RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



BHARATESH HOMOEOPATHIC MEDICAL COLLEGE AND

HOSPITAL, POST GRADUATE RESEARCH CENTRE

BELGAUM-590016, KARNATAKA

Recognised by

CENTRAL COUNCIL OF HOMOEOPATHY, NEW DELHI

Affiliated to

RAJIV GANDHI UNIVERSITY OF HEAITH SCIENCES,

BANGALORE

SYNOPSIS

M.D. (HOMOEOPATHY)

“A clinical study on the RHEUMATIOD ARTHRITIS and IT’S HOMEOPATHIC MANAGEMENT”

By

DR.NANDAKUMAR K.RAWAL

Under the Guidance Of

DR. RAVEENDRA. NADHAN M.P. MD (HOM)

PROFESSOR AND PG Guide

DEPARTMENT OF ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY

BHARATESH HOMOEOPATHIC MADICAL COLLEGE AND HOSPITAL, BELGAUM.

From,

DR. NANDAKUMAR K. RAWAL

TO,

DR. RAVEENDRA NADHAN M.P. M.D (HOM)

PROF. & P.G. Guides

Department of Organon of Medicine and Homoeopathic Philosophy, Bharatesh Homoeopathic Medical College & Hospital,

Belgaum.

Sub: Application to my synopsis for the dissertation

Respected Sir,

I, Dr. NANDAKUMAR K. RAWAL,

Would like to forward my application for the approval of my synopsis under your Guidance for the following topic, “A clinical study on THE RHEUMATIOD ARTHRITIS and IT’S HOMEOPATHIC MANAGEMENT”. Hope you will approve the same.

Thanking you.

Date:

Place: Belgaum. Yours Sincerely

Dr. NANDAKUMAR K.RAWAL

Department of Organon of Medicine and Homoeopathic Philosophy, Bharatesh Homoeopathic Medical College and Hospital, Belgaum.

From,

DR. RAVEENDRA NADHAN M.P. M.D (HOM)

PROF. & P.G. Guide

Department of Organon of Medicine and Homoeopathic Philosophy, Bharatesh Homoeopathic Medical College & Hospital,

Belgaum.

To,

Dr. NANDAKUMAR K. RAWAL

Sub: Acceptance of synopsis for the dissertation

Dear Doctor,

I have accepted your topic, “A clinical study on THE RHEUMATIOD ARTHRITIS and IT’S HOMEOPATHIC MANAGEMENT” For the dissertation.

Your synopsis will forward to RGUHS.

Date:

Place: Belgaum

DR. RAVEENDRA NADHAN M.P. M.D (HOM) PROF. & P.G. Guide

Department of Organon of Medicine and Homoeopathic Philosophy, Bharatesh Homoeopathic Medical College & Hospital, Belgaum.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE -II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

| |NAME OF THE CANDIDATE AND ADDRES |Dr. Nandkumar K. Rawal |

|1 | | |

| | |PG Student Department of ORGANON OF medicine and homeopathic philosophy. |

| | |Bartesh Homeopathic Medical college and Hospital , Belgaum. |

| | | |

| | |PERMANENT ADDRESS: |

| | | |

| | |Dr. Nandkumar K. Rawal |

| | |S/O K.B.RAWAL, CHAITANYA NILAYA, SADASHIV TEMPLE ROAD, PO- BANHATTI-587311 |

| | |TQ JAMKHANDI |

| | |DIST BAGALKOT. |

|2 |NAME OF THE INSTITUTION |BARTESH HOMEOPATHIC Medical COLLEGE AND Hospital, DHARWAD ROAD, Belgaum. |

| | |(KARNATAKA) |

|3 |NAME OF THE COURSE AND SUBJECT |M.D. (HOMEOPATHY) ORGANON OF MEDICINE AND HOMEOPATHIC PHILOSOPHY. |

|4 |DATE OF ADMISSION TO THE COURSE | |

| | |02-11-2011. |

|5 |TITLE OF THE TOPIC | “A clinical study on THE Rheumatiod arthritis and it’s Homeopathic |

| | |management ” |

|6 |Brief resume of the intended work |

| |Need for the study |

|6.1 |Rheumatoid Arthritis is chronic multisystem disease of unknown cause. The most prominent feature of RA is inflammatory |

| |arthritis of the peripheral joints (synovial), usually symmetrical distribution, its systemic manifestation includes |

| |haematologic, pulmonary, neurological and cardiovascular abnormalities. |

| |The incidence of Rheumatoid Arthritis is in the region of 3 cases per 10,000 in population per annum. |

| |The prevalence rate is 1%, with women affected 3 to 5 times as often as men. |

| |RA is up to 3 times more common in smokers then nonsmokers, particularly in men and those who are RA factor is positive(1). |

| |First degree relatives prevalence rate is 2-3% and genetic concordance monozygotic twins are approximately 12-15%. |

| |RA is known to reduce the life span of patient by 3 to 12 years. |

| |There is no known cure for RA but many different types of treatments can alleviate symptoms and or modify the decease |

| |process. |

| |If RA is not treated in initial stage it leads to deformities, in other symptoms of medicine the drugs given are only to |

| |alleviate the symptom at the cost of many side effects. |

| |As our homoeopathic drugs which can give better results without any side effects and at the lower cost for the patient, this|

| |clinical study is taken up to assess the efficacy of homoeopathic drugs in RA. |

| | |

| | |

| |Homeopathy can be a great boon for all those suffering from RA. As homeopathic prescription is based upon careful analysis |

| |of symptoms of the patient it becomes a system of medicine that understands and treats the patient to ensure the complete |

| |elimination of the disease from the roots. |

| |Null Hypothesis: Miasmatic Background does not have significant role in the assessment and management of RA. |

| |6.2 Review of Literature: |

| |"Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral |

| |polyarthritis. It is the most common form of chronic inflammatory arthritis and often results in joint damage and physical |

| |disability. Because it is a systemic disease, RA may result in a variety of extra-articular manifestations, including |

| |fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis, and hematologic |

| |abnormalities...."1 |

| |Etiology: |

| |The exact etiology of RA is not known. |

| |RA is an autoimmune disease. |

| |The tendency to develop RA may be genetically inherited. It is also suspected that certain infections or factors in the |

| |environment trigger the immune system to attack the body’s own tissues, (Auto-immune response) resulting in inflammation. |

| |Up to 50% of genetic contribution to susceptibility is due to genes in the HLA region. |

| | |

| |HLA - DR4 is the major susceptibility hyplo-type in most ethnic groups, occurring, for example in 50-75% of Caucasian |

| |patients with RA compared to 20-25% of normal populations. |

| |It is upto 3 times more common in smoker than nonsmokers. |

| |RA can occur at any age but usually between 25 to 55 years of age group. Women affected three times more often than men1. |

| |Pathology: |

| |RA is characterized by persistent cellular activation, autoimmunity and the presence of immune complexes at the site of |

| |articular and extra-articular lesions. This leads to chronic inflammation, granuloma formation and its distraction. |

| |Subcutaneous nodules consist of a central area of fibrinoid material surrounded by palisade of proliferating mononuclear |

| |cells. Slimier granulomatous lesions may occur in the pleura, lungs, pericardium and sclera; lymphnodes are often |

| |involved.1 |

| |clinical features: |

| |Symptoms commonly associated with rheumatoid arthritis include |

| |• Joint pain, joint swelling, joint stiffness, and warmth around the affected joint. |

| |• Morning stiffness that lasts one or more hours. |

| |• Symmetrical pattern of affected joints, meaning the same joint on both sides of the body is affected (e.g., both knees). |

| | |

| |• Small joints of the hands and feet are characteristically involved, although any joint can be affected. |

| |• Rheumatoid nodules (firm lumps under the skin), found over the extensor surfaces of the elbows and hands of about 20 of |

| |rheumatoid arthritis patients. |

| |• Fatigue and noticeable loss of energy. |

| |• Low grade fevers and sometimes flu-like symptoms. |

| |• Loss of appetite, weight loss. |

| |• Anemia associated with chronic diseases, depression |

| |• Dry eyes and dry mouth. |

| |• Joint deformity and instability from damage to cartilage, tendons, ligaments, and bone. |

| |• Limited range of motion in affected joints.2 |

| |Rheumatoid arthritis can also produce diffuse non specific inflammatory changes in the lungs, membrane around the heart |

| |(pericardium), the membranes of the lung (pleura), and white of the eye (sclera),in the blood vessles,lymph nodes and |

| |peripheral nerves.3 |

| |MIASMATIC BACKGROUND: |

| |Rheumatoid Arthritis is having all the three miasm i.e. psora, syphilis and sycosis. |

| |The initial stage of rheumatoid arthritis without bone destruction is psora, when the destruction of bone starts, the |

| |condition becomes syphilitic, Formation of Rheumatoid nodules under the skin and joint space, tophi deposits in joints and |

| |connective tissue are Sycotic origin. |

| |IN PSORA: Various types of rheumatisms, especially of functional and inflammatory in nature; ostitis, ostiomylitis, the |

| |rheumatic pains of psora are generally neuralgic in type; sore bruised and pressive pains are psoric. Sensation of numbness,|

| |tingling, dryness, heat, and burning of hands and feet are characteristics of psora. |

| |IN SYPHILIS: Bony pains, Ostiomylitis with bone destruction and deformity; caries and necrosis of the bones and spine. |

| |Ulcers and gangrenous infection, malignancy of bones and degenerative changes are syphilitic tendencies. The syphilitic |

| |patient subject to various deformities and atrophy of various organs. |

| | |

| |IN SYCOSIS: Rheumatoid Arthritis is the auto immune disorder (i.e. Inflammation of joint due to antigen and antibody |

| |reaction i.e. immune complex deposited in the joint space), is Sycotic origin.Formation of Rheumatoid nodules under the skin|

| |and joint space, arthritic deformities, tophi deposits in joints and connective tissue are Sycotic origin.4 |

| |theraputics |

| |RHUS toxicodendron: |

| |From the earliest homeopathic times RA has been the great the Rheumatic remedy of the school. Joints are hot, painful and|

| |swollen, pains tearing in tendons, ligaments and fasciae, Limbs stiff and paralyzed. Numbness and formication after |

| |overwork and exposure, loss of power in forearm and fingers, crawling sensation in the tips of fingers and tingling in feet.|

| |All Rhus Tox symptoms are relieved by motion, worse from sitting, rising from a sitting position or on first commencing to |

| |move. Continued motion however relieves.5 |

| | |

| |COLCHICUM: |

| |Sharp pain down right arm. Tearing in limbs during warm weather, tingling during cold. Pins and needles in hands and |

| |wrists, finger tips numb. Pain in front of thigh. Right plantar reflux abolished. Limbs lame, weak, tingling. Pain worse |

| |in evening and warm weather. Joint stiff and feverish, shifting rheumatism; pain worse at night. Inflammation of great toe |

| |can’t moved or touched. Tingling in the finger and nails, edematous swelling and coldness of legs and feet 6. |

| |LITHIUM CARBONICUM: |

| |Paralytic stiffness all over, itching at joints, rheumatic pains throughout shoulders joint, arm and fingers and small |

| |joints generally, pain in hallow of foot, extending to knee. Swelling and tenderness of finger and toe joints; better by |

| |hot water. Nodular swelling in joints.6 |

| |BRYONIA: |

| |Rheumatism that come with gradually increasing severity and involving one joint after another, until all the white fibrous |

| |tissues are in a state of inflammation, pain and distress there is an aggravation from motion and an extreme state of |

| |irritability.7 |

| |6.3 aims and Objectives of the Study: |

| |To develop evidence based support on the efficacy of Homeopathic medicines in the treatment of Rheumatoid Arthritis. |

| |To assess and evaluation of Constitutional remedies and Miasmatic remedies. |

| |To find out a group of medicines that can be more efficacious in the treatment and control of Rheumatoid Arthritis. |

|7. |MATERIALS AND METHODS |

| |7.1 SOURCE OF DATA: |

| |The subjects for the study will be selected from the OPD, Peripheral and regular camp visit of Bharatesh Homoeopathic |

| |Medical College and Hospital Belgaum. |

| |7.2 METHOD OF COLLECTION OF DATA: (INCLUDING SAMPLING PROCEDURE, IF ANY) |

| |Patient will be selected randomly on the basis of inclusion and exclusion criteria for the study. |

| |Minimum sample size will be 30 cases. |

| |All patients registered between periods of November 2011 to July 2013 will be selected. No new case will be taken for the |

| |study after July 2013. |

| |Duration of study 6 months. |

| |Follow ups will be seen weekly or fortnightly as per requirements. |

| |Prognosis - Assessment will be on the general and local improvement of the subjects. |

| |Inclusion Criteria: |

| |Patients of all ages and both sexes are included both seropositve and seronegative cases are included. |

| | |

| | |

| | |

| | |

| |Exclusion Criteria: |

| |Cases with severe joint deformities and complications are excluded and persons with known immune compromised diseases are |

| |excluded. |

| |Diagnostic Criteria for RA: |

| |Diagnosis of RA is made with four or more of the following - |

| |Morning Stiffness (> one hour) |

| |Arthritis of tree or more joints areas. |

| |Arthritis of hand joints. |

| |Symmetrical Arthritis. |

| |Rheumatoid nodules. |

| |Rheumatoid factor. |

| |Radiological changes. |

| |Duration of six week or more. |

| |Assessment Criteria: |

| |The treatment efficacy will be assessed clinically on the basis of improvement in all the signs and symptoms which will be |

| |assigned with self gradation. |

| |The result will be analyzed and produced by using appropriate statistical methods. |

| | |

| | |

| | |

| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIN TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE |

| |MENTION BRIEFLY. |

| |Yes, |

| |As per the requirement of the cases following test are done to diagnose RA. |

| |1) Serological tests for RA Factor. |

| |2) X-Ray of the joint. |

| |3) Hematology for ESR and CRP. |

| |4) Complete blood count. |

| | |

| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION: |

| |Yes, |

| |Ethical clearance has been obtained from the institution. |

|8. |LIST OF REFERENCES: |

| |Davidson S. Davidson’s principles and practice of medicine: 20th edition published in India; by a Churchill Livingstone |

| |Elsevier ltd; in august 2006. Pg No.1101. |

| |Harrison TR. Harrison’s Principle of internal medicine (Vol.2). 16th edition. Published in new Delhi(in India):by a |

| |Churchill Livingstone Elsevier ltd; in 2006 pg no1968 |

| |HarshMohan. Text book of pathology: 4th edition, Jay Pee Brothers medical publishers (p) ltd ;New Delhi, 2000.pg no-83,85 |

| |Banarjea S. Miasmatic diagnosis practical tips with clinical comparisons: revised edition; published by B Jain 2003. pg no |

| |90-95 |

| |Dewey WA. Practical Homeopathic Therapeutics: Reprint Edition-B Jain Publishers (P) LTD New Delhi; 1996. Pg. No. 313. |

| |Boericke W. Pocket Manual of Homoeopathic Material Medica and Repertory: low priced edition. Published in New Delhi: B Jain |

| |publishers (P) ltd; in 2006 pg no554, 225&404. |

| |Kent JT. lectures on Materia Medica, Low priced Indian edition. B. Jain Publishers (P) LTD. New Delhi, 2004. Pg. No.247. |

| |Luthra N. Homeopathy for Rheumatoid Arthritis, Homeopathy for all; Vol No.10 (106), A HFY Publications New |

| |Delhi; October 15, 2008 Pg.No.45. |

| |Dr.Rajesh Shah’s advice of Rheumatoid Arthritis. askdr.. |

|9 |SIGNATURE OF THE CANDIDATE | |

|10 | REMARKS OF THE GUIDE | |

|11 |11.1 NAME AND DESIGNATION OF ( IN BLOCK LETTERS)|Dr. RAVEENDRA Nadhan M.P. |

| |GUIDE. |MD (HOM) Prof. and PG Guide. Dept. of Orgonon|

| | |of Medicine and Homoeopathic Philosophy, Baratesh HomOeopathic |

| | |Medical college and Hospital, Belgaum. |

| |11.2 SIGNATURE OF THE GUIDE | |

| |11.3 CO-GUIDE ( IF ANY) | |

| |11.4 SIGNATURE | |

| |11.5 HEAD OF DEPARTMENT |Dr. (Mrs).M.N.Shaik. |

| | |MD(HOM) Prof., PG Guide & HOD. |

| | |Dept. of Orgonon of Medicine and Homoeopathic Philosophy, |

| | |Baratesh HOMOEOPATHIC MEDICAL college and Hospital, Belgaum. |

| |11.6 SIGNATURE | |

|12 | 12.1 REMARKS OF CHAIRMAN AND PRINCIPAL | |

| |12.2 SIGNATURE | |

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