Rheumatoid arthritis is a chronic inflammatory autoimmune disorder that mainly affects the small joints, resulting in pain, stiffness, and loss of function. It has no known cure and conventional treatments can have adverse effects. Homoeopathy offers a natural approach by regulating the immune system using carefully selected individualized remedies without side effects. Some common homoeopathic medicines used to manage rheumatoid arthritis symptoms include Berberis vulgaris for rheumatic pains that change location, Bryonia alba for aggravated pain with movement and stiffness, and Rhus tox for pain and stiffness relieved by motion.

1. CLINICAL OVERVIEW AND TIPS FOR MANAGEMENT
RHEUMATOID ARTHRITIS

2.  Rheumatoid arthritis is a chronic
,inflammatory, autoimmune disorder that mainly
affects the small joints of the body
Definition
…resulting in pain, stiffness ,deformity and loss of function of the joints
involved.

3. Chronic- symptoms last for several years, with a relapsing- remitting course
Inflammatory- disease process affects the synovial membrane of joints
causing bone erosion
Autoimmune-immune system which normally protects the body, attacks
its own tissues
Systemic- inflammation may affect other organs such as heart,lungs,blood
and blood vessels,nerves etc
Disease Characteristics

4. Risk Factors
Genetic Factors
• RA has a genetic link, it
can run in families
• HLA-DR4 gene may
play a role in increasing
the risk
• Although, not everyone
with this marker has
RA, nor everyone with
Gender
• Females are 2-3 times
more likely to develop
RA than males
• Almost 70% of patients
of RA are females
Age
• RA may develop at any
age
• More likely to begin in
the age group of 40-
60 years

5. Other Factors
 Viral and bacterial infections may trigger the faulty auto-immune
response
 Stress may also precipitate disease activity
 Hormonal factors females who have given birth or have breast
fed have slightly lower risk . Pregnancy and lactation improve
symptoms temporarily
 Trauma
 Smoking increases the risk of developing disease in genetically
predisposed persons
 Low testosterone level in males may be a predictor of developing
RA in the future

6. Joint pathology
 Small joints like those of wrist and hand are most
commonly affected
 Chronic Inflammatory process mainly affects the
Synovium i.e. the lining of the joints causing joint
swelling, bone erosion, and eventually deformity

7. Signs & symptoms of RA
 Bilaterally symmetrical pattern of joint
involvement
 Small joints of hand and wrist are
affected first
 As the disease progresses others joints
like knee, hip, shoulder, ankle get
affected
 Pain in joints is the main presenting
complaint
 Stiffness of joints in the morning or after
a period of rest which may last for
several hours
 Fever
 Fatigue
 Weight loss
 Nodules under the skin of
arms, elbows
 Symptoms may come and go, and
vary in severity
 Periods of increased activity or “Flare
ups” are interspersed with episodes
of relative remission.
 Loss of function of joints and disability

8. Systemic complications of RA
 Anemia
 Eye: Redness, gritty sensation, corneal damage
 Skin: fine nodules under the skin, rashes, ulcers
 Lungs: interstitial lung disease
 Bones: Osteoporosis
 Inflammation of small blood vessels called vasculitis
 Heart and circulatory system: increased risk of Coronary artery
Disease, atrial fibrillation, pulmonary embolism
 Psychological effects: depression ,anxiety

9. Diagnostic tests
Blood
• Rheumatoid Factor (RF): This
antibody is present in almost 80%
of patients of RA. some patients of
RA may be seronegative for
rheumatoid factor
• Anti cyclic citrullinated peptide
(anti-CCP antibody) : present in
about 50-75% cases. It is useful in
diagnosing early cases and more
aggressive forms of RA
• Anti nuclear antibody (ANA) :
frequently found in RA patients
• ESR and C-reactive proteins:
Indicate chronic inflammation and
disease activity
Imaging
• X-ray: may be useful in tracking
the extent of bone damage over a
period of time
• MRI may also reveal evidence of
bone and joint pathology
• Bone densitometry: may be used
to detect signs of osteoporosis

10. Objectives of treatment
 Reduce inflammation
 Prevent bone and joint damage
 Preserve joint mobility
 Aggressive treatment at an early stage to prevent disease
from becoming severe and chronic
 Prevent and treat systemic complications
 Palliative care and rehabilitation in progressive cases

11. Conventional treatment and adverse effects
Drugs Adverse effects
NSAID’s and other anti-inflammatory drugs Gastritis, G.I bleed
Anti rheumatic drugs (DMARD’s) like
Methotrexate
Vomiting, diarrhea, hair loss, abnormal liver
function
Anti-TNF drugs Immunosuppression, lymphoma, skin cancer
Immunosuppressants Risk of infection, infertility

12. Scope of Homoeopathy
• Homoeopathic medicines work by regulating
immune system, thereby making them effective
in treating auto-immune disorders like RA
• Carefully selected Homoeopathic medicines act
as tailor made remedies for an individual patient
in contrast to a “one size fits all” approach of
conventional treatment
• Symptomatic relief can be achieved with
Homoeopathic medicines without any side effects
• The underlying genetic/miasmatic cause is
addressed by prescribing an anti-miasmatic
remedy

13. Clinical tips – Homoeopathic management
 Actea Spicata- Rheumatism of small joints especially wrist, ankle and
toes. Swelling of joints from slight fatigue
 Berberis Vulgaris- Rheumatic symptoms with urinary complaints, rapid
change of symptoms specially in regard to place and character pain in
heels. Rheumatic pain in shoulders, arms, hands and fingers, legs and
feet. Pain between metatarsal bones ,Pain in balls of feet on stepping.
Intense weariness and lameness of legs after walking a short distance.

14. Clinical tips contd.
 Bryonia alba- joints are hot, red and swollen. Tearing pain aggravated
by least movement, better by rest. Stiffness of nape of neck
 Caulophyllum- pain and stiffness of small joints of fingers ,toes, wrist.
Pains are erratic, changing place every few minutes
 Causticum- Burning, rawness and soreness of joints with contracted
tendons. Ailments from long-lasting grief. Aggravation in clear, fine
weather while better by warmth and damp weather.
 Cimicifuga- rheumatic pains with stiffness of neck and back

15. Clinical tips contd
 Colchicum- Joints are stiff and hot. Shifting joint pains, aggravated at
night. Patient screams with pain on touching the joint or stubbing a toe
 Dulcamara- Joint pains induced by exposure to damp cold, aggravated
by every cold change and somewhat relieved by moving about and by
external warmth
 Formica rufa – Pains worse from motion cold & before
thunderstorm, better by pressure
 Gaultheria- Inflammatory rheumatism
 Guaiacum- Indicated in acute condition with pain and swelling , also
effective for stiffness, contraction and immobility of limbs. Intolerance to
heat and pressure

16. Clinical tips contd
 Kali hydroiodicum- Rheumatism of knee with effusion. Pains at night
,and in damp weather. Better by motion , open air
 Kalmia latifolia- Intense pain in joints, changing place suddenly, joints
are red and hot
 Lac Caninum - Affection of joints with alteration of sides; erratic pains.
forgetfulness.
 Ledum palustre- affected parts are cold to touch but it is not felt
subjectively to the patient. Joints are affected from below upwards and
or upper left, lower right. Joint pains worse from warmth, at night; better
from cold or icy-cold application.

17. Clinical tips contd
 Medorrhinum- Pains are worse from sunrise to sunset, during
thunderstorm and from covering, relief in open air
 Phytolacca decandra- Joint pains and stiffness are worse in the
morning, shift rapidly ,and worse from motion and at night
 Pulsatilla- Pains in limbs shifts rapidly, erratic pains aggravation on
beginning to move, better in open air, by cold application, chilliness
 Rhus tox- Pain and stiffness of limbs, better by motion, aggravated in
cold weather

18. Clinical tips contd
 Stellaria media- Synovitis, pain in shoulder, arms, legs, different
parts, shifting pains with stiffness of joints morning aggravation, sharp
shifting rheumatic pains all over with stiffness better evenings , cold
air, by motion
 Stillingia- Chronic periosteal rheumatism, Worse, in afternoons, damp
air, motion. Better in morning, dry air.

19. General Measures
Regular exercise within the limit of pain to improve
muscle strength
Avoid exercise when joints are acutely inflamed
Hot or cold application as required to ease pain and
muscle stiffness

20. Contributors
 Dr. Anjali Miglani, S.M.O
 Dr. Anubha Sikka, M.O
 Dr. Jithesh T.K, C.M.O
 Dr. Pradip Kumar Roy, S.M.O
Compiled by :
Dr. Deepti Chawla, C.M.O, Dte. Of AYUSH, GNCT of Delhi