Osteoarthritis (OA) - Overview of Ayurveda

• This is the most common type of arthritis.
• It is due to damage to articular cartilage, due to interaction between genetic, environmental and biochemical factors leading to inflammatory response.
• Risk factors are obesity, family history, trauma, occupation (miners, cotton workers, farmers),sports (repeated use and injury in some sports)

Causes;

Primary: Unknown

Secondary: 

•           pre existing joint disease-rheumatoid arthritis, gout, septic arthritis spondylo arthritis
•           metabolic- acromegaly, hereditary hemochromatosis
•           systemic diseases- hemophilia, neuropathies, sickle cell disease

Clinical features;

• Joint pain with movements and when weight bearing(relieved by rest).
• Morning stiffness less than 30 minutes.
• Reduced range of movement/functional limitations.

Signs

•        Crepitus
•        Restricted movements
•        Bony enlargement
•        Joint effusion
•        Bone instability
•        Muscle wasting
•        Gelling; in the morning or after other long periods of inactivity,some people with osteoarthritis may experience a feeling of stiffness(caused by a temporary thickening of natural fluids inside the joint)

Clinical subsets; 

• Localized osteoarthritis
• Primary generalized
• Erosive osteoarthritis
• Crystal associated osteoarthritis
• Nodal osteoarthritis:

- Most commonly in female at menopause.

- Painful swollen joints

• Hip osteoarthritis:

- More common in men.

- Associated with nodal osteoarthritis.

• Knee osteoarthritis:

- Usually bilateral.

- Medial compartment is more commonly affected.

- Strongly associated with nodal osteoarthritis in hand in elderly women.

- Previous trauma is risk factor.

- Lead to varies deformity(bow-legged)

• Primary generalized osteoarthritis;

- This is rare.

- Usually seen in associated with nodal OA and knee OA.

• Erosive osteoarthritis;

- This is rare.

- Severe functional impairment can be seen.

- X-ray: marked osteolysis

• Crystal associated osteoarthritis;

- Calcium pyrophosphate deposition in intra articular cartilage.

- Present in knee, wrist commonly.

Treatments in Ayurveda

• Bahya Chikitsa (external treatments)

 Abhyanga(medicinal herbal oil massage): oils used for abhyanga-tila taila(sesame oil), pinda taila, narayana taila, shulahara taila, vata viduranga taila,ksheerabala taila,mahamasha taila

 Swedana (sudation therapy/fomentation);the procedure which relieves stiffness, heaviness, coldness of the body and produce sweating is known as sweda. There are many methods of sweda mentioned in ayurvedic classical texts. Among them vashpa sweda (also known as nadi sweda: the process by which the patient is made to perspire by using a tube and passing medicated steam on the affected npart of the body, pinda sweda (Fomentation by means of bolus containing prescribed drugs or without being wrapped with cloths ex:patra pinda sweda, shashtika shali pinda sweda), avagaha sweda(process of fomenting by which the patient is made to bath in medicated decoction,oil,ghee,milk,meat juice etc ina tub), upanah sweda(appilcation of hot paste on body) are best for osteoarthritis.(for more details refer the article on sudation therapy on ayudhara)

 Dhaara/seka (pizhichil); is a main supplementary procedure of pouring a liquid on the body or a specific part of the body in a particular rhythm for a stipulated period of time)

 Vasti-janu vasti; warm medicated oil is poured pooled in the panful knee joint for a specified period of time.

 Pichu; a larger piece of cotton swab or sterile gauze is dipped in medicated oil mixture or ghee and then apply on the painful joint and wrapped around it and keep for specific time duration.

Abhyantara Chikisa (Internal Treatments)

Snehapana (intake of medicated oil or ghee in a specified quantity according to stength of the patient and according to the disease.

 Pancakarma; Virechana(therapeutic purgation):medicinal formula is given orally.

             Vasti (medicated enema):medicinal formula is given through the anal route.