by Forest Raga February 4, 2021
The present study was carried out to investigate the efficacy and safety of the effectiveness of Guduchi in Amavata(Rheumatoid arthritis) in comparison with Indomethacin
Objective: To evaluate the effect of trial drug Guduchi in Amavata and compare the trial drug with the control group (Indomethacin).
and Sidh Makardhwaj) in patients with rheumatoid arthritis.
Treatment Offered
Selection of patients
A total of 90 patients of Amavata were randomly selected for the present study, from the Dravyaguna OPD of Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi. The case selection was done randomly of age (between 20-60 years), sex, occupation, and socioeconomic status. Both acute and chronic phase Amavata patients were selected for the study after fulfilling the diagnostic criteria (of Rheumatoid Arthritis in Modern Medicine(Table 2) and the clinical features of Amavata described in Madhava Nidana)(Table 1), inclusion criteria, and exclusion criteria.
Table 1
| S .NO | Symptoms |
|---|---|
| 1 | Alasya (lethargy) |
| 2 | Angamarda(body pains) |
| 3 | Apaka (indigestion) |
| 4 | Aruchi (anorexia) |
| 5 | Bahu mutratam (polyuria) |
| 6 | Gaurava (Heaviness) |
| 7 | Hridgraha (chest catch) |
| 8 | Kostha baddhata (constipation) |
| 9 | Nidra viparyaya (sleep disturbances) |
| 10 | Sandhi graham (morning stiffness) |
| 11 | Sparsha asahishnuta (tenderness) |
| 12 | Anga Shunata (Swelling of body) |
| 13 | Trishna (thirst) |
| 14 | Vrschcikadamshavat vedana (stinging pain) |
Inclusion criteria
1. Adult subjects (both male and female) between 20 to 60 years presenting mild, moderate, and severe degree presentation of Amavata.
2. Subjects pertaining to classical symptoms of Amavata.
3. Amavata of any dosha anubandha.
4. Patients having highly elevated Rheumatoid factor and C - reactive protein level.
5. Both seropositive and seronegative patients were included in this study.
Exclusion Criteria
1. Patients below age 20 and above age 60 years.
2. Patients associated with severe joint deformities.
3. Patients associated with severe Ankylosed joints, Septic arthritis, Osteoarthritis, and Gouty arthritis.
4. Rheumatoid arthritis associated with other systemic or metabolic disorders like Diabetes mellitus, Hypertension, Pulmonary tuberculosis, etc.
5. Pregnant and lactating women.
Observations
The data collected and compiled from this clinical trial were sorted out and processed further by subjection to varied statistical methods
Statistical observation confirms an incidence of disease and it is found notably higher in females than in males. The maximum number of patients registered in the present study belongs to the age group between 40- 60 years i.e. 74.1% followed by rare occurrence (7.4%) in 20-29 years of age group.
A greater number of patients were housewives (40.7%) followed by service (23.5%), business (19.8%), unemployed (8.6%), and agriculture (7.4%). Though this pattern of occupational incidence cannot be realistically generalized but notably high incidence of housewives contributes to the fact that ""Nishcalatva"" a sedentary mode of lifestyle as one of the factors leading to Amavata. Apart from this nature of household work, vega Dharana and irregular food habits may trigger the disease formation in females.
Results
Effect of therapy on subjective parameters
In group 1, highly significant results (p<001) in subjective parameters like Pain (66.7%), Angamarda(66.7%), Aruchi(93%), Alasya (81.5%), Gauravata(92.6%), Jvara(100%), Apaka(92.6%), Shunata anganam(88.9%).
In group 2, highly significant results (p<001) in subjective parameters like Pain (96.3%), Angamarda(66.7%), Aruchi(81.5%), Alasya(55.6%), Gauravata(88.9%), Jvara(92.6%), Apaka(51.9%), Shunata anganam (88.9%).
In group 3, highly significant results (p<001) in subjective parameters like Pain (88.9%), Angamarda (88.9%), Aruchi(85.2%), Alasya (81.5%), Gauravata(51.9%), Jvara(96.3%), Apaka(92.6%), Shunata anganam (85.2%).
Intergroup comparison between group 1, 2 and 3
The intergroup comparison of pain grade was highly statistically significant at the 1st 2nd and 3rd follow-up. The absence of pain was higher in group 2 as compared to groups 1 &3 at each follow-up.
The intergroup comparison of Angamarda was statistically significant at 2nd to follow up. The absence of Angamarda was higher in group 3 as compared to groups 1 & 2 at each follow-up.
The intergroup comparison of Aruchi was not statistically significant at 1st 2nd and 3rd follow up. The absence of symptoms was higher in group 1 as compared to group 2 &3 at each follow-up.
The intergroup comparison of Alasya was statistically significant at 1st and 3rd follow up. The absence of symptoms was higher in group 3 as compared to groups 1&2 at each follow-up.
The intergroup comparison of Gauravata was statistically significant at 3rd to follow up. The absence of symptoms was higher in group 1 as compared to group 2&3 at each follow-up.
The intergroup comparison of Jvara was not statistically significant. The absence of symptoms was higher in group 1 as compared to group 2&3 at each follow-up.
The intergroup comparison of Apaka was statistically significant at 3rd to follow up. The absence of symptoms was higher in groups 1 and 3 as compared to group 2 at each follow-up.
Conclusion
Amavata is chronic in nature and described as krichrasadhya vyadhi. The condition of an exaggerated state of disease is said as pravruddha Amavata. Vitiation of Ama and Vata are essential entities in causing Amavata. The exact etiology of the disease remains unknown, but the pathognomic cause like Ama is believed to act as an autoantigen, which triggers the immunological reaction in genetically susceptible individuals.
Guduchi and Shunthi kvatha are almost equally effective as the Standard group of Indomethacin in the majority of the symptoms. Overall effectiveness in signs and symptoms were seen in the volunteers taking both trial and standard drug which concluded the synergistic effect of both drugs help in the resolution of Amavata better. If the disease is genetic and autoimmune in origin, complete remission is not possible. But Ayurvedic management can help to decrease the symptoms of Amavata. The specific Ayurvedic line of management and drugs helps in modifying the immune response to autoantigens. At the same time, the drugs are safe and can be given for a longer duration without any adverse effects. As a whole, Guduchi showed encouraging results but this has to be taken for a longer duration.
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