Materia Medica Malaysiana

Needed - 400 rheumatologists

The Health Ministry is aware of this grave shortage of rheumatologists.
Health Minister Datuk Dr Chua Soi Lek said to achieve a ratio of one rheumatologist to 85,000 population, a target for developing countries, Malaysia needed at least 400 of them by 2020.
"This means that we will have to beef up our speciality and sub-speciality training and recruitment program- mes," he said.
Of the 19 rheumatologists, seven are in government hospitals - four in Selayang and one each in Putrajaya, Taiping and Seremban.
Generally, Dr Chua said, rheumatologists undergo a minimum of three years' training after acquiring their post-graduate qualification in Internal Medicine.
Currently, he added, there were six rheumatology training centres - Selayang, Putrajaya, Seremban, Taiping, Universiti Kebangsaan Malaysia and University Malaya Medical Centre.
There are eight doctors now undergoing training in rheumatology.
Meanwhile, the Malaysian Society of Rheumatology has set up an accreditation board to determine the training requirements, and the training guidelines have been posted on its website at www.msr.org.my.
Dr Chow, who sits on the accreditation board, said: "Rheumatology is a relatively new field. We had our first rheumatologist in the 80s."
Asked why many doctors did not specialise in the field, she said it was not considered lucrative. However, the number of patients seeking treatment for rheumatic diseases and musculoskeletal conditions in both public and private hospitals was "high".
Unlike diseases that kill, she said, rheumatic diseases did not attract much attention, but they could severely debilitate people and place a tremendous burden on healthcare systems.
Rheumatoid arthritis affects five in 1,000 Malaysians. Worldwide, 40 per cent of people over the age of 70 suffer from osteoarthritis of the knee. Eighty per cent of those with osteoarthritis have some degree of limitation of movement, and 25 per cent cannot function normally.
"Many people do not know that musculoskeletal or rheumatic diseases are a major cause of morbidity throughout the world, having a substantial influence on health and quality of life and inflicting an enormous burden of cost on health systems," said Dr Chow, a consultant rheumatologist, who is also the president of the Arthritis Foundation of Malaysia.
To assist doctors in the management of arthritis, Dr Chua said his ministry had distributed the Clinical Practice Guidelines on the Management of Osteoarthritis in 2002 with support from the Academy of Medicine and the Malaysian Society of Rheumatology.
"There is a public misconception that arthritis is a single disorder affecting only the elderly and that not much can be done about it. This is far from the truth," said Dr Chua, adding that there were actually a large number of different conditions and syndromes that could come under this label with the common denomination being pain and inflammation of the joints.
He said the most common arthritis was osteoarthritis, a degenerative condition whose hallmarks were joint pains and limited movement resulting from progressive loss of cartilage, especially among older people, those with previous joint injuries and the obese.
Osteoarthritis of the knee affects five to 10 per cent of the adult population, 30 per cent of them over the age of 65.
"About three times as many women as men have the disease and about half of the patients suffer from work-related disability, resulting in total cessation of employment 10 years down the line from the onset," Dr Chua said.
Dr Chua said life expectancy may be reduced by three to 10 years. He also pointed out that arthritis did not spare children as there was Chronic Juvenile Arthritis that afflicts them.
He said arthritis also occurs in connective tissue disease that usually affected young women in the reproductive age group and may damage any organ in the body.