Arthritis- Her life was turned upside down by a strange disease

Jun 14, 2009

SHE claims to have had the sickness since childhood, but it was not pronounced until she was 16. “My legs began to swell and soon became painful,” she recalls. “The pain pierced through my flesh like a needle, making it difficult for me to walk.”

By Stephen Ssenkaaba

SHE claims to have had the sickness since childhood, but it was not pronounced until she was 16. “My legs began to swell and soon became painful,” she recalls. “The pain pierced through my flesh like a needle, making it difficult for me to walk.”

Irene Nabifuge is a 27-year-old former teacher whose life has been turned upside down by a strange disease.

Today, she is confined to her parents’ home in Namasuba, unable to move or do anything for herself. Her story is a sustained struggle of pain and frustration.

Initially, Nabifuge was diagnosed with sickle cells. “Seven years later, my fingers started getting deformed; they developed a strange pattern, stretching and growing into different directions,” she says.

Several hospital visits and tests later, it was discovered that Nabifuge had rheumatoid arthritis.
Rheumatoid arthritis is increasingly becoming a health concern. Unfortunately little is known about the condition.

What is rheumatoid arthritis?
“This is a disease of the joints. Although it attacks and destroys the joints leading to deformities, its causes are not known,” says Dr. Mark Kaddu Mukasa, a rheumatologist in Mulago Hospital.

While this disease is linked to genetic factors, these are not sorely responsible for its occurrence.

Dr Kaddu says although some families have a higher chance of acquiring the disease, it is exacerbated by environmental factors such as viral infections and smoking.

He says while this condition is the second most common after osteoarthritis (arthritis caused by breakdown and loss of joint cartridge), Uganda lacks statistics about the condition.

Kaddu, however, says the disease affects about 1% of the world’s population.

“Out of 30 million Ugandans, about 300,000 have rheumatoid arthritis.”
Every Friday, Dr. Kaddu attends to 40 patients at the weekly rheumatoid arthritis clinic at Mulago Hospital.

“This includes 10 new patients and 30 continuing ones, four of which are severe,” he says.

According to medicinenet.com, rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the US.

The disease is three times more common in women than in men. It can begin at any age, but mainly starts after 40 and before 60. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

Diagnosis
The first step in the diagnosis of rheumatoid arthritis is a meeting between the doctor and the patient.

The doctor reviews the history of the symptoms, examines the joints for inflammation and deformity, the skin for rheumatoid nodules, and other parts of the body for inflammation.

Certain blood and X-ray tests are often obtained. The diagnosis will be based on the pattern of the symptoms, distribution of the inflamed joints and the blood and X-ray findings.

Diagnosis also involves tests for what is medically known as rheumatoid factor and a couple of other tests which assist in the diagnosis.

Treatment
At the moment, there is no cure for the disease. “We use drugs and other forms of therapy such as physiotherapy, exercises and immobilising joints by use of splints (kisementi) to reduce swelling and pain.”

Patients are also given ordinary painkillers such as aspirin, panadol and diclophenac to reduce the pain.
“All these are administered as doctors watch for side-effects such as renal impairment,” says Dr. Kaddu.

“We also use steroids to reduce swelling even though these may lead to peptic ulcers and other side-effects such as brittle bones, wearing of the skin and fat accumulation.

These are administered for a short time, before patients are put on disease modifying drugs such as antimalarials.

Patients also receive a drug called methotrexoate and folic acid. All these are administered as doctors monitor for liver problems because the disease tends to affect the liver.

Check your diet
Suggestions have been made to the effect that foods such as glucosamine sulphate, wheat and tomatoes could precipitate rheumatoid arthritis.

Dr Kaddu, however, says there are no studies to prove this. He advises patients to desist from taking herbal medicine.

He also recommends natural remedies such as Omega 3(Fish oil) and egg shell supplements. Ultimately, he says, patients should stick to to their treatment.

Counselling
Since the disease is for a lifetime, patients should be constantly counselled about dealing and living with it without resentment.

Avoid cold conditions
Patients should always wear warm clothing and gloves during cold weather to avoid stiffness.

Treatment
There are no clear-cut measures to prevent the onset of rheumatoid arthritis. However, the disease can be put in check and prevented from progressing once it presents. Patients need to observe the following rules:

Report signs in time
Kaddu says it is important to get an early diagnosis to enable timely treatment to slow the progression of the disease.

“Once the disease destroys the joints, it then becomes difficult to reverse the situation.” He says most patients come for treatment when the condition is in its advanced stage.

The patients also need to adhere to a continuous regime of physiotherapy and occupational therapy.

Stop smoking
Smoking increases the risk of arthritis. It is, therefore, advisable for people to keep away from the deadly habit.

The drugs dilemma
One of the challenges of the disease is the high cost of drugs and treatment.

Nabifuge says she spends about she250,000 on drugs per month.
According to Dr Kaddu, effective drugs cost $200 (she450,000) per dose.

“The most effective of them, Rituxumab, goes for she7m per dose,” he says.

Kaddu says even though there are drugs such as sulphursala, lephruenomiad and others which cost about she35,000 per dose, per month, they are not very effective.

Absence of medical facilities and trained medical workers to handle the disease has only made matters worse. There is only one rheumatology clinic in the country at Mulago Hospital.

The clinic operates once a week on Fridays. It is run by Dr. Kaddu Mukasa, the only trained rheumatologist in the country.

It might be too late to reverse Nabifuge’s condition, but a lot more people will be saved if measures are taken to provide facilities and to raise awareness about the disease.

Symptoms of rheumatoid arthritis
The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation.

“It presents in the form of rheumatoid nodules (swellings over bonny prominences such as elbows and fingers, leading to disfiguring of the body,” says Dr Kaddu.

He says a patient usually gets involvement of other body parts such as the lungs, leading to difficulty in breathing, inflammation of the blood vessels and, in worse cases, a heart attack.

Other signs of the disease include: Finger stiffness, where patients wake up in the morning unable to flex or use their fingers. This goes on for about an hour.

“Sometimes the disease affects knees, shoulders and other joints and, in some cases, patients may present with a fever and ulcers.”

Misconceptions
Since the disease presents with different signs, it is often confused with many complications. Sometimes patients present with acute chest complications, fever, chest pain, difficult breathing, just like sickle cell patients.

“We thought she had sickle cells and, for many years, we sought treatment for that, says Tolofisa Kigongo, Nabifuge’s mum.

Other people confuse the disease with kidney failure because the patients’ feet, legs and other limbs swell; a sign that also presents among renal failure patients.

The moment the fingers and the feet develop deformities, some superstitious people begin to associate rheumatoid arthritis with witchcraft.

Dr. Kaddu says the best way to eradicate these misconceptions is by consulting a doctor and going for regular check-ups.

Types of arthritis
Viral arthritis
This is the inflammation of the joints that results from a viral infection. It lasts a short time and usually disappears on its own without any lasting effects.

Symptoms include joint pain and swelling of one or more joints. The arthritis is mild, but there is no known way to prevent it.

Reactive arthritis
This occurs as a reaction to an infection elsewhere in the body. It is also known as Reiter’s syndrome. Some doctors refer to it as a seronegative spondyloarthropathy.

Thumb basal joint arthritis
This is a common condition which often affects both hands. It is painless in some people, but others have great difficulty because of pain and weakness of pinch.

Over time, the thumb may draw into the palm and be compensated by stretching and hyper extending the adjacent joint.

Fungal arthritis
This is an inflammation of a joint caused by infection by a fungus. Fungal or mycotic arthritis is a rare condition and may be caused by any of the invasive fungi.

These organisms may affect bone or joint tissue. One or more joints may be affected, with the large weight-bearing joints, especially the knee, most commonly affected.

Juvenile arthritis
This is not a single disease, but rather, a variety of diseases with persistent symptoms of arthritis which start before the age of 16.

Tuberculosis arthritis
This is an infection of the joints caused by tuberculosis. The most affected joints include the spine, hips, knees, wrists and ankles. Most cases involve just one joint. Tuberculosis involving the spine is often referred to as Pott's disease.

Septic arthritis
Also known as infectious arthritis. Septic arthritis is an infection in a joint. A single large joint is usually involved with septic arthritis, but many joints can be involved.

Infectious arthritis
This type is caused by a germ that travels through the body to a joint. The germ can be a bacterium, virus or fungus.

The germ can enter the body through the skin, nose, throat, ears, or through an open wound. Most often, infectious arthritis develops after an existing infection anywhere in the body travels through the bloodstream to a joint.

Nongonococcal infectious arthritis
An acute or sub-acute illness with potentially significant morbidity and mortality. Bacteria, mycobacteria or fungi can cause the disease.

Both healthy and individuals with predisposing conditions can be infected. In approximately 10% of patients, it affects multiple joints.

Psoriatic arthritis
This is one of over 100 types of arthritis. Psoriatic arthritis is associated with psoriasis (a skin disease in which scaly red and white patches develop on the skin). Researchers believe psoriatic arthritis is caused by a combination of genetic and environmental factors.

About.com: arthritis

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