Mr. U is a retired senior executive in his sixties. Around three months ago, the active gentleman came down with a fever and excruciating body pain that subsided in a few days. A month later, he suffered severe pain in the knee and ankles. He tried a gamut of treatment options — physiotherapy, yoga and herbal concoctions in that order — and felt some relief after eight weeks. Soon after, he began to experience pain in the shoulder.
Maheshwari, in her forties, works as a domestic help. An attack of chikunguniya about three years ago has left her with a persistent knee problem. From quack doctors promising miraculous cures to erratic physiotherapy and massages, she has given it all a shot but finds no relief. The fact that she is overweight and her knees were already wearing out has only aggravated her condition.
The pain, says Dr Jayateerth Kulkarni, Arthroscopy and Joint Replacement Surgeon, Fortis Hospital, Bangalore, is the result of the counter-attack by the body’s immune system to an infection. “The immune system is activated when exposed to certain antigens (unique proteins or other distinct molecules) present in the infecting virus/bacterium. The body’s own antigens do not usually activate the immune system but some viruses have antigens that resemble that of the body. The immune response to such a virus will be to attack the body’s cells. This phenomenon — known as cross-reactivity — results in inflammation of tissues and damage to the cells. When this occurs in muscles and joints, it causes muscle pain and inflammatory arthritis. Only a few viruses have cross-reacting antigens and only these will cause post-viral arthritis. The classic example is the Chikungunya virus.”
Dr. Pon Singh, Secretary, Indian Medical Practitioners Cooperative Pharmacy & Stores (IMCOPS), adds, “According to the Siddha system, some fevers are caused by krimis , (micro-organisms such as virus and bacteria). Whenever a krimi enters the human body, it invades the saptha dhatus (seven vital tissues) that constitute the human body. Viruses that cause Chikungunya, dengue, or flu reside at the major joints such as elbow, wrist, knee and ankle. They produce toxins and affect the immune mechanism, leading to muscular and joint pains accompanied by fever. The cartilages also get affected and cause joint inflammation, which presents as pronounced pain. Typically this occurs a few weeks after the viral infection. By the time arthritis develops, the virus is no longer present in the body. “
So how does one treat a problem like this? Dr. V. Ramasubramanian — Consultant, Infectious Diseases, Apollo Hospitals & Adjunct Professor of Infectious Diseases, Sri Ramachandra Medical College, Chennai and Director, Immune Boosters Adult Vaccination & Travel Clinic — says, “Treatment is purely supportive and symptomatic with pain killers as there are no specific anti-viral medicines for these viruses.” About other options like Physiotherapy, herbal concoctions and Yoga, he says, “All these therapies give a feeling of well being but may also have unknown benefits. As an allopath I am not qualified to discuss their benefits. But any kind of graded exercise, physiotherapy or movement in general will help strengthen the muscle and support the joint.” Dr. Kulkarni adds that anti-inflammatory drugs, splinting, ice packs, physiotherapy, and Ayurvedic massage will also help.
Dr. Singh feels that curative and even preventive treatments are available in the Siddha system. “Several concoctions are actually administered in Government allopathic hospitals during mass attacks. Pranayama boosts the immune system but yogic postures and physiotherapy are contraindicated as the pain may be aggravated. Patients should drink plenty of water and liquids such as fruit juices, gruel or porridge, which are easily digested. The recovery also depends on the type of virus and the quantum of viral load entering the blood stream. The cure is not complete with the death of the virus because the immune system is affected severely.”
How long does it take for complete release from pain? Dr. Ramasubramanian observes that viral arthritis generally lasts only for a few days post-infection. “Post-Chikungunya, it can last up to three months, in some cases over a year. Studies have shown that in 12 per cent of chikungunya patients, the pain can last for over three years but will settle eventually. No viral arthritis by itself lasts indefinitely. Since there is no specific anti-viral medication, early treatment is only supportive and not beneficial. In general, the healthier the body, lower the debility. Healthy food, good exercise and avoiding obesity is the way forward. Once the infection resolves, graded mobility would help”
“Control of mosquitoes and general hygienic precautions are the mainstay of prevention,” concludes Dr. Kulkarni
