Perception is everything: OA is exciting

On a hot humid afternoon in August 2010 following an Asia osteoarthritis (OA) network session, a small group of APLAR stalwarts sat together and began a dialogue. Present at that meeting were Drs. PH Feng, Anita Lim, CS Lau, KY Fong, Katy Leung, Keith Lim, Albert Leung, Ester Penserga, among others. This network was to raise the awareness of a very common and often neglected subject in rheumatology circles. In scientific meetings when run concurrently with the ‘sexier’ science of biological therapies for rheumatoid arthritis (RA) and the molecular genetics of lupus, our championed subject stands little chance of drawing in the crowds. We may have smaller numbers but we have a passion for the cause. As a group we decided to make our own statement. The Asia OA network is represented by concerned individuals to raise this awareness. Our agenda is to up the ante on action to help sufferers of OA in the region, promote collaboration in clinical care and research, and to lobby health decisionmakers to take action. With the twin risk factors of rising obesity and an ageing populace, this is a major epidemic looming, a ‘tsunami’ that cannot be ignored. But, to pay lip service to the problem is a common response. This head-in-the-sand behaviour regarding OA may reflect our natural instinct as doctors to play denial at our impotence. Like the surgeon during the rounds, who ignores the patient he cannot cure. It is true, we do not have a wellconceived bullet to shoot and destroy the beast that causes OA or a pill that makes cartilage grow back. This does not make our patients’ suffering less painful, their plight less important or their hopes less deserving of our attention. Let’s start with simple figures that we know. The population of Asia today is 3.9 billion. In 20 years it will be about 4.3 billion. Demographic predictions suggest that the proportion of the population over 60 years old will be about 20%, with a conservative figure of 15% of these people with symptomatic OA. One-third of these could be severely disabled; this could translate to 130 million sufferers, just under 40 million people with disabling disease 20 years from now. The prevalence of RA in China for example is about 0.3%, and 0.06% for systemic lupus erythrmatosus (SLE). Are we spending too much time on these and not enough on the bigger problem? Many societies in our region have no access to joint replacement surgery. The diagnosis of end stage OA may not be a death sentence but it is akin to sentencing a thoroughbred with a broken leg. What does a poor farmer in rural Asia do with a bad knee? Can rhetoric about action on disability translate into action, making joint arthroplasty accessible to the poorest? How much more do we gain if we set our energies to supervise proper, safer conservative management in the prevention of OA? If a problem is very large, making a small difference translates to a lot. In a recent editorial by Paul Dieppe, who writes in this issue, he describes many important points about the disease, ‘joint failure’. He articulates succinctly, in the way only he can what most of us feel about the condition. Many of us regard him as a great icon, a guru of the subject, and owe much of what we understand of OA to his contributions. In that excellent editorial, one point he makes is that ‘osteoarthritis is exciting’. Exciting it is and exciting it was, back then in the 1990s, when KL, one half of this editorial was his lecturer. Paul got him excited about OA, got him to read 200 hand X-rays and packed him off to Puerto Rico to study the hands of monkeys. KL returned triumphant, declaring that he had solved the problem of OA! Twenty years later, KL himself suffers from distal interphalangeal joint OA of one finger, a legacy of bad golf, as one does, hacking that tiny ball all over the park just to get it into one small hole. Dr Lim realised to his great despair, that of course he hadn’t cured OA. Yet, as Dieppe says, and as the papers in this issue show, we have made tremendous progress in the past 20 years. International Journal of Rheumatic Diseases 2011; 14: 111–112