Abstract:-
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular manifestations. It is a chronic inflammatory disorder caused in many cases by the interaction between genes and environmental factors, including tobacco, that primarily involves synovial joints. It typically starts in small peripheral joints, is usually symmetric, and progresses to involve proximal joints if left untreated. Joint inflammation over time leads to the destruction of the joint with loss of cartilage and bone erosions
A comprehensive clinical approach is required to make the diagnosis and prevent debilitating joint damage. The treatment of patients with rheumatoid arthritis requires both pharmacological and non-pharmacological (physical therapy, counselling, and patient education) therapy. Today, the standard of care is early treatment with disease-modifying anti-rheumatic drugs. Despite treatment, many patients progress to disability and suffer significant morbidity over time.
Homoeopathy, however has widened the treatment approach with desirable remission at earlier stages and delayed the progression of the disease, also it has better prospects in palliation of associated symptoms in advanced stage of the disease.
Etiological Factors :-
The etiology of RA has a significant basis in genetics. It is thought to result from the interaction between patients’ genotypes and environmental factors The risk of developing rheumatoid arthritis has been associated with HLA-DRB1 alleles: HLA-DRB104, HLA DRB101, and HLA-DRB1*10. Some genetic polymorphisms are associated with RA in different ethnic groups.
The term epigenetics refers to inheritable changes without altering the DNA sequence. These changes may be present in chromatin or the DNA. These include DNA methylation, histone modification, and non-coding RNA-mediated regulation. Cigarette smoking is the strongest environmental risk factor associated with rheumatoid arthritis. Studies have shown in anti citrullinated protein antibody (anti-CCP) positive individuals, there is an interaction between the HLA DR alleles and smoking that increases the risk of RA.
Other environmental factors may play a role as a trigger for RA, which is more closely associated with seropositive RA. These include silica, asbestos, textile dust, and P gingivalis. This suggests that external exposure to various antigens in parts of the host distant from the joints then triggers an autoimmune inflammatory response in the joints. These distant locations include the lungs, oropharynx, and GI tract. Changes in the composition and function of the intestinal microbiome have been related to rheumatoid arthritis as well. The composition of the gut microbiome becomes altered in patients with rheumatoid arthritis (dysbiosis), where rheumatoid arthritis patients have decreased gut microbiome diversity compared with healthy individuals.
Sign and Symptom of The Disease :-
Onset of rheumatoid arthritis is usually insidious, often beginning with systemic and joint symptoms. Systemic symptoms include afternoon fatigue and malaise, anorexia, generalized weakness, and occasionally low-grade fever. Joint symptoms include pain, swelling, and stiffness. Occasionally, the disease begins abruptly, mimicking an acute viral syndrome.
The disease progression and development of structural damage vary. The course is unpredictable in individual patients.
Joint symptoms are characteristically symmetric. Typically, stiffness lasts > 60 minutes after rising in the morning but may occur after any prolonged inactivity (called gelling). Involved joints become tender and swollen, occasionally with erythema, warmth, and limitation of motion. The joints primarily involved include the following:
- Wrists and the index (2nd) and middle (3rd) metacarpophalangeal joints (most commonly involved)
- Proximal interphalangeal joints
- Metatarsophalangeal joints
- Shoulders
- Elbows
- Hips
- Knees
- Ankles
However, virtually any joint, except the distal interphalangeal (DIP) joints, may be involved. Different patterns of disease presentation include - Monoarthritis of knee, wrist, shoulder, or ankle
- Polymyalgia rheumatica–like presentation predominantly with shoulder and hip girdle involvement, especially in older adults
- Palindromic rheumatism, characterized by recurrent attacks of arthritis of one to several joints, lasting for hours to days
- Joint swelling without chronic joint damage
- Robustus rheumatoid arthritis with proliferative and damaging synovitis, but minimal pain
Staging :-
Stages of RA as Defined by the ACR - Stage 1: No destructive changes on X-rays
- Stage 2: Presence of X-ray evidence of periarticular osteoporosis, subchondral bone destruction but no joint deformity
- Stage 3: X-ray evidence of cartilage and bone destruction in addition to joint deformity and periarticular osteoporosis
- Stage 4: Presence of bony or fibrous ankylosis along with stage 3 features
Homoeopathic Therapeutics :-
Arnica
In homeopathy, arnica is indicated for RA when joints are tender to the touch. Arnica is an an_-inflammatory agent that has been shown to lower markers of inflamma_on in laboratory studies.When applied topically, arnica may reduce pain and bruising. Research has found that arnica cream is as effec_ve as an ibuprofen gel at relieving osteoarthri_s pain.
Bryonia
Treat arthri_c pain, par_cularly in the knees and elbows. when joints are red, hot, swollen, and painful. More specifically, it is indicated for tearing/throbbing pain and pain that worsens with movement.In laboratory studies, bryonia has been shown to have an_-inflammatory and analgesic (pain relieving) proper_es.
Caulophyllum
It is recommended to treat migra/ng pain in small joints of the hands and feet. Typically prescribed to women used in folk medicine to treat joint pain, regulate menstrual periods, and induce labour. Caulophyllum has been shown to have an/-inflammatory and an/- rheuma/c proper/es. Studies also show that caulophyllum lowers biomarkers associated with RA joint pain and inflamma/on.
Causticum
It is used in homeopathic medicine for RA accompanied by joint deformi_es and weakness. It help relieve joint pain, s_ffness, and swelling. caus_cum is prescribed for nighdme pain that interferes with sleep. In studies, caus_cum has been shown to relieve joint pain slightly beeer than acetaminophen.
Colchicum
It is used in homeopathy to relieve chronic joint pain and inflamma_on associated with rheumatoid arthri_s. It is indicated for tearing pain that worsens with cold air and pain that migrates from one side to another.Colchicum’s an_-inflammatory proper_es have been widely studied, and its compounds were used in the development of colchicine, a medicine to treat gout.
Ledum Palustre
It is used in homeopathy to treat arthri_s that starts in the feet and travels up the body to other joints. In laboratory studies, ledum palustre was found to contain an_-rheuma_c compounds that may be beneficial for trea_ng RA in a few different ways. It has an_- inflammatory and analgesic proper_es that relieve RA symptoms, but, more notably, its an_- prolifera_ve effects may hinder the underlying disease process.
Rhus Tox
Rhus tox comes from the poison ivy plant. Ofen called by its scien_fic name, rhus toxicodendron, it is used in homeopathy to treat pain and s_ffness. Pa_ent feels beeer with movement of joint whereas rest aggravates the complaint. A few studies have demonstrated the an_-inflammatory proper_es of Rhus Toxicodendron.
