Almost all age groups are affected by this disease. It can be classified into three main catagories : from heredity, from infection, acquired by injury. Let’s look first at the development of the disease. First the synovial membrane becomes hyperamic proliferative and swollen. There are the presence of numerous lymphocytes and plasma cells. An effusion accumulates and thus the joint becomes swollen. From the edge of the synovial membrane where it joins with the articular cartilage an inflammatory granulation spreads, called the ‘pannus’. This tissue gradually destroys the articular cartilage. Pannus adheres to and penetrates into articular cartilage and destroys the cartilage. Capsules and ligaments becomes stretched and lax in some cases. Surrounding muscles may go into spasm and cause joint deformities. When healing occurs, the pannus is replaced by fibrous tissues. This leads to fibrous ankylosis with permanent restriction of movement. This is why the joint cannot be restored to its previous normal condition. Thus it is true that arthritis cannot be fully cured.
In many of my cases there is a tendency to get the disease among people whose relatives suffered from this disease. Onset of the disease is insidious. Patients always give a history of occasional pain with soreness, which subsides with acute treatment. The suffering increases in intensity and duration. Careful case taking will reveal that 80% of these cases have rheumatism in the background. This is the most difficult part of rheumatism to control and cure.
The background miasm must be found. It is important to assess the pathological condition of the disease. X-ray of the affected part and blood test for urea, uric acid, RA factor must be done, as it gives a clear picture where the disease stands and how much the patient is affected. This assessment is necessary to get a clear picture how much progress is possible. For example, sometimes x-ray gives the picture of loose bodies (usually found in knee joint x-ray). In these cases progress is not as good as in other cases. In 80% of these cases progress is satisfactory. In 20% of cases progress is negligible. Still, the sufferings of the people can be reduced. In these cases anti-miasamatic constitutional medicines help. But a follow up or intercurrent remedy is equally important. A carefully selected intercurrent medicine works firstly to reduce pain rapidly and secondly to boosts the action of the constitutional medicine.
An anti-miasamatic medicine works more rapidly and efficiently if a follow up medicine is prescribed carefully. Giving relief to the patient is very important. If the patient is relieved of his sufferings he will give whatever time the doctor needs to cure. But if he does not get relief, he will not spare even a month to his or her doctor for treatment.
In this variety, the patient suffers from arthritis because of infection of the sinovial membrane and periosteum. Pain is more severe than the chronic arthritis and fever always accompanies it. Movement of the joints becomes most restricted. Acute and superficial medicines are of help. I always prescribe superficial medicines at this stage. This acute medicines must be prescribed on the basis of homeopathic theory. Every dose must be perfect, that it does not cause any medicinal aggravation. Any medicinal aggravation will increase the suffering of the patient. I find Arsenicum album is the first and most effective medicine in many cases of infective arthritis. Pathology should be in mind. Sometimes a prescription on the basis of pathology helps to control the acuteness of the disease condition. Echinacea Angustifolia, and Secale cor, can be of great use in these conditions. 80% of cases are covered by Arsenicum album, Aconitum napelus, Belladonna, Apis mel, Sabina, Colchicum and Caulophylum. These medicines are of great help if given carefully and maintaining the relationship with the constitutional remedy. In my search of arthritis treatment I often prescribed Ferrum phosphoricum in the decimal scale and I find it very effective. I have seen Ferrum phos act as an anti inflammatory medicine. If there is too much inflammation with pain I prescribe Ferrum phos. along with the indicated remedy. Ferrum phos is compatible with almost all medicines. The patient gets relief quickly from fever and pain. Inflammation of the sinovial membrane reduces quickly. Aconitum nap. reduces pain rapidly and it increases blood circulation at the affected part. Fluids accumulated at the area will drain quickly if Aconitum is given in controlled doses ( I uses Aconitum in lower potencies at frequent and short intervals but not more than 3 to 4 doses). Thus the oedema of the joint is quickly reduced. Berfore using Aconite nap I have to be sure that the joint is not infected with tuberculosis, or any other deadly infection. If it is, Aconitum will help metastasize of the disease.
Ferrum phos.6x reduces hyperaemia. This hyperaemia is the basic change that occurs in arthritis. I have used it succesfully in case of fluid effusion. Bones, tendons, ligaments and synovial membrane all come under the domain of this medicine. It works without disturbing the effect of anti miasmatic medicines. I applied this combination in 80 cases of which 75 responded positively. The other five cases responded, but very slightly. In those five cases the patient did not follow the guidelines as I had instructed.
Symphytum also helps in controlling the inflammation of the synovial membrane. To some extent it helps in remodeling of the bone periosteum. Symphytum increases the secretion of calcium. It helps even in advanced stage of arthritis where degeneration has startedand the tibia, femur and patella are involved. In these cases, careful use of symphytum restarts regeneration. Using Symphytum, 100% of cases responded positively. I use this medicine in every case of arthritis but the time of use is different and it depends on the pathological condition of the patient, the anti miasamatic medicine and the effect of the anti-miasamatic medicine has had. If applied correctly, symphytum can do great service. This remodeling also includes reduction of extra calcium deposits. In many cases I have found that where there is reduced space between the tibia and femur due to deposits of unwanted calcium – Symphytum dissolved the excess calcium and hence the space between the two bones is restored. Thus symphytum reduces the inflammation and at the same time reduces the friction between the bones. A low potency given in rapid succession for two to three months as cognate or intercurrent remedy, it arrests further degeneration.
Regeneration depends on age of the patient, and how much damage the disease has inflicted. Patients 50 years of age do not get much regeneration. If x-ray shows moderate to advanced stage of degeneration, the chance of regeneration is very low. What is more important, degeneration is stopped by this type of treatment.
In a few cases I have seen progress come to halt. Constitutional, acute or pathological prescriptions do not work. I carefully looked at the cases for several months and found that thyroid obstruction plays an important role. Though I have done blood tests of those patients for T3,T4 and TSH, they revealed normal value. I watched a few patients complain of gaining weight rapidly, drowsiness, profuse sweating, alternate heat and chill. In cases of irregular menstruation or history of irregular menstruation, these patients were not responding to the constitutional medicine. I wanted to verify my theory. I divided some patients into two groups A and B. “A” group having the five symptoms mentioned above. “B” group is devoid of those symptoms. I gave thyroidinum 6x or 6c ( according to the condition of the patient) to group A before giving constitutional medicine. In group B I started constitutional medicine as the first prescription. Result was positive. “A” group patients responded towards development as well as group B patients. To those patients, who are taking eltroxin, thyronorm and similar medicines for their thyroid and not responding properly to the constitutional drug, I applied the same above mentioned theory and it worked.
Doing this experiment several times and on several occasions now I am sure that some kind of thyroid obstruction comes in the way of treatmen of arthritis. Secondly tuberculosis I suspect may be the cause of obstruction. Still I am not sure. But in some cases I have found that those patients who got tuberculosis before or have tuberculosis in their background do not respond to constitutional medicine properly,until a dose of tuberculinum or bacillinum is given.
While taking the case of arthritis I found a few patients who give a different type of history. In these cases the patient got some injury to a joint and it was not treated properly. The injured area begins to become sore after six months to one year. This type of arthritis is less severe than the previous cases. In this case I always begin with an anti-injury medicine. I first focus on the acute sufferings of the patient. I consider modalities mainly and the clinical findings I find at the affected area. When the severity of the disease is reduced I think of the patient’s constitution. But most of these cases do not require deep acting medicine. Only 10% of cases of these aquired type require anti-miasamatic drugs. If the symptoms present are studied carefully and individualized on the basis of modalities, that will cure the case. I divided these type of cases into two groups. In group 1 I treated them according to the above mentioned theory. In group 2. I treated them with the conventional constitutional medicines from the beginning. Both the categories responded positively. But it was obvious that group 1 patients were more rapidly relived.
During the process of treatment, often a well controlled case aggravates suddenly and unexpectedly. The previous medicine does not seem to act. All those medicines which were controlling the condition fail to arrest the exacerbation. This situation is puzzling and disappointing. The case of Mrs. S., aggravated in this way. She came to me for the treatment of her arthritic knees. X-ray of knees showed degenerative changes and reduced space between the tibial and femoral end, tissue swelling and fluid effusion. I began her treatment with Mezerium 200 according to her condition and symptoms as mentioned above. She was doing fine. Her pain, stiffness and swelling of the joint was almost gone. She was walking long without pain and soreness. This time I was astonished to see one day when she came with severe swelling of one knee and pain and sensitiveness. I asked her about every one of her activities from dawn to dusk, to see if she did something wrong. But she said she said she did exactly as she was told to do. I repeated the medicines according to the theory, but they failed. When she returned after ten days she told me that she was getting fever at night for the last three days. Hot application was giving relief. She was afraid of her disease. She was restless and very weak. Her blood test showed CRP increased. These symptoms told me to give Arsenicumalb 200 (6d) every four hours followed by placebo for seven days. After ten days she was feeling good. Her temperature was gone. Fluid effusion was reduced by 80%. And CRP was 6. After this condition was over the constitutional medicines worked as good as before. CRP was increased, meaning that there was infection. This infection causes inflammation of the synovial membrane. In the above mentioned case, the aductor magnus tendon, tibial collateral ligament and patellar retinaculum were sore from touch. This type of exacerbation is often encountered. First consider if the patient did anything which could trigger increased suffering. Secondly, think of infection. Most of the aggravations I see are due to infection.