Abstract
Abstract
Background: A significant number of patients with Amavata attend Ayurvedic out-patient departments. Rheumatoid arthritis (RA), a prototype of Amavata, is the most common form of inflammatory polyarthritis that leads to joint deformities and systemic complications. Anaemia of inflammation is associated with RA in over 50% cases. The severity of RA can be assessed using tools such as the Clinical Disease Activity Index (CDAI), whereas that of anaemia can be assessed according to the World Health Organisation (WHO) recommendations. A validated tool for systemic Ama-assessment, the Ama Assessment Index (AAI), is also available. Anaemia is often observed as an associated feature in Amavata (RA), though it is not described as a feature of Amavata in classical Ayurveda texts. There are no studies that attempt to establish the relationship between Dhatukshaya, particularly Raktadhatu-kshaya in Amavata. We, therefore, investigated the association of the features of Raktadhatu-kshaya in patients with Amavata (RA).
Objectives: The primary aim of this study was to find the association between Amavata (RA) and Raktadhatu-kshaya based on the features described in the classical texts and laboratory investigations. The secondary objectives were to evaluate the association of anaemia and its severity with the severity of Amavata (RA) as assessed by the AAI and CDAI.
Methods: This cross-sectional study was carried out at a super-specialty Rheumatology OPD. Consecutive treatment-naïve adult patients with inflammatory polyarthritis fulfilling 2010 ACR/EULAR classification criteria for RA were studied. A careful clinical examination, assessment for Raktadhatu-kshaya and Ama, and laboratory tests, including complete blood count, were performed in all cases. The analysed data is presented in this communication.
Results: Thirty out of 39 patients (76.92%) were anaemic. Twenty-one patients (53.84%) had anaemia of inflammation (normocytic normochromic), nine patients (23.07 %) had nutritional anaemia, whereas the remaining nine were non-anaemic. Features of Raktadhatu-kshaya, viz., dry skin and preference for sour and cold items, were found in 51.28%, 53.84%, and 53.84% cases, respectively. However, Sirashaithilya (venous insufficiency) was not found in any of these patients. The correlation of Raktadhatu-kshaya with Ama-score and CDAI could not be evaluated due to the small size of subgroups.
Conclusion: Raktadhatu-kshaya is usually associated with Amavata and can be due to inflammation or iron deficiency. It has a significant impact on the clinical and patient-reported outcomes. It should be considered a complication of Amavata syndrome and treated accordingly. Correction of Raktadhatu-kshaya may indicate successful management in these patients.

Key words: Ama-score, CDAI, Disease severity, Inflammation, Iron-deficiency, Venous insufficiency