Rheumatological diseases in Singapore

More than 600,000 people in Singapore, or about 11 per cent of the population, suffer from one of several rheumatological diseases.

Yet, little is known about this cluster of conditions that includes lupus, rheumatoid arthritis, and osteoarthritis. Many are complex autoimmune conditions in which the immune system turns against itself and attacks the body’s major organs. They often strike people in their prime, tend to affect more women than men, and in some cases are twice as likely to affect Asians than Caucasians.

Not surprisingly, diagnosing rheumatological diseases is difficult, and so is often delayed. Treatment options are also limited.

For one lupus patient, the challenges of having a disease that is difficult to detect are all too familiar. Ms Chan was correctly diagnosed with lupus only in 2011, years after the symptoms appeared. When her disease was finally under control, Ms Chan – an art gallery owner who represents international sculptor Ju Ming and champions local artists – decided to channel some of her energy into building a fund for rheumatological disease research.

“From my personal experience as a lupus patient, I understand the pain and struggles that individuals suffering from rheumatological diseases go through,” Ms Chan told The Business Times last year. “I also realised that this field has not been sufficiently researched, particularly in Asian patients. There hasn’t been a new drug or medication available on the market for the past 20 years,” she said.

Ms Chan initiated the Reverie ​Rheumatology Research Fund, with the first funds raised via a gala dinner in November 2014. Held in conjunction with the 15th anniversary of her gallery, iPreciation, the gala dinner featured works donated by Ju Ming as well as well-known Singapore artists like Lee Wen, Milenko Prvacki and Tay Bak Chiang. The artworks were sold to raise money for the Fund. The event raised over $580,000. “The goal is to raise $3 million by next year, and $12.5 million in the long term,” said Professor Julian Thumboo​, Senior Consultant, Department of Rheumatology and Immunology​, Singapore General Hospital (SGH), a member of the SingHealth​ group.

It was during a consultation with Prof Thumboo, her doctor and the then-head of the rheumatology department, that Ms Chan learnt about the department’s research efforts. Thanks to Ms Chan, the Fund will suppo​rt research in systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, osteoarthritis and spondyloarthritis – five commonly-seen conditions at SGH's​ Autoimmunity and Rheuma​​​tology Centre​. The Centre, which opene​d in 2013, is a multi-disciplinary facility dedicated to diagnosing and treating patients with rheumatological diseases. The data collected from the Centre’s more than 5,000 pat​ients is being used in education and research.​​​

Five Life-changing Diseases

 

Rheumatoid Arthritis (RA)

 

​In rheumatoid arthritis (RA), the immune system attacks the body's own tissues, such as the joints. It occurs two to three times more frequently in women than men.

Some symptoms: Pain and swelling of the joints, which typically persist for more than six weeks and is usually worst in the morning.

Why research is needed: If not well-treated, RA can lead to progressive joint damage, pain and loss of physical function. Some 20-30 per cent of patients do not respond to currently available therapies.

 

Systemic Lupus Erythematosus (SLE or Lupus)

 

In Systemic Lupus Erythematosus (SLE or lupus), the immune system attacks organs like the kidneys, brain, intestines and skin, the blood and joints.

Some symptoms: ​Commonly associated with a butterfly-shaped rash on the face which worsens with sun exposure. Can also lead to swelling around the eyelids, and of feet and legs.

Why research is needed: Lupus treatment isn’t one-size fits- all, being dependent on the symptoms and the organs affected. Early identification is needed to start treatment as soon as possible to prevent organ damage.

Systemic Sclerosis (Scleroderma or Hard Skin)

Systemic sclerosis (scleroderma or hard skin) causes uncontrolled overproduction of fibrous tissue, leading to scarring of organs and blockage of blood vessels.

Some symptoms: Puffy swollen fingers and skin hardening or tightness are among the first signs. Also joint pain and swelling, muscle weakness, breathlessness or persistent dry cough.

Why research is needed: ​Lupus treatment isn’t one-size fits- all, being dependent on the symptoms and the organs affected. Early identification is needed to start treatment as soon as possible to prevent organ damage.

Spondyloarthritis (SpA)

​In Spondyloarthritis (SpA), the joints of the spine are affected, causing inflammation, severe pain and stiffness in the back. Can also affect the joints, digits and tendons in upper and lower limbs. Partly hereditary.

Some symptoms: Pain and stiffness in the lower back, especially bad in the morning, are among the first signs. The eyes may also be affected, and symptoms include redness and blurred vision.

Why research is needed: Scientists are investigating the genes and bio-markers that can help predict the group of patients likely to develop rapid disease progression.

​Osteoarthritis (OA)

Osteoarthritis (OA) is the most common form of joint disease, affecting 10-20 per cent of the population, and is linked to age, obesity, sports injuries, family history and other forms of arthritis like gout.

Some symptoms: Recurring pain in affected joints or their surrounding muscles after prolonged or strenuous exercise is one of the first signs of the disease.

Why research is needed: ​No proven treatment yet to delay the progression of the disease. Treatment is mostly aimed at symptom relief, so weight loss, exercise and physiotherapy are often recommended.

Ref: Q15