Publications by authors named "Chayawee Muangchan"

14 Publications

  • Page 1 of 1

Are oral lichen planus patients at high risk of hepatitis C? A case-control study.

J Stomatol Oral Maxillofac Surg 2021 Jul 28. Epub 2021 Jul 28.

Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.

Objective: To assess the correlation between oral lichen planus (OLP) and viral hepatitis C (HCV).

Methods: This retrospective case-control study included a sample of OLP patients in a 3-year interval. The predictor variable was the presence of OLP (yes/no). The outcome variable was the diagnosis of HCV. Other study variables were grouped into demographic, anatomic, and clinical. Descriptive, bi- and multivariate statistics were computed with a significant level at P ≤ 0.05.

Results: The sample was composed of 237 OLP patients (38.8% females) with a mean age of 59.9 ± 17.8 years (range, 17-96), and 948 age- and gender-matched control individuals. The significant higher frequency of HCV was identified in OLP patients (frequency: 19.8% vs. 2.1%; adjusted matched odds ratio [mOR], 9.5; 95% confidence interval [95% CI], 5.98 to 15.91; P < 0.0001; Pearson's Phi coefficient [r], 0.307). In the adjusted model, OLP with HCV was associated with 1) oro-cutaneous manifestations (mOR, 17.58; 95% CI, 1.92 to 161.26; P = 0.0059; Bayesian posterior probability of positive test [W], 96%), 2) any intraoral forms other than reticular/plaque-liked forms (mOR, 0.09; 95% CI, 0.04 to 0.18; P < 0.0001; W, 52%), and 3) poor response to topical corticosteroids (mOR, 0.05; 95% CI, 0.02 to 0.16; P < 0.0001; W, 88%).

Conclusions: OLP, especially oro-cutaneous disease or steroid-refractory OLP, are associated with an increased frequency of HCV. Not only HCV screening in OLP patients, but oral examination in HCV patients, are both recommended as primary preventive measures.
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http://dx.doi.org/10.1016/j.jormas.2021.07.013DOI Listing
July 2021

High burden of skin sclerosis is associated with severe organ involvement in patients with systemic sclerosis and systemic sclerosis overlap syndrome.

Rheumatol Int 2018 12 11;38(12):2279-2288. Epub 2018 Sep 11.

Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.

The objective of this study is to investigate the impact of skin sclerosis burden on an internal organ involvement over a 1-year period, as measured by time-adjusted accrual-modified Rodnan skin score (TA-mRSS), and to evaluate association between TA-mRSS patterns and laboratory tests in patients with systemic sclerosis (SSc). This prospective study was conducted at Siriraj Hospital (Bangkok, Thailand) during the November 2013-November 2016. SSc patients by ACR/EULAR 2013 or ACR 1980 criteria were eligible. TA-mRSS was classified as low, intermediate, or high, and then compared between groups. Correlation between the arithmetic mean of laboratory tests and TA-mRSS was assessed by multiple linear regression analysis. A total of 118 patients, with 81.4% women, median (IQR) age 49.8 (43.8, 55.1) years, disease duration from onset of non-Raynaud symptoms to first visit of 3.3 (1, 6.8) years, 78% dcSSc, and 75.3% anti-Scl-70 positivity, were analyzed. TA-mRSS over 1 year ranged from 0 to 37.44. The high skin sclerosis burden group had a median TA-mRSS > 7.26 (> 67th percentile). Patients with high TA-mRSS were dcSSc, high initial and average mRSS, and had tendon friction rub, digital ischemic complications, usual interstitial pneumonia, diastolic dysfunction, gastrointestinal dysmotility, and low serum albumin. In multiple linear regression analysis, the arithmetic mean of hemoglobin (B = - 1.007, 95% CI - 1.779 to - 0.236), erythrocyte sedimentation rate (B = - 0.078, 95% CI - 0.126 to - 0.029), serum glutamic oxaloacetic transaminase (B = 0.073, 95% CI 0.026-0.12), creatine phosphokinase (B = 0.012, 95% CI 0.003-0.021), and albumin (B = - 4.117, 95% CI - 6.958 to - 1.276) were associated with TA-mRSS. This study found a higher cumulative course of mRSS over a 1-year period to be significantly associated with severe internal organ involvement.
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http://dx.doi.org/10.1007/s00296-018-4156-4DOI Listing
December 2018

Relationship Between Health-Related Quality of Life and Patient Acceptable Symptom State With Disease Activity and Functional Status in Patients With Ankylosing Spondylitis in Thailand.

J Clin Rheumatol 2019 Jan;25(1):16-23

Department of Medicine.

Objective: This study aimed to identify factors associated with EuroQoL-5 Dimensions, 5 Levels and Patient Acceptable Symptom State (PASS) and health utility (HU) in Thai patients with ankylosing spondylitis (AS).

Methods: This was a cross-sectional study of consecutive AS patients visiting Siriraj Hospital between May 31, 2012, and March 31, 2016. Demographic data and outcomes related to HU (Thai version of EuroQoL-5 Dimensions, 5 Levels), disease activity (Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score-erythrocyte sedimentation rate or Ankylosing Spondylitis Disease Activity Score-C-reactive protein, number of tender and swollen joints, and enthesitis), and functional status (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire) were collected. Regression analysis was used to explore factors associated with each EuroQOL-5 Dimensions (EQ-5D) domain, HU, and PASS.

Results: Among 119 AS patients, the mean age was 40.4 years; 61.3% were male. The mean EQ-5D was 0.75. In univariate analysis, lower disease activity and less impaired function were significantly associated with higher HU and not to mild problems in each EQ-5D domain. In multivariate regression analysis, Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and Health Assessment Questionnaire adjusting for age explained 77.4% of the HU variance. Patients answering yes to PASS were significantly older, had higher HU, and lower disease activity compared with those answering no to PASS. Usual activity and pain problems were importantly related to PASS after adjusting for other domains and age.

Conclusions: Disease activity and functional status in AS patients were significant factors related to HU and PASS. To improve quality of life, treatment goals should be achieving remission, improving function, and controlling pain.
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http://dx.doi.org/10.1097/RHU.0000000000000750DOI Listing
January 2019

An investigation of the independent risk factors that differentiate gout from pseudogout in patients with crystal-induced acute arthritis: a cross-sectional study.

Rheumatol Int 2018 Jan 6;38(1):89-95. Epub 2017 Dec 6.

Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.

Objectives: To identify independent risk factors that differentiate gout from pseudogout in patients that present with crystal-induced acute arthritis.

Methods: This cross-sectional study was conducted at Siriraj Hospital (Bangkok, Thailand) during the 25 May 2014-28 November 2014 study period. Patients who presented with crystal-induced acute arthritis were eligible for inclusion. Diagnosis of gout or pseudogout was made by microscopic visualization and analysis of crystals in synovial fluid. Patients with other causes of acute arthritis were excluded. Patients diagnosed with gout were compared with patients diagnosed with pseudogout and factors with a p value less than 0.05 were included in logistic regression analysis.

Results: A total of 103 patients were included. Gout and pseudogout were established in 59 (56.7%) and 44 (42.3%) patients, respectively. Gout patients were younger than pseudogout patients (66.9 ± 14.5 vs. 78.9 ± 12.0 years; p = 0.0001); had higher BMI (22.9 ± 2.5 vs. 21.0 ± 2.5 kg/m; p = 0.001); had history of recurrent arthritis (91.5 vs. 9.1%; p = 0.001); had higher prevalence of below-knee arthritis (66.1 vs. 31.8%; p = 0.001); had less periarticular soft tissue swelling (57.6 vs. 81.8%; p = 0.01); and had hyperuricemia (8.0 ± 2.5 vs. 5.6 ± 2.7; p = 0.001). In adjusted multivariate analysis, hyperuricemia during acute arthritis/gouty attack characterized gout (OR 2.08, 95% CI 1.2-3.6), while monoarticular attack (OR 4.12, 95% CI 1.3-13.0) and periarticular soft tissue swelling (OR 4.03, 95% CI 1.1-14.9) were indications for pseudogout.

Conclusions: The independent risk factors were found to differentiate gout from pseudogout: Gout: hyperuricemia during gouty attack; Pseudogout: monoarticular attack and periarticular soft tissue swelling.
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http://dx.doi.org/10.1007/s00296-017-3891-2DOI Listing
January 2018

2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis.

Int J Rheum Dis 2017 Sep 21;20(9):1166-1184. Epub 2017 Jul 21.

Rheumatology Unit, Department of Medicine, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand.

Aim: In June 2015, the Thai Rheumatism Association (TRA) approved an update of its recommendation for the use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic (tsDMARD) in the treatment of rheumatoid arthritis (RA) to cover those currently available in Thailand (etanercept, infliximab, golimumab, rituximab, tocilizumab, abatacept and tofacitinib).

Method: A search of the literature was performed between January 2000 and June 2015. Existing RA recommendations, in relation to the use of bDMARDs and tsDMARD, were identified and evaluated by the AGREE II instrument prior to their use as a 'guide' for developing this TRA recommendation. An additional literature search was performed in order to answer specific clinical questions that could not be found in existing guidelines.

Result: Thirteen recommendations were developed. They covered the use of RA classification criteria, the aim of RA treatment, when to initiate bDMARDs/tsDMARD or taper or switch them to other medications, as well as monitoring these drugs during their use. In addition, specific issues including their use and vaccination, malignancies, pregnancy and lactation, and perioperative period also were addressed. Public hearings were performed at the annual meeting of the TRA and of the Royal College of Physicians of Thailand. The recommendations were distributed to other professional associations related to RA management, as well as government sectors associated with the reimbursement policy, prior to development of the final version.

Conclusion: These recommendations will help Thai rheumatologists prescribe bDMARDs and tsDMARD more appropriately when treating RA patients.
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http://dx.doi.org/10.1111/1756-185X.13130DOI Listing
September 2017

Metabolic syndrome is associated with disease activity in patients with rheumatoid arthritis.

Joint Bone Spine 2016 Oct 26;83(5):563-7. Epub 2016 May 26.

Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 8th floor Asadang building, 2, Wanglang road, Bangkok-noi, 10700 Bangkok, Thailand. Electronic address:

Objective: To investigate the association between metabolic syndrome (MS) and disease activity in patients with rheumatoid arthritis (RA).

Methods: Siriraj Rheumatoid Arthritis registry is a prospective cohort study establishing since May 2011. A total of 267 patients who had complete data in February 2015 were included in these analyses. All clinical and laboratory data related to disease activity, functional status, and parameters of MS according to the 2001 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were collected. Univariate and backward stepwise multivariate analyses were performed to identify factors associated with MS.

Results: Most (88%) were female with the mean age±standard deviation of 59±11.1 years old. MS was found in 43 patients (16%). Patients with MS had a significantly lower proportion of patients with remission (time-adjusted mean of disease activity score 28 or DAS28<2.6) than those with non-MS (2.3% vs. 16.5%, P=0.02). Multiple logistic regression analysis identified 3 independent factors associated with MS including body mass index [OR 1.2, 95% CI 1.1 to 1.3], educational level≤12 years [OR 5.92, 95% CI 1.47 to 23.83], and disease remission [OR 0.11, 95% CI 0.01 to 0.93]. This model correctly predicted 84% of cases.

Conclusion: Remission rate is significantly lower in RA patients with MS. Disease activity of RA, body mass index, and educational level are associated with metabolic syndrome in patients with RA.
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http://dx.doi.org/10.1016/j.jbspin.2015.10.016DOI Listing
October 2016

Reply.

Arthritis Care Res (Hoboken) 2016 09 28;68(9):1385-6. Epub 2016 Jul 28.

The University of Western Ontario, London, Ontario, Canada.

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http://dx.doi.org/10.1002/acr.22851DOI Listing
September 2016

Treatment Algorithms in Systemic Lupus Erythematosus.

Arthritis Care Res (Hoboken) 2015 Sep;67(9):1237-1245

University of Western Ontario, London, Ontario, Canada.

Objective: To establish agreement on systemic lupus erythematosus (SLE) treatment.

Methods: SLE experts (n = 69) were e-mailed scenarios and indicated preferred treatments. Algorithms were constructed and agreement determined (≥50% respondents indicating ≥70% agreement).

Results: Initially, 54% (n = 37) responded suggesting treatment for scenarios; 13 experts rated agreement with scenarios. Fourteen of 16 scenarios had agreement as follows: discoid lupus: first-line therapy was topical agents and hydroxychloroquine and/or glucocorticoids then azathioprine and subsequently mycophenolate (mofetil); uncomplicated cutaneous vasculitis: initial treatment was glucocorticoids ± hydroxychloroquine ± methotrexate, followed by azathioprine or mycophenolate and then cyclophosphamide; arthritis: initial therapy was hydroxychloroquine and/or glucocorticoids, then methotrexate and subsequently rituximab; pericarditis: first-line therapy was nonsteroidal antiinflammatory drugs, then glucocorticoids with/without hydroxychloroquine, then azathioprine, mycophenolate, or methotrexate and finally belimumab or rituximab, and/or a pericardial window; interstitial lung disease/alveolitis: induction was glucocorticoids and mycophenolate or cyclophosphamide, then rituximab or intravenous gamma globulin (IVIG), and maintenance followed with azathioprine or mycophenolate; pulmonary hypertension: glucocorticoids and mycophenolate or cyclophosphamide and an endothelin receptor antagonist were initial therapies, subsequent treatments were phosphodiesterase-5 inhibitors and then prostanoids and rituximab; antiphospholipid antibody syndrome: standard anticoagulation with/without hydroxychloroquine, then a thrombin inhibitor for venous thrombosis, versus adding aspirin or platelet inhibition drugs for arterial events; mononeuritis multiplex and central nervous system vasculitis: first-line therapy was glucocorticoids and cyclophosphamide followed by maintenance with azathioprine or mycophenolate, and then rituximab, IVIG, or plasmapheresis; and serious lupus nephritis: first-line therapy was glucocorticoids and mycophenolate, then cyclophosphamide then rituximab.

Conclusion: We established variable agreement on treatment approaches. For some treatment decisions there was good agreement between experts even if no randomized controlled trial data were available.
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http://dx.doi.org/10.1002/acr.22589DOI Listing
September 2015

The 15% rule in scleroderma: the frequency of severe organ complications in systemic sclerosis. A systematic review.

J Rheumatol 2013 Sep 15;40(9):1545-56. Epub 2013 Jul 15.

Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Objective: The prevalence of organ complications in scleroderma (systemic sclerosis; SSc) varies by definition used. This study was done to determine the frequency of several features of SSc.

Methods: A search of Medline-Ovid/Embase, PubMed, and Scopus databases from 1980 to November 30, 2011, was conducted to identify relevant articles with at least 50 patients with SSc extracting prevalence of each organ complication. Study quality was assessed using the STROBE (Strengthening The Reporting of OBservational studies in Epidemiology) checklist. Pooled prevalence was calculated using the random effects method. Heterogeneity was quantified using I(2).

Results: A total of 5916 articles were identified (913 from Medline-Ovid/Embase, 1009 from PubMed, and 3994 from Scopus); 5665 were excluded, leaving 251 articles for full-text review, with 69 included. Where available, frequencies were also included from the Canadian Scleroderma Research Group. Many severe complications in SSc occur about 15% of the time, including cardiac involvement (15%, 95% CI 6-24), diastolic dysfunction (16%, 95% CI 14-17), estimated pulmonary artery pressure > 40 mm Hg (18%, 95% CI 14-21), pulmonary arterial hypertension by right heart catheterization (15%, 95% CI 12-17), forced vital capacity (FVC) < 70% predicted (15%, 95% CI 12-17), FVC < 80% predicted (17%, 95% CI 12-21), myositis (13%, 95% CI 10-17), inflammatory arthritis (12%, 95% CI 9-16), Sjögren overlap (13%, 95% CI 10-16), and digital ulcers (DU; 15%, 95% CI 10-20); and 15% of DU have complications (amputations 12%, 95% CI 8-16, and hospitalizations 13%, 95% CI 6-21). Scleroderma renal crisis is uncommon but occurs in almost 15% (12%, 95% CI 5-19) of cases of disseminated cutaneous SSc. There is no 15% rule within skin and gastrointestinal tract for SSc.

Conclusion: The "15%" rule for frequency of significant organ involvement in SSc is helpful.
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http://dx.doi.org/10.3899/jrheum.121380DOI Listing
September 2013

Low socioeconomic status (measured by education) and outcomes in systemic sclerosis: data from the Canadian Scleroderma Research Group.

J Rheumatol 2013 Apr 15;40(4):447-54. Epub 2013 Feb 15.

Western University, Schulich School of Medicine and Dentistry, Department of Medicine, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada.

Objective: In systemic lupus erythematosus, socioeconomic status (SES) affects outcomes. SES can modify outcomes by altering timing of access to care and adherence. It is unknown whether SES affects systemic sclerosis (SSc) outcomes. Disease can affect income and cause work disability, thus education (completed long before SSc onset) may be a proxy for SES.

Methods: The Canadian Scleroderma Research Group collects annual data on patients with SSc. Baseline data were used from a prevalent cohort. Education was stratified by whether participants completed high school. Regression models assessed effects of education on organ complications and survival.

Results: In our study, 1145 patients with SSc had 11.0 ± 9.5 years' disease duration; 86% were women, with a mean age of 55.4 ± 12.1 years. About one-quarter did not complete high school; this was more common in older patients (p < 0.0001), men (p = 0.017), those with lower income (p < 0.0001), the unemployed (p < 0.054), smokers (p < 0.001), where DLCO was < 70% predicted (p = 0.009), in those with arthritis (p = 0.047), higher Health Assessment Questionnaire-Disability Index (p = 0.017), elevated erythrocyte sedimentation rate (p = 0.019), median C-reactive protein (p = 0.002), proteinuria (p = 0.016), steroid use ever (p = 0.039), and those more likely to have died in followup (12.7% vs 8.0%; p = 0.024). However, adjusting for confounders, there was no effect of education on mortality; whereas mortality was related to age, diffuse cutaneous SSc (dcSSc) subset, elevated pulmonary arterial (PA) pressure on echocardiography, low forced vital capacity expressed as percentage of predicted, and proteinuria (similar in the dcSSc subset and in limited cutaneous SSc), mortality was increased in older patients, those with elevated PA pressure, and those with low DLCO.

Conclusion: Completing less education than high school was not associated with a worse prognosis in SSc after adjustment for confounding characteristics.
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http://dx.doi.org/10.3899/jrheum.120570DOI Listing
April 2013

Association of C-reactive protein with high disease activity in systemic sclerosis: results from the Canadian Scleroderma Research Group.

Arthritis Care Res (Hoboken) 2012 Sep;64(9):1405-14

University of Western Ontario, London, Ontario, Canada.

Objective: This study was performed to determine the prevalence of elevated C-reactive protein (CRP) levels and the significance of CRP in clinical parameters in systemic sclerosis (SSc; scleroderma) patients.

Methods: Canadian Scleroderma Research Group data were used. Statistical comparisons were made for CRP levels ≤8 mg/liter versus >8 mg/liter, early (≤3 years from first non-Raynaud's phenomenon symptom) versus late SSc, and diffuse cutaneous SSc (dcSSc) versus limited cutaneous SSc (lcSSc). A survival analysis was analyzed between patients with normal versus elevated CRP levels.

Results: A total of 1,043 patients (mean ± SD age 55.4 ± 12.1 years, mean ± SD disease duration of 11.0 ± 9.5 years) were analyzed; elevation of CRP level and erythrocyte sedimentation rate (ESR; >20 mm/hour) occurred in 25.7% and 38.2%, respectively. Mean ± SD baseline CRP level in dcSSc (11.98 ± 25.41 mg/liter) was higher than in lcSSc (8.15 ± 16.09 mg/liter; P = 0.016). SSc patients with an early disease duration had a higher mean ± SD CRP level (12.89 ± 28.13 mg/liter) than those with a late disease duration (8.60 ± 17.06 mg/liter; P = 0.041). Although not consistent in all subsets, CRP was significantly associated (P < 0.01) with ESR, modified Rodnan skin score (MRSS), worse pulmonary function parameters, disease activity, damage, and Health Assessment Questionnaire. CRP level seemed to normalize in many SSc patients over time. Total lung capacity <80% predicted, MRSS, and serum creatinine were predictors of elevated CRP levels in SSc (odds ratio [OR] 2.76 [95% confidence interval (95% CI) 1.73-4.40], P = 0.0001; OR 1.03 [95% CI 1.01-1.05], P = 0.005; and OR 1.005 [95% CI 1.001-1.010], P = 0.02, respectively). Survival for patients with elevated CRP levels was less than for patients with normal CRP levels (P = 0.001).

Conclusion: CRP level is elevated in one-quarter of SSc patients, especially early disease. It is correlated with disease activity, severity, poor pulmonary function, and shorter survival.
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http://dx.doi.org/10.1002/acr.21716DOI Listing
September 2012

Interleukin 6 in systemic sclerosis and potential implications for targeted therapy.

J Rheumatol 2012 Jun 15;39(6):1120-4. Epub 2012 Apr 15.

Division of Rheumatology, Department of Medicine, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand.

Objective: The purpose of this study was to review the potential importance of interleukin 6 (IL-6) in systemic sclerosis (SSc).

Methods: PubMed and Scopus databases and American College of Rheumatology (from 2009-10) and European League Against Rheumatism abstracts (2009-11) were searched using keywords "scleroderma; SSc; cytokines; interleukins; interleukin 6" and publications were excluded if not pertaining to IL-6 in SSc. Data were extracted from selected articles to construct a cell interaction model of the effects of IL-6 in SSc.

Results: A total of 416 reports were found (PubMed, n = 82; Scopus, n = 331; 3 abstracts); 372 were excluded (irrelevant) leaving 41 publications and 3 abstracts (39 from PubMed, 18 from Scopus; but 16 were repeated from PubMed search), where 40 suggested IL-6 was important in SSc and 4 did not. Effects of IL-6 in SSc were summarized schematically.

Conclusion: Of the 44 publications, 40 suggested that IL-6 may be important in SSc, allowing for a conceptual framework within SSc including effects on macrophages, fibroblasts, plasma cells, monocytes, and extracellular matrix.
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http://dx.doi.org/10.3899/jrheum.111423DOI Listing
June 2012

The study of clinical manifestation of osteoarticular tuberculosis in Siriraj Hospital, Thailand.

J Med Assoc Thai 2009 Mar;92 Suppl 2:S101-9

Division of Rheumatology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: To study of clinical manifestations of osteoarticular tuberculosis.

Material And Method: This study is an observational retrospective study design from the electronic medical record database of Siriraj Hospital in 2005-2006.

Results: Ninety- nine patients fit in to the inclusion criteria. All were non HIV-infected. There were 44 males (44.4%) and 55 females (55.6%) with a male/female ratio of 8:10. The mean and median age was 50.9 +/- 19.8 and 50 years, respectively, with a range from 1-85 years. The most frequent chief complaint was pain (84.8%), followed by functional disability/neurological deficit (47.5%), constitutional symptoms (38.4%), fever (24.2%), localized swelling (21.2%), fistulas and drainage (11.1%) and discovery as a co-morbid disease (1%). The most frequent clinical manifestation was tuberculous spondylodiscitis (66.7%) followed by tuberculous septic arthritis (28.3%), tuberculous osteomyelitis (10.1%), tuberculous tenosynovitis (4.0%), tuberculous bursitis (2.0%) and tuberculous pyomyositis (2.0%). Concurrent pulmonary TB was 30.3%. The mean and median time to diagnosis was 20.4 +/- 16.9 and 13 weeks, respectively, with a range from 4 days to 104 weeks. The shortest duration of time to diagnosis was 0-4 weeks (19.2%) followed by 12-16 weeks (14.1%) and 20-24 weeks (13.1%). The longest duration of time to diagnosis was 104 weeks (1%). The diagnosis from histopathology was 46.5%, positive AFB 40.4%, positive PCR 33.3% and positive culture 19.2%. The radiological abnormalities were osteolytic lesion (79.8%), narrowing intervertebral disc space/joint space (54.5%), cold abscess (49.5%) and vertebral collapse (43.4%). Surgery with medical treatment was performed on 72.7% while the percentage of those receiving medical treatment only was 27.3%. The results of treatment were improvement with residual deformities/dysfunction occurring in 97%. Death occurred in 3%.

Conclusion: Osteoarticular tuberculosis is common in all age groups. Tuberculous spondylodiscitis was the most frequent clinical manifestation in Siriraj Hospital, Thailand. Although the patients were provided with adequate medical and surgical therapy, osteoarticular tuberculosis was still associated with mortality and morbidity.
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March 2009
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