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|title=Amavata (Rheumatoid arthritis)
|title=Amavata (Rheumatoid arthritis)
|titlemode=append
|titlemode=append
|keywords=Amavata, Rheumatoid arthritis, Charak samhita, carakasamhitaonline, Indian System of Medicine.
|keywords=Amavata, Rheumatoid arthritis, Charak samhita, carakasamhitaonline, Indian System of Medicine, Ayurveda
|description=The conditon in which ama alomg with vitiated vata effects the joints
|description=The conditon in which ama alomg with vitiated vata effects the joints
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
The clinical condition in which aggravated [[vata]] is associated with metabolic toxins (ama) and mainly affects joints is termed as ‘amavata’. This condition closely resembles with rheumatoid arthritis. The main culprit behind this disease is the deranged digestion and metabolism (agni). Arthralgia, stiffness and swellings of joint are main clinical features. The treatment is focused to improve digestion and metabolism and maintain equilibrium of [[vata dosha]]. Detail description of amavata as a separate disease entity is observed in the text of Madhava Nidana.
The clinical condition in which aggravated [[vata]] is associated with metabolic toxins (ama) and mainly affects joints is termed as ‘amavata’. This condition closely resembles with rheumatoid arthritis. The main culprit behind this disease is the deranged digestion and metabolism (agni). Arthralgia, stiffness and swellings of joint are main clinical features. The treatment is focused to improve digestion and metabolism and maintain equilibrium of [[vata dosha]]. Detail description of amavata as a separate disease entity is observed in the text of Madhava Nidana.
A comparative study of the pathophysiology of this disease by [[Ayurveda]] and allopathic system reveals that modern medicine emphasizes on control of inflammation with use of NSAIDS, immunosuppressives and TNF blockers.This is an “offence strategy” which has rapid response but needs to be continued indefinitely and has high incidence of toxicity.On the other hand [[Ayurveda]] follows primarily a “defense strategy” which takes longer time to control inflammation and the symptoms but incidence of toxicity is very little, if at all. In patients with acute inflammation and severe discomfort, initial treatment should be with immunosuppressives and TNF blockers. On control of acute symptoms ayurvedic treatment should be continued.This combined (Symbiohealth) approach in the management of disease can give insight into the genetic and epigenetic phenomenon and opens the doors for groundbreaking research.<ref>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. AYU [serial online] 2012 [cited 2021 Jul 24];33:466-74. Available from: https://www.ayujournal.org/text.asp?2012/33/4/466/110513</ref> This article describes the etiopathogenesis and management of amavata.
A comparative study of the pathophysiology of this disease by [[Ayurveda]] and allopathic system reveals that modern medicine emphasizes on control of inflammation with use of NSAIDS, immunosuppressants and TNF blockers. This is an “offence strategy” which has rapid response but needs to be continued indefinitely and has high incidence of toxicity. On the other hand [[Ayurveda]] follows primarily a “defense strategy” which takes longer time to control inflammation and the symptoms but incidence of toxicity is very little, if at all. In patients with acute inflammation and severe discomfort, initial treatment should be with immunosuppressants and TNF blockers. On control of acute symptoms ayurvedic treatment should be continued. This combined ([[Symbiohealth]]) approach in the management of disease can give insight into the genetic and epigenetic phenomenon and opens the doors for groundbreaking research.<ref>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. AYU [serial online] 2012 [cited 2021 Jul 24];33:466-74. Available from: https://www.ayujournal.org/text.asp?2012/33/4/466/110513</ref> This article describes the etiopathogenesis and management of amavata.
'''National Ayurveda Morbidity Code''': EC-6
'''National Ayurveda Morbidity Code''': EC-6
'''ICD code''': M06.9
'''ICD code''': M06.9
'''Keywords''': Amavata, rheumatoid arthritis, ama, [[basti]], niruha, rukshasweda
'''Keywords''': Amavata, rheumatoid arthritis, ama, [[basti]], niruha, ruksha sweda
==Causes of the disease==
{{Infobox
|title = Contributors
|label1 = Section/Chapter/topic
|data1 = [[Chikitsa]] / [[Vyadhi]] / [[Amavata]]
|label2 = Authors
|data2 = Aneesh E.G., Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.
|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.T. R.A., Jamnagar
|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com
|label6 = Date of first publication:
|data6 = August 18, 2021
|label7 = DOI
|data7 = In process
}}
==Causes ([[hetu]]) ==
*Dietary: Intake of incompatible combinations of foods. [M.Ni 25/01]<ref name=MNi> Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>, irregular dietary habits.
*Dietary: Intake of incompatible combinations of foods. [M.Ni 25/01]<ref name=MNi> Madhavakara. Madhava Nidanam (Roga vinischaya). Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007</ref>, irregular dietary habits.
*Lifestyle: Indulging in strenuousactivities immediately after intake of unctuous/heavy to digest foods. [M.Ni 25/01]<ref name=MNi/>
*Lifestyle: Indulging in strenuousactivities immediately after intake of unctuous/heavy to digest foods. [M.Ni 25/01]<ref name=MNi/>
*Psychological: Negative mental states while taking meals. [Cha.Sa. [[Vimana Sthana]] ] Stress is a triggering factor for rheumatoid arthritis.<ref name=Moov>Mooventhan A, Shetty GB. Effect of integrative naturopathy and yoga in a patient with rheumatoid arthritis associated with type 2 diabetes and hypertension. Ancient Sci Life 2017;36:163-6.</ref>
*Psychological: Negative mental states while taking meals. [Cha.Sa. [[Vimana Sthana]] 2/9 ] Stress is a triggering factor for rheumatoid arthritis.<ref name=Moov>Mooventhan A, Shetty GB. Effect of integrative naturopathy and yoga in a patient with rheumatoid arthritis associated with type 2 diabetes and hypertension. Ancient Sci Life 2017;36:163-6.</ref>
*Others: Improper management in pregnancy and post partum period causing aggravation of [[vata]] can lead to amavata.<ref name=Desh>Deshpande SV, Deshpande VS, Potdar SS. Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study. J Ayurveda Integr Med. 2017 Jan-Mar;8(1):42-44. doi: 10.1016/j.jaim.2016.10.003. Epub 2017 Mar 14. PMID: 28302414; PMCID: PMC5377475. </ref>
*Others: Improper management in pregnancy and post partum period causing aggravation of [[vata]] can lead to amavata.<ref name=Desh>Deshpande SV, Deshpande VS, Potdar SS. Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study. J Ayurveda Integr Med. 2017 Jan-Mar;8(1):42-44. doi: 10.1016/j.jaim.2016.10.003. Epub 2017 Mar 14. PMID: 28302414; PMCID: PMC5377475. </ref>
Body ache, anorexia, morbid thirst, laziness, heaviness, feverishness, indigestion and edema in body parts are the general features of amavata in its initial phase. [M.Ni 25/6]<ref name=MNi/> When the disease aggravates, it causes severe pain associated with swelling especially in joints of upper and lower limbs and in sacral region. Generalized symptoms like loss of appetite, pain or heaviness in abdomen, excessive micturition, burning sensation, sleep disturbances, constipation, abdominal distention, vomiting, giddiness are also seen. [M.Ni.25/7-10]<ref name=MNi/>
Body ache, anorexia, morbid thirst, laziness, heaviness, feverishness, indigestion and edema in body parts are the general features of amavata in its initial phase. [M.Ni 25/6]<ref name=MNi/> When the disease aggravates, it causes severe pain associated with swelling especially in joints of upper and lower limbs and in sacral region. Generalized symptoms like loss of appetite, pain or heaviness in abdomen, excessive micturition, burning sensation, sleep disturbances, constipation, abdominal distention, vomiting, giddiness are also seen. [M.Ni.25/7-10]<ref name=MNi/>
===Dosha specific clinical features===
=== [[Dosha]] specific clinical features===
{| class="wikitable"
{| class="wikitable"
|+ Table 1: Dosha specific clinical features
|+ Table 1: [[Dosha]] specific clinical features
|-
|-
! Dosha !! Specific clinical features
! [[Dosha]] !! Specific clinical features
|-
|-
| | Vata || Pain
| | Vata || Pain
==Pathogenesis==
==Pathogenesis==
Continuous use of incompatible foods and indulging in strenuous activities immediately after unctuous meal leads to indigestion. The channels of transportation and transformation of body fluid (rasavahasrotasa) and marrow (majjavahasrotas) are affected by incompatible foods. This leads to the formation of ama (metabolic toxins). These toxins are circulated all over the body by vyana vata.
Continuous use of incompatible foods and indulging in strenuous activities immediately after unctuous meal leads to indigestion. The channels of transportation and transformation of body fluid (rasavaha srotasa) and marrow (majjavaha srotas) are affected by incompatible foods. This leads to the formation of ama (metabolic toxins). These toxins are circulated all over the body by vyana vata.
Physical exercise after taking food is crucial cause of amavata. This is responsible for the movement of [[dosha]] from gastrointestinal tract (koshta) to peripheral tissues (shakha). The circulating toxins accumulate in the joints and affect the associated structures at the joint. This causes clinical features of amavata.<ref name=Mahto>Mahto RR, Dave AR, Shukla VD. A comparative study of RasonaRasnadiGhanavati and SimhanadaGuggulu on Amavata with special reference to Rheumatoid arthritis. Ayu. 2011 Jan;32(1):46-54. doi: 10.4103/0974-8520.85724. PMID: 22131757; PMCID: PMC3215416.</ref>
Physical exercise after taking food is crucial cause of amavata. This is responsible for the movement of [[dosha]] from gastrointestinal tract (koshta) to peripheral tissues (shakha). The circulating toxins accumulate in the joints and affect the associated structures at the joint. This causes clinical features of amavata.<ref name=Mahto>Mahto RR, Dave AR, Shukla VD. A comparative study of Rasona Rasnadi Ghana vati and SimhanadaGuggulu on Amavata with special reference to Rheumatoid arthritis. Ayu. 2011 Jan;32(1):46-54. doi: 10.4103/0974-8520.85724. PMID: 22131757; PMCID: PMC3215416.</ref>
In amavata, the intestinal mucosal permeability and peristalsis is impaired. Alteration of bacterial flora of the gut occurs. These factors may result in malabsorption. This causes indigestion and further vitiation of [[dosha]].<ref name=Basisht>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. Ayu. 2012 Oct;33(4):466-74. doi: 10.4103/0974-8520.110513. PMID: 23723661; PMCID: PMC3665188.</ref>
In amavata, the intestinal mucosal permeability and peristalsis is impaired. Alteration of bacterial flora of the gut occurs. These factors may result in malabsorption. This causes indigestion and further vitiation of [[dosha]].<ref name=Basisht>Basisht GK, Singh RH, Chandola H. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system. Ayu. 2012 Oct;33(4):466-74. doi: 10.4103/0974-8520.110513. PMID: 23723661; PMCID: PMC3665188.</ref>