Management of Viral Arthritis (Asthidhatugata Jwara) through Ayurveda

68 Journal of Ayurvedic and Herbal Medicine 2022; 8(2): 68-71 Case Report ISSN: 2454-5023 J. Ayu. Herb. Med. 2022; 8(2): 68-71 Received: 14-05-2022 Accepted: 07-06-2022 © 2022, All rights reserved www.ayurvedjournal.com DOI: 10.31254/jahm.2022.8203 *Corresponding author: Dr. Pooja BA Associate Professor, Department of Panchakarma, Sushrutha Ayurvedic Medical College and Hospital, Banglore, Karnataka-560105, India Email: drpoojaba@gmail.com Management of Viral Arthritis (Asthidhatugata Jwara) through Ayurveda Sameena KS 1 , Pooja BA 2 , Sreenidhi GS 3 1 House Surgeon, Sushrutha Ayurvedic Medical College and Hospital, Bangalore, Karnataka-560105, India 2 Associate Professor, Department of Panchakarma, Sushrutha Ayurvedic Medical College and Hospital, Banglore, Karnataka-560105, India 3 Associate Professor, Department of Rasashatra and Bhaishajya Kalpana, Sushrutha Ayurvedic Medical College and Hospital, Banglore, Karnataka-560105, India ABSTRACT Acute-onset arthritis is a common clinical problem facing both the general clinician and the rheumatologist. A viral etiology is thought to be responsible for approximately 1% of all cases of acute arthritis with a wide range of causal agents. This is a case report of female patient aged 27 years was diagnosed with viral arthritis [1] visited department of Panchakarma , SAMC&H Bangalore for the treatment of the same. She was given with Patrapinda sweda to the lower limbs followed by Shamanaushadi Yogaraja guggulu 1-0-1 A/F with warm water and Rasnaerandadi kashayam 20 ml-0- 20 ml B/F with warm water for one month and has found satisifactroy improvement in her symptoms. Considering symptomatology, in Ayurveda classics it can be compared with Asthi dhatugata jwara [2] Keywords: Viral arthralgia, Patrapinda Sweda, Acute Arthritis, Shamanushadis. INTRODUCTION Viral arthritis is inflammation of the joints from a viral infection [1] . Approximately 1% of all cases of acute arthritis are thought to have a viral etiology. Viral attacks are usually accompanied by joint pain and swelling (Arthralgia). As per allopathic science viral arthritis can be managed symptomatically with NSAID's, analgesic, and antibiotics, but sometimes even after eliminating the virus out of body some people will get joint pain and also swollen joint. Parvovirus B 19, hepatitis B and C, HIV and the alpha viruses are among the most important causes of virally mediated arthritis. Post viral arthralgia may affect patient from 6 months up to 2 years. Pain, swelling, tenderness and restricted range of motion in bones and joints affect quality of life. The diagnosis of virally induced arthritis can be difficult to confirm but should be considered in all patients presenting with acute-onset poly articular symptoms. In addition to serological testing for the causative agent there may be associated clinical features that point clinicians to a specific virus such as the typical ‘slapped cheek’ rash seen in parvovirus -associated arthritis or jaundice associated with acute hepatitis B (HBV) infection. In many cases however, these features may be subtle, absent or temporally distant from the joint symptoms making the diagnostic process difficult. Based on clinical signs and symptoms like Sandhi vedhana , this can be co related to Asthidhatugata jwara [2] . Since modern line of management is aimed at reli ving symptoms by NSAID’S etc which in turn leads others side effects such as GI erosion, GI disturbances, Headaches, Allergic reactions. Therefore, in order to eradicate the cause from roots Ayurveda line of treatment includes Snehana , Swedana and Shodhana which is the best line of treatment. CASE REPORT A female patient aged 27 years visited Panchakarma OPD no 4. Her chief complaints were pain and swelling in the both the knee joints which radiates to toes since 3 years, which got aggravated again from 2020. History of present illness Patient gradually started feeling pain (grade: 7) in her both knee joints 2017 November. Pain was very severe which radiates from knee till calf and toes. Pain gets aggravated on walking, climbing steps, or sitting for longer duration. She also complains of stiffness in the knee and ankle joint. Pain gets relieved on application of medicated Ayurvedic oil. Pain (grade: 8) again got severely aggravated from January 2020

69 Journal of Ayurvedic and Herbal Medicine|April-June|2022 due to sitting for longer hours in work from home schedule. So, she got admitted in Sushrutha Ayurveda Medical College and Hospital. Past history : No H/O Hypertension, Diabetics mellitus, Osteo arthritis Family history : none Ashtavidha Pariksha Nadi : 82/min Mala : Prakrut Mutra : Prakrut Jihwah : Alipta Shabda : Prakrut Sparsha : Anushnashita Drik : Prakrut Akriti : Madhyama Dashavidha pariksha Prakruti : Pittavataja Vikruti : Dosha – Vata, Dooshya – Rasa, Rakta, Asthi Satwa : Pravara Sara : Madhyama Samhanana: Avara Pramana : Avara Satmya : Sarva rasa Aharashakti : Madhyama Vyayamashakti : Avara Vaya (age) : 28 years Assessment Criteria 1 DAS Score 2 SF-36 3 General health and disability index 4 Grading of sandhishoola (pain) Sr. No. Severity of pain Grade 1 No pain 0 2 Mild pain 1 3 Moderate, but no difficulty in moving 2 4 Severe, with difficulty 3 in moving the body parts 5 Grading of Sandhishotha (swelling) Sr. No. Severity of pain Grade 1 No swelling 0 2 Slight swelling 1 3 Moderate swelling 2 4 Severe swelling 3 Treatment protocol Oral medicine 1 Yogaraja guggulu [3]. 1-0-1 A/F with warm water 2 Rasnaerandadi kashayam [4]. 20 ml-0-20 ml B/F with warm water Therapy: Adhobhaga abhyanga and Patra pottali sweda(ksheera bala taila) for 6 days. Method of pottali preparation Ingredients • Nirgundi [5] . -Vitex negundo-100 grm • Eranda [6] . -Ricinus communis-100 grm • Dhatura [7] . -Dhatura metal-25 grm • Shigru [8] . -Moringa oliefera-25 grm • Arka [9] . -Calotropis procera-25 grm • Grated coconut-150 grm • Lemon-4 • Oil-100 ml • Saindhava, shatapusha [1] . Kusta [11] . -10 grams each Preparation of pottali Fresh leaves should be cleaned and chopped finely. First add 50 ml of oil into frying pan, to it add grated coconut & sliced lemon and fry till turns to light tinged brown. Add chopped leaves and fried till brownish color. It should be divided into 4 equal parts on 4 different pieces of Cora cloth and made into 4 Pottalis (average weight of 1 Pottali = 300- 350 grm). Therapy procedure Initially Abhyanga with Ksheera bala taila (which was heated indirectly over hot water bath) to lower limbs (supine and prone position) for 10

70 Journal of Ayurvedic and Herbal Medicine|April-June|2022 min later Patra pottali sweda was applied to lower limbs (both supine and prone position) for 20 min. Initially after heating Pottali from indirectly heated oil, temperature was checked by placing Pottali on dorsum of the hand. At first Pottali is applied by tapping on lower limbs followed exerting mild and even pressure. Care was taken to maintain the temperature of the Pottalis throughout the procedure by reheating. Later excess oil is cleaned with dry towel followed by instructing the patient to take warm water bath. Patient was kept on hospital diet and on daily basis her vitals are been assessed. She was also assigned with yoga practices and Pranayama classes. RESULT Prescribed Ayurvedic treatment helped in managing the progressive signs and symptoms of disease. Joint pain, tenderness and swelling is reduced. Improvement in performing day to day life activities was noted. Overall quality of life is improved. 1 Functional Improvement is noted in DAS Score, SF-36, General health and disability index after treatment. 2 Assessment of sandhi shoola (pain). Left lower limb Name of joint Right lower limb After PPS After Shamanaushadis After PPS After shamanaushadis 3 1 Janu 2 1 2 0 gulpha 3 1 3 Assessment of sandhi shotha (swelling). Left lower limb Name of joint Right lower limb After PPS After Shamanaushadis After PPS After shamanaushadis 1 0 Janu 2 0 0 0 Gulpha sandhi 2 0 • After 2 days of therapy, she found 60% relief in pain in both knee joint calf region but there was stiffness in the right ankle and pain in phalanges of both limbs. • On 4 th day of therapy, she was feeling better and stiffness in right ankle was relived whereas pain in phalanges still present. • On 5 th day of therapy patient found over all relief in the pain (96%). Patient stayed in hospital IPD for 7 days and has found satisfactory relief in the symptoms (98%), She was able to walk or climb steps without discomfort or pain. DISCUSSION Among different inflammatory joint disorder viral arthritis seen clinically due to exposure to the virus. After subsiding the symptoms of main pathology most of the time in same people pain in the joints and swelling still persists as a complication of viral fever. This post viral arthralgia impacts physically and psychologically. Though in the management protocol many forms of oral medicines are available among which NSAID’S are routine option. Though there are adverse reaction expected by administration of NSAID’s in the management of viral arthalgia looking into these limitations through Ayurvedic management Snehana, Swedana, Shamanaushadis were administered. External oleation followed by sudation using different herb ( Nirgundi, Eranda, Arka, Shatapushpa, Dhatura, Shigru, Saindhava etc ) made in the form of pottali and it is applied to affected parts. As all these drugs are Vatahara in nature further the procedure swedana also helped to relieve Shoola ( i.e,pain ), Sthabdata ( i.e, stiffness). The drug Yogaraja Guggulu constitutes ingredients Guggulu, Eranda etc which are helpful to relieve pain, swelling, and stiffness. Rasnaerandadi kashayam mainly constitutes Rasna and Eranda which is best Vatahara and also helps to eliminate the Doshas out of the body in mild quantity. CONCLUSION A female patient aged 27 years diagnosed with viral arthritis compared to Asthidhatugata jwara as per Ayurveda classics was treated with Snehana, Patra Pinda Sweda , and Shamanaushadis effectively Significant improvement was observed in patient so Snehana, Patrapottali sweda , and Shamanaushadis is found to be clinically effective in the management of signs and symptoms of viral arthritis. Conflict of Interest None declared. Financial support None declared. REFERENCE 1 Ralston SH, Penman ID, Strachan MW, Hobson R, editors. Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. 2018:1095. 2 Agnivesha CS. revised by Charaka and Dridhbala with Ayurveda Deepika commentary, by Chakrapanidatta, edited by Vd. Jadavaji Trikamaji Acharya. Chaukhambha Surabharati Publications, Varanasi-221. 2002;1:17- 23. 3 sthana; 3 rd chapter/20 th verse, Published by Chaukhambha Orientalia, Varanasi. 2015:97. 4 Sahasrayoga , 1 st edition; 1990, published by Kendriya Ayurvediya Vignana Anusandhana Parishad ,Pp.153.

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