Patient reported reactive arthritis. It was diagnosed in 2004 for which treatment followed and remission continued till 2010. With knee joint difficulty, it reappeared again in the same year and continued for a few months and recurred in 2012. In 2016, it relapsed, and patient had problem while sitting on floor, standing from sitting posture, walking, climbing stairs, using Indian styled toilet, keeping heels on floor etc. At time of consultation, patient had pain & swelling in his knees, back and legs. He had been suffering from mild fever for last two months that was relieved after taking ayurvedic medicines. Fever occurred when patient’s joint condition worsened.Patient had gastric problem and he had difficulty in passing gas, sometime he had sour eructation, nausea, heart burn, bloating etc. Patient consulted Rheumatologist for arthritis problem and followed medicines intermittently.Patient reported that water/fluid aspirated from his knees. He has undergone various investigations to confirm this problem. Patient complained that the skin on his feet became hard, caused itching and had dark discoloration.HLA B 12 test was positive, ESR was elevated, Hb was low, RA factor was negative, and X-RAY revealed fluid deficiency in knees.Specific History (H/0 Present Illness)After being diagnosed in 2004, patient periodically suffered from this problem.Physical/ Systemic FindingsBM-2times, clear-regular-sometimesmucous Appetite – low, Urine – normal, Gas – Yes, Acidity Yes, occasionally, Sleep – normal but disturbed during pains, Mind – normal but sometimes stressed.H/0 Past illness/ Family HistoryThere was no history of HTN, THYROID and DIABETES. Patient’s father had BP problem.
Samprapti Ghataka– Dosha: Vata pradhan kapha dosha Dushya: Ras, mansa, asthi, majja
Srotas: Ras vaha, anna vaha, asthi, majja vaha Adhishthan: Sandhi
Nidana: Dosha vitiating diet and lifestyle that contains dry, light, cold items, over thinking, fasting, ignoring natural urges, stress etc.
Chikitsa Sutra
Nidana parivarjan – Avoid things in diet and routine that accelerates progression of disease
Shaman Chikitsa – Vata-kapha shaman, amapachan, srotoshodhan, vedna shaman, rasayan
Shodhan Chikitsa – Some effective and easy to implement methods are shared to practice at home
Sattvavjay Chikitsa – Patient education, expectation management and approach of treatment is shared
Specific Advice:
Pathya: Patient was advised to do regular and gentle massage with lukewarm oil, drink lukewarm water, do yoga-pranayam, morning walk, get regular morning sun exposure, drink turmeric mixed milk, take a mixture of saunth, ajawain & methi, physical exercises were recommended according to strength etc.
Apathya: Avoid heavy work, consumption of cold potency things, curd, rice, pickles, citrus fruits, non-veg foods, alcohol, katahal, potato, ice-cream, oily-fried, rajma, chhole, chane, white flour, fast foods, excess tea-coffee, awakening till late night, sleeping during the day etc.
Treatment Plan in July 2016
|
Churna Twakrog |
Tablets Peedantak |
Products Shodhak |
|
Rasna |
Rakta |
|
|
Amavatadi |
Arthritis |
|
|
Dasavtar |
|
|
|
Rejuva |
|
|
Modifications/Changes made in prescription during course, Below changed medicines were given as per patient’s feedback:
In Aug 2016
Same medicines were repeated and in products Maha Rasnadi kwath and Digestol tablet were added.
In Feb 2017
In powder, Amrit Rasayan was added in place of Rejuva Churna while in tablets, Lakshadi Guggulu and Punaroday Vati was advised instead of Arthritis tablet and Rakta Shodhak Guggulu. Ayurshakti tablet was additionally placed with previous products.
Outcome
Patient gradually started to feel changes in his joint pain and swelling. His digestive problems like gas, bloating, acidity, bowels, appetite progressively got better. Fever was not present, but quality of sleep had improved. His skin problem became normal. Based on his experience, patient was apprehensive about coming winter season since during cold weather his condition becomes worse. But, to his surprise, in March patient reported that except couple of incidences his condition in remained completely normal. After that, patient was advised to taper the dose of medicines to maintain achieved relief.
Parameters during and after the treatment
|
Symptoms Pain/Swelling |
Jul, 2016 |
Aug, 2016 |
Oct, 2016 |
Nov, 2016 |
Dec, 2016 |
Jan, 2017 |
Mar, 2017 |
|
Gas/Acidity |
++++ |
++++ |
+++ |
++ |
++ |
Normal |
Normal |
|
Bowel |
+++ |
+++ |
++ |
++ |
++ |
Normal |
Normal |
|
Movement |
+++ |
+++ |
++ |
+ |
+ |
+ |
Normal |
|
Appetite |
+++ |
++ |
++ |
+ |
+ |
Normal |
Normal |
|
Skin |
+++ |
++ |
++ |
+ |
+ |
Normal |
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