BackgroundThe prevalence of SLE in Malaysia was reported as 43/100,000 individuals and Chinese (57/100,000) have the highest prevalence followed by Malays (33/100,000) and Indians (14/100,000) [1,2].The American College of Rheumatology established case definitions and categorised neuropsychiatric syndromes into two groups: central and peripheral system involvement. There were studies showed that cognitive impairment is the commonest neuropsychiatric manifestations with a prevalence of 66% [3].ObjectivesTo determine the association between neuropsychiatric manifestation with different age group among SLE patients.MethodsThis was a retrospective study. The electronic medical records of all SLE patients seen in rheumatology clinic of Hospital Sultan Ismail, Malaysia from 1/1/2007 to 31/12/2021 were reviewed. SLE patients with neuropsychiatric manifestations were selected and categorised by age into children (< 12 years old), adolescents (aged 12-18 years), young adults (aged >18 to 35 years), middle-aged adults (>35 -55 years) and elderly (>55 years). The association between neuropsychiatric manifestation with different age group was analysed by using SPSS-Fisher’s exact test.ResultsThere was a total of 86 patients and female were 77. The majority were Malay (49/86) followed by the Chinese (33/86), Indians (2/86) and others (2/86). Patients were categorized into children (n:6), adolescents (n:18), young adults (n:43), middle-aged adults (n:16) and elderly (n:3) with the mean age of 28.Our study showed the onset of neuropsychiatric manifestations occurred most during young adulthood (43/86) followed by adolescents (18/86). Seizure disorders is the commonest manifestations (36/86) followed by psychosis (17/86), poly/mononeuropathy (7/86), cognitive dysfunction (7/86), myelopathy (5/86), cranial neuropathy (4/86), mood disorders (3/86), cerebrovascular disease (3/86), movement disorders (2/86), and lastly headache and myasthenia gravis, 1 patient each. 60% of the patients had onset of neuropsychiatric manifestation during first diagnosis and another 7% developed symptoms within 1 year of diagnosis. There was no association between type of neuropsychiatric manifestation with different age group (p = 0.195). Comparison of neuropsychiatric manifestations according to age group was showed in Table 1.Table 1.Neuropsychiatric manifestations according to age groupAge group (years)Central nervous systemPeripheral nervous systemChildren < 12Seizure (4), CVD (1), Cognitive dysfunction (1)Adolescents 12-18Seizure (9), Psychosis (5), Mood disorders (1), Cognitive dysfunction (1)PN/MN (2)Young adults >18-35Seizure (18), Psychosis (10), Cognitive dysfunction (4), movement disorders (2), myelopathy (4), CVD (2)PN/MN (2) CN (1)Middle-aged adults >35-55Seizure (4), Psychosis (2), Mood disorders (2), Cognitive dysfunction (1), Myelopathy (1), Headache (1)PN/MN (3) CN (2)Elderly >55Seizure (1)MG (1), CN (1)CVD: Cerebrovascular disease, PN/MN: Polyneuropathy/Mononeuropathy, CN: cranial neuropathyConclusionSeizure disorders is the commonest manifestations amongst SLE patients in our study group and there was no association between neuropsychiatric manifestation with the age group.References[1]S. N. Yap, M. E. Phipps, M. Manivasagar, S. Y. Tan, and J. J. Bosco, “Fc gamma receptor IIIB-NA gene frequencies in patients with systemic lupus erythematosus and healthy individuals of Malay and Chinese ethnicity,” Immunology Letters, vol. 68, no. 2-3, pp. 295–300, 1999.View at: Publisher Site | Google Scholar[2]K. H. Chua, B. P. Kee, S. Y. Tan, and L. H. Lian, “Genetic polymorphisms of interleukin-4 third intron region in the Malaysian patients with systemic lupus erythematosus,” Journal of Medical Sciences, vol. 8, no. 4, pp. 437–442, 2008.View at: Publisher Site | Google Scholar[3]Carbotte RM, Denburg SD, Denburg JA. Prevalence of cognitive impairment in systemic lupus erythematosus. J. Nerv. Ment. Dis. 1986;174:357–364. [PubMed] [Google Scholar]Disclosure of InterestsNone declared

BackgroundPsoriatic arthritis (PsA) which is a member of the spondyloarthritides includes spinal and peripheral joint involvement. It affects women and men equally. The clinical patterns of PsA were classified into 5 groups according to Moll and Wright..1 Psoriasis is a common chronic inflammatory skin disease and chronic plaque psoriasis is the commonest form.ObjectivesTo study the relationship between plaque and non-plaque psoriasis with their joint manifestation and to describe the demographic characteristics of PsA patients.MethodsThis was a restrospective study. The electronic medical records of all PsA patients under rheumatology clinic Hospital Sultan Ismail followed up from 1/1/2009 to 31/12/2017 were reviewed. Data on demography, type of skin disease, joint manifestation, past medical history, fasting serum lipid and body mass index were obtained and analysed.ResultsWe identified 163 patients, 84 were male patients with male to female ratio of 1.06. The Malays (84/163) were the majority being affected, followed by the Chinese (46/163), Indians (30/163) and others (3/163). The patients were divided into plaque psoriasis (140/163) and non-plaque psoriasis (23/163). The commonest joint involvement in the study was peripheral joint involvement (121/163), axial involvement (22/163) and both axial and peripheral joint involvement (20/163). The peripheral joint involvement was categorised as polyarthritis (67/121), followed by oligoarthritis (47/121), distal interphalangeal arthritis (4/121) and arthritis mutilans (3/121). In the study, we divided the patients into plaque psoriasis [peripheral joint involvement (102/140); axial involvement (16/140); both (18/140)] and non-plaque psoriasis [peripheral joint involvement (15/23); axial involvement (6/23); both (2/23)] and analysed the results by using the SPSS logistic regression. It showed no significant association between type of skin psoriasis with its joint manifestation. (p>0.05).Amongst the 163 patients, 68/163 (42%) had hypertension, 50/163 (31%) had diabetes mellitus, 32/163 (20%) had hypercholesterolemia, 12/163 have ischaemic heart disease, 1 patient had congestive heart disease, 3 had breast cancer, 1 had hepatocellular carcinoma and 2 have chronic kidney disease and cerebral vascular disease respectively.The fasting serum lipid (FSL) was taken for 140 of them (23 patients no data available) and it was noted in 64/140 (without background history of hypercholesterolemia was noted to have FSL≥5.18 mmol/L). 37/64 have borderline high total cholesterol (5.18 mmol/L –<6.2 mmol/L) and 27/64 have high total cholesterol (≥6.2 mmol/L) according to ATP iii cholesterol classification..2 43% (61/142 patients) had body mass index in the overweight group, 29% (41/142 patients) in the obese group and 25% (36/142 patients) in normal group according to WHO classification.3 ConclusionsThere was no association between types of skin psoriasis with their joint manifestation. There was a significant number of patients who had deranged fasting serum lipid and majority of them...

Fibrodysplasia ossificans progressiva is an exceedingly rare genetic disorder that causes the formation of the second skeleton after birth by the heterotopic bone. It is commonly misdiagnosed and treated inappropriately. Although there is no cure for the disease, early and correct diagnosis may slow the disease progress, avoid unnecessary intervention and in turn improve the quality of life. We report a 13 years old girl with fibrodysplasia ossificans progressiva who presented with progressive stiffness of the bilateral hips after a trivial fall. Further history has found progressive joint stiffness involving multiple joints. She had not been diagnosed even though multiple encounters with the health facility for similar complaints. This has highlighted the importance of awareness of the disease among healthcare personnel.

BackgroundNumerous immune-mediated diseases flare or new disease onset after SARS-CoV2-vaccination have been reported. There were case reports showed the immune-mediated disease flare post vaccination but study on new disease occurs post Covid-19 vaccination is still lacking.ObjectivesTo describe two SLE cases that diagnosed post Covid-19 vaccination.MethodsCase reportResults14 years old girl, post Covid-19 vaccination 1st dose 3 weeks ago presented with 2 day history of giddiness, breathlessness, vomiting and diarrhea prior to admission. She also complained of frothy urine for the past 1 week associated with lower limbs swelling and facial puffiness. Clinical examination noted she had sparse hair, oral ulcers and discoid lupus at the ear concha. She also noted to have periorbital puffiness with pedal edema. Lung auscultation noted bi-basal crepitations.Blood investigation noted ANA positive (1:640, speckled) with low complement 3 (0.1g/L). Her full blood count showed leucopenia (3100 UL) with low lymphocyte count of 810UL. UFEME noted protein of 3 + and red blood cell of 2+ with normal renal profile. Her serum albumin was 22g/L. Chest x ray showed clear lung field with no cardiomegaly. Her 24-hour urine protein showed proteinuria of 2.345g/dl and her renal biopsy showed mesangial proliferative lupus nephritis class ii.She was given intravenous methylprednisolone 500mg OD for 3 days and discharged with tapering dose of prednisolone, hydroxychloroquine, calcium supplements, perindopril and frusemide.Another case was a 17 year-old female, post covid-19 vaccination 10 weeks, presented with 3 weeks history of bilateral lower limbs weakness with difficulty in getting up from chair. She also had fever on and off with cough for 1 week. There was no alopecia, oral ulcer, facial rash or photosensitivity. No joints pain. Clinical examination noted presence of proximal myopathy with stable vital signs. Other systemic examinations were unremarkable.Blood investigation noted ANA positive (1: 640, homogenous and speckled) with low complements level (C3 0.19g/L and C4 0.049 g/L).Her creatine kinase was 2367U/L and EMG showed evidence of irritable myopathic process which is consistent with inflammatory myositis. Her TFT was normal. Myositis panel showed anti-Ku and anti-Ro 52 were positive. She was treated as SLE with myositis and intravenous methylprednisolone was given. She discharge well with tapering dose of prednisolone and azathioprine. Her creatine kinase showed improvement with immunosuppression therapy and she was advised on intensive physiotherapy.ConclusionThe onset of these two SLE cases were occurred within the 2 month of post covid-19 vaccination. Whether Covid-19 vaccination direct contribute to the occurrence of SLE remained inconclusive. More studies are required to show its correlation between onset of SLE and Covid-19 vaccination.ReferencesNILDisclosure of InterestsNone declared

BackgroundLupus nephritis (LN) is an important concern among SLE patients in Asia and its mortality rate was reported to be 6 times higher compared to the general population [1]. A study by McCarty et al suggested that African women with serology showed combination of anti-Smith, Ro and RNP antibodies were at increased risk of developing LN [2]. This is further supported by study done by Majed et al showed this unusual combination accelerated development of LN within the first 5 years after SLE onset [3].ObjectivesTo determine the correlation between the combination of autoantibody profile: Smith, Ro and RNP in development of LN amongst Asian ancestry and any association with the duration of LN development from onset of SLE.MethodsThis was a retrospective study. The electronic medical records of all SLE patients seen in the rheumatology clinic Hospital Sultan Ismail, Malaysia from 1/1/2007 to 30/4/2021 were reviewed. Patients who had LN were identified and selected. Data on demography, serology, duration of development of LN from SLE onset were obtained and analysed using SPSS Pearson Chi square and binary logistic regression.ResultsThere were a total of 197 patients and 183 were females. The majority were Malays (96/197) followed by the non-Malay (101/197) which included Chinese (86/197) and others (15/197). The mean age group for the studied subjects was 34 (14-80).Of the 197 (100%) patients, 23 (11.7%) patients had the triple combination of Sm, Ro and RNP antibodies while 174 (88.3%) patients did not have the triple combination.For patient with the triple combination, regardless ethnicity, 20/23 (87%) developed LN within 5 years from the SLE onset while the remaining 3/23 (13%) developed LN after 5 years.For patients without this combination, regardless ethnicity, 142/174 (81.6%) of them developed LN within 5 years and 32/174 (18.4%) of them more than 5 years. This showed combination autoantibody does not significantly accelerated development of LN amongst Asian ancestry patients, P = 0.092.There was also no association between the positivity of triple antibody with the duration of development LN from SLE onset, P =0.772.Further stratification was based on ethnicity showed compare to Non-Malay ethnicity, the Malay patients is 3.966 higher odds of developing LN within the 5 years from SLE onset, P = 0.002.ConclusionPatient with triple serology combination did not showed significant in accelerating development of LN. Our data showed Malay patients are 4 higher odds of developing LN within the first 5 years after SLE onset compare to Non-Malay patients.References[1]Yap DY, Tang CS, Ma MK, Lam MF, Chan TM. Survival analysis and causes of mortality in patients with lupus nephritis. Nephrol Dial Transplant. 2012;27:3248–3254. [PubMed][2]McCarty GA, Harley JB, Reichlin M. A distinctive autoantibody profile in Black female patients with lupus nephritis. Arthritis & Rheumatism. 1993; 36:1560-1993[3]Majed R. Albirdisi, Shirish Sangle, Natasha Jordan, David D’Cruz. Autoantibody profile and ethnicity:risk factors for accelerated development of lupus nephritis. Abstract ACR 2020.Disclosure of InterestsNone declared