Dr Meethu Anna Saji, Dr. Sushikshitha S A
ABSTRACT :
Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disease characterized by symmetrical joint pains, swelling, and stiffness, resulting in progressive disability. This case study describes a female patient aged 60 with complaints of multiple joint pains for six years, with severe exacerbation in the past one month. The joint pains were throbbing in nature, associated with stiffness, worsened with movement and daytime activity, and relieved with warmth. Through extensive case history taking, the patient revealed mental generals like the desire to be in company, consolation amelioration, religious, emotional sensitivity, indecisiveness, and physical generals like thirst, craving for spicy food, and sleep disturbances. Individualized homoeopathic treatment was prescribed based on the totality of symptoms and repertorial analysis. The patient showed marked improvement with successive follow-ups, with alleviation in joint pains, swelling, and frequency of exacerbations, along with overall improvement in her condition. The present study highlights the efficacy of individualized homoeopathic treatment in alleviating the severity of the disease in patients with RA.
KEYWORDS : Autoimmune Disease, Case Report,Homoeopathy,Joint Pain,Pulsatilla,Rheumatoid Arthritis
CHIEF COMPLAINTS
Pain in multiple joints since 6 years, aggravated since 1 month.
HISTORY OF PRESENTING ILLNESS
The patient was apparently healthy six years back, after that she gradually developed pain in finger joints, occurring occasionally. Her complaints have worsened over the past month. Initially, pain was felt in finger joints, i.e., Left > Right, and then it gradually increased to shoulders, neck, and jaw joints. Similarly, pain in knee joints, i.e., Right > Left, gradually increased to thigh regions. Pain was throbbing in nature, associated with stiffness, and was relieved by warmth.
INVESTIGATION
The diagnosis of this case was made on the basis of history, symptomatology, and physical examination. Apart from that, in the Blood report, it was revealed that it was a case of Rheumatoid arthritis.
REPERTORIAL TOTALITY:
The following rubrics were selected from the Synthesis repertory for case analysis, drawn from the mental generals, physical generals, and local particulars of the case:
- MIND – COMPANY – desire for
- MIND – IRRESOLUTION
- MIND – RELIGIOUS AFFECTIONS
- MIND – CONSOLATION – amel.
- MIND – FEAR – animals, of
- MIND – WEEPING – telling sickness; when telling of her
- STOMACH – THIRST
- GENERALS – FOOD AND DRINKS – spices – desire
- SLEEP – DISTURBED
- EXTREMITIES – PAIN – Thighs – tearing pain
- EXTREMITIES – PAIN – Lower limbs motion agg.
- EXTREMITIES – PAIN warmth amel.
REPERTORIAL ANALYSIS:
The symptoms of the patient were analysed and evaluated. Prominent mental and physical particulars were taken into consideration for the formulation of the totality. Repertorization of the case was done. After the repertorization of the case, PULSATILLA turned out to be the medicine that covered all the rubrics and obtained the maximum marks i.e., 19/11. Although while repertorizing the case, other medicines were running close in the repertorization chart, the medicines that were running close in the repertorization chart are: Carc. (12/10), Phosphrus (20/9), and sulphur (18/9). Mentally, the patient was sympathetic and liked helping others. She was emotional and crying while describing her symptoms. Her mental condition improved with consolation. She was indecisive and liked being with people. She had a fear of animals like snakes. She was very religious in nature. Physically, she was thirsty and had a desire for spicy food. She had disturbed sleep due to her complaints. She was a hot type of patient. She had pain in the finger joints, more in the left than the right. She had pain in the shoulder, neck, and jaw joints. She had pain in the knee joints extending upwards, more in the right than the left. All the symptoms of the patient were prominent in the case. But according to the repertorization and the consultation of the Materia medica, Pulsatilla 30 turned out to be the selected medicine of the case.
PRESCRIPTION:(15/08/2024)
Rx :Pulsatilla 30 Single dose
DISCUSSION
This case is a classic demonstration of the application of classical principles of individualization, totality of symptoms, and miasmatic assessment in managing a chronic Rheumatoid Arthritis. Contrary to the conventional treatment targeting only the specific manifestations of the disease, the homoeopathic treatment used the peculiar mental generals, such as mild and sympathetic nature, desire for company, weeping while narrating the case, aggravation from consolation, indecisiveness, religiousness, and fear of animals, especially snakes, along with the physical generals, including increased thirst and spicy food, disturbed sleep, and hot state of the body, to select the appropriate homoeopathic remedy.
The patient’s physical complaints about the symptoms of the disease also showed individual peculiarities, such as aggravation from movements and improvement from warmth, which were used to narrow down the list of possible remedies. The repertorial analysis of these symptoms revealed that the most adequate homoeopathic remedy for this patient was Pulsatilla, as it received the highest number of points (19/11) in the repertory. According to the materia medica, Pulsatilla is known to affect the joints, especially the small ones, have a good response to warmth, and aggravate from moving. Thus, the choice of this remedy was appropriate and fully justified.
It is also worth noting that, following the prescriptions of Pulsatilla 30C, the patient’s condition began to improve. The symptoms of the disease progressed only during the aggravation periods, which allowed her to resume most of her daily activities. Moreover, the pain in the jaws, neck, and shoulders disappeared, while the pain and swelling of the fingers and wrists were almost gone. Notably, laboratory monitoring confirmed objective immunological regression, with Rheumatoid Factor converting from positive () to negative.
This is another confirmation of the efficacy of the selected individualized treatment for the patient’s chronic Rheumatoid Arthritis.
However, it cannot be concluded that individualized homoeopathic treatment of chronic Rheumatoid Arthritis in this patient has improved her quality of life after 6 months of follow-up. The main reason is that the present case is a single-case study, which limits the possibility of generalization and proof of the causation relationship. Although the patient’s condition has improved, and her Rheumatoid Factor has become negative, this observation cannot be applicable to other patients. Further research is needed to confirm the hypotheses and provide more evidence for the effectiveness of individualized approaches in treating Rheumatoid Arthritis.
CONCLUSION
The above case illustrates the efficacy of individualized homoeopathic treatment in managing Rheumatoid Arthritis, a chronic autoimmune disorder. The prescription was made on the totality of symptoms, including mental and physical generals. There was significant improvement in pain, stiffness, swelling, and mobility in the joints, as well as an improvement in the general state of the patient. The sustained improvement over follow-up with a decrease in exacerbations suggests the potential efficacy of constitutional homoeopathic treatment in managing chronic inflammatory diseases. This case also emphasizes the importance of miasmatic approach and follow-up in ensuring successful treatment outcomes.
PATIENT PERSPECTIVE
The patient reported that she had significant relief from pain and stiffness in her joints after she started with the homoeopathic treatment. She found it easier to move about and perform her day-to-day activities. The episodes of pain had reduced over time, and she had improved sleep patterns due to reduced pain. She had an improved state of mind, feeling better, and was satisfied with the treatment, appreciating the holistic approach.
INFORMED CONSENT : Informed consent was obtained from the patient for publication of this case report.
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Dr Meethu Anna Saji, Dr. Sushikshitha S A
1.Undergraduate Scholar, 2.Professor and Guide, Department Of Physiology and Biochemistry,
Alva’s Homoeopathic Medical College and Hospital, Moodbidri, Karnataka, India.
Email : meethusaji2001@gmail.com
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