Dr. Bernard Lee on Rheumatoid Arthritis, As Featured on FM97.2《最爱粉TASTIC》

When Joint Pain Is More Than Just Getting Old

Most people assume that aching, swollen joints are a sign of ageing. Something that comes with the territory after fifty. Something you manage with rest, paracetamol, and the occasional hot pack.

But some joint conditions have nothing to do with age. They are not caused by wear and tear. They are driven by the immune system. Without the right diagnosis, they can go undetected for years.

Rheumatoid arthritis is one of them. And it affects people in their thirties and forties just as readily as it affects the elderly.

The FM97.2 Feature

FM97.2, Singapore’s leading Mandarin-language radio station, invited Dr. Bernard Lee Mun Kam to appear on 《最爱粉TASTIC》(The Fentastic Show) as part of its 医疗大小事 (Medical Matters) segment, a recurring feature dedicated to health education for the public. The segment was hosted by DJ 粉樱.

Dr. Bernard Lee Mun Kam (李文鉴医生) is the Founder and CEO of Singapore Paincare Holdings Limited and a Consultant Pain Specialist at Singapore Paincare Center. He was invited to explain the difference between rheumatoid arthritis and ordinary degenerative joint disease. It is a distinction that matters greatly for patients who may be receiving the wrong treatment.

His appearance on 《最爱粉TASTIC》with DJ 粉樱 reflects the trust that Singapore’s Chinese-language media places in Dr. Lee as a credible voice on pain conditions affecting the community.

What Dr. Bernard Lee Discussed

Rheumatoid Arthritis Is Not the Same as Wear-and-Tear

Dr. Lee opened by drawing a clear line between two conditions that are often confused.

Degenerative arthritis (the kind most people are familiar with) typically develops in the fifties or sixties. It is caused by physical wear: cartilage breaking down, meniscus tearing, joints losing their cushioning over time. It is mechanical in origin.

Rheumatoid arthritis is something else entirely. It is an autoimmune disorder. The immune system, instead of protecting the body, becomes hypersensitive and begins to attack the body’s own joints, treating them as foreign tissue. This triggers acute inflammation, swelling, and if left unmanaged, structural destruction.

This distinction is not academic. The treatment pathways are completely different. Getting the diagnosis wrong means treating the wrong disease.

Why Rheumatoid Arthritis Spreads Beyond the Joints

One of the points Dr. Lee emphasised was that rheumatoid arthritis is a systemic condition. It does not stay confined to one joint.

Because it is immune-driven, the inflammation can affect blood vessels, the eyes, and the skin, not just cartilage. Patients sometimes present with what seems like unrelated symptoms, and the connection to their joint pain is not immediately obvious.

Understanding this systemic dimension is part of why specialist involvement matters. A pain specialist experienced in inflammatory conditions looks beyond the joint itself.

Who Gets Rheumatoid Arthritis and When

Dr. Lee addressed one of the most common misconceptions about rheumatoid arthritis: that it is a disease of the elderly.

It is not.

Rheumatoid arthritis can affect women in their thirties and forties. It is not tied to menopause or old age. The current evidence suggests that women are approximately twice as likely to develop the condition as men. Researchers believe this is linked to the influence of oestrogen on immune regulation.

For many women in Singapore, the thought of a serious autoimmune joint condition may not occur to them when their knees or fingers begin to hurt. Dr. Lee’s point here is important: age is not a reliable way to rule out rheumatoid arthritis.

Why Symptoms Alone Cannot Tell You If You Have RA

Before listing symptoms, Dr. Lee made a point that shapes everything else. The symptoms patients associate with rheumatoid arthritis are largely the same symptoms that appear in TCM wind-damp rheumatism (风湿病) and other general joint conditions.

In Traditional Chinese Medicine, rheumatism refers to joint aching and stiffness triggered by cold, rain, and damp weather. It is an externally driven condition. Clinical rheumatoid arthritis, by contrast, is internally driven, triggered by the body’s own immune system attacking its own joints. The character “类” (lèi) in the Chinese clinical term 类风湿关节炎 is significant. It means “resembling rheumatism, but classified specifically.” It is not the same condition.

The problem, as Dr. Lee explained it, is that the surface symptoms overlap heavily. A patient who describes morning joint stiffness and aching in humid weather is describing something that fits both TCM rheumatism and early RA. Most patients who eventually receive an RA diagnosis first present thinking they have ordinary joint pain.

Dr. Lee walked through four symptom patterns that commonly bring patients in, and was deliberate about which ones point toward RA and which ones do not.

Morning stiffness: common to both conditions, not specific to RA. Patients wake up with joints that feel extremely tight, including the knees, fingers, and shoulders. Some cannot make a fist or open their palm. Dr. Lee placed this squarely in the TCM rheumatism presentation. Stiffness alone, without swelling, does not distinguish RA from general joint conditions. A patient with this symptom alone is still in the rheumatism category, not yet pointing to RA.

Pain plus swelling together: the picture begins to shift. Pain alone is also not specific to RA. What changes the clinical picture is when joint pain comes with visible swelling. A joint that is painful, tight, and swollen, and sometimes red and warm to the touch, is showing signs of active inflammation. Dr. Lee noted this combination is more suggestive of RA than pain or stiffness alone. But even then, other inflammatory joint conditions can look identical at this stage.

Weather sensitivity: present in RA, but not caused by the weather. Joints that ache and tighten before rain or in humid conditions are a common complaint across many joint conditions. RA patients do genuinely experience this. The reason is not that weather causes the condition. Changes in barometric pressure and humidity can aggravate already-inflamed synovial tissue, triggering a flare. The root cause remains the immune dysfunction. Weather is a trigger, not the driver. Because many joint conditions share the same response to humidity, weather sensitivity on its own cannot distinguish RA from TCM rheumatism or anything else.

Nighttime pain that disrupts sleep: the pattern that leans most toward RA. Joints at rest should not be a source of significant pain. When pain is bad enough at night to prevent sleep, when the joint is doing nothing and should be quiet, that is the pattern Dr. Lee specifically flagged as more characteristic of RA. Nocturnal joint pain that breaks rest is not typical of ordinary wind-damp rheumatism. This is the symptom that, when present, most clearly shifts the suspicion toward rheumatoid arthritis.

Dr. Lee was honest about what this means overall. Symptoms alone cannot reliably identify RA. The presentations overlap too much. Every patient with joint pain believes they have some form of arthritis, and they may be right. But which kind requires proper clinical investigation. That is his argument for not self-diagnosing and not accepting or refusing treatment based on symptoms alone.

How Rheumatoid Arthritis Is Diagnosed

Diagnosis relies primarily on blood tests, though Dr. Lee noted that the picture is not always straightforward.

Inflammatory markers (CRP, or C-Reactive Protein, and ESR, or Erythrocyte Sedimentation Rate) indicate whether active inflammation is present in the body. More specific tests look for Rheumatoid Factor (RF) and anti-CCP antibodies, which are associated with rheumatoid arthritis in particular. When the immune system begins attacking the joints, it releases specific antibodies into the bloodstream, and these are what the blood tests detect.

There is an important exception. Approximately 10 to 15% of patients with rheumatoid arthritis will have normal blood results despite showing significant clinical symptoms. This is known as seronegative RA. In these cases, joint swelling, visible deformity, and imaging findings on X-ray, CT, or MRI become the basis for diagnosis, particularly when a relatively young patient presents with joint damage that cannot be explained by degenerative wear. Relying on blood tests alone risks missing this group entirely.

Treatment and Why Getting the Diagnosis Right Is the Critical Step

Dr. Lee was emphatic on air: the diagnosis is not just a step before treatment begins. It is the most important decision in the entire process, because the treatment carries real consequences.

Steroids (corticosteroids) are typically used first to suppress the overactive immune response and bring inflammation under control. They are effective, but long-term or high-dose steroid use carries its own risks and cannot be sustained indefinitely. In more severe cases, cytotoxic medications (agents similar in mechanism to those used in chemotherapy) may be used to prevent the immune system from continuing to attack the joints. These suppress immune function broadly. Patients on these medications may become more susceptible to infections and illness, because the system that keeps them well is the same one being suppressed.

This is not a trivial commitment. It is why Dr. Lee returned, at the close of the segment, to a point he considers fundamental: not every joint pain is rheumatoid arthritis. Some patients who present with joint swelling and pain may have a condition that can be resolved with a single targeted injection. Putting those patients on long-term immunosuppressive therapy would be unnecessary and potentially harmful.

The outlook for true RA is one of long-term management rather than cure. Approximately 90% of patients will need ongoing medication and specialist monitoring to keep the condition under control. Good control is itself the goal, and even that is not always straightforward to achieve. Dr. Lee compared it to managing high blood pressure: the medication is ongoing, the condition does not disappear, but with the right treatment it can be lived with well.

The right treatment, however, starts with the right diagnosis.

About Dr. Bernard Lee Mun Kam (李文鉴医生)

Dr. Bernard Lee Mun Kam is a Consultant Pain Specialist with over 20 years of clinical experience in pain management.

He founded the Chronic and Interventional Pain Management Service at Tan Tock Seng Hospital in 2002, serving as Director of the Pain Management Unit within the Department of Anaesthesia until 2007. He subsequently established Singapore’s first Women’s Pain Centre at KK Women’s and Children’s Hospital, where he practised from 2009 to 2018.

Dr. Lee is the Founder and CEO of Singapore Paincare Holdings Limited, the first pain management group to be publicly listed on the Singapore Exchange (SGX) in 2020. Singapore Paincare operates clinics island-wide under an integrated care model that brings together pain specialist consultations, minimally invasive procedures, physiotherapy, TCM, and cognitive behavioural therapy.

He developed the Painostic® diagnostic methodology, a registered trademark and the clinical foundation of Singapore Paincare’s approach to root-cause pain diagnosis and personalised treatment planning.

His specialties include joint pain, nerve pain, spinal conditions, musculoskeletal pain, and headache and facial pain. Rheumatoid arthritis falls within the joint pain conditions managed at Singapore Paincare Center.

Frequently Asked Questions About Rheumatoid Arthritis

Is TCM rheumatism the same as rheumatoid arthritis?

No. In Traditional Chinese Medicine, rheumatism (風師病) refers to joint pain triggered by cold, rain, or damp weather. It is an externally driven condition. Rheumatoid arthritis is an autoimmune condition triggered internally by the immune system attacking the body’s own joints. The symptoms can look similar, but the cause and treatment are completely different.

What is the difference between rheumatoid arthritis and osteoarthritis?

Osteoarthritis is caused by physical wear and tear on joints, typically developing in the fifties or later. Rheumatoid arthritis is an autoimmune condition where the immune system attacks the joints. They have different causes, different symptoms, and require completely different treatment approaches.

Can rheumatoid arthritis affect young women in Singapore?

Yes. Rheumatoid arthritis is not limited to older adults. It commonly affects women in their thirties and forties and is approximately twice as common in women as in men. Hormonal factors, particularly the influence of oestrogen on the immune system, are thought to contribute to this pattern.

What are the early warning signs of rheumatoid arthritis?

Most joint symptoms, including morning stiffness, weather-related aching, and general joint pain, are shared across many conditions and cannot confirm RA on their own. The symptom that most specifically points toward RA is nighttime joint pain severe enough to disrupt sleep, when the joints should be at rest and quiet. Pain combined with visible swelling also raises suspicion. Blood tests and clinical assessment are the only reliable way to confirm RA.

Can blood tests always detect rheumatoid arthritis?

Not always. Around 10 to 15% of rheumatoid arthritis cases are seronegative, meaning blood markers like Rheumatoid Factor and anti-CCP antibodies come back normal despite the condition being present. Clinical symptoms, physical examination, and imaging are used alongside blood tests to reach a diagnosis.

Is rheumatoid arthritis curable?

Rheumatoid arthritis is generally a chronic condition. Most patients, around 90%, will manage the disease long-term through medication and specialist oversight rather than achieving a complete cure. The aim of treatment is to control inflammation, protect joint function, and maintain quality of life.

Should I see a pain specialist for rheumatoid arthritis in Singapore?

A specialist assessment is important because not all joint pain and swelling is rheumatoid arthritis. Some conditions that look similar may be managed with a targeted procedure rather than long-term medication. Getting an accurate diagnosis before starting treatment is essential, given the side effects that some RA medications carry.

This article is intended for general informational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for diagnosis and treatment tailored to your individual condition.