Homoeopathic aid in juvenile idiopathic arthritis

Dr.Shivram1,Dr.G.Jaysee John1, Dr.Priyanka Kapoor1,  Dr.Priyanka Naraniya1.¹PG SCHOLARS^, DR.MPK HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE, HOMOEOPATHY UNIVERSITY, JAIPUR.

ABSTRACT: Auto immune diseases are emerging as new medical challenges in present Era. Children are nowadays new victim of it. Juvenile rheumatoid arthritis, one of the autoimmune diseases is the most common chronic diseases of childhood and has a strong adverse effect on bony development in the growing child. Acquiring autoimmune diseases in their early life makes their life’s expectancy and quality of life, quite miserable.

KEY WORDS: Children, Arthritis, Idiopathic, Rheumatoid, Autoimmune, Homoeopathy.

INTRODUCTION: Juvenile Idiopathic Arthritis(JIA), formerly known as Juvenile Rheumatoid Arthritis(JRA),is  a autoimmune diseases. A type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. Cytokines triggered by immune system responsible for destruction and deformity of joints. And resultant inflammation causes redness, swelling, warmth, and soreness in the joints.

TYPES OF JUVENILE IDIOPATHIC ARTHRITIS

• Pauciarticular/ Oligoarticular: A most common form of JRA where four or fewer joints are involved; It typically affects large joints, such as the knees. Nearly half of children affected this type of JRA. Girls under age 8 are most commonly affected by this type of JRA. Eye disease like iritis ,uveitis affects from 20% to 30% of children with pauciarticular JRA and is more common in children with abnormal ANAs. 
• Polyarticular: About 30% of all children with JRA have polyarticular disease, in which five or more joints are affected. The small joints, such as those in the hands and feet, are most commonly involved, but the disease may also affect large joints. Polyarticular JRA often is symmetrical. Children with JRA usually test negative for rheumatoid factor. These children often have a more severe form of the disease, thats similar to adult rheumatoid arthritis.
• Systemic The systemic form of JRA is characterized by spiking fevers up to 103 degrees and a persistent red rash. Joint swelling and damage may not appear for months or years after the fevers begin, but once inflammation begins it can do irreversible damage to joints and internal organs such as the heart, liver, spleen, and lymph nodes. The systemic form, sometimes called Still’s disease, affects 20% of children with JRA. Anemia and elevated white blood cells can be an indicator of JRA Almost all children with this type of JRA test negative for both rheumatoid factor and ANA. 
• Juvenile Psoriatic Rheumatoid Arthritis: It most commonly occur with psoriasis.
• Enthesitis-related JIA: It affects where bone meets the tendons and ligaments.The genetic marker HLA-B27 is often present.
• Undifferentiated Rheumatoid Arthritis: Where symptoms may span two or more subtypes or not fit any of the other subtypes.

SYMPTOMS:The most common symptoms are following-

• Pain. Inflammation causes pain and soreness in joints that causes limps while walking . Pain appear especially in the morning or after a nap.
• Swelling. Joint swelling is common but is often first noticed in larger joints such as the knee. Swelling present with warmth and  redness around joints.
• Stiffness. Stiffness appears in joints, particularly in the morning or after naps.
• Fever, swollen lymph nodes and rash. In some cases, recurrent fever, swollen lymph nodes or a rash on the trunk may occur  which is usually worse in the evenings.
• Reduce range of motion: It reduce mobility of joints hence limping can be seen during motion.

DIAGNOSIS:  Diagnosis can made by a thorough physical exam and some diagnostic tests, such as:

• • C-reactive protein test
  • ESR 
  • CBC
  • Rheumatoid factor test.
  • Antinuclear antibody. 
  • HLA-B27 test. 
  • X-ray or MRI scan.

 COMPLICATIONS

• • Eye complaints-These diseases cause eye inflammation as uveitis, iritis , blurred vision, eye pain, eye redness and sensitivity to light and if, left intreated then  result in cataracts, glaucoma and even blindness. 
  • Stunted growth– Juvenile idiopathic arthritis can interfere with child’s growth and bone development that cause uneven limbs and joint distruction.
  • Anemia
  • Joint distruction
  • Uneven limbs
  • Weight loss
  • Chronic recurring pain in joints
  • Pericarditis

HOMOEOPATHIC VIEW POINT OF MANAGEMENT: Some important homoeopathic medicine that have special affinity to joints, enlisted below.

Rhus tox- Pain and Stiffness in joints, worse on rising in the morning, ameliorated by warm applications, aggravated by cold air, winter. Chronic inflammation of articular structure,esp from a blow and sprain, synovitis, false anchylosis.

Bryonia: Stitching pain  Rheumatic pain in limbs. Aggravation by slightest touch, motion or contact. All the limbs seem bruised and paralyzed. Heaviness of limbs. Tearing, stinging, stitching pain in limbs. Ameliration by sitting, lying, warmth of bed.

Actea spicata: It has special affinity for smaller joints esp. wrist. Affected joints are swollen and great weakness as if paralysed. Right arm and right wrist are specially affected. Pains are of violent, drawing character and worse by touchand movement. Worse at night, motion, change of weather, fatigue.

Kalmia latifolia: Right side specially affected. Pain are sticking, darting, pressing, shooting in downward direction, and attended with numbness. Severe pain in joints which changes places suddenly and goes from one joint to another. Joints are red, hot, painful, swollen. Heart complaints alternates with RA. Worse by least movement, becoming cold. Relived by  continued motion.

Lithium carbonicum: It has rheumatism diathesis and accompanied with heart and eye symptoms and recurring attacks of acute inflammation of small joints. Rheumatism associated a peculiarity of eruption appear in affected part. Great tenderness ,swelling, and redness of joints.Aggravated at night, morning, relieved by rising or moving about; hot water.

Causticum: complaints of joints with stiffness and contraction of flexor tendons and shortening of muscles.Worse at clear fine weather. Feel good at damp weather and warm air.

Calcarea carbonicum: Tearing in all the limbs. Bruised pain in long bones and joints. Great weakness and weariness in limbs. Cracking in knees and shoulder. Cramps in arm and legs, in fingers and toes. Left lower and right upper limbs most affected. Aggravated by cold wet weather, morning, evening, after walking, 

Ammonium carbonicum: Especially suited for scrofulous children. Pain in limbs at night. Burning of hands and feet. Weakness and languor of all the limbs. Right side more affected.

Cina: Spasmodic twitching of limbs. Jerking and distortion of limbs. Pain in limbs.Worse by external pressure, morning.

Sanguinaria– Rheumatism in all joints with swelling and spasmodic pain. Rheumatism pains in all limbs, with stiffness and rigidity. Acute inflammatory and arthritic rheumatism. Aggravated by from lifting, night, turning in bed, motion, hot weather.

Calcarea fluricum: Piercing, darting, grinding pain in all joints, cramps in muscles of legs. Nodes and hard bone swelling. In tarsal and carpal articulations osseous growths. Crepitation of joints.

LIFESTYLE MANAGEMENT: Lifestyle managements can help children cope with their symptoms more easily and reduce the risk of complications.

• Moderate Exercises : Leading an active lifestyle with exercise at least three times per week can strengthen muscles and improve joint flexibility, making it easier to cope with JIA in the long run. Independent activity and positive reinforcement will also keep children from developing depression or other negative emotional and social problems. 
• Nutritious Diet :Weight changes are common in children with JIA. Medications may increase or decrease their appetite, causing rapid weight gain or weight loss. In such cases, a healthful diet containing the right amount of calories can maintain an appropriate body weight.
• Physiotheraphy : A physiotherapist can teach child the importance of sticking with an exercise routine and can even recommend exercises suited to their specific condition and help to build strength and restore flexibility in stiff, sore joints.

CONCLUSION AND DISCUSSION: Homoeopathic medicines have been clinically proven to reduce arthritic inflammation, relieve pain and mend tissues in a safe and effective way. Selection of these medicines completely depand on individualization and symptomatology. Homeopathy anamnesis finds the root cause of the triggers factors and treat accordingly, thus helps to bring back the equilibrium of the body’s immune system to normal state hence help to cure the auto immune diseases. 

REFERENCES:

1. Boericke W. Pocket Manual of Homoeopathic Materia Medica. 9th ed. New Delhi: B Jain Publishers(P)Ltd;2014
2. Puhlmann C.G. Handbook of  Homoeopathic Practice. Reprint ed. New Delhi: B Jain Publishers(P)Ltd;1994
3. Roberts H. A., The Rheumatic Remedies. Reprint ed. New Delhi: B Jain Publishers(P)Ltd;2000
4. Davidson’s principles and practice of medicine.23rd edition. Elsevier India; 2018
5. Mehta P.J.,Practical medicine.20th ed.NBD Mumbai; 2013