Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity

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REVIEW ARTICLE February 2023 Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2 97 Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity Ayushi Patel 1 , Namrata Tiwari 2 , Dileep Singh 3 1 First Year MD Scholar, Department of Rachana Sharira, Shri Narayan Prasad Awasthi Government Ayurved College, Raipur, Chhattisgarh, India. 2 Reader, Department of Rachana Sharira, Shri Narayan Prasad Awasthi Government Ayurved College, Raipur, Chhattisgarh, India. 3 Lecturer, Department of Rachana Sharira, Shri Narayan Prasad Awasthi Government Ayurved College, Raipur, Chhattisgarh, India. I NTRODUCTION Rheumatoid arthritis is an autoimmune chronic inflammatory disease characterized by a deviated immune response shown by the body towards its own tissues. Ordinarily the immune system of our body distinguishes between the self and non self antigens and shows its response according to that but due to Address for correspondence: Dr. Ayushi Patel First Year MD Scholar, Department of Rachana Sharira, Shri Narayan Prasad Awasthi Government Ayurved College, Raipur, Chhattisgarh, India. E-mail: ayushipd 1228@gmail.com Submission Date: 14/12/2022 Accepted Date: 21/01/2023 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA some unknown factors and trigger events, derangements in the immune system occurs and instead of targeting the foreign antigens, the immune system fails to distinguish starts attacking its own tissues. This phenomenon is termed as Autoimmunity [1] Autoimmunity is present in all the individuals but when it breaks down the immune tolerance, the end result occurs as Autoimmune disorders [2] In Ayurved, Maharishi Charaka has described the concept of Vyadhikshamatva which can be correlated with the body’s Immunity. Vyadhikshamatva is actually the capacity of the body which resists the occurrence of disease and protects the body from innumerable infections [3] According to our Acharyas , this capacity is imparted to the body by a substance known as Oja . Oja is the supreme essence of all the Dhatus which provides strength to the body against the diseases [6] Just like in modern medical science, immunity is a resistant capacity provided mainly by T cells and B cells and even a slight A B S T R A C T Ayurveda , although an ancient science, incorporates all those aspects and facts which have been emerging from various researches in the modern medical science since ages. In recent times, various autoimmune disorders like rheumatoid arthritis, SLE, myositis, muscular dystrophies etc. are getting public attention more than ever. These autoimmune disorders are actually the consequences of the misalignment of immune system towards its own body tissues. Autoimmunity comes under the concept of immunology and in Ayurveda , immunology is described as Vyadhikshamtva and Oja Bala . Oja , the quintessence of the seven Dhatus is responsible for providing immunity to the body. Any fluctuations in Oja tends to generate disease causing elements in the body. In Ayurveda it has been mentioned that Oja gets deformed in three ways: Ojo-Kshaya , Ojo-Vyapad and Ojo-Visramsa . Out of these, Ojo- Visramsa may be considered as most relevant with the concept of Autoimmunity. Ojo-Visramsa can be defined as the dislocation or the diversion of Oja from its normality, whether it may its normal location, structure or function. Comparably, autoimmunity is also the misalignment of the immune system such that the system which should ideally defend the body against the diseases, starts attacking its own body and creates various autoimmune disorders. Hence this article is an attempt to create a novel concept about Ojo-visramsa and its relatability with autoimmunity through a pathogenic analysis of rheumatoid arthritis so that it can be more helpful for the physicians to treat these disorders to benefit the society in an efficient way. Key words: Autoimmunity, Autoimmune disorders, Ojo-Visramsa, Rheumatoid Arthritis.

Ayushi Patel et al. Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity ISSN: 2456-3110 REVIEW ARTICLE February 2023 Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2 98 disequilibrium in their functions gives rise to autoimmunity [4] Likewise, Vyadhikshamatva is the capacity imparted by the Oja and vitiation of Doshas cause Vikruti in Oja and manifestations of various symptoms occurs [11] Out of the 3 of Oja described by Acharyas, it has been found out that Oja Visramsa can be best associated with the phenomenon of Autoimmunity in Rheumatoid Arthritis because the manifestations of symptoms mentioned in Ojo- Visramsa and Rheumatoid arthritis are very similar. A IMS AND O BJECTIVES 1 Pathogenic Analytical study of Rheumatoid arthritis as an Autoimmune Disorder. 2 Comparative study of rheumatoid arthritis with the Lakshanas of Ojo-Visramsa mentioned in ancient Literatures. M ATERIALS AND M ETHODS This article has been prepared on the basis of thorough study of the relevant topics from classical literary materials such as Charak Samhita , Sushruta Samhita with its commentary by Dalhan, Ashtang Sangrah, Ashtang Hrudaya and Sharangdhara Samhita . Various textbooks of modern medicine and pathology have been referred to collect materials about rheumatoid arthritis and autoimmune disorders. Relevant articles about Oja, Oja Vikrutis, Vyadhikshamatva , immunology, rheumatoid arthritis and autoimmunity have also been reviewed to efficiently complete this article. O BSERVATION Autoimmunity in Rheumatoid arthritis Autoimmunity is a state of body in which the immune system of the body fails to distinguish between self and non self antigens and reacts by the formation of autoantibodies against one’s own tissue antigens [5] Autoimmunity is present in all the normal individuals but the T and B lymphocytes that recognise self tissue as antigen (autoreactive) are either eliminated or suppressed by the body’s immune tolerance mechanism. Autoimmune diseases occur when these autoreactive T and B cells escape this tolerance mechanism, gets triggered by various exogenous (microbial) and endogenous (genetic susceptibility) factors and deviates its target from foreign to self antigens. In Rheumatoid arthritis, the chronic inflammation at the synovial lining of joints mainly occurs due to the continuous production of the autoantibodies called the rheumatoid factor by the B cells. Rheumatoid factor is nothing but the formation of IgM antibody against the IgG. Also there takes place an activation of the CD 4+ T cells, these cells elaborate cytokines mainly TNF, interferon, IL-1 and IL-6, further activating the endothelial cells , B lymphocytes and macrophages. Activation of macrophages releases more cytokines which damages the joint tissues and vascularisation of cartilage termed as pannus formation [14] This pannus formation (inflamed synovium) invades bone and cartilage to cause joint erosion. Activated endothelial cells express adhesion molecules which further stimulates the collection of inflammatory cells and this process goes on damaging the joint. Prostaglandins and nitric oxide produced within the inflamed synovium cause vasodilation, resulting in pain and swelling. The inflamed synovial cells also produces M-CSF and the activated T cells produces RANKL which plays important role in osteoclasts activation causing bony erosions and periarticular osteoporosis. Thus autoimmunity damages the joint and atrophies the muscle adjacent to the inflamed joints leading to biomechanical dysfunction and further amplification of destruction. Rheumatoid nodules in small joints and granulomatous lesions may occur in lungs, pleura, pericardium and sclera as a result of inflammatory process [12] Ojo-Visramsa In Ayurveda , there are 3 types of Vikruti mentioned . They are Oja-Visramsa, Oja- Vyapad and Oja-Kshaya. [8] Oja Kshaya is the reduction in the quantity of Oja , whereas Ojo Vyapad is the vitiation of Oja by vitiated Doshas and Dushyas. Oja Visramsa is the displacement of the Oja from its normal place [9] Or we can say that deviation from its normal function. It can also be defined as the impairment in the distribution of Oja all over the body. The normal function of Oja is to provide ‘Bala’ (strength) and Vyadhikshmatva (immunity) to

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Ayushi Patel et al. Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity ISSN: 2456-3110 REVIEW ARTICLE February 2023 Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2 99 fight against diseases [10] But when there is a displacement of Oja from its normal function, it produces following symptoms mentioned as per our Acharyas [9] ▪ Sandhi Vishlesha meaning the looseness and displacement in the joint or synapse. ▪ Gatranam Sadanam meaning fatigue which may be due to the weakness in the body. ▪ Dosha Chyavanam which means migration of vitiated Doshas to other sites. ▪ Kriyasannirodhashch which means the impairment or blockage of the functions of body as well as the mind which ultimately results in the sluggishness of various physical and mental activities DISCUSSION Thorough study of the Ayurvedic literatures reveals that Oja provides natural defence to the body against various diseases [7] Similarly modern medical science holds T cells and B lymphocytes, responsible for the ultimate defence mechanism of the body. Derangements in both the things forms the basis of some abnormalities in the body. For e.g.; any kind of disequilibrium in Oja causes Ojo-Visramsa manifesting various symptoms whereas disequilibrium in the form of auto activation of immune system (T cells and B cells) results in autoimmune disorders like rheumatoid arthritis. The cardinal symptoms of rheumatoid arthritis can certainly be summed up under the four Lakshanas of Oja Visramsa . The characteristic feature of rheumatoid arthritis is the inflammation of synovial joints resulting in the destruction of bone and articular cartilages. Initially erosion of bony margin takes place due to osteoclastic activity stimulated by auto activated T cells [12] In addition to that persistent inflammatory process causes weakening and rupture of tendons. Due to this, there occurs a looseness or laxity in joints. This can be termed as Sandhi Vishlesha in terms of Ayurveda. Prostaglandins and nitric oxide within the inflamed synovium and vasodilation resulting in swelling and pain. Anorexia and weight loss occurs throughout the disease course. Osteoporosis and muscle wasting occurs as a result of systemic inflammation [13] All the above symptoms accounts to the fatigue or Gatrasadanam in the Ayurvedic terms. The next symptom of Ojo-Visramsa is Doshachyavanam which means the migration of vitiated Doshas to different other sites. It has been accountable that in rheumatoid arthritis, there is an infiltration of autoactivated T lymphocytes and B cells, plasma cell, dendritic cells and macrophages and various TNFs, ILs in the in the synovium [13] These cells can be compared to the Doshachyavanam. The systemic inflammation, anorexia, weight loss, fatigue, subluxation of metatarsophalangeal joints, characteristic rheumatic nodules in the small joints, pain and swelling in the joints causes reduction in the physical and mental activities of the patient [14] This is actually Kriyasannirodha mentioned as one of the Lakshana of Ojo-visramsa . CONCLUSION The pathogenic analytical study of the rheumatoid arthritis reveals that there is a deflection of immune response of the body towards its own tissues. That is the reason why rheumatoid arthritis is categorized as an autoimmune disorder. Oja Visramsa also means the dislocation or a deflection of Oja from its normality. Hence, Ojo-Visramsa can be correlated with the autoimmunity. Furthermore, the Lakshanas of Ojo- Visramsa and rheumatoid arthritis are very much alike. Thus, it can be concluded that the autoimmunity in rheumatoid arthritis can be associated with the principle of Ojo Visramsa mentioned in Ayurveda. REFERENCES 1 Harsh Mohan, Editor. Textbook of Pathology 6 th ed. Jaypee Brothers Medical Publishers, New Delhi; 2010, 61. 2 Harsh Mohan, Editor. Textbook of Pathology 6 th ed. Jaypee Brothers Medical Publishers, New Delhi; 2010, 843. 3 Ivan Damjanov, Editor. Pathology secrets 3 rd ed. Mosby Elsevier; 2009, 58.

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Ayushi Patel et al. Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity ISSN: 2456-3110 REVIEW ARTICLE February 2023 Journal of Ayurveda and Integrated Medical Sciences | February 2023 | Vol. 8 | Issue 2 100 4 K. Sembulingam, Prema Sembulingam. Essentials of Medical Physiology, Jaypee Brothers, 5 th Edition,118- 120. 5 Chakrapani Datta, Pandit Jibananda Vidyasagar, Editor. Chakrapani tika, 1888. 6 Pandey K and Chaturvedi G., Editor. Vividhashitpitiya, Charaksamhita - Vidyotini hindi Commentory, Chaukhamba Bharati Academy, Varanasi, Reprint 2016:570 verse 7. 7 Pandey K and Chaturvedi G., Editor. Arthedashamahamuliya, Charaksamhita-Vidyotini hindi Commentory, Chaukhamba Bharati Academy, Varanasi, Reprint 2016:853 verse 9,10. 8 Ambikadutta Shastri, Editor. Doshadhatumala Kshayavruddhi Vijnaniya. Sushruta Samhita (Purvardha), Chaukhamba Sanskrit Sansthan, Varanasi; Reprint 2020:79, verse 24. 9 Ambikadutta Shastri, Editor. Doshadhatumala Kshayavruddhi Vijnaniya. Sushruta Samhita (Purvardha), Chaukhamba Sanskrit Sansthan, Varanasi; Reprint 2020:80, verse 29. 10 Prof. Dr. Subhash Ranade, Prof. Dr. R.R. Deshpande, Prof. Dr. Swati Chobhe, Editors. Concept of Ojas. A Textbook of Kriya Sharira, part II, Chaukhamba Sanskrit Pratisthan, Delhi, 2016: 245, 255. 11 Prof. Dr. Subhash Ranade, Prof. Dr. R.R. Deshpande, Prof. Dr. Swati Chobhe, Editors. Vyadhikshamatva: Immunity. A Textbook of Kriya Sharira, part II, Chaukhamba Sanskrit Pratisthan, Delhi, 2016: 257, 260,261. 12 LongoD.L, FauciA.S, KasperD.L, Hauser S.L, Jameson J.L, LoscalzoJ. Editors. Harrison’s Principle of Internal Medicine. 18 th edition. The Mcgraw- Hill Companies, Newyork;2019.2720. 13 Stuart H.Ralston, Ian D.Penman, Mark W.J. Strachan, Richard P. Hobson. Editors. Davidson’s Principle and Practice of Medicine. 23 rd Edition. Elsevier Health Sciences, London, England; 2018. 1021-1024. 14 Stuart H.Ralston, Ian D.Penman, Mark W.J. Strachan, Richard P. Hobson. Editors. Davidson’s Principle and Practice of Medicine. 23 rd Edition. Elsevier Health Sciences, London, England; 2018. 81-84. ******************************* How to cite this article: Ayushi Patel, Namrata Tiwari, Dileep Singh. Analytical study of Rheumatoid Arthritis w.s.r to Ojo-Visramsa as Autoimmunity. J Ayurveda Integr Med Sci 2023;02:97-100. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2023 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Dhatu, Dosha, Oja, Ayurveda, Sushruta-samhita, Dushya, Acharya, Vyadhikshamatva, Body, Disease, Joint, Rheumatoid arthritis, Vikruti, Pain and swelling, Ayurvedic terms, Immune system, Endogenous factors, Exogenous factors, Function, Rheumatoid factor, Charak Samhita, Vitiated dosha, Oja Kshaya, Ojo Kshaya, Autoimmune disorder, Muscle wasting, Autoimmunity, Nitric oxide, Osteoporosis, Articular cartilage, Autoantibodies, IL-1, T cell, B-lymphocytes, Synovial joint, Immune tolerance, IL-6, Metatarsophalangeal joint, Bony erosion, Ojo visramsa, Prostaglandin, Pannus formation, Granulomatous lesion, Plasma cell, Osteoclast, Macrophage, Adhesion molecule, IgM antibody, Interferon, Cytokine, RANKL, M-CSF, IgG, Inflammatory cell, T lymphocyte, B-cell, Endothelial cell, Joint erosion, Dendritic cell, TNF, Endogenous.