Keelvayu is a disease caused due to derangement of Vatham or Vali humour mainly. The disease is usually associated with complaints like difficulty in flexion and extension of the joints, pain, swelling, accompanying other symptoms like fever, indigestion, megham (gonorrhoea) etc along with it. There are mainly ten types of Keelvayu. Of them, one of the commonest type is Vali Azhal Keelvayu, which can be compared to Rheumatoid Arthritis as per Modern Medicine.
According to Siddha, Vali Azhal Keelvayu is caused due to derangement of Vali and Azhal humour. This results due to improper dietery habits like increased consumption of Red Meat, Eggs, Fishes, Alcohol and Sedentery life style etc. Initially indigestion symptoms are seen like frequent constipation, obesity, abdominal discomfort etc. Then the joints of wrist, ankle, shoulders and fingers are involved with pain, redness and stiffness. The patient complaints of morning stiffness for more than one hour. This is a multi-system involving disease more common in females than in males. Genetic and Environmental factors are precipitating ones.
The cause of onset of the disease may be traumatic, viral, over exposure to hot and cold weather, psychic factors etc. Mostly females above 40 years of age are affected.
Hence, this disease can be defined as Chronic, Severe, Symmetrical, Ankylosing (stiffness) type of polyarthritis affecting the connective tissues of smaller joints initially and later major joints with more pronounced morning stiffness.
Clinical Features / Manifestations
Onset of this disease is mostly insidous or slow. But acute or systemic onset may also be present. The disease starts with assymmetrical presentation and later becomes symmetrical. Articular manifestions like pain, joint swelling, erythema, tenderness, joint deformity, fibrin deposit etc are present.
Non articular involvement includes vasculitis, tendinitis, myositis, kerato conjuctivitis, peripheral neuritis, cervical compression, bursitis, ulcerations, gangrene, scleritis, episcleritis, pleural effusion, fibrosing alveolitis, pericarditis, myocarditis, endocarditis, aortic regurgitation, aortitis, anaemia, esinophilia etc.
Signs and Symptoms
Excessive sweating in palm and sole, low grade fever, loss of weight, increased ESR, RA factor positive, anaemia, mild leucocytosis, esinophilia, prolonged morning stiffness, rheumatoid nodules, deformities of hands (chronic case), symmetrical involvement of small joints of hands and feet, Non articular manifestation, X ray of joints showing narrowing joint space and deformity and X ray of chest showing fibrosing alveolitis, pleural effusion are seen.
Swan neck deformity : Flexion of distal interphalangeal joint and hyperextension of proximal interphalangeal joint.
Button hole deformity : Flexion of PIP and hyperextension of DIP
Z Deformity of thumb and ulnar deviation of fingers.
Subcutanious nodules in Extensor aspects of limbs.
Attrition of Extensor tendon at wrist causing dropped fingers.
The drug of choice must be Anti-inflammatory or Anti-vatha as well as Analgesic or pain releiver. Initially purgation should be administered with any one of these, Agasthiyar kuzhambu, Kodasuri tablet, Sanjeevi tablet, Maantha ennai, so as to bring the Vatham to normal. Then internal medicines are administered.
Serankottai preparations like Rasa Gendhi Mezhugu, Serankottai nei, Idivallathi mezhugu etc
Nilavembu kudineer (It is advised to take Serankottai Preparation and Nilavembu kudineer for 1 year)
Arumuga Chendooram etc
External Applications like Oil Application with Bandaging. No Ottradam or formentation (Kizhi) should be done. Vedhu can be done.
Oils like Ulunthu thailam, Agasthiyar thylam, Vatha kesari thylam, Kukkil vennai etc can be applied and bandaged.
Treatment through Modern Medicine and its limitations
Usually a Rheumatologist prescribes medicines under NSAID’s to control inflammation and morning stiffness. Along with this, analgesics like Paracetamol in the dose of 500mg is administered. The main aim is to retard the progression of the disease, control the joint inflammation, pain, morning stiffness and prevent joint deformity. During severe arthritis and systemic manifestation, NSAID is not effective so Corticosteroids are administered. Another groups of drugs are Disease modifying antirheumatic drugs or DMARD’s including gold, antimalarials, D-penicillamine etc. During certain stages Surgery followed by Physiotherapy is undergone.
Side effects :
NSAID produces adverse effects in GIT (Peptic ulcer, Small bowel ulceration/perforation, Colitis, Stomatitis, Oesophagitis),
Renal (Acute renal failure, Interstitial nephritis, Hyponatraemia, Hyperkalaemia, Transient rise in serum creatinine)
Cardiovascular (Interference with actions of anti-hypertensive and anti-cardiac failure drugs)
Hepatic (Cholestasis, hepatic failure)
CNS (Headache, Tinnitus, Insomnia, Abnormal behaviour)
Skin (Rashes, Erythema), Haematological (Bone marrow suppression, Anaemia secondary to GI blood loss, Thrombocytopenia.
The adverse effects of DMART includes Renalfailure, Bone marrow suppression, Stomatitis etc.
The symptoms may subside with adminteration of medicines but it may
reoccur with more severity as the disease becomes chronic finally leading to permanent debility.
Siddha System of medicine stresses on the correct selection of medicines according to the age, disease progression, symptoms, mental state of the patient etc. If diagnosed in the earliest stage, Siddha treatment is cent percent successful. Anxious and depressed patients should be well counseled. After the administration of Siddha drugs when the pain and inflammation subsides, patient should be encouraged to do mild exercises and yoga with breathing exercises. A regulation in diet should be made right from the beginning of the treatment throughout the life of the patient. Cold food items, tapioca, sour food items like tamarind, excessive use of salt, curd, excess of non- vegetarian diet, smoking, tobacco, alcohol, fermented rice or gruel, non vegetarian diet especially red meat etc should be strictly avoided. Prayers and Meditation should be a part of life always.