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The Story of PRA

Anna Kristina M. Gutierrez-Rubio, MD

It began with an invitation. It was 1963, and the Philippine College of Physicians (PCP) was invited to participate in a scientific meeting in Sydney, Australia. The delegate was to present an original work on any of the group of diseases referred to at the time as “rheumatism.” 

Fifty years ago, relatively few physicians were known to specialize in the treatment of these diseases, let alone have an interest in investigative work in this still unnamed field. In fact, among its members, the PCP knew of only one. 

 

A young internist named Lourdes Aguirre Manahan had been working quietly but diligently in her arthritis clinic in the heart of Manila. Earlier forays into research had unexpectedly triumphant results: a paper published, multiple citations, an eponymous syndrome. She was naturally meticulous; she documented everything in her neat script, writing pages and pages of handwritten notes and tables. She had an entire cohort of patients that she’d examined, mostly alone, for a decade. 

Dr. Manahan presented her paper, “Rheumatic disease in the Philippines.”[1] It was the beginning of an Australian spring; the air was growing warmer. Buds were pushing up from the ground—and something else was growing too. 

 

A few months prior, physicians from Australia and India had discussed plans to form a partnership of nations in the region. During that same spring meeting in Sydney, with four member nations-- Australia, India, Japan and New Zealand—SEAPAL (Southeast Asia and Pacific Area League against Rheumatism) was born.[2] 

Dr. Manahan flew home with the seed of an idea. On May 27, 1964, the Philippine Rheumatism Association held its inaugural meeting; Selwyn Nelson, the first SEAPAL president, was guest speaker. In 1965, they were admitted into SEAPAL. That same year, they were admitted into the International League Against Rheumatism during the 11th International Congress of Rheumatology in Mar Del Plata, Argentina.

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At its founding, what would be known as the Philippine Rheumatology Association (PRA) had a membership of ten. They were internists, orthopedists, physiatrists. Even though rapid advancements were being made in the treatment of chronic rheumatic diseases, these illnesses were still virtually unknown to the public. Gout and arthritis were illnesses of the old or infirm, to be treated with rest and a visit to the local faith healer. Many suffering from lupus, scleroderma, or vasculitis died without ever having seen a rheumatologist, never knowing what afflicted them. The PRA forerunners were lampposts in the darkness. 

Then came the homecoming of the first physicians formally trained in rheumatology: Dr. Tito P. Torralba and Dr. Clemente M. Amante, followed soon by Dr. Merle L. Ypil-Barba, the first rheumatologist to practice in her hometown of Cebu. Still, a decade after its inauguration, there were only four rheumatologist members, though the PRA had doubled in membership. As pioneers, they each treated thousands of patients in their clinics with the small armament of immunomodulatory drugs available at the time. They dedicated long hours to teaching the next generation of physicians on the rheumatic diseases, emphasizing the importance of clinical eye and a thorough exam. 

 

It became clear that in order to sustain the subspecialty and grow their ranks, they would need to train young rheumatologists themselves. Dr. Amante and Dr. Torralba established the first formal rheumatology fellowship programs at the Philippine General Hospital and the University of Santo Tomas Hospital. In the beginning, they would welcome a single trainee every few years. Before the end of the decade, these programs would double the number of rheumatologists in the country. By 1988, the new established Philippine Specialty Board of Rheumatology, with Dr. LA Manahan as the first chairman, would certify its first fellows.

 

The eighties were a tumultuous time in the Philippines; elections, revolutions, a new government. The small band of physicians did not let that deter them.

 

On January 20 to 24, 1980, with Dr. Torralba at the helm, the PRA hosted the 4th SEAPAL Congress at the Philippine International Convention Center. Physicians from the region and beyond, as far west as Britain, were in attendance. A report of topics discussed at the congress could be mistaken for one of a meeting today: the evolution of immunotherapy (though auranofin was described as the drug of the decade), dilemmas in the diagnosis of rheumatic diseases, and the epidemiology of rheumatic diseases among member nations.[3] 

Spurred on by this success, the PRA made plans to host the second Rheumatology Association of ASEAN (RAA) Congress on December 3 to 6, 1989. Established in 1984, the RRA was a confederation of societies from Southeast Asian nations. Dr. Amante was president of the RAA, and the second RAA congress was to usher rheumatology “into the nineties.” However, on December 1, 1989, residents of Manila and Cebu awoke to the sound of helicopters flying overhead. The Christmas coup would terrorize the two cities until December 9. 

Undeterred by this setback, members of the PRA would continue to represent the country in international societies and through collaborations in research. Dr. Torralba served as SEAPAL president and ILAR Vice-President concurrently from 1984 to 1989. Dr. Amante was RAA president from 1989 to 1991. And in 1985, and again in 1991, Dr. Manahan collaborated with RD Wigley and K Muirden to publish the COPCORD (Community Oriented Program for Control of Rheumatic Diseases) studies. Launched by the World Health Organization and ILAR, the COPCORD’s aim is to measure the burden of arthritis and disability in the community to foster health education, prevention, and inform medical strategy. [4, 5] 

In the nineties, galvanized by an increase in membership, the PRA hosted its first annual meeting at the Hotel Intercontinental Manila, Makati, on January 9, 1994. The first Dr. Lourdes Manahan Memorial lecture was prepared by Dr. Manahan herself, in which described the early days of the PRA in her lecture “History of the PRA.” That year, the organization would also induct its fellows for the first time, among them Drs. Sandra T.V. Navarra, Ester G. Penserga, and Joseph M. Antigua. 

After that, the PRA found its stride. With yearly annual meetings and rheumatology fora, beginning with the first Rheumatology Forum in Caylabne Bay, the organization truly began to bring rheumatology to the masses. The Philippines hosted an international congress a second time when it concurrently held the third APLAR (Asia Pacific League of Associations for Rheumatology, formerly SEAPAL) Symposium on Therapy of Rheumatic Diseases and the fifth RAA Congress of Rheumatology with their fifth annual convention on January 18 to 22, 1998, at the Philippine International Convention Center. 

The PRA has had its annual conventions in several cities across the nation, including Manila, Cebu, Iloilo, Davao, Cagayan de Oro, Baguio, Bacolod, Subic, and Tagaytay. The PRA once again hosted the APLAR on March 31 to April 5, 2014 for the 16th APLAR Congress in Cebu. These meetings continue to advance research and education in rheumatology through sessions tailored to persons with varying levels of knowledge in the field, from patients, to paramedical professionals, to general physicians and specialists. In the over fifty years since its foundation, the Philippine Rheumatology Association was the little engine that could. Beginning with just ten members, the organization has grown slowly but steadily and is now over a hundred strong. There are now six institutions that train young rheumatologists: East Avenue Medical Center, Dr. Jose Reyes Memorial Medical Center, Makati Medical Center, St. Luke’s Medical Center, the University of Santo Tomas, and the University of the Philippines-Philippine General Hospital. Their graduates serve patients from the mountains of Baguio and Bukidnon, to the coasts of Zamboanga and Surigao. The organization continues to be a driving force in research on the rheumatic diseases, with the hope of someday finding lasting cures for all those it serves. And as public awareness on the rheumatic diseases continues to grow, the PRA continues to rise to the occasion, training rheumatologists to the highest standard, tirelessly educating fellow physicians and the community, and serving the Filipino people expertly and compassionately.