RHEUMATOID ARTHRITIS (RA) and Role of Homeopathy in RA

It is a disease in which there is inflammation in multiple systems of the body primarily affecting the synovium (Covering of the bones) and the adjacent tissues.

Causative factors:
There are multiple factors that are involved.
a) Immunogenic factors (e.g. HLA-DRBI) are important in knowing the expression and progress of the disease. The combination of conserved amino acids sequence in the third hyper variable region of HLA-DRBI with a positive RA factor make the individual 13 times more vulnerable to develop bony erosions at the end of one year after the disease has started.

b) Other factors: hormonal factors before menopause the incidence of RA is more in women. Remission of RA during pregnancy is common. The outcome of RA is very poor in the lower socio economic group.

How RA starts: It starts after an event which triggers the immune system which leads to a series of intersecting immunological pathways which eventually lead to joint destruction. The proliferative synovial tissue erodes the cartilages and then the bone which leads to deformed joints. Due to this process the ligaments become lax; there is subluxation of the tendons and subsequently of the joints. There is also inflammation of the surrounding tissues in that region.

Presentation of RA
It presents as acute inflammation of multiple joints (Polyarthritis) developing over a few days, weeks or months. There is pain in the joints and muscles before frank swelling of the joints develop. The disease starts in the joints of the fingers of the hands (Metacarpophalengeal joints) or the toes (Metatarsophalengeal joints) and the wrists. There is stiffness of the joints and swelling of the synovial tissue is a common feature.

The disease course:
There are different ways in which RA can behave. Patients suffering from RA for more then 6months will develop progressive erosive joint disease which will lead to significant disability
up to 10% suffer from acute episode and progressive disease,20% tend to suffer from an episode of inflammatory Polyarthritis and do not suffer further.
Due to RA 50% of the individuals suffering from the disease are unable to work 10years after its onset and life expectancy is reduced by 5 years in women and 7 years in males. The high rate of mortality is due to cardiovascular disease.
The criteria to term a patient free from RA are:
A minimum of five of the following requirements are to be fulfilled for at least 2 consecutive months
. Morning stiffness lasting for less then 15 minutes
. No fatigue
. No joint pain
. No joint tenderness or pain on motion
. No swelling of the soft tissue in the joints or the tendon sheaths
. ESR less then 30 mm/hr in women and 20mm in males.

The factors that show poor prognosis of the disease are:
. Multiple joints are affected.
. Uncontrolled inflammation of multiple joints. (Polyarthritis)
. Structural damage deformity shown on X-ray films.
. Difficulty in movement
. Presence of nodules, vasculitis. (Inflammation of the veins.)
. Psychological factors, low socio economic conditions, employment requiring moderate to severe manual labor.

Types of presentation:
a) Classical: pain stiffness and swelling of the small joints of the hands and wrists. Symptoms fluctuate in severity from day to day.
b) Palindromic: Intermittent episodes of pain swelling and redness usually of single joints followed by rapid return to normalcy in several days.
c) Systemic: weight loss, pleurisy and pericarditis with minimal joint involvement.
d) Polymyalgic: pain and stiffness in the shoulders and hips with subsequent synovitits.
e) Monoarthritic: Single joint involvement mainly in the knee.
f) Acute onset: Sudden overnight onset with stiffness and pain.
g) With generalized lymphadenopathy (Inflammation of the lymph nodes.)
The clinical criterion is that the disease must be present for a minimum of six weeks. The joints should feel hot, swollen and usually tender to touch. There should be generalized lymphadenopathy.
. Laboratory findings
. Increased ESR
. Increased WBC count
. Mild normocytic anemia
. Thrombocytosis
. Positive RA factor
. Positive antinuclear test
. Arthrocentecis of the synovial fluid shows it to be straw colored with increased neutrophils.
Role of Homeopathy in RA:
As we know now that RA is a progressive disease and it can lead to severe disability and even death.

The role of homeopathy lies in the fact that it can bring back the lost balance in the human body when it is in a diseased state. Homeopathic remedies act at the psycho neuro endocrinal axis. In other words it stimulates the human body which in turn will take care of the disease.

So the first step in treating RA is a correct case history. Human body is a complex network and the human mind can play a major role in defining any disease. So we have to know the emotional nature in details all the events that have happened which have affected the patient have to be mentioned in details.

The patients should give all the details avoiding any conflicts. As the homeopath believe to treat the man in disease and not the disease in man. The emotional aspect, intellectual attainments any conflicts have to be explained to the best of patient's ability. As it is important to know the causative factor that has brought in the present situation.

In homeopathy the symptoms are listed in a book known as a repertory. (It is an index of symptoms and the remedies that can cure that symptom are noted.)So if we take for e.g. the extremity chapters from any repertory and search for the patient's symptoms we can get the exact symptom or the similar expression and the remedies which are listed against these symptoms have the capacity to cure them. In addition to this we have sophisticated homeopathic software's which help to go through the huge database and find the right expression of the disease.

If we consider a remedy say Calcarea flur in this remedy we find the symptoms of erosion of joints, cracking of the joints, destruction is as if the theme of the remedy. At the mental level the patient is very aggressive, angry and destructive. So this remedy has the capacity to act in diseases which have progressed to the level of destruction and when it is given in the indicated case it will relieve the patient at the physical as well as at the mental level.

So we have to understand that the homeopathic remedies act at a very deep level and if the line of treatment is managed properly we can get amazing results.

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