Homoeopathic approach in Osteo arthritis

Prof (Dr) Samarendra  Prasad  Mishra 

Abstract:
The incidence of arthritic diseases in clinical practice are  very  common in  now- a- days.. This disease  produces  a definite problem for aged persons/senior citizens  as it hampers their  walking habit & also normal routine works. So, life becomes  disgust   for them.  This troublesome disease has extremely  less amenable in other pathies   including modern medicine. Most sophisticated knee surgery  has also  no surety for them. In this context, Homoeopathy has some scope in this disease  to prevent further damage of knee joints, minimizing the most troublesome  pains, stiffness & immobility.  it is a degenerative disease  , difficult  to  permanent cure  with time to time troublesome symptoms .So, I have  suggested  a  scientific  clinical  homoeopathic protocol basing on my personal clinical experience ,where at least  within a period of 06 months, patient to be  applied different   groups of  homoeo  medicines  singly basing on the character/symptoms  of the disease  with need of the  patient  & found it  as  good success.

Keywords: Osteo-arthritis of Knee &  its modern concepts, Treatment options  of OA of Knee including exercises, Homoeopathic treatment Protocol,  Related homoeopathic & batch flower remedies.

Disease Profile– Osteoarthritis of  Knee
Osteoarthritis of Knee, is  a very common disease in  now- a- days   after Diabetes & Hypertension. Commonly, it is known as wear-and-tear arthritis because the natural cushioning between joints & cartilages — wear away. Due to this, the bones of the joints rub more closely against each other. So,  the  shock-absorbing benefits of cartilage is loosed in a great way.

Pathophysiology in OA of Knee-
This rubbing results in-

• Pain
• Swelling 
• Stiffness 
• Decreased ability to move & 
• Sometimes, formation of an  extra bits of bone is  known as Bone spurs. It is just like a  hard lump & remains  around the affected joint.

Incidence-
The chance of developing osteoarthritis  of Knee rises after age of  45. Women are more likely to have Osteoarthritis than men. it may be also hereditary. In some cases, it may result from injury/infection to knee or due to obese conditions. 

Causes Osteoarthritis of Knee-

Age.(after 45 years) is the most common cause of OA, because, the ability of cartilage to heal decreases as a person gets older. It may also develop at earlier but % are less. 

Weight. more body weight increases  much pressure on the knees. So, obese persons are the more suffers of  this disease

Heredity. genetic mutations might make a person more likely to develop Osteoarthritis of the knee. It may also be due to inherited abnormalities in the shape of the bones that surround the knee joint

Gender. women ages 45 and older are more likely than men to develop osteoarthritis of the knee.

Repetitive stress injuries. People with certain occupations like lifting heavy weights (55 pounds or more)  are more likely to develop Osteoarthritis of the knee because of the constant pressure on the joint.

Athletics. Athletes involved in soccer, tennis, or long-distance running may be at higher risk for developing Osteoarthritis of the knee due to frequent injuries of knee. But, regular moderate exercise strengthens the joints and can decrease the risk of Osteoarthritis. 

Other illnesses. Rheumatoid arthritis, metabolic disorders like iron overload , excess growth hormone & Diabetic Mellitus, produce the chance of higher risk to develop Osteoarthritis of Knee.

Symptoms of  Osteoarthritis of  Knee –

• Pain that increases when person is  in  active work, but gets a little better with rest
• Swelling of /around Knee joints
• Feeling of warmth in the joint(Hot sensation)
• Stiffness in the knee, especially in the morning or on  sitting for a while
• Decrease in mobility of the knee, making it difficult to get in and out of chairs or cars, use the stairs, or walk
• Creaking  sound that is heard when the knee moves

Diagnosis  of the  Osteoarthritis  Knee –

1. Taking detail case history of affected Patient
2. Physical examination  of Knee joint & its  adjacent affected parts can give clear diagnosis of OA of knee.

Laboratory Investigations in OA knee:-

• X-rays of Knee joints-which can show bone and cartilage damage as well as the presence of bone spurs
• MRI scans-MRI scans may be ordered when X-rays do not give a clear reason for this disease. 
• Blood tests like- DC, TLC, ESR, RA factor, CRP, Serum Uric acid  are  required to rule out other conditions that could be causing the  knee pain.

Aims   while  treating a case  of Osteo-arthritis  Knee- To relieve the pain and To return of its mobility. 

The treatment plan must be  included combinations of medicines & exercises. 

The patients of OA knee should be encouraged for-

• Weight loss- 
• Some physical exercises-like a) Strengthening exercise which help to keep the knee joint mobile and flexible . 

Sit to stand. Sit in a chair. Slowly stand up & sit back down again without using the hands. Focus on keeping the  feet shoulder-width apart and knees over the feet. Repeat it  for 30 seconds.

One-leg balance: Stand next to a table &  place one hand on it for support. Lift one leg and balance on the other for up to 10 seconds. Repeat it on the other side.

b) Simple exercise– Walking, Swimming & Biking. .  Start with just for 10 minutes. After  few days, slowly  increase that time to more  5 to 10 minutes. The goal is to work up to 30 minutes of any one above exercise, 5 days  per  week.

c) Range-of-motion Exercises-

-Sitting knee extension. Sit in a chair. Slowly extend one leg as much as you can, or until it’s parallel to the floor. Hold for 1 to 2 seconds; lower back to the ground. Switch sides. Repeat 10 times.

-Sitting knee flexion. Sit on the edge of a chair. (Make sure the chair is stable and won’t tip over.) Lift one knee and place your shin in your hands. Gently pull your shin toward your thigh. Hold for 1 to 2 seconds; lower back to the ground. Switch sides. Repeat 10 times.

Wearing of Knee caps- helps less bending of knee joints & less joint rubs. So pain & stiffness naturally will be less.

Scope in Allopathy-

• Pain relievers and anti-inflammatory drugs to relieve acute unbearable pain.
• Injections of corticosteroids/hyaluronic acids into the knee joints-Those are the  powerful anti-inflammatory drugs. Hyaluronic acid is normally present in joints as a type of lubricating fluid. 
• Calcium, Vitamin-D are often times found in there prescription.

Surgery-includes Arthroscopy, Osteotomy & Arthroplasty of Knee joint. 

Avoidable activities for OA patients-

• Do not sit in floor with bending knees
• Do not frequent go up & down up stairs.
• Use western  type of Latrine

Homoeopathic  approach  to  Osteo-arthritis of  Knee
Homeopathy has wide  scope for its  treatment with its varieties of medicines in different forms. The selection of  homoeopathic remedies must be based upon the theory of individualization and symptoms similarity by  detail case taking.  But, the difficulty here is, due to  the unbearable recurrent  knee joint  pains, stiffness & immobility  felt by the patient , it may not give sufficient time to the treating doctor for a smooth treatment.  So, it is better to  formulate  a  well programmed homoeopathic treatment protocol for  a certain period of time(at least for 06 months)  rather than giving a single or one type of  remedy through out the treatment period. However, all types of the medicines in the protocol  should neither  be mixed nor  to be given simultaneously. As per the  need, they may be given singly in due course. 

The suggestive Homoeopathic Treatment  Protocol  –

         Selection of a-

a. Constitutional /Miasmatic medicines	should be selected on the totality of symptoms
b. Nosode/Sarcode/Imponderabilia medicines	can be given as an  intercurent remedy(like Like X-ray, Osteoarthritis Nosode,  Sycotic Compound, etc) as weekly/ fortnightly/monthly once.
c. Pain relieving remedies	can be given  during  only acute exaggerations  of symptoms– (like Mother tinctures & Biochemics as-Apocynum andro, Gaultheria procumbens, Hymusa, Guaicum sanctum/ officinale, Nyctanthes Arbor – tristits, Stellaria media, Biochemics like- Mag. phos, Cal. phos, Calc. fluor, Kali. mur etc . or some acute potentized drugs like Ledum, Phytolacca, Kalmia, Benzoic acid, Kali. iod, Rhus tox, Bryonia, Belladonna, Ruta, Colchicum, Guaiacum etc.) for short period.
d. External applications	may be made by using  medicines- Arnica mont, Symphytum, Eucalyptus Oil ,Turpentine Oil  on homoeopathic way
e. Emotional remedies	if patient is a long sufferer, treated in all pathies  without much benefit, loses hope for his recovery & produces  abundant mental symptoms than  physical symptoms- besides homoeopathic  medicines,  another similar therapy like homoeopathy –called “BATCH  FLOWER  REMEDY THERAPHY”, is also effective in this case.

Flow  diagram  of  proposed   Homoeopathic  Treatment  Protocol  for  an  OA of  Knee disease-

Some important  homoeopathic & batch flower  remedies are given below, which helps me  a lot  in the  treatment of Osteoarthritis of Knee.

1.Kali. iod–

Rheumatism of Knee with effusion in joint- so huge swelling of Knee found.
Pain–< night, while bending the knee  & lying on affected side.. >by  motion & open air.
I have got much more response from this drug.

2.Osteoarthitis-Nosode–
It is made from synovial liquid of arthritis – joint. A proving of the Osteo arthritis Nosode of the hip was read in the 18 th All India Homeopathic Conference at Madras on 10th October 1970 .The two preparations of the Osteo arthritis Nosode are done from the synovial liquid of joints. The Osteo arthritis Nosode that originated from Dr. Foubister comes from the knee of a patient suffering from an Osteo arthritis affection and the other stock from the hip of a similar case.  OA of Knee,   < from first motion , night. right side,  > prolonged movement

3.Calcaria carb. – Osteoarthritis of knee joint especially in fat and obese persons. < when getting up from a sitting position , by walking & Cold. Cold , clammy knees is another feature of Calcarea carb. There is cramps in calves when stretching out the legs at night.   They have a special craving for eggs and undigestable things. 

4.Sulphur –  This is a polycreast, constitutional & miasmatic drug.Contains all signs of inflammation( Swelling, hot sensation, Redness , Painful, loss of functions of affectedjoint etc.). In OA of knee- all signs of inflammation are found. So it is a great remedy to be used & its action toabsorb the effusions from joint.

5. Benzoic acid –

• Arthritis of Knee joints, cracking sound on walking.
• Pains-Tearing, stitching type.
• Knee- Swollen hugely with redness,  <  at night, motion.
• Urine-highly offensive, dark brown colour.
• Blood examination- ↑ of Uric acid 

 6.Guaiacum. –

• Knee-swollen hugely with much stiffness.
• Hot sensation in knee area.
• Pain-< on heat & motion. >by  Pressure.

7. Bryonia alba-

•   Knee-Stiff , painful, swollen ,red  & hot
•   Pain—Stitching, tearing type.
•   < motion . > by pressure &  rest.

8.Rhus Tox. – Rheumatism caused by damp weather and worse in damp climate; Pains –<  1^st. motion, cold, night . > by continued motion.

9.Sycotic  co– Rhustox like modality. Can be given when Rhustox fails to act.

10.Ledum pal. – Pain-Sticking, tearing, throbbing. < by motion , night, warmth of bed. >by holding  knee in ice-water.

11.Lactic acid – Osteoarthritis with diabetes.

12.Calcarea fluor – Chronic synovitis of  knee joints.< rest, change of weather. >by heat.

13. Ruta graveolens –It  is effective for Osteoarthritis of knee joint where the patient feels the knees give way , while ascending and descending stairs. 

14.Phytolacca – Rheumatic  modalities are  in between Rhustox(Aggravation- Night & Bryonia- Aggravation-  from Motion).

 15. X-Ray– Rheumatic pain  with trembling of limbs. Sensation of electric current in the limbs.

16. Arum met.– It is a syphilitic drug & has got  solvent action to the joints having bone tissues formed.

17.Argentum met.– got the action in protecting cartilages of knees.

Homeopathic  Mother Tinctures-

1. Apocynum  andro- A good drug for Rheumatic pains, stiffness of joints with swellings.
2. Gaultheria  procumbens- Joint pains accompanied with  gastric disturbances. Both External & internal uses can be  done.
3. Jacaranda  caroba- It is a remedy for the rheumatism with urinary symptoms. Rheumatic pain in the right knee. Gonorrheal Rheumatism..
4. Nyctanthes  arbortristis- Remittent fever with sharp shifting pain in knee joint . Synovitis
5. Stellaria media- Joints are stiff. Rheumatic pains in different parts of the body..

Bio-Chemic  Support
Calcarea phos– Rheumatism of the joints. Cold, change of weather, motion, getting wet, generally aggravates symptoms. Relieved by rest, warmth and by lying down

2. Calcarea fluor -Chronic synovitis of knee-joint. < during rest, change of weather >by  heat, warm application

3. Kali. mur- relives the sub- acute inflammatory stages of joints.

Bibliography-

• Knee Osteoarthritis: Causes, Symptoms, Treatments – WebMD https://www.webmd.com/osteoarthritis/ostearthritis-of-the-knee-degenerative-arthritis.
• Boericke, William.(1996), . Pocket Manual of Homoeopathic  Materia Medica & Repertory, Reprint ed., B. Jain Publisher (P) Ltd., New Delhi.
• hpathy.com/cause-symptoms-treatment/osteoarthritis.

Prof. (Dr.) Samarendra  Prasad  Mishra
B.H.M.S(Hons), M.D.(Hom) Materia  Medica(Utkal)
Ex- Professor  Dept. of Materia Medica- MaharanaPratap  Homoeopathic Medical College, New Rajendra Nagar, Raipur, Chhattisgarh.
Mob-09438564739, e- mail-dr_spm@rediffmail.com