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Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
By
Dr. Pravin VermaConsultant Ayurveda Physician And Panchkarma specialist
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Amavata (Rheumatoid Arthritis) is an Autotoxic,
Nonsuppurative, psychosomatic, proliferative,
Type III immune mediated, inflammatory
Disease.
According to Ayurveda RA may be compared with
Amavata.
Rheumatoid Arthritis affects through out the world
without any influence of climate, altitude and
Geography, with female to male ratio of 3:1.
Every year about 0.02% new cases are reported.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Unknown Provoking Factors
Non-specific immune response
Inflammatory lesion
IL-1, IL-6 &IL-8 From macrophages
& FibroblastsIL-2, IL-6 & IFN-
From T-Cells
OFR & hydrolyticEnzymes from
Neutrophils
Continued inflammation & Joint destruction
RHEUMATOID ARTHRITIS
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Synovial pannus eroding articular cartilage.
Swan neck deformity of the fingers
Courtesy by- Davidson’s Principles and Practice Of Medicine.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Systemic Involvement Of RASystemic Involvement Of RASystemic effect : Fever, weight loss, fatigue.
Musculoskeletal : Muscle wasting, tenosynovitis, bursitis osteoporosis.
Hematological : Anaemia, thrombocytosis, eosinophilia.
Lymphatic system : Splenomegaly, Felty’s syndrome.
Eye : Episcleritis, scleritis, scleromalasia, keratoconjunctivitis sicca.
Cardiovascular : Pericarditis, myocarditis, endocarditis, digital arteritis conductiondefects, coronary vasculitis, ulcers, granulomatous arteritis, visceral arteritis,
Respiratory system : Nodules, pleural effusion, fibrosing alveolitis, bronchiolitis, Caplan’s syndrome.
Nervous system : Cervical cord compression, amyloidosis, compression neuropathies, peripheral neuropathy, mononeuritis multiplex.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
PAIN PATHWAYPAIN PATHWAY
Mechanical Thermal Chemical
Small Myelinated Afibers
Small Unmyelinated
C fibers
sharp-fast pain velocity of 6-30 m/sec. slow-chronic pain
velocity of 0.5-2.0 m/sec.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Effect Of Blood Supply On PainEffect Of Blood Supply On Pain
Tissue Ischemia
Rise of Concentration OfLewis’s “P Factor”
Blood Supply Occluded In Muscle
Pain
Muscle Contraction
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
ETIOLOGY
EXTERNAL INTERNAL BOTH
TOXINS &
FREE RADICALSAGRAVATION
OF VATA
KAPHASTHANA
STOMACH
CHEST
TRIKASANDHI
FOREHEAD
NECK
ETIOLOGY OF RHEUMATOID ARTHRITIS
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Sign & SymptomsSign & SymptomsAccording To Madhava NidanAccording To Madhava Nidan
1. Anga Pida (Body Ache)
2. Aruchi (Anorexia)
3. Pipasa (Thirst)
4. Aalasya (Fatigue)
5. Anga Gaurava (Heaviness In Body)
6. Jwara (Fever)
7. Burning & Redness If Pitta Is Associated
8. Heaviness & Itching If Kapha Is Associated
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Diagnostic CriteriaDiagnostic Criteria
Diagnosis of Rheumatoid Arthritis in patients enrolled for present study was based on the criteria of American Rheumatoid Association. Presence of any of four of the above criteria was conformed the diagnosis.
1. Morning stiffness.
2. Joint tenderness (pain in motion).
3. Swelling of three or more joints from six months or more.
4. Arthritis of hand joints from six weeks or more.
5. Symmetrical arthritis from six weeks or more.
6. Rheumatoid nodules.
7. Rheumatoid factor.
8. X-Ray changes.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Selection Of Patients & GroupingSelection Of Patients & Grouping
72 patients
Group A Group B
Sub-group A1 Sub-group A2 Sub-group B1 Sub-group B2
(33) (39)
(14) (19) (15) (24)
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Plan Of TreatmentPlan Of Treatment
Group A – Treated with Oral Medicine as -
Amavatari Rasa 250 mg. BD.Sanjeevani Vati 125 mg. BD.And some other herbal medicines
Group B - Treated Along with above Oral Medicine &
Bahya Snehan with Mahavishagarbha Tail
Nadi Sweda with Dasamool Kwatha.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Snehana Snehana Literally ‘Sneha’ means Oleate or to make smooth.
It produces Snehana (Unctuousness), Vishyandana (Fluidity),
Mrudutwa (Softness) and Kledana (Smoothness) in the body.
Snehana is of two types -
(1). Bahya (External)
(2). Abhyanatara (Internal)
Bahya Snehana (abhyanaga) improves the circulation.
This may helps in mobilizing the localised toxins in to the
systemic pool. After that these autotoxins may be eliminated
by different mechanisms.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Swedana Swedana The process which relieves stiffness, heaviness, coldness and
which induces sweating is known as Swedana Karma.
Effect of Swedana are as follows –
• Improves digestive Power.
• Limbs become soft.
• Skin becomes smooth.
• Increases interest towards food.
• Channels will be cleared.
• Restores the function of the joints.
Due to Swedana (sudation), vitiated doshas can be brought
back to the Kostha and can be eliminated by means of elimination
therapies.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Assessment of clinical symptomsAssessment of clinical symptoms
The patients were assessed with the following clinical
symptoms before and after the treatment –
1. Pain
2. Swelling
3. Stiffness
4. Grip power
5. Walking time
6. Appetite
7. Fever
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
SCORE OF PAIN IN RHEUMATOID ARTHRITIS
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
SCORES OF SWELLING IN RA
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
SCORES OF MORNING STIFFNESS IN RHEUMATOID ARTHRITIS
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
SCORES OF GRIP POWER IN RHEUMATOID ARTHRITIS
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
NEGATIVE SCORES OF APPETITE IN RHEUMATOID ARTHRITIS
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
NEGATIVE SCORES OF WALKING TIME (Distance of 10 mts.) IN RHEUMATOID
ARTHRITIS
0
50
100
150
200
250
300
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
SCORES OF FEVER IN RHEUMATOID ARTHRITIS
0
0.5
1
1.5
2
2.5
3
A1 A2 B1 B2
Before TreatmentAfter Treatment
A1 & B1– Disease less than 3 Yrs.A2 & B2 – Disease more than 3 Yrs.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Between The Group Comparison (Unpaired ‘t’ Test)Between The Group Comparison (Unpaired ‘t’ Test)
CriteriaCriteriaGroup A(N=33)Group A(N=33)
Mean SDMean SD
Group-B (N=39)Group-B (N=39)
Mean SDMean SD
Value ofValue of
t & pt & p
PainPain 0.4242 0.5019 0.1795 0.3888 t = 2.33
p<0.05 S
SwellingSwelling 0.4545 0.6170 0.2051 0.4091 t = 2.05
p<0.05 S
StiffnessStiffness 0.4555 0.5056 0.1538 0.3655 t = 3.80
p<0.001 HS
Grip PowerGrip Power 0.5758 0.5019 0.1282 0.3387 t = 4.09
p<0.001 HS
Walking TimeWalking Time 81.30 49.49 72.12 40.79 t = 0.86
p>0.05
AppetiteAppetite 0.5455 0.5056 0.1538 0.3655 t = 3.80
p<0.001 HS
FeverFever 0.5758 0.5019 0.1282 0.3387 t = 4.49
p<0.001 HS
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795
Conclusion and Results
Rheumatoid arthritis is an incurable disease and
present study concluding the following –
(1). In RA relief can be given with oral medicine.
(2). When Snehan and Swedan is added, the relief rate is
highly significant.
(3). Addition of Snehan and Swedan have proved its place in
the Ayurvedic managements.
So one can say the Sansodhana treatment are essential for
better management of Rheumatoid arthritis.
Jain Hospital – Pandeypur, Varanasi-2, U.P. INDIA. PH - +91 542 3252795