This presentation is a case report of a 62-year-old female Indian, clinically diagnosed with Rheumatoid Arthritis at the age of 12. The patient lived with the disease for fifty years, combating it with painkillers and DMARDs until the blizzard stuck in December 2010 in New York, when she became wheelchair dependent with excruciating pain. She developed stasis ulcer with foul smell and oozing in the left ankle and returned back to India in Being dissatisfied with allopathic treatment, she started Ayurvedic Out Patient treatment from March 31 st 2012, followed by In Patient treatment for one month in August 2012 at Coimbatore. The stasis ulcer completely healed within two weeks of outpatient treatment. Within three months, the patient reported significant relief from pain and was able to move around with some difficulty. At baseline the RA Factor was 640 IU/ml and DAS Score was After the Āyurvedic treatment, over a period of eight months, RA factor became 64 IU/ml and DAS Score was The patient is completely mobile now without pain with persisting stiffness of right knee, and significant changes in the blood parameters. She has stopped all her medications and leads a normal life. The diagnosis was confirmed as Rheumatoid Arthritis as per the 1987 ACR Criteria. The patient had stopped modern medications before starting Ayurvedic treatment. Pain, stiffness and tenderness of the joints could be satisfactorily managed with Ayurvedic interventions. She voluntarily discontinued her anti-hypertensive medications when she came to India. BASELINE OBSERVATIONS *Joints of hand and feet painful, swollen and with deformities. Other joints also affected. Knees are badly affected, especially the right knee which is very tender and difficult to move. She is in the third stage of progression of RA. *Wheelchair bound. Unable to care for self. All movements and attempting to walk extremely painful. *Stasis ulcer on left ankle 1 to ½ cms wide with foul smell and oozing. Did not respond to treatment in USA. *Has lost nearly 19 kilos after the blizzard in LAB REPORTS RA Factor – 640 IU/ml; CRP – 5.24 mg/dl; ESR – 124 mm/hr Hb – 10 g/dl; DAS Score – Painful joints- 27. Swollen joints- 14. JOINT COUNT AT BASELINE WITH X RAYS PRESCRIPTION Ambulatory Treatment Psp 1(31/3/12)- Amrtotaram ks + Rasnayogaraja guggulu ks+ Vidaryadi ks+Kokilakshaka ks, Sukumara lehyam Psp 2 (12/4/12)- Jadamayadi churnam added Psp 3 (4/5/12)- Dhanvantara ks+ Rasnayogarajaguggulu ks + Ksheerabala (101), Gugguluthiktakam ks+ Kokilakshakam ks + Chandraprabha Psp 4 (4/5/12)- Sukumara ghrtam, Chyavanaprasham added. Treatment during Hospital Admission (Aug 2012) 7 days of Abhyangam- Balaguluchyadi co oil (head), Dhanvantharam T +Pinda T+ Sahacara T(Body) 14 days of Dhara & Pizhicil- same oils 5 days of Kadikizhi 7 days of Navarateppu 7 days of Kshiravasti 10 days of Matravasti - Madhuyastyadi T 27 days of Kshiradhara & Lepam with Jadamayadi churnam Ayurvedic Management of Chronic Rheumatoid Arthritis with Severe Deformities- A Case Report Dr Sujithra Rammanohar AVP RESEARCH FOUNDATION, COIMBATORE, TAMILNADU, INDIA INTRODUCTION Order online at CHANGES OBSERVED The first change observed in the patient was the healing of the stasis ulcer, which had not responded to months of treatment while she was in the USA. Interestingly, no specific medicines were given to treat stasis ulcer. Only the treatment for Vatarakta was administered. After the ambulatory treatment at the out patient clinic, patient showed significant improvement clinically and in the lab tests. From a wheelchair bound state, she was able to with the help of a walking stick and assistance. In a few months after the in patient treatment, the patient showed dramatic improvement and is now able to care for herself, cook and even go to church. There is no pain and discomfort, but the right knee is very stiff. During IP treatment, there was raise in blood pressure, which could be managed with Ayurvedic medicines. DISCUSSION (Reflections) The line of treatment for the disease described in Ayurveda as Vatarakta was administered to the patient which seems to have a beneficial effect in stasis ulcers by improving blood circulation. Therefore, this treatment should be assessed for efficacy in varicosity and vascular disorders.The treatment protocol is an algorithm making use of internal medicines, therapies, diet and lifestyle regulations. There is no single medicine or formulation for treatment of Vatarakta After in patient treatment, there was dramatic change in the lab tests, and not as much in clinical symptoms. Within few months after the in patient treatment, the patient also showed clinical improvement. Karaskara Ghritam helped in relief of pain during this, which was then discontinued. TREATMENT OUTCOMES (LABS & DAS SCORE) CONCLUSION Very advanced cases of Rheumatoid Arthritis are quite challenging to manage. But this case suggests that even in severe RA with deformities, Ayurveda can improve quality of life within a comparatively short period. Further studies are warranted to explore the scope of Ayurveda in improving quality of life in patients with advanced RA associated with severe deformities. CHANGES OBSERVED The first change observed in the patient was the healing of the stasis ulcer, which had not responded to months of treatment while she was in the USA. Interestingly, no specific medicines were given to treat stasis ulcer. Only the treatment for Vatarakta was administered. After the ambulatory treatment at the out patient clinic, patient showed significant improvement clinically and in the lab tests. From a wheelchair bound state, she was able to with the help of a walking stick and assistance. In a few months after the in patient treatment, the patient showed dramatic improvement and is now able to care for herself, cook and even go to church. There is no pain and discomfort, but the right knee is very stiff. During IP treatment, there was raise in blood pressure, which could be managed with Ayurvedic medicines. DISCUSSION (Reflections) The line of treatment for the disease described in Ayurveda as Vatarakta was administered to the patient which seems to have a beneficial effect in stasis ulcers by improving blood circulation. Therefore, this treatment should be assessed for efficacy in varicosity and vascular disorders.The treatment protocol is an algorithm making use of internal medicines, therapies, diet and lifestyle regulations. There is no single medicine or formulation for treatment of Vatarakta After in patient treatment, there was dramatic change in the lab tests, and not as much in clinical symptoms. Within few months after the in patient treatment, the patient also showed clinical improvement. Karaskara Ghritam helped in relief of pain during this, which was then discontinued. TREATMENT OUTCOMES (LABS & DAS SCORE) CONCLUSION Very advanced cases of Rheumatoid Arthritis are quite challenging to manage. But this case suggests that even in severe RA with deformities, Ayurveda can improve quality of life within a comparatively short period. Further studies are warranted to explore the scope of Ayurveda in improving quality of life in patients with advanced RA associated with severe deformities. 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