Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Users Online: 2082 | Home Print this page Email this page Small font size Default font size Increase font size


 
 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 36  |  Issue : 4  |  Page : 225-228

A case study on successful ayurvedic management of a rare case of reiter's syndrome


Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital and Research Centre, DMIMS (DU), Wardha, Maharashtra, India

Date of Web Publication28-Nov-2017

Correspondence Address:
Vaishali Kuchewar
Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital and Research Centre, DMIMS (DU), Salod (H), Wardha, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0257-7941.219370

Rights and Permissions
  Abstract 


Reiter's syndrome is a clinical syndrome of arthritis, urethritis, conjunctivitis, and mucocutaneous lesions. Skin and mucosal involvement is observed in about 10% of the cases. A 34-year-old male was brought in severe condition. He had red colored foul smelling maculopapular skin lesions all over body, swollen and painful knee and shoulder joints. History revealed that he was suffering from Reiter's syndrome since 2003. He used to get admitted between the months of February and May every year due to aggravation of symptoms. Every time he was treated with systemic antibiotics, corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs. He was successfully treated with external application and internal medication with tikta (bitter) and kaṣāya (astringent) drugs. He got significant relief in skin lesions as well as joint pain and his quality of life was markedly improved. This case study demonstrates that Reiter's syndrome can be well managed with Ayurvedic medicines.

Keywords: Ayurvedic intervention, maculopapular skin lesions, Reiter's syndrome


How to cite this article:
Kuchewar V. A case study on successful ayurvedic management of a rare case of reiter's syndrome. Ancient Sci Life 2017;36:225-8

How to cite this URL:
Kuchewar V. A case study on successful ayurvedic management of a rare case of reiter's syndrome. Ancient Sci Life [serial online] 2017 [cited 2019 Nov 17];36:225-8. Available from: http://www.ancientscienceoflife.org/text.asp?2017/36/4/225/219370




  Introduction Top


The clinical syndrome of arthritis, urethritis, conjunctivitis and mucocutaneous lesions is commonly known as Reiter syndrome. It is a multisystem disorder triggered by genitourinary or enteric infection. The classic triad, namely urethritis, arthritis and conjunctivitis presents in only one-third of patients and the tetrad, with the addition of the mucocutaneous findings of balanitis and keratoderma blennorrhagica is seen rarely.[1],[2]


  Case Report Top


A 34 year old man was brought by his relatives to the OPD of Kayachikitsa in the month of April 2011 in a severe condition [Figure 1], [Figure 2], [Figure 3]. Clinical examination revealed red colored foul smelling maculo-papular lesions all over body including scalp, nails, palms, soles. There was also swelling of both the knee and shoulder joints and was unable to walk due to severe pain. He had also restricted movements of both shoulders. Previous history revealed that he was suffering from above illness since 2003. The symptoms used to get aggravated very fast in a very short period in the month of February to May of every year so much so that every time he had to be admitted for treatment where he was treated with systemic antibiotics, corticosteroids, immunosuppressants and non-steroidal anti-inflammatory drugs. In spite of continuous medication, his condition was deteriorating. He was admitted in Kayachikitsa ward. On examination, his prakṛti (body constitution) was pitta-kaphaja. His agni bala (Digestive power) and Sharir bala (physique) was avara (poor). No specific etiological factor (occupation related or life style related) was found in history. The laboratory studies showed the following: hemoglobin 11.4 g/dl, leukocytes 6400/cu mm, neutrophils 68%, lymphocytes 26%, Eosinophils 01%, Monocytes 01%, ESR 96 mm/h. The urine analysis showed no albumin, pus cells, epithelial cells or RBCs.
Figure 1: Skin lesions of legs before treatment

Click here to view
Figure 2: Skin lesions of hands before treatment

Click here to view
Figure 3: Skin lesions of palms before treatment

Click here to view


Considering the history, clinical examination and investigations, following treatment was given [Table 1].
Table 1: Treatment plan

Click here to view


There was gradual improvement in the skin lesions within eight days [Figure 4] and [Figure 5]. The scales started shedding and Papular lesions converted into macules. Itching and burning sensation also decreased. Svedana (sudation) of both knees and shoulder was helpful in relieving pain and restricted movements.
Figure 4: Skin lesions of legs on 15th day of treatment

Click here to view
Figure 5: Skin lesions of Rt. shin on 15th day of treatment

Click here to view



  Discussion Top


It was difficult to correlate Reiter's syndrome with any one of the different Kuṭha rogas (skin diseases) described in Ayurveda. Some of the features of Kaphaja and Pittaja visarpa (one of the skin disorders) were found in this patient. The treatment was decided on the basis of predominance of doṣa and dhātu (~body tissues) involvement. The symptoms indicated vitiation of pitta and kapha doṣa and rasa and rakta dhātu. Treatment was planned according to treatment principles governing vitiation of Raktavāha srotas (~macro and microchannels of blood).

Triphalā and Nimbapatra (leaves of Azadirachta indica) were used to made decoction for the cleansing of skin lesions because Triphalā is anti-inflammatory, astringent and Neem is an antiseptic. These were helpful in shedding of the scales of skin and preventing secondary infection. The Cikitsā Sthāna of the SuśrutaSaṃhitā recommends Triphalā among medicines that are good for purifying a wound.[10]Mṛdu virecana (Mild purgation) was given with Harītakī cūrṇa which proved helpful for koṣṭha śuddhi (~bowel cleaning). In Reiter's syndrome, there is involvement of nails and joints. It is because of this that Panñcatikta ghṛta guggulu was selected. It is a combination of drugs having Tikta Rasa (bitter taste) dominance. Tikta Rasa is commonly used in skin diseases and as a vehicle to deliver medicines at the level of Asthi dhātu (~bony tissue). Guggulu is a proven anti-inflammatory agent.[11]

Gandhaka Rasāyana is a Sulphur based preparation. It is considered as a Rasāyana (rejuvenator) which promotes positive health and vigor, retards aging process and increases longevity in individuals by increasing immunity in the body, thus increasing resistance against the factors causing ailments. It is indicated in kuṭha (skin disorders).[12]

Mahāmañjiṣṭhādi Kvātha is described as Rakta śodhaka (~ remover of blood impurity), āmapācaka and viahara (detoxifier).

Aśvagandhā cūrṇa was used as an anti-anxiety drug because the patient was in stress due to chronic illness. Aśvagandhā has been used as a Rasāyana. It has a significant anti-stress adaptogenic effect.[13] It is also proven for its anti-inflammatory and antioxidant properties.[14],[15]

Karañja oil was used due to its Kaṇḍughna (anti-itching) and kṛmighna (anti-infective) property. It is commonly used in different skin diseases.[16],[17] It is also cost effective.

Guḍūcī ghanavaṭi was continuously used for one month. It has been used in Ayurvedic preparations for the treatment of various ailments throughout the centuries. It is used as a rasā yana to improve the immune system and body resistance against infections.[18] After completion of two months treatment, patient was apparently well. In the Next year (2012), he again had skin lesions but the intensity was not severe. He responded well to Panñcatiktaghṛta guggulu and Mahāmañjiṣṭhādi Kvātha with the previous dose for one month. From the year 2013 to 2016, patient was advised Guḍūcī Ghana 500 mg twice a day from the month of January to April as a preventive measure. He got significant relief in skin lesions as well as joint pain and his quality of life was markedly improved [Figure 6], [Figure 7], [Figure 8]. Patient is still on regular follow up and free from Arthritis and cutaneous lesions.
Figure 6: Legs after completion of treatment

Click here to view
Figure 7: Hands after completion of treatment

Click here to view
Figure 8: Palms after completion of treatment

Click here to view



  Conclusion Top


This case study shows that Reiter's syndrome can be successfully managed with Ayurvedic intervention. It is supportive for further research in Reiter syndrome and other autoimmune dermatological disorders.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pavlica L, Mitrović D, Mladenović V, Popović M, Krstić S, Andelković Z, et al. Reiter's syndrome – Analysis of 187 patients. Vojnosanit Pregl 1997;54:437-46.  Back to cited text no. 1
    
2.
Schneider JM, Matthews JH, Graham BS. Reiter's syndrome. Cutis 2003;71:198-200.  Back to cited text no. 2
[PUBMED]    
3.
Ram Narayan Sharma. Ayurved Sar Sangraha. 18th ed. Nagpur: Baidyanath Ayurved Bhawan; 1997. p. 517.  Back to cited text no. 3
    
4.
Deshpande AP, Jawalgekar RR. editors. Dravyaguna Vigyan. Part 2. Anmol Prakashan Poona; 2002. p. 425.  Back to cited text no. 4
    
5.
Ram Narayan Sharma. Ayurved Sar Sangraha. 18th ed. Nagpur: Baidyanath Ayurved Bhawan; 1997. p. 291.  Back to cited text no. 5
    
6.
Ram Narayan Sharma. Ayurved Sar Sangraha. 18th ed. Nagpur: Baidyanath Ayurved Bhawan; 1997. p. 713.  Back to cited text no. 6
    
7.
Deshpande AP, Jawalgekar RR, editors. Dravyaguna Vigyan. Part 2. Anmol Prakashan Poona; 2002. p. 452.  Back to cited text no. 7
    
8.
Deshpande AP, Jawalgekar RR, editors. Dravyaguna Vigyan. Part 2. Anmol Prakashan Poona; 2002. p. 574.  Back to cited text no. 8
    
9.
Deshpande AP, Jawalgekar RR, editors. Dravyaguna Vigyan. Part 2. Anmol Prakashan Poona; 2002. p. 342.  Back to cited text no. 9
    
10.
Susruta, Bhishagratna KK. An English Translation of the Sushruta Samhita, Based on Original Sanskrit Text. Vol. 2. Susruta: Bhishagratna, Kunja Lal, Kaviraj; 1907. p. 344.  Back to cited text no. 10
    
11.
Singh RH. The Holistic Principles of Ayurvedic Medicine. Vol. 14. Delhi: Chaukhamba Sanskrit Pratishthan; 2003. p. 220.  Back to cited text no. 11
    
12.
Laxmipathi Sashtri Rasayanadhikara. Yogaratnakara. 3rd ed. Varanasi: Chaukhambha Sanskrit Sansthan Publication; 1983. p. 501.  Back to cited text no. 12
    
13.
Bhattacharya A, Ghosal S, Bhattacharya SK. Anti-oxidant effect of Withania somnifera glycowithanolides in chronic footshock stress-induced perturbations of oxidative free radical scavenging enzymes and lipid peroxidation in rat frontal cortex and striatum. J Ethnopharmacol 2001;74:1-6.  Back to cited text no. 13
[PUBMED]    
14.
Anbalagan K, Sadique J. Influence of an Indian medicine (Ashwagandha) on acute-phase reactants in inflammation. Indian J Exp Biol 1981;19:245-9.  Back to cited text no. 14
[PUBMED]    
15.
Dhuley JN. Adaptogenic and cardioprotective action of Ashwagandha in rats and frogs. J Ethnopharmacol 2007;70:57-63.  Back to cited text no. 15
    
16.
Ayurvedic Pharmacopoeia of India. Part 1. Vol. 2. Delhi: Government of India, Ministry of Health and Family Welfare, Department of Ayush; 1999. p. 80-7.  Back to cited text no. 16
    
17.
Pandey G. Dravya Guna Vijnan. Part 2. 1st ed. Varanasi: Krishnadas Academy; 2001. p. 128-9.  Back to cited text no. 17
    
18.
Ayurvedic Pharmacopoeia of India. Part I. 1st ed., Vol. 1. New Delhi: Department of Ayush, Ministry of Health and FW; 2001. p. 53-5.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1461    
    Printed42    
    Emailed0    
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal