Pediatric rheumatology in Southeast Asia: insights from the Singapore experience

Pediatric rheumatology is a well-established subspecialty in just 4 of 11 Southeast Asia countries. With the development of a dedicated pediatric rheumatology clinical program in Singapore and the establishment of an Internet-based registry, insights into local disease descriptions and epidemiology are possible. Concurring with reports from other parts of Asia and the West, a comparable proportion of referrals were for nonrheumatic conditions, although specific disease distributions were different. Juvenile idiopathic arthritis (JIA), vasculitides, and systemic lupus erythematosus are among the common rheumatic diseases seen in Singapore. Other than Henoch-Schönlein purpura and Kawasaki disease, other forms of systemic vasculitides are rare. JIA subtype distribution was unique, with enthesitis-related JIA showing predominance. Epidemiologic data are limited. Singapore has less of a biologic accessibility issue than other countries in Southeast Asia due to a stronger economy and strong financial support from foundations/organizations. As a multicultural Asian society, Singapore has traditional/alternative medicine practice as part of its health care system. Raising pediatric rheumatic disease awareness in the medical community and among the public is crucial to improving referral behavior and avoiding diagnosis delay and improper management. An urgent need exists for pediatric rheumatologists in Southeast Asia. With many differences between the East and West, establishment of a local, comprehensive, hands-on pediatric rheumatology fellowship training program may be a better strategy to decrease the patient-to-doctor ratio, eventually leading to an improvement in overall childhood-onset rheumatic disease outcomes.