Understanding Rheumatoid Arthritis

Dr. Sanjeev Rastogi has been a noted name in the modern generation of traditional medicine experts. With his specific blend of scientific advancement and traditional philosophy, he has made some special contributions to the understanding of Panchakarma and Ayurveda in general.

As a first class Graduate and Post Graduate in Ayurvedic medicine from prestigious Banaras Hindu University he has represented in many national and international conferences. He is having more than twenty scientific papers published in various national and international journals and two books to his credit.

Recently, on the invitation of Govt. of China he was on his specialized study trip to acquire knowledge and work culture in the field of traditional medicine and Acupuncture in China.

Rheumatology has been a subject of special interest to, him. The research work done on the 'development of management strategies for rheumatic disorders' by him was considered as an original contribution to the subject.

Foreword

The monograph entitled "Understanding Rheumatoid Arthritis" authored by Dr. Sanjeev Rastogi is an excellent update on the subject. Rheumatoid Arthritis is a common major crippling disease prevalent throughout the world. Though the etiology of rheumatoid disease is not precisely known, the nature of the disease and its path physiology is vividly described in recent years. The role of stress, free radical injury and the auto-immune basis of the disease have been gaining more and more evidence through recent studies. Such studies have gradually paved the way for use of newer diagnostic procedures in the management.

Lnspite of significant advancement in the understanding of the path physiology of Rheumatoid arthritis so far there has not been any significant breakthrough in the treatment. The newer no steroidal ant inflammatory drugs have emerged as notable addition to the armamentarium of a Rheumatologist over the conventional usage of Aspirin and corticosteroids.

Though these drugs have succeeded in providing commendable relief to the patients of Rheumatoid Arthritis in terms of pain and allied symptoms, the goal of actual cure of this disease still remains insurmountable. The concept of disease modifying agents and the use of Gold Salts, Chloroquin and other such remedies are being explored with newer hopes but the rate of success as recorded so far is not very encourage-aging.

It is at this state of affairs that the author of this monograph attempts to present an interface with the knowledge of classical Ayurvedic medicine in this field. Ayurveda describes a number of clinical conditions manifesting with involvement of joints with varied etiology. The most important among them is the disease entity termed as AMAVATA' first described in a medieval text Madhav Nidana. Amavata is caused due to `Ama' an abnormal by product of faulty digestion and metabolism due to Mandeni. Ama is considered an antigenic material and as such the role of Ama in Amavata as conceived in Ayurveda is strikingly comparable to the modern concept of Auto immune basis of Rheumatoid Arthritis.

The author of this interesting monograph has done a commendable job in adopting a real integrated approach throwing significant light on the understanding of Rheumatoid Disease through an interface of Ayurveda and western modern medicine.

The author of this monograph Dr. Sanjeev Rastogi is personally known to me for several years. He is a brilliant scholar of Classical Ayurvedic medicine with due scientific temper. We had the opportunity to work together on the same theme at Banaras Hindu University when he worked for his Doctoral thesis under my supervision. I hope, this monograph will prove to be an useful addition to the contemporary literature on Ayurveda and the author will continue to bring out many more books and monographs in near future.

Rheumatoid arthritis is one of the most devastating diseases prevalent in India. Researchers are continuously made world over to manage this disease but still the results are not very satisfactory, fortunately in Indian traditional medicine we have a good stuff about this disease entity and its management. Utilization of old wisdom with contemporary scientific vision is the theme of this book. Surprisingly many of the folk healings or apparently unscientific looking remedies turn to be most scientific when evaluated accordingly. This book is the result of most of my research work on Rheumatoid arthritis management in Banaras Hindu University. Experiencing the traditional Chinese medicine and Acupuncture for the management of RA is a definite addition to the core of the subject. I hope it will be thought provoking and interesting to the clinicians and scientists working in the field of Rheumatology and even will be helpful for the sufferer of it as a scientific guide to resolve some of their queries and as an add to understand their own management.

Rheumatic diseases cover a large part of body of medicine and affect a very large number of people in different countries worldwide. Unfortunately, India is no exception to this. Population studies have shown the affliction of about 8-9% (70-80 million approx.) adult population in India with some or other form of rheumatic disease (Malviya. A.N. 1994). Contrary to the common belief, most of the serious, crippling and sometimes even life threatening arthritis occurs in young persons, in prime of their lives. This produces drastic effects on the productive life of patient. Arthritis in this age group is the leading cause of loss of man-hours and industrial absenteeism, causing enormous economical losses to the nation.

Out of some 180 conditions, that can qualify as rheumatic disorders (Hart F.D. 1984), a few are recognized as most devastating. Rheumatoid arthritis is highly ranked in this group. Still, a disease of unknown etiology, rheumatoid arthritis is now well known for its potentials of causing serious arthritic and extra arthritic derangements and this has lead to a rapidly growing consensus for recognizing it as Rheumatoid Disease rather than rheumatoid arthritis (Hough A.J. 1993).

During past few years some major breakthrough have been made towards a more clear genetic and immunological understanding of this disease. The genic association of rheumatoid disease is identified and so the disease susceptibility in a part of population is now understood on genetic grounds. This has helped a lot to the knowledge of its etiopathogenesis but not much to the part of its management. A big array of medicaments like newer generations of NSAID, steroids and cytotoxic drugs have been tried, but remained unable to check the progression of disease or to reduce the morbidity associated.

The intrinsic nature of the rheumatoid disease posed an ultimate challenge to the skill and humanity of the medical world. The chronicity of disease process, variability, of clinical presentation, its tendency to exacerbate and remit, biochemical and immunological complexity, variable responses to the specific treatment and the myriad ways in which the disease affects the patient's life style, family relationship, self image and employability combine to complex the therapeutic equation. This poorly understood disease variability has now stressed the fact that every patient with rheumatoid disease should be taken as an individual and that the therapeutic decisions be based upon individual circumstances.

In such enigmatic situation, Ayurvedic therapeutic modalities are often opted for management of rheumatoid disease. Though believed; and often opted by a good population belonging to the rheumatoid disease, Ayurvedic therapeutic intervention has also not resulted in substantially sustainable improvements. Researches in this field during past few decades have not resulted in any major breakthrough on the part of its management. This can also be because of a modified therapeutic and resea 'Arch approach currently practiced which does not utilize the Ayurvedic fundamentals of disease management in their full dimensions. Contrary to the common practice of Ayurvedic therapeutics, of now (which largely remained with its samsamana aspect only) Ayurveda classically approaches towards a disease in many other ways. Nidana Parivarjana and Pathya Sevana are the main stay of Ayurvedic therapeutics though largely neglected in current practice. Amavata, as a disease entity-is used synonymously for rheumatoid disease in Ayurveda. This disease has been described with a distinct etiopathogenesis, having Ahara identified as the first and for most etiological factor for Ama formation and thus the amavata genesis in this connection (Ma. ni 25/1).

Probable role of specific diets and specific weather conditions as etiopathogenetic and modifying factor in rheumatoid disease is recognized very recently by the modern world (Van de leaar et al, 1992, Guedj. 1992). In a definite proportion of seropositive rheumatoid population it is recognized as because of some kind of food intolerance.

Accumulation of Ama in the joints is considered responsible for inflammatory changes in Amavata. Appropriate application of Snehana and Swedana measures are found useful in mobilization and dissociation of this Ama and hence leading to clinical improvements.

Psychological status of the patient has also been identified as a disease modifying factor in rheumatoid disease. A state of cittavasada or the depressed mood is found almost universally associated with Amavata and this is because of long term consequences of the disease. A psychotherapeutic (Satvavajaya) intervention also becomes an integral part of its management and the therapeutic potentials of it in the rheumatoid disease are being postulated.

This multifactorial situation laid a stress upon need of renovating the present status of therapy for Amavata or Rheumatoid Arthritis and to look for a thorough review from Ayurveda and Modern medicine for a more comprehensive and precise therapeutic regimen for Rheumatoid disease.

This is an attempt to probe scientifically into the principle of traditional and modern management of rheumatoid disease. A lot of work still remains to be done to evolve a suitable, feasible and substantially beneficial therapeutic regimen on scientific line for this disease, nevertheless it is hoped that this monograph will help igniting the appetite of the researchers, scientists and all who are concerned and thus will share in paving the way for a truly scientific and substantial management strategy against this dreaded crippler of mankind.