Rheumatoid Arthritis

By

Dr. Pravin Verma Consultant Ayurveda Physician And Panchkarma specialist

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Amavata (Rheumatoid Arthritis) is an Autotoxic, Nonsuppurative, psychosomatic, proliferative, Type III immune mediated, inflammatory Disease. According to Ayurveda RA may be compared with Amavata. Rheumatoid Arthritis affects through out the world without any influence of climate, altitude and Geography, with female to male ratio of 3:1. Every year about 0.02% new cases are reported. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Unknown Provoking Factors Non-specific immune response Inflammatory lesion

IL-1, IL-6 &IL-8 From macrophages & Fibroblasts

IL-2, IL-6 & IFN-γ From T-Cells

Continued inflammation & Joint destruction

OFR & hydrolytic Enzymes from Neutrophils

RHEUMATOID ARTHRITIS

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Synovial pannus eroding articular cartilage.

Swan neck deformity of the fingers

Courtesy byDavidson’s Principles and Practice Of Medicine. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Systemic Involvement Of RA Systemic effect : Fever, weight loss, fatigue. Musculoskeletal : Muscle wasting, tenosynovitis, bursitis osteoporosis.

Hematological : Anaemia, thrombocytosis, eosinophilia. Lymphatic system : Splenomegaly, Felty’s syndrome. Eye : Episcleritis, scleritis, scleromalasia, keratoconjunctivitis sicca. Cardiovascular : Pericarditis, myocarditis, endocarditis, digital arteritis conductiondefects, coronary vasculitis, ulcers, granulomatous arteritis, visceral arteritis, Respiratory system : Nodules, pleural effusion, fibrosing alveolitis, bronchiolitis, Caplan’s syndrome. Nervous system : Cervical cord compression, amyloidosis, compression neuropathies, peripheral neuropathy, mononeuritis multiplex. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

PAIN PATHWAY Mechanical

Small Myelinated Aδ fibers

sharp-fast pain velocity of 6-30 m/sec.

Thermal

Chemical

Small Unmyelinated C fibers

slow-chronic pain velocity of 0.5-2.0 m/sec.

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Effect Of Blood Supply On Pain Blood Supply Occluded In Muscle Tissue Ischemia Rise of Concentration Of Lewis’s “P Factor” Muscle Contraction Pain Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

ETIOLOGY OF RHEUMATOID ARTHRITIS ETIOLOGY EXTERNAL

BOTH

INTERNAL TOXINS & FREE RADICALS

AGRAVATION OF VATA

KAPHASTHANA

STOMACH

NECK

TRIKASANDHI CHEST

FOREHEAD

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Sign & Symptoms According To Madhava Nidan 1. Anga Pida (Body Ache) 2. Aruchi (Anorexia) 3. Pipasa (Thirst) 4. Aalasya (Fatigue) 5. Anga Gaurava (Heaviness In Body) 6. Jwara (Fever) 7. Burning & Redness If Pitta Is Associated 8. Heaviness & Itching If Kapha Is Associated Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Diagnostic Criteria 1. Morning stiffness. 2. Joint tenderness (pain in motion). 3. Swelling of three or more joints from six months or more. 4. Arthritis of hand joints from six weeks or more. 5. Symmetrical arthritis from six weeks or more. 6. Rheumatoid nodules. 7. Rheumatoid factor. 8. X-Ray changes. Diagnosis of Rheumatoid Arthritis in patients enrolled for present study was based on the criteria of American Rheumatoid Association. Presence of any of four of the above criteria was conformed the diagnosis. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Selection Of Patients & Grouping 72 patients

Group A (33)

Group B (39)

Sub-group A1

Sub-group A2

Sub-group B1

Sub-group B2

(14)

(19)

(15)

(24)

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Plan Of Treatment Group A – Treated with Oral Medicine as Amavatari Rasa 250 mg. BD. Sanjeevani Vati 125 mg. BD. And some other herbal medicines

Group B - Treated Along with above Oral Medicine & Bahya Snehan with Mahavishagarbha Tail Nadi Sweda with Dasamool Kwatha. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Snehana Literally ‘Sneha’ means Oleate or to make smooth. It produces Snehana (Unctuousness), Vishyandana (Fluidity), Mrudutwa (Softness) and Kledana (Smoothness) in the body. Snehana is of two types (1). Bahya (External) (2). Abhyanatara (Internal) Bahya Snehana (abhyanaga) improves the circulation. This may helps in mobilizing the localised toxins in to the systemic pool. After that these autotoxins may be eliminated by different mechanisms. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Swedana The process which relieves stiffness, heaviness, coldness and which induces sweating is known as Swedana Karma. Effect of Swedana are as follows – • Improves digestive Power. • Limbs become soft. • Skin becomes smooth. • Increases interest towards food. • Channels will be cleared. • Restores the function of the joints. Due to Swedana (sudation), vitiated doshas can be brought back to the Kostha and can be eliminated by means of elimination therapies. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Assessment of clinical symptoms The patients were assessed with the following clinical symptoms before and after the treatment – 1. Pain 2. Swelling 3. Stiffness 4. Grip power 5. Walking time 6. Appetite 7. Fever

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

SCORE OF PAIN IN RHEUMATOID ARTHRITIS 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

SCORES OF SWELLING IN RA 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

SCORES OF MORNING STIFFNESS IN RHEUMATOID ARTHRITIS 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

SCORES OF GRIP POWER IN RHEUMATOID ARTHRITIS 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

NEGATIVE SCORES OF APPETITE IN RHEUMATOID ARTHRITIS 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

NEGATIVE SCORES OF WALKING TIME (Distance of 10 mts.) IN RHEUMATOID ARTHRITIS 300 250 200 Before Treatment After Treatment

150 100 50 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

SCORES OF FEVER IN RHEUMATOID ARTHRITIS 3 2.5 2 Before Treatment After Treatment

1.5 1 0.5 0

A1

A2

B1

B2

A1 & B1– Disease less than 3 Yrs. A2 & B2 – Disease more than 3 Yrs. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Between The Group Comparison (Unpaired ‘t’ Test) Criteria

Group A(N=33) Mean SD

Group-B (N=39) Mean SD

Value of t&p

Pain

0.4242 ± 0.5019

0.1795 ± 0.3888

t = 2.33

Swelling

0.4545 ± 0.6170

0.2051± 0.4091

Stiffness

0.4555 ± 0.5056

0.1538 ± 0.3655

Grip Power

0.5758 ± 0.5019

0.1282 ± 0.3387

t = 4.09 p<0.001 HS

Walking Time

81.30 ± 49.49

72.12 ± 40.79

t = 0.86 p>0.05

Appetite

0.5455 ± 0.5056

0.1538 ± 0.3655

t = 3.80 p<0.001 HS

Fever

0.5758 ± 0.5019

0.1282 ± 0.3387

t = 4.49 p<0.001 HS

p<0.05 S t = 2.05 p<0.05 S t = 3.80 p<0.001 HS

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Conclusion and Results Rheumatoid arthritis is an incurable disease and present study concluding the following – (1). In RA relief can be given with oral medicine. (2). When Snehan and Swedan is added, the relief rate is highly significant. (3). Addition of Snehan and Swedan have proved its place in the Ayurvedic managements. So one can say the Sansodhana treatment are essential for better management of Rheumatoid arthritis. Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795

Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795