Unravelling Sandhigata Vata (Osteoarthritis)

[Full title: Unravelling Sandhigata Vata (Osteoarthritis): A Comprehensive Analysis of its Pathophysiology]

Journal of Ayurveda and Integrated Medical Sciences 2025 Volume 10 Number 1 JANUARY E-ISSN:2456-3110 Review Article Sandhigata Vata Publisher www.maharshicharaka.in Unravelling Sandhigata Vata (Osteoarthritis): A Comprehensive Analysis of its Pathophysiology Meghashree 1* , Shet B P 2 , Kalkura K R 3 DOI:10.21760/jaims.10.1.28 1* Meghashree, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India 2 Pramod Shet B, Associate Professor, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India 3 Rashmi Kalkura K, Assistant professor, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India The article delves into the detailed analysis on concept of pathophysiology of the Sandhigata Vata. It explores how etiological factors imbalances the Dosha and the picture from imbalanced Doshas to development of features of Sandhivata which are impacting individual’s daily lives, especially in old age. Classical Ayurvedic texts detail the symptoms of Sandhigata Vata, which bear resemblance to osteoarthritis. The modern lifestyle's stressors exacerbate Vata imbalances, contributing to the prevalence of this condition. This condition has become increasingly prevalent, affecting over 528 million people globally in 2019, an increase of 113% since 1990, with a notable increase since 1990. The knee is the most commonly affected joint, with 365 million individuals experiencing osteoarthritis in this area. Women and older adults are majorly impacted, with 60% of patients being female and 73% aged over 55. Understanding the pathogenesis of diseases like Sandhigata Vata is crucial for healthcare professionals to diagnose and address these ailments effectively. Through accurate identification of Sandhigata Vata's specific development path, Ayurvedic physicians can implement tailored treatment plans, leading to a significant improvement in the overall well-being of affected individuals Keywords: Sandhivata, Gata Vata, Vata Vyadhi, Degenerative Joint Disease, Ayurveda, Joint Pain Corresponding Author How to Cite this Article To Browse Meghashree, Post Graduate Scholar, Department of Kayachikitsa, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Karnataka, India Email: Meghashree, Shet B P, Kalkura K R, Unravelling Sandhigata Vata (Osteoarthritis): A Comprehensive Analysis of its Pathophysiology . J Ayu Int Med Sci 2025;10(1):196-202 Available From https://jaims.in/jaims/article/view/3909 Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted 2024-12-13 2024-12-24 2025-01-03 2025-01-13 2025-01-24 Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note None Nil Not required 12.85 © 2025 by Meghashree, Shet B P, Kalkura K R and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0] J Ayu Int Med Sci 2025 ; 10 ( 1 ) 196

Introduction Samprapti , also known as pathogenesis, refers to the development of a disease. It details the entire process, beginning with causative factors to exposure of disease [1 ] These factors cause initial disturbances in the body and mind, eventually leading to the production of premonitory symptoms and the disease itself. This allows healthcare professionals to identify, name and diagnose the illness. Though Vata is one of the three fundamental Doshas [2] , it is responsible for a greater number of diseases compared to Pitta and Kapha combined [3] Vatavyadhi (Diseases occur due to vitiation of Vata dosha ) is a significant ailment categorized as one among eight major diseases Ashtamahagada (Eight major diseases) [4 ] Sandhigata Vata , a specific joint disorder arising from aggravated Vata , is extensively elaborated upon in classic Ayurvedic texts under Vatavyadhi . This condition remains a significant health concern in modern times. The contemporary lifestyle characterized by stress, irregular food habits and physical exertion exacerbates Vata imbalance, leading to a surge in Sandhigata Vata cases. This condition significantly impacts daily life, particularly in the old age, often resulting in disability. Classical Ayurvedic texts describe the characteristic signs and symptoms of Sandhigata Vata as Vata Poornadhrithi Sparsha (on palpation joint appears as leather bag inflated with air), Sandhi Shotha (oedema of joints), Prasarana- Akunchana Vedana (pain while making efforts for extensions and contraction of joints) [5 ] , Hanti Sandhi (Diminution of movement of joints), Sandhi Shoola (Pain in joints) [6 ] and Sandhi Atopa (crepitus in joints) [7] Sandhigata Vata shares striking similarities with osteoarthritis. Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage, leading to stiffness, swelling, pain and reduced mobility [8 ] This condition has become increasingly prevalent, affecting over 528 million people globally in 2019, an increase of 113% since 1990, with a notable increase since 1990. The knee is the most commonly affected joint, with 365 million individuals experiencing osteoarthritis in this area. Women and older adults are majorly impacted, with 60% of patients being female and 73% aged over 55 [9 ] Aims and Objectives Sandhigata Vata Understanding the pathophysiology of as described in ancient Ayurvedic texts can provide valuable insights for the effective management of joint disorders Materials and Methods As the study is a review study, the available literature Samhitas and other books are searched for the disease and analysed to get a compendious concept in the Patho-physiology of Sandhigata Vata Electronic Databases: CAM, PubMed, Google scholar, MEDLINE etc, were searched Observation Pathophysiology explains process of disease development in the body which outlines the stage of disease formation beginning from imbalanced state of Dosha to manifestation of symptoms. To understand the pathophysiology of Sandhigata Vata , it is important to understand the following factors Importance of Vata Vata Dosha governs all bodily functions. The ability to provide other bodily entities, such as other Dosha, Dhatu and Mala mobility belongs to the Vata Dosha in the human body. Vata is responsible for all motion, so this Dosha is also known as life in living beings. Vayu is life, Vayu is strength, Vayu maintains living organism, the same Vayu is verily the universe [10] Role of Vata in health When non-vitiated Vayu is at its abode with unobstructed movement, is responsible for long lifespan of hundred years devoid of diseases [11] Role of Vata in causing diseases When dislodged or impaired , Dosha harm the body by diseases according to their respective site and function, and may even lead to instantaneous death [12 ] Gatavata Vata , influenced by Aharaja (dietary), Viharaja (lifestyle) or Manasika (psychological) factors, can become imbalanced within the body. When this vitiated Vata accumulates in a specific region, Meghashree et al. Unravelling Sandhigata Vata (Osteoarthritis) J Ayu Int Med Sci 2025 ; 10 ( 1 ) 197

It disrupts normal function of that particular site, this condition is known as Gatavata. [13] Gata - situated in or gone to any state or condition or fallen into When Doshas are in a state of imbalance due to an underlying pathological condition they exhibit aberrant patterns in their movement, distribution, localization and manifestation within the body. This irregular behaviour is a hallmark of disease and distinguishes it from the normal, harmonious state of the Doshas Sandhigata Vata Common causes include factors such as excessive physical exertion, irregular daily routines, exposure to cold and windy environments, consumption of dry and light foods, lack of proper rest, obesity etc. These factors can disrupt the balance of Vata Dosha in the body, leading to imbalance in Vata Dosha [14] which vitiates Asthi , as Asthi is the Ashraya for Vata Dosha. General pathogenesis of Vatavyadhi is outlined in Ayurvedic literature as, aggravated Vata caused by depletion of Dhatu occupies empty channels in the body, leading to localized or generalised ailments [15] Other author further opines on this by explaining that Dhatukshaya (depletion of Dhatu) creates these empty channels, allowing Vata to circulate freely, does accumulation and obstruction, ultimately disrupting normal function [16] The pathogenesis of Sandhigata Vata can likely be understood within this framework by understanding two ways of aggravation of Vata they are Dhatukshayajanya (due to depletion of Dhatu ) and Margavarodhajanya (due to obstruction of channels). Dhatukshayajanya Samprapti of Sandhigata Vata / Nirupastambhita Sandhigata Vata : Dhatu nourishes and sustains the body By various aetiology Kshaya (depletion) of Dhatu will be seen. Mostly in old age, Vata predominance occurs with decreased and impaired Agni (digestive and metabolic fire) further leads to depletion of Dhatus quantitatively and qualitatively. As Kapha is decreased the Shleshaka Kapha which resides in joints and Shleshmadhara Kala also get affected and corresponds to depletion of Asthisandhi . This depletion of Dhatu leads to aggravation of Vata give rise to further depletion of Sandhi Further indulging in Vata aggravating factors does Rukshata (Dryness), Parushata (Hardness) and Kharata (Roughness) of Asthivaha Srotas leads to the Riktata of Asthivaha Srotas (emptiness of channels). Aggravated Vata fills up the Asthivaha Srotas and Sthana Samshraya (Localization) of aggravated Vata takes place in Khavaigunyayukta Sandhi (joints susceptible for pathological changes), impairs the normal functioning of that particular joint The localized Vayu due to its Ruksha (dry), Laghu (Light), Khara (Rough) qualities results in Sandhigata Vata. The Guna of Vata are exactly opposite to that of Kapha and hence results in diminishing Shleshaka Kapha which helps in Samshleshana of Sandhi. Margavarodhajanya Samprapti of Sandhigata Vata / Upasthambhita Sandhigata Vata : Vata also get aggravated by occlusion of channels Vata, Pitta , and Kapha move in all the channels of the body. Usually, Sandhigata Vata occur in weight bearing joints. In patients with obesity, sedentary life style Meda Dhathu produced in excess which causes obstruction in the channels and does not nourish the forth coming dhatus. The excessive fat will cause Avarana of Vata (Obstruction) leads to the Vimargagamana (Altered movement) of Vata This vitiated Vata when settle down in joints will further develops Sandhigata Vata . Sandhi is classified as one of the Marma (Vital point) in the body. In addition to the pathogenesis due to Dhatukshaya and Margavarodha , Vata vitiation cause due to any external injuries, referred to as Marmaghata may leads to Sandhigata Vata Samprapti Ghataka Dosha - Vata especially Vyana Vata and Shleshaka Kapha Dushya - Asthi, Majja, Meda, Rasa Srotas - Asthivaha, Majjavaha, Medovaha Srotodushti - Sangha, Vimarga Gamana Agni - Mandagni Udbhava Sthana - Pakvashaya Adhishtana - Sandhi Pradesha Vyakta Sthana - Asthi Sandhi Dosha marga - Marmasthi Sandhi Rogamarga - Madhyama Vyadhi Swarupa - Chirakari Sadhyasadhyata - Naveena- Sadhya, Jirna- Kruchra Sadhya. Meghashree et al. Unravelling Sandhigata Vata (Osteoarthritis) J Ayu Int Med Sci 2025 ; 10 ( 1 ) 198

Discussion As vitiated Vata alone isn't directly involved in Sandhigata Vata , it's not described under the 80 types of Nanatmaja Vikara of Vata . However, it's elaborated upon in the context of Vatavyadhi Chikitsa . It is possible that the role of Vyana vayu is crucial in categorizing Sandhigata Vata under Vatavyadhi . The exact cause of Sandhigata Vata isn’t mentioned, but factors causing Vatavyadhi and Asthi Sroto Dushti (bone channel vitiation) can be considered. Various causative elements lead to the aggravation of Vata which occurs through processes such as Dhatukshaya (tissue depletion) and Margavarodha (channel blockage) ultimately resulting in Sandhigata Vata These pathological developments can be understood as Vishista Samprati indicating a specific pathogenesis for Sandhigata Vata . This condition is frequently compared to degenerative joint diseases such as osteoarthritis, which predominantly affects individuals over the age of 55. Approximately 73% of people living with osteoarthritis are in this age group primarily due to the degeneration of cartilage and bone [17] Classical texts note that Shareera Dhatukshaya (tissue depletion) typically occurs at old age, contributing to the condition known as Kalaja Nidana in Sandhivata . Cartilage is primarily composed of chondrocytes, which exist within a cell matrix rich in proteoglycans. As individuals age, the degeneration of cartilage reduces the joint space, resulting from the damaging effects on chondrocytes Understanding Shatkriyakala of Sandhigata Vata Meghashree et al. Unravelling Sandhigata Vata (Osteoarthritis) J Ayu Int Med Sci 2025 ; 10 ( 1 ) 199

This degeneration leads to increased bone hardness, a condition referred to as sclerosis, which may contribute to osteoporosis. This sequence of events can be hypothetically characterized as Tarunasthi Dhatukshaya in older adults, subsequently leading to further aggravation of Vata due to the interplay of Ashraya-Ashrayi Bhava . A study exploring the intersection of aging and inflammation in osteoarthritis has suggested that the condition was once understood solely as cartilage degradation. However, contemporary understanding recognizes the involvement of inflammaging originating from the synovium, cartilage, and subchondral bone. Inflammaging, a term describing chronic, low-grade inflammation associated with aging, contributes to osteoarthritis by elevating levels of reactive oxygen species and inflammatory cytokines, which are linked to age-related diseases such as cancer and diabetes. Both innate and adaptive immune responses are activated, resulting in increased cytokines that damage cartilage. Additionally, antigens from damaged joints can activate inflammasomes, while aging can impair the regulatory functions of B and T lymphocytes, exacerbating self-reactivity and worsening joint damage [18 ] For individuals who lead a sedentary lifestyle and are obese Srotoavarodha (channel obstruction) by Meda may lead to vitiation of Vata , which adversely affects the bones and aggravates Vata . Studies investigating the onset of osteoarthritis in sedentary adults have established that a lack of physical activity contributes to a phenomenon known as stagnant cartilage syndrome. This term reflects the difficulties associated with maintaining thick cartilage under physiological stress. The hypothesis suggests that physical inactivity can foster knee osteoarthritis by creating a stagnant diffusion barrier at the synovial fluid-cartilage interface, which can limit the nutrient supply and promote waste accumulation, thus disrupting cellular homeostasis and leading to progressive tissue degradation [19 ] In acute cases of Sandhigata Vata the typical stages of Sanchaya (accumulation), Prakopa (aggravation) and Prasara (manifestation) may be expedited resulting in a more rapid manifestation of the disease. Conversely, in slow and chronic conditions while Vata aggravation may occur still it may not be sufficient to elicit the clinical symptoms associated with Sandhigata Vata . Vata as a Dosha , is fundamentally associated with Gatyatmak (movement) However, alterations in its movement can occur due to the influence of its subtypes or the interaction with other Doshas or Dhatus . In the case of Sandhigata Vata , there is an increase in the qualities of Rukshata (roughness), Kharata (grittiness) and Shitata (coldness) which are manifestations of Vata 's increased properties Consequently, the Dosha tends to remain confined within the body during the stages of Sanchaya, Prakopa and Prasara Avastha . Further exacerbation of Vata due to additional causative factors can lead to the manifestation of Shula (pain) which arises from aggravated Vata . Shopha (Swelling) occurs as a result of Srotorodha and the accumulation of disturbed Rasa along with an imbalance in Kapha This swelling is not typically tense; thus, palpation may reveal characteristics of Vatapurnadhriti (a condition of fullness). Atopa or sounds produced due to friction within the tissues, results from the increased Kharaguna in the dhatus , which is often associated with Shleshmakshaya (deterioration of Kapha ). Hanti Sandhi or joint dysfunction, manifests at later stages, often due to the destruction and alteration of other joint structures, including variations in Snayu (ligaments) and Asthi (bone) leading to marked impairments in joint articulation Conclusion Sandhigata Vata or joint disease, manifests primarily through two distinct pathophysiological mechanisms. When triggered by etiological factors such as Adhyashana (overeating), Divashayana (excessive daytime sleep) and Vegavidharana (suppression of natural urges), the disease primarily progresses through the obstruction or blockage of channels. Conversely, Sandhigata Vata arising from a lifestyle characterized by Ruksha ahara-vihara (dryness), Sheeta ahara-vihara (cold exposure), Vishamashana (irregular eating), and Chinta, Shoka, Bhaya, Rogatikarshanata (emotional distress) predominantly develops through tissue depletion or Dhatukshaya . A comprehensive understanding of the causative factors and their corresponding disease processes is essential for the formulation of effective and timely treatment plans tailored to individual patient conditions. In the realm of Ayurveda, therapeutic intervention is fundamentally centred around disrupting the pathogenesis itself, a principle known as ‘ Samprapti Vighatana ’ Meghashree et al. Unravelling Sandhigata Vata (Osteoarthritis) J Ayu Int Med Sci 2025 ; 10 ( 1 ) 200

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