Manjeet Saluja
Arthritis affects the joints with inflammation and pain. It also limits the movements of the joints. There is a misconception that Arthritis affects only older people. Arthritis affects people at any age and both sexes. However the fairer sex is more serverely affected. Arthritis, when it strikes the young, causes an impediment in life with troubling consequences. The pain, immobility and disability put brakes on a speeding life and lead to frustration, anger and bitterness. Lack of exercise, poor eating habits, vanishing support systems all contribute in making the disease worse
Some of the facts about Arthritis :
- In the US, Arthritis is second only to heart disease as a cause of work disability
- Arthritis strikes women more than men
- Arthritis is one of the most prevalent chronic health problems all over the world
- In Americans, Arthritis is the leading cause of disability among individuals over the age of 15
- Cost to the US economy totals more than $86.2 billion annually
- Arthritis affects people in all age groups including nearly 300,000 children
- Overall Arthritis : Women – 41.0 million, Men – 28.9 million
- Statistics from Asia, including India, are few but the situation is no different from the rest of the World
A population survey study in a village, Bhigwan, near Pune, under the WHOCOPCORD program, in 1996 showed that almost 12% – 15% of the community suffered from Rheumatism. These were the leading ailments compared to other medical illnesses like Hypertension, Diabetes, etc. More than 70% of these cases were women. (For details, visit our website : www.rheumatologyindia.com)
Rheumatoid Arthritis (RA) is preferentially a female disease, and too often seen in younger age groups. A recent WHO report on RA shows an unusually high prevalence for young Indian (Asian) women from a rural village (Bhigwan – COPCORD) study in West India.
Besides the anguish Arthritis causes to young women, the impact of the pain and disability affects life in many ways, such as :
Physical : Arthritis can develop life long disabilities / deformities. These not only restrict many activities of daily living, but also the outward appearance of the patient. Disclosure of RA becomes an even bigger question, especially if she is a working woman or if she is to get married. Pain and other symptoms interfere with the daily living activities and performance in the job. It limits daily activities such as walking, dressing, bathing, cooking and performing other household chores.
Mental : The inability to cope with the stress caused due to the physical imbalance is high. The patient gets anxious about her disease to the extent that depression sets in. She faces a feeling of uselessness and irritability. Sleep disturbance, appetite loss, etc. are also accompanied with loss of ambition and loss of self-esteem Many working women with arthritis rarely reach their potential in their workplace and invariably retire young, relying on the family and close ones to perform the tasks of daily living.
Marriage and Family : While the woman of the house may be the one with arthritis, it ultimately atfects the entire family in sorne or the other ways. The situation is indeed stressful if a young woman who is not yet married gets afthritis. Should the prospective in laws and future husband be told about ailhritis of the bride? Many educated people know very little about arthritis and have a general negative attitude to the extent that even if the bride has well controlled or treated
afthritis they do not want to consider her for a relationship. Sometimes, even daughters of mothers with rheumatoid arthritis may suffer in match making. lf staying in a nuclear family the spouse has to take on certain household responsibilities. The children also have to make certain adjustments.
Arthritis as such is also tough on marriage. Maybe she and her spouse would have decided to have a family with 2 – 3 children, but then her rheumatologist would have advised her not to have more than 1 child. Arthritis can add more stress to her family and it all depends on the manner she handles her relationships.
Social : Gathering with friends and family to talk, laugh and share things keeps everyone connected with life. But due to arthritis the patient may find herself withdrawing from her social circle. lt also means hard to entertain at home. Pain and fatigue can make you self conscious or shy around other people. Any unexpected pain or side effect from the medication or even her appearance could zap her confidence about entertaining.
Economical : lf she is a working woman then arthritis maybe one of the major reason for leaving work early. lt further affects the budget of the house. Due to the high cost of medicines she has to compromise on many other things in life maybe in terms of materialistic things. This leads to loss of income.
Lifestyle changes : Arthritis can change the way peopte participate in the activities that they once carried out with ease.Adjusting to a new life style can be challenging. Squatting is a common practice in our country especially to answer the call ol nature.Sitting cross – legged is common habit in our culture, especially while having meals and also while praying. Some women in the rural areas sit cross – legged while cooking. For a young woman living in the village going in the fields for ablution, she has to finish pertorming this task either before dawn or after sunset which makes her life more miserable.
Many of the houses are built with standard features such as multiple staircases, hard to reach cabinets and lndian toilets. Daily activities become challenging in a house that can’t accommodate limited physical abilities.
She may have trouble entering or leaving home, opening or closing doors and using bathroom amenities.
The results of the ongoing WHO – COPCORD village Bhigwan study on asking patients of ‘What is the impact of Rheumatic
musculoskeletal pain and disability of on you life?’ are shown in Table 1 . The answers were recorded by village health volunteers but even then many cases must have found it difficult to give correct answers. All said and done, it gives some idea what the patients perceive as most impodant effects. As it is obvious, the major impact was on ability to work and finance in these patients from village Bhigwan where the majority of the cases were women and that too in 20 – 45 year age group. Besides doing household work and looking after large ioint families, many women in villages do labour work in the fields to augment their family income.
Expert help : lt is important to obtain correct expert opinion and treatment from a doctor. Though many doctors are trained to manage general symptoms of arthritis, a rheumatologist is best suited to treat chronic progressive afthritis such as rheurnatoid arthritis. Remember there are no cures in most of the cases as these diseases tend to be chronic like diabetes. But proper regular treatment can improve quality of life and prevent deformities. And if the patient is a young
woman, she needs expert help to tide over not only the illness, but so many personal, family, social and occupation related issues.
Useful guidance can also be obtained from the psychologist, counsellor and also patient support groups such as MAI (Mission
Arthritis lndia).
MAI : (For details visit the MAI page on the CRD website: www.rheumatologyindia.org). An organisation like MAI can help
you learn more about how to communicate clearly and deal with issues related to arthritis more openly. To live successfully depends greatly on how you manage your disease.
Being flexible and creative can help you balance work responsibilities with demands of arthritis. Some ways to manage this are:
o Maintaining a positive attitude.
o Setting priorities. Do the most important tasks while you feel the strongest and highly energetic.
o Forming meaningful relationships;friends can help you combat depression, distract you from pain and support you when you have a flare.
ln fact a strong support system like MAI can actually improve the physical health of many such young women suffering from
arthritis.
