It’s always a joint effort.

“Rheumatology specialises in auto-immune diseases, that is, those that start from an over-active immune system, and lead to your body attacking itself,” Dr. Supat Thongpooswan, a rheumatologist and doctor of internal medicine at Bumrungrad International Hospital, tells me. “It can cause things like arthritis, joint and muscle pain, body rashes, and many other unexplained symptoms.”

As someone who had always assumed joint pain was a result of lifestyle choices, such as in the case of office syndrome; or a symptom of age; I’m intrigued to learn that many of the diseases that cause muscle and joint pain fall under the spectrum of auto-immune disorders, and that they can target anyone, regardless of age.

“When you’re young, you tend to assume that back and joint pain is from your work, or because you’ve been lifting too much,” Dr. Supat explains. “However, you need to compare your current symptoms to how you were in the past, and compare yourself to your peers. If you have more symptoms than usual with no change in lifestyle, your pain has quantitatively increased, and you have more symptoms than others your age, you need to think twice about whether or not this pain is normal.”

Born and brought up in Thailand, Dr. Supat graduated from the Faculty of Medicine at Ramithibodi Hospital, Mahidol University, before going to the US for further training, in New York and Florida. After gaining experience there, he came back to Thailand and joined Bumrungrad Hospital in 2018, where the highly-qualified personnel and state-of-the-art facilities have allowed him and his team to diagnose previously-undiagnosed cases in the Southeast Asian region. He speaks further to Masala about the risks associated with auto-immune disorders, and how diagnosing and treating them in a timely manner is key.

What are the most common types of diseases treated by a rheumatologist, especially here in Thailand?

Rheumatoid arthritis is probably the most common one, closely followed by lupus, called SLE (systemic lupus erythematosus) in Thailand. The third most common auto-immune disorder is ankylosing spondylitis (AS), a disease that causes chronic back pain.

Other very common diseases are gout and pseudo-gout. Unlike the other diseases, gout is not an auto-immune disease, but instead is caused by overly high amounts of uric acid in the body. When you have too much uric acid for a long period of time, it starts depositing in various areas of the body, and causes problems such as joint pain and kidney stones.

Which diseases are more systemic and have more long-term effects, and what are the risks associated with them?

The most concerning one is lupus or SLE, a disease that affects every area of the body. It can cause inflammation of the kidneys, and can affect your heart, brain, eyes, joints, and skin, and can even cause hair loss. The spectrum of the disease ranges from usually very mild symptoms to, in more rare cases, severe symptoms, but if it’s detected sooner rather than later, it can remain a mild case.

Another one is rheumatoid arthritis, which is a disease that can cause symmetrical joint pain. This pain is different from other joint and back pain as it’s often worse in the mornings when you wake up, unlike the kind of pain that you get during normal everyday activities. Another disease that can cause chronic back pain is Ankylosing spondylitis.

Who are most at risk for these diseases, and what are the symptoms that people should look out for?

Anyone who has a family history of auto-immune diseases or thyroid problems is more at risk, especially if an immediate family member has it. If you have unexplained symptoms that don’t make sense with your lifestyle, such as joint pain in the mornings, and especially if your symptoms are worsening with time, immediately seek a medical provider to see if it’s serious, or if you need any further investigation. If we see signs that are abnormal, such as inflammatory markers that are higher than normal, or unexplained low haemoglobin, or abnormal kidney function, then we will seek further investigation.

How does Bumrungrad use new technology or developments to help in the diagnosis and treatment of auto-immune diseases, which can be hard to identify?

We try to make sure that the investigation, diagnosis, treatment, and re-evaluation of the treatment is all connected and done as efficiently as possible. We have MRIs and PET scans that can quickly get results, so you can get your answers within one week. Our MRI machine is designed with a protocol to look for specific inflammation in the back, called the spondyloarthritis protocol. If there is unexplained inflammation, we access the PET scan to look for the source of the inflammation. We also have state-of-the-art laboratories where we can check for almost everything that we need to, in a timely manner.

For those who don’t want to take too many pills, we now have upcoming treatments for Rheumatoid Arthritis and AS that consist of injections every two weeks or so, which is much more convenient.

What are some testimonials or success case stories that you’d like to tell us?

We have had several cases where a diagnosis couldn’t be found, and our team has solved several of them in the Southeast Asian region. Many of these patients had unexplained symptoms and couldn’t find the right diagnosis, which delayed treatment, which meant that their joints or kidneys ended up damaged. We had to diagnose and treat them as quickly as possible, and give them a plan to improve their health in the long term.

What advice would you give in terms of preventative measures and lifestyle changes we can take?

The root causes of these auto-immune diseases are multi-factorial – they could be genetic or environmental, or a flare-up could be triggered by a previous infection or stress. While your diet is important, it is still under investigation whether diets are directly correlated to certain autoimmune diseases. Those who are diagnosed with gout, however, I would advise that you avoid certain foods to reduce your uric acid, such as red meat, seafood, alcohol, and sweet drinks.

I encourage my patients to exercise every day, and to swim often, as swimming is one of the best exercises to strengthen your joints without gravity weighing on the weight-bearing joints. In the long run, it will help not just your joints, but your core muscles and your spine.