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Young and feeling it in the bones

No longer disease of elderly,arthritis is arriving early with those in their 30s suffering from it.

Written by Pritha Chatterjee | New Delhi |
October 15, 2011 3:40:21 am

At 35,Gurgaon-based software professional Ramneek Mehta shuffled like an old man while walking due to excruciating pain in his knees. He went to three different hospitals but stubbornly refused to believe the diagnosis — that he had osteoarthritis,a degenerative bone disorder.

“I would often skip office due to the pain but did not specify any disease in leave applications,” he says. “I always knew arthritis to be a disease of the elderly; my mother is an arthritis patient.”

Six months after the diagnosis in late 2009,Ramneek was forced to go on a year-long sabbatical for a total knee replacement surgery.

According to the Arthritis Foundation of India (AFI),most Indians living with arthritis are much younger than we think. “While it is true that many people get arthritis as they get older,it is also true that it can develop early on as well,” says Dr Sushil Sharma,chairman,AFI.

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Arthritis is a broad term used to denote pain in joints that arises on account of degeneration of cartilage or inflammation of joint lining.

THE YOUNG OLD

There is a ‘broad’ definition of a young patient in arthritis. “Anybody less than 50 years of age and suffering from arthritis is considered a young patient. For,aggravated symptoms in the 50s mean that mild symptoms started showing up in the 40s or earlier that the patient obviously ignored,” says Dr Sushil Sharma.

Dr R K Sharma,senior consultant of orthopaedics at Apollo Hospital,says: “Osteoarthritis used to be a ‘senior citizens’ disease’ — seen in patients in their 60s and 70s. In the last two years,however,we are increasingly seeing arthritic patients in their 30s and 40s.”

“At our outpatient’s department,around 10-20 per cent patients of arthritis are younger than 50,” adds Dr Sushil Sharma.

Dr P K Dave,former director,AIIMS and present HoD in orthopaedics at Rockland Hospital,New Delhi,agrees: “Rheumatoid arthritis started affecting young adults some 10 years ago; now we are seeing a lot of young patients with osteoarthritis. Five years ago,young women who were diagnosed with rheumatoid used used to be incredulous. Today,there is a similar disbelief regarding osteoarthritis.”

A 36-year-old housewife from East Delhi,Mamata Singh,who was diagnosed with arthritis two years ago,wants to keep it under wraps. “If I find it so hard to believe,imagine what my in-laws would think.”

“I had thought it was an infection or something. I was on a bike with my husband,and suddenly there was this excruciating pain in my knees,and the joints swelled,” she says.

Mamata says she is yet to reconcile herself to the imminent need for surgery. “As long as it can be managed with medicines,I want to avoid invasive procedures.”

Causes and symptoms

“While joint soreness is a warning sign of a of lot of things,one of the most obvious causes is arthritis. When the pain becomes worse due to weather changes or if you are sick or have a fever,it could be a sign of the early onset of arthritis,” says Dr Ramneek Mahajan,joint replacement Surgeon,Orthonova Hospital,and a consultant at Fortis,New Delhi.

The progressive decline in age profile of patients is attributed to a combination of factors,at the root of which is a sedentary lifestyle.

“Lack of exercise and obesity among young adults are the most important contributing factors. As Indians,we are also used to sitting cross legged on the floor,with our knees bent. This result in degeneration of the bones,” Dr Rajiv Thukral,consultant, orthopaedics at Max Super Specialty Hospital,New Delhi,said.

But then,there is an interesting case of a 40-year-old management executive Vipin — a regular gymmer since his teenage — who was diagnosed with osteoarthritis earlier this year. “I always thought arthritis was caused due to lack of exercise,and I had maintained my weight for the last ten years,” says Vipin.

Doctors warn that the “obsessive,heavy weight exercise routine” of youngsters can also damage the cartilage of the knee joint.

Genetic factors also make Asians more predisposed to degeneration of their knee joints. “There is no research to quantify these genetic reasons,but there are observations,” says Dr Sushil Sharma.

Osteoarthritis affects young women more than men. “Women are genetically more predisposed to bone degeneration. Lifestyle factors add to this problem — like north Indian women in particular are prone to obesity and have more sedentary lifestyles. Among young women,desktop jobs and household chores together leave little time for exercise,” Dr Thukral says.

MANAGING ARTHRITIS

While knee replacement is not very old in India,it has come to be the only solution for arthritis management in the elderly.

Dr Sushil Sharma,however,says knee replacement surgery is usually the last resort for young adults. “For those in mid-30s,knee replacement isn’t considered at all. For those in their mid 40s,we try to delay the replacement at least till the patient reaches the 50s.”

This,doctors say,is there is a greater fear of wear and tear of the artificial joint if you are young and active.

“If the patient is young at the time of implant,there may be a need for another implantation in the next 25 years,” Dr Sharma adds.

The decreasing age profile of arthritis patients has brought forth a number of treatment options.

Dr R K Sharma says: “There are inflammatory pain relief medications and administering of a particular category of steroids known as Corticosteroids. There are also injectible options-like the synvisc injection of a drug called Hyaluronan that alleviates the symptoms of arthritis to a great extent.”

There is also high tibial osteotomy — where a wedge of the medial portion of the knee is removed to transfer the weight bearing position of the knee. Joint Lavage is another option if the damage is partial. “Here,the loose debris of the damaged tissue are washed away by a surgical procedure,”Dr Dave says.

A less common option,around for two years in select hospitals,is cartilage transplant.

Excessive texting may cause thumb arthritis

While many were disappointed over the TRAI’s cap on SMSes,it could well be a step in the right direction. “Due to excessive texting,increasing number of patients are complaining of sustained pain in their fingers,especially the thumb,” said Dr Raju Vaishya,president,Arthritis Care Foundation (ACP) and senior orthpaedic surgeon at Indraprastha Apollo Hospital,New Delhi. “The pressure applied at the tip of the thumb is magnified at the base of the thumb. Repetitive motion causes pain and inflammation of the basal joint leading to thumb arthritis,” said Dr Vaishya.

(Names of patients have been changed to protect their identity)

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