Featured Case

MODERN DIAGNOSIS: Hyperuricemia

ABOUT THE DISEASE:

Hyperuricemia occurs when there’s too much uric acid in your blood. Only about a third of people experience symptoms. If uric acid levels remain high, over time they can lead to several diseases, such as gout or kidney stones.

High uric acid levels can lead to several diseases, including a painful type of arthritis called gout. Elevated uric acid levels are also associated with health conditions such as heart disease, diabetes, and kidney disease.

Causes: Uric acid is formed when purines break down in your body. Purines are chemicals found in certain foods. This typically includes:

• red meat
• organ meat
• seafood
• beans

Normally, your body rids itself of uric acid when you urinate. Hyperuricemia occurs when your body either makes too much uric acid or is unable to excrete enough of it. It usually happens because your kidneys aren’t eliminating it quickly enough.

Excess uric acid levels in your blood can lead to the formation of crystals. Although these can form anywhere in the body, they tend to form in and around your joints and in your kidneys. Your body’s defensive white blood cells may attack the crystals, causing inflammation and pain.

Only about one- third of people with hyperuricemia experience symptoms. This is known as asymptomatic hyperuricemia.

Although hyperuricemia isn’t a disease, if uric acid levels remain high, over time they can lead to several diseases like gout, Tophaceous gout, Kidney stones. 

Diagnosis: Medical history and clinical evaluation are the primary diagnostic tools. Blood test and urine test are the laboratory investigations that is used in confirming the diagnosis. Uric acid is normally found in your urine as your body excretes it. A 24-hour urine collection if elevated levels of uric acid are found in your blood. This urine test is then repeated after a purine-restricted diet, which helps in determining whether: 

you’re eating too much high-purine foods: 

your body is making too much uric acid;

your body isn’t excreting enough uric acid. 

In this case report, a 41 year old male patient, who is a known case of Hypertension since 5years presented with pain over the low back region for 6 months associated with pain over the right shoulder region. He had an episode of left shoulder pain in 2015, for which he took ayurvedic treatment and got relief. In 2019, he developed general joint pain, and took allopathic medicines. The symptoms reduced. It was at this time, that an elevated Uric acid was detected in the urine. The biomedical diagnosis was made by the ayurvedic physician, when the patient came for consultation in August 2020. 

Image 1. Lab report at baseline dated 12.8.2020

Treatment & prognosis: The treatment for hyperuricemia will depend on its cause. If hyperuricemia is asymptomatic, treatment isn’t recommended. If hyperuricemia is caused by an underlying cause, then the cause is addressed. This as such, is not life threatening, but this leads to other conditions, over time that can cause serious health issues. These definitely require medical intervention and can become life threatening. 

Reference

• https://www.healthline.com/health/hyperuricemia

AYURVEDA DIAGNOSIS: Paittika Vatarakta 

The biomedical diagnosis of Hyperuricemia cannot be directly correlated to any specific condition mentioned in the classical textbooks of Ayurveda. There are diseases that can be directly linked to the diseases mentioned in the Ayurvedic texts. But sometimes, the diagnosis is such that the physician uses his yukti to create a term for the disease. Though the classical text clearly mentions that giving a name for a disease is not mandatory for treating a condition, here a terminology was given for the purpose of educating the reader. Based on the symptoms, the ayurvedic correlation is made to vatarakta- the specific type being paittika. 

Prognosis- There are basically two types of Vatarakta- Utthana and Gambhira. In the utthana avastha, it is sukhasadhya when supported with the appropriate medications. But in the Gambhiravastha, it is krcchrasadhya.

About vatarakta: 

Nidana & Samprapti: 

प्रायेण सुकुमाराणामचङ्क्रमणशीलिनाम्। अभिघातादशुद्धेश्च नृणामसृजि दूषिते।

वातलैः शीतलैर्वायुर्वृद्धः क्रुद्धो विमार्गगः। तादृशैवासृजा रुद्धः प्राक्तदेव प्रदूषयेत्॥३॥

आढ्यरोगं खुडं वातबलासं वातशोणितम्। तदाहुर्नामभिः———————————॥४॥(AH.Ni.16)

When a person takes excessive foods and exposes to lifestyle activities which aggravate Vata and also is used to long distance rides on animals like elephants, camels, horses, the vata gets severely aggravated by its own causes. On the other hand rakta or blood gets vitiated by the consumption of lavana, amla, katu, kshara etc causes mentioned above. The vitiated rakta quickly blocks the passages of vayu and interferes with its smooth movements. The vata, whose passages are blocked by rakta further undergoes vitiation and further contaminates the rakta or blood. The blood vitiated by vayu later burns the whole blood in the body. The blood contaminated by vitiated Vayu leaves its place and gravitates towards the foot. This vicious amalgamation of vitiated vata and rakta is called vatarakta. This is said to be a dangerous amalgamation which causes serious painful symptoms comprising of a disease called vatarakta. Later the pitta and kapha join this amalgamation and make the clinical picture of the disease even more complicated. 

Lakshana: Here the subtype has been specified as Paittika. 

पित्ते विदाहः सम्मोहः स्वेदो मूर्च्छा मदः सतृट्।

स्पर्शाक्षमत्वं रुग्रागः शोफः पाको भृशोष्मता॥१५॥(AH.Ni.16)

The symptoms in Paittika vatarakta are vidaha, sammoha, sveda, murccha, trt, sparshakshamatva, rug, raga, shopha, paka, and ushmata. 

In this case report, a 41 year old male patient, who is a known case of Hypertension since 5years presented with pain over the low back region for 6 months associated with pain over the right shoulder region. He had an episode of left shoulder pain in 2015, for which he took ayurvedic treatment and got relief. In 2019, he developed general joint pain, and took allopathic medicines. The symptoms reduced. It was at this time, that an elevated Uric acid was detected in the urine. The biomedical diagnosis was made by the ayurvedic physician, when the patient came for consultation in August 2020. The avastha of the condition was not specified by the treating physician. 

Sadhyasadhyata: As this considered to be mild compared to that of the Gambhiravastha, the management is possible, but as this patient had been suffering from the condition since sometime, the chronicity can be attributed to being Kricchrasadhya. In this case report, considering the chronicity of the symptoms, and the pattern of recurrence, it is chronic. So it can be categorised as Kricchra sadhya. 

Line of treatment: 

वातशोणितिनो  रक्तं स्निग्धस्य बहुषो हरेत्।

अल्पाल्पं पालयन् वायुं यथादोषं यथाबलम्॥१॥(AH.Ci.22)

The general line of treatment advocated is raktamokshana, along with the maintenance of the snigdha guna. According to the dosa and the bala, the vitiated vata has to be addressed tactfully. 

Treatment and rationale of treatment as specified by the treating physician: Only Varibaladi Kasaya was prescribed to the patient, and this was chosen considering the anti inflammatory and anti oxidant properties of ingredients in the formulation. 

OUTCOME MEASURES

In this case report, a 41 year old male patient, who is a known case of Hypertension since 5years presented with pain over the low back region for 6 months associated with pain over the right shoulder region. He had an episode of left shoulder pain in 2015, for which he took ayurvedic treatment and got relief. In 2019, he developed general joint pain, and took allopathic medicines. The symptoms reduced. It was at this time, that an elevated Uric acid was detected in the urine. The biomedical diagnosis was made by the ayurvedic physician, when the patient came for consultation in August 2020. 

Assessment: Subjective and objective parameters were assessed to analyse the outcome of the treatment.

Subjective parameters: After 2 weeks of starting ayurvedic medicines, the pain reduced. After 4 weeks of starting the treatment, the patient got complete relief from symptoms. 

Objective parameters: Uric acid was constantly monitored during and after treatment to assess the outcome of the treatment. 

Image 1. Uric acid value during treatment dated 26.8.2020

Image 2. Uric acid value after treatment dated 10.9.2020

The uric acid value at baseline was 8.8. During treatment, it became 7.4 and after treatment, it was recorded 5.2.