ARTHRITIS is not a single disease. It describes more than 100 conditions that include inflammation and damage in the joints, the tissues around the joints and connective tissues. Arthritis is the inflammation of one or more joints. Osteoarthritis is the most common form of arthritis.
More than 350 million people have arthritis globally. Around 23.46 million individuals in India had O.A in 1990; this increased to 62.35 million in 2019. The age standardized prevalence of OA increased from 4,895 in 1990 to 5,313 in 2019 per 1,00,000 persons. The prevalence and incidence for osteoarthritis and knee osteoarthritis were consistently higher in females than males.
The impact of osteoarthritis in India is increasing. Suitable measures should be adopted to control and prevent the risk factors of osteoarthritis. Ayurveda treatment for Arthritis plays an important role in managing the symptoms of arthritis.
CAUSES OF ARTHRITIS
- Obesity and Overweight – Over weight will be an added factor for degeneration of weight bearing joints like knee joint. Obesity causes added strain on joints.
- Weak muscles- under nourishment can cause weakness of muscles which results in decreased strength of joints.
- New or old injuries – injuries to joints or bones can result in arthritis and swelling. E.g. sports injury.
- Auto immune disorder – a fault in the immune system that causes the body to attack its own tissues in the joints.
- Hereditary or family history- arthritis can be inherited for example arthritis caused by a metabolic condition such as gout.
- Increasing age – as age progresses wear and tear of joints are common. The bones become more brittle leading to increased risk of fracture.
- Over use of legs affects joints activities that involve repetitive movements of a particular joint e.g., athletes, tailor
- Infection – Arthritis caused by an infection is called ‘reactive arthritis’. It is very difficult to diagnose and can develop at any age.
SYMPTOMS OF ARTHRITIS –
The symptoms of arthritis include:
- Joint pain – Pain in joints is experienced while moving joints.
- Stiffness on joints – Difficulty in joint movement mainly in the morning.
- Tenderness – Soreness while touching joints.
- Cracking sound – Sound heard from joints on joint movements because of friction between bones.
- Bone spurs – Lumps of bone form around the joint.
- Swelling on joints – Swelling on joints which makes movement difficult.
- Redness on joints – Swelling on joints associated with redness.
- Disability to move far – Difficulty in walking for long distances.
- Fever – In rheumatoid arthritis the patient may suffer from fever.
- Joint Deformities – In severe cases of rheumatoid arthritis it may cause deformities to joints namely ulnar deviation, swan neck deformity etc.
- Weight loss
- TYPES OF ARTHRITIS – The 3 most common types of arthritis are
- OSTEOARTHRITIS
- RHEUMATOID ARTHRITIS
- GOUTY ARTHRITIS
Other types are
- JUVENILE ARTHRITIS
- ANKYLOSING SPONDYLITIS
- SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
- SCLERODERMA
- OSTEOARTHRITIS – Women are more likely to develop osteoarthritis than men. It is more prevalent in people who are above the age of 40 or who have previously injured a joint.
It is a chronic condition in which the joints become inflamed and damaged. The bones in the joints rub together which results in damage of joints and reduction in space between bones and causes pain, swelling, stiffness and reduced movements.
The mainly effected joints are knee joint, hip joint, finger joint and big toe. The symptoms include joint pain, joint stiffness, restricted joint movements, cracking sound on joint movements and less joint flexibility than before.
The main causes of osteoarthritis are being overweight, previous injury to joint, frequent kneeling, climbing and squatting, heavy weight lifting etc. It is diagnosed with the help of X-ray which will give a picture of the joints.
- RHEUMATOID ARTHRITIS – It is an auto immune condition in which the immune system of body mistakenly attacks the body’s healthy tissues that is joints, causing inflammation. It is a type of inflammatory arthritis. In order to fight an infection our immune system sends extra blood and fluid to the infected area, in this case it is to the joints. This may cause difficulty in the movements of joints, pain in joints and the extra fluid can stretch the joint capsule. It can also lead to nerve ending irritations which results in pain. This inflammation and stiffness can cause permanent damage to a joint.
Rheumatoid arthritis usually starts in the small joints of the hands and feet and it can effect the same joints on both sides at the same time.
It is more common in women than men. The mostly effected age group is from 40 yrs to 60 yrs. The symptoms of rheumatoid arthritis can be summed up as
- Swollen and tender joints
- Morning stiffness on joints which lasts for more than half an hour
- Severe tiredness
- Fever
- Reduced appetite and distaste.
This can be clinically diagnosed with signs and blood test namely RA factor.
- GOUT ARTHRITIS – It is a type of arthritis which is related to increased uric acid presence in blood. The uric acid tends to form sharp crystals in one or more joints. The main sites include big toe, knee, ankle, wrist or elbow joint.
It is more prevalent in men than women and it affects men above 40 years of age. Women usually get affected after menopause.
The risk factors include family history of gout, intake of diuretic for blood pressure or medicines of rheumatoid arthritis, having blood pressure, cholesterol or diabetes and who had undergone gastric bypass surgery.
The signs and symptoms are pain and redness on joints, swelled joints. The attack last for 3 to 10 days. The Uric acid buildup lead to disfiguring lumps called tophi that form around the affected joint. When the uric acid crystals accumulate in the urinary tract they can cause kidney stones.
- HOW TO DIAGNOSE ARTHRITIS – A physician will be able to diagnose arthritis by physical examination. He / She will check for fluid around the joints, warm and red joints and document the range of motions in the joints.
Blood tests that check for anti-bodies like anti- cyclic citrullinated peptide (ccp), Rheumatoid factor (RF) and antinuclear anti body (ANA).
Imaging scans such as X-ray, MRI and CT scan also given a clear picture of bones and cartilages helps in ruling out arthritis.
- HOW TO TREAT ARTHRITIS– The main aim is to reduce the swelling and pain and to prevent further damage to the joints. The treatment includes giving medicines which are analgesics helps in pain management, NSAIDS helps in managing pain and inflammation, steroids like predinisone and immune suppressants for severe inflammatory arthritis like RA.
Supplements are advised for the patients like fish oi, turmeric supplement etc. Surgery is recommended in severe cases where the joint is replaced by artificial joint mainly on knees and hips. Another method is joint fusion which is done in fingers and wrists.
Physical therapy involves exercises which will strengthen the muscles around the joints and provide flexibility and balance to improve mobility.
Lifestyle changes – obesity is a risk factor of arthritis so the patient should maintain a moderate weight. A nutrient dense diet which includes anti-oxidants such as fruits and vegetables those helps in reducing inflammation can be preferred. The food to be avoided are fried foods, processed foods, dairy products and a high intake of meat. Smoking should be avoided. Regular exercise is a must for arthritis patients. Staying active is important but should not put pressure on your joints. Over exerting should be avoided.
- ARTHRITIS AYURVEDIC CORRELATION – One of the oldest records of the disease is a brief description in the Rigveda. Later Indian Ayurvedic physician named Madhava aacharya worte a full description of the disease under the name ‘Amavata’. In Ayurveda arthritis can be explained under ‘Amavata’ and ‘Vatarakta’.
Ayurvedic treatment for arthritis uses a defense strategy. It aims at root cause management.
- NIDANA [Etiological and psychological factors] – The causative factors of arthritis according to ayurveda are –
- VIRUDDHA AHARA – It refers to incompatable food consumption. There are 18 types of viruddha ahara, intake of these will lead to production of ama and imbalance of vata dosha. Examples of viruddha ahara are – a) curd with fish b) sugar and sour taste together e.g., fruit shake c) honey in hot water etc.
- VIRUDDHA CHESHTA – Immediate exertion after taking meals and taking hot and cold substances immediately one after another. Sedentary lifestyle without much movements, day time sleeping and awakening at night. Suppression of natural urges like urination, defecation etc. Excessive indulgence in sexual act, horse riding etc., Exposure to excessive winds due to travelling, diving etc.,
- MANDAGNI – It refers to decrease in Agni which leads to improper digestion of food and results in ama production. This ‘ama’ gets into the circulation and can cause obstruction to kapha sthana that is it leads to ‘amavata’.
- NISCHALATA – Physical inactivity or state of rest will results in kapha vridhi leading to agni mandhya. This lead to formation of ama.
- SNIGDHA BHUKTVATO VYAYAMA – Exercising immediately after food consumption is unhealthy, but exercise after taking unctuous meal has been specialy mentioned in causation of amavata. In gastro intestinal tract, good blood flow is very essential to digest heavy meal. Exercising after intake of food results in decreased blood supply to the gastro intestinal tract.
- MANASIKA NIDANA – This refers to psychological factors. If a person is consuming food when he/she is in excessive stress or grief or anger or fear it will results in improper digestion due to impairment in secretion of intestinal juice thus leading to ‘ama’ formation.
- ROOPA [signs and symptoms) – The signs and symptoms of amavata and vatarakta are-
- Sandhi soola – joint pain
- Sandhi shotha – joint swelling
- Sandhi stabdhata – joint stiffness
- Sparsha sahatva – joint tenderness
- Sashabda sandhi – joint cracking sound
- Angamarda – body pain
- Aruchi- anorexia or reduced apetite
- Trishna – thirst
- Alasya – laziness
- Gourava – feeling of heaviness
- Jwara – fever
- Apaka- indigestion
- Angasunnate – numbness
- SAMPRAPTHI (Pathophysiology) – The consumption of improper food and following lifestyle which is not suitable for the body will act as the major factors for developing ama. In addition to the above, the psychological factors also play major role in causing production of ama.
The nidanas described earlier will result in poor strength of agni (digestive fire) and lead to formation of undigested food or ‘ama’. The aggravated doshas namely vata, pitta and kapha in the ama get localized in to a part of the stomach which either obstruct the movements in the abdomen or eliminated through upper and lower pathways of the alimentary tract.
The above nidanas will lead to production of aamarasa and aggravation of vata dosha which in turn results in sthanasamsraya that is movement of ama to the kapha sthana and sandhi (joints). This causes obstruction in the joints leading to joint pain. One type vata dosha named as vyana vayu propels the amarasa into systemic circulation which on reacting in the small joints leads to pain and swelling.
- CHIKITSA (AYURVEDIC TREATMENT FOR ARTHRITIS) – There are 6 stages in the development of a disease. These are accumulation, aggravation, dissemination, localization, manifestation and disruption of disease. During the first four phases there is no clinical symptoms, it is shown on last two stages.
Arthritis ayurvedic treatment includes executing the defense strategy. The ayurvedic physician can identify the disequilibrium of doshas in the body and re-establish equilibrium and prevent disease manifestations in the first four stages of disease. The offense and defense strategies are to be employed when symptoms appear that is in the last two stages. The defense strategy of ayurveda arthritis treatment includes
- Balancing the doshas
- Increasing agni
- Stopping the formation of aama
- Increasing the digestion and excretion of aama
- Restoring the damaged intestinal mucosa and absorption.
Thus, this includes samana chikitsa and sodhana chikitsa. Samana chikitsa can be attained by giving medicaments. The common medicines given for rheumatoid arthritis treatment in India include
- YOGA RAJA GUGGULU – helps in curing mandagni and pacifying the vata dosha.
- VATA VIDHWAMSA RASA – helps in reduing pain.
- TRIPHALA CHURNAM – it helps to increase agni and therefore decreases ama.
- GANDHARVAHASTADI ERANDA– it acts as a stomach cleansing supplement and helps in relieving pain and removing ama from body.
- RASNADI KASHAYAM –
It helps in pacifying the vata dosha.
The sodhana treatment includes panchakarma therapies. The elimination of aggravated dosha and aama from the body can be achieved by performing panchakarma therapies. The main panchakarma to be done is vasti. Prior to the vasti karma, poorvakarma such as snehena and swedana has to be done with oils and ghees namely chinchadi tailam, pinda tailam, guggulu thikthaka ghritam, rasnadi ghritam etc. Kashaya vasti and anuvasana vasti are performed. Various herbs used for vasti are dasamoola, rasna, bala, aswagandha etc. For anuvasana vasti panchakola ghrita, aswagandha ghrita, dhawantara taila etc are used.
DIET is also as important as therapies for an amavata patient. The diet should be smaller in amount, easy to digest and consumed when the Agni is high. The high Agni level can be clinically manifested by increased appetite and low Agni as lack of appetite and feeling of abdominal heaviness. A diet which is predominantly containing bitter and astringent taste is beneficial as they have antioxidant property.
Pathya aahara (Recommended foods)
- Warm water medicated with panchakola -helps in digestion by improving agnibala.
- Food prepared from barley, horse gram, red variety of rice etc. are recommended. Barley lowers inflammation.
- Green leafy vegetables and fruits namely orange can be included.
- Vegetables which are bitter in taste namely bitter melon can be used. Ayurvedic herbs namely neem, patola and gokharu will help in this condition.
- Spices like ginger, turmeric and garlic have anti-inflammatory and analgesic property.
Apathya aahara (Foods to avoid)
- Dairy products
- Fish and sea food
- Cold and impure water
- Heavy food like urad
- Indian spinach
LIFESTYLE – Life style changes is an important component in the management of amavata through ayurveda. The sedentary lifestyle needs to be changed to active lifestyle. That means exercising daily for a fixed period of duration is as important as medicines, at the same time do not over exert.
Exercising immediately after the food intake should be avoided as it may lead to indigestion. Proper sleep is a must for reducing excessive stress which is one among the factors for imporper digestion. Using warm water for bath is another important lifestyle change to be followed.
YOGA FOR AMAVATA
Yogasanas meditations and pranayama needs to be followed. The yogasanas will helps in improving joint movements, reducing stiffness and improving flexibility and range of motion of joints. The yogasanas include:
- Bhujangasana (Cobra Pose)- Helps in relieving knee pain, strengthens the spine, boosts energy and aids in digestion.
- Setu Bandha sarvangasana (Bridge pose) – Strengthens the finger joints, wrists and shoulders, reduces backache, stress and anxiety.
- Vrikshasana (Tree pose) – Strengthens the legs and back muscles. Increases the range of motion of the knee and spine.
- Paschimottanasana (Seated forward bend) – Improves blood circulation, helps in strengthening the neck and shoulders.
- Trikonasa (Triangle Pose)- Helps in stretching the spine, improves flexibility of shoulder joint.
The practice of meditation and pranayama helps in relieving excessive stress and improves sleep. This is very important for improving the agni and thus preventing the production of amarasa which is the main reason for amavata.
Agni Ayurvedic Village provides the Best arthritis treatment in India. The arthritis is managed here in a classical way in which the first step includes deepana and pachana. This denotes improving the digestion and agni of the patient. This is followed by samana and sodhana chikitsa under the supervision of ayurvedic physicians from Kerala. Along with ayurvedic therapies, we give emphasize to yoga practices which is under the guidance of our yoga instructor. We also give importance to diet ,personalized and customized diet will be provided to the patient. All these factors will help the patient to recover fast from amavata or arthritis.