Rheumatology in India and Pakistan today

Abstract

India has a population of 1.2 billion and growing. It will overtake China by 2030. Neighbouring Pakistan has a rapidly expanding population estimated at 188 million. The frequency and pattern of rheumatic diseases in these two nations are similar to those of western countries [ 1–3 ]; that is a lot of arthritis. Do people with musculoskeletal symptoms receive treatment, and if so who delivers it? In 1994 I commented that the facilities and expertise available to provide treatment in Pakistan were almost invisible [ 4 ]. A few years later I commented on the inadequacy of provision in India [ 5 ]. In both countries the majority with ailments seek the opinion of traditional healers, hakims, mystics and pharmacists because doctors are scarce and their cost, as well as that of conventional treatments, is beyond their ability to pay. Ayurvedic medicine is an established and cheaper alternative in India, where it has deep cultural roots. Herbs and a distinctive spiritual philosophy are instinctively attractive to some and may provide benefits comparable to some conventional painkillers in OA [ 6 , 7 ]. However, the advances in treatment, and therefore outcomes, of inflammatory joint diseases, especially RA, require expertise invested in rheumatologists or those with equivalent training.