Looking beyond the joint pain in ageing population

Why rheumatic health is closely related to brain health

In my years as a surgeon, I’ve seen many patients dismiss their "aching joints" as an inevitable part of growing old. But the 2024 Lancet Rheumatology Series on Ageing brings a vital truth to light which is systemic rheumatic diseases (like Rheumatoid Arthritis or Lupus) are not just about joints. They are systemic conditions that can accelerate "geriatric syndromes" like frailty and cognitive decline.

As we build the community at Aamra, we aren't just looking at how well our members can walk, we are looking at the biological link between inflammation in the body and inflammation in the brain.

1. The inflammation link between the joints and brain

The Lancet Series highlights a critical connection: systemic inflammation. When your body is in a constant state of immune activation due to a rheumatic disease, that inflammation doesn't stay in your knees or hands.

The proven link: Chronic inflammation can cross the blood-brain barrier, contributing to cognitive impairment.

The medication paradox: Interestingly, while some immunomodulatory medications (like steroids) can cause "brain fog," the Lancet notes that properly managing inflammation with modern biologics may actually protect the brain in the long run.

2. Frailty: the modern challenge

In orthopedics and general surgery, we often talk about "frailty." It’s not just being "thin" it’s a state of decreased physiological reserve.

• What the Lancet says: Rheumatic diseases act as a "frailty accelerator." The pain leads to inactivity, which leads to muscle loss (sarcopenia), which leads to a higher risk of falls.

• The Aamra strategy: This is why our "motion is lotion" sessions are non-negotiable. For a member with Arthritis, movement isn't just about flexibility, it’s about preventing the frailty that leads to hospitalizations.

3. The "Geriatric 5Ms": A roadmap for families

The Lancet series urges rheumatologists (and families) to move beyond just counting swollen joints and instead focus on the 5Ms. This is the exact framework we use at Aamra:

• Mind: Monitoring for depression and cognitive shifts linked to chronic pain.

• Mobility: Focusing on gait, balance and the "sit-to-stand" strength.

• Medications: Reducing "polypharmacy" (too many pills), which is common in Indian households and often causes dizziness.

• Multicomplexity: Managing how Arthritis interacts with diabetes or heart disease.

• Matters most: Aligning treatment with the patient's personal goals whatever it is, be it walking at a grandchild’s wedding or staying independent at home.

4. What is available in India?

For our Indian population, the transition to "geriatric rheumatology" is still in its early stages, but here is what you can access today:

• Proven & available: advanced biologics (like TNFs and JAK inhibitors) are widely available in India. When used correctly, these can "shut off" the systemic inflammation that threatens the brain.

• Experimental/emerging: palliative care in rheumatology. While palliative care in India is usually associated with cancer, the Lancet calls for its use in chronic rheumatic pain. This "comfort-first" approach is emerging in top-tier Indian hospitals but is not yet the standard everywhere.

• The "ageism" gap: The Lancet warns against "Ageism" that is the tendency for doctors to say, "it’s just old age" instead of treating the underlying inflammation. In India, we must advocate for our seniors to get aggressive inflammation control that is indicated.

My thoughts on connection between joints and ageing of brain

At Aamra, we see our members as whole individuals. A "stiff hand" is often a signal of a "stiffened" lifestyle. By treating the rheumatic health of our seniors with the latest Lancet backed strategies, we aren't just fixing a joint we are protecting a mind.

Is chronic pain slowing down your loved one? Our Aamra wellness team specializes in the "5Ms" of senior health. Let’s get them moving again. Visit aamra.life to learn more.