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→Differential diagnosis
==== Differential diagnosis ====
==== Differential diagnosis ====
Vatarakta, aamavata and sandhigata vata are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
''Vatarakta, amavata'' and ''sandhigata vata'' are three most common rheumatological clinical conditions. The clinical presentations need to be differentiated for diagnosis and designing treatment protocol.
Criteria Vatarakta Aamvata Sandhigata vata
Criteria Vatarakta Aamvata Sandhigata vata
Dosha Vata associated with pitta Vata associated with aam mainly kapha Vata associated with vata
Dosha Vata associated with pitta Vata associated with aam mainly kapha Vata associated with vata
Dushya Rakta, Twak, mamsa Rasa Asthi, majja
Dushya Rakta, Twak, mamsa Rasa Asthi, majja
Clinical features Pain, burning sensation, swelling, tenderness Pain, swelling, tenderness Painful movements
Clinical features Pain, burning sensation, swelling, tenderness Pain, swelling, tenderness Painful movements
Nature of pain/spread of disease pathogens Spreads like rat poison (moderate), pulsating Like scorpion bite (severe), fleeting Pain on movement, stable
Nature of pain/spread of disease pathogens Spreads like rat poison (moderate), pulsating Like scorpion bite (severe), fleeting Pain on movement, stable
Joints involved Small joints like metacarpal and metatarsal joints Big joints like knee, elbow, shoulder and sacroiliac joint. Wear and tear of excessively used joints
Joints involved Small joints like metacarpal and metatarsal joints Big joints like knee, elbow, shoulder and sacroiliac joint. Wear and tear of excessively used joints
Reaction to sneha (oleation) mild sneha is indicated Strictly contra-indicated as pain increases after massage and oleation Indicated, pain reduces after massage and oleation
Reaction to sneha (oleation) mild sneha is indicated Strictly contra-indicated as pain increases after massage and oleation Indicated, pain reduces after massage and oleation
Aggravating factors in diet Hot, sour, salty, pungent Salt, sweet, heavy to digest food Bitter, pungent, light to digest food
Aggravating factors in diet Hot, sour, salty, pungent Salt, sweet, heavy to digest food Bitter, pungent, light to digest food
Aggravating factors Exposure to heat, travelling Sedentary lifestyle, exertion immediately after taking food Overuse of joints
Aggravating factors Exposure to heat, travelling Sedentary lifestyle, exertion immediately after taking food Overuse of joints
Treatment Sneha, virechana, basti with drugs of mild property, raktamokshna Langhana, basti with drugs of sharp acting property Snehana, basti, brumhana
Treatment Sneha, virechana, basti with drugs of mild property, raktamokshna Langhana, basti with drugs of sharp acting property Snehana, basti, brumhana
Constituent conditions of vatarakta:
==== Constituent conditions of ''vatarakta'' ====
Rheumatoid arthritis and gout are two most common rheumatological conditions.
Rheumatoid arthritis and gout are two most common rheumatological conditions.
Those patients with involvement of small joints of extremities resemble rheumatoid arthritis, on the other hand patients with mono-articular or oligo-articular arthritis and associated elevated uric acid resemble gout. There is a difference of opinion among ayurvedic physicians, some call vatarakta as gout and others call rheumatoid arthritis. Some ayurvedic physicians consider aamvata as rheumatoid arthritis. However, it can be observed that the patients diagnosed as rheumatoid arthritis show clinical features of vitiation of vata associated with kapha dosha. Whereas, the patients diagnosed as gouty arthritis show clinical features of vitiation of vata associated with pitta dosha. Therefore, the former case can be treated on the lines of vatarakta associated with kapha, while the latter can be treated on principles of vatarakta associated with pitta. On close observation it is noted that in aamvata there is involvement of large joins of extremities and sacroiliac joints which is consistent with rheumatoid variant or ankylosing spondylitis. Ayurvedic management depends upon correction of imbalance of dosha, dushya and prakriti of the individual and can be viewed as working through epigenetic pathway. On the other hand, modern medicine system works by antagonizing the pro-inflammatory proteins or acting through “genetic pathway”. It becomes clear that both systems achieve the objective using different ways. It can be compared to digging the tunnel from both sides. However, the direction of diagnosis and treatment needs to be clearly based upon clinical assessment of dosha dominance. The serological parameters can only be utilized for assessment of therapy.
Those patients with involvement of small joints of extremities resemble rheumatoid arthritis, on the other hand patients with mono-articular or oligo-articular arthritis and associated elevated uric acid resemble gout. There is a difference of opinion among Ayurvedic physicians, some call ''vatarakta'' as gout and others call rheumatoid arthritis. Some Ayurvedic physicians consider ''amavata'' as rheumatoid arthritis. However, it can be observed that the patients diagnosed as rheumatoid arthritis show clinical features of vitiation of ''vata'' associated with ''kapha dosha''. Whereas, the patients diagnosed as gouty arthritis show clinical features of vitiation of ''vata'' associated with ''pitta dosha''. Therefore, the former case can be treated on the lines of ''vatarakta'' associated with ''kapha'', while the latter can be treated on principles of vatarakta associated with pitta. On close observation it is noted that in aamvata there is involvement of large joins of extremities and sacroiliac joints which is consistent with rheumatoid variant or ankylosing spondylitis. Ayurvedic management depends upon correction of imbalance of dosha, dushya and prakriti of the individual and can be viewed as working through epigenetic pathway. On the other hand, modern medicine system works by antagonizing the pro-inflammatory proteins or acting through “genetic pathway”. It becomes clear that both systems achieve the objective using different ways. It can be compared to digging the tunnel from both sides. However, the direction of diagnosis and treatment needs to be clearly based upon clinical assessment of dosha dominance. The serological parameters can only be utilized for assessment of therapy.
The condition in which blood vessels, connective tissues and tendons are involved such as vasculitis along with thrombosis and embolism, Thrombo angiitis obliterans (Burger’s disease), Raynaud’s disease are also considered under the disease vatarakta. The treatment focus on correction of rakta-dhatvagni, through which mechanisms in sira(vessels) and kandara(tendons) are corrected.
The condition in which blood vessels, connective tissues and tendons are involved such as vasculitis along with thrombosis and embolism, Thrombo angiitis obliterans (Burger’s disease), Raynaud’s disease are also considered under the disease vatarakta. The treatment focus on correction of rakta-dhatvagni, through which mechanisms in sira(vessels) and kandara(tendons) are corrected.
Investigations:
Investigations: