Sujal Torgal Patil
Arthritis is the painful inflammatory condition of the joints. It includes osteoarthritis, rheumatoid arthritis, gouty arthritis, etc. Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of bones wears down over time.
Although osteoarthritis can damage any joint in the body, the disorder most commonly affects joints in the hands, knees, hips and spine. There is no cure, but at the best it could be managed. The incidence of osteoarthritis is increasing gradually due to inappropriate dietary and lifestyle changes. It is a degenerative disease that affects women who are above 50 years or after menopause. However, there is a rise in cases affecting younger patients. Although not a life threatening disease, it restricts normal body movements and forces patients to lead a restricted life.
In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between bones. In osteoarthritis the cartilage breaks down causing pain, swelling and problems in moving the joint. As it worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint. An inflammatory process leads to the development of cytokines (proteins) and enzymes that further damage the cartilage. In the final stages, the cartilage wears away and the bone rubs against bone leading to joint damage and more pain.
Ayurved has its own scientific diagnostic system. OA generally belongs to a cluster of diseases in which the ayurvedic principle of kinetic energy, vata dosh, prevails. According to ayurved the causes of OA are most often attributed to improper diet, unfavourable lifestyle, trauma, ageing processes, and constitutional predispositions which cause aggravation of vata. Eating excessively dry, extremely heavy and less nutritive foods or processed, canned, dried, fermented or acidic foods aggravates vata.
Vata brings dryness (rukshata), lightness (laghutva), porosity (saushirya) and coarseness (kharatva) to the joints. Asthi dhatu (roughly the bony tissue) is formed from the meda dhatu (roughly the fatty tissue). When there is an imbalance in the meda dhatu it shows in the asthi dhatu as well. Corresponding to ayurvedic models of pathogenesis, the disease is caused when the aggravated vata settles in the knee joint (or any other affected joint) and begins to destroy the structure and function of the joint. The features seen in OA and sandhi-gata-vata are similar. In the ayurvedic disease-entity, pain in the joint is the main feature and can be accompanied by other features including swelling, stiffness, crepitus and difficulties in performing proper joint movements.
In the early stages there could be pitta and kapha along with vata dosha, which resembles rheumatoid arthritis but is not. So diagnosis of the condition is critical. But in jeerna (chronic) sandhi-gata-vata which resembles OA, the reduction and regulation of the vata dosha is an important aspect of ayurvedic treatment.
Current conventional medical treatments focus on pain reduction and control of inflammation; however, these approaches have no effect on the natural course of the disease. The most common medications prescribed for osteoarthritis are, at best, moderately effective. In addition, side effects of these treatments can be quite significant, and at times life-threatening. Often, the ultimate treatment for a disabling joint is joint replacement, with the inherent risks and cost that come with surgery.
Ayurved tries to manage this disorder with a multimodal approach.
l Accurate diagnosis of the condition is the foremost step. After differentiating the condition from amavata or vata rakta the physician examines the patient while noting their prakriti, dietary and other history, seasonal and climatic assessment, nature of pain, severity and stage of the condition, etc.
l Aahar and vihaar are the dietary corrections and lifestyle modifications. Foods that aggravate vata should be barred. A diet shouldn’t be too heavy or light, it should boost the digestive fire, be freshly cooked and warm, and should improve the bone and joint health. Old grains like rice, wheat, barley, ragi, green gram, cow ghee, nuts, butter, dates, raisins, bitter vegetables, milk form the main ingredients of such a diet. Milk and milk products, oil, ghee, fruits, sour or fermented food items, non-vegetarian food should be avoided in the inflammatory stage of osteoarthritis. Boiled water should be consumed is preferable even for RO or filtered water.
One should not assume a certain position for a long time causing undue pressure on certain joints. Continuous sitting, standing, running, hopping, inappropriate posture or even sedentary lifestyle should be avoided. Day nap, night vigil, suppression of natural urges like urination or excessive exertion is undesirable as it results in vata imbalance.
l Lose weight: Higher BMI is usually associated with joint pain and inflammatory diseases.
l Therapeutic management: External and internal treatments are designed to target the reduction of abnormal vata. External treatments like snehan (oil massage), swedan (sudation therapy), janu basti, kati basti, parishek, pottali swedan, lepa, etc, reduce inflammation and pain. Oil enemas (matra basti) and other medicated enemas are indicated wherever needed and are extremely beneficial in nourishing the bony tissue and joint structure.
l Yoga and exercise: Depending on the area or joint affected, certain poses help strengthen the body whereas some worsen the condition. In any case avoid exercise in acute, painful or inflammatory conditions. Bhujangasan, shalabhasan, naukasan and surya namaskar help increase flexibility of one’s back. Poses like gomukhasana, ardha matsyendrasana, baddha konasan and vajrasan help strengthen the knee, ankle and smaller joints in the feet but shouldn’t be practised when in extreme pain or swelling. Slow walking, jogging and swimming also helps mobilise the joints. Pranayam, if done regularly, increases the body’s endurance and helps in better pain tolerance. Meditative practices like guided meditation help in healing and focussing better on the ailment.
l Oral medication is dependent on the stage of the disease and patient’s condition. Scientific minimal medication can reverse pain and swelling if appropriate diet is followed in lesser duration.
In the latter half of our lives our bodies become quite vulnerable to degenerative diseases. But the picture today shows many youth falling prey to these lifestyle disorders. The above guidelines can act as preventive and curative measures in curbing osteoarthritis.
(Writer is chief medical officer at Traya Natural Health Centre and can be reached at [email protected])