Osteoarthritis (OA) is the most common chronic disorder of a wide-ranging etiology, that is related to the ageing process. In Ayurvedic classics, four different nomenclatures are available for the clinical entity, which are similar to OA. i.e. Sandhivata, Sandhigatavata, Khudavata andJeernavata. The term sandhi vata is formed by two words. Sandhi(joint) and Vata(one of the three humours of the body). In India, OA is prevalent among male usually after 45, whereas in female, after the age of 35. Maximum OA cases reported during a survey is between 60-80 years.
- Natural ageing process (Jara)
- Overweight and obese (Sthoulya)
- History of trauma (Abhighataja)
- Wrong posture (Sitting cross leg, squatting posture while using Indian toilets, kneeling, prolonged standing, overuse of stairs etc.)
- Underlying primary joint disease (Rheumatoid/Gouty/Septic arthritis)
- Family history
The cause of Sandhivata in Ayurveda is attributed to improper diet, lifestyle, overuse and oldage etc. leading to degeneration of body elements (dhatukshaya), aggravation of vata; the humour, responsible for all the movements and functions of the body and reduction in shleshmakaKapha; a slimy substance present in the joints. The aggravated vata brings rukshyata (dryness), laghutva (lightness or porousness), Kharatwa (coarseness) in the joints causing degeneration. In normal life, joint surface is covered with a soft and smooth bone called cartilage. It provides padding in joints that acts as a cushion to make friction- free movement of the joint. However, with the advance of age and due to the misuse of joints like bad posture,excess body weight, the joint cartilage gets damaged, develops cracks and becomes rough and flaky.This results in the break off of small pieces of damaged cartilage. A large section of cartilage may get worn out completely, leaving the bone ends unprotected and the rough surfaces rub against each other and cause pain and swelling of joints. In advance cases, there may be locking of the joint.
Common site of involvement (Adhisthana)
OA largely affects the weight- bearing joints of the body. Among them, Knee and Vertebral spine (mainly neck and lower back) are chiefly affected.
Clinical features (Rupa)
The clinical presentation of both Sandhigatavata and osteoarthritis is alike. In Sandhivata, sandhi shula (pain in affected joint) is the key feature. In its early stage a minimum movement causes pain and in later stage pain occurs at rest and even after rest also. The other features include shotha (swelling), stabdhata (stiffness) and atopa(crepitus- creaking and grating sound) and difficulty in performing the functions of involved joint. Weakness around the joint (due to lack of use) and deformity are also complaints associated with OA.
OA is diagnosed through a medical history, physical examination and radiological examination like X-ray of an affected joint.
OA can be managed by controlling pain, maintaining and improving a range of movements and stability of affected joints and limiting functional impairment. The non-drug treatments include; educating the patient about postures etc, social support, physical exercises and weight loss, if needed. In the conventional system of medicine,Non-steroidal anti-inflammatory drugs (NSAIDs) are used as primary care for reducing pain. Since the drugs are prostaglandin inhibitor they may cause gastric erosion, hepatic and renal impairment on prolonged usage.There is also a risk of myocardial damage with COX-2 inhibitors. In contrast, Ayurvedic drugs used to treat OA are safe for long use. Guggulu preparations (Br.Yogaraja Guggulu, Trayodashanga Guggulu) and Shallaki are the promising drugs in Ayurveda for the treatment of OA. Rasayana (disease modifying drugs like Ashwagandha,Bala,Punarnava) are useful in all patients.Regular gentle massage with Taila (oil based local medication like Balaaswagandha taila, Kottamchukadi taila) on affected joints followed by hot compression is also helpful in the alleviation of pain and swelling. Apart from these, Physiotherapy, light exercise (initially with an expert), healthy diet, use of knee pad are beneficial for the patient.
Dr. Kshirod Kumar Ratha,
Research Officer (Ayurveda)
Contact No- +91 9874612213