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...

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...

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal outcomes but is associated with considerable morbidity, and their role in the management of lupus nephritis is not universally accepted. This article is available only as...

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...

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...

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...

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...

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...

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...

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...

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 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...

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....

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...

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...

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...

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...

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.