| Rheumatoid ArthritisHomoeopathy : Rheumatoid ArthritisHomoeopathy The inflammation and destruction of joints caused by a chronic systemic autoimmune disorder is called Rheumatoid Arthritis.
Now
Homoeopathy is often on demand. Dr.S.K.M.SASTRY
M.D(Hom.) |
| Autoimmune Disorder !What is this? : Autoimmune Disorder !What is this? A disease that produces an immunogenic (i.e., immune system) response to some constituent of its own tissue. In other words the immune system loses its ability to recognize some tissue or system within the body as "self" and targets and attacks it as if it were foreign. Autoimmune diseases can be classified into those in which predominantly one organ is affected AUTOALLERGY |
| Autoimmune Disorder !Rheumatoid Arthritis : Autoimmune Disorder !Rheumatoid Arthritis A chronic systemic disease of the joints marked by inflammatory changes in the synovial membrane and articular structures by atrophy of bones. Later deformity & ankylosis is resulted.
RA caused by autoantibodies of the type IgM and hence called RA factor. The synovial fluid contain increased T-cells & macrophages. AUTOALLERGY |
| Rheumatoid Arthritis : Rheumatoid Arthritis Rheumatod arthritis usually affects joints symmetrically (on both sides equally), may initially begin in a couple of joints only & most frequently attacks the wrists, hands, elbows, shoulders, knees and ankles. |
| Inflammation of Synovium : Inflammation of Synovium |
| : Inflammation in the joints manifests itself as a soft, "doughy" swelling, causing pain and tenderness to palpation and movement, a sensation of localized warmth, and restricted movement. Increased stiffness upon waking is often a prominent feature and may last for more than an hour. These signs help distinguish rheumatoid from non-inflammatory diseases of the joints such as osteoarthritis (sometimes referred to as the "wear-and-tear" of the joints). In RA, the joints are usually affected in a fairly symmetrical fashion although the initial presentation may be asymmetrical. Joints |
| Slide 7 : muscle pain
deformed joints
weakness
fatigue
loss of appetite
weight loss
becoming confined to bed in severe cases Signs and symptoms |
| Slide 8 : Anemia due to failure of the bone marrow to produce enough new red cells
Eye burning, itching, and discharge
Hand and feet deformities
Limited range of motion
Low-grade fever Signs and symptoms |
| Slide 9 : Lung inflammation (pleurisy)
Numbness or tingling
Paleness
Round, painless nodules under the skin (usually a sign of more severe disease)
Skin redness or inflammation
Swollen glands Signs and symptoms |
| Signs and symptoms : Signs and symptoms Apart from joints Extra-articular ("outside the joints") are also with rheumatoid arthritis.
It is difficult to determine whether directly caused by the rheumatoid process or from side effects of the medicines commonly used to treat lung fibrosis from methotrexate, or osteoporosis from corticosteroids |
| Joint inflammation activity leads to erosion and destruction of the joint surfaceImpairs their range of movement and leads to deformity. The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes. : Joint inflammation activity leads to erosion and destruction of the joint surfaceImpairs their range of movement and leads to deformity. The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes. Ulnar deviation Boutonniere deformity
(A flower or small bunch of flowers worn in a buttonhole) swan neck deformity subluxation Joint deformities “z” thumb |
| RA consequences : RA consequences SKIN: Subcutaneous rheumatoid nodule, pyoderma gangrenosum, sweet’s syndrome, erythema nodosum, lobar panniculitis, atrophy of digital skin and palmar erythema.
Lungs: Fibrosis of the lungs due to medicines (methotrexate & influnomide. exposure to coal dust.
Kidneys: Renal amyloidosis due to chronic inflammation. Rheumatoid vasculitis is a rare cause of glomerular disease in the kidney. Pencillamine and gold salts cause membranous nephropathy. |
| RA consequences : RA consequences CVS: atherosclerosis, myocardial infarction, pericarditis, endocarditis,
Eye: Dry eyes, scleritis
Gastrointestinal and hematological: Felty syndrome, anaemia, thrombocytosis
Neurological: Peripheral neuropathy, mononeuritis |
| Diagnosis : Diagnosis X-rays of the hands and feet are generally performed in people with a polyarthritis. In rheumatoid arthritis, these may not show any changes in the early stages of the disease, but in more advanced cases demonstrates erosions and bone resorption. X-rays of other joints may be taken if symptoms of pain or swelling occur in those joints. |
| Diagnosis : Diagnosis Presence of bone erosion on X-Ray
Blood tests may show that you have anemia) and an antibody called rheumatoid factor (RF). (Some people with RF never get this disease, and others with the disease never have RF.) |
| Differential Diagnosis : Differential Diagnosis Gout and Pseudogout - usually involves particular joints aspiration of joint fluid clears the doubt
Osteoarthritis – X-Rays of the affected joints and blood tests
Systemic Lupus Erythamatous (SLE) - clinical symptoms and blood tests (antibodies against double-stranded DNA)
One of the several types of psoriatic Arthritis resembles RA - nail changes and skin symptoms help to differentiate.
Lyme disease causes erosive arthritis and may closely resemble RA - blood test in endemic areas
Reactive Arthritis (previously Reiter's disease) - asymmetrically involves heel,sacroiliac joints, and large joints of the leg. It is usually associated with urethritis, conjunctivitis, iritis, painless buccal ulcers, and kerat dermablenrrhagica.
Ankylosing spondylitis - this involves the spine and is usually diagnosed in males, although a RA-like symmetrical small-joint polyarthritis may occur in the context |
| Rarer causes : Rarer causes Sarcoidosis, amyloidosis, and whipple’s disease resemble RA.
hemachromatosis causes hand joint arthritis.
Acute rheumatic fever can be differentiated from RA by a migratory pattern
Bacterial arthritis is usually asymmetric, while RA usually involves both sides of the body symmetrically. |
| Pathology : Pathology It belongs to TypeIII/TypeIV hypersensitivity mechanisms.Type III (called also immune-complex or subacute hypersensitivity) causes tissue damage and inflammation by the deposition of antigen-antibody complexes that activate complement and attract polymorphonuclear cells. Type IV (called also delayed hypersensitivity) involves sensitized T lymphocytes that react with cell bound or associated antigen and release lymphokines, causing mononuclear cell accumulation, tissue damage and inflammation, typically manifesting at least 24 hours after exposure to the antigen.
Cytokines (chemical mediators) give rise to inflammation of joint synovium. Constitutional symptoms such as fever, malaise, loss of appetite and weight loss are also due to cytokines released in to the blood stream. Blood vessel inflammation (vasculitis) affecting many other organ systems can give rise to systemic complications.
As with most autoimmune disease, it is important to distinguish between the cause(s) that trigger the inflammatory process, and those that permit it to persist and progress. |
| Pathology : Pathology The pathology of rheumatoid arthritis within the first few months after symptom onset is distinct from that of the early phases of other inflammatory joint diseases and also of established rheumatoid arthritis.
Initially rheumatoid arthritis is characterised by a distinct profile of “T” cell, macrophage and stromal cell related cytokines in synovial fluid. The synovium, the connective tissue membrane that lines the joints, is the primary site of pathology in rheumatoid arthritis. |
| Important Facts : Important Facts Rheumatoid arthritis (RA) results from an abnormal immune system response
The cause for rheumatoid arthritis is unknown
Rheumatoid arthritis is more common in women
A genetic (hereditary) risk factor for RA has been identified
Vasculitis: Osteoporosis caused by cytokines, Lymphoma |
| Risk Factors and Causes : Risk Factors and Causes The cause for RA is unknown;
Approximately 70–80% of patients who have RA also have high levels of an antibody called rheumatoid factor, which may indicate an immune system abnormality
An antibody is a protein that is produced in response to antigens (cell markers). Not all people who have high levels of rheumatoid factor have RA, and not all patients who have RA have elevated levels of rheumatoid factor |
| Risk factors : Risk factors Gender : women suffer 2 to 3 times more
Genetics : (heredity). RA often is affected by pregnancy—symptoms improve before the infant is born and then worsen after delivery—it may be that hormones in the body influence disease development and progression. The genetic marker HLA-DR4
Several genes have been identified that increase the risk for developing rheumatoid arthritis. For example, This marker, which is present in white blood cells, plays a role in helping the immune system to distinguish between foreign cells (e.g., germs) and the body's own cells.
RA requires susceptibility to the disease through genetic endowment with specific markers and an infectious event that triggers an autoimmune response
cigarette smoking |
| Triggering points : Triggering points The triggered B lymphocytes produce immunoglobins and rheumatoid factors of the IgG and IgM classes that are deposited in the tissue. This subsequently leads activate phagocytic arm of the immune response, leads to the inflammation of the synovium, leading to edema, vasodilation and infiltration by activated T-cells (mainly CD4 in nodular aggregates and CD8 in diffuse infiltrates).
The synovium thickens, the cartilage and the underlying bone begins to disintegrate and evidence of joint destruction accrues. |
| Important points : Important points There is also no clear evidence that physical and emotional effects, stress and improper diet could be a trigger for the disease.
Epidemiological studies have confirmed a potential association between RA and two herpesvirus infections: Should we ignore ?
later |
| Treatment : Treatment There is no known cure for rheumatoid arthritis, but many different types of treatment can alleviate symptoms and/or modify the disease process.
The goal of treatment is two-fold: alleviating the current symptoms, and preventing the future destruction of the joints with the resulting handicap if the disease is left unchecked. These two goals may not always coincide: while pain relievers may achieve the first goal, they do not have any impact on the long-term consequences.
Anti-inflammatories and analgesics improve pain and stiffness but do not prevent joint damage or slow the disease progression. |
| RA & Homoeopathy : RA & Homoeopathy Rheumatoid arthritis is a chronic disorder means that body’s own defense cells attack the joint lining and cause gross changes in them. Although it affect anybody at nearly all ages, this disorders is more common in women and is more common between the ages of 20-50. Diagnoses of arthritis is made on combination of factors; by assessing medical history. It is essential for us to first know about the role of homoeopathy in autoimmune disorder. |
| Autoimmune disorders - Analysis : Autoimmune disorders - Analysis PHYSICAL –
Autoimmunity or auto – allergy: self attack.
Modern medicine talks about physical factors (the tissues fighting against own tissues). We have studied sofar. MENTAL
Autoimmunity or auto – allergy: self attack
Mind tissues (invisible) fights against it’s own mind tissues (invisible), which leads to destruction of mental tissues (invisible) which follow body tissues
Homoeopathy talks little beyond i.e at mental level. Physical being is not different from Mental being |
| Homoeopathic consideration : Homoeopathic consideration Homoeopathy has some favourable notes for RA patients.
Homoeopathy aims at over all patient not merely the disease and it is not to suppress or to give temporary relief.
The time for its treatment is dependent on various factors-The chronicity of the disease (the duration since the disease has been in the body), genetic propensity and the extent of damage. |
| What is to be known in RA : What is to be known in RA Proper evaluation of the patient.
Although RA is a complex disorder every patient expresses special characteristics differing from another.
Proper assessment of curability.
Mental & Physical Constitution. help to select right remedy
Miasmatic analysis guides the remedy
The duration & invasion of disease also play mojor role |
| Homoeopathic explanation : Homoeopathic explanation Homoeopathy may not be in a position to explain how it works in rheumatoid arthritis but, it undoubtedly regulate the immune system and deactivates the misdirected immune cells. They also help in reducing the inflammation in the joints too. Reversal of deformity with homoeopathy is still under debate and nothing conclusive can be said about it.
In incurable cases it certainly palliates. |
| Homoeopathic medicines : Homoeopathic medicines Homoeopathy is based on the law of similars (like cure like) means that substances which in their raw states produce symptoms similar to the disease have the potential to stimulate the body’s own restorative process for a similar illness when given in potentised form when rightly prescribed, they are extremely safe.
Homoeopathic doses activate the inner dynamic vital force of the patient to fight against the ill forces that have mislead the immune system. SYPHILLIS, PSORA, SYCOSIS |
| Homeopathic Remedies : Homeopathic Remedies Arnica,Aur.met, Bryonia, Calc.Carb, calc.fl. causticum, Dulcamera., Kali.Bich., kali.Carb., Ledm,. Pulsatilla, Rhodo. Rhus.Tox, Ruta.colch. amm.phos, pic.acid.
Merc. Syphilinum.symphytum,
Colchicum etc. |
| Slide 33 : THANK U |