Osteoarthritis


Osteoarthritis

Presenting Complaints

  • Pain on multiple joints.
  • Pain on upper and lower back regions.
  • Numbness on both fingers
  • Generalised swelling on whole body.
  • Headache.

Brief Relevant Medical History:


A female patient, aged 45 yrs,not a known DM/HTN came to AyurVAID with the above complaints. Pain on larger joints especially both knee joints,shoulder joint ,neck joint and low back region started one year before. Pain was of aching type. Numbness on the fingers of both hands and generalised swelling on whole body is noted since few months. Pain aggrevated during activities and relieved by rest. Morning stiffness is absent.

History of past illness:

H/O of Rheumatic fever.

30 yrs before she had the history of rheumatic fever and was under medication(injection) for 10 years and got completely reduced. Pain on larger joints started 6yrs before and the pain was very mild at that time. Pain aggrevated since one year and came here for treatment.

Aggravating factor- Cold,activities.

Relieving factors: Rest and hot application.

Current medication: Nothing.

Clinical Status


Allopathy Ayurveda
Vital Parameters

  • BP: 110/70
  • Pulse: 80/min
  • RR: 19/min
  • Weight: 66kg
  • Height: 158cm
  • W-U,cm:95cm
  • W-G,cm-112
  • BMI:26.43 WHR:0.85
AstaSthanaPariksha

  • Nadi:Manda
  • Malam:
    • Pravruthi: 1 times
    • Varna - Haridhra
    • Akriti: Samhat
  • Mutra: 6 times / day
  • Jihva: nirama
  • Shabda: Sadharan
  • Sparsha: Anushnaa seetha
  • Drik: Sadhrana
  • Akruti: Sama
Examinations

  • GC-Normal
  • CVS-Normal
  • CNS-Normal
  • RS-Normal
  • PA-soft,no organomegaly

ROM:

Spine:
Flexion: painful

Neck joint:
Flexion-painful

Shoulder joint:
Elevation-Painful

Gait:

Antalgic gait

DasaVidhaPariksha

  • Prakriti - Kapha vata
  • Vikriti - Vata Kapha
  • Sara - Twak sara
  • Samhanana - Madhyama
  • Pramana - Madhyama
  • Satmya - Madhura rasa
  • Satva - Uthama
  • Aharashakti - Madhyama
  • Vyayam Shakti - Avara
  • Vaya - Madhyama
Rogi Bala - Madhyama
Roga Bala- Pravaram
DSQ findings Rating
1. ADRS Medium Risk
2. LUPPN Medium Severity
Nidana Panchaka
  • Nidana-Alpanna,Prajagarah,Upavasa .
  • Purvaroopa-Shoola
  • Roopa- Sandhi Shoola(Severe aching type of pain on multiple joints), Sopha(generalised swelling on the whole body) Sthamba(stiffness)
  • Upadrava-Asthi dathu kshaya(Degenerative changes)
  • Samprapti
    • Dosha-Kapha vata
    • Dushya-mamsa, asthi,majja
    • Adhistaana - Sandhi
    • Agni- Madhyama
    • Ama- Saama
    • Srotas - Mamsa vaha, Asthi vaha srothas, Majja vaha
    • Sroto Dushti Prakara- Ati pravartti
Lab Findings Last Recorded Value Lab Findings Last Recorded Value

INVESTIGATIONS FINDINGS:

25/2/2015

MRI of Lumbar Spine:

Observation: Mild scoliosis of lumbar vertebra is noted towards left. Anterior osteophytes are noted at multiple vertebral bodies. IV disc space appear minimally reduced at LV5-SV1 level.

Impression:

  • Mild scoliosis left.
  • Lumbar spondylosis.

MRI Cervical Spine

Observation: Anterior osteophytes noted at multiple level. IV disc space reduced between CV5 - CV6 vertebra.

Impression:

  • Cervical spondylosis.

    RogaSamprapti Flow Chart

" Dehe srothamsi riktani poorayitwa
anilo bali
karothi vividhan vyadheen sarvangekanga samsrayan"

(Madhava nidana 22)

Vatavardhaka ahara vihara

Vata prakopa

Vitiated vata lodges in Sandhi's (larger joints)

leads to sopha,shoola,spandata.

Differential Diagnosis with reasoning


  • Rheumatoid arthritis: In rheumatoid arthritis multiple joints are affected with the affected joints being swollen ,warm,painful and stiff,particularly early in the morning on walking or following prolonged inactivity. Morning stiffness lasting for more than one hour. In arthritis of non-inflammatory causes,signs of inflammmation and early morning stiffness are less prominent with stiffness less than one hour, and movements induces pain.
  • Gouty arthritis: Gout cause attacks of painful inflammmation in one ore more joints. The base of the big toe is the most commonly affected joint. Higher amount of uric acid level in blood also noticed.
  • Osteoarthritis: Pain in multiple joints which aggrevated by overactivity and relieved by rest.

The patient was provisionally diagnosed with Osteoarthritis with differntial diagnosis of Rheumatoid arthritis and Gouty arthritis.

Differential Diagnosis with reasoning


  • Ama vata
  • Vata rakta
  • Sandhigata vata

1. Ama vata-
"Angamardharuchitrishna cha alasyam gouravam- jwarah apaka soonathaanganamamavatasya lakshanam"

In amvata pain in multiple joints is present ,also swelling on whole body(soonataa nganam) is seen. These symptoms are similar in this condition. But the other symptoms mentioned in the sloka lakshanas are absent.

2. Vata rakta-
"Padayormoolamastaye kadachithstayorapi akoriva visham krudham kritsnam deham pradhavati"

In vatarakta the vitiated doshas are vata and rakta and initially the symptoms starts at the extremities.

3. Sandhigata vata-
"Hanti sandhigatasandheen soolatopoh karothi cha"
(Madhava nidana)

"Sareeram mandaruksopham sushyathi
spandathe api va
supthastadyo mahathvo va siravate siragate
prasaranakunchanayorapravatha sa vedana"
(charaka samhitha)

In sandhigata vata vitiated vata lodges in sandhi's leads to pain and stiffness of joints.In charaka samhitha it is described as sirasandhigata vata and the lakshanas are swelling on whole body(sareera sopham), deterioration (sushyati), suptatha(numbness) and movement difficulty due to pain(prasaranakunchanayorapravarthi sa vedana)

Evidence Based Diagnosis with References

Reports led to the diagnosis of Lumbar spondylosis with Cervical spondylosis.

Evidence Based Diagnosis with References
Sandhigata vata:

"Vatapoorna druthisparso sopho sandhigato anile
prasaranakunchnayorapravarthi sa vedana"
(Ashtangahridaya nidana)

"Sareeram mandaruksopham sushyathi
spandathe api va
supthastadyo mahathvo va siravate siragate
prasaranakunchanayorapravatha sa vedana"
(charaka samhitha)

  • Sopha (swelling on joints and whole body)
  • Sandhi soolam (pain on multiple joints)
  • Spandatha (numbness)
  • Sushyatha (deterioration)
  • Movement difficulty due to pain (prasaranakunchanayorapravrthi sa vedana)
Details of Allopathy medicine if continued
NA
ChikitsaVivechana:

Samanya vatha vyadhi chikithsa:

“Kevalamniroopastambamadhousnehairupachareth

Snehaiklanthamsamasvasyapayobihisnehayeth punah

Youshairgramyoudakanooparasairvasnehasamyuteh

Payase krisare samla lavane sa anuvasanehi

Vatakhne tarpaneschanne susnigdham swedayeth tatah

swabyaktam snehsamyukthesamkaradyaha punah

(Ashtangahridaya vata vyadhi chikitsa 21/1)

“Vasthi vatha haranam”

Objective of treatment:

Our goal was to reduce Pain, swelling and to increase the mobility of joints.

Line of Treatment:
1.To reduce pain and swelling - Danyamladhara,Choorna pinda sweda and lepam.
2. Alleviate vata with matra vasti and madhuthailika vasti
3.To improve the circulation and to increase the mobility of joints - Kayaseka.

Type – OPT
Duration – 15 days.

Chikitsa Paddhati with details of dose of medicine.

FROM DATE TO DATE PROCEDURE TREATMENT MEDICINES
25/2/2015 27/2/2015 Danyamla dhara Danyamlam
28/2/2015 6/3/2015 Choorna Pinda Sweda Kolakulatha di churnam+C hinchadi T+Prabhanj anam
22/2/2015 22/2/2015 Virechanm Sindhuvarerandam(25ml+Induppu(1/4 tsp)
1/3/2015 7/3/2015 Nasya Anu thaila,Karp asastyadi thaila
5/3/2015 8/3/2015 Matra vasthi Pippalyadi anuvasana thaila
7/3/2015 7/3/2015 Madhuthaili ka vasthi Erandamool a kashyam+P ippalyadi anuvasana thaila
28/2/2015 9/3/2015 Lepa Nagaradi churna+Kar utta gulika+Dan yamlam
8/3/2015 10/3/2015 Kaya sekam Danwantha ram T+Mahanar ayana T
11/3/2015 11/3/2015 Mridu virechana Avipathi churnam

Samana chikithsa:

Advised-

  • 1.Amrithotharam kashayam -15ml kashyam+50ml warm water(6am,6pm)
  • Yogaraja guggulu-1 tablet with kashayam
  • Shaddharana churnam-1//2 tsp thrice daily
  • Dasamoolahareetaki lehyam-1tbsp at bed time. • Amrutharishtam+Punarnavasavam-30ml twice daily after food
  • Sallaki MR-1 tablet thrice daily after food
  • External Application-Kottamchukkadi thailam+Sahachradi thaia+Danwantharam thaila

Integrated View
Osteoarthritis is the most common form of arthritis. It causes pain, swelling, and reduced motion in joints. Risk factors for osteoarthritis are being over weight, getting older and injuring a joint. So the affected joints should be prevented from injuries, trauma and physical stress.Exercise can strengthen the muscles around the joint and making the joints more stable.
Standardised Outcome Scales Used

Womac scale
Before treatment Post treatment
0.37% 0.29%

Patient’s Outcome Scale:



Poor(1); Fair(2); Good(3); Very Good(4); Excellent(5).


# Presenting Complaint Weightage Status_TSD Status_TED Status_1Week
1 Pain on low back 20 1 4 5
2 Swelling on whole body 20 1 4 5
3 Pain on neck joint 20 1 3 5
4 Pain on both shoulders 20 1 4 5
5 Pain on both knee joint 10 1 3 5
6 Head ache 10 1 4 5

After the course of treatment vitiation of vata and kapha is reduced.Pain and swelling on upper low back region is significantly reduced. Pain and swelling on back of neck is reduced. Pain on both shoulders is significantly reduced. Pain on both knee and ankle is reduced. Pain on left calf region is not fully reduced. She is advised to follow up after two weeks and continue oral medicines for these two weeks.

Disclaimer: * Outcomes may vary from person to person