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CASE REPORT
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 186-190  

Ayurvedic management of rheumatoid arthritis: A case study


1 Department of Rasa Shastra and Bhaishajya Kalpana, Ayurveda College and Hospital, R K University, Rajkot, Gujarat, India
2 Department of Kaumarabhritya, G. J. Patel Ayurvedic Collage, Anand, Gujarat, India
3 Department of Rasa Shastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India

Date of Web Publication18-May-2018

Correspondence Address:
Sonam S Bhinde
Madhuram, 38/B, Shreyas Society (West), Rajkot, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_83_17

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  Abstract 


Rheumatoid arthritis (RA), an auto-immune inflammatory disease is one of the challenging conditions for the physicians to handle due to its chronicity, incurability, complications, morbidity, etc. In spite of potent anti-inflammatory agents and powerful immune-suppressive agents, its prognosis is not good, as these drugs have certain limitations including dependency and other side effects restricting quality of life. Considering these inconveniences, alternatives are being searched from traditional systems. Ayurveda through its armamentarium can provide leads in the management of this condition that is similar to Amavata in its clinical presentation. Amavatari rasa is one of the familiar medicaments used throughout India by Ayurvedic physicians for Amavata. In the current study, a clinical experience with Amavatari rasa is placed. A 32-year-old female with diagnosed history of RA was treated by Amavatari rasa. She received 250 mg of Amavatari rasa thrice a day with lukewarm water for 8 weeks and at the end of the treatment, 35% improvement was observed in the overall effect of therapy.

Keywords: Amavata, Amavatari rasa, Ayurveda, rheumatoid arthritis


How to cite this article:
Bhinde SS, Bhinde SM, Galib R, Prajapati PK. Ayurvedic management of rheumatoid arthritis: A case study. Med J DY Patil Vidyapeeth 2018;11:186-90

How to cite this URL:
Bhinde SS, Bhinde SM, Galib R, Prajapati PK. Ayurvedic management of rheumatoid arthritis: A case study. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Jul 17];11:186-90. Available from: http://www.mjdrdypv.org/text.asp?2018/11/2/186/232651




  Introduction Top


Rheumatoid arthritis (RA), an auto-immune inflammatory disease is one of the challenging conditions for the physicians to handle due to its chronicity, incurability, complications, morbidity, etc.[1] It has worldwide distribution and involves all ethnic groups. Depending on the specific definition, the prevalence of RA is estimated to be between 0.3% and 1.5% in North America and its prevalence in India has been estimated to be similar to that in the West. It causes a great deal of pain and suffering and patients with this disease are unable to work within 5 years of its onset and patients with severe forms of the disease die 10–15 years earlier than expected. Thus, RA represents a significant societal problem justifying large efforts to improve its treatment.

While allopathic treatment of RA is improving, remission remains rare, and treatment remains unsatisfactory. In spite of potent anti-inflammatory agents and powerful immunosuppressive agents, its prognosis is not good, as these drugs have certain limitations including dependency and other side effects restricting the quality of life. Considering these inconveniences, alternatives are being searched from traditional systems. Ayurveda through its armamentarium can provide leads in the management of this condition that is similar to Amavata in its clinical presentation.[2] Drugs such as Simhanada guggulu,[3]Rasnasaptaka kwatha, Vata gajankusha rasa, Bruhat vata chintamani, and Amavatari rasa are said to be efficacious in this condition. In this case study, efficacy of Amavatari rasa [Table 1] in a diagnosed case of RA is presented.
Table 1: Formulation composition of Amavatari rasa

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  Case Report Top


A 32-year-old graduate homemaker of 55 kg bodyweight, of Vata pittaja prakriti, residing of rural area of Jamnagar, Gujarat visited out-patient department (OPD) of Rasa Shastra and Bhaishajya Kalpana, IPGT and RA, Gujarat Ayurved University, Jamnagar during June to August 2015 complaining multiple joint pains associated with Angamarda (body-ache), Aruchi (anorexia), Thrishna (thirst), Alasya (tiredness), and Gaurava (heaviness in body) with a chronicity of 1 year. She also revealed episodic attacks of fever in the past 6 months at an interval of 15 days lasting for 1–2 days. Gradual onset of bilateral pain and stiffness was reported by the patient starting from second and third metacarpophalangeal joints, distal interphalangeal joints, proximal interphalangeal joints, middle inter-phalangeal joints, wrist, elbow, and ankle to knee joints. The symptoms were exacerbating during rainy and winter seasons. No history of addiction or previous medical history was noticed. No positive family history was present.

For these symptoms, she was under the supervision of an allopathic physician and was prescribed with anti-inflammatory and analgesic drugs like Voltaren-XR (diclofenac sodium 50 mg), but no relief was symptomatic and self-limiting. The pain started aggravating and spreading to other joints. On visit to the OPD, she was on Voltaren-XR once a day.

On examination, moderate swelling over both wrist joints and metacarpo interphalangeal joints were noticed that was present in this case for the past 3 weeks, tenderness over both the wrist joints and knee joints for 1 month and morning stiffness for an hour for the past 9 months. Sleep was disturbed as the pain was intolerable.

Digestive capacity of the patient was very poor, constant feeling of heaviness in the abdomen was reported by her indicating Vishama jarana shakti (impaired functions of digestive juices). Her diet was dominant in Madhura amla rasa (predominant with sweet and sour) with sedentary lifestyle and had a habit of Diva swapna (sleeping during day time) 2–3 h/day.

Vital data including pulse (86/min), respiration (20/min), and temperature (98F) were normal with clear respiratory and cardiac observations. No signs of the urinary tract or oropharyngeal lesions were found. The abdomen was clear with no signs of tenderness or organomegaly.

Routine hematological (total leukocyte count, differential leucocyte count, Hb, erythrocyte sedimentation rate (ESR), total red blood cell), C-reactive protein (CRP), and RA factor were done. Biochemical investigations such as fasting blood sugar, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatease. were also carried out to exclude other underlying pathology. Grip power and foot pressure were assessed to explore the condition of the patient.

Changes in Sandhi shola (joint pain), Sandhi shotha (edema), Sandhi graha (morning stiffness), Sparshasahatva (tenderness), Angamarda (body-ache), Aruchi (anorexia), Thrishna (thirst), Alasya (tiredness), and Gaurava (heaviness in body), Jwara (fever), and Apaka (decreased digestion) were observed before and after therapy.[4] In addition, foot pressure, grip strength, and disability index were also observed before and after treatment [Table 2], [Table 3], [Table 4].[5],[6]
Table 2: Scoring pattern: Adopted for gradation of symptoms and overall effect of therapy

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Table 3: Grip power

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Table 4: Foot pressure

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Treatment

Amavatari rasa in the dose of 250 mg thrice a day with Anupana (adjuvant) of lukewarm water was administered for 8 weeks.


  Discussion Top


This disease is caused by impairment of Vata and can be traced to the improper functioning of the gastrointestinal system resulting in diminished gastric acid secretion (Mandagni), impaired liver functioning and intestinal absorption. Inappropriate food habits and physical activities such as those observed in the patient such as irregular diet habits, over indulgence in sweets and sour articles, day sleep, and sedentary lifestyles, weaken the digestion and metabolism leading to the formation of Ama (improperly processed intermediate metabolic products). In further course, this Ama spread throughout the body, causing degenerative changes in the system, affecting other tissues including cartilages, muscles, and further impairing metabolism. At different places, this Ama associate with vitiated Vata dosha and manifest characteristic symptoms of Amavata.

Significant relief in Sandhi shula, Sandhi shotha, Angamarda, Aruchi, and Gaurava were observed at the end of the treatment [Chart 1].



Shothaghna (anti-inflammatory) property of Guggulu might be responsible for reduced Sandhishotha.[7]Dipana and Pachana properties of Chitraka and Dipana property of Triphala, Guggulu, and Eranda taila may be helpful in correcting deranged digestive functions that further helps in eliminating circulating Ama from systemic levels accumulated in Sandhi, thus causing reduction in Shotha.[8],[9],[10],[11]

Relief in Sandhi shula, may be due to the Vata shamaka (pacifying vata) and Vedanahara (analgesic) properties of Amavatari rasa. Snigdha guna and Vata shamaka nature of Eranda taila might have played a major role in pacifying aggravated Vata resulting in reducing Sandhi shula. As Shotha and Shula are reduced, Sandhi graha and tenderness were came down. Alasya, Apaka, and Jwara did not shown significant results, it could be due to a short period of treatment.

Kajjali has Sukshma and Sroto shodhaka properties, which helps in normalizing Agni and helps in inhibiting formation Ama. Dipana, Pachana, and Kapha vata hara properties of other ingredients of the formulation such as Gandhaka,[12]Chitraka, and Eranda also helps in normalizing Agni.

Primary pathology in RA is inflammation of synovial membrane. This membrane secretes synovial fluid, which nourishes the cartilage covering the bone at movable joints. When this membrane thickens, synovial fluid accumulation takes place, results in pressure and pain.[13] Thus, decreasing grip power and foot pressure. Analgesic [14] and anti-inflammatory [15] properties of ingredients like Guggulu, helps in decreasing inflammation and thus helping in reducing pressure and pain and ultimately improving grip power and foot pressure. Disability was also reduced from 0.500 to 0.167, which ultimately helped in improving the quality of life [Chart 2].



At the end of 8 weeks, RA factor was decreased from 24 to 15 and CRP from 5.80 to 3.0. There is linear relation between CRP and swelling. Reduction in CRP indicates a reduction in swelling, further indicating reduced pain and inflammation. ESR was also decreased from 52 to 40. All these reductions might be due to Srotoshodhaka properties of Kajjali, so that drug may be reaching to the cellular levels and correcting the dhatvagni. Serum creatinine, SGPT, SGOT, and Hb did not show any significant changes indicating normal physiological functioning of hepatic and renal functioning, further demonstrating the safety of mercurial preparations [Chart 3].



Ayurvedic treatment is aimed at restoring the Doshas to harmonious equilibrium, thereby strengthening individual's healing response. Treatment for a particular disease includes wide range of medicines and therapies based on different aspects. In the current attempt, only Amavatari rasa was administered to the patient without following the needful phases like Dipana, Pachana (specific preliminary treatment procedures), etc., If, one follows these steps, possibilities of better improvement is anticipated. RA with its limited management in modern medicine can be managed effectively with Ayurvedic medicine and Pathyapathya (dietetic regulations). In the current case, no specific dietary restrictions nor lifestyle modifications were advised to the patient. The result obtained was solely of Amavatari rasa. Before starting the treatment, the patient was taking 50 mg of Diclofenac sodium once daily, but by the end of 8 weeks treatment, the need of the analgesic was reduced to twice in a week. This reduction in need of nonsteroidal anti-inflammatory drug is also an important outcome of the therapy restricting the complications and improving the quality of life of the individual.


  Conclusion Top


Based on the preliminary observations, it can be concluded that Amavatari rasa is effective in the management of Amavata. As encouraging results were observed during 8 weeks of study, increased duration of the treatment may be planned to give more significant results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison's Principles of Internal Medicine. 17th ed., New York, Vol. II. McGraw Hill Education, 2008. p. 2083.  Back to cited text no. 1
    
2.
Upadhyaya Y, editor. Madhavakara, Madhava Nidana, Madhukosha Commentary by Vijayrakshita. Part I. 29th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 1999. p. 460.  Back to cited text no. 2
    
3.
Pandey SA, Joshi NP, Pandya DM. Clinical efficacy of Shiva Guggulu and Simhanada Guggulu in Amavata (Rheumatoid Arthritis). Ayu 2012;33:247-54.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Baghel MS. Developing Guidelines for Clinical Research Methodology in Ayurveda (Project Report submitted to WHO Country Office - India), IPGT & RA, Jamnagar, 2011.  Back to cited text no. 4
    
5.
Available from: https://www.rheumatology.oxfordjournals.org/ content/41/12/1457.full. [Last accessed on 2017 Jun 22; at 16.39].  Back to cited text no. 5
    
6.
Gautham P, Thomas T, Shrilatha KT, Acharya GS. A clinical trial on the therapeutic effect of Amritamanjari rasa in Amavata W.S.R to rhumatoid arthritis. Int Ayurvedic Med J 2016;4:3086-93.  Back to cited text no. 6
    
7.
Raut OP, Acharya R, Mishra SK. Oleogum resin guggulu: A review of the medicinal evidence for its therapeutic properties. IJRAP 2010;3:15-21.  Back to cited text no. 7
    
8.
Prakasha B. Bhavaprakasha Nighantu, Haritakyadi Varga/43. 11th ed. Varanasi: Chaukhambha Sanskrit Bhavan; 2013. p. 12.  Back to cited text no. 8
    
9.
Prakasha B. Bhavaprakasha Nighantu, Haritakyadi Varga/43. 11th ed. Varanasi: Chaukhambha Sanskrit Bhavan; 2013. p. 21.  Back to cited text no. 9
    
10.
Prakasha B. Bhavaprakasha Nighantu, Haritakyadi Varga/43. 11th ed. Varanasi: Chaukhambha Sanskrit Bhavan; 2013. p. 204.  Back to cited text no. 10
    
11.
Prakasha B. Bhavaprakasha Nighantu, Haritakyadi Varga/43. 11th ed. Varanasi: Chaukhambha Sanskrit Bhavan; 2013. p. 616.  Back to cited text no. 11
    
12.
Prakasha B. Bhavaprakasha Nighantu, Haritakyadi Varga/43. 11th ed. Varanasi: Chaukhambha Sanskrit Bhavan; 2013. p. 299.  Back to cited text no. 12
    
13.
Tortora GJ, Derrickson BH. Principle of Anatomy and Physiology. 10th ed. New York: John Wiley and Sons, Inc.; 2014. p. 267.  Back to cited text no. 13
    
14.
Mittal V, Sharma SK, Kaushik D, Khatri M, Tomar K. A comparative study of analgesic activity of Plumbago zeylanica Linn. callus and root extracts in experimental mice. Res J Pharm Biol Chem Sci 2010;1:830-6.  Back to cited text no. 14
    
15.
Deng R. Therapeutic effects of guggul and its constituent guggulsterone: Cardiovascular benefits. Cardiovasc Drug Rev 2007;25:375-90.  Back to cited text no. 15
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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