CLINICAL ASSESSMENT OF THE ROLE OF KANSA HARITAKI AND VIRECHANA IN THE MANAGEMENT OF AMAVATA

Amavata is a clinical condition described in Ayurveda that closely resembles with the clinical features of Rheumatoid Arthritis. A Clinical Study was conducted at IPGT and RA, Jamnagar in Kaya Chikitsa de-partment to evaluate the efficacy of Virechan Karma with Eranda Taila and Trivrita Kwatha in patients suffering from Amavata and compared with the trial drug Kansa Haritaki described in Charak Samhita. Efficacy of both of these was compared with the known common drug Trayodashanga Guggulu. In this study, 38 patients of Amavata were registered, of which 29 patients completed the course of the treatment and 9 patients discontinued before completion of course against medical advice. The disease was diag-nosed on the basis of signs and symptoms as described in Ayurvedic and Modern text, aided by American Rheumatism Association Criteria (1988). RA factor test was done in all the patients. The Routine Blood examination (CBC, ESR) with Serum Uric acid, Urine and Stool examination was done to rule out other pathological conditions.

Clinical Study to evaluate efficacy of Panchamuladi Kaal Basti in the management of Amavata w.r.t. Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic autoimmune inflammatory disease that causes to pain, stiffness and swelling of the joints. It affects different parts of the body, mainly effects the joints. Amavata (Rheumatoid Arthritis) has been a challenging problem to the medical field. Various treatment protocols are applied in this disease with partial success. In present clinical study, 30 patients of clinically proven Amavata (Rheumatoid Arthritis) were treated with Panchamuladi Kaal Basti to evaluate its efficacy. Panchamuladi Kaal Basti contains Kwatha Dravyas viz. Bilwa, Agnimantha, Syonaka, Patala, Kantakari etc. with other Kalka and Prakshepa Dravyas. Ayurvediya Nidanadi parameters and American Rheumatism Association guidelines for Rheumatoid Arthritis were followed. Analysis was done and results were calculated statistically using paired ‘t’ test. Results obtained are encouraging and indicate the efficacy of Panchamuladi Kaal Basti over Amavata (Rheumatoid arthritis), exploring many aspects of this clinical entity.

Changes in the Presentation of Incident Gout and the Risk of Subsequent Flares: A Population-based Study over 20 Years

Objective.To examine whether a change in the presentation of incident gout happened over the last 20 years and to determine the risk of subsequent gout flares after an initial gout attack.Methods.All incident cases of gout were identified among residents of Olmsted County, Minnesota, diagnosed in 1989–1992 and 2009–2010 according to the earliest date fulfilling the 1977 American Rheumatism Association preliminary criteria, or the New York or Rome criteria for gout. Patients in both cohorts were then followed for up to 5 years. Cumulative incidence and person-year methods were used to compare flare rates, and conditional frailty models were used to examine predictors.Results.A total of 429 patients with incident gout (158 patients in 1989–1992 and 271 patients in 2009–2010) were identified and followed for a mean of 4.2 years. The majority of patients were male (73%) and the mean age (SD) at gout onset was 59.7 (17.3) years. Classic podagra decreased significantly from 74% to 59% (p < 0.001). Cumulative incidence of first flare was similar in both cohorts (62% vs 60% by 5 yrs in 1989–1992 and 2009–2010, respectively; p = 0.70), but overall flare rate was marginally higher in 2009–2010 compared to 1989–1992 (rate ratio: 1.24). Hyperuricemia (HR 1.59) and kidney disease (HR 1.34) were significant predictors of future flares.Conclusion.Gout flares were common in both time periods. Hyperuricemia and kidney disease were predictors of future flares in patients with gout. Podagra as a presentation of gout has become relatively less frequent in recent years.

Clinical Study to evaluate efficacy of Mustadi Basti in the management of Amavata w.r.t. Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic autoimmune inflammatory disease that causes to pain, stiffness and swelling of the joints. It affects different parts of the body, mainly effects the joints. Amavata (Rheumatoid Arthritis) has been a challenging problem to the medical field. Various treatment protocols are applied in this disease with partial success. In present clinical study, 30 patients of clinically proven Amavata (Rheumatoid Arthritis) were treated with Mustadi Basti to evaluate its efficacy. Mustadi Basti contains Kwatha Dravyas viz. Musta, Ushira, Balamoola, Argawadha and Rasna with other Kalka and Prakshepa Dravyas. Ayurvediya Nidanadi parameters and American Rheumatism Association guidelines for Rheumatoid Arthritis were followed. Analysis was done and results were calculated statistically using paired ‘t’ test. Results obtained are encouraging and indicate the efficacy of Mustadi Basti over Amavata (Rheumatoid arthritis), exploring many aspects of this clinical entity.

Clinical Study to evaluate efficacy of Erandamuladi Basti in the management of Amavata w.r.t. Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic autoimmune inflammatory disease that causes pain, stiffness and swelling of the joints. It affects different parts of the body, mainly effects the joints. Amavata (Rheumatoid Arthritis) has been a challenging problem to the medical field. Various treatment protocols are applied in this disease with partial success. In present clinical study, 30 patients of clinically proven Amavata (Rheumatoid Arthritis) were treated with Erandamuladi Basti to evaluate its efficacy. Erandamuladi Basti contains Kwatha Dravyas viz. Erandamula, Rasna, Bala, Devdaru and Sahachar with other Kalka and Prakshepa Dravyas. Ayurvediya Nidanadi parameters and American Rheumatism Association guidelines for Rheumatoid Arthritis were followed. Analysis was done and results were calculated statistically using paired ‘t’ test. Results obtained are encouraging and indicate the efficacy of Erandamuladi Basti over Amavata (Rheumatoid arthritis), exploring many aspects of this clinical entity.

Comparison of the 2010 American College of Rheumatology/European League Against Rheumatism and the 1987 American Rheumatism Association Classification Criteria for Rheumatoid Arthritis in an Early Arthritis Cohort in New Zealand

Objective.To compare the performance of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria with the 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA) in an early arthritis cohort.Methods.The study included 79 patients with early arthritis (symptoms < 12 months) and a minimum of 1 year of followup between January 2004 and August 2010. Case notes were reviewed to determine which criteria were fulfilled at initial, 3-month, 1-year, and 2-year visits. Requirements for disease-modifying antirheumatic drug (DMARD) therapy and presence of joint erosions were compared at 2 years.Results.At the initial visit, twice as many patients fulfilled the 2010 criteria (67%) compared with the 1987 criteria (34%; p < 0.001). Forty-four percent of patients who fulfilled only the 2010 criteria at the initial visit went on to fulfill both 1987 and 2010 criteria at 3 months (p < 0.001). Eight patients did not meet the 1987 RA criteria solely because of short symptom duration. All 17/79 patients who developed joint erosions went on to eventually fulfill both criteria. Of those patients who fulfilled only the 2010 criteria at baseline, 25/27 (93%) ultimately received DMARD therapy compared with 24/26 (92%) of those fulfilling both 1987 and 2010 criteria.Conclusion.The 2010 ACR/EULAR RA criteria allowed earlier RA classification compared to the 1987 ARA criteria, although both criteria were equivalent in predicting joint erosions and subsequent need for DMARD (Australian New Zealand Clinical Trials Registry ANZCTR 12608000292370).

Estudo radiográfico das alterações da coluna cervical na artrite reumatóide e sua associação com sinais e sintomas da doença

As alterações radiográficas da coluna cervical de 81 pacientes em tratamento ambulatorial de artrite reumatóide foram estudadas e correlacionadas com dor a cervical e os sinais neurológicos relacionados com a compressão das estruturas nervosas contidas no canal vertebral. A correlação das alterações radiográficas com a classificação em graus e em estágios da doença preconizados pela ARA (American Rheumatism Association) e classificação da capacidade funcional de Steinbroker foi também realizada. A avaliação radiográfica foi realizada por meio de radiografias em AP, perfil e dinâmicas da coluna cervical. As alterações radiográficas (migração superior do processo odontóide, instabilidade atlanto-axial, instabilidade sub-axial ou erosão do processo odontóide) foram observada em 65 (80,2%) dos pacientes. Foi observado correlação estatisticamente significativa entre a capacidade funcional dos pacientes (classificação de Steibroker) e estágios da doença (ARA ) com as alterações radiográficas da coluna cervical dos pacientes. A presença de alterações radiográficas da coluna cervical dos pacientes com artrite reumatóide não apresentou correlação estatisticamente significativa com a dor ou sinais de compressão nervosa.

Why do general practitioners request rheumatoid factor? A study of symptoms, requesting patterns and patient outcome

Background: To investigate the reasons why general practitioners (GPs) request rheumatoid factor (RF) assays, we studied 200 consecutive requests for RF from general practice in 1995. Method: By means of an audit questionnaire, we studied 100 negative, 50 positive and 50 borderline RF results and compared these with the presenting symptoms that prompted the request, the GPs' understanding of the significance of the result, the referral intention and behaviour of the GP, and finally, the patient outcome after 5 years. Results: There was an 80% response rate. The presenting symptoms closely matched the American Rheumatism Association revised criteria for the classification of rheumatoid arthritis, indicating that the requests were made on valid clinical grounds, with polyarthralgia, morning stiffness and joint pain being the most common. Most GPs considered a negative or positive result to be meaningful, in that a positive RF meant that a referral was more likely than with a negative or borderline result, even in the presence of appropriate symptoms in all three groups. Seventeen to thirty per cent felt that the test excluded or confirmed RA. The result appeared to influence this decision to a greater extent than it should. A 5-year follow-up on these patients showed that 26/40 patients with positive RF were referred, and that 25 of them developed a rheumatic disease of some kind, with 17 patients eventually being diagnosed with RA. Only 17/80 patients with negative RF were referred, the remainder having no autoimmune problem evident after 5 years, 11 of them developing a rheumatic disease, and only three being diagnosed with RA. Conclusions: Although this is a locally based study, we believe the conclusions would be applicable to all laboratories and GPs undertaking these tests. RF requests are made on valid clinical grounds by GPs, but there may be an over-reliance on the results as regards referral behaviour. If patients were referred on clinical grounds, this would significantly lengthen consultants' waiting lists.