Osteoarthritis

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

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