A Clinical Study On Osteoarthritis With Constitutional Homoeopathic Approach

ABSTRACT
Background
Osteoarthritis is slow degenerative disorder of weight bearing joints which leads to degeneration of hyaline cartilage with or without inflammation of synovial membrane and subchondral bone and may form osteophytes around the edge of joint surface.
Homoeopathy considers ‘Osteoarthritis’ as chronic disorder of chronic miasmatic origin. Hence the treatment is to be given should remove the miasmatic block to cure the disease which is possible with the individualization after considering both mental and physical aspect of patient.
Aims and Objectives
This study was aimed to understand the efficacy of homoeopathic medicines in cases of Osteoarthritis using Constitutional Homoeopathic approach.
The present study was undertaken to fulfill the following objectives:
• To assess the clinical pattern of Osteoarthritis.
• To evaluate significance of Miasmatic prescription in cases of Osteoarthritis.
Study Design
Prospective observational open label study.
Material and Methods
In this study, 30 diagnosed cases of Osteoarthritis were selected according to inclusion and exclusion criteria. Case taking was done by principles of Organon of medicine in the case taking proforma and importance was given to mental and physical generals and Miasm was considered as a sole prescription criteria. Symptom analysis and interpretation with reportorial interpretation was done as per kent’s evaluationof symptoms. The prescription was based on totality of symptoms, reportorial totality and analysis and finally after referring to Materia Medica. Follow up was evaluated by changes in clinical presentation, changes in score of WOMAC Osteoarthritis index and VAS pain scale in every 15 days, and final statistical analysis of data was done.
Conclusion
In this study findings are suggesting that constitutional approach in homoeopathic prescribing can play significant role in relief of pain and treatment of Osteoarthritis.
KEYWORDS
Constitutional, Homoeopathy, Individualization, Miasm, Osteoarthritis, VAS, WOMAC.
INTRODUCTION
Osteoarthritis (OA) is most prevalent type of rheumatological problem. It is most common in elders, and due to the pathology, this arthritis is major cause of the disability in the elderly. Osteoarthritis is not symmetrical disease and affects few major joints only. Increased pressure on one particular joint or fragility of cartilaginous matrix may lead to Osteoarthritis. Complexity of osteoarthritis is increased by release of inflammatory mediators by cartilage, bone and synovial tissue. The source of such mediators would be local from joint cells and systemic from other tissues such as adipose tissue released in blood flow. (1)
Osteoarthritis is more common in females than male but may vary with the increasing age.2,3,6 OA occurs commonly in females after the 4th decade of life but before that it is more common in males,3,6while in urban it is 47%.6,8 Global burden of diseases is the 4th leading cause of years lived with disability.4Osteoarthritis is the second most common rheumatologic problem and it is the most common joint disorder with prevalence of 22% to 39% in India. (2,4,7)
Conventional medical management may give effective relief in symptoms by using Non-steroidal anti-inflammatory drugs(NSAIDs), systemic steroids, glycosaminoglycan peptide complex and other analgesic but no permanent treatment. (9,22) Limitations and unwanted side effects of conventional medical management (10) raise question for safe and effective treatment of osteoarthritis. A study conclude that the small number of clinical trials conducted to date, favoring Homoeopathic treatment of patients suffering from osteoarthritis. (11) And there is no gastrointestinal toxicity or other side effects find out with Homoeopathic treatment. (1) And one study may conclude that Homoeopathy has its place in the treatment of arthritic diseases. (12)
Homeopathy, is a system of medicine that is based on principle “similia similibus curanter”(like cures like).(13,14) Effectiveness of homeopathy in general is wide-spread and trust is growing among the physicians and public. (15) Homoeopathic treatment has also proved to have some effect in reducing oxidative stress. (16)
Homoeopathic treatment uses highly diluted remedies, mostly from natural sources. 17 according to Homoeopathic philosophy Homoeopathic remedies doesn’t exert pharmacological effects but restores homeostasis by modulating the biological systems within the body.18 Homoeopathic complexes have a clear advantage in the treatment of osteoarthritis. But in limited scope, they can improve cases but can not cure. (19)
But individualized Homoeopathic treatment can improve quality of life and provide more relief to patients. (20) Compared to research on conventional therapies the overall quality of studies in homeopathy were worse and have not improved significantly. (21) Method of constitutional medicine of therapeutic is unique to Homoeopathy. Well selected deep acting homoeopathic remedy is equal to the constitutional remedy. (23)
In one study, it was seen that Homoeopathic complexes have a clear advantage in the treatment of osteoarthritis (24) and also Few low-potency homoeopathic complexes in the randomized controlled trials have showed that Homoeopathy seemed to posses significant effects in Osteoarthritis. (25)
The aim of this detailed systemic study is to observe, evaluate and summarize the relevant findings of all relevant individual findings, thereby making the available evidence accessible to decision makers.
None evidence based study tried individualized homoeopathy; instead various ‘complexes’ and ‘combination formulae’ against placebo, conventional oral drugs or topical gels are used. This study will help to find out the curability of the constitutional homoeopathic treatment based on individualization.
METHODOLOGY (MATERIAL & METHODS)
Sources of data – OPD & IPD of Govt. Homoeopathic Medical College & Hospital, Bhopal.
Number of cases – 30 cases excluding of dropouts.
Definitions used for study purpose:
• Case selection – All the diagnosed cases of Osteoarthritis on basis of inclusion and exclusion criteria.
• Case taking – case taking was done according to guidelines in Organon of medicine written by Dr. Samuel Hahnemann.
• Selection of medicine – Selection of medicine was based on individualization after proper Analysis, Evaluation and Miasmatic Cleavage of the case as per homoeopathic principles. Totality was constituted on the basis of method of evaluation and Repertorisation with the help of Boenninghausen’s characteristics and repertory by C. M. Boger, or Synthesis Repertory 9.0 by F. Schroyens.
• Potency & Doses – Potency, dose and repetition was done by following strict Homoeopathic principles on the basis of susceptibility.
• Follow up – Cases were followed up properly on regular basis in every 15 days or as per need of the patient, and results were assessed on the basis of clinical symptoms, changes in WOMAC Osteoarthritis index. Outcome will be measured by the primary measure which will be a visual analogue scale (VAS) for pain.
• Records – Case records were maintained on case taking proforma.
• Methods of tests/procedures – Detailed and thorough case taking of each and every case having osteoarthritis.
a. Relevant clinical examinations and lab investigations.
b. Analysis and Evaluation of symptoms was done after detailed case taking into various categories like mental general, physical generals and perticulars as per homoeopathic principles.
c. Repertorisation was done using synthesis repertory after the evaluation and grading of symptoms by Kent’s method.
d. Inclusion and exclusion criteria were fulfilled in selection of each and every case.
e. Analysis, evaluation and Repertorisation of the totality of symptoms was done by taking help of Computer-aided (Digital) Repertory RADAR repertory software.
f. Final Selection of medicine done by miasmatic inference, consulting Homoeopathic Materia Medica and PDF.
g. On the basis of susceptibility and reactive power, potency, dose and repetition was decided following strict homoeopathic principles.
h. General management which includes proper diet and regimen and rest.
i. Laboratory investigations were done according to the need of the case.
• Statistical methods
Analysis was done for varieties of clinical presentation and effect of homoeopathic medicines was assessed with the help of WOMAC Osteoarthritis index and VAS pain scale. Data of before and after score of WOMAC Osteoarthritis index and VAS pain scale was presented by graphs, pie charts and other standard statistical method. Final calculation was done to find out p- value with the help of Paired t-test for two variables in Microsoft office excel 2007.
OBSERVATION AND RESULTS
In total no. of cases (n=30), knee osteoarthritis was present in all cases (n=30), and osteoarthritis was also associated with pain in other joints is few patients, e.g. lumbo-sacral pain(n=6), shoulder pain(n=4), and cervical pain(n=4).
With reference to all cases (n=30),This critical ratio, paired-t follows a distribution on with n-1(29) degree of freedom. The 5% level is 2.045, 1% level is 2.756 and 0.1% level is 3.659 for 29 degree of freedom. Since the calculated value for t-stat is 10.08 for WOMAC Osteoarthritis index and is 9.05 for VISUAL ANALOGUE SCALE(VAS), which is greater than the table at 0.1%(p<0.001).
DISCUSSION
Homoeopathy as a holistic science considering individualistic approach where in the mental, physical and spiritual aspects of man are considered.
Some small studies have been conducted on OA, fibromyalgia, and myalgias. These studies have shown mixed results, comprised small numbers (30-40 patients), or are of such poor quality that the validity of their conclusions is uncertain. (27) the only placebo-controlled trial of homeopathy on OA to date. In a unique design that attempted to rectify some of the problems with treatment encountered in the Shipley trial, with Homoeopathic medicine R. toxicum. (28) the study used good methodology and were (barely) statistically significant but comprised only 30 patients. In other double-blind study by on RA patients who had “failed conventional therapy were randomized to homeopathy or placebo for 3 months. (29) both groups improved (more so in the homeopathic group), but the difference between groups was not statistically significant.
In homoeopathy, there is no such thing as giving a remedy for a specific ailment or disease. The idea of double blind research is valid for conventional medicine but not for homeopathy which is based on the principle of giving a remedy for a totality of symptoms of an individual and not only for his single ailment, disease or pathology. So, there is need of individualizing constitutional treatment related studies to be done to get real homoeopathic results.
In the above study, period of study was one and half years, which is too short for Osteoarthritis, which is a type of chronic disease, there was good improvement in maximum cases (22 patients ), but there is no surety of their continuous improvement, they may get worse after some time, and to see the curability of the disease we need more studies to be conducted with big sample size for long duration.
CONCLUSION 
The study was carried out for one and half year, 37% patients showed marked improvement, 36% patients had moderate improvement, 17% had mild improvement and 10% had no improvement. Majority of the patients (73.3%) of this study group showed significant improvement in the clinical condition of Osteoarthritis. The WOMAC Osteoarthritis index and VAS pain scale used for the assessment of effectiveness of the constitutional Homoeopathic treatment also showed significant improvement after the treatment and the patients who have reached into irreversible pathological syphilitic stage can also be managed very efficiently with the help of Homoeopathic medicines.
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About the authors:
Dr Ramkrishna Mishra M.D.(Scholar)
Dr Praveen Jaiswal M.D.