HEALTHWATCH
Keep yourself mobile
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What's new in the world of rheumatology? DR. HIRAMALINI SESHADRI reports on IRACON 2004, the annual national conference of the Indian Rheumatology Association.
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In the long run rheumatoid arthritis caused deformities that crippled the patient.
ONLY in the past two decades has Rheumatology been recognised as a sub-speciality of medicine by the public at large. In the early 1980s, Dr. A.N. Chandrasekharan of Chennai was the lone crusader for Rheumatology in the subcontinent and his dedicated work at MMC led to the establishment of the first ever department of Rheumatology in India.
This year it came back full circle to Chennai with the annual national conference of the Indian Rheumatology Association (IRACON 2004) being held at Chennai last week.
Symbiotic relationship
Rheumatology includes all diseases of the musculo-skeletal system and blood vessels, excluding trauma, which usually comes within the purview of the orthopaedic surgeon. Today rheumatologists and orthopaedic surgeons have a symbiotic relationship with the latter replacing with artificial joints what the former could not mend with medicines.
Wear and tear of the joints affects modern man more because he lives longer, tends to be more obese and exercise less. Osteoarthritis, as it is called, was hitherto treated with painkillers with all their attendant side effects.
Not anymore; today arthroscopy, injection of dry, painful joints with enzymes and, most importantly, the use of simple nutritional supplements, which do not have side effects, to regenerate cartilage is brightening the scene.
Supplements
At IRACON 2004, a study of over 8,000 patients treated with supplements such as glucosamine hydrochloride and chondroitin sulfate showed that, over two years, they had significant clinical and radiological improvement.
That other nutritional supplements such as pineapple extract, grape seed extract and antioxidants help is also known, though these areas were not discussed at the conference.
Interested readers may refer to What Your Doctor Does Not Know About Nutritional Medicine May Be Killing You by Dr. Ray Strand brought out by Magna books.
New drug
Just as coronary artery disease is the bread and butter of cardiologists, rheumatoid arthritis (RA) is the bread and butter of rheumatologists. Hitherto, the treatment of RA used to frustrate both doctors and patients for it invariably followed a remitting relapsing course and often inexorably led to deformities that finally crippled and confined the patient to bed.
That scenario is changing. An inexpensive anti-cancer drug called methotrexate and an expensive newer drug called leflunomide when used along with hydroxychloroquine, (a cousin of the common antimalarial chloriquine), has been found to help RA; and many studies reported this benefit in Indian patients.
A hot topic at the conference was the new class of drugs used in RA, the "anti tumour necrosis factor" (TNF)' drugs.
Other medicines
As the name suggests, TNF is a protein discovered by cancer researchers and is a link in the immune response chain. By neutralising it, inflammation that causes swelling and pain in rheumatoid arthritis can be dramatically arrested.
But there is a rub; they cost tens of thousands of rupees and assure no permanent cure. Besides the use of these drugs renders one more vulnerable to tuberculosis; and that is a very dicey situation in a country like ours.
On the gout front, analysis of check up reports at the Apollo First Med Hospitals, Chennai, revealed that high levels of uric acid often exist in the absence of gout; and are often related to high blood fat levels and obesity.
Studies done at Vellore showed that the young can go down with gout too; 20 per cent of their cases were in their twenties!
Ignored
Osteoporosis, which was in the media a lot recently, got its share of attention too. Sadly, rheumatic fever, which maims so many of our children and youth and scars them for life with heart valve problems, was not in the limelight at IRACON 2004.
In the West, rheumatic fever hardly exists and so they have no interest in it. But Indians ought to study it more; particularly the practical aspect of management.
In certain states like Kerala, hospitals refuse to give the penicillin injections that these patients need for fear of public outrage and mob violence should any untoward reaction occur due to the medicine.
Another interesting fact is that a post streptococcal arthritis that mimics rheumatic fever has been found to exist; this does not progress to involve heart valves.
How common is it in India? How do we differentiate between the two? Perhaps IRACON 2005 will give some answers.
Holistic approach
A holistic approach to the management of chronic arthritis has been found to be significantly better than conventional management as reported in the Journal of the British Society for Rheumatology. Here counselling and anti-depression measures were also used.
In my practice, I have found that a body-mind-soul approach is extremely beneficial; for basically when these diseases occur due to stress, the neuro endocrine controls of the immune system go haywire and a confused immune system produces antibodies against one's own tissues. Like your pet dog getting confused and biting you thinking you are a thief.
Psycho-spiritual techniques that help reduce the effects of stress and correct the abnormal immune response help medicines work much better.
The fundamental aim of a Rheumatologist is to ensure that the patient has good mobility; and the recipe for that hasn't changed much.
Eat right, think right, sleep right and exercise right; and you can keep rheumatism and rheumatologists at bay.
The writer is a Senior Consultant, Holistic Internal Medicine and Rheumatology, Chennai.
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