Phytochemicals of Ayurvedic medicine in the treatment of rheumatoid arthritis

The Ayurvedic system of medicine is generally known for its potential to treat rheumatic diseases. However, documentations in international literature are scarce due to several reasons: Western and Ayurvedic medical systems are based on different conceptual frameworks and have no common disease entities. Ayurvedic treatments are often individualized treatments with complex phytochemical compositions. To address these challenges we analysed the Ayurvedic disease entities related to rheumatoid arthritis (RA) by literature [1]. Further, in an open observational pilot study, a team of Indian Western and Ayurvedic physicians diagnosed patients as RA (ARA-criteria 1987) [2] followed by the Ayurvedic diagnosis [1, 2].

Patients were treated with one line of Ayurvedic herbal drug preparations – the monoherb (Semecarpus anacardium Blume) formulation Bhallatak parpati [2, 3], Commiphora mukul Engl. [2], and Asparagus racemosus Willd./Withania somnifera (L.) Dunal (1:1) [2] for 10 months (m). Disease parameters were documented at m 1, 2, 3, 5, 7, 10. Available patients were followed up to 28 months (6 m intervals).

44 patients were diagnosed as RA with the majority in advanced stages. The RA patients belonged to the following Ayurvedic diagnoses: Sandhigatavata srotovarodha (SS) (n = 33), Sandhigatavata dhatukseya (SD) (n = 6), Amavata (A) (n = 5). An intention to treat analysis revealed reductions of ESR (p ≤0.02), swollen joint counts (p ≤0.04), pain index (p ≤0.002) and improvements of the functional status (p ≤0.05) (month 10). Hyaluronic acid concentrations and hematological parameters remained unchanged. The 20% Paulus response was achieved in 34% of all patients and in 58% of the completers (n = 26). The 50% Paulus response was achieved in 15.9% of all patients, in 40% of A-, 33% of SD-, but only in 9% of SS-patients. Mild adverse events occurred in the SD and SS groups. The long-term follow-up (n = 11) revealed a stable improvement.

The selected Ayurvedic drug preparations appear to be promising for the management of subgroups of RA and should be further investigated. Ayurvedic diagnostics may support the selection of responding subgroups. Although the integration of Asian and Western medical systems appears to be difficult because of the different diagnostic criteria, this aspect may specifically open new ways to address fundamental challenges in the diagnosis, prognosis and treatment of multifactorial diseases like RA.

Literatur:

[1] Ulrich-Merzenich G et al. Arthritis Rheum 1999; 42: 1553 – 1555

[2] Ulrich-Merzenich G. Hyaluronic acid and other glycosaminoglycans in rheumatoid arthritis [PhD-Thesis]. Bonn: University; 1998

[3] Chopra A et al. Clin Rheumatol 2012; 31: 259 – 269