Arthralgia Health Dictionary

Arthritis refers to any condition of joints of the limbs or spine associated with in?ammatory or structural change. It is distinguished from ARTHRALGIA which simply implies joint pain with or without any in?ammatory or structural change. The two main categories of arthritis are osteoarthritis, in which the primary change is thought of as mechanical failure of articular cartilage; and rheumatoid arthritis, in which the primary problem is a chronic in?ammation of the synovial lining of joints, tendon sheaths and bursae. Other, less common forms of in?ammatory arthritis include psoriatic arthritis, Reiter’s syndrome, colitic arthritis and Behçet’s syndrome. Spondarthritis refers to an in?ammatory arthritis with involvement of the spine and is often associated with the HLA B27 tissue type. (See OSTEOARTHRITIS; RHEUMATOID ARTHRITIS; RHEUMATIC FEVER.)... arthritis

Hemidesmus indicus

Asclepiadaceae

San: Anantamulah, Sariba;

Hin: Anantamul, Magrabu;

Ben: Anantamul;

Mal: Nannari, Naruninti, Narunanti;

Tam: Nannari, Saribam;

Tel: Sugandipala;

Kan: Namadaballi

Importance: Indian Sarasaparilla or Country Sarasaparilla is a climbing slender plant with twining woody stems and a rust-coloured bark. The roots are useful in vitiated conditions of pitta, burning sensation, leucoderma, leprosy, skin diseases, pruritus, asthma, bronchitis, hyperdipsia, opthalmopathy, hemicrania, epileptic fits, dyspepsia, helminthiasis, diarrhoea, dysentery, haemorrhoids, strangury, leucorrhoea, syphilis, abcess, arthralgia, fever and general debility. The leaves are useful in vomiting, wounds and leucoderma. The stems are bitter, diaphoretic and laxative and are useful in inflammations, cerebropathy, hepatopathy, nephropathy, syphilis, metropathy, leucoderma, odontalgia, cough and asthma. The latex is good for conjunctivitis (Warrier et al, 1995). The important formulations using the drug are Saribadyasava, Pindataila, Vidaryadi lehya, Draksadi kasaya, Jatyadi ghrita, etc. (Sivarajan et al, 1994). The Hemidesmus root powdered and mixed with cow’s milk is given with much benefit in the case of strangury. In the form of syrup, it has demulcent and diuretic proportions. The root, roasted in plantain leaves, then beaten into a mass with cumin and sugar and mixed with ghee is a household remedy in genito-urinary diseases. The hot infusion of the root-bark with milk and sugar is a good alterative tonic especially for children in cases of chronic cough and diarrhoea (Nadkarni, 1998). It has been successfully used in the cure of venereal diseases where American Sarasaparilla (Aralia nudicaulis Linn.) has failed. Native doctors utilize it in nephritic complaints and for sore mouths of children (Grieve and Leyel, 1992).

Distribution: Hemidesmus is distributed throughout India, the Moluccas and Sri Lanka.

Botany: Hemidesmus indicus (Linn.) R. Br. syn. Periploca indica Linn. belongs to the family Asclepiadaceae. It is a perennial, slender, laticiferous, twining or prostrate, wiry shrub with woody rootstock and numerous slender, terete stems having thickened nodes. Leaves are simple, opposite, very variable from elliptic-oblong to linear-lanceolate, variegated with white above and silvery white and pubescent beneath. Flowers are greenish purple crowded in sub-sessile cymes in the opposite leaf-axils. Fruits are slender follicles, cylindrical, 10cm long, tapering to a point at the apex. Seeds are flattened, black, ovate-oblong and coma silvery white. The tuberous root is dark-brown, coma silvery white, tortuous with transversely cracked and longitudinally fissured bark. It has a strong central vasculature and a pleasant smell and taste (Warrier et al, 1995).

The Ayurvedic texts mention two varieties, viz. a krsna or black variety and a sveta or white variety (Aiyer, 1951) which together constitute the pair, Saribadvayam. The drug is known as Sariba. Svetasariba is H. indicus. Two plants, namely, Ichnocarpus fructescens (Apocynaceae) known as pal-valli in vernacular and Cryptolepis buchanani (Asclepidaceae) known as Katupalvalli (Rheeds, 1689) are equated with black variety or Krsnasariba (Chunekar, 1982; Sharma, 1983).

Agrotechnology: Hemidesmus is propagated through root cuttings. The root cuttings of length 3-5cm can be planted in polybags or in the field. They can be planted in flat beds or on ridges. Planting is done usually at a spacing of 50x20cm. Heavy application of organic manure is essential for good growth and root yield. Inorganic fertilizers are not usually applied. Frequent weeding and earthing up are required, as the plant is only slow growing. Provision of standards for twining will further improve the growth and yield of the plant.

Properties and activity: The twigs of the plant give a pregnane ester diglycoside named desinine. Roots give -sitosterol, 2-hydroxy-4-methoxy benzaldehyde, -amyrin, -amyrin and its acetate, hexatriacontane, lupeol octacosonate, lupeol and its acetate. Leaves, stem and root cultures give cholesterol, campesterol, -sitosterol and 16-dehydro-pregnenolone. Leaves and flowers also give flavonoid glycosides rutin, hyperoside and iso-quercitin (Husain et al,1992). “Hemidesmine”- a crystallizible principle is found in the volatile oil extracted from roots. Some suggest that it is only a stearoptene. It also contains some starch, saponin and in the suberous layer, tannic acid (Grieve and Leyel, 1992). The root is alterative, febrifuge, antileucorrhoeic, antisyphilitic, demulcent, diaphoretic, diuretic, tonic, galactogenic, antidote for scorpion-sting and snake-bite, antidiarrhoeal, blood purifier, antirheumatic and aperitive. Essential oil from root is anti-bacterial and the plant is antiviral (Husain et al, 1992).... indian sarasaparilla

A hypersensitivity reaction due to circulating antigen-antibody complexes (see ANTIGEN; ANTIBODIES), so-called because it was a not uncommon reaction to the administration of foreign SERUM which used to be given as a form of passive IMMUNITY before the days of antibiotics. By de?nition, it is a manifestation of sensitivity to serum – but the same clinical and pathological picture can occur 1–3 weeks after the administration of drugs such as PENICILLIN and STREPTOMYCIN. It is characterised by fever, ARTHRALGIA and LYMPHADENOPATHY and is usually self-limiting as it resolves when the supply of antigen is used up.... serum sickness

n. see arthralgia.... arthrodynia

nephritis associated with infected indwelling shunts. The infection is usually with staphylococci (S. epidermidis) and patients present with anorexia, malaise, arthralgia, and low-grade fever. Purpura, anaemia, and hepatosplenomegaly may be found and urine analysis shows heavy proteinuria, often with a *nephrotic syndrome and haematuria. Treatment usually involves removal of the infected shunt as well as antibiotics.... shunt nephritis

Ricinus communis

Euphorbiaceae

San: Erandah, Pancangulah;

Hin: Erandi, Erand;

Ben: Bherenda;

Mal: Avanakku;

Tam: Amanakku, Kootaimuttu, Amanakkam Ceti;

Kan: Haralu, Manda, Oudla;

Tel: Erandamu, Amudamu

Importance: Castor is a perennial evergreen shrub. The Sanskrit name erandah describes the property of the drug to dispel diseases. It is considered as a reputed remedy for all kinds of rheumatic affections. They are useful in gastropathy such as gulma, amadosa, constipation, inflammations, fever, ascitis, strangury, bronchitis, cough, leprosy, skin diseases, vitiated conditions of vata, colic, coxalgia and lumbago. The leaves are useful in burns, nyctalopia, strangury and for bathing and fermentation and vitiated conditions of vata, especially in rheumatoid arthritis, urodynia and arthralgia. Flowers are useful in urodynia and arthralgia and glandular tumours. Seeds are useful in dyspepsia and for preparing a poultice to treat arthralgia. The oil from seeds is a very effective purgative for all ailments caused by vata and kapha. It is also recommended for scrotocele, ascites, intermittent fever, gulma, colonitis, lumbago, coxalgia and coxitis (Warrier et al, 1996). Oil is also used for soap making. Fresh leaves are used by nursing mothers in the Canary Island as an external application to increase the flow of milk. Castor oil is an excellent solvent of pure alkaloids and as such solutions of atropine, cocaine, etc. is used in ophthalmic surgery. It is also dropped into the eye to remove the after-irritation caused by the removal of foreign bodies.

Distribution: It is a native of N. E. tropical Africa. It is found throughout India, cultivated and found wild upto 2400m.

Botany: Ricinus communis Linn. belongs to the family Euphorbiaceae. It is a monoecious evergreen shrub growing upto 4m. Leaves are alternate, palmatifid, 6-10 lobed, each 1- nerved with many lateral nerves and peltate. Lobes are lanceolate, thinly pubescent below, margin serrate and apex acuminate. Paniculate racemes are terminal with male flowers below, female ones above. Perianth is cupular, splitting into 3-5 lobes, laceolate, valvate, margin inrolled and acuminate. Filaments of stamen are connate and repeatedly branched with divergent anther cells. Sepals are 5, sub-equal, lanceolate, valvate and acute. Ovary is globose, echinate, 3-locular with 3 ovules and pendulous. Styles are 3, stout, papillose, stigmatiferous. Capsules are 3-lobed and prickly with oblong seeds having smooth testa and marbled, shiny and carunculate. R. bronze King and R. africanus are two good garden varieties which are known as Italian and East Indian Castors, respectively (Mathew, 1983, Grieve and Leyel, 1992).

Agrotechnology: Castor is cultivated both in the plains and the hills. As it has deep root system it is hardy and capable of resisting drought. It does not withstand waterlogging and frost. It requires hard dry climate for proper development of fruits and seeds. It requires a well- drained soil, preferably sandy loam or loamy sand. High soil fertility is of less importance as compared to the good physical condition of the soil. It cannot tolerate alkalinity. It is generally grown in red loamy soils, black soils and alluvial soils. The plant is seed propagated. The seed rate required is 5-12 kg/ha (pure crop) and 3 kg/ha (mixed crop). Seeds are to be sown on a hot bed early in March. When the plants come up individual plant is to be planted in a separate pot filled with light soil and plunged into a fresh hot bed. The young plants are to be kept in glass houses till early June where they are hardened and kept out. The suitable season of growing is kharif season. The crop is usually sown in April and planting is done in early July. The land is to be ploughed 2-3 times with the onset of rains and is repeated after rain. The spacing recommended is 60X90cm in case of pure crop but it is seldom cultivated pure. It is usually grown mixed with crops such as jowar, arhar, chilly, groundnut, cowpea, cotton, etc. 10-15t FYM/ha and 50kg N, 50kg P2O5 and 20kg K2O/ha will be sufficient. Addition of neem cake is beneficial as it increases oil content. There should be sufficient moisture in the field at the time of sowing. A month after planting, weeding and earthing up is to be done. The plant is attacked by hairy caterpillar, castor semi - looper, castor seed caterpillar, etc. which can be managed by integrated pest management measures. The leaf blight disease occurring in castor can be controlled by spraying with Bordeaux mixture 2-3 times at 15 days interval. Harvesting of ripe fruits can be done from the end of November till the end of February. The fruit branches are picked when they are still green to avoid splitting and scattering of the seeds. The pods are to be heaped up in the sun to dry. Then the seeds are to be beaten with stick and winnowed. Roots, leaves, flowers, seeds and oil constitute the economic parts. The average yield is 500-600kg/ha (Thakur, 1990).

Properties and activity: The beancoat yielded lupeol and 30-norlupan-3 -ol-20-one. Roots, stems and leaves contain several amino acids. Flowers gave apigenin, chlorogenin, rutin, coumarin and hyperoside. Castor oil is constituted by several fatty acids (Husain et al, 1992). Seed coat contained 1. 50-1. 62% lipids and higher amounts of phosphatides and non-saponifiable matter than seed kernel. Fresh leaves protected against liver injury induced by carbon tetra chloride in rats while cold aqueous extract provided partial protection (Rastogi et al, 1991). Root and stem is antiprotozoal and anticancerous. Root, stem and seed are diuretic. The roots are sweet, acrid, astringent, thermogenic, carminative, purgative, galactagogue, sudorific, expectorant and depurative. Leaves are diuretic, anthelmintic and galactagogue. Seeds are acrid, thermogenic, digestive, cathartic and aphrodisiac. Oil is bitter, acrid, sweet, antipyretic, thermogenic and viscous (Warrier et al, 1996). Castor oil forms a clean, light- coloured soap, which dries and hardens well and is free from smell. The oil varies much in activity. The East Indian is the more active, but the Italian has the least taste. Castor oil is an excellent solvent of pure alkaloids. The oil furnishes sebacic acid and caprylic acid. It is the most valuable laxative in medicines. It acts in about 5 hours, affecting the entire length of the bowel, but not increasing the flow of bile, except in very large doses. The mode of its action is unknown. The oil will purge when rubbed into the skin (Grieve and Leyel, 1992).... castor

Linn.

Family: Solanaceae.

Habitat: Native to tropical America; cultivated mainly in Andhra Pradesh, Maharashtra, Karnataka, Uttar Pradesh, West Bengal.

English: Tobacco.

Ayurvedic: Taamraparna, Dhuu- mrapatraa.

Unani: Tambaakhu.

Action: Leaves—decoction is locally applied for muscle relaxation in dislocation, strangulated hernia and orchitis. Also for arthralgia, lumbago, rheumatism and gout (an ointment is made by simmering the leaves in lard). Not used internally as a medicine.

The plant contains nicotine as the major alkaloid.

Toxic influence of cigarette and bidi smoking on carboxyhaemoglobin levels of the blood of regular smokers was compared and no significant difference was observed in both of them. A py- rolysed tobacco product, used in India as a dentifrice, when administered to rats, showed activity comparable to benzo(a)pyrene, a potent carcinogen.

Habitual consumption of betel quid containing tobacco shows a strong cy- totoxic potential.

Nicotiana rustica Linn. is known as Kalakatiyaa or Vfilaayati tobacco. Its nicotine content is high and is not suitable for cigarettes, cigars or bidis. Different variants of this tobacco are used for hookah, chewing and snuff.... nicotiana tabacum

An acute febrile illness, usually seen in children, which may include ARTHRALGIA, ARTHRITIS, CHOREA, carditis (see below) and rash (see ERUPTION). The illness has been shown to follow a beta-haemolytic streptococcal infection (see STREPTOCOCCUS).

Rheumatic fever is now extremely uncommon in developed countries, but remains common in developing areas. Diagnosis is based on the presence of two or more major manifestations – endocarditis (see under HEART, DISEASES OF), POLYARTHRITIS, chorea, ERYTHEMA marginatum, subcutaneous nodules – or one major and two or more minor ones – fever, arthralgia, previous attacks, raised ESR, raised white blood cell count, and ELECTROCARDIOGRAM (ECG) changes. Evidence of previous infection with streptococcus is also a criterion.

Clinical features Fever is high, with attacks of shivering or rigor. Joint pain and swelling (arthralgia) may affect the knee, ankle, wrist or shoulder and may migrate from one joint to another. TACHYCARDIA may indicate cardiac involvement. Subcutaneous nodules may occur, particularly over the back of the wrist or over the elbow or knee. Erythema marginatum is a red rash, looking like the outline of a map, characteristic of the condition.

Cardiac involvement includes PERICARDITIS, ENDOCARDITIS, and MYOCARDITIS. The main long-term complication is damage to the mitral and aortic valves (see HEART).

The chief neurological problem is chorea (St Vitus’s dance) which may develop after the acute symptoms have subsided.

Chronic rheumatic heart disease occurs subsequently in at least half of those who have had rheumatic fever with carditis. The heart valve usually involved is the mitral; less commonly the aortic, tricuspid and pulmonary. The lesions may take 10–20 years to develop in developed countries but sooner elsewhere. The heart valves progressively ?brose and ?brosis may also develop in the myocardium and pericardium. The outcome is either mitral stenosis or mitral regurgitation and the subsequent malfunction of this or other heart valves affected is chronic failure in the functioning of the heart. (see HEART, DISEASES OF).

Treatment Eradication of streptococcal infection is essential. Other features are treated symptomatically. PARACETAMOL may be preferred to ASPIRIN as an antipyretic in young children. One of the NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may bene?t the joint symptoms. CORTICOSTEROIDS may be indicated for more serious complications.

Patients who have developed cardiac-valve abnormalities require antibiotic prophylaxis during dental treatment and other procedures where bacteria may enter the bloodstream. Secondary cardiac problems may occur several decades later and require replacement of affected heart valves.... rheumatic fever

n. inflammation of the liver caused by viruses, toxic substances (including alcohol), autoimmune disease, metabolic disease, or the excess deposition of fat (see nonalcoholic fatty liver disease). Infectious hepatitis is caused by viruses, several types of which have been isolated. These include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Other viral causes of hepatitis include *Epstein-Barr virus, *cytomegalovirus, and rarely *herpes simplex virus. Hepatitis A is transmitted by food or drink contaminated by a carrier or patient and commonly occurs where sanitation is poor. After an incubation period of 15–40 days, the patient develops fatigue, anorexia, nausea, vomiting, arthralgia, and fever. Yellow discoloration of the skin (see jaundice) appears about a week later and persists for up to three weeks. The patient may be infectious throughout this period. Serious complications are unusual and an attack often confers immunity. Injection of *gammaglobulin provides temporary protection, but active immunization is preferable.

Hepatitis B (formerly known as serum hepatitis) is transmitted by infected blood or blood products contaminating hypodermic needles, blood transfusions, or tattooing needles, by unprotected sexual contact, or (rarely) by contact with any other body fluid. It often occurs in drug users. Symptoms, which develop suddenly after an incubation period of 1–6 months, include headache, fever, chills, general weakness, and jaundice. Treatment includes *interferon alfa and other oral antivirals (e.g. *lamivudine, *adefovir dipivoxil, entecavir). Most patients make a gradual recovery but the mortality rate is 5–20%. A vaccine is available.

Hepatitis C (formerly known as non-A, non-B hepatitis) has a mode of transmission similar to that of hepatitis B (predominantly intravenous drug abuse). Treatment is with interferon alfa, peginterferon alfa, ribavirin, telaprevir, and boceprevir.

Hepatitis D is a defective virus that can only proliferate when there is infection with hepatitis B. Patients with D virus usually have severe chronic hepatitis.

Hepatitis E is transmitted by infected food or drink and can cause acute hepatitis; it is especially severe in a pregnant patient.

Chronic hepatitis continues for months or years, eventually leading to *cirrhosis and possibly to malignancy (see hepatoma). It is usually caused by chronic viral hepatitis, alcohol, or autoimmune disease.... hepatitis