Journey from my Ba’s house to being a rheumatologist
I grew up in a small town in India. I used to call my grandmother ‘Ba’. My Ba passed away when I had finished my medical school. I never got a chance to diagnose or treat her ‘arthritis’. I remember her telling me about weather forecast from the way her joints felt. She was treated by a doctor in a clinic down the street from her house with ‘small white pills’ in a bottle and she would have temporary relief.
10 years later I am still trying to find my Ba in every patient I treat with arthritis. I think I am trying to figure out what kind of arthritis she actually had and what could I have done to help her. Even though I could not help my Ba, because of her I treat every patient as I would treat my Ba. She made me a better rheumatologist.
This story of my grandmother brings up a very good question. Does ‘arthritis’ mean same diagnosis for everyone? Now I know that the answer is ‘NO’. I treat every patient with dignity, kindness and compassion, like I would have treated my grandmother. However I don’t think I can treat every patient with the same treatment approach. Most people think arthritis is just one kind and mostly affects older people. However there are more than 100 types of rheumatic diseases and each disease can affect joints. I can not tell you how many patients in my office ask me every day,
WHAT KIND OF ARTHRITIS DO I HAVE?
Arthritis can be mainly divided in 2 category:
1) Non inflammatory (also known as ‘wear and tear’)
2) Inflammatory arthritis
Non inflammatory or ‘wear and tear’ arthritis is called Osteoarthritis (OA). This arthritis mainly characterized by breakdown of the cartilage (the tissue between your joints providing cushions), associated bony changes, deterioration of tendons and ligaments. Although primary OA can affect mainly middle age to elderly people, secondary OA can happen at younger age.
Some of the risk factors for OA :
Having family members with OA
Previous injury or trauma to the joint
Repetitive or overuse injury
Congenital deformities such as unequal leg length, flat feet
Symptoms of OA are mainly joint pain, swelling and stiffness. Some people may notice their joints getting bigger. Most often rheumatologists detect OA based on typical symptoms, physical exam and X-rays. In some cases further imaging and blood tests are require to rule out other diagnosis.
Inflammatory arthritis can be many types and represents systemic inflammation. Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. However some other examples are psoriatic arthritis, ankylosing spondylitis, reactive arthritis, gout, pseudo gout and lupus. Inflammatory arthritis is characterized by pain, swelling, warmth and tenderness. Morning stiffness in theses disease can lasts more than an hour in contrast with osteoarthritis where morning stiffness lasts for few minutes. Because most of theses inflammatory arthritis are systemic, other symptoms depending on what organ of your body is affected, can occur. Diagnosis is based on clinical symptoms, physical exam, x-rays of affected joints and blood tests. Early diagnosis can make big difference and improves outcome of theses diseases.
Please see your rheumatologist to find out what kind of arthritis do you have?