Text by: Charmaine A. Lingdas
Photos by: Joseph A. Bautista
Experts shared their insights on the latest trends and advancements in Rheumatology at the 21st Lourdes Manahan Lectures on April 18, 2024, at the Henry Sy Sr. Building, University of the Philippines College of Medicine.
Diagnosis is the First Treatment Target
Dr. Eric Jason Amante, chairman of the Department of Internal Medicine at Asian Hospital and Medical Center explained the importance of correct diagnosis in applying effective treatment strategies for rheumatic diseases.
“Seventy percent of what we do in medicine is diagnosis,” said Dr. Amante in his lecture, “Diagnosis is the first treatment target.” He emphasized that precision and systematicity in history-taking and physical examination are paramount, urging healthcare professionals to hone their skills in these foundational areas of diagnosis.
Osteoarthritis Management
Renowned osteoarthritis (OA) expert, Dr. Auxencio Lorenz Lucero Jr., highlighted strategies to improve OA patients’ quality of life and noted OA’s global prevalence, particularly its impact on women.
According to the World Health Organization (WHO), Osteoarthritis is a degenerative joint condition that causes pain, swelling, and stiffness, limiting mobility. In the Philippines, OA ranks third among arthritic conditions, affecting about 0.5% of the population, according to the 2003 National Nutrition and Health Survey. OA prevalence rises with age, often affecting the knees, hands, and spine. However, Dr. Lucero emphasized that “OA is not just a simple wear-and-tear disease. It is now viewed as a failure of the synovial joint, impacting not only the cartilage but also the subchondral bone, synovium, and periarticular tissues. The condition results from a complex interplay of mechanical, inflammatory, and metabolic factors leading to the classic clinical signs of osteoarthritis.”
Comorbid conditions associated with OA include hypertension, diabetes, dyslipidemia, and obesity, which affect 55% to 68% of Filipinos. Dr. Lucero acknowledged the challenges in OA treatment, advocating for personalized approaches. He discussed emerging research on clinical phenotyping, proposing tailored interventions for individual patients.
Gout Management
UP-PGH Division of Rheumatology Chief, Dr. Evelyn Salido, emphasized the importance of personalized care and treatment targets during her lecture on optimizing gout treatment strategies.
Gout is an inflammatory arthritis marked by sudden, severe pain, redness, swelling, and warmth in one or more joints. It occurs due to the accumulation of uric acid crystals in the joints and nearby tissues, resulting in intense pain and inflammation.
Dr. Salido stressed that “by integrating the latest scientific advancements with personalized patient care and strong family support, we can significantly enhance the quality of life for gout patients.”
Additionally, she highlighted the significance of managing gout flares and hyperuricemia, as well as the pivotal role of urate-lowering therapy. “It’s crucial to aim for serum uric acid levels below six milligrams per deciliter for effective long-term management,” she advised.
Controlling Pain in Arthritis
Dr. Geraldine Zamora-Abrahan, another rheumatology expert from the UP-PGH, discussed the different classes of medications commonly used to manage arthritis pain, including analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids.
“Controlling pain in arthritis is vital for enhancing patients’ quality of life and functional ability,” remarked Dr. Zamora-Abrahan. “Choosing the right medication is essential in achieving optimal pain control while minimizing the risk of adverse effects,” she noted as she emphasized the importance of selecting medications with better safety profiles and efficacy in addressing both peripheral and central sensitization.
“Incorporating topical pain relievers into treatment regimens can offer additional benefits, such as targeted pain relief and reduced systemic exposure to medications,” she said.
Multi-faceted Targets in Rheumatoid Arthritis (RA)
Dr. Nympha David-Ribargoso, a professor at the College of Medicine of UERM Memorial Medical Center delivered a lecture on understanding the multi-faceted targets in rheumatoid arthritis (RA).
“Patients with RA are not only battling joint inflammation but also grappling with a host of cardiovascular (CV) risk factors,” she explained. “Obesity, lipid abnormalities, hypertension, and diabetes, compounded by chronic inflammation, significantly elevate their susceptibility to cardiovascular events.”
Dr. David-Ribargoso underscored the importance of optimizing cardiovascular risk management in RA patients.
“Treating RA aggressively with diseasemodifying anti-rheumatic drugs (DMARDs) limiting the use of corticosteroids and NSAIDs, and aggressively managing traditional CV risk factors are essential to reduce the substantial burden passed by this common comorbidity,” he said.
Achieving Lupus Low Disease Activity State (LLDAS)
Dr. James Barte shared his insights into achieving Lupus Low Disease Activity State (LLDAS) in patients. “LLDAS represents a state where lupus disease activity is sufficiently low, offering patients a period of relative remission and improved quality of life,” he explained.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that impacts healthy tissues, leading to inflammation, damage, and varied symptoms.
Dr. Barte’s presentation focused on the treat-to-targeted approach necessary for effectively managing lupus, highlighting the various assessment tools utilized in evaluating disease activity comprehensively.
Meanwhile, the need for a paradigm shift in assessing Lupus treatment outcomes was tackled by UP Manila Chancellor Dr. Michael L. Tee. He also underscored the need to move beyond traditional measures of disease activity and focus on achieving LLDAS or remission.
Dr. Tee emphasized that achieving LLDAS involves careful management of medications, including hydroxychloroquine (HCQ) and glucocorticoids (steroids), as well as other immunosuppressive agents as necessary.
“By prioritizing sustained remission through LLDAS, we can enhance patients’ quality of life,” he said. Aside from this, Dr. Tee also emphasized the role of targeted therapy in personalized treatment plans tailored to individual patients’ needs.
Emphasis on Holistic Patient Care
Dr. Bernadette Heizel Reyes, Vice Chancellor for Academic Affairs at UP Manila, emphasized the importance of comprehensive patient assessment and management, particularly in addressing comorbidities that can exacerbate outcomes in chronic conditions. She stressed the significance of taking into account social determinants of health when shaping the progression of diseases.
The Legacy of Dr. Lourdes A. Manahan
The Lourdes Manahan Lectures in Rheumatology (LMLR) is an annual symposium aimed at raising awareness of developments in Rheumatology.
Dr. Manahan was a 1943 UP College of Medicine graduate who pioneered Rheumatology in the Philippines in the 1960s. She established the Section of Rheumatology at UP Manila’s Philippine General Hospital (PGH) in 1971, cementing her legacy in the field. ■
