Rheumatoid arthritis

arthritis

The age of thepatient in India is dropping. The story of a woman struck by it at 26, and how she walked again.The walk that 46-year-old homemaker Sadhana Sahasrabudhe takes with husband Sanjay at a park close to their Kalyan home every evening is precious. It’s only in the last few months since she was bedridden with Rheumatoid(RA) 18 years ago, that she has been able to walk again.For someone who was a whiz at aggressive tag sport kho kho, being confined to a chair in her one-bedroom apartment until Sanjay, a math and science teacher at a Thane school, returned home at 4 pm was nothing short of miserable.RA is a chronic progressive and disabling condition which causes inflammation of the joints. The auto immune disease kicks in when the body’s immune system mistakenly attacks the synovial membrane - a lining that secretes a substance that lubricates and nourishes the cartilage and bones inside the joint - resulting in inflammation, causing permanent damage to the cartilage and bone.It was after the birth of her son Guru Prasad in 1995 that Sahasrabudhe, then 28, began to show symptoms of joint pain in both her elbows and knees.Although she was initially able to walk with the support of a walker, she noticed that the deterioration was swift.Finally, both her knee joints were fused at an angle of 90 degrees, and her elbows, only marginally functional, leaving her bedridden. “I’d take her to the bathroom on a chair. Buying a wheelchair wasn’t an option because her elbows did not allow her to operate it,” Sanjay remembers.“If I had to move, I’d drag the stool I was sitting on across the room to the commode,” she says. “Everyone said I should stay positive, but it sounded only like philosophical drivel,” says Saharabudhe, who finally decided to put her B.Ed degree to good use by tutoring high school students at home.While doctors say the average age when RA strikes is 66.8 years, they have noticed a drop in the age of patients. “The onset of RA is usually in middle-age, but we now have people as young as 30 coming to us,” says arthroscopic orthopaedic surgeon from Lilavati Hospital, Dr Dilip Nadkarni.Dr Rajesh Badiyani, consultant orthopaedic surgeon at Sai Shehdeep Hospital in Navi Mumbai agrees with Dr Nadkarni. In the last five years, he has witnessed a 12-15 per cent rise in the number of young RA patients visiting the hospital.While experts debate the cause of RA, in a majority of cases, genetic factors coupled with stress have been seen to play a key role. In Sahasrabudhe’s case too, both factors contributed. Members of her mother’s family also suffer from the condition. Already genetically prone to the condition, she was left vulnerable when post-partum stress after the birth of her son, upped her risk.Young Indians in metros battling a stressful lifestyle are prime candidates for the condition says Badiyani. “We are leading the hurry-worry lifestyle. In those already prone to RA, the stress response results in the release of neurotransmitters (norepinephrine - responsible for generating body’s fight or flight response), stress hormone cortisol and immune cells, which worsen inflammation in the joints.”Lack of sleep has been identified as a major factor. Dr Suraj Gurav, consultant orthopedic surgeon at the Asian Heart Institute, says, “Sleep calms your nervous system. Lack of it disrupts the body’s ability to regulate stress hormones which could lead to RA. Most working Indians are sleeping less than six hours a day. The connection is obvious.”According to a World Health Organisation report, RA affects between 0.3 to 1 per cent of the adult population worldwide. India figured in the low prevalence regions until 1990. Since then, incidence has risen to cover 1 per cent of the adult population. This means India currently has more than 10 million adults living with RA.Dr Nadkarni says RA cases can be assisted with arthroscopic joint clearance - i.e. the arthroscopic removal of the diseased synovial membrane in the joint. “We see best results when the condition is caught early, when joint surfaces have not been completely damaged. Post the surgery, the intensity drops. With medication and physiotherapy, the patient could lead a normal life,” he adds.In Sahasrabudhe’s case, precious time had been lost. Saving up for their son’s education meant funds for surgery were scarce. Finally, last December, the couple decided to exhaust their savings to fund the knee joint replacement operation which cost nearly Rs 7 lakh. Dr Ashish Arbat, joint replacement surgeon at Fortis Hospital in Kalyan, found that Sahasrabudhe’s leg muscles had wasted away due to inactivity. This, coupled with nerve damage in both legs, meant that some nerves that supplied blood to the legs could get injured during surgery, stopping blood flow altogether. “That would leave amputation as our only solution,” says Dr Arbat.Sahasrabudhe decided to take the risk, and she was fitted with the rotating platform knee system - the self-aligning rotating-bearing that mimics the natural knee movement.For three months after surgery, she was administered the parathyroid hormone (PTH) for bone growth. When she finally stood on her feet at Arbat’s consulting room, she was in tears. “I hadn’t seen the sun in 10 years,” she says.Experts say some foods offer protection against RA-related inflammation and prolong its onset. Here’s what you should be eating:Omega-3 fatty acids found in oily fish has anti-inflammatory properties, helping regulate joint pain. Salmon and bangda fish, tofu, soy-based milk, nuts and yoghurt are all good sources of Omega-3.These help combat free radicals generated by the inflammation process, and reduce pain in joints. Sunflower seeds, peanuts, apricot and olives are good sources.RA creates muscle-bone atrophy and wasting. A diet rich in proteins combined with resistance or weight training exercises helps. And, get enough sunshine since it will help your body create Vitamin-D which helps in the absorption of calcium for bone growth.