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