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Efficacy of Ayurvedic drugs in the management of gouty arthritis -A case

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 Efficacy of Ayurvedic drugs in the
CASE REPORT

management of gouty arthritis – A case

study
Santosh Kumar Maurya1, Dinesh Kumar Verma2
1
Department of Dravyaguna, Shanti Ayurvedic Medical College and Hospital, Ballia, Uttar Pradesh, India,
2
Department of Rasa Shastra, Shanti Ayurvedic Medical College and Hospital, Ballia, Uttar Pradesh, India

Abstract

Our day-to-day life is very much influenced by joint pain conditions in old age. However, these conditions
include osteoarthritis, rheumatoid arthritis, and gouty arthritis. Gouty arthritis is characterized by hyperuricemia,
deposition of uric acid crystals in and around joints, as well as nearby soft tissues. Change in lifestyle has strong
impact on incidence of gouty arthritis. Modern treatment with synthetic drug neither able to subside painful
conditions for longer duration nor completely cure the diseases. Ayurveda describes gouty arthritis under the name
of vatarakta in its classics. Several herbal, herbomineral preparations were reported in classics which are helpful
in gouty arthritis. In the present article, we report success story of Ayurvedic medicines in a complex case of a
54-year-old male with polyarticular tophaceous gouty arthritis with disabling effects in hand and feet.

Key words: Gouty Arthritis, Vatarakta, Ayurveda

INTRODUCTION therapy is one of the most faithful medical systems in Indian

subcontinent, where plants are essential element of society

H
yperuricemia as a result of altered
purine metabolism contributes
in rheumatic disorder known as
gout.[1] Long-term untreated condition leads to
monoarticular arthritis, intercritical period, and
chronic tophaceous gout where monosodium
urate (MSU) crystals were deposited in
connective tissues and kidneys.[2,3] The disease
usually affects middle-aged and elderly men
over 40 years and postmenopausal females.
Numerous risk factors, namely, genetics, age,
and gender or modifiable risk factors including
hyperuricemia, diet, alcohol, medications, body
mass index, and physical fitness.[4] Overall,
typical clinical manifestations of the disease are
swelling, pain, tenderness, heat at joints, flares,
tophi, and urate arthropathy.[5] Joint stiffness,
mobility issues, and erythema also present
in some cases. In a typical practice, urate-
lowering therapy is of main concern. Treatment
includes non-steroidal anti-inflammatory drugs
(NSAIDs), colchicine, and corticosteroids.
Intra-articular corticosteroid injection is also
used in advance cases.[6] Non-pharmacological
measures are also helpful in controlling the
progress of disease. Several alternative therapies
are also used by the patients to treat acute
painful episodes of gouty arthritis.[7] Plant-based
and lifestyle. We are witnessing a golden age of scientific
and systematic development of Ayurveda in the treatment of
such type of chronic diseases. In the present article, we report
success story of Ayurvedic medicines in a complex case
of a 54-year-old male with polyarticular tophaceous gouty
arthritis with disabling effects in hand and feet.
CASE REPORT
A 54-year-old male patient was presented to our OPD at
Shanti Ayurvedic Medical College, Ballia. The patient was
a farmer and belongs to near village Bairiya. He has long
history of pain, swelling, and redness in his right great toe
as well as pain, swelling, and deformity of small and large
joints of both hands and feet without morning stiffness for
approximately 6 years. According to the patient, when he
woke up at midnight, unbearable pain occurs in his toe, and
in the morning, the toe was dark red and warm. Initially,
he took medicine from local health practitioner and treated
with indomethacin leading to the relief over a period of time.
Subsequently, the patient developed recurring incident of
polyarthritis with painless nodules on hand and feet. Then,
Address for correspondence:
Santosh Kumar Maurya, Shanti Ayurvedic Medical
College and Hospital, Ballia, Uttar Pradesh, India.
E-mail: santoshmatrichaya@gmail.com

International Journal of Green Pharmacy • Vol 11 • Special Issue 2018 | S147

 Maurya and Verma et al.: Ayurvedic management of gouty arthritis

he goes to modern medicine doctor, and he was advised to

take allopurinol for 4 months with protein restricted die as
his serum uric acid levels reach up to of 11.93 mg/dL. The
patient comes to us for better one. On the first visit of the
patient, the following observations were made [Figure 1].

He was afebrile, cardiovascular and respiratory system

parameters were normal. Locomotor system examination
demonstrates muscular atrophy of limbs and multiple
deformities of wrists, proximal interphalangeal joints (PIP),
metacarpophalangeal joints of hands, and metatarsophalangeal
joints of feet. Non-inflammatory subcutaneous nodule of
variable sizes (1–2 cm) also present at joints. Biochemical
investigation shows hemoglobin 13.6 g/dL, thin-layer
Figure 1: Blood report before treatment
chromatography of 7800/µL, platelet counts of 130 × 103/µL,
ESR of 18/mm 1st h, uric acid of 13.46 mg/dL, creatinine
of 1.04 mg/dL, negative rheumatoid factor, and C-reactive
protein 12 mg/L. X-ray confirms the disease as joint space
was reduced, subarticular cysts were present at PIP of middle
finger of the left hand. Bilateral reduction of joint spaces and
presence of subarticular cysts was also observed in X-ray of
feet. Histopathology nodule shows the presence of tophus
while no atypical cells were observed.

Drug and Treatment Protocol

The patient was advised to take the following medicine for

3 months as follows:
1. Bodhivriksha Kashaya: 50 mL twice daily
2. Vata gajankush Ras: 365 mg twice daily
3. Amrita Guggulu: 500 mg twice daily Figure 2: Blood report after treatment
4. Punarnava Guggulu: 500 mg twice daily
5. Amrutadi Taila: For local application.

Follow-up was done on every 7th day during the 1st month
and later once in 15 days for next 2 months. Assessment was
made on the basis of subjective and objective parameters
(radiological findings) both before and after treatment.
After administration of drug by the end of 3rd week of the
treatment, the patient gets relief from pain. He was able to do
his day-to-day life work. He was instructed to strictly follow
the prescribed diet regime and lifestyle. In next 20 days, the
changes appear in radiological findings. Blood report reveals
that uric acid was significantly reduced. The treatment will
continue till the complete removal of tophus [Figures 2 and 3].

DISCUSSION Figure 3: X‑ray report after treatment

Gout is a metabolic disorder where uric acid levels exceed its
higher limit 6.8 mg/dL because uric acid excretion through
kidney was impaired.[2] The excess uric acid deposited in the
joint and soft tissues as needle-shaped crystal of MSU known
as tophus.[5] The most common sites are skin overlying joints
and helix of the ears. Usually, the tophi are formed after a
mean period of 10 years of disease duration. This may
lead to nephrolithiasis and renal damage.[8] These changes
manifest certain radiologic changes asymmetrical, erosive
arthritis with preserved articular surface in gouty arthritis.
Bone erosions may be seen in advance stage due to tophi
deposition.[9] The treatment approaches toward gouty arthritis
has been changed a lot in recent years. The pharmacological
measures NSAIDs, colchicine, and steroids should not be

International Journal of Green Pharmacy • Vol 11 • Special Issue 2018 | S148

 Maurya and Verma et al.: Ayurvedic management of gouty arthritis
used for a longer period due to their side effects. Hence, the
use of Ayurvedic medicine in case of arthritis increases day-
by-day. Medicinal plants and mineral drug from Ayurveda
science can be very helpful in the treatment of hyperuricemia
and gout. Ayurveda encourages incorporation of lifestyle
modification along with specific herbs and minerals to cure
various diseases.[7] The effects of such Ayurvedic drugs are
purely based on observation.
CONCLUSION
Polyarticular tophaceous gouty arthritis is uncommon
considering pharmacological treatment of hyperuricemia
and such cases may be considered as differential diagnosis
for rheumatoid arthritis so that early treatment will stop the
disability effects in such patients. We have treated the patients
with such symptoms successfully with the Ayurvedic drugs.
Thus, the current case confirms that herbal treatment of gouty
arthritis can be achieved with the Ayurveda.
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Source of Support: Nil. Conflict of Interest: None declared.