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TITLE OF CASE

Successful Ayurvedic management of Osteoarthritis- a case report

Dr Partap Chauhan

ABSTRACT

A 73-year-old female patient  presented with multiple joint pain on & off without any specific trigger factors for 4 years. Condition got aggravated in the last 1 year.  The associated symptoms are severe abdominal bloating, incomplete bowel evacuation even with laxatives and disturbed sleep. She is a known hypertensive, and is on regular allopathic medication. She took ayurvedic medicines for knee pain for 3 years and got significant relief. But for the presenting complaints, there has been no prior consultation or treatment. The patient approached Dr Partap Chauhan for better Ayurvedic management. On examination, there was pain and swelling in both knees. Based on the clinical examination and X-Ray of the knees findings, the biomedical diagnosis was made as Osteoarthritis and Ayurvedic diagnosis as sandhivata. The line of treatment followed was Vatanulomana, vatapitta shamana, sroto shodhana and ama pacana. Within 1 month of starting treatment, there was a significant reduction in pain and swelling. In 7 months, only mild constipation and bloating persisted. In 11 months, the dose of the anti-hypertensive drugs could be tapered. VAS recorded as 7 at baseline for multiple joint pain reduced to 2 at endpoint. In 1 year and 10 months, the patient got complete relief from all the symptoms. Repeated Xray taken revealed improvement. This case report demonstrates the integrative management of Osteoarthritis in a patient who had been suffering from this condition since 4 years and was worsening.

KEYWORDS

Osteoarthritis, ayurveda, case report, sandhivata

INTRODUCTION

Osteoarthritis (OA) is a common form of arthritis that often affects the knee. In the early stages, there may not be any symptoms. In the later stages, however, they experience pain, stiffness and even restricted movements. Grating sensation, bone spur, tenderness and swelling are also common symptoms of OA knee. If left untreated, the symptoms worsen over time.

OA of the knee affects the bones, cartilage, and synovium in the knee joint. Though the knee is reported to be the most common condition, OA can also affect other joints like the pelvis, shoulder etc..,

Diagnosis; Medical history and clinical evaluation are the main diagnostic criteria. But imaging like Xray, and MRI may be suggested to assess the intensity of the damage. Blood tests may be suggested to rule out conditions like gout or rheumatoid arthritis.

Treatment: In a mild presentation, acetaminophen or over-the-counter medicines may be sufficient to relieve the pain. In moderate to severe presentation, prescription painkillers, corticosteroid injections, physical therapy or even surgery may be required.

Prognosis:The effect of osteoarthritis of the knee can’t be reversed. But treatment and self-care can help relieve the symptoms and slow the condition’s progress. Medications may be always required to manage the pain. Exercise and physical therapy help in improving the quality of life.

PATIENT INFORMATION

The patient is a 73-year-old female patient who is a known case of Hypertension, presented with multiple joint pain on & off without any specific trigger factors for 4 years. Condition got aggravated in the last 1 year. The associated symptoms are severe abdominal bloating, incomplete bowel evacuation even with laxatives and disturbed sleep. There was no prior consultation or treatment for the specific complaints. She had a history of knee pain 3 years back and with regular ayurvedic medication (2017- 2020) got significant relief from the symptoms.  

No relevant family/genetic/surgical history.

Psychosocial history- Stressed due to the illness

CLINICAL FINDINGS

On examination of the Locomotor system:

Swelling over both  knees 

Tenderness over Medial aspect of both knees - Grade 3

Muscle Power- 4+

Crepitations present over both knees R>L 

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; Based on the clinical examination and X-Ray findings, the biomedical diagnosis was made as Osteoarthritis.

Table 1. Symptoms at baseline

 

Symptoms	March 2021
Multiple Joint pain	++++
Stiffness	++++
Gas/Bloating	++++
Constipation	++++
Disturbed Sleep	++

Table 2. Grading was done for Joint pain and the symptoms

Chief Complaints	Grading parameters	Before Treatment
Multiple Joint Pain	VAS scale	High VAS- 7/10
Stiffness of Small Joints of hands and Foot	H/M/L	High
Constipated Bowel+ Abdominal bloating	H/M/L Agni- Vishama/Manda/Sama	High Agni-Vishama
Sleeplessness	H/M/L Duration Quality- Onset-	High- 4Hrs- Disturbed/late onset Poor quality

Image 2. Old X Ray dated 30.12.2018

Image 3. X Ray at baseline dated 2019

Bilateral genu valgus deformity seen with reduction of bilateral tibio-fernoral joint space more prominent in the lateral compartment. Impression- Bilateral knee osteoarthritis.

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

Differential Diagnosis- 

Rheumatoid arthritis

Psoriatic arthritis

Crystalline arthritis

Bursitis

Tendinitis: Based on the clinical examination and X-Ray findings, the condition was diagnosed as Osteoarthritis and Ayurvedic diagnosis as sandhivata. 

Prognosis- Osteoarthritis has no cure and the treatments are given for arresting the progression of the condition and to prevent the deformity. In this case report, patient got relief from all the symptoms. In the repeat X-Ray both knee, Tibio femoral and patello-femoral joint space appears normal with degenerative changes in both knees

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 6 follow ups in total. Each follow up, the symptoms of joint pain, stiffness, bloatedess, constipation and sleep were assessed and tabulated.  

Subjective parameters: The changes observed in the symptoms were noted date wise, and tabulated. 

Table 2. Symptoms tabulated throughout the ayurvedic treatment

 

Symptoms	March 2021	April 2021	Oct 21	Jan 22	Aug 2022,	Jan 2023,
Multiple Joint pain	++++	+++	+++	+	+	Absent
Stiffness	++++	++	+++	+	Absent	Absent
Gas/Bloating	++++	+++	++	+	Absent	Absent
Constipation	++++	++	+	+	+	Absent
Disturbed Sleep	++	+	++	Normal	Normal	Normal

Table 3. The Blood pressure of the patient was recorded date wise. 

DATE	BLOOD PRESSURE READINGS
18-3-21	128/80mmhg
17-5-21	110-78mmhg
23-6-21	134/78mmhg
25-7-21	130/84mmhg
28-8-21	124/80mmhg
2/3/22	132/68mmhg
31-02-2022	128/78mmhg

 

Due to the decrease in the blood pressure, the anti-hypertensive medicines could be tapered after 10 months of ayurvedic medicines. 

Clinician-based assessment; Patient stopped all medications except antihypertensive medication. Patient got relief from all the symptoms. In the repeat X-Ray both knee- (15/12/2021) - Tibiofemoral and patello-femoral joint space appears normal with degenerative changes in both knees. 

Image 3. X Ray during treatment dated 15.12.2021    

Patient-assessed; 

Table 4: VAS was recorded at baseline and at endpoint. Grading was given for symptoms.

Chief Complaints	Grading parameters	Before Treatment	During Treatment	Completion of Treatment
Multiple Joint Pain	VAS scale	High VAS- 7/10	M VAS-3/10	Low 2/10
Stiffness of Small Joints of hands and Foot	H/M/L	High	M	Low to Nil present for 5 mins in the early mornings
Constipated Bowel+ Abdominal bloating	H/M/L Agni- V/M/S	High Agni-V	Low Agni- Sama	Absent - No Bloating, getting clear bowels-feels light
Sleeplessness	H/M/L Duration Quality- Onset-	High- 4Hrs- Disturbed/late onset Poor quality	Medium 4Hrs Slightly better /	Good improvement 4-5 Hrs undisturbed Feels fresh Getting sleep immediately on going to bed

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

Method of assessment- Subjective and objective parameters were the main assessment tools. 

Adverse and unanticipated events; None reported

DISCUSSION: 

Osteoarthritis (OA) is a common form of arthritis that often affects the knee. In the early stages, there may not be any symptoms. In the later stages, however, they experience pain, stiffness and even restricted movements. Grating sensation, bone spur, tenderness and swelling are also common symptoms of OA knee. If left untreated, the symptoms worsen over time. The effect of osteoarthritis of the knee can’t be reversed. But treatment and self-care can help relieve the symptoms and slow the condition’s progress. Medications may be always required to manage the pain. Exercise and physical therapy help in improving the quality of life. In this case report, the patient is a 73-year-old female patient who is a known case of Hypertension, presented with multiple joint pain on & off without any specific trigger factors for 4 years. Condition got aggravated in the last 1 year. The associated symptoms are severe abdominal bloating, incomplete bowel evacuation even with laxatives and disturbed sleep. With ayurvedic treatments, in 1 year and 10 months, the patient got complete relief from all the symptoms. He could also taper the regular anti-hypertensive medicines that he was taking. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case report demonstrates the efficacy of Ayurvedic management in Osteoarthritis. In this case report, patient got relieved from all the symptoms . In the repeated X-Ray both knee,  tibio femoral and patello- femoral joint space appears normal with degenerative changes in both knees

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. https://www.medicalnewstoday.com/articles/310579