Being a rheumatologist suits me perfectly because I thrive on delving into investigations and relentlessly searching for answers.
“Every case is unique and intricately complex, demanding the incorporation of laboratory findings and X-ray results for an accurate diagnosis.”
In the field of autoimmune disorders like systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), the prevailing awareness of their detrimental impact on health is widespread. These chronic conditions necessitate continuous, long-term treatment. Patients with autoimmune disorders in Thailand are concerned about the scarcity of specialized doctors, which raises the question of why there is a shortage of autoimmune specialists and where most of these specialists tend to gravitate.
In this edition of MedPark Stories, we invite you to the Rheumatology Clinic located on the 8th Floor, Counter B, at MedPark Hospital. Our distinguished guest, Dr Sudumpai Jarukitsopa, an internist with expertise in Rheumatology, is here to address and clarify any questions you may have.
Arthritis and Rheumatoid Arthritis: Diseases of Complexity and Challenge
Dr Sudumpai fondly recalls her time studying at Triam Udom Suksa School, where the prevailing choices for students were either the Faculty of Engineering or Medicine. Uninterested in engineering and unfazed by the sight of blood, she set her sights on a medical career.
After successfully graduating from the Faculty of Medicine at Siriraj Hospital, Mahidol University, Dr Sudumpai did a residency in internal medicine at the University of Hawaii, during which she delved into various fields to find a specialization fitting her aptitude and inclination. Eventually, she opted for a fellowship in Rheumatology at the Mayo School of Graduate Medical Education in Minnesota, USA, where she further honed her expertise in treating adult Thai and foreign patients at the Rheumatology clinic.
“I was an early riser. Throughout my residency, I found myself physically and mentally exhausted after sundown. Answering phone calls in the wee hours became a half-awake routine. Concerns about potential miscommunication weighed on me, especially when recommending or conveying important details. Consequently, I discovered that daytime outpatient clinical practice better suited my professional rhythm.”
“Rheumatology aligns perfectly with my preferences, as I relish the investigative process and the quest for answers. Each case typically unfolds with distinct presentations. For instance, a patient may have normal blood test results, but with further medical investigations, the diagnosis may take an unexpected turn. The intricacy lies in the comprehensive approach required, incorporating laboratory findings and X-ray results to arrive at an accurate diagnosis.”
Shortage of Competent and Experienced Rheumatologists
Managing arthritis and rheumatism demands considerable expertise. Presently, the availability of Thai rheumatologists specializing in these disorders is not sufficient despite a growing number of patients. Prolonged waiting times for treatment exacerbate symptoms. One contributing factor to the shortage of rheumatologists may be the intricate diagnostic process that requires time and attention to detail.
“In public hospitals, it is undeniable that doctors operate on tight schedules. Accessibility to treatment in numerous subdistricts is challenging, given the absence of rheumatology specialists. Patients often find themselves redirected to hospitals in Bangkok or the chief district of each province, leading to prolonged waiting periods. Consequently, many opt for private hospitals due to the urgency of their situations. Some even travel from abroad, as specialists in their home countries are scarce.”
“In contrast to public hospitals, rheumatology specialists in private institutions can allocate ample time to diagnosis and treatment. Even when a patient presents with symptoms indicative of rheumatoid arthritis, immediate diagnosis is unfeasible, as a comprehensive assessment demands time for the collection and integration of all medical results. Despite higher treatment costs, private hospitals afford doctors the luxury of thoroughly collecting medical histories, addressing questions, and providing comprehensive advice.”
As per Dr Sudumpai, the array of diagnostic tests for autoimmune disorders is extensive, encompassing blood tests, radiography, X-ray imaging, MRI, synovial fluid analysis, and ultrasound-guided injections. The pharmaceutical options for autoimmune diseases are as diverse as those found in developed countries, indicating that medication availability is not a hindrance.
Dispelling Myths and Misunderstandings Surrounding Gout and Rheumatoid Arthritis
Unlike specialists in other medical fields who can often conclude treatment relatively quickly, patients with arthritis and rheumatism undergo a distinct journey. Once diagnosed, they receive step-by-step guidance from their doctors throughout treatments. Follow-up checkups may extend over several years until the disease is effectively under control. Dr Sudumpai highlighted examples of misconceptions that she often addresses with new patients, many of which stem from myths circulated through word of mouth. One such myth is the belief that consuming chicken can lead to gout.
“Some Thais still harbor the misconception that developing gout means avoiding chicken altogether or that excessive chicken consumption can lead to gout. Contrary to this belief, chicken meat does not contain high uric acid. Foods rich in uric acid are organ meats commonly found in noodle dishes. Many Thais, especially those who enjoy noodles, often choose organ meat, which can contribute to high uric acid levels.”
“Furthermore, uric acid is predominantly present in red meats like pork, lamb, and beef rather than in white meat such as chicken. While most doctors advise against alcohol and sugary drinks containing fructose, it is crucial to provide patients with accurate information. Underlining the importance of taking the time to engage in meaningful conversations with our patients.”
Despite prevailing beliefs among patients, developing rheumatoid arthritis does not necessitate avoiding certain foods like pickled items. Doctors typically do not advise against the consumption of these foods.
“The cause of rheumatoid arthritis is not directly attributable to dietary factors. Many individuals with RA require immunosuppressant medications. Physicians usually caution against consuming raw or uncooked food, as it can potentially lead to complications. In the event of an infection, the immune system responds by activating itself to combat the invading pathogens, which can exacerbate the symptoms of rheumatoid arthritis.”
Dr Sudumpai observed that individuals she encounters in the outpatient clinic -- usually grapple with a level of pain that significantly disrupts their day-to-day existence, persisting for a duration exceeding six weeks. This enduring agony is classified as chronic pain, displaying little tendency for amelioration. Furthermore, it is noteworthy that patients frequently resort to scouring the internet for information before consulting medical professionals.
“In the contemporary era, we find ourselves with the ubiquitous presence of Dr Google. A considerable number of patients resort to online searches to identify potential ailments. While I appreciate the proactive approach of seeking information, they should stay abreast of the latest studies and findings. Failing that, I find it imperative to rectify any misconceptions they may have. Moreover, I strongly advise my patients to supplement their knowledge with information from reputable and trustworthy sources.”
Accurate diagnosis hinges on the utilization of advanced and sophisticated technology
Having been part of the Rheumatology Clinic at MedPark Hospital since its inaugural day, Dr Sudumpai exudes confidence in the promising future of the hospital.
“Our hospital is exceptionally well-equipped, boasting advanced digital medical instruments. Notably, our Medical Imaging Center features a CT scan capable of detecting urate crystals. Our MRI machines adhere to global standards, and our laboratory excels in swift test results turnaround time. Furthermore, for rare, sophisticated tests, we can forward samples to university hospitals or overseas medical center labs.”
Dr Sudumpai described a case where a patient who had been taking Leflunomide for some time decided to become pregnant. Consequently, the patient must discontinue the medication to mitigate potential impacts on the developing baby.
“In this particular scenario, to facilitate the elimination of the medication from her system, she was required to ingest a substance designed to expedite the excretion process. After finishing the prescribed regimen, it became imperative to measure the blood value of Leflunomide, which had to reach a safe level before she could proceed with her plans for conception. To ascertain this level, we sent samples to the Mayo Clinic laboratory in the US. The results, which took three weeks, arrived via email. Our laboratory capabilities extend to a wide array of tests, and where certain analyses are not domestically available, we can send samples abroad for comprehensive analysis.”
Stem Cell Transplantation: The Next Frontier in Medical Treatment
Dr Sudumpai delved into autoimmune diseases, where the immune system erroneously targets the body. While this condition instills fear in many, only a handful are aware of the progressively improving trajectory of treatment outcomes.
“In autoimmune diseases, ongoing studies explore avenues such as stem cell transplantation and CAR T-cell therapy. This category of disease is widely acknowledged to have a genetic basis. With the growing accessibility of whole genome sequencing, there is optimism that identifying the specific culprit genes could pave the way for targeted, precision therapies, potentially offering a curative approach to these conditions.”
Despite advancements in pharmaceuticals, including biologics, DMARDs, and other treatments, Dr Sudumpai asserts that current medications have not yet reached a point where they can provide a definitive cure for autoimmune diseases.
“I always advise my patients to prioritize joint health and remain optimistic about the prospect of curing these diseases, possibly within the next 10-20 years. However, in the present scenario, the likelihood of patients safely discontinuing medication is less than 5%. For the majority, a lifelong commitment to medication treatment is imperative. The specific dosage requirements vary among individuals, contingent on the extent of their self-care practices.”
Incurable Chronic Diseases Do not Have to Stop You From Living a Normal Life
The term "incurable" often unsettles patients, particularly those grappling with Systemic Lupus Erythematosus (SLE), an autoimmune disease. Dr Sudumpai underscores the significance of self-care, recognizing the anxiety associated with this label. It is crucial to emphasize that relentless research endeavors are ongoing to conquer this category of diseases.
“While these diseases are chronic, early treatment can significantly alleviate symptoms. Take Systemic Lupus Erythematosus (SLE) as an example; once considered a debilitating condition, the mortality rate has significantly diminished today. With proper medical care and regular medication adherence to control the disease, the majority of SLE patients can lead lives like their normal counterparts.”
Continuous progress in research fuels our optimism about the potential of gene therapy to usher in precision treatments soon. Dr Sudumpai shared the case of a 30-year-old woman from a neighboring country who fell ill from an unidentified ailment.
“The patient arrived with uncertainty about the nature of her ailment. Despite having a child, she faced difficulty conceiving a second time, experiencing a second-trimester miscarriage. Following her recovery, she suffered a stroke, marked by a sudden loss of speech and hemiparesis. Filled with concern, her relatives brought her to Thailand. In brief, she was diagnosed with Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS), conditions that frequently manifest during pregnancy.”
Dr Sudumpai described this case as particularly severe, marked by a spectrum of symptoms. To reach the conclusive results required comprehensive screening tests, thorough physical examinations, blood tests, and collaboration with neurologists.
“Given her youth, she recovered, regaining her ability to speak and walk like before. However, she must continue to take anticoagulants and medication for SLE. Once the diseases were under control, I gave her the green light to conceive again, and she succeeded. Her child is progressing with normal development. Nonetheless, regular follow-ups remain essential.”
Having treated numerous patients and collaborated with a multidisciplinary team of physicians and staff, Dr Sudumpai expresses her admiration for being a part of MedPark Hospital. She highlights the cohesive teamwork among the management, physicians, and staff, all uniting to commence and navigate the medical journey together.
“In large organizations, staff often face challenges in communication. However, at MedPark Hospital, most staff members know each other well and communicate regularly and openly. Despite the inevitable challenges that may arise, I find a sense of familiarity that allows me to know who to approach for various issues, including seeking consultations on medical cases. For instance, when caring for a patient alongside other physicians and needing to discuss the case, the approachability of everyone is akin to a close-knit community. The supportive nature of the management further enhances the collaborative and cohesive environment.”
Throughout the conversation, sincerity was palpable in her voice, and the sparkle in her eyes reflected a contented life. Beyond her medical expertise, she is a commendable role model for her patients by dedicating two days a week to playing tennis for 1-2 hours, promoting a healthy lifestyle. Driven by the belief that physicians should lead by example, she embodies the principle of practicing what she preaches when advising patients to prioritize self-care.
