3. Gouty Arthritis
Gout is an inflammatory disease in which monosodium urate crystal
deposit into a joint, tendons & surrounding tissues.
The urate crystal can form needle-like crystals in a joint and cause
sudden, severe episodes of pain, tenderness, redness, warmth and
swelling.
Most common rheumatoid disease of Adulthood
The word gout derived from the Latin word gutta, meaning "a drop" (of
liquid).
The term "gout" was initially used by Randolphus of Bocking.
4. 5th century BC Hippocrates referred to Gout as “Unwalkable
disease”
Antonie Van Leeuwenhoek first described the microscopic
appearance of urate crystals in 1679.
Gout is also known as the king of diseases and the disease of
kings“ or "rich man's disease.
5. Predisposing factors:-
High Purine Diet (Red Meat, Fatty Poultry, High Fat Dairy,
Seafood)
Certain vegetables (Peas, beans, lentils, mushrooms, cauliflower,
spinach and sweetbreads )
Alcohol Consumption
Trauma
Osteoarthritis
Surgery
Starvation
8. Common sites of gout
Smaller joints:-
First metatarsophalangeal joint
Interphalyngeal joint of foot
Interphalyngeal joint of the
hands
Knee joint
Elbow joint
10. Primary gouty arthritis
Inherited X-lined trait
Cause by several in born errors of purine metabolism
Production of uric acid exceeds the excretion capability of kidney
Sodium utare is deposited in the synovium and other tissues which
results in inflammation.
11. Secondary gouty arthritis
Affected all ages
Hyperurecemia: Excessive uric acid in blood caused by another
disease
Renal insufficiency
Diuretic therapy
Multiple myeloma
Carcinoma
Cause
Decreased normal excretion of uric acid & other waste products
Increase production of uric acid
12. Pathophysiology:-
A high intake of purine,
alcohol intake
Increased purin synthesis,
decreased renal excretion
Deposition uric acid into the
joints
Increase uric acid in the blood
(Hyperuricemia)
Gout
Gouty arthritis
13. Differential Diagnosis:-
RHEUMATOID ARTHRITIS GOUTY ARTHRITIS OSTEOARTHRITIS
Inflammatory diseases Metabolic disorder Degeneration disease
Proliferation of synovial
membrane
Impaired purine
metabolism
Degeneration of articular
ligament
Atleast three joint are
involved
Monoarticular Weight bearing joint
Morning stiffness 1 hour Morning stiffness NA Morning stiffness 15 min.
Pain extreme Pain mild Pain mild
15. 1.Asymptomatic hyperuricemia :-
Is the period prior to the first gout attack. There are no symptoms,
but blood uric acid levels are high and crystals are forming in the
joint.
Safe under - 5mg/dl or less
Good 5-6 mg/dl
Warning 6-7 mg/dl
Danger over 7 mg/dl
16. 2.Acute gout :
First attack of gout arthritis
Hyperuricemia has caused deposits of uric acid Crystal in joint spaces,
leading to gouty attacks.
Excruciating pain and inflammation of one or more joints specially
metatarsophalangeal joint of the greater toe.(Podagra)
The big toe, knee, or ankle joint are most often affected.
The attack sub side within 3 to 10 days, but may return from time to
time.
After a first gouty attack, half of the people will have no symptoms,
half of patient have another attack.
17. Increased ESR & WBC
Excessive alcohol & fat “Starvation” diet can cause acute
gouty attack
3.Interval/ Intercritical stage
Asymptomatic period
No abnormality in joint
18. 4. Chronic Tophaceous gout:-
Polyarticular arthritis + Tophi formation
Articular tophaceous gout may result in
destructive arthropathy & secondry
Osteoarthritis
19. Sites of tophi
Digits of hand and feet (most common)
Pinna of ear
Bursa around elbow and knees
Achilles tendon
20. Diagnosis
Tests to help diagnose gout may include:
Synovial fluid analysis
Uric acid – blood
Joint x- ray
Synovial biopsy
Uric acid - urine
22. Drug therapy:-
Acute gouty arthritis: Inflammation subsides spontaneously 3 to 5 days
But if cannot tolerate pain
Colchicine and NSAIDs
NSAIDs Indomethacin, ibuprofen & naproxen, celecoxib
Corticosteroid
Chronic or repeated acute episode
Uricosuric drug
Allopurin
Probenecid
Allopurinol
Probenecid
23. Diet therapy:-
Limit meat & Avoid fatty foods
Eat enough carbohydrates
Avoid all form of Asprin and diuretic may precipitated attack
Water - at least eight glasses per day
Some fruits that are low in fructose, - strawberries and cherries etc.
Vegetables - a diet rich in vegetables is good, such as spinach, mushrooms,
asparagus etc.
Vegetable oils such as olive, canola, sunflower
VitaminC
Coffee
25. Introduction:-
Vatarakta is a variety of vataroga in which vata and rakta both are
contaminated
Acharya Sushurit Vatarakta described in vatavyadhi, but Acharya
Charak described in different chapter
Vatarakta also known as –वातशोणित, खुडवात, आढयरोग, वातासृक
्
और वातबलास ।
Vatarakta most common in the big toe, and mid foot, ankle, Knees
and other joints.
Symptoms of vatarakta include burning pain, redness, swelling,
tenderness in the join, often the big toe.
Attacks can come suddenly, often at night.
30. DIFFERENCIAL
DIAGNOSIS
AMAVATA
(Rheumatoid arthritis)
SANDHIVATA
(Osteoarthritis)
VATARAKTA
(Gouty arthritis)
KROSHTUKSHIRSH
(Synovitis of knee)
Ama rasa + Vata Vata Vata + Rakta Vata + rakta
First occurs in big
joints
All joints same
occurs
(Spl-knee, low back
joint)
First occurs in small
joints
Only occurs in knee
joints
Fever present No fever No fever( some
time’s present)
No fever
Joints pain &
swelling
Joints pain Joints pain &
swelling
Knee joints pain
swelling,
Pain like a skorpion
bite & wandering
pain
Normal joint pain Pain like a Rat
poison
Normal joint pain
Shrangal Head
Shape
No pus formation No pus formation Pus formation No pus formation
No benefit by
Raktamokshana
No benefit by
Raktamokshana
Benefit by
Raktamokshana
No benefit by
Raktamokshana
31. Types of Vatarakta:-
According to Dosha
(8-Types)
VATARAKTA
According to Location
(2-Types)
• Single Dosha- Vataja, Pittaja,
kaphaja, Raktaja.
• Double Dosha- Vatapittaja,
Vatakaphaja, Vataraktaja.
• Sannipataja.
• Uthana Vatarakta
• Gambhira vatarakta
32. 1.Uthana vatarakta:-
कण्
ू दाहरूगायामतोदस्फ
ु रिक
ु ञ्चनै:।
अक्लिता श्यावरक्ता त्वग्बाह्ये ताम्रातर्थेष्यते॥२०।।
• Itching
• Burning sensation
• Ache
• Extension
• Pricking pain
• throbbing sensation and contraction and
The skin becomes brownish black, red or coppery in color
33. 2.Gambhira Vatarakta :-
गम्भीरे श्वयर्थू: स्तब्ध: कणिनोऽन्तनभूणशाणतणमान्।
श्यावस्ताम्रोऽर्थवा दाहतोदस्फ
ु रिपाकवान्॥
• Oedema
• Stiffness
• Hardness and excruciating pain in the interior of the body
• Blackish brown or coppery coloration [of the skin] and
• Burning sensation
• Pricking pain
• Twitching sensation and
• Suppuration of the joints
34. Sadhyasadhyata:-
Only 1 Dosha & recent origin – curable(साध्य).
The combination of 2 Dosha &
1year old & without Complications – Palliable(याप्य).
All the 3 Doshas & Complications – incurable(असाध्य).
35. Pathya & Apathya:-
Pathya
Old rice, Yava, Wheat, Masura, Karela, Patola, Amlaki, Dry grapes,
Butter, Ghee, Milk of cow and Goat etc.
Apathya
Masha, Kulath, Tila, Curd, Amla, Lavana, Katu dravyas, Kshariya,
Usana and Vidhahikara etc.
40. Antaparimarjana:- Sodhana chikitsa
Raktamokshana:-
1. Jalauka Raktamokshana- Pain, burning sensation, Pricking pain.
2. Shrunga, Pracchanaa karma- Numbness, Itching.
3. Siravyadhana- Vatarakra symptoms transfer one part to another
then
41. Ama Pachana & Agani deepana :-
Sodhana chikitsa with Katu, tikta, & Ruksha guna pradhana
drug According to Rogi and Roga bala
1. Shaddharan churnam
2. Guluchyadi kwatham or Amritotharah kwatham
3. Dasamooladi kwatham
44. Svedana Karma:-
Svedana is contra indicated in Vatarakta but just purpose of
virechana we can do Mridu Svedana
1. Kapha pradhan:-Pottali And Sekam
2. Vata pradhan:- Very mild Upanaham svedam
45. Vamana Karma:-
Gambhira & Kapha pradhana & few Pitta pradhana associated with
sever complication.
Mrudu Vamana karma :- According to koshata of Rogi &
Rogavastha
1. Madanaphala
2. Yashtimadhu
3. Ksheeram
46. Virechana karma:-
Gambhira, Pitta, Kapha, Rakta pradhana
Mrudu Virechana karma
1. Eranda thailam or
2. Nimba Amrutha Eranda thailam
3. Trivrut choorna with ksheera or draksha rasa as Anupana
25 ml, with Milk
Acc. to Rogi & Roga bala
47. Vasthi chikitsa:-
णनहणरेद्वा मलां तस्य सघृतैः क्षीरबक्लस्तणभः |
न णह बक्लस्तसमां णकणञ्चद्वातरक्तणचणकक्लितम् ||८८||
बक्लस्तवङ्क्षिपाश्वोरुपवाणक्लथर्थजिराणतणषु |
उदावते च शस्यन्ते णनरूहाः सानुवासनाः ||८९||
In all type of vatarakta widely used vasthi
Ksheera vasthi And Balaguduchyadi ksheera vasthi
Kapha Pradhana vatarakta- Guduchyadi yapana vasthi
Pitta Pradhana vatarakta – Panchatiktaka Vasthi
56. Case Preparation :-
Name of patient- Rishika singh
Age- 30
Sex- Female
Address- Gurgaon, Hariyana
Marital status- Married
Occupation- Lawyer
DOA- 08/02/19
DOD-07/03/19
57. Main Complaint:-
Pain and swelling over multiple joints- wrist, knee, ankle joints – 2 years
Pain and Swelling over bilateral fingers of upper limbs
Occasionaly fever
Indigestion after taking heavy food- 6 Months
Sleeplessness
Past illness
Asthama and Thyroid disease on medication
H/O- Jaundice And malaria
58. Family History- Father had arthritis
Pesonal History:
Bowel: Normal
Appetite: Less
Micturition: Normal
Sleep: Disturbed
59. GENERAL PHYSICAL EXAMINATION:
Build: Lean Weight: 51 kg
Height: 164 cm Pulse rate: 74/min
Temp: 98.80F B.P.: 120/80 mmHg
MENSTRUAL HISTOTY:
Regular cycle
63. Procedure:
Dhanyamladhaya- 3 days
Pizhichil- 7 days
Lepanam- 24 days
Vashti- 3 ( Madhuthailika vasthi 2day)
Amrithakadi podikizhi- 3 days
Pachakizhi- 7 days
Pizhichil- 9 days
64. Daily progress:-
12/02/19- Nausea and joint pain
1.Vilwadi leham- ¼ tsp 4 times a day
2.Vepilla lepam- Bilateral wrist joint, feet & ankle joint
16/02/19- Feeling tiredness
- Drakshadi paneeyam frequently
20/02/19- Pain increase after Amrithakadipodikizhi
Next day Pachakizhi started
65. 26/02/19- Evening pain and fever
- Brihath kasthuri bherava rasam- 1(sos)
Condition on Discharge:-
Pain and swelling all over body reduced
General health improved
Nausea better with Vilwadi leham
Indigestion persist
66. Follow up medication:-
1.Rasanaerandadi kwatham- 2 tab
+ Aganikumararasam- 1
2.Kaisora gulgulu vatika- 1
+ Rasasindooram cap- 1
3.Dadimadi ghritham- 1 tsp
+ Lohasimdooram cap- 1
4.Pinda thailam + Karpooradi thailam- for external application
5.Rhukot plus- for local application
6AM & 6PM
BD/ Before food
At bed time
