:: Rheumatoid Arthritis

RHEUMATISM (originated from the Greek word RHEUMA meaning FLUX) is an indefinite or general term applied to various conditions with pain, swelling and other symptoms that is of articular (related to joints) origin or associated with various aspects of musculo skeletal system. The term ARTHRITIS originated from the Greek word ARTHRON (joint) and ITIS (inflammation), meaning inflammation on joints.
 

CAUSES

The cause of rheumatoid arthritis (RA) is unknown, however the condition involves an attack on the body by its own immune cells (auto-immune disease). This is a progressive disease and results in progressive multiple deformities.

Recent changes in the lifestyle and food habits of man for various reasons have contributed to the increased incidences of RA. Food additives such as taste makers and taste enhancers, which are mostly chemical formulations, are likely to influence one’s blood chemistry. Junk food, extremely spicy and fried food, incompatible and inimical ingredients in the food, irregular food habits etc are likely, in the long run, to contribute to the onset of RA. The human mind also plays a lot in this. Pain is mostly in the mind. Mind also modulates the immune system.

The complications of RA can include joint destruction, gastrointestinal bleeding, heart failure, pericarditis, pleuritis, lung disease, anemia, low or high platelets, eye disease, cervical (neck) spine instability, neuropathy, and vasculitis. Fortunately, improved therapies appear to be reducing the occurrence of these severe complications.

SYMPTOMS

	Fatigue, General discomfort, uneasiness, or malaise, Loss of appetite, Low-grade fever, Joint pain, joint stiffness, and joint swelling often symmetrical.
	May involve wrist pain, knee pain, elbow pain, finger pain, toe pain, ankle pain, or neck pain
	Limited range of motion
	Morning stiffness lasting more than one hour
	Deformities of hands and feet
	Round, painless nodules under the skin
	Skin redness or inflammation, Paleness, Swollen glands
	Eye burning, itching, and discharge
	Numbness and/or tingling

SIGNS

Most of us ignore the early signs and symptoms of RA as insignificant. The onset of the disease is usually gradual, with fatigue, morning stiffness (lasting more than one hour), diffused muscular aches, loss of appetite, and weakness. Pain comes on and off and is unwittingly taken care of with a pain killer tablet bought over the counter from our neighborhood drugstore. Eventually, joint pain appears with warmth, swelling, tenderness, and stiffness of the joint after inactivity. The seriousness of the condition dawns on us only when the joints become swollen. The surface temperature at the joints is perceptibly above the normal body temperature and rashes/flushes may show up as additional symptoms. Pain becomes intense and at times intolerable on certain points of the swollen joints.

Joint involvement in RA usually affects both sides of the body equally -- the arthritis is therefore referred to as symmetrical. Wrists, fingers, knees, feet, and ankles are the most commonly affected joints. Severe disease is associated with larger joints that contain more synovium (joint lining). When the synovium becomes inflamed, it secretes more fluid and the joint becomes swollen. Later, the cartilage becomes rough and pitted. The underlying bone eventually becomes affected. Joint destruction begins 1-2 years after the appearance of the disease. Characteristic deformities result from cartilage destruction, bone erosions, and tendon inflammation and rupture. A life-threatening joint complication can occur when the cervical spine becomes unstable as a result of RA

As the disease progresses, the digits, particularly the toes become deformed, sometimes the foot itself will be turned 90* or more from the line of the ankle. Suppurating wounds are also observed when proper treatment is not resorted to. Ordinary painkillers will not be effective and some of them are contraindicated.

RISK FACTORS

Other features of the disease that do not involve the joints may occur. Rheumatoid nodules are painless, hard, round or oval masses that appear under the skin, usually on pressure points, such as the elbow or Achilles tendon. These are present in about 20% of cases and tend to reflect more severe disease. On occasion, they appear in the eye where they sometimes cause inflammation. If they occur in the lungs, inflammation of the lining of the lung (pleurisy) may occur, causing shortness of breath. Anemia may occur due to failure of the bone marrow to produce enough new red cells to make up for the lost ones. Iron supplements will not usually help this condition because iron utilization in the body becomes impaired. Other blood abnormalities can also be found, for example, platelet counts that are either too high or too low.

Rheumatoid vasculitis (inflammation of the blood vessels) is a serious complication of RA and can be life-threatening. It can lead to skin ulcerations (and subsequent infections), bleeding stomach ulcers (which can lead to massive hemorrhage), and neuropathies (nerve problems causing pain, numbness or tingling).

Vasculitis may also affect the brain, nerves, and heart causing strokes, sensory neuropathies (numbness and tingling), heart attacks, or heart failure.

Heart complications of RA commonly affect the outer lining of the heart. When inflamed, the condition is referred to as pericarditis. Inflammation of heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure characterized by shortness of breath and fluid accumulation in the lung.

Lung involvement is frequent in RA. Fibrosis of the lung tissue leads to shortness of breath and has been reported to occur in 20% of patients with RA. Inflammation of the lining of the lung, called pleuritis, can also lead to fluid accumulation. Pulmonary nodules, similar to rheumatoid nodules, can also develop. Eye complications include inflammation of various parts of the eye. These must be screened for in RA patients.

AYURVEDIC TREATMENT

Chronic RA calls for long term sustained Ayurvedic treatment. In Ayurveda, RA falls under the category of 'Sandhi Vadham’ or 'Ama Vadham'.  As you would have often heard, Ayurveda treats the person and not the disease directly. The interpretation is that Ayurveda believes that any disease is the result of imbalances in the body constitution (Vatha, Pitha, Kapha –the famous Tridosha theory) caused due to various factors by departure from nature norms, and thereby accumulating 'Doshas'. In this case, the aim will be to effect an immune correction to stop further attacks on the joints - presently your own immune system is attacking them……… not a happy situation!

So, what does then Ayurveda do?        The Ayurvedic Doctor adopts a body cleansing/ purification treatment schedule using Pancha Karma procedures (Vamanam, Virejanam, Nasyam, Vasti etc) and then rejuvenates the body with a boosted immune system. This is a very complicated and complex procedure simplistically said in one sentence! It literally dislodges the entire body toxins from its present locations and exits them out. Then with powerful l oral medicines the body constitution is built up anew. Once the body gets its boosted/ corrected immune system, the body itself fights the vitiated Doshas and removes them from the body. Ayurveda thus roots out the disease through the person. This is the underlying philosophy behind Ayurveda.

The individual’s constitutional make up, characteristics of the disease such as its progressive stage, pain, flushes, swelling, deformities and the specific body joints that have been affected are some of the factors that determine the type and course of the treatment. The duration of the treatment cannot be generalized and will be individual specific.
 

PREVENTION

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage of the joints with proper early treatment.

CONCLUSION

There are time tested and proven methodologies and medicines in Ayurveda to treat RA. Along with the treatment, a more organized lifestyle, vegetarianism, suitable physical exercises, Yoga and meditation should be practiced. . The power of mind can overcome any physical aberrations - identifying this fact, we have evolved the Holistic approach to healing. Along with the treatment, Yoga and meditation, medical counseling and stress management effectively contribute towards early recovery. Periodical review of the case can prevent reoccurrence of RA. 

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