Category Archives: Rheumatology

Posts related to all Rheumatic and Autoimmune Disease and it’s homeopathic treatment will fall under this category

SEPTIC ARTHRITIS

Septic Arthritis is invasion of joint by micro-organisms causing inflamation, it is also called infection of joint or Arthrtis due to infection or infective arthritis.

CAUSES

VECTORS

Septic Arthritis can be caused due to infection of any of the following vectors

  • Bacteria
  • Virus
  • Fungus
  • Parasite

Most Common Organisms Known to Cause Septic Arthritis.

  • Staphylococci – Methycillin Resistant Staphylococcus Auris(MRSA)
  • Streptococci
  • Escherichia Coli
  • Pseudomona Aeruginosa
  • Neisseria Gonorrhoeae
  • Neisseria Meningitidis
  • Myocbacterium Tuberculosis
  • Salmonella spp.
  • Brucella spp.
  • Eikenella Corodens
  • Pasteurella Multocida
  • Borrelia Burgdorferi
  • Rubella virus
  • Parvovirus B19
  • Chickungunya virus

RISK FACTORS

Usually its not common to get joint infection unless the immunity of a person is weak or there is history of surgery, prosthesis, deep tissue infections etc.

  • Joint Surgery
  • Prosthetic implants
  • HIV
  • Immuno-suppressive Medication
  • Intravenous drug users
  • Rheumatoid Arthritis
  • Osteoarthritis
  • Arthritis due to Gout
  • Gonorrhoea
  • Infective Endocarditis
  • Deep and /or nonhealing wounds
  • Other deep tissue infections
  • Other causes of septicemia
  • Old age

SIGNS AND SYMPTOMS OF SEPTIC ARTHRITIS

  • Usually single joint infected, less frequently more than one joints are involved.
  • Most commonly involved joint is knee joint and other freqently involved joints are hip, spine, shoulder, wrist, elbow, sacroilliac and sternoclavicular joints.
  • Sudden onset of symptoms, fast progression of disease.
  • Swelling, redness with increased local Heat and pain around joint. Swelling and redness is comparatively much more than other types of arthritis.
  • Fever with or without chills and headache.
  • Cant move joint due to severe pain.
  • Pain aggravated in slightest motion or jarring, pain is ususally aching type with stitching, stinging and pulsating.

DIAGNOSIS OF SEPTIC ARTHRITIS

  • Athrocentesis – microorganisms usually found on culture, WBC count above 50,000-1,00,000/cubic mm, neutrophils more than 90%, lactate count more than 10mmol/l.
  • CBC – increased wbc
  • Blood culture positive for micro-organism
  • ESR – elevated
  • CRP – elevated
  • Procalcitonin – elevated
  • NAAT – to rule out gonorehoea
  • Ultrasound – joint effusion
  • CT scan – Region involved type and extent of damage
  • MRI – Region involved type and extent of damage

HOMOEOPATHIC MEDICINES FOR SEPTIC ARTHRITIS

Septic Arthritis is a medical emergeny case and requires immediate medical intervention any delay in treatment can cause damagr and complete destruction of joint with hours to days.

Acute fast acting Homeopathic Medicines are selected with special affinity to joints and pathogenesis that of sudden, severe, acute inflamation with much swelling redness. Below is the list of indicated homeopathic medicines that I prefer in case of infective arthritis.

  • APIS MELIFICA
  • BELLADONA
  • LEDUM PALUSTURE
  • RHUS TOXICODENDRON
  • BRYONIA ALBA
  • PYROGENUM
  • ACONITUM NEPELLUS
  • MEDHORRINUM
  • TUBERCULINUM
  • SYPHILLINUM

CARPEL TUNNEL SYNDROME CTS

CARPEL TUNNEL SYNDROME CTS is a condition where in the compression symptoms arise due to bundle compression of structures that pass within carpel tunnel affecting the the Median Nerve.

WHAT IS CARPEL TUNNEL?

CARPEL TUNNEL is normal anatomical structure in our body found in every normal individual. It is formed by carpel bones forming a groove as its floor on dorsal side of hand and flexor retinaculum forming the flat roof of carpel tunnel on palmar side of hand.

It provides attachment and passage at the wrist level for the structures to pass through arm to hand. Muscles related to flexing movements of finger pass through this tunnel alomg with median nerve

Structures Passing Through Carpel Tunnel

  • Flexor Digitalis Superficialis – 4 tendons
  • Flexor Digitalis Profundus – 4 tendons
  • Flexor Pollicis Longus – 1 tendon
  • Median Nerve
  • Flexor Carpi Radialis not exactly pass within the carpel tunnel but it traverse through Flexor Retinaculum that is forming the roof of carpel tunnel.

CAUSES OF CARPEL TUNNEL SYNDROME

Anything that exerts pressure to median nerve giving rise to nerve compression symptoms cause carpel tunnel syndrome. In most cases the cause remains obscure and are idiopathic. Any inflamatory process or water retention or metabolites deposition within tissue may cause increase in volume of structures and total content within the carpel tunnel and will cause in pressure of whole bundle which may cause Carpel tunnel due to increased bundle pressure, similarly the adjecent structures to carpel tunnel if inflamed or injured or any overgrowth of it, may exert pressure on carpel tunnel and median nerve within giving rise to carpel tunnel syndrome. Mechanical reasons like wear-tear and injuries are mostly regarded as major factors with ageing and certain genetic, structural and physiological anomalies are known to increase the risk of Carpel Tunnel Syndrome.

Age and Gender

  • Age – Ageing plays a major role in development of CTS its more commonly found in age above 40yrs
  • Gender –  Female sex is more prone to this condition compared to male.

Mechanical

  • OCCUPATIONAL – Work related frequent repetitive forceful pressures jerk and vibrations on hand on regular basis where in there is no sufficient time given to repair the wear and tear and the damage tend to accumulate over time.
  • POSTURAL HABBITS such that it exerts unusual strain on hand and wrist on regular basis.
  • INJURIES to wrist distal part of forearm and wrist. Fractures involving radius ulna carpel and metacarpel bones like Colle’s Fracture, Boxer’s Fracture etc.

Genetic and Systemic 

  • Prediabetics and Diabetics
  • Obesity
  • Metabolic Syndrome
  • Hypothyroidism
  • Arcomegaly
  • Amyloidosis
  • Rheumatoid Arthritis
  • Gout
  • Tumours
  • Hereditary Neuropathy with Susceptibility to Pressure Palsy – Carcot Marie Tooth Syndrome casused due to mutation in gene HS3TC2
  • Narrow Carpel Tunnel
  • Certain drugs like Corticosteriods or Oestrogen therapy.

SIGNS AND SYMPTOMS OF CARPEL TUNNEL SYNDROME

  • Paraesthesia in Index finger, Middle finger, Thumb and the lateral half of  Ring finger
  • Myalgias or neuralgia in forearm upwards to arm, less commonly in wrist and hand
  • Loss of strength of grip and Loss of Manual Dexterity
  • Atrophy of muscles at the base of thumb visible on proximal, thumb-related quadrant of palm (ie proximal lateral quadrant/upper outer quadrant).

HOMEOPATHIC MEDICINES FOR CARPEL TUNNEL SYNDROME CTS

  • HYPERICUM
  • CIMICIFUGA/ACTEA RACEMOSA
  • AGARICUS MUSCARIOUS
  • ACTEA SPICATA
  • PLANTAGO
  • BELLIS PERENIS
  • ARNICA MONTANA
  • GELSEMIUM SEMPERVIRENS
  • TARRENTULA HISPANICA
  • GNAPHALLIUM

TRIGGER FINGER

TRIGGER FINGER or TRIGGER THUMB is a condition where in joints of one or more of the digits(finger/thumb) gets stucked up/locked up at certain postion which is difficult to move and moving it with force may cause popping or clicking sound with pain.

Though it can present in any sex and at any age, it is more commonly found in females around age of 50-60 yrs.

CAUSES OF TRIGGER FINGER/THUMB

Its is also termed as digital Stenosing Tenosynovitis, although there is no predominant inflamation to Tendosynovium but inflamation is found in Tendon Sheath. And also its not comfirmed that inflamatory process has any primary role in its development

Though exact cause behind trigger finger/thumb is not known but the risk factors that tend to increase the incidence of this condition are identified

  • Over straining and over use of hand and fingers espescially activities involving prolonged forceful flexion of digits(fingers/thumb) may be occupational or habbitual routine activities.
  • Frequent injuries – occupational, accidental or even injuries of planned surgery of hand especially ofter surgery for carpel tunnel syndrome
  • Systemic connective tissue disorders
  • Autoimmune diseases especially Rheumatoid Arthritis
  • Hypothyroidism
  • Renal Disease
  • DeQuervain’s Diseases
  • Amyloidosis
  • Diabetes Mellitus and Other Metabolic disorders.

SYMPTOMS OF TRIGGER FINGER/THUMB

  • Though it may involve any digit(thumb/finger) Index finger and Thumb are more frequently involved. One or more digits may be involved.
  • Patient presents with stucked up digit at certain position. It may be at any level from flexed  to extended position usually found at semiflexed position.
  • This locking up may be persistent for a prolonged period of time or may be momentary and recurrent.
  • Aggravations are more commonly experienced at night, especially while holding heavy article with hand or while gripping or applying pressure with fingers or hand.
  • On moving and or forcefully unlocking the stucked finger is bit painful and causes clicking and popping sound
  • In severe cases the finger may be persistently locked for prolonged period of time with constant pain which may also extent to whole hand and wrist.

DIAGNOSIS OF TRIGGER FINGER/THUMB

Diagnosis of trigger finger/thumb is based on clinical symptomatology of the patient where in inflamation or involvement of tendon sheath of flexors is confirmed and excluding probability of other condition like

  • Tumour
  • Sprain of digit
  • Osteoarthritis of metacarpo-phalangeal joint
  • Fracture
  • Tendon Entrapment post-trauma
  • Extensor Apparatus Injury
  • Game Keeper’s Thumb
  • Sesamoid anomaly
  • Dupuytren’s Contracture
  • Focal Dystonia

An injection of lidnocaine in tendon sheath of flexors reduced the pain then it confirms diagnosis Trigger Finger/thumb.

HOMEOPATHIC TREATMENT FOR TRIGGER THUMB

Treatment of trigger finger/thumb is dependent on combination of modalities of physiotherapy, splinting and medication.

HOMEOPATHIC MEDICINES FOR TRIGGER THUMB/FINGER

  • CALCAREA FLOURICA
  • SILICEA
  • THIOSINAMINUM
  • RHUS TOXICODENDRON
  • ACTEA SPICATA
  • THUJA OCCIDENTALIS
  • AGARICUS MUSCARIOUS
  • ARNICA MONTANA
  • BRYONIA ALBA
  • CIMICIFUGA RACEMOSA

REACTIVE ARTHRITIS

Reactive Arthritis was also called Reiter’s Arthritis is RF-negative and HLA-B27 Linked Imflamatory oligoarthritis typical with Enthesitis, accompanied with Inflamatory occular and/or inflamatory genitourinary and other systemic manifestation usually post gastrointestinal or genitourinary infection.

During world war one and two many cases emerged with the Triad of Symptoms viz. Inflamation of Joints, Inflamation of eyes and Inflamation of Uretha. Which drew attention of medical community due to common presentation in many giving it some syndrome like picture. On further investigations it was found out that most of them were exposed to urogenital or Gastro-intestinal infection 1-4 weeks prior to onset of this Triad of Symptoms. This was initially termed as “Fessenger-Leroy-Reiter’s Syndrome” or simply  “Reiter’s Syndrome”. But as the physician Hans Conard Julius Reiter  was involved in attrocities and war crimes with Hitler, so his name was removed and later renamed and termed as “Reactive Arthritis”.

EPIDEMIOLOGY OF REACTIVE ARTHRITIS

  • AGE – It more frequently affects age group of 20-40 years.
  • SEX – It is more common in Males then in Females.
  • ETHNICITY – Due to its association with HLA-B27 it is frequently found in white race compared to dark race as comparatively HLA-B27 occurs more commonly in white population.
  • RISK FACTOR – Person with HIV positive status are more prone to develop reactive arthritis.

SIGNS AND SYMPTOMS OF REACTIVE ARTHRITIS

The onset of symptoms of Reactive Arthritis typically starts 4-35 days after an initial infection of gastro-intestinal system or genito-urinary system.

TRIAD OF REACTIVE ARTHRITIS

Reactive arthritis in most of the cases presents where patient cant – SEE, PEE, climb the TREE! due to following Classical Triad of Symptoms of reactive arthritis

i) OLIGOARTHRITIS

Oligoarthritis involving less than five joints. It may frequently involve knee and sacroilliac joint as well. May present itself in additive pattern where it starts with one joint and add another joints subsequently or it may be migratory in pattern where the set of inflamed joints keep changing by addition and simultaneous substraction of joints involved.

ii) NON-GONOCOCCAL GENITOURINARY INFLAMATION

Inflamation of genitourinary system classically presents itself at the onset of the disease. Not always but in many its typically after initial sexual exposure. It presents as frequent burning micturation, uritheritis, prostatitis, balanitis in men and salpingitis, vulvitis and vaginitis in women.

iii) OCCULAR INFLAMATION

Occular Inflamation may present itself as mild conjunctivitis or uveitis in 75% of cases with gastrointestinal origin and 50% of cases with urogenital  involvement. patients have intermittent irritation in eyes with blurred vision typically commences at onset of disease.

OTHER SYMPTOMS

  • Few patients also presents with peculiar symptom which is specific to reactive arthritis, its Keratoderma Blenorrhagica which are small hard nodule commonly appear on soles occasionally on palms and rarely on other parts of body subcutaneous nodules are not incluced. Even in absence of above mentioned triad of symptom the presence of Keratoderma Blenorrhagica is diagnostic for reactive arthritis.
  • In reactive arthritis; typical to HLA B27 related immunological reactions; involves Entheses that is where skeletal muscles attaches with bones through tendons, where it causes Enthesitis and tendon inflamation especially the tendo-achilles and also fascia in particular Plantar Tendinitis.
  • Occasionally patients also suffer from dactilitis giving finger sausage-like apperance “sausage finger” due to inflamation.
  • Mucocutaneous involvement presents as ulcerative or non ulcerative stomatitis, apthous ulcers and geographic tongue are also seen as presentation of this disease
  • Cardiac involvement causing pericarditis and aortic regurgitation in cases which do no recover soon or if its recurring or progressive.
  • Gastrointestinal manifestation like pain and cramps with frequent semiformed stools with mucous and insome cases blood due to  inflamation and ulcceration in gastrointestinal tract.

Most of the cases of Reactive Arthritis recover within six months, in many cases it keeps comming back time and again and in few it becomes chronic and progressive which may increase risk of severe complications.

COMPLICATIONS OF REACTIVE ARTHRITIS

In chronic progressive and recurring cases the patient may develop following complications

  • Ankylosing Spondylosis
  • Disabling Arthritis
  • Aortitis
  • Aortic Regugitation
  • Conduction defects of Heart
  • Pericarditis
  • Amyloid deposits
  • Immunoglobulin A Nephropathy

CAUSE OF REACTIVE ARTHRITIS

Reactive Arthritis is is HLA B27 linked inflamatory arthritis and enthesitis preceeded by a spell of infection either of genito-urinary system  or gastro-intestinal system by following commonly involved organisms

GENITO-URINARY INFECTIONS ASSOCIATED WITH REACTIVE ARTHRITIS

  • Chlamydia Trachomatis
  • Ureaplasma Urealyticum

GASTRO-INTESTINAL INFECTIONS ASSOCIATED WITH REACTIVE ARTHRITIS

  • Salmonella Spp.
  • Shigella Spp.
  • Campylobacter Spp.
  • Yersinia Spp.

4-35 days after the spell of urethritis or food poisoning by above mentioned organisms the symptoms of reactive arthritis sets in, where the synovial fluid has negative culture ans is free from infection and but the HLA B27 linked  inflamation is thought to be triggered due to

  • Autoimmune reaction due to cross reactivity of micro-organism antigen with joint tissue  or
  • Micro-organism antigenic components that may have settled in joint tissue.

DIAGNOSIS OF REACTIVE ARTHRITIS

Clinically the Reactive Arthritis can be diagnosed with help of Sensitivity and Specificity Guidlines laid down by American College of Rheumatology, for clinical diagnosis with given set of presenting symptom, its as follows

  1. Arthritis > 1 month with Urethritis and/or cervicitis has  sensitivity of 84.3% and specificity of 98.2%.
  2. Arthritis > 1 month with Urethritis or Cervicitis or bilateral Conjunctivitis has Sensitivity of 85.5% Specificity of 96.4%.
  3. Arthritis, Urethritis and Conjunctivitis has Sensitivity of 50.8% and sensitivity of 98.8%.
  4. Arthritis > 1 month, Conjunctivitis and Urethritis has Sensitivity 48.2% and Specificity of 98.2%.

Patients falling in above criteria or those showing just Keratoderma Blenorrhagica without any other symptoms and other suspected cases can be sent for following test for further evaluation.

  • HLA B27 testing
  • Urine routine and culture
  • STOOL Routine and culture
  • Throat swab culture
  • Cervix and Urethral swab culture
  • Erythrocytes Sedimentation Rate
  • C-Reactive Protein Test

HOMEOPATHIC TREATMENT FOR REACTIVE ARTHRITIS

Being an immune mediated systemic reaction that too the one that is triggered with different causative agents and even to same agents different individuals will respond differently.

Though they may have same set of general symptoms like the classical triad of reactive arthritis but intensity of each of the symptom of triad will differ in each individual,

Now this is where the homeopathic individualisation process starts. In Homeopathy we believe that though majority of human genome is the same but the minor variations in gene and the epigenome make the whole lot of difference in various characteristerics of each individual, similarly their immune reaction also varies, so every person should have individualised medicine.

Homeopathic Treatment is based on symptom similarity and individualisation of case based on peculiar symptoms based on which the case is individualised and medicine is selected.

Alternatively as per Homeopathic principle of Genus Epidemicus or pathology based symptomatology there can be disease specific homeopathic medicine derived from common symptomatic representation of a disease condition in a group of population.

Now this can not be the most similimum homeopathic prescription but roughly it can hit the disease condition within an indivudual though not accurate but will yeild some results in most of the cases.

To yield best homeopathic results there can be no generalised common approach for all cases.

But still if we have to attempt common standardised pathology based approach then to give some guidelines on homeopathic approach towards cases of reactive arthritis I have attempted following rough guidelines which may help to give some vision in approach towards such cases.

Its seen that in few case it begins after gastro-intestinal infection and in some case post genito-urinary infection. So this will further guide determining “morbid cause” behind the disease directing us in homoeopathic similimum medicine selection.

Now reactive Arthritis shows a triad of symptom in most of the cases. So this triad helps us to reach to group of medicines with such combination of symptoms.

Intensity, occurance of symptoms and its sequence in triad differs in each individuals. For example

  • In some person urogenital symptoms may be more severe compared to occular symptoms or arthritis symptoms, where as in others arthritis and ocular symptoms would be more severe than urogenital symptoms.
  • Some may not have occurence of  conjunctivitis
  • In some all three triad occur at a time where as in some patients it may occur gradually one after another in different sequence.

All this helps us find out the “seat of disease” in an individual and its degree of affinity towards various organs which can be related to homeopathic medicines during selection process.

Further arthritis may show different pattern like

  • progressive
  • migratory
  • additive
  • symetry
  • predominantly involved joint
  • sequence of joint involvement
  • number of joints involved
  • severity
  • intensity
  • type of sensation and other symptoms

Also similarly symptoms of occular involvement and urogenital involvement should be take in to account in absolute detail. This further helps refine and classify the patient and the respective medicines to be repertorised.

Which other systems and organs are involved like mucous membranes, skin, heart, kidney etc and what type of pathology they are showing like tissue destruction or just inflamation and functional disturbance or tissue lysis with regenerated and degenerative changes this will help to decide what “type of miasm” is underlying wether its psoric, syphillitic or psychotic type pathology.

Certain symptom are very “peculiar” for the  disease and occurs in few individuals like Keratoderma Blenorrhagica eruption, now location of this eruption will further help individualise the case.

Enthesitis – Inflamation of tendo-achilles and plantar fascitis is  “very specific” to the disease but does not occur in all individuals, so if plantar fascitis or inflamation of tendo-achilles if occurs in someine with this disease then it helps further in individualisation of during homeopathic medicine selection.

Other than this the general health and family background should be noted to derive  constitutional types and association of HLA B27 in 75% of this individual further helps in individualisation and homeopathic medicine selection.

COMMONLY USED HOMEOPATHIC MEDICINES FOR REACTIVE ARTHRITIS

  • PHOSPHORUS
  • ARSENICUM ALBUM
  • RHUS TOXICODENDRON
  • BRYONIA ALBA
  • LEDUM PALUSTURE
  • THUJA OCCIDENTALIS
  • ANTIMONIUM CRUDUM
  • ARGENTUM NITRICUM
  • BORAX
  • MERCURIOUS SOLUBILIS
  • PULSATILLA NIGRICANS

FROZEN SHOULDER HOMEOPATHIC TREATMENT

Frozen Shoulder also called Adhesive Capsulitis of shoulder joint is painful stiffness limiting range of motion of shoulder joint caused due to inflammation related pathophysiology in capsule of shoulder joint.

CAUSES AND RISK FACTORS OF FROZEN SHOULDER

CAUSE OF FROZEN SHOULDER

Exact cause of Frozen Shoulder remains unclear but there are many factors that increases the risk and lead to frozen shoulder

RISK FACTORS FOR FROZEN SHOULDER

GENDER

Frozen shoulder is more common in females than in males

AGE

Person above 40yrs of age are more prone to this condition

INJURIES

  • Injury to shoulder joint involving any of its companent especially gleno-humeral joint capsule or rotator cuff.
  • Sports persons typically develop calcifications of tendons around shoulder joint and also in joint structures due to repeated injury and result of prolonged inflamation such persons are at high risk of developing frozen shoulder.

REDUCED MOBILITY

  • Injuries to arm and neck may indirectly affect shoulder joint, due lack of motion in general of that region as a whole and changes pattern of gait and movements of that region.
  • Immobility or reduced mobility post surgerr with general debility and delayed recovery.
  • Immobility post stroke.

MUSCULO-SKELETAL DEFECTS

  • Certain congenital structural anomaly of Musculoskeletal framework which has influence on movement, gait and weight distribution pattern on shoulder joint in abnormal pattern, which may put the person at risk of develooing Frozen Shoulder.
  • Kyphosis or Scoliosis or other congenital or acquired spinal anomaly especially those above thoracic spinal level may increase risk of frozen shoulder.
  • Patients with cervical spondylosis are at risk of developing frozen shoulder.

RHUEMATIC DISORDERS

OTHER SYSTEMIC DISEASES

SYMPTOMS OF FROZEN SHOULDER

  • Pain in affected shoulder aggravates on movement
  • Loss of rang in motion of affected shoulder joint

Frozen Shoulder is divided into 3 stages

1) Freezing Stage

In Freezing Stage there is pain in joint which aggravates on motion and he range of motion gradually starts decreasing.

2) Frozen Stage

In Frozen Stage the pain is not much as compared to freezing stage but the range of motion is completely diminished so much so that patient can barely move the joint or cant move at all.

3) Thawing Stage

In Thawing Stage pain subsides and range of motion gradually starts improving and complete recovery is established in few weeks.

If it is acted upon quickly in freezing stage with intervention of physiotherapy and proper medication the progress of the disease is arrested and soon resolves completely.

DIAGNOSIS OF FROZEN SHOULDER

On clinical presentation of symptoms of the patient frozen shoulder can be diagnosed and radiological tests like X-rays, CT scan and MRI may be suggested inrequired cases to find out extent, severity of pathological condition within and also to rule out any other pathological condition within or around shoulder joint.

If along with shoulder joint if there are other joints involved simultaneously or frequently different joints in past then it becomes necessary to rule out other underlying systemic conditions like Rheumatoid ArthritisGout, Ankylosing Spondylosis, Systemic Lupus Erythematosus etc and for that your doctor may suggest blood tests like RA factor, ESR, CRP, ANA, S.uric acid and HLA B27 (where there is severe spinal involvement along with shoulder). Vitamin D should also be checked wether its in optimal range for better recovery.

TREATMENT OF FROZEN SHOULDER

Treatment of frozen shoulder is based on combination of both Physiotherapy and Medicines.

Physiotherapy plays a major role in cases of frozen shoulder. Physiotherapist takes support of certain modalities, recomends certain exercises and manual physical intervention where in he may exert mild force or pressure along and within the axis of movement of shoulder joint and try to open up the freezed shoulder and gradually retain its laxity and mobility.

Pain may temporarily increase during and  after physical intenvention but with regular recomended exercise and medicines it finally subsides and joint regains its complete range of axis of movement subsequently.

HOMEOPATHIC MEDICINES FOR FROZEN SHOULDER

If the frozen shoulder is without any underlying condition specific medicines will work well but if it is secondary to some underlying condition like autoimmune diseases or metabolic disorders or Infections or some other systemic or acute or chronic complaints then constitutional trearment along with initial acute specific remedy may be required.

List of Common Homeopathic Remedies Used in Frozen shoulder

  • Calcarea Flourica
  • Silicea
  • Calcarea Phosphorica
  • Thiosinaminum
  • Rhus Toxicodendron
  • Bryonia Alba
  • Arnica Montana
  • Plantago Major
  • Belladonna
  • Ledum Palusture

LUMBAR SPONDYLOSIS

Degenerative changes in vertebral bodies and intervertebral disc at the level of L1 to S1 in vertebral cloumn affecting lumbar region of spine is called Lumbar Spondylosis.

It is characterised by degenerative changes of Lumbar vertebral bodies like osteophyte lippings and spur formation, degeneration of  intervertebral disc, narrowing of intervertebral space, Intervertebral disc bulging, intervertebral disc herniation.

It can also be called Osteoarthritis of Lumbar Spine.

CAUSES OF LUMBAR SPONDYLOSIS

Lumbar Spondylosis may be caused due to many factors that can be broadly classified into Mechanical, Congenital or Acquired Anatomic anomalies, Metabolic, Immunologic, Genetic, Nutritional, Ageing and Septic reasons.

Most common of all are ageing and mechanical reasons like excessive wear and tear due to wrong postural habbits, type of work like driving for long duration regularly, sitting for long hours, lifting weights or working with bent posture etc. that exerts much pressure on lumbar spine on regular basis so as to not giving much time to recover again and resulting into accumulation of wear and tear finally damaging the spine and causing lumbar spondylosis.

Metabolic problems like Hyperuricemia/Gout where high level of uric acid in blood damages lumbar spine also this uric acid may get crystalised to form monosodium urate monohydrate and settle in the intervertebral joints and damage them.

Immunologically mediated chronic inflamation in lumbar spine like in Rheumatoid Arthritis, Chickenguniya, Systemic Lupus Erythematosus etc.

Genetic Complaints like Ankylosing Spondylosis etc

Vitamin D deficiency causes reduced calcium assimilation resulting into reduced bone mineral density causing weak bones easy to damage. Insufficient nutrition compared to requirement, which prevents repair work of regular wear and tear of lumbar spine, due to which damages tend to get accumulated resulting into lumbar spondylosis.

Congenital or acquired Anatomical anomalies in musculoskeletal framework that may cause abnormal posture or abnormal weight distribution which results into pressure on spine in wrong fashion gradually facilitates development of Lumbar spondylosis.

Septic Conditions of spine like Tuberculosis of spine may result into lumbar spondylosis due to tissue lysis as result of infection.

SIGNS AND SYMPTOMS OF LUMBAR SPONDYLOSIS

  • Pain and Stiffness  in lower back or Lumbar Region.
  • Sciatica due to compression of nerve roots of sciatic nerve.
  • Pain stinging pain in lumbar spine
  • Pain radiating from lumbar spine to lower limbs
  • Paraesthesia in lower back genitals or lower limbs
  • Cramps calfs, thighs and other muscle and muscle groups of lower limbs
  • Difficulty in walking and maintaining posture and balance.
  • Lack of control on urinary spincter or anal spincter resulting into either retention of urine or bowel or involuntary expulsion of urine and bowel
  • Sexual debility Tabes Dorsalis

COMPLICATIONS OF LUMBAR SPONDYLOSIS

Myelopathy – When there is damage to spinal cord it causes Myelopathy.

Raduclopathy – compression of nerve near nerve root where it emerges out of spinal cord.

Vertebrobasilar insufficiency – Vertebral artery insufficiency due to its occulusion while it passes through vertebral foremen sue to degenerative changes for lumbar spine causes vertebrobasilar insufficiency leading to death of condrocytes of intervertebral disc and osteophytes starts accumulating and depositing.

DIAGNOSIS OF LUMBAR SPONDYLOSIS

  • Clinical symptoms if indicate towards Lumbar spondylosis it can be then confirmed with X ray.
  • MRI and CT scan gives us better imaging which helps  judge and evaluate the extent of damage and condition
  • Myelograph is dye injected while Xray and CTscan this gives detailed shadow to understand even better
  • Electromyography helps evaluate nerve involvement in spondylosis.

HOMEOPATHIC MEDICINES FOR LUMBAR SPONDYLOSIS

  • HYPERICUM PERFOLIATUM
  • CALCAREA CARBONICA
  • GNAPHALLIUM
  • CALCAREA PHOSPHORICA
  • MAGNESIA PHOSPHORICA
  • ARNICA MONTANA
  • NATRUM SULPHURICUM
  • RHUS TOXICODENDRON
  • SILICEA
  • MEDHORRINUM

CERVICAL SPONDYLOSIS

Our spine is classified into cervical, thoracic, lumbar and sacral regions.

Cervical Spondylosis is condition where in vertebra and intervertebral discs of cervical region undergoes degeneration. 

It is characterised by thinning of intervertebral discs, reduced intervertebral space, osteophyte lipping, spurs formations,  herniation of intervertebral disc, nerve compression etc.

It can also be called osteoarthritis of cervical spine.

CAUSES OF CERVICAL SPONDYLOSIS

This degeneration can be due to various mechanical, immunological, infective, metabolic, genetic, nutritional and age related reasons.

It can be due to one or combination of than one ot the above reasons. Most of the cases are due to ageing and mechanical wear and tear related to abnormal physical exertion and postural habbits.

It is commonly seen in people assuming wrong posture for long hours like lying down with head placed on huge pillow or watching mobile phones or reading books with tilted head for long hours, staying on computer workstation with an arm stretched on mouse or key board for long transfers weight on neck.

When such postural habbits are prolonged for few hours to days its starts inflamatory process in cervival spine and if still prolonged for months to years the prolonged inflamation and mechanical wear and tear results into degeneration of spine.

Many genetic and immune mediated conditions like Rheumatoid arthritis, Ankylosing spondylosis, Systemic Lupus Erythematosus, Psoriatic Arthritis etc may result into prolonged chronic inflamation of spine ingeneral and gradual degeneration of cervical spine as well resulting into cervical spondylosis.

Metabolic reasons like hyperuricemia may result into deposition of monosodium urate monohydrate crystals into joint spaces in cervical spine resulting into subsequent erosion and degeneration of spine causing cervical spndylosis.

Certain infections in spine like tuberculosis results into degeneration of spine and spondylosis and when it affects cervical region on spine it causes cervical spondylosis.

With ageing there is depletion of anabolic hormones and other factors required for quick repair process which results into slow repair process compared to daily wear and tear and damages tends to accumulate and gradually resulting into erosion and degeneration of spine.

Nutritional deficiencies arised due to lower intake compared to requirement, resulting into lower calcium vitamin D and many other nutrients which not only slows down the repair process to built up damages but also gives rise to low bone mineral density resulting into erosion and degeneration of vertebral bodies.

SIGNS AND SYMPTOMS OF CERVICAL SPONDYLOSIS

In initial stages it starts with occasional stiffness and pain in neck lasting few minutes to hours after exertion gradually it starts persisting with pain on extreme range of axis of movement of neck then later even on smaller axis or range of motion of neck patient starts feeling stiffness or pain or discomfort in neck

If not taken care the nerves originating from cervical plexus which emerge out from cervical spine they start getting compressed causing myalgia paraesthesia in neck which may radiate to shoulder and extend upto arm and upto tip of fingers.

In severe cases of cervical spondylosis patient may also experience vertigo nausea vomitting complete loss of balance with pain in neck and gastric derangement as concomittant symptoms

COMPLICATIONS OF CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOTIC MYELOPATHY (CSM) – It is caused due injury to spinal cord due to cervical spondylosis.

CERVICAL SPONDYLOTIC RADICULOPATHY – In this the nerve gets pinched and compressed near the nerve root shortly after it leaves spinal cord.

VERTIBROBASILAR INSUFFICIENCY – When vertebral artery which is passing through vertebral formen gets occluded and deprives chondrocytes of intervertebral disc from circulation as a result the die and weaken intervertebral disc and osteophytes starts settling in.

DIAGNOSIS OF CERVICAL SPONDYLOSIS

Cervical Compression Test – When the neck is tilted laterally and applied downward pressure patient feels pain on ipsilateral side in neck or shoulder , its not conclusive but indicative and qualifies case for further radiological investigations

Lhermitte’s Sign – Electrict Shock like pain on flexion of neck

These patients general show reduced range of motion of n

Based on clinical symptoms patient may be sent for X ray  for ascertaining the diagnosis.

MRI and CT Scan helps to further find out extent and severity of damage to spine.

Myelography is done with dye injection in spinal cord during CT or X ray for more detailed radiological imaging

Electromyography and Nerve Conduction Test helps to find out involvement of nerve and nerve damage and extent of nerve injury.

TREATMENT FOR CERVICAL SPONDYLOSIS

Guidlines to patients on maintaining correct posture, avoid jerk and strain to secure neck is of utmost importance in management of cervical spondylosis patients.

Proper calcium intake sufficient exposure to sunlight for vitamin D. Increased protein, vitamin B12 and iron intake.

Exercise like pranayam and walk helps stimulate hormone secretion and thus facilitating absorption and assimilation of nutrients required for repair and rebuilding the worn and damaged tissues and to increase bone mineral density.

Mild gentle exercise of neck helps increase local blood flow and keep tissue supple and stimulate its growth and strenght but if not done under proper guidance of qualified physiotherapist it may further injure the already damaged tissue. So if proper qualified physiotherapist is not available to guide its safer bet not to exercise neck region involving cervical spine on your own and giving it complete rest and let it recover on its own while still continueing with walk and pranayam regularly.

HOMEOPATHIC MEDICINES FOR CERVICAL SPONDYLOSIS

CIMICIFUGA RACEMOSA / ACTEA RACEMOSA

RHUS TOXICODENDRONE

ARNICA MONTANA

PLANTAGO MAJOR

HYPERICUM PERFOLIATUM

TUBERCULINUM

BELLADONNA

CALCAREA PHOSPHORICA

BELLIS PERENIS

SILICEA

MEDHORRINUM

SLE SYSTEMIC LUPUS ERYTHEMATOSUS

SLE or Systemic Lupus Erythematosus or sometime only called Lupus is a chronic systemic autoimmune condition with genetics, nutrition and environment playing a major role in its onset and evolution, its a condition which greatly reduces life expectancy and also causes complications in pregnancy. It falls under disabling disease conditions category though much less than10% cases develops disabilities.

TYPES of SLE

  • Acute Cutaneous Lupus
  • Sub-Acute Cutaneous Lupus Erthematosus
  • Chronic Cutaneous Lupus also called Discoid Lupus Erthematosus
  • Neonatal Lupus Erythematosus
  • Drug Induced Lupus Erythematosus

EPIDEMIOLOGY of SLE

Lupus was the most google searched topic in healthcare related topics in 2017! Now that is something to be added in Epidemiology section!  😀 hehehe!

Female are affected more with SLE than male, female of child bearing age are affected more with female to male ratio of about 9:1.

African, Caribean and chinese ethnic groups are more prone to this condition.

SIGNS and SYMPTOMS of SLE

GENERAL

Undifferentiating symptoms which are common to other diseases as well.

  • Fever
  • Fatigue
  • Malaise
  • Joint pain
  • Muscle pain
  • Bodyache
  • Sleep disturbances
  • Psychiatric Disorders
  • Poor physical fittness
  • Anaemia of chronic disease
  • Raynaud’s Phenomenon

SKIN

Majority of cases shows skin manifestation of the condition

  • Though the rashes and lesion on skin may vary, the classic sign of SLE on skin is butterfly rashes on face, also called Mallar Rashes and is seen in almost half of the cases with skin lesions.
  • If it is Acute type there might not be scaling of skin, not well demarcated distinct edge compared to othe types.
  • If it is Subacute type rashes shows scaling of skin with distinct edges.
  • And in Chronic type rashes shows thick distinct thick scaling with very well demarcated edges.
  • Increased Hairfall is also one of the complaints.
  • Ulcers in mucous membranes esp of nose and mouth.

MUSCULOSKELETAL

It affects Small joints especially of fingers and wrist and it very closely mimicks rheumatoid arthritis and psoriatic arthritis making it clinically difficult in making differential diagnosis.

But it is less destructive and disabling compared to other two conditions, only less than 10% cases of SLE will develop deformities and even fewer will have disabilities.

It not only mimicks Rheumatoid Arthritis but it also seems to have very close relation to rheumatoid arthritis.

It significantly increases risks of fractures and also it is associated with facilitation of Osteoarticular Tuberculosis.

HEAMOTOLOGICAL

  • Anaemia of chronic disease with low Red Blood cell count
  • Low White Blood Cell count
  • Anti phospholipid antibody syndrome is a condition where anti-phospholipid antibodies increases Partial Thromboplastin time causing tendency to heamorrhages and it is frequently found positive in patient with SLE and its coexisting is termed as Lupus Anticoagulant Positive.
  • Patients with SLE frequently show positive results for Anti Cardiolipin Antibodies as well, and patients with these antibodies sometimes shows false positive results for Syphillis.

CIRCULATORY SYSTEM AND HEART

  • Artheroscelerosis – Thickening and deposition of cholestrol plaque in blood-vessel walls which may also give rise to Ischemic Myocardial diseases like Myocardial Infarction.
  • Vasculitis – Inflamation of blood-vessels in some cases
  • Endocarditis – Inflamation of inner linning of heart, when due to SLE its termed as Libman-Sacks Endocarditis
  • Pericarditis – inflamation of outer layers and and surrounding tissues.
  • Myocarditis – Inflamation of cardiac muscles.
  • It may also cause inflamation of Mitral and Tricuspid valves of heart.

LUNGS

  • Pleurisy – Inflamation of pleura.
  • Pneumonitis – Inflamation of lungs.
  • Interstitial Lung Disease
  • Pulmonary Embolism
  • Pulmonary Heamorrhage
  • All these complications and chronic inflamatory processes causes Shrinking Lung Syndrome where there is reduction in lung volume.

REPRODUCTIVE

30 % of pregnancy has comolications like

  • Fetal Death
  • Spontaneous Abortion
  • Still Birth

Prognosis is worse in those who get aggravations in SLE duringbpregnancy.

Neonatal Lupus Erythematosus

Child born to mother with SLE shows symptoms of Discoid Lupus Erythematosus with

  • Heart block
  • Splenomegaly – Enlargement of Spleen
  • Hepatomegaly – Enlargement of Liver
  • Neonatal SLE is self limiting condition and in most cases recovers on its own.

RENAL (Kidney)

  • Painless Heamaturia – Blood in urine.
  • Painless Proteinuria – Protein in urine.
  • Lupus Nephritis leading to terminal Renal failure.
  • Histologically it shows its classical appearance of Membranous Glomerulonephritis with Wire-Loop  Abnormailities due to deposition of Immune Complexes in Basement Membrane.

NEUROPSYCHIATRIC (NP-SLE)

If any Neuro-Psychiatric is caused dur to SLE its called NPSLE Neuro-Psychiatric Systemic Lupus Erythematosus

There are atleast 12  Central Nervous System related and 7 Peripheral Nervous System relate manifestation of SLE that are being observed in patients with SLE.

Central Nervous System(85-90% of all NPSLE)

  1. Headache
  2. Anxiety Disorder
  3. Mood Disorder
  4. Acute Confusional state
  5. Psychosis
  6. Movement Disorder
  7. Cognitive Dysfunction
  8. Seizure Disorder
  9. Myelopathy
  10. Aseptic Meningitis
  11. Cerebrovascular diseases
  12. Demyelinating Syndrome

Peripheral Nervous System(10-15% of all NPSLE)

  1. Acute Inflamatory Demyelinating Polyradiculoneuropathy
  2. Autonimic Disorder
  3. Mononeuropathy
  4. Myasthenia Gravis
  5. Cranial Neuropathy
  6. Plexopathy
  7. Polyneuropathy

DIAGNOSIS of SLE

SLE is considered amongst one of the prototype disease as its very difficult to  differentiate from many other autoimmune conditions as they share in common majority of signs and symptoms making  its diagnosis very difficult, It much depends on clinical picture of the disease and investigations after that there are many criterias based on clinical symptoms coupled with laboratory tests based on which a person can arrive at some conclusion though not absolutely sensitive and specific to confirm diagnosis in every case but fair enough.

LABORATORY TESTS

ANA detection by direct  or indirect immunoflorescence

ANA test detects many different subtypes of ANA related to many other autoimmune conditions as well with many overlapping eachother of which

  • Anti- Double Strand DNA Antibodies most specific of all present in almost 70% cases of SLE with only 0.5% non-SLE cases has t in them.
  • Anti-Smith DNA Antibodies present in most of the cases of SLE and not frequently found in non-SLE person.
  • Anti- Histone Antibodies present in Drug Induced SLE
  • Anti- U1 RNP antibodies – non specific also appears in other conditions like Systemic Sclerosis
  • Anti- Ro or SS-A and  Anti- La or SS-B – non specific for SLE but more Specific to Sjogrene syndrome, but its present in many of the cases of neonatal lupus with heart involvement in particular.

Other Tests

Anti-ENA Test

Lupus Cell Test – It was used in past as it used to show positive in 50-70% SLE cases but was not specific to SLE and used to be present in many cases of many other conditions like RA Scleroderma etc.

DIAGNOSTIC CRITERIA OF AMERICAN COLLEGE OF RHEUMATOLOGY.

Its a stringent criteria developed by American College of Rheumatology, so that non of non-SLE cases should filter in, so many of the SLE cases are also filtered out.

The criteria is that if any patient shows any of the four symptoms out of eleven simultaneously or serially in more than one occasion than he is considered to be positive for SLE.

  1. Mallar Rash/ Butterfly rash on cheeks; Sensitivity of 57% and Specificity of 96%.
  2. Discoid Rash; Sensitivity of 18% and Specificity of 99%.
  3. Serositis, Inflamation of serous membranes around heart (more specific) and lungs(more sensitive); Sensitivity of 56% and Specificity of 86%.
  4. Mucosal Ulcers of oral cavity and nasopharynx; sensitivity of 27% and specificity of 96%.
  5. Arthritis, non-erosive with more than two joints involved with tenderness swelling and effusion; Sensitivity of 86% and Specificity of 37%.
  6. Photosensitivity, Ligh causes aggravation in skin rashes or other Lupus related complaints; Senitivity of 43%and Specificity of 96%.
  7. Non Drug Induce : Hemolytic Anaemia, Leucopenia, Lymphopenia, Thrombocytopenia; Sensitivity of 59% and Specificity of 89%.
  8. More than 0.5g of total protein in urine in a day or cellular cast seen in urine under microscope; Sensitivity 51% and Specificity of 94%.
  9. Anti- Nuclear Antibody positive; Sensitivity of 99% and specificity of 49%.
  10. Positive Anti- Smith, Anti- Double Strand DNA, Positive Anti- Phospholipid Antibody, False Fositive Serological test for Syphillis; Sensitivity 85% and Specificity of 93%; Presence of Anti- ssDNA in 70% of cases.
  11. Neurological disorder Seizure or psychosis; Sensitivity of 20% and Specificity of 98%

This is a very stringent criteria used for research purpose if we go through we may falsely conclude negative diagnosis and miss out on diagnosing many patients who are suffering from SLE

Aslo it misses out on certain factors like antiphospholipid anti bodies which has strong association with SLE  there are many cases who are anti phospholipid antibody positive but are not fitting in above ACR criteria but still they are having SLE.

So more practicle approach widely used is through the Recursive Partitioning which has two classification trees

The Simplest Classification Tree – If patient has any immunological disorder with positive anti- Smith antibody, anti- DNA antibody, false positive serology test for Syphillis, presence of Lupus cells or Mallar rash/butterfly rash, then the person is diagnosed as positive for SLE; specificity of 92% and sensitivity of 92%.

Full Classification Tree : It uses six criterias; sensitivity of 97% and specificity of 95%

HOMOEOPATHIC MEDICINES FOR SLE

I have seen homoeopathy work wonders in SLE especially in cases with NPSLE because then the disease becomes very expressive about itself,  it shows itself not only on skin and joints but also on Neuropsychiatric sphere which show various symptoms typically different in each individual and this is what is required in homeopathic medicine selection, that the body is expressing itself in mental sphere which makes remedy selection easier.

Always a proper case taking needs to be done in deep seated chronic autoimmune conditions like this and a deep acting polycrest remedy should be selected after proper repertorisation as per each individual constitution and constitutional treatment is the only permanant solution for such conditions.

Still some theraputic indications are given which can be helpful guide and can be used as per the symptomatology in course of disease if indicated intercurrently or during acute excerbations of disease showing following symptom.

  • BELLADONNA

    – Typically suited in Mallar rash or Bitterfly rash of Syetemic Lupus Erythemotosua with symptoms of Neuro-Psychiatric SLE (NPSLE) where CNS involvement is markedly noted also suits in PNS symptoms of NPSLC

  • MERCURIOUS SOLUBILIS

    Whenever in case of lupus there are oral and/or naso-pharyngeal ulceration this remedy is very well suited

  • BORAX

    Again this is best suited in mucosal ulceration but in this remedy the ulceration are more marked in oral mucosa than in nasopharynx.

  • SYPHYLLINUM

    A nosode a dose can be given intercurrent as anti miasmatic of the cases that shows syphillitic miasma in the background also useful in cases showing painless red mallar rash or butterfly rash with much thickening and exfoliation especially like in Chronic Lupus Erythemotosus, also suited well in ulcerations of oral and nasopharyngeal mucosa.

  • CINCHONNA OFFICINALIS

    In cases with signs of hemolytic anaemia wether due to disease ot allopathic medicines, it will work wonders in both the cases.

  • FERRUM PHOSPHORICUM

    Where the patient has febrile condition due to disease with malaise, fatigue, Hairloss and aneamia duw to lupus or its medicines, can also be givem in low potencies in biochemic form along with other medicines

  • FERRUM METALLICUM

    Red acute rash typically in acute lupus erythematosus with involvement of oral mucosa, also in later chronic stages when there is are signs of anaemia of chronic disease of hemolytic anaemia

  • RHUS TOXICODENDRON 

    Works wonders in cases of lupus where it not only acts on skin but also wonderfully acts on the joints and musculoskelwtal complaints the disease shows.

  • HYOCYAMUS 

    In patients with symptoms of NPSLE.

  • ACONITE NAPELLUS

    in acute violent spells of relaopse and aggravations with symptoms of NPSLE like mental restlessness and has fear fright and anxiety in general and fear of death in particular.

  • RHUS VENENTA

PSORIATIC ARTHRITIS

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

COUGH AND COLD -Not Only Climate But Also Doctors Making It Worse!

Cough and Cold – Not only Climate But Also Doctors Making Cough and Cold Even Worse!

Cough and Cold – As dry cold climate approaches so does dust, smog and other pollutants along with subjecting organism to unusual insults of polluted atmosphere especially in urban areas where vehicles construction activity,  crackers of festive season pollute the air so much so that majority of the population who breathes here is suffering from respiratory allergy and things become worse for Asthma patients.

In India, winter is season of fruits where many hybrid fruits come to market to which the sellers further chemically  ripen, inject sweetners, artificially colour and glisten to make it attractive and easily saleable, also many fruits like grapes have lots of pesticides and insecticides sprinkled on it.

Its seen that people have increased appetite during winter days, they feel hungry too often, so processed and packaged food like chips, choclates, soft drinks, packaged farsan, biscuits and other bakery products ,etc. comes handy. Its seen that there is huge surge in sales of all these products during cold climate of monsoon and winter, now not to forget its full of artificial colours, artificial flavours, chemical preservatives, artificial dough conditioners, artificial leavening agents, baking powders and what not, eating such thing makes the health scenerio in winter even more worse with cases of respiratory allergies shooting up even further.

It starts with mild damages to mucosa of respiratory system where the superficial mucosal epithelial lining is subjected to pollutants and the epithelial cells gets damaged and the immune system comes into role to fight out the foreign particles but because of excess quantity of allergens and excess toxicity of few of these allergens the immune system is unable to cope up which the basic primary innate immunity, so it startes to call in for more work force and immunoglobulins which makes our body a battle field causing damage even further till it fights allergen off and im this process patient has symptoms of cold, cough, malaise headache. bodyache, fever etc. In most of the cases where the dose of allergen or infectious agent is not high and immunity is strong enough or in patient, who are taking proper primary first aid care and avoiding triggering and maintaining factor of the condition, should not have complications and the bodyfight it out. Also body will form new memory against many new antigens in this process, improving one’s immunity.

But in some case where the outside organism are more virulent or the allergens are more toxic then the damage is greater. Now this damages tissue and damaged tissue becomes fertile ground for microbes like bacteria, virus, fungus etc to grow and they are ample not only in environment but also within our own body. Now with such an opportunity they start growing and making case even more difficult and severe. In cases with pre-existing allergic conditions and atopy, things get even worse causing chest congestion, breathlessness.

Patient suffers from sleepless nights due to cough, sneezing blocked nose,  irritating nose and throat malaise bodyaches and lack of energy. This causes patient to apprehend and anticipate grave condition like swine flu bird flu or Tuberculosis(TB) or severe bronchitis or asthma which drives patient to the allopathic doctor for instant relief.

Now unlike in India and other developing countries, the developed countries like USA UK and other European nations, dispensing of medicines like anti-tussives, anti-allergics, cough syrups with mix of all, antibiotics, broncho-dilators, cortico-steriods for case of uncomplicated cough and cold is strictly discouraged and the medical doctors are strictly guided not to give any of these medicines for such uncomplicated cases.As its usually a self-limiting condition and regresses on its own, medicines only weakens subject’s immunity even further, causing recurrent spells of such cough and cold every few weeks making condition persistent. But in India where almost all the doctor promotes and dispenses mix of these 4-5 harmful medicines at a time from their clinic in all cough and cold patients, regardless of wether patient’s condition requires such medicines or not, ant that is just to give symptomatic relief to patient at cost of his health. When asked to such doctors, they simply answer – “If I will not give quick relief to the patient, with help of such harmful medicines, then the doctor practicing next to me will give relief to the patient with those harmful medicines, then why shouldnt I give and retain my patient!”  . Now its role of health authorities to keep check on dispensing of such harmful cough syrup preparations and corticosteroids. So that every doctor doesnt use it in every case like what the scenerio is right now!

Knowing the well established fact that cough and cold are body’s response to fight out Antigens (foreign particles living or non living) and other external insults on body. Now suppressing it only interferes normal body functioning and weakens immunity even further and such medicines also damages other systems of body and permanently damaging one’s constitution for ever.

Medicines dispensed by allopathic doctors for cough and cold also have antihistaminics, immunosupressants. Now histamin ,we can say,  is the basic reception point of our immune system, supressing it causes less of the molecular expression signals corresponding to the antigen being sent to immune system and the organism as a whole. The result is no proper immune response being established, so patient will have no symptoms (no cough no cold pt feels good) and feel good but also no new immune memory allocation for that particular antigenis being properly developed due to supression as I explained above, so next time again when the same antigen enters our body again we will suffer from same condition. and the recurrency of cold and cold will persist almost every few weeks as we have to stay in same environment.

Most of the viral respiratory infections recover on its own and there are no medicines specific for viruses that cause cough and cold in allopathy so its not advisable to take multiple heavy allopathic medicines untill there are complications due to it.

Signs of complications:

  • Fever persisting for more than 2-3 days secondary bacterial or in immunocompromised fungal infection may be present and specific treatment is required for infection and underlying condition.
  • Pain in ear along with Cough and Cold or fever indicates that there is congestion of eustachian tube due to eustachian catarrah and may damage ear and hearing ;also infection due to this in middle ear is an unwanted complication as it may not only damage ear permanantly but can also progress retrograde into cranium and infect brain to cause meningitis which is a fatal condition.
  • Cough Cold lasting for more than 15-20days not always  but few cases turns out to be because of tuberculosis and specific TB treatment is required and not cough and cold medication
  • Blood in sputum due to violent coughing or sneezing minor capillary rupture may have occurred; now that may provide microbes an entry point for infection
  • Pain in Chest may be due to muscular fatigue due to coughing which is not a major complication but if the pain in chest is due to some other reasons like infective or inflamatory focus in the lung etc then immediate medical attention and specific treatment for tht reason is required
  • Efforts in Breathing if patient has make an effort on breathing like heaviness in breathing suffocative feeling short breaths ; in small children it is noticed by short small fast breath fan like motion of alea of nose unusual excessive movement of abdomen while breathing along with abnormal sound vibrations from chest.
  • Abnormal sounds from chest while breathing like crepitation and wheezing heard on auscultation  ; in children it is easily felt by keeping hand on chest or can be heard by keeping ear on chest.
  • Headache severe persisting after violent coughing may be due to increased intracranial pressure that may have caused damaged and may need immefiate attention
  • Any other chronic disease in in individual
  • Other coexisting infection
  • Immunocompromised Individual

So what to do, so as to get yourself a proper medical observation and yet to be sure that you will not be medicated unnecessarily, for that first of all your doctor should be experienced enough that he doesnt panic unnecessarily on listening to complaints and  should know how to treat patient without help of any unnecessary medication also he should be competent enough to estimate,  evaluate and treat condition and its complications with minimal medication, also  you need to speak to your doctor first that you are not willing to take any heavy medication and you  are ready to bear with the condition till it recovers and you have visited him just to be under proper medical observation so that no complication arise and if at all, it can be addressed and tackled soon. Now that should give your doctor comfort, confidence free hand in treating you successfully with minimal medication and that too only if required making your body less prone to side effects and also boosting your immunity.

In Homoeopathy, unlike Allopathy, we try to boost immune system by enhancing the immune response and helping organism further to develop permenant immunity, so pt initially may have mild aggravations, we call it homoeopathic aggravations, which are favourable for the case and holds good prognsosis.

There are many homoeopathic medicines that can cure the respiratory allergies and viral respiratory infections, not by suppressing, but by enhancing immune expression and developing permanant immunity against it. Homoeopathy works even faster than allopathy in such acute conditions.

Few of the good homoeopathic medicines that can be used in viral respiratory tract infection or other acute or chronic respiratory tract allergies are:

  1. Spigelia constant bland discharge from posterior nares dropping into nasopharynx and anterior portion of nose always remains dry, severe boring pain in orbits as if eyes weee pushed in, severe paraorbital sinusitis.
  2. Allium Cepa have you ever chopped onion?? Then recollect how it feels in your nose and eyes and if you have similar symptoms in cold this medicine is for you,  copious acrid nasal discharge and bland lachrymation(discharge from eyes) with photo phobia with much burning and smarting in eyes with conjunctival hyperaemia causing red suffused looks of eyes , also mild redness of eyelids,much photophobia,  nasal discharge excoriates nose and upper lip, sore raw sensation at bifurcation of trachea, frontal headache due to cold, patient feels better in open air and cold climate and his complaints becomes worse in closed room and warm climate.
  3. Euphrasia Officinalis Copious Bland nasal discharge and acrid lachrymation better in open room, much mucosal discharge from throat need to bring up too frequently which smells too offensive. Patient suffers from bursting headache due to coryza. Copious thick sticky yellowish discharg from eyes causing eye lids to agglutinate in morning ,eye discharge acrid in nature causing excoriation of surface it touches causing redness and ulceration on inner canthus of eyes , eyelids and cheeks, Blisters in eyes and ulceration in cornea with much photophobia. Good remedy for autoimmune or allergic or infective conjunctivitis accompanying cough and cold.
  4. Arsenicum Iodatum acrid fetid profuse thin watery discharge with much sneezing and redness of all mucous membranes, nasal polyps , eustachian catarrah, hypertrophy of eustachian tube causin g hearing problems and deafness, chronic nassal catarrah
  5. Ammonium Carbonicum Morning sneezing, this medicine works well in patient complaining severe violent bouts of sneezing early in the morning soon after waking up of touching feet to ground or soon after morning bath. typically suited to stout women with tendency to catch cold easily. Can’t tolerate cold climate or  cold food and drink , thirstless and doesnt like water much aversion, lympohmegaly (enlarged lymphnodes), sharp burning watery discharge that continues whale day and stops with nose block at night. slow stertorous opressed breathing. burning in throat and chest , Pneumonia , emphysema, ulcerative tonsilitis, purulent, supurative and gangreneous condition of tonsils,
  6. Spongia Tosta constant tickling and irritation in throat pt has to clear throat too frequently, stitching stinging burning pain in chest, dryness of nasal mucosa alternates with thin fluent watery discharge.
  7. Senega burning and scrapping sensation as if mucosa has abrassions bursting cough, copious thich tough tenacious mucous difficult to bring up, hacking cough, thorax feels as if shrunk and is too narrow, hoarseness of voice.
  8. Occimum Sanctum generaly used in lower potencies for hay fever , otitis media with throbbing pain due to eustachian catarrah, epistaxis with much running nose and violent sneezing, too restless cant lie in bed sits with hands on head and elbow on knee this position gives him some relief , warm drink relieves complaints.
  9. Sabadilla lachrymation with hyperaemic congestion of conjunctiva with much burning, thick tough mucous adhered within throat giving sensation as if skin is hanging within, urging patient to swallow constantly, empty swallowing pains a lot, tongue has sensation as if its burnt.
  10. Rumex Crispus mucous membranes too sensitive causing tickling sensation in pharynx going down deep to bronchus which triggers cough, pain below clavicle , cold starts with copious thin watery nasal discharg soon followed by thick stringy discharge so is with mucous discharge from throat. Urticaria accompanies with or alternates cough and cold with intense itching, early morning diarrhoea accompanies cough.

Also read for associated complaints and their medicines:

Best HOMOEOPATHIC Medicines indicated in ASTHMA

ASTHMA

Best HEADACHE Medicines in Homoeopathy

HEADACHE

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