Arhritis Anhang

[Constantine Hering, M.D.]

Puls. and coffee for rheumatic pains in the limbs

Yam-ha = Totes meer

Juvenile Rheumatoid Arthritis

[Nimish Mehta]

Abrot.: Inability to move. Marasmus of lower extremities only. Soreness and lameness, worse mornings. Gout in wrists and ankles. Inflammatory rheumatism before swelling begins. Marasmus of children with marked emaciation (of leg), the skin is flabby and hangs loose in folds. Constipation # diarrhoea (= lienteria). Marasmus of children with marked emaciation (legs); skin flabby and hangs loose in folds.

Acon.: Arthritic and rheumatic drawing and tearing pains (limbs). Acute and violent pulling in the joints and the bones, mitigated by the heat of a bed. Contraction of the tendons, and stiffness in

the flexor muscles of the limbs. Cramp-like contraction of several limbs. Aconite is generally indicated in acute or recent cases occurring in young persons, especially girls of a full, plethoric habit

who lead a sedentary life; persons easily affected by atmospheric changes; dark hair and eyes, rigid muscular fibre.

Apis: Oedematous. Synovitis. Felon in beginning. Knee swollen, shiny, sensitive, sore, with stinging pain. Feet swollen and stiff. Feel too large. Rheumatic pain in back and limbs. Tired, bruised feeling. Numbness of hands and tips of fingers. Hives with intolerable itching. Oedematous swellings. Adapted to the strumous constitution; glands enlarged, indurated; scirrhous or open cancer. Women, especially widows; children and girls who, though generally careful, become awkward, and let things fall while handling them.

Ars.: Acute drawing pains in the arms and in the hands. Swelling of the arms, with blackish pustules of a putrid smell. Acute drawing pains in the night, beginning from the elbow and ext. armpits acute pulling and shooting in the wrists. Cramps in the fingers. At night, sensation of fullness and swelling in the palms of the hands. Excoriation between fingers. Hard swelling of the fingers, with pain in the finger-bones. Cramp in the legs.

Acute drawing pains in the hips, extending to the groins, the thighs, and sometimes even to the ankle-bones, with uneasiness, which obliges one to move the limb constantly. Tearing and stinging

in the hips, legs, and loins.

Tearing in the tibia. Rheumatic pain in the legs (tibia). Paralytic weakness of the thigh. Pain, as from a bruise in the joint of the knee. Affections of the shin-bones. Fatigue in the legs and in the feet.

Pains in the fleshy part of the toes “As if galled by walking”. Great Prostration, with rapid sinking of the vital forces; fainting.

a. Depression, melancholy, despairing, indifferent.

b. Anxious, fearful, restless, full of anguish.

c. Irritable, sensitive, peevish, easily vexed.

The greater the suffering the greater the anguish, restlessness and fear of death. Mentally restless, but physically too weak to move.

Bell.: Pains in the joints and bones. Rheumatic pains (in the joints) flying from one place to another. The pains < chiefly at night, and in the afternoon towards three or four o’clock. < least touch/sometimes also the slightest movement. Some of the symptoms < or start after sleep. Jerking in the limbs, muscular palpitations and shocks of the tendons. St.Vitus dance. Sensation in

the muscles, as if a mouse were running over them. Cramp, spasms, and convulsive movements, with violent contortion of the limbs, convulsive fits, with cries, and loss of consciousness, epileptic convulsions, drawing back of the thumbs. Renewal of the spasms by the least contact, or from the glare of light. Burning in the inner parts. Attacks of immobility and of spasmodic stiffness of

the body, or of some of the limbs, sometimes with insensibility, swelling of the veins, bloatedness and redness of the face, pulse full and quick, with copious sweat. Spasms in single limbs, or of

the whole body, in children, during dentition.

Adapted to bilious, lymphatic, plethoric constitutions; persons who are lively and entertaining when well, but violent and often delirious when sick.

Bry.: Over-sensitiveness of the senses to external impressions. Rheumatic and gouty pains in the limbs, with tension, < motion/contact. Tension, drawing pains, acute pullings and shootings (limbs) and chiefly during movement, with insupportable pains on being touched, sweat of the part affected, and trembling of that part when the pains diminish. Stiffness and shootings in the joints, on being touched and when moved. In the evening, pain, as from fatigue, in the limbs, with paralytic weakness. Torpor and numbness of the limbs, with stiffness and pain of fatigue. Pale, tense, hot, swelling. Red, shining swelling of some parts of the body, with shooting during movement.

Pain, “As from a bruise”, or of subcutaneous ulceration, or “As if the flesh were detached from the bones”. Dragging, with pressure, on the periosteum.

It is best adapted to persons of a gouty or rheumatic diathesis; prone to so-called bilious attacks. Irritable, inclined to be vehement and angry; dark or black hair, dark complexions, firm muscular fibre;

Dry, nervous, slender people.

Calc.: Pain as if sprained; can scarcely rise; from overlifting. Pain between shoulder-blades, impeding breathing. Rheuma in lumbar region; weakness in small of back. Curvature of dorsal vertebrae.

Nape of neck stiff and rigid. Rheumatoid pains, as after exposure to wet. Sharp sticking, as if parts were wrenched or sprained. Weakness of extremities. Swelling of joints (knee). Arthritic nodosities.

Leucophlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking. Disposed to grow fat, corpulent, unwieldy. Child: red face, flabby muscles, sweats easily and takes cold readily. Large heads and abdomens; fontanelles and sutures open; bones soft, develop very slowly. Curvature of bones (spine and long bones); extremities crooked, deformed; bones irregularly developed. Head sweats profusely while sleeping, wetting pillow far around.

Cham.: Cracking in joints, with pain in them as if bruised. Pain in periosteum of limbs with paralytic weakness. Convulsive single jerks in limbs. All joints sore as if bruised and tired out, there is no power in hands or feet, though without corresponding weariness. Persons (child) with light-brown hair, nervous, excitable temperament; Child exceedingly irritable, fretful; quiet only when carried; impatient, wants this or that and becomes angry when refused, or when offered, petulantly rejects it.

Med.: Rheumatic pain in top of left shoulder, < motion, occasional little darts of pain if kept still. Rheumatic pain in (right) shoulder and arm. Cracking of joints (elbows). Much pain in left arm, cannot hold a paper, veins become enlarged, worse raising arm. Trembling of arms and hands.

For persons suffering from gout, rheuma, neuralgia and diseases of the spinal cord and its membranes -even organic lesions ending in paralysis- which can be traced to a sycotic origin.

Rhus-t.: Hot, painful swelling of joints. PAINS TEARING IN TENDONS, LIGAMENTS AND FASCIAE. Rheumatic pains spread over a large surface at nape of neck, loins, and extremities;

> motion. Soreness of condyles of bones. LIMBS STIFF, PARALYZED. COLD FRESH AIR IS NOT TOLERATED; IT MAKES THE SKIN PAINFUL. Tenderness about knee-joint.

Loss of power in forearm and fingers; crawling sensation in the tips of fingers. Tingling in feet. Adapted to persons of rheumatic diathesis; bad effects of getting wet (after being over-heated).

[Suriyakhatun Osman]

CONVENTIONAL PERSPECTIVE AND MANAGEMENT

Many different ways of classifying arthritis

Involvement of joints

Monoarthritis and polyarthritis

Monoarthritis including Pyogenic arthritis

Tubercular

Haemophiliac

Secondary osteoarthritis

Gout

Polyarthritis

Rheumatoid arthrits

Primary osteoarthritis

Juvenile chronic polyarthritis

Spondyloarthropathies

Cause of arthritis

Degenerative as in osteoarthritis

Metabolic as in gout

Autoimmune as in rheumatoid

Infective as in Tubercular

Secondary as in psoriasis

Seropositive/seronegativ

Seropositive as in rheumatoid arthritis, Still’s disease.

Seronegative spondyloathropathies

Focusing on the commonest forms of arthritis we have:

Degenerative arthritis of which the most common is osteoarthritis.

Osteoarthritis is a very common condition and is probably the most common chronic disease and typically joints affected are the weight bearing joints and well as the spinal column. Big joints are affected and it involves degenerative processes involving the wear and tear of the joints. In cases of injuries, the degenerative changes can arise very much later in life. In osteoarthritis there is wearing out of the cartilage part of the joint and the joint becomes stiff and painful, and may creak as it moves. When the cartilage gets worn out, the bones on either side of the joint reacts by forming small bony outgrowths called osteophytes. Spondylosis is the name given to osteoarthritis affecting the spine. In such cases the main problem is degeneration of the disks which separate

the vertebrae.

Inflammatory arthritis is the other big group and the most common of it is rheumatoid arthritis, gout and soft tissue rheumatism. Rheumatoid arthritis tends to come on at an earlier age than osteoarthritis, which may be around thirty years to fifty years old and is more aggressive and has a more rapidly deteriorating course. Serious disabilities may occur within ten years in some individuals. Although it particularly affects the small joints, especially of the hands and feet, causing a typical hand deformity where the fingers slant sideways, it can also affect almost any joint in the body, and also cause nodules under the skin and eye problems. Besides rheumatoid arthritis, there are many other forms of inflammatory arthritis, some of them associated with infections and metabolic disorders such as gout in which uric acid is deposited in the joints affected, starting an inflammatory process. In conventional medicine, the cause in unknown except that it tends to occur as an inherited weakness.

Soft tissue rheuma affects the soft tissues around the joints (tennis elbow, housemaid’s knees, frozen shoulder). The most well known soft tissue rheuma is fibromyalgia which affects groups of muscles and has certain pain points throughout the muscles. It is thought to be associated with chronic fatigue and may occur with other health issues such as irritable bowel and migraine. Fibromyalgia is also associated with poor sleep and a multitude of emotional consequences.

Diagnosis of arthritis and rheumatism

Diagnosis is made by medical and family history and an assessment of the level of pain and range of movement and areas of stiffness which include the duration and times of the pains. This is to identify the types of arthritis present although in conventional management it does not really change the management very much because the management consists only of anti- inflammatory and pain relieving drugs with their fair share of side effects. These drugs do not stop the progress of the disease. Imaging Tests are also carried out, the most common being X ray but ultrasound and MRI can also be done. The image will be read for structural changes in the joint, signs of joint erosions, cartilage loss, soft tissue tears, inflammation, location and amount of fluid, and presence of loose tissue fragments.

Relevant lab tests can be done to check for the levels of inflammation, serological tests, presence of antibodies and the state of the liver and kidney and the full blood picture which can demonstrate the inflammation via the raised ESR and the presence of infection by the white blood cell count. Renal and kidney profiles are important because of the drugs used in conventional medicine which may compromise these organs. For gout the uric acid level can be obtained.

Conventional management

As mentioned before, in conventional medicine, management is by drugs which suppress inflammation and pain.

Depending on the type of arthritis, the drugs used are:

Non steroidal anti inflammatory drugs

Glucocorticoids – for example prednisolone

Biological response modulators –These are substances that modify the body’s response to infection and disease. Examples are: monoclonal antibodies, interferon, interleukin-2 (IL-2), and several

types of colony- stimulating factors (CSF, GM-CSF, G-CSF).

Disease Modifying Anti-rheumatic drugs. These slow down the destructive processes in inflammatory arthritis. Examples: Hydroxychloroquine, Sulfasalazine, gold salts and cytotoxic drugs.

Specific arthritis like gout are treated with uric acid lowering drugs

Other drugs to deal with depression and spasms are also used.

Supplements may be recommended when bone loss like osteoporosis is involved. Lifestyle exercises, joint sparing techniques and dietary changes may be recommended and physiotherapy may be applied. In advanced cases with severe loss of function, surgery may be recommended and in some cases of arthritis of the knees, knee replacement can be recommended.

HOMEOPATHIC PERSPECTIVE AND MANAGEMENT

Homeopathic Case taking in arthritis

Questions to ask in the case taking will be:

Who is the person with arthritis?

This is important as regards age sex, body build and occupation as well as the lifestyle including food and activities. Family history and relationships, job and occupation are all important.

As an example, in a young man works as a manual laborer and takes a lot of carbohydrates and sweet drinks who started to have knee pains, it would be for a different reason than a lady of 50

who works in an office and is particular about her food and takes balanced meals as well as swims regularly. In the former case, the arthritis could be psoric in nature and in the latter case there is

a possibility of it being sycotic.

What started the arthritis or the question: When did it start and what was happening at that time, is particularly useful in ascertaining a possible trigger for the arthritis. This could be an emotionally traumatic event or a physical trauma as well as an infectious disease.

The constitution of the person with arthritis. This would give information about the type of arthritis that the person has and would indicate the group of remedies and adjuvant measures needed.

Local symptoms related to the arthritis including which joints affected need to be recorded and this would include modalities of location, sensation, time of occurrence, ameliorations and aggravation factors, periodicity if any and concomitant symptoms.

Mental generals and physical generals are an important part of individualising the case.

Family history would point to the susceptibilities and the inherited miasms of the patient.

Other symptoms of the patient both related and unrelated to the arthritis have to be recorded as well. This will be useful to derive the essential drug picture of the patient.

Homeopathic drug treatment of arthritis

The treatment approach will depend on the degree and type of arthritis, whether it is in the curable state or the incurable state of arthritis.

In any type of arthritis, when the disease is recurring but in between the attacks the joint is normal and there are no pathological changes, the approach to take would be to prescribe based on essential totality. Such cases are curable with the right approach and the right homeopathic treatment.

The remedy prescribed would be a constitutional remedy given in single doses at a potency of 1M and repeated monthly or at any suitable interval according to the response of the patient to the remedy.

In cases where the pathology has advanced and there are organic changes which render the disease incurable, then the remedies given will be based on the local pathology ie. pathological prescribing. The remedies will be prescribed in low potencies of between 6 C or 12 C and frequently repeated as needed.

Bry.: Pain with inflammation < movement and > moderate pressure and rest.

Acute painful joints < movement in acute pains of rheumatoid arthritis when the pains are worse by slightest motion or touch. The joints are acutely inflamed and there is anguish and agony on account of pain. The pains are associated with swelling of the joints. In acute exacerbations with fever. There may be whitish coating on the tongue and the mouth and the throat are extremely dry. Fever may be associated with thirst.

Led.: Excellent remedy for gout and rheumatism which is of ascending nature, > cold application.

Rhus-t.: Pain < first movement/damp weather and > continuous motion.

< cold wet weather, or by getting wet. In a case needing Rhus tox, the pains at night cause the patient to have to change positions regularly in order to find relief.

Colch.: Pain <: motion/touch/mental effort; >: warmth and rest;

Kalm.: Pain descending type of pain, pain with palpitation of heart and slow pulse

Guai.: Gouty abscesses of joints, pain > cold bath and cold application.

Benz-ac.: Gouty concretions of joints, knee pain due to abnormal deposition of uric acid

Hyper.: Rheumatoid arthritis with nerve pain.

Puls.: Rheumatoid arthritis when the pains keep changing their locations. <: at night/on rest/in warm closed rooms; >: in open air/warm applications;

Salicylic-ac.: pains with fever. Involvement primarily in the upper extremities. There may be profuse swelling and redness in the affected joints. Most often, the pains are associated with high to very high fever. The pains are pricking type and may be < exposure to cold and > warmth in general.

Phyt.: < in the morning hours Along with the joint pains, there may be a sore, bruised feeling in the whole body. There may be stiffness in the shoulders, knees and ankles. The feet are swollen and walking is restricted on account of acute pain. Associated symptoms are weakness and fatigue. There is pain in the heels which feels better by raising the leg.

Gels.: Acute pain burning in nature and < heat. Extreme weakness with lethargy. < change of seasons and in damp surroundings. The joints are swollen and there may be extreme weakness in the surrounding muscles. During an acute attack, there is marked trembling of all the limbs. Sore, bruised feeling in the back muscles as well.

For cases of rheumatoid arthritis, the following remedies have been found useful:

In Cases of gouty arthritis, several remedies are known to improve the local pathology and reduce the uric acid levels in the blood. Among the remedies are:

Colch.: Chronic cases of gouty arthritis where the pain is in the big toe and the pain is intense when stubbing the toe. There may be inflammation in the affected joint and pains <: in the evening/night/

warm weather.

Benz-ac.: Offensive urine and the color of the urine may be darker than normal. While there may be pain in the big toe which is tearing in nature, the knees may also be affected and swollen. Cracking is present around the joints and <: in the open air/uncovering the affected joints;

Led.: Pains travel from below upwards (starting in the feet and travelling to the knees). Small joints are more commonly affected. Warmth aggravates and cold applications ameliorate. The ball of the great toe may be swollen as well as the ankles.

Ant-c.: Gout with gastric symptoms. Appetite is much increased an over indulgence in food which raise uric acid may contribute to the problem. Pain < heat/cold bathing. The person does not like to be outdoors in sunny weather. Irritability as well as thick white coat on the tongue are characteristic.

Sabina.: Gout in females where there is a presence of uterine symptoms. Pains are shooting in nature and aggravated in a warm room. There is inflammation in affected joints

In cases of osteoarthritis, the degenerative pathology has caused damage to the joint and there may be the presence of osteophytes. While early cases may be curable, this type of arthritis is amenable to palliation for established cases and maybe even for heavily drugged cases which tend to be the most difficult to manage. In such cases, low potencies and mother tinctures are useful and it is only when the symptoms are much ameliorated and when there are signs of elimination and discharge that the case can be treated in a more comprehensive manner by selecting the indicated essential totality. Elimination may be seen in the form of skin symptoms, mucous formation or any discharges from the body.

Remedies chosen may be from those described earlier including Ledum, Rhus-t. and Bry. and these other remedies as below.

Form-ac.: and Form. indicated for inflamed and painful joints <: moving/cold/before a storm; >: pressure;

Lith-c.: Pain stitching or stabbing and burning. Temporary > cold applications and not by rest or moving. Pain is severe enough for the patient to scream in pain. There may be backache with great weakness and profuse sweating. Pains will move to other joints when affected joint is covered. <: uncovering/eating;

Stict.: Pain in the shoulder, wrist joint ankle and knee joints. It is for joints which have swelling due to fluid and may reduce the fluids.

Berb.: Pain in the heels and is useful in cases with renal issues and a stitching backache.

Chel.: Rheuma with oedema heat and tenderness with stiffness, constipation with whitish stools (may indicate gall bladder pathology). Pain < movement and > temporarily bathing with hot water.

Ferr-pic.: Pain increased by walking .

Lact-ac.: Arthritis associated with Diabetes Mellitus

Hyper.: Arthritis associated nerve pain as in ostearthritis affecting the spine.

In one sided cases, the indicated nosode or main remedy associated with the miasm discovered can be prescribed at the start of the case to bring out the symptoms of the case which have been suppressed. Nosodes that may be called for: Med. Tub. Syph. and Psor. carefully chosen based on the prominent symptoms of the patient and the known family history as well as the past history.

In some cases, a miasmatic homeopathic remedy may be chosen for example, Sulph. in cases which do not have characteristic symptoms to prescribe on. It could be given in 200c as a single dose

and with a period of waiting without remedies to observe the response to the remedy before re-prescribing.

Emotional aspects of Arthritis cases

While it has been mentioned that in cases which are incurable and a lot of pathology is present the remedies chosen have to be based on pathological prescribing, when there are very prominent mental symptoms with strong implications on the anxiety and behaviour of the patient, a remedy based on the mental generals may be chosen. My own preference is not to go too high, and the potency I usually use in 200 c. The number of doses depends on the response of the patient to the remedy. One dose or three doses depending on the response of the patient to the remedy.

[Santanu Maity]

Shares lessons he learned in treating very many cases of arthritis.

When treating arthritis, and infection from a virus or bacteria comes in the way of progress, that condition must be dealt with as an acute, not chronic one. A deep acting miasmatic drug must not

be applied here. When an antimiasmatic drug is given during this acute condition, the case becomes an obstinate one. After that, even acute medicines stop acting, and the case is lost. We have to

deal with the acute infection. This acute infection should be treated from the aspect of acute disease.

Allied abnormalities are one of the main obstructing causes I have found, which come in the way of treating arthritis. In one difficult case I treated, the patient was suffering from pain at the lumbo-sacral region, with pain radiating towards the legs, aggravation from rest and relived from movement. The pain was intolerable at night and while lying down. X-Ray showed degeneration of bones at the sacro-pelvic junction. On palpation the junction was sensitive to the least pressure and relieved from moderate heat application. The pain was aggravated also in the morning from first movement and relived from continued movement to some extent. This patient was a male, 41years of age. I prescribed Mezereum 200 C.

After one week the patient comes back to tell me that nothing has happened. No relief is there. Once again I investigated the symptoms. He explained that he has susceptibility to cold and also had constipation for years. Here constipation is the main allied complication. I asked him to explain his constipation. He said he faces difficulties while passing stool hard and dry. The anus is sore and there is slight swelling and sticking pain during and after stool. This time, I did not give any medicine related to his main complaint, but rather tried to treat the constipation with Aesc-h. 1M(2d), followed by placebo for seven days. Aesculus Hip also has back pain with stiffness. After one week he showed some little improvement from his symptoms. I repeated Mezereum200(2d) followed

by placebo for one week. After the week he said there was great relief of nightly pain. Now he can sleep at night. Suffering is there but less than before. Now the same medicine (Mezereum) begins

to act when closely related allied abnormalities are treated and controlled. So I think that it is not always necessary to focus on the chief complaint of the patient.

One thing I found which is also necessary, is wiping out the effect of the previous medicines, even when a continuous process of chronic treatment is going on. This condition is often encountered while treating an obstinate type of arthritis. I was treating a lady aged 55 for her arthritic knees for almost one year. She was doing fine and progress was satisfactory. Then her pain, swelling and soreness increased severely. A uric acid and urea test revealed normal values. She complained of being feverish. Thirst was there, but for little and frequently. Temperature aggravation was midday and midnight. She was weak but restless and I thought of Arsenicum album. She had not done anything wrong which could aggravate the disease. I was confused about what to do and thought

I was going to lose her case. Nothing was coming in mind. She was following every instruction. I thought to make a fresh beginning of the case. I gave her Nux Vom 200 (2d) with placebo for five days, with the option in my mind that I was going to take the case anew.

Now I started Ars. 200(3d) with placebo. After a week there was a great relief. Pain and swelling was reduced by 50%. Fever was gone. I prescribed placebo for another week. I was thinking about what Nux-v. did. It wiped out the medicinal effect of the previous medicines, though it is said Nux-v. only antidotes medicines from the vegetable kingdom. But I have seen that Nux-v. 200 antidotes the secondary action of every medicine. In several chronic cases where there was a continued treatment that became stuck, one needs a wiping of previous medicine effects. A fresh beginning makes the disease move forward.

The acute exacerbation of symptoms is often encountered. This must be controlled firmly and correctly or the case is lost. I have looked carefully into this acute aggravation of the symptoms. Almost 80% of these cases are due to bacterial or viral infection. What is more common is the common cold virus infection. When the patient is infected with this virus with body ache, fever and malaise, joint pain increases. When the infection is cured, all other symptoms are gone, but the joint pain remains.This virus mainly affects the synovial membrane, tendons and muscles surrounding the structure. X-Ray of the suddenly aggravated joints reveals no further bony abnormalities. X-ray shows only tissue swelling around the joint. I have been treating a 45years old man for the last eight months. He first came to me with polyarthritis. Every joint of his body was affected. Tearing pain was there with stiffness after rest. There was severe tearing pain from slight movement and aggravation at night. All metacarpal and metatarsal joints were swollen and stiff and sensitive to touch. I started his treatment with Actaea spicata 30, along with a few intercurrent and follow up medicines like Caust. Hyper. Ruta. Symph. Act-r. etc. His development was satisfactory. He was doing his salesman’s job very well, which was becoming difficult when he first came to me.

He discontinued the treatment for one month. Viral fever was the main suffering when he came back after a month’s interval. All his joints were aching. It is difficult to distinguish whether it from the arthritis or because of viral infection. I made a plan. I decided to treat the fever first, then see if there is there is any relapse of the arthritis. When the fever was over, the sufferings allied with fever were gone. But the pain and swelling and stiffness of the joints remained. He was moving his joints but writhing in pain. The right shoulder joint was much more affected. It swelled and was sensitive to pressure. Previously he had the modalities of getting relief from moderate heat application. Now he said heat aggravates the pain. Previous medicines failed to response. I stopped all the medicines and prescribed Apis mellifica 200(5d) at 3 hour intervals with placebo for 3 days. His pain swelling and sensitiveness of joints were reduced by 80% when he came back after 5 days.

I was also relaxed and happy that the crisis was over. Another 6 doses were required (B.D) to wipe out rest of the suffering.

It is not always necessary that we stick to the chronic treatment plan and wait for a long while before the chronic medicines starts the secondary action and the patient gets relief. Rather, we can give the patient relief and then can go back to the previously planned constitutional treatment.

If the knees are the parts involved by arthritis, the patient must follow one rule strictly. He must not bend the knee. This posture stretches and injures the shortened and fibrosed tendon. This only increases the pain and soreness. No medicine will be helpful if this practice is continued. Long walking is injurious to arthritic joints. But patients must walk 30 to 40 minutes every day in two divided slots. Otherwise muscles around joints becomes stiff and mobility decreases.

Cases where indicated medicines fail

In some cases there is frequent relapse of disease. What brings back the disease? Inherited miasm and infection are the causes. Staphylococcus aureus, nesseria gonorrhoea, are the causative organisms which cause infection to the synovial membrane and synovial fluid. Infection spreads to the joint through blood, infection from bone itself, infected places on the skin. All these are infections which cause or aggravate the arthritic condition.

In some cases I did blood tests which revealed that CRP is normal. There are some cases where in spite of staphylococcus infection, CRP remains normal. TSH was normal and urea was within normal limits. Only uric acid levels is sometime at the upper limit. In some cases CRP was elevated. I consider that these internal abnormalities be treated first. I stop all miasmatic medicines.

The present aggravations and ameliorations are the main complaints I consider. The time of aggravation is also a main symptom in prescribing. Prescription from this aspect gives quick relief to the patient and the severe pathology of the disease is controlled.

Arthritis without complication responds rapidly to medicines, if the patient is not suffering from vitamin D3 deficiencies or Calcium deficiency. These plays an important role treating arthritis.

I always give emphasis on correcting the deficiencies as well as stopping and controlling the last two conditions mentioned while treating arthritis. Correcting the diet depends on natural foods. Natural foods help much better in correcting these deficiencies, though in some severe deficiencies there remains no time for dietary compensation. An external supply of calcium and vitamins becomes evident. When the patient is advised dietary supplements, it is important that his digestive function and assimilation is normal. If not, you have to consider digestive treatment along with

the main treatment. Calcarea carb onicum and Calcarea phosphoricum in trituration helps much in supplementing the patient who has calcium deficiency.

I wanted to find out whether constitutional treatment gives relief to the patient’s suffering or a therapeutic approach acts earlier.

Patient

Constitutional approach

Therapeutic approach

Remedies with follow up relation.

Management

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

A

Apis mellifica200.3 hourly.(5d)

no

Arthritic management

pain begins to reduce.

Pain lesser than 2^nd day.

Effusion begins to reduce.

Effusion less again.

Effusion less.

Pain and effusion both are less.

Both less.

Both less.

Patient feels > by 50%.

B

Arsenicum album200(6d). 4 hourly.

Ferrum phosphoricum 6x.T.D.

Same

pain much less.

Inflammation slightly less.

Pain almost gone.

Inflammation much less.

Inflammation slightly remains.

Patient did not report.

Patient did not report.

Patient feels better by 50%.

C

Bellis perenis200(8d). 3 hourly

Helleborus N6

Same

Pain begins to less.

Pain less.

Pain less.

Pain less.

Drawing sensation begins to lessen.

Drawing sensation less by 60%.

Patient feels better. Pain absent.

D

Kali iod200(6d).3 hourly.

Actaea spicata200(4d)B.D.

Same

Pain begins to lessen from evening.

Pain less by 50%

Pain less by 80%

Pain gone. Soreness much less

Pain less again.

Soreness reducing.

Patient feels much >

E

Graphites200(2d)

Placebo T.D

Same.

Pain begins to lessen.

Pain less.

Pain less. Soreness slight less.

Patient feels good by 30%.

F

Calc-hypo.30(6d) T.D.

Placebo T.D.

Same

Pain begins to lessen.

Soreness less slight.

Pain and soreness less

Less.

> 40%.

G

Kalmia lat200(4d)B.D.

Placebo T.D.

Same

Pain begins to lessen.

Soreness begins to be less.

Patient feels better by 30%

H

Mezereum200(4d) B.D.

Placebo

Same

Pain begins to lessen.

Soreness slight less.

Patient feels better by 30%.

I have seen clinically in treating for the last 10 years that Actaea spicata is complementary and follows Kali i. very well. Actaea spicata also follows Graphites and Calc-hyp.

While treating arthritis I always try to do a combination of therapeutic approach and constitutional approach. At the beginning, if the patient’s suffering becomes great and he is at the edge of his tolerance, I prefer to start with the therapeutic approach. When the torture of pain cools down, I start the constitutional approach. In absolutely every case, it stops the disease pathology and reduces sufferings quickly. The therapeutic approach makes the way smoother for the constitutional medicines. A disease, like arthritis which cannot be cured, should be treated with the intention that the pathology of the disease process must be held to where it is, and the sufferings of the patient reduced.

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