RHEUMATOID ARTHRITIS AND ITS HOMEOPATHIC MANAGEMENT

                                                             RHEUMATOID ARTHRITIS

DEFINITION:-

                    Rheumatoid arthritis is a progressive and persistent type of polyarthritis that starts in the peripheral joints but later involves almost all the joints of the body, bilaterally and symmetrically causing permanent disability and invalidism.

CAUSES 0R AETIOLOGY:-

-          Auto immune disorder.

 Some of predisposing factors are

-          Age - 30-40 years.

-          Sex – 3-4 times more common in females.

-          Climate – more common climates are cold, damp and fog.

-          Heredity – family history of the disease may be obtained in some cases but not in all cases.

PATHOLOGY:-

            The pathological changes are progressive and irreversible. The synovial membrane is involved first. The membrane becomes more vascular, swollen and hypertrophied, the membrane and the underlying connective tissue is infiltrated with lymphocytes (esp T lymphocytes), plasma cells and macrophages. At this stage there may be effusion into the joint space. A circular ridge of granulation tissue forms at the periphery which later invades the articular cartilage (pannus formation) and causes its destruction, this is followed by fibrous adhesions resulting in fibrous ankylosis.bony ankylosis occurs still later. In advanced cases osteoporotic changes occur in the adjoining bones along with wasting of the muscles and atrophy of the overlying skin. Rheumatoid nodules seen in subcutaneous tissue, immunological damage to small sized arteries is responsible for severe systemic features of the disease. That it is a systemic disorder of the connective tissue is evident by the fact that lesions also occur in the pleura, lungs, heart and the sclera.

SYMPTOMS:-

-          Pain is more on night.

-          Swelling of all over the joints.

-          Morning stiffness of all joints.

-          Hands show the typical table fork deformity.

-          Restricted movements of all joints.

-          Malaise, tiredness, loss of weight.

-          Numbness and tingling in the limbs.

-          Vague pain in the muscles and joints.

-          Low grade fever.

-          Other non – articular involvements include pleural effusion, scleritis, episcleritis, arteritis, peripheral neuropathy and myopathy.

INVESTIGATIONS:-

-          ESR – ESR is consistently high, much above the normal value.

-          Agglutination test.

-          C-reactive protein test.

-          Examination of synovial fluid.

-          Radiology – x ray.

COMPLICATIONS:-

1.       Tendinitis, rupture of tendons and rupture of the joint capsule.

2.       Local nerve compression occurs in carpal-tunnel syndrome.

3.       Septic arthritis, more likely to occur during steroid therapy.

4.       Refractory anemia.

5.       Myelopathy when cervical spine is involved.

6.       Secondary amyloidosis

TREATMENT:-

1.       Rest - during acute stage the  patient should be given complete rest for  2-3 weeks.

2.       Use of anti inflammatory drugs – like aspirin, ibuprofen, ketoprofen, fenoprofun, diclofenac etc.

3.       Physiotherapy.

4.       Surgical measures.

DIET:-

-          Rich in vitamins  food like milk, eggs,

-          Rich in iron food.

-          Avoid potato, beetroot.

-          Avoid alcohol and cigarette smoking.

HOMEOPATHIC REMEDIES:-

1.       ARNICA:-

       Limbs and body ache as if beaten; joints as if sprained. Bed feels too hard, chilly patient, Nervous; cannot bear pain; whole body oversensitive. Great fear of being touched or approached. Pain in back and limbs, as if bruised or beaten. Cannot walk erect, on account of bruised pain in pelvic region. Rheumatism begins low down and works up. [Ledum.]. Even its very good remedy for any injury.

2.       ACTACEA SPICATA:-

       Sharp rheumatic pains in small joints. Wrist ankles and toes. Swelling of joints from slightest fatigue. The wrist is swollen, red and is worse by any motion. There is sudden lassitude after talking or eating.

3.       CAULOPHYLLUM:-

       It is one of the best remedies for small joint affections when there are sharp  needle like prickling pains which constantly shift from one place to another. There are cutting pains on closing the hands. In females, it may be associated with rigid os and severe pains during menses. All the complaints are made worse from motion.

4.       COLCHICUM:-

       Sharp pain down left arm. Tearing in limbs during warm weather, stinging during cold. Pins and needles in hands and wrists, fingertips numb. Limbs, lame, weak, tingling. Pain worse in evening and warm weather. Joints stiff and feverish; shifting rheumatism; pains worse at night. Oedematous swelling and coldness of legs and feet. Tingling in the finger nails.

5.       DULCAMARA:-

       The rheumatic troubles induced by damp cold are aggravated by every cold change and somewhat relieved by moving about. Rheumatism alternates with diarrhoea. Rheumatic symptoms after acute skin eruptions. Pain in shin-bones. Perspiration on palms of hands. Paralysis; paralyzed limbs, feet icy cold.

6.       GUAICUM OFFCINALE:-

        Rheumatic pain in shoulders, arms and hands. Growing pains. [Phos. ac.].Gouty tearing, with contractions. Immovable stiffness. Ankle pain extending up the leg, causing lameness. Joints swollen, painful, and intolerant of pressure; can bear no heat. Stinging pain in limbs. Arthritic lancinations followed by contraction of limbs. A feeling of heat in the affected limbs. Worse; from motion, heat, cold wet weather; pressure, touch, from 6 pm to 4 am. Better; external pressure.

7.       KALI IODOM:-

         Shoulders: tearing in left; in right, then in right ear; pain in tendons of right on motion, touch, and rest, like a tension and as if swollen; bruised pain in left; paralytic pain only on moving them. Tearing twitching in right knee. Painful drawing in calves when sitting. Tearing in back part of left heel when sitting; in right heel when standing, >walking. Tearing in great toes; in right second toe.

8.       PULSATILLA:-

          It is a good remedy for arthritis of the small joints when pains are sharp and constantly shifting and changing place from one to another. The pain is associated with chillness. They are better by motion and in open air, hot patient, thirstless.Knees swollen, with tearing, drawing pains. Drawing, tensive pain in thighs and legs, with restlessness, sleeplessness and chilliness. Boring pain in heels toward evening; suffering worse from letting the affected limb hang down. [Vipera.].

9.       VIOLA ODORATA:-

          It is a good remedy for rheumatism of the small joints specially with a pressing pain in right carpel and metacarpal joint. It is associated with milky urine which smells strong. The complaints are worse from cool air.

Some of other homeopathic drugs are benzoic acid, calc carb, capsicum, causticum, ferrum iodum, ledum pal, lycopodium, natrum phos, rhododendron, sepia, sulphur, thyroidinum