It is a common misconception that autoimmune diseases (AIs) affecting joints, such as rheumatoid arthritis (RA), only affect the elderly. Statistics show that both the young and active can also suffer from these debilitating conditions.
Marlise van der Merwe, mother of Charl (18), and Donay (12) who both suffer from juvenile idiopathic arthritis (JIA), another type of AI says, “Both had been relatively healthy toddlers, so it came as a complete shock when Charl first fell ill at age 14.”
“He was just a young boy, but had lost complete mobility – I had to bath and feed him, he couldn’t even lie down and spent his days in a recliner. The whole family took huge strain, and one night I came home and found my husband sobbing in the pantry.”
It is estimated that 1 in 1000 children suffer from JIA, affecting their joints with disease before the age of 16. The debilitating nature of the arthritis makes it difficult for sufferers to lead a normal life, let alone take part in physical activity.
Patients of all ages
Dr Elsa van Duuren, a rheumatologist at Jacaranda Hospital in Pretoria says that as people become more aware of the facts around joint pain they are more inclined to seek help. "Many people believe that only the elderly suffer from arthritis but I treat patients of all ages in my practice. Often they are misdiagnosed because some doctor’s rule out the possibility of a patient having some form of arthritis as they are too young, and the elderly don't seek treatment as they believe there is nothing that can be done," explains Dr van Duuren, "These are the two most common misconceptions that people have about several types of arthritis."
According to Dr van Duuren, these conditions develop when the body’s immune system mistakes healthy cells for harmful ones and attacks them.
"AIs can cause many symptoms, from general symptoms such as fatigue and malaise, fevers, joint pain as well as symptoms of involvement of other organ systems, such as skin rashes, abnormal gastro-intestinal symptoms, chest pain, back pain and inflammation of eyes. Examples of AI’s, other than RA and JIA that can cause a variety of symptoms are systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), Crohn’s disease and ulcerative colitis, psoriasis and psoriatic arthritis."
"The disease process causes inflammation in the body, which can in turn, cause a number of other complications such as osteoporosis and cardiovascular disease, and patients need to be monitored regularly," adds Dr van Duuren.
According to Dr van Duuren patients often want to know what causes an AI. "The fact is that we are not sure. Patients may be genetically predisposed and then something triggers the illness. However it is important to note that it is not a family illness as such, so while a mother may be afflicted, her child will not necessarily develop any problems," explains Dr van Duuren. "Triggers differ from person to person and it's impossible to identify a specific cause. There is no evidence that diet will cause or aggravate any of these diseases, but some patients feel that if they eat a certain food their symptoms worsen and they then can then cut that type of food out,” she says.
Early diagnosis and aggressive treatment are critical to help to minimise the devastating effects of these diseases. Evidence suggests that disease control as soon as possible after onset determines the subsequent disease course and long term outcomes, which suggests there is a therapeutic window of opportunity.
"The treatment for AIs vary from patient to patient depending on the type of AI they suffer from as well as their individual profile. We use a combination of symptomatic treatment such as anti-inflammatory drugs and disease modifying drugs to treat these diseases. We also recommend exercise to help improve a patient's general health, improve mobility and to strengthen muscles. The type of exercise will vary according to the patient and the type of AI they are suffering from. The daily stresses of life may also aggravate, and can trigger a flare of symptoms, so patients are encouraged to reduce stress,” says Dr van Duuren.
Richard Sterne's story
In 2008 at the age of 27, Richard Sterne was at the height of his professional golfing career and ranked number 29 in the Official World Golf Ranking when he began experiencing lower back pain.
Within two years, however, the pain had become so severe that he could not rotate his body at all and had lost his full range of motion. As a result, he missed most of the 2010 and 2011 seasons due to injury.
He tried various medications and was finally granted permission from his medical scheme to use a biologic disease modifying treatment in 2011. Within about eight months he was back on the professional circuit.
“It took me a while to regain my full fitness,” explains Sterne. “But I took a holistic approach, using exercise to strengthen my back for support.”
In February 2013, Sterne won the Jo’burg Open by seven strokes, to end a four year 'winless' period. This marked his sixth victory on both the European and Sunshine Tours and came on the back of a second place finish he had in the previous week at the Dubai Desert Classic.
The win moved him inside the top 60 ranking, which meant qualification for the WGC-Accenture Match Play Championship and to the top of the Race to Dubai standings.
"Patients must not lose hope. Treatment has improved significantly and newer therapies including the very exciting biologic disease modifying drugs have made a tremendous impact on our ability to treat the various AIs. With the help of these therapies, patients are now able to live a fuller, healthier and more active life no matter what their age. They can still reach for the stars and realise their dreams." concludes Dr van Duuren.
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