India: Bone of Contention

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A recent pan-India health survey reveals that osteoarthritis has emerged as the numero uno ailment in India, even trouncing traditional heavyweights like AIDS, diabetes, cancer and hypertension.

The survey – titled ‘TNS Arogya 2006-07 The Health Monitor’ – conducted by TNS, an ISO-accredited market research agency in Delhi, in October 2007, was carried out across a swathe of 15 cities – Delhi, Lucknow, Ludhiana, Jaipur, Varanasi, Chennai, Bangalore, Hyderabad, Cochin, Kolkata, Patna, Mumbai, Ahmedabad, Nagpur and Indore. According to the study, in the age band of 25 to 35 years, osteoarthritis is the second most prevalent disease in India after diabetes. Despite this, reports the study, awareness amongst Indians about the bone ailment is almost nil as compared to high profile diseases like cancer, AIDS and diabetes.

The objectives of the TNS annual survey are to map the stated prevalence rates of important diseases in India and to calculate the stated incidence rates for commonly occurring ailments in the country. This research is a pointer to the healthcare habits of Indians – their attitudes towards well-being and preferences for Over-the-counter (OTC) medicines for common ailments.

Osteoarthritis – or degenerative joint disease (DJD) – is a common rheumatological disorder. The World Health Organization (WHO) estimates that 70 million Indians are its victims, nearly 80 per cent of them above 75 years. Although the symptoms occur earlier in women, the prevalence of osteoarthritis among men and women is at par, say experts.

The diagnosis is largely clinical because radiographic findings do not always correlate with symptoms. “Osteoarthritis may first appear without any symptoms in persons aged between 20 and 30 even though its quintessential symptoms, such as pain and inflammation, surface in middle age,” says Dr Prakash Mittal, a Delhi-based orthopaedic surgeon. “Till age 55,” he adds, “the ailment occurs equally in both sexes; after 55 years, the incidence scales up amongst women.”

It is estimated that approximately four per cent of the world’s current populace is affected by osteoarthritis. According to the US-based Arthritis Foundation, one-sixth of the total US populace, or 40 million Americans, are victims of arthritis, of which osteoarthritis is the most common. The Foundation also estimates that 80 per cent of the 50-plus people in the world will experience arthritis in one of its many hundred forms.

Intriguingly, arthritis is not one disease with a common cause. There are different types of arthritis, each with its own cause. However, osteoarthritis is caused by the wear-and-tear of joints. “Just about everybody who lives long enough,” warns Dr Mittal, “can be a victim of osteoarthritis. The joints most commonly affected are the knees, spine, thumb and fingers. Hip osteoarthritis is typical in the west while in India, knee osteoarthritis is the commonest type.”

The symptoms of osteoarthritis may range from stiffness to swelling to lack of mobility, especially if large weight-bearing joints are impacted. “In the spine,” elucidates Dr Mittal, “it results in back and neck pain and sciatica or arm pain. Sciatica pain is referred from the spine and can be mistaken to be arising from the knee. It usually travels along the back of the thigh and calves to the feet.”

A surreptitious and gradual progression of pain is usually osteoarthritis’ typical initial symptom. The pain may be localised to the knee or radiate widely. It is often aggravated by weight-bearing or increased mobility. Patients may also complain of anterior knee pain that worsens with prolonged sitting, climbing stairs, jumping, squatting or kneeling. Initially, pain reduces with rest but as the disease progresses, pain may occur both during rest and activity. Other symptoms include stiffness, limited mobility and the ‘gel phenomenon’ – stiffness with rest/inactivity that eases out after a few minutes of activity.

Experts say that osteoarthritis’ early signs can be joint aches after physical activity/exercise. In later stages, however, joint pain becomes more persistent, along with morning stiffness and difficulty in climbing stairs and getting out of bed or sitting for long. One may also hear a crunching feeling or the sound of bone rubbing against bone. In advanced stages, a person may be confined to bed or move only with ambulatory support.

According to Dr Ravinder Chaddha, former physician of the Indian cricket team, and a consultant at Escorts Hospital, New Delhi, prolonged sitting results in the weakening of muscles. “Office jobs, especially,” says the expert, “involve limited physical movement which triggers knee stiffness and then osteoarthritis. Osteoarthritis of the knee is the commonest problem in India as people are constantly sitting on chairs, cross-legged or squatting.”

While high-impact activities can aggravate joint pain, regular exercise can prevent or relieve it. “Exercise nourishes the joint cartilage and removes waste products from the joints,” says Dr Chadha. “It strengthens the muscles around the joints – providing support for the joint – thereby reducing injuries caused by fatigue. Stretching also helps maintain one’s range of pain-free motion.”

Doctors warn that because osteoarthritis is often a mild problem, there’s no prescribed treatment for it. However, gentle exercise helps. If hands are osteoarthritis-affected, dipping them in hot, briny water is a great therapy. For mild pain or stiffness, simple analgesics (pain relieving drugs) are effective. For severe conditions, however, surgery is the only way out. Replacing the hip/knee with a new synthetic one made of titanium, metal and plastic can make a huge difference in reducing pain and enhancing mobility. Weight reduction, especially amongst menopausal women, considerably whittles down the risk of knee osteoarthritis.

“Indian youth, especially, should be on guard,” exhorts Dr Mittal. “If certain activities cause pain (such as running), switch to less strenuous activities. In office, don’t sit for hours at one place; keep moving and get the circulation going. And, last but not least, control your weight by consuming less fatty foods and exercising regularly.”

(Courtesy: Women’s Feature Service)

By Neeta Lal