The occurence of arthritis, a ‘common household disorder of old age‘ has been increasingly alarming – both in number and the varied affected age groups. According to research by SRL Diagnostics, arthritis affects more than 180 million individuals in India, higher in incidence than AIDS, cancer or diabetes.
Arthritis is the swelling of one or more joints in the body, causing pain, stiffness, and restriction in movements. There are many websites to check symptoms and spike our collective anxiety. But it is important to note the relationship this disease has with women. According to research conducted jointly by the Arthritis Foundation of India, the Indian member of the International Osteoporosis Foundation, and the World Health Organisation (WHO), the severity of the disease tends to be higher amongst individuals born women than men.
There are four broad categories of arthritis: Osteoarthritis, Rheumatoid Arthritis (RA), Gout, Fibromyalgia, Childhood Arthritis, and Undifferentiated Arthritis. In layman’s terms, Rheumatoid Arthritis (RA) is an autoimmune disease entailing chronic inflammation, while osteoarthritis is a degenerative disease that causes the cartilage at the end of our bones to wear down.
We will be majorly talking about RA and osteoarthritis in this article and the reason why it affects individuals assigned women at birth more than others, and ways to alleviate if not resist the development of these disorders.
Hormonal changes and child-birth
Women, after a certain age, are observed to develop various chronic health issues. The onset of menopause is often associated with symptoms of joint pain. The occurrence of osteoarthritis, prevalently in the hands and knees, has been observed after menopause. Research shows increasing evidence of estrogen’s relationship with tissue activity. According to Dr. Shital Punjabi, a practicing gynaecologist of 25 years, “Estrogen and androgen have anti-inflammatory properties. So when estrogen level drops during menopause, RA symptoms may appear or worsen.”
Any menstruator today is aware of the silent but haunting spectre of PCOS and PCOD (Polycystic Ovary Syndrome and Polycystic Ovary Disorder). PCOS is a hormonal imbalance, majorly caused by high androgen secretion by the ovaries. The role of hormones in osteoarthritis and RA makes PCOS and PCOD sufferers prone to joint-related symptoms. PCOS presents both hormonal and metabolic issues, often resulting in abnormal thyroid activity, insulin resistance, and hyperandrogenism. These often lead to weight gain and eventual obesity. Weight increases the chance of worsening symptoms of osteoarthritis.
For individuals choosing to reproduce, it is important to stay informed about how childbirth can trigger issues of sacroiliac joints. The sacroiliac joint connects the pelvis and lower spine, a crucial area for childbearing. The probability of SI joint dysfunction increases during the gestation period as the apparatus loosens to provide higher mobility. Research has also shown women with existing RA symptoms suffer from heightened effects after childbirth. New mothers must be equipped to notice any flare or new symptoms because early treatment will prevent future complications.
Nutrition, gender roles and implications on women’s health
Against popular myth, calcium deficiency is not a direct cause of arthritis. It is definitely the culprit of osteoporosis. But calcium and vitamin deficiency can lead to fatigue and sluggishness. Rheumatoid Arthritis is an autoimmune disease, determined by both genetic and environmental factors. The most common deficiencies seen in patients of RA are folic acid, vitamin (C, D, B6, B12, E), calcium, magnesium, zinc and selenium.
Patients with early symptoms can manage the progress of the disease with the help of dietary regulation and supplements. Clinical Dietician Aditee Raizada confirms that “a big number of Indian women are malnourished. That is the main reason why women are likely to get RA in comparison to men.” According to Aditee, including nuts, milk products, fruits, and omega 3-rich food in the daily diet helps.
Gendered social conditioning assigns women caregiver responsibilities within the household. The implied sacrifice leads them to neglect their own health and needs. The cream goes to the rest and the bottom scrapings are left for the caregiver. Arthritis is also a direct result of wear and tear.
The physical labour in the “traditional” role of women in Indian household entails a large amount of invisible, strenuous and repetitive work. RA, affecting women at a younger age than men, is also known as “gathiya” in the Hindi speaking belt. But not all joint pains amount to arthritis. It is important for women to recognise their own needs and track symptoms.
In all irony, the field of orthopedic practice is heavily populated by cis-gendered men. With the sizeable population of patients being those assigned women at birth, the scales are awfully tipped. Gendered social conditioning and stereotypes have a higher tendency of getting reinforced in this ecosystem.
The difference in gender experience is a nuance that might seem small in the diagnosis of a disorder or the heavily formulated treatment in allopathy. But for a country that is just waking up from its victorian moralities and still deep into the pitcher of patriarchal categorisations – more women doctors in this field will help in faster and earlier diagnoses.
It is important to recognise the difference in the build of bodies according to hormonal distribution and skeletal structures or movement ranges. Additionally, individuals assigned female at birth go through conditioning and neglect, orchestrated by the society’s understanding of gender roles. We must be equipped with knowledge, thanks to whatever little research results available to us. Arthritis might be an after-thought for the youth or a resignation post-retirement, but the symptoms and early stages can be managed, even reversed with care.
Moreover, it is high time we acknowledge the health implications of gender roles within households, especially physical labour, on women.
Featured Illustration: Ritika Banerjee for Feminism In India