Arthritis and Osteoporosis are crippling diseases that eventually lead to functional limitations and confine patients to a wheelchair, robbing them of the quality of life. With the world this month observing these two diseases- namely, Arthritis and Osteoporosis , amid the current Covid-19 pandemic, the Sunday Observer asked long experienced Chartered Physiotherapist Dr Gopi Kitnasamy how a non invasive holistic approach could improve life’s quality and prevent these diseases .
Excerpts
Q. World Arthritis Day was observed on October 12. Why is a special day devoted for this particular health issue?
A. The idea of observing this Day since 1996 is to increase global awareness about the rheumatic and musculoskeletal diseases among people through education and to prevent/manage it.
Q. How many Lankans suffer from it? Do you have any statistics?
 Dr Gopi Kitnasamy |
A.. While it is very common among Lankans, we are unaware of any statistics on Arthritis in Sri Lanka. However, we have one of the rapidly ageing populations in the world. So the numbers are likely to increase alarmingly in the future.
Q. As one of the commonest causes for disability in the world with studies showing that 1 in 5 get arthritis at some time or other, tell us how this condition impacts on patients and their families?
A. Arthritis is the leading cause of disability in the world cutting across barriers of sex and race. It affects a person’s overall function and mobility.The physical disability arising from pain which is the primary symptom of Arthritis and loss of functional capacity reduces the quality of life and increases the risk of further morbidity. Apart from causing lifelong disability, it puts a severe economic burden on families when the main breadwinner is unable to go to work.
Q. Are there many forms of arthritis? Which of them are the commonest?
A. Actually, arthritis is not a single disease; it is an informal way of referring to joint pain or joint disease. Arthritis means joint inflammation. There are over 100 diseases and conditions that affect joints, the tissues around joints and other connective tissue. Some common types of arthritis include rheumatoid arthritis, osteoarthritis, childhood arthritis, lupus, psoriatic arthritis and gout.
Q. How does it originate? In the joints? Bones?
A. Arthritis is derived from the Greek term “disease of the joints.” It is defined as an acute or chronic joint inflammation that often co-exists with pain and structural damage. Arthritis (arthro = joint, itis = inflammation) can involve almost any part of the body, often affecting the hip, knee, spine or other weight-bearing joints, but also found in the fingers and other non-weight-bearing joints. Some forms can also affect other parts of the body.
Q. Can it be mistaken for another disease that also causes pain in the joints e.g Rheumatism?
A. It is surprisingly common for arthritis to be misdiagnosed. Arthritis is the chronic or acute inflammation of joints, often accompanied by structural damage and pain. In contrast, Rheumatism is an informal term used to describe joint diseases or syndromes. Medical literature does not generally use the term rheumatism. Instead, arthritis is commonly used to refer to such conditions.
Q. Rheumatoid arthritis is also characterised as an autoimmune disorder. What is the difference between these two conditions?
A. Rheumatoid arthritis is a type of arthritis that can affect more than just the joints. In some people, it can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
Q. Causes? Age, gender, excess weight, injury?
A. There is no single cause for the different types of arthritis, as it may vary according to the type or form of arthritis. Most types of arthritis are linked to a combination of factors, but some have no obvious cause and appear to be unpredictable in their emergence.
Q. Who are more vulnerable to developing arthritis, gender wise and age wise? Why?
A.. Women have a significantly higher risk for developing arthritis, particularly osteoarthritis due to reasons such as the unique function and motions of women’s joints, wider hips, which some experts believe affects the alignment of the knee and increased stress on the inner side of the knee, more flexible joints and hypermobility, number of full-term childbirths and hormonal changes after menopause. Studies have proved that 60 percent of all people with arthritis are females.
Q. Occupation wise what categories of workers are most at risk?
A. Physically demanding occupations and occupations which involve heavy lifting, frequent and repeated kneeling or squatting, stair climbing, crawling, running, standing for long hours, bending and whole-body vibration, and repetitive movements are at risk of causing arthritis related conditions.
Q. Risk factors for developing Arthritis?
A. The risk of Osteoarthritis increases with aging due to reasons such as less water content in cartilage as we age, reducing its ability to cushion and absorb shock.
Cartilage also goes through a degenerative process which is when arthritis can develop.
Q. Other contributory factors?
A. Some people may be genetically more likely to develop certain arthritic conditions. Additional factors, such as previous injury, infection, smoking and physically demanding occupations, can interact with genes to further increase the risk of arthritis. Excess body weight can cause wear and tear in the weight bearing joints which can lead to Osteoarthritis.
Q Does Arthritis and Osteoarthritis refer to the same condition?
A. Osteoarthritis is the most common type of arthritis. It is also called Degenerative Arthritis. When the cushioning surface on the ends of bones (cartilage) is worn out, the bone rubs against bone, causing pain, swelling and stiffness. The risk factors include excess body weight, family history, age and previous injury or over use.
Q. Can an injury to a joint that occurred several years ago, progress to arthritis later?
A. Arthritis can be caused by the wearing out of a joint that has had any kind of physical injury, such as, from sports, accident, fall or other physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
Q. What are the early symptoms of the onset of arthritis?
A. The signs and symptoms of arthritis that appear and how they appear may vary, depending on the type. You can develop symptoms gradually or suddenly. The early symptoms are pain in one or many joints which may be on and off or constant, swelling - when the skin over the joint becomes red, swollen and feels warm, difficulty in moving a joint, stiffness in the early morning or after sitting for long hours or persistent. When you see these early signs, please consult a doctor.
Q. What are the most significant health impacts of arthritis?
A. Arthritis can have a profound impact on a person’s health, quality of life and well-being due to their symptoms, physical limitations, management of the condition and mental health issues which can result in job loss, increased financial burden/stress and also limit social participation. They are also at a high risk of developing cardiovascular diseases, diabetes, cholesterol and high blood pressure.
Q How can you prevent developing arthritis?
A. Some causes of arthritis are beyond one’s control, like growing old, gender or a family history of arthritis. The risk of arthritis can be reduced by keeping the joints healthy as you age. Being active is most important. Focus on low impact exercises like cycling, swimming or walking. Actively stretching the joints daily, maintaining a healthy body weight, avoiding injuries to the joints, controlling blood sugar and cholesterol levels would help. Stop smoking and excessive alcohol, and consume healthy foods such as, green vegetables, whole grains, nuts, fish and omega 3 rich foods.
Q As a Physiotherapist, tell us how you treat persons with arthritis? Surgery? Exercises?
A. Physiotherapists help to manage pain and overcome challenges faced with arthritis and reduce limitations on mobility using various electrotherapy modalities, appropriate manual and exercise therapy and guide you on lifestyle modifications. Exercise is an integral part of any arthritis treatment program, as it helps to strengthen muscles and stabilise the joints, preventing further damage. Graded exercise starts slowly and increases in small steps. It is important that you pace yourself while doing these exercises and find the right balance between rest and activity. These exercises are tailored to the patient’s condition and needs by the attending physiotherapist.
Q. On another note, World Osteoporosis Day (WOD) was also this month (October 20). Is there a link between Osteoporosis and arthritis? What is osteoporosis?
A. Although osteoporosis and osteoarthritis are two very different medical conditions with little in common, the similarity of their names causes great confusion. These conditions develop differently, have different symptoms, are diagnosed differently, and are treated differently. Osteoporosis (Osteo = bone, porosis = porous), which literally means porous bone, is a disease in which the density and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases. Arthritis is an acute or chronic joint inflammation that often co-exists with pain and structural damage.
Q At present, osteoporosis is vastly under diagnosed and under-treated. Your comments?
A. Osteoporosis is known as a silent disease because it can progress undetected for many years without symptoms until a fracture occurs. The loss of bone occurs silently and progressively, often without symptoms until the first fracture occurs, commonly in the wrist, spine or hip. Osteoporosis can be diagnosed by a bone mineral density test, which is a safe and painless way to detect low bone density. A bone density (assessment) test tells you if you have normal bone density, low bone density (osteopenia) or osteoporosis. It is the only test that can diagnose osteoporosis, is effective and accurate. The lower the bone density, the greater the risk of breaking a bone. Bone density tests are easy, safe, non invasive and painless. I would advise anyone with symptoms to consult the doctor to take it with their advice.
Q. Have you any easy to follow Golden rules to keep both arthritis and osteoporosis at bay, for our readers?
A. Make simple changes to your diet. Take enough exercise, not too much or too little, but at your pace. Being active and giving up bad lifestyle habits would not only help reduce the risks of arthritis and osteoporosis, but also control other non communicable diseases such as, Diabetes and Hypertension.