Keywords: Rheumatoid arthritis, auto immune, homoeopathy, sycosis, immune-modulation
- RA – Rheumatoid arthritis
- RF – Rheumatoid factor
- ACPA – Anti-Cyclic Citrullinated Peptide
- anti-CCP – Anti-cyclic citrullinated peptide antibody
- CRP – C reactive protein
- ESR – Erythrocyte sedimentation rate
Rheumatoid arthritis is a chronic inflammatory disease of unknown etiology, marked by a symmetric, peripheral polyarthritis. It often results in joint damage and physical disability. As it is a systemic disease, it may result in a variety of systemic manifestations, including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis and haematologic abnormalities.
- Incidence increases between 25 and 55 years of age
- Early morning stiffness lasting more than 1 hour
- Inflammation and swelling of joints
- Earliest involved joints are the small joints of the hands and feet, later spreading to the proximal joints like knee, hip, elbow and shoulder
- Flexor tendon tenosynovitis is a hallmark of rheumatoid arthritis
- Ulnar drift or ulnar deviation
- Swan neck deformity
- Boutonniere deformity
- Z-line deformity
- Flat feet
Extra articular manifestations1
- Neurologic – cervical myelopathy
- Hematologic – anemia of chronic disease, neutropenia, splenomegaly, felly’s syndrome, large granular lymphocyte leukemia, lymphoma
- Ocular – keratoconjunctivitis sicca, episcleritis, scleritis
- Pulmonary – pleural effusions, pulmonary nodules, interstitial lung disease, pulmonary vasculitis, organizing pneumonia
- Cardiac – pericarditis, ischemic heart disease, myocarditis, cardiomyopathy, arrythmia, mitral regurgitation
- Renal – membranous nephropathy, secondary amyloidosis
- GIT – vasculitis
- Skeletal – osteoporosis
- Endocrine – hypoandrogenism
- Skin – rheumatoid nodules, purpura, pyoderma gangrenosum
Diagnostic criteria of Rheumatoid arthritis1
|Joint involvement||1 large joint
2-10 large joints
1-3 small joints
4-10 small joints
>10 joints (at least 1 small joint)
|Serology||Negative for RF and ACPA
Low positive RF or low positive anti-CCP antibodies
High positive RF or high positive anti-CCP
|Acute phase reactants||Normal CRP and ESR
Abnormal CRP or abnormal ESR
|Duration of symptoms||<6 weeks
>or= 6 weeks
A score of >or= 6 full fills requirements for definite Rheumatoid arthritis
- Detection of serum RF and anti-CCP antibodies are important in differentiating rheumatoid arthritis from other polyarticular disease
- Synovial fluid analysis
- Joint imaging
|· Various types of rheumatism especially when disease is functional and inflammatory in nature
· Pain < at winter
· >hot application
· Sore bruised and pressive pain
|· Arthritic deformans
· All joint pains
· Rheumatism and rheumatoid arthritis
· Rheumatic pains <cold and damp weather
· >motion, unnatural discharges
· Stiffness, soreness and lameness
|· Bone pains
· Acute rheumatic pains <at night
· Burning, bursting and tearing pains
- Joints – arthritis
- Joints – rheumatism, chronic
- Joints – stiffness, morning
- Clinical – rheumatism, small joints, especially in hands
- Clinical – auto-immune diseases
Essential synthesis repertory4
- Extremities – inflammation, joints, chronic
- Extremities – pain, joints, rheumatic, small joints
- Extremities – stiffness, joints, morning
Arnica – local rheumatism in winter from exposure to dampness and cold, affected parts feel sore and bruised. < any motion. Fear of being touched. Rheumatism begins low down and ascends.
Actea spicata – very severe agonizing pain in metacarpal and metatarsal joints, wrists, fingers, ankles and toes of tearing and drawing character. Great stiffness of joints after rest. Swelling of joints after fatigue.
China – later stages of inflammatory rheumatism. Rheumatic pains in metatarsal bones and phalanges; rheumatic gout. Great debility, trembling with a numb sensation. Weariness of joints, worse mornings and when sitting.
Colchicum – shifting rheumatism; pains worse at night. Tearing in the limbs during warm weather, stinging during cold.
Formica rufa – rheumatic pains; stiff and contracted joints. Rheumatism comes on suddenly and with restlessness. Relief after midnight and from rubbing. Weakness of lower limbs.
Phytolacca – rheumatic pains, worse in morning. Wandering pain from one joint and place to another, with swelling and redness. Pains fly like electric shock.
Rhododendron – rheumatism in the hot season. Joints swollen. Pain in the shoulder, arm and wrists; worse when at rest. Cannot sleep unless legs are crossed. Rheumatic and tearing pains in all the limbs, especially right side.
Rhus tox – Hot, painful swelling of joints. Pains tearing in tendons, ligaments, and fasci. 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.
Ledum pal – Gouty pains shoot all through the foot and limb, and in joints, but especially small joints. Swollen, hot, pale. Throbbing in right shoulder. Pressure in shoulder, worse motion. Cracking in joints; worse, warmth of bed. Gouty nodosities. Rheumatism begins in lower limbs and ascends.
Kali carb – Uneasiness heaviness, and tearing in limbs and jerking. Tearing pain in limbs with swelling. Limbs sensitive to pressure. White swelling of knee. Tearing in arms from shoulder to wrist. Lacerating in wrist-joint. Pain from hip to knee. Pain in knees.
Pulsatilla – Drawing, tensive pain, with restlessness, sleeplessness and chilliness. Numbness around elbow. Hip-joint painful. Knees swollen, with tearing, drawing pains. Boring pain in heels toward evening; suffering worse from letting the affected limb hang down Feet red, inflamed, swollen. Legs feel heavy and weary.
Lycopodium – Tearing in shoulder and elbow joints. One foot hot, the other cold. Chronic gout, with chalky deposits in joints. Profuse sweat of the feet. Pain in heel on treading as from a pebble. Painful callosities on soles; toes and fingers contracted. Twitching and jerking.
Causticum – Dull, tearing pain in hands and arms. Heaviness and weakness. Tearing joints. Unsteadiness of muscles of forearm and hand. Numbness; loss of sensation in hands. Rheumatic tearing in limbs; better by warmth, especially heat of bed. Burning in joints. Cracking and tension in knees; stiffness in hollow of knee.
Chelidonium – Pain in arms, shoulders, hands, tips of fingers. Icy coldness of tips of fingers; wrists sore, tearing in metacarpal bones. Whole flesh sore to touch. Rheumatic pain in hips and thighs; intolerable pains in heels, as if pinched by too narrow a shoe; worse, right. Feels paralyzed. Paresis of the lower limbs with rigidity of muscles.
Homoeopathic remedies have a great scope in treating rheumatoid arthritis and other similar auto immune diseases as they tend to have an immune-modulatory effect in the organism. The progression of the disease can be controlled efficiently and the disease can be cured completely if structural changes have not occurred.
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