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TITLE OF CASE

Standalone ayurvedic management of Rheumatoid arthritis- A case report

Dr Partap Chauhan

ABSTRACT

A 40-year-old female patient suffered from pain in the right knee joint which was progressive in nature and later she experienced pain in the left leg, heels and fingers of the hand, for 6 months.  She consulted an allopathic doctor and took painkillers. She underwent the standard of care, but got only temporary relief. She approached Dr Partap Chauhan for better management of her condition. Based on the clinical evaluation and ACR/EULAR criteria, the biomedical diagnosis was made as Rheumatoid Arthritis and the Ayurvedic diagnosis was made as Amavata. The line of treatment followed was tridosa shamana, sroto shodhana, ama pacana, balya and rasayana. After 1 month of treatment, the symptoms started reducing. In 4 months, she got complete relief from her symptoms. The RF and CRP were positive before treatment, came down to normal limits after treatment.

KEYWORDS

Amavata, rheumatoid arthritis, case report, RA, standalone

INTRODUCTION

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by inflammatory arthritis and extra-articular involvement. It is a chronic inflammatory disorder of unknown etiology that primarily involves synovial joints. It typically starts in small peripheral joints, is often symmetric, and progresses to involve proximal joints if left untreated. Joint inflammation over time leads to the destruction of the joint with cartilage and bone erosion. RA with a symptom duration of fewer than six months is defined as early RA, and when the symptoms have been present for more than six months, it is defined as established RA.

Diagnostic criteria: Inflammatory arthritis involving three or more joints assessment done using tools as recommended by ACR and EULAR, Positive rheumatoid factor (RF) and anti-citrullinated peptide/protein antibody (ACPA), such as anti-cyclic citrullinated peptide antibody (anti-CCP) testing, Elevated levels of C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), Antinuclear antibody (ANA) testing, Radiographs of the hands, wrists, and feet, Synovial fluid analysis, Magnetic resonance imaging (MRI) and ultrasound, etc.

There is no pathognomonic laboratory test for rheumatoid arthritis, which makes the diagnosis of this disease challenging. A thoughtful and comprehensive clinical approach is required to complete the diagnosis and prevents debilitating joint damage. 

Treatment: NSAIDs, Steroids, Conventional DMARDs, Biologic agents, Targeted synthetic DMARDs, Surgery - Synovectomy, Tendon repair, Joint infusion, Total joint replacement. The patient had taken painkillers and other medications ( details not available), but did not get relief.

PATIENT INFORMATION

The patient is a 40 year old female who had pain in the right knee joint since 6 months. This was progressive in nature and later she experienced pain in the left leg, heels and fingers of the hand. She underwent standard of care as recommended by an allopathic doctor. She could only get temporary relief and the condition progressed to a stage where she could not walk, move or work properly due to the intense pain. She was prescribed multivitamins and calcium supplements 1 month back. The condition aggravates after sitting down for a prolonged period resulting in stiffness and swelling in her joints and heaviness in her body. Since she could only get temporary relief, she opted for Ayurvedic treatment.

No relevant family/genetic/surgical history.

Psychosocial history- Irritability is present. 

CLINICAL FINDINGS

On examination- Tenderness, swelling at the knee, elbow, and wrist joints.

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The biomedical diagnosis was confirmed by the Ayurvedic physician based on the clinical evaluation, blood reports and the ACR/EULAR criteria.

Image 2. Baseline Blood reports dated 18.8.2022

Image 3. Baseline ACR/EULAR criteria done 

The ACR/EULAR is 7 confirming the diagnosis as RA. 

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Amavata.

Differential Diagnosis- 

Osteoarthritis

Psoriatic arthritis

Systemic lupus erythematosus

Sjogren syndrome

Polymyalgia rheumatic

Chronic gouty arthritis

Calcium pyrophosphate deposition disease 

Based on the clinical findings and investigation reports, the physician confirmed the condition as RA. 

Prognosis- Rheumatoid arthritis has no cure and is a progressive disease. All individuals will experience multiple exacerbations and, without treatment, tend to have poor outcomes with increased disability and mortality. Early treatment (within six months of symptom onset) has shown the improved functional capacity and decreased disease activity as measured by swollen joint count and tender joint count.

The patient underwent standard of care for symptoms as recommended by an allopathic doctor. But she did not get satisfactory response. But after 1 month of ayurvedic treatment there was a reduction in symptoms. After 4 months of treatment, she got complete relief from symptoms and the RA factor and CRP both were negative. 

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 4 follow ups in total. After 1 month of treatment, there was a reduction of pain, swelling, stiffness, and improvement in the movement of joints. After 4 months of treatment, the patient got complete relief from all the symptoms. 

The symptoms as proceeding through the treatment were tabulated. Pain, stiffness, joint movement and swelling were observed. 

Table 1. Symptoms improvement -date wise observation

Symptoms	Aug-22	Sep-22	Oct-22	Nov-22	Dec-22
Pain	++++	+++	++	+	Absent
Stiffness	++++	+++	+	+	Absent
Movement	++++	+++	++	+	Normal
Swelling	++++	++++	+++	++	Absent

Clinician-based assessment; On examination, there is no swelling or tenderness in the joints. 

Patient-assessed; Not relevant

Image 4. Blood report during treatment ( after 2 months ) dated 17.10.2022

The RA was recorded as Non-reactive and CRP was positive. 

Image 5. Blood report after treatment ( after 4 months ) dated 4.12.2022

The RA and CRP was recorded as Negative.

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Photographs taken before and after treatment were the primary assessment criteria. 

Adverse and unanticipated events; None reported

DISCUSSION: 

Rheumatoid arthritis has no cure and is a progressive disease associated with morbidity and increased mortality. All individuals will experience multiple exacerbations and, without treatment, tend to have poor outcomes with disability and increased mortality. Here, the ayurvedic diagnosis was made as Amavata and the line of treatment followed was tridosa shamana, sroto shodhana, ama pacana, balya and rasayana.

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report demonstrates the successful standalone ayurvedic management of Rheumatoid arthritis in a 40 year old female patient who was not responding to standard of care. 

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011 Dec 1;84(11):1245-52. PMID: 22150658.
2. Aswathy YS, Anandaraman PV. Therapeutic influence of some dietary articles on gut microbiota in the pathogenesis of rheumatoid arthritis (Amavata) - A review. Ayu. 2019 Jul-Sep;40(3):147-151.