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TITLE OF CASE

Successful Standalone Ayurvedic management of Osteoarthritis of bilateral knees- a case report 

Dr Partap Chauhan

ABSTRACT

A 66 year old male patient presented with bilateral knee joint  pain, right greater than left since 3 months associated with crepitation in right knee joint and difficulty in climbing stairs since 1 month . Patient also had low back stiffness since 30 years. He had tried ayurvedic medicines for 2 months. As there was no relief, the patient approached Dr Partap Chauhan for a second ayurvedic consultation. Based on the ACR criteria for early diagnosis of Osteoarthritis of the knee, the treating physician made the biomedical diagnosis as osteoarthritis of knee and Ayurveda diagnosis as Sandhivata. The line of treatment planned was to pacify the primary vitiated dosa- vata and primary symptom- vedana. Apart from this, rakta shodhana, deepana, pacana, and recana dravya were included in the treatment. the After 4 months of Ayurvedic treatment, the patient attained complete relief from the knee joint pain and crepitus. He could climb the stairs without any pain. The persisting low back stiffness since 30 years had significantly reduced after the treatment. The WOMAC scale assessment score before treatment was 64, which was reduced to 1 after treatment. This case report demonstrates the successful standalone ayurvedic management of osteoarthritis – knees in an elderly male, who did not get relief with conventional medicines.  

KEYWORDS

Osteoarthritis, sandhivata, sandhigat vata, bilateral knees, standalone, case report, janu

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 66 year old male patient presented with bilateral knee joint  pain, right greater than left since 3 months associated with crepitation in right knee joint and difficulty in climbing stairs since 1 month . Patient also had low back stiffness since 30 years. He had tried ayurvedic medicines for 2 months. As there was no relief, the patient approached Dr Partap Chauhan for a second ayurvedic consultation. Based on the ACR criteria for early diagnosis of Osteoarthritis of the knee, the treating physician made the biomedical diagnosis as osteoarthritis of knee and Ayurveda diagnosis as Sandhivata. 

No relevant family/genetic/surgical or psychosocial history.

CLINICAL FINDINGS

General examination                                                               

Locomotor system examination

Important clinical findings:

Vitals- Normal (GALS assessment)
(i)   Gait  (G):   Patient feels pain during walking at ankle joints and no pain at turning back.
 (ii) Arms (A):   Patient feels no pain in arm swinging and other movements.
(iii) Legs (L):   Patient feels pain and stiffness at knees during bending and walking movements and at ankle joints during walking.
(iv) Spine (S):   Patient feels stiffness in the lower back during tilting forward movements.

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.

Image 2. Diagnosis proof ACR Criteria for Osteoarthritis Knee at baseline

Image 3. WOMAC Scale documented at baseline 

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

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- The prognosis for osteoarthritis patients depends on the joint involved, how many joints are involved, and the severity. There is no cure for osteoarthritis, and all the currently available treatments are directed towards reducing symptoms. In this case report, after 4 months of treatment, the patient got complete relief  from the knee joint pain and crepitus. The persisting low back stiffness since 30 years had significantly reduced after the treatment. 

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 1. Symptoms tabulated throughout the ayurvedic treatment

DATE	OBSERVATION OF SYMPTOMS
09/05/23	Slight reduction in Knee joint pain and crepitus, low back stiffness
12/06/23	Significant reduction in knee joint pain and crepitus. Pain- present while climbing stairs. Low back stiffness- reduced
16/7/23	Knee joint pain- occurs rarely. Crepitus- absent. Low back stiffness- reduced
19/08/23	Completely relief from knee joint pain Low back stiffness- significantly reduced. Patient could climb stairs without pain

Clinician-based assessment; After 4 months of treatment, the patient got complete relief from the knee joint pain and crepitus. He could climb the stairs without any pain. The persisting low back stiffness since 30 years had significantly reduced after the treatment. 

Patient-assessed; WOMAC Scale was recorded at endpoint 

Image 4. WOMAC Scale documented at endpoint

WOMAC Scale was recorded as 64 at baseline became 1 at endpoint. 

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. Here the ayurvedic diagnosis was Sandhivata, and the line of treatment followed was vata shamana and vedan shamana. Apart from this, rakta shodhana, deepana, pacana, and recana dravya were included in the treatment. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case highlights the efficacy of ayurveda in treating osteoarthritis in a patient who had been suffering from this condition with restricted mobility in day-to-day life. The patient attained a symptom-free condition with the standalone ayurveda treatment.

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