Ayurveda Treatment Outcomes for Osteoarthritis
Ayurveda is the oldest system of medicine in the world and by far the most commonly practiced form of non-allopathic medicine in India, particularly in rural India, where 70% of the population lives. Ayurveda is also playing an increasing role in European and North America, since its broad introduction in Western countries in the 1980s. At present, it is one of the fastest-growing CAM therapies worldwide. Osteoarthritis (OA) is a very commonest type of arthritis generally found in older age group. Osteoarthritis is known as Sandhi vata in Ayurveda. It is a joint disorder caused by the erosion/ breaking of cartilage that cushion bones at joints and causing pain, swelling and stiffness as bones rub together. The joints most commonly affected are the knees, hips, hands and spine. OA is the leading cause of disability in elderly persons and affects approximately 14-20% of all adults aged ≥25 years. The prevalence rate of OA is 38% in people over 45 years old and 70% in people over 65 years old thus, its prevalence and health impact increase with age. To address the prevalence, cost, and disability associated with OA, multiple organizations have been trying to understand pathogenesis of OA to reduce its incidence and to discover a disease-modifying OA drug that could slow or halt its progression. The number Osteoarthritis patients in Ayurveda hospital and clinic of India have been increasing in recent years. General People says that Ayurveda medicine and Panchakarma (detoxification technique) has promising relief effect in osteoarthritis. Researchers claimed that Ayurveda treatment outcome is better than or equal to conventional drug for improvement of pain and knee function. Ayurveda has an elaborate disease classification system of rheumatic disorders as like modern medicine. Herbal and mineral formulations possessing such a combination that has preventive and therapeutic effects are described as Rasayana (immunomodulatory and facilitating regeneration) in Ayurveda. Rasayana therapies have been widely used by Ayurvedic physicians since ancient times to promote health and treat immune inflammatory and degenerative disorders. Ayurvedic medicinal plants have demonstrated remarkable biological effects, especially those of anti-inflammatory and immune-modulatory activities that are relevant and potentially useful to treatment of chronic musculoskeletal disorders. Several controlled drug trials were conducted to demonstrate efficacy and safety of standardized Ayurvedic drugs containing several plants mentioned in Ayurveda classics, for treatment of osteoarthritis (OA). The primary outcome of Ayurvedic medicinal plants have analgesic, anti-inflammatory, chondroprotection, soft tissue healing, antiosteoporosis, immune-modulation, anti-lipogenesis, anabolic effect, and anti-oxidative stress. The secondary outcome of Ayurvedic antiarthritis drugs and regimen are to improve digestion and metabolism, normalize the gut function and clear bowel movement. The goal of OA treatment for medical profession is not only control symptoms but also prevent disease progression, minimize disability, and improve quality of life. Management of OA includes varied techniques and principles, both non pharmacologic and pharmacologic in nature. Prevention of OA is the best treatment option. Preventive measures are Limiting modifiable risk factors such as obesity, smoking, joint damage, and lack of adequate exercise that can have a significant effect on decreasing the risk of OA development. Non pharmacologic approaches include patient education, weight loss, exercise, physical and occupational therapy, assistive devices, acupuncture, ultrasound, and surgery. Obesity remains the most important and modifiable risk factor for the development of OA .Pharmacologic management OA cases by Anti-inflammatory drugs, often called as Non-Steroidal AntiInflammatory Drugs (NSAIDs) are helpful because they relieve pain and stiffness. These NSAIDs have no long term benefit to the patient rather well known adverse side effects. Further it may be dangerous in the elderly and in the presence of renal insufficiency and gastrointestinal disorders. Intra articular glucocorticoid injections may be preferable and effective in some cases. Surgery should be reserved as a last-resort effort to manage OA symptoms in patients whose disease is refractory to less-invasive management methods. Surgical interventions include total joint arthroplasty and joint lavage and debridement. There is no evidence demonstrating that lavage or debridement is more effective in relieving pain or improving function than nonsurgical treatment. Total joint replacement appears to be a successful therapy when joint pain severely limits a patient’s ability to function. The efficacy of glucosamine and chondroitin remains controversial. Glucosamine, which is naturally produced in the body, is an amino monosaccharide that acts as a substrate for glycosaminoglycan, proteoglycans, and hyaluronic acid to form articular cartilage. Chondroitin also serves as a building block for joint cartilage. The large-scale Glucosamine/ Chondroitin Arthritis Intervention Trial (GAIT; N=1,583) failed to demonstrate a significant reduction in overall pain after 24 weeks in patients treated with glucosamine only, chondroitin only, or the combination of glucosamine plus chondroitin; however, a subgroup of patients with moderate-to-severe pain did experience significant pain reduction with the combination of glucosamine and chondroitin. Topical agents such as capsaicin and topical NSAIDs may offer an alternative in patients unable to tolerate systemic agents and may also be used as additive therapy. Though effective, opioids should be reserved for resistant cases and should be considered for short-term use only. The efficacy of intra-articular glucocorticoids, tramadol, and glucosamine with or without chondroitin is questionable; these agents may be tried when other options fail.