ESR Archives - InnoHEALTH magazine

Agonizing Ankylosing Spondylitis is More Common in Young Men

InnoHEALTH Magazine — Tue, 18 Dec 2018 05:50:28 +0000

Agonizing Ankylosing Spondylitis is more common in young men between 20 and 30 years of age than women; occurs in children as well.

For young people, less heard ailment Ankylosing Spondylitis (AS) is an emerging disturbance, but that is a stark reality: initially, victims develop symptoms such as low back pain and stiffness that lasts for more than 30 minutes and worsens in the morning or after prolonged inactivity.

Panacea lies in regular exercise before AS grips individual like a wasp with stiffened ligaments and muscles. Dr. Uma Kumar, states that such cases were burgeoning, and timely treatment can only stave off complications.

Patients with AS must exercise regularly because it helps to limit spinal deformity and maintain their spinal movement and flexibility, while also relieving the back pain. Swimming and deep breathing are the best exercises. In addition, a hot shower in the morning can help to ease the pain and stiffness. Patients should avoid smoking, eat a healthy diet and maintain a healthy weight.

AS is not curable, but it is completely treatable if detected early. Only 10% of patients have a severely disabling disease. With the help of the correct medication and lifestyle modification, approximately 80% people with AS remain completely independent or just minimally disabled in the long-term.

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In an exclusive interview to InnoHEALTH magazine, Dr. Kumar traces the original meaning of the disease, and says the word Ankylosing Spondylitis (AS) is derived from the Greek words ankylosis meaning ‘stiffening’, spondylosis meaning ‘vertebra’, and – it means ‘inflammation’.

She answered several questions on the ailment.

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Question: Can you please explain in detail AS?

AS is a chronic inflammatory type of spondyloarthritis (a broad term for all types of arthritis that affects the spine) that is further classified as an ‘axial spondyloarthritis’ because it affects the joints of the spine and pelvis (where the sacral bone attaches to the iliac bone on either side of the body). When spinal ligaments get inflamed at the point where they attach to the vertebrae, the ‘bone-making cells’ of the body get stimulated and start to grow bone within the ligaments, which results in the formation of bony bridges between adjoining vertebrae – this is what leads to a stiff back.

Question: Does it affect other parts of the body as well?

Sometimes, other joints of the body such as the ankle, knee, and hip may also be affected. AS is more common in young men between 20 and 30 years of age than women. It can occur in children as well. The prevalence of AS ranges from 0.8% to 1.8% in the general population.

Question: Are genetic and environmental factors linked to AS?

The exact cause of AS is unknown. However, there is a strong genetic predisposition and most patients with AS have the HLA B27 gene. About 6% to 8% of the Indian population has the HLA B27 gene and amongst them, those with a family history of AS in a first-degree relative have a 30% chance of developing the disease. However, only 2% of individuals with this gene actually develop the disease. It is hypothesized that some stimuli (e.g. environmental factors, gut microbiome) trigger AS development in genetically predisposed individuals. Moreover, AS can also develop in individuals without HLA B27. It is likely that there are some undiscovered genetic factors that could also be involved in its etiology.

Question: Whether Initial symptoms itself are alarming or not?

Initial symptoms may not appear alarming, but they can be serious. Patients with AS initially develop symptoms such as low back pain and stiffness that lasts for more than 30 minutes and worsens in the morning or after prolonged inactivity. They often find it difficult to turn on the bed during the latter part of the night and the pain sometimes wakes them up from sleep. Typically, the back pain improves with activity. Some of the tendons and ligaments of the body may also get inflamed (e.g. costochondritis & Achilles tendinitis).

Question: What are the other symptoms?

Other symptoms of AS are chest stiffness; pain in the neck, hip, shoulder, glutes (buttock) and heel; as well as arthritis of the knee, ankle, toes or fingers. About 30% of the patients may develop uveitis (painful red eye) and a similar number of patient’s long-standing disease may develop osteoporosis (thin weak bones). The lungs, heart (valves) and kidneys may also get affected.

Question: How can it be diagnosed accurately?

We do clinical diagnosis with imaging and genetic tests. AS is diagnosed based on a patient’s clinical profile and radiological (X-ray) investigations. Blood tests include genetic tests to detect the HLA B27 gene; and tests that detect raised erythrocyte sedimentation rates (ESR) and increased C-reactive protein (CRP) levels to help support the diagnosis. X-ray imaging cannot detect bone changes during the initial stages of the disease making early diagnosis difficult. However, MRI scans of the sacroiliac joints can be used to diagnose AS in the early stages, when the X-ray of this region still appears ‘normal’.

Question: Can treatment help to slow down or stop the progression of AS?

The aim of treatment is to relieve pain; slow down or stop disease progression, and maintain mobility of the spine. Medicines for AS include non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, disease modifying anti-rheumatic drugs (DMARDs) and biologics (targeted therapy). NSAIDs provide pain relief and also retard the progression of AS and patients prescribed these medicines must take them regularly and NOT ‘as and when required’. DMARDs like methotrexate, sulphasalazine, and leflunomide are prescribed for patients with peripheral arthritis. Patients who do not respond well to these drugs may be prescribed biologics such as anti-TNF alpha agents and anti-IL-17 inhibitors, as long as they have not had TB or a similar significant illness in the past.

These biologics and other tools that help us assess the disease have made it possible for patients to lead an almost normal life. Oral or parenteral glucocorticoids have no role in the management of AS though intraarticular steroid injections may sometimes be needed.

Question: Is surgical intervention a solution?

Surgery is rarely required for correcting spinal deformity, though a hip or knee replacement surgery may be needed if there is significant joint damage.

Question: What should be a frequency for consulting doctors?

Regular follow-up with the doctor is extremely important to adjust the dose and to detect any drug adverse effects or any complication or comorbidity at the earliest.

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Arthritis includes more than 100 different conditions that affect joints and the surrounding tissue. The most common form of arthritis in the United States is osteoarthritis, followed by gout and rheumatoid arthritis. Symptoms include pain, aching, stiffness, and swelling in or around the joints. Arthritis affects people of all ages, including children. Although the risk of developing arthritis increases with age, more than half of adults with arthritis are younger than 65. About 1 in 4 adults has arthritis in US.

According to Centers for Disease Control And Prevention in US, Arthritis affects about 1 in 4 adults in the United States; That’s 54 million men and women; As the US population ages & obesity increases, the number of adults with arthritis is expected to increase to 78 million by 2040; one-third of adults living in rural areas have Arthritis; over 1 in 2 adults with Arthritis in rural areas are limited by it; Arthritis is a leading cause of disability in the US. Twenty-four million adults report limitations due to Arthritis. And, the most common form of Arthritis in US is osteoarthritis.

People with arthritis can manage symptoms & reduce pain by learning self-management strategies and being physically active.

Prevention tips – Early diagnosis and appropriate management of arthritis, including self-management activities, can help people with the condition live well without pain. Everyone should exercise regularly to stay healthy, including people with Arthritis. Physical activity has been proven to reduce the pain and restore function. There are proven exercise programmes that can help people with arthritis increase their physical activity safely and comfortably. Maintaining a healthy weight has shown to decrease the risk of developing Osteoarthritis and gout and may decrease disease progression and arthritis-related activity limitations.

The post Agonizing Ankylosing Spondylitis is More Common in Young Men appeared first on InnoHEALTH magazine.

Testing Times for India

InnoHEALTH Magazine — Thu, 23 Nov 2017 07:34:34 +0000

Brig (Hony) Arvind Lal is a pioneer in bringing laboratory services in India at par with the international world. He has modernized Indian medical diagnostics and initiated the first Public Private Partnership (PPP) in the field of laboratory testing in India. Under his guidance, Dr Lal PathLabs (LPL) has become one of the most reputed laboratories in Asia having to its credit quality accreditations from various national and international bodies. Currently they operate over 172 labs, including Asia’s biggest lab at Rohini, New Delhi with 1,500 collection centers and pick-up samples from another 7,000 medical establishments all over India. The lab tests over 50,000 patients every day or nearly 10 million patients in a year.

He holds the honorary rank of a Brigadier in the Indian Army and the Government of India conferred him Padma Shri (Indian national award) in 2009, for his contributions to Medicine.

In an interview with KANIKA CHAUHAN InnoHEALTH , he sheds light on the evergrowing demands of quality testing and test labs in the country and shares his vision of a healthier future for India and every Indian.

Q1. When the Lal Path Labs started 68 years back, what was the scenario of Indian healthcare industry? How do you see the market now? And how has been the journey?

My late father Dr. Major S.K Lal started this lab in April 1949. He was a displaced person from the partition and came to India from Rawalpindi in 1947. After coming to Delhi he worked in a government lab for one-and-a-half years and then started the first pathology lab in North India. At that point of time there were hardly any pathology tests as we know neither there were any routine tests like, HP, TLC, ESR, Urine Test, Blood sugar Test, Cholesterol test. So there was not any competition then.

Q2. What is your future business plans both at National and International level?

We are running 1700 laboratories in India and about 1600 collection centers. In addition we take another 5000 collections of blood samples from our pick up points. For example Medanta, Fortis, Moolchand and Apollo are some of the pick-up points we have.

Last year we tested about 1.35crore patients, so the average of the samples we can test is about 55000 in a day. We are the biggest Histopathology Biopsy Centre in the world.

Histopathology Biopsy is a test basically to detect cancer. Suppose if a lady has a lump in her breast, so she feels something has to be done about the lump, a part of the lump is surgically taken out which is known as the biopsy, it is the biopsy we test and find out the results. There is a possibility of two things either the tumor is benign (Non-Cancerous) or malignant (Cancerous). If the lady has malignancy she under goes with further tests, chemotherapy and radioactive therapies as per clinical requirement. We are the largest Histopathology in the world. We test about 1000 biopsies in one day and we are the second largest kidney biopsy center in the world. We are the only laboratories in India which have their own electro-microscope for very high end testing. We have our centers in all the major cities of India.

Our next step would be to set up another comprehensive laboratory in Lucknow. We have such research center in Kolkata and next year we will make one in Lucknow. With this we will provide high end services for the people in the region for whom the services are not available.

Q3. With so many market players why people should opt for Dr. Lal? What additional value you bring to the table?

We have many reasons, first of all people know that we are not fly by night operators and also they have faith in us since last 70 years plus people come to us for their pathological tests because 70% of all the medical decisions are nbased upon the pathology test of a patient, hence if the pathological tests result aren’t in place 70% of the medical decision can’t be taken. Gone were the days when people used to visit the “vaids” and doctors and they felt the nerves and pulse gave medicines, now it is evidence based medication. If someone has fever the doctor would suggest the person to get a blood test because it could be malaria, chikungunya, dengue or it could be anything. And if the person is diagnosed with anything she or he will get the treatment for the same. Now the medicines are completely evidence based, there is no hit and trial. These are the reasons why people come to us.

Q4. With Dr. Lal Path labs entering into the international market with operations in countries like Middle East, Malaysia, Bangladesh, Nepal and many more, where do you see the potential for growth of your organization?

The first reason is, India is not having the kind of quality labs that it should have. There is a demand and supply problem. That is because there are no large laboratories. There are lots of facilities that claim to do testing, but they are not testing laboratories but testing shops. This is what is to be changed and people give the example of our establishment and say that “they should be like Dr. Lal’s laboratory.” All these countries you have mentioned, we are getting their samples for testing but only one lab is set up in Nepal and next would be in Bangladesh and then we will go to other countries. The reason we are slow on this is because our own country is huge. I usually say to people that if we will take out Uttar Pradesh and put it in the Indian Ocean, India would be the 5th largest country in the world. So this is the reason that we want to look at our country first and then look at the outside market.

Q5. What kind of environment does your organisation provide to patients?

Our organisation provides a very sterile kind of an environment, it doesn’t smell, and blood is not spilled around, there are no flies buzzing around the surroundings. This is a kind of a place where anyone would like to go to.

Q6. Now days there so many machines available in the market for test like sugar, BP etc, which we can be used by the patients themselves. How good is that? What are your views?

These are known as point of care testing and people can test a few things but in India people can only test blood sugar. For which we suggest the patient to check his or her blood sugar on a regular basis of 15 or 20 days, so these are called Point of Care Testing (POCT).

The POCT in India is not established because firstly, it is very expensive and secondly the Indian people aren’t savvy. There are seven types of care testing which is emanated by a lady. A lady can go to the bathroom and test her pregnancy by a UPT (urinal pregnancy test) in which she gets to know whether she is pregnant or not then in this case there is no need of a pathological test. When I was young we never had cats and dogs as pets but we had rabbits , so I never couldn’t understand why my father killed those rabbits and I got my answer when I was studying medicine. The reason why rabbits were killed during that time i.e, in early 1950s people used to check the pregnancy through it. A pregnant woman’s urine was injected into a female rabbit and after killing them they use to dissect the abdomen area to find ovulating ovaries. This is how pregnancy test were conducted.

Q7. Now a days Dr. Lal Path labs is focusing on inorganic growth; how beneficial it is to patients?

The growth in any sphere or in any business is either organic or inorganic, organic means when a person is creating his own set up, say if a person is doing well in Delhi so he decides to open a set up in Uttar Pradesh and then in Uttarakhand, and inorganic growth is when other person is ready to give up her or his lab to somebody else irrespective of any reason the former will give some certain amount of money to the latter in position of the lab this is called inorganic growth. We have done 10 inorganic growths till now and yes we will buy some more from south of India and west of India.

Q8. What innovations you think can bring down cost, keep quality and improve efficiency on which researchers and start-ups concentrate?

There is no start-up in my line, if one is a qualified pathologist either he can work in a pathology lab or can start his own lab. The start-up in Delhi is difficult because Delhi has become a saturated city. there are many people who are running many pathology labs and they shouldn’t run these pathology labs and the reason they are running the labs is because it is very lucrative, which is very unethical and should not be done.

So the government of India has also started the voice to our ways and they said that we are going to have a clinical establishment act which has been passed by the parliament in 2010. Since the healthcare is state subject so all the 29 states have not adopted it or implemented it. There are a chain of pathology labs which are not run by the pathologists they are run by the non-pathologists they are not even doctors they are quacks. So this brings out the quality and efficiency of the whole industry.

They are many diseases which affect the mankind these days and these diseases are called the non-communicable diseases. The non-communicable diseases can’t communicate with others, whereas malaria, chikungunya and dengue are communicable diseases because it happens through a mosquito bite. TB is a communicable disease too and if a person’s lungs are infected by TB people around them will get infected. In India we lose two patients of TB in every three minutes, India has a burden of communicable diseases which includes Hepatitis A.

But a bigger set of diseases have come out which are called NCDs (Non Communicable Diseases) and the NCDs are killing 65% of our people and if we will not control the NCDs it will also affect the two per cent of our GDP. The NCDs are headed by the high blood pressure, obesity, smoking, cardiac diseases, lung diseases, cancer, kidney diseases and stroke. Why it is becoming so important to us because it is also called the life style diseases, it changes the lifestyle of the person which has suddenly come up. India has large number of cancer patients and also large number of blood pressure patients. There is an element of genetic transfer of physical appearance of a person but some diseases are also transferred which only run in families.

The problem with Indian people is they only come in illness, but they should know that they should get their self-check on a regular basis to keep a check on their health, my main point is to make people aware of the annual healthcare which is very important for one’s health which is in between the doctor and a patient and also make them aware of the testing in wellness not in illness.

The post Testing Times for India appeared first on InnoHEALTH magazine.