With an estimated more than five million Filipinos suffering from arthritis and other diseases of the joints, Rheumatology, as a subspecialty of Internal Medicine, has indeed come of age.
Actually, Rheumatology does not only involve arthritis problems, but also covers prevalent problems of medical diseases involving the muscles, and connective tissues. Hence, simple and complex connective tissue or autoimmune disorders are within the domain of Rheumatology.
I always fondly remember the subspecialty’s soft-spoken pioneer in the country, Dr. Lourdes Manahan, under whose service in the Department of Medicine at the Philippine General Hospital I had the privilege to be under for several months while I was in residency training.
She didn’t frequently stand up to speak during departmental conferences, but whenever one of the residents in her service was under fire for the management of a patient she was also familiar with, she would stand up and take up the cudgels for her beleaguered resident.
Of course, whenever she spoke, no further questions were asked; and the other consultants would even apologetically say in a much friendlier tone that they were just clarifying.
Once, a co-resident admitted a 20-something female with what appeared to be severe arthritis. One look at the patient, and she said softly so the patient could not hear it, “Lupus ‘yan. Workup mo” (That’s a case of lupus. Do a work-up to rule it out).
Further work-up indeed showed she had lupus. It was only after Dr. Manahan’s “intuitive diagnosis” that we started to notice the skin rashes and other signs of vascular inflammations.
I remember her clearly emphasizing that lupus should not be considered a form of arthritis, but that joint swelling is one of most common presentations. Of course, every doctor knows it’s important to distinguish lupus from other forms of arthritis because treatment would be quite different.
Another pioneer in Rheumatology, who we also fondly remember as one of our mentors in Internal Medicine at the PGH, was Dr. Clemente Amante. He had a way of simplifying complex autoimmune mechanisms so our then limited understanding could easily understand them.
Making rounds with him was never stressful; none of those typical anguish residents would experience with so-called “tormenting mentors.” His disposition was ever jovial, and serious discussions of joint inflammations and vascular complications of connective tissue disorders seemed like a light-hearted, friendly banter.
When our editorial staff proposed to me that we would focus on Rheumatology and the activities of the Philippine Rheumatological Association (PRA) for this issue, my usual reply when given cover-story proposals of “Why is that so?” or “Email me the details and I’ll think about it,” was replaced by a quick “It’s about time.” The images of Dr. Lourdes Manahan and Dr. Clemente Amante. quickly flashed in my mind and I said to myself, ‘Sorry, Ma’am, Sir, it took us this long.”
We thank the PRA for collaborating with us for this issue. May all our readers enjoy reading it, and the rest of the forthcoming H&L issues for 2018.
RAFAEL R. CASTILLO, MD