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Don't ignore your pain

Do you often get a shooting pain along your fingers, or swelling and stiffness in your hands and feet for more than an hour in the morning? Then you need help, feels Dhamini Ratnam.

health-and-fitness Updated: Sep 03, 2009, 19:25 IST
Dhamini Ratnam
Dhamini Ratnam
Hindustan Times

Do you often get a shooting pain along your fingers, or swelling and stiffness in your hands and feet for more than an hour in the morning?

Have you received an injury to a joint when you were younger which you didn’t bother treating?

Have you been facing regular pain in your ankles, calves, wrists, back, neck or shoulders?

Don’t ignore this pain. These are some of the symptoms faced by rheumatoid arthritis (RA) patients. And if you think it only affects those over 60, think again.

“It is a misconception that arthritis affects only older people. In fact, almost 80 per cent of my patients are in their 30s and 40s,” says Dr C Balakrishnan, a consultant rheumatologist and the head of the department of rheumatology of PD Hinduja Hospital, Mahim.

RA is an inflammatory condition of the lining of joints, like knees, ankles or elbows. Soft tissue rheumatism is a swelling of the muscles and tendons surrounding these joints. Both these types of arthritis can affect younger people.

“While it is mostly a genetic condition, soft tissue rheumatism in 30- and 40-year-olds has work-related causes, like a badly-angled computer screen that you haven’t set right, or posture that you haven’t corrected,” says Dr Arvind Chopra, chief rheumatologist, Centre for Rheumatic Diseases, Pune.

Soft tissue rheumatism can be prevented and treated effectively but rheumatic arthritis is another matter altogether. The one common factor they share, as far as treatment is concerned, is the need for timely diagnosis.

“There is no cure for RA, which is an auto immune disease, but with timely intervention, the pain, swelling and stiffness can be reduced and damage to the joints can be slowed down,” says Balakrishnan.

On the other hand, once the cause of soft tissue rheumatism is known — it could be a bad shoe, or wrong posture — it can be effectively treated, says Chopra. But patients need to be educated about how to cope with such forms of arthritis.

“They come to me with shattered confidence. Most worry about how they will take care of their children,” Balakrishnan says. “Our society is not arthritis-friendly,” he adds. “Persons with RA need support from their workplace and their family. For instance, someone with a sales job, which involves a lot travelling, should be given a desk job.”

Coping with the different forms of rheumatism isn’t easy, and many young people like 38-year-old Nitin Kumar (name changed) find it difficult to accept the condition. Yet, having RA doesn’t signal the end of a normal healthy life, as Deepa Mehta, 38, discovered.

Read an account of how the two learnt about their condition and learnt to cope:

Two years ago, Nitin Kumar, 38, had a life most people spend their 20s working towards — a house in Juhu, a swanky car, a high paying job in the advertising industry, and a marriage that, in his words, “completed him”. Then it came crashing down.

“I woke up one morning in pain. I felt it first in my knees, then it gradually spread to my wrists and fingers. One day I discovered I couldn’t move two fingers in my left hand,” says Kumar, describing the steady progression of rheumatoid arthritis through his joints, which eventually made it difficult for him to hold things, or shake hands. He even stopped going to the gym.

“Driving from my office in VT to home everyday took a toll on my knees. I couldn’t sit in my air-conditioned cabin for too long. I took a month-long break from office because of the pain,” he adds.

What made matters worse was that Kumar’s condition was misdiagnosed for over a year and a half. “My joint pains were initially accompanied with fever, so doctors treated me for pretty much everything under the sun,” says Kumar with a laugh. “They gave me medicines for chikungunya, malaria, typhoid and even dengue.” Needless to say, nothing worked.
That’s when Kumar made a trip to a rheumatologist, and finally discovered what his condition was.

Return to normalcy, bit by bit
In the past six months, Kumar has undergone physiotherapy. His visits to doctors’ clinics have stopped; he has started working out at the gym again, albeit with lighter weights, and even plans to start yoga soon. He has also started paying more attention to his diet.

“But he hasn’t still accepted it,” says Kanchan, his wife. “At the back of our mind, we still think, ‘why us’.” “It’s traumatic to see him go through what he does — being bedridden for days on end, the terrible pain in the morning. I don’t think we’ve accepted the fact that he’s got RA.”

For a patient of RA, there are good days, when the pain goes into remission and there are bad ones, when it returns with a vengeance. But Kanchan can only take it a day at a time. As of now.

Deepa Mehta, 38, knows only too well what Kanchan must go through. Like her, she too was “broken” when she heard the news and wondered if she could ever have a normal family life. Only in her case, she was the one with RA.

‘Ignored it for a year’
Mehta had been married two years when she was diagnosed with RA. She was 27 then. She too faced the symptoms for an entire year before the disease was diagnosed. But unlike Kumar, Mehta’s symptoms lasted only a few minutes. “My ankles would pain only for a few moments after getting up in the morning,” she says. “I ignored it for a whole year. Then I got it checked by my family doctor, who asked me to undergo an RA test.”

According to consultant rheumatologist Dr C Balakrishnan, head of the department of rheumatology, P D Hinduja Hospital, “RA should ideally be diagnosed within the ‘window period’ of one year, for treatment to be more effective. While it cannot be cured since we don’t know what causes it, its progression can be arrested if diagnosed sooner.”
Mehta, who’s been battling RA for over a decade now, attributes much of her strength to the support she has received from her family. Like Kumar, she too tried several different therapies, “from Reiki to Pranic healing and Ayurveda”. “You learn to stick to one therapy only after you have accepted the fact that you have the condition.”

Work around the limitations
Very often, as Mehta’s case proves, acceptance improves the situation.

“Despite my doubts, I decided to have to a baby. Believe it or not, I didn’t need any RA medicines for the duration of my pregnancy, and some 8 months after that, as there was simply no pain. My remission came at the right time,” she says.
Soon after she had her son, Mehta joined Mission Arthritis India (MAI), a Pune-based voluntary organisation started by a group of arthritis patients for spreading awareness about the condition. Mehta, who was a home maker until then, realised this was her calling. She’d been through the worst and she wanted others to know that if she could do it, so could they.
“Sure, my life has limitations. Everyday tasks like bathing or cooking become difficult. I can’t even kneel down or sit on the ground to play with my son. I’ve even stopped driving,” she says. “But with a little bit of support, a routine can be created that take these limitations into consideration,” she adds. Instead of kneeling to play with her son, Mehta plays with him on the bed. Instead of driving, she takes an auto, or gets dropped by her husband. And she’s employed a cook, whom even her father-in-law greatly appreciates.

“RA can be managed. And it doesn’t have to be the end of what we call a normal life.” Some names have been changed to protect identities

Exercising with Rheumatism
It may seem counterintuitive to exercise when suffering with joint pain, but a study published in Arthritis Care and Research journal shows how physical activity is actually a natural pain reliever for most people suffering from arthritis. Regular exercise significantly improves and manages arthritis pain. Dr Shivangi Borkar, a physiotherapist in PD Hinduja hospital tells us what precautions RA patients need to take before starting an exercise regime.

1. Respect pain: Don’t exercise when your pain has relapsed.
2. Always remember to keep the position of the joints right. This helps avoid unnecessary strain.
3. Do exercises that help you maintain the range of motion of your limbs — like stretches, arm and leg swings etc. This also prevents stiffness from setting in. Swimming is an excellent exercise.
4. Do mild resistive exercises. Use low weight dumbbells only. Gradually increase the weight but only till what’s comfortable for you, or you’ll end up doing more harm than good to your body.
5. Use support equipment like knee or elbow braces if needed.
Here are some other tips you might find useful.
n Apply heat to the joints you’ll be working before you exercise. Heat can relax your joints and muscles and relieve any pain you have before you begin. Heat treatments — warm towels, hot packs or a shower — should be warm, not painfully hot, and should be applied for about 20 minutes.
n Move your joints gently at first to warm up. You might begin with range-of-motion exercises for five to 10 minutes before
you move on to strengthening or aerobic exercises.
n Exercise with slow and easy movements. If you start noticing pain, take a break. Sharp pain or pain that is stronger than your usual joint pain might indicate
something is wrong. Slow down if you notice inflammation or redness in your joints.
Trust your instincts and don’t exert more than you think your joints can handle. Take it easy and slowly increase both the amount of time and intensity of your workout. Don’t overdo it. Talk to your doctor if you feel weak, find a reduced range of motion in your joints, develop swelling and pain in your joints.
Sources: WebMD, MayoClinic

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