Osteoarthritis

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Table of Contents
Casestudies of Contents

Brief Medical History

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 aggravated 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 aggravated since one year and came here for treatment.

Aggravating factor – Cold,activities.

Relieving factors: Rest and hot application.

Current medication: Nothing.

Integrated Summary

Clinical Status

Allopathy Ayurveda
Vital Parameters
1. BP: 110/70
2. Pulse: 80/min
3. RR: 19/min
4. Weight: 66kg
5. Height: 158cm
6. W-U,cm:95cm
7. W-G,cm-112
8. BMI:26.43
9. WHR:0.85
Astasthana Pariksha
1. Nadi:Manda
2. Malam:
i. Pravruthi: 1 times
ii. Varna - Haridhra
iii. Akriti: Samhat
3. Mutra: 6 times / day
4. Jihva: nirama
5. Shabda: Sadharan
6. Sparsha: Anushnaa seetha
7. Drik: Sadhrana
8. Akruti: Sama
Examinations
1. GC-Normal
2. CVS-Normal
3. CNS-Normal
4. RS-Normal
5. PA-soft,no organomegaly

ROM:
1. Spine:
i. Flexion: painful
2. Neck joint: Flexion-painful
3. Shoulder joint: Elevation-Painful

Gait:
1. Antalgic gait
Dasavidha Pariksha
1. Prakriti - Kapha vata
2. Vikriti - Vata Kapha
3. Sara - Twak sara
4. Samhanana - Madhyama
5. Pramana - Madhyama
6. Satmya - Madhura rasa
7. Satva - Uthama
8. Aharashakti - Madhyama
9. Vyayam Shakti - Avara
10. Vaya - Madhyama
Rogi Bala - Madhyama
Roga Bala- Pravaram
DSQ findings Rating
1. ADRS
Medium Risk
2. LUPPN
Medium Severity
Nidana Panchaka
1. Nidana-Alpanna,Prajagarah,Upavasa .
2. Purvaroopa-Shoola
3. Roopa- Sandhi Shoola (Severe aching type of pain
on multiple joints), Sopha(generalised swelling on
the whole body) Sthamba(stiffness)
4. Upadrava-Asthi dathu kshaya(Degenerative changes) 5. Samprapti
i. Dosha-Kapha vata
ii. Dushya-mamsa, asthi,majja
iii. Adhistaana - Sandhi
iv. Agni- Madhyama
v. Ama- Saama
vi. Srotas - Mamsa vaha, Asthi vaha srothas, Majja vaha
vii. Sroto Dushti Prakara- Ati pravartti
1. Lab Findings
2. Last Recorded Value

INVESTIGATIONS FINDINGS:

25/2/2015

i. MRI of Lumbar Spine:

a. 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.

b. Impression: Mild scoliosis left.
- Lumbar spondylosis.

ii. MRI Cervical Spine
a. Observation: Anterior osteophytes noted at multiple level. IV disc space reduced between CV5 - CV6 vertebra.

b. 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

1. 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 inflammation and early morning stiffness are less prominent with stiffness less than one hour, and movements induces pain.

2. Gouty arthritis: Gout cause attacks of painful inflammation in one or more joints. The base of the big toe is the most commonly affected joint. Higher amount of uric acid level in blood also noticed.

3. Osteoarthritis: Pain in multiple joints which aggravated by overactivity and relieved by rest.

The patient was provisionally diagnosed with Osteoarthritis with differential diagnosis of Rheumatoid arthritis and Gouty arthritis.
Differential Diagnosis with reasoning

i. Ama vata
ii. Vata rakta
iii. 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(soonataanganam) 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 start 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)

i. Sopha (swelling on joints and whole body)
ii. Sandhi soolam (pain on multiple joints)
iii. Spandatha (numbness)
iv. Sushyatha (deterioration)
v. 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.

Samana chikithsa:

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

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.

Outcome

Standardized Outcome Scales Used

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

Conclusion

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.

Patient's Stories

Patient’s testimonials

* Outcomes may vary from person to person

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