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Idiopathic inflammatory myopathies: Not nearly the end of the road

The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and...

Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series

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...

Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix....

One Hundred and Seventy Cases of Childhood Onset Rheumatological Disease in Singapore

Children with rheumatological disease form a small but important proportion of the ill paediatric population. Most of the published data available are based on...

Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report

Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter....

Verrucous Haemangioma—A Case Report

Verrucous haemangioma is an uncommon congenital vascular malformation which may grow to large sizes. It has a characteristic hyperkeratotic and verrucous surface which resembles...

Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome: A Brief Review of a Rare Condition

The acronym SAPHO refers to a syndrome characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. In 1961, a link between acne conglobata and arthritis...

The Role of Occupational Therapy in Rheumatoid Arthritis Management

Rheumatoid arthritis is a systemic disease characterised by remissions and exacerbations that vary in severity and timing among people. Its chronic and degenerative course...

A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation

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...

Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain

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...

Intra-Synovial Corticosteroid Injections in Juvenile Chronic Arthritis—A Review

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...

Managing Problem Gout

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval...

Lipid Disorders and Rheumatic Diseases

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of...

Rheumatoid Arthritis—A Review

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...

Imaging of Thoracic Manifestations of Scleroderma

Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys,...

Overview of Imaging in Rheumatologic Diseases

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...

Advances in Antiphospholipid (Hughes’) Syndrome

Phospholipids (PLs) are components of cell membranes. Their function is not only to maintain the structure of the membranes but also to modify the...

The Appropriate Use of Antineutrophil Cytoplasmic Antibody (ANCA) Testing in Rheumatic Diseases

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...

Oral Tolerance: Mechanisms and Therapy of Autoimmune Diseases

Immunologic tolerance is a hallmark of the immune system whereby immune cells are tolerant of self antigen. Historically, this tolerance was thought to be...

The Genetics of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic rheumatic disease characterised by protean clinical manifestations as well as the presence of multiple autoantibodies. Tissue deposition...

Systemic Lupus Erythematosus in Singapore

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...

Murine Lupus: Pathogenic Mechanisms and Genetic Origins

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...

Education in Rheumatology

The fact that there is an increasing and growing need in societies for care of sufferers of rheumatic conditions can be shown from national...

The Sensitivity and Specificity of Autoantibodies to the Sm Antigen in the Diagnosis of Systemic Lupus Erythematosus

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,...

Clinical Predictors of Nephritis in Systemic Lupus Erythematosus

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal...

Adult-onset Still’s Disease in an Oriental Population: Manifestations, Course and Outcome in 16 Patients

Although George Still first described systemic onset juvenile rheumatoid arthritis (JRA) comprising fever, arthritis, lymphadenopathy and splenomegaly in 1897, it was not until 1971...

Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate...

Ankylosing Spondylitis in Singapore: A Study of 150 Patients and a Local Update

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...

Development of Rheumatology in Singapore

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...

Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic...

Aetiology and Distribution of Mandibular Fractures in the National University Hospital, Singapore

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken...

Under-diagnosed Psychiatric Syndrome II: Pathologic Skin Picking

Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction...

Under-diagnosed Psychiatric Syndrome I: Trichotillomania

Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century...

Current Therapeutic Strategies in Glomerulonephritis

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients...

Use of Ligase Chain Reaction and Polymerase Chain Reaction on Urine Specimens to Detect Chlamydia trachomatis Infections in a Sexually Transmitted Diseases Clinic in Singapore

Infections caused by Chlamydia trachomatis are amongst the most common bacterial sexually transmitted diseases (STDs) in the world, causing substantial morbidity in young sexually-active...

Role of Ultrasonography in Screening for Urological Malignancies in Patients Presenting With Painless Haematuria

Haematuria of any degree should never be ignored and, in adults, it should be regarded as a symptom of urological malignancy until proven otherwise....

Diabetic Retinopathy

Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent...

The Genetics of Spondyloarthropathies

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...

A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals

The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a...

Bilateral Synchronous Renal Oncocytoma: A Case Report and Review

Oncocytomas are neoplasms characterised by large epithelial cells with finely granular eosinophilic cytoplasm called oncocytes. They were first described by Zippel in 1942 and...

Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic...

An Audit of Patients with Rheumatic Disease Requiring Medical Intensive Care

Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare...

New Disease Modifying Agents in Adult Rheumatoid Arthritis

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...

New Cyclooxygenase Inhibitors

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...

10th Seah Cheng Siang Memorial Lecture: Going Places—A Rheumatological Odyssey

I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965...

Update in the Management of Stroke

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

Immunotherapy in Autoimmune Diseases

In the early 1700s, Lady Mary Wortley Montagu, wife of the British ambassador to Turkey, introduced the practice of variolation against smallpox into Western...

Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore

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...

Statins and Bone Morphogenetic Proteins: New Pathways in Bone Formation

Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip...

Clinical Update on Osteoporosis

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A...

The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its...

Steroid-induced Osteoporosis

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed....

An Asian Perspective to the Problem of Osteoporosis

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular...

Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of...

Validity and Reliability of the EQ-5D Self-report Questionnaire in Chinese-speaking Patients with Rheumatic Diseases in Singapore

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...

Contemporary Management of Fibroids

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in...

Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography

The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of...

Surgical Management of Colorectal Metastases to the Liver

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver...

The Diagnosis and Management of Hypercalcaemia

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in...

Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases

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...

Nipah Encephalitis Outbreak in Malaysia

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started...

Melanocytic Lesions of the Face: Diagnostic Pitfalls

Cutaneous melanocytic lesions are amongst the commonest tumours in all races but are more common in Caucasians with fair skin. Although most are benign...

Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature

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...

A Case Report of Occupational Asthma due to Gluteraldehyde Exposure

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been...

Bile Duct Perforation in Children: Is it Truly Spontaneous?

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive. This article is available only as...

Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report

Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis....

Swallowed Foreign Bodies in Children: Report of Four Unusual Cases

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating...

Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The NORSE (New-onset Refractory Status Epilepticus) Syndrome: Defining a Disease Entity

Status epilepticus (SE) describes a clinical condition characterised by an epileptic seizure or a series of seizures that lasts for at least 30 minutes...

Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...

Rapid Identification of Pathogenic Rapidly Growing Mycobacteria by PCR-Restriction Endonuclease Analysis

The pathogenic rapidly growing mycobacteria (RGM) capable of producing disease in humans consist primarily of the Mycobacteriumabscessus (M. abscessus), Mycobacterium chelonae (M. chelonae), Mycobacterium...

A Walk Through the Management of Parkinson’s Disease

The management of idiopathic Parkinson’s disease is deceptively simple. Current practice, which consists of replacing dopamine on a twice or thrice daily regime may...

Perforated Appendicitis in Children: Benefits of Early Laparoscopic Surgery

Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal...

The Value of Joint Aspirations in the Diagnosis and Management of Arthritis in a Hospital-based Rheumatology Service

Joint aspiration with synovial fluid analysis can provide information which complements that which is available from the history and physical examination of the patient,...

Forestier’s Disease Presenting as a Retropharyngeal Mass in an Elderly with Dysphagia

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,...

Male Breast Cancer in Singapore: 15 Years of Experience at a Single Tertiary Institution

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its...

Internet Addiction in Young People

The Internet has in recent years become ubiquitous in the lives of young persons and children due to rapid information technology (IT) development, high...

Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?

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...

Singapore Rhabdomyosarcoma (RMS) Experience: Shall We Change Our Practice?

Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most...

Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery

Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is...

Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?

A good history and a detailed physical examination is often sufficient to make a diagnosis of a recurrent anterior dislocation of the shoulder, even...

Acute Onset Polyarthritis with Pitting Edema: Is it RS3PE?

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....

Tackling osteoporosis and fragility fractures in Singapore

A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young...

Herpes zoster-associated aseptic arthritis in adult patients: A case report

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,...