Category Archives: Rheumatology

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

Dermatology, HOMEOPATHIC TREATMENT, Orthopedic, Rheumatology

SLE SYSTEMIC LUPUS ERYTHEMATOSUS

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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

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

Allergies, ENT, HOMEOPATHIC TREATMENT, Infectious diseases, Pediatrics, Rheumatology

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

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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

Also read

NIPAH VIRUS on Killing Spree In India – Its Homoeopathic Medicines

H7N4 TYPE BIRD FLU First Ever Human Case in China

HONG KONG FLU Epidemic 2018 The Virus That Killed Million In A Year

Gastroentrology, Gynaecology, HOMEOPATHIC TREATMENT, Infectious diseases, Nephrology, Neurology, Oncology, Rheumatology, Urology

ABDOMINAL PAIN Homeopathic Medicines

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ABDOMINAL PAIN -10 BEST HOMOEOPATHIC MEDICINES

Pain in abdomen may be due to many reasons it can be because of minor gastric disturbance or may be due to severe conditions like Pancreatitis, Hepatitis, Ascitis, Cholecystitis, Cholelithiasis, Urolithiasis, Apendicitis, Tumours Malignant or Non Malignant, Hernia, Strangulated Hernia, Gastric or Peptic ulcers, fistula in Gastro Intestinal tract, Gynaecological complaints, Helminthiasis or Amoebiasis or other infections, Urinary tract infections etc.

All these may be due to minor infections or minor physiological disturbance to severe septic conditions and severe autoimmune conditions. So if pain persists then Its advisable to rule out any underlying pathological condition under observation of qualified physician.

In homeopathy each medicine has its own sphere of action, that is, more affinity towards certain organs and systems compared to other, also such action has a peculiar mode of action producing perculiar type of pathology in the organ, system and organism as a whole.

So its important to understand the person’s constitution and underlying pathological cause due to which the patient is having pain so that we can relate it to medicinal symptoms and select the most similimum medicine to treat not only the symptom of pain but also the underlying cause along with.

There are many medicines in homoeopathy which has special affinity towards certain abdominal organs and nerves along with,  which can be used for abdominal pain depending on which organ and system is involved and what kind of patholigy its showing.

Below I have mentioned GENERAL MEDICINES that have specific affinity towards certain abdominal organs and produce peculiar pathological action giving rise to characteristic symptoms in corresponding constitution types that have been mentioned.(FOR MORE SPECIFIC CONDITIONS BEHIND ABDOMINAL PAIN I HAVE GIVEN LINKS OF MY VARIOUS ARTICLES)

  1. MAGNESIA PHOSPHORICA One of the best Anti-spasmodic remedy in homoeopathy, Severe cramping pain in abdominal muscles due to indigestion causing flatulence or constipation, gas in bowel loop compelling patient to bend double with eructation of gases, patient has fullness and distention of abdomen patient has to the loosens the belt or clothing around belly and walk with frequent release flatus  relieved by rubbing with pressure and warmth.
  2. NATRUM PHOSPHORICA complaints due to hyperacidity burning pain in abdomen and sour eructation , good remedy for Gastro-oesophageal-reflux disorder, patient has sensation of some lump type obstruction in throat, good remedy for flatulent colic during jaundice.
  3. CARBO VEGETABILIS Its one of the best homoeopathy emergeny life saving remedies , can be used from minor to severe conditions ; typically suited to fat sluggish and lazy persons with weak vital force and immunity; typically shows singns of sluggish circulation causing hypoxic condition; also it affects the blood vessels causing ecchymosis and mucosal heamorrhage; stagnant circulation causing sepsis gangrene patient goes into septic shock with cyanosed appearance blueness of face and exretmities  , very cold body but hot head; very good remedy for abdominal affections with or without infections Contractions from chest to abdomen; all gone empty sensation in abdomen not relieved after food, cramps in abdomen compelling patient to bend double, pain in abdomen due to slow sluggish digestion causing food to putrify, pain in abdomen and septicemia due to strangulated hernia.pain aggravates by lifting weight,exterme fetid flatulence with Gastro-oesophageal-reflux disorder distentension and fullness of abdomen pt has to loosen belt and clothes around waist(Mag phos); aggravation 30 minutes after meals even with the lightest mealor food, sour rancid belching, severe burning pain in epigastrium which is sensitive to touch ; general hyperacidity and flatulence due to indigestion ; pt has aversion to food in general esp heavy oily food, gastric disturbance triggers asthmatic affections. pain due to ulcers fistula in Gastro-intestinal tract. a good remedy in cholera typhoid liver affections gengrene hernia appendicitis
  4. PLUMBUM METALLICUM constrictive sensation in internal organs,contracting and boring pain in abdomen, sensation as if whole abdominal wall is pulled backwards and tied to spine causing pressure tightness of abdomen and radiating pain, abdominal pain due to lead poisoning painter’s colic, pain in abdomen due to kidney ailments like acute nephritis etc. accumulation of gasses in bowel loop which doesnt pass off causing abdominal pain.
  5. CAULLOPHYLUM False labour pains, Spasmodic pain of abdomen due to gastric disturbances.
  6. COLOCYNTHIS cutting agonising pain in abdomen, boring sensation as if stone were ground together in abdomen,
  7. MAGNESIA CARBONICA typically suited to individuals having hyperacidity and excessive secretion of digestive juices and mucous from gastro-intestinal tract,sour body odour , broken down and worn-out women during climecteric age having uterine affections; this individuals are oversensitive to external impressions like noise touch bright lights etc,typically ailments from blows , shock,  brain fag, this constitutional types have tendency towards constipation; Pain in abdomen with Rumbling and Gurgling within very heavy downward dragging sensation towards right illiac fossa and pelvis, colicky gripping pain preceeds stools with severe tenesmus in constipation or when these subjects contract diarrhoea or dysentry.
  8. BRYONIA ALBA typically suited to individual having tall dark robust lean and strong muscle fibre; patients having right sided complaints, Patient has  stitching and tearing pain worse by slightest motion making patient too irritable due to pain , pt wants to rest complately due to it , burning, stitching, tearing, pressing pain in epigastrium as if a heavy stone was in the pit of the stomach, region to tender and sensitive to touch or slightest motion even on breathing for that purpose, severe constipation with stitching tearing pain in abdomen with dry hard knotty large stools difficult to pass.
  9. NUX VOMICA predominantly a male remedy. It is a wonderful remedy to start homoeopathic  treatment as it antidotes bad effects of most allopathic and homoeopathic medicines taken in past also it balances digestive system thats been disturbed due to irregular lifestyle ; medicines alcohol spicy oily food etc; Its frequently used by homoeopath as first prescription when the homoeopath wants to borrow time to conclude the constitution of the patient and yet start the basic treatment; This remedy is typically suited to persons whose constitution is deranged and shaped up as a result of leading irregular and sedentary life style ; like irregular meal pattern ireegular sleep pattern night watching ; no exercise ; excess of sexual indulgence and frequent excess of alcoholic beverages causing digestive disturbance and liver affections Bruised and Sore abdominal muscles with stitching spasmodic colicky pain causing short breath and urge to pass stools ; abdominal distended with gaseous accumulationspain due to strangulated inguinal and umbilical hernia; Pain in abdomen due to alcoholic hangover; Pain due to severe constipation as a bad effect of allopathic medication.
  10. ASAFOETIDA Typically suited more to hysterical and Hypochondriacal patients,flatulent and spasmodic contraction of stomach and oesophagus with reverse peristalsis, abdominal pain due to severe ulcers fistulas and other abdominal presentation of secondary and tertiary syphillis; this rem,edy has typical boring pulsating and throbbing pain; lots of gas formation pain around umbilicus gasses accumulates in large quantity and the whole ball of gas ascends upwards giving out frequent loud eructations with pain in epigastrium.

ABDOMINAL PAIN DUE TO UROLITHIASIS/RENAL STONES/KIDNEY STONES/URINARY BLADDER STONE AND URINARY TRACT INFECTION : CLICK THE FOLLOWING LINK

RENAL CALICULUS

ABDOMINAL PAIN DUE TO MENORRHAGIA and DYSMENORRHOEA : CLICK THE FOLLOWING LINK

http://atomictherapy.org/best-menorrhagia-medicines-homoeopathy/

ABDOMINAL PAIN DUE TO GALL STONES/GALL BLADDER STONE/CHOLELITHIASIS AND CHOLECYSTITIS : CLICK THE FOLLOWING LINK

http://atomictherapy.org/best-gall-stone-medicines-homoeopathy/

PAIN IN ABDOMEN DUE TO LEUCORRHOEA : CLICK THE FOLLOWING LINK

LEUCORRHOEA

PAIN IN ABDOMEN DUE TO CONSTIPATION : CLICK THE FOLLOWING LINK

Best Constipation Medicines in Homoeopathy

PAIN IN ABDOMEN DUE TO LOOSE MOTIONS/DIARRHOEA/DYSENTRY : CLICK THE FOLLOWING LINK

http://atomictherapy.org/best-loose-motion-medicines-homoeopathy/

KEEP READING THIS POST WILL BE CONSTANTLY UPDATED.

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, 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, Orthopedic, Rheumatology

RHEUMATOID ARTHRITIS

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RHEUMATOID ARTHRITIS HINDI EXPLANATORY VIDEO

Rheumatoid arthritis is a chronic systemic auto-immune disorder predominantly affecting synovial joints.

Rheumatoid Athritis may also affect tissues other than those in joint; like blood, skin, pleura, lungs, kidney, nerves, heart, pericardium, blood vessels, eyes, liver etc.

CAUSES OF RHEUMATOID ARTHRITIS (RA)

It is still unclear how it is caused but it is believed to be combination of

1) Genetic Factors

HLA-DR4 – HLADRB1 is storngly associated with Rheumatoid Arthritis but not in all ethnicity it shows the same significance.

MHC class II related allotypes and T-cell Associated Protein PTPN22 are also found to be associated with RA.

2) Environmental and Lifestyle Factors

Environmental factors like radiations, pollution etc. Exposure to fine crystalline form of pure silica i.e. Silicon Dioxide can cause Rheumatoid Arthritis, is an established fact.

Lifestyle factors like addiction to cigarette smoking, mental stress, physical stress and digestive disturbances are also doubted (though unconfirmed).

Hormonal fluctuations during pregnancy, menopause, hormonal medications etc. are also believed to be strong contributing factors.

Still we are not able to link any infectious agent or vector associated to RA.

PATHOGENESIS AND PATHOPHYSIOLOGY OF RHEUMATOID ARTHRITIS (RA)

It has been observed that there is an abnormal immune response, where in, there is a state of persistent cellular activation, due to constant positive feedback (probably due to inhibition of negative feedback pathway or exaggerated positive feedback due to certain factors) causing formation of immune complexes and autoimmunity. This initially shows up in synovial joint and less frequently or later in other organs and tissues as well.

Rheumatoid Arthritis manifests in following phases :-

  • Initial phase – shows non-specific inflamation
  • Amplification phase – caused by T-cell activation
  • Chronic inflamatory Phase – where Cytokines like Interlukine-1 Interlukine-6 Tumour Necrosis Factor-alpha comes in picture causing chronic inflamation and tissue injury

Antibodies to IgGFc are called Rheumatoid Factor (RF/ RA factor) and Antibodies to Citrulinated Peptides (ACPA) are major factors specific in pathology of Rheumatoid Arthritis.

Other nonspecific factors are abnormally Glycosylated Antibodies. These are believed to be the contributing factors in arthritis. Though they are not specific to Rheumatoid Arthritis and are also present in many other Autoimmune conditions.

B lymphocytes   → Plasma cells    → RA factor and ACPA(of IGg And Igm Classes) + Fc receptors & compliment (binding due to antibody’s altered N glycans) (simultaneously; doubted TNF activation at this Stage)  → Macrophage activation    → Synovial macrophage & dendritic cells further expresses MHC class II molecules    →  Synovial oedmatous inflamation with T cell activation(also doubted TNF activation through T cell product IL17) and infiltration(mainly CD4 and CD8)    → Intense inflamation – Granulation tissue formation -Angiogenesis – Inflamatory products damaging tissues – Thickening of synovium- Cartilage disintegration -Bone disintegration-Joint degeneration.

It is observed that presence of B-cell and T-cell at site is not necessary for the pathogenesis. So the exact role of B-cell and T-cell is doubted. Also TNF a major foctor responsible for progress of Rheumatoid Arthritis is doubted that wether its predominantly derived through B-cell or T-cell channel or through both as presented in above flow chart.

Other factors like IL1, IL6, IL15, IL17 are also believed to be important in pathogenesis of Rheumatoid Arthritis.

Signs and Symptoms of Rheumatoid Arthritis

General Symptoms

  • Fatigue
  • Low Grade Fever not necessarily in all cases.
  • Malaise
  • Morning Stiffness
  • Loss of appetite
  • Weight Loss

Arthritis

Polyarthritis i.e. multiple joint involvement -small joints of hands, feet and spine are affected more than compared to larger joints like – knee, shoulder, hip joints but not always, in many patients, initially it may present as Monoarthritis ie single joint involvement.

Synovitis and erosion of joint tissue, tendinitis,  with surrounding tissue swelling. It presents as swollen, tender,  warm joints, causing stiffness and resulting into loss of range of motion of joint.

Morning stiffness difficultly in motion of affected joint with sensation of stiffness and pain. Morning stiffness lasts for more than an hour. Aggravation of pain and stiffness of joints  on prolonged rest and ammelioration on motion is a distinguishing character of inflamatory arthritis like Rhuematoid Arthritis in its early stages, compared to non inflamatory conditions like osteoarthritis, where the causes are mechanical so it has motion aggravation and rest ammelioration and morning stiffness is not prolonged for more than an hour, pain is nociceptive and not neuropathic.

Various Deformities

  • Necrotising Granuloma or Rheumatoid Nodule typically appears over areas where there is excessive mechanical stress, like bony processes or prominencies eg knuckles, wrist, elbow, heel etc, they are few milimeters to centimeter in diameter.
  • Ulnar deviation of fingers.
  • Button Hole Deformity or Boutonniere Deformity –  proximal interphalangeal joints flexed and distal interphalangeal joints extended.
  • Swan Neck Deformity flexed distal interphalengeal joint and proximal interphalengeal joint hyperextended
  • Hammer Toe Deformity
  • Z-thumb deformity or Z deformity the interphalengeal joint gets hyperextended and there is subluxation of metacarpo-phalengeal joint with fixed flexion.
  • Arthritis Mutilans
  • Atlanto axial subluxation due to erosion of odontoid process and transverse process which initially presents as clumsiness and may progress into quadripelgai and eventually death.
with Ulnar Deviation of fingers in Rheumatoid Arthritis
Swan Neck Deformity with Ulnar Deviation of fingers and Rheumatoid Nodules

 

Multiple Necrotising Granomatous Nodules of Rheumatoid Arthritis
Multiple Rheumatoid nodules seen on knuckles and wrist

 

Disfigurement in rheumatoid arthritis
Disfigurement of hand in rheumatoid arthritis

 

Disfigurement of Toes in Rheumatoid Arthritis
Disfigurement of Toes and feet in Rheumatoid Arthritis

 

Disfigurement of Rheumatoid Arthritis
Disfigurement of toes in Rheumatoid Arthritis

Skin Symptoms of Rheumatoid Arthritis

Necrotising Granuloma or rheumatic nodule many a times appears in the skin.

Rheumatic Nodule of Skin in patient with Rheumatoid Arthritis
Rheumatic Nodule of Skin in patient with Rheumatoid Arthritis

Mononeuritis Multiplex caused due to severe Rhematic vasculitis and vasculitic nerve infarction of small and medium sized blood vessels also giving rise to skin ulcers

Occasionally the skin may also present with

  • Pyoderma Gangrenosum
  • Sweet’s Syndrome
  • Erythema Nodosum
  • Lobe Paniculitis
  • Atrophy of finger skin
  • Palmar Erythema
  • Fragile Skin

Few of above complications are due to prolonged allopathic medication.

Lungs involvement

Fibrosis of lungs is well recognised consequence of allopathic treatment for Rheumatoid Arthritis.

Caplans syndrome, when RA pt gets exposed to coal dust it gives rise to rheumatoid lung nodules.

Pleural effusion is associated with Rheumatoid Arthritis.

Cardiac involvement in Rheumatoid Arthritis

Rheumatiod Arthritis  may affect heart and cause pericarditis, endocarditis, valvulitis, Left Ventricular Failure, Fibrosis.

Rheumatiod Arthritis significantly increases risk of artherosclerosis, myocardial infarction, stroke.

Most of the RA patients do not develop pain of angina or myocardial infarction so are at high risk to be left undiagnosed.

Rheumatoid Arthritis Affects major components of blood

In blood, Rheumatoid Arthritis causes Hepcidin levels to increase leading to Anaemia of Chronic Disease.

Leucocytopenia in patients with felty’s syndrome.

Neutropenia and Thrombocytosis if inflamation persists.

Rheumatoid Arthritis Affects Kidneys

Renal Amyloidisis is consequence of chronic inflamation of RA.

Allopathic treatment of RA may cause membranous nephropathy.

Eye Manifestation of Rheumatoid Arthritis

Episcleritis, Scleritis, Keratitis Keratoconjunctivitis, Scleromalacia, Keratomalacia, Xeropthalmia are occular complications of Rheumatoid Arthritis.

Liver Complications in Rheumatoid Arthritis

Liver may be affected due to prolonged allopathic treatment of Rhuematoid Arthritis and if there are any other inflamatory Liver complaints or autoimmune conditions affecting liver, coexisting with RA, it can create complications in liver.

Neuronal Complications Due To Rheumatoid Arthritis

RA affects neurons to cause Peripheral neuropathy, Mononeuritis Multiplex, Carpel Tunnel Syndrome, Myelopathy due to Rheumatoid disease of spine. Atlanto-Axial subluxation due to erosion of odontoid process and transverse process which initially presents as clumsiness and may progress into quadripelgai and eventually death.

DIAGNOSIS OF RHEUMATOID ARTHRITIS (RA)

X-rays 

X-rays may not show any changes in early stages though sometimes mild soft tissue swelling might be visible in later stages along with soft tissue swelling it may show juxta-articular osteopenia and loss off joint space in advanced stage it may also show nodes  bony erosion subluxation of affected joints.

Blood Tests

Test for RA factor

Negative serological tests doesnt exclude the probablity of Rheumatoid Arthritis. As 20-25% of RA patients are negative for RA factor test which is considerably large number. Also during first year of development of rheumatoid factor majority of the patients are usually negative. 10% of healthy person may show positive for RA Factor. Even persons with Hepatitis C and persons with chronic autoimmune diseases like Systemic Lupus erythematosus or  Sjogren’s syndrome may show positive RA factor test. So the test is not specific and also not much sensitive.

Test for ACPA (measured as Anti-CCP antibodies)

ACPA with 95% specificity is much more specific compared to RA factor test but has lower sensitivity only 60-70% compared to 80-85% of RA Factor test.

Patients with clinical features and all other investigations pointing towards Rheumatoid Arthritis except their RA Factor and Anti-CCP tests are negative sich patients are called seronegative Rheumatoid Arthritis cases almost 25% cases falls in this category.

New point of care test is introduced where in; RF and anti-MCV are detected which has sensitivity of 72% and specificity of 99.7%

Other non-specific, indirect, additional supportive tests to RA factor and ANTI-CCP tests are :-

ESR; CRP; CBC; RFT; LFT; ANA; Ferritin levels.

DIAGNOSIS AND CLASSIFICATION CRITERIA FOR RHEUMATOID ARTHRITIS 

This diagnosis and classification criterion is jointly developed  by American College of Rheumatology and European League Against Rheumatism has become widely accepted globally is as follows:

A Score of 1-10 is established by adding scores of following 4 different criteria

  1. Number and type of joints involved
  2. RA factor and ACPA tests
  3. Acute Phase Reactants CRP and ESR
  4. Duration of Disease

1) Score Rating of NUMBER and TYPE of JOINTS involved

  • 1 Large joint = 0 points
  • 2-10 Large Joints =1 point
  • 1-3 small joints(with/ without Large Joint involvement) = 2 points
  • 4-10 small joints(with/without Large joint involvement) = 3 points
  • Involvement of more than 10 joints including atleast 1 small joint =5 points

2) Score Rating of Specific Serological Tests (RA factor and ACPA)

  • Negative RA factor and ACPA = 0 points
  • Low positive RA factor or Low Positive ACPA = 2 points
  • High Positive RA factor or High positive ACPA = 3 points

3) Score Rating of Acute Phase Reactants

  • Elevated ESR and CRP = 1 point

4) Score Rating of Duration of disease

  • Duration of Arthritis if more than 6 months =1 point

A score of 6 or above establish positive Rheumatoid Arthritis as diagnosis.

HOMEOPATHIC ARTHRITIS MANAGEMENT

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.
  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.

Rheumatoid Arthritis falls under immunologically mediated arthritis.

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.

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. As each case has a different constitution, miasmatic background, severity of ailment and other  external inimical factors. So in many cases before it gets cures, it may require series of medicines one after another as per case demands during progression of treatment. It all depends upon how well the physician is able to find out the similimum and type of case and its requirement.

HOMEOPATHIC MEDICINES FOR RHEUMATOID ARTHRITIS

Though the approach should always be constitutional in autoimmune disease like rheumatoid arthritis, there are certain medicines which broadly shows pathological drug picture of rheumatoid arthritis or striking peculiar so could be used as therapeutic guidance.

  • SILICEA – Rheumatoid Arthritis post exposure to fine crystalline form of silica ie silicon dioxide (an established factor that contributes in development of rheumatoid arthritis).
  • RHUS TOXICODENDRON – While repertorising I have frequently ended up Selecting this remedy in final roundction during conditional approach. Rheumatoid Arthritis has stiffness of joints on prolonged rest especially in morning last more than an hour and gradually ameliorating on motion.  Rhus tox has common symptom of aggravation on rest and amelioration on motion and also this medicine has great affinity towards joints and immune mediated disorders.
  • LEDUM PALUSTURE – This homeopathic  medicine has always given me good results in any type of inflammatory joint complaints with swelling and redness especially around ankles.
  • APIS MELIFICA – I use this medicine with great results during active phase of disease where patient has developed swelling and redness with severe pain just like Ledum  pal but more severe acute and sudden in onset.
  • CALCAREA CARBONICA – Can be used as complimentary medicine during the course of the treatment of rheumatoid arthritis especially in later stages where patients starts showing symptoms of bone erosion and reduced bone mineral density around articular surface due to prolonged inflammation and chronic autoimmune condition in body.
  • GUALTHERIA PROCUMBENS – In my experience gaultheria yields good results good results; usually in low potency and mother tincture forms; during active exacerbation of disease where in patients joint pains rheumatoid arthritis aggravates on disturbed digestion and other gastric ailments.
  • SYPHYLLINUM – indicated in later stages where patient starts showing signs of destruction of tissue, degeneratation and disfigurement and necrotising granulomatous nodules of lungs skin and bones. Especially in cases of rheumatoid arthritis with history of syphilis(treponema pellidum) infection this nosode should be administered
  • TUBERCULINUM – Patients with rheumatoid arthritis if exposed to coal for longterm, they typically develop necrotizing granulomatous nodule in lungs in such condition this medicines comes in to aid in such rare peculiar symptom. Also it should be thought of in patients with necrotising granulomatois nodule of rheumatoid arthritis on bones and skin.
  • DULCAMARA – this remedy should be thought of when Rheumatic complaints tend to increase in damp cold weather.
  • BELLADONNA – inflammation of joints during acute exacerbation of RA.
Dermatology, HOMEOPATHIC TREATMENT, Rheumatology

PSORIASIS

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Psoriasis is an endogenous immune-mediate condition(believed to be autoimmune) where there is increased epidermal cell proliferation which is result of excessive cell division in basal layers and transit time of keratinocytes through epidermis is reduced and reduced epidermal turnover from 28days to 5-6 days; its clinically characterized by well-defined erythematous plaques with silvery scales and flakes

CAUSES

i)Genetic

A strong association has been noticed between certain loci on genome , many genes have been identified but still it remains unclearance how they all might be interelated

Most of the gene identified are related to MHC (Major Histocompatibility Complex) and T cells.

  • 9 Loci on different Chromosomes are identified by Genome-wide linkage Analysis which are supposed to be linked with Psoriasis and named Psoriasis Susceptibility 1 to 9 (PSORS1 till PSORS9) within this locus are also found genes contributing in pathways of inflamation and certain mutations in this region have been found in psoriasis. Genome Wide Association Scan identified many other non-specific genes which are responsible in expressing inflamatory protiens which affects the cells of immune system which are also involved in psoriasis.
  • PSORS1 is located on chromosome 6 in Major Histocompatibility Complex ; 3 Genes in this Locus are associated with Psoriasis vulgaris viz:- 1)HLA-C variant HLAC-w6 it encodes a MHC Class 1 Protien 2)CCHCR1 variant WWC it encodes coiled protein which if found to be overexpressed in epidermis of Psoriatic patch on skin.
  • CDSN Variant allele5 which encodes Corneodesmosin it is expressed in Granular and Cornified layers of Epidermis and upregulated in Psoriasis.
  • IL12β gene on chromosome 5q which expresses Interlukin12B(IL12B)
  • IL23R gene on Chromosome 1p which expresses interlukin23 receptor and is inlolved in T cell differentiation;psoriasis is belived to be T cell medaited inflamatory condition.
  • Both this above mentioned genes are also involved in upregulating Tumour Necrosis Factor α (TNFα) and Nuclear Factor κB.
  • Gene encoding CARD14 is found directly linked to Plaque type Psoriasis; any mutation in this gene and environmental trigger causes plaque type psoriasis.

ii)Environment and Lifestyle

Harsh environment like excess of heat and cold, extreme dry wether, irregular diet and sleep pattern, excess of mental and physical stress, substance abuse, regular exposure to excess of chemicals and other pollutants etc have been associated with aggravations in those with prexisting psoriasis and precipitates in those  genetic predesposition to develop psoriasis.

iii)Microbes

After infection with certain bacteria and virus its been observed that body develops an autoimmune state resulting into psoriasis.

iv)Medicines

Certain medicines induce it, like beta blockers, calcium channel blockers, antihyperlipidaemic medications, captopril, anti malarials,  lithium, NSAIDS, terbinafin, glyburide, interleukins, interferons, TNF inhibitors like infliximab and adalibumab, terbinafin, Granulocyte colony stimulating factor, glyburide, withdrawal of cortocosteroidal topical applications shows severe rebound aggravations.

TYPES OF PSORIASIS

  • Plaque
  • Guttate
  • Pustular
  • Erythrodermic
  • Inverse/flexural
  • Seborrheic-like
  • Oral

OTHER MAJOR SUBTYPES OF PSORIASIS :-

  • Palmo-Plantar
  • Napkin
  • Acrodermatitis continua
  • Generalised pustular psoriasis/pustular psoriasis of Von Zumbusch; during pregnancy its termed as impetigo herpetiformis
  • Annular Pustular
  • Any of above type may present with involvement of nail and joints and it will be termed as nail psoriasis and Psoriatic Arthritis respectively.

SIGNS & SYMPTOMS FOR DIAGNOSIS

Though all signs may not be present or common in every case. There are various types of psoriasis and also within each of these type the presentation may vary in each individual but still there are few signs and symptoms; the presence of which may help us in diagnosis.

  • Silvery adherent scales and flakes
  • Well defined margins
  • Itching irritation and pain restricted only on papuler/pustules /plaque
  • Red erythematous base with plaque above
  • Frequently observed cyclic pattern of eruptions
  • Extensor surface involvement
  • Auspitz’s sign ; there is pin point bleeding when the scale is removed
  • Koebner Phenomenon; in this we observe psoriatic lesions are induced at the site of trauma to the skin.

Common Homoeopathic medicines for Psoriasis

A constitutional approach is required in its treatment

Homeopathic Remedies are selected only after proper case taking and repertorisation; Few of the remedies frequently prescribed are

SULPHUR

Sulphur is an elementary substance occuring in nature as a brittle crystalline solid. Sulphur was used as a most powerful specific against itch. Sulphur is a very beneficial remedy in Psoriasis and has marked affinity towards skin. Sulphur is the greatest antipsoric remedy for almost every kind of itch. Troubles of very long standing resulting from suppressed erruptions. Skin is usually dry, rough, scaly, with voluptous itching. Itching of whole body aggravated at night from warmth. Unhealthy skin, useful in dirty filthy people who are prone to skin infections. Severe burning after scratching. Painfully sensitive to warmth of bed causes severe itching.

ARSENIC ALBUM

Arsenic album is a very deep acting remedy affecting every organ and tissue. Arsenic is useful in case of psoriasis. Acting on skin Arsenic causes intense itching, burning of skin, with dry rough scaly erruptions worse from cold and scratching. Anxiety, restlessness, prostration, burning with cadaveric odour of body are prominent characteristics of Arsenic. The surface of the body is pale, cold, clammy. Erruptions cause intense burning is the marked general of Arsenicum album.

PHOSPHOROUS

Phosphorous is suited to young people who grow rapidly and are inclined to stoop. Phosphorous causes degeneratiion and inflammation of mucus membrane. In case of psoriasis the erruptions are dry scaly with severe itching and bhrning of skin. Numbness and formication of skin. Most of the symptoms are aggravated by midnight. Phoshorous is usually suited to tall slender persons, with thin transparent skin weakened by loss of animal fluids with great nervous debility.

SILICEA

Silicea is one of the frequently indicated remedy in case of Psoriasis. The action of silicea is slow. Suited to complaints that develop slowly. Silicea is useful in psoriasis where the erruptions are dry, scaly, with coppery or silverish spots. Erruptions itch only in daytime and evening. Silicea mainly acts on constitution that are sluggish. Slow nutrition if the individual receives a slight injury it suppurates. Silicea hastens formation of abscess and boils. Sometimes Presents with moist scaly erruptions with severe itching.

NATRUM MURIATICUM

Natrum muriaticum is another deep acting remedy which is very valuable in Psoriasis. The skin is greasy, oily especially on hairy parts. Dry erruptions especially on margins of hairy scalp and bends of joints. Crusty erruptions in bends of limbs, margins of skin folds, behind the ears. Presents with severe itching. Erruptions become raw red and inflammed by scratching.

THUJA OCCIDENTALIS

Thuja has marked sphere of action on the skin. Thuja cheifly acts on the mucus membrane of skin, glands, gentitourinary tract. Remedy for soft tissue growths like warts. Thuja patient has characteristic picture in case of psoriasis. Presents with waxy shiny face often looks sick. The skin looks unhealthy everywhere about the body. Painful sensitivness of skin. Dry skin with brownish spots. Very sensitive to touch. Erruptions only on covered parts of the body which burn after scratching. Aggravation at night from warmth of bed.

CALCAREA CARBONICUM

Calcarea carbonicum is one of the polcrest remedies and usually ranks with sulphur and lycopodium at the head of antipsorics. Calcarea is a chief representative of calcium compounds. Calcarea carb is one of the efficient remedies in psoriasis. Muscles and skin of calcarea carb become lax and flabby. With tendency of patient to grow fat. There is flaccidity of skin from head to foot. Scaly or scaby erruptions. Skin is rough dry with burning pains. Very unhealthy skin, every little injury tends to ulcerate. Excoriation of skin in several areas with severe itching. Complaints worse from exertion and cold in every form.

GRAPHITES

Graphitis is a mineral carbon. The chief action of Graphitis is on skin, especially at the flexures, folds of skin, behind the ears. Graphitis produces thickening and induration of skin. Very efficient remedy in case of psoriasis. Thick crusts are formed on the skin and has tendency to produce excoriations, cracks or fissures at muco cutaneous junctions of eyes, nostrils, folds of skin etc. Erruptions are cracked, moist which bleed easily. Skin is dry rough, irritable that breaks open easily and exude a gluey moisture like discharge. Aggravation in folds and slow to heal. Moist crusty erruptions which are aggravated by heat. As per my clinical experience Very well indicated in women of climacteric age having palmoplantar psoriasis

PETROLEUM

Petroleum is one of the indicated remedies in psoriasis. Very marked skin symptoms. Skin is usually dry constricted, very sensitive, rough, cracked and leathery at times. Erruptions usually have thick, hard, yellowish green crusts. All erruptions itch violently and one must scratch until it bleeds. Parts turn cold from scratching. Great sensitiveness of skin Complaints worse during winter and relieved by warmth. Petroleum just like graphites has frequently given me very good results in palmo-plantar psoriasis.

Few solved Psoriasis cases at Dr. SHAH’s Homoeopathy with before and after pics  in links below

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