A clinical study to evaluate the effectiveness of Navakarshika kashaya in Vatarakta(Psoriatic arthritis)

Vatarakta is an illness caused by the concurrent aggravation of both Vata and Rakta which is acts as the combination of wind and fire. Vitiated Vata and Rakta lead to the initiation and progression of a disease process that is specific to Vatarakta.As per Acharya Charaka, Vatarakta is of two types. a) Uttana  b) Gambhira. A third clinical entity, Ubhayashrita Vatarakta is also described as a condition showing features of both Uttanaand Gambhira variety. Uttana Vatarakta manifests in Tvakaand Mamsa. Gambhira Vatarakta has involvement with gambhira dhatus.Psoriatic arthritis(PsA) is defined as inflammatory arthritis associated with psoriasis, usually seronegative for rheumatoid factor. Purvaroopa(prodromal features), Roopa(clinical features) and Updrava(complications and comorbidities) of Vatarakta which are seen in Psoriatic arthritis are Sandhi shaithilya(~loss of functionof joints), nistoda-sphurana-bheda in hasta pada sandhi(~pain in joints of hands and feet commonly), ruka bhutva bhutva nashyati(~pain that is of relapsing-remitting nature), vaivarnya and mandalotpatti(~discoloration and skin lesions). shvayathu stabdha kathina(~hard and immobile swelling), bhrisha artiandtoda(~excess pain in involved parts), daha(~burning sensation), shyava and tamrata(~discoloration), paka(~suppuration or irreversible destruction.) mamsa kotha(~pyoderma gangrenosum), sphota, pangulya, angulivakrata(arthritis mutilans), aswapan(~loss of sleep), bhrama, klama( depression, anxiety), marmagraha(~rigidity of vital points around joints, improper function of vital organs)- murchha(loss of consciousness)- shwasa(~metabolic syndrome and its components, atherosclerosis, aortic insufficiency, conduction disturbances. chronic obstructive lung disease). Clinical features of vataraktaare similar to that of psoriatic arthritis. For all practical purposes it seems that psoriatic arthritis is similar clinical entity as vatarakta.

 In allopathic sciences, psoriatic arthritis is treated based on updated EULAR recommendations. Agents used are non-steroidal anti inflammatory drugs(NSAIDS), conventional synthetic disease modifying anti rheumatic drugs (csDMARDs) , biologic disease modifying anti rheumatic drugs (bDMARDs), phosphodiaesterase 4 inhibitor. However, these treatment recommendations have side effects like upset stomach, nausea, diarrhea, hair loss, rash or skin reaction, risk of infection, malignancy due to inhibited tumor surveillance, congestive heart failure, demyelinating disease, infusion reactions and injection site reactions, gastrointestinal perforations; liver, kidney and lung disorders. Each class of agent is used for 3-6 months before assessing outcome, based on effect the drug is either continued indefinitely or patient is shifted to other class of agents. Navakarshika kashaya is a herbal formulation for treatment of vatarakta as mentioned in several ayurvedictexts. It has nine components taken in equal proportion *Triphla, Nimba, Guduchi, Vacha, Manjistha, Katuki, Daruharidra.*Contents of Navakarshika kashaya are easily available in local market as well as in neighbourhood of Indian population. Therefore, it is a promising, cost effective therapy without any side effects in comparison to prevalent conventional therapies. So, if this is effective in treatment of psoriatic arthritis, it will be helpful in reducing disease burden, improving health quality in psoriatic arthritis patients in a cost effective manner.