How my air purifier healed my joint pain and why this disturbs me

Growing up with working parents, I created a system to stay healthy all by myself. It was hinged on the intuitive practice of reading the signs of my body. For the first 24 years of my life, this helped me feel in control of my physical well-being — I could tell when a fever was coming on, how to nip infections in the bud, how long to be active, when to rest, what to eat and how to heal injuries fast. 

I felt blessed that I was allergic to almost nothing — my mother and I brushed against jellyfish that had floated ashore at the beach in Puri and while she got a severe reaction, I escaped with a mild boil. While much of it had to do with the cornucopia of biological healing mechanisms that comes with being a child, I felt invincible and fearless knowing I could bounce back from any malady because I was perfectly in tune with my body. 

All of that changed about two years after I moved to Delhi. In 2016, I walked into the living room of my rented apartment on a winter evening and saw, for the first time, an indoor haze blocking the view of the balcony that I liked to leave open for fresh air. 

Then began a series of unexplained anomalies in the form of food allergies. Even as we queued up to buy expensive face masks from a tiny Khan Market shop that had mysteriously won the city’s trust (and vanished into oblivion within a couple of years as public knowledge about pollution science evolved), I felt my throat closing up one afternoon after biting into a juicy slice of pineapple — a fruit I had enjoyed all my life. Kiwis I had picked up from a village near Sitlakhet in Uttarakhand during a forest walk the same November became the next poison. Strawberries in a homemade jam a friend served for breakfast during the following spring triggered a similar reaction — throat closing, sniffling, coughing and a red ring on the neck. I popped an antihistamine tablet in each instance and avoided these fruits ever since.

It isn’t uncommon for allergies to crop up late in life. Mine came with a host of undiagnosable features that snatched away the sense of control over my body I thought was innate. My periods became shockingly short. There was a lump in my neck (close to the thyroid gland) that would come and go as it pleased. My lymph nodes would get swollen without a warning. I could no longer understand or manage infections that became more frequent. The texture of my skin changed and my eyes needed constant lubrication. Most tragically, March went from being a time for a printemps walk under the flowering trees of Lodhi Garden in gleeful appreciation of the wellspring of life that is Earth to paranoid cocooning indoors to prevent hay fever from pollen. Everything, all at once.  

At the very beginning of the novel coronavirus disease (COVID-19) pandemic in India, right before the 2020 lockdown, I got myself tested for all kinds of viral infections as mandatory protocol at my former workplace for any employee who had high fever. The diagnostic analysis cleared me of any infection but the general physician examining my report drew my attention to one elevated marker that I had never heard of before — rheumatoid arthritis factor (RF). The doctor said this can indicate an incurable autoimmune condition where antibodies mistakenly attack healthy tissues. But since healthy individuals can also have high RF, specific tests were prescribed to rule out the disease. Before I could get them done, the country-wide prolonged lockdown was announced. 

Around the same time, I reconnected with a childhood friend who had suffered the devastating side effects of the steroid medication for an autoimmune disease she was diagnosed with. She moved cities, restricted herself indoors to avoid pathogen exposure and underwent expensive and experimental gene therapy to reverse her condition and get off steroids. She felt good for a year until she took the COVID-19 jab in 2021 and soon after developed strange blood clots on her limbs and was diagnosed with another autoimmune disease. She blamed it on the vaccine and said her doctor had observed similar cases. But there was no scientific evidence to make that link. 

Her harrowing experience led me to do a wider exploration of confusion and paranoia regarding vaccines among autoimmune disease patients, as most take immunosuppressants to manage their condition and now they were required to boost their immune systems to prevent the deadly COVID-19. 

In 2021, I interviewed Dr Uma Kumar, the founder-head of the rheumatology department at the All India Institute of Medical Sciences in Delhi, for the story. She had noted vaccine hesitancy among her patients and other startling observations linking the spike in autoimmune conditions in India, including air pollution. During the interview, I told her about my elevated RF and she examined the small joints in my hands for swelling and asked me if I experienced any pain. I didn’t and that led her to rule out any possibility of an existing rheumatoid arthritis flare-up. She advised that I get the specific medical tests done in future if I ever experience joint pain in my hands, feet and knees. 

This winter, the air pollution levels in Delhi-NCR have been off the charts as usual (although there is no way to find out the actual intensity due to vast data gaps). People protesting in the city’s streets have been detained. Cloud seeding has been attempted several times, but it never led to enough rainfall to clear up the city’s air. 

This time, apart from the seasonal stuffy chest, I experienced pain across multiple joints and acute fatigue. After a couple of weeks of feeling like I am trapped in the body of a 70-year-old every time I took the stairs, I remembered Dr Kumar’s advice. I got blood tests done to check my erythrocyte sedimentation rate, C-reactive protein quantity, RF and anti cyclic citrullinated peptide levels. The first three of the four turned out to be quite high, the last normal. The last one is a more specific indicator of the autoimmune condition rheumatoid arthritis and Dr Kumar ruled out the disease. Why the elevated levels, then? Some 20 per cent of Kumar’s patients have false RF positivity and this can be linked to inflammation caused by air pollution, she opined. 

I mentioned the findings to my partner and it struck him that I only complain of fatigue during the winter and never during the monsoon season. 

Experts recognised the link between particulate matter pollution and increase in cases of rheumatoid arthritis in the country at a conference of the Indian Rheumatology Association held last month.

Dr Kumar and other rheumatologists who participated in the conference concurred that air pollution could be one of the factors leading to development of the condition even in people who are not genetically predisposed to it. Several studies illustrate this link, which, in simple terms, is a result of the inflammation and immune response mounted by our body when fine particulate matter enters and alters our cells. 

So, while I was relieved that I don’t have a chronic ailment, I am also confronted with the reality that my joint pain and fatigue can be associated with the toxic air I am forced to breathe. 

I have a small, portable air purifier that I want to hug as long as I am awake, like I am Emma from the show Bates Motel who had to move around with an oxygen tank because she had cystic fibrosis. Even if the machine is just a placebo, being around it makes me feel less lethargic and the joint pain is hardly noticeable. But this privilege comes with the burden of guilt that I am deepening inequality while just trying to remain healthy. 

The psychological toll of air pollution may be just as big as its impact on human physiology. The fact that the crisis is invisible until it I see its scars on my body makes it all the more intimidating.

The paranoia of damaging my lungs while enjoying a walk with friends, the gloom of seeing everyone around me coughing and the sky constantly grey, the helplessness of knowing that while I can afford a Rs 5,000 gadget to create a safe surrounding for myself, many others with much higher exposure to pollutants won’t be able to. Will air ourifiers become the new AC — a necessary evil that increases individual carbon footprint?

Just like writing this piece helped clear my mind, I wish there were a way to drain out all the pollutants from our body so that both mental and physical health could be protected.