Utility of Rheumatic remedies by HA Robert in a case of rheumatoid arthritis

Dr Komal Patel

ABSTRACT: Rheumatoid Arthritis (RA) is a common form of inflammatory arthritis, occurring throughout the world and in all ethnic groups. There are a variety of systemic manifestations, the characteristic feature of RA is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. This article aims to correlate the rubrics from THE RHEUMATIC REMEDIES by H. A. ROBERTS with the symptoms of Rheumatoid arthritis which can help in clinical practice.

KEYWORDS: Rheumatoid Arthritis, Repertory, Rubrics, Repertorial approach.

DEFINITION: Rheumatoid arthritis (RA) is a chronic, multisystem disease of unknown etiology. Although there are a variety of systemic manifestations, the characteristic feature of RA is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. Te potential of the synovial inflammation to cause cartilage destruction and bone erosions and subsequently join deformities is the hallmark of the disease. ^[1]

EPIDEMIOLOGY: The prevalence of definite RA is approximately 1% of the population (range 0.3 to 2.1 percent); women are affected approximately three times more than men. The prevalence increases with age, and sex differences diminish in older age groups. The onset is frequently during the fourth and fifth decade of life, with 80 percent of all patients developing the disease between the age of 35 and 50. ^[1]

CLINICAL FEATURES: Pain, swelling, and tenderness may initially be poorly localized to the joints. Pain in affected joints, aggravated by movement, is the most common manifestation of established RA. Generalized stiffness is frequent and is usually greatest after periods of inactivity. Morning stiffness of greater than 1-h duration is an almost invariable feature of inflammatory arthritis and serves to distinguish it from various noninflammatory joint disorders. The majority of patients will experience constitutional symptoms such as weakness, easy fatigability, anorexia, and weight loss. Clinically, synovial inflammation causes swelling, tenderness, and limitation of motion. Warmth is usually evident on examination, especially of large joints such as the knee, but erythema is infrequent. Characteristic deformities of the hand includes (1) radial deviation at the wrist with ulnar deviation of the digits often with palmar subluxation of the proximal phalanges (“Z” deformity); (2) hyperextension of the proximal interphalangeal joints, with compensatory flexion of the distal interphalangeal joints (swan neck deformity); (3) flexion deformity of the proximal inter-phalangeal joints and extension of the distal interphalangeal joints (boutonnière deformity); and (4) hyperextension of the first inter-phalangeal joint and flexion of the first metacarpophalangeal joint with consequent loss of thumb mobility and pinch. Typical deformities may also develop in the feet, including eversion at the hindfoot (subtalar joint), plantar subluxation of the metatarsal heads, widening of the forefoot, hallux valgus, and lateral deviation and dorsal subluxation of the toes. ^[1]

MANAGEMENT:

• Rest and splinting of the joints should be instituted in the acute stage of illness.
• Active and passive physiotherapy helps in mobilization and prevention of contractures.
• Analgesics: Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line drugs used in the management of RA. They act by suppression of inflammation.
• Disease-modifying Anti-Rheumatic Drugs (DMARDs)
• Corticosteroids
• Immunosuppressants
• Surgery: Surgical therapy is useful in maintenance of joint function, prevention and correction of deformities. ^[2]

CASE STUDY: A 40-year-old female patient presented with the following problem:

CHIEF COMPLAINT: Severe joint pain and stiffness since 6 months. Primarily her hands, wrists and knees were the joints involved.

ODP OF CHIEF COMPLAINT: She complained of drawing and tearing type of pain which initially was limited to the metacarpophalangeal joints. She occasionally had swollen joints which looked inflamed (shiny and red) especially the wrist and knee joint. The patient sometimes experienced numbness over the parts associated with tingling and pains. The pains were more in the morning after long periods of inactivity.

MODALITIES: < – Initial movement, After rest and cold wet weather.

> – By heat and when warmed by exercise

FAMILY HISTORY: FATHER – DM since 14 years

PAST HISTORY: Nothing Specific

PHYSICAL GENERALS:  

• Diet – Mixed diet
• Appetite – Satisfactory
• Desires – N.S
• Aversion – N.S
• Thirst – Sufficient
• Stool – Normal
• Urination – NAD
• Sleep – Sound sleep
• Dreams – Does not remember

LOCAL EXAMINATION:

• Tenderness and swelling was present at multiple joints.
• Range of motion was limited.

INVESTIGATIONS:

RA factor: Positive

CRP : 96, RA factor : >160

TOTALITY OF SYMPTOMS:

• Severe drawing and tearing type of joint pain.
• Swelling over the joints with redness and tenderness.
• Numbness of parts with tingling and pain.
• < – Morning, initial movement, after rest
• > – heat application

REPERTORIAL TOTALITY: Rubrics selected from THE RHEUMATIC REMEDIES by H. A. ROBERTS^[3]

1. JOINTS – Swelling – Shining
2. EXTREMITIES IN GENERAL – Numbness – tingling and pains
3. EXTREMITIES IN GENERAL – Pain – or tearing, during rest
4. EXTREMITIES IN GENERAL – Stiffness – On first moving the part after rest, sense of
5. EXTREMITIES IN GENERAL – < motion: beginning: sense of stiffness
6. MODALITIES – > heat

The remedy selected from the above rubrics was RHUS TOX 200 X TDS X 4 weeks.

FOLLOW UP:

4 WEEKS: Significant reduction in pain and stiffness. Improved morning stiffness. RHUS TOX 200 X TDS X 4 WEEKS.

8 WEEKS: Further improvement in joint mobility and a decrease in swelling. RHUS TOX 200 X TDS X 4 weeks.

12 WEEKS: Continued improvement in all symptoms. The patient reported increased energy levels and better quality of life. RHUS TOX 200 X TDS X 4 weeks.

CONCLUSION: The scope of this repertory lies in the availability of physical symptoms. Homoeopathy offers a safe and effective approach when the correct remedy is selected. Robert’s repertory can be of great help when the appropriate rubrics are selected based on the symptoms expressed by the patient.

REFERENCES:

1. Harrison’s principles of internal medicine 11^th
2. Medicine prep manual for undergraduates 6^th
3. The rheumatic remedies by h. A. Roberts.

Dr. Komal Patel (MD PART 1)
Dept. of Repertory, D.K.M.M.H.M.C. Chh. Sambhajinagar (Aurangabad)
Email:  komalpatel.kp991@gmail.com