Thirty-year-old Rani Saranya from Kerala spent nearly eight years visiting clinics before physicians identified the reasons for her ongoing pain, repeated skin lesions, fatigue and digestive issues.
She received a diagnosis of PASH syndrome, a rare autoinflammatory disorder involving pyoderma gangrenosum, acne and hidradenitis suppurativa, together with fibromyalgia and irritable bowel syndrome. “Obtaining a diagnosis brought relief because it clarified what was occurring in my body and enabled access to suitable treatment and support,” she says. The findings provided understanding, yet living with several chronic illnesses continues to present difficulties.
Her symptoms were first managed as distinct issues instead of linked conditions. “For many years I had symptoms without realising they were connected. I saw various doctors and received differing views, but the problems were handled separately rather than as parts of one picture,” she says.
Such delays are common. Hidradenitis suppurativa, a component of PASH syndrome, is often underdiagnosed. Large reviews estimate its prevalence at 0.3 to 0.4 percent, though some studies suggest it may affect up to 2.5 percent of adults, indicating many undetected cases.
IBS is estimated to affect 5 to 10 percent of people worldwide, while fibromyalgia affects around 2 to 4 percent globally. Research shows notable overlap between these conditions.
Pandurangan Basumani, senior consultant interventional gastroenterologist and director at Kauvery Hospital in Chennai, notes that overlap among these disorders is increasingly recognised. “Roughly one-third of patients may have more than one of these conditions at a given time,” he says.
Patients with fibromyalgia often experience IBS, jaw disorders and chronic back pain, while those with hidradenitis suppurativa may also have fibromyalgia, migraine, chronic fatigue syndrome and bowel disorders, he adds.
Underlying mechanisms involve immune-mediated inflammation, genetic factors, environmental triggers and central sensitisation, in which the nervous system grows more sensitive to pain signals.
Beyond diagnosis, treatment costs remain a challenge. Ms. Saranya uses the biologic adalimumab, with each injection costing about ₹6,000. Depending on disease activity, she needs one or two injections weekly.
She also faces recurring expenses for consultations, tests, wound care and travel. “Living with multiple chronic conditions means healthcare is an ongoing process requiring constant monitoring and adjustment,” she says.
She currently receives no insurance coverage or government assistance. She believes inclusion of rare autoinflammatory disorders such as PASH syndrome in government rare-disease programmes could improve financial support.
Experts indicate these difficulties are typical for patients with overlapping chronic illnesses.
Dr. Basumani says medicine is shifting from viewing these disorders as isolated conditions. “The needed change is to recognise that these illnesses are interlinked. Care should be patient-centred rather than process-centred,” he says.
Integrated clinics can provide same-day multidisciplinary consultations, digital coordination tools and simultaneous management of inflammation, pain and mental health.
Arul Prakash, clinical lead at SRM Prime Hospital in Chennai, notes that patients with chronic inflammatory disorders often need input from gastroenterologists, rheumatologists, infectious-disease specialists, pain clinics, psychiatrists and physiotherapists. Multidisciplinary meetings are becoming more common but remain limited to few centres. “There is room for improvement so more patients can benefit from coordinated care,” he says.
Ms. Saranya says awareness is the most urgent requirement. “Chronic pain conditions are often invisible. Just because someone appears healthy outwardly does not mean they are not struggling physically and emotionally every day.”
