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Article ; Online: Correlation between Cumulative Methotrexate Dose, Metabolic Syndrome and Hepatic Fibrosis Detected by FibroScan in Rheumatoid Arthritis Patients.

Lertnawapan, Ratchaya / Chonprasertsuk, Soonthorn / Siramolpiwat, Sith / Jatuworapruk, Kanon

2023 Volume 59, Issue 6

Abstract: Background and ... ...

Abstract	Background and Objectives
MeSH term(s)	Humans ; Methotrexate/adverse effects ; Metabolic Syndrome/complications ; Antirheumatic Agents/adverse effects ; Insulin Resistance ; Elasticity Imaging Techniques ; Cross-Sectional Studies ; Arthritis, Rheumatoid/complications ; Arthritis, Rheumatoid/drug therapy ; Liver Cirrhosis/complications ; Liver Cirrhosis/drug therapy
Chemical Substances	Methotrexate (YL5FZ2Y5U1) ; Antirheumatic Agents
Language	English
Publishing date	2023-05-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina59061029
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Article ; Online: Thai rheumatology training, leadership, and gender parity in the last 3 decades: An analysis of a nation-wide database.

Jatuworapruk, Kanon / Lertnawapan, Ratchaya / Watcharajittanont, Nattawat / Gupta, Latika

International journal of rheumatic diseases

2023 Volume 26, Issue 10, Page(s) 2107–2109

MeSH term(s)	Humans ; Faculty, Medical ; Leadership ; Rheumatology/education ; Rheumatology/organization & administration ; Rheumatology/standards ; Southeast Asian People ; Thailand ; Gender Equity
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Letter
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.14768
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Article ; Online: Efficacy of febuxostat versus allopurinol and the predictors of achieving target serum urate in a cohort of Thai people with gout.

Lertnawapan, Ratchaya / Jatuworapruk, Kanon

Clinical rheumatology

2020 Volume 40, Issue 1, Page(s) 255–262

Abstract: Objective: The objectives of our study were to compare the efficacy of febuxostat with allopurinol in Thai subjects with gout, as well as to determine the predictive factors of responsiveness to urate-lowering agents and to evaluate the safety of ... ...

Abstract	Objective: The objectives of our study were to compare the efficacy of febuxostat with allopurinol in Thai subjects with gout, as well as to determine the predictive factors of responsiveness to urate-lowering agents and to evaluate the safety of febuxostat in a real-world setting. Methods: The study was a retrospective cohort study; a total of 354 gout patients were recruited from February 2015 to November 2018. The patients were categorized according to prescription of allopurinol or febuxostat. Demographic data, comorbidities, concomitant medications, gout-related clinical parameters, and the laboratory results were collected. The serial serum urate (sUA) levels were recorded at the beginning of the treatment (baseline), and after treatment at 12 weeks, 18 weeks, and 27 weeks. The primary efficacy endpoint was the achievement of target urate of < 6 mg/dl in people taking febuxostat, compared with those taking allopurinol. The secondary endpoints were the predictive factors of achieving target urate level and adverse drug reactions in patients taking febuxostat. Multivariable regression analysis was used to determine factors associated with achieving target serum urate. Results: After the treatment, the febuxostat groups had significantly lower mean sUA compared with the allopurinol groups across all follow-up periods. The proportion of people who achieved target serum urate was also higher in the febuxostat groups compared with the allopurinol groups throughout the follow-up periods. The multivariable regression analysis showed that febuxostat 40 mg (OR = 10.96 (95% CI 4.32-27.80); p value < 0.001), febuxostat 80 mg (OR = 9.54 (95% CI 3.91-23.28), smoking (OR = 2.35 (95% CI 1.13-4.91); p value = 0.023), and low baseline serum urate (OR = 0.62 (95% CI 0.52-0.74); p value < 0.001) were associated with the achievement of target serum urate. No adverse drug reaction from febuxostat was observed even among people with renal insufficiency. Conclusion: In a Thai cohort, people receiving febuxostat are more likely to achieve target serum urate level, compared with people receiving allopurinol. Febuxostat (40 or 80 mg), smoking, and low baseline serum urate were associated with the achievement of target serum urate. Key points: • Febuxostat showed superior urate-lowering efficacy compared with allopurinol in an Asian population. • In addition to febuxostat, lower baseline serum urate level and history of smoking were associated with achieving target serum urate in gout patients.
MeSH term(s)	Allopurinol/therapeutic use ; Cohort Studies ; Febuxostat/therapeutic use ; Gout/drug therapy ; Gout Suppressants/adverse effects ; Humans ; Hyperuricemia/drug therapy ; Retrospective Studies ; Thailand ; Thiazoles/therapeutic use ; Treatment Outcome ; Uric Acid
Chemical Substances	Gout Suppressants ; Thiazoles ; Febuxostat (101V0R1N2E) ; Uric Acid (268B43MJ25) ; Allopurinol (63CZ7GJN5I)
Language	English
Publishing date	2020-06-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-020-05262-6
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Article ; Online: Isaacs' syndrome in a patient with dermatomyositis: case report and review of the literature.

Lertnawapan, Ratchaya / Kulkantrakorn, Kongkiat

International journal of rheumatic diseases

2017 Volume 20, Issue 8, Page(s) 1039–1045

Abstract: This is a case report of Isaacs' syndrome in dermatomyositis. The patient presented with proximal muscle weakness, rash, elevated muscle enzyme, myopathic electromyograph and typical muscle biopsy. Ultimately he developed typical symptoms of Isaacs' ... ...

Abstract	This is a case report of Isaacs' syndrome in dermatomyositis. The patient presented with proximal muscle weakness, rash, elevated muscle enzyme, myopathic electromyograph and typical muscle biopsy. Ultimately he developed typical symptoms of Isaacs' syndrome which is an autoimmune channelopathy from voltage gated potassium channel antibody (anti-VGKC) leading to dysfunction of axonal discharge at neuromuscular junctions. It shares some similar characteristics with dermatomyositis such as autoimmunity, its association with malignancy and the response to treatment.
MeSH term(s)	Adult ; Autoantibodies/blood ; Autoimmunity ; Biomarkers/blood ; Biopsy ; Dermatomyositis/complications ; Dermatomyositis/drug therapy ; Dermatomyositis/immunology ; Dermatomyositis/physiopathology ; Electromyography ; Humans ; Immunohistochemistry ; Immunosuppressive Agents/therapeutic use ; Isaacs Syndrome/drug therapy ; Isaacs Syndrome/etiology ; Isaacs Syndrome/immunology ; Isaacs Syndrome/physiopathology ; Male ; Motor Activity ; Muscle Strength ; Neuromuscular Agents/therapeutic use ; Potassium Channels, Voltage-Gated/immunology ; Recovery of Function ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Autoantibodies ; Biomarkers ; Immunosuppressive Agents ; Neuromuscular Agents ; Potassium Channels, Voltage-Gated
Language	English
Publishing date	2017-08
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.12881
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Article: Lupus protein-losing enteropathy patient with protein C and protein S deficiency-induced thrombosis: A case report with review of the literature.

Lertnawapan, Ratchaya / Sakonlaya, Dussadee

Acta reumatologica portuguesa

2017 Volume 42, Issue 3, Page(s) 265–268

Abstract: ... A case report of SLE with PLE in an Asian female; presented with edema, pleural effusion, ascites and profound hypoalbuminemia. She also had severe protein C and protein S depletion from GI loss which caused extensive thrombosis. Her disease was ... ...

Title translation	Lupus protein-losing enteropathy patient with protein C and protein S deficiency-induced thrombosis: A case report with review of the literature.
Abstract	A case report of SLE with PLE in an Asian female; presented with edema, pleural effusion, ascites and profound hypoalbuminemia. She also had severe protein C and protein S depletion from GI loss which caused extensive thrombosis. Her disease was refractory to the treatment with high dose steroid, azathioprine, mycophenolate mofetil and cyclophosphamide. Bowel resection was performed without improvement. Fortunately, the patient responded to another course of pulse methyl prednisolone and a second line medication after surgery. .
MeSH term(s)	Female ; Humans ; Middle Aged ; Protein C Deficiency/complications ; Protein S Deficiency/complications ; Protein-Losing Enteropathies/complications ; Thrombosis/etiology
Language	English
Publishing date	2017-07
Publishing country	Portugal
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	442031-7
ISSN	0303-464X
ISSN	0303-464X
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Article ; Online: Association between cumulative methotrexate dose, non-invasive scoring system and hepatic fibrosis detected by Fibroscan in rheumatoid arthritis patients receiving methotrexate.

Lertnawapan, Ratchaya / Chonprasertsuk, Soonthorn / Siramolpiwat, Sith

International journal of rheumatic diseases

2018 Volume 22, Issue 2, Page(s) 214–221

Abstract: Background: Methotrexate (MTX) is recommended by recent American College of Rheumatology and European League against Rheumatism guidelines as a first-line drug for rheumatoid arthritis (RA). Liver fibrosis, which occurs as a long-term side effect is of ... ...

Abstract	Background: Methotrexate (MTX) is recommended by recent American College of Rheumatology and European League against Rheumatism guidelines as a first-line drug for rheumatoid arthritis (RA). Liver fibrosis, which occurs as a long-term side effect is of major concern. Monitoring aminotransferase and albumin is suggested in the guidelines, unfortunately this method is unreliable for detecting liver fibrosis. We try to find the association between clinical parameters, cumulative MTX dosage, liver fibrosis scoring systems and the presence of liver fibrosis assessed by transient elastography (TE; Fibroscan®). Method: Rheumatoid arthritis patients prescribed MTX were evaluated for liver fibrosis with TE. Two subgroups of patients were compared: non-fibrosis and fibrosis (TE > 7 kPa). Univariate and multivariate logistic regression analysis was performed to identify factors associated with liver fibrosis. Results: One hundred and eight patients were recruited. Twenty-nine patients (26.8%) were classified by transient elastography as liver fibrosis cases. The multivariate analysis demonstrated statistical significance only in the association of body mass index (odds ratio [OR] = 1.22; 95% CI 1.05-1.41; P = 0.01); fatty liver (OR = 2.32; 95% CI 1.58-9.19; P = 0.02); alanine transaminase (OR = 1.04; 95% CI 1.02-1.09; P = 0.04) and cumulative MTX dosage (OR = 1.03; 95% CI 1.01-1.04; P = 0.001). Conclusions: Liver fibrosis measured with Fibroscan was associated with cumulative MTX. RA patients with metabolic syndrome including high body mass index and fatty liver, had a higher risk of MTX-induced hepatic fibrosis. RA patients with high cumulative MTX dose, especially patients with concurrent metabolic syndrome, should be cautiously monitored for liver fibrosis.
MeSH term(s)	Adult ; Aged ; Alanine Transaminase/blood ; Antirheumatic Agents/administration & dosage ; Antirheumatic Agents/adverse effects ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Body Mass Index ; Chemical and Drug Induced Liver Injury/diagnostic imaging ; Chemical and Drug Induced Liver Injury/etiology ; Dose-Response Relationship, Drug ; Elasticity Imaging Techniques ; Fatty Liver/complications ; Female ; Humans ; Liver Cirrhosis/chemically induced ; Liver Cirrhosis/diagnostic imaging ; Male ; Metabolic Syndrome/complications ; Methotrexate/administration & dosage ; Methotrexate/adverse effects ; Middle Aged ; Predictive Value of Tests ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome
Chemical Substances	Antirheumatic Agents ; Alanine Transaminase (EC 2.6.1.2) ; Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2018-11-22
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.13442
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Article ; Online: Multifocal osteolysis with chylous polyserositis and intrathoracic vein thrombosis: a diagnostic challenge for rheumatologists.

Jatuworapruk, Kanon / Lertnawapan, Ratchaya / Ratanabunjerdkul, Hataiwan / Kintarak, Jutatip / Satdhabudha, Opas

International journal of rheumatic diseases

2018 Volume 21, Issue 7, Page(s) 1458–1462

Abstract: Vanishing bone disease with multisystemic involvement may mimic systemic autoimmune or autoinflammatory diseases. We present a 19-year-old man who was hospitalized due to chest pain following a progressive osteolysis of the bony thorax. The disease later ...

Abstract	Vanishing bone disease with multisystemic involvement may mimic systemic autoimmune or autoinflammatory diseases. We present a 19-year-old man who was hospitalized due to chest pain following a progressive osteolysis of the bony thorax. The disease later expanded into the pleura, peritoneum and pericardium in a form of massive chylous polyserositis. The patient also developed thrombosis of multiple central veins, which in turn worsened the chylothorax by increasing the pressure in the thoracic duct. This is the first case of vanishing bone disease complicated by triple chylous effusions and central vein thrombosis.
MeSH term(s)	Biopsy ; Chylothorax/diagnosis ; Chylothorax/etiology ; Chylothorax/therapy ; Chylous Ascites/etiology ; Diagnosis, Differential ; Disease Progression ; Fatal Outcome ; Humans ; Lymphoscintigraphy ; Male ; Osteolysis, Essential/complications ; Osteolysis, Essential/diagnosis ; Osteolysis, Essential/therapy ; Pericardial Effusion/etiology ; Pleural Effusion/etiology ; Predictive Value of Tests ; Serositis/diagnosis ; Serositis/etiology ; Serositis/therapy ; Tomography, X-Ray Computed ; Venous Thrombosis/diagnosis ; Venous Thrombosis/etiology ; Venous Thrombosis/therapy ; Young Adult
Language	English
Publishing date	2018-07-02
Publishing country	England
Document type	Case Reports
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.13329
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Article ; Online: The GOUT-36 prediction rule for inpatient gout flare in people with comorbid gout: derivation and external validation.

Jatuworapruk, Kanon / Grainger, Rebecca / Dalbeth, Nicola / Lertnawapan, Ratchaya / Hanvivadhanakul, Punchong / Towiwat, Patapong / Shi, Lianjie / Taylor, William J

Rheumatology (Oxford, England)

2021 Volume 61, Issue 4, Page(s) 1658–1662

Abstract: Objectives: To develop and validate a gout flare risk stratification tool for people with gout hospitalized for non-gout conditions.: Methods: The prediction rule for inpatient gout flare was derived from a cohort of 625 hospitalized people with ... ...

Abstract	Objectives: To develop and validate a gout flare risk stratification tool for people with gout hospitalized for non-gout conditions. Methods: The prediction rule for inpatient gout flare was derived from a cohort of 625 hospitalized people with comorbid gout from New Zealand. The rule had four items: no pre-admission gout flare prophylaxis, no pre-admission urate-lowering therapy, tophus and pre-admission serum urate >0.36 mmol/l within the previous year (GOUT-36 rule). Two or more items are required for the classification of high risk for developing inpatient gout flares. The GOUT-36 rule was validated in a prospective cohort of 284 hospitalized people with comorbid gout from Thailand and China. Results: The GOUT-36 rule had a sensitivity of 75%, specificity of 67% and area under the curve of 0.71 for classifying people at high risk for developing inpatient gout flares. Four risk groups were developed: low (no items), moderate (one item), high (two items) and very high risk (three or four items). In a population with frequent (overall 34%) in-hospital gout flares, 80% of people with very high risk developed inpatient flares while 11% with low risk had inpatient flares. Conclusion: The GOUT-36 rule is simple and sensitive for classifying people with high risk for inpatient gout flares. The rule may help inform clinical decisions and future research on the prevention of inpatient gout flares.
MeSH term(s)	Gout/drug therapy ; Gout Suppressants/therapeutic use ; Humans ; Inpatients ; Prospective Studies ; Symptom Flare Up ; Uric Acid
Chemical Substances	Gout Suppressants ; Uric Acid (268B43MJ25)
Language	English
Publishing date	2021-07-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keab590
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Zs.B 240: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Anaphylaxis and biphasic phase in Thailand: 4-year observation.

Lertnawapan, Ratchaya / Maek-a-nantawat, Wirach

Allergology international : official journal of the Japanese Society of Allergology

2011 Volume 60, Issue 3, Page(s) 283–289

Abstract: Background: Anaphylaxis, a severe systemic allergic reaction, can be fatal. However, its prevalence has been underestimated especially in biphasic phase, due to a lack of case awareness. This study aimed to determine the rate of anaphylaxis, describe ... ...

Abstract	Background: Anaphylaxis, a severe systemic allergic reaction, can be fatal. However, its prevalence has been underestimated especially in biphasic phase, due to a lack of case awareness. This study aimed to determine the rate of anaphylaxis, describe clinical manifestations and management, and identify the causative agents and risk factors of biphasic anaphylactic reaction. Methods: An observational study was conducted at the Emergency Department of Thammasat University Hospital, Thailand, during the period 2004-2008. Results: Of total 208 cases of anaphylaxis identified, the median age was 20.67 years; 52.9% were male. The anaphylaxis rate was 49 per 100,000 patient-years. No fatal case was found; 58.7% had a history of atopy, and 38.5% had experienced a previous allergic reaction, of whom 8.8% had had a previous anaphylactic reaction. The causative allergens were identified in 82.2% of cases; food allergy was most common. Urticaria was the most common presentation (87%). Among 6.3% of the patients who developed biphasic reaction, a significantly longer time from onset of symptoms to administration of epinephrine was detected, with a median of 240 minutes for those with biphasic anaphylaxis, versus 70 minutes for those without (p = 0.002). The median times from onset to hospital arrival and the arrival to administration of epinephrine were also significantly longer in the biphasic group than the non-biphasic patients (p = 0.002 and p = 0.001, respectively). In multivariable regression models, the time intervals from onset and hospital arrival to administration of epinephrine continued to predict biphasic phase occurrence (p < 0.01). Conclusions: Anaphylaxis predominantly occurs among children and young adults. Delayed administration of epinephrine was associated with the occurrence of biphasic anaphylaxis.
MeSH term(s)	Adolescent ; Adult ; Allergens/immunology ; Anaphylaxis/drug therapy ; Anaphylaxis/epidemiology ; Anaphylaxis/etiology ; Child ; Epinephrine/therapeutic use ; Female ; Histamine Antagonists/therapeutic use ; Humans ; Male ; Risk Factors ; Thailand/epidemiology ; Vasoconstrictor Agents/therapeutic use ; Young Adult
Chemical Substances	Allergens ; Histamine Antagonists ; Vasoconstrictor Agents ; Epinephrine (YKH834O4BH)
Language	English
Publishing date	2011-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1336498-4
ISSN	1440-1592 ; 1323-8930
ISSN (online)	1440-1592
ISSN	1323-8930
DOI	10.2332/allergolint.10-OA-0256
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Article ; Online: Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus.

Lertnawapan, Ratchaya / Totemchokchyakarn, Kitti / Nantiruj, Kanokrat / Janwityanujit, Suchela

Rheumatology international

2009 Volume 29, Issue 5, Page(s) 491–496

Abstract: Pneumocystis jeroveci pneumonia (PCP) is an opportunistic infection which occurs mostly in the immune-deficiency host. Although PCP infected systemic lupus erythematosus (SLE) patient carries poor outcome, no standard guideline for prevention has been ... ...

Abstract	Pneumocystis jeroveci pneumonia (PCP) is an opportunistic infection which occurs mostly in the immune-deficiency host. Although PCP infected systemic lupus erythematosus (SLE) patient carries poor outcome, no standard guideline for prevention has been established. The aim of our study is to identify the risk factors which will indicate the PCP prophylaxis in SLE. This is a case control study. A search of Ramathibodi hospital's medical records between January 1994 and March 2004, demonstrates 15 cases of SLE with PCP infection. Clinical and laboratory data of these patients were compared to those of 60 matched patients suffering from SLE but no PCP infection. Compared to SLE without PCP, those with PCP infection have significantly higher activity index by MEX-SLEDAI (13.6 +/- 5.83 vs. 6.73 +/- 3.22) or more renal involvement (86 vs. 11.6%, P < 0.01), higher mean cumulative dose of steroid (49 +/- 29 vs. 20 +/- 8 mg/d, P < 0.01), but lower lymphocyte count (520 +/- 226 vs. 1420 +/- 382 cells/mm(3), P < 0.01). Interestingly, in all cases, a marked reduction in lymphocyte count (710 +/- 377 cells/mm(3)) is observed before the onset of PCP infection. The estimated CD4+ count is also found to be lower in the PCP group (156 +/- 5 vs. 276 +/- 8 cells/mm(3)). Our study revealed that PCP infected SLE patients had higher disease activity, higher dose of prednisolone treatment, more likelihood of renal involvement, and lower lymphocyte count as well as lower CD4+ count than those with no PCP infection. These data should be helpful in selecting SLE patients who need PCP prophylaxis.
MeSH term(s)	Adult ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes/immunology ; Case-Control Studies ; Female ; Humans ; Immunosuppressive Agents/immunology ; Immunosuppressive Agents/therapeutic use ; Lupus Erythematosus, Systemic/drug therapy ; Lupus Erythematosus, Systemic/immunology ; Male ; Middle Aged ; Odds Ratio ; Opportunistic Infections/drug therapy ; Opportunistic Infections/immunology ; Pneumonia, Pneumocystis/drug therapy ; Pneumonia, Pneumocystis/immunology ; Prednisolone/immunology ; Prednisolone/therapeutic use ; Retrospective Studies ; Risk Factors
Chemical Substances	Immunosuppressive Agents ; Prednisolone (9PHQ9Y1OLM)
Language	English
Publishing date	2009-03
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8286-7
ISSN	1437-160X ; 0172-8172
ISSN (online)	1437-160X
ISSN	0172-8172
DOI	10.1007/s00296-008-0721-6
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