Introduction

This disease is known as Amavata in Ayurveda, and it was first described by Madhav Nidan. Ama and Vata are pathologically dominant in this disease. There is improper food metabolism as a result of various causative factors, resulting in the formation of an intermediate product that is toxic in nature known as Ama. If this Ama is not excreted from the body, it is absorbed and causes pain, inflammation, and joint stiffness. Rheumatoid Arthritis (RA) is a chronic inflammatory disease that primarily affects the synovial membranes of multiple joints. The disease has a broad clinical spectrum and a wide range of joint and extra-articular manifestations. The general population prevalence is 1-2%, with a male to female ratio of 1:3.1-3 The usual age of onset is 20-40 yrs, although Rheumatoid Arthritis may begin at any age. Susceptibility to Rheumatoid Arthritis has genetically determined. If not treated appropriately, Rheumatoid Arthritis has a strong tendency to shorten life and cause severe disability.

The disease nomenclature is critical for easy identification and understanding of a specific disease. It is done based on vitiated doshas, manifested symptoms, involved dushya, hetu, and the primary pathological factor, and so on. Amavata, as the term implies, is formed by the union of two words, Ama and Vata, which are the two predominant pathological factors at work in the disease process. Other doshas are also mentioned by Acharya Madhava. The correct definition of Amavata was given to Acharya Madhav. Vitiated Vata and Ama enter the kostha trika and sandhi pradesha at the same time, resulting in gatra stabdhata and trika samdivendana. Amavata is the medical term for this condition. The term ‘yugapat’ means simultaneous vitiation of vata and kapha dosha, as main pathogenic factor of the disease.4-7

Classification

Based on the Dosha Predominant Classified into 7 types:7-10

1. Vataja Amavata- vata dosha is more predominant.

2. Pittaja Amavata- Pitta dosha is predominant.

3. Kaphaja Amavata- Kapha dosha is predominant.

4. Vatapittaja Amavata- Vata and Pitta is predominant

5. Vatakaphaja Amavata- Vata and Kapha is predominant

6. Pittakaphaja Amavata- Pitta and kapha is predominant

7. Sannipataja Amavata- All the 3 doshas are equally vitiated.

Causes

Aharaja Nidana 10-13

• Virudhahara- The dietary articles which are unwholesome for the normal functioning of the doshas and dhatus (body tissues), e.g. boiled yoghurt, fish along with fruits, milk along with pulses especially black gram, untimely food, eating food before digestion of previous food, improper quantity of food, food which is not properly cooked, etc.

• Guru Ahara- Foods which are heavy and large and difficult to digest.

• Excessive intake of tubers and roots for the purpose of body nourishment.

• Consumption of food with allergens, e.g. animal products, nuts, wheat products, seafood.

• Mandhagni- Low digestive fire

Viharaja Nidana 13-14

• Virudha Chesta- Activities which are not favourable to the normal physiology of the body. This includes suppression of natural urges, sleeping during day time, late night sleep, not maintaining the proper body posture during walking, lying, sitting, etc.

• Doing exercises beyond the body capacity leading to physical exertion.

• Excess indulgence in sex

• Nischalata- Physical inactiveness or a sedentary life style.

• Doing exercises immediately after taking snigdha ahara, i.e. heavy food or oily food or food rich in fat, carbohydrates.

Manasika Nidana

• Emotional disturbances

• Stress

Lakshanas15-17

Angamardha (General body pain which is of crushing type), Aruchi (Anorexia or loss of appetite), Trsna (Excessive thirst), Alasya (Lethargy or feeling inactive), Gaurava (Feeling of heaviness in the body), Jwara (Fever), Apaka (Indigestion), Sandhi Sotha (Swelling in the joints), Sandhi Shoola (Continuous and severe Pain in the joints that even disturbs the sleep), Sandhi Stabdhata (Stiffness of the joints that can affect the movements), Sandhi Gaurava (Feeling of heaviness in the joints), Agnimandhya (Low digestive fire), (thorax), Kukshi Katinya (Rigidity of abdomen), Moorcha (Loss of motor functions or inability of the sense organs to perceive its sensory objects), Vibandha- Constipation, etc.

Discussion

According to Ayurveda, health is more than just being free of disease. To be healthy, a person should be happy physically, mentally, socially, and spiritually. Drastic changes in human lifestyle and pollution have not only created social problems, but have also had a significant impact on health, leading to the exacerbation of certain disorders, Amavata (Rheumatoid Arthritis) being one of them. Pain, whether physical, mental, or both, has been an impediment to living a happy life. Pain can be so severe that it disables, cripples, and confines a person to bed. Amavata (Rheumatoid arthritis), in particular, is a leading cause of disability. Amavata is a common musculoskeletal condition that affects people all over the country.19-20  The main culprit in Amavata is Vayu, which is Pradhan among the Tridosa. Ama, along with Vata Dosha, moves towards Kapha Sthanas, passing through Rasa Vaha Dhamanis, where it combines with the Tridosa and becomes further Dushita, before settling in the Sandhis, where Nidana Sevana and Amavata's Lakshana are produced. Rasavaha Srotasa and Rasa Dhatu are the first to be affected, and Majjavaha Srotasa is also affected due to Sandhis involvement. Samshodhana is essentially bio-purification of the body with the goal of cleansing the macro and micro channels of the biological system-Srotas. Shodhana Karma is Mulavata Chikitsa, which means that the disorders he treats do not reoccur. Panchakarma encompasses all aspects of life's treatment, promotion, prevention, and cure.20-22

Conclusion

Amavata is a slow-progressing metabolic disorder that can limit our daily activities. It affects bodily systems other than the joints as it progresses. Due to complications, it can also become life threatening in the final stages. Early intervention and treatment are required because it can cause permanent deformities in the body, particularly the joints. Amavata's pain is another important feature that makes her life miserable. Because of all of this, Amavata has a negative impact on the patients' psychology. The Ayurvedic approach to Amavata management does not only focus on symptom removal but also on improving the patient's health status following Amavata treatment through its various nourishing and rejuvenating therapies. In the treatment of Amavata, Ayurvedic treatment combined with a strict diet and exercises has a high success rate.