Case Studies 21 : Rheumatoid Arthritis with Lumbar Spondylosis.
A chronic longstanding suffering in a person not only has an impact on his physical being but his mental health is also deranged.
Anger, frustration, guilt, apathy, helplessness are the feelings which encroach the mind and cause an added disturbance.
At this very point alleviating few physical symptoms will not help but an overall approach is of necessity.
I strongly accept as true that, it is Homoeopathy and only Homoeopathy that will take care of every aspect of the patient.
Let’s go through the case:
Thisis an interesting case of a lady aged 39 yrs, suffering from Rheumatoid Arthritis with Lumbar Spondylosis since 5-6 yrs.
Her condition was vulnerable as there were incapacitating deformities in her limbs.
She also had a history of Chikungunia and Osteoarthritis since 6 yrs.
Rheumatoid arthritis(RA)is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated.
The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (hyperplasia) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. The pathology of the disease process often leads to the destruction of articular cartilage and ankylosis (fusion) of the joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, membrane around the heart (pericardium), the membranes of the lung (pleura), and white of the eye (sclera), and also nodular lesions, most common in subcutaneous tissue. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in both its chronicity and progression, and RA is considered a systemic autoimmune disease. It is a clinical diagnosis made on the basis of symptoms, physical exam, radiographs (X-rays) and labs.
The arthritis of joints known as synovitis is inflammation of the synovial membrane that lines joints and tendon sheaths. Joints become swollen, tender and warm, and stiffness limits their movement. With time RA nearly always affects multiple joints (it is a polyarthritis), most commonly small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.
There is no known cure for rheumatoid arthritis, but many different types of treatment can alleviate symptoms and/or modify the disease process.
Her case history is as follows:
Complaints started with H/o Chikungunia. It was treated with painkillers and subsided for short while. Thereafter a regular pain started in all the joints along with high grade fever. As it remained persistent for a moderate duration, investigations were done and a diagnosis of rheumatoid arthritis was done.
Allopathic treatment was taken. Initial 3 yrs went well and she could manage well with her day to day activities.
Thereafter condition deteriorated. In next 2 yrs pain enhanced and deformities were developed. Her activities were completely restricted. She was on continuous painkillers and steroids.
Associated with it was the overpowering depression and loss of interests.
When she came to me there were major deformities in both knees. She had to walk bent. Pain was excruciating.
It is a challenge to deal with such cases as painkillers and steroids has already done a lot of suppression. The first job here is to stop the dependence of these medicines and then recovery takes place.
She was consulted on 17th Nov. 2012.
Investigations:
30.05.2007: X-Ray :
- Spondylosis of Lt. Int. Articular process of L5 vertebra. Bilateral sacro-ilitis. Intervertebral spaces normal.
03.03.2012: X-Ray (Knees) :
- Bilateral Knee joint Osteoarthritis.
12.11.2007: Blood Count :
- Hb : 10.0 gm% Now : 7.5 gm%
- ESR : 50
- C. Reactive protein (CRP): 7.4 gm/L
19.06.2007 : HLA : B27 +ve.
29.11.2011 : HLA : B27 –ve.
C/C:
1. Pain in Lumbar region since 6-7 yrs.
2. Burning in soles since 6-7 yrs.
3. Stiffness and pain in all jointssince 6 yrs.
- Onset : Sudden. Starts with high grade fever, remains for 2 days; very high with chills.
- Pain in both feet → elbows → jaw → knees.
- Rt. → Lt.
- Rt. > Lt.
- Progressing.
- Stiffness+++.
- Type of pain : Shooting, burning, lightening.
< Exertion. > Movement.
< Walking. > During menses+++.
< Mental stress. > Massaging.
< 11-12 a.m. > Hot bathing.
< New moon, full moon.
< Empty stomach.
< Fanning.
Past History:
- Jaundice 6-7 yrs of age.
- Typhoid like fever 6 yrs before.
- Eosinophilia in childhood.
- Rt. Side ectopic pregnancy in 2001.
- 2 Miscarriages in 2002 and in 2003.
- Cesarean delivery – Taken Heparin inj. For 9 months in 2004.
- Moles removed by laser in 2005.
Family History:
Father : HTN, I.H.D.
Mother : HTN.
Physical Generals:
- Diet : Vegetarian.
- Appetite : Average. Can tolerate hunger.
- Desire : Spicy++, Sour++, Milk+, Curd+, Fruits, Juices.
- Aversion : Oily.
- Food< : Besan, Oily < Acidity.
- Head : Hair fall++, Dandruff+.
- Nose : Suffocated feeling in closed room, strong smells.
- Tongue : Moist, pale, white coated.
- Thirst : Thirsty. 7-8 glasses / day. L.Q.L.I.
- Chest : Palpitations after over exertion, pain. Burning d/t acidity.
- Stomach : Acidity with sour eructation. Food comes out.
- Hiccough.
- Stools : Once a day. Satisfactory.
- Piles since 1-2 yrs.
- Burning during and after stools.
- Urine : 4-5 times / day. Once at night.
- Perspiration: Scanty.
- Skin : Dryness; scaling.
- Sleep : Night : 7 hrs at night.
3 hrs sometimes in afternoon.
Disturbed sleep.
Unrefreshed feeling.
Position : On Rt. side.
Snoring.
- Dreams : Fearful dream; fear remains for 2-3 days,
Snakes, dead people.
- Thermal : Chilly.
Mind:
1. Tell me about your childhood?
I belong to a joint family. Financially we were not very sound. We were 3 siblings I was 2nd elder. I was average in
studies but always wanted to obtain good education. I started doing job at age of 20 to persue my studies and
avoid being dependant.
I was never an aggressive child, but always desired that people should listen to me. Whenever I felt that something
unfair was done with me I use to get upset and stop eating. I always liked clean and up to date work.
I was more close to my mother and sister. I liked to be in company.
I Feared dark, lightening.
2. Tell me about your education and work?
I have completed my education in law (LLB). I got married in 2001. I was working after the marriage but left the job
when I got a kid.
I stay now in a nuclear family. Financial conditions are good.
3. Tell me about your nature?
I get angry when people around me don’t listen or do things as I say. I cannot tolerate wrong to happen with me. I
shout and react. I feel bad.
I can’t be in rest. I am in habit of constantly doing some or the other work or worrying about something. Cleanliness
is something I am bound to. It’s like a burden on my head if I don’t do it.
I worry about every small thing as things not kept in place. At present my main concern is that I am not able to pay
proper attention to my child’s development due to the disease. I can’t take his studies, cannot accompany him to
places he wants to. I am very attached to him. I feel worse when I remember the situations before as I could
manage all the activities.
One more thing I will like to add is that I don’t like being sympathized and the feeling of being dependant on others.
I like to learn new things. I have many friends. I like travelling, reading.
4. Tell me more about your worries and tension?
The most important is which I have discussed that is I can’t take proper care of my son. Joint family when we were
staying together in Nagpur. Now we have shifted to Pune.
One setback for me was my 3 miscarriages. I conceived for full term after a period of 4 yrs of my marriage.
I get irritated on myself when I don’t do my work properly.
One more thing that irritates me is people not following time and discipline.
My observation:
- Active.
- Honest.
Totality:
- Anxiety conscience / guilt.
- Fastidious.
- Delusion neglected duty.
- Active.
- Ambitious.
- Destruction joints / deformities / Rheumatic syphilitic.
- Rt. to Lt.
- Desire open air.
- Miscarriages tendency for.
- > Menses during.
- Desire – sour.
- Thirsty.
- Thermal : Chilly.
- Miasm : Syphilitic.
Remedy Selected:CYCLAMEN 30.
Response:
After consultation patient was admitted.
Pain killers were completely stopped. Initially she felt the pain and distress for the withdrawn dependence, but thereafter our commanded the post. In next 10 to 15 days there was major relief in pain and stiffness of all the joints.
It got revealed by the fact that she had good movements in her right elbow which helped her eat properly. Earlier she had to bend her neck to eat the morsel. Hands could be taken back to tie the hair.
Stiffness and deformity in knee joints were improving. The leg at knee joint was straightened. She could now walk relatively very straight and with a good speed. She could ascend and descend comfortably.
Breathlessness experienced at ascending and descending had reduced considerably. Now she could climb to 4th floor properly, earlier where even one floor was difficult.
Swelling in knee, hands was reduced to the extent that the normal grooves were visible.
She would experience heavy pain and weakness as a part of pre-menstrual symptoms which had markedly reduced this time.
She had spent sleepless nights since many years.
Appetite and sleep had a drastic improvement.
Depressive mood was switched over with aliveness, positivity and happiness.
Its science and not a miracle!!!
D/D:
Aurum Met :
- Mental symptoms of guilt, remorse are same as to medicine prescribed but following points
differentiate.
- Menses release the pain i.e. > Joint pains menses during is marked modality and is not covered by
Aurum.
Pulsatilla :
- Changeability is the characteristic of Puls. It is not seen in the patient
- Puls is hot and patientis chilly.
- Rhematic, syphilitic presentation isnot well covered by Puls.
- Activity and enthusiasm in the patient along withthe remose feeling is not seen in Puls markedly.