Treatment of Lupus Nephritis: Top Ten Tips

from the lecture of Dr. Frederic Houssiau delivered during the #LupusACA 2017 Convention at Melbourne, Australia

  1. Always perform a renal biopsy
  2. Define a target
  3. Prescribe less steroids
  4. Prescribe mycophenolate mofetil or (Eurolupus) IV Cyclophosphamide for induction
  5. Maintain immunosuppression
  6. Prevent and treat co-morbidities
  7. Unmask non-adherence to therapy
  8. Keep the faith in targeted therapies
  9. Watch the Calcineurin-inhibitor story
  10. Keep hoping for precise medicine

Rheumatoid Arthritis: Treat Early to Prevent Disability

It takes an average of 5 years before patients with Rheumatoid Arthritis become diagnosed with the disease. By this time, they have contracted significant disability or disfigurement.

Most patients are mistaken to have gout or osteoarthrits and are given medications which take away the pain temporarily but don’t prevent progression of disease.

Early treatment can provide remission and significantly improve quality of life.

PRA Launches its Gout Awareness Campaign

When in Gout, consult a Rheumatologist… 😊

Philippine Rheumatology Association

Gout is an episodic, severely painful form of inflammatory arthritis caused by increased uric acid. It afflicts 1.6% of Filipinos and has increased in prevalence over the last decade. It primarily affects men, starting in their 20’s. Women, mostly those who are post-menopausal, may become victims as well.

Left untreated, gout becomes more severe and attacks more frequent as time goes by. It may be triggered by eating purine rich foods. It also can be seen in patients on various medications like aspirin, diuretics and some anti-TB medications.

During gout attacks, pain is extreme. Even lightly touching affected joints can be intolerable. Patients are unable to walk or put any weight on painful joints for days. This leads to missed days at work, anger and depressive symptoms, and overall poor quality of life.

Later on, chronic gout can frequently lead to kidney stones, joint erosions and deformities, large visible joint and soft…

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PRA Statement on UA Block

A friendly reminder/warning to our dear patients (From the Philippine Rheumatology Association)…

Philippine Rheumatology Association

The Philippine Rheumatology Association warns the public against the use of UA Block, an unregistered herbal supplement for arthritis. The Philippine Food and Drug Administration (Ph FDA), through advisory no. 2015-035, has declared this drug to be potentially dangerous to health. Rheumatologists have observed serious medical complications which may be associated with this product among some patients.

UA Block

Selling of this product is in direct violation of the Food and Drug Administration Act on 2009 (Republic Act No. 9711). To ensure public safety, we call on everyone to remain vigilant and report establishments selling these products to or (02) 807-8275.

Link to Philippine FDA Advisory No 2015-035 here.

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A Lay Fora on Gouty Arthritis

2014 in review

The stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 2,500 times in 2014. If it were a cable car, it would take about 42 trips to carry that many people.

Click here to see the complete report.

On Making Science Interesting, The “Curse of Knowledge” and The Myth of “Dumbing Down” (A Letter to My Co-Fellows)

Dear Co-Fellows:

I believe that we are all like 13 year olds learning a new and difficult topic, especially in a challenging field as rheumatology. And sometimes, we have been told not to be “too basic” or “too elementary” in our explanations; that we should use the scientific language to speak and explain…

I beg to differ. I believe that we should simplify as much as we can to the point of telling stories or simple analogies.

I’ve been reading a book called Made to Stick and it has helped me a lot. I will share some concepts to you when we have free time. I shared one this morning, about the “Curse of Knowledge.” It simply means that once we have become knowledgeable about a certain topic, we tend to forget how we learned it (whether it was the hard way or the easy way), and sometimes, we find it hard to understand why people don’t understand what we talk about (when it seems soooo easy to us). I am guilty of this curse, especially on the technical, geeky stuff. A lot of times I find it hard to understand why people can’t understand these stuff (like, why Ken can’t get the concept of Cloud-based files storage like Dropbox. Hehe). That is my “Curse of Knowledge.” What I “hear” in my brain, and the cadence by which I hear it is not the same as what Ken “hears” or how fast he “hears” it. I need to simplify (mistakenly perceived by others as “dumbing down”) so that people can understand.

The book I am reading, Made to Stick taught me the principle of accuracy vs accessibility when teaching. Let me share this brief excerpt:

“We discussed the Curse of Knowledge in the introduction—the difficulty of remembering what it was like not to know something. Accuracy to the point of uselessness is a symptom of the Curse of Knowledge. To a CEO, “maximizing shareholder value” may be an immensely useful rule of behavior. To a flight attendant, it’s not. To a physicist, probability clouds are fascinating phenomena. To a child, they are incomprehensible.

People are tempted to tell you everything, with perfect accuracy, right up front, when they should be giving you just enough info to be useful, then a little more, then a little more.”(Excerpt From: Heath, Chip. “Made to Stick.” Random House Publishing Group, 2008. iBooks.)

Also, watching this 11 minute TED video by Tyler DeWitt awhile ago, inspired me once more, to overcome this “Curse of Knowledge”  and shy away from the myth of “Dumbing Down” and be able to teach in a simple way. I hope you too will find it useful as we become educators in the near future 🙂

Here’s the video: 

Enjoy guys 🙂



Educational Resources

Available at the National Bookstore or at the Section of Rheumatology UP-PGH


The Section of Rheumatology has actively produced educational materials for the lay. The first was in 2000 with the Arthritis Komiks series – Arthritis, Osteoarthritis, Gout– in the Filipino language. These were given free to patients and caregivers during section activities like ABaKaDa ng Rayuma, a monthly lay encounter in the Outpatient Department of UP-PGH and during the Lupus Club meetings. Copies of the Arthritis series is still available in the office. These comics series were made possible by educational grants from Pfizer Philippines and MSD, with story line by Dr. Heizel Manapat-Reyes and Dr. Clemente M. Amante as adviser.

Recently, several members of the staff collaborated with training residents of the Department of Medicine as authors of the Health Booklet series project of the Department. This was a department project of the former Chair and now Dean Agnes Mejia. The most recent publication is Arthritis in the Young

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When The Current Situation is Less Than Ideal


These are tough days. From reports of international terrorism, to the local corruption that plagues every aspect of our government. We blame the government, we blame each other, and at times we blame (or question) God. How could He allow such atrocities and injustices to happen? And we ask ourselves: Shouldn’t we unite, arise and fight?

Yesterday’s devotional reading of Jeremiah Chapter 29 gave me an important insight. Jeremiah was a prophet at the time of the Babylonian exile of the Israelites. He is the modern-day equivalent of priests or pastors.

There are times when our situation will be less than ideal, and God may have brought us to a place of discomfort or we may be away from our friends and relatives or the government may be bad or oppressive.

But He says that He know the plans He has for us. And that these are plans for our good and not for disaster (29:11). No matter how bad looking it might seem at the outset, no matter how long the trouble, God wants us to trust that He knows what He is doing, and what He is doing is and will always be for our own good. We need to pray and seek Him out continually (29:12) because if we do, with all our hearts, humbly and without presuppositions and presumptions, He will hear us and we will find that He has been behind every nook and turn all along (29:13). The sufferings will pass. The troubles will be replaced with peace. He will bring joy and comfort to us.

And what is our role? Our role is to be still before Him and pray. In Jeremiah Chapter 29, Jeremiah wrote the exiles in Babylon, urging them not to defer their lives. He asked them to make the most out of their time in Babylon. God’s instruction for everyone was to build homes, plan to stay. There were no instructions about fighting the government, about packing their bags and making an escape back to their hometown. No! They were asked to stay, marry, have children, find spouses for their children, multiply. They were not urged to take arms against the city they were exiled into. They were not asked to form militant groups and rally in front of the king. And mindful of the history of the Babylonian empire, it wasn’t easy for them to do this. This was a foreign land. The Temple which was very dear to them as nowhere. They have a pagan king. The food was different, the culture miles apart from the kind they grew up with. It was hard adaptation. But God asked them to stay and make the most out of their time for the next 70 years. That’s an entire lifetime. And not just that. He asked them to “work for the peace and prosperity of the city where they were sent into exile. (29:7 NLT)” God asked them to “Seek the welfare of the city…and pray on its behalf; for in its welfare (you) will have welfare. (29:8 NASB).

Sometimes, we squirm at the slightest inconvenience when God brings us somewhere beyond our comfort zone. It may be a new responsibility under an unforgiving, demanding boss. It may be relationship that has gone sour and unexciting. Or it may be a love that has yet to arrive. It may be being governed by people who take your money and spend it lavishly to provide for themselves and their families comforts unimaginable even for ancient kings. It may be a place of work and being with a group of people who don’t share your views or principles and keep you in isolation. It may be being far away from family and friends, in a country with a different language and culture. It may be religious oppression and non-tolerance.

In all these situations, God asks us NOT to postpone and defer our lives until the problems end. He wants us to keep plodding on through the situation we are in, making the most out of the situation, while also seeking His heart and His will in the process. He wants us to trust Him, that no matter how grim the situation or seeming prognosis, everything will be all right in the end. His plans are meant for our good. And yes, that includes the injustices and oppression around us. I feel sad when I see leaders, including church leaders urging people to fight the government, as if that was what God inspired their hearts to do. For me, it betrays a lack of understanding of Scripture, and an empty hollow faith, a lack of trust in the Sovereign power of God. Instead of rallying, demonstrating and hitting back, His Word tells us to respect the all governing authority (yes, the government and yes, our bad bosses), because all authority comes from Him and those in positions of authority have been placed there by Him. (Romans 13:1-2 NLT). He even goes to say that “anyone who rebels against authority is rebelling against what God has instituted, and they will be punished.” (13:3 NLT). This was written by St Paul, who was then, a prisoner of the Romans. He urged his people to obey the same authorities who shackled him and who were about to execute him.

God wants us to pray for our situation, for the welfare of the people who lord it over us, for the unpleasant people who annoy us, for our places of work and residence. We are to pray for it/them, as their welfare will determine our welfare.

At the end of the reading is a beautiful promise. “I will bring you back again,” the Lord said about His exiled people. God will restore peace, justice and prosperity again.

We need only to be still before Him.


Undulating and Flexing

A sad but true article about the current troubles in Iraq…

The Hormonal Endocrinologist

The You Version Bible App’s Life Journal Plan was designed as a guide for the user to be able to go through the New Testament twice and the Old Testament once within a year’s time.

Allan got us synced on it, and now we’ve gone through Zephanaiah, Jeremiah, and the history of the Israelites’ struggles against the Assyrian and Babylonian empires.

A noticable pattern appears throughout the lives of some of our Old Testament heroes and the chosen people as a whole – that of running to God and then running away from Him to go back to the idols they have created. The attraction being that these false gods and idols are controllable (the alternative true God is of course, above and beyond us). These “gods” allowed all sorts of perversions that catered to the flesh – sex worship (the Asherah poles) and child sacrifices (to the god Molech)…

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