Ayurvedic conservative management of Raynaud’s phenomenon associated with Rheumatoid Arthritis -A case report

Raynaud's phenomenon manifests as an intensified vasospastic response to emotional stress or exposure to cold, leading to a tri-color change in the peripheral regions of the body. The classic progression of colors includes white, which indicates ischemia resulting from vasospasms; blue, which reflects the deoxygenation of blood; and red, which occurs during reperfusion. Rheumatoid Arthritis is classified as an autoimmune and chronic inflammatory disorder, wherein the immune system mistakenly attacks healthy cells, resulting in inflammation. A range of causes and related diseases have been associated with the onset of Raynaud's phenomenon, with Rheumatoid Arthritis being a notable example. This case report details a 29-year-old female patient who presented to the outpatient department of the Government Ayurveda College Hospital in Thripunithura, Ernakulam, Kerala. She reported significant concerns, including a blackish discoloration on the distal extremities of her hands and feet, as well as joint pain affecting all limbs. Clinical examination revealed the presence of gangrene at the tips of her fingers and toes, an ulcer located at the lower end of her right foot, coldness in her extremities, swelling in the elbow and knee joints, edema in her hands and feet, and a loss of pinprick sensation on the bilateral plantar surfaces of her feet. Based on her clinical manifestations and investigative results, she was diagnosed with Raynaud’s phenomenon in conjunction with Rheumatoid Arthritis. Initial treatment focused on managing the Rheumatoid Arthritis, followed by symptomatic care for vasculitis. The therapeutic approach adhered to the protocols outlined in the Brihatrayees, specifically targeting vatarakta and nijavrana chikitsa. Internal sneha preparations utilized included Jeevanthaydi ghrita, Madhuparnyadi taila, and Ksheerabala, while external applications comprised Ksheerabala, Balaguduchyadi taila, and Pinda taila, supplemented by panchakarma therapies. The patient exhibited significant improvements, including pain relief and stabilization of gangrene progression; however, no reversal of symptoms was observed even after one year of treatment.