AYURVEDIC TREATMENT OF RHEUMATOID ARTHRITIS: A CASE STUDY

Pain makes us conscious for the presence of the injurious agent and that is why we seek removal of the injurious agent by appropriate measures. Rheumatoid arthritis (RA) is corelated with aamvata in Ayurved. Rheumatoid arthritis is basically an autoimmune chronic inflammatory disorder that mainly affects the symmetrical metacarpophalangeal joint and more than two to three proximal interphalangeal small joints of the body. This disease is commonly found in females as compared to males. The female male ratio is 3:1. Prevalence of Rheumatoid arthritis increases with age, with 5% of women and 2% of men over 55 years being affected. Rheumatoid arthritis is rare in men under the age of 45, where there is 6:1 female surplus. It’s a very painful disease which usually cause tender, swelling and inflammation in joints. Joint stiffness worse in the morning and remain for more than one hour. Chronic inflammation, granuloma formation and joint destruction is commonly seen. Fatigue, fever, weight loss, irritation and depression are also the most common non-articular symptoms. A satisfactory treatment is available in Ayurvedic medicine for this disorder. Various Ayurvedic drugs have been proved useful for these manifestations. This case report is a classic case of Rheumatoid arthritis, which was treated for six months under the name of aamvata with Ayurvedic drugs. The patient was on modern medicine and we efficaciously exchange him from conventional modern medicine to ayurvedic medicine.

Download Full-text

Rheumatoid arthritis synovial fluid neutrophils drive inflammation through production of chemokines, reactive oxygen species and neutrophil extracellular traps

10.1101/2020.07.16.20155291 ◽

2020 ◽

Author(s):

Helen L Wright ◽

Max Lyon ◽

Elinor A Chapman ◽

Robert J Moots ◽

Steven W Edwards

Keyword(s):

Rheumatoid Arthritis ◽

Synovial Fluid ◽

Neutrophil Migration ◽

Joint Damage ◽

Inflammatory Disorder ◽

Ros Production ◽

Chronic Inflammatory Disorder ◽

Adaptive Immune Cells ◽

Activated Neutrophils ◽

Healthy Control

Rheumatoid arthritis (RA) is a chronic inflammatory disorder affecting synovial joints. Neutrophils are believed to play an important role in both the initiation and progression of RA, and large numbers of activated neutrophils are found within both synovial fluid (SF) and synovial tissue from RA joints. In this study we analysed paired blood and SF neutrophils from patients with severe, active RA (DAS28>5.1, n=3) using RNA-seq. 772 genes were significantly different between blood and SF neutrophils. IPA analysis predicted that SF neutrophils had increased expression of chemokines and ROS production, delayed apoptosis, and activation of signalling cascades regulating the production of NETs. This activated phenotype was confirmed experimentally by incubating healthy control neutrophils in cell-free RA SF, which was able to delay apoptosis and induce ROS production in both unprimed and TNFα primed neutrophils (p<0.05). RA SF significantly increased neutrophil migration through 3μM transwell chambers (p<0.05) and also increased production of NETs by healthy control neutrophils, including exposure of myeloperoxidase (MPO) and citrullinated histone-H3-positive DNA NETs. IPA analysis predicted NET production was mediated by signalling networks including AKT, RAF1, SRC and NF-κB. Our results expand the understanding of the molecular changes that take place in the neutrophil transcriptome during migration into inflamed joints in RA, and the altered phenotype in RA SF neutrophils. Specifically, RA SF neutrophils lose their migratory properties, residing within the joint to generate signals that promote joint damage, as well as inflammation via recruitment and activation of both innate and adaptive immune cells. We propose that this activated SF neutrophil phenotype contributes to the chronic inflammation and progressive damage to cartilage and bone observed in patients with RA.

Download Full-text

A Severe Necrotizing Inflammatory Reaction of Leg Wounds Following Autologous Peripheral Blood Total Nucleated Cells Treatment in an Old Patient With Rheumatoid Arthritis and No-Option Chronic Limb-Threatening Ischemia: Is Cell Therapy Suitable for All Patients?

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734621997570 ◽

2021 ◽

pp. 153473462199757

Author(s):

Valerio Vallini ◽

Luigi Venturini ◽

Paolo Carnesecchi ◽

Roberto Andreini ◽

Simone Meini

Keyword(s):

Rheumatoid Arthritis ◽

Cell Therapy ◽

Inflammatory Reaction ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Inflammatory Diseases ◽

Inflammatory Disorder ◽

Skin Atrophy ◽

Chronic Inflammatory Disorder ◽

Increased Risk

Chronic limb-threatening ischemia (CLTI) represents an unfavorable evolution of peripheral artery disease, characterized by pain at rest, ulceration, and gangrene and also by an increased risk of cardiovascular events, amputations, and death. According to scientific literature, in almost one third of cases affected by CLTI, defined as no-option CLTI patients, revascularization strategies are not feasible. In the past decade, several studies investigated the role of therapeutic angiogenesis through cell autologous therapy, administered through intramuscular injections or multiple local intralesional and perilesional injections. In this article, we report the case of a necrotizing inflammatory reaction in a patient affected by CLTI and chronic leg wounds that occurred on the multiple injection sites after autologous peripheral blood-derived mononuclear cells (PB-TNCs) transplantation. Since the patient was affected by corticosteroid-induced skin atrophy and rheumatoid arthritis, we hypothesize that an increased skin fragility and a mechanism of immune-mediated pathergy could have been main factors leading to worsening of wounds. This case report strongly suggests the urgent need to better define the indications and contraindications of cell therapy, and further studies of adequate methodology are required to definitively assess the efficacy and safety of autologous cell therapy by local injections of PB-TNCs in patients with chronic inflammatory disorder, such as rheumatoid arthritis, especially in case of concomitant marked skin atrophy. Pending definitive evidence from literature, a strong caution is needed in patients affected by chronic systemic inflammatory diseases, since multiple injections, acting as mechanical stimulus and pathergy trigger, might exacerbate a severe and uncontrolled inflammatory response.

Download Full-text

Smart Drug-Delivery Systems in the Treatment of Rheumatoid Arthritis: Current, Future Perspectives

10.5772/intechopen.99641 ◽

2021 ◽

Author(s):

Largee Biswas ◽

Vikas Shukla ◽

Vijay Kumar ◽

Anita Kamra Verma

Keyword(s):

Rheumatoid Arthritis ◽

Drug Delivery ◽

Drug Delivery Systems ◽

Folate Receptor ◽

Joint Destruction ◽

Delivery Systems ◽

Inflammatory Disorder ◽

Emerging Trends ◽

Smart Drug ◽

Smart Drug Delivery

Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disorder characterized by cellular infiltration in synovium causing joint destruction and bone erosion. The heterogeneous nature of the disease manifests in different clinical forms, hence treatment of RA still remains obscure. Treatments are limited owing to systemic toxicity by dose-escalation and lack of selectivity. To overcome these limitations, Smart drug delivery systems (SDDS) are under investigation to exploit the arthritic microenvironment either by passive targeting or active targeting to the inflamed joints via folate receptor, CD44, angiogenesis, integrins. This review comprehensively deliberates upon understanding the pathophysiology of RA and role of SDDSs, highlighting the emerging trends for RA nanotherapeutics.

Download Full-text

Temporomandibular Joint Monoarthritis in Rheumatoid Arthritis - A Rare Case Report

Bangladesh Medical Journal ◽

10.3329/bmj.v48i3.51797 ◽

2021 ◽

Vol 48 (3) ◽

pp. 43-45

Author(s):

Md Abu Shahin ◽

Sudhir Karmacharya ◽

Md Ariful Islam ◽

Mamun Khan ◽

Abdulla Al Morshed ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Temporomandibular Joint ◽

High Titer ◽

Clinical Signs ◽

Joint Stiffness ◽

Signs And Symptoms ◽

Joint Inflammation ◽

Joint Involvement ◽

Inflammatory Disorder ◽

Clinical Signs And Symptoms

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ) is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the rheumatologist. TMJ complaints are present in about more than 50% of patients of RA. TMJ is usually among the last joint to be involved and is associated with many clinical signs and symptoms of which pain is a major problem leading to inflammation, limited movements, swelling, joint stiffness, and muscle spasm. Here reported case is 64 years old male, ex-smoker, diagnosed case of diabetes mellitus for 7 years, hypertension for 2 years, came to hospital with the complains of pain in left jaw for 1 year. He had no history of other joint pain, morning stiffness or any deformities. The patient was diagnosed as a case of rheumatoid arthritis on the basis of inflammatory monoarthritis with high titer positive RA factor and anti CCP. The patient gradually improved after treatment with methotrexate. Inflammatory markers like ESR dropped down with the clinical improvement. TMJ is seldom joint to be affected first in the disease course. Bangladesh Med J. 2019 Sep; 48 (3): 43-45

Download Full-text

Rheumatoid Arthritis Management for General Internists

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v8i0.104 ◽

2016 ◽

Vol 8 ◽

Author(s):

Mitchell Uh MD FRCPC ◽

David Collins MD FRCPC ABIM

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Joint Destruction ◽

Morbidity And Mortality ◽

Inflammatory Disorder ◽

General Internists ◽

Canadian Population ◽

Increased Risk ◽

Significant Disability

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that causes progressive joint destruction, deformity, and significant disability. In addition to arthritis, RA is associated with numerous extra-articular features with attendant morbidity and mortality. These include but are not limited to ocular inflammation, interstitial lung disease, pleuropericardial disease, vasculitis, accelerated atherosclerosis, and increased risk of lymphoma. The prevalence of RA in the Canadian population is approximately 1%.

Download Full-text

Comprehensive Review on Ayurvedic Formulations and Herbal Medicines for Treatment of Rheumatoid Arthritis

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/07218 ◽

2021 ◽

Vol 23 (07) ◽

pp. 772-790

Author(s):

Farha Sultana ◽

◽

Bhavika Arora ◽

Sandeep Arora ◽

Rakesh K. Sindhu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Joint Destruction ◽

Herbal Medicines ◽

Inflammatory Disorder ◽

Infectious Agents ◽

Genetic Changes ◽

First Choice ◽

Environmental Agents ◽

Herbal Therapies ◽

Cartilage Erosion

Rheumatoid arthritis, an autoimmune inflammatory disorder is characterized by progressive cartilage erosion leading to joint destruction, pain, stiffness, and swelling. Although the etiology of the disease is unknown, genetic changes due to factors such as environmental agents, immune response towards infectious agents influence rheumatoid arthritis. Earlier NSAIDs were the first choice of drugs for the treatment of disease but due to having certain side effects and limitations, herbal therapies which possess higher efficacy and safety are now in demand. There are hundreds of plants that have phytoconstituents that exhibit anti-inflammatory activity. A combination of plants is used to make polyherbal formulations that act synergistically to give anti-arthritic activity. The review is about the botanicals and traditional formulations which have been clinically tested for the treatment of Rheumatoid arthritis.

Download Full-text

Modelling rheumatoid arthritis: A hybrid modelling framework to describe pannus formation in a small joint

10.1101/2021.09.02.458714 ◽

2021 ◽

Author(s):

Fiona R Macfarlane ◽

Mark AJ Chaplain ◽

Raluca Eftimie

Keyword(s):

Rheumatoid Arthritis ◽

Numerical Simulations ◽

Model Parameters ◽

Inflammatory Disorder ◽

Pannus Formation ◽

Chronic Inflammatory Disorder ◽

Modelling Framework ◽

Small Joint ◽

Pip Joint ◽

The Impact

AbstractRheumatoid arthritis (RA) is a chronic inflammatory disorder that causes pain, swelling and stiffness in the joints, and negatively impacts the life of affected patients. The disease does not have a cure yet, as there are still many aspects of this complex disorder that are not fully understood. While mathematical models can shed light on some of these aspects, to date there are not many such models that can be used to better understand the disease. As a first step in the mechanistic understanding of RA, in this study we introduce a new hybrid mathematical modelling framework that describes pannus formation in a small proximal interphalangeal (PIP) joint. We perform numerical simulations with this new model, to investigate the impact of different levels of immune cells (macrophages and fibroblasts) on the degradation of bone and cartilage. Since many model parameters are unknown and cannot be estimated due to a lack of experiments, we also perform a sensitivity analysis of model outputs to various model parameters (single parameters or combinations of parameters). Finally, we connect our numerical results with current treatments for RA, by discussing our numerical simulations in the context of various drug therapies using, for example, methotrexate, TNF-inhibitors or tocilizumab, which can impact different model parameters.

Download Full-text

The Influence of Rheumatoid Arthritis on Work Productivity among a Sample of Iraqi Patients

Al-Rafidain Journal of Medical Sciences ( ISSN: 2789-3219 ) ◽

10.54133/ajms.v1i.47 ◽

2021 ◽

Vol 1 ◽

pp. 110-117

Author(s):

Faiq Isho Gorial ◽

Sattar Jabbar Naema ◽

Hameed Oda Ali ◽

Saad Abdulrahman Hussain

Keyword(s):

Rheumatoid Arthritis ◽

Work Productivity ◽

Control Group ◽

Inflammatory Disorder ◽

Chronic Inflammatory Disorder ◽

Daily Life Activities ◽

Rheumatology Unit ◽

Medical City ◽

The Impact ◽

Control Study

Background: Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that impact daily life activities. The impact on work productivity is critical because of persistent work disability. Aim: To evaluate work productivity in RA patients compared to healthy controls, and to assess the impact of socio-demographic characteristics on work productivity. Methods: This was a case-control study conducted at the Rheumatology Unit of Baghdad Teaching Hospital, Medical City during the period from August 2020 to the end of March 2021. Seventy-two patients with RA were selected and compared with 72 healthy subjects as a control group. All patients were diagnosed according to ACR/EULAR 2010 RA classification criteria. The socio-demographic and clinical features, lifestyle practices, and disease activity of the patients and controls were all recorded during interviews. A standardized Arabic version of the Workplace Activity Limitation Scale (WALS) and the Job Limitations Questionnaire were used to assess the impact of RA on work productivity (WLQ-25). Results: The vast majority of patients were females (58.1%). Positive rheumatoid factor was reported in 94.4% of the patients. The patients showed a significantly lower WALS total score and higher WLQ-25 total score median (IQR) compared with controls. Conclusion: Active RA impairs the work productivity which was influenced by CDAI score and negatively associated with the use of DMARDs.

Download Full-text

Joint Ventures: Helping Those With Rheumatoid Arthritis Live Well

International Journal of Yoga Therapy ◽

10.17761/ijyt.23.2.m453443w8g822207 ◽

2013 ◽

Vol 23 (2) ◽

pp. 91-100 ◽

Cited By ~ 1

Author(s):

Aggie Stewart

Keyword(s):

Quality Of Life ◽

Rheumatoid Arthritis ◽

Stress Reduction ◽

Symptom Relief ◽

Well Being ◽

Inflammatory Disorder ◽

Yoga Therapy ◽

Chronic Inflammatory Disorder ◽

Stiffness Loss

Objectives: Rheumatoid arthritis (RA) is an autoimmune, chronic inflammatory disorder that causes pain, swelling, stiffness, loss of joint function, and reduced quality of life. Yoga therapy may help individuals with RA manage stress and increase well-being. This study focused on the identification of therapeutic objectives and a methodology to achieve symptom relief, regain function, and enhance quality of life for individuals with RA. Methods: Four women with RA participated in private yoga therapy sessions for 2.5 months. Assessment based, tailored home practices were developed and modified to address participant - identified goals. Results: Participants reported decreased pain, fatigue, swelling, and flares; increased energy; pain-free range of motion and strength around affected joints; and a heightened sense of well-being. Conclusions: Tailored yoga therapy that emphasizes stress reduction may be beneficial for individuals with RA.

Download Full-text

Hydrogels in the treatment of rheumatoid arthritis: drug delivery systems and artificial matrices for dynamic in vitro models

Journal of Materials Science Materials in Medicine ◽

10.1007/s10856-021-06547-1 ◽

2021 ◽

Vol 32 (7) ◽

Author(s):

Isabel Maria Oliveira ◽

Diogo Castro Fernandes ◽

Ibrahim Fatih Cengiz ◽

Rui Luís Reis ◽

Joaquim Miguel Oliveira

Keyword(s):

Rheumatoid Arthritis ◽

Drug Delivery ◽

In Vitro Models ◽

Delivery Systems ◽

Disease Models ◽

Inflammatory Disorder ◽

Tissue Destruction ◽

Animal Testing ◽

Chronic Inflammatory Disorder

AbstractRheumatoid arthritis (RA) is an autoimmune and chronic inflammatory disorder that mostly affects the synovial joints and can promote both cartilage and bone tissue destruction. Several conservative treatments are available to relieve pain and control the inflammation; however, traditional drugs administration are not fully effective and present severe undesired side effects. Hydrogels are a very attractive platform as a drug delivery system to guarantee these handicaps are reduced, and the therapeutic effect from the drugs is maximized. Furthermore, hydrogels can mimic the physiological microenvironment and have the mechanical behavior needed for use as cartilage in vitro model. The testing of these advanced delivery systems is still bound to animal disease models that have shown low predictability. Alternatively, hydrogel-based human dynamic in vitro systems can be used to model diseases, bypassing some of the animal testing problems. RA dynamic disease models are still in an embryonary stage since advances regarding healthy and inflamed cartilage models are currently giving the first steps regarding complexity increase. Herein, recent studies using hydrogels in the treatment of RA, featuring different hydrogel formulations are discussed. Besides, their use as artificial extracellular matrices in dynamic in vitro articular cartilage is also reviewed.

Download Full-text