World Arthritis Day was first celebrated in 1996 by ARI (Arthritis Rheumatism International). It is being celebrated each year on October 12th. On this day people with arthritis from around the world join together to make their voices heard.
The aims of World Arthritis Day are:
- To raise awareness about arthritis in all its forms among the medical community, people with arthritis and the general public.
- To influence public policy by making decision-makers aware of the burden of arthritis and the steps, which can be taken to ease it.
- To ensure all people with arthritis and their caregivers are aware of the vast support network available to them.
Each year World Arthritis Day focuses on a different aspect of living with a rheumatic disease. This year’s ‘Let’s Work Together’ theme considers the challenges of work, be it paid employment, voluntary work or work at home supporting a family and embraces people with rheumatic diseases, healthcare professionals and employers.
The symptoms of pain, swelling, or stiffness with limitation of joint movement is called arthritis. In certain serious types of arthritis (e.g. rheumatoid arthritis) the stiffness and limitation of joint movement is especially worse for prolonged periods in the mornings. Occasionally, the symptoms may be acute with red, hot swollen joints. In chronic cases the joints may become deformed. The term arthritis, therefore, is non-specific. By itself it does not refer to any specific disease. It simply denotes the symptom of some joint disease.
Several population studies around the world have shown that approximately 20-30% of the visits to any health-care setting are due to problems related to locomotor system. Therefore, locomotor system diseases are among the most common diseases in all the populations around the world. Fortunately, approximately 70% of these conditions are minor, self-limiting conditions related to trauma, injuries, sprains, wrong use or over-use of the locomotor system including sudden unaccustomed physical work and habitual bad posture. Another common cause of ‘rheumatism’ is the aging of the joints called osteoarthritis. Although painful and often disabling, this problem is fortunately not a life threatening serious systemic disease.
Interestingly, psychological problems may often lead to aches and pains, a condition called ‘psychogenic rheumatism’, ‘pain amplification syndromes’ or fibromyalgia. There are other many non-specific aches and pains of minor types (possibly due to minor viral infections) that are self-limiting and usually disappear in about 6 weeks. These patients only need to be seen by a physician-rheumatologist to exclude any serious type of arthritis that may only require reassurance and/or a short course of some symptom relieving medicines.
Unfortunately, approximately 30% of diseases of the joints have the potential of becoming serious life threatening systemic problems. This is especially so if the patient is a young or middle-aged woman or man with symptoms persisting for more than 6 weeks. This may be the beginning of a crippling and occasionally life threatening systemic rheumatic disease. These diseases may cause complications in several other organ systems in the body. Unless diagnosed early and managed by rheumatologists the outcome may be serious.
As arthritis is not a single disease, treatment differs depending upon its type. However, the common goal of treatment is to keep the joints moving properly by relieving the pain and stiffness and by reducing swelling. In general, simple pain relievers like paracetamol, tramadol, and more ‘strong’ drugs called non-steroidal anti-inflammatory drugs (NSAIDs e.g. aspirin, ibuprofen, indomethacin, diclophenac, naproxen, aceclofenac, piroxicam, meloxicam, and the newer drugs like celecoxib, etoricoxib) are often used for short periods, especially in acute cases, early stages and in minor forms of arthritis.
Controlling and reducing weight reduces strain on weight-bearing joints. Exercise and physiotherapy help in keeping the muscles strong and movement of the joints as normal as possible. Proper occupational therapy would prevent further damage, maintain muscle power and help in coping with the functions of daily living. Severely damaged hips and knees may need to be surgically replaced by specialist orthopaedic surgeons. That is the stage at which the consultation with Orthopaedic specialists is required.
Specific treatment for the commonest form of arthritis i.e. osteoarthritis (the arthritis of ‘joint aging’), is fairly simple in the early stages. Weight reduction, avoiding activities and posture that further damage the joint, regular exercises to build up the muscles that support the involved joints (under the guidance of a trained physiotherapist), and the occasional use of simple anti-inflammatory drugs (non-steroidal anti-inflammatory drugs, mentioned above) prescribed by a physician, is all that is required. In advanced cases joint replacement surgery is a fairly safe and highly effective method of treatment with excellent long-term results.
Rheumatoid arthritis and other systemic inflammatory arthritides like psoriatic arthritis and arthritis related to diffuse collagen diseases need the expertise of rheumatologists for prolonged, intense, and specialised form of treatment with disease modifying drugs (mentioned above). Ignoring or delaying appropriate consultations and treatment may lead to serious complications. The same is true of juvenile chronic arthritis seen in childhood and juveniles.
Joint infections are acute rheumatological emergencies. They require prompt diagnosis and appropriate antibiotic and surgical treatment including drainage of pus from the joints. Any delay may lead to permanent damage.
Treatment of gout needs special mention because the disease is preventable. Although the tendency to develop gout is hereditary, there are several life-style related factors that predispose the person to attacks of gouty arthritis. These include sedentary habits, lack of exercise, obesity, excess food intake especially of rich refined, high-calorie food including soft drinks (high fructose levels rapidly increase uric acid levels), sea-food, a lot of red meat, some forms of alcoholic drinks especially beer, fermented food (that contain yeast). The most important new information related to diet and uric acid-gout is that none of the vegetables or cereals (including daals) is of any harm; they do not increase blood uric acid levels.
Therefore, shunning tomatoes, spinach, all variety of daals etc., is absolutely not recommended. Milk and milk products have been found to actually decrease blood uric acid levels. An acute attack is usually precipitated after a late-night party with a lot of eating and binge drinking, or sometimes after an injury or any other stress like surgery, or infection. Thus, in persons with a family history of gout, a diet restricted in calories, with lots of fruits and salads (high in soluble as well as insoluble fibres), complete avoidance of soft drinks, sea-food, red meat and fermented food, regular exercise to keep the weight under control, abstinence from alcoholic drinks (especially beer), prevents attacks of gout. This would also prevent the other diseases often associated with gout such as, high blood pressure, abnormalities of blood lipids (including high ‘bad’ cholesterol [LDL-cholesterol], and high triglycerides) that may lead to heart attack and stroke, and diabetes.
Certain drugs (e.g. diuretics for the treatment of fluid retention) also predispose to gouty attacks. However, if despite these restrictions the person gets an acute attack of gout; it must be considered a rheumatological emergency. Urgent consultation with a rheumatologist is necessary. Strong non-steroidal anti-inflammatory drugs and local injection of depot-preparation of glucocorticoids into the joint bring about immediate and dramatic relief. An important point to remember is that in a person who has never taken a drug called allopurinol, which is the standard drug for reducing blood uric acid levels, should NOT be prescribed in a person with impending acute attack of gout as it worsens the acute attack. On the other hand, if the person is already on allopurinol since long before the onset of acute attack, the dosage should not be changed till the acute attack has subsided completely.