Arthritis
June 12, 2023
The word ‘arthritis’ literally means inflammation of the joints. Arthritis affects 15% people all over world. Similar word to arthritis is Rheumatism which indicates pain arising from joints or other elements of musculoskeletal system
It is classified as below
Osteoarthritis
Osteoarthritis (OA) is a condition that usually develops over several years, due to slow degeneration of joints. It affects several different joints.. Due to gradual erosion, ligaments face stretching that initiates the pain. Women more prone to this than men especially after menopause. its high prevalence among elderly people made it a major cause of disability among elderly.
DEFINITION
Osteoarthritis is a chronic degenerative disorder of multifactorial etiology, characterized by loss of articular cartilage and periarticular bone remodeling. It involves the entire joint including the nearby muscles, underlying bone, ligaments, synovium and capsule.
CLASSIFICATION OF OSTEOARTHRITIS
- Idiopathic (Primary) O.A. – is the most common form of the disease, no predisposing factor is apparent.
- Secondary O.A. – is pathologically indistinguishable from idiopathic O.A. but is attributable to an underlying causes like trauma, calcium deposition, other diseases etc
Risk factors for Osteoarthritis
- Age – old age is risky
- Sex – females having more chance to be affected.
- Trauma – Direct or indirect injuries to the articular cartilage lead to its degeneration. Fractures of different bones, especially of weight bearing.
- Abnormal posture, abnormal walking styles, and unequal length of leg will exert stress and strain over the joint.
- Diseases like Hyperparathyroidism, Diabetes mellitus, etc. also may lead to osteoarthritis
- Obesity
People with an elevated body mass index (BMI) as a measure of relative weight for obesity, has a positive tendancy to develop arthritis.
Symptoms
- Joint Pain- Most common symptom. Typically, the pain of osteoarthritis is aggravated on joint usage and relieved during rest, but as the disease progresses, it may become persistent.
- Stiffness- Muscle spasm lead to stiffness, especially during morning time or after a period of inactivity may be prominent but usually lasts less than 20 min.
Signs
- Swelling– Physical examination of the osteoarthritis joint reveals localized soft tissue swelling of mild degree. It is due to the changes in articular ends.
- Crepitus– rubbing sound or feeling on joint movement is called as crepitus. It is one of the characteristic sign of osteoarthritis joint.
- Ø Local rise of temperature- On palpation of the joint local rise in temperature is an indicative of inflammation.
- Muscle Atrophy– weakness of local muscles involved is atrophy which may be due to disuse or due to reflex inhibition of muscle contraction
PATHOLOGY OF O.A
The changes mainly occur in cartilages, adjacent bones and synovium. The changes are most common in the weight-bearing regions of articular cartilages. Initially there will be thinning of cartilages which lead to structural change in them.Further progression o causes loosening, flaking and fissuring of the cartilage resulting in breaking off of pieces of cartilage. Strength of associated bones will be reduced along with spur formation on margins of bones called as osteophytes.
Main reasons for the development of osteoarthritis are
- The properties of the articular cartilage and bones are normal, but excessive load on the joint causes the tissue fail.
- The applied load is reasonable, but the quality of the cartilage or bone are inferior.
In the early stages the cartilage is thicker than normal. With the progression of osteoarthritis, joint surface thins then the cartilage softens.
Laboratory and Radiological Findings
Radiological techniques like x ray,MRI scan,CT scan etc are used for diagnosis. They reveal tissue damage, structural changes etc.
Management
The management of osteoarthritis involves conservative, medical to surgical methods
Conservative
Patients should be educated about their condition and its progression, including advice on jointprotection and emphasizing the importance of strengthening and exercise. Patients with overweight should be advised for weight loss.
Some non-pharmacological interventions that can be offered include local heat or ice packs, joint supports, andphysiotherapy which are the most effective conservative approach.
Medical
Simple analgesics and topical NSAIDs are the base of most medical management for OA, along with the conservative measures..
Surgical
If conservative and medical interventions fail, then surgical intervention may be considered, especially if their joint symptoms have a substantial impact on their quality of life.
Osteoarthritis in Ayurveda or Sandhigatha vata
Osteoarthritis can be correlated to sandhigata vata according to Ayurveda. Deranged vata among the three doshas, is the main culprit behind sandhigata vata. Vatadosha is mainly situated in bones &joints hence due to vitiation of Vatadosha there are changes or deformity occursin these in bones &joints.
Causative factors
Nidana of sandhigata vata can be classified to two
External cause
Include injuries, trauma especially to marmma(vital points)etc are coming under this category
Internal cause
This again divided into two
- Unhealthy food habits
Ahara or food is the most common contributing factor for the producing of a disease. Habituation to foods which are excessively dry ,cold,and light also to spicy food articles will trigger vitiation of vata. Another main cause is alcohol abuse which is also a cause for vata vitiation.
Another unhealthy food habits are untimely food, skipping foods, food articles which are contradict to season and place.
Faulty lifestyle or behaviors
- Excessive fasting
- Excessive or improper exercise
- Excessive physical straining which are intolerable to body.
- Carrying excessive load causes excessive pressure and stretching effect over the structures of the joint.
- Apart this physical causes excessive mental stress,sadness etc also vitiate vata.
Samprapthi
Aggravation of Vata in the bones & bone-marrow dries joints and gives rise to cracking of bones & joints, piercing pain in the joints diminution of muscle tissue & strength, causing weakness and pain.
CHIKITHSA(Treatment)
Ayurveda offers effective and safe treatment for prevention and cure of osteoarthritis. Ayurvedic treatment has the potential of regenerating the cartilage in mild to moderate OA. In case of severe OA, it arrests the progress of degeneration. General lines of treatment would be Snehana (oleation), Svedana (fomentation), Mridu Samshodhana (mild bio-purification), Basti (enema) and Vatahara Aushadha (Vata pacifying medicines). Regulation of Ahara and Vihara may also be applicable in Sandhigata Vata.
.
Treatments
Abhyanga: Oil Massage
Vata vitiation causes dryness of joints which initiate degeneration of tissues. Oil application prevent the same. massage stimulates blood circulation and assists the lymphatic system, improving the elimination of waste throughout the body. Absorption through the skin can be enhanced by suspending the drug in an oily vehicle and rubbing it on the skin. Thus, the medicaments used as massage are absorbed through the skin.Oils like Dhanwantharam tailam, murivenna,narayana taila, sahacharadi taila,panchasnham kuzhambu etc are some of the oils used for abhyanga in OA.
Swedana:Sudation
Different methods like bashpa sweda, patrapottali sweda, jambira panda sweda etc are used for sudation based on the condition of the patient.This will help to open the pores in body and helps for elimination of waste materials and absorption. This therapy also help to reduce stiffness and increase range of movements.
Upanaha: This is application of medicinal pastes over affected area and covers the area with some particular leaves which reduce inflammation and stiffness.
Vasthi(enema)
This is considered as the best treatment for vata diseases. rectal and colon regions are rich in capillary blood vessels hich enhances quick absorption of medicine.
Jalookavacharanam:
Leech application will improve local circulation thus accelerate tissue repair.
Activities
- Correction of poor posture
- Excessive loading of the involved joint should be avoided
- Patients with OA of the knee or hip should avoid prolonged standing, kneeling, and squatting
- Obese patients should reduce body weight.
- An exercise program should be designed to maintain range of motion, strengthen periarticular muscles, and improve physical fitness
Posted by admin