RESEARCH Criteria Description
Revolutionary changes are under way in RA care Dr. Anil, MD(Ayu), Dr. Girish, MD(Ayu), Dr. Prashant, BAMS, Dr. Poornima, MD(Ayu), Dr. Subramanya, PhD, Dr. Mahadevan, PhD Institute of Ayurveda & Integrative Medicine (I-AIM), School of Health Sciences Transdisciplinary University, Bangalore, India
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are is an important condition for the treatment of any disease. It is also understood that care for the different diseases are witnessing revolutionary changes with changing times. Same is the case for diseases like Rheumatoid Arthritis where life-style and diet has been put in the fore front for the complete healing of the disease through Ayurveda. This article pours out more wisdom in this area of disease handling.
ble synovial membrane of the joints. Typical symptoms of the disease include stiffness, pain, inflammation and swelling of joints leading to deformity. The most commonly affected joints are small joints of the hands, feet, knee, ankles, wrists and elbows. The incidence of RA in India is for 0.8% of the total population. Women are seen three times more likely to develop RA than Men. Young adults and children can develop Juvenile Rheumatoid arthritis.
It is understood that Rheumatoid arthritis (RA) is a chronic inflammatory form of arthritis. It is one of the auto-immune disorders that affects a number of tissues and even organs, but primarily it damages the flexi-
The American Rheumatic Association has mentioned 7 criteria for diagnosing RA which are shown in the table. If 4 or more of these criteria are present, then a confirmed diagnosis of RA can be made.
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Duration
Current standard of care for RA in modern medicine are:
Morning stiffness
Stiffness in and around the joints, lasting at least 1 hour before max- >= 6 weeks imal improvement
Arthritis of 3 or more joint areas
At least 3 joints areas simultaneously have soft tissue swelling or fluid observed by a physician; 14 possible areas include left and right PIP. MCP, wrist, elbow, knee, ankle and MTP joints.
Arthritis of the hand joints
At least 1 area swollen in a wrist, >= 6 weeks MCP or PIP joint
• DMARDS - These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include Methotrexate, Leflunomide, Hydroxychloroquine and Sulfasalazine.
Symmetrical arthritis
Simultaneous involvement of the same joint areas on both sides of >= 6 weeks the body
• STERIODS - Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage.
Rheumatoid nodules
Subcutaneous nodules over bony prominences or extensor surfaces or in juxta-articular regions
Serum rheumatoid factor
Increased rheumatoid factor
Radiographic changes
Characteristic changes on posterior and anterior wrist radiograph, with erosions or unequivocal bony decalcifications localized in or most marked adjacent to the involved joints; osteoarthritis changes alone do not qualify
>= 6 weeks
Rheumatoid Arthritis in Ayurveda Amavatha, a disease mentioned in Ayurveda, shares a lot of similarities with RA. Symptoms in Ayurveda include Shotha (Inflammation), Shula (Pain), Sabdata (Stiffness) and Ragata(Redness). Amavata is an agonizing disorder resulting from formation and accumulation of metabolic toxins (Ama - free radicals) and aggravation of Vatadosha. Contribution for accumulation of ama includes: • Life-style • Diet • Stress and psychological factors
• NSAIDS - can relieve pain and reduce inflammation. Which include internal administration of ibuprofen and naproxen sodium etc.
• SURGERY - If medications fail to prevent or slow joint damage, surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. • REHABILITATION - The rehabilitation management of individuals with RA is imperative to decrease the potential long-term disabilities. Specifically, individuals with rheumatoid arthritis are at risk for decreased flexibility, muscle atrophy, decreased muscle strength and reduced cardiovascular endurance. approaches include internal medicine, purification therapies and external therapies. The goals of these treatments in Ayurveda is: 1. Elimination of Metabolic toxin (Ama) 2. Restoring Normal Metabolism (Agni) 3. Improving immune response to protect articular structures 4. Symptomatic relief- pain, inflammation, stiffness, swelling etc. LINE OF TREATMENT IN AMAVATHA (RA)
• Poor digestion and metabolism The accumulation of Ama combined with aggravation of Vata leads to Amavatha or RA. Several studies as well as experience at the Institute of Ayurveda and Integrative Medicine (I-AIM), suggest that Ayurvedic treatments have a potential for improvement in RA. Ayurveda based Treatment Approaches The lines of treatment of RA or Amavatha in Ayurveda are focused on reducing Ama and correction of Vata imbalance. The three broad classes of treatments employed for Amavatha treatment
INTERNAL MEDICINE
PURIFICATORY THERAPIES
EXTERNAL THERAPIES
LANGHANA
VIRECHANA
SWEDANA
SHAMANA
BASTI
RUKSHANA
DEEPANANA & PACHANA
UPANAHA
SNEHAPANA
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