Diagnosis and Sympotms of Rheumatoid Arthritis and Simillimum

With an advancement of the medicine, physicians and researchers have tried to come up with a variety of treatment plans for various diseases. Some of them were effective and others were not so effective. One such ailments in which the outcome was not so effective is Rheumatoid arthritis. With the series of clinical practice physicians realised that not only the latent power of homoeopathy effectively helps to cure the sickness but also helps in the symptomatic management of the case without any long term side effects on the patient, unlike other system of medicines. In this article, a collective group of homoeopathic medicines are grouped together for their therapeutic application by homoeopaths.

Rheumatoid arthritis is referred as the condition leading to the inflammation of synovial membrane in multiple joints. It is a chronic, symmetrical, non-suppurative condition and the criteria of its diagnosis was laid down by the American Rheumatism Association in 1987. It is an autoimmune disorder with an unspecified etiology but several factors had been observe to play an important role in its initiation. It is mostly associated with genetics and secondly it is observed to show the linkage to the exposure of some agents such as mycoplasma, clostridium and some virus. The exposure to the virus in a genetically predisposed individual leads to the formation of IgM antibodies in the serum and the activation of an autoimmune disorder.

Pathology due to the inflammation of synovial membrane there is an increase in synovial boundaries of articular surface are maintained. 3. Irreversible with major degree of destruction : there is irreversible damage to the joint and cartilage which leads to deformities and in advance cases the subluxation and dislocation of the joint Criteria by American Rheumatism Association 1. Morning stiffness fluid initially which later on get hypertrophied and pannus is formed surrounding the cartilage. The cartilage is changed in its appearance and elasticity as the pannus extends deep upto the bone, leaving it raw and painful. The joint is left deformed and painful due to fibrosis of the capsule and thus leads to deformation of joint on further progression of disease. The surrounding tissues also develop some anomalies and adds on to the progression of disease. Course of disease varies from patient to patient. It range from mild to severe. It is mostly observed in the young individuals of age starting from 20 to 30 years, where females are comparatively more prone than males. Apart from the linkage to virus, some precipitating factors are over exertion, stress, trauma and other infections as well.

Staging of Rheumatoid Arthritis

Reversible : there is no destructive change seen on the X-ray film and the inflammation is restricted to the synovium.

Irreversible with minor degree of destruction : in this the minor changes can be seen in the synovium such as reduction in space and early cartilaginous changes on the X-ray film:

1. Swelling of three or more joints
2. Swelling of joints in hands and wrist
3. Symmetrical swellings
4. Rheumatoid factor positive
5. Rheumatoid nodules present
6. X- Ray changes

Presence of more than four of these symptoms points towards the Rheumatoid arthritis. Small joints are mainly involved In rheumatoid arthritis such as phalangeal joints metacarpophalangeal (MP) joints, posterior proximal interphalangeal (PIP) joints, wrists, knee, elbows etc rather than the involvement of large joints such as hip joints, atlantoaxial joints etc. Clinical examination often reveals the involvement of multiple joints with oedema, severe muscle spasm, restricted range of motion, raised temperature of the joints along with typical joints deformities like Swan-neck deformities, Boutonniere deformities, hammer toe deformities, Ulnar deviation and flexion deformities.

Investigations:

1. X-Ray : reduce joint space with erosion
2. Blood tests : ESR is raised Decrease in Haemoglobin Rheumatoid factor positive
3. Synovial fluid examination: Inflammatory
4. Anti cyclic citrullinated peptide (Anti-CCP): positive

Differential diagnosis includes:

1. Systemic lupus erythematosus: The symmetrical involvement of joints is not present. Also the erosion is not commonly observed.
2. Osteoarthritis: This usually occurs in old people and majorly involves large joints. The intensity of symptoms is way less as compared to Rheumatoid arthritis.
3. Psoriatic arthropathy: Absence of Rheumatoid factor along with the involvement of nails and skin.

Management by Homoeopathic Remedies:

1. Colchicum autumnale: Affects the muscular, periosteum and synovial membranes of joints markedly. Joints stiff and feverish, shifting rheumatism, aggravation from motion, mental exertion. Amelioration by stooping.
2. Causticum: Manifestations specially on the chronic rheumatism. Contracted tearing pains in limb, amelioration by warmth and aggravation by dry cold winds, cold air.
3. Gaultheria procumbens: Inflammatory rheumatism is the characterstic feature of this remedy. Dosage is directed in tincture and low potencies.
4. Guaicum officinale: Chiefly suitable remedy for arthritic diathesis, rheumatism. Immovable stiffness. Aggravation by heat, cold weather and amelioration by external pressure.
5. Pulsatilla prantensis: Female predominant remedy for the women with weeping tendency. Especially suitable for a female ailments at puberty. Numbness around the elbow. Aggravation from heat, lying on left or painless side, allowing the feet to hang down. Amelioration by open air, motion and cold application.

Conclusion

According to the study above, we can interpret that the Simillimum can be found depending upon the totality of symptoms. The remedy will not only help in providing the symptomatic relief but will also help to achieve the cure where the causative factor is linked with mental trauma. The physician can choose the most suitable remedy according to the case for his clinical applications in homoeopathy.