a case study of ankylosing spondylitis

7/27/2019 A Case Study of Ankylosing Spondylitis

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A Case study of Ankylosing spondylitis

Miss.R.Karthika D/O.R.Rajendran,Age:15/F came to our OPD with complaints of pain in

both the hip joints,pain in left ankle joint since two months.She was not able to walk due

to pain.She came with the support of a walker.

History

No H/O Diabetics mellitus,hypertension,IHD,headache,vomiting, and fits.

History of appendisectomy (child hood),piles(non bleeding).

She was wrongly diagnosed as being infected with TB and she was under ATT.

Blood reports

RA factor -55

Anti TB IgG -32 u/l

Anti TB IgM -2.1(positive)

ESR -33/70

S. uric acid -5.7

HLAB27 -Positive

HB -10.6

MRI :- SI joints

B/L Sacroiletis - RT>LT

O/E

TMJnormal

Neck -Normal


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Shoulder joint -Normal

Patricks -RT Positive

Futher investigation

T3 -122 ng/dl

T4 -6.70g/dl

TSH -3.55 Iv/UL

Anti ds(DNA) -33.33 (positive)

ANA -0.84 negative

AMA -14.68 V/M negative

ATG -313.56 IV/ML negative

Calcium 10.18 (10 is N)

Intact parathyroid hormone -7.73 pg/ml (15 is N)

Serum Protein Electrophoresis

Reduced alpha1 and Hypergamma globulinemia,No M-Band seen.

TB Gold(Quantiferon) 0.15(negative).

As TB feron was negat ive, ATT was stopped

Diagnosis

Ayurvedic view Gambeera vata raktham ( Modern view Ankylosing spondylitis)

Dosham Vatham

Dushyam Raktham

Avastha Chirakari

Agni Samagni


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Koshtam Madhyama koshtam

Malam Normal

Treatment

Phase I:

Ama pachanam,Agni deepanam

Indukantha kashayam -50ml 4 times per day before food.

Amritha aristhtam -15ml bd after food.

Nayopayam lehyam -1 tsp bd after food.

Indukantha ghrutam - 1 tsp bd after food.

Phase II:

Vataraktha haram

Rasna erandadhi kashyam - 50 ml 4 times per day before food.

Aba guggulu -1-0-1 after food.

Senthil - 2-0-2 after food.

Drakshadi rasayanam -1tsp bd after food.

Tippili rasayanam -1 tsp bd after food.

Phase III:

Raktha prasadhanam

Manjishtadhi kashayam -50ml 4 times before food.

Senthil -2-2-2 after food.


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Sudharsanam -2-0-2 after food.

Karisalai kalpam -2-0-2 after food.

External Treatment

Phase I Podi kizhi, Lepam 2 days

Phase II Abyangam ,Dasamoola ksheera dhara ,lepam 5 days

Phase III Virechanam(Nimbaamrutha erandam) 1 day

Phase IV Kaya sekam, Lepam, Avagaham 2 days

Phase V Kayasekam, Lepam, Avagaham, matra vasti 4 days

Phase VI Kashaya Vasti (Guduci ksheera vasti) 4 days(alternative

days)Phase VII Kayasekam, matra vasti, kati vasti 3 days

Phase VIII Abyangam, kashaya dhara 1 day

Conclusion

After 22 days of treatment, pain in the hip joints reduced. Patient was able to

walk without the support of the walker.

Rasayana Karma

Pippali vardhamana rasayanam

1 st day 2 gms

2 nd day 4 gms

3 rd day 6 gms

4 th day 8 gms

5 th day 10 gms

6 th day 12 gms


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7 th day 14 gms

8 th day 16 gms

9 th day 18 gms

10 th day 20 gms

11 th day 18 gms

12 th day 16 gms

13 th day 14 gms

14 th day 12 gms

15 th day 10 gms

16th day 8 gms

17 th day 6 gms

18 th day 4 gms

19 th day 2 gms


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Case Study-Lance Adams syndrome

N.Balamurugan,S/O G.Narayanasamy,Age 31/M attended the OP ward on 24.3.2011

with complaints of jerks(involuntary movements) in all four limbs,dysarthria since 3

years.He had involuntary movements during rest sleep and activity,but no fasciculations

or wasting of the tongue was noticed.

History

A known case of bronchial astha, had acute asthmatic attack,was on ventilator

support and developed continuous jerky involuntary movements on recovery.

No DM,


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No HT,

No APD,

No IHD/CVD,

No TB,

No jaundice

No headeache

No Vomitting

No injury

No Calculi

History of Tracheotomy done.

History of fits-Generalised tonic clonic seizures

No History of attack for the past 6 months.

On Examination

Comprehension Normal

Naming of objects Normal.

Difficulty noticed in repetition of words.

No spasticity of tongue

No wasting

DTR -Normal

Power -G4.

Plantar -Flenor(B/V)

X chest taken -Normal

MRI Brain -Normal with B/L martoiditis


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Gandharva Hasthathi kashayam 50ml two times a day before food.

+

Mahakalyanaka kashayam

Vaishvanara churnam - 1 tsp bd with kashayam

Sahacharadi tailam 10 ml with milk at night after food.

External

Jeevanthyadi churnam(udvarthanam) for 5 days.

Sahacharadi kulumbu (for abyangam,kaya sekam,mamsa kizhi)

Talam Rasnadi churnam + Ksheera bala

Nasyam Sahacharadhi thailam(pratimarsha nasyam)

Phase II

Internal

Vidaryadi + Badra darvadi kashayam -50 ml bd before food

Poorna chandrodayam -1 - 0 1 after food

Ashwaganda churnam -1 tsp with milk at night after food

Saraswatha churnam -1tsp bd with honey

Bala churnam -1 tsp with milk bd after food

Sukumara lehyam - 1 tsp at night after food

Sahacharadi Vp + Rasa tailam -1 tsp with milk bd after food


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External

Abyangam, Jambeerapinda swedam, pizhichal was given

Niruha vasti Dvipanchamooladhi

Shiro vasti --Sahacharadi VP

Chetasa ghrtam 1 tsp bd after food

Danatanayanadi ksheera kashayam 50 ml at night(before food)

Dhatu kalpam leoodhyam - 1 tsp bd after food

Draksha +Balaaristam -15ml bd after food.

a case study of ankylosing spondylitis

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