Dr Natarajan

for the use only of a registered medical practitioner or a hospital or a laboratory

for the use only of a registered medical practitioner or a hospital or a laboratory.

EFFICACY OF R. COMPOUND

IN DEGENERATIVE ARTHRITIS

IN GERIATRIC PATIENTS

Dr. NATARAJAN V.S., M.D. FRCP (Edin) Prof. & Head of Dept.

Dr. KRISHNASWAMY B., MD, Assistant Professor,

Dr. SHANTHI RAVINDRAN., MD, Assistant Professor,

Dr. MUTHUKRISHNAN, MBBS, Research Medical Officer.

Department of Geriatric Medicine, Govt. General Hospital, Madras.

 

 

A Clinical trial was conducted to evalute the efficacy and safety of R. Compound in elderly patients with degenerative arthritis, at Geriatric department, Govt. General Hospital, Madras. Hundred patients above the age of 60 years, belonging to both sexes with osteoarthritis were given R. Compound for 3 months. Clinical and functional improvement were assessed every 15 days and at the end of the trial. The result showed, good response in 48 cases (51.06%), satisfactory response in 32 cases (34.04%) and poor response in 14 cases (15.04 %), There was no significant adverse effect observed during the trial.

Key words : Osteo arthritis - R. Compound.

 

The Antiseptic, Vol. 92 No. 8, PP 306-07, Aug. 95.

 

 

INTRODUCTION

Arthritis is a common and often chronic condition among the aged.' A major consequence of this is the limitation of activities of daily living, leading to loss of indepedence. Osteoarthritis(OA) is the most common from the chronic arthritis among older persons.2 Its incidence and prevalence increase with age, occurring in 20 % and 40 % of males and females older than 60 respectively.

Elderly population forms about 8 % of total population in India. Osteoarthritis of various Joints, attended with pain and restricted mobility, forms major morbidity in these elders.' Since long term medication are required for OA, drug side effects and interactions are the important determinants of drug selection.5

Pre-existing peptic ulcer, renal and hepatic dysfunction, obstructive pulmonary disease, may all be aggravated by the commonly used NSAID. R. Compound, an Ayurvedic preparation, has been found useful in young patients with various types of arthritis 6,7,8 but these trials have not included elderly patients. Hence a trial is attempted to use R. Compound in the elderly patients with various degenerative joint diseases, to assess the efficacy and safety.

 

OBJECTIVE

To assess the efficacy and safety of R. Compound in elderly patients with degenerative arthritis.

 

MATERIALS AND METHODS

Patients above the age of 60 years of both sexes attending Geriatric OR Government General Hospital, Madras with degenerative joint diseases were chosen, Patients with pre-existing renal disease, peptic ulcer, and any other major illness, are excluded from the trial. A thorough general examination and detailed examination of the specific joint involved were done in all patients. Patients subjective symptoms like pain and stiffness were noted. Swelling and restriction of joint movements were assessed at the beginning of the trial and once in every two weeks. R. Compound was administered in the dose of 2 tablets three times a day for 2 weeks, followed by 2 tablets twice daily for 4 weeks. Maintenance dose of 1 tablets three times a day was given for 6 weeks. Specific side effects like gastric disturbance and renal dysfunction were assessed periodically. Com­plete haemogram, blood sugar, urea, creatinine, x ray of the involved joint were done in all patients at the beginning and on completion of the trial.

 

OBSERVATION & RESULTS

The following table gives the age group, sex of the patients and various joint involvements.

Age groups - Males and Females

Age group

Male

Female Total

60-69

29

39 68

70-79

17

11 28

80-90

3

1 4

 

Types of joint invlovement

 

Involved joints

Male

 

Female

Total

Knees

33

36

69

Shoulder

8

7

15

Cervical spine

6

4

10

Lumbo sacral spine

6

11

17

 

The age range was between 60-84, the mean age being 66.64, osteoarthritis of knee joint was seen in 69 patients. peri-arthritis of shoulder in 15 cases, cervical spondylosis in 10 cases and Lumbosacral spondylosis in17 cases, were present. More than one joint involvement was seen in 11 patients.

Out of 100 cases who entered the trial, 94 patients completed the 3 months trial. Two patients were withdrawn from the trial because of persistent G.I. disturbances and there were 4 dropouts from patients side (cause not known). Out of 94 cases, who have com­pleted the trial, 48 cases (51.06%) showed good response in terms of pain relief, reduction in joint swelling and improvement of joint movement

 

Satisfactory response was found in 32 cases (34.04%). In these Patients there was slight restriction of joint movement and swelling.Poor response was observed in 14 cases (15.04%).

 

Transient gastric disturbances in the form of pain and abdominal discomfort was observed in 12 cases (12.76%). These patients improved with antacids and completed the trial.

 

Renal functions were normal in all cases at the end of trial.

 

The following table gives improvement in various signs and symptoms

Results of R. Compound treatment

Sign/symptom

Total cases

Good

Fair

Total

satisfactory

relief

%

Poor

1. Pain

94

48

32

80

85.1

14

2. Stifness

74

32

24

56

75.67

18

3. Swelling

68

24

16

40

58.82

28

4. Range of movement

72

22

38

60

83.33

12

 

DISCUSSION

In a management of OA, decision should consider age related changes that may affect drug absorption, distribution, metabolism and elimination. The treatment modality may potentially be more hazardous. NSAIDS are the most frequently prescribed medication which can produce gastric ulceration, an important problem, leading to perforation and bleeding.9 Long term treatment may lead to nephrotoxicity. '° NSAID related psychotic reactions are more common, in elderly. Hence various alternative forms of therapy have been tried in elderly patients. Physical therapy is usually tried as first line, in elderly patients. Alternatively ayurvedic medicines can be tried in elderly patients.

 

Gum Guggul has since long been used in ayurvedic system of medicine and preparations like Yograj Guggul and Mahayograj Guggul are in common use for muscular rheumatism. R. Compound containing the essential Mahayograj Guggul, Maharasandi quath and gold, possesses anti rheumatic and anti inflammatory actions. Various clinical trials have shown the usefulness of R. Compound in chronic arthritis.' 1,12 Hence this trial was conducted in elderly patients with degenerative arthritis and R. Compound was found to be useful. Side effects like G.I. distrubances were found less common and transient in nature.

Hence R. Compound can been considered as alternative form of medicine in elderly patients with arthritis.

 

CONCLUSION

 

R. Compound has been found to be effective and safe in elderly patients with degenerative joint disease. There was no significant side effects observed during the trial

 

ACKNOWLEDGEMENT

 

Thanks are due to the Director of Medical Education, Goverment of Tamilnadu and Dean, Madras Medical College, Madras for permitting us to carry out this trial. Our heart felt thanks to M/s. Alarsin

Pharmaceuticals, Bombay for the financial assistance offered to conduct this trial.

 

REFERENCES

1. Calkins E., Arthritis in elderly. Bull Rheum Dis. 40: 15, 1991.

2. Calkins E., Arthritis in elderly. Bull Rheum Dis. 40: 15, 1991.

3. Lawrence R.C., Hochberg, M.D., et al, Estimates of Prevalence of selected arthritic and musculoskeletal diseases in United States. Rheumatol J. 16: 47, 1989

4. Natarajan VS., et al., Nutrition in Health and Disease in Elderly Project Report Geriatric Unit GH 1991

5. Gideon Nesheve, M.D., et al Clinical presentation and Treatment of arthritis in the Aged. The age in skeleton clinics in Geriatric Medicine Nov. 1972.

6. Ramachandra K., R. Compound in Rheu­matic arthritis Mediscope 15: 2538, 1972.

7. Ethirajulu G., Reddy J.V, R. Compound in Rheumatoid arthritis and other chronic arthritis and Osteo arthritis. Paper presented at V conference of Tamilnadu Orthopaedic Association, Madras 1973.

8. Faulkhen G., et al, Asprin & bleeding peptic ulcer in elderly B.M.J. 297-1311 : 1988

9. Blacksherji, et al, Renal complication of NSAID, identification and Monitoring of those at risk, semin, arthritis Rheum 163, 1985.

10.Sardesai H.V. Deshpande, S.S. Use of R.Compound in Rheumatoid arthritis, Seapalar 1968.

11. Patnaik B.C., clinical trial with R. Compound in Rheumatiod and other arthritis disorders.

 

 

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