Treatment of Arthrogrypsis Mulptiple Congenital Disorder Abstract.

ABSTRACT

The musculoskeletal system is the most important system of body responsible for various body movements and moving to-and-fro. If there is a certain deformity in the single body part or joint, the dependency on other human beings increases due to which the daily activities are compromised. What if, a child is born with such kind of deformity! Arthrogryposis multiplex congenital disorder (AMC) is a disease of one such type in which a joint becomes fixed either in a fully extended or flexed position. This is manifested as early as a child is born with deformed joints and hence, the physical structure and daily activities of the child are compromised but with the regular physiotherapy along with Ayurvedic herbs-mineral drugs, one can win over this disease and live a normal and happy life.

INTRODUCTION

Arthrogryposis multiplex congenital disorder is a non-progressive joint disorder, usually seen in newborns in which there are multiple joint contractures that may affect two or more than two joints. A contracture occurs when a joint becomes fixed in a fully flexed or fully extended position and sometimes in a partial flexed or extended position. These contractures affect the range and motion of the joints and muscles and hence, muscle atrophy occurs commonly. This disease is usually seen in a newborn.

For simplicity, AMC refers to,

• Arthro-joints

• Gryposis-deformed

• Multiple-many

Thus, as its name suggests, multiple joint deformities are here and it is congenital in most cases.

AETIOLOGY
AMC is not only a disease but rather, it is a symptom that can be found in different disorders. The exact and popular reason is thought to be the development of extra connective tissue around the joint which makes it to be fixed in a place. When a joint movement is affected, tendons connected to the joint are not at all stretched to its normal length, which makes the movement difficult. Muscles of the affected limb may be underdeveloped or atrophied. Usually, soft tissue webbing may develop over the affected joints.

The main etiological factors for the AMC are listed below:-

• The foremost & important factor in newborns seems to be the chromosomal abnormality like single gene changes which may be autosomal dominant, autosomal recessive, or X-linked changes.

• Maternal fever during pregnancy which may affect the growth of the body or use of certain drugs like thalidomide may severely affect the joints, bones, and muscles.
• Certain viral infections to the mother during pregnancy which may affect the nerve impulses of muscles.

• Malformations of CNS in which along with AMC, many other congenital disorders like pleural deformity, gastric deformities are present.

• During multiple twin pregnancies, one fetus may not get the proper growth and proper movement of joint, hence contracture can occur.

• Abnormalities of tendons, bones, or joints.

• In trisomy 18, (chromosomal abnormality), AMC is usually identified as a symptom.

SYMPTOMS:

The symptom list varies from person to person as it is not usually only associated with joint contractures but a different range of symptoms such as-

o Abnormal pleural membrane

o The abnormal mucous membrane of eyes, nose

o Dislocation of hips

o Scoliosis

o Talipes equinovarus

o Club foot

o Ulnar deviation of the hand

DIAGNOSIS-
As such, there is no prenatal diagnosis method but only an ultrasound can detect abnormal limbs.

o After birth, a thorough physical examination along with a proper medical history followed by an x-ray will reveal affected joints.

o Genetic testing is recommended to find the primary cause of AMC.

AYURVEDIC VIEW-

Arthrogryposis multiplex congenital disorders can be considered as Sahaja vyadhi. Beejadusti (male/female gamete abnormality) causes dhatwagnimandhyam (poor metabolic activity at the level of growth) which affects dhatu pagina am (transformation of tissues) leading to poor status of dhatus (tissue elements) and in turn, there is excessive formation and accumulation of malas (waste products) in the body. As a result, tridosadushti (vitiation of 3 doshas) occurs, predominantly Vata dosha. This pathology starts in garbha (embryo) leading to congenital malformations and anomalies of various systems.

As it is a genetic disease, a complete cure is difficult but the disease progression and complications can be arrested by dosha shaman chikitsa and agnideepan, especially Vata dosha has to be treated since it is confined to joints. Therefore, deepen pachan along with strengthening the vitality of joints should be done to eliminate the accumulated malas and to ignite the Agni.

Keeping all this in mind, Planet Ayurveda, one of the leading herbal Ayurvedic drug manufacturing company has come up with the following medicines to treat the patient based on the above principle which is as follows-

1. BOSWELLIA CURCUMIN-
As the name suggests, it contains two most potent adaptogenic herbs- Boswellia known as shallaki (Boswellia serrata) and curcumin known as Haridra (Curcuma longa). As per a research published by Neutraceuticals business review, these two herbs together inhibit the production of inflammatory markers and decrease the pain significantly. They are more effective than pain killers which work on cox-2 active receptors

Dose- 1 capsule once daily with plain water after meals
For children below the age of 12 years- half capsule once daily

2. ASHWAGANDHA-
Its name already reveals the meaning- one like a horse. Consuming this capsule once daily gives strength to the joints and gives the power to run like a horse.

Dose- 1 capsule once daily with plain water after meals
For children below the age of 12 years- half capsule once daily

3. JOINT AID PLUS-
The main ingredients are nirgundi (Vitexnegundo), guggul (Commiphora Mukul), shonth (Zingiber Officinale), shallaki (Boswellia serrata), and ashwagandha (Withania somnifera). Nirgundi-as name suggests, the beautiful herb for all the remedies has powerful alkaloid called nishindine helpful in curing the pain and inflammation of joints. Guggulu, shallaki, ashwagandha is best for strengthening the joints, and short and Guggulu together helps to pacify the Vata dosha.

Dose- 1 capsule once daily with plain water after meals
For children below the age of 12 years- half cap once daily

4. KUMAR KALYAN RAS-
If we go through its name, Kumar in Ayurvedic texts is a baby below the age of 18 years and Kalyan which shows magical effects on the child. It contains kumariras (Aloe Vera’s juice), swarn (purified and processed gold), loha (purified and processed iron), shuddha Parada (purified& processed mercury), abhraka (purified mica), Mukta (calx of the shell), Bakshi ka (purified & processed copper-iron rust). This rasa pacifies all the three doshas and directly work on the Agni and ignite it.

Dose- 1 tablet once daily with plain water after meals
For children below the age of 12 years- half tablet once daily.

As AMC is a Congenital disorder and usually find in newborns, the dose of each and every drug can be changed.

CONCLUSION:
So, at the end along with physiotherapy, regular exercises, and administering medicines, AMC can be treated well.