Dr RG Wiseman Pinto
With changing lifestyles, arthritis is becoming increasingly common. Early diagnosis, appropriate treatment, exercise and healthy living can help reduce disability and improve quality of life.
Arthritis is the inflammation of joints, causing redness, pain, tenderness and stiffness. Arthralgia refers to joint pain without inflammation and usually resolves. Both conditions may be acute or chronic, affecting one or multiple joints, including the knees, hips, ankles, shoulders, elbows, hands, feet and spine.
Although arthritis is common among older adults, younger individuals and children can also be affected. Childhood arthritis may result from rheumatoid arthritis or hereditary bleeding and coagulation disorders such as haemophilia, which can begin in infancy.
Osteoarthritis, commonly seen after 60 years of age, results from wear and tear of cartilage, altering joint function and anatomy. However, changing lifestyles have increased its occurrence among younger people. Important risk factors include trauma, infections, tuberculosis, diabetes, chronic kidney and liver diseases, immunosuppression, HIV/AIDS, obesity, hormonal factors, previous joint surgery and genetic or familial predisposition.
Obesity is a major contributor to knee osteoarthritis. Severe cases can cause considerable disability, restricting walking and everyday activities. Sports injuries and occupational factors can further aggravate joint problems. Some patients develop bow legs or knock knees. Ankylosing spondylitis affects the spine, pelvis and sacroiliac joints, while rheumatoid arthritis is an autoimmune disease associated with genetic and familial factors, including HLA-DR.
Joint replacement has become increasingly common in India and worldwide, including Goa. Former prime minister Atal Bihari Vajpayee underwent knee replacement surgery at Breach Candy Hospital in Mumbai, performed by a team of Indian doctors in the USA led by Dr Ranawat. The procedure received widespread media attention.
Dr Zelio De Mello, Professor and Head of Orthopaedic Surgery at Goa Medical College, trained under Dr K Dholakia at Bombay Hospital and routinely performs knee and hip replacements at GMC. The Government of Goa provides implants free of cost.
Treatment depends on the cause and severity. Exercise, physiotherapy, walking, swimming, newer medicines and immune-modulating drugs can provide benefits. Knee braces and caps may help, while squatting should be avoided. Hyaluronic acid injections may be useful in selected cases. Steroid injections require caution because of the risks of steroid arthropathy and infection. Joint replacement or arthroplasty remains an option for severely damaged joints. Robotic assistance is increasingly used to improve surgical accuracy. Careful preoperative assessment and postoperative management are essential to prevent complications.
Gout is also a common problem in Goa. Claims that wearing gold rings on fingers or toes prevents arthritis have appeared in certain reports and studies, but such claims should not replace established preventive and medical measures.
Investigations may include haemoglobin, white blood cell counts, differential counts, platelet counts, ESR, CRP, kidney and liver function tests, electrolytes, uric acid, lipid profile and imaging. Pulmonary and cardiac function assessments may be required before surgery. Thyroid function tests are indicated when hypothyroidism is suspected. Genetic and HLA-DR testing may assist in evaluating selected cases of rheumatoid arthritis.
Obesity must be addressed through appropriate lifestyle measures and medical supervision. GLP-1 medicines may help eligible patients manage weight. Health education, balanced nutrition, regular exercise and timely treatment are essential to reducing disability. Preventing and treating arthritis requires awareness, early diagnosis and appropriate care.
(The writer is a Professor of Pathology, former Head of Department at Goa Medical College, former Dean of Goa University and the current President of the Asian Society of Cytopathology)
