Dr . Manjeet Kaur

Osteoarthritis (OA), the most common form of arthritis seen in older adults, is a leading cause of disability and significantly affects the quality of life. In Ayurveda, it is referred to as Sandhi Vata or Sandhigat Vata, commonly known as Sandhivata, which can be correlated with osteoarthritis. OA occurs when the cartilage that cushions joints deteriorate, leading to pain, swelling, and stiffness as bones rub together. The most affected joints include the knees, hips, hands, and spine. Knee osteoarthritis is particularly prevalent and characterized by the gradual breakdown of cartilage in the joints, formation of new bone at the joint margins, and is strongly associated with aging, often resulting in chronic disability.

Increasing Prevalence of Osteoarthritis in India

Recently, the number of osteoarthritis patients seeking treatment in Ayurvedic hospitals and clinics in India has been rising. Many people believe that Ayurvedic medicine and Panchakarma (a detoxification technique) provide promising relief from osteoarthritis. Researchers have found that the outcomes of Ayurvedic treatments can be as effective, if not better, than conventional drugs in alleviating pain and improving knee function.

Ayurvedic Approach to Rheumatic Disorders

Ayurveda classifies rheumatic disorders in a detailed manner, similar to modern medicine. Herbal and mineral formulations in Ayurveda, known as Rasayana therapies, offer both preventive and therapeutic effects. These therapies have been used since ancient times to boost immunity and treat inflammatory and degenerative conditions.

Epidemiology of Osteoarthritis

OA is a widespread musculoskeletal disorder, affecting over 303 million people globally in 2017. In India, it is the most frequent joint disease, with a prevalence of 22% to 39%. OA usually begins without symptoms in the 30s or 40s and is highly prevalent by age 60. Women, especially post-menopausal, show a higher prevalence.

Types of Osteoarthritis

Primary Osteoarthritis: Often seen in older adults, influenced by genetics, metabolism, and aging.

Secondary Osteoarthritis: Caused by local factors like trauma, malalignment, inadequate blood supply, or infections

Causes of Sandhigata Vata in Ayurveda

Ayurveda identifies several factors contributing to Sandhigata Vata, including:

• Ruksha Aahara (dry food)
• Atimaithuna (excessive sexual activity)
• Ativyayama (excessive physical activity or exercise)
• Sheeta Bhojana (cold food or drinks)
• Dhatukshaya (loss of body tissues)
• Roga Atikarshana (depletion caused by chronic illnesses
  
  Ayurveda identifies various causes of Sandhivata (Osteoarthritis), including dietary habits, lifestyle factors, and chronic illnesses that deplete vital tissues and disrupt bodily functions. Factors like consuming dry, bitter foods, excessive physical activity, psychological stress, and other chronic conditions can aggravate Vata, leading to joint-related disorders.

Ancient Ayurvedic texts describe it with symptoms like:

• Shula (joint pain)
• Shotha (swelling)
• Prasaarana-Aakunchanayo Pravruttischa Vedana (painful joint movement)
• Vatapurnadritisparsa (coarse crepitation or crackling sound in joints)
  Common symptoms include joint pain, stiffness, and limited movement, often aggravated by physical activity. OA can affect one or multiple joints, leading to significant discomfort and functional limitations.

Pathogenesis of OA

OA can result from primary wear and tear or secondary factors like previous injuries or genetic mutations. The deterioration of cartilage and changes in the bones and synovium contribute to the progression of the disease.

Grading of Osteoarthritis

OA severity is graded from normal (Grade 0) to severe (Grade 4), characterized by pain, joint space narrowing, and deformities.

Commonly Affected Joints and Risk Factors

OA often targets specific joints, including the fingers, thumb base, neck, lower back, knees, and hips. Risk factors include trauma, congenital malformations, chronic inflammation, obesity, and menopause, especially in women. OA of the spine can cause spinal stenosis, leading to pain in the limbs.

Ayurvedic Treatment Options for Sandhigata Vata

Ayurveda offers several treatments focused on balancing the Vata dosha and providing relief from symptoms .

In Sandhigata Vata, especially when the Asthi Dhatu (bone tissue) is weakened, the line of treatment focuses on nourishing and supporting bone health.

Acharya Charaka mentions two types of pathogenesis for Sandhivata:

1. Vataprakopa (Aggravation of Vata): Due to Dhatu Kshaya (tissue loss) or Svanidaanjanya (depletion).
2. Srotorodha (Blockage of body channels): Leads to metabolic disruption.

Treatment Approach

1. Nidana Parivarjanam (Avoidance of Causative Factors):
   • The first step is to eliminate the causative factors.
   • Maintaining a healthy lifestyle and diet is crucial for successful treatment.(Factors like consuming dry, bitter foods, excessive physical activity, psychological stress, and other chronic conditions can aggravate Vata,)
2. Samshaman Chikitsa (Conservative Management):
   • Used when symptoms are mild and the patient’s strength is low.Treatments include drugs with anti-inflammatory, analgesic, and rejuvenative properties.
   • Guggul:Triphala guggul, Amruta guggul,kaishore guggul,Raasna guggul, yogaraj guggul,mahayograj guggul,Rasnadi guggul.
   • kwath:Maharaasnaadi kada,Sahacharaadi kada .
   • Churna:Ajamodadi churna,Rasna churna.
3. Samshodhan Chikitsa (Elimination Therapy):
   • Recommended for severe cases with strong symptoms.
   • Uses Panchakarma procedures to eliminate toxins and balance the doshas.
   Treatment Plan for Different Stages:
   • Mild: Use Ashwagandha Churna with Muktasukti Bhasma and Godanti Bhasma.
   • Moderate: Add Shallaki tablets and Guggulu preparations.
   • Severe: Use a combination of Vrihat Vatachintamani Ras and herbal powders.
4. Rasayan therapy:Ashwaganda Arista , Shatavari kalp and some gold formulations are used .

Additional Therapies

• Snehana (Oleation and Massage):Internal Oleation: Taking oils internally helps. You can use Narayana oil, sesame oil, cow ghee, or Bala taila with warm water. Improves blood circulation, reduces pain, and lubricates joints.
• Swedana (Sudation or Sweating Therapy): Induces sweating to reduce stiffness and improve movement.
• Upanaha Sweda (Poultice Therapy): Reduces pain and swelling in joints.
• Mriduvirechana (Mild Purgation): Cleanses the body and restores balance in the doshas(saamvayu).Erand taila or Gandarwa Haritki is used.
• Basti (Enema): Nourishes the body, strengthens joints, and alleviates Vata disorders.
• Janubasti (Knee Therapy): Uses medicated oils (Narayan taila /mahanarayan taila)to relieve knee pain and swelling.
• Agnikarma (Cauterization): Uses heat to relieve pain and stiffness in joints.
• Lepa (topical application of herbal pastes)
  

1. Internal Oleation: Taking oils internally helps. You can use Narayana oil, sesame oil, cow ghee, or Bala taila with warm water.

2. External Oleation: Massaging the affected area with Vishgarbha taila is beneficial.

3. Sudation (Sweating Therapy): Sudation helps relieve pain and stiffness. The types used include tapa sweda (dry heat) and bhaspa sweda (steam therapy) with Nirgundi kwath.

4. Lepa (Herbal Paste): Applying green lepa or lep goli to the joints helps reduce swelling and pain.

5. Raktamokshana (Bloodletting): Bloodletting or leech therapy gives immediate relief by removing toxins from the affected area.

6. Agni karma (Cautery): Cautery is performed on the most painful joints to reduce pain.

7. Anuloman (Mild Laxatives): To balance Vata, you can take mild laxatives like castor oil (Eranda taila) or Gandharva Haritaki to promote downward movement of Vata.

Importance of Oil Therapies

Treating Sandhigata Vata mainly involves alleviating the aggravated Vata dosha. Using oils (snehana) with heat (swedana) over the affected area can significantly reduce pain, stiffness, and improve joint flexibility.

Janu Basti: A Specialized Ayurvedic Therapy

Janu Basti is a specialized Ayurvedic procedure designed specifically for knee osteoarthritis (Janu Sandhigata Vata). Although classical Ayurvedic texts do not directly describe Janu Basti, it is widely used as supportive therapy. It involves applying warm medicated oils on the knee joints, providing lubrication and warmth to alleviate pain and improve joint function.

Mahanarayana Taila, a well-known Ayurvedic oil, is often used in Janu Basti to treat various Vata-related disorders effectively.

Types of Joint Disorders: Aamvata, Vatarakta, Sandhivata, and Kroshtukashirsha

Common Features of Joint Disorders

1. Aamvata (Rheumatoid Arthritis):
   • Affects smaller joints first, often starting with the great toe.
   • Pain and swelling are common.
   • Mild fever may be present.
   • It’s a Vata-Kapha dominant disorder, affecting the Rasa Dhatu (body fluid).
2. Vatarakta (Gout):
   • Usually affects smaller joints, beginning with the great toe.
   • Pain and swelling are noticeable, and fever can occur.
   • It’s a Tridoshaja Vyadhi (disorder involving all three doshas), primarily affecting Rakta Dhatu (blood).
   • Patients find relief through Raktamokshana (bloodletting).
3. Sandhivata (Osteoarthritis):
   • Typically affects weight-bearing joints, especially the knees.
   • Pain is present but may vary, and fever is usually absent.
   • It’s a Vata-dominant disorder involving the Rasa Dhatu, and Raktamokshana is not useful.
4. Kroshtukashirsha (Psoriatic Arthritis):
   • Mainly affects the knee joints with pain and swelling.
   • The knee joint shows a typical “jackal’s head” shape.
   • It is a Tridoshaja Vyadhi but mainly dominated by Vata dosha.
   • Raktamokshana does not provide any relief.

Complications of Joint Disorders

Possible complications include:

• Osteonecrosis
• Chondrolysis
• Carpal Tunnel Syndrome
• Joint dislocation
• Stress fractures
• Bleeding in the joint
• Loss of stability

Diet and Lifestyle Guidelines

• Pathya (Favorable Diet): Include wheat,kulatha,patola leaves,shigru(moringa),garlic,ginger meat, milk, clarified butter (cow ghee), and warm water.eat warm meals.Eat sweet,sour tasting items like khajur,jaggery etc.
• Apathya (Unfavorable Diet): peas,chickpeas,pigeon pea (arahara), green moong. Avoid curd, dairy, excess salt, fried foods, and fast foods.Avoid fasting as it will increase vata.
• Lifestyle Recommendations: Sun exposure, warm baths, massage,gentle pressing and avoiding stress and late-night activities help manage symptoms.

Sandhivata, or osteoarthritis, is a common disorder affecting mainly older adults and causing significant pain and disability. Ayurveda offers a holistic treatment approach, focusing on balancing doshas, reducing pain and inflammation, and restoring joint function through various therapies and lifestyle adjustments.

Modern Medical Perspective on Osteoarthritis

Explanation of Osteoarthritis from a Modern Medical Viewpoint

• Osteoarthritis (OA) is a degenerative joint disease where the protective cartilage that cushions the ends of bones wears down over time. It is often seen in weight-bearing joints like the knees, hips, and spine but can also affect the hands and other joints. OA is primarily caused by aging, joint injury, and repetitive stress on the joints.

Pathophysiology: Cartilage Degradation and Joint Inflammation

• In OA, the cartilage, which acts as a shock absorber in the joints, gradually breaks down, leading to bone friction, pain, and stiffness. This wear and tear can cause the bones to thicken, and bone spurs (osteophytes) may form, worsening joint pain and reducing mobility. Inflammation may also occur in the surrounding tissues, further contributing to discomfort and limited movement.

Conventional Treatment Options

• Modern medicine offers a variety of treatments to manage OA symptoms and improve joint function. These treatments focus on reducing pain, maintaining joint mobility, and slowing the progression of the disease.

Pain Management: NSAIDs, Corticosteroids, and Analgesics

• NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like ibuprofen and naproxen are commonly used to reduce pain and inflammation.
• Corticosteroids can be injected directly into the affected joint to provide temporary pain relief and reduce inflammation.
• Analgesics, such as acetaminophen, are used to manage pain without addressing inflammation.

Physical Therapy and Exercises

• Physical therapy is a key component of OA management. It involves exercises that strengthen the muscles around the joints, improve flexibility, and reduce pain. Therapists guide patients through specific exercises tailored to their condition, helping to enhance mobility and overall function.

Surgical Interventions: Joint Replacement

• When conservative treatments are no longer effective, surgical options like joint replacement may be considered. In these procedures, the damaged joint surfaces are replaced with artificial components, significantly improving pain and mobility. This is most common in severe cases of knee and hip osteoarthritis.

omparison of Ayurvedic and Modern Treatments

Benefits and Drawbacks of Ayurvedic and Modern Treatments

• Ayurvedic Treatments focus on natural healing, balancing the body’s energies (doshas), and improving overall health. Benefits include fewer side effects, holistic care, and personalized treatments. However, Ayurvedic remedies may take longer to show results, and their effectiveness can vary based on individual constitution and adherence to lifestyle changes.
• Modern Treatments provide quicker symptom relief through medications, injections, and surgeries. These methods are highly effective for pain management and restoring joint function, especially in severe cases. However, they may come with side effects, such as gastrointestinal issues from NSAIDs, risks associated with surgeries, and potential over-reliance on medications.

Combining Both Approaches for Better Results

• Combining Ayurvedic and modern treatments can provide a more comprehensive approach to managing osteoarthritis. Ayurveda can enhance overall wellness and address the root cause of joint imbalance, while modern medicine can offer immediate symptom relief and advanced interventions when necessary.
• For example, using Ayurvedic herbs and therapies alongside physical therapy and medication can improve joint health, reduce inflammation, and support long-term management. This integrated approach allows patients to benefit from the strengths of both systems, leading to improved outcomes and a better quality of life.

Preventive Measures for Osteoarthritis:

Tips from Ayurveda and Modern Medicine: Both Ayurveda and modern medicine suggest ways to prevent osteoarthritis. Ayurveda recommends maintaining a balanced diet, using joint-strengthening herbs, and following daily routines that reduce joint stress. Modern medicine advises regular exercise, healthy eating, and avoiding joint injuries.

Importance of a Healthy Lifestyle: Keeping a healthy weight and staying active are crucial. Excess weight puts extra pressure on joints, especially the knees, which can worsen OA. Gentle exercises like walking, swimming, and yoga help keep joints flexible and muscles strong .

Early Action: Taking steps early, like managing minor joint pain and maintaining a healthy lifestyle, can prevent OA from developing or worsening. cRegular check-ups and addressing symptoms early can make a big difference in long-term joint health.

Embrace a holistic approach by considering both Ayurvedic and modern perspectives for managing osteoarthritis. This combination can help you achieve better joint health and a higher quality of life.Sandhivata, or osteoarthritis, is a common disorder affecting mainly older adults and causing significant pain and disability. Ayurveda offers a holistic treatment approach, focusing on balancing doshas, reducing pain and inflammation, and restoring joint function through various therapies and lifestyle adjustments.