When Afna Shanavas first complained of pain at 16, doctors suspected stress. It would take another 10 years for her to discover she had arthritis.
Writing during school exams became increasingly painful, and she was constantly exhausted. But despite visits to specialists, her symptoms were repeatedly treated with painkillers and she was asked to rest.
“I knew I was in pain, but people did not believe me,” Ms Shanavas, now 26, said. “My mother took me to orthopaedic and neurological specialists, and the answer was always painkillers.
“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.”
“I was even referred to a psychologist because doctors thought the pain was psychosomatic.”
Ms Shanavas, a psychologist, has now finally been diagnosed with inflammatory polyarthropathy and ankylosing spondylitis, two conditions that can cause chronic pain and inflammation.
Cycle of pain
At 17, while in Grade 12, she had experienced a severe episode in which her neck seized up. She was admitted to hospital for emergency treatment amid concerns that she might be having a stroke. Doctors later ruled out a stroke.
While recovering in intensive care, Ms Shanavas decided to pursue a career in psychology, hoping to better understand the relationship between the brain and physical health.
The cause of her symptoms remained elusive despite consultations with doctors in the UAE and India.
However, a minor cut to a finger that refused to heal led to 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,” said Ms Shanavas.
The ANA test was positive, although several other markers were negative. Ms Shanavas subsequently became pregnant and postponed further investigations.
After her pregnancy, her symptoms worsened. It was only then that she underwent further investigations and was diagnosed with inflammatory polyarthropathy and ankylosing spondylitis
Inflammatory polyarthropathy, or polyarthritis, is an autoimmune condition that causes inflammation in five or more joints.
As a type of arthritis, ankylosing spondylitis usually affects the spine and pelvis, reducing flexibility and leading to a stiff, hunched-over posture.
“It was a huge surprise as I thought this was a disease for the elderly,” she said.
The conditions are usually only diagnosed in people under 45 following three months of chronic pain and an in-depth evaluation of medical history, a physical examination, internal imaging and blood tests.
Ms Shanavas is now urging people to recognise that arthritis can affect young people, too.
Invisible condition
Ms Shanavas, now head of inclusion and well-being at The Oxford School in Dubai, takes several medications to manage her symptoms.
Her treatment schedule includes a biological injection every two weeks that slows down her overactive immune system, as well as multiple probiotics, supplements and corticosteroid creams to manage her flare-ups.
She has kept a journal documenting her experiences over the past decade, which she hopes to publish.
One of the most difficult aspects of living with the condition, she said, is that its effects are not always visible to others.
“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.”
Rare in young people
Arthritis in young people remains relatively rare. It is an umbrella term for more than 100 conditions affecting the joints and surrounding tissues. Symptoms and causes vary, and some forms can begin in childhood or early adulthood.
Rheumatoid arthritis is an inflammatory condition that commonly develops in adulthood, while osteoarthritis is associated with changes in the joint's structure and becomes more common with age.
Juvenile idiopathic arthritis refers to a group of inflammatory conditions that begin before the age of 16.
Dr Humeira Badsha, a rheumatologist in Dubai, said arthritis care was moving away from general pain relief towards precision medicine and individualised therapy.
“Treatment is increasingly targeted at the specific inflammatory pathways driving each patient's disease,” she said.
“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.”
GLP-1 weight-loss therapies can help arthritis by reducing wear and tear on overstressed joints.
Dr Usama Hassan Saleh, a consultant in orthopaedic surgery at the Medcare Orthopaedics and Spine Hospital in Dubai, said genetics can also play a role.
“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 include joint pain, stiffness, swelling and difficulty moving the affected area.
“Seeking medical advice early can help establish the type of arthritis and ensure that appropriate treatment begins promptly,” said 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.”