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Precision medicine promises to transform healthcare for groups and individuals through early disease detection, refining diagnoses and tailoring treatments. Analysis of large-scale genomic–phenotypic databases is a critical enabler of precision medicine. Although Asia is home to 60% of the world’s population, many Asian ancestries are under-represented in existing databases, leading to missed opportunities for new discoveries, particularly for diseases most relevant for these populations. The Singapore National Precision Medicine initiative is a whole-of-government 10-year initiative aiming to generate precision medicine data of up to one million individuals, integrating genomic, lifestyle, health, social and environmental data. Beyond technologies, routine adoption of precision medicine in clinical practice requires social, ethical, legal and regulatory barriers to be addressed. Identifying driver use cases in which precision medicine results in standardized changes to clinical workflows or improvements in population health, coupled with health economic analysis to demonstrate value-based healthcare, is a vital prerequisite for responsible health system adoption.

Pharmacogenomics, the study of the effect of genetics on the variation in drug response, is designed to maximize drug efficacy and minimize adverse effects. It is assuming increasing importance in clinical practice. Rheumatologists, who manage patients with complex diseases with unpredictable outcomes over long periods of time, should embrace tools that help customize treatment for their patients. In this article, the basis for pharmacogenomics is presented, followed by description of the tests relevant to drugs encountered in rheumatology practice, concluding with ideas about implementation and future developments.

We have previously validated the English version of the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQOL) in our patients with lupus. Many of our Chinese patients are not fluent in English and therefore a Chinese version (SLEQOL‐C) has been adapted for their use.Two independent translators translated the SLEQOL into Chinese. A consensus version was derived from both sets of translations. Back translation of this version was performed by another 2 independent translators who had neither been involved in the forward translation nor encountered the SLEQOL. The final version, SLEQOL‐C, was finalized after rectifying the discrepancies revealed by the back translation. Linguistic validity was tested in open interviews with bilingual patients with lupus. The SLEQOL‐C and SLEQOL were administered to patients to determine whether they displayed differential item functioning (DIF).In general, most of the items in English could be expressed in Chinese precisely, although a few instructions had to be altered slightly to make them more idiomatic. The forward and back translations of the SLEQOL were accomplished without major difficulties. A total of 638 patients were interviewed (62.8% with the SLEQOL and 37.2% with the SLEQOL‐C). Using DIF analysis, there was no detectable test bias due to language use after controlling for repeated observations, age, sex, and ethnicity.The SLEQOL‐C has semantic, idiomatic, and conceptual equivalence to the SLEQOL. The rigorous process of cross‐cultural translation provides some measure of quality in the content validity.

This paper updates the treatment of Stevens–Johnson syndrome and toxic epidermal necrolysis supported by relevant views about the pathogenesis.

Drug allergies are unpredictable immunologic adverse effects, usually immunoglobulin E-mediated immediate hypersensitivity or T-cell-mediated delayed hypersensitivity. There is a paucity of accurate prospective data on drug allergy in hospitalized patients.

To examine the relationship between ethnicity and major organ involvement at and after diagnosis in community‐based cohorts of Caucasian and Chinese systemic lupus erythematosus (SLE) patients resident in Rochester, Minnesota, and Singapore, respectively.Clinical manifestations at and after diagnosis were compared in Caucasian and Chinese SLE patients. The association between ethnicity and disease manifestations at and after diagnosis was determined using logistic regression and Cox proportional hazards models, respectively, adjusting for the influence of demographic, socioeconomic, disease‐related, and therapy‐related factors.At diagnosis, Caucasian SLE patients were 3 times more likely than Chinese SLE patients to have serositis (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.01–9.71), nearly 7 times more likely to have a hematologic disorder (OR 6.95, 95% CI 2.20–21.97), and far less likely to have a malar rash (OR 0.19, 95% CI 0.07–0.54) or positive antinuclear antibodies (OR 0.11, 95% CI 0.03–0.52). Ethnicity was not associated with the prevalence of proteinuria or central nervous system (CSN) and other major organ involvement at diagnosis. After diagnosis, there was a trend toward less development of proteinuria and other major organ involvement in Caucasians (relative risk [RR] 0.47, 95% CI 0.19–1.15, and RR 0.22, 95% CI 0.05–1.04, respectively).Chinese SLE patients are far less likely to have serositis or a hematologic disorder at diagnosis and may be more likely to develop proteinuria or CNS or other major organ involvement over the course of the disease, compared with Caucasian SLE patients. This may contribute to the increased mortality seen in Chinese SLE patients.

To examine the relationship between ethnicity and major organ involvement at and after diagnosis in community-based cohorts of Caucasian and Chinese systemic lupus erythematosus (SLE) patients resident in Rochester, Minnesota, and Singapore, respectively. Clinical manifestations at and after diagnosis were compared in Caucasian and Chinese SLE patients. The association between ethnicity and disease manifestations at and after diagnosis was determined using logistic regression and Cox proportional hazards models, respectively, adjusting for the influence of demographic, socioeconomic, disease-related, and therapy-related factors. At diagnosis, Caucasian SLE patients were 3 times more likely than Chinese SLE patients to have serositis (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.01–9.71), nearly 7 times more likely to have a hematologic disorder (OR 6.95, 95% CI 2.20–21.97), and far less likely to have a malar rash (OR 0.19, 95% CI 0.07–0.54) or positive antinuclear antibodies (OR 0.11, 95% CI 0.03–0.52). Ethnicity was not associated with the prevalence of proteinuria or central nervous system (CSN) and other major organ involvement at diagnosis. After diagnosis, there was a trend toward less development of proteinuria and other major organ involvement in Caucasians (relative risk [RR] 0.47, 95% CI 0.19–1.15, and RR 0.22, 95% CI 0.05–1.04, respectively). Chinese SLE patients are far less likely to have serositis or a hematologic disorder at diagnosis and may be more likely to develop proteinuria or CNS or other major organ involvement over the course of the disease, compared with Caucasian SLE patients. This may contribute to the increased mortality seen in Chinese SLE patients.

Dapsone 100 mg/pyrimethamine 12.5 mg (Maloprim; Beacons Chemicals Pte Ltd, Singapore) is routinely prescribed for antimalarial chemoprophylaxis in military servicemen in Singapore who are not glucose-6-phosphate dehydrogenase-deficient.

No abstract.