A Decade of Dismissed Pain: Woman Finally Diagnosed with Arthritis After 10 Years of Misdiagnosis

Afna Shanavas, now 26, endured a decade of debilitating pain that began when she was just 16. Initially, doctors attributed her symptoms to stress, a diagnosis that persisted despite her visits to numerous specialists. Writing during school exams became excruciatingly difficult, and she suffered from constant exhaustion. However, her symptoms were consistently met with prescriptions for painkillers and advice to rest.

"I knew I was in pain, but people did not believe me," Ms Shanavas recounted. "My mother took me to orthopaedic and neurological specialists, and the answer was always painkillers." She added, "Because I was doing well in academics and sports, one doctor suggested I was under too much pressure and that my parents were expecting too much from me." The situation escalated to the point where she was referred to a psychologist, as doctors suspected her pain was psychosomatic.

Ms Shanavas, who is now a psychologist herself, has finally received a diagnosis of inflammatory polyarthropathy and ankylosing spondylitis, two conditions known for causing chronic pain and inflammation.

The Cycle of Pain

At 17, during her Grade 12 year, Ms Shanavas experienced a severe episode where her neck seized up, leading to hospitalization and emergency treatment due to concerns of a stroke, which was later ruled out. While recovering in intensive care, she decided to pursue a career in psychology, aiming to better understand the connection between the brain and physical health. Despite consulting doctors in both the UAE and India, the cause of her symptoms remained a mystery.

A turning point came with a minor finger cut that refused to heal, prompting rheumatology tests in Sharjah. "I had never even heard of a rheumatologist, who did an antinuclear antibody test, which helps guide investigations to understand why my finger cut was not healing," Ms Shanavas explained. The antinuclear antibody (ANA) test came back positive, though other markers were negative. Ms Shanavas became pregnant shortly after and postponed further investigations. Her symptoms intensified post-pregnancy, leading to the comprehensive investigations that resulted in her diagnosis of inflammatory polyarthropathy and ankylosing spondylitis.

Inflammatory polyarthropathy, also known as polyarthritis, is an autoimmune condition causing inflammation in five or more joints. Ankylosing spondylitis, a form of arthritis, primarily affects the spine and pelvis, leading to reduced flexibility and a hunched posture. "It was a huge surprise as I thought this was a disease for the elderly," she admitted. Typically, these conditions are diagnosed in individuals under 45 after three months of chronic pain, a thorough medical history review, physical examination, imaging, and blood tests.

Ms Shanavas is now advocating for greater awareness that arthritis can affect young people. She currently manages her symptoms with a regimen that includes a bi-weekly biological injection to regulate her immune system, along with probiotics, supplements, and corticosteroid creams for flare-ups. She has documented her decade-long journey in a journal she hopes to publish.

An Invisible Condition

One of the most challenging aspects of living with her condition, Ms Shanavas noted, is its invisibility. "The hardest part is that I can look completely fine on the outside," she stated. "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."

Arthritis in young people, while relatively rare, is an umbrella term encompassing over 100 conditions affecting joints and surrounding tissues. Symptoms and causes vary, with some forms appearing in childhood or early adulthood. Rheumatoid arthritis typically develops in adulthood, while osteoarthritis is linked to joint structure changes and becomes more prevalent with age. Juvenile idiopathic arthritis refers to inflammatory conditions starting before age 16.

Dr Humeira Badsha, a rheumatologist in Dubai, highlighted the evolution of arthritis care towards precision medicine and individualized therapy, moving away from general pain relief. "Treatment is increasingly targeted at the specific inflammatory pathways driving each patient's disease," she explained. "Anyone on chronic, long-term medication needs a thorough baseline medication review before a new drug is started, and regular monitoring afterwards. Arthritis can appear at any age, depending entirely on the underlying classification."

Dr Usama Hassan Saleh, a consultant in orthopaedic surgery at the Medcare Orthopaedics and Spine Hospital in Dubai, mentioned that genetics can also be a contributing factor. "Some forms of arthritis, including osteoarthritis and rheumatoid arthritis, have a hereditary component, meaning that having a close relative with the condition may increase a person's risk," he said. "However, family history does not mean that someone will inevitably develop arthritis, as other lifestyle and environmental factors can also contribute."

Early symptoms often include joint pain, stiffness, swelling, and difficulty with movement. "Seeking medical advice early can help establish the type of arthritis and ensure that appropriate treatment begins promptly," advised Dr Saleh. "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."