We recognise the need for continued growth to be able to provide our patients with care that is efficient, safe and up-to-date. Therefore, the Division actively takes part in championing in-hospital, local and international initiatives in research, collaboration and education.
1. Inflammatory Arthritis
The Inflammatory Arthritis (IA) programme is a multi-faceted programme by the Division of Rheumatology in NUH.
The Division provides inpatient and outpatient care for more than 2,000 patients with IA, which includes rheumatoid arthritis (RA), psoriatic arthritis (PsA), undifferentiated arthritis (UA), spondyloarthritis (SpA), ankylosing spondylitis (AS) and selected patients with septic arthritis.
Our IA programme adopts a multi-faceted approach in its effort to drive progressively better outcomes for our patients:
2. Connective Tissue Diseases
Connective tissue diseases (CTDs) are a group of autoimmune diseases characterised by a failure in self-tolerance to a wide variety of autoantigens (i.e. self-proteins) and include conditions like systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). These diseases are very heterogeneous but they have some commonalities. The immune system creates inflammation by developing autoantibodies to specific autoantigens and attacks the skin, joints, kidneys, lungs, nervous system and other organs of the body. It is believed that exposure to a variety of environmental factors may be required to trigger the acute clinical manifestations that are characteristic of these specific diseases in genetically predisposed individuals.
The Division of Rheumatology in the National University Hospital (NUH) is one of the established rheumatology units in Singapore and has a history of excellence in all three of our missions – patient care, education and research. Faculty and staff in the Division of Rheumatology participate in basic, translational and clinical research to better understand and treat CTDs. Additionally, the Division of Rheumatology works to train the next generation of rheumatologists and rheumatologist-scientists focused on understanding the pathogenesis and advancement in the treatment of patients with CTDs.
The Division of Rheumatology provides holistic clinical care to patients with connective tissue diseases. Our team also actively conducts research on and participates in regional and national collaborations to investigate Systemic Lupus Erythematosus (SLE) and Systemic Sclerosis (SSc / Scleroderma).
Systemic Lupus Erythematosus (SLE)
Our longitudinal SLE cohort is part of the largest Asia-Pacific cohort of over 2000 SLE patients, under the international collaboration, APLC (The Asia Pacific Lupus Collaboration). APLC includes investigators from 16 research centres across Australia, China, Dubai, Hong Kong, Indonesia, Japan, Malaysia, the Philippines, Singapore, Taiwan and Thailand. APLC has developed a draft definition of lupus low disease activity state (LLDAS). LLDAS is defined conceptually as "a state which, if sustained, is associated with a low likelihood of adverse outcome", considering both disease activity and medication safety. APLC has embarked on multiple projects to validate this LLDAS definition in retrospective and prospective studies. Click here for the APLC website. Through our participation in the APLC, we have established a carefully characterised multi-ethnic SLE cohort.
Basic and translational projects in SLE include: (i) microparticles being characterised for their interactions with endothelial cells and examined for their association with disease activity and damage accrual (e.g. cardiovascular disease); (ii) human and murine neutrophils and low-density granulocytes are examined for formation of neutrophil extracellular traps (NETs) and whether "NETosis" may lead to exaggerated immune responses leading to SLE and other rheumatic diseases; (iii) deep immune profiling of lupus immunocytes and kidneys using high-dimensional analysis technologies in SLE patients with active disease (e.g. lupus nephritis) and (iv) biomarker and imaging research in neuropsychiatric SLE.
Systemic Sclerosis (Scleroderma)
In collaboration with the Singapore General Hospital and Tan Tock Seng Hospital, the NUH Division of Rheumatology participates in the study of Systemic Sclerosis through the Scleroderma Cohort Singapore (SCORE). Through the cohort, we aim to understand the characteristics of Systemic Sclerosis unique to our local population, while contributing to efforts to push new frontiers in the treatment of this difficult disease.
3. Gout research
Gout research aims to improve the care of gout and understand the pathogenesis of this ancient disease. The programme includes both basic science and clinical pursuits. Together with basic scientist from Singapore Immunology Network, we explore the role of inflammatory pathways and genes leading to gout. We also evaluate the lifestyle and dietary risk factors for development of gout, as well as the mortality in gout in our population using large scale cohort study. Within our hospital, we enroll patients with gout to assess clinical factors, health related quality of life, impact of gout and medication adherence amongst our gout patients. We also collaborate with various faculties in the National University of Singapore.
Clinical improvement projects have been conducted to improve treatment to achieve target urate level and medication adherence, including an ongoing project piloting telehealth in titration of urate lowering therapy. In addition, we participated in a national study to evaluate pharmacogenetics of the use of allopurinol in gout. We have also successfully completed a pharmaceutical clinical trial on IL-1 inhibitor in the treatment of acute gout.
Ongoing translation research are (i) NLRP3 inflammatory pathways; (ii) Lipidomics in gout; (iii) Risk of knee replacement in gout in the Singapore Chinese Health Study; (iv) Metabolic syndrome in gout patients; (v) Factors influencing Medication Adherence; and (vii) Utility of Gout Impact Scale as a patient reported outcome.
4. Translational Immunology
Autoimmune diseases are human pathologies that are increasing in frequency worldwide. Reports from developed countries show that nearly 5 – 10% of individuals (80% being females) suffer from one or more autoimmune diseases. A rheumatologist is a physician/scientist with multi-disciplinary competencies in the field of rheumatic diseases. The basis of this competence is an understanding of immunology where cell- and antibody-mediated rheumatic diseases may be treated by utilising the immune system's ability to facilitate a return to normal health. The restoration of health in autoimmune diseases has already been subject to a quantum leap with the advent of biological therapies and newer approaches are expected to contribute further.
The Division of Rheumatology in National University Hospital has an interest in establishing a translational immunology programme focusing on rheumatic diseases. Our research leverages on the basic research produced by the National University of Singapore and the Agency for Science, Technology and Research scientists to make an impact on patient care. Within the Division of Rheumatology, there are several Principal Investigators with interest and expertise in translational immunology and rheumatic diseases.
Our translational immunology branch integrates clinical science, molecular and cellular biology, bioinformatics and physiology through collaborations with key researchers locally and internationally. The scale, scope and multi-disciplinary nature of translational research requires a large quantity of carefully prepared, quality-assessed biospecimens to be available for study and that the results of these studies be analysed in the context of well curated clinical data. Our biobank and clinical dataset of various rheumatic diseases therefore form the central infrastructure component of translational research.
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