Early detection crucial to treat rheumatoid arthritis

ARTHRITIS OF the knee afflicting the old and obese people (osteoarthritis) is a common form of disease. Yet it is not the only form of arthritis that is prevalent in India. But sadly any pain in the joints is often wrongly diagnosed as arthritis afflicting the old. And herein lies a big problem.

Nearly seven million people in India suffer from a form of arthritis the rheumatoid arthritis - that initially affects the small joints. Yet due to lack of awareness even among the medical fraternity has led to a situation where these patients are being treated like an osteoarthiritic patient.

Rheumatoid arthritis unlike osteoarthritis is not the result of wear and tear of the cartilage or other tissues surrounding the bone.

The synovium found in the bone is a joint lining membrane which surrounds the joint cavity. It produces the fluid that lubricates the joint for smooth movement. In the case of rheumatoid arthritis the synovium becomes inflamed and thickened and produces large amount of fluid.

This increased amount of fluid causes swelling, stiffness and pain. At a chronic stage the thickened and inflamed membrane releases proteins that damage the bone and cartilage. The bone damage in turn results in joint damage, instability and deformity.

"Hence wrong diagnosis can lead to serious problems as the patients can end up with irreversible disability and deformity," said Dr. S. Mukherjee, President of the Indian Rheumatology Association. "It is an autoimmune disease where the immune system affects the healthy body tissues.

Hence no system of medicine can cure rheumatoid arthritis." The cause of disease is not known. The disease can also reduce the life span by a few years and in some cases can prove fatal if not treated properly.

Though a cure for rheumatoid arthritics has not been found, early detection and medication can prevent progression of the disease.

Early detection becomes paramount as deformity and disability can set in as early as six weeks from the onset on the disease.

Wrong diagnosis can be easily prevented as rheumatoid arthritis shows certain unique symptoms. For one, it mostly affects the wrists and the joints of the fingers and feet first and then spreads to other joints unlike osteoarthritis that affects the big joints like the knees and hip.

Also, multiple joints are affected in a symmetrical pattern like - inflammation on both the wrists and/or fingers of the hand. Joint stiffness in the mornings is a noticeable symptom.

In children rheumatoid arthritis is n mistaken for rheumatic arthritis. Rheumatic arthritis as a rule attacks only the big joint like the knee and it always has a triggering mechanism (streptococcus infection) causing rheumatic fever with sore throat. Triggering mechanism is not yet known in rheumatoid arthritis though the gene has been identified.

Females are more affected than males. "The ratio is 3:1. And one very important observation has been that the number of females affected prior to menarche and after menopause are less and almost the same as males," said Dr. Mukherjee. Also, pregnant women suffer less pain.

A strong hypothesis is that female hormone has a role to play in women.

Wrong diagnose is not the only problem that confronts the disease. Choice of medicines to treat rheumatoid arthritis has also been found wanting. But the world arthritis day celebrated on October 12 has brought cheer to the patients. Mumbai based Aventis Pharma Ltd had launched a drug Arava (leflunomide) to treat the disease.

According to Dr. A.N. Malaviya, consultant Rheumatologist in New Delhi and considered as a the father in Rheumatology, Arava is a very good disease-modifying drug for rheumatoid arthritis. "It helps slow down the disease progression," said Mr. B. Ahmed, Executive Director (Commercial operations) Aventis Pahrma Ltd.

The early onset of response and sustained benefit are the other benefits of the drug. The medicine has been launched in India only three years after its introduction in the U.S. Arava has been found to affect the foetus if taken by pregnant women. Hence judicious use of the drug becomes mandatory.

R. Prasad

in Chennai

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