Inflammatory Arthritis Among Military Servicemen From a Rheumatology Center in Singapore

2021 ◽  
Author(s):  
Choon-Guan Chua ◽  
Bernard Yu-Hor Thong
Keyword(s):  
Inflammatory Arthritis ◽  
Armed Forces ◽  
Tophaceous Gout ◽  
Biologic Dmards ◽  
Palindromic Rheumatism ◽  
Military Organizations ◽  
Service Support ◽  
Medical Centers ◽  
Cutaneous Adverse Reactions

ABSTRACT Introduction Musculoskeletal disorders are one of the most common reasons military servicemen seek medical care during their line of duty. This study aims to review the clinical profile and outcomes of military personnel with inflammatory arthritis (IA) referred to a specialist rheumatology center in Singapore. Materials and Methods Consecutive new case referrals from the Singapore Armed Forces medical centers during the study period January 1, 2010, to December 31, 2019, were retrospectively studied. Results There were 123 referrals, comprising 112 (91.1%) males, with the majority being Chinese (110, 89.4%). The mean age was 25.5 ± 11.1 years. The most common diagnoses were gout (including chronic tophaceous gout; 34, 27.6%), spondyloarthritis (18, 14.6%), palindromic rheumatism (8, 6.5%), rheumatoid arthritis (4, 3.3%), and juvenile idiopathic arthritis (4, 3.3%). Among servicemen with gout, all were male, the majority (31, 91.3%) were Chinese, and mean age was 34.1 ± 8.8 years. Mean body mass index (BMI) was 27.5 ± 3.9 kg/m2, of which 41.2% had moderate-risk and 47.1% high-risk BMI for cardiovascular disease and diabetes mellitus (DM). Comorbidities included hyperlipidemia (14), hypertension (6), and type 2 DM (3). Urate lowering therapy was initiated in 27 (79.4%) patients, comprising allopurinol (85.2%), probenecid (11.1%), and their combination (3.7%). One patient developed allopurinol-induced hepatitis; none had severe cutaneous adverse reactions. Among the remaining patients with IA, conventional synthetic disease-modifying antirheumatic drugs (DMARDs) used were sulfasalazine (8), methotrexate (4), hydroxychloroquine (4), and leflunomide (2). Biologic DMARDs used in five patients comprised adalimumab (3) and golimumab (2). Conclusion Servicemen with IA and good functional status can still be physically fit and deployable into certain combat and service support vocations. This will optimize manpower resources in military organizations with a shrinking young workforce.

Innate Lymphoid Cells Type 2 Attenuate Inflammatory Arthritis and Protect from Bone Destruction

2018 ◽  
Author(s):  
Yasunori Omata ◽  
SSbastien Lucas ◽  
Kerstin Sarter ◽  
Darja Andreev ◽  
Tatjana Primbs ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Bone Destruction ◽  
Innate Lymphoid Cells ◽  
Lymphoid Cells

Militaries’ Organizational Cultures in a Globalizing World

2021 ◽  
Author(s):  
Joseph Soeters
Keyword(s):  
World War Ii ◽  
Large Scale ◽  
National Level ◽  
Work Organization ◽  
Armed Forces ◽  
Strategic Decision ◽  
Organizational Cultures ◽  
Military Organizations ◽  
Globalizing World ◽  
The Way

Organizational cultures in military organizations consist of symbols, practices, habits, hidden assumptions, and beliefs about what needs to be done, and what is appropriate and what is not, before, during, and after operations. Generally speaking, organizational cultures in military institutions are similar to those in any other work organization. Upon closer examination, however, it appears that the military’s 24/7, communal life outside society, its emphasis on hierarchy and discipline, and in particular its license to use large-scale force make it different. Relatedly, the way in which the military’s organizational cultures are created and recreated has aspects and emphases that are less common in conventional work organizations. Recruiting and socialization patterns of new organizational members in the military have been studied frequently because they are so distinctive in the armed forces. Military organizational cultures are not identical worldwide. Military organizations differ internationally, as military organizations are still strongly connected to their national backgrounds, including the languages, legal regimes, political atmospheres, and general ways of living in the many nations across the globe. National societies and their histories shape military organizational cultures in multiple ways. Dramatic experiences at the national level, for instance during World War II, may lead to a continuation or, just the opposite, the disruption of armed forces’ organizational cultures. Yet despite the differences, something of a world culture impacting on the use of force seems to emerge as well. In an era when international alliances carry out most missions, different national backgrounds influence strategic decision making and the way operations are conducted. Most of the time, national armed forces operate separately, in their own area (or time) of operations, sometimes guiding troops from smaller and less wealthy partnering nations. The coordination of actions between the various areas of operation is generally not very well elaborated. This applies not only to combat operations but also to peace missions. A full integration of national armed forces, such as in a United Nations security force or a European army, is an ideal that some may dream of, but it is still far from reality. The greatest degree of integration is likely to be found in international headquarters.

scholarly journals The Prevalence of Type 2 Diabetes and Prediabetes Among Armed Forces Personnel: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Mohammad Sepandi ◽  
Maryam Taghdir ◽  
Soheil Hassanipour ◽  
Mojtaba Sepandi ◽  
Sepideh Abbaszadeh
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Meta Analysis ◽  
Armed Forces

scholarly journals PROTIOKLEPNI BOJ V SLOVENSKI VOJSKI

2017 ◽  
pp. 15-33
Author(s):  
VIKTOR POTOČNIK
Keyword(s):  
Key Words ◽  
Armed Forces ◽  
Weapon Systems ◽  
Service Support ◽  
Combat Effectiveness ◽  
Effectiveness Coefficient

Povzetek Od 90. let prejšnjega stoletja je v opremljanju z oklepno tehniko v oboroženih silah zaznati spremembe. Obseg tankovskih zmogljivosti se je zmanjšal, hkrati pa se povečujejo zmogljivosti tako imenovanega lahkega oklepa in oklepne zaščite v enotah bojne podpore in enotah zagotovitve bojnega delovanja. Dejansko se je delež oklepa na bojišču povečal. V doktrinarnem smislu Nato ne namenja veliko pozornosti protioklepnemu boju, v Vojaški doktrini SV (2006) pa protioklepnega boja sploh ne najdemo. V članku je opredeljen protioklepni boj v doktrinarnem smislu in analizirane so protioklepne zmogljivosti sodobnih vojsk. Na podlagi tega je predstavljenih nekaj ugotovitev in priporočil o stanju protioklepnega boja v SV. Ključne besede: Protioklepni boj, protioklepni oborožitveni sistemi, Slovenska vojska, koeficient bojne učinkovitosti. Abstract Since the 1990's, several changes have occurred in armoured formations. The scope of tank capabilities has been reduced considerably, while at the same time the presence of light armour and armour in combat support and combat service support units has increased. The percentage of armour in the battlefield has thus increased considerably. Nevertheless, doctrine-wise anti-armour combat is not a high priority for NATO and it is not even mentioned in the Slovenian Armed Forces doctrine (2006). The article deals with anti-armour combat from a doctrine perspective, and provides an analysis of anti-armour capabilities of modern armed forces. Building on this, it puts forward some conclusions and recommendations for the Slovenian Armed Forces. Key words: Anti-armour doctrine, anti-armour weapon systems, Slovenian Armed Forces, combat effectiveness coefficient.

Introduction

2021 ◽  
pp. 1-43
Author(s):  
Michael E. O’Hanlon
Keyword(s):  
National Security ◽  
Analytical Methods ◽  
Armed Forces ◽  
Computational Algorithms ◽  
Military Effectiveness ◽  
Military Organizations ◽  
Security Environment ◽  
The Us ◽  
Basic Facts ◽  
American Grand Strategy

This chapter sketches out the characteristics of today's global security environment in a broad brush by describing the US Department of Defense. It focuses on the science of war, a subdiscipline of defense analysis that, beginning with a foundation of basic facts and figures about military organizations and operations, uses analytical methods to tackle key questions in the national security field. With this context, the chapter illustrates the analytical methods including simple computational algorithms for assessing military effectiveness and predicting combat outcomes. It also includes the study of defense budgets and economics, as well as efforts to understand the physics and technology of military weapons and operations today. The chapter then discusses many of the ABCs of the US armed forces. It explains the evolution of American grand strategy — the theory of the case for how the nation should ensure its safety, prosperity, and survival — that these forces are designed to undergird.

The Expanding Domestic Role of Western Armed Forces and its Implications

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Jori Pascal Kalkman
Keyword(s):  
Civil Rights ◽  
Armed Forces ◽  
Civilian Control ◽  
Military Police ◽  
Military Organizations ◽  
The Military ◽  
Domestic Roles

Abstract The domestic roles of Western armed forces are expanding. Although there is broad academic agreement that this trend is widespread, research on its implications has been relatively scarce. Here, I examine three debates that have emerged in the wake of expanding domestic military roles. They include: discussion on the origins of this trend between functionalists and politically-oriented scholars; its implications for civilian control and civil rights; and its effects on military-police convergence. This is followed by a call for more research on how the expanding domestic roles of Western armed forces relate to domestic civil-military collaboration, the management of military organizations, military visibility and reputation, perceptions of new tasks within the military, and the scale of this trend. A concluding section makes a case for drawing more academic attention to this phenomenon.

scholarly journals P022 Audit of musculoskeletal ultrasound to optimise DMARD therapy among patients in a district general hospital

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Michael Chen-Xu ◽  
Dovenik Hyseni ◽  
Katerina Achilleos
Keyword(s):  
Chronic Pain ◽  
Inflammatory Arthritis ◽  
Significant Proportion ◽  
Musculoskeletal Ultrasound ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Biologic Dmards ◽  
Retrospective Audit ◽  
The Impact ◽  
Active Synovitis

Abstract Background/Aims  Musculoskeletal ultrasound (MSUS) has utility in optimising the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) in patients with inflammatory arthritis. However, it is unclear whether this is useful among patients with concomitant chronic pain and/or fibromyalgia, who often have elevated disease activity scores. We aimed to evaluate the impact of MSUS on inflammatory arthritis patients with concomitant chronic pain and/or fibromyalgia who met criteria for treatment escalation in a district general rheumatology service. Methods  We conducted a retrospective audit of inflammatory arthritis patients with concomitant chronic pain and/or fibromyalgia who were eligible for DMARD escalation and underwent a MSUS since 2017. Scanning was performed by either a trained rheumatologist or musculoskeletal ultrasonographer. Synovitis was assessed following OMERACT guidelines. Results  43 patients with inflammatory arthritis and concomitant chronic pain and/or fibromyalgia who underwent MSUS were identified. The mean age was 57.0 years (SD 15.6), and 34 patients (79%) were female. Rheumatoid arthritis was the most frequent diagnosis with 32 patients (74%), with psoriatic arthritis in 5 (12%), undifferentiated inflammatory arthritis in 4 (9%) and axial spondylarthritis (axSpA) in 2 (5%). 20 patients (47%) had a concurrent diagnosis of fibromyalgia. The median tender joint count among non-axSpA patients was 10 (IQR 4-15) and 2 (IQR 0-4) for swollen joints. MSUS was requested for consideration of a bDMARD switch in 21 patients (49%), a new bDMARD in 15 (35%), and starting an adjunctive csDMARD among 7 (16%). 34 patients (79%) were already established on csDMARDs, with 15 patients (35%) being on one or more, and methotrexate being the most prescribed csDMARD in 26 (76%). 14 patients (33%) were already established on bDMARDs, 9 (21%) had been on them previously and 20 (47%) were bDMARD naïve. Among those on bDMARDs, anti-TNFs agents were the most prescribed (71%). Active synovitis was identified in 17 patients (40%). Greyscale synovitis, tenosynovitis and enthesitis were seen in 30 (70%), 10 (23%) and 2 patients (5%), respectively. Erosions were identified in 12 patients (28%), with 2 (17%) having new erosions. 27 patients (63%) had either a csDMARD started (n = 7, 33%), or a bDMARD started (n = 11, 31%) or switched (n = 9, 25%) after MSUS. Those with fibromyalgia were less likely to start or switch DMARDs (8/20 patients, 40%) than those without (19/23 patients, 82.6%), Pchi-squared = 0.004. Furthermore, active synovitis on MSUS was associated with DMARD escalation (14/17 patients [82.4%] with synovitis versus 13/26 patients [50%] without; Pchi-squared = 0.03). Conclusion  MSUS avoided unnecessary DMARD escalation in a significant proportion of patients with inflammatory arthritis and features of concomitant chronic pain and/or fibromyalgia (n = 26, 37%), potentially resulting in reduced patient exposure to harmful DMARD side effects, and cost savings for the service. Disclosure  M. Chen-Xu: None. D. Hyseni: None. K. Achilleos: None.

scholarly journals Gaucher disease: clinical phenotypes and refining GBA mutational spectrum in Thai patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tim Phetthong ◽  
Thipwimol Tim-Aroon ◽  
Arthaporn Khongkraparn ◽  
Saisuda Noojarern ◽  
Chulaluck Kuptanon ◽  
...  
Keyword(s):  
Gaucher Disease ◽  
Age Of Onset ◽  
Lysosomal Storage ◽  
Pathogenic Variants ◽  
Medical Centers ◽  
Neurologic Involvement ◽  
Therapeutic Research ◽  
Type 3

Abstract Background Gaucher disease (GD) is a rare lysosomal storage disorder, characterized by hepatosplenomegaly and pancytopenia, with or without neurologic involvement. The disorder is categorized into three phenotypes: GD type 1 or nonneuronopathic GD; GD type 2 or acute neuronopathic GD; and GD type 3 or chronic neuronopathic GD. The purposes of this study were to describe clinical characteristics of Thai GD in patients diagnosed and/or followed up during 2010–2018 and to perform re-genotyping including analysis of GBA recombinant alleles which had not been investigated in Thai patients before. Results There were 27 patients from seven medical centers, enrolled in the study. All the cases had pediatric onset. GD3 (44.5%) was the most common phenotype, followed by GD2 (40.7%) and GD1 (14.8%), with one case of neonatal GD. The median age of onset for GD1, GD2, and GD3 was 72, 4 and 12 months, respectively, suggesting relatively earlier onset of GD1 and GD3 in Thai patients. All patients with GD1 and most patients with GD3 received ERT. Four patients with GD3 had ERT followed by HSCT. Patients with GD3 who received no or late ERT showed unfavorable outcomes. We identified 14 variants including two novel (p.S384F and p.W533*) and 12 reported pathogenic variants: p.L483P, p.N409S, p.R159W, p.P305A, p.A175G, p.D448H, p.V414L, IVS2+1G>A, IVS6-1G>C, IVS7+1G>C, IVS9-3C>G, and Rec1a. The p.L483P was the most prevalent allele found in this study, at 66% (33/50 alleles), followed by IVS2+1G>A, Rec1a, and IVS6-1G>C. Twenty-four percent of patients were reassigned with validated genotypes, most of whom (4 of 6) were patients with GD2. The [p.S384F + p.W533*] being compounded with p.L483P, was found in the patient with neonatal GD, suggesting that the p.S384F could potentiate the deleterious effect of the p.W533*, and/or vice versa. Conclusions Neuronopathic GD was strikingly prevalent among Thai affected population. Homozygous p.L483P was the most common genotype identified in Thai patients. Recombinant allele Rec1a and splicing mutations were associated with GD2 and severe cases of GD3. Mutation spectrum could be useful for designing stepwise molecular analysis, genetic screenings in population, and new therapeutic research for neuronopathic GD.

scholarly journals Infection of a tophaceous nodule of the wirst and hand

2018 ◽  
pp. bcr-2018-226029 ◽  
Author(s):  
Wajdi Bouaziz ◽  
Mohamed Ali Rekik ◽  
Ahmed Racem Guidara ◽  
Hassib Keskes
Keyword(s):  
Antibiotic Therapy ◽  
Inflammatory Pain ◽  
Inflammatory Arthritis ◽  
Inflammatory Process ◽  
Surgical Excision ◽  
Daily Practice ◽  
Bacteriological Examination ◽  
Tophaceous Gout ◽  
Gouty Tophus ◽  
Difficult Challenge

Tophaceous gout occurs years after recurrent attacks of acute inflammatory arthritis. The urate deposits are incriminated in the inflammatory process; however, their infection is exceptional. We report the observation of an infected gouty tophus of the pinky and the wrist of a 40-year-old man, presented as an excruciating inflammatory pain with buff-yellow swelling of the fifth right finger and wrist in a febrile context. As a matter of fact, the evolution was favourable after surgical excision and antibiotic therapy. The infection of a tophus is an exceptional complication of the gout. In daily practice, this diagnosis is really a difficult challenge for the clinician. The systematic bacteriological examination of the tophi with cutaneous fistulation is necessary to introduce prematurely an adapted treatment.

scholarly journals Use of biologic or targeted-synthetic disease-modifying anti-rheumatic drugs and risk of diabetes treatment intensification in patients with rheumatoid arthritis and diabetes mellitus

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Sarah K Chen ◽  
Hemin Lee ◽  
Yinzhu Jin ◽  
Jun Liu ◽  
Seoyoung C Kim
Keyword(s):  
Diabetes Mellitus ◽  
Tnf Inhibitor ◽  
Antidiabetic Medication ◽  
Treatment Intensification ◽  
Biologic Dmards ◽  
Treatment Switching ◽  
Biologic Dmard ◽  
Insulin Use

Abstract Objectives Given that RA treatment might affect the severity of diabetes mellitus (DM), we compared the risk of DM treatment intensification in patients with both RA and DM newly initiating a biologic DMARD or tofacitinib. Methods Using claims data from the IBM MarketScan database (2005–2016), we identified patients aged ≥18 years with RA who initiated abatacept, a TNF inhibitor (TNFi), rituximab, tocilizumab or tofacitinib. Patients were required to have type 1 or type 2 DM and to use at least one antidiabetic drug at baseline. We assessed DM treatment intensification (i.e. addition of a new insulin or non-insulin antidiabetic medication). We also assessed non-insulin antidiabetic medication switching events. Results We included 10 019 patients with RA and DM initiating a biologic DMARD or tofacitinib. Baseline insulin use was the highest in rituximab initiators (44%) and lowest in tofacitinib initiators (35%). The incidence rate per 1000 person-years for DM treatment intensification ranged from 148.2 (tofacitinib) to 198.0 (rituximab). The risk of DM treatment intensification was similar between abatacept and TNFi [hazard ratio (HR) 0.97, 95% CI: 0.82, 1.15], rituximab (HR 0.99, 95% CI: 0.79, 1.23) and tocilizumab (HR 0.94, 95% CI: 0.74, 1.19), but lower for tofacitinib compared with abatacept (HR 0.67, 95% CI: 0.50, 0.90). The risk of non-insulin DM treatment switching was not different between abatacept and other biologic DMARDs. Conclusion In patients with both RA and DM, we found no difference in the risk of DM treatment switching or intensification after initiating abatacept vs TNFi, rituximab and tocilizumab, whereas the risk appeared to be lower for tofacitinib.

Sign in / Sign up

Export Citation Format

Share Document