`To improve the arthritis care in our State, more focussed training for medical students and junior doctors is necessary. Early diagnosis of these diseases can prevent disabilities and deformities.'

Binoy J. Paul

This rheumatologist and Associate Professor of Medicine in the Government medical college in Kozhikode, who was recently on a tour of a few rheumatology centres in the U.K., tells R. Madhavan Nair that there is an urgent need to improve facilities for treatment of rheumatic ailments in the State.Rheumatology is the branch of modern medicine dealing with diseases affecting joints and musculo-skeletal system. This is a new specialty, because arthritis has now become a common problem.

Dr. Paul has in mind what more needs to be done in the State for patients in need of treatment for rheumatic ailments.

He says improved facilities will be a blessing to patients afflicted with joint ailments, such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and vasculitis. These belong to a group of autoimmune diseases, in which the body itself produce certain antibodies which destroy human tissues. The exact cause of these diseases is unknown.

"Better management of these ailments are now possible since recent advances in immunology, molecular biology and genetics has made it possible to find out the pathogenesis of many of these diseases. Newer tests are available for the early detection of these diseases. Many newer drugs have also been developed to prevent the damage caused by these antibodies," says Dr. Paul.

Recently, he spent a few weeks in some of the rheumatology centres in the U.K. "Rheumatology is a well recognised speciality of medicine all over the U.K. There are separate departments in almost all secondary care centres (which are equivalent to our district hospitals)," he says.

These hospitals had rheumatology consultants, each of them working with a team of junior doctors, specialist nurses, physiotherapists, podiatrist, an occupational therapist and a social worker. "This arrangement serves to provide comprehensive care for arthritis care. All the special immunological tests are done in standardised laboratories under strict supervision by the NHS (National Health Services)," Dr. Paul said.

Though many newer drugs are available, they are very costly even in the U.K. There are strict guidelines for use of these drugs by the doctors, but once these are prescribed by a specialist, it is given free of cost like any other ordinary drug. The effects and side-effects are well monitored by the doctor or the specialist nurse.

Early diagnosis and prompt therapy of arthritic disorders make life easy for patients affected by crippling joint diseases.

Dr. Paul is a recipient of Dr. Eapen Samuel Memorial Award for the best research paper, fellowship of the IMA Academy of Medical Specialties, New Delhi, and the prestigious overseas membership of the British Society for Rheumatology for his outstanding contribution to the medical efforts to understand rheumatology.

More specialists needed

He believes that even in Kerala, with its fairly high health standards, practising rheumatologists are few in number. Moreover, investigations are expensive. The tests done by the private laboratories are not well standardised.

The newer drugs that produce better results are not manufactured in India; when imported, they are prohibitively expensive and only a few can afford them.

"To improve the arthritis care in our State, more focussed training for medical students and junior doctors is necessary. Early diagnosis of these diseases with prompt and specific treatment can prevent disabilities and deformities. The laboratory tests should be standardised and should be available at affordable costs. Newer drugs should be manufactured indigenously to reduce the cost," he said.