Arthritis simply means joint pain, stiffness or swelling due to inflammation. Like fever is a symptom of hundreds of other diseases, arthritis is a symptom caused by more than 100 diseases. Only further clinical details will reveal the actual disease.
2. Which Doctor & specialty deals with Arthritis and Rheumatism?
The specialty dealing with arthritis and Rheumatism is called Rheumatology. The physicians specializing in this field of medicine are called Rheumatologists. Patients having persistent arthritis and who are unfortunate not to have been seen and treated by trained and experienced rheumatologists, may end up getting their joints completely destroyed and require joint replacements by Joint Surgeons called Orthopaedic surgeons at exorbitant costs (about 3 lacs per joint).
3. More about Rheumatology & Rheumatologist
Rheumatology is a recent sub-specialty in internal medicine devoted to medical management of all forms Arthritis, Connective tissue diseases like SLE, Soft tissue rheumatism, Gout, Osteoporosis and other Musculoskeletal diseases. Clinicians who specialize in rheumatology are called Rheumatologists. After five and half years of medical schooling and three years of training in internal medicine, rheumatologists devote an additional two to three years in specialized rheumatology training institutes like AIIMS to treat more than 100 types of arthritis.
4. How do you know whether you have arthritis?
Arthritis patients will experience pain and swelling of one or more joints, feel stiffness in the joints – more in the morning. In some type of arthritis you may have long fever associated with skin rashes or ulcers, in others you may have stiffness and pain in the lower back, at others times, your fingers may turn blue during winters. Your joints may starts making noises like grating sensation.
5. Is it seen only in elderly people?
No, that is a misconception. Inflammatory arthritis can affect any age group but usually affects females in reproductive years it can affect children too, when it is called JIA (Juvenile Inflammatory Arthritis). Osteoarthritis (wear and tear arthritis) usually affects old people but can occur earlier in people with history of joint injuries & in those with hypermobile joints & obesity.
6. Is arthritis more common in women?
Rheumatoid arthritis & other Autoimmune arthritis like SLE, Scleroderma are more common in women. However, Ankylosing spondylitis presenting with severe early morning stiffness and Gout is found more commonly in male population.
7. Will exercise cure my arthritis?
No. Exercise is only supportive but never curative. It may helps to reduce the pain and stiffness in the joints. Exercise also helps in increasing the flexibility, range of movement and strengthening the muscles around the joint. However, patients with deformities of the joints should consult a Rheumatologist about the type of exercise.
8. What are the types of arthritis?
Osteoarthritis and Rheumatoid Arthritis are the two most common conditions we come across. However, Rheumatic diseases are of more than 100 types & fall into four main groups:
- Autoimmune inflammatory arthritis: These result, when body’s immune system attacks own healthy joint tissues, leading to inflammation and damage to the joints tissues. Rheumatoid arthritis is most common and is of the most damaging kind affecting more than one crore people in India and affects the young and the old alike. Other types include Gout, Spondyloarthritis such as Ankylosing spondyloarthritis, Reactive arthritis and Arthritis associated with Colitis and Psoriasis. Other rarer disorders that can affect multiple parts of the body called connective tissue diseases such as Systematic Lupus Erythematosis (SLE), Scleroderma, Polymyositis and various vasculitides. In this group, Ankylosing spondylitis affecting young men involves low back causing severe back stiffness before spreading to other joints.
- Degenerative diseases called wear and tear diseases are most common and include Osteoarthritis of knees, hips and vertebral column (ie, cervical and lumbar spondylosis).
- Soft tissue rheumatism where rheumatic pain arises from damage to areas around joints, such as ligaments and tendons. Minor injury or overuse can result in localized pain which often lasts only for a short period, Tennis elbow for example.
- Infection: when bacteria directly cause septic arthritis, it can rapidly destroy the joints and should be treated as an emergency.
9. Need for a correct diagnosis and treatment?
A correct diagnosis is very important for almost all arthritis types otherwise immune system will go on attacking joint & body tissues, and though the pain may be controlled, the joints will continue to erode without appropriate treatment. The message is, don’t be afraid to see a Rheumatologist about your aches and pains, and don’t be afraid to protest if you’re told just to take a pain killer to relieve your pain without knowing the type of arthritis. Pain killers do not cure any of the arthritis types. Timely diagnosis and early treatment will stop the further damage to the joints as well as will prolong your life.
10. What is the difference between Arthritis and Rheumatism?
People are often confused about the meaning of the two words – Arthritis & Rheumatism (Gathiya & Bai). Arthritis means disease of the joints and generally results into inflammatory swelling of the joints. The term Rheumatism (Bai) is used by common people to refer to all types of diffuse or migrating body aches and pains, which may include early arthritis.
11. What are the treatment strategies?
It depends upon the cause. If a patient with arthritis reports early, can lead a normal life with modern anti-rheumatic therapy. Much can be done, even in late stages. If symptoms of arthritis have not subsided within 04 weeks, indication is that joints are in trouble & require professional help as body has already failed to ward off the evil of arthritis by itself.
We now think of four different types of treatment strategies to save your joints:
a. Prevention is better than cure: steps can be taken to prevent development of arthritis. Get your joints screened by a Rheumatologist for any risk factor to ward off the development of arthritis.
b. Cure : In some cases, Arthritis can be cured depending upon the cause, if treated early.
c. Effective treatment & control of established disease: Nowadays, modern anti-rheumatic therapy rendered by a Rheumatologist can save the joints from damaging effect of arthritis. Earlier the treatment, the better. These include disease modifying anti-rheumatic drugs (DMARDs), Anticytokines and anti B cell therapies.
Treatment is getting better day by day in Rheumatology. New anti rheumatic drugs and procedures are safer and more effective than before. The best of old therapies are being combined with modern therapy. We call it “fusion therapy” to improve the quality of life.
d. Experimental therapies are being used when standard therapies are ineffective and there is no option except undergoing surgery. These are becoming very popular abroad, comes “at the point of care PRP therapy & Adipose derived autologous mesenchymal stem cell therapy”. This comes under rapidly progressing field of Regeneration medicine. These procedures are done under informed consent. Numerous series of cases and studies have shown their safety and effectiveness.
12. What is the role of steroids in arthritis control?
Steroids are strong anti-inflammatory drugs, they produce almost instant relief of pain, but they may produce side effects if given in high doses or over a prolonged period. Hence we discourage the long term use of steroids. When a joint is very painful or swollen, an injection in the joint is called for. This promptly helps relieve pain and reduces swelling.
13. What are Disease modifying antirheumatic drugs (DMARDs)?
These drugs modify the pathology of arthritis make the disease inactive. These are slow acting drugs e.g. methotrexate, hydroxychloroquin, leflunomide, salazopyrin and D-penicillamine & Gold. These days effective biologic drugs like infliximab (‘Remicade’®), etanercept (‘Enbrel’®) and rituximab (‘Mabthera’®), abatacept (‘Orancia’®) and tocilizumab are available in India but their price is beyond the reach of common man. These drugs must only be given by specialist Rheumatologist with precautions to prevent adverse effects.
14. What is the role of diet in arthritis?
Articles of diet seem to have no definite role in causation or treatment of arthritis. However, it has minor role in Gout, a very painful kind of arthritis occurring in men. Over consumption of alcohol, non-vegetarian food and tea or coffee can increase blood uric acid and precipitate gout. Yes, an overweight person is more prone to develop osteoarthritis, when calorie intake needs to be controlled. Consuming fresh fruits in balanced diet and keeping normal weight will help in prevention and treatment of arthritis.
15. What is the future of an arthritic patient?
The future of an arthritic patient is bright if one can be diagnosed with the exact type of arthritis especially at an early stage and start immediate treatment under a Rheumatologist. In that case it is almost certain that the patient will never be crippled and will lead a normal life at work and in the family.
16. Is arthritis curable?
In depends upon the cause and the stage of the disease. Some types of arthritis may not be totally curable but are certainly controllable. After all diabetes, hypertension and other chronic diseases are also incurable, yet people take treatment for these diseases with a view to control them and save their organs. So, why neglect arthritis? At an early stage, most types of arthritis are easily controllable perhaps even curable. Prolonged treatment is required, but even this helps a lot in preventing the patient from becoming crippled.
17. Does arthritis run in families?
Arthritis does not run in families the way diabetes does. However, a few families show traits to develop arthritis, based on their genetic makeup.
18. Can alternative therapies help in arthritis?
Acupuncture is a Chinese medicine, how it works is not entirely clear. It may provide short-term pain relief in joint paints. S-adenosylmethionine (SAMe, pronounced “Sammy”) and Glucosamine are being marketed as a remedy for arthritis and may relieve pain in some of the patients, but there is no scientific evidence that they have any effect on the disease process.
19. When surgery is required in case of arthritis?
Severe cases of arthritis might need surgery to replace or repair damaged joints.
20. How can a Rheumatologist help you?
A Rheumatologist helps in
- Making the correct diagnosis
- In preventing/ reversing/ treating/ controlling the condition to the best possible extent.
- Assessing whether a surgery or joint replacement is needed.
Pearl of wisdom: “Report early to a Rheumatologist to save your joints from arthritis and to prolong your happy & healthy life”