Dr. Sunil V Nukapur

Rheumatoid arthritis is an autoimmune disorder in which the body recognizes the body's own system as foreign and produces an inflammatory reaction. The synovium which is the space between the bones and the joints and contains a lubricating fluid which allows easy movement of the joints.

Inflammation of this space leads to painful, swollen joints that can also turn red and become stiff over a period of time. The joint surfaces can gradually progresses to produce deformities (the swan-neck deformity of the hand for instance) and disability.

Because it is an autoimmune disorder, the exact etiology is not known but lifestyle, stress, cold weather are supposedly predisposing factors. That being the case, it is not surprising that Ayurveda has a variety of options, both in terms of do's and don't's to manage rheumatoid arthritis - both the severity of symptoms and further progression of the disease.

Do's: A well-planned diet will help by supporting optimal functioning of the immune system and nourish the affected joints.

1. People diagnosed with RA should follow a diet that is rich in fruits and vegetables. Drumsticks, bitter gourd, carrot, papaya, green leafy vegetables, cabbage, etc., reduce inflammation and hyperactivity of the immune system. The antioxidant properties in these neutralize the free radicals circulating in the body (responsible for increasing inflammation). This helps control the longstanding inflammation of the joints
2. It is also advisable to eat them as whole fruits and not as juices. The fiber in the whole fruits helps digestion
3. Sprinkle pepper powder over cooling food items like cucumber and radish
4. Include garlic which is an excellent remedy for RA, can be mixed with buttermilk
5. Whole grains such as wheat, brown rice, millet, barley are beneficial for RA, their high fiber content helps in proper digestion and promotes regular bowel movements
6. Honey mixed with water
7. Drink boiled milk to which dry ginger powder is added; this can replace tea and coffee
8. Milk mixed with turmeric powder is also helpful in controlling inflammation
9. Work at reducing weight

Don'ts: In addition to adding the above to your diet, there are some things to avoid, which can worsen symptoms of inflammation.

1. Avoid overall unhealthy and irregular diet habits which affects the immune system and aggravates symptoms
2. Avoid sleeping during daytime and staying awake at nights
3. Avoid deep fried foods and fermented food items
4. Given its autoimmune nature, it is better to avoid regular allergy-inducing foods like dairy products, soy, peanuts, processed foods, artificial additives, etc. These could trigger an enhanced allergic reaction.
5. Avoid alcohol, tobacco
6. Avoid tea and coffee and other caffeinated drinks

With simple daily food habit and lifestyle changes, the severity of RA can be managed effectively.

The ability of the human body to move is because of the wonderful and smooth coordination between the various muscles and joints in the body. Of the muscles, there are some muscles which we can control, known as voluntary. The limbs and hands for instance, can be controlled by us. On the other hand, the muscles of the stomach, heart and other internal organs cannot be controlled by us. These are known as involuntary muscles. When there is an abnormality in the muscle growth, the condition is known as muscular dystrophy (MD). There are multiple types of MD, and most of these are due to genetic abnormalities and are inherited from the mother. It is caused due to lack of a protein named dystrophin.

It is mostly seen in boys at a young age, and it can progress with age. In some people, the onset is late, and even smooth muscles like the heart can be affected. The most common presentation is muscle wasting with gradual loss of muscle mass and loss of strength in the muscles. This leads to waddling gait, muscular pain and stiffness, difficulty sitting and standing, frequent falls, and other learning disabilities. As the disease progresses, there is a further limitation of movement with shortened muscles and tendons, increasingly curved spine, cardiac issues, difficulty swallowing and breathing problems. These symptoms are due to the smooth muscles being affected.

Though there are multiple varieties of it, the most common ones are Duchenne and Bekcer’s. In Duchenne, the symptoms begin to manifest at about 3 years of age and by the age of 20, the child usually dies of respiratory failure. While there is no specific treatment for MD yet, there are a lot of supportive measures including drugs and physiotherapy to improve function and restore quality of life to the extent possible.

1. Corticosteroids are useful in improving muscle mass and reduce the pace of disease progression. Heart medications like beta blockers and ACE inhibitors are useful where the heart function is affected.
2. Mobility aids like canes, walkers, and wheelchairs may be used depending on the severity of symptoms.
3. Patients are asked to perform general exercise to improve overall body movement and reduce rigidity. Walking, swimming, jogging are useful in keeping the muscles agile.
4. Braces may be useful to keep the muscles in tension.
5. If the lungs are affected, breathing assistance may be required to ensure there is sufficient oxygenation. A ventilator may be required in some people.

Though not proven yet, there are drugs being tested to delay muscle wasting, altering the damaged dystrophin, and other advanced techniques to treat MD. Currently, however, drugs and physiotherapy are the only methods available.