RHEUMATOID ARTHRITIS

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology and a long-term condition that can cause pain, swelling and stiffness in the joints. Rheumatoid arthritis is an autoimmune disorder. This means that the immune system mistakenly attacks healthy tissues in the body, rather than microbes. It usually presents as bilateral symmetric polyarthritis (synovitis) that affects the hands and feet. Any joint lined by a synovial membrane may be affected, and extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant. If  it is untreated, this can damage the joints, cartilage, and nearby bones.

The prevalence of RA is estimated to be 0.5-1 percentage of the adult population. The percent of women to men RA patient ratio is 2-3:1.Although the possibility of occurring RA at any age is common, the peak age of onset is 45 yrs-65 yrs.

PATHOGENESIS

The pathogenesis of rheumatoid arthritis (RA) is a complex phenomenon, which is not yet fully understood. RA is a disease driven by T cells after an unknown initiating event. The persistent inflammation is maintained by auto antigens. In common with other autoimmune diseases, it is likely that early in the course of RA, the antigen drive may be dependent on a single or a few auto antigens. Later in the disease, it is likely that there is epitope and antigen spreading so that a potentially large number of auto antigens may be involved. The endoplasmic reticulum glucose-regulated (GRP78) chaperone, is preferentially stimulates T cells from the synovial fluid of patients with RA

CAUSES:

SYMPTOMS:

Signs and symptoms of rheumatoid arthritis may include:

• Tender, warm, swollen joints
• Joint stiffness that is usually worse in the mornings and after inactivity
• Fatigue, fever and loss of appetite

Early rheumatoid arthritis tends to affect the smaller joints first , particularly the joints that attach the fingers to hands and toes to the feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of the body.

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don’t involve the joints. Areas that may be affected include:

• Skin
• Eyes                                                                
• Lungs  
• Heart                       
• Kidneys
• Salivary glands                                                                                
• Nerve tissue
• Bone marrow
• Blood vessels

The signs and symptoms may vary in severity . Periods of increased disease activity, called flares, alternated with periods of relative remission, when the swelling and pain fade or disappear occur.

DIAGNOSIS:

BLOOD TESTS:

• C-reactive protein test
• Rheumatoid factor
• Erythrocyte sedimentation rate
• Anti-cyclic citrullinated peptide (anti-CCP) antibodies.

IMAGING TESTS

• MRI
• Ultrasound
• X-ray

NATUROPATHY TREATMENT PROTOCOL

AIM:

• To reduce pain
• To control the inflammatory process
• To reduce joint stiffness
• To improve muscle strength and enhance the range of motion
• To minimize disability
• To improve quality of life and thereby reduce dependency

YOGA THERAPY:

   1.Joint exercise

   2.Asanas

• Shavasana
• Ardha uttanasana
• Virasana
• Baddha konasana
• Marjariasana                                
• Supta padangustasana
• Tadasana
• Utkatasana
• Urdhva hastasana
• Veerabadrasana

3.Pranayama :

• Nadi shodhana
• Chandra bedhana

            Relaxation technique:

• Mind sound resonance technique
• Yoga nidra

DIET THERAPY:

• Vegetarian diet improves gut microbiota and modify the fecal microbiota.
• Plant based low carbohydrate diet
• Anti-inflammatory diet-Tomatoes,green leafy vegetables, such as spinach, nuts like almonds and walnuts,fruits such as strawberries, blueberries, cherries, and pineapples and oranges.
• Anti-oxidant rich diet-Blueberries, cranberries, strawberries, blackberries, raspberries
• Fasting modifies disease activity thus reducing inflammation
• Gluten free diet
• Raw juice diet (eg. green leafy veg juice combined with carrot and beetroot)-alkaline action of this dissolves the accumulation of deposits around the joints.
• Fresh pineapple has bromelain enzyme which has the action to reduce swelling and inflammation
• Ginger has the anti-inflammatory effect similar to aspirin used in painful condition
• Black sesame soaked water-reduces joint pain, prevents bone loss, improves bone strength, and exerts anti-inflammatory effect.
• Fasting reduces/decreases the potent inflammatory mediators such as B4 (LTB4) and various cytokines, thereby reducing the migration of neutrophils to inflammatory site. 
• One week fasting is more beneficial if it is followed and preceded by plant-based vegetarian diet

HYDROTHERAPY:

• Full Immersion bath (33.5-41 degree Celsius)
• Balneotherapy
• Revulsive compress
• Steam bath
• Neutral arm and foot bath
• Leg pack
• Cold douches-reduce stiffnes and pain

MUD THERAPY:

• Head out immersion bath followed by mud therapy of (4-42 degree Celsius)
• Thermal mud therapy
• Hot mud application
• Mud compress and poultice

MASSAGE THERAPY:

• Light and moderate pressure massage reduces pain and increases activity of the limbs.

HELIO THERAPY:

• Sun bath-exposure to sunlight increases blood level of natural opiates (endorphins), thus reduces pain

PHYSIOTHERAPY:

• TENS
• Ultra sound
• IFT
• Exercise therapy

CHROMOTHERAPY:

• Yellow colour-reduces muscular pain and inflammation
• Blue colour-for 15 min (of variable period) reduces pain in RA

ACUPUNCTURE:

Stimulation of points such a

LI1, TW5, LI4, ST36, GB36, GB39

Both by traditional needling method and electro-acupuncture relieve pain and tenderness in RA.