By 2025, India is poised to be the osteoarthritis capital of the world, with over 60 million people likely to be affected by this degenerative joint disease, primarily in the knees and hips. Osteoarthritis occurs when the cartilage wears away, causing bones in the joints to rub against one another, which leads to increased friction, pain, swelling, and stiffness for the patient. Twenty years ago, it was largely believed that this disease only affected the geriatric population; however, an increasing number of patients in the thirty to fifty years age group are now being diagnosed with osteoarthritis. Though not fatal, osteoarthritis can lead to severe functional limitations, a decrease in the quality of life, or even cause a patient to be permanently bed-ridden.
In India, growing obesity rates, vitamin D deficiency, jobs that involve kneeling, squatting or lifting heavy loads, and untreated joint injuries are major factors that can lead to osteoarthritis, affecting almost 15 million people each year. The Indian population, in general, is more vulnerable to osteoarthritis than people from other parts of the world because of a genetic predisposition toward weaker bone and muscle strength.
According to physicians, cases of osteoarthritis—along with other forms of bone and joint disorders—far surpass the number of cardiovascular and cancer cases combined in India. Despite the vast prevalence of osteoarthritis among Indians, concerns regarding osteoarthritis are deprioritized. The public health system in India is already overburdened with patients seeking treatment for diseases that are more acute in nature than osteoarthritis, such as cardiovascular disease, malaria, tuberculosis, and water-borne diseases, which require immediate medical attention. Coupled with the financial constraints that the government of India is burdened with—due to much of the budget being spent on developing other sectors like education, transportation, agriculture, industries—not much is being done in the area of treating osteoarthritis on a widespread level. I often see television commercials, newspaper articles, and billboards from government health bodies spreading awareness about proper sanitation, polio and other vaccines for children’s health, HIV, and the like, but I have never come across any awareness programs regarding osteoarthritis or any other joint disease. Despite the fact that there are physicians who specialize in joint health in India, and joint disease treatments are offered in public hospitals, this lack of attention demonstrates that the government has not yet realized the magnitude of the impact that joint disease has—and will continue to have—on the Indian population.
The lack of awareness about osteoarthritis is particularly salient in rural communities in India. Often, residents of these communities unknowingly mistake joint disease for sprains or pulled muscles and nerves. Furthermore, several of these rural populations lack education and resources on joint disease, and as a result, many do not know what osteoarthritis is. This is why the lack of action from the government regarding joint disease awareness and treatment options is highly alarming.
Even among the portion of the Indian population that is aware about osteoarthritis and its impact on daily life, there is general tendency for people afflicted with this disease to delay treatment—surgery in particular—for as long as possible. Indian patients may avoid surgery for a few reasons, such as a cost-savings measure. In addition, I believe there is a psychological factor adding to their reluctance to go under the knife. People in India are generally averse towards surgery, fearing the potential negative consequences from undergoing surgery. Add to that the approximately INR 200,000 price tag of a total knee replacement, and it is very easy for an Indian to get swayed away from the idea of undergoing surgery.
A prime example is my own mother who has been suffering from Stage III osteoarthritis for the last 7 years or so. The onset of her disease was about 23 years ago, when she suffered a minor injury to her right knee and left it insufficiently treated at the time. Over the years, climbing stairs and long hours of walking has severely aggravated her condition. Although she is well aware that a replacement surgery is inevitable, she has been delaying it as much as possible, and has instead been opting for alternative control and pain-relief measures like Ayurveda and synovial fluid injections, amongst other things like weight control measures, or refraining from long walks or climbing stairs to reduce the pressure on her knees. Though such treatments offer temporary alleviation from pain, a replacement surgery and possibly a revision surgery further down the road is unavoidable. In my opinion, word-of-mouth referrals also go a long way in influencing Indian people to undergo a particular treatment, especially when it comes to surgery. Many of my mother’s friends, for example, also suffer from osteoarthritis, and, like my mother, practically none of them have received a replacement surgery. Until positive clinical outcomes are demonstrated, Indians will be wary of the risks of surgery.
This is why it is so important for the government to take appropriate actions to inform people about this disease and the best course of treatment to be taken. Though the Government of India’s Ministry of Health & Family Welfare has recently announced many programs for non-communicable diseases and injury/trauma and healthcare of the elderly, there hasn’t been any mention of osteoarthritis in any of these initiatives, which is baffling, given the sizeable number of people affected by this disease. There are major orthopedic MNCs who have a presence in the country and are involved in providing joint disease solutions, such as DePuy Synthes and Stryker, and also some larger domestic companies like, GPC Medical. These companies also have a part to play in educating the public on this disease by collaborating with government bodies. This would serve to create brand loyalty for these company’s products and as a consequence, strengthen their position in the market.
In conclusion, unless significant steps are taken to control the rate at which osteoarthritis is affecting Indians, and also to educate the public about treatments for this disease, we could see a large section of the population suffering from severe disabilities in the near future.
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