Rheumatoid arthritis
- Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting joints and frequently other organs.
- It occurs when the immune system mistakenly attacks its own body’s tissues.
- RA can affect multiple joints and in some people can damage the skin, eyes, lungs, heart, and blood vessels.
What is Rheumatoid arthritis?
- It occurs in the joints on both sides of the body, which makes it different from other types of arthritis.
- More than one joint is affected and small joints (wrist, certain joints in the hands and feet) are typically affected first.
- Uncontrolled inflammation damages cartilage in the joints and this can deform joints. Eventually, the bone itself erodes, which can lead to the fusion of joints.
Causes of Rheumatoid arthritis:
- The exact cause of Ra is unknown. It’s caused by a combination of genetics, hormones and environmental factors.
- With rheumatoid arthritis, something triggers the immune system to attract joints. An infection, smoking, unhealthy food, and physical or emotional stress may be triggering.
Symptoms of Rheumatoid arthritis:
- Pain, swelling, or tenderness in more than one joint of the hands, wrists, knees, or shoulders.
- Stiffness especially in the morning or after sitting for a long time.
- Pain and stiffness in the same joints on both sides of the body.
- Fever(low grade), fatigue, weakness, and anemia.
- Over time the patient may experience increasing difficulty with pain and stiffness, as well as impaired joint function.
- Sleep habits become disturbed and patients may experience depression and weight loss.
What are the risk factors?
- Sex: Women are two or three times more likely to develop RA.
- Family history: You are more likely to develop RA if your family has RA.
- Smoking: Smoking increases the risk of RA.
- Obesity: Chances are higher if you have obesity.
How is Rheumatoid arthritis diagnosed?
Blood tests :
- High ESR confirms inflammation in joints.
- High C reactive protein
- RF test: About 80% of people with RF test are positive.
- Anti-CCP test: About 60 to 70% of people with RA have an antiCCP test positive.
- Hemoglobin test: A chronic anemia is positive. Both serum iron levels and iron binding capacity are low.
Imaging tests :
- X-rays, ultrasounds, and MRI tests to look for signs that joints are wearing away.
Ayurved concept on Rheumatoid Arthritis:
- Acharya Charak did not include the disease Amvat(RA) as a separate disease in his book Charak Samhita.
- Charak Samhita’s Ch-28 vatavyadhi highlights Ama(आम) as one of the causes responsible for vata imbalance.
वेगसंधारणात् आमत् अभिधातात् अभोजनात् | चरक चि. 28 /15-28
- Acharya Charak mentioned amavat disease in a chapter focusing on treatment of edema (श्वयधु) and anemia (पांडु).
काश्यॅम् आमवातन् असृक अम्लपित वैवण्यॅम् | चरक चि. 12/52
गुल्मं आनाह आमवात: च रक्तपितं च नाशयेत् | चरक चि. 16/62
Amavat (RA) is mentioned in Bhavprakash Sanhita.
- Amavata is a disease caused by the aggravation of vayu associated with Ama. Vitiated vayu circulates the ama all over the body through channels. Ama takes shelter in joints and stomach(Shlesma sthan) and produces symptoms such as stiffness, swelling, pain, and tenderness in small and big joints.
What is Ama?
उष्मणोड़ल्प बलत्वेन धातुम् आद्यम् अपाचितम् |
दुष्टम् आमाशयगतं रसम् आमम् प्रचक्षते || अष्टांगह्रदय 13/25
- Due to lack of digestion (less strength of digestive fire) nutritive juice (formed after the digestion of food ) is not formed well, this contaminated juice stays in the stomach and the intestines will become Ama.
अजीर्ण आध्यरसो जात: संचितो हि क्रमेण वै |
आमसंज्ञाम् स लभते शिरो गात्र रुजाकर: || भावप्रकाश चि. 26 /5
- Due to impairment of the digestive fire, food that is consumed is putrefied and is gradually accumulated. It is known as ‘Ama’ which leads to headaches and aching of the body.
Definition of Amavat (RA)
युगपत् कुपितावेतौ त्रिकसंधि प्रवेशकौ |
स्तब्ध: च कुरुतो गात्रम् आमवात: स उच्यते || भावप्रकाश 26/6
- In the case of Amavat vat and kapha doshas, they get vitiated and aggravated at a time and enter the trika sandhi (sacrococcygeal joint). As a result, the entire body including the joints becomes rigid and stiff.
Causes of Amavat (RA)
विरुध्ध आहार चेष्टस्य मन्दाग्नै: निश्चलस्य च |
स्निग्धं भुक्तवतो हि अन्नं व्यायामं कुवॅत: तथा || भावप्रकाश 26/1
- Incompatible food.
- Unsuitable body activity.
- Impairment of the digestive fire.
- Lack of exercise.
- Vigorous exercising immediately after consuming oily or fatty food
Symptoms of Amavat (RA)
अंगमर्दो: अरुचि तृष्णा च आलस्यं गौरवं ज्वर: |
अपाक: शूनता अङगानाम् आमवातस्य लक्षणम् ||
स कष्ट सर्वरोगाणाम् यदा प्रकुपितो भवेत् |
हस्तपाद शिरो गुल्फ़ त्रिक जानु उरु संधिषु ||
करोति सरूजं शोथं यत्र दोष: प्रपद्यते |
स देशो रुज्यते अत्यर्थ व्याविद्ध इव वृश्चकै: ||
जनयेत् स : अग्निदौर्बल्यम् प्रसेक अरुचि गौरवम् |
उत्साहहानिम् वैरस्यम् दाह: च बहूमूत्रताम् ||
कुक्षौ कठिनताम् शूलम् तथा निद्राविपयॅयम् |
तृट छदिॅ भ्रम् मूच्छाॅ: च ह्रदग्रहं विडबध्धताम् |
जाड्य आन्त्रकूजनाम् आनाहं कष्टाम् च अन्य उपद्रवान् || भावप्रकाश 26/8-11
- Generalized body pain, loss of taste, thirst, lethargy, fever, indigestion, and edema of different body parts including joints.
- It is very difficult to cure when it occurs.
- Whenever there is the accumulation of dosha and Ama, that particular area is painful and edematous.
- Bony joints of the shoulder, wrist, metacarpophalangeal, foot, ankle, knee, cervical, pelvis, and sarco-coccygeal are swollen and painful.
- The pain resembles that of a scorpion sting.
- Other symptoms include lowered digestive fire, excess salivation, distaste, heaviness, loss of enthusiasm, perception of different tastes, burning sensation, polyurea, rigid chest, constipation, sluggish intestinal motility, borborygmus, and abdominal distension.
Types of Amavat
- Pittaj Amavat
Burning sensation and redness dominate in case of Pitta involvement.
पितात् सदाह राग , भावप्रकाश 26/12
- Vataj Amavat
Aching or piercing pain is observed in Vat dominance amavat.
सशूलं पवनात्मकम् | भावप्रकाश 26/12
- Kaphaj Amavat
Heaviness with itching sensation is noticed in Kapha dominance amavat.
स्तिमितं गुरु कण्डूकं कफजुष्टं तमादिषेत | भावप्रकाश 26/12
Amavat – Line of treatment
लड़घनं स्वेदनं तिक्तं दीपनानि कदूनि च |
विरेचनं स्नेहन: च बस्तय: च आममारुते ||
रुक्ष: स्वेदो विद्यातव्यो वालुका पुटकै: तथा |
उपनाहा: च कर्तव्या: ते अपि स्नेह विवर्जिता || भावप्रकाश 26/14-15
- Langana (Fasting): Diet restriction or an easy digestive diet is to make the body light.
- Sweden (Hot fomentation): Procedures used to induce sweating. It helps in relieving stiffness and heaviness.
- Food and drugs that are bitter and pungent in taste, appetizers, or digestants.
- Induction of purgation.
- Consumption of medicated oil or fat.
- Enema with medicated decoctions.
- Fomentations should be dry in nature preferably with heated sandbags.
- Avoiding the application of oil externally.
- Bandaging with thick leaves is useful without oil.
Healthy Diet for Amavata (RA)
रुच्यं दध्यात् अथ सात्म्यम् आमवात हित: च यत् | भावप्रकाश 26 /21
- Whatever food is given that should be delecious and suitable to the disease.
यवा: कुलत्था: श्यामका: कोद्रवा रक्तशालय: |
वास्तुकं शिग्रु वर्षाभू: कारवेल्लं पटोलकम् ||
आद्रकं तप्तनीरं च लशुन तक्र संस्कृतम् |
जाड्गलानां तथा मांसं स आमवात गदे हितम् || योगरत्नाकर चि . 1-2
- Barley, horse gram, foxtail millet, kodo millet, red rice
- Drum stick, pointed gourd, bitter gourd, ginger
- Hot water
- Garlic processed in buttermilk.
- The meat of animals living in desert-like regions.
Unhealthy diet for Amavat (RA)
दधि मत्स्य गुड क्षीरं पोतकी माष पिष्टकम् |
वर्जयेत आमवातार्तो मांसम् आनुप सम्भवम् ||
अभिष्यन्दकरा ये च ये च अन्य गुरुपिच्छिला: | भावप्रकाश 26/129
- Curd, fish, jaggery, milk, spinach, black gram, and flour prepared from cereals.
- Flesh of aquatic animals.
- A diet that is heavy to digest, sticky, and causes obstruction of channels.
Lifestyle modification for Amavat (RA)
असात्म्यं वेगरोधं च जागरं विषमाशनम् | योगरत्नाकर चि. ¾
- Forcibly controlling the natural body urges.
- The habit of keeping awake throughout the night.
- Irregular eating habits.
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