|Year : 2022 | Volume
| Issue : 1 | Page : 6-9
Amavatotsava: Celebrating the life despite limitations imposed by arthritis
Sanjeev Rastogi, Nidhi Singh, Preeti Pandey, Ankita Verma, Sumit Kumar, R Chinmayi
Arthritis Treatment and Advanced Research Centre, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India
|Date of Submission||25-Jan-2022|
|Date of Acceptance||07-Feb-2022|
|Date of Web Publication||20-Apr-2022|
Dr. Sanjeev Rastogi
Arthritis Treatment and Advanced Research Centre, State Ayurvedic College and Hospital, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rastogi S, Singh N, Pandey P, Verma A, Kumar S, Chinmayi R. Amavatotsava: Celebrating the life despite limitations imposed by arthritis. J Ayurveda Case Rep 2022;5:6-9
|How to cite this URL:|
Rastogi S, Singh N, Pandey P, Verma A, Kumar S, Chinmayi R. Amavatotsava: Celebrating the life despite limitations imposed by arthritis. J Ayurveda Case Rep [serial online] 2022 [cited 2023 Mar 29];5:6-9. Available from: http://www.ayucare.org/text.asp?2022/5/1/6/343502
Psychological impacts of arthritis are known and visible. These affect adversely the coping mechanism and negatively modulate the patient's ability to respond to the pathogenesis. Unfortunately, in the routine rheumatology practice which is largely drug based, this important aspect of joint care is ignored. We propose here a unique concept of Amavatotsava which means to celebrate the life despite limitations imposed by arthritis. This article gives a reasoning and an outline of how this will run on pilot basis at Arthritis Treatment and Advanced Research Center, Lucknow and how this will affect the people suffering from arthritis.
Joint pain and associated movement limitation are frustrating to all irrespective of their activity levels prior to the onset of joint disease. The discovery of a joint pathology naturally passes through conventional phases of denial, anger, bargaining, sadness, depression, and subsequent acceptance. This is more common in conditions having unknown etiologies and inadequate treatment opportunities. This is observed that discovery of a difficult to treat, high cost, and pervasive illness forces the people to seek alternative, unconventional, and often unproven care which sometimes adds to the prevailing miseries.
The psychological impacts of joint diseases are intensively studied and are well known. In conditions like osteoarthritis, rheumatoid arthritis, spondyloarthropathy, psoriatic arthritis, systemic lupus erythematosus, and various other autoimmune arthritic disorders having unclear etiopathogenesis and treatments options, such impacts are highly visible. Studies suggest that those suffering from joint diseases have a greater possibility to develop serious psychological disturbances, mood disorders, anxiety, and substance abuse disorder compared to the nonarthritic population., Sleep disturbances, low mood, and anxiety are found to affect pain perception, and those having such issues are found to perceive the higher intensity of pain. Mood disturbances are also found to affect the inflammatory process inherent to the pathogenesis of arthritis. This is observed that inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate are substantially higher in arthritis associated with mood disorders compared to those having no mental health issues.
In conditions like chronic fatigue syndrome and fibromyalgia, sleep disturbances and depression are commonly associated with constitutional and psychological features. Although a cause and effects relationship between such pain syndromes and psychological state has not been established, their mutually influencing nature is well studied and understood.
The psychological state in joint disease also indirectly affects the course of illness and expected outcomes. Those who suffer from mood disorders are found to have low esteem, reduced adherence to treatment protocol, especially exercises, reduced self-confidence, and reduced hope of getting better. This makes them less responsive to interventions. Pain catastrophization which is commonly observed in people suffering from joint diseases for a long time makes them less appreciative of all efforts of health-care providers and less appreciative of benefits obtained by the therapy.
Studies suggest that psychological interventions in disabling conditions such as rheumatoid arthritis and osteoarthritis add value to the standard care and improve the outcome and hence are worth including in the conventional practice of joint care. There is evidence that the effects of psychological interventions are mediated by improvements in self-efficacy and coping. Psychological interventions are found to improve mood status in such patients. The effects of psychological interventions on disease-specific outcomes however are modest and not sustained compared to the secondary outcomes which are sustained and significant.
Seeing the plausibility of benefits obtainable in joint diseases by selected psychological interventions, various programs and approaches have been experimented, suggested, and experienced as regular interventions in identifiable subpopulations of arthritis expected to be benefitted from this. Such interventions have already been in practice to improve coping in chronic illnesses and chronic pain management. Studies suggest that following a mindfulness therapy program helps patients with osteoarthritis and rheumatoid arthritis by decreasing their anxiety and stress levels. The European League against Rheumatism has recently put a great emphasis upon health professionals to adopt a patient-center framework within a biopsychosocial perspective to maximize the benefits of a constellation of interventions in osteoarthritis and inflammatory arthritis.
Despite the high plausibility of possible benefits of psychological interventions among people suffering from arthritis and its clear recommendation by global organizations and stakeholders in the field, this has not been commonly observed in routine rheumatology practice. Rheumatology has conventionally been visualized as a practice executed by a team of diverse experts including a physical therapist, nutritionist, and psychologist led by a rheumatologist. Such meticulousness and diligence however are not liberally seen in the rheumatology clinical practice where a greater impetus is given upon drug component of therapy.,
Satvavajaya (Ayurvedic psychotherapy) has been one among the three principal treatment approaches of Ayurveda namely, Yukti vyapashraya chikitsa (YC) (rational drug-based therapy), Daiva-vyapashraya chikitsa (divine and spiritual therapy), and Satvavajaya chikitsa psychotherapy (SC). Besides YC, SC has also been greatly utilized in the management of joint disorders in Ayurveda and is found to be a promising approach needing serious exploration. Satvavajaya literally stands for a structured approach to strengthen and elevate the Satva where Satva is equated with the inner strength of a person being reflected as his reaction time, tolerance to adversity, and resiliency. The people are classified on the basis of their Satva characteristics which can be grouped as Pravara (~higher), Madhya (~medium), and Avara (~lower) levels of Satva reflecting respective psychological features and characteristics. For a similar intensity noxious stimulus, Avara satva people are expected to respond more outrageously comparing to Pravara satva who may respond only subtly. This Satva classification of Ayurveda forms the basis of Laghu vyadhita (~subtly expressive) and Guru vyadhita (~highly expressive) variety of expressing similar diseases. In the context of rheumatology, we understand that some people express their pain more explicitly compared to others even if it arises from similar pathology. Naturally, Satva plays an important role in pain perception and responses to the treatment.,
Ayurveda proposes means and methods to elevate Satva which can naturally help to modulate pain perception and subsequently may modify the course of illness. Having the company of people with a positive attitude and getting reassurance about the capabilities by seeing their peers with similar disabilities and limitations performing are two important aspects of rebuilding self-esteem among arthritic people. Working on the principles of Satvavajaya (ahitebhyo arthebhyo manonigrahaata = countering and substituting the negative feelings with more positive ones), a shifting of focus from the negative impact of arthritis to positive aspects of other capabilities the person may have been expected to make a substantial change in self-image related to the capabilities and areas where the person can still find pleasure. Despite a great possibility of impacting upon the well-being of arthritic people, such practices have not been commonly employed either in conventional or traditional rheumatology.
Arthritis Treatment and Advanced Research Center (ATARC) at State Ayurvedic College and Hospital, Lucknow has recently hypothesized to bring this idea of self-esteem building of Satvavajaya chikitsa down at the community level for easing and allowing its practice for eventual benefits to arthritis patients. The execution plan composes of organizing a congregation of people of all walks suffering from arthritis, with various psychological levels and status in reference to their disease and allowing them to understand that there is much in their life to be explored beyond arthritis and associated debility. This is commonly seen that the suffering of arthritis gradually takes over the individual personality and transforms it into an arthritic personality characterized by low self-esteem, catastrophization, anxiety, depression, sleep disturbances, and social isolation. Such people fail to take interest in daily life activities and their thought process usually revolves around arthritis and associated pain and disability. Amavatotsava seems appropriate phrase for the activity as it stands for celebration despite having Amavata a disease akin to a constellation of inflammatory joint diseases as are known in modern rheumatology. The name seems meaningful as it aims to make people understand that there is much in life to celebrate and enjoy despite limitations imposed by arthritis. The objective of the activity is to involve the arthritis cohort in activities that had been of their interest before they developed joint-related features. Being in a cohort of similar people, and seeing others having similar limitations yet opening up is supposed to act as a big barrier breaker that would have prevented the people to look at the brighter sides of their inner self. Building self-confidence, regaining self-esteem, making a new network of real people with real problems, developing a collective feeling to handle the problems, and looking beyond arthritis are some of the expanded goals of this activity.
To ensure the community participation, a specific core message is prepared for its sharing with arthritis community and inviting them for participation in Amavatotsava [Box 1].
| Defeating Arthritis and Celebrating Life|| |
This activity is planned to be done on pilot basis in early 2022 based upon the existing COVID-19 scenario. A dedicated team of Ayurvedic and modern rheumatologists, research scholars, nursing professionals, and other paramedics is gearing to take-up the task in a perfect manner. After finding the worth of it, and after collecting the feedback from participants and facilitators, this is proposed to be carried out as a community-based regular activity of arthritis cohort at ATARC. This is hoped that this new initiative will bring new horizons in Ayurvedic management of arthritis and will give a new lease of relief, freshness, vitality, and vigor to the arthritis cohort.
|Table 1: List of activities proposed to be carried out during Amavatotsava|
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Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Oberoi S, Chaudhary N, Patnaik S, Singh A. Understanding health seeking behavior. J Family Med Prim Care 2016;5:463-4.
] [Full text]
Nazarinasab M, Motamedfar A, Moqadam AE. Investigating mental health in patients with osteoarthritis and its relationship with some clinical and demographic factors. Reumatologia 2017;55:183-8.
Straub LE, Cisternas MG. Psychological well-being among US adults with arthritis and the unmet need for mental health care. Open Access Rheumatol 2017;9:101-10.
Vallerand IA, Patten SB, Barnabe C. Depression and the risk of rheumatoid arthritis. Curr Opin Rheumatol 2019;31:279-84.
Ziarko M, Siemiątkowska K, Sieński M, Samborski W, Samborska J, Mojs E. Mental health and rheumatoid arthritis: Toward understanding the emotional status of people with chronic disease. Biomed Res Int 2019;2019:1473925.
Sturgeon JA, Finan PH, Zautra AJ. Affective disturbance in rheumatoid arthritis: Psychological and disease-related pathways. Nat Rev Rheumatol 2016;12:532-42.
Pejovic S, Natelson BH, Basta M, Fernandez-Mendoza J, Mahr F, Vgontzas AN. Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: A further test of the 'unitary' hypothesis. BMC Neurol 2015;15:53.
Lwin MN, Serhal L, Holroyd C, Edwards CJ. Rheumatoid arthritis: The impact of mental health on disease: A narrative review. Rheumatol Ther 2020;7:457-71.
Cohen EM, Edwards RR, Bingham CO 3rd
, Phillips K, Bolster MB, Moreland LW, et al
. Pain and catastrophizing in patients with rheumatoid arthritis: An observational cohort study. J Clin Rheumatol 2019;25:232-6.
Prothero L, Barley E, Galloway J, Georgopoulou S, Sturt J. The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews. Int J Nurs Stud 2018;82:20-9.
Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B. Psychological interventions for rheumatoid arthritis: A meta-analysis of randomized controlled trials. Arthritis Rheum 2002;47:291-302.
Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL, et al
. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77:797-807.
Glauser TA, Ruderman EM, Kummerle D, Kelly S. Current practice patterns and educational needs of rheumatologists who manage patients with rheumatoid arthritis. Rheumatol Ther 2014;1:31-44.
Misra DP, Ravindran V, Sharma A, Wakhlu A, Negi VS, Chaturvedi V, et al
. Rheumatology practice and training in India – A perspective from rheumatology consultants. Indian J Rheumatol 2020;15:92-9. [Full text]
Rastogi S, Singh RH. Therapeutic potential of Satvavajaya therapy in the management of Amavata. Bull Indian Inst Hist Med Hyderabad 1995;25:46-60.
Murthy AR, Singh RH. The concept of psychotherapy in ayurveda with special reference to Satvavajaya. Anc Sci Life 1987;6:255-61.
Amin H, Sharma R. Nootropic efficacy of Satvavajaya Chikitsa and Ayurvedic drug therapy: A comparative clinical exposition. Int J Yoga 2015;8:109-16.
] [Full text]
Rastogi S, Singh RH. Arthritis drug market: What is there on the name of Ayurveda? AAM 2020;9:2-4.
Rastogi S. Emanating the specialty clinical practices in Ayurveda: Preliminary observations from an arthritis clinic and its implications. J Ayurveda Integr Med 2021;12:52-7.