Affecting more men than women, the autoimmune disease is a debilitating condition that needs proper management, writes Nadia Badarudin
HAVE you wondered what it feels like when your finger joints are so stiff and painful that even turning a door knob becomes a huge challenge?
Can you imagine enduring the throbbing pain of swollen knees that make walking almost impossible?
Annie Hay looks in the pink of health at 57. However, who would have thought that behind that smile, she is among the 70 million sufferers of an incurable autoimmune disease?
It all began 23 years ago when she woke up one morning and noticed her knees were reddish and swollen. Thinking that the condition might be related to a previous injury, she just ignored it and went to work. However, there was no improvement after two weeks. The swelling worsened and caused her much pain.
The persistent pain eventually became unbearable to the point that she began limping.
The experience that Annie went through is attributed to rheumatoid arthritis (RA), an autoimmune disease that causes the joints to become chronically inflamed, painful and swollen. The most commonly affected joints include the small joints of the fingers, thumbs, wrists, feet, knees and shoulders.
Studies show that women are more likely to develop RA than men. The disease can last for years, as in Annie’s case.
If left untreated, it can lead to debilitating effects including depression, joint deformities and disabilities.
Having this crippling illness is frustrating and stressful, especially when you are young and still working, says Annie who currently works as a customer service unit administrator with an international oil company.
“I was 34 when I was diagnosed. At that time I was staying in a four-storey walk-up apartment and I travelled to work by bus. The two factors were huge obstacles especially on days when I was in pain and could barely stand or walk,” she says as she recalls her struggles in coping with the disease during its initial years.
“Sometimes, when my knees felt bad, I purposely used a walking stick and hoped that someone would be kind enough to offer me a seat on the bus. When I got back from work, it was a struggle to climb the stairs to the top floor where I was staying. It was frustrating and I felt crippled,” she adds.
Annie’s first round of medical treatment did not go well. She then sought traditional alternative treatments. She eventually underwent knee replacement surgeries in 1999.
MORE IN WOMEN
RA is a chronic disease, which means that it can last a long time. Many think that the disorder is only about the joints, but the inflammations can eventually affect the eyes, skin, heart, lungs, muscles, bones, nerves and blood.
As with other autoimmune diseases, RA can happen to anyone at any age, but it is most common in people between 40 and 60, says associate professor and consultant rheumatologist at University Malaya Specialist Centre Dr S. Sargunan.
Dr Sargunan says RA is a multi-factorial disease and the prevalence is more in women. “Females are two to three times more likely to get the disease. I see female patients who mainly get the disease when they are young and are about to start college or first job.
“This definitely will affect their work productivity and personal lives as they enter their marriage and child-bearing years,” he says, adding that the disease is detected mainly via a blood test.
Why are females more prone to develop RA?
Dr Sargunan says: “This can be linked to the nature of the female hormone oestrogen. In RA, the body’s immune system is triggered to produce abnormal antibodies that ‘attack’ or go against the body. The process involves T-cells, in which their functions are affected by oestrogen.”
He says studies show that one to three per cent of women in the world may get RA in their lifetime. There are also studies indicating that the disease is more severe and difficult to treat in women than in men as the latter tend to have better responses and sustained remission compared to women in the early phase.
Online health and medical website WebMD states women who have never been pregnant are at a higher risk to develop the disease. The RA condition may improve during pregnancy but is likely to recur after giving birth.
It also mentions that women who breastfeed have a lower risk of developing RA compared to those who have not.
INCURABLE BUT TREATABLE
Dr Sargunan says there is no cure for RA, but thanks to early diagnosis and more effective treatments, the disease has become manageable. Joint deformities or disabilities are also becoming less frequent and less severe in patients, he adds.
The goals of treating RA are to reduce pain, improve physical functions and slow its progression. The common treatment options include non-steroidal anti-inflammatory drugs (NSAIDs that reduce acute inflammation), corticosteroids (drugs containing anti-inflammatory and immunoregulatory properties), conventional disease-modifying anti-rheumatoid drugs (DMARDs), biologic DMARDs and surgery.
“Biologic DMARDs (via injections) are meant for patients with severe RA and who are non-responsive to traditional DMARDs. Biologic is becoming more common in patients who need more than the traditional medication. But it is expensive,” he says.
Having RA does not mean that a patient cannot live a normal life. Annie (who is now on biologic treatment), for instance, refuses to let RA dictates her life.
Besides living a healthy lifestyle, she is actively involved in the Rheumatoid Arthritis Support Group (a support group for patients under the Arthritis Foundation Malaysia) that reaches out and provides emotional support to patients. Among the group’s activities is PACE or People with Arthritis Can Exercise classes for members.
Dr Sargunan says having RA may be difficult to some, but the key in managing and coping with it is early detection and treatment.
“Always be alert when you feel stiff at the joints in the morning. That’s the ‘hallmark’ sign of RA. Female patients should consult the doctors when about to start a family and discuss the side effects of existing medications.
“Part of the treatment is to be active and get the joints moving. Do joint-strengthening exercises to help take away the stress from the joints,” he says.
He says there are special tools and devices including forks and spoons, computer keyboards or toothbrushes that can help patients with the tasks.
“However, the most important thing is to stay positive. Take it as part and parcel of life. And remember, help from the experts are plenty,” he says.
• Arthritis Foundation Malaysia (AFM)
Room 7, Level 3
Bangunan Sultan Salahuddin Abdul Aziz Shah
16, Jalan Utara, Petaling Jaya, Selangor.
Telephone: 03-7960 6177
Fax: 03-7956 7177
Follow @ArthritisFM on Twitter
• Rheumatoid Arthritis Support Group (RASG)
Contact: (Same as AFM)
This article was first published in www.nst.com.my on 18 October 2016.