suruchi ppt-1.pptx on RA detailedexplanation

ppt

1. P. G. DEPARTMENT OF ROG NIDAN & VIKRITI VIGYAN RISHIKUL CAMPUS, U. A. U., HARIDWAR SUPERVISOR: PROF.(DR) RUBY RANI AGARWAL(H.O.D) P. G. Deptt . of Rog Nidan & Vikriti Vigyan Rishikul Campus, UAU, Haridwar PRESENTED BY: SURUCHI BALUNI P. G. Scholar Batch 2022 ANALYTICAL STUDY OF AMA IN RHEUMATOID ARTHRITIS IN CORRESPONDANCE TO RA FACTOR AND CRP CO-SUPERVISOR: Rishikul Campus, UAU, Haridwar

2. Contents Of Study Design INTRODUCTION NEED FOR THE STUDY PREVIOUS RESEARCH WORK DONE AIMS AND OBJECTIVES HYPOTHESIS PLAN OF STUDY REVIEW OF LITERATURE CLINICAL TRIAL CRITERIA FOR ASSESSMENT INVESTIGATION CONCLUSION

3. INTRODUCTION Rheumatoid Arthritis is a systemic autoimmune disease characterized by inflammatory polyarthritis usually involving peripheral joint, especially the small joints of hand and feet in a symmetric distribution. Chronic untreated inflammation may lead to joint erosions and joint destruction. Genetics and environmental influences are important in the susceptibility to RA. Women are affected approximately three times more often than men .

4. Amavata explained in Ayurvedic texts can be considered similar to Rheumatoid Arthritis because of resemblance of its symptoms. Ama is major entity in manifestation of the disease Amavata and it is explained as ऊष्मणोऽल्पबलत्वेन धातुमाद्यमपाचितम् | दुष्टमामाशयगतं रसमामं प्रचक्षते || (AH.Su.13/25 ) Due to hypofunctioning of Ushma ( Agni ) the Anna Rasa is not formed properly and that undigested food in stomach ( Apakwa Anna Rasa ) is termed as Ama .

5. Need Of Study

6. This is an era for Ayurveda to go hand with modern science to cope up with various diagnostic difficulties and also to prove diagnostic methods described in Ayurveda , as per modern science with evidence. Hence this study will be done to assess the relation between RA factor and CRP in Rheumatoid Arthritis to Ama so that chronicity of patient of Amavata can be assessed easily and based on that assessment, adequate treatment, dietary and lifestyle interventions or modifications can be done, to provide relief to the patient.

7. There is no work done till now related to Ama assessment in Rheumatoid Arthritis in corresponding to RA factor and CRP. But still articles in various journals and data about researches in various research portal is available related to this topic. Previous Research work Done

8. AIMS AND OBJECTIVES : To analyze status of Ama in Rheumatoid Arthritis. To assess Ama in Rheumatoid Arthritis correspond ing to RA factor. To assess Ama in Rheumatoid Arthritis in corresponding to CRP.

9. HYPOTHESIS NULL HYPOTHESIS : There is no significant relation of Ama in Rheumatoid Arthritis. There is no significant relation between Ama and RA factor in Rheumatoid Arthritis There is no significant relation between Ama and CRP in Rheumatoid Arthritis . ALTERNATE HYPOTHESIS : There is significant relation of Ama in Rheumatoid Arthritis. There is significant relation between Ama and RA factor in Rheumatoid Arthritis There is significant relation between Ama and CRP in Rheumatoid Arthritis .  

10. PLAN OF STUDY

11. REVIEW OF LITERATURE

12. MODERN REVIEW RA is a chronic, multisystem disease of unknown etiology. Although there are a variety of systemic manifestations, the characteristic feature of RA is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. The potential of the synovial inflammation to cause cartilage destruction is the hallmark of the disease.

13. Clinical Findings SYMPTOMS AND SIGNS The onset of disease is insidious , beginning with prodrome of fatigue, weakness , joint stiffness , vague arthralgias and myalgias. Symmetrical Swelling of multiple joints involving wrist, hand and feet often associated with > 1 hour of morning stiffness. Most common joint involved include MCP, PIP, wrist, MTP, Ankles , elbows, shoulders and knees. DIP joints, sacroilliac and vertebral joints are spared except C1, C2. In chronic condition when disease become severe swan neck deformity, the buttonniere or button hole deformity, z deformity of the thumb can be seen . Dorsal subluxation of the ulna at the distal radio-ulnar joint is common and may contribute to rupture of fourth and fifth extensor tendons.

14. EXTRA-ARTICULAR LESIONS Non- specific inflammatory changes are seen in the blood vessels (acute vasculitis), lungs, pleura, pericardium, myocardium, lymphnodes , peripheral nerves and eyes. Rheumatoid nodules in the skin particularly found in the subcutaneous tissue over pressure points such as the elbows, occiput and sacrum. Similar nodules may be found in the lung parenchyma , pleura, heart valves, myocardium and other internal organs .

15. Pathophysiology of RA CD4+ T cell Cytokines Proteases Release of Adhesion Molecules Destruction of cartilage, bone, fibrosis, ankylosis Genetic susceptibility (MHC Class II) A CT I V A T I O N Joint Deformities Inflammatory damage to synovium , small vessels , collagen Cytokines (TNF ᾳ ,INF ℽ , IL-1) Anti-IgG Antibody (Rheumatoid Factor) Endothelial Cells Macrophages Formation of immune complex, inflammatory cells, Pannus B-Cell

16. ACR/EULAR 2020 CRITERIA . Joint involvement   1 large joint 2-10 large joints 1 1-3 small joints 2 4-10 small joints 3 >10 joints (at least 1 small joint) 5 Serology (need at least 1 result) Negative RF Low Positive RF 2 High Positive RF 3

17. Acute Phase Reactant (need at least 1) Normal CRP and Normal ESR Abnormal CRP or Abnormal ESR 1 Duration of Symptoms <6 weeks >6 weeks 1 A score of six or more than six (≥6) is equal to definite RA .

18. RA FACTOR- RA Factor in patient’s serum reacts with IgG coated latex particles ( in RA test reagent) and agglutination are formed. RA test is performed to detect the presence of rheumatoid factor in the serum of the patient with rheumatoid arthritis. CRP- CRP – Turbilatex is a quantitative turbidimetric test for the measurement of C-reactive protein in human serum .Latex particles coated with specific anti-human CRP are agglutinated when mixed with samples containing CRP. The agglutination causes an absorbance change, dependent upon the CRP contents of the patients sample that can be quantified by comparison from a calibrated of known CRP concentration.

19. AYURVEDIC REVIEW- AMAVATA DEFINITION युगपत्कुपितावन्तस्त्रिकसन्धिप्रवेशकौ | स्तब्धं च कुरुतो गात्रमामवातः स उच्यते || मा नि २५ / ५   The Ama when combines with Vatadosha , enters to Kostha , Trik and Sandhi Pradesha produces stiffness in whole body resulting in a painful disease called as Amavata. .

20. NIDANA विरुद्धाहारचेष्टस्य मंदाग्नेः निश्चलस्य च । स्निग्धं भुक्तवतो हृयन्नं व्यायामं कुर्वतस्तथा ।। M.N. 25/1 In Madhava Nidana specific aetiological factors which are responsible for causing Amavata has been mentioned . ViruddhaAhara (Incompatible food). ViruddhaChesta (Inappropriate habits ). Mandagni (Hypo-functional Agni ). Nishchalata (Sedentary habits). Exertion immediately after taking Snigdha -Ahara .

21. Madhava Nidana has described the Rupa of Amavata as Samanya and Ativrddha Lakshna (M. N. 25/6-10). LAKSHAN Samanya Rupa of Amavata अङ्गमर्दोऽरुचिस्तृष्णा ह्यालस्यं गौरवं ज्वरः । अपाकः शूनताऽङ्गानामामवातस्य लक्षणम् ॥६॥ (M.N.25/6 )

22. SELECTION OF PATIENTS-   35 individuals will be selected randomly from OPD, IPD, Rishikul Ayurvedic Hospital/Campus, for this study irrespective of their sex, religion, occupation etc. A detail proforma will be prepared according to the Ayurvedic classics and allied science. Individual fulfilling the inclusion and exclusion criteria will be registered .  

23. CRITERIA FOR SELECTION OF PATIENTS

24. CRITERIA FOR ASSESSMENT

25. Sno. LAKSHANA OF AMA PRESENT ABSENT 1. Shrotorodha (obstruction of channels)     2. Balbhransh (loss of physical strength and weakness)     3. Gaurava (heaviness)     4. Anilmoodta (Gaseous Obstruction)     5. Alasya (laziness)     6. Apakti (indigestion)     7. Nishthevan (excessive salivation)     8. Malsanga (constipation)     9. Aruchi (anorexia)     10. Klama ( fatigability)     SUBJECTIVE PARAMETERS The assessment for study will be done on following parameters

26. SNO. LAKSHANA Of Amavata PRESENT ABSENT 1. Angmarda (Pain in the body) 2. Aruchi (Anorexia) 3. Trishna (Thirst) 4. Angagaurav (Heaviness in body parts) 5. Angashunta (Numbness in body parts) 6 Alasya (Laziness) 7 Hasta Sandhi Shoola (Pain in joints of hand) 8 Hasta Sandhi Shotha (Inflammation in joints of hand) 9 Hasta Sandhi Shotha (Inflammation in hand joints)

27. 10 Padha Sandhi Shoola (Pain joints of leg) 11 Padha Sandhi Shotha (Inflammation in joints of legs) 12 Gulfa Sandhi Shoola (Pain in ankle joints) 13 Gulfa Sandhi Shotha (Inflammation in ankle joints) 14 Trika Sandhi Shoola (Pain in sacro -iliac joint) 15 Trika Sandhi Shotha (Inflammation in sacro iliac joint) 16 Janu Sandhi Shoola (Pain in Knee joint) 17 Uruha Sandhi Shoola (Pain in femoral joint)

28. 18 Urha Sandhi Shotha (Inflammation in femoral joint) 19 Vrishekdanshavata Vedana (Pain like scorpion bite) 20 Vairasyta (loss of taste) 21 Daha (Burning Sensation) 22 Bahumutrata (excessive micturition) 23 Kukshi Kathinyam (tightness in abdomen) 24 Kukshi Shoolam (Pain in abdomen ) 25 Nidra Viparya ( Sleep disturbance) 26 Chardi (Vomiting ) 27 Moorcha (Unconsciousness) 28 Hridgraha ( Palpitation)

29. OBJECTIVE PARAMETERS 1-RA –FACTOR- QUALITATIVE RA –FACTOR Agglutination Present RA- Factor Positive RA- FACTOR Agglutination Absent RA- Factor Negative QUANTITATIVE VALUES IN IU/ml RA -FACTOR 0-20 NORMAL RA- FACTOR 21-50 MILD RA-FACTOR 51- 100 MODERATE RA-FACTOR >100 SEVERE

30. CRP QUALITATIVE C-REACTIVE PROTEIN Agglutination Present CRP POSITIVE C-REACTIVE PROTEIN Agglutination Absent CRP NEGATIVE QUANTITATIVE RANGE IN mg/dL C-REACTIVE PROTEIN 0-6.0 NORMAL C-REACTIVE PROTEIN 6.0-20.0 MILD C-REACTIVE PROTEIN 20.0-40.0 MODERATE C-REACTIVE PROTEIN >40 SEVERE

31. MALES RANGE mm in 1 hour 0-15 NORMAL 16-30 MILD 31-100 MODERATE >100 SEVERE FEMALES RANGE 0-20 NORMAL 21-50 MILD 51-100 MODERATE >100 SEVERE ESR

32. ASSESSMENT OF DEHA PRAKRITI     According to the Ayurvedic concepts of Deha Prakriti of every patient will be assessed on the Performa of CCRAS – Ayurveda Prakriti web portal analysis will be made for evaluation and incidence of association of disease with different type of Deha Prakriti.

33. INVESTIGATIONS Hb gm% TLC DLC ESR RA Factor CRP Serum uric acid

34. SAMPLE SIZE - For observational study, as per sample size calculation: N=4pq/d 2 Where p=prevalence (0.75%) q=1-p d=marginal error 3%. Total 35 individuals will be selected from Rishikul Ayurvedic College campus. TYPE OF STUDY Observational study   LEVEL OF STUDY : OPD

35. PERIOD OF STUDY: 18 months METHOD OF DATA COLLECTION: The data will be collected by two methods : By personal observations. By questionnaires.   OBSERVATION AND RESULT The inference will be made on the basis of statistical analyzed data by applying appropriate statistical test

36. • ETHICAL CLEARANCE: Study will start after getting clearance from institutional ethical committee . DISSCUSSION: Under this chapter result will be discussed on the basis of Ayurvedic concepts as well as modern scientific parameters.   SUMMARY AND CONCLUSION : All the work will be summarized and conclusion will be made on the basis of results and discussions. .