Featured Case

MODERN DIAGNOSIS: Osteoarthritis bilateral knee- KL grade- 2

ABOUT THE DISEASE:

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.

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.

In this case report, the patient is a 46-year-old male who suffered from bilateral knee joint pain and swelling for 3 years. He also complained of stiffness of the knee joint along with the crackling sound during movements. The patient took NSAIDs for 4 months and got relief. But when the medicines were stopped, the condition relapsed. He tried physiotherapy also, but the symptoms persisted.

The diagnosis was done based on the clinical evaluation, lab investigations and imaging. It was grade 2 OA.

Image 1. X Ray of the bilateral knee taken prior to starting the treatment is added below

Table 1. Assessments done at baseline are added below

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.

Reference

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

Image 1. X-Ray bilateral knee was taken prior to starting the ayurvedic treatments

AYURVEDA DIAGNOSIS: Janusandhigata vata

ABOUT THE DISEASE:

The classical term 'Janu Sandhigata Vata' in Ayurveda can be correlated with Osteoarthritis (OA) of the knee joint. It is one such chronic, degenerative, inflammatory disease which has a great impact on the quality of life of an individual. Present day activities are prone to cause many life deteriorating conditions. Food, lifestyle and environment are three important determinants related to the cause of disease. Sandhigatavata is one among the vatavyadhi. This is highlighted as a degenerative disease under the concepts of dhatu saithilya and dhatu kshaya. Acarya Charaka has used the term Sandhigata anila in Vatavyadhi Ciiktsadhyaya.

The word 'Gata' denotes movement or carrying something along with or to reach a particular site through any particular pathway. The knees are the most weight-bearing joint, and hence get affected very fast. The presentation of this pathogenesis is seen as Janu Sandhigata Vata.

Symptoms: The disease has no specific purvaroopa. But the clinical signs and symptoms include joint pain (Sandhi vedana), Sandhi Shotha (Swelling), Vatapurna druti sparsha, pain and tenderness during the movements of the joints (Prasarana akunchana pravrutisavedana), cracking sounds (Atopa) and degeneration of the joint (Hanti sandhi).

In this case report, a 46-year-old male patient suffered from bilateral knee joint pain and swelling for 3 years. He also complained of stiffness of the knee joint along with the crackling sound during movements. Six months back the patient took conventional treatments like NSAIDs and physiotherapy. But the symptoms persisted and for further management, he consulted Dr Dudhmal. Based on physical examination and radiological findings the biomedical diagnosis was made as Osteoarthritis of bilateral knee joint - KL grade- 2. The ayurvedic diagnosis was Janusandhigata vata. The line of treatment adopted was Agnikarma with electrocautery. Follow up internal medications were given to be continued until last follow up.

Samprapti: No direct references for samprapti of janusandhigatavata is found. The general Samprapti of Sandhivata – Vatavyadhi can be applied for Janusandhigata vata. When vitiated Vata dosha gets Sthana Samshraya in Janusandhi, it causes pain and inflammation in the knee joints and in later stages dislocation and loss of function of the joint of the knee.

Treatments: The treatment of Janusandhigata vata is aimed at reducing the Vata dosha and balancing the shleshaka kapha so that the joint spaces are adequately lubricated for the free movement of the knee joints. For this many procedures have been mentioned like snehana, swedana, mridu samshodhana, Basti and vatahara aushadha prayoga, Ahara and Vihara. In some texts, practices of upanaha, agnikarma, bandhana, mardana etc are also described. Different Ghritas, Guggulu, Shallaki preparations are used for Internal medicines.

Reference:

1. Janu sandhigatavata: a comprehensive review of the ayurvedic literature. Biswajit and rabindranath. International journal of scientific research. Volume - 9 | issue - 11 | November - 2020 | print ISSN no. 2277 - 8179 | doi : 10.36106/ijsr

OUTCOME MEASURES

A 46-year-old male patient suffered from bilateral knee joint pain and swelling for 3 years. He also complained of stiffness of the knee joint along with the crackling sound during movements. Six months back the patient took conventional treatments like NSAIDs and physiotherapy. But the symptoms persisted and for further management, he consulted Dr Dudhmal. Based on physical examination and radiological findings, the biomedical diagnosis was made as Osteoarthritis of bilateral knee joint - KL grade- 2. The ayurvedic diagnosis was Janusandhigata vata. The line of treatment adopted was Agnikarma with electrocautery.

Assessment criteria: Both subjective and objective criteria were used for assessing the outcomes.

Subjective parameters: There was a significant improvement in the pain and swelling noted after 4 sittings of agnikarma.

Table 1. The VAS, stiffness and crepitus noted before and after treatment added below

Objective parameters: The swelling is relieved. There was a significant improvement in the range of movements in the right and left knee.

Table 2. The Range of movements (ROM) measured with Goniometry recorded before and after treatment was added below

Disease modifying effect: The patient is in remission.