Abstract
Background and aim: Niruha Basti (Kshara Basti) is an important therapeutic measure in Rheumatoid Arthritis (RA) management. Recently, gut microbiota is an indispensable environmental factor in RA progression. Basti, being directly administered into gut, the site of gut microbiota, we assumed that Basti has an action on gut microbiota. So, this study was taken up to analyze the effect of Kshara Basti in Prevotella copri and Prevotella histicola of gut microbiota in RA patients. Experimental procedure: 5 patients satisfying all criterions were recruited after for the trial from Kollam district of Kerala when gene expression analysis revealed presence of P.copri and P.histicola in feacal samples. Kshara Basti was administered for 8 days. On 9th day and 25th day, gene expression analysis was repeated to compare the two species before treatment (BT), after treatment (AT) and after follow-up (AF) Results: The trial revealed marked improvement in clinical signs and symptoms of RA, accompanied by alterations in the levels of P.copri and P.histicola post treatment and follow-up. Interestingly, the findings were inconsistent with prior reports suggesting pathogenic role of P.copri. Conclusion: Kshara Basti (medicated enema) administration led to substantial improvement in RA clinical assessment parameters. The observed increase in P.copri levels alongside symptomatic relief challenges its previously assumed pathogenicity, while P.histicola appeared to exert a protective role. Gene expression analysis from 10 healthy control suggested that P.copri is a common and possibly dominant gut inhabitant in individuals from Kollam district, Kerala. These observations align with existing Indian population studies that identify P.copri as a prevalent gut species.

Key words: Ayurveda, Amavata, Kshara Basti, Panchakarma, Prevotella copri, Prevotella histicola