Treatment Of Pigmented Villonodular Synovitis In Ayurveda With Herbal Remedies
Abstract
Pigmented villonodular synovitis (PVNS), also known as villous synovitis or synovial xanthoma, is an idiopathic form of villous overgrowth and hyperpigmentation. PVNS is a rare disease but can cause local aggression and relapses. It is characterized by synovial hyperplasia and pigmentation (hemosiderin) in the joints, tendon sheaths and bursae. It usually affects large joints such as the knees and hips and is rarely seen in the temporomandibular. Although it usually occurs between the ages of 20-40, it can also be seen in children and adults. Now, we will discuss the causes, symptoms, pathogenesis, complications, diagnosis, and treatment according to modern science, an Ayurvedic overview of PVNS, and herbal remedies by Planet Ayurveda.
Introduction
Pigmented villonodular synovitis (PVNS) refers to a severe form of synovitis that affects soft tissue in the joints and muscles. Pigmented villonodular synovitis usually affects the knee, hip, and ankle and has a poor prognosis, with symptoms occurring years before diagnosis. In addition, pigmented villonodular synovitis is more aggressive than the other major subtypes of tenosynovial giant cell tumor (tenosynovial giant cell tumor). There are mainly 2 types of Pigmented villonodular synovitis:
- Localized PVNS: In this type, only some of the joint parts are affected. It can also happen when your tendon is affected. Recurrence of this type is 8% after the synovectomy.
- Diffuse PVNS: In this type, the symptoms occur throughout the joint. This type is rarer, more painful, and more difficult to treat than localized PVNS. Recurrence of this type is 30% after the synovectomy.
Causes
The exact cause is unknown. In normal joints, the thin layer of tissue is the synovium that surrounds all joints and tendons, the connective tissue of muscles and bones. When healthy, the synovium produces a small amount of fluid that lubricates the joint, aiding movement. The abnormal synovial lining caused by pigmented villonodular synovitis causes joint swelling, sometimes interferes with movement, and can grow and destroy nearby joints, including large bones.
Pathogenesis
It is caused by overexpression of the CSF1 gene (colony-stimulating factor 1), also known as M-CSF (macrophage colony-stimulating factor). Overexpression causes abnormal cells to form focal areas of soft tissue hyperplasia in synoviocytes in joints. It is a highly localized neoplastic synovial tumour (not a true tumour).
Symptoms
There are the following symptoms of Pigmented villonodular synovitis:
- Severe joint pain
- Joint pain (Up to 99% of patients)
- Tenderness in and near the joint
- Restriction of joint movement
- Locking or entrapment of the joint
- Joint burst
- Hemarthrosis is a state of articular blood that is into the joint cavity.
Complications
- breakdown of ligament
- degeneration of bone
- breakdown of tendon
- degeneration of bone
Diagnosis
- Physical examination
- MRI
- Joint aspiration
- Arthrography
- X-ray
- Biopsy
Treatment
- Open surgery
- Arthroscopic surgery
- Drug therapy
- Total joint replacement
- Radiation therapy
Ayurvedic Overview Of Pigmented Villonodular Synovitis
In Ayurveda, PVNS is correlated with Kroshtukasheersha (क्रोष्टुकशीर्ष), also called Hydrops and inflamed knees. It is described as a Vata vyadhi by Acharya Sushruta in the Nidana sathana. Bhavaprakasha named it Jmbookamasthakam. According to the Ayurvedic view, Vata and Rakta, the incidence of the disease usually affects people. It occurs locally in the knee joint, causing swelling that looks like the head of a Jackal and makes it difficult for the patient to walk due to pain.
वातशोणितजः शोफो जानुमध्ये महारूजः। शिरः क्रोष्टुकपूर्वं तु स्थूलः क्रोष्टुकमूर्धवत्।। (सु. नि. १/७६)
The above shloka states that, the vitiation of Vata and Rakta in the knee joint causes swelling that are fiercely painful, and as thick as the head of a shrigal (Jackal) and are called kroshtukashirsha.
Nidana (Causative Factors) Of Vata Dosha
- Excessive jumping
- Injury due to fighting
- Sleep in the daytime
- excessive physical activity
- due to staying awake at night
- heavy lifting
- fast walking and running
- over fasting
- eating despite indigestion
- fall from a certain height
- consuming large amounts of food and small amounts of food at irregular times
- Excess intake of pungent, astringent, dry, bitter, cold, mild and dry vegetables.
Pathogenesis Of Vatavyadhi
Vata energy is aggravated by the above factors, causing the channels to remain empty. Vata, which deteriorates when filled with space, may be limited to a specific region, or it may affect the whole body such as vata vyadhi, and may lead to various diseases.
Symptoms Of Imbalance Of Vata
There are the following symptoms of Vata imbalance:
- Pulsation
- Roughness or dryness
- feeling of emptiness
- Sensation loss
- pain like cutting
- dizziness
- bloating
- loss of sensory functions
- delusion
- giddiness
- constipation
- black discolouration of body parts
- emaciation
- sleeplessness
- stiffness
- decreased body strength
Treatment Of Vata Dushti
- Deepan pachana (carminative)
- Swedana- sweating therapy
- Snehana- oleation or lubricating therapy
- Mridu Viechana- mild laxatives (substances used to induce purging)
Nidana (Causative Factor) Of Rakta Dushti
- Eating opposite foods and eating during digestion
- Exposure to fire
- Excessive heat, thick, oil and water consumption
- Sleep during the day
- Excessive exposure to heat and the sun.
- Excessive anger
- eating despite indigestion
- Eating substances that cause burns in the body
Symptoms Of Vitiated Rakta
- Excessive anger
- Burning sensation
- Loss of digestive fire
- Weakness in sense organs
- Skin discoloration
- Metabolic joint disorders
- Bleeding disorders
- Reddish discolouration in the eyes, skin, and urine
- Suppression of urges
- Excessive thirst
- Itching
- Fever
- Skin-related disorders
- Excessive sweating
Management Of Rakta Dushti
- Purgation
- Raktashodhak (blood purification): herbs used are Neem, Manjishtha, Daruharidra, Haridra,
- Fasting therapy
- Raktamokshan (blood-drawing therapy)
Herbal Remedies By Planet Ayurveda For PVNS
Planet Ayurveda is a GMP and ISO-certified company known worldwide for its herbal and natural products. All products are as described in old holy books. Planet Ayurveda has the best combination of herbs to treat various ailments. These medicines have no side effects on the body. Planet Ayurveda provides you with amazing remedies that are beneficial These herbs are as follows:
- Boswellia-curcumin
- Joint Aid Plus
- Lakshadi Guggul
- Kanchnaar Guggul
- Kamdudha Ras (moti Yukt)
Product Description
1. Boswellia-Curcumin
These are polyherbal capsules that are made up of Shallaki (Boswellia serrata), and Curcumin or Haridra (Curcuma longa). This amazing combination is useful to reduce pain. Shallaki is used for its anti-inflammatory action which ceases the secretion of cytokines and reduces swelling or inflammation. Haridra has antioxidant properties that protect brain neurons. It is helpful in the formation of blood in the body and is also a blood purifier. Haridra is also applied on cuts and bruises because of its antibiotic action. It is an amazing remedy for wounds, sprains and inflamed joints.
Dosage: 2 capsules, two times a day after meal.
2. Joint Aid Plus
Joint Aid Plus are polyherbal capsules that are made up of Ashwagandha (Withania somnifera), Sonth (Zingiber somnifera), Nirgundi (Vitex negundo), and many more. Withania somnifera provides strength to the ligaments and muscles. Shallaki is used as an analgesic and has anti-inflammatory properties. These capsules reduce pain, swelling and tenderness. It is used in various types of joint problems like gout, rheumatoid arthritis, and osteoarthritis. It is also an immune modulator. Sonth is also used as an analgesic and is helpful in digestion.
Dosage: 1 capsule, two times a day.
3. Lakshadi Guggul
These are polyherbal tablets that are made up of Shuddh Guggulu (Purified Commiphora mukul), Nagabala (Grewia populifolia), Asthisamharaka (Cissus quadrangularis), etc. Its taste is bitter and astringent. It is helpful in healing wounds. It has antipyretic, antibacterial, and antifungal properties. It is an amazing formulation for heart diseases. It enhances bone density. Another name for Asthisamharaka is Hadjod, which helps to promote the healing of fractures and is also a pain reliever in joint disorders. Shuddh Guggul is used to reduce the inflammation of the joint.
Dosage: 2 tablets, two times a day.
4. Kanchnaar Guggul
These are poly herbal tablets that are made up of Tejpatra (Cinnamomum tamala), Varuna bark (Crataeva religiosa), Amalaki (Emblica officinalis), Kachnar bark (Bauhinia variegata), Trikatu- Ginger (Zingiber officinale), Black pepper (Piper nigrum) and Pippali (Piper longum), etc. Its effect is hot and its taste is bitter. It is an effective pain reliever. It reduces the stiffness and swelling of the joints. It is useful in blood purification.
Dosage: 2 tablets, two times a day.
5. Kamdudha Ras (Moti Yukt)
Kamdudha Ras (M) is a polyherbal pill that is made up of Mukta Shukti bhasma (pearl oysters), Shankh bhasma (conch shell), Praval bhasma (Coral calx), Shuddha Gairik (red oxide of iron), Giloy satva (Tinospora cordifolia), etc. It is a blood purifier. It acts as an anti-emetic, anti-inflammatory, and anti-arthritic. Mukta Shukti bhasma pacifies the Kapha and Pitta dosha and it is a source of vitamin A, vitamin B12, calcium and iron. Giloy is also called Guduchi and its potency is hot. According to our Samhitas giloy acts as rasayani (rejuvenating), and Amahara (detoxifying) etc.
Dosage: 2 pills, two times a day.
Conclusion
PVNS (Pigmented Villonodular Synovitis) can be a different type of synovitis that can affect the joints in the body, but most commonly the knees. PVNS is usually classified as localized or diffuse. Pigmented villonodular synovitis (PVNS) refers to a severe form of synovitis that affects soft tissue in the joints and muscles. Pigmented villonodular synovitis usually affects the knee, hip, and ankle and has a poor prognosis, with symptoms occurring years before diagnosis. In Ayurveda, the symptoms of pigmented villonodular synovitis are almost similar to Kroshtukasheersha. In this disease, Vata and Rakta vitiation often come into play. Planet Ayurveda offers some herbs that are effective in treating pigmented villonodular synovitis without causing side effects.
