DISSERTATION ON

OSTEOARTHRITIS IN FEMALES AND ITSHOMOEOPATHIC APPROACH

IN PARTIAL FULFILLMENT FOR THE REQUIREMENT

OF

B.H.M.S. Degree Year:

2018-2019

SUBMITTED TO

MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES,

NASHIK

Dr. URMILA PAWAR

BY
DR. MOHD SAFWAN SOHIL SHAIKH
AT

Dr. G. D. POL FOUNDATION’S

Y.M.T. HOMOEOPATHIC MEDICAL COLLEGE SEC-4,

KHARGHAR, NAVI-MUMBAI

1
 DEPARTMENT OF SURGERY

CERTIFICATE

This is to certify that dissertation entitled

“OSTEOARTHRITIS IN FEMALES AND ITS HOMOEOPATHIC
APPROACH”
has been carried out by DR. MOHD SAFWAN SOHIL SHAIKH under
guidance of
DR. (MRS) URMILA PAWAR in partial fulfilment of completion of
internship for B.H.M.S. degree.

Dr. (Mrs) URMILA PAWAR Dr. (Mrs) P.P.PAGE

DEPT OF SURGERY PRINCIPAL

Y.M.T.H.M.C DEPT OF ORGANON

Y.M.T.H.M.C

2
 ACKNOWLEDGEMENT
Every work needs efforts of many people to accomplish the goal of completion
and like my work too fortunately got the contribution of very special and
efficient people and has been brought to fruition due to the efforts of them.
It gives me immense pleasure and blissfulness to express my deep sense of
gratitude towards my guide, Dr. (Mrs.) Urmila Pawar Mam, Associate
Professor of Department of Surgeryat Dr. G.D. Pol Foundation’s Y.M.T.
Homoeopathic Medical College and Hospital, Kharghar, Navi Mumbai, for
accepting me as a student, extending her valuable guidance, help and constant
encouragement in every aspect of my study from selection of the topic till
submission of my work and for being there for me whenever I needed her
suggestions. My sincere thanks to Dr. Gajanan D. Pol, Founder and Chairman
of Dr. G.D Pol Foundation’s YMT Homoeopathic Medical College and
Hospital, Kharghar, Navi Mumbai for the facilities provided at the U.G
Institute.
I want to express my deep sense of gratitude towards Dr. (Mrs.) P.P Page
Mam, Director and Principal, Professor and Head of Department of Organon of
Medicine and Homoeopathic Philosophy, for her kind permission to carry out
the study in this institute by providing all the facilities; for continuous
encouragement and strong support to her each and every student like me during
the whole period of this Under Graduation course.
Iwould like to express my special thanks to Dr. D.G Bagal Sir, Vice Principal,
Professor and head of Department of Homoeopathic Repertory for his
experienced and practice oriented guidance to the post graduate students and for
his constant encouragement and support during this study.
I would like to thank all my teachers at Dr. G.D. Pol Foundation’s Y.M.T.
Homoeopathic Medical College and Hospital, Kharghar, Navi Mumbai, in shaping
me as a professional. I am grateful to Dr. Ramjee Singh sir, President of CCH for
providing the best education in the field of Homoeopathy in India. I wish to thank
Dr. A.N.Bhasme Vice-President of CCH for valuable support and his contribution in
developing the science of Homoeopathy all over India. I wish to thank Dr. Dilip
Mhaisekar sir, Hon. Vice Chancellor; MUHS Nashik, for his valuable upgradation of
Homoeopathy at the University
I am indebted to Dr. Mohan Khamgaokar sir, Hon. Pro-Vice-Chancellor, MUHS
Nashik, for his valuable guidance.
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I am thankful to Dr. K.B. Garkal Registrar, MUHS Nashik, for his valuable
support. I wish to thank Dr. V.R. KawishwarDean of Homoeopathic faculty,
MUHS Nashik for his valuable guidance.

I am indebted to Dr. K.D. Chavan, controller of examination, MUHS Nashik, for his
valuable support.
I wish to sincerely thank and appreciate my friends and colleagues for their
valuable moral support, patient hearing, timely encouragement and help they all
rendered during the course of the study.
I am forever grateful to my adorable parents, whose foresight and values paved
the way for a privileged education, who greatly offers counsel and
unconditional support at each turn of the road.
My work is a result of the immense encouragement, blessings, support and
unconditional love and care showered on me by my parents MRS. SHAHIDA
SHAIKH & MR. MOHD SOHIL SHAIKH .
They have played the most important role, by being with me through the tough
times during my journey to completion.
I am deeply indebted and grateful to them for everything.
Finally I hope that, this dissertation will encourage more people to research facts in
the deep ocean of knowledge towards the science of homoeopathy.
I would finally like to say that I am just a follower of the master DR. SAMUEL
HAHNEMANN; who has always made me believe in the power of homoeopathy, and

encouraged me with this quote “Dare to be wise”.

Above all I thank God Almighty for His blessings, for giving me this life and love to
do something worthwhile for mankind.
With Deep Gratitude
DR. MOHD SAFWAN SHAIKH

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 INDEX

Sr. No. SUBJECT PAGE NO.

1. AIMS AND OBJECTIVES OF STUDY 6

2. INTRODUCTION 7

3. MATERIALS AND METHODS 8

4. OSTEOARTHITIS – A DETAIL STUDY 10

5. OSTEOARTHRITIS – IN FEMALES 27

6. HOMOEOPATHIC APPROACH IN GENERAL 32

7. HOMOEOPATHIC APPROACH & OSTEOARTHRITIS 36

IN PARTICULAR

8. CASES 39

9. CONCLUSION 93

10. OBSERVATION 94

11. MASTER CHART 98

12. BIBLIOGRAPHY 99

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 AIMS AND OBJECTIVES
• TO STUDY IN DEPTH THE GIVEN TOPIC BY ANALYSIS OF SEVERAL CASES.

• TO KNOW THE EFFICACY OF HOMOEOPATHY IN MANAGEMENT OF

OSTEOARTHRITIS IN FEMALES.

• TO STUDY THE DISPOSITION IN A PERSON TO GET OSTEOARTHRITIS IN

FEMALES.

• TO TREAT PATIENT WITH HOLISTIC APPROACH AND PROVIDE BEST POSSIBLE

RESULTS.

• FOR A BETTER UNDERSTANDING OF DYNAMIC CONCEPT OF DISEASE AS

COMPARED TO THE MATERIAL CONCEPT OF DISEASES.

• TO INDIVIDUALISE CASES REQUIRING DIFFERENT CHRONIC REMEDIES

DEPENDING ON DIFFERENT FUNDAMENTAL CAUSES.

• TO UNDERSTAND IMPROVEMENT IN SUSCEPTIBILITY AFTER ACUTE AND

CHRONIC REMEDIES.

• TO UNDERSTAND THE ROLE OF AUXILLARY LINE OF TREATMENT ALONG

WITH HOMOEOPATHIC MEDICINE.

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 INTRODUCTION
Developed, as we call our world in this stage, what’s the actual meaning of developed
countries? Are we developed in means of living, developed with respect to
industrialisation, developed in matters of means of transportation & communication? Yes,
we are developed and more civilised if compared with our ancestors. But, it is said that
everything has its merits and demerits. We are developed in our medical facilities too, but
have we noticed that simpler diseases have developed into more progress one. They have
become our daily part of life. Every second one or the new manifestation in the same
disease is seen or itself a new disease is diagnosed.

As clearly mentioned by Hahnemann, our mother of all miasms, psora has now travelled
so far, that it has been complexed with many other manifestations and taken a new face
altogether. It is becoming difficult and difficult day by day in order to achieve cure. The
pathologies have become more and more complex nowadays.

My topic Osteoarthritis is the one of such diseases which are rendered miserable to cure
because of this industrialization & civilisation. Again the incidences have increased due to
the same reason. Prevalence is more due to habit we have fall to.

I have tried my level best to make a paper on this disease with respect to females, who
are more prone to this disease, Osteoarthritis.

I will be glad if my work ‘OSTEOARTHRITIS IN FEMALES AND ITS

HOMOEOPATHIC APPROACH’ will prove a great help to you, to help the suffering
humanity, to cure your fellow beings, to achieve our mission as a physician of healing art,
as described by Hahnemann.

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  MATERIAL AND METHODS:
The present study entitled as “OSTEOARTHRITIS IN FEMALES AND ITS
HOMOEOPATHIC APPROACH ” will be carried out at Y.M.T Homoeopathic Medical
College ,Kharghar, Navi Mumbai ,with the help of our respective teachers.

 SELECTION OF SAMPLES:
10 Cases of Osteoarthritis in females will be selected as samples for research study.

INCLUSION/EXCLUSION CRITERIA:
 INCLUSION:
1) Diagnosed cases of osteoarthritis.
2) Only females presenting with symptom of osteoarthritis will be considered.
3) Women from different socio economic groups and occupation will be considered.

 EXCLUSION:
1) All male patients presenting with osteoarthritis will be excluded.
2) Patient with gross pathological changes will be excluded.

 STUDY DESIGN:
Observational study

 INTERVENTION:
The detailed case history of the patient will be taken and processed in a standard
homoeopathic case record. Every case will be analyzed and repertorized by using
repertory. And according to the repertorial totality Homoeopathic similimum will be
selected.

 SELECTION OF TOOL
• Standardized homoeopathic case taking format will be prepared and used in each
case.
• Potency and repetition of the selected medicine will be decided as per the need
of the case.
• Literature will be collected from Books of Medicine,
Repertory, Philosophy, clinical therapeutic books, Webpages

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  BRIEF OF PROCEDURE:
The detailed case history of the patient will be taken & processed in a standard case
record. Every case will be analyzed and repertorized. After Detailed case study
based on similarity of symptoms and Repertorial totality a drug will be selected.

 DATA COLLECTION:
Only menopausal female patient presented with symptoms of osteoarthritis
will be taken for study. The detailed case history of patient will be taken and
processed in a standard homoeopathic case record.

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10
 OSTEOARTHRITIS – A DETAIL STUDY
Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology
characterized by loss of articular cartilage, hypertrophy of bone at the margins,
subchondral sclerosis and range of biochemical and morphological alterations of the
synovial membrane and joint capsule. Pathological changes in the late stage of OA include
softening, ulceration and focal disintegration of the articular cartilage; synovial
inflammation also may occur. Typical clinical symptoms are pain, particularly after
prolonged activity and weight bearing; whereas stiffness is experienced after inactivity.1 It
is probably not a single disease but represents the final end result of various disorders as
joint failure. It is also known as degenerative arthritis, which commonly affects the hands,
feet, spine, and large weight-bearing joints, such as the hips and knees. Most cases of
osteoarthritis have no known cause and are referred to as primary osteoarthritis. Primary
osteoarthritis is mostly related to aging. It can present as localized, generalized or as
erosive osteoarthritis. Secondary osteoarthritis is caused by another disease or condition.1
Osteoarthritis (OA) is the second most common rheumatological problem and is most
frequent joint disease with prevalence of 22% to 39% in India.2-4 This is the most
common cause of locomotor disability in the elderly. Gastrointestinal toxicity is present in
50% of NSAIDs users and 5.4% develop a more serious event requiring hospitalisation
due to its frequent use. There use may have a significant impact on overall cost of therapy
in patients of OA in spite the fact that NSAIDs are not very costly. Hence, OA represents a
major cause of morbidity and disability, as well as a significant economic burden on
patients and health care resources. The article reviews different aspects of OA with an
emphasis on early treatment with different modalities to minimize the major physical,
mental, social and economic trauma.

CLASSIFICATION:-
1) Primary osteoarthritis (idiopathic)
A. Localised

– Hands – nodal osteoarthritis more than three joints involved

– Hip – eccentric, concentric, diffuse

– Knee – medial tibiofemoral, lateral tibiofemoral, patellofemoral

– Spine – epiphyseal, intervertebral, spondylosis

B. Generalised

1. Small (peripheral) joints

2. Large (central) joints

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3. Mixed and spine

C. Erosive osteoarthritis

2) Secondary
i) Congenital and developmental disorders, bone dysplasias.

ii) Post-surgery / injury – meniscectomy.

iii) Endocrine – diabetes mellitus, acromegaly, hypothyroidism, hyperthyroidism,

hyperparathyroidism, Cushing syndrome.

iv) Metabolic – hemochromatosis, ochronosis, Marfan's syndrome, Ehler-Danlos syndrome,

Paget disease, gout, pseudogout, Wilson’s disease, Hurler disease, Gaucher disease. v)
Rheumatologic– rheumatoid arthritis.

vi) Neurological– Charcot joints.

vii) Haematological –

hemoglobinopathies. viii) Iatrogenic

– intra-articular steroids.

ETIOLOGY:-
Exact etiology is unknown and multiple factors interact to cause this disorder.

Age : Although advance osteoarthritis may occur in many young people in early 20’s, the
frequency of condition escalates markedly in advancing years. Furthermore, older people
are found to have rapid radiological progression of osteoarthritis.
Sex : The Framingham Knee Osteoarthritis study suggests that knee osteoarthritis
increases in prevalence throughout the elderly years, more so in women than in men.
Females are found to have more severe OA, more number of joints are involved, and have
more symptoms and increased hand and knee OA. These observations and others reporting
a painful form of hand osteoarthritis after the menopause suggest that loss of estrogen at
the time of menopause increases a woman’s risk of getting osteoarthritis,13 however few
contrary reports are pouring in.
Obesity : Obesity precedes rather than follow knee osteoarthritis and indeed weight loss
prevents development of knee osteoarthritis.

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Genetic : Hip osteoarthritis has a significant genetic component.16 Nodal generalised
osteoarthritis is a polyarticular form of osteoarthritis characterized by Heberden’s nodes
occurring mainly in women of perimenopausal age. Heberden’s nodes appear to be
inherited independently as an autosomal dominant trait with greater penetrance in
women.17 In 1990, Knowlton et al18 reported a non-glycine, second position, autosomal
dominant Arg-Cys mutation of COL2A1 in an American family with inherited generalized
OA and minor chondrodysplasia. COL2A1 and vitamin D receptor gene polymorphism
may also be included within genetic risk profile.
Bone density : Negative association has been reported between osteoporosis and
osteoarthritis at certain sites particularly the hip.

Cigarette smoking : Protective influence of smoking on knee osteoarthritis has been

reported from various studies including Framingham study.

Local factors : Major direct injury particularly if resulting in a fracture of articular surface
is considered a cause of osteoarthritis. Trauma in college years (mean age 22) increases
subsequent prevalence of osteoarthritis in subjects in their 60’s.
Joint location : OA is more common in hip and knee joint but occur rarely in ankle.
Alteration in chondrocyte responsiveness to different cytokines may be the reason e.g.
knee chondrocytes exhibit more IL-1 receptors than ankle chondrocytes and knee
chondrocytes express mRNA for matrix MMP-8.
Other : Chondrocalcinosis,10 crystals in joint fluid / cartilage, prolonged immobilization,
joint hypermobility or instability, peripheral neuropathy, prolonged occupational or sports
stress are the important risk factors for the causation of OA.

PATHOGENESIS
Although the aetiology of OA is incompletely understood, the accompanying biochemical,
structural and metabolic changes in the joint cartilage has been well documented. It is now
known that cytokines, mechanical trauma and altered genetics are involved in
pathogenesis and that these factors can initiate a degenerative cascade that results in many
characteristic alterations in the articular cartilage in OA. Normal hyaline cartilage is
composed of chondrocytes embedded in extracellular matrix which in turn is constituted
by water, type II collagen and proteoglycan. The cartilage remains stable with active
degeneration and regeneration occurring in equilibrium. Whatever is the triggering event,
it leads to matrix and cartilage degeneration on one hand and active chondrocyte
replication with enhanced biosynthesis on the other hand. This leads to a state of
homeostasis, known as compensated OA, in which both repair and degeneration are
balanced. After a few years, the reparative process is exhausted. This leaves cartilage
degradation unopposed leading to progressive OA. More recently it has become apparent
that OA is a disease process that affects the entire joint structure, including cartilage,

13
synovial membrane, subchondral bone, ligaments and periarticular muscles. This
ultimately results into inflammation, pain and structural damage leading to loss of function
(Fig. 1).
The structural changes, metabolic, biochemical changes in osteoarthritis cartilage and role
of growth factors and cytokines in the pathogenesis of OA is depicted below.

Structural changes: Mainly are reductions in stainable proteoglycan, fibrillation, collagen

crumping, chondrocyte multiplication or migration and loss of cartilage. Initially, localized
areas of softening present a pebbled texture at surface followed by disruption along
collagen fibre planes (tangential flaking, vertical fibrillation). As deep clefts are formed in
cartilage, nearby matrix gets depleted of metachromatic material indicating loss of
proteoglycans. Subsequent focal proliferation of chondrocytes occurs as an attempt at
local self-repair leading to irregularly shaped hyaline and fibro cartilage. Later new bone
formation occurs in subchondral bone and at joint margins (osteophytes) Sub-articular
cysts predominate wherever overlying cartilage is thin or absent. Separated fragments of
cartilage and bone may form loose bodies, undergo dissolution or become incorporated
into synovium and proliferate locally. Synovium becomes thick and hypertrophied and
capsule contracts with infiltration of lymphoid follicles, lymphocytes and macrophages.
Calcification may occur as calcium crystals deposit in cartilage with presumed secondary
uptake in synovium. Despite loss of bone and cartilage in some parts of joint, net effect of
new cartilage and bone formation is an increase in joint size and remodelling of shape.

Metabolic and biochemical changes in osteoarthritis cartilage

• Generalised – Increased hydration and swelling with loss of tensile strength is
noticed in early OA, whereas increase in type I collagen synthesis and progressive fall
occurs in proteoglycan concentration in later stage of OA.

• Specific collagens – Initial swelling of collagen fibrillar network with loss of type II
collagen, specific cleavage of collagens and loss of tensile strength with increased content
of collagen type IV. Type III and X collagen are also synthesized.

• Proteoglycans – Increased extractability and decrease in monomer size because of

specific cleavages by aggrecanases and metalloproteinase.
• Cytokines, proteinases and inhibitors – There is increase in pro-inflammatory
cytokines, aggrecanases, MMPs (matrix metalloproteinase), cathepsins and decrease in
overall inhibitors (TIMP etc.). Of the three major MMPs (1, 8, and 13) that degrade native
collagen, MMPs -13 is most important, as it preferentially degrades type II collagen whose
expression is greatly increased in OA. The aggrecanases belong to a family of
extracellular proteases known as disintegrin and metalloproteases with thrombospondin
motifs (ADAMTS). ADAMTS-4 and ADAMTS-5 appear to be major enzymes in
cartilage degeneration in arthritis. Whereas, IL-1beta synthesized by mononuclear cells
(including synovial cells) in inflamed joint is considered by many investigators as a prime
14
mediator in cartilage matrix degradation and stimulates synthesis and secretion of many
degradative enzymes in cartilage including latent collagenase, stronelysin, gelatinase and
tissue plasminogen activator. The balance of active and latent enzymes is controlled to
some extent by at least two enzyme inhibitors: TIMP and plasminogen activator
inhibitor1(PAT-1).Which in turn are reglated by TGF-beta. However, the imbalance
between proteoglycan synthesis and degradation is important in pathogenesis of cartilage
breakdown.

Growth Factors and Cytokines Anabolic

• TGF (tissue growth factor beta- 1, 2 & 3) help in chondrocyte proliferation, matrix
synthesis, modulate effects of IL-1 and increases proteinase inhibitors.
• Fibroblast and platelet derived growth factors also help in differentiation and
proliferation of chondrocytes and MMP production.
• Insulin growth factor-1(IGF-1) increases glycosaminoglycan (GAG) and collagen
synthesis.
• Bone morphogenetic proteins increase matrix synthesis.

Catabolic
• Interleukin-I (IL-1) and tumor necrosis factor (TNFa) increase MMPs, inhibit GAG
synthesis and can further potentiate the degenerative cascade.
• Oncostatin-M combines with IL-1 and TNF to promote matrix breakdown.
• Others like IL-17 and IL-18 increase expression of IL-1bð and IL-6 and increase MMP.
• NO (nitric oxide) is a major catabolic factor produced by chondrocytes in response to
proinflammatory cytokines such as IL-I beta and TNF-alpha. NO can inhibit collagen
and proteoglycan synthesis, can activate MMPs and cause an oxidative injury as well as
produce apoptosis leading to degradation of articular cartilage.
• Prostaglandins effects on chondrocytes metabolism are complex and include enhanced
type II collagen synthesis, activation of MMPs, and promotion of apoptosis. In cartilage
explants, IL-1beta induces COX-2 expression and PGE2 production coordinate with
proteoglycan degradation. Moreover, COX-2 inhibition prevents IL-1beta induced
proteoglycan degradation.

Regulatory
• IL-6 increases proteinase inhibitors production and proliferation of chondrocytes while
IL-4, IL-13 and interferon ³ oppose effects of proinflammatory cytokines. IL-1 receptor
antagonist blocks effect of IL1.

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CLINICAL FEATURES
Symptoms: Pain is the chief complaint. This is due to stimulation of capsular pain fibres,
mechanoreceptors (increased intra-articular pressure due to synovial hypertrophy),
periosteal nerve fibres and by perception of subchondral micro fractures or painful
entheses and bursae. Stiffness is other complaint described as gelling of joint after
inactivity with difference in initiating movement. Some patients may complain of joint
swelling and deformity and coarse crepitus.

Signs: Coarse crepitus, due to irregularity of articular surface, bony enlargement due to
remodelling and osteophytes, deformity, instability, restricted ability and stress pain.

Nodal generalized osteoarthritis:Present commonly as polyarticular, finger I-P joint

involvement, Heberden (distal I-P joint) and Bouchard (proximal I-P joint) nodes. There is
female predominance peaking around menopause and marked familial predisposition.
Typically patient is a woman aged 40-60 years developing discomfort followed by
swelling of single finger inter-phalangeal joint, later involving another I-P joint within few
months and then another producing stuttering onset of polyarthritis of distal and proximal
IP joints.

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Erosive osteoarthritis:Uncommon variety, with hand I-P joint involvement, inflammatory
signs, erosion in subchondral regions in radiography and tendency for ankylosis of I-P
joints. Subchondral erosive change may lead to ‘Gull’s wing’ as remodelling occurs.

Large joint osteoarthritis

Knee : Most commonly affected by osteoarthritis, usually bilateral, often occurs in

association with hand osteoarthritis especially in women. Invariably focal with principal
sites involved being (i) medial tibiofemoral compartment with severe bone and cartilage
attrition at this site resulting in various deformities; (ii) patellofemoral compartment
(lateral > medial) because of its intimate relationship with the quadriceps mechanism
leading to greater functional impairment.

Hip : Superior pole osteoarthritis is commonest with focal cartilage and loss in superior
part of joint. Osteophyte formations are prominent at lateral acetabular and medial femoral
margins with thickening of cortex of medial femoral neck by periosteal osteophytes.
Central medial osteoarthritis is less common, with more central joint space loss with less
femoral neck buttressing. More associated with nodal osteoarthritis.

Osteoarthritis at other joint sites

Osteoarthritis of spinal epiphyseal joints (lower cervical and lower lumbar segments), first
carpometacarpal and/or first metatarsophalangeal joints is common and may occur as a
part of pattern of generalised osteoarthritis or as an isolated feature (Table 1).The
diagnosis of OA is essentially clinicradiological.

Table 1
Classification criteria for osteoarthritis of the hip:-
Traditional format
Hip pain plus at least two of the following
ESR of less than 20 mm per hour
Femoral or acetabular osteophytes on radiographs Joint
space narrowing on radiographs (superior, axial and or
medial)
Classification-Tree format
Hip pain plus femoral or acetabular osteophytes on
radiographs or
Hip pain plus joint space narrowing on radiographs and an
ESR of less than 20 mm per hour.28
Classification criteria for idiopathic osteoarthritis of the knee:-
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Traditional format
Knee pain plus osteophytes on radiographs and at least one of the
following
Age more than 50 years
Morning stiffness lasting 30 minutes or less
Crepitus on motion
Classification-Tree format
Knee pain and osteophytes on radiographs or
Knee pain plus patient age of 40 years or older,
Morning stiffness lasting less than 30 minutes and crepitus on
motion.29
Classification criteria for osteoarthritis of the hand:-
Hand pain, aching or stiffness plus
Hard tissue enlargement of two or more of 10 selected joints Plus
Fewer than three swollen metacarpophalangeal joints Plus Hard
tissue enlargement of two or more distal interphalangeal joints
or
Deformity of two or more of 10 selected joints.30
(10 selective joints are 2nd and 3rd DIP joint, 2nd and 3rd PIP joint
and 1st carpo-metacarpal joint of both hands)

INVESTIGATIONS
X-rays are still the main diagnostic tool however arthroscopy, ultrasound, MRI, CT scan
etc. are used specially for experimental studies and not recommended for routine clinical
use. Plain radiographs can show joint space narrowing, osteophytes, sclerosis and
subchondral radiolucency’s. Other features like effusions, loose bodies, joint alignment,
subluxation, chondro-calcinosis, and collapse due to avascular necrosis are also noticed.
Modified radiographic techniques with higher magnification and resolution may detect
early subchondral bone abnormalities by stereoscopereconstruction. Radionuclide studies
may detect abnormalities before radiographic signs are identified. Arthrocentesis and
laboratory testing may help identify an underlying cause of secondary OA.

Radiological findings of specific joints10

Hand : Single postero-anterior view is satisfactory. Bone sclerosis, focal narrowing and
lateral subluxation accompanied by erosions and in case of erosive osteoarthritis, all
changes of osteoarthritis plus subchondral bone erosion-gullwing appearance may be
noticed.

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Knee :
Views –

A. Standing anteroposterior (weight-bearing).

B. Lateral.

C. Notch patellar views (sunrise view)

1. Posteroanterior intracondylar (PAIC)

2. Tangential patellar

Findings –

A. Joint space narrowing

1. Medial tibiofemoral joint space narrowing

2. Patellofemoral joint space narrowing

3. Lateral joint space narrowing to lesser extent

B. New subchondral bone formation

C. Tibia lateral subluxation

D. Medial osteophytes formation is most prominent initially

Hip : Single non-weight bearing A-P view of pelvis is usually satisfactory and has
advantages of incorporating both hips on same radiograph.
Sacroiliac joint:
Osteophyte and joint space loss may need to be distinguished from inflammatory
sacroiliitis. Osteoarthritis causes more focal space narrowing and sclerosis with overlying
osteophytes, usually anterosuperior/inferior and is identified by discontinuity of trabecular
lines across joint.

Foot : Posteroanterior radiograph of foot.

Spine : More in lower cervical and lumbar spine and may also in facet joints (cervical
region). Lateral, AP lumbosacral and cervical views are appropriate.

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MANAGEMENT OF OSTEOARTHRITIS

Goals of managing osteoarthritis include controlling pain, maintaining and improving

range of movement and stability of affected joints and limiting functional impairment .

AUXILLARY MANAGEMENT
Education, behavioral intervention, weight loss, lower extremity strengthening exercise for
20-30 minutes per day, quadriceps strengthening, gait training, active range of motion of
hip, knee and ankle, instructions in use of cane, graded elastic band use and pool therapy
are modestly effective in reducing pain and disability. Mechanical aids in the form of
shock-absorbing footwear with good mediolateral support, adequate arch support and
calcaneal cushion are also helpful. Lateral heel wedges may reduce pain related to
osteoarthritis of medial tibiofemoral compartment and applying adhesive tapes to patella
can provide relief in patellofemoral osteoarthritis

Lifestyle modification, particularly exercise and weight reduction, is a core component in

the management of osteoarthritis.Guidelines from Osteoarthritis Research Society
International (OARSI) advise that nonpharmacologic treatment of hip and knee
osteoarthritis should initially focus on self-help and patient-driven modalities rather than
on modalities delivered by health professionals.

The ACR strongly recommends the following nonpharmacologic measures for patients
with knee or hip osteoarthritis] :

• Cardiovascular or resistance land-based exercise

• Aquatic exercise

• Weight loss, for overweight patients

The ACR conditionally recommends the following measures for patients with knee or hip
osteoarthritis:

• Self-management programs

• Manual therapy in combination with supervised exercise

• Psychosocial interventions

• Thermal agents

• Walking aids, as needed

20
 • For patients with knee osteoarthritis, the ACR also conditionally recommends
the following measures:

• Medially directed patellar taping

• Medially wedged insoles for lateral-compartment osteoarthritis

• Laterally wedged subtalar strapped insoles for medial-compartment

osteoarthritis
• Tai chi

For knee osteoarthritis, an American Academy of Orthopaedic Surgeons (AAOS)

guideline suggests encouraging patients to participate in self-management educational
programs such as those conducted by theArthritis Foundationand to incorporate activity
modifications into their lifestyle (e.g., walking instead of running or engaging in
alternative activities).

Instruct the patient to avoid aggravating stress to the affected joint. Implement corrective
procedures if the patient has poor posture.

Weight reduction relieves stress on the affected knees or hips. The benefits of weight loss,
whether obtained through regular exercise and diet or through surgical intervention, may
extend not only to symptom relief but also to a slowing in cartilage loss in weight-bearing
joints (e.g., knees).In addition, weight loss lowers levels of the inflammatory cytokines
and adipokines that may play a role in cartilage degradation.

Some patients with osteoarthritis benefit from heat placed locally over the affected joint. A
minority of patients report relief with ice.

Physical activity

Although people with osteoarthritis tend to avoid activity, exercise is an effective

treatment for this condition, producing improvements in pain, physical function, and
walking distance. Long-term walking and resistance-training programs have been shown
to slow the functional decline seen in many patients with osteoarthritis, including older
patients.

Osteoarthritis of the knee may result in disuse atrophy of the quadriceps. Because these
muscles help protect the articular cartilage from further stress, quadriceps strengthening is
likely to benefit patients with knee osteoarthritis. Stretching exercises are also important in
the treatment of osteoarthritis because they increase range of motion.

21
In a study of patients with knee osteoarthritis, Jan et al found that in most respects, non–
weight-bearing exercise was as therapeutically effective as weight-bearing exercise .After
an 8-week exercise program, the 2 types of exercise resulted in equally significant
improvements in function, walking speed, and muscle torque. However, patients in the
weight-bearing group demonstrated greater improvement in position sense, which may
help patients with complex walking tasks, such as walking on a spongy surface.

The importance of aerobic conditioning, particularly low-impact exercises (if osteoarthritis

is affecting weight-bearing joints), should be stressed as well. Swimming, especially the
aerobic aquatic programs developed by the Arthritis Foundation, can be helpful.

The benefits of exercise have been found to decline over time, possibly because of poor
adherence. Factors that determine adherence to exercise have not been carefully studied in
patients with osteoarthritis. In a review of this topic, Marks and Allegrante concluded that
interventions to enhance self-efficacy, social support, and skills in the long-term
monitoring of progress are necessary to foster exercise adherence in people with
osteoarthritis.
Assistive devices
The use of assistive devices for ambulation and for activities of daily living (ADLs) may
be indicated for patients with osteoarthritis. Braces and appropriate footwear may also be
of some use. A cane can be used in the contralateral hand for hip or knee osteoarthritis.
The patient can be taught joint-protection and energy-conservation techniques .For
patients with hand osteoarthritis, the ACR conditionally recommends evaluating the
patient’s ability to perform ADLs and providing assistive devices as needed. The ACR
conditionally recommends splints for patients with trapeziometacarpal joint involvement.

Occupational therapy and physical therapy

Occupational adjustments may be necessary for some patients with osteoarthritis. An
occupational therapist can assist with evaluating how well the patient performs ADLs, as
well as with retraining of the patient as necessary. Joint-protection techniques should be
emphasized. Physical therapy modalities, especially those aimed at deconditioned patients,
can be helpful, particularly in patients with hip or knee involvement.

Electromagnetic field stimulation and TENS

A pulsed electromagnetic field stimulation device (Bionicare) has been approved by the
US Food and Drug Administration (FDA) for use in patients with knee osteoarthritis.
Pulsed electromagnetic field stimulation is believed to act at the level of articular cartilage

22
by maintaining the proteoglycan composition of chondrocytes through down regulation of
its turnover.

A multicentre, double-blind, randomized, placebo-controlled 4-week trial in 78 patients

with knee osteoarthritis found improved pain and function in those who were treated with
the device.A doubleblind, placebo-controlled 3-month trial in 58 patients with moderate-
to-severe knee osteoarthritis showed that the use of a highly optimized, capacitively
coupled, pulsed electrical stimulus device yielded significant symptomatic and functional
improvement.

Another randomized clinical trial demonstrated that pulsed short-wave treatment was
effective in relieving pain and improving function and quality of life in women with knee
osteoarthritis on a shortterm basis; additional studies are needed to validate the 12-month
follow-up.

Transcutaneous electrical nerve stimulation (TENS) may be another treatment option for
pain relief. To date, however, there is only limited evidence that TENS is beneficial in this
setting. A systematic review could not confirm that TENS is effective for pain relief in
knee osteoarthritis.A randomized controlled trial found that TENS applied in conjunction
with therapeutic exercise and daily activities increased quadriceps activation and function
in patients with tibiofemoral osteoarthritis.

Acupuncture
Acupuncture is becoming a more frequently used option for treatment of the pain and
physical dysfunction associated with osteoarthritis. Some evidence supports its use. For
example, a review article of randomized, controlled trials reported that the level of pain
persisting after acupuncture was significantly lower than the level of pain persisting after
control treatments.

Arthroscopy:-
A procedure of low invasiveness and morbidity, arthroscopy will not interfere with future
surgery. However, a randomized, controlled trial in patients with moderate-to-severe
osteoarthritis found that arthroscopic surgery for osteoarthritis of the knee provided no
additional benefit beyond that afforded by optimized physical and medical therapy.
Arthroscopy is indicated for removal of meniscal tears and loose bodies; less predictable
arthroscopic procedures include debridement of loose articular cartilage with a micro
fracture technique and cartilaginous implants in areas of eburnated subchondral bone (see
the images below). These treatments have varying success rates and should be performed
only by surgeons experienced in arthroscopic surgical techniques.Overall, arthroscopy is
not recommended for nonspecific “cleaning of the knee” in osteoarthritis.
23
 Arthroscopic view of a torn meniscus before (top) and after (bottom)
removal of

loose meniscal fragments. Arthroscopic view of an

arthritic knee.

Arthroscopic view of a knee

after the removal of loose
fragments of

articular and meniscal cartilage. Arthroscopic view of the removal of cartilaginous loose
body.
Patients who undergo arthroscopy usually require a period of crutch use or exercise
therapy. This period typically lasts days but sometimes extends for weeks.

24
Osteotomy
Osteotomy is used in active patients younger than 60 years who have a malaligned hip or
knee joint and want to continue with reasonable physical activity.The principle underlying
this procedure is to shift weight from the damaged cartilage on the medial aspect of the
knee to the healthy lateral aspect of the knee. Osteotomy is most beneficial for significant
genu varum, or bowleg deformity. (The effectiveness of osteotomy for genu valgum is not
highly predictable.)

Osteotomy often can help individuals avoid requiring a total knee replacement until they
are older. It can lessen pain, but it can also lead to more challenging surgery if the patient
later requires arthroplasty.

Contraindications for osteotomy are as follows:

• Knee flexion of less than 90°

• A flexion-extension contracture of more than 15°

• Varus over 15°-20°

• Instability from previous trauma or surgery

• Severe arterial insufficiency

• Bicompartmental involvement

Patients undergoing osteotomy require partial weight-bearing until bony healing occurs.
Afterward, exercise is indicated.

Arthroplasty
Arthroplasty consists of the surgical removal of joint surface and the insertion of a metal
and plastic prosthesis (see the images below). The prosthesis is held in place by cement or
by bone ingrowth into a porous coating on the prosthesis. The use of cement results in
faster pain relief, but bone ingrowth may provide a more durable bond; accordingly,
prostheses with a porous coating are used in younger patients.

25
 Anteroposterior radiograph shows knee replacement in 1 knee
and arthritis in the other, with medial joint-space narrowing and subchondral sclerosis.

Anteroposterior radiograph of the pelvis and hips shows an

arthritic hip not treated surgically and atotal hip replacement. Anteroposterior
radiograph obtained after knee replacement. Lateral radiograph obtained after knee
replacement (same patient as in the above image).
Arthroplasty is performed if all other modalities are ineffective and osteotomy is not
appropriate or if a patient cannot perform ADLs despite maximal therapy.This procedure
alleviates pain and may improve function. At a minimum, 10-15 years of viability are
expected from joint replacement in the absence of complications.

Infection is a particular postoperative concern in cases of total joint replacement. This

complication is now rare, however, especially with the use of perioperative antibiotics.

Prevention of thrombophlebitis and resultant pulmonary embolism is important in patients

who undergo lower-extremity arthroplasty procedures for osteoarthritis. The surgeon must
use all means available to prevent these complications. Early motion and ambulation,
when possible, are of particular importance. The use of low-molecular-weight heparin or
warfarin is also indicated.

After joint replacement, patients require partial weight-bearing, which progresses to full
weight-bearing in 1-3 months; range-of-motion and strengthening exercises are started
within a few days after jointreplacement surgery and continued until the patient has good
range of motion and strength. After resection arthroplasty of the hip, patients require
instruction in the use of crutches or a walker, which are usually needed permanently.

Fusion and Joint Lavage

Fusion consists of the union of bones on either side of the joint. This procedure relieves
pain but prevents motion and puts more stress on surrounding joints. Fusion is sometimes
used after knee replacements fail or as a primary procedure for ankle or foot arthritis.
26
Observational studies suggested a benefit for joint lavage. However, sham-controlled trials
yielded conflicting results, and a meta-analysis concluded that joint lavage does not result
in pain relief or improvement of function in patients with knee osteoarthritis.

Prevention
Overweight patients who have early signs of osteoarthritis or who are at high risk should
be encouraged to lose weight. Recommend quadriceps-strengthening exercises in patients
with osteoarthritis of the knees, except in those with pronounced valgus or varus deformity
at the knees. It has been proposed that low vitamin D levels may play a role in the
development and progression of osteoarthritis; however, studies of vitamin D status and
osteoarthritis have produced conflicting results.

A systematic review found no convincing evidence that selenium, vitamin A, or vitamin C

is effective for the treatment of osteoarthritis. A prospective cohort study also found no
evidence that vitamin C supplementation slowed the progression of knee osteoarthritis;
however, it did find that patients who reported taking vitamin C were 11% less likely to
develop knee osteoarthritis.

OSTEOARTHRITIS IN FEMALES
Further study of the disease, Osteoarthritis, in depth with respect to females is summarized
under following headings:

FEMALE HORMONAL ASPECTS AND OSTEOARTHRITIS:-

Although the simultaneous occurrence of the menopause and OA in women suggests a
role for female hormones, the underlying mechanisms for this have not yet been
elucidated. Reviewing the associations between OA and exogenous hormone use, and OA
and other female hormonal aspects, showed that the assumed associations are not as clear
as expected.

In these two systematic reviews, we included a total of 25 studies reporting on the

incidence and prevalence of associations between OA and female hormonal aspects. We
found limited evidence for a protective effect of 1) unopposed estrogen use for incident
total joint replacement (hip or knee), 2) ever breastfeeding for carpometacarpal rOA,and
3) a protective trend for incident rOA of the knee. We also found limited evidence for an
increased risk of parity for carpometacarpal and distal interphalangeal rOA, and of low
estradiol serum levels in the early follicular phase of the menstrual cycle for incident knee
rOA. Most evidence we found was conflicting, or was evidence for ‘no association’. It is

27
possible that the relationships with OA are too complex, or other aspects (not yet
determined) play a role in the increased incidence of OA in women aged 50 years and
over.

Osteoarthritis and other rheumatic diseases have been associated with an increase in the
prevalence of cardiovascular diseases (CVDs) in both men and women . As for OA, the
prevalence of CVD increases in women with climacteric onset, whereas before that time
women have a reduced risk compared to men. Another similarity is that associations
between CVD and female hormonal aspects are not yet fully elucidated. Young
premenopausal women are less likely to have CVD than their postmenopausal peers.
Although this is thought to be due to the diminishing levels of estrogen as a result of the
menopause, postmenopausal women do not benefit from hormone replacement therapy
(HRT) . Conflicting relations have been observed when studying associations between
HRT and CVD. Two large observational studies found lower rates of CVD and cardiac
death in postmenopausal women who used HRT compared to those who did not use HRT ,
whereas two randomized placebo-controlled prevention trials could not confirm a cardio-
protective effect of HRT . An explanation for this discrepancy between the results from a
clinical trial and observational studies is still lacking.

One important difference is that in the observational studies HRT is mostly prescribed for
menopausal complaints, while in the clinical trials women with severe menopausal
complaints are excluded or are outnumbered . Van der Schouw et al. hypothesised
climacteric complaints are a marker for susceptibility to the beneficial effects of HRT.

Subsequently, from the same research group, Gast et al. observed that the risk profile for
women with transitional vasomotor complaints (e.g. night sweats and hot flushes) is less
favorable than that for women who do not experience these complaints . Also, women
who use HRT may differ from women who do not, since women with menopausal
complaints may visit their physician more often and might subsequently be more likely to
receive HRT .This difference between HRT users and non-users may also be applicable in
OA studies, and might partly explain why conflicting findings emerge. In our systematic
review on OA and HRT we observed a similar discrepancy, though not as distinct as in the
previous example. The results from observational studies were conflicting or no
association was found, and we could include only one randomized controlled trial which
studied hip and knee replacement . Nine years prior to our systematic reviews, Wluka et
al. also reviewed the association between HRT and OA; they concluded that in
postmenopausal women, radiological disease progression was reduced and incident
disease may be prevented by HRT use, but that hard evidence from trials was lacking .
New findings during the nine years since our reviews, show that evidence on the

28
association of HRT and OA remains conflicting. Studying the influence of menopausal
vasomotor symptoms may shed new light on the associations between OA and female
hormones.

Early degenerative signs and the menopause:

In our systematic reviews we did not include any studies assessing OA using MRI, simply
because we did not find any relevant studies using MRI that complied with our inclusion
criteria. MRI can visualize degeneration of individual tissues in an earlier stage than
radiography, and is suggested to be the best imaging technique currently available for
detecting early osteoarthritic changes . We studied the crosssectional associations between
menopausal aspects and early degenerative signs of knee tissues on MRI in our OA sub-
cohort of the Rotterdam Study. Our aim was to establish where degeneration of joint
tissues can first be visualized in relation to menopausal aspects. We found indications that
in middle-aged women (mainly in those with overweight) early signs of degeneration of
knee tissue can first be visualized in the bone (bone marrow edema-like lesions, and
osteophytes), but not in cartilage. This is in agreement with Sniekers et al. who reported
that estrogenreceptor knockout mice show an increase in the number and/or size of
osteophytes and thinning of the lateral subchondral plate, whilst this was not the case in
wild type mice; no differences in cartilage damage was observed between both types of
mice . Although cartilage degeneration was long considered the main feature in OA
pathology, it is now known that OA affects all joint tissues. However, it is not known
which tissue is in fact affected first. Even though MRI is more sensitive than radiography
in the visualization of cartilage degeneration, good visualization remains a challenge
considering that cartilage is only 1.3-2.5 mm thick in healthy humans , and even less in
OA patients . As discussed in , it is possible that alterations in cartilage are actually
present, but we are not (yet) able to visualize them on MRI. Studying cartilage on a
biochemical level, using advanced quantitative MRI techniques (like dGEMRIC, T1ρ or
T2 relaxation time quantification) might provide more information on the degenerative
process. Zhao et al. found a local spatial correlation between the presence of bone marrow
lesions and advanced cartilage degeneration using T1ρ. In addition, in studying cartilage
using fluorescent microscopic representative images, Rolauff et al. found distinct spatial
and angular patterns between neighboring chondrocytes in animal and human cadavers ;
these alterations in cartilage were not macroscopically visible at that point. Even though
these advanced techniques are not generally used in daily practice and might not be
practical for use in a high-risk profile, they can provide new knowledge on the
mechanisms of OA.

29
OVER WEIGHT:-
In the menopausal transitional period the production of female hormones by the ovaries
diminishes dramatically, resulting in the end of the fertile period. This transition usually
occurs over a period of several years and is a normal part of natural aging. As stated
above, the prevalence of OA and CVD increases with climacteric onset, whereas before
that time women have reduced risk compared to men in both diseases. Similar to OA,
CVD is associated with obesity and it is suggested that a pathological alteration of fat
mass (such as in overweight and obese persons) could be the link between CVD and
rheumatic diseases . Around the time of menopause the distribution of body fat changes
and women get more body fat overall, but specifically, more abdominal and visceral fat .
Intraabdominal fat tissue is functionally and metabolically different from subcutaneous
tissue. High body weight and high body fat levels can influence the development of OA in
various ways, not only locally by higher biomechanical or differential loading of the knees
, but also systemically by secretion of inflammatory mediators and estrogens by adipose
tissue . Being overweight, and thus having a lot of adipose tissue, has been proposed to
cause a state of permanent low-grade, sub-clinical inflammation of this adipose tissue.
Especially visceral fat seems to play an important role in this process. It is not yet fully
elucidated what role sex hormones have in the change in body fat distribution in
perimenopausal women. When estrogen levels become sufficiently low, it is generally
assumed that accumulation of visceral fat occurs. It is also suggested that estrogens limit
fat storage in visceral adipocytes in premenopausal women, due to regulation of lipolysis
and lipogenesis. It is possible that changes in body fat distribution combined with changes
in hormonal levels play a role in the increased OA incidence in menopausal women.

Interactions between BMI and other OA risk factors:

Being overweight is the most important modifiable risk factor for OA, especially in those
who also have other risk factors. Moreover, risk factors can interact with each other,
making it even more challenging to identify OA at an early stage and to develop
preventive strategies. Before our study, very few studies had investigated interactions
between BMI and other risk factors and, those that did, mostly included populations with
established knee OA. However, identifying persons at high risk requires a study
population that is actually‘at risk’ for OA development. Therefore, we studied interactions
between the known risk factor ‘body mass index’ (BMI=kg/m2) and other known risk
factors. Reijman et al. found a high BMI ≥27 to be clearly associated with incident knee
rOA .Therefore, in a general population we investigated the associations of known risk
factors and knee symptoms with rOA to see whether they differ between women with a
high BMI (≥27) and with a low/normal BMI (<27). In this open study population we

30
found that risk factors for and symptoms of knee rOA differ in magnitude between those
with low/normal BMI and with high BMI, irrespective of OA severity. Although exploring
interactions is difficult because a high level of statistical power is needed to reveal
significant results, we found a significant interaction between BMI and knee morning
stiffness lasting <30 minutes (OR=3.19, p<0.05). Also, being post-menopausal and
tenderness on palpation of the knee joint space showed a trend for interaction.

SYMPTOMS:-
Pain perception, similar to OA, is a multifactorial phenomenon. There are different types
of pain which can generally be distinguished according to the pathogenesis. Normal tissue
sends out physiological nociceptive pain signals as a warning when it is actually damaged
or at high risk of becoming damaged.
This is absolutely necessary for survival because it triggers acute pain-avoiding behaviour.
Pathophysiological pain is triggered by inflammation or injury to the joint. In OA pain is
considered to be mainly pathophysiological nociceptive, although other mechanisms have
also been reported. Sensitivity to pain is highly variable among humans and the
development of chronic pain is partly dependent on genetic variance. Therefore, people
who develop chronic pain might have an unfavorable genetic makeup.
Catechol-0-methyltransferase (COMT) is an enzyme that degrades neurotransmitters like
dopamine.
Dopamine plays a role in the general feeling of well-being and in experiencing pleasure
and happiness. The secretion of COMT is influenced by estrogen levels; low estrogen
levels, such as found in postmenopausal women, because lower levels of COMT. Wise ET
al.found that psychological factors fluctuate with experiencing pain in knee OA patients,
and in animal studies the inhibition of COMT secretion was shown to increase pain
sensitivity. Low levels of COMT are also associated with anxiety phenotypes in women.
Van Meurs et al. examined whether individuals with the Val158Met variant of COMT (a
well-known functional polymorphism) experienced more hip pain in relation with hip OA.
They found that women carrying the 158Met allele of COMT, compared to carriers of the
ValVal genotype, were almost 3-fold more likely to experience hip pain, while women
with the 158Val allele were 4.9-fold more likely to experience hip pain. These associations
were not observed in men, but may also have been due to statistical power problems. For
the pain due to knee OA an association with this polymorphism of COMT is not yet
established .The relationship between sex hormones and pain perception is not yet fully
understood. During the menopausal transitional period, joint aches and stiffness are
common and increase in prevalence, but these complaints are not necessarily related to
OA .Pain perception in premenopausal women fluctuates, with an increase in perceived
pain in the lowestradiol/progesterone phase of the menstrual cycle. This is in line with the
31
decline of COMT levels with the diminishing of estrogen levels in postmenopausal
women, making these women more susceptible to experience pain. However, not all
postmenopausal women with knee rOA experience knee pain.

Early degenerative signs and symptoms:

We found that bone marrow lesions (BMLs) were associated with being postmenopausal
in overweight women. Changes in the size of BMLs were associated with changes in knee
pain in those with and without established knee rOA, and another study reported that
BMLs were associated with the risk of knee joint replacement in persons with knee rOA.
The relation between BMLs and the presence of pain was systematically reviewed in
2011, and the overall evidence was moderate to strong. In our study, in disease-free
women BMLs were significantly associated with being postmenopausal and increasing
years since menopause. These findings were adjusted for current hormone use, of which
the prevalence was low. Estrogen use has been found to be protective for BMLs the
histology of BMLs is heterogeneous, and the presence of BMLs in other joint diseases
(such as rheumatoid arthritis) may have a different pathological basis. On MRI, BMLs are
defined by the Knee Osteoarthritis Scoring System (KOSS) and the Whole-Organ
Magnetic Resonance Imaging Score (WORMS) as ill-defined areas of increased signal
intensity to the subchondral bone. In vivo BMLs are found to represent multiple
histological abnormalities, including bone marrow fibrosis, bone marrow necrosis, bone
marrow edema and trabecular abnormalities, which are not specificallycharacteristic for
OA. The size of MRI-detected BMLs in the knees is not static and in persons in an early
stage of OA, fluctuation in knee pain may be due to changes in BMLs. It is possible that in
advanced disease, pathology of other structures contribute to knee pain.

Predicting radiographic disease and knee pain:

Not everyone with knee rOA has knee complaints and vice versa. In the RS.I.1 cohort,
Odding et al.
found that in subjects with rOA in the knees, knee pain was present in 25.4% of the men
and 34.2% of the women. In subjects with knee pain, 32.9% of the men had knee rOA as
did 44.7% of the women. Also in other population studies, large variations were seen. This
discrepancy between pain experience and prevalence of knee rOA is well reported.
Currently, it is impossible to identify which patients with knee complaints presenting to
their physician will, or will not, develop rOA pathology in the knee at a later stage.
Knowledge on which risk factors predict rOA development in the future will help to
formulate a
‘high-risk profile’ which can be used in daily practice. We studied possible predictors for
developing OA pathology on X-ray in persons with knee complaints, but with no rOA at
32
baseline in the painful knee. This study revealed that the best predictors of knee rOA
development are female gender, having joint complaints in joints other than the knee, and
having a Kellgren & Lawrence grade 1 in the painful joint. It would be even better to
prevent people from becoming symptomatic, in other words to prevent the development of
(OA-related) knee pain. Pain is the most important clinical symptom of OA and in middle-
aged people knee pain is most often attributed to (early) OA. Predicting who will develop
knee pain in a later stage can therefore be considered an important step in the process of
identifying persons at high risk of OA. We took another step back in the process of early
identification of OA. We earlier found that women with knee pain are at higher risk of
developing rOA in the future. Therefore, we studied predicting factors for knee pain
development after two years in women without knee pain at baseline. When we analyzed
all women together (irrespective of the pain status of the other knee at baseline), we found
that having knee pain in the other knee, and having had knee trauma in the past, were the
best predictors of OA. In a subgroup analysis of women without knee pain in either knee
at baseline, the best predictors of knee pain were 1) tenderness on palpation of the
tibiofemoral joint space, 2) knee trauma in the past, and 3) lateral meniscus degeneration.
In women with pain in one knee at baseline, the best predictors for new pain in the other
knee were 1) knee trauma in the past, 2) crepitus on active movement, 3) being
postmenopausal, and 4) high BMI. BMI was a significant predictor in all studied groups.
However, in the final analysis which included all predictors with a p-value <0.1 in the
separate determinant groups, BMI remained significant only in the group with unilateral
knee pain at baseline. In this latter group the incidence of knee pain in those with
normal/low BMI (<27) was half that compared to those with high BMI. In the other
groups this difference was somewhat smaller. This may indicate that in women with
unilateral knee pain, losing weight is even more important for prevention of new knee pain
than in women who do not have knee pain. In obese persons, symptom relief in knee OA
was found to be more closely associated with decreasing body fat and increasing physical
activity, than decreasing body weight. Therefore, the advice to start exercising and adopt a
healthy diet might be most valuable for the group of women who already have knee pain
in one knee. It should be noted that, at the moment we assessed knee pain, this pain had
been present for only a short period of time; also, the severity of this pain was not
evaluated.

The incident knee pain that we found does not necessarily become chronic or disabling. A
prospective study to establish which persons with knee pain develop chronic knee pain
may provide new insight into the etiology of (chronic) pain development. This is currently
being investigated in the CHECK cohort in the Netherlands, which includes subjects with
knee or hip OA and related symptoms due to suspected early OA .However, a problem is

33
that once knee pain is established, we do not know whether it is already too late to reverse
or stop the process.

HOMOEOPATHIC APPROACH IN GENERAL

“The physician’s high an only mission is to restore the sick to heath, to cure, as
it is termed.”
The mission as it is clearly described by the FATHER OF HOMOEOPATHY,
Dr. Samuel Hahnemann is to cure the suffering human being. In order to
achieve this mission he has shown us the path how to succeed in his writings,
Organon of Medicine, sixth edition. According to aphorism 29, modus operandi
of homoeopathy is described with the help of law of similars.
A set of totality of symptoms of the natural disease manifested in human being,
is matched with the set of totality of symptoms of the drug i.e. capable of
producing similar artificial disease in a healthy human being. In this manner we
select the indicated remedy with the help of knowledge of Materia Medica,
Organon of Medicine & Repertory.
We also take into consideration the following points in order to select the remedy
& decide its posology.
SUSCEPTIBILITY
By susceptibility we mean the general quality or capability of the living organism of
receiving impressions; the power to react to stimuli.
Men we give a drug to a healthy person for the purpose of making a
homoeopathic "proving" or test, the train of symptoms which follows represents
the reaction of the susceptible organism to the specific irritant or stimulus
administered.
When a homeopathically selected medicine is administered to a sick person,
the disappearance of the symptoms and restoration of the patient to health
represents the reaction of the susceptible organism to the impression of he
curative remedy.
We shall see that the kind and degree of reaction to medicines depends upon the
degree of susceptibility of the patient, and that the kind and degree of
susceptibility, in any particular case or patient, depends largely upon how the
case is handled by the physician; for it is in his power to modify susceptibility.
Indeed, this power to modify susceptibility is the basis of the art of the
physician.
If the physician knows how to modify susceptibility in such a way as to satisfy
the requirements of the sick organism and bring about a true cure, then is he a
physician indeed; since cure consists simply in satisfying the morbid

34
susceptibility of the organism and putting an end to the influx of disease-
producing causes.

MIASMS
When Hahnemann added his miasm theory to the mix in 1828 it was greeted
with shock, horror, disbelief, uproar and laughter by the entire medical world.
Even homeopaths blushed with shame; most completely ignored the idea as
preposterous. It was hard to see where Hahnemann was coming from. The
grand scheme of the miasms, so familiar today, seemed just like words from an
alien language. If you start from symptom totality, then you can just about reach
the even wider concept of a miasm as a grouped entity deriving from hundreds
of cases. But if you start from the familiar allopathic terrain of ‘disease’
affecting whole populations, then the idea of miasms as internal inherited
dyscrasias seems very potty indeed! The conceptual challenge is simply one of
width of view. Each individual case, upon which homeopathy is based, must
now be also viewed in the light of another totality – the family legacy of Psora,
Syphilis and Sycosis.
We can see that Hahnemann must have got his idea of miasms through an
extension of the very fruitful concepts of similar and poisonings, with which he
was deeply immersed in the original construction of homeopathy. His mind
simply must have been drawn towards seeing the wider patterns in cases. For
example, Hahnemann "suggested, in 1789, that Mercury…displaced the
syphilitic disease by imposing a similar illness," [5; 3]. He "had taken his time
to formulate his first intuitive deduction [similia] in fact seven years…[he]
clung obstinately to the everyday world of common sense…and had no use for
the theories of pathology then current…[being, in fact] dissociated from
theories of physiology and pathology," [5; 4].
The notion of Psora has many facets; for example, "seven-eighths of all the
chronic maladies prevalent' are ascribed by Hahnemann to Psora…" [16; Vol.
1, 142] He did not confine its meaning solely to Scabies; "Psora…was widely
known in Hahnemann's time, was the general term for a whole series of skin
troubles of the most varied kinds…" [16; Vol. 1, 143] Its underlying significance
was even broader: "To Hahnemann psora is a disease or disposition to disease,
hereditary from generation to generation for thousands of years and it is the
fostering soil for every possible diseased condition." [16; Vol. 1, 144] However,
it does not mean that everyone needs to be dosed up with Psorinum, Syphilinum
or Medorrhinum, it just means the broad outline of the miasms need to be kept
in mind when observing the symptoms of a specific case or family. In a family
with some evidence of alcoholism, deafness, blindness, bone disorders and
insanity, one is entitled to believe a syphilitic streak is present. It does not
dominate one’s view of each case, but it is useful background information. It
35
guides one towards certain remedies, and away from others, but should never
dictate practice. Hahnemann certainly regarded medical speculation as "arid
and obfuscating scholasticism." [26; 62] and "the elaborate manipulation of
hollow symbols." [26; 62]. The reason was its lack of efficacy and harmful
practices.
Homeopaths must never allow miasms, like some cuckoo in the nest, to
exclusively dominate its conceptual base in the way ‘evolution’ has come to
dogmatically dominate biology, or genetics and bacteria totally dominate
allopathy. Such ‘soiling of its nest’ would be to indulge a catastrophic delusion,
to let the subject be well and truly hijacked by one idea, and might comprise a
lamentable waste of otherwise objective talent. And to do so would in any case
be to abandon the strong empiricism that powers homeopathy and to surrender
to an unhealthy domination by theory.
Kent makes it very clear that homeopathy has a vitalistic rather than
materialistic view of disease: "the microbe is not the cause of disease. We
should not be carried away by these idle allopathic dreams and vain
imaginations but should correct the Vital Force." [32] And that 'the Bacterium
is an innocent feller, and if he carries disease he carries the Simple Substance
which causes disease, just as an elephant would.' [32]
In modern homeopathy it is clear that all these topics and concepts are just as
vibrant and as integral to the subject as they were in previous times. The modern
homeopath must strive not only to become saturated in materia medica, case-
taking and the ability to discern the genuine symptom totality of the patient, but
must also navigate a good course through all the conceptual terrain of
homeopathic theory, which is invaluable as it enriches practice at every turn.
Just as theory has become the lamp illuminating the path, so also practice is the
ongoing empirical force that justifies and informs theory.
The theory of miasms originates in Hahnemann's book The Chronic Diseases
which was published in 1828, around the same time that he decided to fix 30c as
the standard potency for all homoeopaths. He declared that the theory was the
result of 12 years of the most painstaking work on difficult cases of a chronic
character combined with his own historical research into the diseases of man.
The three miasms given in that work are held to be responsible for all disease of
a chronic nature and to form the foundation or basis for all disease in general.
This latter aspect was then to receive considerable amplification from Kent.
Kent was also able to clearly identify those remedies that relate to each miasm.
Though now generally accepted by most homeopaths without question, at the
time, the theory was generally greeted with disbelief and derision from all but
the most devoted followers. This can be explained in part by the primitive
nature of medical science at that time, which was not really very willing

36
accommodate any theory for the origin of disease, least of all such a grand and
all-embracing one.
The word miasm means a cloud or fog in the being. The theory suggests that if
100% of all disease is miasmatic, then 85% is due to the primary and atavistic
miasm Hahnemann called Psora. The remaining 15% of all disease he held to be
either syphilitic or sycotic, being derived from suppressed Syphilis or
suppressed Gonorrhoea. Hahnemann unlike Kent later attached no moral
dimension whatsoever to the sexual nature of the two latter miasms. Kent of
course, emphasised this a great deal. Which is hardly surprising in the
somewhat Puritanical atmosphere of nineteenth century small town America.
Taking them in reverse order, we can depict the main characteristic features of each
miasm.
SYCOSIS
This miasm is held to be responsible for many sexual and urinary disorders, and
affections of the joints and the mucous membranes. Also those conditions
worsened by damp weather and by contact with the sea. Thus arthritis and
rheumatism, asthma, catarrhs, bronchitis, cystitis and warts are all regarded as
partly or mainly sycotic in character. The wart came to be seen as the
underlying archetype of this miasm as it is also held to be responsible for all
warty excrescences and growths. Chief remedies are Thuja, Lycopodium,
Natrum sulph, Causticum, Kali sulph, Staphysagria, Calc and Sepia amongst
many others.
SYPHILIS
This miasm is held to be responsible for many diseases of the nervous system,
the blood and skeleton as well as a range of psychological disorders, including
alcoholism, depression, suicidal impulses, insanity, loss of smell and taste,
blindness, deafness and ulcerations. It is also associated with many heart
conditions, some vesicular skin eruptions and diseases that have a definite
nocturnal periodicity. Chief remedies are Arsenicum, Aurum, Mercury,
Phosphorus and Lycopodium, Nitric acid, amongst many others.
PSORA
The word Psora is derived from the Hebrew 'Tsorat' and Greek 'Psora' and
means a groove or stigma. Hahnemann held that all non venereal chronic
diseases are Psoric. That includes most diseases of a chronic nature, all skin
diseases, most mental illness other than syphilitic ones, allergies, varicose veins,
haemorrhoids, most dysfunctional diseases of organs and systems, etc.
He lists among others, catarrhs, asthma, pleurisy, haemoptysis, hydrocephalus,
stomach ulcers, scrotal swelling, jaundice, swollen glands, cataract, diabetes,
tuberculosis, epilepsy, fevers and suppressed urine as all being typically psoric
manifestations. Plus, of course, the whole gamut of skin problems.
37
 Chief Psoric remedies he suggests include Sulphur, Natrum mur, Calc carb,
Arsen alb, Lycopodium, Phosphorus, Mezereum, Graphite, Causticum, Hepar
sulph, Petroleum, Silica, Zinc and Psorinum amongst many others.
Hahnemann also claimed that Psora was the most ancient and insidious miasm,
and that it was derived from skin eruptions of various types in the past, such as
scabies (Itch), leprosy and psoriasis. These had been contracted by ancestors or
in one's own early childhood. The suppression of these conditions especially
through the use of ointments he held to be the primary cause of Psora.
'Psora is that most ancient, most universal, most destructive, and yet most
misapprehended chronic miasmatic disease which for many thousands of
years has disfigured and tortured mankind... and become the mother of
all the thousands of incredibly various chronic diseases...' [Chronic
Diseases, p9]
Kent, in his Lectures, then greatly enlarged upon the theory, proposing that Psora was the
foundation of all other illness, without which mankind would be pure and healthy both in
mind and body, as in the Garden of Eden. He thus regarded Psora as being equated with
the 'Fall of Man' and with original sinfulness. He portrayed Psora in this highly moralistic
light as also being the foundation of the sexual miasms that came later.

38
 HOMOEOPATHIC APPROACH & OSTEOARTHRITIS IN
PARTICULAROSTEOARTHRITIS & MIASMS
PSORA SYCOSIS SYPHILIS TUBERCULAR
1.Various types of 1.Rheumatism with 1. Pain in long bones 1.Lack of strength of
inflammatory numbness & paralytic gag. At night. bones & delayed
rheumatism of extremities Aching pain in milestones , sense
e.g. otitis bones of limbs of great exhaustion ,
Various deformities easily made tired
& atrophy , , never seems to get
emaciation of rested. Rickets ,
extremities may
marasmus & delayed
occur.
8 walking in
children.

2.Psoric rheumatic 2.Joint pains are 2.Bony pains are 2.Tubercular

pains are generally sycotic syphilitic rheumatic pains are
associated with Easy sprains of joints recurrent & periodic ,
neuralgic pains while walking .joints often associated with
which are sore , & connective tissue new moon &
bruised & preside in are full moon phase.
character affected

3.stitching 3.Burning ,
,pulsating & bursting &
wandering pains tearing pain are
are sycotic syphilitic.
Pallid , oedematous ,
puffy
The gouty diathesis is
sycotic.
Modalities:- Modalities:- Modalities:- Modalities:-
Acute inflammatory Gag. By rest, damp, All the complaints Agg. by
rheumatic pains are rainy, humid are agg.from sunset thunderstorms, at
better by rest, quiet atmosphere, during to sunrise , night, & by milk,
.Gag. by winter, thunderstorms, perspiration , fruits & greasy or
wants warmth changes of weather sea side & oily foods . Agg
& from heat. thunderstorm .Also occurs in closed , &
externally &
internally. gag by warmth the
of bed, at night patient is unable to
, extremes of tolerate any pressure
temperature. to

39
 the chest.

Ameliorated in Ameliorated by Amelioration occurs Amelioration in dry

summer , from heat, motion, unnatural between sunrise & weather,open air &
by natural discharges discharges sunset , from a during the day.
such as urine , through the mucus change of position, Temporary
sweat , surfaces, such as in lukewarm ameliorated by
leucorrhoea & nasal climates, & from offensive foot or
menstruation etc.
discharges. any abnormal axillary sweat
Amelioration by discharges . foot or when
stretching in dry Amelioration suppressed induces
weather, lining on during cold of lung trouble.
stomach or with winter, & through
pressure also when discharge of pus. Tubercular
warts appears , manifestations
markedly are always
ameliorated by the ameliorated by
return of acute nose bleeding. Other
gonorrhoeal modalities depend
manifestation. upon the
preponderance of the
psoric or syphilitic
miasm.

40
 SCOPE & LIMITATIONS:-
Homoeopathy as discovered by DR.HAHNEMANN though a science of healing, it is not
complete in all aspects. As every coin has two sides Homoeopathy also has its own scope
& limitations .thus scope and limitations of Homoeopathy in the case of osteoarthritis is
discussed under following headings:-

*According to cause :-

1. Age: - According to age susceptibility varies, thus the scope is good if the susceptibility
is high.
2. Sex: - Females have high susceptibility than males, hence are prone to OA, thus the
management is more favourable in condition of females.
3.Maintaining factors:-
• Obesity- As obesity is one of the leading factors of OA, thus management of
weight plays an important role in treating OA by homoeopathy.
• Cigarette smoking- As smoking is directly related to OA, abstinence from
smoking is also a way to avoid OA.
4. Bone density: - Osteoporosis & Vit D deficiency which can be treated by supplements,
which will help in overcoming the sign & symptoms of joints pains, & homoeopathy,
thus gives a helping hand via constitutional remedy.
5. Trauma & Deformities:-As in cases of traumas & injuries, the e cause is external there
is no role of homoeopathy. In cases of deformities as there are destructive changes,
homoeopathy has got a limited scope, just a palliative treatment. In both the cases
surgical aid is needed.

*According to stage of disease:-

1. Acute: - OA per say is a chronic illness. Thus in case of acute exacerbation of the
complaints can be taken care by acute short acting remedies e.g.:- Rhys tax, Bryonies,
Leduc, colchicum etc. As we have vast no. of remedies acting acutely on joints thus a
good scope in homoeopathy.
2. Chronic: - In any chronic case, we consider constitution, characteristic metals &
physicals, and thus a constitutional remedy is selected. Moreover, miasms also play an
important part in treating a chronic case so anti –miasma tic or an undercurrent helps in
the progress of cure.
*According to miasmatic dominance:-

41
1. Psora:- Homoeopathy has an excellent scope in psoric stage of disease, as there are no
such structural changes & as there are only functional inflammatory changes.
2. Sycosis:- As there are reversible structural changes in Sycosis, scope of homoeopathy is
fair.
3. Tubercular:- As when the disease in tubercular, the susceptibility is high, the scope is
fair to good, and mostly it is taken care by anti-tubercular drugs. But there are high
chances of the disease to progress to the next stage where Homoeopathy per say has
limited scope.
4. Syphilis:-Syphilitic stage has irreversible destructive changes; hence it is a limitation of
homoeopathy. Here the choice of treatment is palliative.

Here the treatment is assisted with the help of anti –miasma tic remedies.

42
 CASE STUDY
CASE NO:1

 PRELIMINARY DATA:
NAME-MRS ABC

AGE/SEX-60YRS/F

ADDRESS-ANDHERI
RELIGION-ISLAM

MARITAL STATUS-

MARRIED

OCCUPATION-HOUSEWIFE.

 CHIEF COMPLAINT:
Pain and swelling in left knee since 4 months,swelling gradually
increased. Pain <sitting
<hot fomentation
>walking
NO H/O fall or trauma. Took treatment from Ved but no relief.

 ASSOCIATED COMPLAINTS:
Slipped sisc 8yrs back.

 PATIENT AS A PERSON:
Appearance-dark complexioned thin,coarse tremors of hands &legs
Appetite-normal,non veg
Likes-sweets+++
Dislikes-brinjal,cabbage,chicken
Thirst-15-16 glasses/day,tepid water
Stool- unsatisfactory urge for stools
Urine-NC

43
 Perspiration-more in palm and
soles Sleep-7-8hrs refreshing
Dreams-not remembered.

 GYANEC/OBS.H/O:
Menoapuse since 8 yrs in the beginning when my menses stopped I used to
perspire a lot
,feel hot,so I used to get irritated,but then they slowly subsided
O/H : G3P2A1L2

 GENERAL REACTIONS:CHILLY PATIENT.

FAN-wants always

BATH-warm water

COVERING-thin throughout year

SEASON-winter

 MENTAL CHARACTERISTICS:
Lives with husband,3 daughter .All her children are well educated.One of her
married daughter lives with her as her mother in law is strict & she couldn’t
get along with her.Initially used to be angered very easily.Violent anger
would even hit her children for small matters.Is very stubborn
&obstinate.Will do what she wants.Says I love my husband a lots.Is worried
about the fact that she cannot offer namaz.Is very religious,says everything
happens by gods will.Says the best thing that happened to her was getting his
husband,says wants to die before him.

 FAMILY HISTORY:
Mother- Myocardial Infarction,DM,Hypertension Father-
Myocardial Infarction,Hypertension.

 PAST HISTORY:NS

44
 G/E:
Pulse-82beats/min
BP-130/80mmHg RR-
18/min
TEMP-Afebrile.
No pallor/icterus/lymphadenopathy.

 S/E:
R.S-AEBE
CVS-S1S2 heard CNS-
soft,no tenderness GIT-
conscious,well oriented.

 LOCAL EXAMINATION:

Left knee-Effusion++ ;Sinovitis+

Tenderness-Nil;ROM-10-100
Crepitus-Minor
Left shin-pitting oedema upto ankle
Right knee-NAD

 PROVISIONAL DIAGNOSIS:OA Knees

 INVESTIGATION:

Xray left knee jt AP/LAT view

CBC with ESR

Serum creatinine,uric acid

Urine routine.

 HAHNEMANIAN CLASIFIACTION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom.

45
 REPERTORIAL TOTALITY:
• Violent anger
• Religious
• Obstinate Chilly patient.

 SUSCEPTIBLITY :Low
 MIASM:Sycosis
 DIET AND REGIMEN:Have food rich in calcium &vit D like milk &milk product.

Expose to sunrays for vit D.

 AUXILLARY MODE OF TREATMENT:

Physiotherapy for knee joint.

PRESCRIPTION 7/10/18
Mrs XYZ
Rx
Nux vomica 200 (1p)
Cosmos tds x 7days

Follow up
Date Complaints Remedy given
14/10/18 Patient says she is Nux vomica 200 bd x
aggravated .swelling is 7 days
increased .pain is more while
sitting.Feels as if someone
have beaten with
hammer,better bt stretching.
Generals normal
Advice-avoid diet rich in
protein.
29/10/18 Lt knee joint pain Nux vomica 200 bdx7
>25%,swelling>trembling>>. days
Walking is still painful.
Generals normal

46
 5/11/18 Lt knee joint Nux vomica 200 tds
pain>70%,swelling>> x1month
trembling in left side of
body.
Generals normal.
Since then patient was >with
her complaints so nux
vomica 200 tds was given
for 15 days interrupted with
SL 200 tds for 15 days
6/12/18 Lt knee joint pain-SQ Syphilnum 1M
Trembling of both legs –SQ hs(1p) Nux vomica
Pain in calf muscles-SQ 200 qds x15 days
Retrosternal buring-SQ
Generals-normal
Stool 1sthard followed by
soft

22/12/18 Lt knee joint pain ->50% Cosmos 200 tds x 15

Trembling of both leg –SQ days
Pain in calf muscles->
Retrosternal burning->
Generals -normal
7/1/19 Stiffness and pain in both Cosmos 200 bdx7
joint reduced trembling days
reduced
Generals –normal

SUMMARY:

A Case of OA female patient who responded wonderfully to her constitutional

remedy NUX VOMICA given in high potency in repeated doses,however than
case came to standstill. Hence SYPHILINUM was given as an anti miasmatic
remedy which helped the patient lot followed by her constitutional remedy.

47
Case No: 2

PRELIMINARY DATA:
NAME: Mrs. ABC Sex/Age-F/57yrs
Address-Sharda Niwas, Room No 1, col Dongri Gali No-2, Andheri (E)
Occupation: Housewife Religion: Hindu
Marital Status: M, 30yrs

 CHIEF COMPLAINT:

B/L Knee pain since 4yrs Lt → RT, left > right

Pain with heaviness &swelling from knee to ankle, unable to bend knees
< Getting up from sitting position >rest
< sitting down on the floor
< walking <under fan
 ASSOCIATED COMPLAINTS :
Bleeding P/R - Dark Red profuse bleeding
A/F - Drinking chuna water for leg pain
Since then has hemorrhoids problem bleeding < Spicy foods
Breathlessness since 3yrs
A/F- Bleeding P/R episode
<Long distance walking >in sitting positions
<Climbing stairs
Is on multi vitamins & iron tablets
 PATIENT AS A PERSON:
Appearance: Average built fair complexion
Appetite: Normal, veg
Likes: NS
Dislikes: NS
Thirst: Thirsty, 3-4 L/D, tepid water, small qty at small intervals
Food/Drinks Agg/Amel: NS

48
Stool: Normal, bleeding P/R <spicy food
Urine: Normal

Perspiration: Moderate, NO, NS

Sleep: 5 Hrs refreshing
Dreams: NS

 GYANAEC/OBS. H/0:
Menopause since 6yrs-6 mnths before her menses stopped completely, her M.C
became irregular with heavy bleeding on most episodes, didn't took any Rx for the
occ heavy flow
„thought it was age related, then after her menses stopped completely, complains
ofhot flushes and disturbed sleep on and off since menopause most imp
complains of knee pain which she says were not present before her menopause
except on occasions of exertion.
O/H: G1P1AOL1-G1-Male-24yrs-FTND, hospital
Past M/H-3-5days/26-28 days-regular, moderate flow ,NO, NS, no dysmenorrhea.
Contraception H/0-had not used any because she separated from her husband after
her sons birth.
Supplements H/0-not taken any supplements until the appearance of breathlessness
 GENERAL REACTIONS (including Thermal Modality)
Fan - S-Always, W- Slow, Covering -During winter only
Bath -S-Hot water, W-Warm
(Ambi ->Chilly)
 MENTAL CHARACTERISTIC -
Stays with husband &son, moved to Mumbai after marriage since 30 yrs Says
wants to be cured so that she can travel to different places likes travelling and
learning new things, cheerful, happy go lucky types Childhood-evrything was
good, was v fearless n daring Married life-mother in law was v cruel, used to
impose a lot of restrictions on her but says she was v obstinate, did not leave her
rights, used to feel bad about her husbands behaviour with her, so she separated
with her son n raised him up alone, likes to b in companyn talks a lot,

49
 can mix v easily with others,does not bothers about people opinion about
her, weeps on thinking about past events or when someone talks about
it,says Jo ho gaya so ho gaya,aage jo hoga dekha jayega,
does not wanted to be dependent on anyone uptil death
F/H-N.S
P/H-Fever with haemoptysis-2004,admitted in hospital (Dengue?)
G/E: Pulse-64beats/min B.P-138/90mmHg RR-18/min Temp-afebrile Pallor -+ no
cyanosis / lymphadenopathy

S/E:
R.S-AEBE CVS-S152heard GIT-soft ,no tenderness CNS-conscious,
well oriented

ΚΝΕΕ RT LT
SLR painless painless
ROM full 65degree
CREPTS 2+ 3+
SWELLING -ve 2+
FIGURE OF 4 -ve -ve
GENU VALGUS +VE +VE

 DIAGNOSIS-OA Knees with haemorrhoids and anaemia

 INVESTIGATIONS-past inv reports

9/10/09-X Ray Knee jt AP/Lat view
-early degenerative changes seen at It knee jt
-knee jt space is marginally reduced at medial compartment, evidence of
small osteophytes on the sup ninf margins of patella, femur n tibia 25/2/11-X Ray
Chest PA ViewNormal, ECG-Normal, Pelvic USG-Normal ,Bld sugar F-76mg/dl,
PP-99mg/dl, CBC-Hb9gm%/Lipid profile-Normal

50
 Hahnemannian classification of disease-Dynamic chronic miasmatic disease
with fully developed symptom

 REPERTORIAL TOTALITY:
Cosmopolitan
Weeps on thinking about past events
Cheerful
Obstinate
Company desires for
Loquacious
Chilly patient
Knee pain <under fan

 SUSCEPTIBILITY:-High

 MIASM: Tubercular

 DIET AND REGIMEN-Have food rich in calcium & vit D like milk n milk
products & those rich in iron.
Exposure to sun rays for vit D
 AUXILLARY MODE OF TREATMENT:
Physiotherapy for knee jt

 PRESCRIPTION:
13/11/18
Mrs. P. K.
Rx
Calcarea Phos 200 bd 15 days

51
FOLLOW UP:

Date Complaint Remedy

Given

27/11/18 B/L Knee pain Lt >Rt -SQ Calc Phos

Swelling in It leg from knee to ankle-SQ 200 bd for
Breathlessness on exertion -SQ 15days
No episode of eating spicy and bleeding
P/R
Started physiotherapy since 1 week
Generals–Normal--
O/E: BP -130/80mm Hg, Pulse-
66beats/min,
Weight —51kg
Swelling in leg Lt3+>Rt1+
ROM at knee jt -painful Lt>Rt, non
restricted
12/12/18 B/L Knee pain Lt >Rt > Calc Phos
Swelling in It leg from knee to ankle-O-- 200 bd for
, a month

Breathlessness on exertion -SQ

Heaviness sensation is persistent, as if
10kg weight has been kept on knee
Generals–Normal- O/E: BP -124/84mm
Hg, Pulse-70beats/min, Weight-51kg
ROM at knee jt -painful Lt>Rt, non
restricted Swelling - 0-- Patient
continued physiotherapy

52
10/1/19 B/L Knee pain Lt >Rt -->>-- Calc Phos
Swelling in It leg from knee to ankle--, 200 bd for
a month
Breathlessness on exertion ->-
Generals–Normal O/E: BP -102/76mm
Hg, Pulse-68beats/min, Weight —51kg
ROM at knee jt -painful Lt>Rt is >50%
non restricted Patient continued
physiotherapy, was > with it

SUMMARY:
A Case of OA Knees with haemorrhoids & anaemia, responded wonderfully to her
constitutional remedy Calc Phos given in medium potency her knee swelling along
with her breathlessness improved to a greater extent, along with the patients sincere
effort in doing regular physio exercises, which further enhanced the action of her
constitutional remedy in relieving her complaints

53
 Case No-3
PRELIMINARY DATA:
Name-Mrs ABC Sex/Age-F/45 yrs
Address-Sai ganesh bldg No 2, Tata Compound, Andheri(w)
Occupation-HousewifeReligion–Hindu Marital Status-M since 30 yrs
 CHIEF COMPLAINT:
B/L knee pain since 5-6 yrs with occ swelling
-A/F-death of eldest son
Pulling type of pain ,taking allop Rx
<walking,
>rest >pressure
B/L swelling of ankles -
<walking
 ASSOCIATED COMPLAINTS :
NS

 PATIENT AS A PERSON:
Appearance: Average built wheatish complexion, flat warts on face n neck
Appetite: Normal, veg
Likes: salty2+
Dislikes: sweets
Thirst: moderate, tepid water,1 glass at a time
Food/Drinks Agg/Amel: NS
Stool: Normal
Urine: Normal
Perspiration: Moderate, NO, NS
Sleep: disturbed due to thoughts, stress
Dreams: NS

54
 GYANAEC/ H/0:
FMP-doesn't remembers, LMP-Menopause since 3yrs
Pa MH--4-5days/30days-bright red ,profuse heavy bleeding for 1" 3days, NO, NS
Complaints before, during--NAD ,after menses-weak and lethargic Didn't took any
treatment for the heavy flow, all of a sudden, my menses stopped

/OBS. H/0;
G4P4AOL3-G1-boy-24yrs-All are FTND
G2-female-22yrs
G3-female-19yrs
G4-female-16 yrs
Contraception H/O- used Cu-T 10yrs back, the one with 3 yrs duration
Supplements H/0-not taken any supplements

 GENERAL REACTIONS (Including Thermal Modality)-chilly patient

Fan-summer- wants, winter-no
Covering- summer-occ, winter-thick blanket
Bath -summer-lukewarm, winter-hot

 MENTAL CHARACTERISTIC -
Stays with husband, 2sons,BILn his 2sons, came to Mumbai 30 yrs ago,husband
is a taxi driver, she got married at a younger age,is illiterate
V stressed about financial condition of family husband is the only earning member
,son is studying ,daughters have left their studies, they all are left to be married
Weeps easily thinking about her sons death>consolation
Says 'Pehle main bohot acchi thi, sukhi thi,mere bête ke jaane ke baad se hi ye
sab hone laga hai' Has to keep herself busy with people to refrain from
thinking about it, gets very sad when alone She keeps thinking about son n
family Decessive-can take her own decisions Never expresses her anger on
anyone, cannot backanswer or fight Sons death-he was the eldest son, had
studied v weli all through his life, was studying engineering in Jalgaon
,suddenly suffered with high fever n was admitted in hospital there he died in

55
15-20 days he had a lot of dreams of bringing d family out of poverty ,n they a
lot of expectations on him
F/ H-N.S
P/H-N.S
G/E:
Pulse-70beats/min B.P-140/90mmHg RR-18/min Temp-afebrile No Pallor/ no
cyanosis / no lymphadenopathy
S/E:
R.S-AEBE CVS-S1S2heard GIT-soft ,no tenderness CNS-conscious, well oriented

KNEERTLT

SLR painfull painfull

ROM full full
CREPTS 2+ 1+
SWELLING +ve +ve
FIGURE OF 4 -ve -ve

 PROVISIONAL DIAGNOSIS-OA Knees with depression

 INVESTIGATIONS-
X Ray B/L Knee jt AP/Lat view
X Ray B/L foot Lat view

 HAHNEMANIAN CLASSIFICATION OF DISEASE Dynamic chronic

miasmatic disease with fully developed symptom

 REPERTORIAL TOTALITY:
Grief ailments from
Anxiety future about

56
 Fear poverty
Timidity
Sadness alone when
Chilly patient

 SUSCEPTIBILITY:-high

 MIASM: syphilis

 DIET AND REGIMEN-Have food rich in calcium n vit D like milk & milk
products n those rich in iron
Exposure to sun rays for vit D

 AUXILLARY MODE OF TREATMENT: Physiotherapy for knee jt

PRESCRIPTION: 30/12/18
Mrs. ABC
RX
Calcarea Carb 200 bd 15 days

FOLLOW UP:

Date Complaints Remedy

Given

13/1/19 Pain in both the knees ->- Cold n coryza since Calcarea
67days-whitish nasal discharge She says she Carb 200 bd
never used to get coryza but after taking 15 days
medicine,it started along with profuse
perspiration Swelling in knees n ankle-SQ-
Sleeplessness-SQ Generals–Normal-

57
27/1/19 Pain in both the legs since 2days-sudden onset Calcarea Carb
But the knee jt pain -> rt>It Cold n coryza–0- 200 every 4hrly
for
Swelling in knees n ankle-SQ- Sleeplessness-
3days
SQ– Generals–Normal– O/E: BP-
124/80mmHg
Dorsalis pedis-feeble No calf tenderness SLR-
RT70deg LT-80deg

1/2/19 Pain in both the knees>75% <walking Pain in Cruda plana 200
back > ,can sit in the same position for long 2P
Swelling in knees n ankle ->> Sleeplessness- SL 30 tds for
>-<when thinks about her dead son and 1month
because her unmarried daughters doesn't talk
properly to her Pain in throat since 1
day,A/Ficecream Generals–Normal O/E: BP-
140/80mmHg
30/2/19 Pain in both the knees >50% <walking Pain in Cruda plana 200
back 3P SL 30 tds for
>20% Pain in throat >> Sleeplessness-SQ 15days
Generals–Normal
O/E: BP-130/80mmHg

17/3/19 Pain in both the knees <since 3-4 days Calcarea Carb
Pain in back-SQ- 200 tds X 7
days
Pain in throat and headache<since 4days
A/F-cold drinks

58
24/3/19 Pain in both the knees >> Cruda plana 200
Pain in back >> tds for 15days

Pain in throat >> Sleeplessness-SQ–

Generals–Normal–
O/E: BP-
142/90mmHg

7/2/18 Pain in both the knees >>> Calcarea

Pain in back >> Carb 200 tds
Carb 200 tds Cough with yellowish X 7 days
expectoration easy expectoration since 1wk SL 200 tds
Pain in left shoulder joint, no H/0-any trauma X 7 days
or fall
Headache on and off <tension
Sleeplessness–SQ–
Generals–Normal–
O/E: BP-
130/80mmHg
R.S - AEBE,clear

14/4/19 Pain in both the knees Cruda plana

>50% Pain in back >> 200 tds
for Cough > 15days
Pain in left shoulder joint >25% <raising hand
Headache >--<taking tension Sleeplessness–
SQGenerals–
NormalO/E: BP-120/80mmHg R.S -
AEBE,clear

59
28/4/19 Pain in both the knees ->>- Calcarea
Pain in back ->- 200 tds
Pain in left shoulder joint - > 15days
Headache >occ heaviness
Sleeplessness-SQ-
Generals- loss of appetite, Stools-
constipation-othirst urine-Normal

SUMMARY:
A Case of OA Knees with depression, was given her constitutional remedy which
showed good results right from beginning but the patient complaints used to
relapse on & off because of her depression that acted as a maintaining cause &
would further affect her sleep. also the patient never paid attention for doing
physio exercices. However her constitutional remedy when further given in high
potency helped the patient a lot in the long run.

60
Case No: 4

 PRELIMINARY DATA:
NAME: Mrs ABC Sex/Age-F/69yrs
Address:Lila taher, Vallabh nagar Society,1" Floor, Opposite Cooper Hospital
Occupation: Housewife
Religion: Hindu Marital Status: Married since 45years

 CHIEF COMPLAINT:
K/C/O-Hyperlipidaemia since 5yrs,
Hyperuricaemia since 4yrs
Pain in both knees rt > It since 8-9yrs
< Getting up from sitting position >continuous motion
< walking >massage
<initial motion >bathing with warm water
<descending and ascending stairs
<standing
ODP-Complaints started gradually8-9yrs ago.No H/o trauma No other joint
involvement.
Stiffness of both knees for 5-10 mins <getting up from sleep
On T. Zyloric 50mg 1 od
T. Typtomer 10mg 1 od

 ASSOCIATED COMPLAINTS :N.S

 PATIENT AS A PERSON:
Appearance: Warts on the face, prominent linea nasalis Appetite: Normal Veg
Likes: sweets+++
Dislikes: vegetables
Thirst: more, 10-15 glasses/day

61
Food/Drinks Agg/Amel: N.S
Stool: N.C
Urine: N.C
Perspiration: Profuse, all over the body, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: not remembered
 GYANAEC/ BS. H/O:
Menopause since 20yrs
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
Past M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-
Used OC Pills for approx 3yrs initially Supplements H/0- taken calcium on & off

 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)

Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat
 MENTAL CHARACTERISTIC -
Stays with husband, has 3 daughters, all of them are married. Has anxiety about
disease. Says if I wont be able to walk, then who will look after me. I should be
mobile at home atleast .Started weeping on saying this, says I feel better by
weeping .Does not want to get operated as there are many failures, says I will be
bedridden. Feels better by conversing with people. Feeling of loneliness. Her
relation with her husband is good,says he is very calm and does not demand
anything .Does not feel angry on anyone.

F/ H- Mother-Hypertension, paralysis
Father- Hypertension, Diabetes mellitus

P/H-Fracture of left foot in teenage

G/E: Pulse- 78 beats/min ; B.P- 128/70mmHg ; Temp- Afebrile Wt-69kg No

pallor /icterus / cyanosis / lymphadenopathy S/E:
R.S-AEBECVS-S1S2heard GIT-soft, no tenderness
62
CNS-conscious, well oriented

 LOCAL EXAMINATION:
B/L Ant medial joint line prominent
Right knee-ROM-5-105
Minimal effusion
Medial laxity+ ;Crepitus+ .Mild knee valgus
Left knee-ROM-0 to 100. no effusion/synovitis. crepts+

 PROVISIONAL DIAGNOSIS-Right >Left OA Knees + hyperlipidaemia

+hyperuricaemia

 INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view
CBS with ESR
Serum uric acid
Serum cholesterol
Blood sugar -fasting, post prandial

 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom

 REPERTORIAL TOTALITY:
Weeping while narrating symptoms->weeping,>consolation
Anxiety about disease
Timid
Craving for sweets
Warts on the face
>warm bathing

63
 SUSCEPTIBILITY:-High

 MIASM: Psora

 DIET AND REGIMEN-Have food rich in calcium & vit D like milk n milk products n
those rich in iron
Exposure to sun rays for vit D

 AUXILLARY MODE OF TREATMENT:

Physiotherapy for knee jt:
SWD to knees
Vastus medialis strengthening
Calf stretching active, passive ,assisted

 PRESCRIPTION 22/1/19
Mrs. ABC
Rx
Puls 200 bd X 7 days
FOLLOW UP

Date Complaints Remedy Given

1/2/19 Knee pain < Weakness-SQ Puls 200

Calf pain < Pain in thigh < gds x
7days
Patient feels pain has increased due to
exercise. Started crying says I cant go to
buy vegetables, my husband has to go,
what will happen to him if I am not well.
Generals-Normal Patient has started
doing exercices shown by her
physiotherapists

64
8/2/19 Knee pain >25% Weakness-SQ OAN 200 h.s
Calf pain slightly > Pain in thigh > (2P) Puls
Patient is very happy as all her children 200 qds x
14days
have come down esp to meet her.
Generals-Normal

22/2/19 Knee pain >> Weakness-> Pain in Puls 1M tds

thigh > x Pain in calf muscles only 15days
while walking.
Doing physiotherapy exercise regularly
Generals-Normal
7/3/19 Knee pain>50% Cosmos200
Morning stiffness in fingers since 2days (2P)
Stiffness of toes <morning >continued Puls 1M tds x8
motion days
Reports: Hb-12 gm% leucocytes-
6,600/cu mm
ESR-75 S.Uric acid-5.7mg%
S.Cholesterol-
251.6mg/dl. Blood Sugar-F-113.8mg/dl
PP-
128mg/dl Generals-Normal

15/3/19 Knee pain -SQGenerals-Normal Thuja 1M h.s

Pain in calf muscles-SQ (2P)
Morning stiffness-SQ Puls 1M tds x
Patient is following uric acid diet strictly 15days

65
30/3/19 Patient says she is better Thuja 1M h.s
Knee pain -SQGenerals-Normal (2P)
Pain in calf muscles-SQ SL 30 tds x 15 days
Patient continues doing exercices

15/4/19 Pain in knees <flexion <walking Calc sil 30tds x

Pain with stiffness <morning. 15days

Generals-Normal

30/5/19 Knee pain -SQ- Calc sil 1M (1P)

Calf pain < with cramps SL 200 qds x 15
Pain in thigh increased since 1 week days

Stiffness < midnight

15/6/19 Pain in knees and calves < since 7 days Rhus tox 200
Weakness-<- Generals-Normal qds x 15days

30/6/19 Pain in knees >> Stiffness in joints > Calc sil 1M bd X 1

Weakness->- Patient continues doing month
exercices, says feels > with it

30/7/19 Patient overall better Can walk for Calc sil 1M bd X 1

almost 1520 mins now without pain Pain month
in knees > Can stand for % an hour

SUMMARY: A case of OA with valgus deformity was given constitutional

remedy repeatedly in high potency, the patient was initially > then <, so then a
specific remedy was given which helped the patient to an extent along with
physiotharapy. Howeve in this case, OA can be claimed to be treated but not
cured.

66
CASE NO:5
 PRELIMINARY DATA:

NAME-MRS .ABC OCCUPATION-HOUSEWIFE

SEX/AGE-F/57yrs RELIGION-HINDU

ADDRESS-BYCULLA MARITAL STATUS-MARRIED

 CHIEF COMPLAINT:
H/O Fall 8 months back injury to right knee
Pain in right knee then started
<standing <sitting <climbing stairs.>SWD >Exercise and hot fomentation.

 ASSOCIATED COMPLAINTS:
.NS

 PATIENT AS PERSON:

Appetite-Normal,veg

Likes-Sweets,spicy

Dislikes-NS

Thirst-thirsty ,3-4 lit/day ,small qty at small intervals

Stool-normal,satisfactory

Urine-normal

Perspiration-Moderate,non staining,non offensive

Sleep-6hrs refreshing

DREAM-NS

 GYNAEC/OBS.H/O:
 MENOPAUSE-Since 6 yrs but 6 month before her menses stopped completely her cycle
became irregular with heavy bleeding on most episodes,complaint of hot flushes and
disturb sleep on and off ,knee pain were not present before her menopause except
occasions of exertion.
 OBS H/O:G1P1A0L1,male child 24yrs old
67
 PAST MENSTRUAL HISTORY:3-5 days /26-28 days regular ,moderate flow, non
offensive,non staining.
 THERMALS:CHILLY

Fan-always

Covering-during winter only

 MENTAL CHARACTERISTICS-

Stays with husband & son,moved to Mumbai after marriage since 30yrs.Says
wants to be cured so that she can travel to different places,likes travelling and
learning new things,cheerful.

Childhood everything was good ,was very fearless.Married life was not good as
her mother in law was very cruel,used to impose a lot of restrictions on her but
says she was very obstinate did not leave her rights,used to feel bad about her
husband behavior with her,so she separated with her son and raised him up
alone,likes to be in company and talks lot,can mix very easily with others,does not
bothers about people opinion about her,weeps on thinking about past event,does
not wanted to be dependent on anyone until death.

 F/H:N.S

P/H:Dengue admitted in hospital

 G/E:

Pulse-64 beats/min

BP-130/90mmHg

RR-18/min

Temp-afebrile

Pallor-+

S/E:

RS-AEBE CVS-S1S2 heard GIT-soft,no tenderness CNS-

conscious,well oriented.

68
KNEE RIGHT LEFT
SLR painless painless
ROM full 65 degree
CREPTS +ve +ve
SWELLING -ve +ve

 DIAGNOSIS-OSTEOARTHRITIS
 INVESTIGATION- X ray B/L knee –AP and LAT view.
 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic

miasmatic disease with fully developed symptoms.

 REPERTORIAL TOTALITY:

Obstinate

Independent

Hardworking

Suppressed emotions

Chilly patient

 SUSCEPTIBLITY-Low
 MIASM-Syphilis
 DIET AND REGIMEN-Have food rich in calcium and vitamin D

Exposure to sunrays

 AUXILLARY MODE OF TREATMENT-

Physiotheraphy for knee joint

PRESCRIPTION 11/3/19

MRS .ABC

Rx

Silicea 200 (1p)

Sl 30 tds x15 days

69
FOLLOW UP
Date Complaints Remedy given

26/03/19 Pain in right knee Silicea 200 (1p)

>15%.generals normal SL 30 tds x 1 month
Xray shows osteopenia
Patient was doing regular
physio exercise
26/04/19 Pain in both knees >25% Silicea 200 (1p)
Burning in throat since SL 30 tds x15 days
last week >cold water
swelling of
medial malleolus
Generals-normal
13/05/19 Patient says earlier when Silicea 1M (1p)
she was on allop SL 30 tds x 1month
medicine she couldn’t
differentiate between
taste but now she can
Pain in both knees >>
Bitter taste in mouth >
Generals-normal
15/06/19 Pain in both knees >>> Phytum 200 (1p)
Generals-normal SL 30 tds x15
No new complaints days
30/06/19 Pain in both knees>>> Phytum 200 (1p)
Generals-normal SL 200 bd x1 month
Pt continue
physiotheraphy

SUMMARY:
A case of post traumatic OA, responded well to her constitutional remedy given
in high potency in frequent doses.In fact her symptom of bitter taste in mouth
which was not covered by remedy was also>>. Along with the medicine patient
continued physiotherapy.

70
 Case No:6

 PRELIMINARY DATA:
NAME: Mrs J.NSex/Age-F/69yrs
Address:Lila taher, Vallabh nagar Society,1" Floor, Opposite Cooper Hospital
Occupation: Housewife
Religion: Hindu Marital Status: Married since 45years

 CHIEF COMPLAINT:
Pain in knee since 1 month left>right
Pain in right knee started 10 days back ,mild pain .No H/O trauma
Lightening like pain esp after long walk
<walking
<climbing stairs >rest > physiotherapy
C/O- pain in right heels since 10-12 years ,now has increased in intensity .In past had
taken injections for pain .Pain in heels comes only after sitting for short
time.<massage.
 ASSOCIATED COMPLAINTS :N.S

 PATIENT AS A PERSON:
Appearance: Warts on the face, prominent linea nasalis Appetite: Normal Veg
Likes: NS
Dislikes:Bitter ,sour food
Thirst: more, 10-15 glasses/day
Food/Drinks Agg/Amel: N.S
Stool: N.C
Urine: N.C
Perspiration: Profuse, all over the body, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: as if falling from height

71
 GYANAEC/ OBS. H/O:
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-Used OC
Pills for approx 3yrs initially Supplements H/0- taken calcium on & off
LMP- 15/03/2017

 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)

Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat
 MENTAL CHARACTERISTIC -
Stays with husband, has 3 daughters, all of them are married. Has anxiety about
family. Says if I wont be able to walk, then who will look after me. I should be
mobile at home atleast .Started weeping on saying this, says I feel better by
weeping .Does not want to get operated as there are many failures, says I will be
bedridden. Feels better by conversing with people. Feeling of loneliness. Her
relation with her husband is good,says he is very calm and does not demand
anything .Does not feel angry on anyone as she suppress her anger.

F/ H- Mother-Hypertension, paralysis
Father- Hypertension, Diabetes mellitus

P/H-Fracture of left foot in teenage

G/E: Pulse- 78 beats/min ; B.P- 128/70mmHg ; Temp- Afebrile Wt-69kg No

pallor /icterus / cyanosis / lymphadenopathy S/E:
R.S-AEBECVS-S1S2heard GIT-soft, no tenderness
CNS-conscious, well oriented

 LOCAL EXAMINATION:
B/L Ant medial joint line prominent
72
Right knee-ROM-5-105
Minimal effusion
Medial laxity+ ;Crepitus+ .Mild knee valgus
Left knee-ROM-0 to 100. no effusion/sy

 PROVISIONAL DIAGNOSIS-B/L OA knees with OA right foot

 INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view
CBS with ESR
Serum uric acid
Serum cholesterol
Blood sugar -fasting, post prandial

 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom

 REPERTORIAL TOTALITY:
Sensitive to reprimand
Weeps easily>consolation
Anxiety about family
Fear of water
Dreams of falling from height
Aversion to bitter taste
Pain in both knees<descending motion

 SUSCEPTIBILITY:-High
 MIASM: Sycosis

73
 DIET AND REGIMEN-Have food rich in calcium and vit D like milk & milk products n
those rich in iron
Exposure to sun rays for vit D

 AUXILLARY MODE OF TREATMENT:

Physiotherapy for knee jt:

PRESCRIPTION 17/4/19
Mrs. ABC
Rx
Nat Mur 200 (1p)
SL 200 tds x 7 day
FOLLOW UP
Date Complaints Remedy Given

24/4/19 Knee pain –SQ Thuja 1M (1p)

Heel pain –SQ Nat mur 200 tds x7
Generals –normal days

3/5/19 Pain in left knee>50% Nat mur 200 (2p)

Pain in right knee >60% Cosmos 30 tds x
Heel pain -> 7days

Generals -normal

11/5/19 Pain in both knees >70% Nat mur 1M (1p)

Loose motion last week but now> Cosmos 30 tds
x1month

10/6/19 Knee pain>80% Nat mur 1M

Heel pain >80% qdsx1month

Generals-normal

74
10/7/19 Pain in both knees >70% Nat mur 1M (1p)
Heel pain >85% SL 30 tdsx1month
Generals-normal

12/8/19 Pain in both knees >> Nat mur 1M(1P)

Pain below right malleolus SL 200 tds x
Generals-normal 1month

9/9/19 Pain in left knees>> Nat mur 200 tdsx30

Pain in right knee>> days

Heel pain>
Generals -normal

 SUMMARY:
A case of OA knees with OA right foot was given constituonal medicine starting
with medium potency but didn’t helped much.later constituonal medicine was
given in high potency in frequent doses which helped patient to greater extent
along with regular physiotherapy.

75
Case No:7

 PRELIMINARY DATA:
NAME: Mrs ABC
Sex/Age-F/61yrs
Address: Lila taher, Vallabh nagar Society,1" Floor, vile parle Occupation:
Housewife Religion: Hindu Marital Status: Married since 45years

 CHIEF COMPLAINT:
Pain in both knees since 2-3 yrs <since 4-5 months.left >right took some
ayurvedic treatment for same.swelling of both knees.
<pressure < ascending stairs <walking <sour
food >hot water fomentation >extension of
knee joints
Throbbing pulsating pain in knees.stiffness of knee joint .crepts/crakling sounds in
both knee joints.

 ASSOCIATED COMPLAINTS :N.S

 PATIENT AS A PERSON:
Appearance: moderately built whitish complexion
Appetite: Normal Veg
Likes: sweets+++
Dislikes:NS
Thirst: thirstless
Food/Drinks Agg/Amel: N.S
Stool: every alternate day ,no straining.
Urine: N.C
Perspiration: Profuse, more on face and back, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: not remembered

76
 GYANAEC/ OBS. H/O:
Menopause since 20yrs
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
Past M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-Used
OC Pills for approx 3yrs initially Supplements H/0- taken calcium on & off

 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)

Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat

 MENTAL CHARACTERISTIC -
Stays with husband, has 3 daughters, all of them are married. Is very disturbed
&tensed about son marriage as he isn’t getting suitable match .Her husband expired
18 years back due to myocardial infarction.She used to work before but now she
doesn’t do.She doesn’t like to interfere in other people matters.Weeps easily esp
when thinking aboutr husband.feels.consolation,very sensitive,mild and gentle by
nature.

F/ H- Mother-Hypertension, paralysis
Father- Hypertension, Diabetes mellitus

P/H-Fracture of left foot in teenage

G/E: Pulse- 78 beats/min ; B.P- 128/70mmHg ; Temp- Afebrile Wt-69kg No

pallor /icterus / cyanosis / lymphadenopathy S/E:
R.S-AEBE CVS-S1S2heard GIT-soft, no tenderness
CNS-conscious, well oriented

 PROVISIONAL DIAGNOSIS- B/L OA Knees

77
  INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view

 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom

 REPERTORIAL TOTALITY:
Mild
Sensitive
Weeps easily
Likes sweets
Thirstless
Pulsating pain in knee joint
Pain>extension of knee joint

 SUSCEPTIBILITY:-High

 MIASM: Psora

 DIET AND REGIMEN-Have food rich in calcium and vit D like milk n milk products n
those rich in iron
Exposure to sun rays for vit D
 AUXILLARY MODE OF TREATMENT:
Physiotherapy for knee jt:
PRESCRIPTION 7/5/19
Mrs. ABC
Rx
Puls 200 (1p)
Cosmos tdsx7 days

78
FOLLOW UP
Date Complaints Remedy Given

14/05/19 Knee pain >25% Pulsatilla 200

Swelling of knee >25% (1p) cosmos 30
tds x15 days
Generals normal

28/05/19 Knee pain -SQ Pulsatilla 200

Generals-Normal (3p) cosmos
200tds x15days

11/06/19 Says after taking puls felt almost Pulsatilla 200 4

90% better,pain had disappeared pills every 3rd
but now had reappeared again. day cosmos 30
tds x1month

11/07/19 Knee pain>80% Pulsatilla 200 4

Stiffness -0- pills every 3rdday
cosmos 30 tds
Generals-Normal x1month

26/7/19 Pain on exertion

Pulsatilla 200 4
Swelling>> pills every 3rd
day cosmos 30
tds x15

10/8/19 Knee pain >90% Pulsatilla 1M

Coryza thin watery since 2 (1P) cosmos 30
days,A/F cold drinks Generals tds x 15 days
-normal

79
25/8/19 Knee pain –o- Pulsatilla 1M
Coryza >50% (1P) cosmos 30
tds x 15 days
Generals-Normal

15/9/19 Knee pain -0- Phytum 1M (1p)

Coryza-o- Generals- cosmos tds
normal x10days

25/09/19 Pain in knees occasionally mild Pulsatilla 1M bd

fever 3 days back ,now afebrile. x4 days.
Generals -normal Cosmos
tdsx1month.

 SUMMARY:
A case of early OA with soft tissue calcification,was given her constitutional
remedy in high potency &infrequent doses.although it help the patient but to limited
extend.Hence it was repeated frequently in high potency &it showed magical result

80
Case No: 8

 PRELIMINARY DATA:
NAME: Mrs ABC Sex/Age-F/45yrs
Address:santacruz Occupation: Housewife
Religion: Hindu Marital Status: Married since 30 years

 CHIEF COMPLAINT:
Pain in right and left knee joint.left >right since 1-2 yr now increased since
2months.Pulling type of pain .Burning sensation in knee joint ocassionally.
Swelling of knee joint is unable to walk
<initial motion <walking > allopathic medicine

 ASSOCIATED COMPLAINTS :Retrosternal burning ocassionally <spicy food.

 PATIENT AS A PERSON:
Appearance: Warts on the face, prominent linea nasalis Appetite: Normal Veg
Likes: sweets+++
Dislikes: NS
Thirst: takes only sips of cold water
Food/Drinks Agg/Amel: N.S
Stool: N.C
Urine: N.C
Perspiration: Profuse, all over the body, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: not remembered

 GYANAEC/ OBS. H/O:

Menopause since 2yrs

81
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
Past M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-
Used OC Pills for approx 3yrs initially Supplements H/0- not taken

 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)

Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat.

 MENTAL CHARACTERISTIC -
Stays with husband, has 3 daughters, all of them are married. Has anxiety about
disease.Wants everything in its proper place.If it is not there,then she herself will
take trouble even if her knees are aching.Anxiety that her disease will remain
uncured and fear that she will die soon.She like company.Shares a good
relationship with husband .No tension as such in her life.

F/ H- Mother-NS
Father- NS

P/H-NAD

G/E: Pulse- 78 beats/min ; B.P- 128/70mmHg ; Temp- Afebrile Wt-69kg No

pallor /icterus / cyanosis / lymphadenopathy S/E:
R.S-AEBE CVS-S1S2heard GIT-soft, no tenderness
CNS-conscious, well oriented

LOCAL EXAMINATION:
B/L Ant medial joint line prominent
Right knee-ROM-5-105
Minimal effusion
Medial laxity+ ;Crepitus+ .Mild knee valgus
Left knee-ROM-0 to 100. no effusion/sy

82
 PROVISIONAL DIAGNOSIS-B/L Early OA knees
 INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view

 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom

 REPERTORIAL TOTALITY:
Fastidious
Anxiety about disease
Fear of death
Restlessness<night
Chilly patient

 SUSCEPTIBILITY:-High

 MIASM: Tubercular

 DIET AND REGIMEN-Have food rich in calcium and vit D like milk n milk products n
those rich in iron
Exposure to sun rays for vit D

 AUXILLARY MODE OF TREATMENT:

Physiotherapy for knee jt:

 PRESCRIPTION 24/06/19
Mrs. ABC
Rx
Ars alb 200 (1p)
SL 30 tds x 7 days

83
FOLLOW UP

Date Complaints Remedy Given

12/7/19 Knee pain >15% Arsenic album

Generals –normal 200(1p)
Patient is doing proper physiotheraphy SL 10 tdsx7 days
exercise

22/7/19 Knee pain >15% Calc ova tosta

200(1p)
Leucorrhoea -<
Cosmos 30 tdsx15
Generals-normal
days

7/8/19 Knee pain > Arsenic album

Leucorrhoea >25% 200(1p)

Generals-normal SL 10 tdsx7 days

17/8/19 Pain in knees >75% Arsenic album

Leucorrhoea-SQ 200(1p)

Generals -normal SL 30 tdsx10 days

27/08/19 Knee pain -.80% Arsenic album

Generals-Normal 200(1p)
SL 30 tdsx10days

7/09/19 Pain in knee ocass Arsenic album

Leucorrhoea >> 200(1p)

Backache with sensation of tightness SL 30 tdsx10days

Generals -normal

84
SUMMARY:
A case of OA where arsenic album was given on basic of her life situation and
mental characteristics,initially it showed ordinary result .Hence then patient was
reverted to specific like calc ova tosta which helped temporary relived but then
patient was aggravated.hence arsenic album was given infrequent doses which
shows magical result.

85
Case No: 9

 PRELIMINARY DATA:
NAME: Mrs ABC Sex/Age-F/46yrs
Address:Andheri Occupation: Housewife
Religion: Hindu Marital Status: Married since 18 years
 CHIEF COMPLAINT:
Pain in right knee since 1-2 yrs.used to work on sewing machine but had taken
leave temporary because of knee pain.Swelling of knee .Feels as if she will fall
off while walking .<motion <standing <sitting
>lying down >hot fomentation.
Cramps in leg after sitting for a long time.
 ASSOCIATED COMPLAINTS. NS
 PATIENT AS A PERSON:
Appearance: Fair
Appetite: Non Veg
Likes: sweets+++
Dislikes: spinach
Thirst: large quantity at frequent intervals
Food/Drinks Agg/Amel: N.S
Stool: N.C
Urine: N.C
Perspiration: Profuse, all over the body, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: not remembered

 GYANAEC/ OBS. H/O:

Menopause since 2yrs
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
Past M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-not
taken Supplements H/0- not taken

86
 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)
Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat.
 MENTAL CHARACTERISTIC -
Stays with husband and son,her husband use to drink and hit her a lot so she now
left him .Anger when someone lies,I stop talking to that person until he
apologise,suppress anger.
Does not like going out much .keep thinking about the past,used to cry after
going home when people ask her about past.indescive.
Spend most of the time at home working on her machine as it give her independent
feeling.

F/ H- Mother-NS
Father- NS
P/H-NAD
G/E: Pulse- 78 beats/min ; B.P- 128/70mmHg ; Temp- Afebrile Wt-69kg No
pallor /icterus / cyanosis / lymphadenopathy S/E:
R.S-AEBE CVS-S1S2heard GIT-soft, no tenderness
CNS-conscious, well oriented
LOCAL EXAMINATION:
B/L Ant medial joint line prominent
Right knee-ROM-5-105
Minimal effusion
Medial laxity+ ;Crepitus+ .Mild knee valgus
Left knee-ROM-0 to 100. no effusion

 PROVISIONAL DIAGNOSIS- OA of right knee

 INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view
 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic
disease with fully developed symptom

87
 REPERTORIAL TOTALITY:
Timid
Reserved
Independent
Hardworking
Suppressed emotions
Chilly patient

 SUSCEPTIBILITY:-Low
 MIASM: Sycosis
 DIET AND REGIMEN-Have food rich in calcium n vit D like milk n milk products n
those rich in iron
Exposure to sun rays for vit D
 AUXILLARY MODE OF TREATMENT:
Physiotherapy for knee jt.
 PRESCRIPTION 20/7/19
Mrs ABC
Rx
Silicea 200 (1p)
SL tdsx 7 days
FOLLOW UP
Date Complaints Remedy Given

28/07/19 Knee pain >15% Silicea 200 (1p)

Says getting up from sitting position has SL tdsx 7 days
become easier
Cramps in leg >10%
Generals-normal

88
5/08/19 Knee pain >initially but then was Silicea 200 (1p)
<again,so patient took her previous allop SL tdsx 15 days
medicine,then she felt much better.
Cramps>>
Generals-normal

19/08/19 Knee pain >10% Silicea 200 (1p)

Cramps>> SL tdsx 15 days
Generals-normal
But patient has restore to allop medicine
for
instant relief so that she can do her
work.

Patient didn’t return for follow up

 SUMMARY:
A case of OA knees ,was given silicea 200 in high potency as her constituonal
remedy ,by slowly increasing potency,on other hand patient wanted instant relief
to resume back to her work so she kept restoring to allopathy medicine.later
patient didn’t return for follow up.

89
Case No: 10

 PRELIMINARY DATA:
NAME: Mrs ABC Sex/Age-F/48yrs
Address:Lalbaug Occupation: BMC service
Religion: Hindu Marital Status: Married since 18 years

 CHIEF COMPLAINT:
B/L knee pain since 8-9 months.Left >right .
<sitting & getting up from sitting position
<initial motion
<winter
<morning
Initially started as a clicking sound lt>rt
Occ cramps in thigh bilaterally

Pain in heel region of right foot since 6 month

<walking <pressure
>hot water fomentation > rest

 ASSOCIATED COMPLAINTS. NS

 PATIENT AS A PERSON:
Appearance: Fair
Appetite: Normal, Veg
Likes: spicy
Dislikes: vegetables
Thirst: more during meals,tepid water
Food/Drinks Agg/Amel: N.S
Stool: N.C
90
Urine: N.C
Perspiration:moderate ,more on back, NO .NS
Sleep: 6-7hrs, refreshing
Dreams: not remembered

 GYANAEC/ OBS. H/O:

Menopause since 2yrs
O/H: G3P3AOL3-GI/62/63-All females -40yrs/37yrs/32yrs-1/2nd-FTND ;3“-LSCS
Past M/H-3-4days/28-30days-regular, moderate ,NO, NS Contraception H/O-not
taken Supplements H/0-T.shelcal OD since 1 year

 GENERAL REACTIONS (Including Thermal Modality)- (Ambi » Chilly)

Fan - S-always, W-slow, Covering -thin in all season ;Bath – S-cold, W-warm
Cannot tolerate heat

 MENTAL CHARACTERISTIC -
Stays with husband and 2 children .desire solitudes,says she is at her ease when
she is alone.Work by rules ,she gets angry if rules are not followed.Gets angry
very easily even if senior does something against rule she get angry and tell them
on face.Reaches on time or mostly before time.Says people are trouble lott
because of my punctuality.Thinks she si always correct.when she is wrong she
wont express it. Says I adjust with people at home in case of difference of
opinion.she is influenced easily by religious talk and she cannot bear noise at all
she get easily angered.

F/ H- Mother-NS
Father- Hypertention since 6 years

P/H-Renal calculi 6 years back

91
G/E: Pulse- 78 beats/min ; B.P- 130/70mmHg ;
Temp- Afebrile , Wt-69kg
No pallor /icterus / cyanosis / lymphadenopathy

S/E:
R.S-AEBE CVS-S1S2heard GIT-soft, no tenderness
CNS-conscious, well oriented

LOCAL EXAMINATION:
B/L Ant medial joint line prominent
Right knee-ROM-5-105
Minimal effusion
Medial laxity+ ;Crepitus+ .

 PROVISIONAL DIAGNOSIS- B/L OA of right knee

 INVESTIGATIONS-
X-Ray B/L Knee-AP and Lat view

 HAHNEMANIAN CLASSIFICATION OF DISEASE-Dynamic chronic miasmatic

disease with fully developed symptom

 REPERTORIAL TOTALITY:
Desire solitude
Religious affection
92
 Anger contradiction from
Irritablity noise from
Chilly patient

 SUSCEPTIBILITY:-High

 MIASM: Syphilis

 DIET AND REGIMEN-Have food rich in calcium and vit D like milk n milk products n
those rich in iron
Exposure to sun rays for vit D

 AUXILLARY MODE OF TREATMENT:

Physiotherapy for knee joint.

 PRESCRIPTION 20/8/19
Mrs.ABC
Rx
Aurum met 200(1p)
SL tdsx 7 days
FOLLOW UP
Date Complaints Remedy Given

29/8/19 Knee pain >15%,more on waking up Aurum met 200

Pain on &off (1p)
Cracking in knees on walking Cosmos tds x5 days
Pain in right heels –SQ-
Generals-normal
3/9/19 Knee pain > Aurum met 200
Stiffness of finger occ (1p)

Pain in right heels –SQ- Cosmos tds x5 days

Generals-normal

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8/09/19 Knee pain >> Aurum met 200(1p)
Stiffness of fingers>> SL tdsx 10 days
Patient continue with phsyitheraphy >>
Cracking in knees >>
Pain in right heels –SQ-
Genrals -normal
18/9/19 Pain in knee <on exertion Aurum met 200(2p)
Stiffness of finger>> Cosmos tds x10
Crackling in knees>> days

Pain in right heels>>

Generals -normal

 SUMMARY:
A case of B/L OA knees and OA right foot,was given her constitutional
remedy aurum met in hight potency ,initially result was ordinary but latter
patient started with physiotherphy regularly with medicine and it showed
result in the long run.

94
 CONCLUSION
On carefully studying in depth of each case, which was indeed useful in relation of
my topic Osteoarthritis in females, we can draw following conclusions:

• Osteoarthritis though a disease with irreversible pathology, can be treated

satisfactorily with Homoeopathic line of treatment. Even as a palliative mode of
treatment.
• When the best selected remedy helps in first prescription it can be repeated till
we get a proper satisfactory result.
• In cases when the remedy that has acted best in first prescription, if gives no
benefit in further repetition, the next line of treatment is introduction of an anti-
miasmatic drug, which will make way for the further action of the same
indicated remedy.
• When there is improvement in the cases, the best indicated remedy is our
second best, placebo.
• In many cases, the main cause of the disease is either improper dietary intake of
calcium and essential food products or sedentary lifestyle and lack of exercise,
thus the treatment is enhanced with the auxillary modes of treatment. Even
correction in diet & regimen gives a helping hand to the Homoepathic
treatment.

Thus, we can conclude that Homoeopathy has an indeed good scope in helping the
suffering humans with the disease, Osteoarthritis, when the remedy is prescribed on
the basis of totality of symptoms. Thus with the Homoeopathic treatment with
physiotherapy and dietary supplements hand in hand, pave a good scope in
decreasing the suffering vital force from the so called disease Osteoarthritis.

95
 OBSERVATION
1) AGE:

40-50 years
51-60 years
61-70 years

From the above pie chart, we can observe that in the cases seen of OA in females,
there is more predominance in the age group 40-50 yrs. Although it is a
degenerative disease &considered to be affecting the elderly, we see that 50% of
the patients affected are from 4050 yrs of age as opposed to 35% from 51-60age
group and 15%from 61-70 age group.

AGE NO OF CASES PERCENTAGE(%)

40-50 4 50%
51-60 3 35%
61-70 3 15%

96
 2) MIASM:

SYPHILIS 30%
SYCOSIS 30%
PSORA 20%
TUBERCULINUM 20%

From the above pie chart ,we can observe that in cases seen of OA in females,
30% of the affected patients are from the syphilitic and sycotic miasm each and
only 20% belong to psora & tubercular miasm each.
MIASM PERCENTAGE(%)
SYPHILIS 30%
SYCOSIS 30%
PSORA 20%
TUBERCULAR 20%

97
 3) CALCIUM SUPPLEMENTS:

Take Ca supplement
Don’t take Ca supplement

From the above pie chart, we can observe that in cases seen of OA in females those
who have taken calcium supplements in past had shown late onset as compared to
those who have not taken calcium supplement at all, as we see that 60% of women
taking calcium supplements showed s/s of OA at an older age as compared to the
40% who had not taken calcium supplements at all.

CALCUIM SUPPLEMENT PERCENTAGE(%)

TAKEN 60%
NOT TAKEN 40%

98
 MASTER CHART

CAS NAME AG MIASM DIAGNOSIS REMEDY CALCIUM RESPONS

E NO E SUPPLEM E
ENT IN
PAST
1 MRS.ABC 60 Sycosis OA KNEE Nux TAKEN BETTER
yrs vomica
200 (1p)
2 MRS.ABC 57 Tubercul OA KNEE calc phos TAKEN BETTER
yrs ar 200 bd x
15 days
3 MRS .ABC 45 Syphilis OA KNEE Calc carb NOT BETTER
yrs 200 bd x TAKEN
15days
4 MRS.ABC 69 Psora OA KNEE Puls 200 TAKEN AGGRAV
yrs bd x 7 days ATED
5 MRS.ABC 57 Syphilis OA KNEE Silicea TAKEN BETTER
yrs 200(1p)
6 MRS .ABC 69 Sycosis OA KNEE Nat mur TAKEN BETTER
yrs 200 (1p)
7 MRS ABC 61 Psora OA KNEE Pulsatilla TAKEN BETTER
yrs 200 (1p)
8 MRS .ABC 45yr Tubercul OA KNEE Arsenic NOT BETTER
s ar album200 TAKEN
(1p)
9 MRS ABC 46 Sycosis OA KNEE Silicea 200 NOT BETTER
yrs (1P) TAKEN
10 MRS.ABC 48 Syphilis OA KNEE Aurum met NOT BETTER
yrs 200 (1p) TAKEN

99
 BIBLIOGRAPHY

1. Kumar & Clark's Clinical Medicine – 7th edition (Published By Saunders,

2009)

2. Davidson’s Principles and practice of Medicine – 20th edition published by

Elsevier

3. Guyton And Hall Textbook Of Medical Physiology-11th Edition

4. Harrison’s manual of medicine – 17th edition

5. Pocket Manual Of Homoeopathic Materia Medica By William Boericke, M.D.,

9th Edition, IBP – Publishers

6. ORGANON OF MEDICINE by Hahnemann Samuel- 6th edition

7. Keynotes And Characteristics With Comparisons of some of the Leading

Remedies of the Materia Medica Henry Clay Allen, M. D.

8. Lectures On Homoeopathic Philosophy by James Tyler Kent, A.M., M.D.-

Reprint 9th edition

9. www.homeoint.org

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