R.A.

1. R.A. 3A6 – 2011 (Dr. Navarra)

3. Misconceptions

4. I have always thought that rheumatoid arthritis (RA) is just one those diseases that would present with joint pains. This perception changed the day I met RA patients for the first time. - Kaye Chua As what I’ve learned on my first encounter with patient-partners of SLE, RA patient partners were an added twist. I didn’t thought of RA as a very chronic type of disease before. But seeing them, I took RA very seriously now. • Mai Cho I noticed how RA has become a debilitating disease yet none of them showed me that it was hard living with the disease, instead, they showed me how they can overcome the disease and still continue on living. - Joyce Chua

5. Beyond Harrison

6. With books, we may understand the scientific and clinical side of rheumatoid arthritis…with our patient-partners, we learn to integrate and develop a bridge with what we have learned and the people who have developed yet continues to conquer this disease. - Greg Co The saying “patients are our best teachers” holds true for the experience I had with our RA patient partners. - Lester Chua

7. It is not simply a means of learning, hearing from these patients, since they are worth far more educationally than visual aids or realistic counterparts to the textual references our brains are forced to memorize. The lessons gained in the few hours that we spend listening to them encompass everything we should have learned over the past three years. - Rosalyn Chan

8. The Women

9. Sonia – 61/F • She was 23 when first diagnosed with RA • Pain and swelling manifested first on her left and right wrists • There was no methotrexate yet during that time, and so she was only given NSAIDS, hydrotherapy, and synovectomy • Had a flare when she gave birth to her youngest child • She had cutaneousvasculitis, osteoporosis, surgical menopause, and joint deformities Prepared by: Kathleen S. Chua

10. Sonia – 61/F • To her, RA brings “…lifetime pain. It is a disabling disease.” • She channels her strength to do things she is capable of doing with the help of assistive devices. • “I find happiness in what is left behind.” Prepared by: Kathleen S. Chua

11. Elyn – 54/F • She was diagnosed to have juvenile RA • Started on her wrists; initially stiff then becomes very painful • There were no specific drugs yet at the time of diagnosis, and so she was only given aspirin  epigastric pain • She moved to Manila from Pampangga and further stress brought about pain and swelling, aggravating her polyarthritis • She consulted a physician and prescribed with steroids  self-medicated  avascular necrosis  total bilateral hip replacement in 1993 Prepared by: Kathleen S. Chua

12. Elyn – 54/F • She transfers from one doctor to another; was prescribed with methotrexate, COX-2 inhibitors, folate, and calcium+Vit D • She developed hyperuricemia and hypercholesterolinemia • “We are trying to become normal.” • She became depressed before because of non-acceptance • Her life changed when she started to participate in the Patient Partners. • Currently, she is the president of the Arthritis Club Prepared by: Kathleen S. Chua

13. Eloisa – 34/F • She was diagnosed to have RA at 20 years old • The first manifestation was pain in all of her joins, especially on her hands and knees • She was prescribed NSAIDS and steroids 10mg/day  self-medicated and was lost to follow-up  avascular necrosis  hip joint replacement • Upon consult, the steroids were tapered and DMARDs and calcium supplement was given Prepared by: Kathleen S. Chua

14. Eloisa – 34/F • “I have a positive outlook in life with the help of my family and friends.” • On her spare time, she does cross-stitching – one of her works showed the symbol of RA and lupus: a bumblebee and a butterfly Prepared by: Kathleen S. Chua

15. Zenaida – 60/F • She was 15 years old when diagnosed to have RA • Started with her right ankle and foot • She was only given mefenamic acid to relieve the pain – “I could not dance the boogie!” • Had rashes and blackened right foot in 1995 – “I even placed oil, gaas, and luya on my rashes!” • Still worked hard in different companies despite the extreme pain – “I remember taking 1500mg of mefenamic acid!” • Became a 5-star hotel telemarketer once, but quitted job because of poor cold tolerance • She considers her jobs as blessings Prepared by: Kathleen S. Chua

16. Zenaida – 60/F • “I focus on the positive aspects of life.” • “Patient partners was the best thing that happened in my life.” • “I have loving people around me!” Prepared by: Kathleen S. Chua

17. Awareness

18. Not only we had fun when we were amazed with them saying the different procedures and purpose of the tests without reading a copy, but also appreciated the problem of RA patients with their hands, feet and gait. - Lester Chua

19. One thing caught my attention throughout the session, their lack of knowledge with regards to rheumatoid arthritis before they had them. Most of them self medicated for sometime after consulting a doctor and finding relief from the medications given to them. It then took its toll by giving them deformed hands and limping gait. Most of this could have been prevented if only they were properly educated with regards to their condition. - Melody Chua

20. Patient-Partner Experience

21. The remarkable part of their talk is that the four ladies are masters of musculoskeletal examination! They are not physical therapists, nor nurses, nor doctors, and I don’t think they were ever required to have study marathon with Harrison. There is definitely a truth in the saying “the best teachers are the patients”. • Eunice Co Another thing I enjoyed about the activity is that I’ve got the chance to interact with them who are brave enough to show us about their illness and disabilities. - Mai Cho

22. During the PP activity, I did not only learn about the Rapid Musculoskeletal Screener, which Lola Zenaida presented to us amazingly (without any copy whatsoever!). She also taught us a lot by showing us personally her deformities and her limited range of motion. She made us hear the crepitus on her jaw, touch her fingers with the swan neck deformity, press her ballotable and protruding distal ulna which she taught us to be the so-called “piano key sign”. It was a different learning experience than simply reading about it in Harrison’s. - KC Chua

23. It is very humbling that it is them who, after facing and accepting their disease, are teaching us. - Eunice Co I am thankful that they braved through their conditions and are even willing to share their experiences with us. It takes a lot of courage to go through the very same emotions again just to educate us. They not only helped to hone us into becoming well educated doctors, they also helped us to become compassionate and more understanding of their situations. - Melody Chua

24. It is really good that there are now lots of programs that create awareness for people and also educate us medical students. It is a privilege that this module creates a way in which students may receive a different kind of education through patient partner interaction. - Joyce Chua

25. Moral lessons

26. They never lost hope. I believe they want to make the most out of their lives, and treat the disease as a way of making them stronger. - Lester Chua • From this activity I learned that, Sometimes we complain even with the smallest amount  of pain a mosquito bite can give us, but wait until you experience RA, only then that you'll realize you got a lot of reasons to thank of. - Arnel Co

27. I admire the positive outlook in life this patients have regardless of what they have gone through. - Arnel Co You will be really deceived when you meet the four patient-partners with RA last week. They have this very light aura… It makes you think that they are the most happy and most carefree beings in the world. But behind this impression, you will see a different person—a person in constant battle with the troubles brought about by this disease. • Kaye Chua They never lost hope. I believe they want to make the most out of their lives, and treat the disease as a way of making them stronger. - Lester Chua

28. The best lesson I think that can be learned from Patient Partners is that the disease is not merely a disease, nor is it merely a patient, but the disease and the patient are both elements of a human being – an individual with a story to tell and, if you listen carefully enough, a lesson to leave behind. - Rosalyn Chan

29. She inspired me to always look at the positive things in life. - KC Chua

30. Like the Bees

31. When I heard that the bee represented RA, I began to wonder what is the reason behind this. • Bee’s are hardworkers and with this disease, you really have to have the patience and fortitude to struggle with the everyday stiffness and limited range of motion • Bee’s produces honey which is sweet and nutritious where I found that to be of our patient-partners as they were refreshing and informativeAs I was curious, I went to research and found out that bee venom are used for patients with RA as it has anti-inflammatory effects HOWEVER, this kind of therapy, apitherapy, would involve being stung by a bee and I’ve read that some people would reach up to 80 times can help against RA • I’ve realized that this disease has already have patients resorting to extreme measures which shows how debilitating RA can be. - Greg Co

32. Future doctors

33. Also, the first hand experience of seeing the effects of lack of knowledge especially the effects of improper use of medications is something that I will never forget. With this experience, I will be able to serve future patients that I would encounter by being reminded always that I should take my time to educate RA patient. - Lesley Chua

34. As a future doctor, I must be very observant of all the things happening with the patient. Books are not the best teachers, but the patients themselves. • Mai Cho This activity reminds me that when looking at our RA patient-partners taking on the challenge together with discovering new innovations such as the bottle opener and the device used to button down shirts, everything is possible, just as long as we continue to believe in ourselves and never give up. - Greg Co