Clinical study of Agnikarma and Panchatikta Guggulu in the management of Sandhivata (osteoartheritis of knee joint)

BACKGROUND: Sandhivata is a disease described under Vatavyadhi and resembles osteoarthritis (OA) in respect to etiology, pathology, and clinical features. Knee joints are more prone to be affected by this disease because it is the most frequently involved joint in daily works. Acharya Sushruta has indicated Agnikarma, when severe pain occurs in Twak, Mamsa, Sira, Snayu, Sandhi, and Asthi due to Vata Prakopa. Panchatikta Guggulu is a formulation mentioned in Chakradatta and Bhaishajya Ratnavali in the context of Kushtha Roga where it is also indicated for Sandhigata Vata and Asthigata Vata. AIMS: The aim of this study is to evaluate the comparative effect of Agnikarma alone and Agnikarma along with Panchatikta Guggulu orally in Janugata Sandhivata (OA of knee joint). MATERIALS AND METHODS: Thirty-three patients of Janugata Sandhivata were registered and randomly divided into two groups. In Group A (n = 18), Agnikarma was done with Panchadhatu Shalaka once every week for one month while in Group B (n = 15), Agnikarma along with Panchatikta Guggulu orally was given for one month. Weekly assessment was done for relief in Sandhishula (pain), Sparshaasahyata (tenderness), Sandhisphutana (crepitus), Sandhigraha (stiffness) by subjective gradation, and range of movement (ROM) was recorded in research proforma. RESULTS: In Sandhishula, 86% relief was found in Group A whereas 77.78% relief was obtained in Group B. Sparshaasahyata was reduced by 69% in Group A while 87.78% in Group B. Nearly 39% improvement was seen in Sandhisphutana in Group A while 46.67% in Group B. In Sandhigraha, 63% relief was obtained in each of the groups. The patients got relief from the pain after first sitting of Agnikarma in both the groups. The relief was sustained for more than 3 months in most of the patients. There was no significant difference in radiological findings before and after treatment in both the groups. CONCLUSION: It was concluded that Agnikarma is effective in the management of pain in the Sandhivata. However, the addition of Panchatikta Guggulu in the treatment provides better efficacy on joint stiffness and crepitus. Further analysis showed that better relief in pain was observed in Group A while relief in tenderness, crepitus, and stiffness was found better in Group B.