economic evaluation of new and often expensive therapies. This article is available only as a PDF. Please...

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This signaled the beginning of increased collaboration between the obstetricians and neonatologists in the management of high-risk pregnancies through multidisciplinary birth defect clinics and high-risk perinatal...

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major public health threat with wide-ranging medical, social and economic consequences. First gaining foothold among intravenous drug users and commercial sex workers, HIV quickly spreads to...

Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall 2-year mortality is more than 50% despite vasodilators, anticoagulants, systemic corticosteroids and cytotoxic drugs. This article is available only as a PDF. Please click on “Download...

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this. This article is available only as a PDF. Please...

Betel quid/areca nut use has been common in South and Southeast Asia and the Asia Pacific region for a long time and is common among migrated communities in Africa, Europe and North America. Because of its ancient history, its use is socially acceptable among all sections of society, including...

The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...

Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues. It is based on the same principle of tracer kinetics used in conventional nuclear medicine. This article is available only as a PDF. Please click on...

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice computed tomography (CT) technology such as thin detector collimation and fast gantry rotation allow the heart to be scanned in a single breath-hold. This article is...

Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis. Staphylococcus aureus is the commonest cause of septic arthritis and various series reported rates of 17% to 80%. This article is available only as a PDF....

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20% of all diarrhoea-related deaths and global mortality among children less than 5 years of age is estimated at nearly half a million. This article is available...

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced bone density, altered appetite and tendency towards urinary incontinence, predispose older patients to complications during hospitalisation. Studies have shown that about one-third of older persons...

Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%. This article is available only as a PDF. Please click on “Download PDF” on...

The metabolic syndrome (MS) is characterised by a clustering of metabolic risk factors and an insulin-resistant state.1 Its prevalence is high in Western, as well as Asian, populations.2-4 There are numerous correlations between the MS and hypertension, although this is not always the case.5 Resistance to insulin-mediated glucose disposal...

The first case of human immunodeficiency virus (HIV) infection was detected in Singapore on 16May 1985. The number of newly diagnosed HIV/acquired immuno-deficiency virus syndrome (AIDS) infections has been increasing since 1985, and a total of 1599 cases were detected as of December 2001. In a known cohort of...

Singapore has an estimated annual incidence of end-stage renal disease (ESRD) of 158 per million population.1 However, the number of children who develop renal failure, and requiring renal replacement therapy, is relatively low compared to adults. The incidence of ESRD in children ranges from 5 to 6 per million...

In the last few years, hundreds of papers exploring the issue of postoperative nausea and vomiting (PONV) have been published. It has been estimated that the overall incidence of PONV for all surgeries and patient populations is between 25% and 30%, with severe, intractable PONV estimated to occur in...

Thyroid eye disease (TED) is a visually and socially disabling condition. Newly diagnosed patients are often fearful of sight-threatening complications that include optic nerve compression or restrictive strabismus. Although the current literature has pointed to age (>60 years), gender (male), abnormal thyroid function (both hyper- and hypo-thyroidism), smoking and...

There is increasing evidence that retinal and cardiovascular diseases share a “common soil”. Risk factors for cardiovascular disease, such as hypertension, diabetes, hyperlipidaemia and cigarette smoking, are known to influence the development of a range of retinal diseases, including hypertensive retinopathy, diabetic retinopathy, retinal vein and artery occlusion, retinal...

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately 2.2%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Public health education is a cornerstone in the primary prevention of chronic diseases. In the United States, for example, studies have shown that cardiovascular public health education contributed to increased hypertension detection and control as well as a decline in smoking, thus contributing significantly to the major reduction in...

In order to commit to their mission and placement requirement efficiently and effectively, policy-makers need to decide which types of students their training units should recruit, what type of curriculum they should design and what kinds of support mechanisms they should implement. This article is available only as a PDF....

Laparoscopic cholecystectomy has become a routine surgical procedure in general surgical units all over the world. Its implementation has expanded dramatically and is considered a feasible and safe approach even for acute cholecystitis.1,2 Laparoscopic management of acute cholecystitis may still be associated with increased risks of complications such as...

Cardiovascular complications account for the highest rate of morbidity and mortality in patients with diabetes mellitus (DM), type 1 and type 2, respectively. The Copenhagen City Heart Study, carried out in 13,105 subjects followed up prospectively for 20 years, reported that in patients with type 2 DM, the risk...

Joint aspiration with synovial fluid analysis can provide information which complements that which is available from the history and physical examination of the patient, and can help to differentiate various causes of arthritis. It is most useful in monoarthritis, where septic arthritis as a medical emergency needs to be...

Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...

Population studies on pain prevalence are useful in determining the impact that chronic pain has on the society. It draws the attention of healthcare administrators to chronic pain as a problem and direct healthcare spending accordingly. Previous studies performed using variations in definitions and methodology, yielded rates between 10%...

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a non-inflammatory enthesopathy of unknown etiology. Affecting predominantly men, it results in flowing, robust ossification of the anterior longitudinal ligament of the spine. This article is available only as a PDF. Please click on “Download PDF” on top to...

Angiosarcoma is a rare tumour commonly affecting elderly men, usually occurring on the head and neck region. The tumour usually presents as ecchymosis-like plaques, and less commonly with haemorrhage, oedema, ulceration and recurrent facial angioedema. This article is available only as a PDF. Please click on “Download PDF” on top...

With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management of disease. However, participation in health screening can vary greatly within populations and is influenced significantly by sociodemographic and attitudinal factors. This article is available only...

The incidence of OSA in severely obese Asians is poorly documented. This is also compounded by a varied racial profile across Asia. Singapore, with its mixed ethnic population is uniquely poised to study the prevalence of sleep disturbances and the results of different interventions. In this study we sought...

Liver transplantation is the best treatment modality for patients with end-stage liver diseases. It has been landmarked as one of the most important advances in the medical field. Its applicability is expanding tremendously worldwide, particularly in many Asian countries. The history of liver transplantation dates back to 1963 when...

Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have better outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events. This article is available only as a...

Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%. This article is available only as a...

Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the term IgE-mediated food allergy is appropriate. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...

Obesity is a condition characterised by an excess of body fats. According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above and at least 400 million adults worldwide in 2005. Obesity poses a serious health burden as it is associated...

The prevalence of obesity has risen by three-folds or more in many countries since 1980. In 2005, it was estimated that globally there are about 1.6 billion overweight adults and at least 400 million of them are obese. This increase in the prevalence of adults being overweight and obese...

According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above and at least 400 million adults are obese worldwide in 2005. Obesity increases the risk of chronic diseases such as diabetes mellitus, cardiovascular disease, stroke and some cancers. It is...

Non-alcoholic fatty liver disease (NAFLD) is increasing recognised as one of the most important causes of chronic liver disease in Western countries. It encompasses a spectrum of diseases ranging from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH). Hepatic steatosis is a common clinical and histological finding and it is...

Multiple sclerosis (MS) is one of the most common disorders of the central nervous system with a lifetime risk of 1 in 400. In about 75% of MS patients, activities of daily living will become affected at later stages. In up to 15% of patients, the disabilities will become...

Breast cancer is the leading cancer among women in Singapore, accounting for 29% of all cancers occurring in women between 2006 and 2010. Evidence shows that breast cancer screening with mammography is effective at reducing breast cancer mortality, particularly where the uptake of screening is high, at a recommended...

Depression in the elderly is a major public health issue. Associated morbidities such as higher risk of impairment in physical, mental and social functioning can be substantial, with the most serious complication being suicide. In the elderly, depression can often be undiagnosed and untreated because it may be related...

A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

A good history and a detailed physical examination is often sufficient to make a diagnosis of a recurrent anterior dislocation of the shoulder, even in the absence of a radiologically documented dislocation of the joint. The anterior apprehension test has recently been supplemented with the relocation, crank, and load...

According to the National Health Survey, the percentage of Singapore residents with diabetes mellitus (DM) aged between 18 and 69 years has risen from 8.2% in 2004 to 11.3% in 2010. DM can lead to a myriad of long-term health complications such as coronary heart disease, kidney failure and...

A 48-year-old female presented with pain and swelling in the bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrist joints for the past 20 days. It was acute in onset, severe in intensity to such an extent that she was unable to make a fist. It was associated with acute...

Aseptic arthritis can often be associated with viruses— in the Singapore context—dengue or chikungunya viruses. The association of varicella-zoster virus (VZV) with arthritis however, is rare. Few cases of aseptic arthritis associated with VZV have been documented in the paediatric literature in the past 50 years and fewer still...

Patients with rheumatic diseases frequently consult primary care physicians, internists and orthopaedic surgeons. In the past, few doctors took interest in these diseases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate monohydrate crystals in the joints and soft tissue giving rise to an acute inflammatory response. This article is available only as a PDF. Please click on...

Back pain is a common but often self-limiting problem. However, it is important to recognise causes of chronic backache such as ankylosing spondylitis which are potentially disabling but treatable. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.