Connect with us

Life style

Rheumatoid Arthritis doesn’t stop at your joints; And neither should your treatment

Published

on

Dr. Aruna Caldera

By Dr. Aruna Caldera, Consultant Rheumatologist MBBS, MD, MRCP (UK), MRCP (Rheumatology)

The word arthritis comes from ancient Greek. “Arthron” means joints; “itis” means inflammation; so, arthritis means inflammation of joints. Arthritis is one of the commonest disease categories which effect man. Some forms of arthritis may not even require any form of specific treatment, whereas some may even kill you.

Among long-term arthritis conditions, the most serious is rheumatoid arthritis. This disease occurs due to genetic variations that cause the immune system to malfunction and produce antibodies against the joints, leading to joint damage. We call this process, auto immunity; in simple words, your immune system which is supposed to protect you, starts to work against you.

If proper treatment is not started on time, the progression of the disease will be extremely difficult. Without proper treatment, it can make life miserable and may even lead to premature death.

Rheumatoid arthritis is a chronic, systemic inflammatory disease. Joint involvement is only one part of it. In simple terms arthritis is not limited to the joints. This is why relying only on ointments or topical treatments can lead to extra-articular (other organ) damage some of which could be catastrophic and lead to premature death.

If untreated, inflammation damages the joints—causing deformities, cartilage loss, and involvement of more joints over time. Complications usually appear after 10–15 years. Those who don’t understand, or refuse to believe this, often rely on short-term fixes and, unfortunately, will suffer later.

Eventually, joint deformities can become so severe that a person may not be able to walk without aid, button clothes, dress themselves, go to the toilet independently, open a bottle, or even open a door.

There are several types of rheumatoid arthritis:

Classical rheumatoid arthritis:

Affects small joints (fingers, wrists) and large joints (elbows, ankles, knees). Symptoms include morning stiffness, joint pain, swelling, weak grip, and fatigue.

Palindromic rheumatism

: Sudden joint pain (and swelling) that disappears within hours or days. Many of these patients may later develop classical rheumatoid arthritis. However, treatment can reduce this risk of progression to classical type. Medication may be needed even when symptoms are absent.

Monoarticular rheumatoid arthritis:

Affects a single joint. It is often mistaken for other conditions like gouty arthritis or osteoarthritis. Without proper treatment, it can destroy the joint and later progress to classical rheumatoid arthritis. Commonly affects larger joints, like knees, ankles, hips, and shoulders.

Polymyalgic onset (proximal) rheumatoid arthritis:

Seen in older individuals and even could be missed by clinicians. Patients usually complain of stiffness in both shoulders rather than joint pain or swelling.

Most patients experience morning stiffness (difficulty moving joints after waking) and joint “gelling” (stiffness after rest). Stiffness can last from minutes to hours and is caused by inflammatory substances accumulating in joints during sleep and rest.

Other symptoms may include whole-body pain, fatigue, weight loss, mild fever, depression, fibromyalgia (generalised wide spread pains)

Rheumatoid arthritis affects the whole body. The effects on other organ systems are identified as” extraarticular manifestations”. Most organs can get involved in poorly controlled disease. Some of the common manifestations include,

Skin vasculitis rashes and skin nodules

Lung disease (interstitial lung disease)

Heart disease (ischemic heart disease)

Osteoporosis

Eye problems which can even cause blindness (uveitis, scleritis)

Nerve disorders (polyneuropathy, mononeuritis)

Dry mouth (Sjogren’s syndrome)

About 40% of patients may develop such complications. The only way to reduce them is timely treatment.

In addition to joint swelling, the whole hand may swell like wearing a boxing glove. Swelling in the wrist can compress the median nerve, causing carpal tunnel syndrome (numbness in fingers). Surgery should not be rushed—arthritis must be treated first.

The disease can even affect the upper spine (neck joints). Neck pain along with other joint pain should not be ignored. In simple terms, rheumatoid arthritis can affect almost any joint except most parts of the spine.

No blood test is required to suspect or even diagnose rheumatoid arthritis. In some patients the rheumatoid factor antibody test will never be positive (seronegative rheumatoid arthritis). Waiting for lab confirmation before starting treatment is an unwarranted delay.

Some tests may show abnormalities:

Rheumatoid factor antibodies, Anti-CCP antibodies, ANA may be positive

ESR and CRP may be elevated

Haemoglobin may be low (anaemia of chronic disease)

Platelets may be high

Blood tests are more useful for monitoring treatment and medication safety rather than initial diagnosis. One important fact we must realise is the titre of the antibody test positivity has no correlation to disease activity and we cannot use the antibody titres to evaluate the response to treatment.

There are treatments that can even bring the disease into remission in no time at all. However, patients who delay treatment, take insufficient doses of medicines, stop medication early, follow inconsistent treatment, or rely on unscientific treatment methods are unlikely to achieve this.

Proper treatment involves starting with stronger medications and gradually reducing it as the disease improves. Simply controlling symptoms, without addressing the disease progression, is not enough; that is why using pain killers and prednisolone only cannot prevent extraarticular manifestations.

The first goal is on-drug remission. After that, patients should continue medication for more than 12 months without symptoms before gradually tapering. Stopping/tapering medications too early often causes relapse, which is a major reason why many patients fail to recover. Some patients may relapse even after stopping medication, but modern treatments allow long-term control without harm and sustained, drug-free remission in other patients. Most novel therapies are available in Sri Lanka as well.

The medications used are called DMARDs (Disease-Modifying Anti-Rheumatic Drugs). These do not just control symptoms—they change the course of the disease. Most patients respond to conventional DMARDs, but if not, biologic or targeted synthetic DMARDs should be started early—not after joint damage occurs. These treatments are available in Sri Lanka. Without consulting rheumatologist, patients may not receive these advanced forms of novel treatments.

Having rheumatoid arthritis is like being trapped in a room with a venomous snake. As long as you stay alert, you can avoid harm—but if you ignore it, it will strike. The disease must be treated at any cost. The choice is yours. With proper treatment initiated early, you can live a normal life. Ignoring the disease will not make it go away. Misinformation by people who aren’t aware of the severity of the disease and medications used often causes patients to avoid ideal treatment, leading to worse outcomes.

There is no point worrying after diagnosis; see a specialist early and seek treatment. You can live a normal life. Even pregnant or breastfeeding mothers can be treated safely without harming the baby. The precious time you waste starting a DMARD will definitely impact the final outcome.



Continue Reading
Advertisement
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Life style

The last kings of the wilderness: vanishing tuskers

Published

on

In the vast dry-zone wilderness of Sri Lanka, where ancient reservoirs mirror crimson sunsets and monsoon winds whisper through forests untouched for centuries, there still roams a giant who has become both legend and symbol.

His name is Mahasen — perhaps the most celebrated wild tusker Sri Lanka has ever known.

To wildlife enthusiasts, photographers, researchers, and villagers across the North Central Province, Mahasen is not merely an elephant. He is the living embodiment of Sri Lanka’s ancient wilderness, a reminder of a time when giant tuskers ruled the forests that surrounded the island’s great hydraulic civilisation.

Secretary and Chief Coordinator of Wild Tuskers of Sri Lanka, Chandika Lakmal, describes Mahasen as “one of the greatest living treasures of Sri Lanka’s natural heritage.”

“When people see Mahasen, they are not simply looking at a wild elephant,” he said.

“They are witnessing history, culture, ecology, and wilderness all combined into one magnificent animal. Tuskers like Mahasen are extremely rare, and losing such an elephant would mean losing a part of Sri Lanka’s identity itself.”

Sri Lanka has long shared a sacred bond with elephants. Ancient kings regarded tuskers as symbols of sovereignty and divine authority.

From the kingdoms of Anuradhapura and Polonnaruwa to the Kandyan era, elephants marched beside rulers during ceremonies and wars alike. Within Buddhist culture, elephants became revered symbols of strength, wisdom, and spiritual purity.

Yet among all elephants, the tusker has always occupied a special place.

Unlike African elephants, only a very small percentage of male Asian elephants develop tusks. This makes Sri Lankan tuskers exceptionally rare. Over centuries, they became deeply embedded in folklore, temple art, and village legends.

Mahasen stands today as perhaps the finest surviving example of that ancient legacy.

Mahasen, one of Sri Lanka’s most iconic wild tuskers, photographed during his majestic prime in 2014 and in 2025 as the ageing giant continues his struggle for survival in the island’s shrinking wilderness

The legendary tusker was first photographed in 2002 by renowned wildlife photographer Vajira Wijegunawardena. During those early years, wildlife enthusiasts referred to him as the “Somawathiya Tusker” because he was frequently sighted around the floodplains near Somawathiya before travelling towards Minneriya and Kaudulla during the season of the great elephant gathering.

Later, the giant elephant was named Mahasen in honour of the ancient King Mahasen, the visionary ruler who built the magnificent Minneriya Tank. The name reflected not only strength and majesty, but also a deep connection to the same historic landscape shaped by kings, forests, and elephants thousands of years ago.

Today, Mahasen is believed to be around 60 years old, making him one of the oldest surviving wild tuskers in Sri Lanka. Towering above most elephants, he possesses perhaps the largest pair of tusks ever documented among Sri Lanka’s wild elephants, stretching beyond six feet in length.

For decades, Mahasen became one of the greatest attractions of the famous elephant gathering at Minneriya National Park and Kaudulla National Park — one of the largest congregations of Asian elephants anywhere in the world.

Photographers from across the globe waited patiently for hours hoping to capture the old king emerging from the dusty grasslands, at dusk, his enormous tusks glowing beneath the golden evening light. For many wildlife lovers, witnessing Mahasen in the wild became an unforgettable experience.

“Mahasen carries an extraordinary presence,” Chandika Lakmal explained. “Even among large elephants, he stands apart. There is a certain calmness, confidence, and dignity in the way he moves. You immediately understand why ancient people considered tuskers sacred.”

Yet beyond his beauty and fame, Mahasen also represents the fragile future of Sri Lanka’s elephants.

Modern conservation science identifies elephants as “keystone species” and “umbrella species,” meaning their survival protects entire ecosystems. Elephants create pathways through forests, disperse seeds, maintain grasslands, and help sustain biodiversity across vast landscapes.

“Elephants are ecosystem engineers,” Chandika Lakmal said. “The forest itself depends on them. Without elephants, the structure of these ecosystems begins to change. Protecting tuskers, like Mahasen, means protecting entire habitats and countless other species.”

Sadly, Sri Lanka’s wild elephants now face mounting threats.

Habitat fragmentation, shrinking forests, electric fences, roads, railway accidents, illegal shootings, and human-elephant conflict continue to endanger their survival.

Nearly 60 percent of Sri Lanka’s wild elephants live outside protected national parks, surviving within fragmented forests and ancient tank ecosystems increasingly surrounded by human settlements.

Traditional elephant migration corridors that existed for centuries have now been blocked by agriculture and development projects. As elephants lose access to food and water, they are increasingly forced into villages and farmlands, creating dangerous encounters between humans and wildlife.

Even Mahasen has not escaped these pressures.

In recent years, the ageing tusker’s movements have become increasingly restricted. Wildlife observers believe the enormous weight of his tusks, combined with old age, has forced him into smaller forest patches between Kakirawa and Maradankadawala where food and water are available within shorter distances.

Several months ago, Mahasen was discovered with a serious wound on his back believed to have been caused either by a gunshot injury or a clash with another elephant. Wildlife officials intervened quickly and treated the giant tusker, offering hope that he would recover once again.

However, concern continues to grow among conservationists and wildlife enthusiasts as sightings of Mahasen have become increasingly rare in recent months.

For many Sri Lankans, the thought of losing Mahasen is deeply emotional.

“Mahasen is not just another elephant,” Chandika Lakmal said quietly. “He is one of the last living symbols of Sri Lanka’s ancient wilderness. Future generations deserve the chance to see such animals alive in our forests, not only in photographs or history books.”

Despite his immense ecological and cultural importance, many villagers living near elephant habitats still struggle with fear and economic hardship caused by crop raids and property damage.

Conservationists stress that long-term coexistence can only be achieved through proper land-use planning, protection of elephant corridors, community awareness, and sustainable conservation policies.

Across the forests of Yala National Park, Wilpattu National Park, Gal Oya National Park, and Wasgamuwa National Park, Sri Lanka’s remaining tuskers continue their silent struggle against an uncertain future.

But among them all, Mahasen remains special.

He is more than an old tusker wandering through fading forests.

He is the last king of a vanishing wilderness.

And as long as Mahasen still walks beneath the ancient trees of Sri Lanka’s dry zone, the spirit of the island’s wild heritage continues to survive majestic, untamed, and unforgettable.

By Ifham Nizam

Continue Reading

Life style

Stars shine bright

Published

on

Leading figures from the industry graced the ‘Tharulya’ Muhurat ceremony

An auspicious beginning for ‘Tharulya’

The Muhurath ceremony of ‘Tharulya’ the newest teledrama directed by Sudarma Jayewardena, was held in a graceful setting at Waters Edge recently, bringing together artistes, television personalities and invited guests from the entertainment industry.

The auspicious occasion marked the official beginning of the much-awarded teleseries, with the lighting of the traditional oil lamp adding colour and glamour to the evening.

Cast members and crew joined Sudarma in celebrating the launch while industry well-wishers extended their support for the production.

Sudarma is known for her emotionally rich story telling and distinctive creative touch. When asked about her new tele-serial, she expressed optimism ‘Tharulya’ is expected to bring a fresh narrative to the local television audiences. For her ‘Tharulya’ can be described as a reflection of dreams, emotions and human relationships, woven into meaningful teledrama narratives. The word ‘Tharulya’ evokes a poetic sense of stars, hope and destiny, symbolising the journeys and emotional bonds explored through the story.

Sudarma Jayewardena is known for her work as a actress, director, producer and creative visionary behind several acclaimed teledramas. Over the years she has build a reputation for presenting emotionally layered stories that explore family dynamics, social realities, women’s experiences and human relationships with sensitivity and depth .

Her teledramas are known for strong story telling, refined casting and cinematic production.

The teledrama, ‘Ganga Adare’, directed by Sudarma, is among the well known television production.

This tele-series became popular on the small screen for its emotional story telling, strong character development and family centred narrative style that resonated with Sinhala TV audiences.

Sudarma’s involvement in musical events, like ‘Sonu Nigam,’ highlighted her versatility beyond teledramas, showcasing her ability to create large scale entertainment events that combined glamour, culture and audience appeal.

Sudharma, who is no stranger in the entertainment industry, is the Managing Director of Star Events. ‘Tharulya’ was produced by Saranga Mendis. This much talked about teleserial is all set to unspool on Derena TV.

Beyond teledramas , Sudarma also contributed to musical and entertainment programmes, expanding her influence within Sri Lanka’s media industry. Her productions are often noted for their polished presentation and emotional story telling. (Zanita) Pix by Thushara Attapathu

Continue Reading

Life style

Sri Lanka and Viet Nam soar into a new era of co-operation

Published

on

Landmark visit celebrating diplomacy, connectivity and growing economic partnerships

Air Bridge of Friendship


The state visit of the Party Secretary and State President, To Lam of Viet Nam, to Sri Lanka, heralds a defining moment in bilateral relations, where diplomacy and aviation converge in a new era of connectivity. With the launch of Viet Nam air services, linking the two nations, the partnership soars behind traditional statecraft -opening a seamless corridors for tourism, trade and cultural exchange between South and South East Asia.

My interview with the Ambassador for Viet Nam in Sri Lanka, Trinh Thi Tam, went as follows:

(Q) How significant is the State visit to Sri Lanka by Party General Secretary and State President To Lam?

(A)Party General Secretary and State President To Lam’s visit to Sri Lanka is highly significant as it takes place when the two countries have just celebrated 55 years of diplomatic relations in 2025. Viet Nam is the first ASEAN members to visit Sri Lanka, and is also the first ASEAN country that President Anura Kumara Dissanayake visited after assuming office. More, importantly, both sides agreed to elevate bilateral ties to a Comprehensive Partnership on this occasion, opening a new chapter for cooperation in politics, trade, tourism, culture, education, and connectivity. The visit reflects the strong mutual trust and the shared determination to deepen cooperation in the years ahead.

(Q) Viet Nam and Sri Lanka share centuries old Buddhist links. How can these spiritual and cultural ties be transformed into stronger people-to-people tourism?

(A) Viet Nam and Sri Lanka share centuries-old Buddhist and cultural links, which create a very strong foundation for closer people-to-people relations. These spiritual ties can be transformed into stronger tourism cooperation through Buddhist pilgrimage tours, exchanges between temples and universities, cultural festivals, and tourism promotion programmes. Increased air connectivity and easier travel arrangements will also encourage more visitors to explore each other’s cultural heritage and strengthen mutual understanding between the two peoples.

(Q) Direct flights between Colombo and Ho Chi Minh City has generated great excitement in Sri Lanka. How important is this milestone for tourism and bilateral relations?

Proud moment for Ambassador Trinh Thi Tam

(A) The launch of direct flights between Colombo and Ho Chi Minh City by Viet Nam Airlines (national carrier) and Viet Jet (a private airline) is a historic milestone for bilateral relations. It not only shortens travel time but also creates new opportunities for tourism, trade, investment, business cooperation as well as people-to-people and cultural exchange. This achievement comes at a very meaningful moment, following the establishment of the Comprehensive Partnership, demonstrating the commitment of both countries to enhance practical cooperation and strengthen connectivity between Southeast Asia and South Asia.

(Q) Do you think this direct flight will significantly increase Vietnamese tourist arrivals to Sri Lanka within the next few years?

(A) Yes, we believe the direct flights will significantly increase Vietnamese tourist arrivals to Sri Lanka over the next few years. Sri Lanka is becoming increasingly attractive to Vietnamese travellers because of its beautiful beaches, Buddhist heritage, natural landscapes, and hospitality. Easier connectivity and tourism promotion activities will help more Vietnamese people discover Sri Lanka. We also expect stronger two-way tourism exchanges, contributing positively to economic cooperation and people-to-people relations between the two countries.

(Q) Do you see Colombo becoming a stronger regional hub connecting Viet Nam with the Indian Ocean region?

(A) Colombo has great potential to become a stronger regional hub connecting Viet Nam with South Asia and the Indian Ocean region. Sri Lanka’s strategic geographic location, combined with improving connectivity and growing economic cooperation, can help facilitate trade, tourism, logistics, and maritime cooperation. Following the establishment of the Comprehensive Partnership, Viet Nam sees many opportunities to work more closely with Sri Lanka in regional connectivity initiatives and strengthen economic links between Southeast Asia and the Indian Ocean region.

(Q) Viet Nam and Sri Lanka have enjoyed decades of friendly relations. What makes this partnership unique in Asia?

Proud moment for Ambassador Trinh Thi Tam

Trinh Thi Tam played a key role in celebrating the historic visit

(A) The Viet Nam–Sri Lanka partnership has been built on longstanding friendship, mutual trust, and deep cultural connections rather than only economic interests. The two countries have consistently supported each other over many decades and share common values regarding independence, peace, and international cooperation. President Ho Chi Minh, Viet Nam’s Nation Father, stopped over in Sri Lanka on three occasions. Vietnamese people has always treasured the strong, unconditional support offered by Sri Lankan people during our hard struggle against imperialism and colonialism. The recent elevation of bilateral ties reflects the maturity of this relationship and the shared vision to expand cooperation across many sectors in a sustainable and balanced manner.

(Q) How does Viet Nam view Sri Lanka’s role with South Asia and the Indian Ocean together?

(A) Viet Nam highly values Sri Lanka’s important role in South Asia and the Indian Ocean region. Sri Lanka’s strategic location and historical role as a maritime and commercial centre make it an important partner for regional connectivity and economic cooperation. With Sri Lanka’s keen interest in engaging more with ASEAN (Regional Comprehensive Economic Parnership ) Viet Nam believes Sri Lanka can play an even stronger role in connecting South Asia and Southeast Asia, especially in trade, tourism, logistics and maritime cooperation.

(Q) How would you describe the current diplomatic relationship between Viet Nam and Sri Lanka after the Party General Secretary and State President’s visit?

(A) Following the visit, the diplomatic relationship between Viet Nam and Sri Lanka can be described as stronger, more dynamic, and more future-oriented. The establishment of the Comprehensive Partnership demonstrates the high level of political trust and creates a solid framework for expanding cooperation in many important sectors, including trade, investment, tourism, education, digital transformation, agriculture, and cultural exchanges between the two countries.

(Q) After the Party General Secretary and State President, what is your vision for Viet Nam-Sri Lanka relations over the next decade?

(A) Over the next decade, we hope Viet Nam–Sri Lanka relations will develop into a stronger, broader, and more practical partnership under the framework of the Comprehensive Partnership. We expect deeper cooperation in trade, tourism, connectivity, digital economy, education, renewable energy, agriculture, and maritime cooperation. At the same time, people-to-people exchanges and cultural cooperation will continue to grow, creating a solid foundation for long-term friendship and mutual prosperity between the two countries.

(Q) What message does Viet Nam wish to send to Sri Lanka and South Asian Region through the visit?

(A) Through the Party General Secretary and State President’s visits to India and Sri Lanka, Viet Nam wishes to send a strong message of friendship, cooperation, and shared development to Sri Lanka and the wider South Asian region. The visits demonstrates Viet Nam’s commitment to strengthening partnerships in South Asia and promoting peace, stability, connectivity, and economic cooperation in the Indo-Pacific region.

Continue Reading

Trending