How would you explain to a group of 12-year-olds what you do as a rheumatologist?
I help people who suffer from problems with their joints, bones and spine. I also treat illnesses that arise when the white blood cells attack the body. This is when the patient suffers hair loss, red eyes, rashes, joint swelling, fever and a low blood count.
Why do the joints and spine give us trouble? Why do they swell up and are often painful?
This happens when they are inflamed, that is, when you feel pain, stiffness, difficulty in moving the joint, or sometimes even the sensation of being “jammed” or the joint “giving way”. The common triggers include injury, overuse and strain.
An autoimmune attack on the joints or spine can also be triggered in people who are genetically predisposed, for example, those who carry the HLA B27 gene, or those with viral or bacteria infections like diarrhoea or urinary tract infection.
Which can hurt more – the joints or the spine?
Usually, the joints are more painful, especially the knees, ankle or feet. They sometimes cause the patient to limp. Some may not able to walk at all. Spine inflammation usually causes stiffness and can also be painful, but to a lesser degree.
Who is your typical patient?
I see several hundreds of patients every month in my clinic. Three in five are elderly, three in 10 are in their 40s, and one in 10 is a young adultor young person.
What is the most dramatic illness you have seen?
I treated a woman who had flown in from India. She had severe rheumatoid arthritis and had swollen and painful knees, ankles, wrists, elbows, fingers and shoulders. She was in a wheelchair when she came in.
I removed the inflamed joint fluid from her knees and gave her an anti-inflammatory injection. Feeling better, she asked for the same injections for her ankles, wrists, elbows and shoulders, and I did them. She flew back home the next day.
So when does a person with back pain usually see you?
Usually people come to see me for back pain when massage, tuina (a Chinese therapeutic massage), acupuncture and painkillers fail. They are usually recommended by friends or family members. Occasionally, patients search the Internet for a rheumatologist and find my name.
Then there are those who suffer from chronic back pain, which resulted in them becoming stiff and even hunched over.
A common and treatable cause for that is called Spondyloarthritis (SpA), of which Ankylosing Spondylitis (AS) is one of the conditions. AS usually affects younger people, beginning in their 20s. It mainly happens in men.
Can AS be cured?
In the past, there were not many effective treatments for AS, other than non-steroidal anti-inflammatory drugs. The sufferers were told to ‘live with it’. With the advent of biologic agents in the early 2000s, the course of the disease has changed. Early and intensive treatment can bring the disease to remission.
Even those with chronic or late diseases can still be treated to slow their progression and have good symptom control and quality of life.
What kind of ammunition do you have to treat AS?
We have what we call anti-TNF (Tumour Necrosis Factor, an inflammatory chemical that the body can overproduce, causing spine and joint inflammation) blockers which are given to patients with AS.
An example is Enbrel. It is injected under the abdominal fats with minimal pain once every one or two weeks, or once a month, depending on the severity of the disease.
Occasionally, I inject anti-inflammatory medications into the paraspinal area (the muscles that run next to, and are roughly parallel with the spine) of patients with AS to bring relief to the back and spine pain.
Are you mindful of your spine and your posture, having seen how disease can ravage a person’s spine?
Yes, we must be mindful of our daily sitting posture and even standing and walking posture. On a regular basis, it is good to do some back stretching and strengthening exercises. Nowadays, many people are developing neck or cervical spine problems due to prolonged computer work, typing on the laptop, and looking at tablets and mobile phones.
Tell me some surprising facts about our spine.
Other than the tailbone, there are 22 vertebrae in our spinal column. It also contains over 120 muscles and 220 ligaments, which work together with the 100 joints in the spinal column to ensure great flexibility and range of movement for the spine. The backbone structure can withstand weights of hundreds of kilograms.
What are the perks of your job?
It is always a joy to see those who came in a wheelchair or with a walking aid be able to walk when they return for their follow-up visit.
What about the downside?
When patients default on their follow-up treatments and are in a worse state than before.
Photo: The New Paper
Dr Yoon Kam Hon is a rheumatologist at El Shaddai Arthritis and Rheumatism Specialist Medical Centre
A version of this story was published in The New Paper on September 25, 2016.
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