With Christmas, the New Year and Thai Pongal just behind us, most people, especially women who have uncomplainingly stood long hours on their feet to make the delicacies served at this time, are now complaining of pain in different parts of their bodies.
The Sunday Observer spoke to Consultant Rheumatologist at National Hospital of Sri Lanka, Dr Gunendrika Kasthuriratne to find out the main reasons for this pain, which parts of the body are most vulnerable to pain early warning symptoms to watch out for and most importantly how such pain can be reduced and if advanced beyond normal treatment how it can be eliminated with surgery. She also offers at our request a healthy diet that will help prevent Sri Lankans at risk of developing Osteoarthritis (OA.)
Q. The season of merry making may be over but it is only now that most people, especially women are complaining of the adverse fallouts from long hours of standing making the traditional cakes and sweetmeats. Pain is one of the key complaints they have. What does pain signify? According to them they have been told they may be suffering from osteoarthritis or osteoporosis. Are they the same thing?
A. Osteoarthritis and osteoporosis are two different conditions. Osteoporosis (OP) is silent, no pain unless you get a broken bone (fracture) due to OP. The reason for pain after standing for long hours is osteoarthritis of the weight bearing joints, most commonly in knees.
Q. What are the main causes for this condition?
A. The cause of OA is loss of cartilage on the articular surfaces of the bones making a joint.
Q. Will OA of knees spread to the other joints later? If so, which joints are most likely to get affected?
Dr Gunendrika Kasthuriratne
A. OA will involve the knees of most people. In addition, other weight bearing joints like hips and ankles may also be affected. In some people, OA can also involve small joints of the fingers.
Q. What is the main reason for OA? And at what age does this condition start?
A. Aging is the leading risk factor. The cartilage loss starts after 35 – 40 years of age.
Loss of cartilage on the bone surfaces will disturb the smooth movements of the joints. It is like losing the shock absorbers of wheels. The wear and tear resulting in after the cartilage loss will create inflammation and pain in the joints.
Q. Any other risk factors for OA?
A. Being female ( gender,) obesity, lax muscles, over use and injuries, for example past fractures or sports injuries involving the articular surface of the knee joint may accelerate cartilage loss and consequent OA.
Activities like prolonged standing, excessive walking and climbing steps frequently will increase the pain.
Q. Other than these are there other modifiable factors we should know about?
A. Mal alignments in the legs (for example congenital or acquired foot deformities) may also accelerate cartilage loss in the knee joint. Other inflammatory type arthritis such as Rheumatoid arthritis affecting the knee or hip may precipitate early onset OA of the same joints.Correction of those deformities and proper treatment for inflammatory arthritis will help to prevent development of premature OA.
Q. What about the genetic factor? For example, if you have a family history of OA how vulnerable are you to inheriting it?
A. Influence from genes has been estimated to be around 40 percent for knee OA. It is as high as 65 percent for inheritance of hand and hip OA.
Q. Gender-wise, who are more vulnerable to be affected? And why?
A. Females are more commonly affected than males.
One reason is that the ligaments and muscle tendons are lax due to the effect of female hormones which are fluctuating during the menstrual cycle. And secondly the anatomical differences of bone structure when compared with men put females at high risk of getting overloading of knees and consequent cartilage loss. And thirdly obesity is found commoner among females.
Q. Will smoking aggravate this condition?
A. We have found no direct relationship between cartilage loss and smoking.
Q. What about alcohol?
A. No direct impact.
Q. Obesity?
Studies have shown that many Lankan women are becoming increasingly obese. Can obesity and excessive weight cause OA? If so, how?
A. Yes, as I have mentioned earlier, obesity is a major risk factor for OA. When the body weight is more, the knees will have to bear more. If a patient with OA of knees can reduce 10 percent of body weight, their knee pain will significantly reduce.
Q. Will diet help reduce these adverse impacts? If so could you suggest a healthy diet for Sri Lankan patients with available locally grown ingredients?
A. Yes, a diet with less calories is essential to maintain the ideal body weight for your height. (BMI). Obese people will bear more weight on your osteoarthritic knees, and will have more pain.
Locally grown food for losing weight or maintaining the ideal BMI would be vegetables, cereals and fruits. Rice, bread, fast food and all bakery food in higher amounts will increase body weight. Protein containing food will not cause weight gain. Eggs are a good source of protein.
Q Who makes the final diagnosis of OA? A specialist or any physician?
A. A specialist rheumatologist will be the best. But physicians and even general practitioners can clinically diagnose obvious cases. Best is to refer to a rheumatologist in doubtful situations. Possibility of other types of arthritis needs to be excluded in some cases.
Q. How is the diagnosis done? Walk us through the procedure?
A. Diagnosis is mainly clinical. The nature of pain, the age of onset of symptoms and the lifestyle of the person will tell us the diagnosis. There are no blood tests to diagnose OA.
Q. At what age do the symptoms begin to show? And what are the signs we should look out for?
A. The symptoms will gradually start around 40 years onwards. The pain is initially only after excessive walking, prolonged standing or in persons who often have to climb up and down stairs. Most commonly occurs in knees. In advanced disease, the knees will appear bowed.
And they may have rest pain at night.
Q. Any tests to show these osteo arthritic changes? X-ray? Blood tests?
A. An Xray will show the osteoarthritic changes. Blood tests will not change in OA.
Q. If detected and treated early can OA be reversed?
A. Lost cartilage will not re-grow. It has to be considered as part of aging.
Q. Can OA be managed to delay the disability loss and reduce the pain of the patients?
A. There is no specific treatment to regrow cartilage. But we can treat the pain and advise patients on how to prevent pain.
Q. How?
A. Maintain ideal body weight, avoid prolonged standing, divide your daily work to avoid knee strain, avoid frequent steps climbing. Use a commode in the toilet. If you walk for exercise, wear proper shoes.
Q. At what stage will a patient require surgery? What is this surgery called?
A. Knee or hip replacement surgery. When the knees or hips get severely affected or when the pain is very disabling, not resolving with analgesics, those joints are replaced by artificial joints by the orthopedic surgeons.
Q. What are the gaps you see at present in our health system of delivering quality care for O A patients in Sri Lanka?
A. Awareness about the cause of OA, the risk factors and lifestyle changes with aging is lacking among the general public. Knowledge about the importance of a healthy diet, regular exercises and avoiding obesity should be delivered to the public since it is a very common condition when reaching middle age.
Q. How would you like to close them?
A. This kind of health educating information by leading newspapers, television and radio would be of great use.
Q. With the ageing population rising do you see more people developing OA in Sri Lanka in the future?
A. That is inevitable. Lack of exercise and unhealthy diet patterns are an easing trend. So more people may suffer from pain due to OA.
Q. As the immediate past President of the College of Specialists in Rhuemotology and Rehabilitation Sri Lanka, what has the College done so far in raising awareness and expanding more opportunities for free OA checks for Lankas suspected of having OA ? Any guidelines on Do’s and Don’ts ?
A. We have regional academic programs for doctors and every year we arrange programs for patient awareness on world arthritis day which falls on October 12.
The do’s would be to maintain ideal body weight, use a commode in the toilet instead of a squatting pan, wear proper shoes when you exercise and the don’ts will be to do prolonged walking or standing and climbing steps frequently.
Q. Do you have a message to give all those at risk on how to prevent OA ?
It is not possible to prevent OA since it is part of the natural course of aging. But once you have it, the dos and don’ts will be very useful to prevent pain from OA.
Q: Some trial studies have shown that Acupuncture provided relief and improved physical dysfunction in patients with OA. Your comments?
A. Can’t comment on that because that is not a subject I have learnt.
