Arthritis, an inflammatory disease that causes pain and stiffness in joints can affect one or several joints. Millions of people throughout the world suffer from a severe ailment that limits range of motion and interferes with daily activities. Arthritis may not be preventable, but can be managed better, claim experts.
In a “World Arthritis Day” special interview with Medically Speaking, a panel of experts suggested the efficient ways to manage arthritis better. The panel included: Dr Sanjay Wadhwa, HOD, Physical Medicine Rehabilitation, AIIMS; Dr CS Yadav, Chairman of Orthopaedic Department, Primus Hospital; Dr Uma Kumar, HOD, Rheumatology, AIIMS.
Read more to find out:
What exactly is arthritis ?
Dr Uma Kumar: This is a very basic and very important question. Here I would like to clarify that all joint pains are not arthritis. Arthritis is only when one develops a pain in the joint, swelling around the joint, the joint is red, and when the patient wakes up in the morning or after a long period of inactivity, there is a severe stiffness in the joints that lasts more than 30 minutes. That is the classical definition of arthritis, and arthritis is just one of the symptoms of many types of rheumatological disorders. So it is not like arthritis is a diagnosis, it is just a manifestation and there are two hundred conditions where people can have arthritis.
Take us to the prevalence around arthritis and help us dispel the myth around arthritis.
Dr Sanjay Wadhwa: For the common people it is important to realize that there are 4 main types of arthritis , 1st is Rheumatoid arthritis which Is an implementary type of arthritis; 2nd Osteoarthritis which is a degenerative type of arthritis so called wear and tear process in the joints; Gout arthritis and Spondyloarthritis. Out of these four, osteoarthritis is the most common one and rheumatoid is inflammatory and it is more serious type of arthritis.
Is there any cure for arthritis other than pain management or it is the only cure till a person reaches to the stage of surgery?
Dr Sanjay Wadhwa: There are many things that can be done for arthritis , surgery is sometimes required and it can play an important role in the life of a person with arthritis. The fact that surgery is sometimes surgery is required does not mean that it is the indication of failure of treatment.
What will you tell those who are scared of the surgery as surgery does not mean failure of medication?
Dr CS Yadav: When the x-ray is very bad, it clearly indicates that the origin of the pain is from arthritis, i.e., the articular damage. Secondly, the activity of daily living of the patient is significantly affected when limbs are worn and the gate is disturbed. If a patient has all these symptoms on a daily basis, she is in pain and the gate is affected, and if the x-ray is very bad, then this becomes the reason for surgery. If the surgeon is good, joint replacement surgery is almost 100% successful. Implant choice matters only 10%, but the most important thing is surgical skills. If you do it properly and use implants made of proper biomaterial at the age of 50, it will last a lifetime and it really changes the life of the patient. Orthopaedic surgery has been revolutionised by joint replacement. Whatever fear the patient has of failure, it is because of the surgical errors.
Does arthritis affect females more than males?
Dr Uma Kumar: Yes, females are affected more than males and there are certain reasons behind it. The only arthritis which is more common in males is gout arthritis. What happens is that the immunity genes are located on the X chromosome and women have a double X chromosome, so anything which gets wrong happens to a person who has more robust immunity. Also, female sex hormones are involved in immunity, so when immunity is getting aberrant it is moving in the wrong direction, so women are affected more. Plus, their lifestyle is also very erratic, they do not eat well, and the way they work at home is also not normal. Even while doing puja, the posture they hold puts all the pressure on the knee, causing arthritis.
There is a myth that arthritis affects people only at an older age and not the young age, so if you could bust this myth for us that. Is it true or not?
Dr Sanjay Wadhwa: Arthritis can affect anyone at any age. Children are also affected by arthritis, but there are different types of arthritis that affect children. And there are different types of arthritis that affect people in their middle age. The wear and tear or degenerative arthritis, which is medically called osteoarthritis, is definitely more common as age advances. But yes, children also suffer from arthritis, but their arthritis is different from that of adults.
How significant and important is early diagnosis? Can it help prevent surgery at all?
Dr CS Yadav: Basically, prevention is the only thing that always matters. The thing is, every joint needs exercise. Most doctors write medicines and do not advise exercise, and except for Rheumatoid and Gouty arthritis, the majority of arthritis patients need exercise. By proper exercise, I mean muscle strengthening exercises and those muscles that are rigid, muscle stretching, balancing exercises, and weight reduction are the main things that need to be done and matter more than the drugs. So, most of the arthritis can be prevented and will not even reach the level of surgery, so we should actually prevent the arthritis.
Is it possible to completely prevent arthritis by keeping your lifestyle good right from the beginning?
Dr Uma Kumar: Look, we are talking about types of arthritis. If we take precautions, we can surely prevent arthritis to a great extent and delay the onset of arthritis. I cannot make that statement that only lifestyle is going to control arthritis completely because there are a lot of factors that you pointed out, be they genetic or environmental, which include smoking, air pollution, pesticides and chemicals in food etc. So we cannot completely prevent arthritis, but we can manage it better. And along with the medicines, exercise, lifestyle management is very important and even yoga helps in controlling it too. It is very important for people to understand that it is completely treatable. Early treatment is very important. We can say there is a window of opportunity. It means that at a point when no irreversible damage has happened, we can prevent all the surgeries.
Help us understand in layman’s terms, those diagnosed with arthritis, what would their early treatment entail? Does treatment entail even an attempt to cure the disease, if not completely to a large extent, or is it focused more on pain management?
Dr Sanjay Wadhwa: Any comprehensive treatment plan will try to relieve the symptoms, which very often is pain and stiffness, but it will go much beyond that. It will try to focus on the quality of life of the individual, because when a person is suffering from an illness, which traditionally is considered not curable, it has to be enduring, but it has to be understood in a manner. So that quality of life is maintained, the person is able to carry on with day-to-day activities as expected at that age and gender. A person with arthritis can hope to live a long time, like any other non-arthritis patient, but he has to do some of the things himself and herself, and then the medical team will guide him on how to proceed further in life in a very safe manner. There are different things that can be done, and in our field, I would like to summarise the main components. Because rehabilitation plays a very important role in the life of any person with a chronic disease and arthritis is one of the prototypes of chronic diseases. It is a disabling disease, but it is not necessary that every person with arthritis has to be disabled. So what I say is, if we remember the English alphabet “E”, it is the commonest alphabet in the English language. So the first “E” is Evaluation. No two people with arthritis are the same, but what is the difference? We come to know this through their proper and thorough evaluation, and this is essentially clinical and sometimes supported by investigations.
The second “E” is Education when a person has to live a long time and the disease is chronic. He has to be educated about what aspects of life are likely to be affected, how to pay attention to body weight control, how to pay attention to food and nutrition and how to adjust to the immediate environment.
Thirdly, “E” is Exercise. It is a very important component of comprehensive management and rehabilitation.
And then another “E” plays a very important role, that is Equipment. You must have seen in day-to-day life many people with arthritis using certain equipment, such as walking sticks or walkers, and sometimes their finger joints are affected and deformed, so they have to do splints. So there is so much equipment which makes the performance of day-to-day life easier, and it can reduce the strain on the joints. Sometimes equipment is used to reduce the tendency to worsening of the deformities. and then immediate attention to the environment. For example, a person with arthritis in their lower link joints will find it difficult to climb stairs and if there are hand-rails attached to the stairs, they can hold and climb and come down easily. If they are replaced by ramps, it will become even easier.
In many cases, surgery does not happen and surgery becomes necessary. Take us to the advancements of the surgery of arthritis.
Dr CS Yadav: Yes, people may continue their usual lifestyles, walking, cycling, golfing, swimming, and trekking are all options. Almost all actions are permitted just for the purpose of ensuring the readability of an implant, however they are not permitted to sit on the floor or use the Indian toilet.
Why is there a fear and misconception amongst people?
Dr CS Yadav: People living in India, which is the source of many misconceptions, are the cause of fear. Second, because to a lack of surgical skills, it is the surgical skills that matter 80 to 90% of the time, including biomaterials and the environment. It should be a safe environment. As a result, the procedure went horribly wrong. If one of the patients isn’t happy, he will also notify a significant number of other people who are afflicted.
What is the type of post-surgery care that is needed and the significance of the same?
Dr Uma Kumar: Treatment of rheumatoid arthritis, or any other form of arthritis, is so much more advanced and even awareness is increasing, so fewer people require replacement surgery. I wish this. But yes, those who have undergone replacement surgery require a certain kind of rehabilitation program, from strengthening of their muscles to gradually increasing their activities, and whatever medicines are required or prescribed should be taken and I would like to highlight one thing that patients who have arthritis and have undergone surgery need to take their medicines for arthritis, it’s not like arthritis is not affecting one joint. Just one joint is replaced, other joints are vulnerable.
Are you seeing hesitancy among patients when it comes to physiotherapy?
Dr Sanjay Wadhwa: There are few things which are very important to understand. Rehabilitation is comprehensive care that is much more than physiotherapy. Some people with arthritis, especially those who have involvement in the finger joints and thumb, etc. Sometimes they require occupational therapy as well, so there is much more to rehabilitation. Therapy is only one component. Then sometimes the use of heat and cold is important. Some patients require hydrotherapy in order to facilitate performance of exercises with partial weight relief in the cool temperature can also be controlled. So, there are so many things depending upon the needs. When COVID started, it was a total disruption of life. This was exhilarated by sudden severe lockdown throughout the country. So this did disrupt the treatment and visit of the person to the hospital because transport was also hampered. but we did not stop the cure of the arthritis patients. We made use of the technology available, we started tele-consultations, tele-rehabilitation, all these things were started through the AIIMS and AIIMS has been advocating and expanding these services. So our patients were in touch with us. Some of them were not be able in touch with us because of the lock down and restrictions.
Did you see any fear among people related to surgery due to Covid? To what extent can a patient delay their surgery?
Dr CS Yadav: If you have a knee or total hip replacement at the age of 50, you will have it for the rest of your life. As previously said, it can last for 20 years, 30 years, or even longer. They are handicapped and wheelchair bound if it is done, as it is in the field of rheumatoid arthritis. Even at the age of 18 or 20, we can do joint replacement surgery. As a result, around the age of 50, these individuals will require one joint replacement. So, it is possible, but it will need more skill. It requires a more prominent centre. A revision surgery is what we call it. It’s also a highly successful operation. So there’s nothing to be concerned about. The quality of one’s life is really essential. If you are young, you are productive, so get it and if your joints fail at the age of 50, once again, it can be done with a great result.
What would be your message to people on World Arthritis Day?
Dr Uma Kumar: All joint pains are not arthritis, and arthritis in current times is completely treatable, so much so that one may not require replacement later in life. You have to get your physical activity right, 150 minutes per week. Good diet, exercise, yoga, stay positive. And if you have symptoms suggestive of arthritis, do not delay, go and consult your rheumatologist. If they are not available, go to the physician.
Dr Wadhwa any advise for people?
Dr Sanjay Wadhwa: Never skip the exercises. Exercises are useful for everybody. This improves overall fitness and is especially helpful for people with arthritis, they are more important. It is important to know which exercise is to be done and how. Regarding the goals of exercise, our honorable Prime Minister has given us a mantra, “Fitness Per Dose Aadha Ghanta Roj”. So, if arthritis patients exercise for half an hour every day, they will benefit greatly. That is my message.