RHEUMATOID ARTHRITIS

“JOINT PAIN” - MANAGING RHEUMATOID ARTHRITIS BASED ON HOLISTIC APPROACH

The word arthritis means inflammation of the joint ("arthr" meaning joint and "itis" meaning inflammation). Inflammation is a medical term describing pain, stiffness, redness and swelling. Rheumatoid arthritis (RA) is a chronic disease in which various joints in the body are inflamed, leading to swelling, pain, stiffness, and the possible loss of function. Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks joints and other tissues. The pattern of joints affected is usually symmetrical, involves the hands and other joints, and is worse in the morning. Rheumatoid arthritis is a systemic (body-wide) disease, involving other body organs, whereas osteoarthritis is limited to the joints. Both forms of arthritis can be crippling.

Causes of Rheumatoid arthritis:

Don’t know exactly what causes rheumatoid arthritis. The condition is most likely triggered by a combination of factors including an abnormal autoimmune response, genetic susceptibility, and some environmental or biologic trigger such as a viral infection or hormonal changes.

Rheumatoid arthritis is considered an autoimmune disease. In autoimmune disorders, the body’s immune system mistakenly attacks and destroys healthy cells and tissue. The immune system determines the body's responses to foreign substances (antigens) such as viruses and toxins. The immune response helps the body to fight infection and heal wounds and injuries. The inflammatory process is a byproduct of the immune response.

·        Genetic factors may play some role in RA either in terms of increasing susceptibility to developing the condition or by worsening the disease process. The main genetic marker identified with rheumatoid arthritis is HLA (human leukocyte antigen).

·        Environmental Triggers like Infections - Although many bacteria and viruses have been studied, no single organism has been definitively identified as a trigger for RA.

Risk Factors

·        Age - Although rheumatoid arthritis can occur at any age from childhood to old age, onset usually begins between the ages of 30 - 50 years. Juvenile rheumatoid arthritis is the term used for arthritis that affects children. Juvenile rheumatoid arthritis often resolves before adulthood. 

·        Women are more likely to develop RA than men.

·        Some people may inherit genes that make them more susceptible to developing RA, but a family history of RA does not appear to increase an individual's risk.

·        Heavy long-term smoking is a very strong risk factor for RA, particularly in patients without a family history of the disease.

·        People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.

Clinical Manifestations

Most commonly, the onset of symptoms takes place over the course of weeks or even months. But sometimes, rapid onset with more severe symptoms may also occur. The hallmark symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour, where Stiffness from osteoarthritis, in contrast, usually clears up within half an hour. Even after remaining motionless for a few moments, the body can stiffen. Movement becomes easier again after loosening up.

·        The inflamed joints are usually swollen and often feel warm and "boggy" (spongy) when touched. The pain often occurs on both sides of the body (symmetrically) but may be more severe on one side of the body, depending on which hand the person uses more often.

·        Although rheumatoid arthritis almost always develops in the wrists and knuckles, the knees and joints of the ball of the foot are often affected as well. Many joints may eventually be involved, including those in the cervical spine, shoulders, elbows, tips, temporomandibular joint (jaw), and even joints between very small bones in the inner ear. 

·        Inflammation of small blood vessels can cause nodules, or lumps, under the skin. They are about the size of a pea or slightly larger, and are often located near the elbow, although they can show up anywhere. Nodules can occur throughout the course of the disease, although they are usually a sign of more severe disease

·        Fluid may accumulate, particularly in the ankles. In some cases, the joint sac behind the knee accumulates fluid and forms what is known as a Baker's cyst. This cyst feels like a tumor and sometimes extends down the back of the calf causing pain.

·        Flu-Like Symptoms Symptoms such as fatigue, weight loss, and low-grade fever may also be present.

·        In children, juvenile rheumatoid arthritis, also known as Still's disease, is usually preceded by high fever and shaking chills along with pain and swelling in many joints. A pink skin rash may be present.

Diagnosis

Rheumatoid arthritis can be difficult to diagnose. Many other conditions resemble RA. Its symptoms can develop insidiously. Blood tests and x-rays may show normal results for months after the onset of joint pain.

Specific findings or presentation more likely to suggest the diagnosis of rheumatoid arthritis include morning stiffness, involvement of three joints at the same time, involvement of both sides of the body, subcutaneous nodules, positive rheumatoid factor, and changes in x-rays.

Various blood tests may be used to help diagnose RA, determine its severity, and detect complications of the disease.

·        Rheumatoid Factor. In RA, antibodies in the blood that collect in the synovium of the joint are known as rheumatoid factor. In about 80% of cases of RA, blood tests reveal rheumatoid factor.The presence of rheumatoid factor plus evidence of bone damage on x-rays also suggests a significant chance for progressive joint damage.

·        ESR test is used not for diagnosis but to help determine how active the condition is.

·        C-Reactive Protein. High levels of C-reactive protein (CRP) are also indicators of active inflammation. Like the ESR, a high result does not indicate what part of the body is inflamed, or what is causing the inflammation.

·        Anti-CCP Antibody. The presence of antibodies to cyclic citrullinated peptides (CCP) can identify RA years before symptoms develop. In combination with the test for rheumatoid factor, the CCP antibody test is the best predictor of which patients will go on to develop severe RA.

·        X-rays generally have not been helpful to detect the presence of early rheumatoid arthritis because they cannot show images of soft tissue. However, x-rays can help track the progression of joint damage over time. Imaging tests, such as ultrasound, or magnetic resonance imaging (MRI). Dual energy x-ray absorptiometry (dexa scans), also called bone densitometry, may be used to check for signs of bone density loss associated with osteoporosis.

Complications

The course of rheumatoid arthritis differs from person to person. For some patients, they disease becomes less aggressive over time and symptoms may improve. Other people develop a more severe form of the disease, which can lead to serious complications that affect not only the joints but other areas of the body including organs. Fortunately, for many patients newer treatments are helping slow the progression of the disease and preventing severe disability.

Many complications of rheumatoid arthritis are the result of chronic inflammation. These may include Joint Deterioration and Pain, Peripheral Neuropathy, Anemia, Eye Problems, Infections, Skin Problems, Osteoporosis, Lung Diseases, Vasculitis, Heart and Circulatory Diseases, Lymphoma and Other Cancers, Periodontal Disease, Kidney and Liver Problems, Emotional Complications & Pregnancy Complications.

MANAGEMENT

Lifestyle changes and home treatments also can help reduce rheumatoid arthritis symptoms.

Exercise - It is important for patients with RA to maintain a balance between rest (which will reduce inflammation) and moderate exercise (which will relieve stiffness and weakness). Studies have suggested that even as little as 3 hours of physical therapy over 6 weeks can help people with RA, and that these benefits are sustained.

The goal of exercise is to: Maintain a wide range of motion, Increase strength, and endurance, and mobility, Improve general health, & Promote well-being

Start with the easiest exercises, stretching and tensing of the joints without movement.

Next, attempt mild strength training. The next step is to try aerobic exercises. These include walking, dancing, or swimming, particularly in heated pools. Avoid heavy impact exercises, such as running, downhill skiing, and jumping. Tai chi, which uses graceful slow sweeping movements, is an excellent method for combining stretching and range-of-motion exercises with relaxation techniques. It may be of particular value for elderly patients with RA.

Diet - in recent years, a number of studies have suggested that the omega-3 fatty acids contained in fish oil may have anti-inflammatory properties useful for RA joint pain relief. The best source of fish oil is through increased consumption of fatty fish such as salmon, mackerel, and herring.

Pain management - Patients can learn strategies to cope with the stress and frustration of living with chronic pain. Relaxation and stress management techniques such as guided imagery, breathing exercises, hypnosis, or biofeedback can be helpful.
Although there is no definitive evidence to support their efficacy, some patients report relief with modalities such as acupuncture, massage, and mineral baths.

Herbal remedies - Researchers are currently conducting studies to determine if supplements extracted from the turmeric spice can help prevent joint inflammation. 

HOMOEOPATHIC MANAGEMENT

Homoeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to treat rheumatoid arthritis but to address its underlying cause and individual susceptibility. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating body’s natural ability to heal itself, acting as a catalyst for healing. As far as therapeutic medication is concerned, several well-proved remedies are available for rheumatoid arthritis which can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homoeopathic doctor in person.

Some important arthritis remedies are given below which are much helpful in treatment of rheumatoid arthritis:

Indicated Remedies	Indications
Aconite	Sudden onset after exposure to cold dry air. Pains, with formication and numbness. Rheumatic inflammation of joints; pains intolerable. Intense bright-red swelling of parts. Sensitive to contact. High fever. Worse at night. With the rheumatism anxiety, fear, restlessness is well marked in aconite. Arthritic and rheumatic drawing and tearing pains, especially in the limbs.
Actea spicata:	This plant remedy is useful especially for those cases of RA who has small joints affected, especially fingers and toes.
Arsenicum	Acute drawing pains in the arms and in the hands. Swelling of the arms, with blackish pustules of a putrid smell. Acute drawing pains in the night, beginning from the elbow and extending to the armpits acute pulling and shooting in the wrists. Cramps in the fingers. At night, sensation of fullness and swelling in the palms of the hands. Excoriation between fingers. Hard swelling of the fingers, with pain in the finger-bones. Cramp in the legs
Belladonna	Joints swollen, red, hot, shining. Exquisitely sensitive to touch or jar. Red streaks radiate from inflamed joint. Recurrent fever with pains attacking nape of neck. Pains in the joints and bones. Rheumatic pains (in the joints) flying from one place to another. The pains are aggravated, chiefly at night, and in the afternoon towards three or four o’clock. The least touch, and sometimes also the slightest movement, aggravates the sufferings.
Bryonia	Over-sensitiveness of the senses to external impressions. Rheumatic and gouty pains in the limbs, with tension, worse from motion and contact. Tension, drawing pains, acute pullings and shootings, especially in the limbs, and chiefly during movement, with insupportable pains on being touched, sweat of the part affected, and trembling of that part when the pains diminish. Stiffness and shootings in the joints, on being touched and when moved. In the evening, pain, as from fatigue, in the limbs, with paralytic weakness.
Calcaria fluoride:	This medicine works for those patients of arthritis who tend to have large or medium joint affections such as knee joint, spine or shoulders. These patients will have more pain on waking up in the morning or while getting up from a sitting position and they feel better after walking for some time. The joint pains are better by hot application. At the level of emotions, these patients are likely to tough, strong willed, who might look stiff and at times rude. They do not give up easily.
Causticum	Arthritic and rheumatic drawing and tearing pains, especially in the limbs. Acute and violent pulling in the joints and the bones, mitigated by the heat of a bed. Contraction of the tendons, and stiffness in the flexor muscles of the limbs. Cramp-like Contraction of several limbs. Torpor and paleness of some parts, or of the entire left side of the body.
Medorrhinum	Rheumatic pain in top of left shoulder, worse from motion, occasional little darts of pain if kept still. Rheumatic pain in (right) shoulder and arm. Cracking of joints, especially elbows. Much pain in left arm, cannot hold a paper, veins become enlarged, worse raising arm. Trembling of arms and hands.
Natrum Muriaticum:	This medicine is suitable to those patients who may have developed Rheumatoid Arthritis (RA) after prolonged stress in the form of grief, which could be in the form of death of some dear one; or after breaking a relationship. It is the emotional trauma that leads to disturbance of immune system, in turn, leading to the disease like RA.
Rhus Tox	Hot, painful swelling of joints. Pains tearing in tendons, ligaments and fasciae. Rheumatic pains spread over a large surface at nape of neck, loins, and extremities; better motion. Soreness of condyles of bones. Limbs stiff, paralyzed. The cold fresh air is not tolerated; it makes the skin painful. Tenderness about knee-joint. Loss of power in forearm and fingers; crawling sensation in the tips of fingers.
Salicylic acid	Acute, inflammatory rheumatism of one or more joints, especially elbows or knees. Great swelling and redness. High fever. Very sensitive to least jar. Motion impossible.

 

DYSPEPSIA

MULTI-DIMENSIONAL APPROACH  TO  DYSPEPSIA. SAY NO TO PROTON PUMB INHIBITORS

Dyspepsia, also known as indigestion or upset stomach, is a term that describes discomfort or pain in the upper abdomen. It is not a disease. Various conditions cause dyspepsia. It can be caused due to various medications, stressed lifestyle and spicy foods. The main symptom is usually pain or discomfort in the upper tummy (abdomen). In addition, other symptoms that may develop include Bloating, Belching, Quickly feeling full after eating, Feeling sick (nausea) & Being sick (vomiting). Hyperacidity is also called Acid Dyspepsia, which is one of the most common problem. Hyperacidity is a medical condition in which the stomach secretes a lot of acids.

Causes of Dyspepsia

Indigestion is usually related to lifestyle and what we eat and drink. It may also be caused by infection or some other digestive conditions.
Some common causes include:
Life Style factors - Eating too much, Eating too rapidly, Consuming fatty or greasy foods, Consuming spicy foods, Consuming too much caffeine, Consuming too much alcohol, Consuming too much chocolate, Consuming too many fizzy drinks, Emotional trauma, moderate to intense exercise immediately after eating.
Functional dyspepsia - a type of indigestion that may undermine the stomach's ability to accept and digest food and then pass that food on to the small intestine.
Gallstones
Gastritis (inflammation of the stomach)
Hiatus hernia
Infection, especially with bacteria known as Helicobacter pylori
Nervousness
Obesity - caused by more pressure inside the abdomen
Pancreatitis (inflammation of the pancreas)
Peptic ulcers
Smoking
Some medications like Antiinflammatory medicines are the most common culprits. These are medicines that many people take for arthritis, muscular pains, sprains, period pains, etc. For example: aspirin, ibuprofen,and diclofenac but there are others. Antiinflammatory medicines sometimes affect the lining of the stomach and allow acid to cause inflammation and ulcers.
Various other medicines sometimes cause dyspepsia, or make dyspepsia worse. They include: digoxin, antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines and bisphosphonates.such as antibiotics and NSAIDs (non-steroidal anti-inflammatory drugs)
Stomach cancer

Clinical manifestations of Dyspepsia
Most people with indigestion feel pain and discomfort in the stomach or chest area. The sensation generally appears soon after consuming food or drink. In some cases symptoms may appear some time after a meal. Some people feel full during a meal, even if they have not eaten much. Heartburn and indigestion are two separate conditions.
Heartburn is a burning feeling behind the breastbone, usually after eating.
The Common symptoms are Nausea, Belching, Feeling bloated (very full)
In very rare cases indigestion may be a symptom of stomach cancer.
Mild indigestion is rarely anything to worry about. if symptoms continue for more than two weeks. Consult a physician immediately if pain is severe, and symptoms like
Loss of appetite or weight loss, Vomiting, Black stools, Jaundice (yellow coloring of eyes and skin), Chest pain, Shortness of breath, Sweating, Chest pain radiation to the jaw, arm or neck.

Investigations

Majority of patients indigestion is mild and does not occur very often. In such cases no treatment from a doctor is required. People who experience indigestion regularly consult a good physician.
Blood test - if the patient has any symptoms of anemia then blood test is needed.
Endoscopy - patients who have not responded to treatment, or those with certain signs and symptoms, may be advised to have their abdomen examined in more detail like endoscopy is advised.
Tests to diagnose Helicobacter pylori infection - this may include a urea breath test, a stool antigen test, and a blood test. Peptic ulcers are often cause by this bacterium.
Liver function test  if the patient may have a biliary condition, which affects the bile
ducts in the liver. This involves a blood test that determines how the liver is working.
X-rays - usually an upper-gastrointestinal and small bowel series. X-rays are taken of the esophagus,stomach and small intestine.
Abdominal ultrasound - high-frequency sound waves make images that show movement, structure and blood flow.
Abdominal CT (computed tomography) scan.

Management
In modern medicine, Proton pump inhibitors like omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole rank among the top 10 prescribed classes of drugs and are commonly used to treat acid reflux, indigestion, and peptic ulcers. Although generally assumed to be safe, recent studies have shown that they have numerous side effects, from an altered gut environment and impaired nutrient absorption to an increased risk for cardiovascular events, kidney disease, and dementia.

Lifestyle changes

For all types of dyspepsia, the National Institute for Health and Care Excellence (NICE) recommends the following lifestyle changes like Make sure you eat regular meals, Lose weight if you are obese, If you are a smoker, consider giving up, Don't drink too much alcohol.
Changing the way you eat may help your symptoms. Steps you can take include: Allow enough time for meals, Chew food carefully and completely, Avoid arguments during meals, Avoid excitement or exercise right after a meal, Relax and get rest if indigestion is caused by stress.
Posture - Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.
Bedtime - If symptoms recur most nights, the following may help:
Go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime and don't drink in the last two hours before bedtime. If you are able, try raising the head of the bed by 10  20 cms (for example, with books or bricks under the bed's legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this, do not use additional pillows, because this may increase abdominal pressure.
Spices and condiments such as pepper, mustard must be avoided.
Vinegar or pickles, which make food more palatable and lead to overeating, must be avoided.
Alcohol, tobacco, strong tea and coffee must be avoided. Highly seasoned meats, pulses, potato, rice, cheese, refined, processed, stale and tinned foods should all be avoided.

Home Remedies:
For instance, drinking a glass of water at the first sign of indigestion can give you much relief. Water helps dilute stomach acids thus giving you relief from bloating and burning.
Apple cider vinegar is often used to kick start a slow stomach and settle indigestion due to its antibiotic properties. Add one tablespoon apple cider vinegar to a cup of water. Mix in one teaspoon honey. Drink this solution two to three times a day for quick relief.
Fennel seeds can be really helpful for indigestion caused by very spicy or fatty food. Fennelseeds contain oil that can help reduce nausea and control flatulence.
Ginger stimulates digestive juices and the flow of enzymes that help you digest your food. This makes ginger an effective remedy for indigestion from overeating.
Baking soda - Indigestion often happens due to high levels of stomach acids. Baking soda is one of the most simple and effective treatments for indigestion because it acts like an antacid. Stir one half teaspoon of baking soda into half a glass of water. Drinking this solution will neutralize the acid in your stomach and give your relief from bloating.
Coriander is an effective spice to treat indigestion. Add some roasted coriander seeds to half a glass of buttermilk and drink it twice a day.
Drinking herbal tea after eating a heavy meal can greatly reduce indigestion. Dip your favorite herbal tea bag into a hot cup of water and cover it for five minutes. Drink it while it is still warm. You can try herbal tea containing mint, raspberry and blackberry for instant relief. Peppermint or chamomile tea can also calm your stomach, especially after overeating.

HOMOEOPATHIC MANAGEMENT

Homoeopathy is a remarkable resource for those dealing with digestive disorders. Homeopathic constitutional treatment based on the individual case is the most suitable and would aim to heal the underlying physical or emotional crisis causing digestive disorders. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating bodys natural ability to heal itself, acting as a catalyst for healing. Homoeopathy can be of assistance in retrieving normal motility and treating any psychological issues related to IBS. Homeopathic remedies can help rebuild mind, body and spirit as well as personal relationships for a balanced lifestyle. Homeopathy will reinforce and tone the bodys systems. Homeopathic remedies can help deal with anxiety, depression, and stress along with digestive problems. It will attend to nutritional problems and help the patient develop a healthier body image.

Some Homoeopathic remedies for Dyspepsia are

Indicated Remedies
Indications

Arsenicum album
This remedy may be indicated if a person feels anxious, restless yet exhausted, and is worse from the smell and sight of food. Burning pain is felt in the stomach and esophagus, which often is relieved by warmth and sitting up. Vomiting and diarrhea are possible. Upsets from spoiled food or from eating too much fruit often respond to this remedy.

Bryonia
When this remedy is indicated, the stomach feels heavy, with rising acid and a bitter or sour taste. Pain and nausea are worse from motion of any kind. The person may have a dry mouth and be thirsty for long drinks, which may increase discomfort. Bryonia is strongly suggested if a person is grumpy and wants to stay completely still and not be touched or talked to.

Carbo vegetabilis
Sour belching bringing only small relief, burning pain in the stomach and abdomen, and flatulence after eating may be seen when this remedy is needed. The person feels cold and faint, with a strong desire for fresh or moving air. Digestion may be slow and incomplete, with nausea or cramping.

Colocynthis
Cutting, cramping pain in the stomach and abdomen, with relief from hard pressure or from doubling over, indicates a need for this remedy. A bitter taste in the mouth, a feeling that the intestines are about to burst, or a sensation that stones are grinding together in the abdomen may be present. Indigestion may be worse when the person feels upset, especially after suppressing anger.

Lycopodium
This remedy is indicated for many digestive troubles. The persons appetite may be ravenous, but eating even a small amount can cause a feeling of fullness and bloating. Rumbling gas may form in the abdomen, pressing upward and making breathing difficult. The person often has a strong desire for sweets, is sleepy after meals, and feels worst in the late afternoon and evening.

Natrum carbonicum
This remedy can be helpful to mild people who have trouble digesting and assimilating many foods and have to stay on restricted diets. Indigestion, heartburn, and ulcers can occur if offending foods are eaten. Milk or dairy products can lead to flatulence or sputtery diarrhea that leaves an empty feeling in the stomach. Cravings for potatoes and sweets are common; also milk, but it makes these people sick, so they have usually learned to avoid it.

Natrum phosphoricum
A sour taste in the mouth, an acid or burning sensation in the stomach, sour vomiting, regurgitated bits of food, and a yellow coating on the tongue are all indications for this remedy. The person may have problems after consuming dairy products or too much sugar. Another indication for Natrum phos is a craving for fried eggs.

Nux vomica
This remedy is often useful for indigestion, and is especially suited to those who overindulge in stimulants, food, and alcohol. Chilliness, irritability, and sensitivity to odors, sound, and light are often seen. Pain and weight can be felt in the stomach, with cramps or constricting pains. The person often feels an urge to vomit or move the bowels (which may make the person feel better, but is rarely successful).

Phosphorus
Burning pain in the stomach that feels better from eating ice cream or other cold, refreshing foods suggests a need for this remedy. The person is usually thirsty for cold drinks, but often feels nauseous or vomits once liquids warm up in the stomach. People needing Phosphorus may have a tendency toward easy bleeding and sometimes develop stomach ulcers.

Pulsatilla
Indigestion that is worse from eating rich and fatty foods, with a feeling of a lump or pulsation in the stomach, suggests a need for this remedy. Discomfort often is worse from warmth, especially in a stuffy room, and the person may feel better from gentle walking in open air. A bitter taste in the mouth can take the pleasure out of eating. A person who needs Pulsatilla usually does not feel thirsty and may be tearful and emotional.