Indian Write-Ups
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| A Holistic Approach To Arthritis Dr Pradip Nayak MS (Orthopedics) Mumbai |
| Functional ability and depression Arthritis, like most chronic diseases, is characterized by an unknown etiology and an unknown course and prognosis at the individual level. This disease has a highly variable and unpredictable course. However, sooner or later, all patients with arthritis will be confronted with the physical consequence of this disease, i.e., a decrease in functional ability. The inflammation of the joint characterized by pain, stiffness and lack of energy, and fatigue leads to a decrease in functional ability in a varying degree and progression. Thus, loss of functional ability makes patients less mobile, unable to perform their activities of daily living or those related work and leisure, which often results in qualitative and quantitative changes in social relationships. In addition to the physical and social consequences, psychological problems also occur. As a result, a decrease in self-esteem, a decline in psychological well-being, or the occurrences of depressive symptoms are commonly reported in patients with arthritis. Dickens et al conducted a systematic review and meta-analysis to examine the strength of association between rheumatoid arthritis and depression. Twelve independent studies compared depression in patients with rheumatoid arthritis and depression in healthy control subject. The review concluded that depression is more common in patients with rheumatoid arthritis than in healthy individuals. Management Several bodies have drawn up clinical guidelines for the management of low back pain and arthritis. a. Light physical activity This is to be encouraged and it is appropriate to refer the patient to physiotherapy outpatients, if the episode is acute. b. Medications To encourage early movement, adequate pain relief must be offered to the patient at the first consultation. c. Exercises Bed rest is not recommended for patients with low back pain or arthritis. Exercises that involve movement of the joint and lower back, d. Depression and anxiety It must be considered in all cases, as psychological causes can be an obstacle to recovery. There are many ways in which to deal with depression. Professional counseling can be helpful, as can psychotherapy and psychoanalysis, but these latter two are very time consuming and quite costly. One of the treatments most readily available is antidepressant medication. These may be looked upon as a chemical crutch, which will help a patient carry on with his daily life. Depression can otherwise make day-to-day decision very difficult, which might otherwise be easy. Antidepressant medications are not to be confused with some of the tranquilizer, which were widely used in the past (e.g. diazepam) and work in a completely different way. They are not addictive, as they work by allowing your body to make better use of its own depleted brain chemicals (neurotransmitters). No drug is without side effects, but the side effects of the modern antidepressants are much less than the original ones. Antidepressants take a while (between two weeks and two month) to have their full effect. The most likely type of medication will be a tricyclic antidepressant (e.g. amitriptyline, imipramine, dothiepin and lofepramine) or a selective serotonin reuptake inhibitor (SSRI e.g. fluoxetine, paroxetine, sertraline). References
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