Multiple Joint Pain Research Articles

Polyarticular Juvenile Idiopathic Arthritis leading to Renal Amyloidosis

The incidence and prevalence of renal amyloidosis is rare. We are presenting a case of 21 year 21-year-old male with multiple joint pain complicated by adult-onset Nephrotic Syndrome due to renal amyloidosis. The patient improved on medications.

Integrative Approach to Managing Multiple Joint Pain with Stiffness, Swelling, and Stress Using Yogic Practices and Herbal Remedies: A Case Study

Integrative Approach to Managing Multiple Joint Pain with Stiffness, Swelling, and Stress Using Yogic Practices and Herbal Remedies: A Case Study

Chikungunya encephalitis: A case report

Rationale: Transmitted to humans via the Aedes mosquito, Chikungunya virus (CHIKV) is associated with multi-system complications, sometimes collectively referred to as “atypical features.” However, a disorder of the nervous system appears to be the most common severe complication of CHIKV infection. Patient’s Concern: A seventy-five-year-old patient from India presented to the hospital with fever, chills, rigors, and multiple joint pains for which he was worked up. Diagnosis: CHIKV encephalitis. Interventions: The patient was treated initially on supportive therapy with antipyretics, intravenous fluids; however, during his hospital stay, the patient had altered sensorium during which he was managed in the intensive care unit; required mechanical ventilation. Outcomes: The patient sccumbed to his illness. Lessons: Treating clinicians should keep CHIKV disease in the differential diagnosis in cases of febrile exanthems associated with disabling arthritis, especially in a CHIKV-endemic country like India.

AYURVEDIC MANAGEMENT OF RHEUMATOID ARTHRITIS WSR TO AMAVATA- A CASE REPORT

Introduction: The Ayurveda described Mandagni as the root cause of all the diseases. The Acharyas mentioned Amavata as one of the common disorders caused by the impairment of Agni, formation of Ama and vitiation of Vata Dosha. The Ama is carried by the vitiated Vata and deposited in Shleshmasthanas producing symptoms like Angmarda, Aruchi, Alasya, Sandhiruk and Sandhishoth. On the basis of sign and symptoms Amavata can be equated to Rheumatoid Arthritis in modern era. Rheumatoid arthritis is a systemic autoimmune disease characterised by inflammatory arthritis and extra articular involvement. The onset of disease, beginning with prodrome of fatigue, weakness, joint stiffness, vague arthralgias followed by pain and swelling of joints. Aim: To evaluate the efficacy of Oral Ayurvedic drugs in management of Amavata. Method: In the present case, a female patient aged 36 years presented in OPD Of Asthi-SandhirogaVibhaga of RGGPG Ayurvedic College Paprola Distt. Kangra (H.P.) with the complaints of pain in multiple joints since 2 years. She also complained of generalised weakness and morning stiffness. The investigations were advised and oral Ayurvedic formulations like Vishtindukvati, Amavatari Ras and TrikatuChurna were prescribed to the patient. Result: The Ayurvedic management showed desired results in relieving the symptoms of patient. Discussion: The Ayurvedic drugs are effective in treating Amavata equated to RA and better alternative to NSAIDS, DMARDS and steroids in Rheumatoid arthritis management in todays world.

Management of Amavata w.s.r. to Rheumatoid Arthritis

Vitiated Vata Dosha, weakened Agni, and accumulation of Ama at Shleshmic Sthana mainly at Sandhi (joints) are responsible for the development of Aamvata. Amavata can be correlated with Rheumatoid Arthritis due to similarities in clinical symtoms. Rheumatoid arthritis is one among the autoimmune diseases causing chronic symmetrical polyarthritis. The treatment in Modern science includes the use of NSAID’s (Non steroidal anti-inflammatory drugs), DMARD’s (Disease-Modifying Antirheumatic Drugs), glucocorticoids, and immune-suppressants, long-term use of which causes several side effects. Ayurveda treatment procedures and medication used for the treatment of Amavata have Agni Deepana, Ama Pachana, Vata Shamaka, Sroto shodhana actions which are helpful to retard disease process and reduce signs and symptoms of the disease. In the present case, 65-year female patient presented with, complaints of multiple joint pain with swelling and morning stiffness, restricted joint movements, loss of appetite, fatigue, weakness, fever (on and off), migratory pain, and symmetrical joint involvement. Patient was administered with Phalatrikadiguggulu, Shwadanshtradi guggulu. Mahayograjguggulu, Rasapachak vati, Sameerpannag rasa and Gandharvaharitaki churna added as Nitya Virechana. Ruksha Swedan with Valukapottali had also been given. The therapeutic interventions adopted in the study have shown beneficial effects in the patients of Aamvata.

Case report: Propylthiouracil-induced serious side effect: Perinuclear antineutrophil cytoplasmic antibody-associated vasculitis or IgA vasculitis?

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease characterized by the inflammation and destruction of small blood vessels and circulating ANCAs. Drugs such as antithyroid drugs (ATDs), especially propylthiouracil (PTU), have been used for the production of ANCAs and cause the development of drug-induced AAV. The pathogenesis of this disease is unclear but could be related to the physiological processes affecting the degradation of neutrophil extracellular traps (NETs). At present, PTU is widely used in patients with Graves' disease (GD) who are preparing for pregnancy and whose condition has not been controlled. Once drug-induced AAV has occurred with important organ damage, considering NETs have a significant role in the immune system, whether the cessation of drugs could stop the progression of organ damage is unclear, and a consensus regarding standard treatment has not been established. In this case report, a female patient who planned pregnancy was hospitalized with multiple joint pain, impaired renal function, and hematuria. Immunofluorescence of the renal biopsy demonstrated spherical and diffuse mesangial distribution of IgA (3+). Autoimmune serology demonstrated positivity for autoantibodies against p-ANCA and an anti-MPO titer 74.72 RU/mL. She was diagnosed with PTU-induced p-ANCA-associated and IgA-associated vasculitis (IgAV). The patient accepted low doses of glucocorticoid, immunosuppressive therapy and RAI treatment. Both her kidney function and thyroid function remained were on the mend. The authors believe that this type of patient needs to fully consider their pregnancy preparation needs, suspend pregnancy when a small chance of GD remission is indicated, and avoid the use of drugs with reproductive toxicity and other serious adverse events. The multidisciplinary combination therapy of low-dose glucocorticoids and immunosuppressants combined with iodine radiotherapy is one reasonable scheme. At the same time, it is necessary to eliminate the organ damage caused by other reasons. This report provides a clinical treatment basis for patients with drug-induced vasculitis manifestations who cannot receive an accurate diagnosis.

Delayed Hypoparathyroidism Following Thyroidectomy

Abstract Hypoparathyroidism is the most common complication following total thyroidectomy, occurring in 7.6% following anterior neck surgeries. The majority (19%–38%) of postoperative hypoparathyroidism is transient, resolving within 6 months, and permanent hypoparathyroidism is observed in 1.5% after total thyroidectomy, increasing to 6.4% in patients undergoing total thyroidectomy with prophylactic neck dissection. A 26-year-old Indian married woman, a mother of a 6-month-old baby currently lactating, presented with complaints of multiple joint pains and fever of 3-day duration with a history of thyroidectomy 8 years back and developed symptoms of hypocalcemia during the hospital stay. Evaluation revealed hypoparathyroidism. The nonspecific nature of hypocalcemic symptoms and lack of continuous follow-up for a long time after thyroidectomy could contribute to a delay in the diagnosis of hypoparathyroidism. However, it is an important diagnosis to consider in any patient with a history of neck surgery.

Role of Ayurvedic medicines with Panchakarma therapy in SLE w.s.r. to Aamvata

Background: Autoimmune disorders occur when the body’s immune system is working hard to defend against potentially precarious substances our bodies such as allergens, toxins, infection or food but does not identify the difference between the invaders and own body cells. SLE is an autoimmune disease in which organs, tissues and cells undergo damage, mediated by tissues binding auto antibodies and immune complexes. SLE affects heart, joints, skin, lungs, blood vessels, liver, kidney and nervous system. Due to Piita Pradhantwa in SLE it can be correlated with Pitta Anubandhi Amavata as both are systemic autoimmune disease having involvement of mainly Pitta Dosha. Materials and Methods: A male patient with complaints of pain in multiple joints with swelling, recurrent mouth ulcers, weakness all over the body and erythematous rashes on both hands with some discharge came to OPD of PTKLS Hospital and diagnosed as Amavata and admitted in IPD of the Hospital and treated according to Ayurveda Protocol including oral medications and Panchakarma therapy. Result: Patient got symptomatic relief. Details of this will be discussed in full paper. Discussion: In Ayurveda, symptoms of Vata Kapha Anubandhi Amavata can be correlated with RA and symptoms of Pitta Anubandhi Amavata can be correlated with SLE as there is involvement of Pitta Dosha and Rakta Dhatu in SLE.

A Case Study on Bala Amavata w.s.r. to Juvenile Rheumatoid Arthritis

Introduction: Amavata is one of the most difficult to cure (Krichhrasadhya) diseases mentioned in Ayurveda. The main pathological factor in the development of this disease is “Ama”. This Ama is carried by “Vata” and travels throughout the body and gets lodges in the joints, which is the seat of “Kapha”. Accumulation of Ama in all the joints, results in Shotha (edema), Shoola (pain) and Stabdhata (stiffness) in the joints. Clinically, it is closely related to Rheumatoid Arthritis, which is a chronic inflammatory autoimmune disease involving multiple joints of the body. Methodology: A 13years boy with multiple joint pain, diagnosed as Amavata treated with Ayurvedic treatment modalities like Patrapinda Sweda and Virechana. Result: Remarkable improvement was noticed in pain, swelling, morning stiffness and restricted joint movement within first two months. Discussion: In modern medicine, the treatment of this disease includes steroids and Immunomodulator drugs together with non-steroidal anti-inflammatory drugs (NSAIDs), which acts as only Symptomatic treatment, whereas Virechana karma is one of the important bio-purificative methods which is indicated for complete elimination of Dushita Doshas and Ama from the body. Hence this article highlights on the importance of Ayurvedic treatment in the management of Amavata (Rheumatoid Arthritis).

E034 Drug-induced accelerated nodulosis in a patient with rheumatoid arthritis

Abstract Background/Aims Drug-induced accelerated nodulosis (DIAN) is characterized by the occurrence or progression of multiple subcutaneous nodules in a patient treated for rheumatoid arthritis (RA). It was first and most commonly reported with methotrexate in RA patients. Methods A 37-year-old normotensive, non-diabetic, seropositive rheumatoid arthritis female presented with complaints of nodules over the bilateral hands and feet from the last three months. The treatment history included methotrexate therapy (10 mg/week) for one year. Methotrexate-induced rheumatoid accelerated nodulosis (MIAN) was suspected. Methotrexate was stopped and hydroxychloroquine was added considering the low disease activity. The nodules decreased in number as well as size. On follow-up, she presented with increased multiple joint pain and swelling with ESR 60 mm/hour, CRP 13.6 mg/L, and leflunomide was added. After six months of leflunomide use, she again developed multiple bilateral nodules on the extensor and palmar surface of fingers and feet, ranging from 0.5 to 1 cm. The CRP was 9.2 mg/L, ESR 80 mm/hour, complete blood count showed mild anaemia with normal renal and liver function tests. The nodule biopsy showed palisading granuloma consisting of lymphocytes and histiocytes in mid and deep reticular dermis with large foci of fibrin deposition and collagen degeneration s/o rheumatoid nodule. Leflunomide was stopped. Results The leflunomide was switched to sulfasalazine along with colchicine, and hydroxychloroquine was continued. The patient is doing well on follow-up in terms of disease activity and nodule size. Palmeiro. A.G., et al. 2022 reviewed 39 studies from 1st Jan 1988 to 1st Jan 2022 and found 109 cases of accelerated nodulosis. 99 patients had RA, methotrexate was the culprit drug in 89, followed by etanercept in 7 and leflunomide was in just 3 patients. Although there are no exact treatment guidelines, tumour necrosis factor inhibitors were avoided due to increased nodulosis risk. Recently, Valor-Méndez. L., et al 2020 reported improved nodulosis with Janus Kinase inhibitors like baricitinib, which seems to be a future option. Histologically, rheumatoid nodules and accelerated nodulosis are indistinguishable. The exact pathogenesis is unknown but, polymorphic variants of methionine synthase reductase or haplotype HLA-DRB1*0401, and adenosine A1 receptor promotion in multinucleated giant cells are associated. Conclusion Drug-induced accelerated nodulosis (DIAN) and MIAN are not that rare but diagnosis is challenging. It causes significant morbidity and affects the quality of life because of the predominant involvement of hands and feet. It should be suspected especially when disease activity is low or rapidly progressive nodules with a change in immunotherapy. Partial to total improvement can be achieved by identifying and stopping the culprit drug. We need specific guidelines, more treatment options, and a specific national registry to report such adverse effects with biologics and non-biologic disease-modifying antirheumatic drugs. Disclosure H. Singh: None. R. Kaur: None. G. Mohan: None.

A Comprehensive Ayurvedic Management of Amavata

Amavata is an Ama pradoshaja vikara, caused by Agnimandya, which leads to accumulation of Ama in Shleshmasthana and Prakopa of Vata dosha, resulting in pain, stiffness and swelling of joints, which closely resembles the chronic inflammatory autoimmune disorder called Rheumatoid arthritis. Prevalence of rheumatoid arthritis is approximately 0.8% worldwide and 0.5-0.75% in India. Materials and Methods: A 44 years female presented with pain in multiple joints associated with swelling and stiffness since 2 years was diagnosed as Amavata. The patient was treated with Kottamachukkadi lepa, Dashamoola kashaya and Dhanyamla Kayaseka, Vaitarana basti followed by Guduchyadi kashaya basti along with Rasayana and oral medications. Results: There was a significant improvement in overall symptoms. Conclusion: Contemporary medicine offers DMARDS and steroid medications for very long time as it is Auto immune condition. Whereas on other hand Panchakarma therapies can target on root cause of the Vyadhi and provide more promising results.

Ayurvedic Management of Utthana Vatarakta – A Case Report

A 59-year-old upper-middle-class woman residing in Shornur for the past 10 years and having worked as a nurse for 33 years was admitted to Vaidyaratnam Ayurveda College hospital on September 27, 2023, for a 15-day duration, presenting with complaints of multiple joint pain, left-sided headache, itching of the whole body, crawling sensation persisting for a decade, and blackish discoloration of nails in both upper and lower limbs consistent with nail psoriasis. The diagnosis for this case was established as Utthana Vatarakta, seronegative arthritis. Comprehensive treatment approach involving internal medicines, Rukshana, Snehana, Swedana, Sodhana, and Samana therapies was implemented. Following the 15-day treatment regimen, the patient experienced significant alleviation of complaints improvement in Ama Assessment tool scoring, Visual Analog Scale and Clinical disease activity index.

Cute sarcoidosis Löfgren Syndrome treated by Chinese medicinal formula based on Syndrome Differentiation: A case-based review

Löfgren syndrome (LS) is a unique acute manifestation of sarcoidosis and characterized by erythema nodosum, bilateral hilar lymphadenectasis, and/or bilateral anklearthritis or periarthritis. A 37-year-old female patient with LS presented with fever accompanied by multiple joint swelling and pain, nodular skin erythema, and bilateral hilar lymphadenectasis. The patient had received treatment involving non-steroidal anti-inflammatory drugs and glucocorticoids in other hospitals, but the effects were poor, and the conditions reemerged. The LS duration has lasted for more than 3 months. Following traditional Chinese medicine (TCM) treatment, syndrome differentiation as well as giving patients oral Chinese medicine decoction, the symptoms of the patient were rapidly relieved within one week and did not recur during a six-month follow-up period. This case is the first clinical report of acute sarcoidosis LS treated using TCM and reflects the significant advantages of this form of therapy in emergency treatment

Ulnar Nerve Palsy as the Initial Presentation of Small Vessel Vasculitis With a Negative Antineutrophil Cytoplasmic Antibody Level

Small-vessel vasculitis is a rare disease entity that affects the arteries, arterioles, capillaries, and venules of the circulatory system. Small vessel vasculitis can cause severe small vessel inflammation and multisystem involvement. The respiratory tract and kidneys are the most commonly affected organs, and occasionally neurological manifestations can occur. But neurological manifestation as the initial presentation without other system involvement is very rare. We report a case of a 16-year-old previously well female patient presenting with right lower limb distal muscle weakness associated with malaise, lethargy, and multiple joint pains for 2 weeks. On examination, she had palpable purpura below the knees with right sided ulnar nerve palsy. Her antineutrophil cytoplasmic antibody and antinuclear antibody testing was negative. A skin biopsy showed vasculitis involving small vessels. She was started on Prednisolone 60mg daily, followed by Mycophenolate Mofetil 500mg twice daily, and physiotherapy. She had a good clinical response to treatment over time.

Contemplating the Role of Panchakarma in the Management of Psoriatic Arthritis and its Ayurvedic Perspective

Psoriatic arthritis is an inflammatory disorder that is chronic and progressive, which affects both skin and joints. Approximately 10-15% of patients who have psoriasis also develop an associated inflammation of their joint. Genetics, dietary, lifestyle related, environmental and psychological factors play a major role in pathogenesis. It is characterized by scaly skin lesion, itching, discharge, joint pain, swelling and stiffness. By considering these signs and symptoms, nearly it can be correlate to Dhatugata kusta, is a condition where in Vatapradhana tridosha affects the Gambhira dhatus causing by deterioration of Uttarottara dhatu. Thus, it is necessary to plan a treatment considering all the factors like Dosha, Dushya, Desha, Kala, Bala and Avastha of disease. Samshodhana is renowned for its ability to eradicate diseases at their core by eliminating morbid Doshas. The Doshas that are pacified by Shodhana never recurs; hence repeated Shodhana chikitsa helps in Bahudoshavastha. A 42 year male patient presented with complaints of silvery blackish scaly skin lesion all over the body. Associated with itching, blood mixed serous discharge, foul smell, multiple joint pain and stiffness visited Panchakarma OPD, GAMC Bengaluru. Patient treated with Pachana Deepana, Virechana, Takradhara and Kustaghna Basti. The present case study is intended to understand the accuracy of multimodal Panchakarma approach, which gives promising results and balance the Tridosha by eliminating the root cause of the disease.

Role of Matra Basti and Akshitarpan in the Management of Sjogren’s Syndrome W.S.R Vatadhikya Vatarakta: A Case Study

Sjögren’s syndrome, characterized by lymphocytic infiltration of salivary and lacrimal glands leading to glandular fibrosis and exocrine failure with Clinical manifestations of keratoconjunctivitis sicca, resulting from inadequate lubrication due to inflammatory infiltration of lacrimal glands, and xerostomia, manifesting as a dry mouth. In Ayurveda patient’s symptomatic representation can be correlated with vataadhkiya vatarakta. In the present case report, a 50-year-old female Lucy Chaudhary from Noida, Uttar Pradesh with complaints of dry eyes, dry mouth and pain in multiple joints with generalized weakness for the past three years. Previously she had taken allopathic treatment, but she did not have any relief. The patient was managed with Panchkarma procedures including Matra Basti and Akshi Tarpan for 16 days with an interval of 8 days. The therapy got its effective results in treating Sjögren's syndrome which depicts that Ayurveda therapeutic protocols can be successfully adopted in the case of Sjögren's syndrome.

A ROLE OF AYURVEDIC MANAGEMENT IN AAMVATA W.S.T TO RHEUMATOID ARTHRITIS A CASE STUDY

One of the most prevalent disorders, aamavat is caused due to impairement of agni (digestive fire) and vitiation of vata dosha in addition to two other doshas. Aamavata is the consequence of Aam combining with Vata dosha and occupying Shleshmsthan (Asthisandhi). The primary pathogenic elements that cause the Aamvata are Vata and Aama. It is Madhyam Rogamarg's vyadhi. The primary locations where cardinal symptoms like Sandhishool, Sandhisotha, and Sandhigraha appear are Asthi and Sandhi. In modern textbooks, it is associated with the disease "Rheumatoid Arthritis"¹ based on clinical sympto matology. Present case is a female patient aged 54 years female having history of pain and morning stiffness in multiple small joints for one year, swelling in both hand and knee joints for 4 months, and lowgrade fever. On taking complete history and clinical evaluation lead to the diagnosis of Aamvata.considering the symptoms of Aamvata patient is treated according to the line of treatment of Aamvata². i.e Swedan, deepan, virechan, snehpan etc. Along with oral drugs for 30 days. Before starting the treatment, the grading was done on the basis of subjective criteria and after treatment, the grade was reduced. There was no side effect observed during and after the treatment. Therapy gives significant relief in symptoms of Aamvata.

A Case of Thymoma Masquerading as Hiatus Hernia, Pericardial Effusion: A Diagnostic Dilemma

Thymoma is a rare neoplasm of the thymus gland, and as an adult, it accounts for 30% of anterior mediastinal tumors. The peak incidence is between 55 and 65 years old. Thymoma is a cancer that is extremely uncommon, accounting for just 0.2-1.5% of all malignancies, with an estimated incidence of between 0.13 and 0.32 per 100,000 people each year. We discuss a rare instance of a 58-year-old female patient who was admitted after complaining of multiple joint pain, gastroesophageal reflux disease (GERD), and generalized weakness. She was initially diagnosed with hiatus hernia and pericardial effusion based on imaging studies. However, her symptoms persisted despite treatment, and further evaluation revealed the presence of a thymoma. It was hard to make a diagnosis because the patient had a thymoma, a hiatus hernia, and pericardial effusion all at the same time. The initial diagnosis was complicated by the fact that the patient had unusual and refractory symptoms, which means they needed a thorough evaluation and follow-up. The case highlights the diagnostic complexity associated with thymoma, especially when coexisting with other conditions such as hiatus hernia and pericardial effusion. Despite its rarity, thymoma necessitates considerations in patients presenting with nonspecific symptoms, emphasizing the importance of thorough evaluation and follow-up. This underscores the need for a comprehensive diagnostic approach to ensure timely and accurate management, particularly in cases with an atypical and refractory presentation. In the described case, nurses' initial assessment skills are crucial for identifying the need for critical care intervention. Their role extends beyond the perioperative phase, encompassing patient education on procedures and potential outcomes.

ROLE OF AYURVEDA IN THE MANAGEMENT OF OBESITY (STHAULYA): A LITERARY REVIEW

In this era, most people are suffering from lifestyle disorders like cardiovascular diseases, asthma, chronic obstructive pulmonary diseases, diabetes mellitus, etc. unhealthy diet, wrong sleeping patterns, less physical activity, stress all these things are leading people towards lifestyle disorders. The occurrence of these diseases is directly linked to the day-to-day habits of an individual. People are inclined towards a sedentary lifestyle that can lead to various chronic diseases, which can have life-threatening consequences. Today’s generation has become physically inactive due to the modernization and development of multiple technologies, which leads people towards a sedentary lifestyle. Obesity (Sthaulya) is one of the lifestyle disorders which is more complex and invites several complications like hypertension, multiple joint pain, diabetes mellitus, fatty liver, etc. In Ayurveda, it is described under the term medoroga. In Charaka Samhita Acharya Charaka has described sthaulya under ashtoninditiya purusha. The main factor in sthaulya vyadhi is the abnormal function of med-dhatvagni. A metabolic disorder occurs due to an imbalance between the intake of energy and its expenditure, which results in the growth of adipose tissue and increased body weight. Ayurveda is one of the most ancient sciences which describes fundamental and applied principles of health disease and its management. There are many drugs, various formulations, pathya-apathya, dincharya, rutucharya, and yoga which are helpful in the treatment and prevention of obesity. Ayurveda has preventive and treatment aspects about sthaulya (obesity), which this article studies. The objective of this study is to study the effectiveness of ayurvedic management in obesity, to study obesity, to study sthaulya, study medoroga.

Blue-coloured keratoelastoidosis marginalis-like lesions intwo middle-aged women.

A woman in her 40s presented with bluish discoloration of palms of 4 years’ duration. She also had multiple large joint pains (shoulders and knees) and stiffness of the back, limiting her mobility. Another woman in her 40s presented with bluish discoloration of the palms and soles, progressive backache and knee, ankle and shoulder joint pains of 9 years’ duration.