Rheumatoid arthritis is an inflammatory type of arthritis that can causes joint pain, swelling and damage. It can affect people of any age, gender or race but women are more prone in some countries. RA has an auto immune nature which is caused by genetic or environmental or both factors. It shows period of normalcy followed by a flare up, the cycle being repeated. Cold climate and sedentary lifestyle are the most important triggers observed in daily life. Considering the auto-immune nature, it is not easy to cure the disease. Proper diagnosis and symptomatic management can reduce the suffering of the affected person.
Signs and symptoms
- Joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
- Morning stiffness that lasts for 30 minutes or longer.
- More than one joint is affected.
- Small joints (wrists, certain joints in the hands and feet) are typically affected first.
- The same joints on both sides of the body are affected.
Causes
With an autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack, in the case of RA, the synovium. That’s the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender, look red and swollen and moving the joint may be difficult.
Pathophysiology
The synovitis, swelling, and joint damage that characterize active RA are the end results of complex autoimmune and inflammatory processes that involve components of both the innate and adaptive immune systems. In a susceptible individual, the interaction of environment and genes results in a loss of tolerance of self-proteins that contain a citrulline residue. These proteins are generated via post translational modification of arginine residues to citrulline residues by the enzyme peptidylarginine deiminase. Patients with shared epitopes generate citrullinated peptides that are no longer recognized as “self” by the immune system, which consequently develops ACPAs against them.16 Comparison of magnetic resonance imaging (MRI) and synovial biopsy data from healthy individuals with MRI and biopsy data from patients positive for RF and/or ACPA demonstrate that systemic autoantibody production precedes inflammation and adhesion molecule formation in the synovium, indicating that perhaps some secondary event is required to initiate involvement of the synovium in RA.
Diagnosis
History and Clinical examination
Blood tests:
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
Rheumatoid factor (RF)
Imaging techniques:
X-ray
Ultrasound
MRI
Treatments
RA has no cure but there are treatments that can help manage the symptoms.
Rheumatoid arthritis (RA) treatment includes managing the symptoms and slow the progression of the condition.
Recently, advances in treatment strategies have resulted in ever-improving outcomes and quality of life for those with rheumatoid arthritis. The treat-to-target approach has resulted in fewer symptoms and higher remission rates for those with RA. The treatment strategy involves:
setting a specific testing goal that signals either remission or low disease state
testing acute phase reactants and performing monthly monitoring to assess progress of treatment and management plan
switching medication regimen promptly if progress isn’t made.
Treatments for RA help to manage the pain and control the inflammatory response which can in many cases result in remission. Decreasing the inflammation can also help to prevent further joint and organ damage.
Treatments may include:
medications
dietary changes
therapies
exercises
Rheumatoid Arthritis Medications
There are many types of medications for RA. Some of these medications help to reduce the pain and inflammation of RA. Some help to reduce flares and limit the damage that RA does to the joints.
The following over-the-counter medications help reduce the pain and inflammation during RA flares:
NSAID s (Non-steroidal anti-inflammatory drugs)
corticosteroids
acetaminophen
Disease modifying antirheumatic drugs (DMARDs) work by blocking your body’s immune system response. This helps to slow down the progression of RA.
Biologics – These new generation biologic DMARDs provide a targeted response to inflammation rather than blocking the body’s entire immune system response. They may be an effective treatment for people who don’t respond to more traditional DMARDs.
Janus kinase (JAK) inhibitors -These are a new subcategory of DMARDs that block certain immune responses. These help prevent inflammation and stop damage to the joints when DMARDs and biologic DMARDs don’t work.
Prognosis
It is a long-term condition with a bad prognosis. Only symptomatic treatments are available. A permanent cure is rare.
Complications
If not treated properly, RA affects almost all the systems in body and cause complications.
Eyes – Dryness, pain, inflammation, redness, sensitivity to light and trouble seeing properly.
Mouth – Dryness and gum inflammation, irritation or infection.
Skin – Rheumatoid nodules – small lumps under the skin over bony areas.
Lungs – Inflammation and scarring that can lead to shortness of breath and lung disease.
Blood vessels – Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs.
Blood – A lower than normal number of red blood cells.
Heart – Inflammation can damage the heart muscle and the surrounding areas.
Disease & Ayurveda
Vaatarakta
Nidana
Food which is Vidaahi, viruddham & asrkpradooshanam(causing indigestion&acidity, opposite in potency, causing vitiation of Rakta)
Unhealthy habits of sleep & waking up, sex
Intolerant personality
Sedentary lifestyle
Injury
Absence of Sodhanakriya(panchakarma)
Causative factors for the vitiation of rakta along with usage of Vaata-vitiating and cold diet & regimen
Purvaaroopa
Similar to Kushtha (severe skin disease affecting deeper dhatus)
Samprapti
Due to its causative factors, Rakta gets vitiated in the body. This person when uses Vaata-vitiating and cold diet & regimen Vaata also gets vitiated & travels through abnormal path in the body. When this Vaata gets obstructed by the aggravated Rakta, Vaata vitiates that rakta also and produces the disease called Vaatarakta.
Lakshana
Saada – fatigue
Slathangatha – feeling of loose joints & body
Kandu(itching), Sphurana(throbbing), nisthoda(pricking pain), bheda(piercing pain), gaurava(heaviness), suptata(numbness) of joints especially jaanu(knee), jangha(calf), ooru(thigh), kati(sacrum), amsa(shoulder), hasta(arms), paada(legs) and angasandhishu(in joints of the body)
Divisions
Uttaanam
Gambheeram
Prognosis
Yaapyam
Chikithsa
Ayurvedic treatment for Vaatarakta starts with balancing the vitiated Rakta by doing raktamoksha (blood letting) which is done after using Sneha therapy prior to it. Raktamoksha should be done intermittently, considering the strength of the patient & balancing Vaatadosha.
Samana
Lepanam & parishekam with soolahara & raktaprasadana dravyas
Swedanam
Upanaham
Aamapachanam
Agnideepanam
Puraanaghrutam in Vaata dominant Vaatarakta
Sodhana
Raktamoksha
Virechanam
Vasti -especially ksheeravasti
Commonly used medicines
Rasnerandadi kashayam
Maharasnadi kashayam
Kaishoraguggulu
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Certain home remedies and lifestyle modifications will help to improve the quality of life while living with RA. This includes exercise, rest, and assistive devices.
Exercise – Low impact exercises can help to improve the range of motion in the joints and increase their mobility. Exercise can also strengthen muscles, which can help to relieve some of the pressure from joints.
Get enough rest and sleep
Apply heat or cold accordingly
Ice packs or cold compresses can help to reduce inflammation and pain. They may also be effective against muscle spasms.
Try assistive devices such as splints and braces can hold the joints in a resting position. This may help to reduce inflammation.
Canes and crutches can be helpful to maintain mobility, even during flares.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, fresh vegetables, fruits and leaves.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Lack of body movements is one of the main cause of Vaatarakta
Yoga
Yoga and other exercises are not advised during a psinful flare up with severe inflammation. Regular stretching and mild cardio exercises are advised in the normal period. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Sookshma vyayama for whole body
Yoga for joint pain and arthritis
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
PMID: 28378441
The effect of a pedometer-based intervention on increasing physical activity and decreasing fatigue among individuals with RA was tested. Participants completed baseline questionnaires; had 1 week of activity monitoring; were randomized to control (education [EDUC]), pedometer and step-monitoring diary (PED), or pedometer and diary plus step targets (PED+) groups, and were followed for 21 weeks for the study. A total of 96 individuals participated. Eight did not complete the 21-week assessments. Both intervention groups significantly increased, and the EDUC group decreased steps. Between-group changes in fatigue were not significantly different. Mean changes in fatigue scores from baseline to week 21 were -1.6. Function and self-reported disease activity also improved in the PED and PED+ groups. It was concluded that provision of pedometers, with and without providing step targets, was successful in increasing activity levels and decreasing fatigue in this sample of individuals with RA.
PMID: 31625439
The aim was to study if cumulative glucocorticoid use could be related to cognitive impairment in rheumatoid arthritis (RA) patients. A sample of 60 RA patients and 64 controls were studied for the Mini Mental State Examination (MMSE) and depression scale (using CES-D or Center for Epidemiological Studies Depression scale). RA patients also filled a visual analogic scale (VAS) of pain and had disease activity evaluated by DAS-28 ESR (disease activity score using erythrocyte sedimentation rate). Clinical and treatment data, including cumulative dose of glucocorticoid, were collected from the charts. Patients with RA had more cognitive impairment and depression than controls. A weak and negative association of MMSE with VAS of pain was but not with depression and cumulative glucocorticoid doses. The study suggests that although RA patients have more cognitive impairment than controls, no correlation of this problem with cumulative glucocorticoid doses was found.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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