Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder, which principally attacks the peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels. It may also affect many tissues and organs. It primarily affects the joints inflaming their lining (synovium), resulting in pain and swelling that eventually leads to deformity. It is characterized by spontaneous remissions and unpredictable exacerbation.
Rheumatoid Arthritis is a medical condition that has multi-faceted shades of presentation, including many systemic complaints as the disease progresses. The main aim of treating a Rheumatoid Arthritis patient is to arrest the progress of the disease and prevent onset of any abnormality. With persons in whom the deformity has already set in, the aim is to reduce pain and deformity.
AyurVAID's treatment modality for Rheumatoid Arthritis includes both internal medications and therapies, judiciously administered after assessing the patient's individual clinical condition. Therapies like Lepa (anointions), Vasti (medicinal enema) and Dhāra (pouring of medicinal liquid in a particular fashion) are often employed. Significant pain reduction and improvement in a patient's range of movements can be brought about by appropriate Ayurveda treatment. Even in conditions of deformity, extended treatment can assist the patient meaningfully.
The joints become swollen, tender and warm, and stiffness limits their movement. With time, RA nearly always affects multiple joints ( polyarthritis). Most commonly, small joints of the hands, feet and cervical spine are affected, but larger joints like the shoulder and knee can also be involved. Synovitis can result in tethering of tissue with loss of movement and erosion of the joint surface, causing deformity and loss of function. Increased stiffness early in the morning is often a prominent feature of the disease which may last for more than an hour. In most patients, the disease follows an intermittent course and allows normal activity, although 10% suffer total disability from severe articular deformity, associated extra-articular symptoms, or both. The prognosis worsens with the development of nodules, vasculitis, and high titers of rheumatoid factor (RF).
The disease has been shown to place an enormous burden on society.
- The studies show that about 8-9% of the adult population suffers from some form of Rheumatic disease - and about 5-6% of the population has joint (or related) diseases.
- About 1% of the world's population is afflicted by Rheumatoid Arthritis, and women are affected three times more often than men.?
- Although it can occur at any age, it begins most often between ages 25 and 55.
- The prevalence of RA in adults in India varies from 0.5-3.8% in women and from 0.15-1.37% in men, with peak incidence in the fourth decade of life.
Risk Factors associated with rheumatoid arthritis include the following:
Age – The most common onset of rheumatoid arthritis is between the ages of 40-60, though there are cases at variable ages.
Family History – If a family member has rheumatoid arthritis, you may be at increased risk. It is also thought that there may be a genetic predisposition to developing rheumatoid arthritis but no direct correlation has been made.
Gender – Women have an increased risk of developing rheumatoid arthritis than men
Smoking – heavy smoking increases your risk of developing rheumatoid arthritis
Rheumatoid arthritis can be difficult to diagnose because presentations can vary in locations in the body and symptoms can look like other muscular-skeletal ailments such as osteoarthritis, hepatitis C, Gout and Lyme disease.
Presentations may include multiple joint involvement, positive rheumatoid factor, pain in both sides of the body, stiffness, and changes in x-rays.
Testing is extremely important to determine the stage of the disease and in selection of appropriate treatment options. Testing can include blood tests and/or X-rays, such as:
• Rheumatoid Factor
• Eryhrocye Sedimentation Rate Test
• C-Reactive Protein (CRP)
• Anti-CCP Antibody Test
• Anemia Testing
• Dexa Scan
• Magnetic Resonance Imaging (MRI)
Rheumatoid arthritis can be included under the clinical condition called Vatarakta. Vatarakta is a condition in which the blood and its pathways are impaired simultaneously with the impairment of vata(the humor that controls body movements) causing diverse symptoms that also include joint inflammation and restricted movements. It is classified into uttana (involving the superficial structures) and gambhīra (involving deeper structures) based on the chronicity and progression of the disease. The treatment of the disease also gets more difficult as the condition progresses and the severity increases. The rheumatoid arthritis of recent origin and with minimal morbidity can be managed well, while the others can be brought under control. While in chronic condition, with the involvement of deeper structures, the efficacy of treatment is variable.
Ayurveda approach to medical management
Rheumatoid arthritis is a condition that demands the best implementation of the nuances of clinical skills of an Ayurveda physician. It is a medical condition that has multifaceted shades of presentation, which includes many systemic complaints as the disease progress. The main aim of treating a rheumatoid arthritis patient is to arrest the progress of the disease and prevent onset of any abnormality. Persons in whom the deformity has already set in the aim is to reduce the pain and deformity.
The treatment modality is both internal medications and therapies, judiciously administered after assessing the clinical condition. Here the therapies like lepa (anointions), vasti ( medicinal enema), dhara (pouring of medicinal liquid in a particular fashion) are of great significance. Significant improvement in respect to pain and range of movements can be brought about by the appropriate treatment. In conditions of deformity also treatment in long run may be of some help to the patient. In progressive state involving multiple systems though some efficacy is evident , the benefit of the treatment is unpredictable.
Treatment specific information
The nature of the disease necessitates long run treatment protocol with continuous internal medications regular therapies. The patient need to be on naimittika rasayana (rejuvenation therapy specific to the disease) during the convalescence also.