Arthritis emerging non-communicable disease in Sri Lanka

The number of patients seeking treatment for joint related pain is colossal. The amount of painkiller tablets that is dispensed at a busy government clinic is staggering. I have heard pharmacists complaining about the mountains of pills that are distributed at arthritis clinics. Most patients are already disabled and struggle to reach the consultation desk because of their joint pain. Observing their facial expressions, it’s obvious that most of these patients are suffering from an element of depression because of constant 24x7 pain. Some impatiently wait a few years for expensive joint replacement surgeries. And yet, Sri Lanka hasn’t still recognised arthritis as a red alert ailment. In our list of non-communicable diseases, the disease arthritis is missing.

Osteoarthritis the emerging threat….
Out of all forms of arthritis, osteoarthritis is undoubtedly one of the most devastating diseases worldwide. The pain and disability indirectly impacts the economy with loss of work hours. The cost for pain medication is enormous. And the loss of work hours because of osteoarthritis made it the second most costly disease in USA with an estimated 16.5 billion dollar expense to the government. Painful knee osteoarthritis occurs in 10% men and 13% in women aged 60 years or older in USA. 

In osteoarthritis the cartilage layer which acts as a shock absorber between joints gets damaged. The exact triggering event is unknown, but we do know that this disease runs in the family, affects in overweight people and happens in an already injured joint. Overuse of any joint because of sports or occupation can also cause permanent damage to cartilage. Once the cartilage is damaged, there is no proper medication to regenerate it back. 

Osteoarthritis could affect both large and small joints of your body. Some of the common joints affected are the hips, knees and the hands. It could also lead to deformities in these joints. The usual role of cartilage is to protect and prevent bone from rubbing against bone within a joint. Cartilage covers the bone endings which usually connect and form a joint. When the cartilage wears out, these bone endings move against each other causing enormous pain and disability.

Sri Lankan situation
We are unaware of the Sri Lankan statistics on arthritis, but what we rheumatologists know of is the gradually expanding patient number. Sedentary lifestyle might be one of the reasons why this disease is so prevalent in the post millennial era. Obesity directly contributes to damage of the weight bearing joints. Unfortunately we do not have an established joint protection programme in Sri Lanka. A proper awareness campaign is necessary where patients are taught correct strategies to prevent conditions like osteoarthritis.

The Sri Lankan patients are popular for their dependence on medication rather than reliance on lifestyle modification techniques. We are a nation that fancies instant remedies than long term solid methods of modifying the cause of diseases. Hence we see patients who are addicted to pain killers despite  possessing a fair knowledge on drug side effects. 

The need of the hour is to first of all accept arthritis as serious non communicable disease

Although we do not have nationwide studies done on arthritis, the prevalence is seen more in females than males. Also we see a lot of post-menopausal patients with severe disease
The need of the hour..

In the world renowned Nature Reviews medical journal, five essential steps in treating osteoarthritis were published. These are weight reduction, land based exercise, hydrotherapy (water based exercise), strength training and self-management /education. In addition to these I advocate the value of walking canes, to offload the affected joint. Walking canes should be height adjusted, used on the correct side and with correct coordination of arms / legs to help ease the knee/hip/ankle pain. 

The global trend is shifting towards treating knee osteoarthritis pain using antidepressants like duloxetine. 

The reason being that long term pain is perceived in areas of the brain that are responsible for emotions. In short, arthritis related pain causes depression on the long run. Therefore psychological counselling is a must for all patients. Unfortunately we do not have such a service in either government or private sector hospitals.

 Losing weight is one of the cornerstones of osteoarthritis treatment

The need of the hour is to first of all accept arthritis as serious non communicable disease in Sri Lanka. Certain countries in the African continent have teamed up with the world health organisation to include arthritis in their list of non-communicable diseases. We also need research to prove how prevalent this ailment is. And a proper analysis on the cost devoted for medical or surgical management of arthritis. 

I see good awareness on the dangers of obesity and weight reduction strategies among Sri Lankans. Losing weight is one of the cornerstones of osteoarthritis treatment. To protect people from non-communicable diseases like cardiovascular disease and diabetes, they require exercise; and for regular exercise one needs healthy painless joints. Therefore promoting arthritis free joints will directly lead to a disease free healthy population. 

It’s interesting to know that we have a higher life expectancy at birth (77 years) than even China (76). Sri Lanka boasts of excellent health care standards that might have led to this longevity. But are we using medication to prolong life and at the same time inviting certain diseases to settle in a patient who does not accept life style modifications? This is a question that remains unanswered. I hope the health authorities accept arthritis as an emerging treat very soon as “a stitch in time saves nine”!