Single Blind Randomized Experimental Study to Assess the Efficacy of Simarouba glauca 6C, 12C and 30C in the Treatment of Rheumatoid Arthritis Patients

Rheumatoid arthritis (RA) isthe most common inflammatory arthritis and autoimmune disease that isassociated with progressive disability, systemic complications, early death andsocioeconomic costs.[1]

RA occurs in 0.5-1.0% of the adult population worldwideand is more common in women.[2,3] Its Indian prevalence is rangingbetween 0.19-2.50%. The peak incidence is between the ages of 20 and 40, themost productive years of adulthood.[3,4]

Complex aetiological factors like genotype(50%),environment, age, gender, family history, smoking, etc., can cause RA. These triggersentail several inflammatory cascades leading to persistent synovial inflammationand associated damage to articular cartilages.[5] About80% of RA patients are Seropositive for Rheumatoid Factor (Normal range: 0-20 U/ml)and its presence predicts a more aggressive & destructive course.[6]

Patients often complain of pain & early morning jointstiffness lasting >1 hour. Typically the small joints of hands and feet are affectedwith a polyarticular (>5 joints) symmetric distribution. Later it may affectthe large joints.[7]

The confirmative diagnosis may be done with ‘2010American College of Rheumatology / European League against RheumatismClassification Criteria for RA’.[8]

RA has a significant negative impact on the ability toperform daily activities, including work & household tasks, and health relatedquality of life. The goal of treatment in RA patients is to eliminate symptoms,slow disease progression and optimize quality of life.

Simarouba galuca (Lakshmi Taru) is a herb wellknown for its medicinal uses including Rheumatoid Arthritis.[10,11] RecentIn-vitro studies have evidenced the anti-inflammatory activity of its extractsin Arthritis Models.[12,13] But no evidence is available for itsHuman Use. This information intended me to do a Comparative Experimental Studyof this medicine in different Homoeopathic potencies, to check itsEffectiveness and Anti-inflammatory property in RA patients.

Bibliography:

**1.**McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. NewEngland Journal of Medicine. 2011-Dec 8;365(23):2205-19.

**2.**Smolen JS, Aletaha D, et.al. Rheumatoid arthritis. Lancet[Internet].2016; 388 (10055):2023-2038.

**3.**Handa R, et.al. Literature review of rheumatoid arthritis inIndia. International journal of rheumatic diseases. 2016-May;19(5):440-51.

4. Carmona L, et.al.(2010). Rheumatoid arthritis. Best Practice & Research ClinicalRheumatology, 24(6):733-45.

**5.**Scott DL, et.al. (2010). Rheumatoid arthritis. The Lancet,376(9746):1094-1108.

**6.*Firestein GS. Evolving concepts of rheumatoid arthritis. Nature.*2003-May;423(6937):356-61.

**7.**Ankoor S. et.al. Rheumatoid Arthritis. Harrison’s Principles ofInternal Medicine. 19th Edition. McGraw Hill. 2015:2136-37.

**8.**Aletaha D, et al. 2010 Rheumatoid arthritis classificationcriteria: American College of Rheumatology/European League Against Rheumatismcollaborative initiative. Arthritis & rheumatism. 2010-Sep;62(9):2569-81.

9.https://www.medassignments.com/rheumatoid-arthritis-7111 (Last accesses 20.07.2020)

**10.**Sharanya VK, et.al. A pharmacological review on simarouba glauca.Int.J.Pharma.Res.Rev. 2016-Jun;5:32-6.

11. Bhattacharyya RK, Debbarma N, et.al.  Medicinal plants-Simarouba glauca and Dilleniaindica. *Int.J. Minor Fruits, Medicinal and Aromatic Plants.*2018;4(2):42-5.