A Clinical Study to Evaluate the Safety and Therapeutic Efficacy of Safuf-e-Chobchini in the Management of Waja-al-Mafasil (Rheumatoid Arthritis); A Block Randomised,Open label,Standard Control Study.

Rheumatoid arthritis is a chronic, systemic inflammatory disease of unknown etiology that primarily targets synovial tissue.Rheumatoid arthritis is a global disease with a variable geographic prevalence of 0.5% to 1% adults.The incidence of rheumatoid arthritis increases between 25 and 55 years of age, after which it plateaus until the age of 75 and then decreases.The disease may be insidious in nature rarely occurring in men younger than 30 years with gradually rising incidence with advancing age. In women the incidence steadily increases from mid 20s to peak incidence between 45 to 75 years. Rheumatoid arthritis occurs more commonly in females than in males, with a 2-3:1 ratio.

It has been recognised that genetic factors contribute to occurrence of rheumatoid arthritis.Increasing evidence supports a substantial role for environmental factors including smoking,other pulmonary exposures (silica), obesity, vitamin D deficiency as enhancing factors for rheumatoid arthritis risk.

The primary target tissue is the inflamed synovium that contains a range of activated leucocytes and stromal cells that under the influence of inflammatory cytokines drive local cartilage and bone destruction. Patient often complains of early morning joint stiffness lasting more than 1 hour that eases with physical activity.The earliest involved joints are typically the small joints of the hands and feet.

In Unani system of medicine, Rheumatoid arthritis comes under the heading of “Waja-al-Mufasil” and “ghatiya”.The cause of this disease is believed to be derangement of temperament (soo-e-mizaj.The management of rheumatoid arthritis has continued to improve globally, where early use of conventional and biologic disease modifying antirheumatic drugs (DMARDs) have dramatically improved patient outcome ;however ,a sizeable proportion of patients do not respond adequately to treatment. In addition, these powerful drugs are often associated with unpleasant side effects and occasionally serious adverse events. Furthermost ,the high cost of biological drugs has hindered their accessibility .For these reasons rheumatoid arthritis patients are increasingly seeking complimentary and alternative medicines⁶.The unani formulation Sufuf-eChobchini is a unani pharmacopeial formulation commonly prescribed for waja’almufasil(arthritis).It contains eight herbal drugs namely Ushba-e-Maghrabi (Smilax aristolochifolia),Chobchini (Smilax china L.),Gul-e surkh(Rosa damascena Mill.),Barg-e sana (Cassia angustifolia Vahl),Suranjan Sheeren (Merendra persica), Sandal sufaid (Santalum album L.),Bisfaij fistaqui (Polypodium vulgare),Aftimoon (Cuscuta reflexa Roxb.).

These ingredients are reported to have anti inflammatory, analgesic,phelgemogue and purgative activities . Even though this formulation has been used in the unani system of medicine for years,its efficacy in rheumatoid arthritis has not been validated using modern scientific parameters