Ayurvedic Treatment and Medicine for Joint Pain

 

Joint pains are the most common problem for which the patient consult an Ayurvedic doctor. Various conditions can affect the functions of the joints leading to the manifestation of different joint diseases. Joint pain can be because of multiple causes such as degenerative changes, injury to joints, inflammatory causes, autoimmune diseases. Ayurvedic treatments for joint pain depends on the nature of the disease. They are entirely individualized approach depending on the condition of the disease. Sandhigata Vata, Vata Rakta, Ama Vata are the few joint diseases mentioned in Ayurveda. We can compare these conditions to osteoarthritis, gout, rheumatoid arthritis, according to modern science.

Arthritis

Arthritis is a rheumatic disorder that attacks the joints. Many oversights it to be a disorder of bones. Some believe that arthritis is just about old age and knee pains. However, in Ind?'[ia, the awareness and understanding of the facts of arthritis have become better over the decades. There was a prediction by the researchers of health in India years ago, which states that India would emerge as a capital of osteoarthritis by 2025 with more than 60million population being affected. The prevalence of this disease is 2017 in India, when compared to other major diseases such as diabetes, hypertension, AIDS, and cancers, which remain much higher. More than 180 million people have been affected back then in India. As we know, the prevalence always rises. It may have crossed millions by now. Studies say that over fourteen percent of Indians seek a doctor for the issues with knee specifically. However, arthritis does not constrain only to osteoarthritis. 

There are rheumatoid arthritis, osteoarthritis, septic arthritis, stills disease, gout, and pseudogout, Psoriasis, Lyme disease, Hepatitis, Celiac disease, reactive arthritis, sarcoidosis, hemochromatosis, Hashimoto’s disease, juvenile idiopathic disease, non-celiac gluten sensitivity, Whipple’s disease, etc. 

Osteoarthritis: 

Osteoarthritis

The second most complained rheumatic problem in India is osteoarthritis. This is a chronic, gradually worsening joint disease. An adult population of four to 6 percent shows the effects of osteoarthritis in our country, making it one of the five top chronic diseases in the world. In world statistics, more than 100 million people have been patients for this. It causes disability and stunting of capability as likely in all chronic diseases. Women have been facing this, more than men, even from their early 30s sometimes. They take a rank of four globally where men are on the eight. Before we go further into the progression of the disease we shall see how a healthy knee works. A healthy joint is smooth, without any fissures or breakages in the articular cartilage, and in the bone. While most of them take it to be a knee issue, in particular, osteoarthritis affects the neck, fingers, and thumb, hips besides knees. 

Symptoms of osteoarthritis: 

The primary signs start with the cracking sound in the joints. This happens when the joint is moved or changed position. In some this comes as an ageing ailment, in some, it starts early with the problems of calcium. The pain is felt after prolonged activity or work. And the pain subsidies with some rest. The situation worsens with more physical work. Stiffness happens more in the mornings as a common sign in arthritis. Joint sticking and instability are greatly reported. 

Many people in India strongly believe that cold weather and winters worsen the pain of arthritis. However, there is no proper claim to this perception. In smaller fingers, the bones become swollen. Though they are not painful, they hinder the movement. Inflammation, pain along with tenderness. Reduced movement of fingers, weakness, redness, weakness, tenderness, crunching sound while moving the fingers and toes, Trouble holding things or gripping them.                                                                             

Most commonly, osteoarthritis is the disease of the aged and woman in the early 30s. The severity prevails with ageing and can be found in about 30 percent of women by the age of 60. It has already affected 30 to 54 million in the united states of America, and in Australia 1.9 million are affected. The above 18 percent of females and 10 percent of males are affected over the globe among the people of 60 years. Two per cent of patients with osteoarthritis live 2 per cent of years with a disability. Overall 3.4 per cent of the population is living with osteoarthritis, which is over 250 million. 

Causes of osteoarthritis: 

The causes of osteoarthritis are of multiple kinds. Primary causes being the change in the sexual hormones in women after menopause or nearer to it is one. This is more prevalent in women rather in men of the same age. A previous history of joint disclosures, fractures, or tearing of cartilages, ligament injuries leads to early osteoarthritis. 

The occupational causes of osteoarthritis are genetic reasons on the first hand. Obesity, overweighting is a critical reason for osteoarthritis. Those that work manually, that is who puts the body to more use gradually develop osteoarthritis. Who climbs the stairs daily, who is physically demanding work, those that walk at work, those that sit with twisting or squatting, those do heavy lifting, and woman who does the household chores all alone, those who avoid the milk and leaves in diet, those who sew the sewing machines, and works manually on certain equipment. Secondary causes include cases or any diseases that already exist. Inflammations such as gout, chondritis, rheumatoid arthritis, accumulation of uric acid in the joints, joint injuries, congenital diseases, and infections, obesity, alkaptonuria is an example of genetic causes to osteoarthritis. The list goes on with ligament deterioration, injuries to ligaments and cartilages, etc to various syndromes, diseases gathered together. 

The severity of osteoarthritis: 

The severity of osteoarthritis scales from zero to four. Stage zero is not a completely normal form of the disease but the symptoms in this stage won’t are unbearable to bear. The progression will not jump straight into the fourth stage. A joint capsule is lined by a joint lining called synovium, cartilage and filaments, and synovial fluid. 

The healthy cartilage is maintained by hydrostatic pressure and osmotic pressure balance. In osteoarthritis, the collagen fibres of the cartilage start dissolving. This increases the water content in the joints, resulting in swollen joints. 

The proteoglycans that protect this collagen also decreases, thus degrading the cartilage. In some patients the cartilage structures are seen floating in the fluid, making it more painful. 

The ligaments that are attached to the joint, evolve weary. They thicken, form fibres, and gradually tore. The bone density starts to weather and loses gradually. At this stage the joint replacement surgeries take place. 

The swollen joints are when the water increases in the joint inflaming it. This causes immobility, and pain in the joint. The cartilage pieces also float in the fluid. 

The movement in the joints becomes uneasy to impossible. Mobility in the joints arrests making daily activities difficult. 

This is why it is said that osteoarthritis causes disability. There can be joint buckling and cracking sound can be heard in moving, opening, and standing. 

Diagnosis of Osteoarthritis:

The diagnosis of osteoarthritis as in any disease starts with clinical examination and family history. The earliest diagnosis is Xray which primarily confirms the disease. Joint sclerosis, cysts forming, osteophytes, space narrowing everything can be seen through it. Synovial fluid tests are done to evaluate for gout and causes for inflammation. 

Let us talk about the medication and ways to embrace osteoarthritis. 

Painkillers, losing weight, and exercise are the primary steps in caring for the disease. However, as the severity and grievances increase, the adaptations also improve. 

Obesity and heavyweight is the main thing to focus upon, either by diet or by exercise. The exercises should be done under physician or therapist care. 

The massaging of the joints so far has not established any medical value. Knee braces help but are not widely prescribed. 

The self-management of osteoarthritis is the best way to lead a healthy life. Acetaminophen and NSAIDs are the first lines of painkillers. The NSAIDs of selective inhibitors, weak and strong opioids, like tramadol, antibiotics such as doxycycline are used for clinical improvements. 

Diclofenac is recommended as a topical medication. Opioid medications are not given importance in treating. 

Next in line are injections. Steroids, hyaluronic acid, and platelet-rich plasma are injected. 

The surgeries done are joint replacement surgery and other surgeries like osteotomy and arthroscopic surgery.

Gout 

gouty arthritis

Gout is a form of arthritis. It is an inflammation to be said in a word. A single joint swells and develops inflammation alongside the pain. The deposition of the uric acid crystals occurs in the joints. Talking about its prevalence, the gout is more common in men than in women. Five to twenty-seven amongst a thousand men are said to be affected as per previous research. Women are more likely to develop gout after menopause. If you have gout, most typically the big toe of your feet gets affected. An attack of gout comes unpredictably. The symptoms do not show anywhere before, they come with the acute attack and leaves after it subsides. However, gout can only be kept away or can be controlled by adding changes in the lifestyle and managing it effectively. 

Signs and symptoms of Gout

The gout is a sudden development in the joint. You may wake straight up in the midnight finding gout on your feet. It results in problematic pain and gives rise to sleeplessness. The area around the toe affected becomes swollen, redness, tender, got, and with intensifying pain and discomfort. The pain goes to aggressive and peak levels within twenty-four hours.

The body temperature lowers down than usual. But as the symptoms grow severe fatigue, weakness and a high fever develop. 

The joint located at the base of the toe is called the metatarsal- phalangeal joint. It is the most affected joint in gout. Whereas the other joints such as heels, ankles, wrists, and fingers can also cultivate gout. 

As we have said earlier, gout us nothing but an accumulation of uric acid crystals. In severe conditions, where the uric acid crystals aggregation is called hyperglycemia. 

This results in hardened and enormous deposits of uric acid, but these depositions are painless. These structures are called tophi. This condition on progression can end up in chronic arthritis. 

An acute attack of gout can last from three to ten days or may even go off quickly. until it leaves, the warmth, hotness, and tenderness of the joint persist along with the discomfort. The tophi lumps, that are formed on severity, do not only constrain to the joint affected but also stiffens the soft tissue and skin surrounding the toe. The movement of the joint becomes impossible. 

You may not be able to move the toe as the pain grows worse. As said the distress rises and intensifies up to twelve to twenty-four hours. 

After the swelling lessens and gout gets diminished, slight pain and discomfort persist in the joint. High levels of uric acid can also lead to the formation of stones, that is precipitated forms of uric acid crystals. T

his within days can develop to form a urate neuropathy. 

Cause of gout: 

Gout is attributed to a variety of causes. 

Lifestyle and dietary habits account for about twelve percent of gout. 

Eating foods that gave higher amounts of uric acid leads to its deposition in the body. Beer, seaweed, dried shrimps, mushrooms, organ meat, and purine-rich foods add to the uric acid levels. 

Decreasing the consumption of alcohol, low-fat dietary products and coffee, high protein foods, and, increasing vitamin c drinks can regulate the situation. 

A balanced diet with leaves such as spinach and lettuce, beans and lentils, brown beard, fruits, and vegetables certainly eases the metabolism. 

However, vitamin C supplements are not considered a straight remedy as they are not of any proven justification. 

In general, the uric acid that is produced by the digestion is filtered by the kidneys and expelled out from the body. 

When the kidneys fail to filter it efficiently or when the uric acid increases quickly, gout appears. 

Another factor is genetics. 

Obesity or overweight like in any other disease adds to the cause of gout too. About 60 per cent of the gout causes are by genetics. 

Family history of kidney diseases, Lesch-Nyhan syndrome, other anomalies that are hereditary add to the start of gout. Specifically, in obesity, uric acid is produced in higher quantities which becomes tough to oust from the body.

Medical conditions: 

Already existing cardiac and nephron diseases, hypertension medications, high blood pressure, and diabetes, previous history of surgeries and medication used for them, lipid metabolism, sleep apnea, insulin resistance, hemolytic anaemia, psoriasis, lead poisoning, etc, adds to the risks of the disease. Using immunosuppressive drugs and inhibitor drugs, beta-blockers, angiotensin receptor blockers, diuretics, cyclosporin can increase the chances of gout. 

A body mass index of more than or equal to 35 in men can cause a threefold risk of gout. 

Diagnosis of gout:

A brief history of genetic diseases, previous trauma, and surgeries, medications are enquired for.  

A plain X-ray can show bone erosion as in chronic and advanced gout. However initial stages of gout can not be diagnosed by X-ray alone. 

Synovial fluid tests: this test is to be done under the care of a professional. This fluid is taken by arthrocentesis and examined for the presence of uric acid crystals. These are collected from other undiagnosed inflamed joints. Under polarized light, they are observed. However, the test is not preferred mostly under the rest. 

Blood tests to check on the count of white blood cells and eosinophils, erythrocyte sedimentation rate. More to say the hyperuricemia is not a measuring scale for gout chances. More than half of the gout patients have no such extreme deposits of uric acid in the blood. 

In hyperuricemia, the plasma urate levels rise more than 7mg/dl in males and in females, it is 6mg/dl. Ct scan, ultrasound are other diagnostic tests.

Medications for Gout: 

NSAIDs from the most powerful indomethacin to naproxen sodium, ibuprofen, Advil are prescribed to avoid the acute attacks. Colchicine is prescribed to replace NSAIDs in some patients.corticosteroids are given to reduce the inflammation. 

In general, allopurinol is the preventive medicine prescribed for gout. Interleukins are given to relieve the pain. Surgical methods are adopted to remove tophi and in joint replacement. 

Rheumatoid Arthritis

Rheumatoid Arthritis

Rheumatoid arthritis is also a chronic inflammatory disease. It just does not confine to the joints but acts on to certain other parts of the body. The main reason behind this being said both genetic and environmental factors. The prevalence of the disease is about one per cent of the Indian population. That is how common the condition is in our country. However, a study conducted in 2018 brought out to the conclusion that rheumatoid arthritis is greater in women than in men. This condition brings disability in adults, whereas deaths are also noted from even 1990. 

It’s a long term disease, affecting the joints. Wrists, joints and hands being most implicated. 

The joints become swollen, warm, painful for weeks to months. Both sides of the body parts show the discomfort. Fever, weakness and fatigue develop. Inflammation can reach to lungs and heart gradually and red blood cell count can fall. 

Signs and Symptoms of Rheumatoid Arthritis:

The synovial membrane of the joint swells. Joints are affected symmetrically on both sides of the body. The whole joint becomes warm, stiff, tender. 

A patient can experience more information and inactivity early in the mornings. The movement becomes restricted. As the severity increases, the inflammation reaches to the tendon, bone loss and cartilage loss begins. 

Deformities like ulnar deviation, buttonhole deformity, swan neck deformity and Z- thumb, fixed flexion. 

In extreme cases, arthritis mutilans joints are diagnosed.

The skin shows rheumatoid nodules in the skin in 30percent of the people. Found in the elbow, heel and knuckles and sometimes in internal organs. 

Necrotizing granuloma of the skin is a prominent sign of rheumatoid arthritis.

Lungs show fibrosis, pleural effusions are also typical for this disease.

Renal amyloidosis, membranous neuropathy, anaemia, atherosclerosis, myocardial infarction, episcleritis of eyes, dryness of Lacrimal and salivary glands, keratitis, autoimmune hepatitis of liver are the complications of other organs. 

The median nerve may swell in the wrist, which is a Carpel tunnel syndrome. 

Peripheral neuropathy occurs in rheumatoid arthritis. Osteoporosis and lymphoma risks are higher in this disease.

Causes for Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease. Although no specific reason for it is not told, genetic and environmental causes add for it. 

40 to 65 per cent of rheumatoid arthritis cases are of family history. The risks are about three to five times. The genes associated with the diseases is HLA-DR4 antigen. 

Even the cytokine signalling, lymphocyte receptor and immune activation etc sum up the influence of HLA mutation. 

Those who smoke have three times more risk than nonsmokers. 

Diagnosis of Rheumatoid Arthritis:

X-rays show whether the hands and feet are affected. For more clearer imaging, other techniques like magnetic resonance imaging and ultrasound are also used. Ultrasonography using high frequency has improved the resolutions by far. 

Blood tests are carried out to test for rheumatoid factor and anti-citrullinated protein antibodies called ACP’s. 

Other blood tests are done for complete blood count, liver enzymes, kidney functioning, erythrocyte sedimentation rate. Immunological tests are done. 

Prevention and management of Rheumatoid Arthritis:

There is no cure for this disease. But treatments prove symptoms and also the progression. 

A Combination of methotrexate and tumour necrosis factor in the improved disease. 

For pain management, physical therapy, analgesics and disease-modifying antirheumatic drugs are prescribed. Rituximab, methotrexate, hydroxychloroquine, leflunomide, infliximab are among those. 

Non- NSAIDs such as paracetamol are used for pain easing but for the disease. Capsaicin which is a neuromodulator is also used in reducing pain. 

Surgery like synovectomy, joint replacement surgery, physiotherapy, cold and heat stimulation, acupuncture, electronic stimulation, hydrotherapy and exercising daily has helped the disease. 

Ayurvedic Treatments for Joint Pains

Ayurvedic Treatments for joint pains such as osteoarthritis, gout, rheumatoid arthritis, etc. depends on the state of dosha predominance. The dosha predominance can be understood by knowing the symptoms. In a vata predominant condition, the pain will be severe. In kapha predominant conditing, one will have a dull ache in joints. When pitta dominant disease is there, we can observe swelling in the joints associated with a burning sensation.

Ayurvedic treatments are entirely individualized, as the treatment approach to a degenerative condition is altogether different from a patient who is having an inflammatory joint disease.

The dosha predominance is analyzed properly using ayurvedic diagnostic tools, and then suitable treatment protocols are advised.

Ayurvedic treatments for joint pains are aimed to

  1. Give relief of pain.
  2. Normalizing joint functions.
  3. Correcting the deformities.
  4. Preventing further progression of the disease.

Janu Basti

Few treatments used in treating joint pains are

  1. Abhyanga – Oil application
  2. Choorna Pinda Sweda/Podi Kizhi – Poultice is done with herbal powder and other ingredients.
  3. Patra pinda Sweda/Ela kizhi – Poultice is done with herbal leaves and other ingredients.
  4. Shashtika Shali Pinda Sweda/Navara kizhi – Poultice is done with Navara rice and other ingredients.
  5. Naranga Kizhi – Poultice is done with lemon and other ingredients.
  6. Lepana – application of medicated paste.
  7. Valuka Sweda – Sudation is given using sand.
  8. Lavana Sweda – Sudation is given using salt.
  9. Kashaya Dhara – Flowing medicated decoction.
  10. Dhanyamala Dhara – Flowing medicated fermented liquid.
  11. Bandhana – Bandage with medicated oil.
  12. Janu basti – Retention of medicated oil in knee.
  13. Greeva Basti – Retention of medicated oil in neck.
  14. Kati basti – Retention of medicated oil in the lower back.
  15. Pichu – Keeping medicated oil in a gauze.
  16. Vasti – Medicated decoction or oil enema.
  17. Vamana – Therapeutic vomiting.
  18. Virechana – Therapeutic purgation.
  19. Nasya – Nasal medication.
  20. Rakta moksha – Therapeutic bloodletting.
  21. Thaila Dhara – Dripping of medicated oils.
  22. Pizhichil – Flowing of medicated oil.

Greeva-Basti

Ayurvedic medicine for Joint Pains

Ayurvedic medications for joint problems are selected depending on the state and stage of the diseases. Here are a few classical medications that are commonly used in ayurvedic joint pain treatment.

  1. Ashtavarga Kashayam.
  2. Gandharvahastadi kashayam.
  3. Maharasnadi Kashayam.
  4. Prasaranyadi Kashayam.
  5. Rasna erandadi Kashayam.
  6. Rasnadi Kashayam.
  7. Sahacharadi Kashayam.
  8. Manjishtadi Kashayma.
  9. Maha manjisthadi Kashayam.
  10. Shatavaryadi Kashayma.
  11. Bala Kashayam.
  12. Vidarayadi Kashayma.
  13. Guluchyadi Kashayma.
  14. Kolakulathadi Choorna.
  15. Kottamchukkadi Choorna.
  16. Upanaha Choorna.
  17. Grahadhoomadi Choorna.
  18. Rasnadi Guggulu.
  19. Tryodhashanga Guggulu.
  20. Kaishora Guggulu.
  21. Bala Thaila.
  22. Kottamchukkadi Thaila.
  23. Masha Thaila.
  24. Mahanarayana.
  25. Thaila.
  26. Prabanjana Thaila
  27. Prasaranyadi Thaila.
  28. Sahachardi Thaila.
  29. Gugguluthiktaka Ghrutam.
  30. Rasnadi Ghrutam.

Detoxification procedures are advised when the disease is chronic. Detoxification (Panchakarma) procedures help to eliminate the aggravated and accumulated toxins from the body. The cleansed body receives medicines efficiently and produces quicker results and prevents the movement of aggravated doshas to other parts of the body.

Diet for joint Pain

Diet plays a vital role in healing in joint pains. Depending on the diseases, the diet may vary. 

  • Use Purana Yava, Godhuma, Shali (Old Barly, Wheat, Rice Grains that are to be used).
  • Jangala desha mamsa (meat of animals living in arid places)
  • Use of red gram, Bengal gram, green gram, lentils, kidney beans
  • Food should be easily digestible.

Avoid

  • The foods that are heavy for digestion, 
  • Curd, dairy products,
  • Black gram
  • Horse gram
  • Alcohol
  • Excess Sour, salt substances
  • Roots and vegetables that cause constipation
  • Extra use of oily fried food.
  • Incompatible food

The right diet can be formulated depending on the nature of the disease, analyzing the causative factors, triggers, etc.

Conclusion

Joint pains are one of the most devastating conditions that are a disease of multiple causations. Joint pain restricts the movement of joints. It makes the person feel miserable. If it is not treated in time, it can cause severe and disable damage to joints and make life miserable.

To sum up, arthritis affects more than 15 per cent of the population in our country. Be it through any type of arthritis men and women after 30years of age are falling to arthritis. Beyond the three discussed above, there is psoriatic arthritis which is also remarkably prevalent and prominent in India. This is seen in people suffering from psoriasis. 30 percent of the patients of psoriasis catch up with this joint inflammation disease. Gout also is a complication of psoriatic arthritis. 

All the possible ways to avoid these conditions are by a healthy lifestyle, balanced diet, and fitness. Treatments are always improving for each disease; however, a cautious life is better than living a suffering life. 

Reference:

  1. Healthline
  2. Wikipedia- arthritis
  3. Epidemiology
  4. osteoarthritis
  5. EN – Wikipedia
  6. IJCMR
  7. Health line
  8. Mayo Clinic
  9. gout
  10. Wikipedia gout

[P.S This article is only for information and educative purpose and not a substitute for your medical advise. Self-medication is harmful. Kindly consult your physician for more details].

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