Dismissed as Stress for a Decade, a Young Woman Finally Finds Her Arthritis Diagnosis

Afna Shanavas was 16 when she first told doctors she was in pain. They suspected stress. It took another ten years, and a small cut on a finger that would not heal, before she learned she had arthritis.

The early years followed a pattern. Writing during school exams hurt, and she was constantly exhausted. Her mother took her to orthopaedic and neurological specialists, and the answer was almost always painkillers and rest. Because she was doing well in academics and sports, one doctor suggested she was under too much pressure and that her parents expected too much of her. She was even referred to a psychologist, because doctors believed the pain was psychosomatic. "I knew I was in pain, but people did not believe me," she said.

At 17, in Grade 12, her neck seized up in a severe episode. She was admitted for emergency treatment amid fears she might be having a stroke. Doctors later ruled that out. While recovering in intensive care, she decided to pursue a career in psychology, hoping to understand the relationship between the brain and physical health. Consultations with doctors in the UAE and India still did not explain her symptoms.

The break came from the cut on her finger. Its refusal to heal led to rheumatology tests in Sharjah. She had never heard of a rheumatologist, she said, but this one ordered an antinuclear antibody test to help investigate why the wound was not mending. The ANA test came back positive, though several other markers were negative. Then she became pregnant and put off further investigation.

After the pregnancy her symptoms worsened, and only then did she undergo the full workup. The result was a diagnosis of inflammatory polyarthropathy and ankylosing spondylitis. The first, also called polyarthritis, is an autoimmune condition that inflames five or more joints. The second is a type of arthritis that usually affects the spine and pelvis, reducing flexibility and sometimes producing a stiff, hunched posture. "It was a huge surprise as I thought this was a disease for the elderly," she said. Such conditions are usually diagnosed in people under 45 after three months of chronic pain, followed by a review of medical history, a physical exam, imaging and blood tests.

Shanavas, now 26, is head of inclusion and well-being at The Oxford School in Dubai. She manages her condition with a biological injection every two weeks that slows her overactive immune system, along with probiotics, supplements and corticosteroid creams for flare-ups. She has kept a journal of the past decade and hopes to publish it. The hardest part, she said, is that she can look completely fine. People do not always understand why she needs a day off, because they cannot see the pain or fatigue, and she has often felt misunderstood.

Arthritis in young people is relatively rare, but it is not unheard of. The term covers more than 100 conditions affecting joints and surrounding tissues, and some forms begin in childhood or early adulthood. Juvenile idiopathic arthritis refers to inflammatory conditions that start before 16. Rheumatoid arthritis commonly develops in adulthood, and osteoarthritis, tied to changes in joint structure, grows more common with age. Dr Humeira Badsha, a rheumatologist in Dubai, said arthritis can appear at any age depending on the underlying classification. She said care is shifting from general pain relief toward precision medicine, with treatment aimed at the specific inflammatory pathways driving each patient's disease. She added that anyone on long-term medication needs a thorough baseline review before a new drug starts, and regular monitoring afterward.

Dr Usama Hassan Saleh, an orthopaedic consultant at Medcare Orthopaedics and Spine Hospital in Dubai, said some forms, including osteoarthritis and rheumatoid arthritis, have a hereditary component, though family history does not make the disease inevitable. Early symptoms include joint pain, stiffness, swelling and difficulty moving the affected area. He urged people to seek advice early so the type can be identified and treatment begin promptly. GLP-1 weight-loss therapies, the article notes, can also help by reducing strain on overstressed joints. Shanavas, for her part, is asking people to recognise that arthritis can affect the young.