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Adjuct Associate Professor Leong Keng Hong, one of Singapore’s leading rheumatologists shares his passion in his medical field, and tells us more about juggling his many interests.

Mild-mannered, genial and a man of many hats - these are a few things you will observe of A/Prof Leong Keng Hong when you meet him for the first time. Having dedicated his academic and professional life to rheumatology studies, A/Prof Leong is nowhere near being bored of the subject; a fact evident when he talks about his passion.

"Rheumatology is a branch of internal medicine that deals with the immune system," explained A/Prof Leong. "Many people have the misconception that rheumatology deals with old people, but much of this branch of medicine affects the young, specifically in the area of autoimmune diseases like rheumatoid arthritis, lupus and such.

"I find autoimmune diseases very fascinating. At the forefront of medicine, you have genetics and immunology. Autoimmune diseases are related to the latter, and there is a lot of basic science involved; in the diagnosis of these diseases, you also require a lot of clinical skills. Rheumatology, to me, offers a blend of these two, which was the reason why I was attracted to this field.”

Internal medicine versus surgery

Despite his love for his field of speciality, A/Prof Leong never discounts the importance of the other branch of the medical profession headed by surgeons.

"Doctors that specialise in internal medicine tend to think more about the disease - how to target the disease process and administer the medicine to correct the disease. This may sound more preventive, but it all depends on the nature of the problem," clarified A/Prof Leong.

"Let's say you have a growth; you can reduce the size of the growth with medicine, but you would need surgery to completely remove it. Or say you have blocked bile ducts or broken bones. Surgical treatments are definitely required to correct the problem. But with conditions like high-blood pressure, for example, there is nothing to operate on, so you have to use medicine to ease the problem. Like in autoimmunity, where there is a lot of 'friendly fire' going on between your immune system and body tissue, you have to use medicine to 'get rid' of that reaction."

Medical advancements in rheumatology

The development of disease-modifying antirheumatic drugs (DMARDs) has greatly increased the efficacy of treatment of rheumatoid-related diseases. A/Prof Leong says that the older ones work, but were less targeted, so patients would experience some side effects. There was also a group of unfortunate patients for whom the older DMARDs did not work.

"DMARDs are usually injected into the patient, and you can see the easing up of the inflamed joints in as short as two weeks," said A/Prof Leong.

The problem with these new drugs, as with most, lies in their high cost - something which A/Prof Leong is seeking to address, working with the Lupus Association Singapore.

"We are looking at approximately $2,000-plus a month, for about six months to a year of therapy, so the cost makes it quite inaccessible for most people. We're compiling a list of drugs and the people who would most benefit from them, so that the government can consider subsidising the costs for a specific group of patients," said A/Prof Leong.

"We're compiling a list... so that the government can consider subsidising the costs for a specific group of patients."

Rheumatoid Arthritis

Autoimmune diseases occur when the immune system mistakenly attack the body's own tissues besides external infections. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints and the tissue around it, as well as other organs in the body. In the long run, it damages joints and can affect other organs.

Symptoms

  • Multiple joints are inflamed in a symmetrical pattern (both sides of the body affected), often involving small joints of the hands, wrists and feet
  • Difficulty with simple daily tasks, such as turning door knobs and opening jars
  • Occasionally, only one joint is inflamed - like other forms of arthritis such as gout or joint infection

Effects

  • Chronic inflammation can damage body tissues, cartilage and bone
  • Loss of cartilage and erosion and weakness of the bones as well as the muscles
  • Joint deformity, destruction, and loss of function

It is important to note that patients may experience long periods without symptoms, so it is vital to seek professional help when you have the symptoms.

On the misconception that rheumatoid arthritis (RA) affects mostly the old

Think arthritis and one thinks old people with achy joints. But there are, in fact, many forms of arthritis (over one hundred and growing) ranging from those related to wear and tear of cartilage to those resulting from an overactive immune system (such as RA).

A/Prof Leong said: "RA or lupus usually starts when you're in your 20s to mid-40s. More than half of the patients I see in my clinic are young people. It is less common for these diseases to start when you are elderly; a lot of autoimmune diseases actually become quieter as you age."

Early detection of these diseases is key, as they can cause joints to sustain irreparable damage and become deformed. Complications of other parts of the body (see boxes) can also arise; more so with lupus, which can be fatal when it affects major organs in your body, like the kidneys, lungs and heart.

RA affects 1-2 per cent of population, and is as common as leukaemia. Unfortunately, changing up your lifestyle does not have an effect on the disease, so you should seek professional help if you think you have the condition.

 

Lupus

"Lupus usually starts when you’re in your 20s to mid-40s. More than half of the patients I see in my clinic are young people."

Lupus is a condition of chronic inflammation caused by an autoimmune disease, like rheumatoid arthritis. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. The precise cause of lupus is not known; genetics, viruses, and exposure to ultraviolet light and drugs may play a role.

Symptoms

As A/Prof Leong said, "Lupus is also known as the disease with a thousand faces", so no two cases of lupus are exactly alike. The wide range of symptoms include:

  • Achy joints, arthritis, and swollen joints, especially in wrists, small joints of the hands, elbows, knees, and ankles
  • Swelling of the hands and feet due to kidney problems
  • Fever, rashes, fatigue, sensitivity to sun or light, among others

Effects

Lupus can lead to complications in parts of the body, including:

  • Severe kidney damage that can result in death
  • Damage to the central nervous system, causing headaches, dizziness, memory problems, seizures, and even behavioural changes
  • Increased risk of anaemia, bleeding, blood clotting, and vessel inflammation, non-infectious pneumonia, cardiovascular disease, heart attacks and cancer, among others
  • Increased risk of miscarriage, hypertension during pregnancy, and preterm birth

Lupus is extremely challenging to diagnose; doctors will usually ask a series of questions to determine your condition. If you are suspected of having the disease, they may conduct a range of blood tests for confirmation.

On his "Co-Curricular Activities"

Besides heading his own clinic, A/Prof Leong contributes to many other charitable causes related to his interests. The founder and ex-president of the Osteoporosis Society (Singapore) is now mostly involved in the Lupus Association Singapore.

"I feel that the hallmark of a good doctor goes beyond simply treating patients. There is no point in having the best treatment or medicine available if the patient doesn't understand it and shuns it because of certain misconceptions. With the Lupus Association, we engage past patients to share their treatment experiences. Patients tend to believe fellow sufferers’ advice more than their doctors," said A/Prof Leong with a laugh. "So it's good to have this kind of sharing and flow of information, which will empower patients to face the disease and the treatment's temporary side effects, such as the swelling of the face."

A/Prof Leong also lectures medical students as an Adjunct Associate Professor at the National University of Singapore. "I had great teachers when I was growing up, and I feel that it's important to not only impart medical knowledge, but also convey the ethical implications of being in the medical industry, especially as doctors."

With a few "Best Lecturer" awards under his belt, we say he is not doing that bad either.

Rheumatology aside, A/ Prof Leong said he likes to help his wife garden. He is also an avid traveller who enjoys experiencing different cultures. Mostly, he travels with his wife, unless he is going for a conference, which occurs twice a year, once to the US, the other to the UK. But even travelling can take on a charitable slant. "My wife and I sometimes travel to China on humanitarian trips," said A/Prof Leong.

In terms of paying it forward, and juggling family, work and numerous charitable causes, one does not have to look far with A/Prof Leong in the room, despite him humbly insisting that he is "trying to do better".

"I had great teachers when I was growing up, and I feel that it's important to not only impart medical knowledge, but also convey the ethical implications of being in the medical industry, especially as doctors." - A/Prof Leong on lecturing at the National University of Singapore

Osteoporosis

Osteoporosis is the condition where bones lose their density, leading to abnormally porous bones that are more compressible like a sponge than dense like a brick, as it should normally be. This leads to an increased risk of bone fracture, even with a minor fall or injury. Common areas that sustain bone fractures include the spine, hips, and wrists.

Symptoms

You may have osteoporosis without having any symptoms, until you sustain a painful fracture.

Effects

You will usually experience pain at and around the site of the fracture, such as:

  • Severe "band-like" pain that radiates around from the back to both sides of the body when your spine is fractured; with time, repeated spine fractures can cause chronic back pain as well as loss of height or curving of the spine, which gives the individual a hunched-back appearance
  • Pain in the feet when you sustain stress fractures while walking or stepping off a curb

Since you may have osteoporosis without knowing it, a bone density test is the only test that can diagnose it before a broken bone occurs.

 
 
 
A/PROF LEONG KENG HONG

MBBS (Singapore) 1983
Master of Medicine (Singapore) 1989
Doctor of Medicine 2005
Member of the Royal College of Physicians (UK) 1989
Fellow of the Academy of Medicine, (Singapore) 1992
Fellow of the Royal College of Physicians (Edinburgh) 1997

Leong Keng Hong Arthritis and Medical Clinic
6 Napier Road #04-18
Gleneagles Medical Centre

Singapore 258499
Tel : (65) 6472 4337
Fax : (65) 6472 0691
Email : info@leongkenghong.com
Website :