In the following interview, Head of Department of Rheumatology of the Mongolian National University of Medical Sciences and consultant doctor of the Mongolia-Japan Teaching Hospital Dr. D.Zulgerel delved into the causes, treatment and prevention of inflammatory joint diseases that are common among Mongolians. In particular, osteoarthritis is common and the number of people undergoing joint replacement surgery is high in our country.
Inflammatory joint diseases are common among Mongolians. What is the reason for this?
Rheumatology is a very broad field. Osteoarthritis is the most common disease among people. This includes knee arthritis. The primary cause of this disease is aging. Mostly middle-aged and older people suffer from the disease. However, it mainly occurs in young people after an accident or injury. The disease is also related to heredity. Another major factor, especially the main reason for the recent increase, is people’s lifestyle. With the development of techniques and technology, for example, we do not walk up the stairs, instead we use the elevator. In other words, as technology develops, our physical movement and activity are decreasing. As a result, inflammatory diseases of bones and joints have increased.
Is this disease only increasing in Mongolia? Is it widespread in other countries?
This disease is likely to grow in the world. As mentioned earlier, it is due to changes in people’s lifestyles and reduced mobility. Obesity is also a factor that stimulates the disease.
Are Mongolians at risk of osteoarthritis due to the extreme cold in winter? In other words, is climate and extreme weather one of the reasons for the increase in the disease?
Of course, the cold weather affects it to some extent but it is not the main factor. People’s lifestyle is causing arthritis to increase around the world and in our country. For example, when driving a car, a person hardly moves. As a result, obesity is on the rise among citizens. All of the body weight gets concentrated on the knees. So, as people become heavier, the more load is put on the knees. For instance, if you are 160 centimeters tall but weigh more than 100 kilograms, your legs will not be able to withstand your weight and deteriorate.
Another thing to be aware of is the recent decrease in children’s mobility. This was proven by research conducted in the UK and USA. Children no longer leave the house at all, they are using mobile phones and watching TV. Studies have shown that the earlier a person starts regularly exercising, the more likely they are to continue doing so throughout their life. Therefore, it is important to keep children physically active from an early age. As a result, people can prevent inflammatory joint diseases.
There are people who think that osteoarthritis is a disease that cannot be completely cured once it has occurred. Is this correct?
There are many people who have misconceptions about this disease. In specific, people often think of arthritis as related to throat problems. Some people say, “I have arthritis now because I had a sore throat when I was young.” In fact, osteoarthritis has nothing to do with throat disease. On the other hand, there is a disease called rheumatoid arthritis caused by bacteria, which is related to throat disease. Children between the ages of five and 15 are commonly affected by it. In general, there are more than 200 diseases of arthritis. Osteoarthritis, which we are talking about, is the most common disease in the population. As mentioned above, this disease can be misunderstood and mistreated. So, we must diagnose and cure arthritis appropriately.
Does our country have enough capacity and human resources to diagnose this disease?
More than 200 joint diseases mentioned earlier may have similar clinical symptoms. More specifically, all these diseases can have symptoms of knee pain. But their causes are different. This is why they require different treatments. Therefore, people should be correctly diagnosed and find the right treatment. They mustn’t arbitrarily treat it however they think is right or based on what they heard from someone. In general, such an attitude is common among Mongolians. In terms of the diagnosis of osteoarthritis, it is not a problem for our industry. The diagnosis of the disease is determined by the simplest method – X-ray examination. We don’t even need expensive tests. This disease can be cured if the underlying causes can be identified and resolved. If the condition worsens to a severe form, the only option would be to get surgical treatment. But it is completely possible to cure or prevent in the early stages.
There are quite a few people who use massage therapy to treat their arthritis pain. There are many places that offer such services. Is osteoarthritis a disease that can be cured with massage?
Massage therapy has a certain effect on the treatment of joint diseases. But this is not the main method of treatment. The key to effective treatment is distinguishing between modifiable and non-modifiable factors. For example, we cannot change a person’s age or heredity. But modifiable factors include lifestyle. This is a personal factor.
First of all, people need to maintain normal body weight. International guidelines include such recommendations. But people should consult a professional when it comes to weight loss. Since the knee is an important organ that carries all the body’s load, people shouldn’t jump or run abruptly. A rehabilitation physician evaluates the physical condition of patients and adjusts their exercise load. Another important thing is to pay attention to physical activity. People who are constantly sitting are more likely to suffer from osteoarthritis. Therefore, they should get advice from a rehabilitation physician on what exercises they can do while sitting. On top of that, choosing the right shoes is one of the ways to prevent and treat the disease. It is also recommended to use crutches if a patient is overweight and has arthritis. This can reduce the burden on the knees. Meanwhile, doctors decide whether medication-assisted treatment is required. People should not take medicine at will.
How does the Mongolia-Japan Teaching Hospital provide assistance and services to citizens in this field?
In our hospital, four specialized doctors provide care and services every day. The workload is high. Since 2014, we have been providing rheumatology care and services to citizens. Our branch studies connective tissue. We are talking about the connective tissue of the bones. Bone is the hardest connective tissue in the human body. Connective tissues are found in all organs of the body. Therefore, rheumatology is a science that unites all medical branches.
How can people change their lifestyles? What should middle-aged and older people, who are at risk of getting osteoarthritis, pay attention to?
Osteoarthritis is completely preventable. First of all, citizens should evaluate their daily physical activities. On the other hand, you could deteriorate your joints if you do work that exceeds your physical strength. Therefore, it is necessary to exercise according to your age and body weight. The World Health Organization recommends 30 minutes of moderate-intensity physical activity per day. With such a lifestyle, we can prevent this disease. Of course, we should also try to maintain normal body weight. Body weight depends on several factors, such as diet, food and physical activity. When it comes to food, recently people are consuming a lot of semi-processed products and carbonated drinks. These are bad for the bones. Therefore, we have to try not to consume them as much as possible. Also, many studies have confirmed that alcohol and tobacco contribute to arthritis. Therefore, it is advisable to give up these bad habits. Vitamin D intake is also crucial. This vitamin is the main transporter of calcium to the bones. If we don’t get enough of this vitamin from the sun or food, the risk of getting osteoarthritis is heightened.
On the other hand, it is good that people have recently gained knowledge and understanding about the right lifestyle and are becoming more active by hiking, exercising, going to the gym and practicing yoga. Of course, if you are not sick, you can be physically active. However, if you have been diagnosed with osteoarthritis, you should definitely consult your doctor before engaging in vigorous exercise. It is essential to follow a doctor’s advice because everyone needs different treatment.
Joint replacement surgery is performed for osteoarthritis. People have different opinions about whether this is right or wrong. As a medical professional, what advice would you give on this?
If the joint structure is damaged or changed, a joint replacement surgery is performed according to the doctor’s instructions. This is a good treatment. But one thing to keep in mind is that people often skip post-surgery rehabilitation. It is an operation that only replaces the surface of the joint. Therefore, treatment to restore the function of ligaments, tendons and muscles that move the joints must be done after surgery.
In addition to joint inflammation, what kinds of diseases are likely to increase in the future?
Depending on people’s lifestyles, gout is increasing. It is also a preventable disease. Its symptoms include arthritis. In particular, joints get swollen and become painful. But its cause is different from osteoarthritis. From 1990 to 1993, I studied at the Leningrad Institute of Advanced Medical Studies in Russia. Back then, the Russian professors told me, “You must have seen many people with gout. Mongolians eat meat.” But at that time, I had never seen a single person with gout in Mongolia. You might be wondering why I’m talking about this. It is because Mongolians understand that gout is a disease caused by eating too much meat. But it is not. Because gout is a metabolic syndrome disease, it is associated with poor diet. Alcohol and drug abuse, high cholesterol, lack of exercise and obesity are risk factors for gout. It is also affected by the use of semi-processed products. Another thing to be aware of is the misuse of medicines. There is also a list of drugs that cause gout. Citizens should pay attention to the fact that it is also a disease related to wrong lifestyles but can be prevented.