RHEUMATOID ARTHRITIS – AAMAVATA

Rheumatoid Arthritis (RA) is a systemic disease that primarily causes joint inflammation, pain, loss of function and eventual joint destruction and deformity. The disease is of variable severity ranging from mild inflammation in a few joints to symmetric involvement in multiple joints, mainly in the hands and feet.

A QUALIFIED AYURVEDA PRACTITIONER SHOULD BE CONSULTED TO ENSURE APPROPRIATE PROCEDURES AND MONITOR PROGRESS

WHAT IS RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands and both knees. But sometimes RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or the lungs.

TYPES OF RHEUMATOID ARTHRITIS

Seropositive RA

If your blood tests positive for the protein called rheumatoid factor (RF) or the antibody anti-cyclic citrullinated peptide (anti-CCP), it means your body may be actively producing an immune reaction to your normal tissues. Your chance of developing RA is four times greater if your parents or siblings test positive for RF. According to Johns Hopkins Medicine, approximately 80 percent of people who have RA are RF-positive. Having these proteins doesn't necessarily mean you have RA. However, if you do, it can help doctors identify the type.

Seronegative RA

People who test negative for RF and anti-CCP in their blood can still have RA. Diagnosis isn't based on just these tests. Your doctor will also take into account clinical symptoms, X-rays, and other laboratory tests. People who test negative for RF and anti-CCP tend to have a milder form of RA than those who test positive.

Juvenile RA (Juvenile Idiopathic Arthritis)

The Mayo Clinic reports that juvenile RA is the most common type of arthritis in children younger than age 17. Symptoms may be temporary or last for a lifetime. Like adult RA, symptoms of juvenile RA include joint inflammation, stiffness, and pain. If the disease is severe, it can cause eye inflammation and interfere with a child's growth and development.

Overlapping And Often-Confused Conditions

Autoimmune diseases share many common symptoms, making them particularly difficult to diagnose. People who have one autoimmune disorder often develop another. Some conditions that are overlapping or often confused with RA include:

Lupus
Fibromyalgia
Lyme Disease
Chronic Fatigue Syndrome
Neuropathy
Sciatica
Anemia
Hypothyroidism
Depression

RA can also be confused with osteoarthritis, which isn't an autoimmune disease. It's instead caused by wear and tear of joints.

CAUSES OF RHEUMATOID ARTHRITIS

In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body's cells for foreign invaders and releases inflammatory chemicals that attack those cells. Tn RA, it attacks the synovium, the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen, and moving the joint may be difficult.

Researchers aren't sure why people develop RA. They believe these individuals may have certain genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress or some other external factor.

SYMPTOMS OF RHEUMATOID ARTHRITIS

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain.

These symptoms are clues to RA:

Joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
Morning stiffness that lasts for 30 minutes or longer.
More than one joint is affected.
Small joints (wrists, certain joints in the hands and feet) are typically affected first.
The same joints on both sides of the body are affected.

Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months.

DIAGNOSIS

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a Rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.

Medical History. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease.

Physical Examination. The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever.

Blood tests. The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:

Erythrocyte sedimentation rate (ESR, or "sed rate") and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis.
Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA.

Imaging Tests. RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don't show up on the first tests that could mean RA is in an early stage and hasn't damaged bone yet. Imaging results can also show how well treatment is working.

COMPLICATIONS OF RHEUMATOID ARTHRITIS

Rheumatoid arthritis increases your risk of developing:

Osteoporosis. Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
Rheumatoid Nodules. These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the heart and lungs.
Dry eyes and Nouth. People who have rheumatoid arthritis are much more likely to develop Sjogren's syndrome, a disorder that decreases the amount of moisture in the eyes and mouth.
Infections. Rheumatoid arthritis itself and many of the medications used to combat it can impair the immune system, leading to increased infections. Protect yourself with vaccinations to prevent diseases such as influenza, pneumonia, shingles and COVID-19.
Abnormal Body Composition. The proportion of fat to lean mass is often higher in people who have rheumatoid arthritis, even in those who have a normal body mass index (BMI).
Carpal Tunnel Syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
Heart Problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
Lung Disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
Lymphoma. Rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.

DEFENSE STRATEGY FOR MANAGEMENT OF RHEUMATOID ARTHRITIS -RA-AAMAVATA

Before executing the defense strategy, healthcare providers should keep in mind two fundamental points: In contrast to the offense strategy of modern medicine, there is no target in the defense strategy and the tools and processes employed in the defense strategy of Ayurveda have multiple effects. These effects are usually weak, but their cumulative effect is powerful. The second point to take into account is Ayurveda's concept of the six stages of disease. In the first four stages, accumulation, aggravation, dissemination and localization of Doshas occur. There are no clinical manifestations and symptoms are vague. Characteristic symptoms appear during fifth and sixth stages of manifestation and disruption of disease. A health-care provider who is an expert in identifying Vikrti, or disequilibrium of Doshas in the body can reestablish equilibrium and prevent disease manifestations in the first four stages of disease. When symptoms appear in the last two stages, manifestation and disruption, both the offense and defense strategies are to be employed appropriately.

Based upon the Ayurvedic concepts of pathophysiology discussed earlier, the defense strategy consists of:

Balancing the Doshas.
Increasing the digestive and metabolic fires, or Agni.
Stopping the formation of Aama at different levels.
Increasing digestion and excretion of Aama.
Restoring the damaged intestinal mucosa and absorption.

Since Ayurvedic procedures and therapies have multiple effects, management will be enumerated and described by the therapy rather than the effect.

MEDITATION AND PRANAYAM (DISCIPLINED BREATHING):

These help in re-establishing the connection to the source to correct the "mistake of the intellect" and balancing the Doshas.

TREATMENT FOR RHEUMATOID ARTHRITIS IN AYURVEDA

YOGIC AASANAS, MASSAGE AND SWEATING OR SAUNAS:

Yogic exercises help in regaining strength, correcting deformities and improving posture. (Also recommended are tai chi, swimming, walking)

Self-massage/Abhyanga with sesame oil in winters and coconut oil in Niramavastha and in chronic conditions in summers has detoxifying, rejuvenating, anti-inflammatory and Vata pacifying effect. Using the sauna or sweating using various herbal preparations also has detoxifying effect. Local fomentation with Nirgundi has anti-inflammatory effect. A qualified Ayurveda practitioner should be consulted to ensure appropriate procedures and monitor progress.

PANCHAKARMA THERAPY:

For increasing the Agni, excretion of Aama and removal of vitiated and accumulated Doshas, purification or Shodhana and pacifying or Shamana treatments are given. This category of treatment comes under Panchkarma therapy. It consists of

Medicated or retention enemas.
Medical emesis.
Medical purgation
Nasal medication.
Bloodletting.

Out of these five treatments the medicated enema is considered to be the most effective and specific therapy for this category of diseases. Emesis and purgation may reduce Agni and hence are not much used in Aamavata. Bloodletting is effective but because of its invasive nature is not used much. Medicated or retention enemas include herbal retention enemas and oil retention enemas. Herbal retention enemas remove Aama and accumulated Doshas. Various herbs used are Dashmoola, Rasna, Eranda (Ricinis communis) Bala (Sida cordifolia), Shatavari (Asparagus racemosus), Guduchi (Tinospora cordifolia), Ashwagandha (Withania somnifera), and Gokshura (Tribulus terrestris).

Oil retention enemas help to replenish the depleted body constituents. Various oils used are Panchkola Ghrita, Rasnadi Ghrita, Ashwagandha Ghrita, Castor Oil, Dhanvantara Tailam, and Narayana Tailam.

Based upon the clinical condition of the patient and judgment of the treating physician these enemas can be prescribed every other day or less frequently.

Pacifying treatments are called "Shamana treatments" and are recommended when the patient is not able to tolerate the Shodhana or purifying treatments. These are also given as maintenance treatments following the purifying treatments. These treatments help eliminate accumulated Doshas, Aama, and toxins and to regain strength. The following are various Ayurvedic herbal preparations used in the management of Aamavata.

DECOCTIONS

Maha Rasnadikwatha, Ashwagandharistha, Bhallatakasava-this can give rise to severe reactions in some patients especially with Pitta Prakriti hence it has to be used under medical supervision, Rasna Panchak Kwatha, Rasna Saptaka Kwatha, Dashamoolarishta, and Amritarishta.

HERBAL POWDER MIXTURES/CHURNAS

Ajmodadi Churna, Panchakol Churna, Shunthi Churna, Ashwagandha Churna, Dashamool Churna, Rasna Churna, Musta Churna, Vaishwanara Churna, Kariramoola.

TABLETS

Simhanad Guggulu, Mahayogaraja Guggulu, Yogaraja Guggulu, Punarnava Guggulu, Triphala Guggulu.

GHEE/OIL

Panchakola Ghrita, Rasnadi Ghrita, Ashwagandha Ghrita, Dashamula Taila, Eranda Taila (castor oil), Narayana Taila, Dhanvantara Taila.

AVALEHA

Bhallataka Avaleha, Gorakha Avaleha. Various preparations of Bhallataka can be used in Aamavata.

HERBS AND SUPPLEMENTS

Ayurvedic practice often involves the use of herbs and supplements as treatment.

Some of the herbs that Ayurvedic practitioners often use to treat RA include:

Boswellia serrata (Indian frankincense)
Garlic
Ginger
Ricinus communis (castor oil)
Ashwagandha

An Ayurvedic practitioner may also prepare special oils that contain herbs. People can massage these oils into areas where they experience symptoms.

DIET FOR RHEUMATOID ARTHRITIS

FOODS TO EAT

For amavata, Ayurveda recommends a diet that balances vata.

Examples of foods to eat on this diet include:

Grains that are easy to digest, like cooked oats, rice, and cream of wheat
Legumes, such as lentils, dal, mung beans, miso, and tofu
Green, leafy vegetables
Berries
Buttermilk
Wild animal meat
Aged wine in moderate amounts
Warm water medicated with Panchkola (Pippali, Pippalimula, Chavya, Chitraka, Shunthi) in small quantity at a time helps in digestion and disintegration of Aama.
Barley, horse gram, kodo millet and the red variety of rice are recommended. These foods are light and easy to digest. Barley kernels and other products made from barley lower inflammatory markers.
Green leafy vegetables and fruits contain a variety of polyphenols, bioflavonoids, catechins, carotenoids, vitamin C, riboflavin, vitamin E, and low molecular weight compounds. These constituents have antioxidant, fibrinolytic and anti-inflammatory characteristics. Vegetables preferably with bitter taste like bitter melon (Memordica charantia), Neem (Azadirachta indica), Patola or luffa, Gokharu (Tribulus terrestris) are recommended.
Spices like ginger, turmeric and garlic help to add flavor to these dishes and also have antimicrobial, anti-inflammatory and analgesic properties besides their Agni promoting impact. • Wine-old wine, Asava and Arishta.
Meat of Laav Pakshi-Jungle bush quail (Perdicula asiatica) prepared with traditional buttermilk.

FOODS TO AVOID

Eating spicy and raw foods can create heat and inflammation, or pitta, inside your body.

Examples of foods to avoid on this diet include:

The majority of allergens come from dairy and animal products, which cause an increased production of pro-inflammatory prostaglandins.

Cold and impure water
Lentils like Urad and heavy foods.
Sour and fermented foods, like hard cheeses, sour cream, green grapes, pineapple, grapefruit, and alcohol
Heating spices, like chili powder and cayenne pepper (Replace these with warming spices like cinnamon, nutmeg, and turmeric)
Vegetable like arabi or eddo (Colocacia antiquorum) Indian spinach (Basella rubra).
Salt, Fish and sea foods.
Hard-to-digest fruits and vegetables, like raw radishes, turnips, onions, apples, broccoli, and Brussels sprouts
Sour and fermented foods, like hard cheeses, sour cream, green grapes, pineapple, grapefruit, and alcohol
Salt
Drinking alcohol
Eating spicy foods
Taking in excess salt
Consuming too many sour, sweet, or sugary foods
Eating uncooked foods
Eating foods that cause acid reflux
Smoking. Multiple studies show that cigarette smoking increases a person's risk of developing RA and can make the disease worse.
Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.

SLEEP

The Ayurvedic lifestyle may help with sleep if symptoms like pain and stiffness keep you awake at night.

Recommended changes to improve sleep include:

Going to bed early and rising early
Avoiding naps during the day, if possible
Taking a warm shower or bath before bed
Trying ashwagandha or warm milk before bed
Eating a light dinner 2 or 3 hours before bed, followed by light walking
Practicing nighttime yoga and meditation
Massaging the soles of the feet with warm sesame oil and wiping it off after 15 minutes or putting on socks before getting into bed

HOW TO REDUCE YOUR RISK OF ARTHRITIS – NO PREVENTION

Some causes of arthritis are beyond your control, like growing older, being female or having a family history of arthritis. But you can take steps to reduce your risk of arthritis or delay its onset.

Here's how to keep your joints healthy as you age:

Stay at a healthy weight. Extra pounds put pressure on weight-bearing joints like hips and knees. Each pound you gain adds nearly four pounds of stress on your knees and puts six times the pressure on your hips.
Control your blood sugar. High blood sugar can stiffen the tissue that supports your joints and make them more sensitive to stress.
Exercise. Just 30 minutes of exercise five times a week helps joints stay limber and strengthens the muscles that support your knees and hips. Focus on low-impact exercises like walking, cycling or swimming.
Stretch. Gentle stretching can improve your range of motion and keep your joints limber. Try to work in simple stretches into every day.
Avoid Injury. An injured joint is more likely to develop arthritis than one that was never injured. Wear protective gear when playing sports and always lift with your knees and hips, not your back.
Quit Smoking. Smoking puts stress on tissues that protect your joints and can lead to arthritis pain.
Eat Fish Twice A Week. Eat fish high in Omega-3s, like salmon, trout and mackerel. Omega-3s have many health benefits and may reduce inflammation.
Get routine preventive care. Your doctor may be able to suggest lifestyle changes that can help reduce your risk or slow the progress of arthritis.

TAKEAWAY

Ayurvedic lifestyle changes may help ease the symptoms of RA. Following a diet rich in herbs, spices, and cooked vegetables is a cornerstone of the practice, along with gentle exercises, such as yoga. These, along with other healthy habits, could complement more conventional therapies.

Talk with your doctor if you'd like to learn more about how Ayurvedic treatment options can be safely integrated into your treatment plan.