Rheumatoid Arthritis

Presenting Complaints with severity and episode duration

  • Multiple joint pain
  • Swelling legs
  • stiffness in legs

Brief Relevant Medical History (Onset, Duration, Ag/Rel Factors, OTT, Prior Confirmed Diagnoses if applicable):
Patient k/c/o Rheumatoid arthritis since 2 years,developed shoulder joint pain with stiffness 2 years back. Later pain and stiffness was observed in all the major and minor joints. She took allopathic treatment for about 6 months and then stopped. Later after 6 months she again developed multiple joint pain which is aggravating by cold and in morning hours. She feels relieved by hot fomentation. Patient underwent hysterectomy 8yrs back and is on Multivitamin tablets. She is also a k/c/o Allergic bronchitis and uses Asthalin inhaler SOS. Not a known DM/HTN.

Current medication: Multivitamin tablet 1/day

Clinical Status

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

1. GC- Fair, Afebrile.
2. CVS- S1, S2 heard
4. RS- NVBSheard
5. PA- Soft, No Organomegaly

MS system:

Joints involvedPainStiffness
Ankle joints++++
Major joints++++
Minor joints++++

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 contiuously
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-
Lab Tests
Lab FindingsLast Recorded ValueLab FindingsLast Recorded Value
Total Chol.-HB13 (20/04/12) 10.7 (3/6/13)
HDL-LiverNormal range
CRP-Positive 20/4/12 Negative 3/6/13

Roga Samprapti Flow Chart

Due to intake of nidana, allDoshas gets aggravated, which vitiates the Vata in kaphasthana, expells in to exterior, then produces swellingalong with joint pain.

Differential Diagnosis with reasoning

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.

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

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

Evidence Based Diagnosis with References
Rheumatoid Arthritis
Evidence Based Diagnosis with References
Chikitsa Vivechana:


 Follow timely meal. Have freshly prepared warm food.
 Cooked vegetables, fruits.
 Boiled- Warm jeera/ Coriander seed / mint for Drinking water.


 Refrigerated, deep fried, oily, spicy, salty, canned food items.
 Avoid sour food and drinks.
 Avoid fermented food preparations, curds.
 Green chillies, Channa,brinjal, Green peas, Rajma, Potato, Cabbage, Cauliflower,pickles.


REGIMEN: Avoid exposure to cold.
 Keep yourself warm and covered.
 Mild exercises as advised.
 Hot water bath.
Details of Allopathy medicine if continued


Type –OPT
Duration – 14days

Primary Treatments-NIL
Main Treatments-
 Valukasweda-14 days
 Sadyovirechana was given after 3 days of valukasweda


Medications -
• GuggulutiktakaKashaya(15ml)+ Tab Yogarajaguggulu 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.
• Kottamchukkaditaila+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)


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

Chandraprabhavati- Kaphamedo dushti janyaroga.

Kottamchukkaditaila indicated in all Vatavyadhi, after removal of amavastha.

Pinda taila-Indicated in Nirama vata.

Referral Opinion Sought if any- No
Integrated View – Patient has multiple joint pain with swelling, started from shoulder joint, seen in almost all major and minor joints, aggravating with cold and in morning. Digestion is hampered. Rheumatoid arthritis factor is positive. Hence the condition of Amavata/ Rheumatoid arthritis is difficult to treat and is advised to continue oral internal medicines and plan for the panchakarma therapies.

1. Samyak Lakshanas achieved (Control Charts Summary to be Attached) Sadyo Virechana chart attached-No.1.

2. Standardised Outcome Scales Used (Summary Table to be Attached)

3. Other outcomes as per following table to be duly filled

#Outcome Parameters
/ / Date-Time:
1Sleep (Nidra)-GoodGoodGoodGood--
2Appetite (Agni)-GoodGoodGoodGood--
3Bowels (Mala)-RegularRegularRegularRegular--
4Urination (Mutra)-RegularRegularRegularRegular--
5Stress (Manas)-NormalNormalNormalNormal--
6Vitality (Ojus)-GoodGoodGoodGood--
7Wellbeing (0-10)-5567--
10Weight, Kg-70707070--
11W-U, cm-34-----
12Diet (Ahara)-FairGoodGoodGood--
13Exercise (Vyayama)-Yoga-----
14Lifestyle (Vihara)-FairFairFairFair--
15Pain in major and minor joints(0-10)VAS1052--
16Stiffness in joints(0-10)VAS842--
17Pain with swelling in ankle joints(0-10)VAS943--

Patient’s Outcome Scale

#Presenting ComplaintWeightageStatus_TSDStatus_TED Status_1WeekStatus_1 MonthStatus_6 Months
1Multiple joint pain50%poorVery good-Very good-
2Swelling in joints50%poorVery good-Very good-
IMPROVEMENT SCORE----->0.0-2.0 -2.0 -2.0
IMPROVEMENT %ge----->0%-100%-100%-100%

Adverse Incident Report (Drug or Treatment): NIL


report1    report1
DateAt the start of TreatmentDuring the TreatmentPost treatment
Images/ Details of the site
Lab Reportsreport

At the end of treatments, patient has got significant relief from her symptoms. Mild pain and swelling is persisting ankle joint. She is advised to undergo Yogabasti after 3 weeks. She is advised to continue all his internal and external medicines for 15 days and review thereafter.

Direction for Future Research

ASO titre and RA factor to be seen before and after treatment.


  1. Bhavaprakasha
  2. Bhaishajyaratnavali
  3. Chakradatta

Disclaimer: * Outcomes may vary from person to person