HEALTHWATCH

Keep yourself mobile

What's new in the world of rheumatology? DR. HIRAMALINI
SESHADRI reports on IRACON 2004, the annual national
conference of the Indian Rheumatology Association.  

The Hindu
Sunday, December 19, 2004

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.

More at:
http://www.hindu.com/mag/2004/12/19/stories/2004121900560600.htm

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