By Chioma Obinna
Many Nigerians still doubt the price to pay for not exercising, eating right and not using their bodies well. Unfortunately, increasing number of people suffering from arthritis may not be unconnected with the common belief among young people, “I am young and energetic. I have six packs.”
Being strong and young now is not an escape route as the scary truth is that over exertion, unhealthy lifestyle, smoking, alcohol and lack of exercise can predispose individuals to arthritis in old age.
But why is arthritis a problem? Arthritis is one of the commonest causes of disability worldwide and it is a disease condition that can render its victims home- ridden. According to experts, it is a painful and degenerative condition marked by inflammation in the joints that causes stiffness. It is a disease that has more than 100 different types and related conditions. Arthritis gets worse with age and it is caused by wear and tear.
Sadly, despite its huge cost on healthcare, it is not well understood.
People of all ages, sexes and races can and do have arthritis. More than 50 million adults and 300,000 children have different types. It is most common among women and occurs more frequently as people get older.
Statistics showed that in Nigeria, for men, the deadliness of rheumatoid arthritis peaks at age 80 and above and kills men at the lowest rate at age 35-39 while women are killed at the highest rate at age 75-79. It is least deadly to women at age 15-19. At 6.9 deaths per 100,000 women in 2013, the peak mortality rate for women was higher than that of men at 2.7 per 100,000.
There are many myths and misconceptions surrounding the disease. It has also been established that the burden of arthritis will increase as the population grows and people get older.
Accidents are not avoidable but there is need for people to avoid traumatic events. If you have any problem, present early to hospital so that doctors can quickly arrest it because some of the things that lead to arthritis are things that are not adequately catered for.
Medical condition, not spiritual
Findings showed that many Nigerians with arthritis develop complications due to ignorance. While some lack awareness on where to go, some ascribe the problem to spiritual attack.
Speaking to Sunday Vanguard, a consultant rheumatologist with Lagos State University Teaching Hospital, LASUTH, Femi Adelowo, said arthritis is not a spiritual attack but a medical condition that can be treated medically.
Said Adelowo, “Arthritis is not just one disease. On the average, 30 in every 100 persons would have one form of arthritis or the other. That is quite significant and, unfortunately, many of these people do not know what to do.”
The consultant, who spoke on the side lines of an event by the Nigeria League of Associations of Rheumatology, NLAR, to mark the World Arthritis Day under the theme, ‘It’s all in your hands: Take Action’, said patients should avoid self-medication but seek intervention of specialists for proper treatment of the disease.
He noted that some of the actions many individuals take without knowing may predispose them to arthritis. For instance, not lifting heavy objects is one way to prevent the commonest types of arthritis like rheumatoid, psoriatic and fibromyalgia.
Lamenting that studies showed huge burden of the disease among Nigerians, he said although there are no accurate data currently, one third of people who are just going about their normal businesses may have one form of arthritis or the other.
Throwing more light on what arthritis is, Adelowo explained: “The commonest type of arthritis is osteoarthritis which is the inflammation of the sinovia joint. A sinovia joint is the juncture of two or more bones and that juncture is covered by a sinovia membrane and the sinovia membrane is like a bag that contains sinovia fluid.
That fluid helps to lubricate the joint. So if there is inflammation of that part of joint, it’s called osteoarthritis. Apart from that, we have rheumatoid arthritis which is what we call an auto immune disease.
It is a situation in which the body now sees itself as a foreign body. Normally, the body has a defence mechanism that helps to fight foreign invasion; that helps to fight germs and anything that is foreign to the body but, for one reason or the other, those defence mechanisms start attacking the body cells as though they are foreign and that leads to inflammation. That is the cause of rheumatoid arthritis.
“We also have septic arthritis which is inflammation of a joint by reason of infection. In this case, the bacteria or virus or fungi in the joint start multiplying. They produce toxic materials which invade the joint tissue and that situation leads to pain, swelling and loss of function, as the case may be. These are the most common types of arthritis that are prevalent in this environment”.
The consultant rheumatologist pointed out that joints are like machines. As people grow older, the tendency is that they have used the joint for a long period of time and, over time, there is a gradual wearing away of the cartilage that covers the joint and that can lead to arthritis. So age is one of the strongest factors in the emergence of osteoarthritis. Another common cause of osteoarthritis is trauma to the joint. If a joint has been traumatized either from a fall or from a road traffic accident or for, whatever reason, a joint was involved in an injury, the injury may have been treated but arthritis tend to result after some three, four years.
“If a joint was infested and treated but not properly treated, that joint stands the risk of developing osteoarthritis in future. Another important cause is weight. It is also more in women than in men. We are not sure exactly why but we know that women tend to have more weight compared to their height than men; that is, the body mass index. So that may be a factor in their predisposition to osteoarthritis”, he added.
Confirming that arthritis also affects young people, Adelowo pointed out that it can occur if they are involved in an accident and not treated properly or they have infection in the joint and not properly treated. Both situations can predispose the young person to arthritis but for rheumatoid arthritis, it is common from age 40 unlike osteoarthritis that is common in the elderly”.
Septic arthritis, which occurs as a result of infection not properly treated, can occur at early age, even right from infancy.
Advocating that Nigerians should take action, he noted that the disease is becoming a public health concern.
Encouraging people to seek treatment for arthritis early, Adelowo stressed that some arthritis, such as osteoarthritis, can be prevented by not putting on weight. “If you put on more weight, you are going to put a lot of weight on the knees and ankles and those are the areas where you have osteoarthritis arthritis. Also when you lift heavy objects from the ground, you may end up damaging your back. In other types of arthritis like gout arthritis, people should avoid alcohol, especially beer, red meat, among others”, the consultant said.
He said there are different types of treatment for the various types of arthritis. According to him, the treatment of the disease requires a multidisciplinary approach. No one specialist treats all the types.
Adelowo stated that treatment involves physiotherapists, rheumatologists, orthopaedic surgeons and occupational therapists among others.
Stating that people should go to hospital to see specialists and stop self-medication, he emphasised that abuse of painkillers by patients can lead to stomach and peptic ulcers.
Also for advanced cases of arthritis in which the joint has been deformed and patient is not able to walk, surgery may be the solution.
He recommended that women who have excess weight should lose weight as weight loss will significantly reduce the risk of arthritis.
“One of the major challenges has been low awareness and then convincing people that what they have has nothing to do with spiritual attack”, the consultant said.
“Another challenge has to do with the cost of drugs which are very expensive. The financial burden is also huge as, apart from the cost of treatment, the cost of transportation and loss of income are also challenging because many sufferers are actually in their old age. Most of them are home-ridden if it is severe enough.”
The commonest symptom that takes patients to hospital when they have arthritis is pain. The pain starts as mild and progresses to become severe as the disease advances. Also, patients can present with stiffness of the joints.
It’s difficult to move the joints through all the range of motion depending on the type of arthritis. In osteoarthritis, the pain increases as the day progresses but the pain of rheumatoid arthritis reduces as the day progresses. So it’s vice versa. Another symptom of arthritis is deformity. Sometimes you find people who have knocked knee or bow legs which is genuvaltum.