Rheumatoid Arthritis

Vital Parameters

1. BP -120/80 mm of Hg
2. Pulse-62
3. RR- NA
4. Weight-70kg
5. BMI-34.6-Obese
6. WHR-0.89

Astasthana Pariksha

1. Nadi - Manda
2. Malam - Prakruth
3. Mutra - Prakruth
4. Jihva - Prakruth
5. Shabda - Prakruth
6. Sparsha - Prakruth
7. Drik - Prakruth
8. Akruti - Sthula

DasaVidhaPariksha

1. Prakriti- kapha vata
2. Vikriti-vata dosha
3. Sara-Mamsa
4. Samhanana-Madhyama
5. Pramana-Madhyama
6. Satmya-Ushna
7. Satva-Pravara
8. Aharashakti-Madhyana
9. Vyayam Shakti-Madhyama
10. Vaya-Madhyama
11. Desha-sadharana
12. Kala - Roga avasta jeerna

Rogi Bala- Madhyana

Roga Bala- Pravara

DSQ findings     Rating

ADRS70       Med
LUPPN 1       NS

Nidana Panchaka

1. Nidana-Irregular food habits, cold heavy food continuously
2. Purvaroopa-Avyakta
3. Roopa-Fever with chills & rigors associated with multiple joint pains
4. Upashaya-Ushnaaharavihara
5. Samprapti

1. Dosha-Kapha vata
2. Dushya-Mamsa, Asthi, Majja
3. Agni-Dhatwagni
4. Ama- Jataragnijanya
5. Srotas- Mamsa, Asthi, Majjavaha
6. Sroto Dushti Prakara-

Roga Samprapti Flow Chart

Due to intake of nidana, all Doshas gets aggravated, which vitiates the Vata in kaphasthana, expels in to exterior, then produces swelling along with joint pain.

Differential Diagnosis with reasoning

1. Rheumatoid Arthritis- The joint involvement is characteristically symmetric with associated pain, stiffness, warmth. The stiffness is characteristically worse in the morning and improves during the day; its duration is a useful indicator of the activity of the disease. The stiffness may recur especially after strenuous activity. The usual joints affected by rheumatoid arthritis are the metacarpophalangeal jts, the PIP jts, the wrists, knees, ankles, and toes. nd tenderness.

2. Gouty arthritis- Excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic. In its chronic stage, gout can affect many joints, including those of the hands. Other problems related to gout can include the formation of tophi, or lumps of crystals under the skin, in the joints and in bone; kidney stones; and impaired kidney function.Uric acid levels are elevated in blood.

Differential Diagnosis with reasoning

1. Amavata- pain and swelling in major and minor joints with Ama lakshanas in body.
2. Vatarakta- Pain in sandhi, starting from foot region extending upwards with Daha, pricking type of pain and discolouration.
3. Sandhivata- Shoola and shopha in sandhi especially in major joints.

Evidence Based Diagnosis with References
Rheumatoid Arthritis

Evidence Based Diagnosis with References
Amavata

Chikitsa Vivechana:

1. Ahara-
i. Follow timely meal. Have freshly prepared warm food.
ii. Cooked vegetables, fruits.
iii. Boiled-Warm jeera/ Coriander seed / mint for Drinking water.
2. AVOID-
i. Refrigerated, deep fried, oily, spicy, salty, canned food items.
ii. Avoid sour food and drinks.
iii. Avoid fermented food preparations, curds.
iv. Green chillies, Channa,brinjal, Green peas, Rajma, Potato, Cabbage, Cauliflower,pickles.
3. Vihara-
a. REGIMEN:
i. Avoid exposure to cold.
ii. Keep yourself warm and covered.
iii. Mild exercises as advised.
iv. Hot water bath.

Details of Allopathy medicine if continued

Kriya-
Type –OPT
Duration – 14days

Primary Treatments- NIL

Main Treatments-
i. Valukasweda-14 days
ii. Sadyovirechana was given after 3 days of valukasweda

Aushadha-
Medications -
• Guggulutiktaka Kashaya (15ml) + Tab Yogaraja guggulu 1+ 10 tsp warm water morning and evening on empty stomach.
• Tab Vishatinduka 2 + Shaddharana 1-three times daily after food.
• Tab Chandraprabhavati 1 after food morning and evening.
• Gandharva hasta taila 3tsp with hot water at bed time.
• Kottamchukkadi taila + Pindataila- Warm and apply half an hour before bath.

Post Treatments- NIL
Chikitsa Paddhati with details of dose of medicine.

Valukasweda- Amavata is a condition dominated with Ama ie., kapha along with vata. Rukshasweda is indicated and hence Valukasweda is preferred.
After 3 days, Virechana was given to remove the liquefied Ama from the body. Patient got 3 virechanavegas with Gandharva hasta erandataila 30ml.
After removal of Amatwa, Valuka Sweda was done using Kottamchukkaditaila and Pinda taila mixture to subside Vata.

Guggulutiktaka Kashaya- Kapha vatahara,kledahara, Lekhanaactions helping toremove Ama and reduce Vata.

Yogarajaguggulu- indicated in Amavata, Sandhi majjagata vata. (BhaishajyaRatnavali)

VishatindukaVati-

Shaddharana Tab- for Amapachana and improving digestion. It removes Amavastha. (Su chi)

Chandraprabhavati- Kaphamedo dushti janyaroga.

Kottamchukkadi taila indicated in all Vatavyadhi, after removal of amavastha.

Pinda taila-Indicated in Nirama vata.

Referral Opinion Sought if any—No