Transcript arthritis n theraps

INTRODUCTION
The Almighty gave us legs to walk on gave us mobility; to
carry us from place to place and gave us hands to be
creative, to perform the daily chores of life and to carry the
burden of mankind.
Primitive hunting man used to walk miles to hunt food
for himself and his family. He had to have strong legs to do
this day in and day out. Since there was never any certainty
where he would go and what he would find, his limbs were
tuned to work that extra mile or two if the need arose. In
those days, limbs or rather the joints served man faithfully
for really long number of years and most mortals were
mobile till death.
But then came the Industrial Evolution and Man had to develop
different faculties. The joints were used less and less till life became
almost sedentary :
From Home  elevator  car  Office  elevator.
The only exercise people indulged in is climbing walls and
jumping to conclusions! The joints now had to be prescribed exercise
by doctors, as a must for maintaining mobility and good health.
As a result of disuse – joints stiffened, synovial fluid dried up,
joints started degenerating earlier. Every which way you looked at it,
the joint refused to cooperate. What more can you call spondylitis in
early 30s and sever OA knee in mid 40s?
JOINTS
Definition :
It is a junction between two o more
bones or cartilage.
It is a device to permit movements.
There are more joints in the child than
in an adult.
Classification of Joints
Functional
1) Synapthrosis
Immovable It.
2) Amphiarthosis - Slights movable
3) Diarthrosis
- Freely movable
Structural Classification
1. Fibrous Joint
2,Cartilaginous Joints
* Synchonorosis or Hyaline Cartilage Joints.
It B/w Epiphysis and diphysis of a growing long bone.
Example :
Spheno – Occipital Bone.
Costochondral and Coststernal Joint.
* Symphysis or fibro cartilaginous Joints.
Example:
Symphysis pubis
Manabrio sternal joint
3. Synovial Joints or Diarthrodial Joints
• Also k/s Freely movable joints
• The ends of tow bones are held together by joint
capsule,
with ligaments and tendons inserted
at the outer surface of capsule.
• A synovial joint has a fluid filled cavity. The fluid
is known as synovial fluid (produced)
• Synovial fluid acts as lubricant.
• Most of the disease of Joints affected Diarthrodial
or Synovial Joints.
Types of Synovial Joints & their movements
1 .Plane or Gliding movement
•Example•
Intercarnel Joints
Inter tarsal joints
Joints b/w bertebras
•Movements – Gliding movements.
Hinge Joints
•Uniaxial Joints
•Movements are limited in one
plane.
Example - elbow joint
Ankle joint
Interphalangeal joints
•movements - Flexion & extension
Pivoto Joints
•Uniaxial Joints
•Example ulnar.
•Movement -
superior and inferior radio
Median Atlanto axial joints
Rotation only
Condoyle Joints
• Joints permit movements mainly in one plane around
transverse axial
but partly in another plane around vertical axis.
• Movement possible –
Flexion & extension & limited
rotation.
• Example
Knee joint
right & left Saw joints 260
Ellipsoid Joints
•Biaxial Joints
•Free movement are permitted around both the axis.
•Movements Possible –Flexion, Extension
abduction, adduction and circumduction.
•Example
wrist Joints
Metacarpophalengeal joints.
Saddle Joint (Seller)
•Multiaxial Joints
•Move possible-- Flexion, Extension, adduction, abduction
and conduct rotation.
•Example 
Sternoclavicular joint
Calcaneocuboid joint
Ball and socket Joint
(Spherodial)
•Multiaxial joint
•Movements occurs around and
indefinite number of axes which have
common centre.
•Movements-Flexion, extension,
abduction, adduction,
medial rotation,
Lateral rotation and
circumduction.
•Example - Shoulder joint
Hip joint
Talocalcaneonavicular joint
Factor maintaining stability of joint
•
Muscles
•
•
Ligaments
Bones
Aging & Joints
•
With aging, a decrease in synovial
fluid, thinning articular cartilage and
decrease flexibility ligament occur.
• Most individual experience some
degeneration is the knees, elbows, hips
and shoulder due to aging presses.
ARTHRITIS
• It is a form of Rheumatism in
which joints have become
inflamed and painful
• Characterized by
Inflammation, Pain
and stiffness and moving
usability
• Arthritis affects about 10 %
people of world Population.
• Most common in older Aged
people due thinking of
particular cartilage and
decrease in
synovial fluid
Also due to injury, Truma, Allergy and
infections disease spread such as
•Tuberculosis.
•Gonococcal
•Syphilitic etc.
Important cause of Arthritis
1. Diffused connection tissue disease such as RA
2. Degenerative joint disease such as OA.
3.Metabolic and endocrine Disease
such as Gouty Arthritis.
CLINICAL MANIFESTATION
(1) Arthralgia
-
Pains in Joint
(2) Chondritis
-
Inflammation of Cartilage
(3 Synovitis -
Inflation of a Synovial membrane.
in joint.
CLASIFICATION OF
ARTHRITIS
1. Rheumatoid Arthritis – and its variants such as
Arthritis with psoriasis
Juvenile rheumatoid arthritis
Rheumatic spondylitis
Reiter’s syndrome
2. Arthritis due to rheumatic fever.
3. Osteoarthritis.
4.Arthritis associated with known infectious
agents – e.g.
Gonococcal,
Tuberculoses – most common
Involve – spine, hip join &
Knee joints
Tuberculosis of spine is
termed as POTTS DISEASE
Spondylitis.
Syphilitic –
Pneumococcal, etc.
5. Associated with metabolic or bio-chemical
or endocrine abnormalities Gout, hemoglobinopathies, onchronosis,
acromegaly, etc.
6.Traumatic arthritis
7.Neuropathic arthritis
8.Allergy and drug reaction.
9. Arthritis with blood disorders
10. Connective tissue disease –
S.L.E.
Polyarhteritis nodosa,
Dermatomyositis.
11. Miscellaneous Disorders Amyloidosis
Erythema multiform,
Ulcerative colitis,
Sarcoidosis
OSTEOARTHRITIS (O.A)
Also called as Osteorthrosis or
Degenerative Joint Disease
Result from a combination of aging,
irritation of joints, wear and
abrasion.
• Commonly known as wear and tear
arthritis and
leading cause of disability in older
individuals.
• Most common form of chronic
disorder of synovial joints
particulars weight bearing joint
In Older Age. The Articular cartilage show
Degenerative changes in CENTRE (Fibrillation of
cartilage)
And
Proliferative change around the edges (Osteophytes )
It is characterized by :
Degeneration of the cartilage with
associated over growth of bone at the margin of
joints
And
Changes in synovial membrane
Affect up to 10% of world population
IT COMMONLY INVOLVES :
•The distal IP joints of the fingers- to form
bony swelling – The Heber den nodes.
• The proximal Interphalangeal finger
joints – to form bony swelling –
The Bouchard nodes
The lumbar spine –
lumbar spondylitis
•The cervical spine –
cervical spondylitis.
•The large joints –
including Hips and Knees.
PRIIMARY– OESTEOARTHRITIES 
•Occur more commonly in women than men .
•Progress begin by end of 4th decade.
Pathogenesis
-Wear and tear with repeated minor trauma,
heredity AND obesity.
Secondary Osteoarthritis 
-May appear at any age.
-Results from any previous injury, fracture
inflammation and congenital dislocation of
the hip.
Clinical manifestaslation :
Joint stiffness. Diminished mobility, pair
etc.
The symptom are prominent on walking up
from
the Bed in morning.
The degenerative changes in the
interphalenges joints
lead to hard bony and pain less modules
at the base of terminal.
Its phalanx called as HEBERDEN”S NODES.
HEBERDEN”S NODES
Pathos Physiology of
secondary osteoarthritis
Most marked in weight – bearing region.
Initially
Loss of cartilaginous matrix
Resulting
Progressive loss of normal metachron
Focal loss of chondrocytes
Causes
Loosening, flaking and fissuring of Articular cartilage.
Resulting
Breaking off of pieces of cartilage.
Developing of Osteophytes.
Thicking of jointCauses swelling.
MACHINICAL SYMPTOMS
ARE CHARACTERRIZED BY:
Pain: The pain is usually relieved by rest. Night
pain may be a feature. Pain on weight- bearing,
if the lower limb joints are involved.
Stiffness after rest: usually lasting less than 5
minutes – with the patient loosening up quickly
by moving the joints. Morning stiffness is not a
prominent feature and short lived if present at
all.
Swelling is usually bony rather than soft tissue in
character.
Risk factors:
•Age
•Obesity
• Repetitive stress injury / trauma to joints.
•Sex – Female are more frequently involved (10:1)
•Genetics – this is a problem often seen within families.
•Other diseases causing cartilage damage – resulting in
secondary osteoarthritis.
X RAY OF NORMAL KNEE JOINT
X RAY OF OSTEORITHRITIC KNEE
OSTEOARTHRITIS OF
KNEE
Most commonly affected joints
found in clinical practice. Joint space narrowing with
Osteophytes (new bone formation) and loose bodies are
seen.
The patellofemoral articulation is the most
commonly affected with medical tibiofemoral
compartment being second.
In early disease, spiking of the tibial
tubercles and marginal Osteophytes are seen.
OSTEORTHITIS OF THE HIP JOINT
This is the second most affected joint in the body.
Secondary osteoarthritis following:
Congenital dysplasia. PERTH’S DISEASE
congenital dislocation, slipped epiphysis, Aseptic necrosis etc
is more common than primary osteoarthritis.
Joint space reduction and marginal osieophyisis are
seen. The femoral head migrates either superiorly or medially.
A-P views of the hip usually provide adequate information.
In certain cases, a CT scan show areas of
subaiticular crescents as in aseptic necrosis or geode formation
in advanced cases.
NORMAL X RAY OF THE
HIP JOINT
OSTEORTHITIS OF THE
HIP JOINT
OSTEOARTHRITIS OF THE HANDS
In osteoarthritis, the distal interphalageal joints are most
commonly affected with joint space narrowing and large
peripheral osteophytes resulting in the clinically evident
“Heber dens nodes “
X RAY OF ARTHITIS OF
THE TOE JOINT
RHEUMATOID ARTHRITIS
Definition –
A systemic connective tissue disorder which affects
predominantly
the synovial joints, hence the term rheumatoid
disease.
Its systemic manifestation include
hematological,
pulmonary, neurological & CVS abnormalities
Etiology :
1. Age – any age, majority Between 20-40.
2. Sex – more in females than males = 5:1
3. Climate – in temperature climate.
4. Familial tendency.
5. Genetic factors.
6. Sex hormones – more in female than in
males.
7.Psychological factor – Physical
8.Exposure to cold & wet.
9.Trauma:
Arthritis may start in a joint which
has been the seat of trauma and
other joints subsequent get involved.
10.Environmental triggers.
EITIOPATHOGENISIS OF
REHEVMATOID ARTHERITIS
(I) IMMUNOLOGIC FACTORS
(II)
GENETIC FACTOR
Genetic susceptibility
( MHC – Class – II )
Antigenic stimulation
( By infections agent )
CD4 + T –Cells
Cytokines
( TNF – α, INF – γ, IL -1)
Activate
B – Cells
Activate
Endothelial Cell
Activate
Macrophages
Anti IgG – antibody
(Rheumatoid factor)
Release of adhesion
molecule
Cytokines
Protease
Formation of immune complex, Inflammatory Cells,
Inflammatory damage to synovium, small vessel collagen
Destruction of cartilage bone fibrosis, ankylosi
joint Deformities
Types of Presentation:1.Classical –
Pain, stiffness and swelling of small joints of head,
wrists.
2.Palindromic –
Pain, swelling and redness usually of a single joint,
followed by rapid return to normal after several days.
3. Systemic -
Weight loss, Pleurisy and pericarditis but minimal joint
involvement.
4. Polycyclic Plain and stiffness in shoulders and hips with
subsequent synoptic.
5. Monoarthritic Single joint involvement usually the knee.
6. Acute Onset Sudden overnight onset with stiffness and pain.
7. With generalized lymphadenopthy.
Clinical Features :In early stage –
•
Joints are warm, swollen and tender.
•
Weakening of joints, capsule and tendon along
with ligament damage.
•
Instability, subluxation, dislocation.
• Severe joint damage may lead to fibrous or body
ankylosis
secondary degenerative changes.
1.Hands Tenosynovitis (inability to appose
the palms)
Rupture of flexor/ extensor tendons
with weakness of grip.
2.Legs Knees – synovial effusion
Ankles – Valgus deformity
3.Cervical Spin -
1.Skin
-
2.Myositis
-
3.Bone
4.Eye
5.Heart
-
6.Blood
-
7.Respiratory-
Palmer erythematic
Rashes Psoriasis.
Muscle wasting around inflamed
joints
Generalized osteoporosis
Keratoconjunctivitis scleritis
Pericarditis
Myocarditis
Rheumatoid Vulvulitis.
Anemia (mild normocytic
norm chromic anemia)
G.I. bleeding by Aspirin and other
Analgesics.
Pleurisy and ale Ural effusion
Rheumatoid nodules
Pulmonary hypertension
8.Nervous System
-
9.Kidney
-
10.Investigation
-
11.Radiology
-
Neuropathy
Nerve root compression
Pain
Numbness or Paraesthesiae
Proteinuria
Microscopic heaematuria
E.S.R. (elevated)
R.A. Factor
S.L.E.
Reduced of joint space
X-ray
bone Deformity
X-RAY & bone Deformity
GOUTY ARTHRITIS
In Gouty Arthritis, sodium create crystals are deposited in
the soft tissue of the joints.
The crystal irritate and erode the cartilage causing The
person who suffers from govt. either produce excessive
uric acid or is unable to excrete as much as normal.
Result in building up uric acids in the blood.
Uric acid + sodium
↓
Crystal of Sod. Ureate
↓
Deposited in the soft tissue of the joints.
DIAGNOSIS OF ARTHRITIS
1.PHYSICAL EXAMINATION
Whenever a patient presents with a problem
joint, the primary care physician has to picture
All the structures that makes up a joint. Any
one or more of the following may be involved:
• Trauma
• Degenerative changes
• Infection: both acute and chronic and
• Neoplastic
•If a Patient is looking with pain in joint
the pain can be of three things.
Bone
Muscle
Nerve
•Examination of – Swelling /Edema
•Tender
•Redness
•Any eruption
•Tortuousness of veins
•Hot/cold ( temperature )
•Movement
•Sound (cracking )
To complete the list, metabolic (gout) &
Neoplastic causes also have to be kept in mind.
On the other hand the joint may be affected
as part of a widespread systemic disease –
Rheumatoid arthritis and other seronegative
spondyloarthropathies.
When a patient presents with any joint pain, it
is the duty of the physician to assess the entire
locomotors system:
ESTABLISH THE EXTENT OF ABILITY OR
DISABILITY
To carry out routine, day-to-day chores.
Eg in rheumatoid arthritis can he open / shut a zip or unbutton
her blouse; what are the activities which are not possible now and
should be our first target at improvement.
Ask the patient:
•
•
•
Can you climb stairs?
Can you dress normally?
Are you free from any muscle stiffness any
where in the body?
If the answer is No. go into details an
if the answer is yes, it is unlikely that the
patient has any significant involvement
in affection of a joint / muscle group.
OBSERVATION
Ask the patient to disrobe as much as is
comfortable for both the physician and the
patient. Ideally patient should be in
undergarments.
Stand away from the patient and observe closely
as the patient carries out your instructions.
Observe the patient from behind to
Assess the buttocks, shoulder, Para spinal
muscles. Are they symmetrical? Is there any
deformity or swelling?
Is the spine straight or tilted/ curved to one
side?
Observe from side
Are cervical and lumber curvatures normal?
Ask the patient to touch the toes.
Is the flexion of hip and spine normal?
(ie whether he can touch the toes)
From the front
1. TOUCH head both ways – checks lateral flexion of the neck.
2. Open and close the mouth – Temporo-mandibular joint.
3. Ask to put hands behind the head – tests gleno-humeral and
sterno clavicular movements.
4. Ask to hold arms straight – tests elbow extension.
5. Ask to supinate and pronate the hands.
6.Ask to spread the fingers and show you the hands-look for
any wasting, deformity or swelling (s).
7.Ask to put thumb and index finger together – checks
pincergrip
1. Closely observe the lags – quadriceps bulk, any
deformity or swelling.
2. Knee joint- any effusions by patellar tap?
3. Observe feel – any deformity? Any callosities?
4. Ask to walk around- is the gait normal? Are the amis
swinging while walking?
5. Is the strike of heal on the ground as well as lift of
toes from the ground normal?
6. Can he turn quickly and normally?
LAB . INVESTIGATION OF
ARTHRITIS
• BLOOD INUESTIGATION
ESR
RA- FACTOR
ASOTITER
SLE
X-RAY REPORTS OF ARTHRITIES
•C. T. SCAN
•MRI
•SYNONICAL BIOPSY
•URIN TEST
OTHER MODE OF TAEATMENT
•ALLOPATHY
Anti inflammatory
Pain killer
Relexacent
Sedatives
Local application
Hot fomentation
•AYUERVEDIC
•UNANI
•NATUROPATHY
•YOGA
Homeopathic Mode of Treatment
• Examination : Physical and LAB Investigation
• Case taking
• Constitution
• History
: weather patient had any trauma
or accident in the past
• Miasm
: psora , syphilis or sycosis
• Diathesis : Rheumatic or Gouty
• Mental
• Location
: Hand , Wrist , Knee, Cervical spine
or Hip joint
• Ailments (Cautions)
HOMEOPHATHIC REMADY
FOR
ARTHRITIS, RHEUMATISM & GOUT
ABROTANUM
Especially for ANKLE JOINT & WRIST JOINT
For OSTEOARTHRITIS
Rheumatism:
For excessive pain before the swelling comens
From suddenly –checked Diarrhea or other
•
•
Secretion,
Alternate with Hemorrhoids, with dysentery
Aggravation; - at night and from cold
Amelioration; - by motion
ACTAEA SPICATA
Special Affinity for Smaller joints
Wrist, & Fingers
Ankles & toes
Rheumatism:
·
Swelling & aching in joints after a slight exercise.
·
Affected joints are swollen and in affected limbs
great weakness.
·
Right arm and right wrist are specially affected.
Pain:
Are violent tearing and drawing character
Aggravation: - At night motion and change of weather.
ARNICA MONTANA
3)
Especially for Traumatic Rheumatism or Arthritis.
Rheumatism:

Ascending type of rheumatism.

Patient cannot bear pain

Great fear of being touched or struck.
Pain;
 in the back and limbs as if bruised or
beaten.
 cannot walk erect on account of pain in
pelvic organ.
Aggravation: At rest; when lying down: from wine
Amelioration: From contact ; Motion
BENGOIC ACID
Especially for GOUTY ARTHRITIS
In a person who have History of
Suppressed Gonorrhea, Syphilis.
Gouty concretion arthritis
Affects all the joints, especially knee joint
Cracking on motion; Nodositis
Urine dark brown
And
The urinous odor highly intensified
Pain – tearing, stitching , in large joints,
Pain aggravates in night
BRYONIA ALBA
 For Articular Rheumatism
 Allumina is chronic of bryonia
 Great dryness of all mucus membrane.
 Great thirst for large quantity of cold water
at long interval
Pain: Stitching, tearing, worse at night.
Aggravation: from slight motion, exertion, touch,
Suppressed discharges of any kind,
at 9 pm
Amelioration: Complete rest, lying on painful side
pressure, cold.
CALCAREA CARB
For Gouty Nodos ties about fingers
Arthritis nodosa deformans.
Aggravation: cold air wet weather, cold water in morning.
Amelioration: Lying on painful side.
CAULLOPHYLLUM
For Arthritis Deformam in women’s.
Affinity for smaller joints.
Pain: Severe drawing, tearing pain.
Pain is of flying nature; migrate from one place to another.
Pain in fingers and wrist. Fingers are very stiff.
Aggravation: in open air and coffee
Amelioration: By emission of flatus.
CAUSTICUM
For Rheumatoid Arthritis
For Chronic Articular Rheumatism
Rheumatism: Of joints with stiffness and contraction
of flexor tendons,
Shortening of muscles.
Aggravation: in clear weather
Amelioration: In damp weather and by warm air.
CMICIFUGA (Actaea recemosa)
·
·
·
·
·
·
·
Articular rheumatism of lower limb.
Joints commonly affected are lumbo-sacral region
and Big Joints.
Rheumatism:
Good remedies for muscular rheumatism.
Especially affects the bellies of muscles of neck and back.
Joints commonly affected are those of
LUMBO-SACRAL REGION and big joints.
Uneasiness, restlessness, aching in the limb
with pain in lumbar and sacral region.
Rheumatism alternates with mental symptoms.
Aggravation:
from using arm in sewing , type writing, piano-playing.
From cold damp weather and during menses.
More severe the flow, greater the sufferings.
Amelioration: from warmth
COLCHICUM AUTUMNALE
·
·
to
Valvular Disease or pericrditis following rheumatism.
Acute Rheumatic fever.
Action more marked on Small Joints
Rheumatic pain
Of the clavicle, neck, shoulder, arms and back.
In the elbow joint, forearm, waist, and ligaments of the finger
Joints, and of great toes.
With lameness in the arm which make it impossible for the patient
·
·
·
·
side
hold lightest thing.
Flying pain in the Hips,
Tearing pain in thighs and knee joints with swelling.
Tingling pain in Toes.
Pain has tendency to move from one joint to another ; from one
to other , from below to upwards or from above to downwards.
Aggravation : From cold damp weather, by motion, during Autumn
FERRUM MET ELLICUM
·
·
·
For Neuralgic and Rheumatic Pain.
Rheumatism of LEFT SHOULDER
Tearing and stinging nature of pain.
Rhematic Pain in Deltoid muscle.
Violent pain in muscles and along the nerves.
Aggravation: From cold and rest
Amelioration: slowly moving
KALI BICHROME
Rheumatism
·
·
·
For Syphilitic Arthritis
Tearing sensation in the tibia, with swelling and
stiffness of joints.
Rheumatism alternates with gastric symptoms.
Pain
·
·
In small spots, which can be covered with TIP of finger.
WONDERING PAIN,
Aggravation: from cold and motion.
KALMIA LATIFOLIA
For Acute Rheumatic fever.
Rheumatism:·
Caused by chill, exposure to cold
·
Right-sided affection.
·
Sensation of numbness, coldness, weakness, in the limbs.
Pain:
WANDERING PAIN, changes place suddenly,
goes from one joint to other.
Pains are sticking darting, pressing,
shooting in the a downward direction.
Joints are hot, red, painful and swollen.
Þ
Heart complaint alternate with Rheumatism.
Aggravation: from least movement , becoming cold.
Amelioration: continued motion
LACHESIS
For Rheumatic Carditis.
Sciatica, right side, better on lying down.
Pain
In lower Extremities, in Tibia, in Neck worse cervical region
Shortening of tendons.
Neuralgia of coccyx, worse rising from sitting posture.
Sensation of threads stretched from back to arms, legs,
eyes, etc.
Aggravation: from warm bath, pressure or constriction, hot drinks
Amelioration: appearances of discharges warm application
LYCOPODIUM CLAVATUM
Chronic Articular Arthritis
Right-sided remedy
Rheumatic Pain
In ankle, and finger Joints,
Painful Callosilitis (CORNS ) on soles
All disease is worse in the afternoon from 4 to 8 pm.
Tearing in shoulder and elbow joints.
One feet hot and other is cold.
Chronic gout, with chalky deposit in joints.
Aggravation: Right side, from right to left, from above downward.
4am to 8 pm. from heat
Amelioration: by motion. After mid night
NATRUM MUR
Chronic articular Arthritis.
Based on History of Dyscrasia.
Symptoms are worse from sunrise to sunset,
especially from 10 to 11 pm.
Painful contraction of the Hamstring.
Pain in back with desire to support.
Palms hot and perspiring.
Ankles weak and turn easily.
Cracking in joints on motion.
Aggravation: from noise, music, lying down, heat, and talking.
Amelioration: open air, pressure against back. Lying on right side.
RHODODENDRON
Fibrous deposit is great Toe-joint.
Right-sided remedy.
Chronic Osteoarthritis
Gout with fibrous deposit in great toe joint.
Rheumatism:Chromic Rheumatism affecting the smaller joint
Acute inflammatory swelling of the joints.
Pain.
·
Drawing ,tearing pain in the limbs.
·
Sometimes wandering from one joint to other.
·
Pain in dorsal region, extending to arm, in bone and
periosteum
·
Pain in the shoulder that arm cannot be moved.
Aggravation ; During rest, before and during storm
Amelioration; By warmth, wrapping up moving.
RHUS- TOXICODENDRON
Right-sided remedy
For Osteoarthritis
Traumatic and Articular Arthritis.
Rheumatism:·
·
·
Caused by lying on damp ground, summer bathing,
working in damp place.
Great restlessness, anxiety and apprehension.
Always want to be moved, cannot remain in one place.
Pain.:
·
·
As if Sprained,
As if muscle or tendon were torn from its attachment.
As if bone were scrapped with knife.
Aggravation; - After midnight, in rainy weather,
" On first moving, and getting up in morning."
Amelioration; - By walking, and continued motion.
SULPHUR
Facilitates absorption of serous or inflammatory exudates
in pleura & joints
Acute and Chronic Rheumatism
After the attack of acute Dyscrasia
Aggravation; By standing, rest, heat, bathing, changeable weather.
Amelioration; By dry warm weather, lying on right side
THUJA OCCIDENTALIS
Gonorrheal Arthritis
Sycotic Poison, Arthritis deformens
Aggravation; At night, at 3pm and 3 am, form cold damp air . Etc…
Amelioration; In open air, by movements, pressure, rubbing
MANAGEMENT
The concept of joint protection is vital for the
patients with OA. Especially where large
joints are involved.
•Protection from overuse is important.
•Assistant devices to reduce weight bearing joint pain –
ie canes.
•Reduce impact exercise like jogging.
Increase non weight bearing exercise –
ie swimming / cycling.
.
•Good quality footwear, when walking recreationally.
•If any leg length discrepancy, ensure it is corrected.
•Weight reduction is crucial especially in obese patients
with large joint problems on weight bearing.
•Physiotherapy will maintain joint protection through
optimizing the strength of adjacent supportive
muscles.
•Heat and ultrasound may relieve muscle spasm.a
General Measures
1. Diet
One has to avoid the following items.
Tea, Coffee, Fried things, Salt, Chilly, Spices and
condiments milk and milk products. Heavy digestive Dal , Rice ,
Pickles Alcohol an d Non- veg diet .
2.
Yogic therapy include
Yogasanas, Pranayama, rest and other arthritic
exercise
3. Rest - Both mental and physical
4. Exercise- morning walk, running etc.
5. Correction of Anemia
6. Avoidance of cold, dampness and draughts.
7. Removal of focal infection
3.Exercises for arthritis
CORRECT YOUR POSTURES
1.Correct postures of sitting, standing and walking
make a difference in patients of cervical spondylitis.
Wrong postures, even temporary, can result in
strains on the joints and bring diseases.
There should not be any hump in the back when the
child learns to sit, stand and walk
3.When we sit, stand, walk or
drive a vehicle, do not bend
spine
Car drivers not keeping their
backs straight also get neck
pains. The seat of the car
should be adjusted nearer to
the steering wheel and if there
is space between seat back and
upper hips area.
A small pillow should
be placed in between.
Sleep, bed and pillow: Both neck and back pain have a definite bearing
with the type of bed
7.
Sleeping posture. Those who suffer from cervical spondylosis
should try to sleep on the left or right side instead of continuous sleeping on
the back. While sleeping on the sides of the body, one should lie with the legs
slightly flexed or bent at the knees towards the abdomen. This offers great
relaxation to the muscles
Standing postures during parties: In most
of the parities, the fashion is to stand for a long
lime at one place.
13. Working on computers need more care for neck pain. The
table should match your height. Roughly your elbows and
table top should be at same level. Your eye level should be in
alignment with screen of computer continuously for hours
Case:Patient’s Name:- Mr. Bhagwan Lal Patel
Address:- Arnodh (Dist.:-Indore)
Age:- 68yrs.
Occupation:- Farmar
Date:- 14/11/08
Mobile:- 99009245062
PRESENT COMPLANTS
Pain & Swelling in both Knee & Ankle Joints
(Since:- 4 Months)
Allergic Rashes on Neck & Face taking
antiallergic.
Difficulty in Breathing.
Pain worse when goes to upstairs & down
stairs.
Personal history
Thermal Relation:- chilly Pt.
Thirst:- 10 to 12 glass per day.
Appetite:- decreased.
Aggravation:- when goes upstairs, down
stairs & cold wet weather.
Amelioration:- warm application.
Stool:- Clear
Urine:- Scanty
MENTAL GENERAL
Restlessness.
Fearful
Irritable+
General Examination
Built:- N
Skin:- Rashes on Neck & Face
Toung:- Red & Cracked
B.P. 130/80 mm/hg
1ST Prescreption
Rx
Rhus. Tox. 200] 1 drm
T.D.S. for 7days
Second prescription
C/o
Slightly relief in pain & swelling
Rashes disappears
Rx
Plc 200]1/2 dm
B.D. for 7 days
C/o
Pain & swelling as it is.
Sneezing & coryza.
Rx
Rhus. Tox. 200]1/2 dm
B.D. for 5 days
C/o
Pain & Swelling worse.
relieved in coryza &
sneezing.
Stiffness in neck.
Pain in both shoulder
Rx
Rhododendron 200 ]1/2 drm
T.D.S. for 3 days
Plc 200 ] B.D for 5 days
Advise
Avoid sour things, fatty food & high rich
protein diet.
Do some mild exercise
C/o
Much relief in all complaints
mentally feel well
Rx
Plc 200 ] 1 drm
B.D for 8 days
C/o
No further relief
Complaints are as it is
Rx
1.
2.
Medorrhinum 1M ] 1dose
Rhus tox 200 ] 1drm
B.D. for 7 days