Philippine Rheumatology Association
Rheumatology is a branch of Medicine that many, especially the lay, have little knowledge about. This is despite the fact that more than five million Filipinos are afflicted with arthritis and rheumatism, including the children. But the Philippine Rheumatology Association (PRA), the pioneering group dedicated towards strengthening the practice and continuing education for its member specialists, is geared towards introducing the specialty to the lay public, so as to debunk prevalent myths and misconceptions surrounding rheumatologic conditions
BY GELYKA RUTH R. DUMARAOS | PHOTO BY RAMIR G. CAMBIADO
During the time when the Philippine Rheumatology Association (PRA) has not been established yet, patients who are suffering from rheumatism and arthritis sought help from different specialists. With doctors from different specialties handling rheumatologic problems, there were glaring disparities in the way these problems were managed. It was therefore imperative to come up with reference guidelines on the management and treatment of these conditions.
But what ignited the move to have a body addressing rheumatology in the Philippines was when the Philippine College of Physicians (PCP) was invited by the Australian Rheumatism Association (ARA) in Sydney, Australia in 1963. At that time, there was only one member in PCP who fit as representative—the lone rheumatologist then, Dr. Lourdes A. Manahan, who presented her paper “Rheumatic Diseases in the Philippines.”
In this event, Dr. Manahan has met specialists in Rheumatology from different nations, specifically representatives from the Southeast Asia and Pacific Area League against Rheumatism (SEAPAL) which was formed by four nations—Australia, Japan, India, and New Zealand. Its goals of promoting research and education in Rheumatology in the region inspired Dr. Manahan to do something about addressing the lack of specialists in her own country.
Upon returning to the Philippines, Dr. manahan gathered a small group of internsts, orthopedic surgeons, and physiatrists, which led to the founding of PRA in May 27, 1964. Dr. Manahan served as the founding president with nine doctors as members. Dr. Manahan was then joined by Dr. Tito P. Torralba, the first formally trained rheumatologist, follewed soon after by Dr. Clemente Amante.
With this, PRA’s membership doubled in 1975, with the pioneers starting to see a big number of patients in their clinics. They were also the first specialists who taught Rheumatology in different institutions.
SEAPAL admitted PRA as its member in 1965. The organization also successfully hosted the 4th SEAPAL Congress on January 20-24, 1980 with Dr. Tito P. Torralba at the helm then.
Aside from SEAPAL, PRA continued to gain memberships with international organizations. It was accepted as member of the Rheumatology Association of ASEAN (RAA), International League Against Rheumatism (ILAR) and Asia Pacific League of Associations for Rheumatology (APLAR).
With PRA members actively participating in these international organizations, many of the society’s members were elected officers in these global groups. They were Dr. Tito Torralba in SEAPAL, RAA ILAR, Dr. Clemente Amante in RAA, Dr. Sandra Navarra in APLAR and Dr. Ester Penserga in RAA.
While PRA continued to rise in membership, it also focused on conducting Rheumatology training programs in different institutions. It started at the University of Santo Tomas and University of the Philippines. This paved the way to the establishment of the Philippine Specialty Board of Rheumatology in 1988. Currently, there are six institutions that train young rheumatologists, two of which also train pediatric rheumatologists.
Through the years, PRA contributed in generating landmark researches in the Asia Pacific region. One of which was the COPCORD study which looked into the disease prevalence of the different rheumatic conditions in the country. PRA also published treatment guidelines on gout, osteoarthritis and TB screening for patients prior to using biologic agents. Moreover, PRA is also collaborating with APLAR in drafting new rheumatologic treatment guidelines relevant for the Asia Pacific region.
Debunking myths and misconceptions
PRA knows that a lot of people have inadequate information about Rheumatology. For PRA, the biggest challenge they have is letting people know what the specialty is about.
To better introduce the speciality, rheumatologists often pronounce the word as “rayumatology” to emphasise that it is a branch of medicine that deals with arthritis and rheumatism. With this, people begin to understand the need to consult such specialists and why they are being referred to them.
Doctors also know that there is a need to debunk a lot of misconceptions about arthritis and rheumatism. The more popular ones are: “All types of arthritis are due to an elevated uric acid,” “Arthritis only occurs in the elderly population,” or “Washing their hands after doing some work causes pasma.”
Physicians spend time in educating their patients about these. Still, despite the effort, PRA knows that they still have a long way to go to bridge the gap and debunk misconceptions and myths.
A part of this challenge is the small population of rheumatologists in the whole country. There are only 150 rheumatologists, mostly practicing in big urban centers like Metro Manila, Metro Cebu and Metro Davao. Patients resort to consulting nonrheumatologists who may not be that dedicated in debunking these misconceptions.
Shaping PRA’s advocacy campaigns
To correct misconceptions and promote their other advocacies, the PRA is partnering with the media for a wider reach. PRA is also using the internet and the social media. It has established a website (https://rheumatology.org.ph), where people can be better informed about the specialty. They can also find in the website a listing of available rheumatologists in their area. Patients can visit PRA’s Facebook page (https://www.facebook.com/PhilRheuma), where doctors post relevant information about rheumatology.
PRA also taps pharmaceutical partners in their awareness campaigns all throughout the nation. Their recently launched campaign “When in Gout, Consult a Rheumatologist,” targets people in the remote areas.
All of these are being conducted aside from the regular trainings in institutions which have published educational materials or rayuma komiks. There are even established patient support groups such as the Lupus Club in the Philippine General Hospital (PGH) and the University of Santo Tomas (UST). The PRA has also collaborated with private organizations like Psoriasis Philippines (Psorphil), Rheumatology Education Trust Foundation, Inc., (RETFI), Lupus Foundation of the Philippines, Inc., PEARL, LUISA and Hope for Lupus.
Despite these efforts, PRA still acknowledges that there are still a significant segment of our society that needs to be tapped.
That is why PRA is also seeking partnership with the government for their campaigns. Improving Filipinos’ health care has been one of PRA’s advocacies for social equity. Giving importance on patients afflicted with rheumatologic conditions, PRA has lobbied for the inclusion of the following: essential rheumatologic drugs including the biologics in the Philippine National Formulary, Philhealth coverage for psoriasis, psoriatic arthritis and orphan diseases and a tax increase on tobacco products to generate revenues earmarked for universal health care.
Some of these have been given attention to and PRA hope to continue to be relevant in pushing for significant healthcare policies that will impact the lives of many Filipino patients.
In addition, the association also puts emphasis on research to improve patient care. Part of PRA’s mission is to produce locally relevant and internationally significant researches. With this, the association encourages fellows to produce well designed research outputs that are presented during the annual convention and other conferences abroad. Fellows are also encouraged to submit these outputs to respectable medical journals for international publication or other rheumatology congresses for poster or podium presentation. PRA grants scholarship to fellows in training who vow to return and practice in areas underserved by rheumatologists.
After 54 years since its establishment, PRA’s membership has evolved from a few multi-specialists to a more homogenous group of adult and paediatric rheumatologists.
This year, PRA is holding its 24th annual convention which targets doctors, nurses, and patients. But more importantly, this convention highlights an introspective moment by launching the association’s very first coffee table book entitled “Foundations”.
After 54 years, PRA looks back, recognizes and gives tribute to the people who have made the organization what it is today—stronger and more anchored to its roots than ever.
PRA hopes to continue all projects that have been started by the present Board and foster new collaboration with significant healthcare stakeholders to further improve the lives of Filipinos with rheumatologic conditions.
“The more popular myths and misconceptions are: “All types of arthritis are due to an elevated uric acid”, “Arthritis only occurs in the elderly population” or “Washing their hands after doing some work causes pasma”
January 2018 Health and Lifestyle