AMAVATA (RHEUMATOID ARTHRITIS-LIKE DISORDER)

CASE STUDY: AMAVATA (RHEUMATOID ARTHRITIS-LIKE DISORDER)

NIDANA (ETIOLOGICAL FACTORS)

• Viruddha ahara sevana
• Guru, snigdha, abhyushita, amla ahara
• Divaswapa
• Mandagni
• Ajirna avastha – vyayama or vata aggravating ahara
• Aama janaka nidana followed by vata prakopaka nidana
  
  

(Ref: Madhava Nidana 25/1-3; Ashtanga Hridaya Nidana Sthana 12/1-3)

POORVARUPA (PRODROMAL SYMPTOMS)

• Angamarda (body ache)
• Aruchi (loss of taste)
• Trishna (thirst)
• Alasya (laziness)
• Gaurava (heaviness)
• Jwara (mild fever)
  
  

(Ref: Ashtanga Hridaya Nidana Sthana 12/2)

LAKSHANA (SYMPTOMS)

• Sandhishoola (joint pain), especially in small joints
• Sandhishotha (joint swelling)
• Mandagni
• Arochaka
• Angamarda
• Daha, jwara, stabdha gati
• Pain increases in morning or after rest
  
  

(Ref: Madhava Nidana 25/4-7; Ashtanga Hridaya Nidana Sthana 12/3-6)

SYSTEMIC EXAMINATION TESTS (MODERN CLINICAL ASPECT)

1. Musculoskeletal Examination:
• Symmetrical joint swelling
• Morning stiffness (>30 mins)
• Deformities in chronic cases (ulnar deviation, swan neck, etc.)
• Restricted joint movement
2. General Examination:
• Low-grade fever
• Rheumatoid nodules

Expected Findings:

• Polyarticular symmetrical arthritis
• Joint tenderness and deformity
• Stiffness relieved with movement

LABORATORY INVESTIGATIONS (MODERN ASPECT)

1. ESR, CRP:
• Elevated (indicating inflammation)
2. Rheumatoid Factor (RF):
• Positive in ~70–80% cases
3. Anti-CCP Antibodies:
• Highly specific for RA
4. X-ray of affected joints:
• Joint space narrowing, erosion, osteopenia
5. CBC:
• Normocytic anemia of chronic disease
6. Synovial fluid analysis:
• Turbid, increased WBCs (inflammatory)

Expected Results:

• Inflammatory arthritis pattern
• Positive RF and anti-CCP
• Elevated ESR/CRP
• Radiological joint destruction in chronic cases

DIFFERENTIAL DIAGNOSIS (MODERN CLINICAL ASPECT)

• Osteoarthritis
• Psoriatic arthritis
• Gout
• Systemic lupus erythematosus (SLE)
• Ankylosing spondylitis
• Septic arthritis

SAMPRAPTI (PATHOGENESIS)

• Mandagni leads to aamotpatti
• Ama gets absorbed and combines with vitiated vata
• Gets sthanasamsraya in sandhi and causes shoola and shotha
• Chronic inflammation leads to dhatu kshaya and sandhi vikriti
  
  

(Ref: Madhava Nidana 25/4; Ashtanga Hridaya Nidana Sthana 12/3-5)

UPASAYA AND ANUPASAYA (PALLIATIVE & AGGRAVATING FACTORS)

Upasaya:

• Langhana, pachana
• Ushna, tikshna, deepana aushadha
• Swedana after ama pachana
• Vatahara snehana and basti

Anupasaya:

• Guru, snigdha, amla, abhyushita ahara
• Divaswapa
• Exposure to cold and damp
  
  

(Ref: Ashtanga Hridaya Chikitsa Sthana 19; Madhava Nidana 25)

SAMANYA CHIKITSA (GENERAL LINE OF TREATMENT)

• Ama pachana with deepana, pachana drugs like shunthi, pippali, chitraka
• Langhana
• Swedana after ama pachana
• Virechana and basti in chronic stage
• Vatahara, ushna, ruksha chikitsa
  
  

(Ref: Ashtanga Hridaya Chikitsa Sthana 19; Chakradatta 25)

VISHESHA CHIKITSA (SPECIFIC TREATMENT)

1. Ama Stage:
• Shunthi + Guduchi + Pippali decoction
• Ajmodadi churna
• Hingwastaka churna + lukewarm water
• Langhana and pachana
2. Chronic Stage:
• Simhanada Guggulu
• Mahayogaraja Guggulu
• Rasnasaptaka Kvatha
• Dashamoola kvatha + eranda taila
• Yogaraja Guggulu with vatari guggulu
3. Basti Therapy:
• Niruha basti with dashamoola + trikatu + honey
• Anuvasana basti with eranda taila, balataila, or mahanarayana taila
4. Local Therapy:
• Abhyanga with sahacharadi taila or mahanarayana taila
• Nadi sweda or patrapinda sweda
5. Dietary Advice:
• Laghu, easily digestible diet
• Avoid milk, curd, and heavy meals

(Ref: Ashtanga Hridaya Chikitsa Sthana 19; Sahasrayoga Guggulu Prakarana; Madhava Nidana 25)