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The Best of Malkoha celebrates half a century of Sri Lankan ornithological writings

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Distinguished gathering

By Ifham Nizam

The launch of The Best of Malkoha: Half a Century of Ornithological Writings marked a significant milestone in Sri Lanka’s birdwatching and conservation history, as the Field Ornithology Group of Sri Lanka (FOGSL) celebrated its Golden Jubilee at the Faculty of Science, University of Colombo.

The book, drawn from five decades of writings published in Malkoha, the FOGSL newsletter, brings together a rich record of observations, discoveries and experiences that helped shape modern field ornithology in Sri Lanka.

The launch formed part of FOGSL’s first-ever Founders’ Day, held on August 22, a date chosen to coincide with the 76th birthday of Vidyajothi Emeritus Professor Sarath Kotagama, one of the Organisation’s founding figures and its enduring source of inspiration.

The occasion brought together academics, conservationists, naturalists, birdwatchers, students, young birders and members of FOGSL, reflecting the broad community that the organisation has cultivated since its establishment in 1976.

Section of the invitees

Biodiversity expert Dr. Rohan Pethiyagoda, delivering the Golden Jubilee Founders’ Day Oration, used the occasion to reflect on five decades of biodiversity research and conservation in Sri Lanka, while paying tribute to Professor Kotagama and the role played by FOGSL in taking birdwatching beyond a small circle of specialists.

Pethiyagoda said the organisation’s greatest achievement had been its ability to make knowledge of birds and nature accessible to ordinary people.

He recalled how, in the early 1990s, Professor Kotagama had proposed producing an affordable field guide so that birdwatching would no longer be restricted by the high cost of existing publications.

That resulted in the publication of A Field Guide to the Birds of Sri Lanka in 1994, which Pethiyagoda published and which subsequently became a bestseller.

The collaboration later produced Sri Lanka Kurulu in Sinhala, making serious bird identification and knowledge available to an even wider audience.

Pethiyagoda recalled a particularly emotional encounter that demonstrated the lasting impact of that work.

During a recent visit to Talangama to accompany Australian birdwatchers, he encountered two boys, aged around 12 and 14, carrying a battered copy of Sri Lanka Kurulu and using it to identify birds.

“I just started crying,” Pethiyagoda said, describing the moment as evidence of how knowledge had been passed from one generation to another.

He said the achievements of the past 50 years should not be underestimated. Sri Lanka has witnessed major advances in health, education, infrastructure and conservation, while the country’s protected-area network has expanded considerably.

At the same time, however, he warned that biodiversity research and conservation continue to face serious institutional challenges.

Pethiyagoda pointed to habitat fragmentation, climate change, inadequate scientific research and restrictions on field research as major challenges facing the next generation of conservationists.

He said climate change would increasingly force species to move towards cooler, higher elevations, but fragmented habitats could prevent them from making such movements.

“Our challenge now is to connect up those little fragments so that plants and animals can migrate across these landscapes,” he said, stressing the importance of restoring ecological connectivity.

He also called for greater investment in ex-situ conservation for species facing extinction and urged the establishment of conservation facilities across Sri Lanka’s different climatic zones.

Pethiyagoda placed particular emphasis on citizen science, arguing that Sri Lanka possessed an enormous reservoir of public enthusiasm for biodiversity.

He noted that more than 20,000 Sri Lankans were now involved in citizen science through platforms such as iNaturalist, with Sri Lankan users generating significant biodiversity data.

“The appetite for science, the appetite for conservation, for exploration, for discovery is there in the people,” he said.

Pethiyagoda also paid an emotional tribute to Professor Kotagama, describing him as the constant force behind much of Sri Lanka’s modern conservation movement.

“In future generations, we will talk of conservation in this country as before Kotagama and after Kotagama,” he said.

He also acknowledged Professor Kotagama’s wife, Namali, for being the “bedrock” of his household and for supporting his decades-long contribution to conservation.

The Golden Jubilee celebrations also looked back at the origins of FOGSL.

The Organisation was founded on October 10, 1976, when four passionate bird enthusiasts—the late P. B. Karunaratne, Professor S.U.K. Ekaratne, Professor Sarath Kotagama and Rex I De Silva —came together with a shared objective of making birdwatching accessible beyond the relatively exclusive group that had traditionally dominated the field.

FOGSL was subsequently formally recognised by the University of Colombo and developed as a platform bringing together birdwatchers, researchers, students, educators and nature enthusiasts.

Its philosophy was simple: one did not need an academic qualification to become a member. Enthusiasm, careful observation, recording and sharing knowledge were enough.

That principle continues to define the Organisation.

FOGSL has since become Sri Lanka’s BirdLife International partner and has played an important role in bird research, conservation, environmental education, field studies, school programmes and citizen science.

Its work has extended from research on endemic birds and migratory species to biodiversity monitoring, conservation education and programmes aimed at children and young people.

Speaking at the event, FOGSL President Professor Nihal Dayawansa said the organisation’s founding vision remained relevant even after half a century.

The Organisation, he noted, was created not simply as a birdwatching club but as a platform through which people could study and conserve Sri Lanka’s birds while inspiring the wider public to appreciate nature.

The Founders’ Day itself was described as an opportunity to honour those who established and shaped the Organisation while celebrating the contribution of generations of members.

Professor Mayuri Wijeyasinghe, Head of the Department of Zoology and Environmental Sciences, said FOGSL had given ornithology a new meaning in Sri Lanka by taking birdwatching beyond an elite community and making it accessible to ordinary people and schoolchildren.

She noted that Sri Lanka, as a tropical island with a remarkable diversity of birds and a high level of endemism, had a special responsibility to understand and conserve its avifauna.

The Dean of the Faculty of Science, Professor I.M.K. Fernando, meanwhile, said that although his own field was physics, he recognised the common foundation shared by all branches of science—curiosity.

He congratulated FOGSL on reaching 50 years and praised its contribution to research, education, student development, wetland conservation, public awareness and science-based advice on development projects.

“The work goes far beyond publishing,” he said, noting the Organisation’s lectures, school programmes, research projects and conservation initiatives.

He also paid tribute to Professor Kotagama, describing him as a legend whose influence had extended well beyond ornithology.

Professor Kotagama, speaking after receiving tributes from colleagues and friends, said the Organisation’s foundations had been laid with a belief that people could make a difference.

He stressed the importance of taking decisions based on scientific knowledge and criticised excessive bureaucratic barriers that, in his view, prevented scientists from carrying out important field research.

Reflecting on his own period as Director of Wildlife Conservation, he said he had sought to transform the Department into a scientific institution.

“For me and for us who were working in the Mahaweli environment programme at that time, we knew that if not for science, you cannot go forward in conservation,”

Professor Kotagama said, stressing that conservation required both natural and social sciences.

He recalled the challenges faced by the Department, including inadequate staffing structures and poor career progression for wildlife officers, and said efforts had been made to introduce a more professional and scientifically grounded system.

The 50-year journey of FOGSL is closely intertwined with the development of modern field ornithology in Sri Lanka.

From the early days when birdwatching was largely confined to a small group of specialists, the Organisation helped create a culture in which students, schoolchildren, amateur birdwatchers and citizen scientists could contribute to the understanding of the country’s biodiversity.

The launch of The Best of Malkoha, therefore, served as more than the unveiling of another publication. It was a record of that transformation.

The writings collected in the volume represent five decades of observations and experiences, documenting how Sri Lankan field ornithology evolved through the work of generations of birdwatchers, researchers and conservationists.

As theOorganisation enters its next half century, the message emerging from the Golden Jubilee celebrations was clear: the future of conservation will depend not only on institutions and scientists but also on an informed and empowered public.

FOGSL’s enduring motto—”Once a member, always a member”—perhaps best captures that legacy: a lifelong connection with birds, nature, scientific observation and the responsibility to protect Sri Lanka’s extraordinary natural heritage.



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When disaster strikes, dignity cannot wait

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Cyclone Ditwah disaster

…UNFPA emergency package puts women, mothers, girls and older persons at the heart of Sri Lanka’s disaster preparedness

By Ifham Nizam

When the rain comes down in Sri Lanka, it can change the landscape in a matter of hours.

A quiet stream can become a torrent, a familiar road can disappear beneath water and a hillside can suddenly give way. But amid the drama of floods and landslides, there are quieter emergencies that rarely make the headlines.

There is the pregnant woman wondering how she will reach a hospital.

There is the mother trying to care for a newborn in an overcrowded evacuation centre.

There is the young girl who needs something as ordinary as menstrual hygiene supplies but has been forced to leave home with little more than the clothes she is wearing.

And there is the elderly woman who has lost the familiarity, privacy and comfort of her home overnight.

For them, a disaster is not only about water, mud, damaged houses or blocked roads.

It is about what happens to healthcare, safety and dignity when normal life suddenly disappears.

That is why a new initiative by the United Nations Population Fund (UNFPA) has placed the needs of women and girls firmly on Sri Lanka’s disaster preparedness map.

UNFPA has handed over emergency supplies worth USD 250,641 to the Ministry of Health, with the support of the Governments of Australia and New Zealand, in an effort to ensure that essential maternal healthcare, hygiene and protection services can continue when disaster strikes.

The supplies are not destined to sit forgotten in a warehouse until the next emergency.

They will be strategically pre-positioned in districts vulnerable to disasters, allowing frontline health workers to reach communities quickly when roads are blocked, transport disrupted and conventional supply chains are struggling to move.

The package includes eight high-performance tents, three of them equipped with solar-powered lighting systems, 999 Midwifery Go-Bags, 1,283 Maternity Kits, 246 Elderly Kits and 1,659 Dignity Kits.

On paper, they may look like numbers in a humanitarian inventory.

Dignitaries

On the ground, they could mean something much more personal.

A safe place for a mother.

A medical bag in the hands of a midwife.

A clean delivery.

A newborn receiving proper care.

A young girl able to manage her period with dignity.

An older woman receiving basic support at a time when almost everything around her has become unfamiliar.

The official handover at the Family Health Bureau in Colombo brought together Health Minister Dr. Nalinda Jayatissa, New Zealand High Commissioner David Pine, Australian Deputy High Commissioner Ruth Baird, Health Ministry Secretary Dr. Anil Jasinghe, Deputy Director-General of Health Services Dr. Vindya Kumarapeli, Family Health Bureau Director Dr. Chandima Sirithunga, UNFPA Representative a.i. in Sri Lanka Phuntsho Wangyel and representatives of the Disaster Management Centre.

But the real story is not the ceremony.

It is what happens after the ceremony.

Because disaster preparedness is ultimately tested not in a conference hall, but in a village cut off by floodwater, a temporary shelter filled with displaced families or a road made impassable by a landslide.

A tent that is more than a tent

Among the most visible elements of the package are the eight high-performance tents.

Three have solar-powered lighting systems and are designed as Emergency Safe Spaces for Maternal and Women’s Care.

At first glance, a tent may sound like a simple solution.

But in an emergency, a safe, functional space can become extraordinarily valuable.

These are intended to provide temporary environments where women, pregnant women and mothers can access essential maternal care, protection, referrals, psychosocial support and livelihood assistance.

In the middle of a disaster, privacy can become one of the first casualties.

Families may be sleeping side by side in schools, community buildings or temporary shelters. Familiar boundaries disappear.

Electricity may fail. Toilets may be overcrowded. Women and girls can suddenly find themselves negotiating everyday needs in circumstances that are anything but ordinary.

A properly equipped emergency space can therefore offer more than shelter.

It can offer a little normality.

And the solar lighting is particularly practical.

When electricity disappears after a flood or landslide, darkness brings another layer of vulnerability. A lighted humanitarian space can make a significant difference to women seeking care or assistance after sunset.

Sometimes resilience is built with sophisticated technology.

Sometimes it begins with a light in a dark place.

Taking healthcare on the road

Then come the 999 Midwifery Go-Bags.

The concept is wonderfully simple: rather than expecting healthcare always to be waiting behind the doors of a functioning hospital, give frontline health workers the tools to take care to the community.

Sri Lanka’s Public Health Midwives are deeply embedded in the country’s maternal and child health system. During normal times, they are familiar faces in communities, providing care, guidance and support.

During an emergency, that community connection becomes even more valuable.

If a road is flooded, a bridge damaged or a health facility temporarily inaccessible, a midwife with the necessary equipment can become an important link between a vulnerable mother and the health system.

The Go-Bags provide portable essential medical tools to help midwives continue delivering life-saving maternal care.

The philosophy is straightforward.

Healthcare should not stop simply because the road has.

A safe beginning

The package also contains 1,283 Maternity Kits with essential care items for safe delivery and newborn health.

For most mothers, childbirth is surrounded by preparation—the hospital bag, clean clothes, family support, medical advice and the anticipation of welcoming a new life.

A disaster can strip away much of that preparation.

A mother may find herself far from her home, surrounded by strangers and uncertain about where the next meal or medical consultation will come from.

A maternity kit cannot replace the comfort of home.

But it can ensure that some of the essential requirements for a safe delivery and newborn care are available when circumstances are at their most difficult.

And sometimes, having the right things at the right time can make all the difference.

The quiet importance of dignity

Perhaps the most revealing name in the package is the Dignity Kit.

There are 1,659 of them.

The contents may be modest compared with the scale of a flood or landslide, but their purpose is deeply human.

Disasters tend to reduce people to statistics: the number displaced, the number of houses damaged, the number of roads blocked.

But behind every statistic is a person with ordinary needs.

Women and girls do not stop menstruating because their homes have been flooded.

They still need hygiene products.

They still need privacy.

They still need to feel clean and safe.

For someone living temporarily in a crowded evacuation centre, access to basic personal hygiene supplies can restore a small but meaningful sense of control.

The same principle applies to the 246 Elderly Kits, designed around the specific hygiene and mobility needs of older women.

Older people can face particular difficulties during displacement.

A familiar home may be gone, movement may be restricted and simple routines may become complicated.

Humanitarian response, therefore, cannot be one-size-fits-all.

Different people experience the same disaster differently.

Preparing before the water rises

One of the most important aspects of the UNFPA initiative is that the supplies will be pre-positioned.

That word may sound bureaucratic.

In reality, it is about time.

During an emergency, every hour matters.

A bridge may be washed away. A road may be buried. A lorry carrying relief supplies may be unable to reach its destination. Communications may be disrupted and local authorities may be overwhelmed by multiple demands.

If essential humanitarian supplies are already closer to vulnerable communities, frontline responders do not have to begin from zero.

The equipment is there.

The supplies are there.

The response can begin.

Minister of Health and Mass Media Dr. Nalinda Jayatissa said building a resilient health sector required strong and proactive measures before disasters strike.

He said the partnership with UNFPA and the Governments of Australia and New Zealand had strengthened local healthcare capacity, helping ensure that maternal and child healthcare and protection services could remain uninterrupted even during severe emergencies.

New Zealand High Commissioner David Pine also stressed foresight and coordination in disaster management.

New Zealand’s support, he said, reflected a commitment to helping Sri Lanka build inclusive resilience and protect vulnerable groups, including pregnant women, older persons and young girls during displacement.

Australian Deputy High Commissioner Ruth Baird highlighted the importance of disaster response systems that are comprehensive and inclusive.

“Protecting the safety and dignity of women and girls during crises is essential to community recovery,” she said, emphasising the value of pre-positioning targeted humanitarian supplies.

For UNFPA Representative a.i. in Sri Lanka Phuntsho Wangyel, the principle is particularly clear.

“In times of crisis, sexual and reproductive healthcare needs do not stop, nor does our social responsibility to keep women and girls safe,” he said.

It is a simple truth worth remembering.

Nature does not suspend pregnancy.

It does not postpone childbirth.

It does not stop menstruation.

It does not remove the need for healthcare because a community has been forced to evacuate.

The human body does not wait for the floodwaters to recede.

Beyond the statistics

Sri Lanka has become accustomed to measuring disasters through numbers.

How many people were displaced?

How many houses were damaged?

How many roads were blocked?

How much rain fell?

How many districts were affected?

Those numbers are essential for planning.

But they cannot tell the whole story.

A statistic cannot tell us about a mother holding her baby in an overcrowded shelter.

It cannot describe the anxiety of a woman wondering whether she will receive medical assistance.

It cannot capture the embarrassment of a young girl who suddenly has no access to basic menstrual hygiene products.

Nor can it tell us what it means for an elderly woman to lose the routines that gave her independence.

This is where the idea of dignity becomes important.

Disaster response is not simply about keeping people alive.

It is also about helping them remain human in circumstances that can make them feel powerless.

That is the thinking behind the UNFPA intervention.

The tents, Go-Bags, maternity supplies, elderly kits and dignity kits are practical tools. But together they represent something larger: an attempt to ensure that women’s health and dignity are built into disaster planning from the beginning.

The real test

Sri Lanka cannot prevent every flood.

It cannot stop every landslide.

It cannot control every extreme weather event.

But it can prepare for what comes next.

It can strengthen early warning systems.

It can train frontline responders.

It can position supplies closer to vulnerable communities.

And it can recognise that women and girls have specific needs that cannot be left to chance.

The real test of disaster preparedness is therefore not simply whether people can be evacuated.

It is what happens after they are evacuated.

Can a pregnant woman find a midwife?

Can she receive safe maternal care?

Can a newborn receive the attention it needs?

Can a young girl manage menstruation with privacy and dignity?

Can an older woman receive the hygiene and mobility support she requires?

Can women find a safe place if they face violence or psychological distress?

These questions belong at the heart of Sri Lanka’s emergency planning.

Because when the waters rise, the road disappears and the lights go out, dignity can become surprisingly fragile.

Yet it can also be protected through remarkably practical measures.

A tent.

A medical bag.

A maternity kit.

A packet of hygiene supplies.

A trained midwife who knows where to go.

A light shining in an otherwise dark shelter.

These may seem like small things against the enormous force of a flood or landslide.

But disasters are lived one person at a time.

And for a woman standing in the middle of one, a small thing can sometimes mean everything.

Sri Lanka’s resilience will ultimately be measured not only by how quickly it rebuilds roads and bridges, but by how carefully it protects the people who are most vulnerable while those roads and bridges are being rebuilt.

When disaster strikes, homes can be rebuilt.

Roads can be repaired.

Bridges can rise again.

But the promise of emergency preparedness should be even more fundamental:

No woman should have to sacrifice her health, safety or dignity simply because disaster has taken away her home.

That is a promise worth preparing for—before the next rain begins.

 

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Vietnamese culinary magic at Sheraton

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Symbolic lighting of the traditional lamp sets the evening aglow

By Zanita Careem

The vibrant flavours and rich cultural spirit of VietNam came alive at the Sheraton Colombo, where a special Vietnamese food festival ” Soul of Vietnam” brought together diplomats, invitees and food enthusiasts for an evening celebrating the country’s much loved cuisine and tradition.

The event was marked by lively Vietnamese entertainment, adding colour and energy to the occasion, as guests enjoyed an authentic culinary journey through VietNam. The Vietnamese cuisine known for its balance of fresh aromatic herbs, subtle spices and contrasting textures were undoubtedly, the highlights of the evening.

From the fragrant flavours of central VietNam, the menu offered a delicious glimpse into the country’s diverse culinary heritage.

The evening also celebrated VietNam beyond its cuisine. A special coffee experience “Sips of Coffee “introduced guests to the country’s distinction coffee culture. While Vietnamese cultural performances, traditional instruments and calligrpahy added colour and character to the occasion.

The chefs behind the unforgettable journey

The presence of the Vietnamese Ambassador Trinh Thi Tam and Embassy representation gave the evening a warm and convivial atmosphere.

The rich aroma of freshly prepared Vietnamese coffee added another sensory dimension to the festival. Sips of VietNam Coffee – a wonderful celebration of Vietnamese coffee – was showcased at the festival, reflecting the culture and friendship which are part Vietnamese ethos. For Vietnamese people, coffee is much more than a beverage. It is a way of life, said the Ambassador of VietNam.

From a small cup of (iced milk coffee) on a busy morning, to a quiet cup of (egg coffee) shared with friends, coffee has become part of our daily rhythm – a moment to slow down, to talk, and to connect, she said pointing out that the Vietnamese coffee has its own character: strong, rich, and full of flavour – much like the Vietnamese people ourselves.

Tonight through different cups of Vietnamese coffee, I hope you will discover not only the taste of our coffee, but also a little piece of VietNam – its energy, creativity, warmth and hospitality, pointed out the Ambassador.

With VietNam and Sri Lanka strengthening their direct connectivity, the festival offered guests a glimpse into the culture, traditions and hospitality of a destination becoming increasinghly accessible to Sri Lankan travellers

Warm welcome from the VietNam Ambassador

Adding an aunthentic touch to the festival are the Vietnamese chefs who joined in the culinary team of the Sheraton Hotel to showcase the distinctive flavours and regional diversity of their cuisine.

Glimpse into the rich traditions and cultural charm of VietNam

Sharing his thoughts on the rich culinary heritage of VietNam

This festival Soul of VietNam took diners on an enticing culinary journey through one of Asia’s most celebrated food cultures.

Presented in collaboration with the Embassy of VietNam the festival at Colombo Kitchen brought authentic Vietnamese cuisine to the city from September 11 until today, Sunday September 20.

From fragrant noodles to delicate flavoured spring rolls, tastefully prepared seafoods, meats, fresh herbs and traditional accompaniments in the buffet showcased the diversity and freshness that made VietNam cuisine appealing.

Dr. Hiniduma Sunil Seneviratne, Miniser of Buddhasasana, Religious and Cultural Affairs, K. A. Vimalentirarajah, Secretary of Trade Commerce, Food Security and Cooperative Development, were also present among, many other invitees.

Adding a touch of elegance to the occasion was the Vietnamese Ambassador Trinh Thi Tam, in a traditional Vietnamese dress that brought the colours, grace and cultural richness of VietNam to the celebrations Her striking traditional attire was a beautiful reflection of Vietnamese heritage, perfectly complementing the evening filled with authentic cuisine, music and warm hospitality, beautifully reflecting the culture and heritage.

This event, organised for the first time by Sheraton Hotel, was a wonderful celebration of Vietnamese cuisine. The General Manager of Sheraton Hotel, Paul Sun, welcomed the guests to this special culinary showcase, speaking of the hotel’s delight in bringing the distinctive tastes and traditions of VietNam to Colombo His speech set the tone for an evening centred on culture, and the hotel’s pleasure in bringing the authentic flavours and vibrant culture of VietNam.

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Understanding Spondyloarthritis

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Persistant back pain and stiffness are often dismissed as everyday aches but they can sometimes signal an underlying inflammatory condition. In this interview Dr. Anura Caldera speaks to Zanita Careem about spondyloarthritis, shedding light on the causes, symptoms and the importance of recognising the condition early.

If you follow the health articles, you may recall a recent article published in this newspaper on back pain. There I discussed how back pain could be caused by inflammation of the spine. This is a serious form of arthritis which we call “Spondyloarthritis”. It is a chronic inflammatory disease that can not only affect the spine, peripheral joints muscle attachments but also many other organs, like eyes, skin, heart and digestive tract.

For many people, back pain is something they try to learn to live with. A long day at work, obesity, poor posture, heavy lifting, lack of exercise or simply getting older are often blamed when the back begins to ache. But not all back pains can be blamed on the above.

Diagnosis delay

Dr Aruna Caldera Consultant Rheumatologist MBBS, MD, MRCP (UK), MRCP (Rheumatology

Because its symptoms can resemble more common forms of back pain, Spondyloarthritis may be overlooked for years. Recognising the warning signs is therefore important, because early diagnosis and appropriate treatment can make a significant difference to a person’s quality of life and life expectancy.

Not a single disease

We broadly divide spondyloarthritis into “axial spondyloarthritis”, which primarily affects the spine and the sacroiliac joints connecting the lower spine to the pelvis, and “peripheral spondyloarthritis”, which primarily affects joints and other areas away from the spine.

Axial spondyloarthritis is divided to two categories; radiographic axial spondyloarthritis (structural changes can are visible on X-rays) and non – radiographic spondyloarthritis (structural changes are not visible on x rays though can be detected on MRIs).

When the disease has progressed without treatment over decades, x ray may reveal characteristic features like, bamboo spine, dagger sign, romanus lesions, etc. Early diagnosis and treatment are aimed to arrest the disease before these classical features develop.

Peripheral forms can include psoriatic arthritis, reactive arthritis and arthritis associated with inflammatory bowel disease. No matter the form, the norm in Sri Lanka is almost every patient presents late because patients are misled by quacks.

Characteristic back pain

The most important clues to axial spondyloarthritis, is the pattern of back pain. Mechanical back pains due to other common causes often become worse with activity and may improve with rest. In contrast, inflammatory type back pain in spondyloarthritis can behave in the opposite way. A person may experience pain and stiffness that are particularly troublesome in the morning or during second half of night. The discomfort may improve after waking and moving around rather than after lying down. Pain can also occur around the buttocks and may alternate from one side to the other.

Heel pain may be a sign of spondyloarthritis

Inflammation can affect joints such as the hips and knees and can destroy the joints within a few years to a level which needs replacement. It can also occur at the points where tendons and ligaments attach to bone, a condition known as enthesitis. Heel pain, for example, can sometimes be related to inflammation around the Achilles tendon (achilles tendinitis) or the plantar fascia (plantar fasciitis). Another characteristic symptom is dactylitis, in which an entire finger or toe becomes swollen like a sausage, sometimes producing what is commonly described as a “sausage finger.”

Other organs also involved

The disease may also extend beyond the joints. Some people with spondyloarthritis develop uveitis, an inflammation inside the eye that can cause eye pain, redness, sensitivity to light and blurred vision. It can cause blindness if left untreated. Others may have psoriasis or inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis.

Cannot solely rely on blood tests for diagnosis

Spondyloarthritis has a strong genetic component. One of the best-known genetic markers associated with the disease is HLA-B27. However, having HLA-B27 does not mean that a person definitely has or will develop a spondyloarthritis. Conversely, a person can have spondyloarthritis without carrying the gene.

Similarly, normal inflammatory blood tests such as ESR and CRP do not necessarily rule it out; actually, up to half of patients will have normal ESR and CRP despite having even severe disease. Diagnosis relies on the overall clinical picture rather than on a single blood test.

Timely diagnosis to minimize complications

One of the major challenges surrounding spondyloarthritis is timely diagnosis. Back pain is extremely common. Most people who develop it do not have spondyloarthritis. As a result, persistent pain may initially be attributed to other mechanical causes. Unfortunately, people get mislead because some common local modalities of treatment will “take your pain away leaving the disease active in the body” allowing it to cause complications in the lungs (interstitial lung disease), eyes (uveitis and few other conditions), osteoporosis (spondyloarthritis increases the risk), heart disease (coronary arteries and valves) and kidneys (multimodal).

Specific treatment is essential

Specific treatment can help control inflammation, relieve symptoms, maintain mobility and reduce the impact of the disease. Treatment is individualised because the condition affects people differently. Exercise and physiotherapy are fundamental components of management, particularly for axial disease.

Novel medicines

Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and relieve pain. Depending on the type and severity of disease, patient will be started on disease-modifying medicines or targeted biological therapies. The management has evolved a great deal over the last couple of decades and most novel medicines are available in Sri Lanka.

For someone experiencing chronic pain, the instinct may be to rest as much as possible. But prolonged inactivity can contribute to stiffness and loss of physical function. For people with spondyloarthritis, maintaining appropriate movement and exercise is an important part of long-term care. Exercise programmes should be adapted to the individual’s condition and abilities, particularly during periods of increased disease activity. You will need to see a physiotherapist in person.

Short term pain relief only will not work

The goal is not simply to reduce today’s pain. It is also to preserve the person’s ability to work, exercise, sleep, travel and participate in ordinary daily activities over long term and prevent extra articular complications in other organs.

One of the most difficult aspects of spondyloarthritis can be that the disease is not always obvious to other people. A person may look perfectly healthy while experiencing substantial pain, stiffness and fatigue.

Psychological burden

The psychological burden also should not be overlooked. Living with a chronic inflammatory disease can affect mood, sleep, relationships, employment and social life.

The most important message is that persistent back pain should not always be dismissed as a consequence of age, work or life. Almost all patients I have seen with spondyloarthritis have wasted golden years sticking to unscientific treatments and wasted tons of money. Once complications occur, the preceding damage cannot be undone; therefore, it is, better seek specialist care when the disease is in its infancy.

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