At 26, Dubai psychologist receives arthritis diagnoses after a decade of pain

Pain that began at school

Shanavas, now 26, told The National that pain began interfering with her schoolwork at 16. Writing during exams became difficult, and persistent exhaustion accompanied her symptoms. Her mother sought help from orthopedic and neurological specialists, but the advice repeatedly came down to painkillers and rest.

"I knew I was in pain, but people did not believe me," she said. "My mother took me to orthopaedic and neurological specialists, and the answer was always painkillers."

One doctor linked her symptoms to pressure from academic and sporting success and suggested her parents expected too much of her. Doctors also referred her to a psychologist, believing the pain was psychosomatic.

The following year, while she was in Grade 12, her neck seized up so severely that she needed emergency hospital treatment. Doctors initially feared a stroke but later ruled it out. During her recovery in intensive care, she decided to study psychology to better understand the connection between the brain and physical health.

Appointments in both the UAE and India failed to establish what was causing her symptoms.

The investigations that led to a diagnosis

A small finger wound that would not heal eventually prompted rheumatology testing in Sharjah. Shanavas said she had not previously heard of a rheumatologist. The specialist used an antinuclear antibody, or ANA, test to help direct the investigation.

Her ANA result was positive, while several other markers were negative. She subsequently became pregnant and deferred further testing. When her symptoms grew worse after pregnancy, she resumed investigations and received the two diagnoses.

Inflammatory polyarthropathy, also called polyarthritis, is an autoimmune condition involving inflammation in at least five joints. Ankylosing spondylitis generally affects the spine and pelvis and can limit flexibility, producing a stiff, hunched posture.

Diagnosis of these conditions is usually made in people younger than 45 after three months of chronic pain. The assessment includes a detailed medical history, a physical examination, internal imaging and blood tests.

"It was a huge surprise as I thought this was a disease for the elderly," Shanavas said.

Research on axial spondyloarthritis documents diagnostic delays internationally. In a 2022 systematic review published in Clinical Rheumatology, Hay and colleagues found that more than three-quarters of 25 studies reported median waits of two to six years. The review also cited a separate 2021 meta-analysis that put the global mean delay at 6.7 years, with a 95% confidence interval of 6.2 to 7.2 years.

Managing symptoms others cannot see

Shanavas now works as head of inclusion and well-being at The Oxford School in Dubai. To manage her conditions, she takes several medications, including a biologic injection every two weeks to slow her overactive immune system. Her regimen also includes multiple probiotics, supplements and corticosteroid creams for flare-ups.

She said the lack of outward signs can make it difficult for others to understand her need for time off.

"The hardest part is that I can look completely fine on the outside," she said. "People don't always understand why I need a day off. They cannot see the pain or fatigue."

"I have often felt misunderstood because of this."

She has recorded her experiences in a journal over the past decade and hopes to publish it. She is also urging people to recognize that young people can develop arthritis.

Arthritis in younger people

Although arthritis remains relatively rare among young people, some forms start in childhood or early adulthood. The name encompasses more than 100 conditions involving joints and nearby tissues, with different causes and symptoms.

Juvenile idiopathic arthritis describes a group of inflammatory conditions that begin before age 16. Rheumatoid arthritis, another inflammatory condition, commonly starts in adulthood. Osteoarthritis involves structural changes within a joint and becomes more common as people age.

US data illustrate the extent of diagnosed arthritis among children. A CDC analysis of the 2017-2021 National Survey of Children's Health estimated that about 220,000 people under 18 had diagnosed arthritis, or 305 per 100,000. Published in Morbidity and Mortality Weekly Report in July 2023, the analysis found that prevalence increased with age: 77 per 100,000 among children younger than 6, compared with 592 per 100,000 among those ages 12-17.

The report also identified differences between groups. Prevalence among non-Hispanic Black children and adolescents was 571 per 100,000, about twice the 260 per 100,000 reported among non-Hispanic White children and adolescents. Rates were markedly higher among children with diagnosed depression, at 1,980 per 100,000, or anxiety, at 1,310 per 100,000.

Treatment tailored to the condition

Dr. Humeira Badsha, a Dubai rheumatologist, said care is shifting from general pain relief toward precision medicine and treatment tailored to each patient.

"Treatment is increasingly targeted at the specific inflammatory pathways driving each patient's disease," she said.

Badsha said patients taking long-term medication need a thorough baseline review of their medicines before starting a new drug, followed by regular monitoring. "Arthritis can appear at any age, depending entirely on the underlying classification," she said.

GLP-1 weight-loss therapies can also help by easing the wear and tear on joints under excessive strain.

Family history is another consideration, according to Dr. Usama Hassan Saleh, a consultant in orthopedic surgery at Dubai's Medcare Orthopaedics and Spine Hospital. He said osteoarthritis and rheumatoid arthritis are among the forms with a hereditary component, so having a close relative with the condition may raise a person's risk. That does not make arthritis inevitable, he said, because lifestyle and environmental factors can contribute as well.

Joint pain, stiffness, swelling and trouble moving the affected area can be early symptoms.

"Seeking medical advice early can help establish the type of arthritis and ensure that appropriate treatment begins promptly," Saleh said. "With the right combination of medical care and lifestyle measures, many people can manage their symptoms, remain active and maintain a good quality of life."