Understanding Rheumatoid Arthritis and Gout w.s.r. to Amavata and Vatarakta

Anubhav; Pankaj Sharma; Vikas Bhardwaj

Understanding Rheumatoid Arthritis and Gout w.s.r. to Amavata and Vatarakta

Anubhav.^1*, Sharma P.², Bhardwaj V.³

DOI:

^1* Anubhav, Post Graduate Scholar, Department of Dravyaguna, Government Ayurvedic College, Patiala, Punjab, India.

² Pankaj Sharma, Lecturer, Department of Kayachikitsa, Government Ayurvedic College, Patiala, Punjab, India.

³ Vikas Bhardwaj, Associate Professor, Department of Samhita Sanskrit and Siddhant, SAHMC, Mohali, Punjab, India.

The term arthritis itself is being used to describe more than 100 rheumatic diseases and conditions that affect joints, tissues surrounding joints and also connective tissues. These diseases have a deep impact on lifestyle of people affected and increase their “Years Lived with Disability”. With early diagnosis and appropriate management arthritic patients can be saved from pain and functional deformity, so that they can remain functional and productive during their life and also their health expenditure can be reduced. In Rheumatoid arthritis the immune system of our body which is designed to protect our body from various diseases attacks the body’s own cells causing damage to body. As for the Gouty arthritis the values of Uric acid increase in body. Gout is a treatable condition but if ignored for a longer period it can cause extremely painful condition with deformity in joints. Factors like Smoking, obesity, overuse of knee joints in Indians like sitting in squat position, Indian way of defecation, use of certain medicines like diuretics etc. increases the chances of RA and Gout. 10 0ut of 100 RA patients have at least one relative suffering from the same disease. Gout is more common in men; the ratio is 9:1 with respect to women.

Keywords: Amavata, Vatarakta, Rheumatoid arthritis, Gout

Corresponding Author	How to Cite this Article	To Browse
Anubhav, Post Graduate Scholar, Department of Dravyaguna, Government Ayurvedic College, Patiala, Punjab, India. Email:	Anubhav, Pankaj Sharma, Vikas Bhardwaj, Understanding Rheumatoid Arthritis and Gout w.s.r. to Amavata and Vatarakta. J Ayu Int Med Sci. 2022;7(3):136-139. Available From https://jaims.in/jaims/article/view/1784

Introduction

The life expectancy of Indians has increased by double since independence. Due to the added years and lifestyle changes, many problems are on the verge of increase like Diabetes, Cardiac problems, Obesity, Musculoskeletal diseases like arthritis. The term arthritis itself is being used to describe more than 100 rheumatic diseases and conditions that affect joints, tissues surrounding joints and also connective tissues. These diseases have a deep impact on lifestyle of people affected and increase their “Years Lived With Disability”^[1] With early diagnosis and appropriate management arthritic patients can be saved from pain and functional deformity, so that they can remain functional and productive during their life and also their health expenditure can be reduced.

Rheumatoid arthritis and Gout^[2,3]

Rheumatoid arthritis, at first its cause remained diagnosed and it was kept under unknown arthritic diseases. But with advancement of science RA has been grouped under autoimmune diseases. In this condition the immune system of our body which is designed to protect our body from various diseases attacks the body’s own cells causing damage to body. In RA the antibody IgM is found in increased numbers. This disease first affects the synovial membranes of the joints causing inflammation and related symptoms like redness, swelling, leading to restriction of degree of movements. In RA the joints involved are large joints and it has mirror effect such that same joint is affected on both sides of body.

As for the Gouty arthritis the values of Uric acid increase in body. Uric acid is a side product of metabolism of foods which are rich in purines e.g. meats. Our body gets rid of this uric acid in normal conditions but sometimes uric acid starts accumulating in our body. This condition can occur due to two main reasons, either body being unable to get rid of uric acid produced in the body or body starts producing excessive of uric acid. This excessive uric acid starts accumulating in our body especially synovial membranes and this triggers our immune system leading to synuvitis. Gout is a treatable condition but if ignored for a longer period it can cause extremely painful condition with deformity in joints leading to decreased functioning and dependency.

Gout mainly affects the small joints first. This can be warning sign as well as wake up call for consulting a doctor and avoid delay.

Prevalence of Rheumatoid arthritis and Gout^[4,5]

RA is prevalent in 1% population in India whereas the Gout has a prevalence of about 0.3-0.6% of total population.

There are many other factors affecting prevalence of these;

Age: The onset of RA is seen in the age group of 20- 40 years of age while Gout is known as the old age disease occurring in the decades of 40 to 60.

Genetics: 10 0ut of 100 RA patients have at least one relative suffering from the same disease and with monozygotic twins this ratio increases to 25 out of 100. While in case of Gout it usually runs in the family.

Sex: Women are three times more prone to RA than men but with increasing age this difference starts to diminish.

In contrast to this, Gout is more common in men, the ratio is 9:1 with respect to women. But after menopause this gap reduces a lot.

Others: Factors like Smoking, obesity, overuse of knee joints in Indians like sitting in squat position, Indian way of defecation, use of certain medicines like diuretics etc. increases the chances of RA and Gout.

Early warning signs in RA and Gout^[6]

In RA our body starts showing some early signs by looking at these we can avoid the delayed diagnosis and deformity.

Fatigue, slight fever, unexpected weight loss, stiffness, tenderness, pain, swelling and redness of joints, numbness and tingling, decreased range of motion and early morning stiffness, also joints are affected on the both sides.

For Gout we can look for hot and tender joints, swelling, red shinning skin over the affected joint, itching and peeling of skin, symptoms develop rapidly and last as a spell up to 10 days.

If these early signs are ignored the joints involved will get deformed and can affect other body organs too.

Similarities of Amavata and RA^[7]

Ayurvedic science mentions a disease named Amvata which resembles in symptoms with RA. According to Madhav Nidan, book of diagnosis in Ayurveda Amvata is caused by Ama and vitiated Vata in body. Ama is the end result of improper or incomplete digestion of food and this Ama formed is carried away by the vitiated Vata in the whole body. During circulation in the body this Ama gets deposited in Shleshmak Kapha Sthan or joints, causing local as well as systemic symptoms like Angamarda (pain), Aruchi (loss of interest in food), Trishna (thirst), Alasya (inaction), Gaurava (feeling of heaviness), Jwara (fever), Anga-Shunayata (numbness), Sandhiruk (joints pain) etc. The pain in joints is correlated with the pain of scorpion bite in Amavata as the pain is unbearable for the patient.

Similarities of Vatarakta with Gout^[8]

Vatarakta is a condition caused by vitiation of Vata Dosha and Rakta by their individual etiologies like exercising after heavy meals. The vitiated Rakta obstructs the path of Vata which ultimately mixes with Rakta and increases its volume. This vitiated Rakta starts moving in body and causes inflammatory changes in joints like redness, heat, itching etc. It can be a very painful condition, during which patient is unable to do his/her day-to-day normal work. This starts from small joints and then spreads to other joints too.

Vatarakta has been mentioned of two types: Uttana (Acute), in this the symptoms occur related to skin and other is Gambhir (Chronic), showing symptoms related to deep tissues like involvement of bones and joints with pain, deformation of joints (tophi formation in joints), tenderness etc.

Management of Amavata and Vatarakta in Ayurveda

Amavata ^[9,10]

Line of treatment to be followed in Amvata is Aptarpan, Langhan, Pachan, Doshavsechan - Virechan, Swedan - Ruksha Swedan, Vasti - Kshar Vasti, Pathya Ahar Vihar.

Formulations which can be used in Amvata as mentioned on the National Health Portal of India:

1. Ajmodadi Churna: 1 to 3 g., to be taken with 50 ml. warm water twice a day.

2. Vaishvanara Churna: 3 to 6 g. is to be taken with 50 ml. warm water twice a day.

3. Guduchyadi Kvatha: 14 to 28 ml. to be taken twice a day.

4. Maha-Rasnadi Kvatha: 28 to 56 ml. to be taken before meal twice a day.

5. Rāsna-Dashamula Kvatha: 14 to 28 ml. to be taken with Eraṇḍa Taila (castor oil) – 7 to 14ml. once a day early in the morning.

6. Rasnadi Kvatha: 14 to 28 ml. to be taken twice a day.

7. Hiṅgulesvara Rasa: 1 to 2 pills, to be taken with 50 ml. warm water twice a day.

8. Maha Yogaraja Guggulu: 1 to 2 pills, to be taken with 50 ml. warm water thrice a day.

9. Yogaraja Guggulu: 1 to 2 pills, to be taken with 50 ml. warm water thrice a day.

10. Siṁhanada Guggulu: 1 to 2 pills, to be taken with 50 ml. warm water thrice a day.

11. Vishamushtika Vaṭi: 1 to 2 pills, to be taken with 50 ml. warm water twice a day.

12. Eraṇḍa Paka: 12 to 24 g., to be taken with 50 ml. warm water once a day.

For local applications

1. Viṣagarbha Taila: to be applied on the affected joint.

2. Eranda Tail: is also used for local application.

Vatarakta^[11]: In vatarakta the patient is given snehapana first and when sneha sidhi lakshan are seen then mild virechana is used in the patient. Vasti is also used to treat the vitiated vata dosha in body. Along this treatment seka (affusion), abhyanga (massage) and preadeha (thick ointments) can be used to relieve local symptoms.

Raktamokshan (blood letting) is done with the help of leech, but it should be done with care as excessive blood loss can cause lameness, vata related diseases and even death.

Guduchi (Tinospora cordifolia) is the drug of choice for vatarakta according to charak. Aslo in formulations Kaishor Guggul is used as it helps in metabolism of uric acid in body and relieves Vatarakta.

Line of treatment for Uttana vatarakta is Lepa (medicinal overcoat), Parisheka (sprinkling of medicinal decoctions), Avagahana (to immerse affected part in medicinal decoctions), and for Gambhir Vatarakta, Snehapana (administration of medicated fats), Virechana (purgation) and Vasti (enema) is done.

Eranda Tail (castor oil) is recommended for Virechana as it helps to digest ama in body and relieves constipation.

Pathya and Apathya in Amavata

Rakta shali (a variety of rice), yava, adrak (ginger), rason (garlic), patol (Trichosanthes dioica), punarnava (Boerhavia diffusa) and shigru (Moringa oleifera) are good for the Amavata patients.

Whereas guru (heavy to digest), abhishyandi (coating in nature), milk, curd, incompatible eating, excessive eating, suppression of calls of nature, etc. are harmfull for amavata patient.

Pathya and Apathya in Vatarakta

Guda haritaki, ginger, spinach, karela, cow milk, plenty of water and liquids to drink, fiber rich food etc. are good in vatarakta.

Use of masha (Vigna mungo), kulatha (Macrotyloma uniflorum), curd, sleeping during daytime, exposure to heat, use of alcohol and meat are to be avoided in vatarakta

Discussion

These Arthritic diseases can have physical, mental as well as financial burden on the person affected. They reduce the productivity of person and increase the dependency on others. Ayurveda has a ray of hope in control of these diseases. With Ayurveda we can look forward to slow down their progress and delay the deformation effects on joints.

Conclusion

Leading a healthy lifestyle with right time and amount of eating, sleeping, exercising, meditating, all these can help us gain a good health. And Ayurveda has always lent a helping hand to those who need help. Ayurveda with its principal of reaching the root cause and eliminating it can help in reducing the number of Years Lived with Disability.

Reference

1. Nethan S, Sinha D, Mehrotra R. non communicable disease risk factors and their trends in India.Asian Pac J Cancer Prev APJCP.2017;18:2005-2010.

2. Avinash Jain et al, Delay in seeking medical help in patients with rheumatoid arthritis in India: A qualitative study, International journal of Rheumatic Diseases, 17,October,2020

3. Manjunath premnath, Acute gout–A harbinger for more serious outcome, APIK Journal of Internal Medicine, year:2022, Volume:10, Issue:1, Pag: 3-7

4. A.N.Malaviya et al, Prevalence of rheumatoid arthritis in the adult Indian population, Rheumatology International, Nov. 1993

5. Himanshu Patel, Dhiren Shah, Hyperuricemia prevalence in Indian subjects with underlying comorbidities of hypertension and/or type 2 diabetes: a retrospective study from subjects attending hyperuricemia screening camps, International Journal of Research in Medical Sciences, Jan-2020

6. Jacqueline bullock, et al, Rheumatoid Arthritis: A Brief Overview of the Treatment, Medical Principles and Practice, published online 2018 sept. 2

7. Madhav Nidan madhukosh vyakhya by Ayurvedacharya Sudarshan Shastri, Chaukhamba Sanskrit sansthan, Varanasi, edition 2002, Ch. 25, Amavata nidana

8. CharakSamhita- Vaidyamanorama- hindi vyakhya, part 2, Acharya Vidhyadhar Shukla, Prof. Ravidutt Tripathi, Chaukhamba Sanskrit Pratishthan, Delhi, edition 2005, Ch. 29, Vatashonitchikitsa adhyaya

9. https://www.nhp.gov.in/amavata-%E0%A4%86%E0%A4%AE%E0%A4%B5%E0%A4%BE%E0%A4%A4_mtl

10. Chakradata, Savimarsha bhavarthasandeepani, Shri jagadishwar Prasad tripathi, Chaukhamba sasnskrit series office, Varanasi, third edition 1961, Ch. 25, Atha Amavata chikitsa

11. CharakSamhita- Vaidyamanorama- hindi vyakhya, part 2, Acharya Vidhyadhar Shukla, Prof. Ravidutt Tripathi, Chaukhamba Sanskrit Pratishthan, Delhi, edition 2005, Ch. 29, Vatashonitchikitsa adhyaya

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-02-24	2022-02-26	2022-03-05	2022-03-12	2022-03-19
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

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