Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Science and Society
  • Published:

An insight into rheumatology in Thailand

Subjects

Abstract

Despite the fact that rheumatic diseases constitute a common health care problem in Thailand, improvements in rheumatology education, research and health care are still required. Low numbers of rheumatologists, their uneven distribution, lack of time to perform both clinical and basic research, lack of patient compliance and restricted access to effective medication comprise some of the barriers that need to be overcome to establish rheumatology education, research and care with a Western-country benchmark. The annual academic activities provided by the Thai Rheumatism Association for rheumatologists, general practitioners, allied health professionals and patients can advance only some forms of education and health care. Better cooperation between the Thai Rheumatism Association, the Royal College of Physicians of Thailand, the Ministry of Public Health and the Thai government is needed to improve rheumatology training, care and research in the country.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. National Statistical Office. National income new series at current market price by type of income: 1990–1992 [online], (2014).

  2. Osiri, M., Maetzel, A. & Tugwell, P. The economic burden of rheumatoid arthritis in a developing nation: results from a one-year prospective cohort study in Thailand. J. Rheumatol. 34, 57–63 (2007).

    PubMed  Google Scholar 

  3. Jitapunkul, S., Kunanusont, C., Phoolcharoen, W., Suriyawongpaisal, P. & Ebrahim, S. Determining public health priorities for an ageing population: the value of a disability survey. Southeast Asian J. Trop. Med. Public Health 34, 929–36 (2003).

    PubMed  Google Scholar 

  4. Chaiamnuay, P., Darmawan, J., Muirden, K. D. & Assawatanabodee, P. Epidemiology of rheumatic disease in rural Thailand: a WHO–ILAR COPCORD study. Community Oriented Programme for the Control of Rheumatic Disease. J. Rheumatol. 25, 1382–1387 (1998).

    CAS  PubMed  Google Scholar 

  5. Davatchi, F. et al. The prevalence of musculoskeletal complaints in a rural area in Iran: a WHO–ILAR COPCORD study (stage 1, rural study) in Iran. Clin. Rheumatol. 28, 1267–1274 (2009).

    Article  PubMed  Google Scholar 

  6. Moghimi, N. et al. WHO–ILAR COPCORD study (stage 1, urban study) in Sanandaj, Iran. Clin. Rheumatol. http://dx.doi.org/10.1007/s10067-013-2430-0.

  7. Ruangjutipopan, S., Kasitanon, N., Louthrenoo, W., Sukitawut, W. & Wichainun, R. Causes of death and poor survival prognostic factors in Thai patients with systemic sclerosis. J. Med. Assoc. Thai. 85, 1204–1209 (2002).

    PubMed  Google Scholar 

  8. Foocharoen, C., Nanagara, R., Kiatchoosakun, S., Suwannaroj, S. & Mahakkanukrauh, A. Prognostic factors of mortality and 2-year survival analysis of systemic sclerosis with pulmonary arterial hypertension in Thailand. Int. J. Rheum. Dis. 14, 282–289 (2011).

    Article  PubMed  Google Scholar 

  9. Netwijitpan, S., Foocharoen, C., Mahakkanukrauh, A., Suwannaroj, S. & Nanagara, R. Indications for hospitalization and in-hospital mortality in Thai systemic sclerosis. Clin. Rheumatol. 32, 361–367 (2013).

    Article  PubMed  Google Scholar 

  10. Louthrenoo, W. et al. Association of HLA-DRB1*15:02 and DRB5*01:02 allele with the susceptibility to systemic sclerosis in Thai patients. Rheumatol. Int. 33, 2069–2077 (2013).

    Article  CAS  PubMed  Google Scholar 

  11. Takeuchi, F. et al. Association of HLA-DR with progressive systemic sclerosis in Japanese. J. Rheumatol. 21, 857–863 (1994).

    CAS  PubMed  Google Scholar 

  12. Kang, S. H. et al. Association of HLA class II genes with systemic sclerosis in Koreans. J. Rheumatol. 28, 1577–1583 (2001).

    CAS  PubMed  Google Scholar 

  13. Loubiere, L. S. et al. HLA allelic variants encoding DR11 in diffuse and limited systemic sclerosis in Caucasian women. Rheumatology (Oxford) 44, 318–322 (2005).

    Article  CAS  Google Scholar 

  14. Gladman, D. D. et al. HLA markers for susceptibility and expression in scleroderma. J. Rheumatol. 32, 1481–1487 (2005).

    CAS  PubMed  Google Scholar 

  15. Louthrenoo, W. et al. Lack of CTGF*-945C/G dimorphism in Thai patients with systemic sclerosis. Open Rheumatol. J. 5, 59–63 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kawaguchi, Y. et al. Association study of a polymorphism of the CTGF gene and susceptibility to systemic sclerosis in the Japanese population. Ann. Rheum. Dis. 68, 1921–1924 (2009).

    Article  CAS  PubMed  Google Scholar 

  17. Fonseca, C. et al. A polymorphism in the CTGF promoter region associated with systemic sclerosis. N. Engl. J. Med. 357, 1210–1220 (2007).

    Article  CAS  PubMed  Google Scholar 

  18. Rueda, B. et al. A large multicentre analysis of CTGF −945 promoter polymorphism does not confirm association with systemic sclerosis susceptibility or phenotype. Ann. Rheum. Dis. 68, 1618–1620 (2009).

    Article  CAS  PubMed  Google Scholar 

  19. Jakes, R. W. et al. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care Res. (Hoboken) 64, 159–168 (2012).

    Article  Google Scholar 

  20. Janwityanuchit, S., Totemchokchyakarn, K., Krachangwongchai, K. & Vatanasuk, M. Infection in systemic lupus erythematosus. J. Med. Assoc. Thai. 76, 542–548 (1993).

    CAS  PubMed  Google Scholar 

  21. Kasitanon, N., Louthrenoo, W., Sukitawut, W. & Vichainun, R. Causes of death and prognostic factors in Thai patients with systemic lupus erythematosus. Asian Pac. J. Allergy Immunol. 20, 85–91 (2002).

    PubMed  Google Scholar 

  22. Foocharoen, C., Nanagara, R., Suwannaroj, S. & Mahakkanukrauh, A. Survival rate among Thai systemic lupus erythematosus patients in the era of aggressive treatment. Int. J. Rheum. Dis. 14, 353–360 (2011).

    Article  PubMed  Google Scholar 

  23. Sirikong, M. et al. Association of HLA-DRB1*1502-DQB1*0501 haplotype with susceptibility to systemic lupus erythematosus in Thais. Tissue Antigens 59, 113–117 (2002).

    Article  CAS  PubMed  Google Scholar 

  24. Louthrenoo, W. et al. The genetic contribution of HLA-DRB5*01:01 to systemic lupus erythematosus in Thailand. Int. J. Immunogenet. 40, 126–130 (2013).

    Article  CAS  PubMed  Google Scholar 

  25. Yang, J. et al. ELF1 is associated with systemic lupus erythematosus in Asian populations. Hum. Mol. Genet. 20, 601–607 (2011).

    Article  CAS  PubMed  Google Scholar 

  26. Yang, W. et al. Genome-wide association study in Asian populations identifies variants in ETS1 and WDFY4 associated with systemic lupus erythematosus. PLoS Genet. 6, e1000841 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yang, W. et al. ITGAM is associated with disease susceptibility and renal nephritis of systemic lupus erythematosus in Hong Kong Chinese and Thai. Hum. Mol. Genet. 18, 2063–2070 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hirankarn, N., Avihingsanon, Y. & Wongpiyabovorn, J. Genetic susceptibility to SLE is associated with TNF-alpha gene polymorphism −863, but not −308 and −238, in Thai population. Int. J. Immunogenet. 34, 425–430 (2007).

    Article  CAS  PubMed  Google Scholar 

  29. Hirankarn, N., Tangwattanachuleeporn, M., Wongpiyabovorn, J., Wongchinsri, J. & Avihingsanon, Y. Association of IL-18 gene polymorphism (−137C) with arthritis manifestations in SLE: combined effect with IFN gamma gene polymorphism (+874A). Clin. Rheumatol. 28, 219–223 (2009).

    Article  PubMed  Google Scholar 

  30. Ittiprasert, W. et al. Complete deficiencies of complement C4A and C4B including 2-bp insertion in codon 1213 are genetic risk factors of systemic lupus erythematosus in Thai populations. J. Autoimmun. 25, 77–84 (2005).

    Article  CAS  PubMed  Google Scholar 

  31. Siriboonrit, U. et al. Association of Fcgamma receptor IIb and IIIb polymorphisms with susceptibility to systemic lupus erythematosus in Thais. Tissue Antigens 61, 374–383 (2003).

    Article  CAS  PubMed  Google Scholar 

  32. Hirankarn, N. et al. The synergistic effect of Fc gamma receptor IIa and interleukin-10 genes on the risk to develop systemic lupus erythematosus in Thai population. Tissue Antigens 68, 399–406 (2006).

    Article  CAS  PubMed  Google Scholar 

  33. Kimkong, I. et al. Association between CTLA-4 polymorphisms and the susceptibility to systemic lupus erythematosus and Graves' disease in Thai population. Asian Pac. J. Allergy Immunol. 29, 229–235 (2011).

    CAS  PubMed  Google Scholar 

  34. Wongpiyabovorn, J. et al. The association of single nucleotide polymorphism within vascular endothelial growth factor gene with systemic lupus erythematosus and lupus nephritis. Int. J. Immunogenet. 38, 63–67 (2011).

    Article  CAS  PubMed  Google Scholar 

  35. Li, R. et al. Association of CD247 with systemic lupus erythematosus in Asian populations. Lupus 21, 75–83 (2012).

    Article  CAS  PubMed  Google Scholar 

  36. Zhang, J. et al. Three SNPs in chromosome 11q23.3 are independently associated with systemic lupus erythematosus in Asians. Hum. Mol. Genet. 23, 524–533 (2014).

    Article  CAS  PubMed  Google Scholar 

  37. Wangkaew, S. et al. Sicca symptoms in Thai patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma: a comparison with age-matched controls and correlation with disease variables. Asian Pac. J. Allergy Immunol. 24, 213–221 (2006).

    PubMed  Google Scholar 

  38. Pimtanothai, N., Kimkong, I., Inwattana, R., Deesomchok, U. & Charoenwongse, P. DRB1*04 subtype in Thai patients with rheumatoid arthritis. J. Med. Assoc. Thai. 85 (Suppl. 1), S366–S370 (2002).

    PubMed  Google Scholar 

  39. Hirankarn, N., Nakkuntod, J., Duangchalermwong, P., Deesomchok, U. & Charoenwongse, P. The association of DRB1*04 share epitope alleles and tumor necrosis factor-alpha gene polymorphism (−863) with susceptibility to rheumatoid arthritis in Thai. Rheumatol. Int. 28, 161–165 (2007).

    Article  CAS  PubMed  Google Scholar 

  40. Louthrenoo, W. & Sukitawut, W. A clinical study of Thai patients with spondyloarthropathy. J. Med. Assoc. Thai. 81, 986–992 (1998).

    CAS  PubMed  Google Scholar 

  41. Deesomchok, U. & Tumrasvin, T. Clinical study of Thai patients with ankylosing spondylitis. Clin. Rheumatol. 4, 76–82 (1985).

    Article  CAS  PubMed  Google Scholar 

  42. López-Larrea, C. et al. HLA-B27 subtypes in Asian patients with ankylosing spondylitis. Evidence for new associations. Tissue Antigens 45, 169–176 (1995).

    Article  PubMed  Google Scholar 

  43. Louthrenoo, W., Kasitanon, N., Sukitawut, W. & Wichainun, R. A clinical study of crystal-proven gouty arthritis in a university hospital. J. Med. Assoc. Thai. 86, 868–875 (2003).

    PubMed  Google Scholar 

  44. Tassaneeyakul, W. et al. Strong association between HLA-B*5801 and allopurinol-induced Stevens–Johnson syndrome and toxic epidermal necrolysis in a Thai population. Pharmacogenet. Genomics 19, 704–709 (2009).

    Article  CAS  PubMed  Google Scholar 

  45. Kuptniratsaikul, V., Tosayanonda, O., Nilganuwong, S. & Thamalikitkul, V. The epidemiology of osteoarthritis of the knee in elderly patients living an urban area of Bangkok. J. Med. Assoc. Thai. 85, 154–161 (2002).

    PubMed  Google Scholar 

  46. Poonpet, T., Honsawek, S., Tammachote, N., Kanitnate, S. & Tammachote, R. ADAMTS14 gene polymorphism associated with knee osteoarthritis in Thai women. Genet. Mol. Res. 12, 5301–5309 (2013).

    Article  CAS  PubMed  Google Scholar 

  47. Tawonsawatruk, T. et al. A genetic association study between growth differentiation factor 5 (GDF 5) polymorphism and knee osteoarthritis in Thai population. J. Orthop. Surg. Res. 6, 47 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  48. Honsawek, S. et al. Association of the IL-6 −174G/C gene polymorphism with knee osteoarthritis in a Thai population. Genet. Mol. Res. 10, 1674–1680 (2011).

    Article  CAS  PubMed  Google Scholar 

  49. Tawonsawatruk, T. et al. Association of estrogen receptor-alpha single-nucleotide polymorphism (codon 594 G A) and Thai patients affected by knee osteoarthritis. J. Med. Assoc. Thai. 92 (Suppl. 6), S45–S50 (2009).

    PubMed  Google Scholar 

  50. Zhan, D., Yuktanandana, P., Anomasiri, W., Tanavalee, A. & Honsawek, S. Association of adiponectin +276G/T polymorphism with knee osteoarthritis. Biomed. Rep. 2, 229–232 (2014).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Honsawek, S. et al. Association of MMP-3 (−1612 5A/6A) polymorphism with knee osteoarthritis in Thai population. Rheumatol. Int. 33, 435–439 (2013).

    Article  CAS  PubMed  Google Scholar 

  52. National Statistical Office. Ministry of Information and Communication Technology [online], (2014).

  53. Soontrapa, S., Bunyaratavej, N., Rojanasthien, S., Kittimanon, N. & Lektrakul, S. Vitamin D status of Thai premenopausal women. J. Med. Assoc. Thai. 92 (Suppl. 5), S17–S20 (2009).

    PubMed  Google Scholar 

  54. Tongboonchoo, C., Tungtrongchitr, A., Phonrat, B., Preutthipan, S. & Tungtrongchitr, R. Association of MTHFR C677T polymorphism with bone mineral density of osteoporosis in postmenopausal Thai women. J. Med. Assoc. Thai. 96, 133–139 (2013).

    PubMed  Google Scholar 

  55. Utennam, D., Tungtrongchitr, A., Phonrat, B., Tungtrongchitr, R. & Preutthipan, S. Association of T869C gene polymorphism of transforming growth factor-beta1 with low protein levels and anthropometric indices in osteopenia/osteoporosis postmenopausal Thai women. Genet. Mol. Res. 11, 87–99 (2012).

    Article  CAS  PubMed  Google Scholar 

  56. Ongphiphadhanakul, B., Chanprasertyothin, S., Saetung, S. & Rajatanavin, R. A specific haplotype in the 3′ end of estrogen-receptor alpha gene is associated with low bone mineral density in premenopausal women and increased risk of postmenopausal osteoporosis. Osteoporos. Int. 16, 1233–1238 (2005).

    Article  CAS  PubMed  Google Scholar 

  57. Chupeerach, C. et al. Association of Thr420Lys polymorphism in DBP gene with fat-soluble vitamins and low radial bone mineral density in postmenopausal Thai women. Biomark. Med. 6, 103–108 (2012).

    Article  CAS  PubMed  Google Scholar 

  58. Weerakulwattana, L., Tirawanchai, N. & Bunyaratavej, N. Analysis of polymorphism of the interleukin-6 gene in Thai subjects with osteoporosis. J. Med. Assoc. Thai. 84 (Suppl. 2), S547–S552 (2001).

    PubMed  Google Scholar 

  59. Songpatanasilp, T. & Chanprasertyothin, S. Effects of differences in polymorphism of gene encoding enzyme faenesyl diphosphate synthase (FDPS), rs2297480, on bone mineral density and biochemical markers of bone turnover in Thai postmenopausal women. J. Med. Assoc. Thai. 94 (Suppl. 5), S38–S46 (2012).

    Google Scholar 

  60. Sukitawut, W., Wichainun, R., Kasitanon, N. & Louthrenoo, W. Use of complementary and alternative medicine in patients with rheumatoid arthritis. Chiang Mai Med. Bull. 42, 105–111 (2003).

    Google Scholar 

  61. Louthrenoo, W. Rheumatic manifestations of human immunodeficiency virus infection. Curr. Opin. Rheumatol. 20, 92–99 (2008).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The views and opinions expressed in this article are the author's and do not reflect those of the author's institution, the Thai Rheumatism Association, the Thai government or any other organization.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Worawit Louthrenoo.

Ethics declarations

Competing interests

The author declares no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Louthrenoo, W. An insight into rheumatology in Thailand. Nat Rev Rheumatol 11, 55–61 (2015). https://doi.org/10.1038/nrrheum.2014.142

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2014.142

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing