Introduction

Juvenile idiopathic arthritis is commonest inflammatory joint disease in children and adolescents, a prevalence of around 48 cases per 100,000 children.^[1] It is defined as arthritis of unknown etiology, which begins before age of 16 years and persists for at least 6 weeks and may persist into adulthood and result in significant morbidity.^[2] The pathophysiology of JIA involves an autoimmune response where body’s immune system attacks its own cells. This process is driven by interactions among immune cells, such as lymphocytes, monocytes, macrophages and neutrophils, along with pro-inflammatory cytokines like interleukins. These interactions lead to an inflammatory response characteristic of JIA. The exact triggers and predispositions for this inflammatory response are influenced by environmental and genetic factors. Infections, genetic susceptibility and stress are commonly associated with JIA determined precise role of environmental factors.^[3] Symptoms include swollen, stiff, and painful joints in knees, hands, feet, ankles, shoulders, elbows or other joints, often in morning or after a sleep; fatigue, decreased appetite, poor weight gain, and slow growth. Nonsteroidal anti-inflammatory drugs (NSAIDs), Disease Modifying Anti-Rheumatic Drugs (DMARDS), corticosteroids and biological agents can give temporary relief. Ayurvedic treatment involves Doshika Ama Pachana (digestion specify to Dosha), and Rasayan Chikitsa is applicable to relieve swelling, stiffness, pain and fatigue.

Case Report

A 9‑year‑old male child of juvenile idiopathic arthritis was brought OPD of Kaumarbhritya department with complaints of pain in multiple joints especially in lower limbs, morning stiffness, difficulty in climbing up stairs and back pain with diagnosed case of juvenile idiopathic arthritis in last 2 months. He was advised on corticosteroid therapy (Tab. Wysolone) for one month but didn’t get relief. He was admitted in IPD of Kaumarbhritya department in January 24 for 30 days for Ayurveda Panchakarma Procedures.

Clinical findings:

On examination, swelling observed on both knee and ankle joints, no tenderness. Morning stiffness was present.

The patient has Kapha‑dominant Prakriti and Kapha Prakopaka Kala (Shishir Rutu). Hence, initial Kapha Shamaka & Rasayana therapy, were done. (Table 2)

Pathya:

Light diet like rice, Mudga Dal, Mudga preparations, Khichadi, green vegetables, boiled vegetables soup and boiled water.

Observations and Results

Laboratory Investigations

Follow-up

Symptoms such as pain in multiple joints especially in lower limbs, morning stiffness, difficulty in climbing up stairs and back pain were completely resolved. No swelling was observed in joints.

Discussion

Therapeutic aim is to reduce joint pain and morning stiffness by reducing joint swelling. The drug Pippali has been selected and administered in Vardhanana Krama to yield its Agni Deepana, Dosha Pachana with Rasayana Karma. Vardhaman Pippali Rasayana is indicated treating Shopha and Vatabalasaka Avastha by Acharya Charaka.^[4]

Vardhamana Pippali Krama works here as Rasayana therapy along with Deepana Pachana Karma by this during therapy patient’s strength has increased and felt energetic.

Pippali has been shown to have immunomodulatory effects regulating the immune system by potentially stimulating immune responses through mechanisms like activating macrophages and enhancing phagocytosis, making it a potential immune booster.^[5] Valuka Swedana reduces stiffness in joints as external therapy.^[6]