Rheumatology And Homoeo Therapeutics
NATIONAL JOURNAL OF HOMOEOPATHY 1997 Sep / Oct VOL 5 NO 5.
Dr E Balakrishnan
'Benz-ac / Sep / Sep / Calc-fl / Eupha

"Rheumatology" is one of the fastest growing super-specialties in modern medicine-Rheumatic diseases have to be diagnosed and treated early to prevent deformity and disability.

"With advances in immunology, immuno-genetics, immuno-regulation, molecular biology with joint re-construction and prosthetic surgery, doctors have been able to contain and treat rheumatic diseases much better than even a few years ago."

Replacements of hip joint, knee joint, shoulder joint, elbow joint, etc are quite common these days. We are really proud of the achievements of the modern science and surgery in the field of spare part surgery reconstructive surgery in tackling rheumatic disease.

True, this is one aspect of the present day advances in orthodox medical system -Allopathy. But, we Homoeopaths have a duty to proclaim, that when they meet with failures with the orthodox system, the dis-eased should not think that they have reached the road's end.

As far as medical treatment for Rheumatic diseases is concerned, we can proudly claim that we have, in Homoeopathic therapeutics enough weapons in our armoury, which when judiciously employed, can cope with any situation, giving immediate relief and radical cure for the ailing rheumatic patients.

Rheumatology is the science or study of Rheumatic diseases, which embraces a diverse group of diseases and syndromes with disorder of the connective tissue. Hence it usually presents pain, stiffness or swelling of muscles and joints. The varied forms of the disease are Rheumatic fever, Rheumatic heart disease, Rheumatoid Arthritis, Osteoarthritis and gout.

So far as Homoeopathic Therapeutics is concerned one major point to be considered in the treatment of Rheumatic diseases is the need for resorting to antimiasmatic drugs to remove the miasmatic bloc in the patient, when only we can go to the root of the disease and effect radical cure.

"The miasms are like enemies entrenched" They make such breaches in the physical and mental economy that the debilitated life force cannot repair them. They deform the body, dull the intellect and destroy reason. They destroy hope and courage and drive the sunshine out of life, making one hypochondriac, even driving him to suicide"

Mostly Rheumatism, Rheumatoid arthritis and Gout is the manifestations of latent sycotic miasm. The syphilitic miasm attacks the bones - Arthritis - Deformans, Osteo arthritis etc are such diseases.

Most often we find that rheumatic complaints are implanted on constitutions vitiated by Tubercular, Sycotic, or Syphilitic miasms.

On case taking we have to delve deep into the life style of the patient and very often we have to go behind the personality to bring forth the complexities. We cannot depend on the presented totality of symptoms alone to arrive at the indicated remedy.

The importance of emotional factors in rheumatic diseases and the need for psychological support should not be overlooked. This support depends upon rapport between the patient and this doctor.

Rheumatic Fever: is a systemic disease that may either be self-limiting or lead slowly to progressive valvular deformity. Rheumatic fever is the commonest cause of heart disease in people under 50 years of age. In overall incidence, it ranks third behind hypertension and atherosclerotic coronary disease.

Rheumatic fever is supposed to be initiated by an infection with group A hemolytic streptococci, appearing usually 1-4 weeks after tonsillitis, nasopharyngitis, or otitis. The acute phase of Rheumatic fever may involve the endocardium, myocardium, pericardium, synovial joint linings, lungs or pleura.

Rheumatic Heart Disease: Chronic rheumatic heart disease results from single or repeated attacks of rheumatic fever which produce rigidity of the cusps. The mitral valve alone is affected in 50-60% of cases; combined lesions of the aortic and mitral valves occur in 20%. Tricuspid involvement occurs only in association with mitral or aortic disease in 10% of cases.

The use of "Streptococcin" the nosode, followed by the indicated drugs from amongst the cardio-rheumatic remedies has been seen to give signal success in this type of disease. Aconitum-ferox, Aur-mur, Cactus, Convaliaria, Cimicifuga, Rhus-tox, Spigelia are some of the leading remedies to be considered.

Rheumatoid Arthritis: is a chronic systemic inflammatory disease of unknown cause. The pathologic findings in the joint include chronic synovitis. Cartilage erosion occurs early in the acute phase effusion and other manifestations of inflammation are common. In the later stage, this may result in fibrous ankylosis. Medor, Guaiacum, Colchicum, Phyt, Rhus-tox, Merc-sol, Sep are some of the leading remedies to be considered.

Ankylosing Spondylitis: is a chronic inflammatory disease of the joints of the axial skeleton. 

Osteoarthritis: is a chronic progressive arthropathy, which is characterized by degeneration of cartilage and hypertrophy of bone at the articular margins. OAN [the osteo arthritic nosode], Leuticum, Aur-met, Causticum, Kali-iod, Rhus-tox, Sul generally come in for consideration.

Gout: is a metabolic disease of a heterogeneous nature, often familial, associated with abnormal amounts of urates in the body and characterized by an early, recurring acute arthritis and later on resulting in chronic deforming arthritis. Medor, Am-benz, Benz-ac, Cockh, Guaic, Puls, Uric acid, Urt-urens are some of the leading remedies.

The clinical indications of a few important remedies which come in for consideration in the treatment of Rheumatic diseases are given below, followed by 5 cases.

Aconitum-ferox : Can be of great help [when indicated] in Rheumatic heart disease. "Rather more violent in it's action than Aconitum-napellus. It is more diuretic and less anti-pyretic. It has proved valuable in cardiac dyspnoea, neuralgia and acute gout. Dyspnoea must sit up. Rapid perspiration. Anxiety with suffocation from feeling of paralysis in respiratory muscles. Cheyenne-strokes breathing.

Actia-spicata : A rheumatic remedy, especially of the small joints, tearing, tingling pains characterize it. Wrist rheumatic; joints are swollen and pains worse by touch and movement.

Cimicifuga : Anti-sycotic remedy. Rheumatism affecting the bellies of muscles. Pains - stitching, cramping. Rheumatic pains in muscles of neck and back which feel stiff, lame, contracted; spine sensitive from using arms in sewing, piano playing. Angina pectoris; numbness of [L] arm. Paroxysms of anguish about heart; Dyspnoea.

Benz-acid: Anti-sycotic; having marked action on metabolism, cures symptoms of uric acid diathesis, with urine having offensive smell, and gouty symptoms. Joints crack on motion, tearing with stitches. Pain in Tendo Achilles. Rheumatic gout; nodes very painful. Gouty deposits. Ganglion, swelling of wrist. Pain and swelling in knees. Bunion of great toe. Tearing pain in great toe. Excess of uric acid.

Kalmia: Anti -syphilitic remedy. Remedy for gouty and rheumatic metastasis of heart. Fluttering heart Palpitation, worse leaning forward. Tachycardia with pain. Rheumatism [even syphilitic] that finally attacks heart, with thickening of valves. Violent tumultuous visible action of heart.
"When rheumatism treated externally and cardiac symptoms ensue [Kent]. Migratory rheumatism with heart affected. Pains extend down [L] arm. Hypertrophy and valvular insufficiency or thickening after rheumatism.

Medorrhinum: Anti-psoric, anti-sycotic and anti-syphilitic. For the constitutional effects of maltreated and suppressed gonorrhoea. Several joints affected. Extensive redress, swelling, pain and tenderness. Acute and chronic gonorrheal rheumatism. Sharp pains at apex of heart, worse motion. Great pain in heart region extending to [L] arm, and throat.

OAN [the Osteo-arthritic nosode] In the treatment of Osteo arthritis involving large joints, this drug is helpful as a direct remedy or as an intercurrent remedy, along with other indicated constitutional remedies.

Phytolacca Anti-psoric, anti-sycotic and anti-syphilitic remedy. Patients of rheumatic diathesis; rheumatism of fibrous perisoteal tissue; mercurial or syphilitic. 

Rhododendron Rheumatic and gouty symptoms well marked. Rheumatism in the hot season. Joints swollen; gouty inflammation of great toe joints. Rheumatic tearing in all limbs, especially [R] side; worse at rest and stormy weather. 

Spigelia Rheumatic pericarditis and endo carditis. Irregularity of the heart. Worse from motion. Must lie on [R] side, with head high.
Useful in the treatment of rheumatism of children

Case 1: 
36 yr old, married woman with two children
Complaints: swelling with redness and rigidity of the joints. Both the wrists and knees since 3 years.
Since Allopathy did not relieve her resorted to Homoeo
History of urinary tract infection on two earlier occasions which was treated and curd with antibiotics. Based on this earlier history of urinary tract infection she was given Medor 1000, 2 doses [12 hours apart.] This brought about fever for 2/3 days with AGG of the swelling at the joints. Urine was having highly offensive smell and S. uric acid was high. Benzoic-acid 200 3 doses per day, for 3 days, brought immense relief for all the complaints. She was further given Benz-acid 1000 2 doses per week, for 3 weeks which completed the cure.

CASE 2:
58 yr old, widow, came in Jan 88. She had rheumatism especially affecting both the wrists and both the ankles with rigidity and swelling since 1984. She was also having extensive psoriasis affecting the scalp, face and chest.

Life Style And Mentals: It was 4 years since she lost her husband. She had 2 sons, one of whom, an earning member lived separately without caring for his mother and family. The other boy was still studying and family was facing great financial difficulties. Brooding over her miserable lot, she was in tears when she spoke about her complaints. 

Treatment: 12/1/88 Medor 1000 - 2 doses [12 hrs apart] initial AGG of the joint pains and swelling for few days.
4/2/88 Sep 200 - 3 doses, 1 dose daily at bedtime for 3 days.
14/2/88 Improvement noticed in the stiffness of the joints and the skin lesions healed up. Kali-sulf 6X - thrice a day.
25/2/88 Sep 10M - 2 doses [12 hrs apart] The rheumatic complaints and skin lesions improved within a month.

The rigidity of the joints and swelling used to aggravate every rainy season and the psoriasis also used to aggravate every winter. She was given 1 dose of Sep 10M at the outset of monsoon and winter for 2 consecutive years. The patient had no relapse of both the complaints. 

Rubrics Considered:

Case 3: 62 yr old female with complaint of: Pain and swelling on the [L] knee joint since 6 months ; [R] knee also painful but not much of swelling. Severe pain on standing for short while; AGG of pain while bending and on motion. 

Investigations
23/9/97 - BUN 18; S. Uric acid 9.2
Urine - occult blood F Positive. Leucocytes 10-12; RBC 6-8; Epi-cells 4-5; Bacteria - Few 

X ray [L] knee joint - Appearance are those of osteo arthritis and medial cartilage disease and suprapatellar effusion. Patient came in for Homoeopathic treatment on 24/10/97.The above complaints started during the rainy season and not much relief from Allopathic treatment.

Treatment: 24/10/97 Thuja 1000 2 doses [12 hrs apart]
31/10/97 Burning micturition, very much reduced; not much relief for the knee pain. Sep 200 daily 2 doses for 3 days and with 3 days gap. Sep 10M 2 doses [12 hrs apart]
8/11/97 knee swelling almost gone. Reported quite well in all other respects. Still under observation.

Case 4:
68 Year old lady suffering from osteo arthritis affecting both the knee joints for few years, had been taking analgesic tablets regularly to see that she is just in a position to do the minimum essential household jobs, could be completely relieved of the major problems-rigidity at the joints and acute pain with the following treatment:
1. OAN 1000 - 2 doses every month for 4/5 months
2. Phytolacca 1000 - 2 doses every week for 2 months
3. Calcarea-fluor 30 - daily 1 dose for about 2 months.

CASE 5:
51 yr old female patient, operated for cancer of the breast in Nov'95 followed by chemo therapy.
Since Aug '97 she is totally bed ridden due to agonizing pain in both the legs down the hip more on the [L] leg; not able to move even to the toilet; despite aggressive treatment in allopathy. On consulting the oncologist, it was opined that proper treatment could be considered only after investigations like CT scan of bone and the chest are done. This was found difficult unless she is in a reasonably fit position to go to the hospital. Patient's husband came in for consultation to see if some relief could be given under homeopathic treatment. Visited the patient on 5/11/97. A miserable picture was presented the patient was shrieking for help, tossing in her bed, because of the excruciating pain .
She was a chilly patient, lying mostly on her back which gave her some relief; nature of the pain was tearing; some relief on hot fomentation. She was placed on Rhus-tox 1000 every 4 hours 4 doses a day, and Euphorbium 6 every 3 hours because of the history of cancerous diathesis.
Marvelous improvement noticed within 2 days; relieved of the pain totally within 4 days; could move about inside the house for her essential needs. Not only that she could go to a hospital on 10/11/97 for the CT Scan.
CT Scan of the chest and bone revealed:
1.Multiple lung and pleural metastasis
2. Multiple liver and bony metastasis in the vertebra and the sternum
3. Possibility of osteoarthritic changes in the vertebrae.