Integrated ayurvedic management of rheumatoid arthritis (amavata) – a case study

Background

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder characterized by joint pain, stiffness, swelling and progressive functional impairment with degenerative changes. It can be correlated with Amavata in Ayurveda. An impeded Agni plays a significant part in the aetiology of Amavata, where the pathological process involves the interaction of Ama and aggravated Vata. Vaitarana Basti, along with Ama pachana and Vata shamana measures, may therefore have therapeutic relevance in such presentations. Case Presentation: A 42-year-old female presented with a seven-year history of progressively increasing pain and stiffness involving multiple small joints, particularly of the hands and wrists, associated with swelling, tenderness, anorexia, indigestion, irregular bowel habits, and disturbed sleep. The symptoms were aggravated during the rainy and winter seasons and the patient had received conventional treatment for approximately seven years with unsatisfactory relief. The clinical assessment revealed was found to be compatible with the classical symptoms of Amavata, while laboratory evaluation showed elevated rheumatoid factor (64 IU/mL) and C-reactive protein (11.53 mg/dL). Disease activity was assessed using Tender Joint Count (TJC28), Swollen Joint Count (SJC28), ESR, Patient Global Health Assessment, and DAS28-ESR. Intervention and Outcome: The patient received an integrated Ayurvedic therapy consisting of Vaitarana Basti for 15 days, Ruksha Baluka Sweda twice daily, Kaishore Guggulu, and Shunthi Kwatha administered as part of the treatment protocol. In this treatment, patient showed a progressive reduction in joint pain, stiffness, swelling and tenderness along with improvement in associated gastrointestinal complaints and sleep. The overall subjective parameter decreased from 27 to 11 (59.26% reduction). TJC28 and SJC28 decreased by 50% and 66.67%, respectively. DAS28-ESR showed from 6.24 to 4.39 (29.65% reduction), with disease activity changing from high to moderate. Rheumatoid factor decreased from 64 to 49 IU/mL, while CRP decreased from 11.53 to 8.27 mg/dL.