Rheumatoid Arthritis- How Ayurveda Helps To Restore the Mobility?

Introduction

Rheumatoid Arthritis (RA) is a chronic inflammatory disease of the joints and its surrounding tissues.  A form of arthritis, RA causes pain, swelling, stiffness, and loss of function in joints on both sides of the body. Though it affects all joints of the body, it most commonly affects the joints of the wrists, fingers, and knees.

Rheumatoid arthritis can affect anyone at any age, but it usually develops between the ages of 40 and 60, and about 75% of those affected are women.

Causes of RA

Rheumatoid arthritis is an autoimmune disease caused by the abnormal response of the body’s immune system, wherein the body’s immune system attacks its healthy cells, causing inflammation in the joint linings. Though the specific causes of RA are unknown, certain factors play a role in increasing the risk of developing the disease. These include

Age-related – RA can occur at any age, but the highest incidence is seen in the 60s

Gender-related – the incidence of RA is 3 times higher in women than men

Genetics/inherited traits-genes, called HLA (human leukocyte antigen) DR4 genotypes. This increases the chances of developing RA

Smoking – cigarette smoking and inhalation increases a person’s risk of developing RA and can make the disease worse

Childbirth  – women who have never given birth may be at greater risk of developing RA

Obesity- the more overweight a person is, the higher the risk of developing RA

Signs and symptoms

Symptoms of RA can vary from person to person and also change from day-to-day.  Sometimes in RA, the symptoms get worse. These are known as flares. When the symptoms are less noticeable, it is known as remissions.

The following are some of signs and symptoms of RA

  • Pain or aching in more than one joint
  • Stiffness in more than one joint
  • Tenderness and swelling in more than one joint
  • Similar symptoms on both sides of the body (such as in both hands or knees)
  • Weight loss
  • Fever
  • Fatigue or tiredness
  • Weakness

Pathophysiology

Since RA is an autoimmune disease, the body’s immune system attacks the normal tissues or organs of the body, mistakenly thinking that they are harmful thus leading to inflammation and damage. The above-listed risk factors send a message to the body to create antibodies known as auto antibodies, which seek out joint linings. These auto antibodies include rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP). This results in the production and release of chemicals which include Tumor Necrosis Factor-Alpha (TNF-α), Interleukin (IL)-1, IL-6, IL-8, Transforming Growth Factor-Beta (TGF-β), Fibroblast Growth Factor (FGF) and Platelet-Derived Growth Factor (PDGF). These chemicals inflame and damage the body’s cartilage, bone, tendons, and ligaments, resulting in the symptoms seen in RA.

Diagnosis

Mainly diagnosed by reviewing symptoms and conducting a physical examination

  • By performing the Antinuclear Antibody (ANA) test to find out the auto-immune nature of the disease
  • By performing the C Reactive Protein (CRP) test
  • By performing Cyclic Citrullinated Peptide (CCP) antibodies  test which detects and measures anti-CCP antibodies in the blood
  • By performing the Erythrocyte Sedimentation Rate (ESR) test which helps to indicate inflammation in the body
  • By performing the Rheumatoid Factor (RF) test which measures the amount of rheumatoid factor (RF) in our blood. RF is a protein produced by our immune system that attacks the healthy joints, glands and other normal cells by mistake
  • By performing a Synovial Fluid Analysis to diagnose the cause of joint inflammation, pain, and/or swelling

Treatments

  • Use of disease-modifying anti-rheumatic drugs (DMARDs) – these medications slow down disease progression and prevent joint deformity.
  • Use of biological response modifiers (biological). These are medications that are effective second-line treatment.
  • Use of joint injection aspiration – these injections deliver steroids directly into the joints of the knee, ankle, or wrist. Steroid joint injections can help to reduce pain and swelling by treating the underlying joint inflammation.
  • By performing joint replacement surgery – joint replacement surgery removes damaged or diseased parts of a joint and replaces them with new, man-made parts that can reduce pain and help in functional mobility. Hips and knees are the ones that are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows.

Prognosis of RA

In RA, early diagnosis and prompt treatment and management can help stop its progression whereas delayed treatment is known to worsen the disease. According to a study conducted approximately 40% of the patients become disabled after 10 years without early intervention. Some patients experience this as a self-limiting disease whereas, for many others, it is a chronic progressive illness.

Complications of RA

  • People with RA are at high risk for developing diabetes and chronic heart disease.
  • Obese patients with RA are at high risk for developing hypertension and dyslipidemia.
  • Individuals with RA are at greater risk for serious infection, respiratory disease, osteoporosis, cancer, and mortality than the general population.
  • Since the functional mobility of most RA patients is limited, it can impair their chances of employment.

Rheumatoid Arthritis and Ayurveda

When one searches Ayurveda texts for a disease affecting the joints in the human body similar to Rheumatoid Arthritis as described in modern medicine, it would be possible to find more than one disease and that too in its various stages/conditions that are similar to Rheumatoid Arthritis. Mainly the various conditions of Vatharaktham and Amavatham diseases as per Ayurveda are comparable to the various conditions of Rheumatoid Arthritis.

As the disease affects the patient for a long duration, it passes through various stages/ conditions. The treatment is decided based on the existing condition/stage of the patient.

Reasons for the Disease

  • Excessive fatty food
  • Intake of incompatible food combination
  • Food items that toxin the blood
  • Unnatural sleep patterns and sexual activity
  • Not doing exercises.
  • Not interested in doing difficult tasks (laziness)
  • Stroke, etc.

Purvaroopam / Premonitory Symptoms

  • Tiredness
  • The weakening of the body parts
  • Itching, trembling, piercing pain, numbness, etc. in knee, ankle, thigh, waist, shoulder, hand, and other joints of the body
  • Recurrence of the symptoms listed above
  • The body is super smooth or rough.
  • Body sweating excessively or not sweating at all
  • Change in colour, itching, numbness, etc. in the body

Symptoms

  • The disease could first appear in the centre of the feet or sometimes of the hand
  • This will spread fast to the other joints of the body

Depending on the stage of the disease, the condition could be divided into two – Uthanam and Ghambheeram.

Uthana Vathashonitham

  • This is the starting stage of the disease
  • Symptoms like itching of the skin, rash, burning, etc. are observed

Ghambheera Vathashonitham

  • Intense pain
  • Inflammation of the joints
  • Feeling of intense pain as if the joints, bones, and marrow are being split apart
  • Deformation of the joints of the body. This becomes more severe as time passes and the patients are not able to walk or do other normal functions with the hand which they were easily doing earlier.

Vatharaktham itself can be divided into 6 types based on the differences of the Dosha. These are:

  • Vathapradhana Vatharaktham
  • Pithapradhana Vatharaktham
  • Dwidoshajha Vatharaktham
  • Rakthajha Vatharaktham
  • Thridoshajha Vatharaktham

Samprapthi (maturation)

The blood gets infected due to the above-mentioned reasons which deform the blood vessels and nerves which in turn infects the Vatha. The blood that is already in an infected condition blocks the respiratory tracts and negatively affects its functioning. This infected air in turn makes the infected condition of the blood even worse and creates many blood-related conditions in the body. These then become conditions that adversely affect the joints.

Prognosis

  • Vatharaktham condition that has not been there for a long time and that has affected only one Dosha can be easily treated and cured
  • However, Vatharaktham that has been caused due to the combination of two Dosha is comparatively more difficult to treat and cure
  • Vatharaktham that has been caused by the infection of the combination of all three Dosha in equal measure cannot be treated and cured completely.

Treatment

The treatment is decided based on the condition/stage of the disease in the patient. Whether it is in the initial stages or the more serious stages of the disease, it should be ascertained if there are any effects of Aama (toxic metabolic waste material formed due to improper digestion for many variable reasons), and if found, Pachana treatment for the digestion of Aama (AamaPachana) should be started. Deepana Pachanadi Langana treatment can be performed if Aama symptoms like swelling of the joints, indigestion, etc. are observed.

Deepana Aushadhangal (Medicines)

Aama Pachana Vati

Shunti Choornam

Trikatu Choornam

Shaddharanam Choornam

Rasnasapthakam Kashayam

Rasnapanchakam Kashayam

Gandharvahasthadi Kashayam

Chiruvilwadi Kashayam

Bahyakriyakal (external treatment procedures)

Bahyakriya (external treatment procedures) can also be performed along with the consumption of internal medicines depending on the severity of the Aama. Commonly performed Bahyakriya are listed below:

  • Kriya of Rukshanaswabhavam should be performed
  • Choornapindaswedam
  • Dhaanyamladhara
  • Kadikizhi
  • Rukshavasthi can be performed if the severity of Aama is extremely high
  • Aama depressants like Shaddharanam Choornam/Vaishwanara Choornam, Amruthothara Kashayam, Inthuppu (rock salt), etc. could be used in Rukshavasthi

Pachanachikithsa

Pachana medicines should be given after Deepanam. Most of the Deepanam medicines have Pachanam properties also. Hence these two procedures could be performed almost simultaneously.

Aama condition will be eliminated by doing these treatment procedures. After this, Shodhanachikithsa  is performed depending on the severity of the disease and the physical strength condition of the patient.

Vataraktahara Chikithsa

Arrangements for Shodhanachikithsa can be slowly commenced once Niramavastha( Absence of toxins) is persisting in the body.

Snehapanam

Snehapanam can be performed with suitable Ghrutham as below:

Ghee

  • Gulguluthikthakam Ghrutham
  • Dhanwantharam Ghrutham
  • Shadpala Ghrutham
  • Rasnadi Ghrutham

Swedanam

Swedanam should be performed after Snehapanam and before Shodhanakriya. Swedanam can be performed by inhaling steam or, in case the pain is more, by performing Dashamoolaksheeradhara.

Virechanam (Purgation)

Avanakkenna (15ml to 25ml early in the morning on the days of Virechanam)

Trivruth Choornam and milk can be given as Anupanam

Hareethakee Kashayam to which ghee is added can be given

Snigdhaswedam

Various Snigdhaswedam can be performed after Virechanam depending on the condition of the disease, especially Patrapodalaswedam, etc. Kizhi procedure can be performed by making Kizhi out of Vatahara leaves and dipping it in Vataraktashamana Thailam like Pinda Thailam, Ksheerabala Thailam, etc.

Ksheeravasthi

Ksheeravasthi is the special treatment described in Vatarakta. This is performed by injecting medicines mixed with milk through the rectum. This procedure is Vatashamana as also Brahanam and strength (Bhalam) enhancing. Ksheeravasthi should specifically be performed if the Vatarakta is existing for a long period.

Rasayanam

The last stage of the treatment is performing Rasayana that will result in the body regaining its strength. The following can be used:

Pippali (long pepper) Vardhamanaprayogam (3g each of Pippali to be increased in dosage each day for ten days and then reduced by 3g each for the next nine days)

Milk/milk gruel (Kanji) should be consumed during these days

A Virechanam in a controlled manner with Avipathi Choornam should be performed after this.

Chyavanaprasham (the strength of the Rasayanam will increase tenfold if Rasaushadha like Rasasindhooram is added)

Things to be careful about in diet

Avoid food that is excessively spicy and sour/bitter (Puli)

Consume lots of whole grains, fruits, vegetables, etc.

Avoid non-vegetarian food

Consume milk

Yoga

It is particularly important to maintain good mental health in this disease condition as this condition is related to disease resistance power. Because of this, it would be helpful if performing Pranayama, Dhyanam, and Asanamare are made into regular habits.

Pranayama

The following can be performed:

  • Nadishudhi Pranayama
  • Ujjayi
  • Bhramari
  • Bhasthrika

Asanam

Performing Asana is important in the treatment of this disease as this is a disease that affects the joints. Asana should be performed daily when the severity of the disease has subsided. This reduces the distortions of the joints and enables smooth movement. The following Asana can be performed:

  • Sukshma vyayamam
  • Thadasanam
  • Padahasthasanam
  • Vajrasanam
  • Gomukhasanam
  • Ardhamatsyendrasanam

All types of Asana can be performed if the body allows it. But performing some Asana would be difficult if the disease has become very severe and the legs and hands have changed its original shape. In these conditions, it would do good to perform Sukshma vyayamam daily.

By following the ayurvedic concept of lifestyle and treatment methods, RA can be managed well and the quality of life enhanced to a great degree.

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