Role of Homoeopathy in Autoimmune Joint Disorders of Children – A Case Study

Akshay M. Patel, MD (Hom)

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Lecturer, Department of Surgery, Smt. Malini Kishore Sanghvi Homoeopathic Medical College, Karjan

*Address for correspondence: Dr Akshay Patel

Email: drakshay80@gmail.com

How to cite this article:

Patel AM. Role of Homoeopathy in autoimmune joint disorders of children – a case study. Journal of Integrated Standardized Homoeopathy 2018; 01(02):

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Received on: September 18, 2018

Accepted for Publication: December 26 , 2018

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Introduction

Managing autoimmune joint disorders can be challenging. Autoimmune joint disorders in children test the skills and competency of a homoeopath, especially in the early years of practice. The following are two cases that will help in understanding the application of Homoeopathic philosophy in the management of autoimmune joint disorders of children.

CASE: 1

D.O.C.: 28/03/15

NAME: Miss MSK        AGE: 15 YRS                SEX: F              EDUCATION: 9^th std     Religion: Muslim

ADDRESS: J

CHIEF COMPLAIN:

LOCATION	SENSATION	MODALITY	CONCOMITANTS
MSS – Since 3 yrs of age, Both wrists Both knees Metacarpals Metatarsals   Restarted since 2014 F: On & Off D: Continue I: increase gradually	Pain3 Stretching type Swelling2 Stiffness Weakness2 Fever on & off	>3 with allopathic Rx for 2-3 yrs.         <2 Night <3 Cold weather <2 Sour food <2 Movements <2 Bending >2 Warm application >2 lying down On allopathic treatment Tab. Mext (5) – ½ Wednesday Tab. Folvit – ½ daily Tab. Mayfer 1 daily Tab. Medel 1/2 bd Tab. Astaflam AP ½ SOS
BLOOD Since 1 Month   Face/Eyes	Tiredness2 Weakness2 Breathlessness Pallor App decrease	<2 while working

 

PHYSICAL GENERAL:

APPEARANCE: lean, thin, fair complexion.

PERSPIRATION: ++ On face and back, no odour, stain yellow – washable

THIRST: 3 litres/day for cold water

CRAVINGS: sour3, pickles3, spicy2

AVERSION: vegetables2, brinjal2, spinach2

STOOL & URINE: N

MENSES: Irregular, D: 1-2 day, profuse: 2 pads/day, clots++, no odour, dark red, menarche 14 yrs, LMP: 27.3.15

LEUCORRHOEA: Since 3 yrs, continues, white curd like, offensive2, no staining

SLEEP: normal

DREAMS: ghosts2

BUS<2 nausea, swing<2 nausea

THERMAL:

	WINTER	SUMMER	MONSOON
FAN	—	Full	Slow
COVER	Blanket	Chadar	Blanket
BATH	Hot	Cold	Warm

 

FAMILY HISTORY: Paternal Grandfather: asthma, Paternal Grandmother: epilepsy, FATHER: hypertension

LIFE SPACE:

The patient belongs to the Muslim community. Her family consists of parents and 2 siblings. Her father is a barber by profession. Mother is a housewife. Both siblings are in school. The family belongs to the lower middle class. The patient’s parents are calm natured. She is attached to both parents equally. The patient is very close to both siblings, but fights with her sister occasionally over toys.

In school, she has good relations with her friends. She shares all her things with everybody. The patient does not have great interest in studies or extracurricular activities at school. She feels shy to be a part of the activities.

MOTHER’S INTERVIEW: According to mother, patient is very irritable by nature. She throws tantrums over small matters. She also cries over very silly matters and her mother must pacify her, after which she settles. Pt has an ambivalent relationship with her sister. She fights with her and cannot stay without her either. The patient prefers to stay alone.

PHYSICAL EXAMINATION:

Weight: 29 kg, Temp: 98.2 °F, Pulse: 88/min, Tongue: pale/ moist, Conjunctiva: pale

RS: NAD, CVS: NAD

MSS:

	Swelling	Warmth	Tenderness	ROM
Rt/Lt Knee	++/++	++/++	+/+	Painful
Rt/Lt wrist	++/++	++/++	+/+	Painful
Metacarpal	—	—	+ in all MCP	—
Metatarsal	—	—	—	—

ROM: range of motion

INVESTIGATION:

3.6.2004

WBC: 11000, N: 44, L: 52, E: 4, M: 0, B: 0, ESR: 35, CRP: Reactive (1:8) 48 mg/dl, RA: 25, Anti CCP: 2

20.8.14

Hb: 7.9, WBC: 10600, N: 57, L: 31, E: 3, B: 0, M:9, ESR: 103, RA: 159, CRP: 146

Clinical Diagnosis: Juvenile rheumatoid arthritis (considering the age of onset and multiple joint involvement with pain, swelling, and morning stiffness; moreover, the RA test was strongly positive)

Miasm: Sycosis

Reasons:

• Chronic inflammation & thickening of the synovial membrane
• Gradual onset and progression of disease
• No deformity has developed
• Stage of disease is structural reversible
• Prognosis is good

Approach: Boenninghausen’s approach (characteristic general modality & physical general)

Totality:

R.S.	P.D.F.
<2 Sour	Irritable – throw tantrums
<2 Night	Reserved
<2 Riding in carriage	Dream of ghosts
<2 Leucorrhoea – curd like	THERMAL: CHILLY
Craving sour3
Craving pickle2
Craving spicy 2
Perspiration staining yellow

 

REPERTORIZATION TABLE

RS

PDF

 

REMEDY: SEPIA

Potency: 30 Infrequent

Susceptibility – Low to moderate (Age: 15 yrs, Pathology: structural irreversible)

Sensitivity – Moderate (mind2, nerves2)

 

CRITERIA:

1. Weakness
2. Tiredness
3. Breathlessness
4. Pain in knee rt/lt
5. Pain in wrist rt/lt
6. Pain in MCP
7. Pain in MTP
8. Knee swelling
9. Wrist swelling
10. Stiffness in joints
11. Leucorrhoea
12. Allopathic medicine

DATE

1

2

3

4

5

6

7

8

9

10

ACTION

28.3.15

S.L./ 1 week

4.4.15

s

s

–

Pain increase since 3-4 days in knee and wrist. Painkillers given by Fa.

Sepia 30 3P HS S.L. TDS/2 weeks

20.4.15

>2

>2

>3

>2

>2

>

>

>

>

>2

Sepia 30 3P HS S.L. TDS/2 weeks

S

NO

2.5.15

>3

>3

>3

>2

>3

>2

>2

>2

>2

>3

Sepia 30 3P HS S.L. TDS/4 weeks

>

NO

30.5.15

>3

>3

>3

>3

>3

>3

>3

>3

>3

+

WT: 30 KG

Sepia 30 3P HS S.L. TDS/4 weeks

>2

—

8.7.15

No complain

Sepia 30 3P HS S.L. TDS/4 weeks

8.8.15

NO complaints. ADV: Rheumatic profile

Sepia 30 3P HS S.L. TDS/2 weeks

14.8.15

No complaints. 8.8.15 Hb: 8.4, WBC: 6300, CRP: 20.8, RA: <10, ESR: 132

Sepia 30 3P HS S.L. TDS/4 weeks

12.9.15

No complaints. Wt: 32 kg

Sepia 30 3P HS S.L. TDS/4 weeks

10.10.15

No complaints

Sepia 30 3P HS S.L. TDS/4 weeks

31.10.15

Wt: 34 kg. ADV: CBC, ESR. Hb: 10.8, WBC: 6900, RBC: 5.58, ESR: 20

Sepia 30 3P HS S.L. TDS/4 weeks

28.11.15

No complaints. Wt: 35 KG

Sepia 30 3P HS S.L. TDS/4 weeks

2.1.16

C/o pain in Rt abdo< during menses. LMP: 1.1.16

Sepia 30 3P HS S.L. TDS/4 weeks

11.2.16

No complaints

Sepia 30 3P HS S.L. TDS/4 weeks

 

NOTE: Patient was on regular treatment till 11.6.16. She was asymptomatic.

Conclusion

Looking to the clinical presentation and investigation, arriving at the clinical diagnosis was easy. The core issue in the case was its management. The case demanded Boenninghausen’s approach based on characteristic general modalities and physical general. The totality and its repertorization reflected Sepia as a constitutional remedy. Treatment was stared with Sepia 30C 3P HS considering low to moderate susceptibility. The registration of the remedy could be observed with the relief in the pain to begin with. In the span of 2 months, all complaints were almost 100% better. The case demanded administration of the same medicine in the same posology. Within 3 months, the RA test was negative but raised ESR persisted. Within 9 months, all investigations were normal with same constitutional force in the same posology.

 

Learning achieved from this case:

• Learning to appreciate characteristics and its reflection in selection of appropriate approach and thus selection of the similimum.
• Learning to analyse and interpret the susceptibility in a case of autoimmune rheumatic joint disorder in a paediatric patient and its importance in management of the case.

Demonstrating the impact of selecting the correct similimum that produced simple amelioration in a case, due to which the patient did not require intercurrent / miasmatic intervention.

 

CASE 2

Background of the Case:

After experiencing the quality of improvement in the above case, the father brought in his younger daughter, who was complaining of left gluteal pain with difficulty in walking. The patient was yet undiagnosed. She had been sent to an orthopaedic surgeon for the clinical assessment, who gave a probable diagnosis of proximal muscle weakness. He referred the patient to a paediatric orthopaedic surgeon, who diagnosed the patient as having infective arthritis and recommended hip aspiration. The patient’s father refused and came to us to for Homoeopathic treatment. This created pressure on me to succeed in treating this case. The case was defined; treatment was started with acute medicine, followed by the constitutional medicine.

 

PRELIMINARY DATA:

OPD Reg. No.: 34729             Date: 28/8/15             Religion: Muslim

Name- Miss. S             Age-12 yr/ female                  Education: 6^th std        Address – J.

 

CHIEF COMPLAINT:

Pain2 in left side gluteal region, radiating to the thigh since 15-20 days.

O: Gradual, F: Daily, D: Continuous, Pain increase gradually.

Pain<getting up++, < Jerk++, < Walking++, < Moving in bed++, > pressure++, > Warm application++

No h/o of any injury.

Tingling and numbness in left foot.

Difficulty in squatting.

Painkillers provide temporarily relief.

Observation: Patient came walking with a limping gait.

 

EXAMINATION:

P: 78/min        Temp: 98.4 f    Tongue: Pink, Clean   Weight: 26 kg

RS: NAD           CVS: NAD         Hip examination: Movement full & free, SLR: Rt. -90, Lt. – 60

  

Acute totality:

Pain <2 jerk

<2 Moving in bed

<2 Walking

>2 Pressure

>2 Warm

Location: Left gluteal region radiation to thigh

Action A: Bryonia 30C QDS/4 days

1.9.15:

Gluteal and thigh pain >, difficulty in walking >

Orthopaedic Surgeon opinion taken. He diagnosed proximal muscle weakness.

Referred the patient to a paediatric orthopaedic surgeon

Action B: Bryonia 200 TDS/10 days

The pain was mildly relieved. Therefore, it was thought to increase the potency and repeat frequently

 

3.9.15:

Paediatric orthopaedic opinion taken.

 

3.9.15: Investigations: Hb: 9.7, WBC: 8210, Platelets: 339000, ESR: 15, HLA b 27: Negative, CRP: 5.9, Anti CCP: <7

MRI: (3.9.15) Mild effusion seen in both hip joints with diffuse synovial thickening. Small focal erosion seen in posterior column of the acetabulum on the left side with adjacent subarticular narrow oedema. Inflammatory or early infective arthritis.

Advice given by paediatric orthopaedic surgeon- painkillers and antibiotics for 5 days. If not better, then go for aspiration.

Action – C: Bryonia 200C TDS & advised not to start allopathic

(The diagnosis was now clear: early juvenile idiopathic arthritis considering her age, inflammatory pathology in the joint and a strong family history of JRA. Hence, she was continued with the same medicine and a detailed case definition was done for selecting the chronic constitutional medicine.)

Date of Case of Definition: 12.9.15. History taken from Father

L	S	M	C
MSS Lt gluteal region     Lt thigh Since 15-20 days F: Daily D: Continuous Gradually increase	Pain2   Difficulty in squatting   No H/o injury   No Fever   ? T/N	<2 Getting up <2 Jerk <2 Walking <2 Morning <2 Moving in bed >2 warm application >2 Pressure

 

APPEARANCE: Lean, thin, fair complexion, medium built

 

PERSPIRATION: Moderate, on forehead, no odour, no stain

APPETITE: Good, THIRST: For cold water, small quantity for long interval

CRAVINGS: egg2, meat2, milk2, ice cream3, sweet3, pungent, sour2

AVERSION: bitter3, ladyfinger2

STOOL: Normal, F: Once/day, satisfactory, URINE: N

Mother’s OBS. HISTORY: FTND at home.

DEVELOPMENTAL LANDMARKS: Dentition/ sitting/ standing/ speech: On time. SLEEP: Position: either side Talking During sleep- Occ., Salivation: Occ.

DREAMS: ghosts2, daily routine.

BUS:< vomiting, headache, vertigo    FASTING:<Abdo pain2

THERMAL: C3H2

 

MEDICAL HISTORY: NIL

FAMILY HISTORY: Elder Sister: JRA, Paternal Grandfather: Hypertension, Paternal grandmother: Epilepsy, Mother: Allergic complaints.

 

LIFE SPACE:

The patient is a lean, thin, young, good looking girl with fair complexion. Her family consists of parents and 2 siblings. Her father is a barber and her siblings are studying. She is studying in the 6^th standard. She is good in studies and she has interest in other activities like drawing, dancing, and singing. According to her father, she has a good memory and can remember everything she has studied. She is also good at drawing. She always finishes her homework daily; if she forgets to do her homework, the teacher beats her, but she doesn’t react.

 

She has good relationships with her friends. She has 5-6 close friends. She is a fairly social person and has fun with all her friends. She often hits her friends during their mischief. She shares her things with friends, but complains to the teacher if someone takes her favourite things.

She is close to all her family members. She wishes to spend time with her elder brother, but cannot as he stays in a hostel. She often quarrels with her elder sister and then sulks for a few hours, but is easily placated. She is rather lazy and does the chores only if ordered to do so by her mother. She obeys her father; he did not approve of her dancing as a hobby, so she stopped. She cries sometimes if scolded. She is shy by nature. She feels shy when guests come to her house. She dreams of her daily routine, parents, friends, and sometimes ghosts.

 

UNDERSTANDING OF THE CASE

 Clinical diagnosis: Early juvenile idiopathic arthritis

Reasons: Age – 12 yrs, Involvement of the hip joint with infective pathology & family history

 

Miasm: Sycosis

Reason:

Chronic Inflammation with erosion, synovial thickening, and effusion

Silent gradual progressive pace

 CHRONIC TOTALITY:

• Anger <2 teasing
• Mixing easily
• ECA ++
• Dreams of ghosts
• Fasting<2 abdominal pain
• Bus< vomiting, headache, vertigo
• sweet3, eggs2, meat2, milk2, ice cream2, sour2
• Thirst: cold water

REPERTORIZATION

CONSTITUTIONAL REMEDY: Calc phos

CRITERIA:

1. Lt side gluteal pain
2. Thigh pain
3. Walking difficulty
4. Squatting difficulty
5. T/N

 

DATE	1	2	3	4	5	Interpretation	ACTION
12.9.15							Bryonia 200 tds/1 week
19.9.15	>2	>2	>	SQ	>2		Bryonia 200 tds/1 week
26.9.15	>3	>3	>	SQ	>3		Calc phos 30 3P HS/1 week
10.10.15	>3					H/o of viral hepatitis 10 days prior. Admitted to a hospital. Took allopathic Rx, which >3 the hepatitis. No other complaints	Calc phos 30 3P HS /2 week
31.10.15	>3	+	>2	>+	0		Calc phos 30 3P HS /3 weeks
28.11.15	0	0	>3	>3	0		Calc phos 30 3P HS /4 weeks
1.1.16	0	0	0	0	0		Calc phos 30 3P HS /4 weeks
12.2.16	0	0	0	0	0	C/o Mild weakness. App-N (A repeat MRI was recommended, but due to financial difficulties, it was not performed)	Calc phos 30 3P HS L/6 weeks
25.3.16	0	0	0	0	0		Calc phos 30 3P HS /4 weeks
7.5.16	0	0	0	0	0		Calc phos 30 3P HS /4 weeks
11.6.16	0	0	0	0	0		Calc phos 30 3P HS /4 weeks

 

Conclusion

Acute remedy Bryonia 30à 200 tds was prescribed followed by Constitutional remedy Calc Phos. Bryonia was needed for almost 6 weeks as response was available but squatting difficulty was not improving. After starting with the constitutional treatment, there was considerable relief in all her complaints.

Both the cases responded well with homoeopathy. The results helped the family develop faith in the young physician as well as faith in Homoeopathy.

 

Learning achieved from this case:

• Learning how to juvenile rheumatic complaints.
• Importance of integrating the opinion given by specialists and interpretation of the specific investigations to arrive at a diagnosis and in turn develop a clinical thinking
• Appreciating the characteristics in a case and creating various totalities – “acute & chronic” and how it helps in assessing susceptibility and in selecting the similimum.
• Learning to analyse the remedy response during follow-up and appreciating the State of Susceptibility of a silently progressive pathological condition and thus producing a CURE / RECOVERY.

TESTIMONIAL BY THE PATIENT’S FATHER REGARDING THE BENEFITS OF HOMOEOPATHIC TREATMENT (TRANSLATED FROM GUJARATI)

“When I came to know that my child had arthritis, I was in lots of stress. I was trying to find out solution. I immediately consulted the orthopaedic surgeon but I didn’t want to continue for long time. Then I heard about your Homoeopathic hospital. I started Homoeopathic medicine and in a short time, my child was better. After some days my second child also had the same complaint and I immediately started Homoeopathic treatment for her as well. Now my both children are much better. They are off the treatment right now. They don’t have any kind of problem now. I am indebted to you Homoeopathic doctors with your medicines. Thank You.”.