AYURVEDA DOES GIVE RESULTS IN ARTHRIIS
Ayurveda has been recognized by the World Health Organization (WHO) as a complete system of natural medicine. The complete, classical Ayurvedic treatment for rheumatoid arthritis (RA) was the first-ever study of the traditional medical system sponsored by WHO.
This study entitled, “The WHO/ICMR Study of the Efficacy of Ayurvedic Treatment for Rheumatoid Arthritis,” was conducted in collaboration with the Indian Council for Medical Research (ICMR) and the Ayurvedic Trust in Coimbatore, India, from 1977 to 1984 and had enrolled 290 patients suffering from RA for over a 7-year period. Conducted almost three decades ago, this study remains the only known study of complete classical Ayurvedic inpatient treatment for RA.
According to the allopathic experts’ assessments and statistical analysis together the Ayurvedic treatment for RA was proved to be safe and effective, and provided symptomatic relief without harmful side effects. While allopathic treatment of RA is improving, remission remains rare and treatment remains unsatisfactory, search for effective alternative and additional therapies for this disease continues.
Potential participants for this study were selected from the outpatient department of the Ayurvedic Trust hospital by the Ayurvedic panel of three Ayurvedic physicians based on the Ayurvedic criteria for Vatarakta or RA. The selected patients underwent Ayurvedic treatment and periodic evaluations by both allopathic and Ayurvedic physicians.
Arthritis- How does PHYSIOTHERAPY help ?
The ICMR team was responsible for the study design, confirmation of RA diagnosis, and enrollment of patients, and for the evaluation of the efficacy of Ayurvedic treatment, based on American Rheumatism Association (ARA) criteria.
The Ayurvedic physicians administered the treatment, closely adhering to the principles set forth in classical Ayurvedic texts. The Ayurvedic physicians prescribed combination of medicines and therapies based on their clinical judgment enabling the patients to receive individualized therapy without the presence of any control group.
Dosage of internal herbal medicines (Kashayams, Arishtams, Gulikas, Lehyam, and Choornam)
Specialized oil therapies (Sneha-Sweda)
Purificatory therapies (Panchakarma Chikitsa) including:
Medicated enema (Vasti or Basti)
Therapeutic purgation (Virechana)
External application of:
Analgesic herbal pastes (Lepa)
Medicated oils (Oushadha Siddha Taila)
Dietary and lifestyle modification
The outcome of the Ayurvedic treatment on each patient was evaluated using the American Rheumatism Association (ARA) criteria such as the grip strength, walking time, number of swollen and painful joints, joint count, functional class, erythrocyte sedimentation rate, and rheumatoid factor. The evaluation is done at several different time points such as time of admission, once every 6 weeks during treatment and at time of discharge of the patient. Alongwith the regular evaluation, various tests such as liver function tests, renal function tests and complete blood count measures were also done once every six weeks.
The duration of treatment varies from 1 to 6 months depending on the how quickly the patient heals. The first group of patients (consisting of 33 patients out of a total of 64 patients) completed their treatment during the first year of the study in 1977–1978.
The information related to each patient was recorded by both ayurvedic and allopathic doctors separately on timely basis. These records were then analyzed by an expert medical statistician to understand the result and efficiency of Ayurvedic treatment.
The outcomes for the first group of patients were as follows:
The mean grip strength for all 33 patients was 82 mmHg at admission and 111 mmHg at discharge, a statistically significant increase.
At the time of discharge, however, all the patients could walk, and 94% were able to walk a distance of 25 ft in less than 10 s. The mean walking time for 25 ft was 7.4s at admission and 4.8 s at discharge, a statistically significant decrease.
The mean number of swollen joints was 6.6 initially and 4.3 at discharge, a significant reduction.
In terms of mean values, the number of painful joints decreased from a mean of 7.8 at admission to 3.6 at discharge.
The mean joint count decreased from 74 to 30, which is statistically significant.
Erythrocyte sedimentation rate
Considering the findings at 1 h, 48% of the patients had an ESR of 50 mm or more initially, compared with 27% at the time of discharge; the means were 59 and 37, respectively.
Whereas 19 (58%) of the 33 patients were classified as belonging to functional class III (limited only to little or none of the duties of usual occupation or self-care) or functional class IV (incapacitated, largely or wholly; bedridden or confined to a wheelchair; little or no self-care) at the time of admission, only 4 were classified as such at the time of discharge.
Class I = complete ability to carry out all usual activities without handicaps
Class II = adequate for normal activities despite handicap of discomfort or limited motion at one or more joints
Class III = limited only to little or none of the duties of usual occupation or self-care
Class IV = incapacitated, largely or wholly. Bedridden or confined to a wheelchair; little or no self-care (ACR)
The RF was determined on admission and discharge in only 15 (45%) of the 33 patients. In 12 patients, there were at least two doubling dilution steps. Two patients showed no change and one had a rise in titer from 1/20 to 1/80. The improvement in the group as whole (12 decreases compared to 1 increase) was statistically significant.
The influence of various background and pre-treatment factors was examined such as:
In general, the improvement in males was better than in females In the case of grip strength, walking time, and joint count, the contrasts were appreciable and statistically significant. Women constituted approximately two-thirds of the study sample. They were affected more severely by the disease and improved more slowly than men.
Age did not have an impact on progress.
There was clear evidence that patients with a short history of RA (less than 1 year) improved more than those with longer histories. The differences were highly significant in the case of grip strength, walking time, and joint count.
There was some evidence that patients who were in functional classes III and IV improved more than those in functional classes I and II, especially with respect to grip strength, walking time, and joint count. Although none of the differences was statistically significant, they were all in the direction of improvement.
Compared with mean values at admission, however, follow-up values of the patients after discharge indicated improvement.
Proving Ayurveda’s Strength: Benefits of the Study in a Nutshell
The analysis of the first cohort of discharged patients in the study clearly indicates that they improved considerably as a result of Ayurvedic treatment.
According to the ARA criteria used to evaluate the effectiveness of Ayurvedic treatment, there was statistically significant improvement in the condition of the patients from the time of admission to discharge.
While overall improvement was greatest in those who were in the early stages of RA, even patients in the more advanced stages (functional classes III and IV) showed significant improvement.
According to the records, reduction in swelling was noted in general as well as 80% of the patients reported relief from pain in the first month of the treatment.
There was no evidence of liver, renal or other toxicity due to Ayurvedic treatment.
The analyses showed that the progress was slower in the steroid consuming patients than in those who were not on steroids. The average treatment duration was 3 months for the non-steroid group compared to 6 months for the steroid group.
The allopathic outcomes measured in this study were statistically significant and positive which proves the efficacy of Ayurvedic treatment for RA.
Classical Ayurveda, with its individualized, holistic treatment, can be noted responsible for the improvement in the varied group of patients regardless of factors such as disease duration, functional status and age.
Ayurveda’s strength in diagnosing RA in the prodromal stages when symptoms are very subtle is proved through this study.
Only two-thirds of those initially diagnosed by the Ayurvedic physicians were confirmed by the allopathic panel as having RA and hence included in the study. The Ayurvedic physicians independently and successfully treated the excluded individuals for vatarakta. Being in the early stages of the disease, these patients benefited greatly from the treatment, hence supporting the allopathic view that treating RA in its early stages yields better outcomes.
This study helped bring Ayurveda to the forefront, showing that Ayurvedic treatment was successful in treating a complex, chronic disease like RA even when judged by allopathic criteria.