Management of Osteoarthritis of Both Knee Joints with Causticum, Law of Palliation- A Case Report
Osteoarthritis is a degenerative joint disease characterized by focal loss of hyaline cartilage with proliferation of new bone and remodelling of joint contour. It is one of the leading causes of disability. OA primarily affects articular cartilage, bone, synovial membrane, capsule and ligaments. It is more common in women than in men and the prevalence increases with age. This article illustrates the clinical application of homoeopathic law of palliation. The law of similars is the fundamental law of palliation. This is a case of a 52-year-old male patient who presented with complaints of tearing pain in both knee joints, especially of left knee with severe burning sensation in knees. On thorough case taking and analysing the case, the homoeopathic medicine Causticum was prescribed in 200th potency orally, as dry dose. The remedy was selected based on totality of symptoms and symptom similarity. The severity of the symptoms was assessed using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS), both before and after the treatment. The scores got reduced after administering our medicine and the patient was symptomatically relieved. Even though Osteoarthritis cannot be cured, it is possible to prevent the progression of pathology, and avert further deformities through our medicines by following the homoeopathic law of palliation.
Introduction
Osteoarthritis is defined as a degenerative, non- inflammatory condition of joints characterized by progressive degeneration of articular cartilage and the formation of osteophytes [1]. It is the second most common problem with a prevalence of 22% to 39% in India [2, 3]. It belongs to code FA01.Z of ICD 11. OA can be primary or secondary [2]. Primary OA is due to wear and tear changes, especially in weight-bearing joints as age progresses. Secondary OA is due to causes like injury, previous infection of joints, obesity, and conditions like hyperthyroidism, coronary heart disease and rheumatoid arthritis [2, 3]. The common risk factors include age of above 45 years, postmenopausal phase of life, obesity, previous knee injury, and conditions like osteoporosis. The patients present with clinical features of pain, joint stiffness, swelling crepitus and varus deformities [1, 2]. The active pharmaceutical ingredients of Bryonia extracts are cucurbitacin glucosides and Trihydroxyoctadecadienoic acids. These are essential for producing mediators of endocrine, immune and nervous systems. Causticum contains calcium sulphate and potassium hydroxide in combinations that have a great sphere of action on the nervous, and circulatory systems and also in mucous membranes. The law of palliation is used in circumstances like incurable cases, where the patient is terminally ill, to reduce pain and bring down the suffering, to improve the quality of life of the patient, and to improve the mental health of the patient [4]. The homoeopathic law of palliation always lies on the grounds of the law of Similars Roberts HA [4]. In all possible cases of palliation, it is necessary that the remedy should symptomatically intercept with the symptom totality to get the best possible and the most harmless way of symptomatic relief.
Materials and Methods
This case was taken in the standardized case record format of Sarada Krishna Homoeopathic Medical College. After thorough case taking, the medicine was prescribed based on totality that included the mental generals, physical generals and characteristic particulars. The severity of symptoms was assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS), both before and after the treatment. The overall improvement of the case was analysed by further follow-ups.
Case Report
A 52-year-old male patient came to our OPD with complaints of pain in both knee joints especially in the left knee, for 3 years, that was increased in the last month. The patient had a history of falls and injuries on his knees for 4 years. The patient had the tearing type of pain that increased when ascending and descending stairs, on continuous walking, on exposure to cold weather, and at night. The complaints alleviated on taking rest, on sitting and on warm application. He complained of a burning sensation in his left knee joint that persisted always.
History of Presenting Complaints
The patient suffered a fall and got his knees injured 4 years. Since then, the pain has been mild and initially started in his right knee joint. The pain gradually increased for which he took allopathic medication for 1 year and got only temporary relief. In the last 6 months, the patient suffered a burning sensation in both knee joints, along with a tearing type of pain. When he came to our OPD he had pain in both knees, especially in the left knee. The patient is non-diabetic, non-hypertensive, and not under any kind of medication. There is no history of any fever, there is no history of any relevant comorbidities.
Past History: Nothing relevant. Family History: Father has diabetes and is under allopathic medication.
Physical Generals
The patient’s appetite was good and ate food 3 times a day. He drank 3 to 4 litres of cold water every day. He voided urine without any difficulty and his stools were regular. His sweat was generalised all over the body. His sleep is disturbed due to pain. He had desires towards a warm climate, warm foods and cold water and preferred covering always. He had an aversion towards fanning and hot climate and intolerance towards sweets. The thermal indicated ambi towards cold, his appearance was towards the hydrogenated constitution.
Mental Generals
The patient showed great irritability and was easily angered. He would become violent and used to throw things when angered. He liked the company of his dearest ones.
Examination of the Patient
His general physical examination revealed mild pallor, no icterus, no clubbing, no cyanosis, no lymphadenopathy. The swelling was present on both knee joints. And his gait was unsteady. The BP was 124/86 mm of Hg. His pulse was 76 beats per minute. His respiratory rate was 18 breaths per minute. His oral temperature was 98.6 ºF.
On examination of the right knee joint, there were no scars, no discolouration, the swelling was present and there were no deformities. On palpation, crepitus was felt, along with local warmth and no tenderness. Both flexion and extension were possible but painful.
On examination of the left knee joint, there were no scars, no discolouration, swelling was present and there were no deformities. On palpation crepitus was felt, along with local warmth with mild tenderness. Flexion was not possible due to stiffness with pain in extension.
Lab Investigation
X-ray of both knee joints revealed the presence of moderate multiple osteophytes, definite narrowing of joint space, and sclerosis. The pathology was under OA Grade III according to Kellegren Lawrence OA grading. Final Diagnosis: Osteoarthritis of both knee joints.
Remedy and Follow-Up
On the first visit of the patient (05-06-23) on account of pain in both knee joints but more on the left, we concluded to give Bryonia Alba 200 for 1 week. On the next visit after one week (12-06-23), the complaints persist as same. Knee joint pain is worse on walking, descending and ascending stairs better by sitting. After considering the totality we gave Causticum 200/2D weekly one dose at night. The patient is followed for one and half months and during this period patient’s knee joint pain gets greatly reduced. The details of the follow-up is given in the table.
| Date | Signs and Symptoms | Prescription | |||
|---|---|---|---|---|---|
| 12-06- 2023 | Knee joint pain persists as same < walking++, <descending++, <ascending stairs+++, > sitting. | Causticum 200/2d, weekly one dose at night for two weeks. | |||
| Q.NO: 1 | Q.NO: 2 | Q.NO:3 | TOTAL | ||
| 17 | 4 | 47 | 68/96 | ||
| 26-06- 2023 | Knee joint pain better than before < walking+, <descending+, <ascending stairs+++, > sitting. | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | |||
| Q.NO: 1 | Q.NO: 2 | Q.NO:3 | TOTAL | ||
| 12 | 4 | 45 | 61/96 | ||
| 10-07- 2023 | Knee joint pain better but persist<cold exposure +, < walking+, <descend- ing+, <ascending stairs++, > rest | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | |||
| Q.NO: 1 | Q.NO: 2 | Q.NO:3 | TOTAL | ||
| 13 | 4 | 31 | 48/96 | ||
| 24-07- 2023 | Knee joint pain greatly reduced <cold exposure, < walking, <descending, <ascending stairs+, > rest | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | |||
| Q.NO: 1 | Q.NO: 2 | Q.NO:3 | TOTAL | ||
| 7 | 2 | 29 | 38/96 |
Table 1: Assessment based on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC).
| Date | Signs and Symptoms | Prescription | ||||||
|---|---|---|---|---|---|---|---|---|
| 12-06- 2023 | Knee joint pain persist as same < walking++, <descending++, <ascending stairs+++, > sitting. | Causticum 200/2d, weekly one dose at night for two weeks. | ||||||
| koos pain | koos symptoms | koos activities | Koos recreation | Koos quality of life | ||||
| 22.5 | 46.5 | 35.5 | 0 | 37.5 | ||||
| 26-06- 2023 | Knee joint pain better than before < walking+, <descending+, <ascending stairs+++, > sitting. | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | ||||||
| koos pain | koos symptoms | koos activities | Koos recreation | Koos quality of life | ||||
| 42.5 | 53.75 | 38.25 | 15 | 50 | ||||
| 10-07- 2023 | Knee joint pain better but persist<cold exposure +, < walking+, <descending+, <ascending stairs++, > rest | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | ||||||
| koos pain | koos symptoms | koos activities | Koos recreation | Koos quality of life | ||||
| 50 | 57.25 | 41.25 | 25 | 56.25 | ||||
| 24-07- 2023 | Knee joint pain greatly reduced <cold exposure, < walking, <descending, <ascending stairs+, > rest | Causticum 200/2d, repeated as weekly one dose at night for 2weeks. | ||||||
| koos pain | koos symptoms | koos activities | Koos recreation | Koos quality of life | ||||
| 55 | 60.75 | 57.38 | 40 | 68.75 |
Table 2: Assessment based on the Knee Injury and Osteoarthritis Outcome Score (KOOS).
| No. of. Visits | 5 |
| Duration of treatment | One and half months |
| Medicine administered | Causticum |
| Potency selected | 200 |
| No. of. Doses | 8 doses |
Table 3: Overall Medication Summary.
Discussion
In a national journal of integrated research in medicine, 100 patients were treated according to symptom similarity and the outcome showed improvement in KOOS scale [5]. If we can take the concept of individualization at grass root level and understand what pathophysiology occurs at the level of knee joint then it becomes very obvious that the homoeopathic medicine can prevent further complications like deformities. A single blinded randomized placebo controlled clinical trial of homoeopathic medicine on osteoarthritis was conducted on 90 patients of osteoarthritis who received treatment based on individualised homoeopathic medicine and on symptom similarity, reported significant decrease in WOMAC index score after an average treatment period of 3 months [6]. In our case, the homoeopathic medicine Causticum covered the symptom totality, and was prescribed [7, 8]. After a treatment duration of one and a half months, WOAMC index score, and KOOS scale index score significantly decreased and patient was improved symptomatically. The administration of similar remedy almost always ameliorates the suffering for a short period, after which we may have a return of symptoms, when the indicated remedy will be called into use again [9]. When the remedy is not repeated, the symptoms may relapse. This case is an example of Dr. Kent’s 7th observation, where there is full time amelioration of the patient yet there is no special relief. Such cases are incurable, and the patient can only be palliated [10].
Conclusion
The law of similars is the fundamental law also in palliation. In cases where cure is not possible, homoeopathic medicines can improve the quality of life of the patient, when prescribed according to symptom similarity. This case has shown the efficacy of the homoeopathic medicine Causticum in the treatment of OA. However, further high-quality clinical trials are needed for the establishment of the effectiveness of the said medicine.
References
-
Mohan harsh (2000) Textbook of pathology. Endocrine system,thyroid, In: 4th (Edn.), Jaypee brothers pp: 1-949.
-
Harrisons (2008) Principles of Internal Medicine. In: 17th (Edn.), Mc Graw Hill Medical, USA, 1.
-
National Institute of Arthritis and Musculoskeletal and Skin Diseases (2021) Osteoarthritis. Health topics.
-
Roberts HA (2016) The principles and art of cure by homoeopathy. In: 3rd (Edn.), B Jain publishers Pvt Ltd.
-
Dave P, Trivedi M, Patel G, Shah P (2018) To Evaluate the Efficacy of Homoeopathic Medicine In Management of Osteoarthritis of Knee. National Journal of Integrated Research in Medicine 9(3).
-
Mohanty N, Sahoo AR, Gautam P, Ghosh P (2023) A Randomised Placebo-Controlled Clinical Trial of Homeopathic Medicines on Osteoarthritis. Homœopathic Links 36(1): 12-15.
-
Boericke W (2016) Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. In: 9th edition. B Jain Publishers Pvt Ltd.
-
Clarke J H (2016) A dictionary of practical materia medica. B Jain Publishers Pvt Ltd.
-
Shriwas M Bhardwaj A (2022) Study of the Significance of Individualization in Management of Osteoarthritis. Annals of the Romanian Society for Cell Biology 26(1): 2552-2557.
-
Kent JT (1985) Lectures on homoeopathic materia medica: together with kent’s ‘new remedies’ incorporated and arranged in one alphabetical order-handover. New delhi, jain pub, India, pp: 96-101.
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