PART – 1 CONCEPT OF RHEUMATOID ARTHRITIS ACCORDING TO ANCIENT INDIAN SCRIPTURES.
PART – 2 EFFICACY OF INTEGRATED YOGA IN PATIENTS OF RHEUMATOID ARTHRITIS WITH NORMAL VALUES ON MEASURES OF INFLAMMATION-A RANDOMIZED CONTROL TRIAL
By
Dr.K Gopinath

PART – 1 CONCEPT OF RHEUMATOID ARTHRITIS ACCORDING TO ANCIENT INDIAN SCRIPTURES.
INTRODUCTION
Rheumatoid Arthritis (RA) is modern term for the disease prevailed in older days also. In Ayurveda it is termed as Aamavaata and in Yoga and spiritual contexts because they did not mentioned any diseases, do not see any particular type of diseases like RA, but they are very clear about the origin of diseases. This can be justified by going through the details of explanation given in modern science about RA. In modern science there is enough evidence we can see about cause of the disease. Though they mention that there is unknown etiology for RA, there is enough evidence coming these days that RA is lifestyle related and the prevalence we are seeing these days is very high because of lifestyle related only, but it takes long time to get manifested after long practice of wrong way of lifestyle, either food or the actions we are doing in our daily life. There is a strong evidence of relation between mind and body, emerging field called Psychoneroimmunology, clearly relates mind to somatic diseases like RA. Though a lot of inventions and discoveries are still to come, this field looks to very promising as per root cause is concerned.
According to Ayurveda, RA is lifestyle related only; it gives elaborate explanation about cause and pathogenesis also about treatment. Ayurveda gives equal importance to both body and mind. Lifestyle correction is mind related only, but after manifestation of RA approach is different. Here comes intervention to both body and mind. Unlike treatment of body according to modern medicine, in Ayurveda, treatment is by whole body purification as panchakarma and also local treatment by oral medications. Looking at whole Ayurveda perspective, the diseases like RA are preventable and treatable and also it is curable.
Because Yoga is a lifestyle, we can relate that lifestyle here. Because Yoga has enough evidence that it is most widely practiced also has good outcome as disease-free state after consistent and long practice. There is a misconception that Yoga is just physical posture or breathing practices. But it is a holistic approach to complete health. Scientists now days understand that there is major role of mind in even somatic diseases. Yoga is winning over mind modulations. This is explained in detail in Yoga texts like Patanjali yoga sutra, Hata yoga, Yoga vaasishta etc.

CONLUSION
compiling all the aspects of rheumatoid arthritis(RA) from the view of modern science, ayurveda and yoga, it gives an idea of total perspective of the disease.
Though RA is studied in deapth in modern science, still it looks very superficial, looking at it overall. Because still scientists are struggling to find out the root cause of the disease.
We can say that it is the branches of the tree, while the way it is explained in ayurveda looks like stem of the tree. Because, in ayurveda it is explained more deeper than modern science. In ayurveda it is clearly explained about cause of the disease, it is purely lifestyle related. But instantly we can not come to conclusion that the lifestyle explained in ayurveda is immediate effect to cause RA. By continuosly following the way of explained lifestyle it will lead to the disease. Also there is a lot of influence of external factors like environment, weather, atmosphere in which person is living..etc.
Coming to yoga point of view, though RA itself is not explained in yoga, still the concept is very clear, perticularly the cause of the disease. Root cause is clearly mentioned in all yoga scriptures. Everything explained in other aspects looks like superficial. We can give lot of explanation for present situation, after disease gets manifested, but root below that is very poorly understood in other contexts except yoga. In ayurveda, the aspect called सत्वावजय(satvāvajaya),- सत्व(satva)- is mind, the whole meaning is winning over mind). where the aspect of mind, it`s importance all are explained, but it looks still deeper in yoga scriptures. So if we treat the root cause there will be root out of the disease, as if we do not want a tree, we are uprooting it. Now it is very clear that, treatment explained in modern science is like top of the tree.. i.e., in modern medicine they are chopping the tree to take out the tree. Obviously the tree will grow in dual time. That is what it is told in modern medicine like remission, flare etc., also rheumatologists clearly mention in the beginning itself that RA is not curable, but treatable.they treat it physically as if it is purely somatic, at any point they do not mention part of mind unless quality of life or anxiety, depression of long standing diseaseis concerned. But never consider part of mind in origin of the disease.in ayurveda also, mind has role in every disease, either after manifestation or in origin point.That is why the three main stay of the treatment in ayurveda is,
दैवव्यपाश्रय (daivavyapāśraya)- devine healing
युक्तिव्यपाश्रय (yuktivyapāśraya)- treatment by doctor using his intellectual
सत्वावजय (satvāvajaya)- Psychotherapy.
But yoga has all the answer for origin of disease and which is what essential in the process of rootout of the disease.
So, compiling all together, ultimately what is the need of the hour is total care for of the disease activity, care of the patient, rootouting the disease. In this view, modern science, ayurveda, and yoga in combination definitely helps- in the sense for symptoms and high disease activity modern science does a good job. Total body purification and all the systems are taken care by ayurveda, where as total mind and body can be managed by yoga practices.
Manytimes, if the tree is very big, and if we are planning to remove that tree means, we will chop all the branches first, then stem and lastly root. Root out is very imprtant as, if the root is left out, there is every chance for regrowth of the tree. But if the tree is not grown bigger, and not established, it can be removed by directly eliminating root.in the same way, if the disease is still in initial stage, directly it can be handled by ayurveda and yoga regimen.

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PART – 2 EFFICACY OF INTEGRATED YOGA IN PATIENTS OF RHEUMATOID ARTHRITIS WITH NORMAL VALUES ON MEASURES OF INFLAMMATION-A RANDOMIZED CONTROL TRIAL

ABSTRACT
The present study was conducted to understand the “efficacy of integrated approach of yoga therapy for Rheumatoid Arthritis (RA) patients, with normal values of measures on inflammation”. RA is chronic, systemic, inflammatory disorder of unknown etiology that is characterized by its pattern of diarthrodial joint involvement. The cause of RA is still unknown; it is thought to be multi factorial with genetic factor and environmental factors playing major roles. Physiotherapy and exercise are main treatment available with pharmacological intervention for the treatment of RA. Stress is now recognized as an important risk factor by considering that the activation of the stress response system influences the close relationship existing between the hypothalamic–pituitary- adrenal (HPA) axis, the sympathetic nervous system (SNS) and immune system. The present randomized control trail was planned to evaluate the effect of yoga vs. conventional care including exercise therapy on pain, pain threshold, joint mobility and psychological stress in subjects with RA who are having normal values of inflammatory measures.
Methods: 49 patients were randomly allotted in to Yoga and Waitlist control group with computer generated random number table after fulfillment of inclusion and exclusion criteria. The age range was between 16- 60 years, with a mean and standard deviation of age 46±9.4 years. Patients were randomly assigned to two groups, yoga (24) and waitlist control (25). Both groups assessed in baseline and after six weeks for pain pressure threshold, Hand grip strength, Pain visual analogue scale (PVAS). They were also asked fill questionnaires such as Hospital anxiety depression scale (HADS) and Arthritis impact measurement scale 2- short form (AIMS2-SF). Baseline ESR and CRP (C-reactive protein) were assessed. During these six weeks, yoga group practiced half an hour of yoga for three days in a week and wait list group continued their conventional care including exercise therapy. At six weeks there were 24 in the yoga group and 25 in the control group.
Data analysis: Tests for Normality (Kolmogorov Smirnov’s) showed significant variance from a normal distribution for some of the variables. Paired sample test was used to assess the within group changes and independent sample t test was done to assess between group changes. Pearson correlation test was done to assess relationship between baseline measures of stress, impact measurement scale and pain. Non-Parametric Wilcoxon’s Sign rank tests were carried out to analyze within group differences and Mann Whitney U tests were done to analyze differences between yoga and control groups for variables not conforming to normality tests.
Results:
Non parametric Mann Whitney U Test showed significant improvement in arthritis impact measurement scale2- SF [AIMS2-SF] (Physical- p =0.001, social- p =0.02, symptom- p=0.000, affect- p =0.000, role- p=0.053) and hand grip strength (right- p = 0.000. left- p = 0.000). Independent sample t test for between group showed significant improvement in hospital anxiety depression scale [] (anxiety- p=0.000, depression- p= 0.000), pain visual analogue scale [PVAS] (p= 0.000) and pain pressure threshold [PPT] (right upper limb- p=0.000, left upper limb-p=0.000, right lower limb- p= 0.000, left lower limb- p= 0.000, head and neck- p= 0.000) in yoga group following intervention.
Conclusions: The results suggest that use of integrated yoga therapy is superior to improve pain, quality of life and joint flexibility in patients with rheumatoid arthritis on conventional care including exercise therapy.
Conclusion:
In conclusion, this short term integrated yoga program conferred beneficial effects in subjects with chronic, inactive rheumatoid arthritis with normal inflammatory measures by reducing Anxiety, Depression, stress, and improving functional activity, quality of life, hand grip strength and pain threshold level. However, it needs to be seen if these effects last for a longer term with these interventions.

Key words: Rheumatoid Arthritis, yoga, pain, Pain pressure threshold, Anxiety, Depression.

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