Diseases of the joints are better known as rheumatic diseases. Osteoarthritis (OA), rheumatoid arthritis (RA) and gout are common varieties of arthritis encountered in clinical practice.
Rheumatism is a broad term reserved for injury or inflammation to the soft tissues. It may include fibrositis and non-articular rheumatism. Sciatica, cervical spondylosis, lumbo-sacral strain and lumbago (lumber spondylosis) are other significant diseases included in this segment.
Rheumatology in Ayurveda
The incidence of arthritis is known to exist since great antiquity. The first accurate account of arthritis occurs in Athravaveda, (composed about 1000 B.C.). Charaka, the great Ayurvcedic physician, described the cause, signs and symptoms, diagnosis and treatment of various forms of arthritis.
Rheumatoid arthritis (RA) is an autoimmune disease, referred to as Amavata in Ayurvedic system of medicine. Gout has been defined as Vatarakta.
In word sandhivata, sandhi means the joint and vata, the vata dosha. When the activities of the vata increase inside the sandhis or joints, it is known as the Sandhivata.
Vata is dry in nature, so it absorbs the fluidity, from any part of the body and it is also destructive or catabolic in nature, due to these two reasons vata cause destruction of the cartilage and reduction in the synovial fluid in the joint capsule.
Incidence of Osteoarthritis in India compared to worldwide
The incidence of clinically significant knee osteoarthritis above the age of 55 years is very high in India- 25 to 30% in women and 15-20% in men. Worldwide, osteoarthritis (OA) is estimated to be the fourth leading cause of disability. It is estimated that approximately 10% of the world’s population who are 60 years or older have symptomatic problems that can be attributed to osteoarthritis.
Osteoarthritis is a degenerative disorder of central and peripheral joints. The exact cause of osteoarthritis is not known. Osteoarthritis is more common in females, in post menopausal age. Decreased levels of calcium have strong linkage with osteoarthritis and can be reason for early onset of degeneration.
Sometimes osteoarthritis is found in joints that are used more than usual. Osteoarthritis is described as primary when no definite cause is present. In secondary osteoarthritis, definite history like fracture is seen.
Signs and symptoms of Osteoarthritis
Osteoarthritis has peculiarity as it first strikes the knee joint. Pain, loss of function and stiffness are the cardinal features of osteoarthritis. Pain is of aching character. In some cases, sudden, sharp incidence of pain is present. The pain of osteoarthritis is aggravated in cold and damp seasons.
Negligible amount of loss of function is seen in the initial stages of osteoarthritis. However, in advance marked loss of function is seen and walking becomes restricted. Nodes in hand joints (Heberden’s nodes) are sometimes seen in osteoarthritis. Cracking sound (described as crepitus) in the knee joint is a hallmark feature of osteoarthritis.
Allopathic Treatment & Side Effects
Painkillers, vitamin D and calcium preparations are the mainstay of allopathic treatment of osteoarthritis. In severe cases, intra-articular injections of corticosteroids are prescribed for symptomatic relief. Trimcocolone is the corticosteroid of choice. Glucosamine is helpful in the first stage of osteoarthritis. If the patient does not respond tot the medicines, knee replacement is recommended with little or moderate success.
Ayurvedic Treatment for Osteoarthritis
The management of a joint disease requires a rational approach. In obese patients, weight management is of prime importance. Ayurveda considers malfunctioning of the digestive system responsible for diseases like arthritis and rheumatism. Osteoarthritis (OA) is known as Sandhigata vata in Ayurveda.
Guggul is the mainstay of treatment of arthritis in Ayurvedic system of medicine. Simhnada-guggul or Yograj guggul, two tablets thrice a day, is highly beneficial in the early stages of osteoarthritis. Once the pain is reduced, the dose should be decreased to three tablets, once a day.
For reducing stiffness, Vatakulantaka rasa, one tablet, twice a day, is added as adjuvant to Simhanada-guggul.
Adraka or Ginger is useful for reducing pain and inflammation. It has good anti-inflammatory activity. 5 gm, dried powder, is recommended for the treatment of osteoarthritis, thrice a day.
For normal functioning of the bowel Triphala powder is good as it acts as a gentle laxative.
Panchakarma therapy procedures like simple massage, potali massage, are also helpful in relieving problems like pain and stiffness, and in improving flexibility and preventing loss of function.
Ayurveda Clinical Studies
Guggul: A study involving a total of 30 patients with osteoarthritis of the knee found significant reductions in swelling and pain over the course of 2 months with Commiphora mukul.
The drug was administered in capsule form (500 mg concentrated exact delivered thrice-a-day) along with food. Based on the evidence it was concluded that there were no side effects reported during the trial.
In an experimental study, C. mukul was reported to be useful in the treatment of osteoarthritis. From the positive outcome of the previous study, the quasi-experimental model was used for investigating the further utility of C. mukul in osteoarthritis.
C. mukul was administered to thirty male and female participants in capsule form (500 mg concentrated exact delivered TID) along with food. At the end of treatment, there was a significant difference in the scores of the primary and secondary outcome measures
Nirgundi taila: A clinical study by Das evaluated the efficacy of nirgundi taila in the management of osteoarthritis. The researchers found that nirgundi taila was much more effective than the control drug (diclofenac sodium), though maximum improvement was reached after a longer time of treatment.
Osteoarthritis vs Rheumatoid arthritis
In Ayurveda, there is very detailed description about rheumatoid arthritis or “Aama vata”. According to ayurvedic fundamental rules, amvata is caused by ama, a toxin that is produced by imbalance in the functioning of the biological fire). Ama is carried by imbalanced the biological air, vata and thereby targets the biological water, kapha-dominated joints.
Painkillers can be used for relieving pain and stiffness associated with osteoarthritis. It might be a temporary phenomenon as painkillers have unpleasant side-effects. An authentic Ayurvedic treatment under expert supervision for at least 2-3 months gives good amount of relief.
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