disease of small joints with different joint involvement

1. RHEUMATOID
ARTHRITIS
आमवात

2. INTRODUCTION
• Agni is among the critical factor in determining optimal health and
internal haemostasis. Agni is responsible for digestion of food. Due to
malfunctioning of digestive fire the resultant Rasa Dhatu is not formed
properly leads to formation of undigested Rasa dhatu.
• This improper Rasa Dhatu remains in stomach and get mixed with food
which is called Aam.
• Main cause of disease is Mandagni according to Vagbhatt.
• Disease caused by Aam and Agni are Pandu,Shoth,Aamvaat,Jwar etc.
• But here we can focussing on Aamvaat.

3. definition
• युगपत्क
ु पपतावन्तस्त्रिकसंपिप्रवेशकौ|
स्तब्ध च गुरूतो गात्रमामवात: स
उच्यते|’(मा.पि.25/5)
जब आम व वात दोष एक साथ क
ु पपत होकर शरीर में पत्रकप्रदेश व
संपियों में प्रपवष्ट होकर शूल व स्तब्धता उत्पन्नकरते है उसे आमवात
कहते है।

4. NIDANA
• पवरूद्धाहार चेष्टस्य मन्दाग्नेपििपिलस्य|
पिग्ध भुक्तोवतो हान्नं व्यायामं क
ु वितस्तथा| (मा.पि.25/1)
• Intake of contradictory food items,
• followed by contradictory lifestyle,
• Slow or inactive indigestive mechanism
• Consumption Of sticky food followed by exercise

5. samprapti
वायुिा प्रेररतो ह आम श्लेष्मस्थािं प्रिावपत|
ते िात्यथि पवदग्धोअसौ िमिी: प्रपतपद्धते||
वातपपत्तकफ
ै भूियो दू पषत: सोअन्नजो रस:|
िोतोस्यपभष्यन्दयपत िािावर्िअपतपपस्त्रिल: ||
जियत्याशु दौबिल्य गौरवं हदयस्य च|
व्यािीिामाश्रयो दोष आमसंज्ञोअपतदारूर्:||(मा.पि.)

6. ववरूद्ध आहार व्यायाम,वेग धारण
↓ ↓
आम विमााण वात प्रकोप
आम वात
↓
वायु द्वारा आम का स्वधमी
↓
कफ स्थािोोंपर जािा
↓
धमवियोोंमें फौलिा
↓
विदोष से वमलकर
↓
रसवह स्त्रोतस् में अवरोध करक
े
↓
सोंवधयोोंमें स्थािसोंश्रय
↓
सोंवधशोथ,शूल,जकडाहट,आलस्य,गुरूता,अरूवि,ज्वर

7. • Due to ingestion of the etiological factors which are
mentioned earlier, disturbs the normal functions of agni as a
result, food is not properly digested and yields immature ras
in the amashaya and this
• Undergoes fermentation or putrefaction because of its
retention for longer duration ,manifests AMA then it is
absorbed in the system and it is taken up by the aggravated
and vitiated vayu specially to the kaphasathan mainly amasya,
sandhi, uras, kantha etc, and the same undergoes in the in the
above mentioned sites and enters the dhamani by circulation
with the help of vata.

8. • Here it amalgamates with the existing Dosas and
vitiated further in excess and produces distress in the
body channels due to its excessive Nature and some
other different qualities of amarasa. So both Ama and
Vata aggravates simultaneously and enter kostha,
Trika and sandhi and ultimately leads to stabdhata in
the body

9. • Genetic- HLA D4
• ENVIRONMENTAL

11. Cardinal symptoms
अंगमदोअरूपचस्तृष्णाह्ाालस्यं गौरवं ज्वर:|
अपाक: शूिताअंगािामामवातस्य लक्षर्म्(मा.पि.25/6)
• Anorexia
• Bodyache
• thirst
• Fever
• Heaviness
• Numbness
• Pain in sacral region
• Inflammation over affected parts

12. MODERN

13. EXTRA MANIFESTATION

14. Special symptoms
पपत्तात सदाहं च सशूंल पविािुगम|
स्त्रस्तपमतं गुरू कण्ङ
ु च कफदुष्टम तमापदशेत|
(मा.पि.25/11)
• Pitta dosha- Burning sensation
Discolouration of the joint
• Vata dosha- more of pain in the joints
• Kapha dosha- heaviness
Feeling as covered with wet cloth

16. ARC 1988 CRITERIA FOR RHEUMATOID
ARTHRITIS
Morning stiffness(>1hr)
Arthritis of three or more Joint areas
Arthritis of hand joints
Symmetrical arthritis
Rheumatoid nodules
Rheumatoid factor
Radiological changes
Duration>6weeks

17. CRITERIA POINTS
1.JOINT INVOLVEMENT 0-5
1 Medium to large joint 0
2-10medium to large joints 1
1-3small joints 2
4-10small joints 3
>10joints;at least one small joint 5
2. SEROLOGY 0-3
Negative RF and negative ACPA 0
Low positive RF or low positive ACPA 2
High positive RF or high positive ACPA 3
3.ACUTE PHASE REACTANTS 0-1
Normal CRP and normal ESR 0
Abnormal CRP or abnormal ESR 1
4.DURATION OF SYMPTOMS 0-1
<6Weeks 0
>6Weeks 1

18. INVESTIGATION
• Blood count- anaemia
• ESR and/or CRP- raised
• Serology- RF ,ACPA/Anti CCP
• X-rays- for erosions
• Aspiration of the joint- in severe cases
• Musculoskeletal ultrasound- for treatment purpose

19. प्रवृद्ध या तीव्र आमवात लक्षण
स कष्ट: सविरोगार्ां यदा प्रक
ु पपतो भवेत|
हस्तपादपशरोगुल्फपत्रकजािूरूसस्त्रिषु||
करोपत सरूजं शोथं यत्र दोष: प्रपद्धते|
स देशो रूज्यतेअत्य्रथ व्यापवध्द इव वृपिक
ै :| |
JOINT INVOLVEMENT IN R.A.
• SWAN NECK DEFORMITY
• BOUTONNIERE DEFORMITY(BUTTON HOLE DEFORMITY)
• Z DEFORMITY
• ULNAR DEVIATION
• COCKUP DEFORMITY

23. PROGNOSIS
एकदोषािुग: साध्यो पत्रदोषो याप्य उच्यते|
सविदेहचर: शोथ: स: क
ृ ि: सपन्नपापतक:
(मा.पि.25/12)
• The disease caused by the one dosha is Sadhya.
• If the vyadhi caused by the two dosha is Yapya.
• If the vyadhi involved the three dosha and are circulating in all over
body and involve the shotha like lakshna that type of Amavata
considerise Krichha Sadhya like avastha

24. TREATMENT
• NSAIDs
• Corticosteroids- oral n injectables
• Dmards
• Anti TNF blockers-infliximab, adalimumab, certolizumab
pegol, and golimumab,
• Monoclonal antibody
• Gold preparation
• Physiotherapy
• Surgery

25. CHIKITSA
• लंघि स्वेदिं पतक्तं दीपिापि कटू पि च
पवरेचिं िेहपािं बस्तयिाममारूते
सैंिवािािुवास्य क्षारबस्त्रस्त प्रशस्यते (चक्रदत)
• आम क
े अल्पबल लंघि उपाय
• आम क
े मध्यबल दीपि पाचि
• आम क
े उत्तमबल दोषावसेचि
1.दीपि पािि िूणा
अजमोदापद चूर्ि,पंचकोल चूर्ि,पत्रकटु चूर्ि,शुण्ठी चूर्ि
2.स्नेहि योग
पवषगभि तैलाभ्यंग,सैंिवापद तैलाभ्यंग,एरण्ड तैल
आमवातगजेन्द्रस्य शरीरवििाररण एक एवाग्रणीह्रन्ता एरण्डस्नेहक
े सरी| (योगरत्नाकर)
3.स्वेदि योग
बालुका पोटली स्वेद, सैंिव लवर् स्वेद, रूक्षपत्रपपण्ड स्वेद

26. 4.ववरेिि योग
एरण्ड तैल,क
ं स हरीतकी,पत्रवृत योग
5.अिुवासि वस्ति- सैंिवापद तैल, िारायर् तैल
आस्थापि वस्ति-दशमूलापद पिरूह वस्त्रस्त,क्षार वस्त्रस्त,एरण्डमूलापद पिरूह वस्त्रस्त,वैतरर्
वस्त्रस्त
पथ्य -षपष्टक शाली,करेला,पटोल,आद्र् रक,रसोि,उष्णोदक,पुरार् मद्ध,गोमूत्र,रूक्षर्
अपथ्य- दपि,मस्तु,गुड,गुरू अपभष्यन्द आहार,रापत्र जागरर्,वेग पविारर्

27. • िागर चूर्ि
• पत्रवृतापद चूर्ि
• हरीतकी एरण्ड
• एरण्ड तैल पाि
• रािापंचक क्वाथ
• रािासप्तक क्वाथ
• रसोिापदक्वाथ
• शट्यापद क्वाथ

28. • Dashamula Kashayam
• Shunti-guduchi kwatha
• Shunti-guda -
• Bhallatakadi churna
• Panchakola Choornam
• Shaddharanam Choornam
• Vaiswanara Choornam
• Rasnadi guggulu
• Yogaraja guggulu
• Punarnava guggulu
• Trayodasanga guggulu

29. For abhyanga purpose
• Kottamchukkadi tailam
• Karpooradi tailam
• Saindhavadi tailam