Rheumatoid arthritis managed with homeopathic medicines –a case report

Swetha¹, Vijayakrishna V² 

ABSTRACT
Rheumatoid arthritis autoimmune disease with an unpredictable course. conventional treatment reduced the severity of symptoms but the pathogenesis is unclear managed with immune suppressive drug , analgesics, antimalarial drug intervention most cases progress to complications which may amount to great burden¹. The patient of Rheumatoid arthritis in a 48 years old woman who was treated with individualized homeopathy for over 3months with improvement in clinical signs and symptoms with reappearing of older symptoms with milder intensity.

INTRODUCTION
Rheumatoid arthritis systematic autoimmune disease characterized by inflammatory arthritis and extraarticular involvement primarily involves synovial joints typically starts in small peripheral joints symmetric and progress to involve proximal joints. Clinically the diagnosis of Rheumatoid arthritis can be differentiated from osteoarthritis¹. The affected area in Rheumatoid are the proximal interphalangeal and metacarpophalangeal joints morning stiffness more than hour. Whereas in osteoarthritis typically affects the distal interphalangeal joint caused by wear and tear affects one side of body morning stiffness resolves with half an hour. During the early phase of the disease the influx of inflammatory cells into the synovial membrane leads to proliferation of monocytes and thickening of the synovial membrane with small villous projections into the joint space. The synovial thickening with a boggy feel on palpation will be noted

cytokines are produced in large amount in the synovium propogated an intense inflammatory response resulted in bone erosions and cartilage loss.

Cytokines are protein messenger that convey information between and within cells through a specific cell surface receptors molecules

The rheumatoid arthritis fluid is hypoxic environment leading to increased production of (cox)2    derived nonciceptive eicosanoids. Most of studies depicts the rheumatoid arthritis HLA –DRH and HLA-DR1 are though to be very important genetic background particulary true among smokers with a positive anti-cyclic citrullinated peptide (anti-CCP) the genetic predisposition and environmental will start an auto immune reaction and antibodies will attack the synovium soft tissue causing inflammation and gradual destruction in the organs progressing into comorbidities such as ophthalmological manifestation such as sjogren syndrome.

Globally the prevalence of Rheumatoid arthritis was 0.24% according to ARA criteria giving a prevalence of India about 0.75% In the year 2019 study reveals that 70% women prone to this condition. However in severe rheumatoid arthritis the autoimmune disease not sparcely reduced with conventional treatment only the management is adopted .

 CASE PRESENTATION
The patient a woman ,teacher was 49 years old when she presented for homeopathic consultation in march 2023 . she was treated with conventional and alternative medication therapy.

PRESENTING COMPLAINTS
The patient had severe  left knee joint pain with lumbar and upper forearm  right shoulder with numbness sensation she says pain is like wandering. She experienced incontinence when laughing or coughing.

Other complaints
Other complaints include distension of abdomen with burning in sternal region when the food is overtaken. On and off she complaints mild headache on sun exposure which subsides after a sleep.

PAST MEDICAL HISTORY
The patient suffered allergic bronchitis at the age of 26 years, repeated urinary tract infection 3years back .

GYNECOLOGICAL HISTORY
The patient attained menarche at the age of 15 years since menarche irregular has not been treated with any medication it resolved on its own, she used to complaint severe dysmenorrhea menses before which used to better with flow of menstrual bleeding.

DIFFERENTIAL DIAGNOSIS
Rheumatoid arthritis may be confused with fibromyalgia which is musculoskeletal pain not progressive or do not cause damage to the joints, lyme disease which affect one or two joints biiten by tick whereas Rheumatoid arthritis is symmetrical.

HOMEOPATHIC CONSULTATION
The patient sought a homeopathic consultation on march 16 , 2023 the joint affection had escalated to the list mentioned earlier with specific kind of nature since childhood as shy in nature, current state of mind she says her husband is not showing enough care and concern towards her, wants everyone at home to talk to her always. By keen observing a allergic bronchitis treated with conventional treatment started with even simpler complication on dermatitis which was been suppressed again lead to the pathology of auto immune. Generally patient was warm blooded with thirstless, indicated the homeopathic remedy Pulsatilla 200 one dose.

Follow up
After the remedy the patient in a months improved with pain and numbness sensations with reappearing of older skin eruptions with itching, showed improvement in immunological parameters.

DISCUSSION AND CONCLUSION
In this case Pulsatilla 200 one dose was prescribed as Individualized Homeopathic medicine as per the totality of symptoms remarkable improvement in rheumatoid factor with aggravating symptoms managed only limitation here was the inability to demonstrate any pharmacological effect of the remedy because homeopathy does not act on matter but on energy fields of the organism needs further studies.

REFERENCES

1. Harrison’s Principles of Internal Medicine ,21e
2. Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatology international. 1993 Nov;13:131-4.
3. Akhondi H, Varacallo M. Rheumatoid Arthritis And Ankylosing Spondylitis.
4. Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, Alpizar-Rodriguez D, Lauper K. Global epidemiology of rheumatoid arthritis. Nature Reviews Rheumatology. 2022 Oct;18(10):591-602.
5. Rao P, Prasanna M. Immunological studies on Rheumatoid Arthritis treated with Homeopathic drugs: Results of the Pilot Study. Indian Journal of Research in Homoeopathy. 2008;2(4):42-9.
6. Broom DC, Samad TA, Kohno T, Tegeder I, Geisslinger G, Woolf CJ. Cyclooxygenase 2 expression in the spared nerve injury model of neuropathic pain. Neuroscience. 2004 Jan 1;124(4):891-900.
7. Gibson RG, Gibson SL, MacNeill AD, Buchanan WW. Homoeopathic therapy in rheumatoid arthritis: evaluation by double‐blind clinical therapeutic trial. British Journal of Clinical Pharmacology. 1980 May;9(5):453-9.
8. Hulekar S, Poolya MC. Effect of Homoepathy in management of Rheumatoid Arthritis. Journal of Medical and Pharmaceutical Innovation. 2022 Mar 18;9(46).
9. Zaman T, Agarwal S, Handa R. Complementary and alternative medicine use in rheumatoid arthritis: An audit of patients visiting a tertiary care centre. National Medical Journal of India. 2007 Sep 1;20(5):236.
10. Kinlen LJ. Incidence of cancer in rheumatoid arthritis and other disorders after immunosuppressive treatment. The American journal of medicine. 1985 Jan 21;78(1):44-9.
11. Mackenzie AH. Differential diagnosis of rheumatoid arthritis. The American journal of medicine. 1988 Oct 14;85(4):2-11.

AUTHORS
Swetha¹, Vijayakrishna V²
1.Post graduate scholar, Dept of homoeopathic material medica , GHMC and H, Bengaluru 560079.
2.BHMS, MD Prof and Pg guide ,Department of Materia Medica GHMC and H, Bengaluru 560079.

Download the full paper with investigations