Rheumatoid Arthritis

If you say ‘arthritis’ most people assume you’re talking about wear and tear on the joints, which many older people have.  That’s osteoarthritis.  Rheumatoid arthritis, or RA, is different.

It is a type of disease known as an autoimmune condition. This means that your body’s immune system has made a mistake and picked a wrong target. To explain: your immune system is designed to defend your body against infection. It should not attack your body. Sometimes the immune system becomes too active, and mistakenly attacks your body, and this is called ‘autoimmune’ disease.When you have RA, your immune system attacks the lining of your joints (the synovial lining). 

RA is a symmetrical arthritis, meaning that it usually affects both sides of the body in a similar pattern, although this is not always the case. It tends to affect the small joints of the hands and feet first – often the knuckle joints in the fingers.  It is described as a polyarthritis, meaning that many joints can be inflamed.

RA is a systemic disease, meaning that it doesn’t just affect joints. RA can affect a person’s whole system, including organs such as the lungs, heart and eyes.

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Symptoms, Precautions & Treatments

कट्य़ां व्यथा भवेन्नित्यं सन्धिषु श्वयथुर्भवेत्। उत्थाने प्य समर्थत्वामामवातस्य लक्षणम्॥(रस रत्न स्समुच्चय २१/४६)

पित्तात्सदाहरागं च सशूलं पवनानुगम्। स्तिमितं गुरुकण्डूं च कफदुष्टं तमातिशेत॥(मा नि २५/११)

स कष्ट्ः सर्वरोगाणां यदा प्रकुपितो भवेत्। ह्स्तपादशिरोगुल्फत्रिकजानूरुसन्धिषु॥

करोति सरुजं शोथं यत्र दोषःप्रपध्यते। स देशो रुज्यते अत्यर्थं व्याविद्व इव वृश्चिकैः॥

जनयेत्सो अग्निदौर्बल्यं प्रसेकारुचिगौरवम्। उत्साहहानिं वैरस्यं दाहं च बहुमूत्रताम्॥

कुक्षौ कठिनतां शूलं तथा निद्रा विपर्ययम्। तृट्छर्दिभ्रममूर्च्छांश्च हृद्ग्रहं विड्विबद्धताम॥

जाड्यान्त्त्राकृजमानाहं कष्टांश्चान्यानृपद्रवान्।(मा नि २५/७-१०)

Vata pradhana symptoms :

  • Katyam vyatha – severe pain

Pitta pradhana symptoms :

  • Shvayatu – Inflammation of affected organ
  • Daha –Burning sensation
  • Trushna – Excessive thirst

Kapha pradhana Lakshanas :

  • Feeling of body being covered by wet cloth
  • Gauravata – Heaviness in the body
  • Kandu – Itching all over body

Others symptoms include :

  • Pain and inflammation of hands , legs , ankles, sacrum , knees and thighs .
  • Pain like scorpion sting
  • Agni mandhya – Poor appetitie
  • Lalasrava – excessive salivation
  • Aruchi – Tastelessness in mouth
  • Bahumutrata – polyurea
  • Hrudgraha – Stiffness in cardiac region
  • Vibandha – Constipation
  • Shareera jadyata – Stiffness all over the body .

We don’t yet know exactly what causes RA itself but some of the factors are:

Immunological factors: Presence of abnormal immunoglobin in the serum known as Rheumatoid factor, genetic influence, trauma, pshycological factors . Hormonal factors – Incidence of Rheumatoid arthritis is more common before menopause and remission of RA during pregnancy is well known , low economic status, infectious agents – Mycoplasma, various viruses EBV , CMV and Rubella Viruse.

The important signs and symptoms to be aware of are:

  • pain, swelling and possibly redness around your joints.  Hands and feet are often affected first, though RA can start in any joint
  • stiffness in your joints when you get up in the morning or after sitting for a while, which lasts for more than 30 minutes and has no other obvious cause
  • fatigue that’s more than just normal tiredness
  • “Z”deformities, Swan neck deformities, Boutonniere deformities are developed in later stages of disease.
  • Rheumatoid nodules
  • Muscle atrophy
  • Rheumatoid vasculities .
  • Lung fibrosis is a complication of rheumatoid arthritis.
  • People with RA are more prone to atherosclerosis , risk of Mycoradial Infraction , pericarditis , endocarditis,
  • Eyes can be directly affected in the form of episclerites or sclerites
  • Liver problem – A Co-Existing auto –immune liver disease , such as primary bilary cirrhosis /Autoimmune hepatitis .
  • Bones – Osteoporesis.

विरुद्धाहार चेष्टस्य मन्दाग्निर्निश्चलस्य च।

स्निग्धं भुक्तवतां ह्यनं व्यायामकुर्वतस्तथा॥(मा नि२५/१)

Viruddha Ahara- Incompatible foods.

Mandagni – Loss of appetite, viruddha Chesta – incompatible habits, snigdham buktavatam – Intake of snigdha ahara (unctous food), sheetala ahara – Which are cold in nature, Atyanta guru ahara –Food which is haevy to digest, Alasya (sedentary life), Vyayama (Excessive exercise ), Apatarpana (fasting in exercise), Prapatana (Fall , injury, Bhagna – Fractures, Kshaya – Depletion of tissues , Jaagarat – Awakening at night , Veganam cha vidharaneeyat – suppression of natural urges, Shaityadi- Excessive consumption of cold foods & activites , Ruksh ahara – Consumption of dry foods , Trasaat – Fear , Kshobha – Irritation , Kashaya , katu , tikta atisevana – Excessive consumption of astringent , bitter and pungent foods , Parinate anne – after the digestion of food , Aparahne –Evening 

  • Prakriti analysis of the patient
  • BAHYA CHIKITSA : (EXTERNAL TREATMENT)

Abhyanga – means performing massage , massage of afflicted part or joint with herbal oils  with mahanaryana taila , Kottamchukkadi taila , dhanwantaram taila , Ksheera bala taila etc

Svedana- (Fomentation / Sudation )It is type of treatment where sweating is induced , usually done after abhyanga or snehana , among which Bashpa sweda , Sarvanga bashpa sweda , Nadi sweda

 Dhara /seka /Pizhichil : pouring of medicated liquids in steams with gentle stroking for a fixed duration . 

Upanaha – Upanaha means poultices using dry powders

  • ABHYANTARA CHIKITSA (INTERNAL TREATMENT ):

Snehana : intake of medicated oils /ghee

Shodana :                     

Virechana : is given after the snehana  &  svedana .

Vasti – means medicated enemas , for vitiated vata given with kashaya or using oils /ghee.

Conservative line of management is followed , if patient is not fit for panchakarma , using ,Amavatari rasa , Rasaraja rasa, trikatu choorna etc   can be prescribed .

Panchakola  sidda jala (Water prepared from Panchakola ie 5 herbal drugs ), Nimba , Karela (Bitter gaourd , Purana shaali (Rice which is harvested long back),Food with Ruksha (Which reduces corpulence ), Avidahi (which are not spicy ), Langana (fasting /consumption of light food )Alavana (not salty), Food should always be fresh and avoid excess food .A low fat milk lactovegetarian diet, which favours sweet , bitter and astringent taste .Diet rich in fruits , vegetables , moderate in protein rich in magnesium , potassium , calcium and fibre .Bananas in plenty –Good source of  potassium. Coconut water – which has good quantities of potassium & magnesium .Frequent self massage with oil , Mrudu Vyayama (Excercises)

Dadhi (Curd), Matsya (Fish )Excessive intake of alchohol, salt and pungent foods . Complete eliminate from, Guda (jaggery),Guru and Madhura Ahara (Foods which are heavy to digest and are sweet in nature ),  coffee , tobacco , pan. Day time sleep must be avoided. Anger , jealousy, frustration , must be avoided

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