That Rheumatoid Arthritis is a serious & disabling condition is fairly well known. However, it often comes as a surprise to many when informed that it is also controllable. We should consider ourselves blessed when compared to our forefathers given the recent treatment options & outcome of rheumatoid arthritis.
One can achieve conquest over Rheumatoid Arthritis when diagnosed & treated early with definite medicines (DMARDs).
The problems with early diagnosis are manifold. Joint complaints are often ignored in the initial stages. The current medical educational system lays emphasis on obvious emergencies & life threatening diseases like heart attack, stroke & infectious diseases like tuberculosis. Thus many of the Family physicians are not well trained in early diagnosis of Rheumatoid arthritis. I’m sure it remains a big responsibility of the Rheumatologist fraternity along with the academic bodies to look after training of the family physicians in musculoskeletal ailments.
Many patients thus end up wasting precious time at this first step of contact with the primary caretaker. Frustration over their complaints & inappropriate guidance may lead them to alternative systems. The Indian system is plagued with numerous ‘so called traditional system doctors’ who administer steroids & spoil the long term prognosis for them. Quick suspicion & immediate referral by a family physician to a Rheumatologist will definitely change their life.
The second step for these patients is accessing a Rheumatologist. I must confess that Rheumatologists are too few & everyone has a long waiting list. A 6- 8 weeks appointment delay obviously eats into the therapeutic window of RA patients. Time is lost at the cost of joint function in these patients. It remains a collective responsibility of us Rheumatologists to bear this in mind so as to maintain the least possible waiting period for a new RA patient.
The next step at the Rheumatologist’s can be plagued by its own set of problems. The first & foremost is the self denial of diagnosis. The myths about arthritis in the society, the so called uncontrollable nature of RA plays an important role in this denial. A gentle reassurance by the Rheumatologist & interaction with old patients in the clinic generally allay the initial fears. The general fear that treatment is based on steroids often plays a spoilsport at this step. All recent research studies have shown that early & aggressive treatment with DMARDs (like Methotrexate, Leflunomide etc) leads to remission.
The time from onset of symptoms to control of RA activity remains the main determinant of the conquest over Rheumatoid Arthritis. Many patients falter at each of these steps & fall into the nadir of the never ending pain of rheumatoid arthritis. The family physician, Rheumatologist & the society share their own set of responsibilities in helping these patients achieve conquest over their arthritis.