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

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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Calorie Counting para sa Weight Loss

Excellent article from “The Hormonal Endocrinologist.” 🙂

The Hormonal Endocrinologist

Upang malaman kung tama ang iyong timbang para sa iyong height:

Body Weight (kg) / Height (m2)

Halimbawa, ako ay 5’ feet at 4 inches = 1.62 meters (5 foot 4′ = 64 inches = 162 cm = 1.62 m), at ang aking timbang ay 58 kg:

58 kg / 1.622 = 22.1 (ang aking BMI)

Ikumpara sa susunod na chart ang resultang makukuha:

Mga Antas ng BMI para sa mga Pilipino

Underweight < 18.5 kg/m2
Normal 18.5 – 23.9 kg/m2
Overweight 24 – 27.5 kg/m2
Obese > 27 kg/m2

Ang normal na BMI para sa mga Pilipino ay nasa 18.5 hanggang 23.  Mas mababa sa 18.5 ay underweight, at and sobra naman sa 23.9 ay overweight o obese.

Upang maabot ang nais na timbang natin, isa mga epektibong weight loss strategies ay ang pagbibilang ng calories.  Ang ating pagkain ay may katumbas na caloric…

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Professor Josef Smolen’s Visit to PGH

Last August 27, the PGH Section of Rheumatology was fortunate to have a visit from the venerable Professor Josef Smolen. He conducted a small group open discussion with the fellows of the section and the section head, Dr Ester Penserga. Other consultants in attendance were Dr. Michael Tee, Dr Jose Paolo Lorenzo and Dr Heizel Manapat-Reyes.

There were various topics discussed, but the focus was on rheumatoid arthritis. Dr Smolen also talked about the use of CDAI/SDAI and their advantages over the DAS28.

It was good exposure for everyone in the group to hear from a very much accomplished rheumatologist. Professor Smolen is co-author of several books: Contemporary Targeted Therapies in Rheumatology, SLE: A Companion to Rheumatology, Rheumatology: 2 Volume Set, and a lot more.

And like the description of him in “The Rheumatologist“, working with the good professor was indeed, fun!

Dr Michael Tee Performs a “Smolen Joint Count”

Prof Smolen signs research papers

Prof Smolen with the Section of Rheumatology UP-PGH (Consultants, Fellows and Residents)

Prof Smolen with the Section of Rheumatology UP-PGH and Pfizer Team