Category Archives: Orthopedic

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Dermatology, HOMEOPATHIC TREATMENT, Orthopedic, Rheumatology

PSORIATIC ARTHRITIS

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Psoriatic Arthritis is a condition found in patient suffering from autoimmune disease called Psoriasis where in there is involvement of joints as well, along with skin and nail. It is classified as Seronegative Arthropathy and individuals with HLA B27 genotype shows more susceptibility towards this condition with genetic and environmental factors playing a major role in precipitation of the condition.

It presents itself as Chronic Inflamatory Arthritis involving one or more joints which accompanies or alternates with acute of spells of Psoriasis or has relation with the cyclic pattern of Psoriasis.

Signs and Symptoms of Psoriatic Arthritis

If a person is suffering from Psoriasis doesnt mean he will develop psoriatic Arthritis, regardless of severity of psoriasis he is suffering from. But its observed that person having Psoriatic Arthritis shows some relation between skin complaints and joint complaints either they aggravate together or alternate each other in their spells of aggravation but not in every case and always.

70% of Psoriatic Arthritis cases presents first sign of disease as psoriasis lesion on skin, in majority cases it usually develop almost 10yrs after onset of appearance of skin psoriasis. majority of them are adults between 35-55yrs.

15% first develops joint complaints then skin psoriasis develops later. and majority of them are children.

15% presents both skin and joint complaints originating simultaneously at the onset of disease.

SKIN and NAIL

Typical features of Psoriasis on Skin and Nail

  • Silverish scaly skin exfoliating cyclically leaving behind clear red base on extensor surface of skin and typically on scalp, around umbilicus.
  • Exudation and cuts may also be seen in severe cases.
  • Onycholysis, Ridges on nail, Pitting on nail, Hyperkeratosis of skin below nails of fingers and toes.

MUSCULOSKELETAL

It more frequently involves small joints of hand and feets especially of Fingers and Toes frequently wrist and spine are also involved, There is morning stifness pain and swelling of joints. Almost 20% cases shows symetry in joints involved.

  • Swelling of fingers, Dactilitis, giving sausage like appearance to fingers.
  • Sacroilitis, Lumbar spondylitis, pain in lower back
  • Cervical Spondylitis, pain in cervical region.
  • Enthesitis of Tendo-Achilles causing severe pain in ankle.
  • Plantar Fascitis causing pain and stiffness in soles.

GENERAL

When the disease progresses or aggravates patient may show signs of

  • Malaise, Fatigue Weakness and Exhaustion.
  • Deformities, Disfigurement and Disabilities.
  • Anaemia of Chronic Disease.

Psoriatic Arthritis presents itself in one of the following five patterns.

1) Oligoarticular

Its the most common type affecting almost 70% of all the cases where in ther is involvement of less than 3 joints and lacks symetry.

2) Polyarticular

Its comparatively severe type and accounts for almost 25% of all the cases of which 50% develops disability and deformities. It typically involves more than 4-5 joints and shows somewhat symetrical pattern. It resembles much to Rheumatoid Arthritis and need to differentially diagnosed which becomes difficult in sero-negative Rheumatoid Arthritis cases.

3) Arthritis Mutilans

Also called Chronic Absorptive arthritis ans is found in almost 5% of all the cases and is the most severe and destructive form of arthritis presented due to psoriasis and in many other conditions like Rheumatoid Arthritis and it shows severe disfigurement and deformities.

4) Spondyloarthritis

Typically affects spine especially the cervical spine and sacro-illiac joint. may also affect other joints as well in a symetric fashion.

5) Distal Interphalangeal

Typically involves distal small joints of fingers and toes with involvement of nails.

Diagnosis of Psoriatic Arthritis

There is no Specific Test Available For Psoriatic Arthritis. It cant be predicited based either only on joint or only on skin complaints that the person is developing Psoriatic Arthritis and its only after both skin and musculoskeletal complaints presents itself the diagnosis can be established. So, early diagnosis is not possible and its usually established only after the disease has progressed enough to show itself on both the spectrums.

The diagnosis of Psoriatic Arthritis depends upon clinical features and host of investigative tests that collectively exclude probability of other conditions and indicate towards Psoriatic Arthritis.

  • Psoriasis with chronic inflamatory arthritis of which the aggravation pattern can be related to cyclic process of psoriasis but not necessarily in all cases. Especially showing features like
  • Distal interphalangeal arthritis
  • 80% of patients presents nail complaints Onycholysis – ridging pitting and hyperkerotosis of skin under nail
  • Dactilitis, sausage like appearance of fingers.
  • 30-50% patients show Enthesitis, involving Tendo-Achilles, Plantar fascia,
  • Pain around Patella, illiac crest, epicondyles, supraspinatus insertions, sacroillitis.
  • X ray shows degenerative changes
  • Family history of psoriasis or psoriatic arthritis
  • Subjects with HLA B27 genotype.
  • Negative Serological tests like RA factor and ACCP of Rheumatoid Arthristis.

For Differential Diagnosis of Psoriatic Arthritis Read

Homoeopathic Treatment For Psoriatic Arthritis

As mentioned above its an autoimmune condition chronic in nature. So its important to treat the cause first and the symptoms will be relieved on its own. For that a proper homoeopathic case taking and constitutional approach is necessary as its deep seated genetic complaint and only a deep seated constitutional remedial force can bring about change for better. But in many severe cases where there are gross degenerative changes or the disease has progressed much further or the pain is severe we need to treat theraputically initially to get the acute exacerbations in check and later we can find out constitutional remedy based on Miasmatic background and totality of symptoms of Mind and Body. Also There arise much need for anti-miasmatic nosode administeration in the course of treatment if the case is improving but improvement is soon regressing or case has hit a stand still and ia not reaponding further in such case we need to consider a nosode.

Homoeopathic Medicines for Psoriatic Arthritis

RHUS TOX

Rhus tox is usually adapted or well suited to a person of rheumatic diathesis. Rhus tox is very well indicated in psoriatic arthritis. The effects on the skin, rheumatic pains, mucus memmbrane affections makes this remedy frequently indicated. Rhus tox affects the fibrous tissue of the joints, ligaments causing rheumatic symptoms. Patient presents with burning eczematous erruptions with tendency to scale formation. Skin is red swollen with intense itching. Hot painfull swelling of joints. Rheumatic pains spread over a large surface area at nape of neck, loins, and extremities which is relieved by motion. The cold fresh air is intolerable makes the skin painful.

URTICA URENS

Urtica urens is one of the indicated remedy for psoriatic arthritis. Rheumatism is usually associated with skin complaints. As its common name stinging nettle implies it produces stinging and burning pain. Skin complaints alternate with rheumatism with severe pain in joints. Itching and swelling all over body resembling hives. Heat in skin of face arms shoulderand chest with formication numbness and itching. Psoriatic errruptions with scales, skin looks wrinkled. Intense burning of skin. Patient is worse from exposure to cold moist air.

RHUS VENETA

In case of Rhus veneta, the skin symptoms of this species of rhus are most severe. Rhus veneta is one of the most actively poisonous remedy among the family. Presents with great restlessness.,numbness and lameness of joints. Bruised feeling in the limbs. Pains as if sprained or dislocated. Presents with trembling of limbs with twitching of muscles. Rashes under the skin with severe nightly itching. Fine psoriatic erruptions on forearm, wrist, back of hands between and on fingers. Severe desquamation with severe itching. Complaints are usually aggravated by warmth.

LEDUM PAL

Ledum pal usually affects the fibrous tissue of joints especially small joints. Hence it can be called as a rheumatic remedy where rheumatism begins in the feet and travels upwards. Ledum pal is very valuable remedy in psoriatic arthritis. There is weakness and numbness of affected parts. Painful cold oedematous joints. Presents with erruptions only on the covered parts of the body. Affecting the skin ledum produces reddish spots with scaly erruptions. Gouty pains shoot all thrkugh the foot and limbs. Cracking in joints worse from warmth of bed. Aggravation from warmth is so severe that the patient can only get relief from rheumatism is by putting his feet in cold water.

BELLADONA

Belladona has marked sphere of action on the skin, bones, glands and nervous system. Useful in case of psoriatic arthritis. Pains are usually throbbing, sharp, cutting, shooting which come and go in repeated attacks. Joints are swollen, red hot with severe throbbing sensation and extreme sensitiveness. The heat, redness and burning characterise most of the skin complaints, and presnts with alternate redness and paleness of skin with scaly erruptions and severe itching. The complaints of belladona come on suddenly, eun a regular course and subside suddenly.

SILICEA

Silicea too can be considered one of the efficient remedy in psoriatic arthritis. Silicea produces inflammation of skin. It acts upon the constitution that are sluggish. There is i.perfect assimilation and defective nutrition. Presents with neurasthenic states and increased susceptibility to nervous stimuli. Presents with moist erruptiions on skin with fomation of scales. Usually patient presents with weak spine, susceptible to draught on back. Pain in coccyx. Diseases of bones of spine.

MEDORRHINUM

Medorrhinum is a nosode prepared from gonorrhoeal virus. It is a powerful deep acting remedy indicated for most of the cgronic complaints. Medorrhinum is a very valuable remedy for arthritic and rheumatic pains , loss of power in joints, joints feel loose. Useful in chronic psoriatic arthritis wuth great disturbance and irritabilty of nervous system. Pain in back with burning heat. Legs feel heavy and ache all night. Acting on skin medorrhinum causes intense itching worse at night. Yellowish copper coloured spots remain after erruptions.

ACTEA SPICATA

Actea spicata is a rheumatic remedy especially affecting the smaller joints, tearing tingling pain. Presents with wrist rheumatism. Though wrist is affected prominently other joints are too equally affected. Slight fatigue causes swelling of joints. Psoriatic erruptions on skin which are dry scaly and with intense itching.

SYPHILLINUM

Syphilinum is another nosode prepared from syphilitic virus. Acts on the bone, nerves, mucus membrane. Indicated in psoriatic arthritis. Presents with rheumatic stiffness and lameness in back. Aching in the whole spine. Inflammation of joints. Pains are usually aggravated by warmth of bed. Indiacted in shifting rheumatic pains and chronic eruptions like psoriasis, presents with dry scaly or pustular erruptions on different parts of the body in patches. Presents with great weakness with very few symptoms, utter prostration and debility in morning or on walking.

THUJA OCCIDENTALIS

Thuja has main action on the skin, bones. Useful in case of psoriatic arthritis. Thuja chiefly acts on the mucus membrane of skin, nerves, glands. Presents with cracking in joints when stretching them. Limbs feel as uf made of wood or glass and would break easily. Psoriatic erruptions itch or burn violently. Erruptions on covered parts of the body. Worse from scratching. Dry skin with brownish spots and scales with severe itching.

ALSO READ

Psoriasis

PSORIASIS

ARTHRITIS (GENERAL)

ARTHRITIS

Rheumatoid Arthritis

RHEUMATOID ARTHRITIS

ANKYLOSING SPONDYLOSIS

ANKYLOSING SPONDYLITIS

GOUT

GOUT

Developmental disorders, HOMEOPATHIC TREATMENT, Nutrition, Orthopedic, Pediatrics

RICKETS

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Rickets is a childhood disease mainly occuring due to vitamin D deficiency. The bones become weak and soft and are more prone to fracture and deformities.
Osteomalacia is similar condition occuring in adults.

Types of Rickets

• Hypocalcemic Rickets  – This occurs due to impaired metabolism of vitamin D and calcium resulting into vitamin D deficiency and Calcium deficiency.
•Hypophosphatemic Rickets – This occurs due to low serum phosphate levels.

Causes

•Vitamin D Deficiency
-decreaed sun exposure
-malabsorption disease
•Chronic liver disease
•Renal tubular disease
•Neonatal hepatitis
•Limited breast feeding
•Improper diet
•Certain medications

•Certain Genetic anomalies

For Pathophysiology Also Refer This link VITAMIN D DEFICIENCY

Genes Related to Rickets-

•The most common form of disease is X-lined hypophosphatemic rickets (XLH).
•It is an autosomal form of disease.
•XLH rickets occur due to inactiving mutations in PHEX gene.
•PHEX(Phosphate regulating neutral endopeptidase) gene is expressed in bones , teeth and in mineralization and renal phosphate reabsorption.
•PHEX is involved in suppressing the response of FGF23
•FGF23(Fibroblast growth factor 23) gene signals the kidney to stop reabsorption of phosphate in to bloodstream.
•PHEX mutations lowers the tubular reabsorption of phosphate and vit D.
This contribute to bone diseases.

Signs and Symptoms –

•Muscle weakness
•Bone tenderness and retarded growth
•Delayed closure of anterior frontalle
•Delayed eruption of teeth and enamel defect
•Enlargement of long bones
•Anterior curving of legs,bow legs
•Green stick fracture
•Seizures and tetany
•Improper gait, bone pain

Diagnosis –

•Blood tests – Serum calcium and serum phosphate show low level along with changes in shape and structure of bone’s.
•Bone biopsy for confirmation.

Homoeopathic Medicine for Rickets-

•Thyroidinum – Thyroid producing anaemia, muscular weakness, nervous tremor, rheumatoid arthritis. Infantile wasting rickets. Delayed union of bones, nocturnal enuresis. Oedema of legs.

•Phosphorus – Dullnes of head, obstinate vertigo. Caries in teeth, drawing and tearing toothache, bleeding and grinding of teeth, gums separated from teeth. Weakness in all limbs, swelling of hand and feets, joint stiff.

•Calcaria Phosphorica – Wewakness of bones,large open frontalle, headache, skull soft. Slow dentition, tearing boring pain in gums, fever during dentition,pain in molars. Rheumatic pain in shoulder and arms, paralysis of joints.

•Baryta Carbonica – Suited to old people, dwarfs, scrofulous children inclined to grow fat. Glandular swelling. Chronic enlargement of tonsils. Abdomen distended and hard.

•Thuja occidentalis – Scalp sensitive to touch and painful, weakness in head. Caries of teeth, crown of teeth remains sound, gums swollen. Trembling of hands and feets, cracking of joints, frozen limbs.

•Silicea terra – Stiffness of nape,caries of clavicle, swelling of gland in nape,coccyx painful, tearing and shooting pain in back.Weakness of joints,cramps of arms and legs,jerk in limbs.

•Kalium Iodatum – Glands swollen or atrophied. Gouty daithesis. Swelling of bones, contraction of muscles and tendons, pain after long injury.its is also very well indicated in Dropsy accompanying Rickets basically due to renal complaints impairing calcium resoption.

Conservative management for Rickets-

  • Exposure to Ultraviolet B rays
  • Increasing dietary intake of calcium
  • Phosphate and vitamin D
  • Cod liver oil
  • Halibut liver oil
  • Vit D fortified milk
  • Vit D supplements

VITAMIN D DEFICIENCY HYPOVITAMINOSIS D

CALCIUM DEFICIENCY

OSTEOPOROSIS

Developmental disorders, Endocrinology, HOMEOPATHIC TREATMENT, Metabolic Disorders, Nutrition, Orthopedic

OSTEOPOROSIS

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Osteoporosis is a disorder of bone where reduced Bone Mineral Density makes the bones fragile

Osteoporosis is a silent disease that causes thinning and weakening of bones

There is decrease in Bone Mineral Density making the bones weak and brittle

Risk Factors of Osteoporosis

  • AGE  and SEX – as age advances chances of osteoporosis increases, Bone Mineral density reached its peak at around 30 yrs of age. Then after certain years it gradually starts depleting due to depleting levels of Growth hormone and later more pronounced after 48 in women and after 60 in men, its attributed to depletion of oestrogen in females and depletion of testosterone in males. its more common and severe in females as oestrogen depletion in females affects more compared to effect of testosterone depletion in males.
  • Genetics and Familial Predesposition
  • Habitat  – in region or lifestyle with lesser exposure to sunlight.
  • Vitamin D deficiency
  • Parathyroid Dysfunctions
  • Thyroid Dysfunctions
  • Kidney diseases
  • Diabetes Mellitus
  • Acromegaly
  • Certain rheumatological conditions
  • Parkinson’s Disease
  • Sedentary lifestyle lack of exercise and physical activity
  • Excessive tobacco smoking
  • High Protein diet
  • High intake of phosphoric acid, usually its through areated soft drinks
  • Prolonged increased exposure to Cadmium.
  • Malabsorption and Malnutrition

Pathophysiology of Osteoporosis

(this part is under construction)

Bone constitutes major portion of Human Skeleton

There Are Over 206 bones in skeleton primarily it consists 270 bones at birth later they fuse together during development

Bones Differs in various size shapes and structures

Bones not only performs the functions of protection protection and support to the body but also helps in storage of minerals lipids and nutritients

Tissue that constitute bone are of two types that gives strength and rigidity to bones viz:

  1. Cortical bone – Cortical Bone forms the outer layer of most of the bones. It is stiffest and hardest. It helps in supporting and protecting the soft tissues of body and gives shape to the body. It Consists of Osteons that in turn consists of Haversion Canal that allows the blood vessels and nerves to travel through them.
  2. Cancellous Bone – It occur at the end of the Long Bones. It is less stiff and weaker compered to the Cortical Bone. They Consists of Red Bone Marrow that produce Blood Cells

The Bone tissue exibits following type of cells:

  • Osteoblast
  • Osteoclast
  • Osteocyte

They help in Synthesization, Bone Resorption as well as Maintainence and repair of bones

Osteoporosis most commonly occurs due to the imbalance in bone resorption and bone formation and insufficient mass

Low Bone Density occurs when osteoclast degrads bone matrix faster than osteoblasts.

Role of Parathyroid Gland in Calcium Metabolism and Osteoporosis

•Hyperparathyroidism-Hyperparathyroidism can be defined as a condition when one or more of the parathyroid glands become hyperactivie and increases in size.
This leads to increased PTH levels in blood
Parathyroid Hormone Vitamin D and Calcium Metabolism –
•Parathyroid hormone is secreted by parathyroid glands.
•PTH along with vit D helps in regulation of calcium level in human body.
•PTH is secreted through negative feedback mechanism of the body when the serum calcium levels are decreased.
•Vit D regulates intestinal absorption of calcium.
•Calcitrol the active form of vit D regulates calcium metabolism.
•Vit D3 is produced from 7-dehydrocholestrol when the skin is exposed to Ultraviolet rays
•Vit D3(Cholecalciferol) is then carried to liver via blood where it undergoes two hydroxylation process.
•First it goes under hydroxylation in liver forming Calcidol 25(OH) and then in kidneys forming Calcidol(1,25 dihyrdroxy vit D).
•The decreased serum calcium level stimulates PTH secretion.
•As Bones are the major store house of calcium,the secreted PTH corrects calcium level by mobilizing calcium from bone through destruction of bones by osteoclasts.
•This leads to osteoporosis where there is weakening of bone decreasing it’s density.

Signs and Symptoms of Osteoporosis

  • Osteoporosis itself may stay silent and show no symptom untill bone becomes weak and break down.
  • Acute and chronic pain in bones and muscles.
  • May precipitate or trigger osteoarthritis
  • Deformities and anomalies to carry out normal daily activities.
  • Stooped posture, loss of height, collapse (loss of consciousness).
  • Fractures are most dangerous aspect of osteoporosis. Fractures most commonly occurs in spine, hip, rib, shoulder, wrist.

Diagnosis of Osteoporosis

The normal Bone Density is within +/-1 SD(+1 or-1)(Standard Deviation) in young adults.

The Score Between -1 and -2.5 is indication of low bone mass.

The score of -2.5 or lower indicates osteoporosis.

  • X rays to an extent helps in detecting reduced Bone Mass also in detecting the complications of osteoporosis like fractures.
  • CT Scan and MRI helps in detecting complications of reduced bone mass, preosteoporosis or follow up examination.
  • Dual Energy X ray Absorptiometry(DEXA) is mostly used for evaluating Bone Mineral Density and its grading for diagnosis of Osteoporosis.
  • Quantitave Ultrasound is a non-invasive method of estimating bone density and risk of bone fracture.
  • Certain Biomarkers are also useful in detecting bone degradation.

Homoeopathic Medicines for Osteoporosis

  • CALCAREA PHOSPHORICA 

    It affects the nutrition of bones and glands indicated in it Homoeopathic form when bones becomes soft brittle and thin, promotes ossification of bones in non union of fractures, pain and burning along the sutures, shifting pain, malassimilation.

  • CALCAREA CARBONICA

    Improper assimilation of calcium gives rise to defective nutrition of bones glands and skin. Swelling of the joints especially knee weakness and trembling of limbs.

  • SYMPHYTUM OFFICINALE 

    injuries to cartilage, periosteum, comminuted fractures, non union of fractures, deficient callus, arthralgia of knees, carries of vertebrae.

  • RUTA GRAVEOLENS 

    Sore tendons, injured or bruised bones, formation of deposit or nodes in periosteum and tendons, ill effects of bruise, fractured bones, brittle paralytic rigidity of injured or affected part.

  • FLOURICUM ACIDUM

    This remedy should be thought of when osteoporosis secondary to some chronic metabolic digestive or autommune condition or post chronic debilitating deep seated  infections  produces slow deeply destructive effects carries of long bones ulceration varicose veins bedsores calcareous degeneration tissues are puffy indurated and fistulus.

  • Ammonium Muriaticum 

    A good remedy to combat secondary effects and complications of osteoporosis especially those due to nerve compression due to degenerative changes of spine as a complication of osteoporosis. Patient has tension and tightness as if muscles or tendons are too short neuralgic pain in stumpsof amputed limbs sciatica pain in heels.

 

VITAMIN D DEFICIENCY HYPOVITAMINOSIS D

HOMEOPATHIC TREATMENT, Metabolic Disorders, Nutrition, Orthopedic

VITAMIN D DEFICIENCY HYPOVITAMINOSIS D

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Vitamin D Deficiency is also called as Hypovitaminosis D and is very common form of nutritional deficiency and it is closely associated with calcium level in blood as it plays a major role in calcium regulation in body.

Vitamin D also called Cholecalciferol is a Fat Soluble Vitamin produced naturally in skin where a precursor 7-Dehydrocholestrol is converted into Pre- Cholecalciferol through conrotatory pathway when exposed to Ultra Violet B (UV-B) rays present in sunrays having wavelenght between 290nm-315nm causing electrocyclic reaction with optimal synthesis between 295nm-300nm when exposed for several minutes to form an equilibrium.

This Pre-cholecalciferol finally undergoes (1,7) antarafacial sigmatropic rearrangement to finally isomerize into cholecalciferol, which an inactive form of Vitamin D.

Cholecalciferol further undergoes Hydroxylation in Liver whith help of 25-Hydroxylase in Hepatocytes and is converted to 25-Hydroxycholecalciferol(Calcifediol) which is an inactive form.

Calcifediol further undergoes Hydroxylation in kidney with help of 1-α-Hydroxylase to form (1,25)dihydroxycholecalciferol(Calcitriol) which is an active form of Vitamin D. Parathyroid hormone tightly regulates amount of active Vitamin D circulating in blood by controlled activation of 1-α-hydroxylase.

Vitamin D Deficiency is usually caused due to

  • Insufficient exposure to Ultra Violet B radiation from Sun. Person with  dark skin colour are more prone to its deficiency as melanin pigment absorbs UVB and doesnt let it penetrate in skin sufficient enough to activation Vitamin D synthesis. also use of sunscreen peeparations doesnt let sufficient penetration of UVB. Also time and period of exposure, altitude, longitude presence of clouds type of clothing worn by person etc determines its amount of absorption and penetration in skin.
  • Insufficient dietary in take of Vitamin D.
  • Cholecalciferol(Vitamin D) is converted into 25-Hydroxycholecalciferol in liver. In certain liver diseases this step of metabolism is disturbed and vitamin D is not converted into 25-Hydroxycholecalciferol(Calcifediol).
  • 25-Hydroxycholecalciferol(Calcifediol) is further converted into active form that is 1,25-Dihydroxycholecalciferol(Calcitriol) in kidney, certain kidney disease hampers this conversion.

Vitamin D deficiency Symptoms

Vitamin D Deficiency shows not only shows symptoms of its deficiency but also symptoms of calcium deficiency in most cases.

  • Osteomalacia
  • Osteoporosis
  • Triggers Osteoarthritis
  • Rickets
  • Periodontitis
  • Paraesthesia
  • Myalgia
  • Tetany
  • Pre-eclampsia
  • Light-Headedness
  • Depression

Vitamin D Deficiency Diagnosis 

Vitamin D Deficiency is diagnosed by measuring level of 25-hydroxycholecalciferol in blood.

Normal level of Vitamin D in blood should range between 30-100ng/ml below this upto 20ng is considered as insufficiency and level below 20 ng is considered as Vitamin D Deficiency.

Sources of Vitamin D

  • Exposure of Skin to Sunlight
  • Fish
  • Eggs
  • Mushrooms
  • Fortified Milk and other food products like oats bread Fortified with Vitamin D.
  • Suppliments are available in both oral and injectible forms.

Excess intake of Vitamin D causes Nausea, Vomitting, Constipation , Confussion, Weakness, Kidney stones(urolithiasis).

Also read following related articles

CALCIUM DEFICIENCY

OSTEOPOROSIS

RICKETS

HOMEOPATHIC TREATMENT, Metabolic Disorders, Nutrition, Orthopedic

CALCIUM DEFICIENCY

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Calcium Deficiency as commonly used  is an ambiguous and misleading term as it may refer to two conditions Dietary Insufficiency without evident Hyopcalcaemia or Hypocalcaemia without Dietary Insufficiency of Calcium both have different Causes and Implications.

Hypocalceamia means reduced calcium level in blood serum below average range of 8.8-10.7 mg/dl.

Calcium is very essential element in human body and is required for maintaining proper anatomical structure and physiological functions in human body, at cellular level of almost all tissue/ organ.

Serum Calcium levels are not indicative of general chornic calcium deficiency/insufficiency, as per body’s requirements,  as  Blood Serum Calcium levels are very tightly maintained in human body within a narrow range. If there is dietary insufficiency then it may not reflect in Blood Serum Levels as the body comprimises Bone Mineral Density to maintain normal Blood Serum Calcium levels as it is more important so as to maintain proper function of other organs and cells especially heart and nerves and other cellular processes as any disturbance in this due to low blood serum calcium level may cause severe acute life threatenig conditions.

Regular intake of calcium is necessary for proper functioning of the body, If there is dietary insufficiency of calcium then the body starts consuming it from bones to maintain normal Blood Serum Calcium level, this depletes the Bone Mineral Density which if prolonged may result into conditions like

  • Osteomalacia
  • Osteoporosis
  • May trigger or contribute to Osteoarthritis.
  • Rickets with pigeon chest open sutures and fontanalles and other anomalies in growing children.

Hypocalcaemia is a severe acute condition usually caused due to deficient calcium metabolism which is regulated by Parathyroid hormone , vitaminD and also healthy functioning of organs like liver and kidney are required for proper calcium metabolism.

Symptoms of Hyopcalceamia

Positive Bathmotropic Effect

As calcium blocks sodium channel which maintains the threshold level of depolarisation of nerve and muscle So, decreased level of calcium will decrease the threshold level for depolarisation which will result in to Positive Bathmotive Effect

Petechea

Recurrent Petechial Heamorrhages which if persists, it tends to overlace and merge with each other appearing like purpura , it appears espescially on weight bearing and dependent parts.

Paraesthesia

Tingling and numb sensation on face especially in perioral region and in limbs on extremities like fingers spreading to hands and toes spreading to feet

Myalgia

Muscular pain especially in lower limbs, its may also accompany paraesthesia.

Tetany

Painful and violent muscular cramps and contractions generalised or may be redtricted to carpopedal region.Positive Trousseau’s  and or Chvostek’s sign for Latent Tetany

Cardiac Symptoms

  • Decreased Chronotropic and Inotropic effect that is reduced heart rate and Myocardial Cantractibility.
  • Which causes decreased cardiac output.
  • ECG shows associated changes like intermittent QT prolongation, typical Ventricular Tachycardia.

Causes

  • Hypoparathyroidism
  • Low Vit D
  • Low dietary intake of calcium
  • Other pathological conditions like kidney or pancrease disease etc.

Homoeopathic Medicines for Calcium Deficiency or Hypocalcaemia

  • Calcarea Carbonica
  • Calcarea Phosphorica
  • Calcarea Fluorica
  • Silicea
  • Magnesia Carbonica
  • Magnesia Muriaticum
  • Magnesia Phosphorica
  • Zincum Metallicum
  • Natrum Mur
  • Natrum Phos
  • Kalium phos

RICKETS

VITAMIN D DEFICIENCY HYPOVITAMINOSIS D

 

OSTEOPOROSIS

Genetic Disorders, HOMEOPATHIC TREATMENT, Orthopedic, Rheumatology

ANKYLOSING SPONDYLITIS

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ANKYLOSING SPONDYLITIS (AS) / MARIE’s Disease / BEKTEREV’s Disease is a Chronic Autoimmune or Autoinflamatory systemic disease which predominantly affects joints and bones of Spine and Pelvis

It falls under AXIAL SPONDYLOARTHRITIS Category.

CAUSES OF ANKYLOSING SPONDYLITIS

Causes are obscure, though Genetics Environmental Factors and Lifestyle in combination are believed to be involved in causation of Ankylosing Spondylitis (AS)

It falls under Sero-negative Systemic Rheumatic  disease where its believed to be mediated by Autoimmune or Autoinflamatory response.

Human Leucocyte Antigen HLA B27 subtypes B2701and B2759  are class I antigen encoded by B locus of Major Histocompatibility Complex (MHC) on Chromosome 6 and presents antigenic peptides (derived from self and non self antigens ) to T cells. HLA B27 is strongly associated  with Ankylosing Spondylitis as 90% of patient showing symptoms of Ankylosing Spondylitis has a genotype presenting it. and 2% of all having genotype expressing HLA B27 contracts Ankylosing Spondylosis.

PATHOGENESIS OF ANKYLOSING SPONDYLITIS

Pathogenesis of AS is still not clear and many factors associated with the pathophysiology directly or indirectly  have been identified

  • Human Leucocyte Antigen (HLA B27 subtypes B2701and B2759)  are class I antigen encoded by B locus of Major Histocompatibility Complex (MHC) on Chromosome 6 and presents antigenic peptides (derived from self and non self antigens ) to T cells. HLA B27 is strongly associated  with Ankylosing Spondylitis as 90% of patient showing symptoms of Ankylosing Spondylitis has a genotype presenting it. and 2% of all having genotype expressing HLA B27 contracts Ankylosing Spondylosis.Now this association with HLA B27 suggests possible link with  CD8 T cells though not proven to involve self antigen it might also be due to reactive arthritis following infection and the antigen might be derived from intracellular microorganism; HLA B27 has many unusual varied properties also it has ability to interact with CD4 so possible association of CD4 in AS is also a probability.
  • Tumour Necrosis Factor α   (TNF α) is found to b implicated in Ankylosing Spondylitis
  • Interleukine 1 (IL 1) is also associated in pathogenesis of Ankylosing Spondylitis
  • Anti-Neutrophil Cytoplasmic Antibodies (ANCAs) are associated with Ankylosing Spondylitis but is not indicator of severity of disease
  • Autoantibodies Specific to Ankylosing Spondylitis have not been identified
  • PTGER4 gene codes for prostaglandin EP4 receptor(EP4). which is associated with bone remodeling and deposition and is highly expressed in those sites of vertebral coloumn which are involved in Ankylosing Spondylitis . Single Neucleotide Polymorphism (SNP) of A/G variant rs10440635a close to the PTGER4 gene on human chromosome 5  possibly influences excessive production of EP4  which causes excessive bone remodelling and deposition in Ankylosing Spondylosis ; though this type of SNP and its association with increased rate of Ankylosing Spondylosis is found only in few ethnic groups

All these and other unknown factors contribute in pathogenesis of Ankylosing Spondylitis which typically results in Annulus Fibrosus Disci Intervertebralis (fibrous ring) of intervertebral disc to OSSIFY which results in the formation of marginal SYNDESMOPHYTES between adjoining vertebrae giving rise to BAMBOO SPINE type appearance of spine

SYMPTOMS AND DIAGNOSIS OF ANKYLOSING SPONDYLITIS

Genetic Testing For Ankylosing Spondylitis

HLA B27 is a non specific test For Ankylosing Spondylitis

As although 90% of those who have AS are HLA B27positive(50% in african-americans and 80% in mediterrenean)

But it has seen in many ethnic group ;esp north scandivanian;that Only 2 % of total HLA B27 positive have AS

Blood Test for Ankylosing Spondylitis

There are no specific Blood Tests Available for AS except for general inflamatory indicators like ESR and CRP which are elevated and tend to increase further on acute episode

Radiological Investigation For Ankylosing Spondylitis

There are no specific Blood Tests Available for AS So its diagnosed based on typical radiological changes but it takes 8-10 years for the disease to become evident enough to establish diagnosis neither CT or MRI can evaluate the disease in early stages

Typical radiological features are:-

  • Axial Spondyloarthritis
  • Early Xray changes include erosion and sclerosis of sacroilliac joints
  • in later stage that erosion increases resulting in pseudo-widening of joint space and Bony Ankylosis
  • squaring of vertebrae with spine ossification with fibrous band running longitudinally called syndesmophyte giving a bamboo spine appearance

Now in case where there are no evident radiological signs it becomes difficult to establish diagnosis as there are no specific blood tests for AS. In such cases clinical features signs symptoms and other non specific blood tests are conducted to evaluate the probability of AS; they are :

  1. Chronic backache with insidious onset before age of 40yrs which has peculiar modalities- Aggravates on rest ;at night and Ameliorates on moderate movement ;exercise ; after getting up from bed in morning
  2. History of inflamatory arthritis or tendinitis
  3. Family history of axial Spondylosis
  4. Positive HLA B27
  5. Responds well to NSAIDs
  6. Elevated ESR and CRP
  7. Other accompaning conditions like IBS Uveitis psoriasis
  8. Schober’s test is a clinical performed during physical exam which is measure of flexion of lumbar spine.

BATH ANKYLOSING SPONDYLITIS DISEASE ACTIVITY INDEX

BASDAI index score is an index which is based on multiple clinical radiological genetic and blood parameters which helps in establishing stage and diagnosis and determine type of management and treatment required

BATH ANKYLOSING SPONDYLITIS FUNCTIONAL INDEX

BASFI index to acess functional impairment

 

GAIT

HUNCHED POSTURE is a severe complication of AS resulting due to complete spinal fusion leading to increased spinal KYPHOSIS which results into forwar and downward shift of Center of Mass to compensate it the knee flexes and ankle dorsiflexes.Their gait has a cautious pattern as they have reduced shock absorbing ability and cant see horizon.

INDICATED HOMEOPATHIC MEDICINES FOR ANKYLOSING SPONDYLITIS

RHUS TOX

Rhus tox is the most common homoeopathic medicine which is very valuable in case of Ankylosing spondylitis, and is useful in various kinds of pains. Rhus tox affects the multiple systems of the body indcluding spine, joints, extremities, skin and mucus membrrane. Patient usually presents with stiffness of back associated with restlessness, is the key indication of this remedy. Pains are aggravated after a period of inactivity. There is marked stiffness, lameness, and pain in the lumbosacral area of back and hips to thighs. Rheumatic pains spread over a large surface area at the nape of neck, back, loins extremities. The small of back aches while sitting. Painfull stiffness on rising from seat. We are led to think of this remedy where we find an irresistible desire to move or change the position constantly. After
resting for a while, when he wakes up and takes a first move, a painful stiffness is felt.

CIMICIFUGA RACEMOSA

Cimicifuga racemosa is one of the indicated remedy for ankylosing spondylitis where there is marked stiffness in the neck area. The patient usually presents with excessive stiffness in the neck with severe pain. The neck muscles feel retracted, neck stiffness is worsened by cold air. The muscular and crampy pains are primilarily are of neurotic origin, occuring nearly in every part of the body. Pains of Cimicifuga are like that of electric shock, which come and go suddenly. Violent lightening type of pain in posterior spinal sclerosis, stiff neck from cold air. Sensitiveness of spine especially in cervical and upper dorsal region. Severe aching pain in lumbar and sacral region.

KALMIA LATIFOLIA

Kalmia is a great rheumatic remedy. Dr Hering introduced Kalmia into homeopathic practice, he himself and his friends being the first provers. Kalmia is one of tbe efficient remedy in ankylosing spondylosis cases where pain and stiffness are marked in lower back,lumbosacral region and neck area. The pains are accompanied with heat and burning in affected area. Pain is attended with excessive stiffness in neck. The pain from neck often radiates down the arms or scapula. Violent pains in the upper dorsal vertebrae. Constant pain in spine. Sensation as if spinal column would break with an anterior convexity and feeling of paralysis in saccrum.

GUAIACUM

Guaiacum is one of the Hahnemans antisporics, is one of the beat known remedies in rheumatism, gout, ankylosing spondylitis. There is Pressure on the vertebrae of the neck. Stiffness in the back, extending from neck to small of back and saccrum, intolearable on slightest motion. Indicated when there are contractive pains between the scapulae. Stiffness from neck may extend to shoulder blades and its painful. All pains are aggravated from motion and heat and relieved during rest.

KALI CARBONICUM

Kali carbonicum is very useful in deep seated diseases lime Ankylosing spondylosis. Kali carb patient presents with severe back pain with stiffness. Small of back feels weak. There is marked Stiffeness and paralytic feeling in the back. Marked indication of kali carb is severe backache during pregnancy and after miscarriage. Burning in the spine. Lumbago with sudden, sharp pains extending up and down of back to thighs. Weakness caused by all potassium salts is more pronounced in this typical salt of potassium
group. Sharp stitching, stabbing pain felt in various parts of the body. Severe backache must lie down for relief.

AESCULUS HIPPOCASTANUM

Aesculus is one of the indicated remedy in ankylosing spondylitis. The main feature of Aesculus is matked pain in lumbosacral area of the back and hips with extreme stiffness. Pain from back radiates to thighs. Lameness in neck. Aching pain between the ahoulder blades, region of spine feels weak. Backache affecting saccrum and hips worse walking or stooping. When walking feet turn under. Rising from seat seems difficult, has to make repeated efforts. Severe pain in lumbosacral region making movement impossible.

SILICEA

Silicea is a very valuable remedy in case of spondylitis. The action of silicea is slow. In the proving it takes long time to develop symptoms. It is therefore suited to complaints which develop slowly. Presents with ankylosing spondylitis with stiffness in nape of neck with severe headache. Coccyx painful as after a long carriage ride. Weakness and paralytic stiffness in back, loins and nape of neck. Swelling and distortion of spine.Aching, shooting, burning and throbbing pain in lumbosacral region with contussive pain between shoulder blades.

COLOCYNTH

Colocynth has a long lasting action on the spine and nerves. The main feature of colocynth is severe pain in the back which finally settes down on the upper part of thigh and buttock. Pain usually confines to small spot making the patient limp and finally becomes so severe that he can neither stand nor walk. Severe burning pain along the saccrum, cramps in hip. Feels better by doubling up, hard pressure and warmth.

CONIUM MACULATUM

Conium maculatum is deep acting antisporic remedy, its action disturbs almost all the tissues of the body. Very well indicated in ankylosing spondylitis of back, weakness is the most striking feature with dorsal pains. Effects of bruises and shocks to spine. After injuries especially in lumbar region. Severe rheumatic pains. The pains are relievex by putting feet on chair. Pain between the shoulder blades. Dull aching pain in lumbar and sacral region.

CALCAREA PHOSPHORICUM

Calcarea phos is a great tissue remedy, though it resembles calcarea carb in many aspects but has its own characteristic symptoms. The spher of phosphate of lime includes all bone diseases whether due to some inherited dyscrasia or defective nutrition in osseous and other structures. It is.a bone salt.without this element no bone is formed, hence it is a valuable remedy. Patient usually presents with weakness of spine, there is curvature of spine towards left , lumbar vertebrae bent towards left. Soreness in sacro iliac symphysis. Rheumatic pains from draught of air with stiffness of neck and back.

HOMEOPATHIC TREATMENT, Orthopedic, Rheumatology

ARTHRITIS

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Arthritis is a term derived from “ARTHRON” means Joint and “ITIS” means Inflamation

Inflamation of joint and surrounding tissue is called ARTHRITIS

Its a general term used to describe pain swelling of joint and its surrounding tissue.

When one joint is involved its called Monoarthritis and when more than one joints are involved its called Polyarthritis

Different types of arthritis have different causative factors like

  • Mechanical
  • Immunological
  • Metabolical
  • Spetic
  • Genetics
  • Lifestyle and Evironmental factors

Though each factor has contribution in certain degree in every type of arthritis; Still it can broadly be classified into 4 major category based on the predominant factor responsible for their Pathophysiolohy/Pathogenesis :

  • Mechanically mediated type
  • Immunological mediated type
  • Metabolical mediated type
  • Spetic

With Genetics Lifestyle and Environment as Contributory factors in each type.

Further various major subtypes are described in detail in following link:

1)OSTEOARTHRITIS
2)RHEUMATOID ARTHRITIS
3)GOUT
4)ANKYLOSINS SPONDYLOSIS

HOMOEOPATHIC MEDICINES and MANAGEMENT OF ARTHRITIS

Homoeopathic Arthritis Management depends on individualisation of the patient based on present symptoms, past history, family history and constitution of the patient.

In arthritis cases it is necessary to take into account the following points (with constant search for underlying miasm and constitution type):

  • When it started, that is since how long its been there.
  • How was the onset when it appeared first time.
  • Wether the complaints had incidious progression or it was sudden.
  • Which joint is involved, wether its single joint or multiple, wether its bilateral and symetrical or diagonal.
  • Particulars like which part was affected first, which side it started first and how much time it took for progression to other side or other joints, sequence in which joints were involved.
  • How and when it gets triggered, aggravation pattern morning stiffness , aggravation on rest/ motion, relation to climate winter/monsoon/summer, relation to heat and cold, aggravation to any particular type of food.
  • Wether its constant or intermittant.
  • The joint is warmer than rest of the body or not.
  • Wether there is swelling around the joint or not.
  • Nodes or nodosities on or around any joints. or any other signs of disfigurement.
  • Movement or other disability in joint.
  • Patient has fever or not or h/o fever before or during the episode of joint pain started.
  • Presence of any concomittants or accompanying symptoms and wether those symptoms are of Psychotic, Syphilitic or Psoric nature.
  • Wether he has any other systemic complaint especially any other autoimmune or metabolic disorder.
  • History of injury, surgery especially affecting neurons or musculoskeletal structure.
  • Nature of work the patient does , postural habits, structural anomalies disfigurements.
  • Diet sleep and exercise routine water intake should also be noted carefully.
  • It is important to note family history of patient wether first degree relative had any autoimmune or metabolic disorder.
  • Wether patient was or is under any long term medication.

A careful history of all communicable ailments should be recorded in sequence as they had been contracted by patient, as it helps us evaluate when and how was the vital force deranged in past and wether the present condition is manifestation of some past ailment, that is any deep seated miasm, also it helps to establish wether its some inherited genetic condition or its acquired condition also it helps differentiate  between

  1. Vector borne conditions like post viral arthralgia/arthritis  and Group A streptococcal borne post pharyngitis systemic autoimmune condition AND
  2. Other Systemic autoimmune conditions like Rheumatoid Arthritis SLE psoriatic arthritis.

These basic question will lead you towards a broader vision in the case and will let you reach upto some conclusion that under what category of arthritis it should be classified and will lead you towards some understanding of miasm and constitution.

As I have mentioned in my other arthritis articles that basically I divide all types of arthritis into four major categories based on their pathogenesis.

  1. Mechanical
  2. Immunological
  3. Metabolic
  4. Septic

After being diagnosed and classified the disease condition from one of the above group we can go further on how to manage each type of case.

Immunologically mediated

Once established that its an immune mediated arthritis its necessary to rule out any damage to other organs like heart, liver, kidney, pancreas, eyes etc, as in most cases autoimmune arthritis is found to involve other system and organs or it is a part of broader systemic autoimmune condition and it is all the more necessary to find out miasmatic background, constitution and individualising symptoms, as such types of arthritis are deep seated having its own sets of aggravating and ammeliorating factors, furthermore its also observed that mental stress and emotional fluctuations have much impact on intensity and frequency of aggravations in almost all types of immunologically mediated arthritis, so its of utmost importance to take proper account of patient’s mental emotional past and present including likes and dislikes aversion and cravings, which helps us to individualise the case.

Once the we have derived constitution , miasmatic background and individuslised the case then comes medicine selection process,

I strongly recomend to go by constitution of patient in immunologically mediated arthritis rather than going theraputic remedy selection.

and it should be kept in mind that the selection procedure of medicine should correspond to degree of mental PQRS , degree of systemic PQRS and degree of musculo-skelatal symptoms of the person in disease should match the degree of pathogenic action on various sphere of the specific medicine.

Though during acute exacerbations of disease it becomes necessary many a times to administer short acting acute medicines theraputically where the new symptoms desnt fall into sphere of the constitutional medicine thats been administered.

Many a times only a single dose of similimum medicine selected may suffice to cure the case  but all patients are not the same each has a different constitution and miasmatic background and severity of ailment and other  external inimical factors, so in many cases it may take series of medicines one by one as per case demands during progression of treatment before the case is cured. It all depends upon how well the physician is able to find out the similimum and type of case and its requirement.

Mechanical

Under mechanical type of arthritis falls osteoarthritis and other types of arthritis caused due to mechanical injuries in such types the case is usually tale tale and shows basic picture of mechanical wear n tear which might be due to poor constitution inherited or might be acquired later on due to external inimical reasons.

In such cases it is necessary to consider that basically the constitution is lacking the capability to repair regenerate and maintain proper quality of joint cartilage and underlying bone and has tendency towards chronic sub-acute inflamation. in such cases it is important to take complete history of patient and family with details of gestational period and individulisation based on Peculiars should be derived forindividualised  remedy selection for complete annihilation of condition;  if not done so the patient might find relief for time being but the symptoms might keep relapsing with time again and again.

In many cases the repair and regeneration mechanisms are sufficient but mechanical wear and tear are in greater proportion and on regular basis so damage tends to accumulate, in such cases there is not much need to go deep into deriving constitution and treatment approach should aim towards elimination of maintaining cause that is excessive mechanical wear and tear and suppliment with nutritious diet and rest to affected part and symptomatic homoeopathic medicines based on theraputics will also work well.

Metabolic

Again this type of arthritis is a deep seated genetic in nature and they might accompany other metabolic syndromes and requires a careful case taking to get a broader picture of the person in disease, all aother systems and organs should be evaluated to understand sphere of disease pathology its extent and severity so it helps us to select the most similimum homoeopathic remedy.

The approach in such cases again remains constitutional , miasmatic and remedy should be selected only after proper individualisation of case and repertorisation.

Septic

In septic arthritis pt needs to be administered short acting acute remedies theraputically with support of deep acting constitutional remedy which can be administered intermittently or after the acute symptoms are ammeliorated to rearrange the deranged vital force.

Commonly Used Homoeopathic Medicines for Arthritis and its symptoms and indications:

RHUS TOXICODENDRON Usefull in almost all types of joint and musculoskeletal complaints where the symptom call for the medicine like stiffness of joints aggravatedon rest and ammeleorated on motion in any ailment involving musculoskeletal system,  rheumatic joint affections, sprain and injury on joints etc

ARNICA MONTANA blunt injury and trauma, sore lame bruised sensation with swelling concussion and contusion call for this remedy

ACTEA SPICATA Pain stiffness and swelling of small joints especially of hands , good remedy for post viral arthralgia like in chickengyunya where small joints are involved

BRYONIA ALBA Stiffness and pain with hot swelling, redness of joints with stitching and tearing pain aggravation on least motion every spot is painful on slightest pressure

LEDUM PALUSTURE Gouty arthritis involving small joints of extremities, hot swollen joints with throbbing pain, gouty nodosities, pain in ball of great toe, podagra, swollen ankles and painful soles, aggravation on warmth of bed , rheumatism starting from lower extremities and ascending upwards. right side more involved compared to left.

HYPERICUM PERFOLIATUM  Degenerative changes of joints involving nerves, sciatica, coccygodynia, cervical and lumbarspondylosis with nerve compression, tingling burning and numb sensation with lancinating pain calls for the remedy, darting pain of shoulders , cramps in calf muscles, pain in tips of toes and fingers, sensation of pressure along the ulnar side if arm.

PLANTAGO MAJOR helps relieve bony snd neuralgic pain in arthritis

BELLIS PERENIS Soreness lameness of joints and muscles, rheumatic joint affections, sciatica where pain radiates down the anterior portion of thigh, sensation as if elastic band is tied around wrist feeling of contration of wrist joint, Railway spine,  sprain and bruises of joints and muscles, good remedy where varicose veins complicate case of arthritis or both are coexisting in any patient.

ACTEA RACEMOSA Rheumatism affecting intercostal region back and neck, cervical spondylosis caising nerve compression and electric shock like shooting pain comes suddenly reaches peak and goes suddenly, stiffness and pain in tendo-achilles. sensation of heaviness in lower extremities, heavy aching tensive pain with twitching and jerking of limbs.

APIS MELIFICA swelling of joint with synovitis and synovial effusion, spetic arthritis, red hot swollen joint , pain on sloghtest pressure or motion, gout , rheumatoid arthritis , post viral arthritis and arthralgia

CALCAREA CARBONICA osteoarthritis, degenarative changes in any joint , osteomalacia or osteoporosis causing joint degeneration, open sutures and fontanale in children, rickets , kyphosis and other loss of normal curvatures of spine, pigeon chest, fractures injuries of bones and joints

COLCHICUM Gouty arthritis , increased Serum Uric acid and tophus formation in joints. typical pain in great toe aggravated at night, sudden gripping cutting pain with much burning comes at night waking patient up from sleep

CALCAREA PHOSPHORICA osteoarthritis due to calcium deficiency , musculoskeletal complaints of old age, developmental musculoskeletal anomaly of growing children, fractures injuries of bones and joints.

BELLADONNA red hot inflamed joint with much pain and swelling

ACONITUM NAPELLUS Acute onset of pain and swelling , can be used in first 24hours or first stage of any acute inflamatory condition with severe mental restlessness fear fright and anxiety.

CALCAREA FLOURICA

NATRUM SULPH a very good remedy for gouty diathesis.

SILICEA

PHOSPHORUS

PHOSPHORIC ACID

TUBERCULINUM

MEDHORRHINUM

SYPHILLINUM

RUTA GRAVEOLANS

GULTHERIA PROCUMBENS

THUJA OCCIDENTALIS

HEKLA LAVA

HOMEOPATHIC TREATMENT, Orthopedic

OSTEOARTHRITIS

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Osteoarthritis is a degenerative joint disease.

Caused due to mechanical stress and covert low grade inflamatory process.

Due to excessive mechanical stress there is increased in demand from factors responsible for repair mechanism. Initially this repair mechanism repairs as it normally should but then it becomes insufficient to repair with same mechanism so it starts compensatory mechanism where in, it tries to maintain structural aspect but at cost of quality of structural components which again due to its inferior quality gets damaged soon further due to prolonged regular mechanical stress these damages gets accumulated even further and now even compensatory mechanism fails to keep up with the amount of damage that’s been done , this starts erosion of the cartilage and the underlying bone and there is general degeneration of joint.

WHAT ARE THE RISK AND CAUSATIVE FACTORS FACTORS OF OSTEOARTHRITIS?

  • Mechanical injury like trauma causing damage to joint or any of its component useful in maintaining strenght structure gait and support to joint.
  • Mechanical stress due to different length of either legs
  • Mechanical stress due to neurological muscular disorder of muscles supporting that particular joint
  • Those who never had habit of running or jogging during their childhood or young age if suddenly starts running in excess on later age, or running along with an injury cuases severe mechanical wear and tear injury to joint.
  • Abnormal body gait and habitual abnormal postures
  • Genetics and hereditary
  • Hormone levels especially sex hormones
  • Metabolic syndrome and obesity( debated as its not the weight thats causing mechanical damage but rather its fats thats responsible to cause metabolic disorder contributing to osteorthritis)
  • Diet and Lifestyle
  • Prolonged regular mechanical stress and insufficient self repair causing accumulation of damages and later resulting into prolonged inflamation causes osteoarthritis.
  • Prevailing condition in body like Osteoporosis, metabolic disorders, autoimmune diseases, joint infections, congenital joint anomaly, certain syndromes like marfan syndrome, elher danlos syndrome, inflamatory diseases like lyme’s disease perthe’s disease

PATHOGENESIS OF OSTEOARTHRITIS

Chondrocytes are responsible to maintain elastic and tensile strength of cartilage by producing collagen and extracellular matrix which maintains hydration by compressive force driving water out and hydrostatic and osmotic pressure drawing water in.

Constant damage to cartilage puts extra load on chondrocytes ;if they aren’t able to repair the damage by producing sufficient collagen and extracellular matrix ; then they start producing different type of collagen just to maintain the structure as far as possible but then this collagen has a different character of retaining more water then the former which spoils the elastic and tensile strength of cartilage as a whole. This further damages the cartilage to the point where it starts disintegrating and shedding off in synovial space which puts extra load on synovium to clear it off for which synoviocytes triggers inflamatory response and synovitis and general mild inflamatory process in joint which gets prolonged due to constant mehanical stress and accumulated damages and finally inflamatory products accumulates damaging joint even further eroding cartillage and bone causing fibrillations and also reduced bone mineral density at site is observed (causation is in debate); finally there is general degeneration of joint leading to pain inflamation and loss of regular function of the affected joint.

WHAT ARE SYMPTOMS OF OSTEOARTHRITIS?

  • Low grade inflamation and degeneration causes pain due to which there may be loss of range of movement of a joint along its axis in varing degrees from mild to severe.
  • This loss of ability of movement further causes dysuse atrophy of muscles related to that particular joint and due to degenerative changes the joint becomes wider which gives typical lean muscle and wide joint looks, like in the Heberden’s Nodes and Bouchard’s Nodes in fingers
  • Osteoarthritis particularly involves weight bearing joint and joints more prone to mechanical stress like knee joint; lumbar spine cervical spine hip joint joints of fingers and less commonly other joints like ankle joint shoulder joint etc
  • It may present in one joint or in multiple joints at a time.
  • Exertion and motion aggravates the complaints and rest ameliorates the complaints.
  • Morning stiffness of affected joint is present in majority cases  though not a specific symptom.
  • Aggravation in cold climate, high humidity,  low atmospheric pressure is seen in many cases tough not consistent every-time.
  • Crepitation on movement or pressure are observed in affected joint.
  • Surrounding muscle spasms and when vertebral bodies are affected the spinal nerve corresponding to it may get compressed leading to spasms paraesthesia myalgia and cramps to correrponding musscle the affected nerve supplies.
  • Joint effusion, especially of knee joint are see not too infrequently.

DIAGNOSIS OF OSTEOARTHRITIS

In most cases sufficient clinical evidence supports the diagnosis but an X ray is required not only to reconfirm diagnosis but also to evaluate to amount of damage within as pain and other clinical symptoms are not indicator of the amount of damage within; in many cases we may also need to exclude other conditions for which further related investigations should be done.

HOMOEOPATHIC MANAGEMENT OF OSTEOARTHRITIS

Once its established that the patient is suffering from osteoarthritis the homoeopathic management of the case will be as follows

As per my classification criteria Osteoarthritis falls under Mechanically mediated type of arthritis

Under mechanical type of arthritis falls osteoarthritis and other types of arthritis caused due to mechanical injuries in such types the case is usually tale tale and shows basic picture of mechanical wear n tear which might be due to poor constitution inherited or might be acquired later on due to external inimical reasons.

In such cases it is necessary to consider that basically the constitution is lacking the capability to repair regenerate and maintain proper quality of joint cartilage and underlying bone and has tendency towards chronic sub-acute inflamation. in such cases it is important to take complete history of patient and family with details of gestational period and individulisation based on Peculiars should be derived forindividualised  remedy selection for complete annihilation of condition;  if not done so the patient might find relief for time being but the symptoms might keep relapsing with time again and again.

In many cases the repair and regeneration mechanisms are sufficient but mechanical wear and tear are in greater proportion and on regular basis so damage tends to accumulate, in such cases there is not much need to go deep into deriving constitution and treatment approach should aim towards elimination of maintaining cause that is excessive mechanical wear and tear and suppliment with nutritious diet and rest to affected part and symptomatic homoeopathic medicines based on theraputics will also work well.

Homoeopathic Medicines for Arthritis with its symptoms and indications:

  • RHUS TOXICODENDRON usfull in almost all types of joint and musculoskeletal complaints where the symptom call for the medicine like stiffness of joints aggravatedon rest and ammeleorated on motion in any ailment involving musculoskeletal system,  rheumatic joint affections, sprain and injury on joints etc
  • ARNICA MONTANA blunt injury and trauma, sore lame bruised sensation with swelling concussion and contusion call for this remedy
  • ACTEA SPICATA pain stiffness and swelling of small joints especially of hands , good remedy for post viral arthralgia like in chickengyunya where small joints are involved
  • BRYONIA stiffness and pain with hot swelling, redness of joints with stitching and tearing pain aggravation on least motion every spot is painful on slightest pressure
  • LEDUM PAL gouty arthritis involving small joints of extremities, hot swollen joints with throbbing pain, gouty nodosities, pain in ball of great toe, podagra, swollen ankles and painful soles, aggravation on warmth of bed , rheumatism starting from lower extremities and ascending upwards. right side more involved compared to left.
  • HYPERICUM PERFOLIATUM degenerative changes of joints involving nerves, sciatica, coccygodynia, cervical and lumbarspondylosis with nerve compression, tingling burning and numb sensation with lancinating pain calls for the remedy, darting pain of shoulders , cramps in calf muscles, pain in tips of toes and fingers, sensation of pressure along the ulnar side if arm.
  • PLANTAGO MAJOR helps relieve bony snd neuralgic pain in arthritis
  • BELLIS PERENIS soreness lameness of joints and muscles, rheumatic joint affections, sciatica where pain radiates down the anterior portion of thigh, sensation as if elastic band is tied around wrist feeling of contration of wrist joint, Railway spine,  sprain and bruises of joints and muscles, good remedy where varicose veins complicate case of arthritis or both are coexisting in any patient.
  • ACTEA RACEMOSA Rheumatism affecting intercostal region back and neck, cervical spondylosis caising nerve compression and electric shock like shooting pain comes suddenly reaches peak and goes suddenly, stiffness and pain in tendo-achilles. sensation of heaviness in lower extremities, heavy aching tensive pain with twitching and jerking of limbs.
  • APIS MELIFICA swelling of joint with synovitis and synovial effusion, spetic arthritis, red hot swollen joint , pain on sloghtest pressure or motion, gout , rheumatoid arthritis , post viral arthritis and arthralgia
  • CALCAREA CARBONICA osteoarthritis, degenarative changes in any joint , osteomalacia or osteoporosis causing joint degeneration, open sutures and fontanale in children, rickets , kyphosis and other loss of normal curvatures of spine, pigeon chest, fractures injuries of bones and joints
  • CALCAREA PHOSPHORICA osteoarthritis due to calcium deficiency , musculoskeletal complaints of old age, developmental musculoskeletal anomaly of growing children, fractures injuries of bones and joints.
  • BELLADONNA red hot inflamed joint with much pain and swelling
  • ACONITUM NAPELLUS Acute onset of pain and swelling , can be used in first 24hours or first stage of any acute inflamatory condition with severe mental restlessness fear fright and anxiety.

For understanding of arthritis in general, its case-taking and homoeopathic management   visit following link

http://atomictherapy.org/homoeopathic-arthritis-management/

HOMEOPATHIC TREATMENT, Orthopedic, Rheumatology

SCIATICA

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Nerve fibres originating from L4-S3 unites in front of piriformis muscle to form the widest single nerve in human body called the SCIATIC NERVE. Myalgia Paraesthesia in the corresponding region of supply of the Sciatic Nerve is termed as SCIATICA.

This symptom can be due to compression of /injury to /pathology of Sciatic Nerve or its nerve fibre origin.

Compression/Injury/ Pathology can be due to trauma / mechanical wear and tear / pathological changes around sciatic nerve or at origin of its fibres at lumbar and sacral region.

COMMON CAUSES OF SCIATICA

  • Lumbar Spondylosis
  • Spinal Stenosis
  • Spinal Disc Herniation
  • Degenerated Vertebra
  • Sciatic Nerve Surrounding Muscle Spasms
  • Sciatic Nerve Surrounding Tissue Inflamation
  • Deep Tissue Abscess Around Sciatic Nerve
  • Fetal Weight During Pregnancy
  • Piriformis Syndrome
  • Tumours in and around Sciatic Nerve
  • Injury During Surgical Procedures

MANAGEMENT OF SCIATICA

Patients presenting with pain along nerve path; should be tested for straight leg raise test

Further imaging tests CT, MRI, MRneurography helps to find out exact cause

Person should also be tested for any deficiency of Calcium through Bone Mineral Density ; Vitamin D levels where sciatica is due to bony degeneration or osteoarthritis of lumbar spine or osteoporosis in general.

Vitamin B12 levels should also be tested

In patients with sciatica due to spinal complaints originated from mechanical reasons

Secure lower back(lumbosacral region) and give it proper rest; mild exercises not involving lumbo-sacral region; helps by not involving lower back but still maintaining healthy equilibrium of body thus helping faster recovery.

Spinal manipulation helps to an extent in disc related pain which is contraindicated in progressive neurological deficits

Patients with sciatica due to non mechanical spinal reason / secondary to tumour / some other pathology like inflamation or abscess around; should be treated first for primary reason.

Homoeopathic Medicines for Sciatica with Indications

MAGNESIA PHOSPHORICA

Magnesium phosphoricum is a great antipsoric remedy. Mag phos is a constituent of nerves, muscles, bones, spine, brain, blood corpuscles. It helps to create white fibres of muscles amd nerves. The deficiency of this salt allows the fibres to contract causing spasms, cramps and other nervous phenomenon. Magnesium phosphoricum is thought of in all maladies having origin in nerve cells and in muscle tissue. Mag phos is very well indicated in Sciatica. It is suited to tall, dark, neurotic, exhausted people. Used for neuralgic pains, having spasmodic effects and have great influence on nerves and muscles. The pains are very violent and may affect any nerve. Pain localises itself in a nerve and become worse especially in case of sciatic nerve. Pains come in paroxysms. The patient feels better in warm place where neuralgias are better. There are times when a nerve in which there is a considerable pain becomes sensitive to pressure. Stiffnness, numbness along the route of nerve from prolong exertion. Rest relieves most of the complaints.

RHUS TOXICODENDRON

Rhus tox is a frequently indicated remedy in rheumatic affections, and neuralgias. Rhus tox affects the fibrous tissue markedly joints, tendons, sheaths, producing pain and stiffness. Rhus tox is very useful in Sciatica. Pains usually spread over a large surface area along the route of nerve, stiffeness of limbs with paralysis. Presents with tingling in feet. Affections of nerves and spinal cord give rise to paretic effects. Symptoms appear on the eft side and go from left to right. Patient is very restless., cannot rest in one position. Complaints come on from cold damp weather aspecially to cold. Pains that run through Rhus tox are aching, tearing with numbness and paralytic weakness of limbs with loss of sensation. Presents with low back ace with stiffnness, aggravatiom on resting after excercise.

CALCAREA CARBONICA

Calcarea carb is chief representative of calcium compound. Calcium metabolism is active during childhood and becomes defective in middle age. Calcarea patient can be described as fair, fat and flabby with tendency to gain weight. Calcarea carb has main action on the vegetative sphere with impaired nitrition being the keynote of its action. Calcarea carb has marked indication in case of sciatica, where there is severe pain in the lower back, lumbar spine to the buttock and down the back of leg. Excruciating pain with burning sensation. Presents with numbness tingling sensation in affected leg or foot. Associated with Weakness of extremities.

BELLIS PERENIS

Bellis is known commonly as Wound wort, therfore like Arnica it is great traumatic remedy. Very well indicated in Sciatica. There is results of injurie to nerves with intense soreness and intolerance of cold bathing. Severe pain at the lowet back, radiatinv downwards, pains may vary widely from a mild ache to sharp burning sensation, can feel like a jolt or electric shock. Worse when you cough sneeze or due to prolong sitting aggravates the complaints. Sore bruised feeling in the pelvic region.

HYPERICUM PERFORATUM

Hypericum perforatum is an excellent remedy for injury to parts rich in sentient nerves. Indicated in traumatic neuralgiaand neuritis.Spasms after injury.
Hypericum perforatum is considered when the sciatic pain is attended with tingling, burning and numbness in affected limb. The spine is very sensitive to touch. Walking or stooping is impossible from intense pain in back and lower limb. Aching pain in left sciatic nerve after prolonged sitting. Violent pains and inability to walk or stoop after a fall on coccyx. Excessive painfullness is the guiding symptom, associated with cramps in calves.

ARNICA MONTANA

Arnica montana is frequently indicated remedy in case of sciatica. Patient usually presents with excessive soreness of lower limbs. Severe neuralgias with low backache and pain radiating from back through thigh to foot. Numbness and soreness after over exertion. Cannot walk erect on account of bruised pain in pelvic region. Limbs ache as if beaten. Numbness in feet. Sore lame bruised feeling all over the body, bed feels hard. Slightest tough is unbearable. Arnica is usually suited to cases when an injury however remote seems to have caused the trouble. Extreme restlessnes, patient constantly changes his position.

CALCAREA PHOSPHORICA

The sphere of action of phospahte of lime includes all neuralgic affections and bone diseases whether due to some dyscrasia or defective nutrition. Calcarea phos is One of the most important tissue remedies. Very well indicated in case of sciatica. The back pains are worse from cold stormy weather. Severe pain in the back and along the route of sciatic nerve from straining, tearing, shooting, and aching in the spine. Soreness in the sacroiliac symphysis. Pain in the lumbar region and sacrum extending to the feet.

PLANTAGO MAJOR

Plantago usually affects the nerves causing nerves causing neuralgias. Patient usually presents with sharp cutting type of pain. Numbness in the affected parts. Trembling of limbs. Severe pain in the back extenxing to feet. Sharp shifting type of pains. Very useful remedy in case of sciatica.

COLOCYNTHS

Colocynth has a long lasting action on the nerve especially the scoatic nerve. The principle feature of colocynth is its severe tearing, neuralgic pains, pains are so severe that the patient is unable to remain still. The sciatic pains ae better feom hard pressure. Neuralgic pains are cutting, clamping, gnawing type followed by numbness and lumbar ache which is relieved by pressure. Severe pain in the back extending downwards, sensation as if heavy weight in the lumbo dorsal region lying on left side. Along with sciatica there is agonising pain in abdomen causing patient to bnd double with restlessness. Sciatic pains extend from lumbar region to limbs. Tensive lancination in lumbar region and hips especially while lying on the back. Pain while walking as if psoas muscles were too short, on stooping it caeses but commences again while walking. Usually Left sided sciatica, pain along the course of left sciatic nerve. Pain in low back radiates to toes.

GNAPHALLIUM

Gnaphalium is an indicated medicine in sciatica, when the pain in the sciatic nerve is attended with numbness. Useful in cases of sciatica where pain is confined to calves and feet. There is intense pain in the nerve accompanied by cramps alternating with numbness. Intense pain along the route of sciatic nerve. Lumbago with numbness of parts and weight or heaviness in pelvis.

ACONITUM NAPELLUS

The rapidity of action of aconite determines its symptomatology. Aconite is one of the indicated remedy in sciatica. Symptoms are acute, violent and painful. They appear suddenly and remain for a short while as if a big stormwhich soon blows over. Neuralgic pains are very intense. Pain in the back. Sensation of burning, numbness, tingling, crawling semsation alon the route of nerve. Parts remain sore and numb after pains. Physical and mental restlessness with state of fear, anguish.

BELLADONA

Belladona is very useful remedy in sciatica. Where the pains are sudden and violent with redness and heat of affected parts. Belladona acts on the nerve centres producing twitching, pains, jerks and spasms in limbs. Invluntary limping. Trembling of limbs. The lower part of the back feels as if broken. Sensation of heaviness in the buttocks and thigh. The sciatic pain is worse from heat and relieved from bending backwards and by rest. Symptoms of belladona that is pain and suffering come on suddenly pass a regular course amd subside suddenly.

SILICEA

Silicea is one the indicated remedy in sciatica. Presents with neurasthenic states and increased susceptibility to nervous stimuli. Sciatic pains usually start in thr back hips and run through the course of sciatic nerve through back of legs and feet. Severe cramps in calves and soles. Weak spine. Severe pain in coccyx.

BRYONIA ALBA

Bryonia is most effective medicine for sciatica that gets worse from walking. The slightest motion may worsen sciatica., in such cases lying down absolutely still provides some relief to the patient. Heaviness in the Affected hip or leg. The general character of pain here is stitching type of pain, pains greatly aggravated by slight motion and better by rest. Usually adapted to nervous dry, alender people. Pain in small of back which becomes worse by stooping. Scaitica better by lying on painful side.

HOMEOPATHIC TREATMENT, Metabolic Disorders, Nephrology, Orthopedic

GOUT

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Gout is metabolically mediated type of arthritis strongly associated with genetics as a major cause, to which diet and lifestyle plays a contributory factor in its pathogenesis.It is primarily caused due to disorder of purine metabolism (purine is one of the major component of our gene it forms base pairs / nucleotides with pyrimidine to give structure to our gene; also purine is present in many food that we eat esp. certain sea food and many pulses).

Its when the final product of purine metabolism i.e uric acid, starts crystallizing and forming Monosodium Urate Monohydrate then it starts depositing in joint and tissues around joint its called gout and not mere hyperuricemia can be termed as gout.

PATHOGENESIS OF GOUT

GOUT PATHOGENESIS FLOW CHART
Purine De Novo Synthesis with Salvage Pathway and GOUT
Purine De Novo Synthesis with Salvage Pathway and GOUT

Overproduction of uric acid may be due to one or more of following factors:-

  • Catabolism,
  • Loss of purine salvage mechanism,
  • Defective or sluggish transportation,
  • Under excretion of uric acid,
  •  Reduced elimination of uric acid due competition of metabolites for elimination,

which results into  hyperuricemia triggering Gout.

Although hyperuricemia has been found to trigger gout but many having maintaining uric acid within normal limits still develop gout and many having uric acid on higher side are still not developing gout. So genetics has major role in determining at what level of serum uric acid the patient may develop Gout.

When Uric acid crystalises into monosodium urate, it then starts precipitating in joints, tendons and surrounding tissues,in small clusters of deposits called tophi. Each tophus is collection of monosodium urate crystals surrounded by a protein wall. This protein wall prevents its interaction with surrounding cells and thus prevents inflamatory response. Occasionally this walled-off tophi breaks open the protein wall and so the urate crystals comes out naked in contact with surrounding cells, which may be due to medical, surgical metabolic, physical stress or sometimes even rise in serum uric acid levels may lead to breaking of this wall, which causes acute inflamation and sets in acute arthritis within few hours.

SYMPTOMS OF GOUT

Its usually observed that small joints of extremities which are not sufficiently insulated to tolerate cold and shocks and those that are in region where circulation is affected due to gravity dependence, like great toe and ankle , small joints of feet, hands and wrist are more prone compared to other joints. Although it can affect all the joints and can present itself with different signs and symptoms but it is classically known as Podagra for the one characteristic symptom it frequently presents in most of the patients, its the intense burning and sharp excruciating pain with mild redness and swelling especially on base of great toe (at first metatarso-phalangeal joint) starting suddenly and frequently at night waking patient up from sleep.

 

 GENES ASSOCIATED WITH HYPERURICEAMIA AND GOUT

1) Absence of gene associated with breakdown of Uric Acid.

In humans unlike other carnivorous primates(meat eater in particular) the Uricase /urate oxidase, an enzyme which breaks down uric acid to 5hydroxyisourate then to allantoin,  has became non functional during evolution phase and is present only as psuedogene/junk gene so, the humans have tendency towards probability of elevated levels of uric acid due to lack of breakdown and accumulation which may trigger gout.

Uric Acid though may have beneficial effect as its a very powerful antioxidant and scavenger, helping body to protect itself from oxidative damage and thus prolonging life and reducing age-specific cancers, so hominids may have opted out the Uricase gene in selective evolution.

After we identified urate oxidase and its activity, we have artificially prepared protien Rasburicase. Rasburicase is now used to treat patient developing acute hyperuriceamia during chemotherapy. Also a PEGylated form of urate oxidase is in clinical development for treatment of chronic hyperuriceamia having “treatment failure gout”.

2) Defect in genes associated transportation and transfer of uric acid for elimination.
  • SLC2A9 The encoded protein by this gene plays a role in transportation of uric acid and also in development and survival of chondrocytes in the cartilage matrix. Any SNP (single neucleotide polymorphism) in this gene causes transcript variants encoding different isoforms, which increases the risk of development of Hyperuriceamia and also it may alter joint cartilage matrix both of these anomaly plays a major role in formation of gout.
  • SLC22A12 has 2 transcript variants encoding different isoforms; basically it encodes urate transporter and urate anion exchanger protein which regulates the level of urate in the blood; its an integral membrane protien primarily found in kidney; SNP of this gene causes altered reabsorption of Uric Acid by the kidney.
3) Genes associated with purine salvage mechanism.
  • PRPSAP1 and HPRT1 are gene related to Purine salvage mechanism.
  • Phosphoribosyl Pyrophosphate Synthatase associated Protein 1(PRPSAP1).
  • PRPP (5-phosphoribosyl 1- pyrophosphate) is a substrate used by HGPRT during purine salvage pathway.
  • Hypoxanthine Phosphoribosyl Transferase 1 (produce hypoxanthine-guanine phosphoribosyl transferase (HGRPT)which plays main role in generation of purine nucleotide through purine salvage pathway).

SNP or deletion of any of the above mentioned gene causes hyperuriceamia and also other severe conditions.

4)Certain Genetic Disease And Syndromes Presents Hyperuricemia And Gout As One Of The Symptom Like In  :-

  1. Familial Juvenile Hypouricemic Nephropathy (FJHN) associated with UMOD gene. UMOD gene produces Tamm horsfall protien, whose function is still not well understood but defect in this gene produce many autosomal renal disorders characterised by juvenile onset of hyperuricemia, gout and progressive renal failure.
  2. Medullary Cystic Kidney disease (type I and II).
  3. Lesch Nyham Syndrome is an X-linked Syndrome caused due to HPRT1 Gene deletion (details of HPRT1 have been mentioned elsewhere above in this page).

Physical trauma, Wasting Diseases ,Surgery are associated with increased uric acid levels.

MEDICINES ASSOCIATED WITH HYPERURICEMIA

Diuretics in higher doses, niacin, aspirin ACE inihibitors angiotensin receptor blockers  beta Blockers ritonavir pyrazineamide ciclosporin tacrolimus.

DIAGNOSIS OF GOUT

In patients with recurrent acute episodes of arthritis especially of great toe accompanying hyperuricemia is sufficient to establish the diagnosis. However an episode of acute arthritis in many instances may not accompany hyperuricemia, so arthroscentesis should be done for synovial fluid analysis for visualising monosodium urate crystals or tophus is the only confirmatory test whether patient is hyperuricemic or not.

DIET AND LIFESTYLE ASSOCIATED TO GOUT AND HYPERURICEMIA

Food rich in purine especially red meat and sea food is considered to be associated with hyperuricemia. Its found that moderate consumption of purine rich vegetarian diet is not associated with the condition. Also total protien  has no impact untill not much of it is in form of purine.

Alcohol consumption and Fructose sweetened food and drinks are strongly associated with it.

Metabolic syndrome, diabetes, cardiovascular disease, and aging process are also associated with this condition and they tend to worsen each other.

Vitamin C, Coffee and switching to Dairy Products for protein requirement will also help.

Weight reduction and regular exercise helps reduce Uric acid.

Raised uric acid level is also associated with renal stones and urate nephropathy.

HOMOEOPATHIC REMEDIES FOR GOUT and HYPERURICEMIA(raised serum uric acid)

ARNICA MONTANA

Arnica is a traumatic remedy par excellence. Arnica is an useful remedy in chronic cases of gout. Old cases of gout rouse into a new soreness of joints with great sensitiveness. Arnica is an important remedy in injuries, bruises, shocks etc. Trauma in all its varieties mental or physical and their effects recent or remote are met with this remedy. If we observe a arnica patient in order to get the external manifestations of his state, he is constantly moving,turning and highly restless. The patient has sore lame bruised feeling, so sore that he can lie on one part only for a while and must keep changing position as the bed he lies on feels hard. Limbs ache as if beaten. Inflamation of joints.

ACTEA RACEMOSA

Actea racemosa is a very well indicated remedy in gouty and rheumatic diathesis. Swelling of joints with raised uric acid levels. Its muscular and crampy pains are primarily neurotic origin, occuring in nearly every part of the body. Pains of actea racemosa are like that of electric shock, comes suddenly and also its relieved suddenly. There is stiffness and pain in the tendo achillies. It has wide action on muscles nerves joints. Rheumatic aching pains in joints and muscles with stifness of joints. Causes depression of mind with low spirits and exhaustion along with oversensitiveness especially during pain.

ABROTANUM

Abrotanum is a very valuable remedy which is used more frequently. Indicated in gout and increased uric acid levels. Rheumatism and gout alternate with haemorrhoids. Abrotanum increases circulation and opens small arteries as a result the blood flow and local defense of joints and muscles is stimulated. Abrotanum relives gout pain.

ACONITE NAPELLUS

Aconite napellus is very well indicated in rheumatic and gouty conditions of joints. Those that come on as first attack. Not old rheumatic and gouty attacks but those that come on from exposure to cold. Rapidity of action of aconite determines its symptomatology. Presents with Symptoms are acute painful and violent pain in the joints. Aconite is indicated in acute onset of pain and swelling. Used in 1st stage of inflammatory condition with severe mental restlessness. Fear. Fright and anxiety.

BELLADONNA

Belladona is useful in inflamtory rheumatism and gout.Symptoms that suggest this remedy are sudden onset, swollen joints, red hot, throbbing pain with extreme sensitiveness. Complaints of belladona that is the pains and suffering come on suddenly run a regular course and subside suddenly. Sudden attack of cold worsens the complaints.

COLCHICUM AUTUMNALE

Colchicum is a primary remedy used for treatment of gout because of its effectiveness.most useful in chronic gout.
Colchicum has marked action of the joints, indicated in case of gouty arthritis and increased uric acid levels. Helps in relieving the gouty paroxysms. Inflammation of great toe, gout in heel, cannot bear to be touched. Oedematous swelling and coldness of feet. Joints are red hot swollen. Pains are usually worse in evening and night.

LEDUM PALUSTURE

Ledum pal is mostly used in rheumatic and gouty diathesis. Remedy affects the fibrous tissues of joints especially small joints, ankles,heels.Used in cases where the gouty pains shoot through the foot, limbs and smaller joints. There is great swelling in the foot and ankle. Joints hot and swollen with with cracking in joints. Gouty nodosities. Ball of great toe is swollen. Soles are very painful can hardly step on them. Aggravation from warmth is so vreat that the patient can only get relief to his rheumatism by sitting with his feet in icy cold water.

NATRUM SULPHURICUM

Natrum sulph is used for symptoms associated with gout it may be acute or chronic. Swelling and burning of joints. Pain compels frequent change in position with stiffness of joints. Burning in sole with oedema of feet.

RHUS TOXICODENDRON

Rhus tox is one of the most frequently indicated remedy for rheumatic and gouty complaints. Rhus tox usually affects the fibrous tissue markedly joints, tendons, producing pain and stiffness. Rhus plays a good role in gouty complaints. Hot painful swelling of joints. Tearning pains in tendons, ligaments and fasciae. Affects the smaller joints, parts feel sore and bruised with stiffmess. All complaints worse from cold damp weather and motion in any ailment and relieved from warmth.

URTICA URENS

Urtica is useful in rheumatic and gouty diathesis. This remedy helps in elimination of uric acid from the body. The patient has tendency to uric acid and gout formation. The joint complaints are usually associated with hive like erruptions. Presents with pain in small joints. Worse from exposure to cold moist air, wet weather.

BENZOICUM ACIDUM

Benzoicum Acidim is a very Specific and Infallible remedy in cases of chronic and acute gout, usually given in lower potencies in frequent repetitions.

Tophus of Gout
LARGE TOPHUS OF GOUT AT Dr SHAH’s Homoeopathy

 

Large Tophus Of Gout at Dr Shah's Homoeopathy
LARGE TOPHUS OF GOUT 2 IMAGE CLICKED AT Dr SHAH’s HOMOEOPATHY by Dr DEEPAN P SHAH
Podagra Gout Hyperuricemia
PODAGRA GOUT HYPERURICEMIA
Podagra – Inflamation of 1st Metatarsophalangeal Joint (Joint of great toe to feet) in patient with Hyperuricemiam or elevated Uric Acid. Its a classical presentation of Gout.
PODAGRA GOUT HYPERURICEMIA
PODAGRA GOUT HYPERURICEMIA
Podagra – Inflamation of 1st Metatarsophalangeal Joint (Joint of great toe to feet) in patient with Hyperuricemiam or elevated Uric Acid. Its a classical presentation of Gout.