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Brewing a different cup of coffee

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One of the top ten Arabica varieties of  coffee in the world, our own Lak Parakum is now being promoted by the Department of Export Agriculture in all Arabica coffee-growing districts in the island. Plants of this variety are distributed among growers through several coffee nurseries in the upcountry. The coffee rust which ended the  island’s coffee romance in British-occupied then  Ceylon is given hope for resurgence with the promotion of the new  variety.

BY RANDIMA ATTYGALLE

History has it that coffee was introduced to Ceylon in 1503 by the Arab traders from Yemen. However, the planting of coffee as a commercial crop in the island commenced with the Dutch occupancy and continued under the British rule. Planter R.B Butler who had experience in coffee plantations in Jamaica came here in 1837 and introduced methods to yield a better coffee crop. By 1863, the value of coffee imported into Europe from all parts of the world amounted to £270 million, and we were exporting nearly a third of that. By 1870, Sri Lanka’s coffee production peaked with over 275,000 hectares being cultivated, according to the Sri Lanka Export Development Board (EDB) data.

The colonial Ceylon was among the top coffee producing and exporting nations and a coffee-drinking culture complete with kopi kaday (coffee kiosks) and kopi kele (coffee forests) evolved. Christine Spittel-Wilson’s famous book The Bitter Berry revolves around the ethos of a Ceylonese coffee plantation.

Sadly, the coffee rust of 1870 (caused by the fungus Hemileia vastatrix) destroyed all plantations bringing the coffee romance of the country to an end. Although rust-tolerant varieties were later introduced, today coffee is an intercrop with tea and coconut. However, Lak Parakum promoted by the Department of Export Agriculture (DEA), encourages planters to expand their coffee acreage.

Sri Lanka’s coffee cultivation covers around 4,600 hectares and the two main commercially important species locally grown are Arabica coffee (Coffea Arabica) and Robusta Coffee (Coffea canephora). These two main species grown here include several varieties. “While Arabica coffee varieties are recommended for mid and up country areas with an altitude of over 400m (Nuwara Eliya, Kandy, Matale and Badulla), Robusta variety is recommended for mid and low country with an altitude of less than 800m( Kegalle, Kurunegala, Kandy and Matale). These

recommendations are made depending on the temperature variation. While Arabica prefers a temperature of 15-28ºC, Robusta thrives in a temperature of 18-36ºC” says Dr. H.M.P.A Subasinghe, Director (Research), Department of Export Agriculture (DEA).

The global specialty coffee market as the EDB notes, is projected to reach over USD 80 billion by 2025 which offers enormous growth potential for coffee producers. In line with this increasing demand, Sri Lanka’s coffee exports have increased in recent years, growing 84 percent from 2017 to reach nearly USD 355,000 by 2019 according to EDB data. The coffee industry as the EDB notes, has attracted increased investment from the private sector and increased local demand and consumption of locally grown coffee in hotels, restaurants and cafes.

More than 80% the world demand is for Arabica coffee and the requirement is 8.8 million mt, says Dr. Subasinghe. Lak Parakum with its quality parameters stands among the best ten Arabica varieties in the world, he adds.

Even after releasing the new variety Lak Parakum, it did not become popular among farmers due to lower prices offered for coffee. But the Director (Research) of the DEA then, Dr. J.M.Seneviratne initiated collaborations with the authorities at the Nuwara Eliya District Secretariat to popularize the new variety among growers in the Nuwara Eliya District. He also worked with Mr. Kenneth McAlpine, a member of the Specialty Coffee Association (SCA) for the global coffee industry to find the quality parameters of Lak Parakum and found that overall score was 85.5 which is way above the cutoff point for the best coffees which is considered to be 75.”

While Lak Parakum is promoted for higher elevations, IMY which is of Robusta variety is also promoted for lower elevations right now. While the domestic coffee consumption is 2,300 mt. our annual production was 2,345 mt. in 2020 according to DEA’s statistics. Our annual export volume was 26.6 mt in 2020. Australia, UAE, USA, Maldives, New Zealand, Chile, UK and Germany are the major buyers of Sri Lankan coffee. The annual coffee import volume was 104.9 mt in 2020.

“Due to immature coffee harvesting and bad processing practices, most importing countries are rejecting our coffee and with the new variety if we can practice timely harvesting and good processing practices, the export potential is very high,” observes Dr. Subasinghe.

Several new measures are now in place to tap a lucrative market for Sri Lankan coffee. Production of planting material with private sector nurseries, awareness programmes for harvesting and processing practices for high quality products, promotion for value addition, introduction of GAP (Good Agricultural Practices) Certification to get premium prices and increasing the coffee extent from 4,600 ha to 5,800 ha and the export volume from 30 mt. to 200 mt by 2025 are among these. Collaborations with the Australian government-funded Market Development Facility for the improvement of the coffee industry are also in place.

Although threats from rust diseases are still prevalent in coffee fields, they can be controlled with good management practices and available control measures, points out Dr. Subasinghe. “Apart from the rust disease, the major pest problem is the coffee berry borer damage. This too can be managed with good crop management practices. While Robusta varieties are highly tolerant for rust, Arabica is medium tolerant.”

Due to the low prices offered for coffee (Rs. 350 to 400 per kilo), many growers had neglected coffee in the last few years, however, currently a kilo of coffee could get Rs. 1,200. “We also offer coffee growers incentives including free planting material, technological assistance for planting, crop management, harvesting, fertilizer application, processing and management of pest and diseases. Subsidies for irrigation facilities and machinery used for post-harvest practices and support for GAP are also offered.”

Managing Director of Kelaneiya & Braemar Estate Maskeliya, Murugiah Balendran, a leading grower of Lak Parakum first experimented with it in 2014. Director (Research) of the DEA then, Dr. J.M.Seneviratne who collected a gene pool from old plants from many areas including Walapane, Ramboda, Galaha and Nilambe offered me mother plants of Lak Parakum and encouraged me to experiment with them,” reflects Balendran who goes onto add that the ‘trial and error’ exercise eventually turned out to be successful. His own estate which was once an exclusive coffee plantation still has coffee trees more than 100 years old.

The senior planter who is now well versed in producing seed stock of Lak Parakum has released about 1,500 kg to nurseries since 2018. “Each kilo of seed could produce 2,000 to 3,000 plants, so a sizeable amount of plants have been generated todate.” Balendran has dedicated four hectares of land to coffee alone today and urge fellow coffee growers to move away from the ‘intercrop mindset’ and allocate more fertile land for the crop. “Many growers plant coffee in vacant land space where largely tea had been removed. However, unless the soil quality is improved, planting coffee in vacant tea and coconut estates won’t do.”

Balendran who also grows several other varieties of coffee including a few Indian ones remarks that there is a notable difference between those and Lak Parakum in terms of the yield, resistance to disease and the texture of beans. “However it will take us another four to five years to show the true potential of it.”

Lack of fertilizer has taken a notable toll on the crop, laments the planter. “At the time of blooming and berries start setting, we need to give some fertilizer. But unfortunately last year our crop was very poor and didn’t match our expectations. Even the seed delivery to DEA and other agents got curtailed to a large extent. Moreover, although I have been supplying coffee seed material from 2018, I have so far not received any significant assistance from any government agency,” remarks Balendran who moots an effective result-oriented incentive scheme for coffee growers.

Photo credit: Murugiah
Balendran, Royal Commonwealth
Society, W.L.H. Skeen & Co.



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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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