Uthira Vaatha Suronitham / Vazhi Azhal Keel Vayu (Rheumatoid Arthritis)

Introduction

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible joints. It usually affects the small joints of hands and feet. It is a form of autoimmune disorder, the causes of which are still incompletely known. It occurs when the immune system mistakenly attacks own body's tissues. Rheumatoid arthritis affects the lining of joints called synovial membrane, causing a painful swelling that can eventually result in bone erosion and joint deformity. Synovial membrane is the soft tissue present in the joints that secrete a clear viscous lubricating fluid. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels. About 1% of the world population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but people of any age can be affected.

Signs and symptoms of rheumatoid arthritis mainly include:

•     Tender, warm, swollen joints
•     Morning stiffness that may last for hours
•     Firm bumps of tissue under the skin of the arms (rheumatoid nodules)
•     Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect smaller joints first particularly the proximal inter phalangeal joints. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the similar joints on both sides of the body. Signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and dislocate (shift out of place).

Investigations

Abnormal antibodies can be found in the blood of people with rheumatoid arthritis.

1.  An antibody called "rheumatoid factor" (RF) can be found in 80% of patients with rheumatoid arthritis.
2.  Citrulline antibody (also referred to as anti-citrulline antibody, anti-cyclic citrullinated peptide antibody, and anti-      CCP antibody) is present in 50%-75% people with rheumatoid arthritis.
3.  Another antibody called the "antinuclear antibody" (ANA) is also frequently found in people with rheumatoid arthritis.
4. Blood tests that are used to measure the degree of inflammation present in the body are Erythrocyte sedimentation rate (ESR) and C-reactive protein.

The rheumatoid factor, ANA, ESR and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis.

Joint X-rays may be normal or only demonstrate swelling of soft tissues early in the disease. As the disease progresses, X-rays can reveal bony erosions typical of rheumatoid arthritis in the joints. Periodic joint X-rays can also be helpful in monitoring the progression of disease and joint damage over time. Procedures like, Bone scanning, done by injecting a small amount of radioactive substance or Magnetic Resonance Imaging (MRI) may be needed to ascertain the diagnosis.

Siddha Concept

The signs and symptoms of Rheumatoid arthritis resemble two diseases Uthiravatha suronitham and Vazhi azhal keel vayu mentioned in siddha literature.

Uthiravatha Suronitham as per siddhar Yugi muni is basically a Vatha disease which occurs due to derangement of Vatha humour. Unlike other vatha diseases, pitha humour (azhal kuttram) is also increased in this disease along with Vatha humour. Symptoms are pain and swelling in smaller joints, mental distress, depression and loss of appetite.

Likewise vazhi azhal keelvayu as mentioned in a text called samabathy kayedu also occurs due to the derangement of vatha and pitha humour. The symptoms according to this text are abdominal discomfort, regurgitation of food, sleeplessness, fever and pricking pain, redness, swelling and burning sensation in joints mainly wrist joint, ankle joint and interphalangeal joints.

It is clear from the above descriptions that Rheumatoid arthritis occurs due to the derangement of vatha and pitha humours according to siddha principles.

Cause and Pathology

According to siddha system in keel vayu and Uthira vatha suronitham , vatha humour (vali kutram) is increased due to excessive consumption of food items like unripened fruits (e.g. raw banana) and potato. Overconsumption of Vatha food substances produce more Vayu (gas) in the intestine and travels through Viyana Vayu (one of the vayus in the body) and resides in the joints and affects them.

Exposure to cold air and rain also increases vatha humour. Along with this both in Vazhi azhal keel vayu and Uthira vatha suronitham, Pitham is also aggravated. This occurs due to excessive intake of non vegetarian diet, alcohol and sedentary life style. Senneer (blood) which is one of the physical constituents (Udal thathukkal) is also affected because pitham humour is associated with Blood.

Management

Treatment is mainly aimed at balancing the elevated humours (mukuttram), Vatham and Pitham through Purgation and Medication. The physical constituents (udal thathukkal) are rejuvanated through dieting. To normalise vatha kuttram purgatives should be given. This is done because of the siddhars saying “viraesanathal vatham thalum” which means, by purgation vatham is normalised. Commonly used purgatives are Agathiyar kulambu, Vellai ennai, Castor oil, Kodasuri tablet, Sanjeevi tablet, Maantha ennai. The purgative and the medium (vehicle) in which it should be given is decided by the siddha physician taking in to consideration the body constitution of the patient, severity of the disease and other factors.

 Then drugs which normalise vatham and pitham and those which revitalise the lost vigor of the udal thathukal (Physical constituents) are given.

Some single herbs which are used for treatment are:

Some medicines advised to be taken orally are herbal preparations like Amukkura choornam, Sittarathai chooranam,Thirkadugu choornam and herbo mineral preparations like Rasagendhi Mezhugu, Serankottai nei, Idivallathi mezhugu,Poorna chandrodayam,Chandamarutha chendooram, Arumuga chendooram, Linga chendooram,Kanaga linga karpura mezhugu and Nandhi mezghugu. A siddha specialist will choose suitable combination of drugs from either these or many others available and the vehicle in which the drug should be given, depending upon the need of the patient. Since treatment is individualistic, consultation of a Siddha practitioner is mandatory before taking any siddha drug.

External therapy like Oil application with bandaging is also done. Attai vidal (Leech therapy) is also found to be useful in treating Rheumatoid arthritis.

Prevention and Diet

According to siddha concept, Rheumatoid arthritis is associated with increase of vatham. Avoiding food stuffs which increase vatham can prevent the onset of the disease. Cold food items, sour food items like tamarind, excessive use of salt, curd, fermented rice or gruel, non vegetarian diet especially red meat should be strictly avoided. Also exposure to excessive cold, smoking, tobacco or alcohol also should be avoided. Regulation in diet should be followed while on medication or otherwise throughout life, to prevent recurrence of the disease.
 

References:

1. http://www.medicinenet.com/ (link is external)
2. http://siddhaconsultingcentre.in/rheumatoid-arthritis (link is external)
3. Eugene Wilson, Herbs used in siddha medicine for Arthritis-A review, Indian Journal of Traditional Knowledge Vol 6(4), October 2007, pp. 678-686
4. Kuppusamy Mudaliar K.N, Vazhi Noi, Siddha Maruthuvam, Tamil Nadu Siddha Maruthuva variyam, 1987 : 580-599