Medicine Man, Music Man
What’s the attraction?

“There were two things that attracted me to rheumatology,” A/Prof Leong states.

The first is that rheumatological conditions tend to affect multiple organs and systems. “Even rheumatoid arthritis affects your eyes, your lungs, etc,” he elaborates. This is interesting for him because “there is still a breadth of internal medicine you need to be familiar with”. This is different from other specialities that focus on oneorgan systems only.

The second thing is that rheumatology is linked to immunology. Targeted therapies in oncology have similarities to what rheumatology does. “So cancer and autoimmunity are like two sides of the same coin; the mechanisms that control both are very similar and that is very interesting to me,” he says.

Internet of things

The proliferation of websites with medical content is a good thing, as far as A/Prof Leong is concerned. He has always encouraged his patients to ask questions, so the Internet has empowered them. “I am not really in favour of doctors who are dictatorial, telling you to take this and that. I think this is a wrong approach,” he stresses. “If you don’t get your patient’s cooperation, it will be an exercise in futility.”

In fact, he will often insist that a patient look up certain issues on the World Wide Web before the next consultation. “Building trust is very important. I am fine with patients trying to find out more. They should, or else there is no point going further.”

He is also of the opinion that no jargon be used and that his medical advice be delivered according to the type of patient he is seeing. “If they are not so educated, you have to use different illustrations. As for those who are very knowledgeable and want a lot of facts, I will give them all the details,” he assures.

According to A/Prof Leong, autoimmune diseases have no cures but tend to settle down over time. However, where there is treatment available to alleviate symptoms, it must be done aggressively to mitigate the overall damage by the time the disease burns out. “We have to keep escalating and changing our drugs to control the disease early. This has been the approach for the past 15 years,” he adds. “So there are diagnostic and therapeutic challenges.” The detective work involved in eliminating suspect diseases and adjusting drugs and dosages to target organs and symptoms is another reason why he was attracted to rheumatology.

A/Prof Leong predicts that targeted therapy will be the next big thing in rheumatology. “These drugs target the immune proteins involved and switch them off,” he explains. There are currently a number of such medications with different targets, such as TNF, IL6, B-cell, T-cell, JAK, etc. Though it is a big advance, it is still not perfect; “there may never be a 100% response as the immune system is very complicated”.

Autoimmune diseases are not lifestylelinked; the trigger tends to be infection. “You can’t really prevent infection,” he quips. They are more common in younger people than older people, and usually emerge between the ages of 20 and 50.