Most of the autoimmune disorders reflect in the form of arthritic or rheumatic symptoms.Autoimmune arthritis is inflammation of joints due to failure of immunological process. In this process the production of antibodies against the body’s own connective tissue is generated. The aetiology of autoimmune disorders, as per modern scientific approach, is probably idiopathic (self originated or of unknown causes). But certain individuals having weak vitality are genetically susceptible to the development of autoimmune diseases. Various micro-organisms, toxins and drugs may trigger the symptoms in such persons. It is accepted fact that the curative capacity of homoeopathy extends to allergic manifestations, autoimmune diseases and viral infections (Annual Report – 2005, Department of Ayush, Government of India).
Mechanism of arthritis of autoimmune origin
Arthritis of autoimmune origin occurs when the immune system mistakenly attacks and destroys its own connective tissues. Normally the immune system helps protect the body from antigens like bacteria, viruses, toxins or incompatible foreign substances. When the immune system detects an antigen, it responds by producing antibodies that destroy the harmful substances by phagocytosis. In normal situations only foreign substances are attacked and destroyed. In weakened and faulty immunity there is loss of tolerance of the ability of immune system to differentiate self-antigen from non-self antigen. This happens because of deletion of self-reactive B and T cells during their maturation in the bone marrow and thymic environments. Subsequent series of complex mechanism results in autoimmunity. The consequences usually are (i) the destruction of one or more types of body tissues, (ii) abnormal growth of an organ or (iii) changes in organ function. Depending on the site and failure there are different types of symptoms of arthritis, even of autoimmune origin.
The commonly affected autoimmune diseases with arthritic symptoms are rheumatoid arthritis, systemic lupus erythematosus (SLE), Sjogren’s syndrome (progressive dryness of mucous membrane sometimes with joint pain and swelling), scleroderma (local and systemic fibrosis with pain, rigidity, swelling and stiffness of fingers and joints) and ankylosing spondylitis. Few other autoimmune conditions with prominently rheumatic symptoms are polymyositis, polyarteritis nodosa (PAN), Hashimoto’s thyroiditis, Grave’s disease, myasthenia gravis, myositis and non-treated multiple sclerosis.
Rheumatism is a term used widely in homoeopathic literatures, which refers any painful disorder of the joints, muscles or connective tissues. Its application depends on totality of symptoms and modality. Whereas the term arthritis is used differently on the basis of recent patho-physiological understandings of inflammation of joints.
The symptoms of autoimmune arthritis vary from disease to disease. Common symptoms are joint pain, stiffness and other inflammatory signs. Case history usually includes, whether inflammation is present or not, number of joints involved, site of the joints involved, aggravating and ameliorating factors, type of pain and about extra-articular manifestations like rash, fever, nodules, etc. in order to understand the disease and choose a right remedy. The short term goal is to alleviate the pain and other symptoms, and long term objective is to reduce the frequency and intensity of further episodes. Selecting a right remedy based on constitution, temperament, totality, generality, etc. and appropriate dose of the same would help for achieving long term goal. Miasms and genetic have great role in selecting the right medicine.
Miasmatic and temperament based approach of autoimmune arthritis
As per recent researches genetics plays significant role in the autoimmune arthritis.
Homoeopathic concept of genetics is categorised in the form of miasms, and fine tuned by differentiation of temperament and constitution. To provide long term and permanent solution for these conditions, one has to look into the miasm and temperament, based on various parameters like generalities (mental and physical), modalities, pathology, thermal relation, past history, and familial trait and tendency. A remedy selected by such parameters and given at appropriate interval (given after the exhaustion of action of previous dose), would reduce the frequency and intensity of exacerbations and episodes of condition. Over a period the episode would fade and patient would get rid of the complaint. It is important to reduce medication as improvement takes place. Frequently prescribed remedies (on the basis of the above parameters) for autoimmune arthritis and its grade of miasmatic affinity and its temperament are the following: Ars alb – pso+++, syp+, syc+++, N3C2M2 (N-Nervous, C-Choleric, M-Melancholic); Bry – pso++, syp++, syc+++, C3P2 (P-Phlegmatic); Ferr m – pso++, syp+, syc++, C3S2P1 (S-Sanguine); Kali c – pso++, syp+, syc++, N3C2; Lach – pso++, syp++, syc+++, C3S3M1N1; Lyc – pso+++, syp++, syc+++, C3N2; Merc s – pso+++, syp+++, syc++, C3N2; Nat m – pso+++, syp++, syc+++, M3C1; Med – pso++, syp++, syc+++, N2C2; Nux v – pso+++, syp+, syc++, C3; Phos – pso+++, syp+++, syc++, S3C2N1; Psor – pso+++, syp++, syc++, M3P2; Puls – pso++, syp+, syc+++, P3S2M2N1; Rhus t – pso+++, syp++, syc+++, M2N2 ; Sep – pso++, syp+, syc+++, P3C2M1; Sil – pso++, syp+++, syc++, M3P2N1; Sulph – pso+++, syp+++, syc++, S3P3N1C1M1 Note: +++ – More affinity, ++ – Moderate affinity, + – Less affinity (Reference: 1. Dr. Subrata Kumar Banerjea, Miasmatic Diagnosis: Pratical Tips with Clinical Comparisons; 2. Parinaz Humranwala, Temperament Types – A Study).
Role of detoxification in autoimmune arthritis
The fundamental causes of autoimmune arthritis are intrinsic factors like damage to gene and autoantibodies. Many environmental factors can trigger the symptoms of the condition. Exposure of environmental toxins leads to the initiation or aggravation of many of the autoimmune arthritic symptoms. When the detoxification process is beyond the capacity of liver, it reflects in the form of disease. Many homoeopathic medicines are known and used to detoxify such toxins. The following remedies are reported to be useful in detoxification: Andrographis paniculata Q, Azadirachta indica Q/1x, Carduus marianus Q, Chelidonium Q, Hydrocotyle Q, Taxus buccata Q and other remedies.
Remedies commonly used to manage the acute episodes of autoimmune arthritisActea spicata – Arthritis of small joints especially wrist, fingers, ankles, toes; character of pain is tearing and tingling; pains worse from touch and motion; swollen and red joints with slight fatigue. Angustura – Cervical spondylitis – pain in spine and nape of neck worse by pressure; stiffness and tension of muscles and joints. Badiaga – Cervical spondylitis with stitching pain and stiff neck; pain in low back and hip. Belladonna – Shiny, swollen joints of first stage inflammation; shooting pain shifting rapidly; affected joint is with heat, redness, throbbing and burning pain; arthritic affection with subcutaneous red streak. Bryonia alba – Arthritis with red, hot and swollen joints; stitching and tearing pains worse on least motion; pain better by absolute rest and lying on painful side. Calcarea fluorica – Chronic lumbago worse by first motion; pain in low back with burning. Caulophyllum – Wrist rheumatism, especially of women; pain worse while closing the hand; character of pain is erratic, drawing and changes one joint to another suddenly. Cimicifuga racemosa – Rheumatism with muscular soreness; pain in the small joints of who uses it more as profession like computer proffession, piano players, etc. Eupatorium perfoliatum – Aching and sore in wrist with swelling. Kalmia – Rheumatic manifestation with cardiac disorder; inflammation of small joints with red, hot, swollen, joint; arthritic pain rapidly shifting from one joint to another; pain wore from least motion. Lachesis – Cervical spondylitis with stiffness of neck; pain in coccyx worse rising from sitting posture; must sit perfectly still. Lycopodium – Psoriatic arthritis with drawing and tearing pains; skin psoriatic manifestation with gastric and hepatic disorder. Phytolacca – Arthritic pain shifts rapidly like electric shock; nature of pain is shooting, lancinating and flying to other part; pain better by stretching the limbs. Rhododendron – Rheumatoid arthritis of acute stage; drawing and tearing pain worse at rest and in wet cold, windy weather. Rhus toxicodendron – Rheumatic pain worse by rest; rheumatism more on right wrist and finger joints; pain on first moving after rest; tenderness in affected part. Sulphur – Psoriatic arthritis with tearing and drawing pain; skin scaly and unhealthy. Viola odorata – Pressing pain in right carpal and metacarpal joints.
Note: This article was written by Dr. R. Valavan and published in Homeopathy for All, Jan 2008.