CLINICAL EFFICACY OF AMAVATARI RASA IN THE MANAGEMENT OF RHEUMATOID ARTHERITIS

Transcription

1 CLINICAL EFFICACY OF AMAVATARI RASA IN THE MANAGEMENT OF RHEUMATOID ARTHERITIS By Dr. Sonam Bhinde Under the Guidance of Prof. P. K. Prajapati Dr. Galib Department of Rasa Shastra and Bhaishajya Kalpana including Drug Research Institute for Post Graduate Teaching & Research in Ayurveda Gujarat Ayurved University, Jamnagar IEC No.: PGT/7/A/Ethics/ /1538 1

2 Amavata is the prime disease which makes the person unfit for independent life. About 60% of the patients become unfit to work 10 years after the onset of the disease. All that modern medicine can do on this disease is anti inflammatory, analgesic and steroids. But it gives only temporary relief. However, till date no satisfactory modern medical management has been developed for this problem. exists all over the world & affects men & women of all races. Women are affected about 3 to 5 times more commonly than men. 2

3 Aim & Objective To evaluate the role of Amavatari rasa in the management of rheumatoid arthritis. 3

4 Ingredients of Amavatari Rasa Sr. No. Ingredients Latin name Part used Proportion 1 Rasa Hydrargyrum - 1 part (Hingulotth Parada) 2 Shuddha Gandhaka Sulfur - 2 parts 3 Haritaki Terminalia chebula Linn. Dried Pericarp 1 part 4 Bibhitaki Terminalia bellirica Linn. Dried Pericarp 1 part 5 Amalaki Embelica officinalis Linn. Dried Pericarp 1 part 6 Vahni (Chitraka) Plambago zylenica Linn. Dried Root 4 parts 7 Shuddha Guggulu Commiphora wightii (Arn) Bhandari Exudate 5 parts 8 Earanda Taila Ricinus communis Linn. Oil Q.S. 4

5 Materials And Methods 41 Patients having Amavata and fulfilling the criteria of diagnosis were selected irrespective of their sex, caste, religion from OPD & IPD of I.P.G.T.& R.A., hospital, Gujarat Ayurved university, Jamnagar. The study was initiated only after getting clearance from institutional ethics committee informed written consent was taken by each patient before starting the treatment. 5

6 Diagnostic Criteria Presence of any four out of the following seven (jone s) criteria 1. Morning stiffness 2. Arthritis of Three or more joints 3. Arthritis of hand joints 4. Symmetric arthritis (more than 6 week s duration). 5. Presence of rheumatoid Nodules 6. Serum rheumatoid factor- positive 7. Typical radiographic changes of arthritis on PA view of hand & wrist radiograph that must include erosions or unequivocal bony decalcification, localized in or adjacent to involved joints. 6

7 Inclusion Criteria 1 2 Patients fulfilling the diagnostic criteria, of either sex with age between 20 to 50 years Willing and able to participate in the study. 7

8 Exclusion Criteria 1 2 Patients having severe systemic illness diseases like hypertension, DM, MI Patients below 20 years and above 50 years of age 3 Pregnant/lactating women 4 Chronicity more than 10 years 8

9 INVESTIGATION 9

10 Posology Dosage form : Capsules of 250 mg Dose : 1 Capsule thrice a day 30 minutes before meal Anupana : Luke warm water Duration : 8 weeks. 10

11 Clinical Assessment The changes in the signs and symptoms were assessed by adopting suitable scoring method and by using appropriate clinical tools. 11

12 Assessment Criteria Improvement in Physical and clinical Parameters Serum Rheumatoid Factor C-reactive protein Improvement in hand grip, foot pressure. 12

13 Functional Assessment To have an objective view of the improvements in the functions of affected joints, functional tests have been done. Hand Grip: To find out the functional capacity of the affected upper limb, Patients were asked to squeeze the inflated cuff of the sphygmomanometer and the grip strength has been recorded in mm of Hg. Foot pressure: To have an objective view of the functional capacity of the legs, foot pressure was recorded by using a weighing machine. 13

14 EFFECT OF THERAPY on Cardinal Symptoms N Mean Difference ±SEM % Change W P Bt At Sandhishula ± <0.001** Sandhishotha ± <0.001** Sandhi Graha ± <0.001** Sunata anganam ± <0.001** 14

15 Discussion Highly Significant relief in Sandhishula may be due to the Vatahara and Vedanahara properties of Amavatari Rasa. Sandhishula is the result of Vata vitiation. Eranda taila by virtue of its Snigdha guna and vata Shamaka nature might have played a major role in Vata Shamana. The Highly Significant relief observed in Sandhishotha may be due to Shothaghna (anti inflammatory) property of Guggulu. Most of the ingredients of the Amavatari Rasa are Deepana Pachana, so the combination might have digested the Ama which was accumulated in Sandhis, thus causing reduction in Shotha. The Highly Significant relief observed in Sandhigraha may be due to the resolution of the Ama in affected parts by the Amahara property of Chitraka and other drugs. Tenderness mainly due to swelling of joint so whenever swelling reduce it also relief in tenderness. 15

16 Effect on General Symptoms %

17 % relief Effect on Grip Power and Foot pressure Symptoms Grip Power Foot pressure 17

18 Effect on ESR, CRP and RA Factor 0 ESR CRP RA

19 Effect on Hematological Parameters Mean Score GROUP B N BT AT Diff± SEM t P Hb TLC ± # ± # RBC Platelets ± # ± # 19 Data: Mean ± SEM, Decrease, increase, # insignificant

20 Effect on Bio-chemical parameters GROUP B N BT Mean Score AT Diff± SEM t P FBS ± # Blood Urea ± # S. Creatinine ± * SGPT ± # SGOT ± # S. Uric Acid ± # Data: Mean ± SEM, Decrease, increase, # insignificant, * significant 20

21 Overall Effect of Therapy 40% 35% 30% 25% 20% 15% 10% 5% 35% 27.50% 17.5% 5% 15% n=40 0% Complete remission Markedly improved Moderately improved Mild Improved Unchanged 21

22 Most of the patients have chronicity more than 1 year and were taking DMARD, Steroids and NSAID that have negative impact on their immune system. Out of 40 patients, 18 patients has stopped their modern medicine by them self, that is because they feel enough relief in symptoms with the given test drug (Amavatari Rasa). Hence, such kind of patients needs long term treatment along with Pathyapathya for better improvement. Due to short duration of treatment and more chronicity, mild to moderate improvement was obtained. 22

23 Conclusion Amavatari Rasa act by its virtue of Dipana (Chitraka), Snehana, Anulomana, Vata Shamana (Eranda), Rasayana, Tridosha Shamana (Triphala), Shothaghna (guggulu), Yogavahi, and Rasayana (Kajjali) property. It is also worth noticing that this drug do not cause any untoward effect which is proved by clinical as well as lab investigations. Though change in biological markers (RA and CRP) are statistically insignificant, Amavatari Rasa caused the decrease in both of them. Clinical signs and symptoms were also reduced significantly. So it could be concluded that Amavatari Rasa Along with proper codes and conducts can be the solution for the giant disease like Amavata (rheumatoid artritis). 23

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