Osteoarthritis in India

1. Is lack of proper nutrition during adolescence and then in pregnancy, the major cause of women suffering from osteoarthritis in India?

• Nutrition has no direct role in the development of osteoarthritis. However, taking a diet rich in proteins and calcium helps strengthen the bones which in turn prevents the progression of arthritis and the pain associated with arthritis.
• If you have uric acid issues then that needs to be controlled with an appropriate diet because uric acid itself if untreated can increase arthritis. 
• Poor nutrition in childhood can lead to bowing of the legs which in turn causes malalignment and then osteoarthritis. 

2. To what extent has the women-centric schemes by the Central and State Governments helped the Indian women to overcome bone related disorders including osteoarthritis?

• Women-centric schemes have helped improve nutrition but remember that just nutrition is good for bone strength and not for osteoarthritis. Osteoarthritis exists even in the western world where in fact the surgeries done for osteoarthritis are much more common. 
• Nutrition in the formative years is important to have good, strong, well-aligned limbs. Remember that your bones increase the maximum strength till the age of 25 and after that, they start losing strength. 
• Too much nutrition and an inactive lifestyle are equally detrimental. Everything is a matter of balance.

3. Statistically, where do Indian women stand in terms of inflicted by osteoarthritis?

• Women are definitely affected more by arthritis. By this I mean they are more likely to get osteoarthritis than men and are more likely to suffer from symptoms of arthritis. The ratio of women to men is about 60:40 but the suffering ratio is 75:25. This is because the bone strength and muscle strength in women are weaker than men so for the same extent of degeneration seen on the x-ray the women are more likely to have pain than men.
• Come to 2013 and India is likely to notice an endemic of osteoarthritis with about 80% of the 65+ population in the country suffering from wear and tear of joints. 40% of these people are likely to suffer from severe osteoarthritis, which will disable them from daily activities, say the experts quoting the World Health Organisation (WHO).
• The reason behind the onset of this endemic is said to be increasing longevity of Indians. By 2020 the number of 65+ population in India is likely to be about 177 million, whereas India had 100 million people in this age group in 2010. Osteoarthritis, which is the most prevalent form of arthritis and the leading cause of disability in India affects over 15 million Indians each year. About 20 years ago, osteoarthritis was known as a disease of the elderly affecting those above the age of 65 years. However, Orthopedicians are increasingly diagnosing younger people in the age group of 35-55.
• The prevalence of OA among elderly is nearly about 56.6%. Community survey data in rural and urban areas of India shows the prevalence of OA to be in the range of 17-60.6%.
• Rheumatoid arthritis which is another form of arthritis called inflammatory arthritis affects women more commonly than men. 
• Arthritis in younger people before the age of 50 is more common in males probably because of more injuries leading to joint damage.

4. Though we talk about osteoarthritis as a major problem among the women in the South Asian region, it has also been seen that staying indoors for long, gaining excess weight or lack of exercise and calcium in the post-menopausal diet are the major reasons for it. Can you please explain?

• This is the bane of modern life. It is common all over the world not just in South Asia. People all over the world are becoming inactive, using their cars and walking less. This leads to weight gain, decreased muscle and bone strength.  A simple exercise like walking is extremely good for the knees. Menopause affects the strength of the bone and not necessarily leads to osteoarthritis. Simply put a weight gain of one kg adds 3 kgs to the knee. 
• Calcium and vitamin D has a role to play in the development of osteoporosis and not osteoarthritis. However, if the bone strength in an osteoporotic knee is low then the pain associated is more. Also the deformation of the arthritic joint increases (particularly seen in the knees). The likely hood of stress fractures also increases in softer bones. This is because arthritic joints become stiff and subject the bones near the joints to stress.

5. To what extent does osteoarthritis become genetic. In how many per cent of Indian women do we see this problem and where does it stand in terms of the osteoarthritis across the world?

• There is definitely a genetic predisposition of osteoarthritis. It tends to run in families.
• It is difficult to define the exact incidence of osteoarthritis but its commonly seen in the knees followed by the hands.

6. What percentage of the women in India and across the world go for surgeries to get rid of osteoarthritis. Has it been successful in most of the cases?

• The indication for surgery in osteoarthritis is pain disability and functional limitation of activities. Hence the indication is patient driven. If people want to improve their quality of life and are in pain because their joints limit their daily activities then surgery should be considered.
• Since knee arthritis is the most common if we talk about the incidence of surgery, then there has been a tenfold increase in the last 10 years. The numbers in themselves speak for the success of the surgery.
• In India, there are approximately 1,30,000 surgeries for joint replacement done in one year. Compared to the USA this is a small number who does about 250000 per year.

7. It is believed that IT professionals, who work for long hours, have a chance of facing osteoarthritis problems by the time they turn 45-50. As women continue to rise working in MNCs, how do you think osteoarthritis can be avoided?

• This comes back to the previous question. It is simply not related to working. It is related to lifestyle. In fact today the younger generation is more aware of their weight and are more into exercise.
• There are both sides of the coin too. Like in any country there is an epidemic of obesity because of unhealthy food habits.
• So more than a specific job sector individual choices, lifestyle, awareness and exercise are determinants as to who is likely to suffer from osteoarthritis.
• The IT professionals are assumed to be the ones behind the desk all the time. Today we see people having standing workstations and they sit less. Activity and movement is the key along with a healthy diet.
• Osteoarthritis cannot be avoided, because we are all going to get old. However, with small changes as mentioned above, it can be delayed, both in its presentation and in its manifestation.

8. What do you suggest for the young women who due to their stressed life are not able to pay heed to their diet and fitness? 

• Exercise whenever you can.
• If you travel by public transport, get off a stop earlier and walk to work. Do not sit at your table for long stretches.
• There are simple exercises that one can do in 7 mins in the office when you are taking a break. We should not find excuses and do the right thing.
• Its particularly difficult to reduce weight and start exercise late in life, so start early.
• It is very satisfying to see ladies with knee pain reporting improved outcomes after taking up walking (to work for example).
• Eat correctly and smartly. There is enough information available on what constitutes a good diet and how to eat.
• As women have looser joints and weaker muscles, strength training is important for them.

9. What are the latest advancement in the treatment process for osteoarthritis and how well are they being preferred by women of the world, precisely Indian women? Is it avoided?

• There are many new drugs that are available nowadays that help slow down the progression of arthritis. They have to be taken for a long period of 2 to 3 months for them to show any benefit however they do work in early stages.
• In younger post-traumatic arthritis (knee) chondrocyte transfer procedures wherein cartilage from one part of the joint is transplanted in the damaged areas have been used with early success.
• There are oil like injections that seem to replicate the natural fluid in the knee (that has decreased because of arthritis) that can be used in early stages.
• Steroid injections are also useful in arthritis to temporary mitigate the pain. 
• Of course, there has been a tremendous improvement in the field of surgeries. Modern implants, less invasive procedures, better pain control, better pre and postoperative exercise programs have all contributed to better patient outcomes.
• The acceptance of surgery is evident from the growing numbers internationally and in India.