Rheumatology has now emerged as a much sought after discipline-Prof. Nighat Mir


 Rheumatology conference proceedings-1

Rheumatology has now emerged as a
much sought after discipline-Prof. Nighat Mir

Three centers are now recognized in Pakistan for
postgraduate training for FCPS in this specialty

LAHORE: Rheumatology which was hardly known and talked about few years ago has now emerged as a much sought after discipline of medicine. Ideally there should be one rheumatologist for eighty thousand people hence we need at least three to four thousand trained rheumatologists in Pakistan whereas we have just about forty. This was stated by Prof. Nighat Mir while speaking in the inaugural session of the 16th Annual International Rheumatology Conference organized by Pakistan Society for Rheumatology held here from October 12-14th2012. Prof. I.A. Naveed Vice Chancellor of University of Health Sciences Lahore was the chief guest on this occasion.
Continuing Prof. Nighat Mir said that at present only three centers in Pakistan are recognized for postgraduate training for FCPS in rheumatology. University of Health Sciences should also explore the possibilities if it can start MD in rheumatology, she remarked. This conference, Dr. Nighat Mir said, will provide an opportunity to all of us to share our knowledge and experience with our colleagues. With proper treatment of rheumatic diseases, damage can be controlled. She was of the view that before every body suffers for life, they must have chance to see a rheumatologist.

On left Prof. Kh. Saadiq Husain presenting a mementoe to Prof.Nighat Mir
while on right Prof. Humayun Maqsood is receiving the mementoe from
Prof. Naveed VC DUHS during the rheumatology conference.
Also seen in the centre is Prof. Kh. Saadiq Husain.

Dr. Javed Malik President of PSR said that rheumatologists are a united group which continues its march forward slowly and steadily. Mrs. Rehman Chairperson of Fatima Memorial System said that we are proud of the fact that we are pioneers in many fields. We are glad to have the training center for postgraduates in rheumatology. Let us all work with devotion and dedication to make Pakistan a much better place to live, she added. 

Prof. I. A. Naveed Vice Chancellor of University of Health Sciences in his address said that weight gain results in much more strain on joints and a vast majority of population in Asia Pacific including India, China, Japan, Pakistan, Taiwan etc., were obese. With increase in weight gain, the cartilage is going to fall apart; hence something needs to be done to prevent this disability. The three centers recognized for postgraduate training in this specialty was not enough and we need to promote this discipline by following this role model set by the recognized training centers. We must give due emphasis to rheumatology in undergraduate training and develop a comprehensive education and training in this specialty. He urged the organizers to design a curriculum for MD in rheumatology and send it to the UHS so that they can get it approved from the faculty for postgraduate programme. Scholarship can also be arranged for deserving candidates to encourage them to take up rheumatology as a career, he stated.

Prof. Kh. Saadiq Husain presenting a mementoe to Prof. Terrence Gibson and Dr. Humaira Badshah
during the rheumatology conference held at Lahore while on right Dr. Javed Malik President Pakistan
Society for Rheumatology is presenting a mementoe to Dr. Hans Rasker from Netherlands.

First Session

Prof. Kh. Saadiq Hussain along with Prof. Humayun Maqsood chaired the first scientific session. Prof. Terence Gibson was the first speaker who gave an Update on Gout. He discussed in detail the origin of uric acid retention, hyperuricemia in gout, relative impairment, and genetic association of gout, reduced quality of life and co-morbidity with gout. Uric Acid, he said, was an independent predictor of vascular diseases. SUA over 0.4 mmol is a risk factor for IHD and SUA of 0.48 is a risk factor for stroke. Speaking about hyperuricemia and incidence of renal failure, he said that West believes that asymptomatic high uric acid does not need treatment but Japanese believe that it should be treated. In the presence of gout, kidney function declines rapidly. In case of young adult with gout, one must check family history. twenty four hour urine creatinine and uric acid. Young people with gout in Pakistan will develop renal failure. Childhood gout leads to progressive renal impairment, hypertension, fibrosis, tubular atrophy and interstitial nephritis.
Prof.Terrence Gibson then talked about acute gout NOMID clinical manifestations, pseudo gout, still’s disease, and AOSD. Rheumatic diseases are characterized by fever and neutrophilia. As regards treatment of gout, no single NSAID is superior to other. When NSAIDs are inadvisable, one can use prednisolone 40mg for seven to days. Colchine 0.5mg should be used sparingly or on alternate days. Cyclosporine reduces colchicines disposal. Use drugs which reduce uric acid. Do not defer treatment because of acute gout. Target SUA less than 0.4 mmol. Allopurinol is best. Febuxostat, peglotiease are also good and effective.
Dr. Humaira Badshah from UAE talked about rheumatologic emergencies and pointed out that they see some of the sickest patients. She then described the case history of a fifty seven years old rheumatic patient who was suffering from multisystem disease. There are much more emergencies in lupus patients. These patients come with fever, rash, feeling tired, low grade fever, shortness of breath. Treatment for lupus emergencies is steroids, pulse methylprednisolone, (Pulse MEP) She further stated that low as well as high dose of MEP both are effective. IV cyclophosphomide can be combined with Pulse MEP. The second case she presented was of lupus nephritis. She then referred to ACR guidelines for induction therapy for acute lupus nephritis using low and high dose of cyclosporine. She also discussed about the induction therapy for membranous lupus. Rituximab anti CD 20, high doses of cyclosporine and stem cell therapy are now being used routinely. Lupus cerebritis, she opined, should not be forgotten. Early use of steroids and cyclosporine was also highlighted.
She then talked about treatment of scleroderma renal crisis. Vasculitis, she said, can present as multisystem disease which requires aggressive treatment. Patients can also present as proctosis. We see these patients referred from eye surgeons. She concluded her presentation by emphasizing on early recognition and prompt treatment. Steroids, she opined, were still the main stay of treatment.
The presentations were followed by lively discussion. Responding to a question regarding acute gout with diabetes mellitus, it was stated that one should go for steroids and IA injections. One should not shy away from using steroids. However, be careful as it can result in increase in myopathies with the use of statins. Role of diet is often over emphasized in this condition.
In his concluding remarks, Prof. Kh. Saadiq Husain said that there is lot of co morbidity in rheumatic diseases. It calls for close cooperation between different departments on the medical floor. We need more trained people in rheumatology who can come to the rescue of medical people in chest, nephrology, dermatology and different medical units. He laid emphasis on people in different disciplines working as a team to look after these patients to ensure better outcome.