A 40 year old male came to my clinic with the complaint of joint
pains since a few months. He said that there was terrible stiffness
every morning on waking, on moving about a bit the intensity of
the stiffness reduced. Especially the back and knees were affected
and visible swelling was observed. At first thought one would
think of Rheumatoid arthritis taking the symptoms and age into
consideration but all the tests for rheumatoid factor were negative
only his ESR was elevated which would be if there was any inflammation
in the joints. On digging further into all his past illnesses
it became very evident that he had suffered from PSORIASIS which
had cleared up. Unfortunately for him the Psoriasis which had
been superficial and limited to the skin was now affecting the
deeper tissues and causing what is known as PSORIATIC ARTHRITIS.
WHAT IS PSORIATIC ARTHRITIS ?
This is a type of chronic disease characterized by inflammation
of the skin and the joints. There may or may not be any visible
skin affection but when present it is usually seen as patchy, raised,
red areas of skin inflammation with scaling. The statistics show
that nearly 10 % of psoriasis patients develop an associated inflammation
of their joints.
This disorder is more evident in the fourth and fifth decade of
life and both males and females are affected equally. The skin and
joint complaints often appear separately. In fact the skin disease
precedes the joint affections in nearly 80 % of the cases. But there
are a few rare cases where there is no history of skin disorder
and this makes the diagnosis difficult.
Psoriatic arthritis is a systemic rheumatic disease that can also
cause inflammation in the eyes, heart, lungs, and kidneys. This
occurs when the skin disease is suppressed by strong chemical medication
and medicated strong ointments which clear up the skin but drive
the disease deeper into the other vital connective tissues. Therefore
its best not to suppress the skin eruptions.
WHAT CAUSES PSORIATIC ARTHRITIS?
The cause is still unknown though there are a few theories about
how it might be caused. Currently most researchers feel that it
involves a combination of genetic and immune, as well as environmental
factors. A genetic marker HLA-B27 is frequently found in the blood
of patients suffering from psoriatic arthritis. There are also some
changes observed in the immune cells.
WHAT ARE THE SYMPTOMS OF THIS PSORIATIC ARTHRITIS?
The symptoms are as follows:
1. The joints most frequently involved are the knees, ankles,
and joints in the feet.
2. The joints are very painful, swollen, hot, and red.
3. The fingers or toes can swell up considerably when inflamed and
appear like a "sausage".
4. Joint stiffness is very common and is usually worse in the morning
5. Some patients also develop inflammation of the tendons (tendinitis)
and the cartilage.
6. There can also be inflammation of other organs in severe cases
especially of the eyes, lungs and aorta.
7. Acne and changes in the nails are commonly seen in this disorder.
There is usually pitting and ridges seen in the finger and toe nails.
Acne is frequently observed in patients with psoriatic arthritis.
WHAT IS THE TREATMENT OF PSORIATIC ARTHRITIS?
There are a number of different types of treatments availible
for this disorder but none of them help to cure or control the disease
effectively. These are just temporary measures to relieve the symptoms.
Homoeopathy is the only system of medicine that has the capacity
to control the disease and nearly cure it. This is due to the fact
that in Homoepathy we treat not only the disorder but the patient
as a whole taking into consideration his entire personality and
symptoms which are peculiar in his case. The constitutional remedy
boosts the patient's own immunity to fight against the on going
inflammation and disease process.
Along with the Homoeopathic treatment it is very
essential to exercise in the correct manner. Exercise programs should
be given by a physical therapist who customizes the program according
to the disease and physical capabilities of each patient. Warm-up
stretching and other techniques like hot shower or heat applications
are helpful to relax muscles prior to exercise. ICE application
after the routine is extremely important to reduce the post-exercise
soreness and inflammation
The constitutional remedy is the most effective one which retards
the disease process and tries to revert the system to its original
form but along with this one needs to give other co-lateral Homoeopathic
medicines to provide symptomatic relief for the pain, swelling and
movements. There are a number of remedies in Homoeopathy which will
help and I have listed a few important ones.
The 40-year old male patient whose case I cited earlier was given
this remedy since all his symptoms matched perfectly with those
of the drug.
The early morning stiffness which got better with movement is the
key symptom. Here the patients all ways says that the initial first
few movements are very painful then it becomes slightly better.
The patient describes the pain as "tearing" especially of the tendons
and ligaments. Another common description is as if the part is "stiff
and paralysed" and there is a constant desire to move the limb.
A Rhustox patient gets relief from taking a hot bath or applying
heat to the joints. Cold and dampness are the two things that makes
their pains worse therefore winter and the monsoon season are the
usually when the symptoms are worse. Rhustox also has the typical
Psoriasis skin symptoms and the most peculiar symptom is " itching
better by Hot water".
Rhustox 200, 5 pills four times a day will give great relief.
There is stiffness and swelling just like in Rhustox but the difference
between the two is that a Bryonia patient is much worse on movement
rather than getting relieved. In fact these patients prefer to lie
in bed and on the affected side whenever they are in pain. They
cannot bear to be touched and will allow you to examine the joint
Here the patient describes the pain as if "sprained"
with a lot of weakness and heaviness. Bryonia patients feel better
when they bandage the affected part and apply pressure but movement
is unbearable. Normally they can't take the heat and want everything
cold including large quantities of cold water but the psoriatic
pains are relieved by warmth.
Bryonia 200, 5 pills four times a day will make movement less
painful for the patient and reduce the inflammation of the joint.
Aurum or rather gold is an element also used by the other systems
of medicine to modify the disease. It prevents the progressive joint
destruction and deformity but injectable gold or oral gold preparation
given has tremendous side-effects including bone marrow suppression
which leads to anaemia , low white blood cells and adverse effects
on the kidney which is extremely dangerous.
In Homoeopathy we potentise this gold to such neglible amounts
so as to avoid the harmful side-effects but retain the curative
power of the drug. Therefore it is used when there is already considerable
joint destruction. The patient says his pain is deep as if the bones
are sore and aching. There is a lot of tightness around the affected
joint, sensation as if bandaged. All the pains are worse at night
time and better in the morning.
Aurum Met 200, 5 pills four times a day will prevent further destruction
and cease the disease process.
This is one of the most important drugs in Homoeopathy for pain
and joint affections. Whenever there is a history of injury to the
part no matter how trivial or how long back it occurred this remedy
should be thought of. The injury could have been the trigger factor
for Psoriatic Arthritis to develop.
The patient says he feels as is the part is bruised or beaten
and has great fear of being touched due to the sensitivity of the
part. He says that everything is too hard and is restless to find
some comfortable place to rest. Like Rhustox, Arnica is better by
motion but the difference is that in this drug Cold gives relief.
Arnica 200, 5 pills four times a day will make the pain disappear