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Rheumatology in Malaysia

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Abstract

Malaysia is a developing country in the South-East Asian region with a significant burden of disability from musculoskeletal disease. Rheumatology in Malaysia is a relatively young speciality. Currently, there is approximately 1 rheumatologist per 390,000 population, mostly concentrated in the urban areas. This article aims to give a brief overview of the research in rheumatology, the healthcare system, and rheumatology training and education in Malaysia. From 1950 until mid-2019, there were 547 publications about rheumatological conditions from Malaysia, with a 27-fold increase in the numbers from the period before 1980 compared to 2010–2019. Although there is universal access to healthcare through the public (government funded) hospitals and clinics, as well as a system of private healthcare, funding for expensive biological therapies remain patchy and scarce, leading to significant under-utilization of such treatments in rheumatology patients. Training in rheumatology in Malaysia is well established with a formalised training curriculum introduced in 2004, followed by the introduction of training in musculoskeletal ultrasound in 2006. To improve care for patients with musculoskeletal conditions, there has been regular continuing educational meetings and courses, not just for rheumatologists, but also for other medical professionals, as not all areas in Malaysia have easy access to rheumatology services. Thus overall, despite the small number of rheumatologists, rheumatology in Malaysia has made encouraging progress over the past 2 decades, but improvements in patient care, training, education and research need to continue in the future.

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References

  1. Current Population Estimates, Malaysia, 2018–2019 (published 15 July 2019). https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=155&bul_id=aWJZRkJ4UEdKcUZpT2tVT090Snpydz09&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09. Accessed 22 Dec 2019

  2. The World Bank/Data/Malaysia (published 2019). https://data.worldbank.org/country/malaysia. Accessed 15 Feb 2020

  3. Department of Statistics Malaysia, Official Portal/Statistics/Household Income and Expenditure (published 9 Oct 2017). https://www.dosm.gov.my/v1/index.php?r=column/ctwoByCat&parent_id=119&menu_id=amVoWU54UTl0a21NWmdhMjFMMWcyZz09. Accessed 15 Feb 2020

  4. Department of Statistics Malaysia, Official Portal/Statistics/Population & Demographics (published 5 Aug 2011). https://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz0. Accessed 15 Feb 2020

  5. IHME/GHDx/Viz Hub. https://vizhub.healthdata.org/gbd-compare/. Accessed 15 Feb 2020

  6. COPCORD website. https://copcord.org/. Accessed 15 Feb 2020

  7. Veerapen K, Wigley RD, Valkenburg H (2007) Musculoskeletal pain in Malaysia: a COPCORD survey. J Rheumatol 34(1):207–213

    PubMed  Google Scholar 

  8. Wang F, Wang CL, Tan CT, Manivasagar M (1997) Systemic lupus erythematosus in Malaysia: a study of 539 patients and comparison of prevalence and disease expression in different racial and gender groups. Lupus 6(3):248–253

    Article  CAS  PubMed  Google Scholar 

  9. Malaysia Science and Technology Information Centre website/Research & Development Grants. https://mastic.mestecc.gov.my/statistic-category/research-development-grants. Accessed 16 Feb 2020

  10. Teng CL, Chew WZ, Das Gupta E, Yeap SS (2020) Rheumatological publications from Malaysia: a bibliometric study. Clin Rheumatol 39(2):547–552

    Article  PubMed  Google Scholar 

  11. Mok MY, Li WL (2010) Do Asian patients have worse lupus? Lupus 19(12):1384–1390

    Article  CAS  PubMed  Google Scholar 

  12. Jasmin R, Sockalingam S, Cheah TE, Goh KJ (2013) Systemic lupus erythematosus in the multiethnic Malaysian population: disease expression and ethnic differences revisited. Lupus 22(9):967–971

    Article  CAS  PubMed  Google Scholar 

  13. Shaharir SS, Hussein H, Rajalingham S, Mohamed Said MS, Abdul Gafor AH, Mohd R, Mustafar R (2016) Damage in the multiethnic Malaysian systemic lupus erythematosus (SLE) cohort: comparison with other cohorts worldwide. PLoS ONE 11(11):e0166270

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chai HC, Phipps ME, Chua KH (2012) Genetic risk factors of systemic lupus erythematosus in the Malaysian population: a minireview. Clin Dev Immunol 2012:963730. https://doi.org/10.1155/2012/963730

    Article  CAS  PubMed  Google Scholar 

  15. Molineros JE, Chua KH, Sun C, Lian LH, Motghare P, Kim-Howard X, Nath SK (2014) Evaluation of SLE susceptibility genes in Malaysians. Autoimmune Dis 2014:305436. https://doi.org/10.1155/2014/305436

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chua KH, Lian LH, Sim XJ, Cheah TE, Lau TP (2015) Association between PDCD1 gene polymorphisms and risk of systemic lupus erythematosus in three main ethnic groups of the Malaysian population. Int J Mol Sci 16(5):9794–9803

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chua KH, Ooh YY, Chai HC (2016) TNFSF4 polymorphisms are associated with systemic lupus erythematosus in the Malaysian population. Int J Immunogenet 43(5):303–309

    Article  CAS  PubMed  Google Scholar 

  18. Veerapen K, Mangat G, Watt I, Dieppe P (1993) The expression of rheumatoid arthritis in Malaysian and British patients: a comparative study. Br J Rheumatol 32(7):541–545

    Article  CAS  PubMed  Google Scholar 

  19. Teh CL, Wong JS (2008) The pattern and clinical manifestations of rheumatoid arthritis in Sarawak General Hospital. Clin Rheumatol 27(11):1437–1440

    Article  CAS  PubMed  Google Scholar 

  20. Chun-Lai T, Padyukov L, Dhaliwal JS, Lundstrom E, Yahya A, Muhamad NA, Klareskog L, Alfredsson L, Larsson PT, Murad S (2011) Shared epitope alleles remain a risk factor for anti-citrullinated proteins antibody (ACPA)–positive rheumatoid arthritis in three Asian ethnic groups. PLoS ONE 6(6):e21069. https://doi.org/10.1371/journal.pone.0021069

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Kong KF, Yeap SS, Chow SK, Phipps ME (2002) HLA-DRB1 genes and susceptibility to rheumatoid arthritis in three ethnic groups from Malaysia. Autoimmunity 35(4):235–239

    Article  CAS  PubMed  Google Scholar 

  22. Guo J, Wu X, Too CL, Yin F, Lu X, He J, Li R, Liu X, Murad S, Padyukov L, Li Z (2012) A replication study confirms the association of dendritic cell immunoreceptor (DCIR) polymorphisms with ACPA—negative RA in a large Asian cohort. PLoS ONE 7(7):e41228. https://doi.org/10.1371/journal.pone.0041228

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Too CL, Murad S, Dhaliwal JS, Larsson P, Jiang X, Ding B, Alfredsson L, Klareskog L, Padyukov L (2012) Polymorphisms in peptidylarginine deiminase associate with rheumatoid arthritis in diverse Asian populations: evidence from MyEIRA study and meta-analysis. Arthritis Res Ther 14(6):R250. https://doi.org/10.1186/ar4093

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ismail E, Nofal OK, Sakthiswary R, Shaharir SS, Sridharan R (2016) The clinical significance of interleukin-1 receptor antagonist +2018 polymorphism in rheumatoid arthritis. PLoS ONE 11(4):e0153752. https://doi.org/10.1371/journal.pone.0153752

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Too CL, Muhamad NA, Ilar A, Padyukov L, Alfredsson L, Klareskog L, Murad S, Bengtsson C (2016) Occupational exposure to textile dust increases the risk of rheumatoid arthritis: results from a Malaysian population-based case–control study. Ann Rheum Dis 75:997–1002

    Article  CAS  PubMed  Google Scholar 

  26. Lau EM, Lee JK, Suriwongpaisal P, Saw SM, De Das S, Khir A, Sambrook P (2001) The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 12(3):239–243

    Article  CAS  PubMed  Google Scholar 

  27. Lee JK, Khir ASM (2007) The incidence of hip fracture in Malaysians above 50 years of age: variation in different ethnic groups. APLAR J Rheumatol 10:300–305

    Article  Google Scholar 

  28. Cheung CL, Ang SB, Chadha M, Chow ES, Chung YS, Hew FL, Jaisamrarn U, Ng H, Takeuchi Y, Wu CH, Xia W, Yu J, Fujiwara S (2018) An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4(1):16–21

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yeap SS, Fauzi AR, Kong NC, Halim AG, Soehardy Z, Rahimah S, Chow SK, Goh EM (2009) Influences on bone mineral density in Malaysian premenopausal systemic lupus erythematosus patients on corticosteroids. Lupus 18(2):178–181

    Article  CAS  PubMed  Google Scholar 

  30. Chong HC, Chee SS, Goh EM, Chow SK, Yeap SS (2007) Dietary calcium and bone mineral density in premenopausal women with systemic lupus erythematosus. Clin Rheumatol 26(2):182–185

    Article  CAS  PubMed  Google Scholar 

  31. Yeap SS, Othman AZ, Zain AA, Chan SP (2012) Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids. Int J Rheum Dis 15(1):17–24

    Article  CAS  PubMed  Google Scholar 

  32. Yeap SS, Hew FL, Damodaran P, Chee W, Lee JK, Goh EML, Mumtaz M, Lim HH, Chan SP (2016) A summary of the Malaysian Clinical Guidance on the management of postmenopausal and male osteoporosis, 2015. Osteoporos Sarcopenia 2(1):1–12

    Article  PubMed  PubMed Central  Google Scholar 

  33. Yeap SS, Hew FL, Damodaran P, Chee W, Lee JK, Goh EML, Chan SP (2017) An update of the Malaysian Clinical Guidance on the management of glucocorticoid-induced osteoporosis, 2015. Osteoporos Sarcopenia 3(1):1–7

    Article  PubMed  PubMed Central  Google Scholar 

  34. World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2018. https://apps.who.int/iris/bitstream/handle/10665/272596/9789241565585-eng.pdf. Accessed 16 Feb 2020

  35. World health statistics 2015. Geneva, World Health Organization; 2015. https://www.who.int/docs/default-source/gho-documents/world-health-statistic-reports/world-health-statistics-2015.pdf?sfvrsn=afb0629f_2. Accessed 16 Feb 2020

  36. Khazanah Research Institute. 2018. The State of Households 2018: Different Realities. Kuala Lumpur: Khazanah Research Institute. https://www.krinstitute.org/assets/contentMS/img/template/editor/FullReport_KRI_SOH_2018.pdf. Accessed 19 Feb 2020

  37. Shahrir M, Shahdan M, Shahid M, Sulaiman W, Mokhtar AM, Othman M et al (2008) Multicentre survey of rheumatoid arthritis patients from ministry of health rheumatology centers in Malaysia. Int J Rheum Dis 11(3):287–292

    Article  Google Scholar 

  38. National Inflammatory Arthritis Registry (NIAR). Preliminary Report, National Inflammatory Arthritis Registry (NIAR) April 2009-August 2010. Hospital Selayang. https://www.crc.gov.my/wp-content/uploads/documents/report/NIAR_Report.pdf. Accessed 16 Feb 2020

  39. Yeap SS (2009) Comment on: Multicentre survey of rheumatoid arthritis patients from Ministry of Health rheumatology centres in Malaysia. Int J Rheum Dis 12(2):177–178

    Article  PubMed  Google Scholar 

  40. Lee KH, Liau SM, Selvadurai S, Wong PS, Cheah CK, Nadiah MN, Loh YL, Gun SC, Chow SK (2019) Comparison of treatment trends and outcomes in treating rheumatoid arthritis between a private and A Government Funded Rheumatology Centre In Malaysia. In: Poster presentation at the 7th Negeri Sembilan Research Day 2019, 26th Sept 2019, Seremban, Malaysia

  41. Wong RS, Abdul Kadir SY (2017) Medical education in Malaysia: quality versus quantity. Perspect Med Educ 6:10. https://doi.org/10.1007/s40037-016-0319-8

    Article  PubMed  PubMed Central  Google Scholar 

  42. WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization; 2019. https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.pdf?sequence=1&isAllowed=y. Accessed 19 Feb 2020

  43. Siti ZM, Tahir A, Farah AI, Fazlin SM, Sondi S, Azman AH, Maimunah AH, Haniza MA, Siti Haslinda MD, Zulkarnain AK, Zakiah I, Zaleha WC (2009) Use of traditional and complementary medicine in Malaysia: a baseline study. Complement Ther Med 17(5–6):292–299

    Article  CAS  PubMed  Google Scholar 

  44. Chow SK, Yeap SS, Goh EM, Veerapen K, Lim KK (2002) Traditional medicine and food supplements in rheumatic diseases. Med J Malaysia 57(3):283–291

    CAS  PubMed  Google Scholar 

  45. Goh EML, Tan LC, Chow SK, Teh LK, Yeap SS (2003) Use of complementary medicine in systemic lupus erythematosus patients in Malaysia. APLAR J Rheumatol 6(1):21–25

    Article  Google Scholar 

  46. Yeap SS, Veerapen K, Lim KKT (2005) A brief history of the Malaysian Society of Rheumatology. APLAR J Rheumatol 8:229–231

    Article  Google Scholar 

  47. Academy of Medicine, Malaysia/Clinical Practice Guidelines/Rheumatology. https://www.acadmed.org.my/index.cfm?menuid=67#Rheumatology. Accessed 17 Feb 2020

  48. Louthrenoo W (2015) An insight into rheumatology in Thailand. Nat Rev Rheumatol 11:55–61

    Article  PubMed  Google Scholar 

  49. A brief history of the Indonesian Rheumatology Association (IRA). https://www.reumatologi.or.id/reuorg. Accessed 31 March 2020

  50. Aggarwal A, Haq SA (2020) Rheumatology workforce issues in South Asia: challenges and solutions. Int J Rheum Dis 23:443–447

    Article  PubMed  Google Scholar 

  51. Number of rheumatology specialists registered in Singapore from 2014 to 2018. https://www.statista.com/statistics/1069499/singapore-medical-specialists-rheumatology/. Accessed 31 March 2020

  52. Misra DP, Sharma A, Agarwal V (2018) Rheumatology science and practice in India. Rheumatol Int 38(9):1587–1600. https://doi.org/10.1007/s00296-018-4111-4

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Subang Jaya Medical Centre, 47500, Subang Jaya, Selangor, Malaysia

    Swan Sim Yeap

  2. Department of Medicine, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia

    Suk Chyn Gun

  3. Department of Internal Medicine, International Medical University, Seremban Campus, Seremban, Negeri Sembilan, Malaysia

    Esha Das Gupta

  4. Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Kiran Veerapen

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  1. Swan Sim Yeap
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All authors were involved in the writing of the paper, revising the paper for critically important intellectual content, giving approval of the final version to be published and agree to be accountable for all aspects of the paper.

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Correspondence to Swan Sim Yeap.

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SS Yeap has received honoraria for scientific advisory board attendance from Amgen, Eli Lilly, Mylan, Novartis and Zuellig Pharma. SC Gun, E Das Gupta and K Veerapen declare no conflict of interests.

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Yeap, S.S., Gun, S.C., Das Gupta, E. et al. Rheumatology in Malaysia. Rheumatol Int 40, 829–836 (2020). https://doi.org/10.1007/s00296-020-04577-6

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