C C RH Quar ter ly Bul I e t i n

t/ol. 23 (3&4) 2001

RHEUMATOID ARTHRITIS : AN ANALYTICAL STUDY OF 25 CASES

S Gopinadhan

SUMMARY aeliology also favours the role of Homoeopathy in its

treatment because Homoeopathy is unique in its
psychosomaiic approach to every individual case of
This scientific paper is based on the analytical study
disease. Since it is a condition that will lead lo severe
of 25 cases of Rheumatoid afthritis treated at Central
physicaldisability and since there is no curative treatment
Resea rc h I nstitute for H omoeopathy, Koftayam u nde r the in other systems of medicine, we are at a great hope ol
project Psychosomatic disorders' classed under
curing such patients if they come for the treatment at an
Behavioural Disorders - Neurotic, anxiety, hysterical,
earlierstage provaded they arq trealed systematically and
psycho somatic disorders. These patients were studied
patiently.
during the period 1992-95 in the OPD ot this lnstitute. ln
majority of these pat ie nts psych ological factors have bee n
found to have a role in the initiation or precipitation of the This short paperonthe study ol25 cases ol Bheumatoid
complaints. The results obtained in this study have been Arthritis, though not a controlled study, reveals how
analysed clinically to show the elficacy of the treatment effectively this condition could be treated without leading
and statistically to prove the validity of the study. to any complications and physical disability.Though the
number ol cases studied was less in number, the results
obtained was genuine and conclusive, Based on the
INTHODUCTION results obtained in this sludy, further well controlled and
Rheumatoid arthritis is a systematic immunological drug related studies can be conducted ln our institutions.
disease characterised by jolnt inflammation. lt is one ol
the most common joint inllammatory disease associated Aims and Objectives
with physicalhandicap. lt is adisease of unknown aetiology,
but evidence points to persistent immune over activity. The aims and objectives of this study are:
auto immunity and presence of immune complexes at the
articular and extra adicularsites. /t was SirWilliam Oslere,
who in 1982 mentioned shock, worry and grief as the
1 . To lind out a group of most efficacious drugs for
the treatment of rheumatoid arthritis.
causative factor for Bheumatiod arthrlrs. Recent studies
show that the immune process are related to the 2. To find out the most useful potency for treating
psychological events, so there is resurgence of the such palients.
interest in the psychogenic aetiology of disease. 8ullatest 3. To find out the most reliable indications of the
studies suggest that psychological factors play a drugs lound most useful.
predominant role in the sero-negative group where as the
biological factors are important in sero-positive group.lt Materials and Method
has also been noted that those who do not express
emotions in situations and conf licts in which the emotions
The materials used for thls study were 25 diagnosed
need to su rface become the victims of such psychosomatic
cases of Rheumatoid arthritis ol less than 10 years
diseases. However, in other studies no co-relation has
duration, treated during the period between 1 992-95. The
been found between the psychogenicity and onset of the
inclusion and exclusion criteria for the selection of these
disease. Similarly the presence of immunological factors
25 cases were the following :
are found in 6070 cases only.
I

I This uncertaintiy in the aetiology and the process of

1. All cases were adult type of Bheumatoid arthritis.

auto immunity makes the role of Homoeopathy more 2. Both sexes were included
important in the treatment of Rheumatoid Arthritis, than 3. Both sero-positive and sero-negative cases were
any other mode of treatment. Again the psychosomatic included.

Asstt. Research Officer (H), Central Research lnstitute (H), Kottayam, Kerala

32
 Rlrc matoiLl,lrthritis )n.\ dtticLtl Stlnl\, o[25 C.!se." (-('l?H Qlct lr BulIetin
l'o1.23 G&1) 2001

4. I/ajority ol the cases inciuded were diagnosed by the 2. Joint lnvolvement

experts from other systems of medicine. Small joints of the hands only
5. All the cases were under different treatment before
Smalljoints of the hands and leet
1

2
including into this srudy.
Small ioints of the hands, leet and wrist 3
6. All cases were included after a clinjco-pathological
Small joints of the
re-investigation and diagnosis including immunology, hands, leet, wrist and
serology and radiology. No invasive techniques were cervical joints
used. N/lajority of the loints including
7. Cases with severe joint deformities and complications large joints
were excluded. Restriction of day to day activities
The method usedlorthis study was aclinicalmethod Nlildly disabled (can't do strenuous
and for the conlirmation and scientificiiy the results work)
obtained have been statistically analysed and evaluated. Moderately disabled (can do his
Allcases were treated as out patjents and no controls were routine activity like bathing, eating,
kept for the study. All cases were treated after a detailed dressing etc.)
history taklng with the helpof case recording proformaand Severely disabled (can't do even his
also after detailed laboratory investigations. The method routine actjvity)
of treatmentwas only medicaland no Iiniments or external
medications were used. Medicines were prescribed after 4. ESR increased
strici individualisation and given in minimum doses as 25 - 49 mmltu. 1
medicated pills in sugar of milk with blank tablets as 50 - 74 mm/hr. 2
placebo to all patienls. Potencies ranging from 30 to 1olvl 75 - 99 mm/hr.
and 0/6 have been used in the study. Repetition and 100 and above 4
change of potency and remedy were done as and when
needed according to the andications. lnstructions were 5. R.A. Factor
given to the patients to avoid coffee, tea, tobacco, cocoa,
Negative 1
perf umes, alcoholic drinks and other medicinalagents. All
Positive 2
patrents were given permission to do their works except
during acute exacerbations (at the same time avoiding CRP
strenuous physical works) Negative 1

Positive 2
ASSESSMENT AND FOLLOW UP
7. Extra - articular manifestations
All cases were followed up for more than 2 years and Absent 0
periodical evaluation was done once in 2 weeks. Final Present
I 1

assessment and evaluation were done in each case on the

completlon of 2 years.
8. X-Ray findings
Joint space reduced any one 1

Bony crosions any two 2

For an effective assessment and evaluation dasease
ntensity scores were given to each and every patient as Soft tissues swellings any three 3
shown below. Alter the completion of 2 years the post Osteoporosis all 1

treatment disease intensity scores were compared with The minimum disease intensity score found among
the pre-treatment disease intensity scores and statistically these patients was 7 and maximum was 25. ln addilion to
evaluated. the assessment based on disease intensity scores,
improvement assessment was also done on the basis of
Disease intensity scores used in this study the change in the frequency and du ration of the atfections.
Symptoms/ Signs Scores
Table 1

L ratn Total number ot patients

Pain only on severe exertion 1

Pain du ring mild exedion 2 Total(T) I/ale(M) Female(F)

Pain even while at rest
Wince with pain 4 25 19

+ 33
 Rhelnlatoid Artht'itis - An /lnttlylical Study of25 Cases
CCRHQua erly Btiletin
,'o1.23 (3&1) 2001

Table 2 Table 7
Age otthe patients (Minimum 24-years Maximum-65 years) Extra articular f indings

'1 10
Subcutaneous nodules
25-30 211
30-35 303 Arteritis
35-40 404
40-45 615 Neuritis
45-50 413 Eye affections
50-55 202
55-60 1'1
'1 01
0 Lungs
60-65
65-70 110 Cardiac
Muscle wasting
Table 3 Osieoporosis
Precipitating lactors Anaemia
M
Table 8
lnfections 211 Laboratorytindings
Climate
Over exertion
Psychological 13 2 11

ESH increased 24 6 1B
Table 4 Hb% reduced 404
Pre-disposing Iactors Total FIBC reduced
M RA factor +ve 16 2 11

Heredity 110 Serum lron - not done

lmmunological 12 2 10 Serum protein - not done
Both 404 Latex agglutinations - not done
Others eg. occuPation Synovial fluid exam - not done
Synovial membrane exam - not done
Table 5 Table I
M Fladiological lindings

Pain. stiffness and swelling of lP, MCP joint 25 19

of hand
Pain stiffness and swelling of wrist 18 3 15 Joint space reduction ,-u4 12
Pain. stiffness and swelling of feet 8 26 Osteoporosis
Pain, stiffness and swelling of cervical joints 6 15 Bony erosions
Pain. stiffness and swelling of other joints 16 3 13 Soft tissue swelling 204
Table 6 Table 10
Obiective symptoms Diseasc lntensity Scores belore Treatment

Frequency

0-5 0
Symmetrical joints involvement 20 4 '16

Tenderness 25 6 19 5-1 0
Swelling 25 6 19 10-15 10
lvlovements restricted- 15-20
MiId 16 3 13
20-25 3
lvloderate 0
Severe 312 25-30
34
Rheumatoid .lrthitis - An Analytical Study of25 Cases CC RH Quarterly Bulletin
t'ol.23 (3&4) 2001

RESULTS Therapeutic Details

For an easy understanding the results obtained are
shown in tabular form Table 14
Drugs used and lound effective
Table 1 l
Disease lntensity Scores of 25 Patients before and after Drug Potency
treatment
Graphites 200 1 01
Before After Lycopodium '1000,0/6 2 1't
treatment treatment Medorrhinum 200, 1M, 10M 2 o2
'l
Pulsatilla 1000, '10M 4
1
't6 9 Rhus tox 200, 1M, 10M 11
2 It) 11
3 17 13
Table 15
4 5
5 '11
7 Drugs used as Complementary and Cognates
6 11 5
7 20 15
Drug Potency To which Drug T M F
8 1'l tycoEod-inmroOo-FuE---=--0-------
I 2-l 16 Lycopodium 1000 Flhus tox 211
10 16 6 Sulphur 1000 Medorrhinum 1 0 1
11 7 3
12 11 o Details about the dosage and repetition will be
13 '13
I understood if we go lhrough the sample cases attached to
14 '13
I this paper.
15 '16
10
16 11
17 16 14 Statistical treatment of the disease intensity scores
18 12 7
19 8 6
20 14 11
Since we have pre-treatment and post-treatment
21 17 11
scores, we use the paired 't' test" 1o lind out whether this
22 11 7 treatment is effective or not. Here lirst we have to make a
15 "Null hypotheses" denoted by Hc : this treatment is not
24 7 5 effective. Sothe hypotheses (alternate) is H1 :thetreatment
25 13 is effective.
Tabte 12
Disease intensity scores after treatment ll X1X\X3...Xn are lhe pre-treatment scores and y,,
Yz Y, Yn are the post treatment scores then to test it we
Scores Flequency
d
0-5 ,1
use the statistic t=--;---t (n-1)df where't'isthe5%
5 - 10 '13
10 - '15
15-20
20-25
8
3
0
tabled C.V. fo Student 't' distribution, d = I.,'
n
(i =
25-30 0

Table 13 dir _d-

1.2.3.-----n), di = (Yi - Xi), S = SD =
Recurrence of the complaints after treatment
-

From the data (scores) obtained lirst we have to

No recurrence 1'1 0 calculate't'. There are also tabled C.V. ol't'at 5% levelof
Recurrence with decreased intensity 2't 4 17
Recurrence with same intensity
Recurrence with increased intensity
significance with (n- 1) df as is denoted as ,ffi . rni. i.

35
t

CC Rlt Quart e r ly Bu I le t ir Rheumaloid Arthritis - An Analytical Study of25 Cases

l/ol. 23 (3&1) 2001

to be found out from the statistical tables. Then if the

I
Fai
d= L = 4.16
observed (calculated) value ot't'> t$f i.e., the tabled t'l

C.V., we accept the Null hypothesis Ho : the treatment is

not effective and reject the alternative hypothesis H1 : the thsysf6yg fl', = (-4.76),
treatment is effective. This is because the ellectiveness
is attributed to the lower values of the post treatment Here the tabled CV or 't' at 5% level o.f significance is
scores (if the effectiveness is attributed to a higher value
of post treatment scores, then to accept Ho : the treatment ,:f)|0#=, * (Calculated from table). Sincethe observed

is not effective the observed value of 't' < rff

value of 't' = - 4.6060 . oqf i.e. z.oo and so we reject Ho:

From the scores given below S, the Standard Deviation = the treatment is not effective in {avour of H,: Hence the
conclusion is that the treatment is effective.

&1 n
6q1
---
25
- 22.6516 = s.0624
DISCUSSION
-4.16
25 thererore = The study of these 25 cases of Rheumatoid arthritis
where n = ;iF: in6r4 t Jrr:l is conclusive in respect, especially that it satisfies the
= - 4.6060 i.e. t = - 4.6060 aims and objectives ol this study. ln addition to this
various tables shown above give some more information
Xi Yi di = (Yr-xi)
aboutthe sex incidence and age incidence. Table I shows
16 -7 49 that Bheumatoid arthritis is more in females and Table ll
16 11 -5 25 shows that the mostvaluable age group is adult and middle
17 13 4 16
age. Again Table lll shows that about half o{ the palients
13 5 -8 64 have one or olher types of psychological problem which
11 7 -4 to
acts as precipitating or triggering Iactor. l\ilore than hall of
11 6 ,q
the patients are found sero + ve while the rest are sero -
20 15 -5 25 ve and it has been lound that in these sero -ve individuals
to tt 25 different types of psychogenicity are lound.
21 16 25
It] o -10 100
4 16
On analysis, the results especially the disease
11 6 -5 intensily scores before and aftertreatment, one may think
13 9 4 16 that there is not much change in the intensity ol the
13 I 4 to disease even alter treatment because the ditference
16 10 -6 50 between the pre and post treatment scores are not very
large. Butthe statislical evaluation o{ the same has clearly
16 11 -5
shown that this treatment is really e{fective in improving
16 14 c 4
this disease condition.The efficacy of this treatmenl can
127 -5 25
also be found out by analysing the recurrence of the
86 -2 4
complaints alter treatment. 22 oul ol 25 cases have
14 11 9
improved and lrom among these 21 cases the in'tensity
17 '1 '1
€ .rb
and frequency has considerably reduced.
11 7 4 16
20 15 -5 25
4 Begarding the aims and objectives, the results show
la o -4 16 that a group with a small number of drugs have been {ound
more uselul in this condition. lt has also been lound that
2o outol25 cases were improved withtwodrugs (Bhus tox
wherel di=-119, I di''?=693 and Puls.). It is evident from the drug therapy part that
Rhus roxis more frequently indicated than any otherdrug.

36
 Rheumqtoid,4rthritis -An Analytical Sh ), of25 Cases CCRHQuarte y Bulleti
lol 23 (3&1) 1001

This may be due to the fact that it has peculiar affinity ACKNOWLEDGEMENT
towards joints, tendons, sheaths, synovjum ligaments,
fibrous tissue etc. (Flefer Table 14). Some of.the more The author of this paper is thankful to the Di.ector, CCBH,
reiiable indicalions for Fhus to.xin this condition have been Assistant Director {H), C.R.l. (H), Kottayam and the other staff who
deduced from this study. They are: helped in various ways for conducting ihe study. Specjat
acknowledgement is due to Dr. YageenThomas, protessorand Head,
Dept. of Statistics, University of Kerala, Karyavattom Campus.
1. < morning on rising upjirs't motion Trivandrum.

2. < beginning to walk after sitting - Iirst motion REFEBENCES

3. < after some sort ol physical movements, while at

1. T.Gibson, An lntroduction to Bheumatic disease, page 32,
rest Butlerwodh.

4. Patients complain of pain at night after some type

2. Harold Kaplan, Benjamin, Sodock, Comprehensive pshychialry,
of physical exertion during day time
Page 1225.1229, William- Walkins

5. < cloudy weather - most of the Rhus tox patients

under this study had this particular modality 3. Solomon G.F., Emotiona! and personal factors in the onset of and
courseof auto- immunedisease particularly Rheumatoid arthritis,
page 159, Press New York - 1981
6. < night

7. < warmth 4- Case Records

Begarding the potency, though potencies ranging Case I

from 30-10M were tried in different cases, 2o0th, 1Oooth
10M werefound more useful(esp. l OOO)than AOth. ln one
of the cases which is a typical Lycopodium case did nol A 41 year male patient running a video parlour came
show any improvement with 200, 1000 and10M, but it has for treatment for pain, swelling. stilfness of various joints
improved much with Lycopodium 0/6 (Refer the case such as lhat of hands, foot, ankles, knees, elbow, wrlsl,
attached). On analysing the symptomatology of these 25 cervical regions etc. especially on right side associated
patients, all were found to have multi - miasmatic basis with burning chest. sour eructations. excessive gaseous
especially Psora and Sycosis. Finally, I like to say that disturbance, ot 4Y2 yts. duration.
whatever results and conclusions drawn are generalization
with this short period o{ study. Symptoms evaluated are:

Desires company Aversion milk

CONCLUSION
Sympathetic Complaints Rt. Side
1. This treatment is elfective in managing RA which is
Easily weeping < beginning to move
clearly evident from the statistical analysjs and
evaluation.
Anxiety about illness < winter

2. The most important drugs found useful are phus fox Sense of heat > continued motion
and Pulsatilla
Desires warm food, drinks > warmth

Most uselul po'tencies are 200, 1 0OO and 1olvl Desires sweels

4. Females especially in adult and middle age are ESR - 78 mm/hr. RA lactor-ve
vulnerable to this disease.
27 .4.52 Lyco.200/2d

Psychologicallactors play some important role in the 7.5.92 No change Lyco.200/2d

aetiology oflhis disease especially in sero-ve patients_
18.5.92 No change Lyco. 1 M/1 d

3'1
 -_\

Rheumaloid Arthrilis - An Analytical Study of25 Cases

CCRH Qua erlY Bulletin
Vol.2i (3&1) 2001

Flatulence > SL Case-ll

1 .6.92
43 vear old female patient reporled with
pain swelling
Nochange Lyco. 10M/1d knees'
22.6.92 and stifiness ol smalljoints of hand and leet' ankle'
*ti"tasiociated with lever and chill Patient
Nochange SL ESR 80 mm/hr. "t" due to pain and stiifness'
12.7.92 "ilo*",
walks with dilficulty
2.8.92 Nochange Rhus tox 200/2d
ESR 128 mm/hr., RA factor +ve
18.8.92 Pain knee slight> Rhus tox 200/1d
SymPloms evaluated are
6.9.92 Same Rhus tox 1 M/ld
Lack of vital heat Desires warm lood, drinks, salt
Lyco. 0/6 7d OD < cold in general Aversion milk
6.10.92 Same
< cloudY weather Pain extremities < morning
Lyco. 0/6 7d OD < night < rising on
25.10.92
< winter Pain extremities beginning to
<

25.11.92 Lyco. 0/6 7d OD walk, Pain > massage

3.10.92 Rhus tox 200 2d
30.12.92 Lyco. 0/6 d on alternate
10.10.92 No change Rhus tox 200 2d
days
24.10.92 no change Bhus tox lM 1d
3.2.93 slight pain rt. Lyco. 0/6 on alternate ct
ankle, knee Days 14.1 1 .92 Pain lP joints >
Lyco. 0i6 6d alternate other comPlaints
28.3.93 same
days
6.12.92 Pain in ioints > SL
26.4.93 Pain rt. knee, Lyco. 0/6 6d alternate
days 6.7.93 Fever, cold, ore Ferr. phos 6x
back ache,
ESR 42 mm/hr throat
21 .6.93 Lyco.0/6 4d once/4 daYs 24.1 1.93 Pain lt. knee, Rhus tox 1M 1d
Lyco.0/6 4d once/4 days It. shoulder
7.8.93
SL
2.11 .93 Lyco 0/6 once/week
13.3.94 Pain elbow, ankle, Rhus tox 10M 1d
ESR '28 mm/hr. knee <
18.11.93 Fever, cold, cough Rhus'tox200/3d 2o.g.g4 Pain and stilfness Mag phos 6x SOS'SL
bodY Pain same
'16.12.93 Pain cervical spine, Lyco' 0/6 once/week 17 .4.94 > ESR 72mmlhr SL
Left knee Flhus tox 10M 1d
2.7.94 Pain rt. ankle,
2.2.94 Lyco. 0/6 6d once/week shoulder

Painlul stool SL 2.11 .94 Pain rt. knee,elbow, SL

20.2.94
ankle <
1 .4.94 SL
16.1 1 .94 same Lyco. 1M 1d
22.4.94 SL
14.12.94 SL
5.6.94 SL
15.1 1 .94 SL
7.8.94 SL
8.4.95 Pain < after Rhus tox 10M 1d
9.1 1.94 Pain ankle 8 Lyco. 0/6d once/week suppressed sweat
It. knee ESR 80 /mm/hr

SL o<oE SL
7.1 .95
38