16 results on '"Ronald Man Lung Yip"'
Search Results
2. The Hong Kong Society of Rheumatology Consensus Recommendations for COVID-19 Vaccination in Adult Patients with Autoimmune Rheumatic Diseases
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Ho So, Chi Chiu Mok, and Ronald Man Lung Yip
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covid-19 ,vaccine ,vaccination ,rheumatic ,rheumatology ,autoimmune ,recommendations ,consensus ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Patients with autoimmune rheumatic diseases are potentially at risk of more serious Coronavirus Disease 2019 (COVID-19) infection and increased mortality due to immunosuppressive therapies and disease-related medical comorbidities. Uncertainty about the safety and efficacy of the COVID-19 vaccines is a major deterrent for patients to participate in the vaccination program. The Hong Kong Society of Rheumatology took the lead to publish a set of consensus statements for COVID-19 vaccination in adult patients with autoimmune rheumatic diseases through a Delphi exercise that involved the senior members of the Society. This serves as a guide to rheumatologists and other specialists, nurses, healthcare professionals, and public regarding COVID-19 vaccination in autoimmune rheumatic diseases.
- Published
- 2021
- Full Text
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3. Role of Interleukin 6 Inhibitors in the Management of Rheumatoid Arthritis
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Ronald Man Lung Yip and Cheuk Wan Yim
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rheumatoid arthritis ,Oncology ,medicine.medical_specialty ,Combination therapy ,Anemia ,Reviews ,sarilumab ,IL-6 inhibitors ,Arthritis, Rheumatoid ,tocilizumab ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tocilizumab ,Rheumatology ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Interleukin 6 ,030203 arthritis & rheumatology ,biology ,Interleukin-6 ,business.industry ,candidates for IL-6 inhibition ,medicine.disease ,Sarilumab ,Methotrexate ,Treatment Outcome ,Tolerability ,chemistry ,Antirheumatic Agents ,Rheumatoid arthritis ,Quality of Life ,biology.protein ,Drug Therapy, Combination ,business ,medicine.drug - Abstract
Rheumatoid arthritis (RA) is a multisystem disease that affects the joints and various organs, resulting in compromised quality of life and increased mortality. A wide spectrum of treatment options is available for RA. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are the first-line of treatment for RA, whereas tumor necrosis factor α inhibitors are commonly used as a second-line biological disease-modifying antirheumatic drug following inadequate response to csDMARDs. However, remission remains difficult to achieve. No single agent is effective for all patients. It is important to consider patients' comorbidities, perspectives, and preferences when selecting treatment. Interleukin 6 (IL-6) plays a prominent role in the pathophysiology of RA and is an important therapeutic target for RA. Tocilizumab and sarilumab are approved IL-6 inhibitors, which have demonstrated good efficacy and tolerability as combination therapy or monotherapy in RA patients with inadequate response to csDMARDs or tumor necrosis factor α inhibitors. Apart from alleviating joint symptoms, inducing remission, and reducing structural damage, tocilizumab and sarilumab exhibit additional advantages in alleviating extra-articular symptoms, such as fatigue and morning stiffness, and have positive effect on anemia and glucose metabolism. Additionally, evidence showed that certain patient subgroups, such as those with comorbidities including anemia and diabetes mellitus, those with early RA, those with high baseline IL-6 levels, those at high risk of tuberculosis infection, or those intolerant to methotrexate monotherapy, may benefit from IL-6 inhibition. Given these advantages, tocilizumab and sarilumab can be considered earlier as a rational choice for treating RA in suitable patients. Future clinical investigations will help refine the use of these agents.
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- 2021
4. The Hong Kong Society of Rheumatology Consensus Recommendations for COVID-19 Vaccination in Adult Patients with Autoimmune Rheumatic Diseases
- Author
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Ronald Man Lung Yip, Chi Chiu Mok, and Ho So
- Subjects
0301 basic medicine ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,rheumatology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,vaccine ,Medicine ,030203 arthritis & rheumatology ,Adult patients ,business.industry ,autoimmune ,RC581-607 ,vaccination ,Rheumatology ,Vaccination ,030104 developmental biology ,covid-19 ,consensus ,recommendations ,rheumatic ,Immunologic diseases. Allergy ,business - Abstract
Patients with autoimmune rheumatic diseases are potentially at risk of more serious Coronavirus Disease 2019 (COVID-19) infection and increased mortality due to immunosuppressive therapies and disease-related medical comorbidities. Uncertainty about the safety and efficacy of the COVID-19 vaccines is a major deterrent for patients to participate in the vaccination program. The Hong Kong Society of Rheumatology took the lead to publish a set of consensus statements for COVID-19 vaccination in adult patients with autoimmune rheumatic diseases through a Delphi exercise that involved the senior members of the Society. This serves as a guide to rheumatologists and other specialists, nurses, healthcare professionals, and public regarding COVID-19 vaccination in autoimmune rheumatic diseases.
- Published
- 2021
5. Myositis‐specific autoantibodies and their clinical associations in idiopathic inflammatory myopathies
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Victor Tak Lung Wong, Tommy Tsz-On Lam, Ronald Man Lung Yip, and Ho So
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Adult ,Male ,medicine.medical_specialty ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Family history ,Prospective cohort study ,Autoantibodies ,Myositis ,business.industry ,Autoantibody ,Interstitial lung disease ,General Medicine ,Middle Aged ,Dermatomyositis ,medicine.disease ,Rash ,Neurology ,Antibodies, Antinuclear ,Cohort ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Transcription Factors - Abstract
Background Myositis-specific autoantibodies (MSAs) have been found to be present predominantly in patients with idiopathic inflammatory myopathies (IIMs). This study aimed to investigate the prevalence of MSAs and their associated complications in a cohort of patients with IIMs. Methods This was a multicentered prospective study. Consecutive adult Chinese patients with IIMs in the regional hospitals in Hong Kong were followed up from July 2016 to January 2018. Clinical characteristics, treatment history, and disease complications were documented. A commercially available immunoblot assay was used to detect the MSAs. Results Out of the 201 patients studied, at least one MSA was found in 63.2% of patients. The most common among the identified MSAs were the anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) and the anti-transcriptional intermediary factor 1-gamma antibody (anti-TIF1-γ Ab) (both 13.9%), followed by anti-Jo-1 antibody (12.4%). Anti-MDA5 was present exclusively in dermatomyositis (DM) and was strongly associated with digital ulcers, amyopathy, and rapidly progressive interstitial lung disease (RP-ILD). Anti-TIF1γ was strongly associated with refractory rash and malignancy. Independent risk factors of RP-ILD included anti-MDA5 (OR 14.5), clinically amyopathic DM (OR 13.9), and history of pulmonary tuberculosis (OR 12.2). Cox regression analysis showed that anti-TIF1γ (HR 3.55), DM (HR 3.82), and family history of cancer (HR 3.40) were independent predictors of malignancy. Conclusions MSA testing enables dividing of patients with IIMs into phenotypically homogeneous subgroups and prediction of potentially life-threatening complications.
- Published
- 2020
6. DAPSA, carotid plaque and cardiovascular events in psoriatic arthritis: a longitudinal study
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Alex Pui-Wai Lee, Shirley King Yee Ying, Lai-Shan Tam, Edmund K. Li, Ronald Man Lung Yip, Jolie Lee, Isaac T Cheng, Cheuk-Wan Yim, Priscilla Wong, Steven H. M. Lam, Martin Li, and Tena K. Li
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Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Immunology ,Subgroup analysis ,Disease ,Severity of Illness Index ,General Biochemistry, Genetics and Molecular Biology ,Cohort Studies ,Psoriatic arthritis ,Rheumatology ,Risk Factors ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Carotid Stenosis ,In patient ,Longitudinal Studies ,Subclinical infection ,business.industry ,Arthritis, Psoriatic ,Middle Aged ,medicine.disease ,Increased risk ,Cardiovascular Diseases ,Female ,business ,Cohort study - Abstract
ObjectiveTo examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis.MethodsA cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models.Results189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42.ConclusionHigher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.
- Published
- 2020
7. Management of rheumatoid arthritis: 2019 updated consensus recommendations from the Hong Kong Society of Rheumatology
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Chi Chiu Mok, Carmen Tze Kwan Ho, Ronald Man Lung Yip, Kitty Y Kwok, and Tommy Tsang Cheung
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musculoskeletal diseases ,medicine.medical_specialty ,Local expert ,business.industry ,Disease Management ,Treatment options ,Biosimilar ,General Medicine ,Guideline ,medicine.disease ,Patient preference ,Treatment failure ,Rheumatology ,Arthritis, Rheumatoid ,Antirheumatic Agents ,Rheumatoid arthritis ,Internal medicine ,medicine ,Humans ,skin and connective tissue diseases ,business ,Intensive care medicine - Abstract
The expanding range of treatment options for rheumatoid arthritis (RA), from conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to biological DMARDs (bDMARDs), biosimilar bDMARDs, and targeted synthetic DMARDs, has improved patient outcomes but increased the complexity of treatment decisions. These updated consensus recommendations from the Hong Kong Society of Rheumatology provide guidance on the management of RA, with a focus on how to integrate newly available DMARDs into clinical practice. The recommendations were developed based on evidence from the literature along with local expert opinion. Early diagnosis of RA and prompt initiation of effective therapy remain crucial and we suggest a treat-to-target approach to guide optimal sequencing of DMARDs in RA patients to achieve tight disease control. Newly available DMARDs are incorporated in the treatment algorithm, resulting in a greater range of second-line treatment options. In the event of treatment failure or intolerance, switching to another DMARD with a similar or different mode of action may be considered. Given the variety of available treatments and the heterogeneity of patients with RA, treatment decisions should be tailored to the individual patient taking into consideration prognostic factors, medical comorbidities, drug safety, cost of treatment, and patient preference.
- Published
- 2019
8. Effect of Achieving Minimal Disease Activity on the Progression of Subclinical Atherosclerosis and Arterial Stiffness: A Prospective Cohort Study in Psoriatic Arthritis
- Author
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Edmund K. Li, Tracy Y. Zhu, Alex Pui-Wai Lee, Emily W. Kun, Bryan P. Yan, Ronald Man Lung Yip, Priscilla Wong, Jack Lee, Mei Yan Law, Qing Shang, Shirley King Yee Ying, Isaac T Cheng, Mimi M. Chang, Martin Li, Tena K. Li, Billy T Lai, Kitty Y Kwok, Lai-Shan Tam, Cheuk-Chun Szeto, and Isaac C Yim
- Subjects
Adult ,Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Multivariate analysis ,Immunology ,Urology ,Arthritis ,Pulse Wave Analysis ,Carotid Intima-Media Thickness ,Cohort Studies ,03 medical and health sciences ,Psoriatic arthritis ,Vascular Stiffness ,0302 clinical medicine ,Rheumatology ,medicine ,Humans ,Immunology and Allergy ,Prospective Studies ,030212 general & internal medicine ,skin and connective tissue diseases ,Prospective cohort study ,Ultrasonography ,030203 arthritis & rheumatology ,business.industry ,Arthritis, Psoriatic ,Odds ratio ,Middle Aged ,Atherosclerosis ,medicine.disease ,Confidence interval ,Treatment Outcome ,Antirheumatic Agents ,Asymptomatic Diseases ,Multivariate Analysis ,Radial Artery ,Disease Progression ,Arterial stiffness ,Female ,business ,Cohort study - Abstract
Objective To investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA). Methods A total of 101 consecutive patients with PsA were recruited for this prospective cohort study. All patients received protocolized treatment targeting MDA for a period of 2 years. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. The primary outcome measure was the effect of achieving MDA at 12 months (MDA group) on the progression of subclinical atherosclerosis over a period of 24 months. Secondary objectives were to compare the changes in arterial stiffness markers over 24 months between the MDA and non-MDA groups, as well as the changes in subclinical atherosclerosis and arterial stiffness markers in patients who achieved MDA at each visit from month 12 through month 24 (sustained MDA [sMDA]). Results Ninety PsA patients (mean ± SD age 50 ± 11 years, 58% male [n = 52]) who completed 24 months of follow-up were included in this analysis. Fifty-seven patients (63%) had achieved MDA at 12 months. Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups. Forty-one patients (46%) achieved sMDA. As shown by multivariate analysis, achieving sMDA had a protective effect on plaque progression (odds ratio 0.273 [95% confidence interval 0.088-0.846], P = 0.024), and less of an increase in total plaque area, mean intima-media thickness, and augmentation index values after adjustment for covariates. Conclusion Our results support the recommendation that once MDA is achieved, it should ideally be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.
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- 2019
9. A case of idiopathic inflammatory myopathy complicated by Epstein-Barr virus-associated lymphoma
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Victor Tak Lung Wong, Ronald Man Lung Yip, Virginia Wen Nga Lao, Ho So, and Hin Ting Pang
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Pathology ,medicine.medical_specialty ,idiopathic inflammatory myopathy ,dermatomyositis ,business.industry ,epstein-barr virus-associated lymphoproliferative disorders ,RC581-607 ,medicine.disease ,medicine.disease_cause ,Epstein–Barr virus ,epstein-barr virus-associated lymphoma ,Rheumatology ,Lymphoma ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Idiopathic Inflammatory Myopathy ,antisynthetase syndrome ,Immunologic diseases. Allergy ,business - Abstract
We report a male patient who had refractory idiopathic inflammatory myopathy (IIM) presented with antisynthetase syndrome, being treated by potent immunosuppressants for years, developed Epstein-Barr virus (EBV)-associated lymphoma. Despite the stepping down of the immunosuppressives and active lymphoma therapy, the patient died. On top of the typical association of IIM and malignancy, rare EBV-associated tumors related to EBV infection secondary to the use of potent immunosuppressive therapies could occur. Further investigations are advisable if there are new symptoms and signs or in refractory IIM cases. This report serves as a diagnostic alert that the causation by EBV infection in unusual tumors found in patients with IIM should be considered, as both the treatment and prognosis may differ. A balance between the risks and benefits of immunosuppressive therapies should always be achieved.
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- 2018
10. Bone Mass, Microstructure, and Strength Can Discriminate Vertebral Fracture in Patients on Long-Term Steroid Treatment
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Jack Lee, Ling Qin, Shirley K Y Ying, Jiayun Shen, James F. Griffith, Carmen T K Ho, Tracy Y. Zhu, Eleven Y Lau, Emily W. Kun, Ronald Man Lung Yip, Sze-Lok Lau, Kitty Y Kwok, Lai-Shan Tam, Violet Ka-Lai Lee, Peggy Tang, Michelle O. Pui, and Tena K. Li
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Male ,0301 basic medicine ,Time Factors ,FRAX ,Bone density ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,Osteoporosis ,Dentistry ,Biochemistry ,Absorptiometry, Photon ,0302 clinical medicine ,Endocrinology ,Bone Density ,Risk Factors ,Prevalence ,Medicine ,Quantitative computed tomography ,Bone mineral ,medicine.diagnostic_test ,Middle Aged ,Radius ,Hong Kong ,Spinal Fractures ,Female ,Adult ,musculoskeletal diseases ,medicine.medical_specialty ,030209 endocrinology & metabolism ,Context (language use) ,03 medical and health sciences ,Internal medicine ,Cortical Bone ,Humans ,Tibia ,Glucocorticoids ,Reduction (orthopedic surgery) ,Aged ,business.industry ,Biochemistry (medical) ,medicine.disease ,Cross-Sectional Studies ,030104 developmental biology ,Case-Control Studies ,Tomography, X-Ray Computed ,business - Abstract
Context Measurement of areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) was able to predict fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) yields additional information about volumetric bone mineral density (vBMD), microarchitecture, and strength that may increase our understanding of fracture susceptibility. Objective To ascertain whether vBMD, microarchitecture, and estimated bone strength derived from HR-pQCT can discriminate vertebral fractures in patients with glucocorticoid-induced osteoporosis (GIOP) independent of aBMD. Design A cross-sectional case-control study. Setting Seven regional hospitals in Hong Kong. Patients A total of 110 patients on long-term glucocorticoids with vertebral fracture, determined radiographically, and 110 patients on long-term glucocorticoids without fracture. Main Outcome Measures We assessed vBMD, microarchitecture, and bone strength; aBMD; and fracture risk assessment tool (FRAX). Results Patients with vertebral fracture had lower total vBMD and a thinner cortex at the distal tibia after adjustment for age, sex, and aBMD or FRAX. In the antiresorptive treatment-naive subgroup, patients with vertebral fracture also had lower total vBMD at both the distal radius and the tibia after adjustment for covariates. Lower total vBMD and a thinner cortex were also noticed in the nonosteoporotic or FRAX score of
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- 2018
11. Local steroid injection versus wrist splinting for carpal tunnel syndrome: A randomized clinical trial
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Ronald Man Lung Yip, Joseph C. K. Cheng, Ho So, and Vincent C.H. Chung
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Male ,musculoskeletal diseases ,Steroid injection ,medicine.medical_specialty ,Time Factors ,Wrist ,Injections ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Rheumatology ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Humans ,Medicine ,Orthopedic Procedures ,Carpal tunnel ,Prospective Studies ,030212 general & internal medicine ,Carpal tunnel syndrome ,Aged ,Analgesics ,business.industry ,Significant difference ,Recovery of Function ,Middle Aged ,medicine.disease ,Carpal Tunnel Syndrome ,Surgery ,body regions ,Clinical trial ,Treatment Outcome ,medicine.anatomical_structure ,Splints ,Patient Satisfaction ,Hong Kong ,Female ,Steroids ,business ,030217 neurology & neurosurgery - Abstract
Aim We conducted a prospective randomized parallel clinical trial comparing the efficacy of local steroid injection and nocturnal wrist splinting in patients with carpal tunnel syndrome (CTS). Methods The well-validated and disease-specific Boston Carpal Tunnel Questionnaire (BCTQ) was employed and its score at 4 weeks after treatment was used as the primary outcome measure. Important secondary outcomes included patient satisfaction, the change of an objective finger dexterity test and the side effects. Results Twenty-five patients in the local steroid group and 25 patients in the wrist splinting group completed the study procedures. At 4 weeks after treatment, there was significant improvement of the BTCQ scores in both the steroid group and splinting group. There was improvement of the finger dexterity test only in the steroid group but not in the splinting group. However, there was no statistically significant difference in the changes of BTCQ scores between the two groups after treatment. Patient satisfaction score was higher in the steroid group. Patients in the steroid group took fewer painkillers after treatment. Four patients developed side effects after splinting and three after local steroid injection, which was not statistically significant. Conclusion Although local steroid injection and nocturnal wrist splinting were equally effective in the treatment of patients with CTS, only the former improved objective hand function. Local steroid injection also resulted in better patient satisfaction and less painkiller use without causing more side effects.
- Published
- 2017
12. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease
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Qing Shang, Alex Pui-Wai Lee, Chun-Kwok Wong, Priscilla Wong, Tracy Y. Zhu, Mei Yan Law, Tena K. Li, Jack Lee, Isaac T Cheng, Shirley K Y Ying, Isaac C Yim, Edmund K. Li, Jiayun Shen, Lai-Shan Tam, Martin Li, Mimi Chang, Ka-Tak Wong, Emily W. Kun, and Ronald Man Lung Yip
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Adult ,medicine.medical_specialty ,Computed Tomography Angiography ,Immunology ,Prior diagnosis ,Comorbidity ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Chest pain ,General Biochemistry, Genetics and Molecular Biology ,Coronary artery disease ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Coronary plaque ,Prevalence ,medicine ,Humans ,Immunology and Allergy ,In patient ,Vascular Calcification ,Coronary atherosclerosis ,030203 arthritis & rheumatology ,business.industry ,Arthritis, Psoriatic ,Middle Aged ,medicine.disease ,Plaque, Atherosclerotic ,Surgery ,Stenosis ,Multivariate Analysis ,medicine.symptom ,business - Abstract
To evaluate coronary atherosclerosis in patients with psoriatic arthritis (PsA) and control subjects using coronary CT angiography (CCTA).Ninety consecutive patients with PsA (male: 56(62.2%); 50.3±11.1 years) were recruited. 240 controls (male: 137(57.1%); 49.6±10.7 years) without known cardiovascular (CV) diseases who underwent CCTA due to chest pain and/or multiple CV risk factors were recruited for comparison.Patients with PsA and controls were matched in age, gender and traditional CV risk factors (all p0.2). The prevalence of overall plaque (54(60%)/84(35%), p0.001), calcified plaque (CP) (29(32%)/40(17%), p=0.002), mixed plaque (MP) (20(22%)/18(8%), p0.001), non-calcified plaque (NCP) (39(43%)/53(22%), p0.001) and combined MP/NCP (46(51%)/62(26%), p0.001) were all significantly higher in patients with PsA. Three-vessel disease was diagnosed in 12(13%) patients with PsA and 7(3%) controls (p0.001), while obstructive plaques (50% stenosis) were observed in 8(9%) patients with PsA and 7(3%) controls (p=0.033). After adjusting for traditional CV risk factors, PsA remained an independent explanatory variable for all types of coronary plaques (OR: 2.730 to 4.064, all p0.001). PsA was also an independent explanatory variable for three-vessel disease (OR: 10.798, p0.001) and obstructive plaque (3.939, p=0.024). In patients with PsA, disease duration was the only disease-specific characteristic associated with more vulnerable plaques (MP/NCP) in multivariate analysis (1.063, p=0.031). The other independent explanatory variables were age ≥55 years (5.636, p=0.005) and male gender (8.197, p=0.001).Patients with PsA have increased prevalence, burden and severity of coronary atherosclerosis as documented by CCTA. Longer disease duration was independently associated with the presence of vulnerable MP/NCP plaques in patients with PsA.NCT02232321.
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- 2017
13. The first case of idiopathic inflammatory myopathy complicated by Epstein-Barr virus-associated smooth muscle tumor and lymphoma
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Ho So, Victor Tak Lung Wong, Ronald Man Lung Yip, Virginia Wen Nga Lao, and Hin Ting Pang
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Pathology ,medicine.medical_specialty ,Epstein-Barr Virus Infections ,Lymphoma ,medicine.disease_cause ,Risk Assessment ,Immunocompromised Host ,Rare Diseases ,Rheumatology ,Biopsy ,medicine ,Humans ,Smooth Muscle Tumor ,medicine.diagnostic_test ,Myositis ,business.industry ,Biopsy, Needle ,Follow up studies ,Middle Aged ,medicine.disease ,Epstein–Barr virus ,Immunohistochemistry ,Magnetic Resonance Imaging ,Idiopathic Inflammatory Myopathy ,Female ,business ,Immunosuppressive Agents ,Follow-Up Studies - Published
- 2018
14. Effect of Treat-to-target Strategies Aiming at Remission of Arterial Stiffness in Early Rheumatoid Arthritis: A Randomized Controlled Study
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Isaac C Yim, Steve Hin-Ting Pang, Lydia Ho-Pui Tam, Virginia Weng Nga Lao, Edmund K. Li, Lai-Shan Tam, Tracy Y. Zhu, Priscilla Wong, Alex Pui-Wai Lee, Xerox Sze-Lok Lau, Qing Shang, Kitty Y Kwok, Isaac T Cheng, Tena Ka-Yan Li, Violet Ka-Lai Lee, Emily W. Kun, Ronald Man Lung Yip, and Queenie Wah-Yan Mak
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musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Immunology ,Pulse Wave Analysis ,Severity of Illness Index ,law.invention ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Vascular Stiffness ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Pulse wave velocity ,Aged ,030203 arthritis & rheumatology ,business.industry ,Remission Induction ,Treat to target ,Early rheumatoid arthritis ,Middle Aged ,medicine.disease ,Clinical trial ,Methotrexate ,Treatment Outcome ,Antirheumatic Agents ,Arterial stiffness ,Disease Progression ,Female ,business ,medicine.drug - Abstract
Objective.To determine the efficacy of 2 tight control treatment strategies aiming at Simplified Disease Activity Score (SDAI) remission (SDAI ≤ 3.3) compared to 28-joint count Disease Activity Score (DAS28) remission (DAS28 < 2.6) in the prevention of arterial stiffness in patients with early rheumatoid arthritis (RA).Methods.This was an open-label study in which 120 patients with early RA were randomized to receive 1 year of tight control treatment. Group 1 (n = 60) aimed to achieve SDAI ≤ 3.3 and Group 2 (n = 60), DAS28 < 2.6. Pulse wave velocity (PWV) and augmentation index (AIx) were measured at baseline and 12 months. A posthoc analysis was also performed to ascertain whether achieving sustained remission could prevent progression in arterial stiffness.Results.The proportions of patients receiving methotrexate monotherapy were significantly lower in Group 1 throughout the study period. At 12 months, the proportions of patients achieving DAS28 and SDAI remission, and the change in PWV and AIx, were comparable between the 2 groups. In view of the lack of differences between the 2 groups, a posthoc analysis was performed at Month 12, including all 110 patients with PWV, to elucidate the independent predictors associated with the change in PWV. Multivariate analysis revealed that achieving sustained DAS28 remission at months 6, 9, and 12 and a shorter disease duration were independent explanatory variables associated with less progression of PWV.Conclusion.With limited access to biologic disease-modifying antirheumatic drugs, treatment efforts toward DAS28 and SDAI remission had similar effects in preventing the progression of arterial stiffness at 1 year. However, achieving sustained DAS28 remission was associated with a significantly greater improvement in PWV. [Clinical Trial registration: Clinicaltrial.govNCT01768923.]
- Published
- 2018
15. Analysis of anti-melanoma differentiation-associated gene 5 antibody in Hong Kong Chinese patients with idiopathic inflammatory myopathies: diagnostic utility and clinical correlations
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Victor Tak Lung Wong, Ricky W.‐K. Ip, Ho So, and Ronald Man Lung Yip
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Adult ,Male ,medicine.medical_specialty ,Interferon-Induced Helicase, IFIH1 ,Disease ,Polymyositis ,Dermatomyositis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Rheumatology ,Asian People ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Aged ,Autoantibodies ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,biology ,business.industry ,Interstitial lung disease ,Middle Aged ,medicine.disease ,MELANOMA DIFFERENTIATION-ASSOCIATED GENE 5 ,Idiopathic inflammatory myopathies ,Phenotype ,Immunoassay ,biology.protein ,Disease Progression ,Hong Kong ,Female ,Antibody ,business ,Biomarkers - Abstract
Aim To compare the prevalence of the anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) in Hong Kong Chinese patients with dermatomyositis (DM) and polymyositis (PM); in addition, to examine the association of anti-MDA5 Ab and the clinical characteristics of these patients. Methods Twenty consecutive existing patients with DM being followed up at the Rheumatology Clinic of Kwong Wah Hospital, Hong Kong were recruited. Twenty patients with PM were recruited from the same clinic as the controls. A commercial line blot immunoassay was used to detect the anti-MDA5 Ab in all the participants. The frequencies of anti-MDA-5 Ab in the two groups were compared. The clinical characteristics of the patients with and without the antibody were analyzed. Results Anti-MDA5 Ab was found in 30% of patients with DM but not in patients with PM. All patients with the antibody exhibited the clinically amyopathic DM (CADM) phenotype. These patients were predominantly male, younger and with shorter disease duration. Anti-MDA5 Ab was significantly associated with rapidly progressive interstitial lung disease (RP-ILD) and digital ulcers. No statistically significant association was found between other disease or treatment variables and the antibody. Conclusion Anti-MDA5 Ab is found exclusively in DM patients of the CADM subtype and is associated with RP-ILD and digital ulcers, suggesting that examination of this antibody is clinically useful in Hong Kong Chinese patients with idiopathic inflammatory myopathies. However, further studies are required to assess its prognostic significance, and to explore the difference of its presentations in various populations.
- Published
- 2018
16. Rituximab for refractory rapidly progressive interstitial lung disease related to anti-MDA5 antibody-positive amyopathic dermatomyositis
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Hin Ting Pang, Victor Tak Lung Wong, Ho So, Virginia Weng Nga Lao, and Ronald Man Lung Yip
- Subjects
Adult ,Male ,medicine.medical_specialty ,Interferon-Induced Helicase, IFIH1 ,medicine.medical_treatment ,Prednisolone ,Gastroenterology ,Dermatomyositis ,Pulmonary function testing ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Refractory ,Internal medicine ,Oxygen therapy ,medicine ,Humans ,Respiratory system ,Glucocorticoids ,Aged ,Autoantibodies ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Interstitial lung disease ,General Medicine ,Middle Aged ,medicine.disease ,Antirheumatic Agents ,Disease Progression ,Rituximab ,Female ,business ,Lung Diseases, Interstitial ,030217 neurology & neurosurgery ,medicine.drug - Abstract
To report our experience in using rituximab (RTX) for treating refractory rapidly progressive interstitial lung disease (RP-ILD) complicating anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab)-positive amyopathic dermatomyositis (ADM). Medical records of four ADM patients with refractory RP-ILD treated with RTX therapy were reviewed retrospectively. All four patients were tested positive for anti-MDA5 Ab and failed to respond to high-dose systemic steroid and other intensive immunosuppressive therapies. Respiratory symptoms, lung function tests, and high-resolution computed tomography (HRCT) of the chest were compared before and after the first course of RTX. After RTX treatment, all four patients had improvement in the respiratory symptoms in terms of New York Heart Association classification. Two patients successfully had their supplementary oxygen therapy weaned off. The lung function tests were significantly better in all patients. The HRCT showed improvement in three patients while the other one remained static. The recalcitrant vasculitic rashes associated with the anti-MDA5 Ab were also better in all patients. The average daily prednisolone dose dropped from 20 to 6.25 mg post-treatment. None of the patients died throughout the follow-up period which ranged from 6 months to 2 years. However, two patients developed chest infection and one wound infection within 6 months after the RTX infusion. Our results suggest that RTX may be a useful therapy for anti-MDA5 Ab-positive ADM associated with RP-ILD. However, infection is the major risk.
- Published
- 2018
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