Author: Dr. Vikram Chauhan

Abstract

All our day to day activities like sitting, walking, running, standing, stretching depends upon the health condition and integrity of the joints. There are many diseases which can affect our joints, and can disturb our life. Osteoarthritis is one such disease which affects joints and causes excess pain and it can interfere with normal daily activities. Osteoarthritis is the most common disease and it is affecting a large population worldwide. The occurrence of osteoarthritis is rising due to faulty lifestyle and its prevalence is high in the elderly people. Osteoarthritis is a degenerative disorder of joints. Commonly affected joints include hip, elbow, ankle, wrist, cervical, lumbosacral spine and other joints. Early diagnosis of osteoarthritis such as through symptoms and screening can often lead to better treatment with likelihood of successful recovery. Osteoarthritis can be correlated with ‘sandhigata vata’ on the basis of similarities in their symptoms. It is a disease of Sandhi (joint). Its symptoms are sandhi shotha (swelling), sandhi shoola (pain), stiffness and loss of flexibility of joints.

Introduction

Osteoarthritis is a chronic degenerative joint disease in which the tissues of the joints start to break down. The type of tissue that covers the surface of a bone at a joint is called cartilage. Cartilage is a connective tissue that protects bones by absorbing shock. It also acts as a lubricant, thus reducing friction between bones of the joint and preventing them from rubbing together. In osteoarthritis the cartilage that protects the ends of bones of joints gradually deteriorates. This increases the friction between joints and joints start to rub against each other when there is any movement of joints. The joints that are most often impacted include the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints in the hands, the wrists, and the smaller joints in the feet, such as the metatarsophalangeal (MTP) joints. Osteoarthritis can be referred to as a wear and tear disease. Osteoarthritis gets worse over time, often resulting in chronic pain and inflammation.

Types of osteoarthritis

Osteoarthritis can be classified into two categories, they are as follows:-

• Primary osteoarthritis – It is the commonest form of osteoarthritis that develops over time. It is caused by normal wear and tear of using the joints throughout your life.
• Secondary osteoarthritis – it is caused by any injury to the joint. Another reason could be infection in the body, that causes postinfectious arthritis, which can lead to secondary osteoarthritis.

Causes of osteoarthritis

The exact cause of osteoarthritis is not clear. There are numbers of factor that can cause osteoarthritis, including

• Aging – As people get older, osteoarthritis becomes more common.
• Gender – Women are more prone to get osteoarthritis than men.
• Injury to the joints.
• Obesity – Increased Weight causes stress to weight-bearing joints, thus leading to stress on joints.
• Joint deformities
• Repeated stress on the joint
• Genetics – It tends to run in the family with the history of osteoarthritis.
• Fractures of bones
• Metabolic disorders – some metabolic diseases can cause osteoarthritis. Such as, diabetes and hemochromatosis (excessive iron in the body).

Symptoms of osteoarthritis

The symptoms of osteoarthritis include:-

• Pain in joints when you use the joint. Osteoarthritis can impact any joint, though it most commonly affects the hands, knees, hips, lower back, and neck.
• Stiffness after periods of rest
• Morning stiffness – Pain and stiffness in the morning, which improves after activity, allowing the joint to warm up.
• Decreased range of motion
• Tenderness around joints.
• Bone spurs – It is a growth of bone that feels like a hard lump around the affected joint.
• Swelling

Stages of Osteoarthritis

Osteoarthritis is classified into four stages. These stages are described on the basis of the amount of damage in the cartilage and the severity of symptoms. They are as follow:

• Stage 0 (Pre-Osteoarthritis) – It is an early stage of osteoarthritis. At this stage the damage begins at the cellular level, without any clinical signs or symptoms.
• Stage 1 (Minor stage) – It is considered a minor or doubtful stage of osteoarthritis. It is due to minor wear and tear of joints. People may feel little to no pain. Treatment during this stage focuses on lifestyle changes, over-the-counter medications, and supplements.
• Stage 2 (Mild) – At this stage, the space between the joints becomes a little narrow. In this stage, bone spurs can grow and become painful. People sometimes may start to feel more pain during activity or after a period of increased activity. Acute and sharp symptoms can be seen. Diagnosis is done by physical exam, assessment of symptoms, and x-ray mainly. Lifestyle changes, like doing low-impact exercises and losing weight, are advised. Over-the-counter medications and supplements are given for the management of symptoms.
• Stage 3 (Moderate) – At this stage, the moderate erosion of the cartilage can be seen. The space between joints gets visibly smaller. More bone spurs grow and can become enlarged. At this stage, patients feel constant pain and stiffness during any activity which involves joints. Morning stiffness becomes worse. Diagnosis can be done with the help of a physical exam, X-ray, and MRI. Treatment involves lifestyle changes, over-the-counter medicine like NSAIDS for the management of pain and corticosteroids injections. Physical therapy is also advised.
• Stage 4 (Severe) – At this stage, almost all the cartilage is completely worn away. The space between the joints is much reduced. Bone spores become larger. Daily activities get difficult to do. At this stage, inflammation is severe. It is diagnosed with imaging techniques. Surgeries are advised at this stage.

Diagnosis of Osteoarthritis

Diagnosis of osteoarthritis can be done with the help of following techniques:

• Physical Exam – A medical professional will assess you and inquire about your symptoms. The examination could reveal:
• During the movement of joints, crepitation could be heard. Crepitation is a crackling (grating) sound produced by joint movement.
• Joint swelling (caused by either fluid in the joint or the feeling of larger-than-normal bones around the joints)
• Restricted range of motion
• Joint tenderness when pressed
• Often, everyday motion hurts.
• Imaging Techniques – The following imaging methods are used to identify and track osteoarthritis.
• X-ray – An x-ray will probably reveal Joint space loss, deterioration of the bone ends, bone spurs, Subchondral cysts, and bony abnormalities close to the joint.
• MRI – It employs radio waves and a magnetic field to produce detailed images of bones, cartilage, and soft tissues. It is effective for diagnosing bone disorders that lead to sudden increases in symptoms.
• Blood Test – It is not possible to diagnose osteoarthritis with blood tests. Alternative disorders like gout or rheumatoid arthritis can be found with them.

Differential diagnosis of osteoarthritis

• Gout
• Rheumatoid arthritis
• Avascular necrosis etc.

Treatment of osteoarthritis

Osteoarthritis (OA) is not curable, but its symptoms can be managed. While the condition typically worsens over time, the rate of progression can differ from one individual to another. Surgical options are available, but other treatments can help alleviate pain and improve your quality of life. While these treatments cannot eliminate OA, they can often postpone the need for surgery or reduce symptoms to a level that minimizes their impact on daily activities.

• Medication – Pain relief medications can help ease pain and swelling. Additionally, you might need oral medications or topical solutions like creams, ointments, or patches that you apply to the skin around the affected joints.
• Exercise – Low-impact exercises such as swimming, walking, and weight training are beneficial. Regular movement of your joints can help reduce stiffness and build strength in the surrounding muscles. Physical therapy can improve mobility and function.
• Heat and cold treatments – Using heat or cold on your affected joints can help reduce pain and stiffness.
• Surgery – Surgery is not necessary for most individuals with osteoarthritis. However, in some cases, a joint replacement (arthroplasty) may be required.

Ayurvedic overview on osteoarthritis

Sandhivata is one of the most prevalent conditions worldwide, impacting a large number of people. The term “Sandhivata” is derived from the words “Sandhi,” meaning joint, and Vata (one of the dosha of the body), indicating that when Vata accumulates in the joint, it causes pain, swelling, and restricted movement. In Ayurveda, Sandhivata is considered a type of Vatavyadhi (disease due to vata dosha) that typically arises in older age. Sandhivata most commonly affects the knee and hip joints, particularly those that bear weight. When the knee joint is involved, the condition tends to be more painful. The clinical presentation of Sandhivata closely resembles that of osteoarthritis, with similar symptoms such as joint pain, stiffness, and limited movement. Sandhivata (osteoarthritis) is caused by vitiated vata, so all the factors which cause aggravation of vata dosha in the body are its causative factors. Factors responsible for aggravation of vata are Aptarpana (excess fasting), vyayama (excessive exercise), excessive consumption of katu (pungent), Tikta (bitter), kashaya (stringent) rasa (taste) pradhan (dominant) ahara (food) and excessive consumption of cold and ruksha (dry) food etc.

Ayurvedic pathophysiology of osteoarthritis

Due to all the factors responsible for aggravation of vata dosha, vata tends to increase pathologically in the body. This increased vata gets settled into asthi dhatu (bone tissue) and Asthi sandhi (bone joints). Vata dosha imparts pathological changes in the Asthi dhatu (bone tissue) and Asthi sandhi (bone joints), thus causing damage in the bone tissues and joints. This leads to initiation of the disease in the body. The Asthi dhatu and vata are always interconnected in an ashraya-ashrayi bhava (abode-resident relationship). Therefore, any pathological increase or decrease in vata has a significant impact on bone tissue, more so than on any other tissue. This vitiated vata causes significant damage to the bones and joints, it leads to the signs and symptoms of sandhigata vata (osteoarthritis), such as shula (pain), and shotha (swelling) in bony joints. If the condition is not treated at an early stage it can cause complications such as immobility, deformities of joints, difficulty in walking, and chronic pain.

Ayurvedic Treatment of Osteoarthritis

Allopathic treatment has certain limitations when it comes to managing this disease. It offers either conservative or surgical options, which are often symptomatic and accompanied by significant side effects. In contrast, conditions like this may be more effectively addressed through the treatments and procedures outlined in Ayurvedic traditions. This type of condition can be more effectively treated through the application of various Panchakarma procedures and Shaman Chikitsa (palliative therapy) in Ayurveda.

• Swedana (Fomentation/sweating therapy): It is typically performed after Snehana (administration of oil either orally or through body massage). Following swedana (Fomentation/Sweating therapy), the cells become activated, helping to flush out toxins. Swedana (fomentation/ sweating therapy), when done after snehana(oil massage), promotes free circulation in the joints, alleviates pain, stiffness, and swelling. It strengthens and rejuvenates the joints, and facilitates easier movement. Type of swedana procedure used in treatment of osteoarthritis are Bashpa sweda (sweating therapy through steam), Pinda sweda (bolus fomentation), shashtika shali pinda Sweda (fomentation with the rice grown in 60 days of duration), Avagaha (sitz bath).
• Dhara (Flow in continuous streams): In this process, therapeutic substances, including herbal oil and processed milk, are poured in a continuous stream while gentle stroking is applied for a set duration. This therapy is extremely effective in relieving joint pain.
• Kati basti (Lower Back Oil Treatment): It is an ayurvedic therapy in which warm medicated oil is held in place within a dough barrier on the lower back (kati area). This treatment is effective in reducing pain, stiffness, and discomfort in the lower back.
• Janu basti (Knee Oil Therapy): It is an Ayurvedic treatment where warm medicated oil is held in place around the knee joint using a dough barrier. This therapy helps to reduce pain, inflammation, and stiffness in the knee region.
• Upanaha (Poultices): It is an ancient Ayurvedic treatment where a paste of medicinal herbs, oils, or powders is applied to the affected area and typically wrapped with cloth or leaves. The poultice is then secured in place, often with mild heat, to facilitate healing, alleviate pain, and enhance circulation. This method is frequently used for treating conditions like joint pain, inflammation, and muscle stiffness.
• Virechana (Purging): Virechana (purging) is an Ayurvedic treatment that involves the controlled cleansing of the body by eliminating toxins, mainly through the use of medicinal herbs or substances that stimulate bowel movements. In the case of osteoarthritis, Virechana is employed to balance the imbalanced doshas (humors), especially Pitta and Vata, which are commonly linked to joint inflammation, pain, and stiffness.

Herbal Remedies for Osteoarthritis by Planet Ayurveda

Osteoarthritis is a prevalent condition often seen in older individuals, resulting from the gradual wear and tear of bones and cartilage over time. It is the commonest type of arthritis. In some cases, the condition can develop earlier, often following an injury. The weight-bearing joints, especially the knees, are most commonly affected, and sometimes both knees are involved, though occasionally only one knee is affected. This condition arises due to the aggravation of Vata dosha, which can be triggered by the degeneration of the joints or any joint injury. In such cases, the OA (Osteoarthritis) Care Pack can be highly beneficial and deliver significant improvement in your condition.

1. Joint Aid Plus
2. Bone Support Capsules
3. Lakshadi Guggul
4. Coral Calcium Complex

Products Description

1. Joint Aid Plus

It is an excellent herbal formulation that includes Shallaki (Boswellia serrata), Guggul (Commiphora mukul), Nirgundi (Vitex negundo), Ashwagandha (Withania somnifera), and several other herbs, all of which are well-known for alleviating pain by balancing and pacifying Vata dosha. These herbs work together to reduce inflammation and manage painful bone conditions. Additionally, these capsules are highly effective in detoxifying the blood, while also promoting the strengthening of bones and muscles. In general, the formulation delivers excellent and effective outcomes in managing almost all types of joint-related issues.

Dosage: Take 1 capsule twice daily with plain water, following meals.

2. Bone Support Capsules

Bone Supports Capsule contains standardized extracts of herbs such as Suhanjana Beej (Moringa oleifera), Hadjod (Cissus quadrangularis), Praval Pishti (Corallium rubrum), Mukta (Pearl calcium compound), Shudh Laksha (Laccifer lacca), Arjun (Terminalia arjuna), and several others. The herbs in this helps to alleviate symptoms associated with Sandhivata (osteoarthritis) and, as the name suggests, promote healthy bone density. These herbs enhance calcium absorption, support joint mobility, and contribute to strengthening the cartilage. The Bone Support formula contains Hadjod (Cissus quadrangularis), which aids in improving bone density, and Arjun (Terminalia arjuna), which promotes better circulation. In addition, it includes Praval Pishti (AN ayurvedic compound) and Mukta (Pearl Calcium compound), both of which help boost natural calcium levels in the body.

Dosage: Take 1 capsule twice daily with plain water, following meals.

3. Lakshadi Guggul

It is a traditional formulation that includes Laksha ras obtained from an insect i.e Laccifer lacca as one of its key ingredients. It also contains Guggul (Commiphora mukul) and Ashwagandha (Withania somnifera), which assist in pacifying Vata dosha and provide significant relief from pain. Additionally, Arjuna (Terminalia arjuna) is included to help improve circulation. This preparation yields excellent results for various bone-related issues. It is also a rich source of calcium and aids in accelerating the healing process.

Dosage: Take 2 tablets twice daily with plain water, following meals.

4. Coral Calcium Complex

It is an excellent formulation serving as a natural supplement of calcium that promotes bone density. It contains various compounds such as Praval Pishti (Coral), Akik Pishti (Agate), Mukta Pishti (Pearl), and several others. The formulation contains the well-known compound Jawahar Mohra Pishti (mineral compound), which aids in balancing digestion-related issues. Overall, the formulation is highly effective and provides excellent results in managing osteoarthritis. It also plays a key role in enhancing bone density.

Dosage: Take 1 capsule twice daily with plain water, following meals.

Conclusion

In this article I have concluded about osteoarthritis. It is a common degenerative joint disease marked by the deterioration of cartilage, which results in pain, stiffness, and inflammation, especially in weight-bearing joints. In this article I have discussed causes, symptoms, stages, risk factors, diagnosis and treatment of osteoarthritis. We discussed the ayurvedic view of osteoarthritis. In Ayurveda, osteoarthritis is commonly associated with a condition called “Sandhivata,” which involves the disruption of Vata dosha in the joints (sandhi). Sandhivata is marked by joint pain, stiffness, and swelling, similar to the symptoms seen in osteoarthritis. In this article I have discussed the ayurvedic aspect of osteoarthritis and its causes, symptoms, pathology, treatment including home remedy by planet ayurveda. Ayurvedic treatment involves the use of herbal remedies, dietary adjustments, Panchakarma therapies, and lifestyle changes, all of which work to balance the doshas (humors) and enhance joint health, much like the approach taken in conventional medicine for managing osteoarthritis.