The aim of this work was to develop a consensual recommendation under the auspices of the Assessment of SpondyloArthritis international Society (ASAS) for early referral of patients with a suspicion of axial spondyloarthritis by non-rheumatologists.
The development of a referral recommendation consisted of four phases:
(1) systematic literature review,
(2) the first Delphi round aiming at identification of unmet needs and development of a candidate list of referral parameters,
(3) the second Delphi round aiming at identification of the most useful combination of referral parameters and
(4) final discussion and formal endorsement by ASAS membership. The following consensus on a referral recommendation was achieved as a result of the Delphi processes and final voting:
Chronic inflammatory arthritis such as Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) are associated with significant morbidity and disability. These may result in decreased quality of life, loss of productivity and increased health cost. According to Malaysian data on the burden of disease published in 2004, musculoskeletal disorders ranked 3rd among diseases in females.
The total drug expenditure in 2005 for the treatment of inflammatory and rheumatic diseases is RM 50.7 million, ranking 5th as the most prescribed group of drugs and forms 7.8% of the top 40 prescribed drugs in Malaysia(1).
The introduction of biologics spawned a new therapeutic era in rheumatology. It has provided another treatment option in controlling disease activity, thus improving patients’ functional status and attenuating structural damage. This will result in potential long term benefits such as improved quality of life and increased prospect of remaining in work.
The Launch of the Management of Osteoarthritis (Second Edition) Clinical Practice Guideline, 28th May 2014
Osteoarthritis is a progressive mechanical failure of the joint, associated with severe pain, disability and poor quality of life. Recently, the Ministry of Health, Malaysia and the Malaysian Society of Rheumatology took the initiative to produce an updated edition of the Management of Osteoarthritis Clinical Practice Guideline.
On the 28th May 2014, Datuk Dr Jeyaindran A/L Tan Sri Sinnadurai, Timbalan Ketua Pengarah Kesihatan (Perubatan) Malaysia, launched the guidelines at Selayang Hospital. An overview of the guidelines was presented by Dr Azmillah Rosman, Chairperson of the Clinical Practice Guideline Development Group, followed by the delivery of the guideline packages to representatives from Jabatan Kesihatan Negeri and Faculties of Medicine of local universities.
To facilitate access to the guideline, documents such as Quick Reference and Training Module are made available in the Ministry of Health and the Malaysian Society of Rheumatology web portals.
This Clinical Guidance is not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.
The contents of this publication are a guide to clinical practice, based on the best available evidence at the time of development. Adherence to this guide may not acceptable methods of care.
Each physician is ultimately responsible for the management of his/her unique patient in the light of clinical data presented by the patient and the diagnostic and treatment options available.
To provide evidence-based guidance in the diagnosis and management of PAH in adults and pediatric patients.
To guide early diagnosis of PAH in adults and pediatric patients so as to enable referral of PAH cases for prompt specialist care
To guide in assessment of patients with suspected PAH
To provide guidance on appropriate and timely PAH management
To guide on monitoring response to treatment
To guide on specific aspects of managing PAH in congenital heart disease
1. What is the definition of PAH?
2. What is the epidemiology and natural history of PAH?
3. How is PAH diagnosis made?
4. What are the investigations to evaluate PAH?
5. How to manage patients with PAH?
6. What are the conventional and PAH specific therapies available?
7. How to evaluate response to treatment?
8. What are the key issues in managing PAH in congenital heart disease?
Adult and paediatric patients with PAH as defined in the updated clinical classification of Pulmonary Hypertension (PHT) from Dana Point, 2008. The inclusion criteria are idiopathic PAH, heritable PAH, Connective Tissue Disease associated PAH and Congenital Heart Disease associated PAH. The other types of PAH are excluded.
These guidelines are applicable to physicians, cardiologists (paediatric and adult), pulmonologists, rheumatologists, critical care providers and primary care doctors involved in treating patients with PAH.
Musculoskeletal pain syndromes are a common health problem. The causes of musculoskeletal pain are varied starting from trauma up to musculoskeletal diseases such as low back pain, Osteoarthritis and etc. Nowadays there are many ways to treat musculoskeletal pain depending on the severity of the condition. Pharmacologic and non pharmacologic therapies such as acupuncture and physiotherapy can be used to manage patient with musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management.
Nowadays acupuncture has grown in popularity among alternative therapies and it is estimated that 2% of adults in the UK use it each year for a variety of conditions. It was claimed to have many benefits and advantages especially reducing pain in various diseases and improve quality of life.
This technology review was conducted following a request from Director of Traditional and Complementary Medical (T&CM) Division, Ministry of Health (MOH) Malaysia to provide the best available evidence in ensuring T&CM practice in Malaysia is safe and conforms to acceptable standards for the benefits of the public, and in line with requirement of the Traditional and Complementary Medicine Act 2013.
Musculoskeletal pain is the pain that affects the muscles, ligaments, tendons, and bones. Musculoskeletal pain has tremendous socioeconomic impact through direct and indirect effects on health. Despite its high prevalence, musculoskeletal pain remains poorly understood and insufficiently treated. Musculoskeletal pain significantly impinges on the psychosocial status of affected people as well as their families and carers.
Musculoskeletal conditions encompass a spectrum of conditions, from those of acute onset and short duration to lifelong disorders; including osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. In surveys carried out in Canada, the United States of America (USA) and Western Europe, the prevalence of physical disabilities caused by a musculoskeletal condition has been estimated at 4% to 5% of the adult population. It increases distinctly with age, and many are influenced by lifestyle factors, such as obesity and lack of physical activity.
Musculoskeletal pain is best treated by treating its cause. Treatment for musculoskeletal pain includes analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and opiods. Many forms of complementary therapies exist, such as massage therapy, acupuncture and chiropractic manipulation. Massage therapy, in particular, has grown in popularity. In Malaysia, Malay massage using the concept of deep tissue massage technique has been used as a complementary therapy for musculoskeletal pain.
The Malaysian Society of Rheumatology was registered with the Registrar of Societies on 7th August 1989, following which the Protem Committee was dissolved and a new official executive committee was elected. MSR soon gained recognition and was warmly welcomed by regional Rheumatology bodies, namely, the Rheumatology Association of ASEAN (RAA) and the Asia Pacific League of Associations for Rheumatology (APLAR). MSR began to actively participate in the activities of these organisations.