Rheumatoid arthritis is considered as an aging disease and thus neglected in India. But Dr Uma Kumar, HOD and Professor of Rheumatology Medicine at All India Institute of Medical Science compares it with chronic diseases like diabetes and says it can be managed. The problem, however, is that there are very few dedicated rheumatologists in India and there are millions of people suffering from rheumatic musculoskeletal disorders.
In an interview with THE WEEK, Dr Kumar talks about the disease, how it affects young people, its management and the need to have dedicated rheumatologists in India.
Excerpts from the interview
People know of rheumatoid arthritis as an age-related problem. But you say there are more than 200 causes. What are the common ones?
It is a wrong perception. Rheumatoid arthritis is a chronic inflammatory arthritis with autoimmune etiology. Autoimmune illnesses occur when the body tissues are attacked by its own immune system. Under normal circumstances the immune system is expected to destroy invaders of the body only like infectious agents (bacteria, viruses etc.). Rheumatoid arthritis predominantly affects women after 30 years of age.
Arthritis is a manifestation of many clinical conditions. There are more than 200 rheumatological illnesses such as rheumatoid arthritis, osteoarthritis, reactive arthritis, ankylosing arthritis, psoriatic arthritis, systemic lupus erythematosus and arthritis related to various infections like tuberculosis, viral and bacterial.
Does it affect young people?
Yes, it can occur in any age group from newborn to centenarian. But, certain arthritides are more common in a particular age group.
What are the advancements in medicine that help improve quality of life of people suffering from rheumatoid arthritis?
Rheumatoid arthritis is a treatable condition like any other chronic disease e.g. diabetes mellitus and hypertension . It can be managed with drugs. There has been significant advancement in the understanding of disease pathobiology in last two decades, which has translated in to development of very efficacious anti-rheumatic drugs. Availability of targeted therapy in form of biological agents (Infliximab, Etanercept, Rituximab, Tocilizumab etc.) has tremendously improved the quality of life of patients with refractory disease. We emphasise on early control of inflammation. The treatment has gone beyond just pain-killers and steroids.
When should one see a doctor?
Anyone who has been suffering from early morning stiffness which lasts more than 30 minutes for two or more weeks. Or if there is swelling, redness and pain in joints, particularly small joints of hands and feet.
How is the new department at AIIMS helping patients?
We are getting patients from all over India and neighbouring countries. Besides providing state-of-the-art clinical care, we do various specialised immunological blood tests. We have a day care facility where patients receive biological infusions, injections in the joint, undergo biopsies, musculoskeletal ultrasound etc.
We also provides rheumatology training to physicians and are in the process of starting super-specialty (DM) courses and fellowships in rheumatology.
What is the need for it to be recognised as a separate specialisation? What is the extent of problem in India?
Nationwide data on the prevalence of rheumatic diseases in India is not yet available. Rheumatological disorders are perhaps the most disabling and deforming diseases. Inflammatory arthritides affect youth in their most productive years and if left untreated result in crippling disability in a few years’ time. There is a wide spectrum of rheumatic diseases seen in India. Each disorder requires specialised treatment. Availability of effective therapeutic agents have brought paradigm shift in the management of these disorders.
Thus, it is obvious that a specialty dedicated to them is needed, as was realised by the developed world long ago.