Publications by authors named "Sian Yik Lim"

Article Synopsis
  • A systematic review examined cases of crystal-induced arthritis (such as gout and calcium pyrophosphate deposition disease) in prosthetic joints, focusing on clinical presentations, diagnoses, treatments, and outcomes.
  • The analysis, which followed PRISMA guidelines, included literature searches from multiple databases and identified 44 relevant cases from 1984 to 2021, predominantly affecting patients with knee arthroplasty.
  • Results revealed that this type of arthritis often appears suddenly as monoarticular arthritis, can be mistaken for infections, and typically responds well to anti-inflammatory treatments within a week.
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Unlabelled: We studied factors affecting osteoporotic hip fracture mortality in Hawai'i, a region with unique geography and racial composition. Men, older adults, higher ASA score, lower BMI, and NHPI race were associated with higher mortality. This is the first study demonstrating increased mortality risk after hip fracture in NHPI patients.

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Objective: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs).

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

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Objective: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs).

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

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Objective: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

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Objective: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

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Background: Previous arthroplasty utilization research predominantly examined Black and White populations within the US. This is the first known study to examine utilization and complications in poorly studied minority racial groups such as Asians and Native Hawaiian/Pacific-Islanders (NHPI) as compared to Whites.

Results: Data from 3304 primary total hip and knee arthroplasty patients (2011 to 2019) were retrospectively collected, involving 1789 Asians (52.

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Objective: The purpose of this study was to investigate differences in clinical characteristics and health care use of Native Hawaiian and White patients with gout.

Methods: We performed a retrospective chart review of Native Hawaiian and White patients with gout treated from 2011 to 2017 within a large health care system in Hawai'i. We compared demographic characteristics, clinical outcomes, and risk factors for gout.

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As one of the most potent osteoanabolic agents with a unique mechanism of action, romosozumab has high efficacy for osteoporosis treatment. It is a monoclonal antibody against sclerostin, a natural inhibitor of the Wnt signaling pathway, and by inhibiting sclerostin, activation of Wnt signaling occurs with a cascade of changes ultimately leading to bone mineral density (BMD) gains. Romosozumab stimulates bone modeling and has a dual effect of activating bone formation while inhibiting bone resorption.

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Increased understanding of the Wnt signaling pathway has led to the development of romosozumab, one of the most potent osteoanabolic agents to date for osteoporosis treatment. Romosozumab is a monoclonal antibody that inhibits sclerostin, a natural inhibitor of the Wnt signaling pathway. Romosozumab, by inhibiting sclerostin activates the Wnt signaling pathway, leading to increased bone formation and decreased bone resorption.

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Background: Hawai'i has the highest nontuberculous mycobacterial (NTM) lung infection prevalence in the United States. Limited data regarding skin and soft tissue infections (SSTI) due to NTM in Hawai'i exists. This study describes patient demographics, clinical courses of infection, treatment patterns, and clinical outcomes of NTM SSTIs in Hawai'i.

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Objectives: To investigate trends of osteoporosis treatment rates, and factors affecting osteoporosis treatment after hip fracture admission within a single health care system in Hawaii.

Methods: A retrospective chart review was conducted of patients aged 50 years or older and hospitalized for hip fractures between January 1, 2011 and December 31, 2019 at Hawaii Pacific Health, a large health care system in Hawaii. We collected data on basic demographics and osteoporosis medication prescription from electronic medical records.

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Septic arthritis due to  complex (MAC) is extremely rare. While MAC infection is classically associated with HIV/AIDS and immunosuppressed states, it may occur in immunocompetent individuals. We report a case of MAC septic arthritis of a native wrist joint in an immunocompetent host.

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Article Synopsis
  • MAC native joint septic arthritis, once rare, is increasingly reported, prompting the need for a thorough review of its cases and treatments.
  • A systematic review identified 33 cases since 1976, highlighting that it can affect both immunocompetent and immunocompromised individuals, often presenting as monoarthritis in the knees and wrists.
  • Diagnosis is frequently delayed, averaging 20 months from symptom onset, necessitating a combination of surgery and antimycobacterial drugs for effective treatment.
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Article Synopsis
  • The 30-day mortality rate for patients aged 50 and older who experienced osteoporotic hip fractures at Hawai'i Pacific Health was 4.2%, with mortality rates increasing significantly over the years to 30.1% by the third year.
  • Factors such as older age, being male, higher comorbidity index, having Medicare/Medicaid insurance, and lower BMI were linked to higher mortality.
  • A study involving a review of 428 patients from January 2015 to May 2016 highlighted these associations using statistical analyses to understand the relationship between demographics, health status, and mortality rates.
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We report a case of statin-associated necrotising autoimmune myopathy successfully treated with subcutaneous immunoglobulin therapy (SCIG) monotherapy without corticosteroids. This is a 51-year old female with seronegative rheumatoid arthritis, who had been on statins for several years, who developed proximal muscle weakness and elevated creatine kinase after resuming her statin post sleeve gastrectomy for weight loss. Our patient had a history of severe side effects to prednisone.

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Recent and comprehensive research of gout in the Pacific region and Hawai'i is significantly lacking. This study was conducted to improve the understanding of the healthcare utilization of gout patients within a single health care system in Hawai'i. The objective was to examine gout inpatient, outpatient and emergency department care within a single health care system in Hawai'i.

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The field of rheumatology has expanded rapidly in recent years, and innovations in immunology, epigenetics, and bone metabolism continue at an astonishing pace. In this fast changing field, optimizing medical education for rheumatologists is vital for maintaining a competent workforce to meet the needs of patients with rheumatic diseases. Several key challenges lie ahead and efforts to optimize medical education for rheumatologists are discussed in this article.

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Increased understanding of bone biology has led to the discovery of several unique signaling pathways that regulate bone formation and resorption. The Wnt signaling pathway plays a significant role in skeletal development, adult skeletal homeostasis, and bone remodeling. Sclerostin is an inhibitor of the Wnt signaling pathway.

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Objective: To evaluate the association of incident gout with the risk of incident septic arthritis in a general population context.

Methods: We investigated the association of incident gout with the risk of incident septic arthritis using the Health Improvement Network, a computerized medical record database from general practices in the UK. We conducted a cohort analysis of the risk of an incident septic arthritis diagnosis among adults with incident gout compared with up to five non-gout individuals matched by age, sex, date of study entry and enrolment year.

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Prolonged bisphosphonate use has been associated with increased risk of atypical femoral fractures. Very few cases of atypical femoral fractures have been reported with denosumab. We report a case of bilateral tibial stress reactions in a 60-year-old man with no history of osteoporosis who was on prolonged high-dose denosumab for the treatment of giant cell tumor of bone.

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Purpose Of Review: Osteoporosis is a skeletal disorder in which bone strength is decreased leading to an increased risk of fracture. In line with advances in knowledge of bone biology, the past several years have held major therapeutic advances in osteoporosis treatment. In this article, we review the current approaches to osteoporosis treatment with a focus on issues of interest to the practicing rheumatologist.

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Septic arthritis is an important concern for rheumatologists in the evaluation of joint disease. Very few studies have addressed the microbiologic epidemiology and outcomes of septic arthritis in the USA since the year 2000. We performed a retrospective study of septic arthritis in a tertiary hospital in West Texas from the year 2000 to 2013.

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