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| CASE REPORT |
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| Year : 2022 | Volume
: 1
| Issue : 1 | Page : 35-38 |
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Efficacy of Hiranyatutta for managing a case of joint pain in secondary hamochromatosis in beta thalassemia major: A pilot case study
Manjiri Ranade
Department of Rasa Shastra, Sri Sai Ayurvedic Medical College, Aligarh, Uttar Pradesh, India
| Date of Submission | 30-Jun-2021 |
| Date of Acceptance | 15-Feb-2022 |
| Date of Web Publication | 12-Aug-2022 |
Correspondence Address:
Dr. Manjiri Ranade
Department of Rasa Shastra, Sri Sai Ayurvedic Medical College, GT Rd, opp. Phal Mandi, Sarsol, Aligarh 202002, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jahas.jahas_2_21
Thalassemias are hereditary globin-producing diseases caused by mutations in the globin gene. In the Indian subcontinent, it is a major concern, particularly among individuals of lower socioeconomic status. Although there is no curative treatment, frequent blood transfusions are required to delay mortality. Although regular blood transfusions are required, they do have health effects. Secondary hemochromatosis (iron overload) is a condition in which the iron in red blood cells accumulates in various body parts as a result of frequent blood transfusions. Secondary hemochromatosis can cause a range of symptoms depending on the organs involved, but the most common and severe symptom is joint pain, which affects the patient not only physically but also mentally. We treated one patient with this condition using Hiranyatutta, a novel ayurvedic medication, and the outcomes were promising. An 18-year-old boy was suffering from this chronic condition since the last 2 years. Joint discomfort and swelling persisted to the point that the patient’s activities of daily life were hampered. The disease activity score using 28 joint counts (DAS28) rating technique gives a score of 5.8 for the baseline severity. Over 3 months, the patient’s symptoms gradually improved. This condition is identical to Vata-Rakta in the Ayurvedic medical system. Traditional approaches to the potential of successful management are being explored as modern sciences have management constraints. With actions such as Tridoshaghna, Vatashamaka, Raktashod-haka, and Vedanahara, therefore alleviating the signs and symptoms of Vata-Rakta, this drug has a synergistic role in breaking the pathophysiology of Vata-Rakta. Though the condition cannot be completely cured, it can be effectively managed and controlled. Because of the suffering associated with the condition, the costs suffered by the patient, and with the objective of bringing relief to the hurting society from this condition, the use of an ayurvedic holistic approach might be valuable. Keywords: Hiranyatutta, secondary hemochromatosis, thalassemia, Yurveda
How to cite this article:
Ranade M. Efficacy of Hiranyatutta for managing a case of joint pain in secondary hamochromatosis in beta thalassemia major: A pilot case study. J Ayurveda Homeopath Allied Health Sci 2022;1:35-8 |
How to cite this URL:
Ranade M. Efficacy of Hiranyatutta for managing a case of joint pain in secondary hamochromatosis in beta thalassemia major: A pilot case study. J Ayurveda Homeopath Allied Health Sci [serial online] 2022 [cited 2023 Nov 30];1:35-8. Available from: http://www.dpujahas.org/text.asp?2022/1/1/35/353697 |
| Introduction | |  |
Thalassemias are inherited disorders of globin production associated with mutations in the globin gene. The prevalence of the thalassemia gene in the Indian population ranges from 0% to 17% in various ethnic groups, with an average of 3%. Every year, approximately 10,000 children with thalassemia major are born in India, accounting for 10% of the global total. Thalassemia is a major concern in the Indian subcontinent, particularly among people of lower socioeconomic status. Although there is no curative treatment, frequent blood transfusions are required to delay mortality. Although frequent blood transfusions are necessary, they are not without their consequences. Secondary hemochromatosis (iron overload) is a condition caused by the iron in red blood cells being deposited in different bodily areas. Iron chelators are used in treatment; they are costly and come with several adverse effects. The expense of therapy is quite high and may not always be attainable because the disease burden is concentrated in low socioeconomic populations. Secondary hemochromatosis can cause a number of symptoms depending on the organs involved, but the most prevalent and debilitating symptom is joint pain, which not only physically affects the patient but also has a negative impact on their mental health. Hiranyatutta is an Ayurvedic plant that is seldom discussed in Ayurvedic scriptures, and we only find a very few references to it.[1] We used this medicine to treat secondary hemochromatosis in children with thalassemia, and the results were encouraging. More research into this Ayurvedic herb as a low-cost therapy for this severe condition is needed, and our case report might serve as a pilot case study. It is worth noting that although this medication is not a cure, it has the potential to significantly enhance a patient’s quality of life.
| Case Report | | |
An 18-year-old male patient was admitted to a tertiary care medical college hospital’s thalassemia unit for routine blood transfusion. The patient has been receiving regular blood transfusions since being diagnosed with Beta-thalassemia 8 years ago. He needed one transfusion every 21 days to keep his hemoglobin levels at 9 gram percent. The patient was active before to the beginning of joint aches 2 years ago. Multiple joints, including the ankle, knees, and upper hand joints, have been impacted by joint discomfort during the previous 2 years. The joint discomfort became more severe with time, interfering with sleep and daily activities. The patient was checked and found to have a high blood ferritin level and an increased erythrocyte sedimentation rate (ESR), confirming the diagnosis of secondary hemochromatosis. After consulting with an Ayurvedic practitioner, the parents chose to Ayurvedic medications.
On examination by an ayurvedic physician, 10 joints (first five metacarpophalayngeal [MCP] joints right hand, wrist, and four MCP left hand) were painful, with four of them swollen [Figure 1]. We chose the disease activity score using 28 joint counts (DAS28)[2] to know the progress of the disease as there is no scale in Ayurveda for assessing the severity of symptoms. According to DAS28, the result was 5.8 points, indicating a considerable degree of joint inflammation. The ESR and serum ferritin levels were both elevated at the commencement of the study. The patient was thoroughly examined from an Ayurvedic standpoint, and the diagnosis of Sandhishoola in Beejadushtijanya Panduroga was made. | Figure 1: Before treatment with Hiranyatutta. Three joints are swollen with pain in all joints. DAS 28 severity score –5.8
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The posology of medications is as described in [Table 1]. The preparation of kwath is described below.
| Preparation of Kwath | | |
2 g coarsely powdered Hiranyatutta root was soaked in 40-mL water overnight. The water was boiled on the second day until it reached a volume of 10 mm. The liquid was then filtered and utilized for therapeutic purposes.[3] The kwath was made fresh every day at the time of consumption.
The patient was advised to keep consuming his allopathic medications (desfrroxamine) in routinely advised doses.
The patient was continued to be evaluated throughout a 3-month period. The patient was called weekly and met in person when he came to the hospital for a transfusion. The timeline is as presented in [Table 2]. Patient condition gradually improved with treatment. Initial signs and symptoms relief included an increase in appetite and a decrease in joint tenderness. The next month, joint swelling began to recede, and stomach pain was fully reduced in the third month [Figure 2]. The timeline of the disease is as mentioned in [Table 2]. Global health scale on numeric rating scale of 1–10[4] reduced to 1 indicating good general health.  | Figure 2: After treatment. Joint swelling has subsided. DAS 28 severity score reduced
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| Discussion | | |
According to Ayurvedic literature, rasa of Suranjana is Tikta and Katu, it has Laghu and Ruksha Guna, with Ushna Virya, and its vipaka is Katu. With all these properties, it does pharmacological actions as Kapha vatahara, Vran Sodhak, Ropak, Sara, Sukrala, Dipana-Pachana, Cakshushya, Rakta Prasadan, Rechak, Vamak, Ama Vish Nashak, and Vidahikara. It functions as a stimulant, laxative, diuretic, anti-inflammatory, bile expectorant, and cancer-fighting agent. In Samhitas, the Ayurvedic qualities of Hiranyatutta are not mentioned. It was first time included in 1935 AD in Acharya Sankar Dut Gond’s Sankar Nighantu. It was later classified as a specialized medicine for the treatment of gout and rheumatoid arthritis by authors such as Yadavji Trikamji, K.C. Chunekar, and Ram Sushul Sing. Hiranyatutta is contained in Rakta prasadan varg by P.V. Sharma (Group of Blood purifiers).
Dried corn of Hiranyatutta is katu, tikta, ushna, and kapha vata shamaka, so it is used in many disorders such as inflammation, swelling, joint pain, gout, sciatica, osteoarthritis, rheumatoid arthritis, indigestion, and wound healing.
According to modern perspectives, Colchicine, found in Hiranyatutta, is hypothesized to block chemotaxis and the function of polymorphonuclear cells, which are responsible for acute inflammation. It is Shothahara and Vednasthapaka. In rabbit experiments, the medication decreased the quantity of serum uric acid.[5] According to the previous description, these medications have a synergistic impact in breaking the pathophysiology of Vata-Rakta. They are Tridoshaghna, Vatashamaka, Raktashod-haka, Vedanahara, and work as Rasayana, improving Dhatu production and so relieving the signs and symptoms of Vata-Rakta.[6] We decided to undertake a feasibility study of the medicine in this specific illness because most of the indications and symptoms of joint pain in secondary hemochromatosis in thalassemia are similar to Vata-Rakta, and not many ayurvedic case reports are there on this common but crippling disease.
Thalassemia cannot be totally cured, although it can be properly managed and controlled. The disorder has been chosen for study because of the suffering associated with the sickness, the losses suffered by the sufferer, and the goal of providing relief to the hurting society from this condition so that people can continue to be productive for society.
The Ayurvedic perspective on secondary hemochromatosis caused by repeated blood transfusion is now relatively inadequate. Blood transfusion is a palliative care, not a curative one, thus even current science has little to offer. Although the hereditary part of the disease is not mentioned in Ayurveda texts, the style of living outlined in Ayurveda, including nonconsanguineous marriages, serves to avoid further transmission of the disease to offspring.[7] As a result, the current therapeutic strategy is palliative, and this medicine, Hiranyatutta, albeit less well-known in Ayurvedic scriptures, can be a useful option for reducing disease symptoms and improving quality of life.
Our study is a feasibility study of the drug because there have been no previous case reports of its usage in the disease. As a result, there could be few errors in estimating dosage, duration, and efficacy of medications in similar individuals. Still, our case reports pave the way for more research into this condition with the used medication.
| Conclusion | | |
According to our case study, Hiranyatutta may be a viable treatment for remission of an acute episode of secondary hemochromatosis. As this is the first time this medicine has been utilized in this situation from an Ayurvedic perspective, additional study for therapeutic usage, as well as more case reports, are needed to substantiate the claim.
What are future implications from our case report?
Future clinical studies aimed at verifying our findings should pay special attention to dosage comparisons, duration comparisons, and medication administration modalities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
| References | | |
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| 2. | van Riel PL The development of the disease activity score (DAS) and the disease activity score using 28 joint counts (DAS28). Clin Exp Rheumatol 2014;32:S-65-74. |
| 3. | Savrikar SS, Ravishankar B Bhaishajya kalpanaa––the ayurvedic pharmaceutics: An overview. Afr J Tradit Complement Altern Med 2010;7:174-84. |
| 4. | Khan NA, Spencer HJ, Abda EA, Alten R, Pohl C, Ancuta C, et al; QUEST-RA group. Patient’s global assessment of disease activity and patient’s assessment of general health for rheumatoid arthritis activity assessment: Are they equivalent? Ann Rheum Dis 2012;71:1942-9. |
| 5. | Mohammad IS, Latif S, Yar M, Nasar F, Ahmad I, Naeem M Comparative uric acid lowering studies of allopurinol with an indigenous medicinal plant in rabbits. Acta Pol Pharm 2014;71:855-9. |
| 6. | Reeta M, Ravindra S, Sumit N, Kotecha M Suranjana ( Colchicum Luteum Baker.): A rhizomatic plant. Ayushdhara 2015;2:171-5. |
| 7. | Patil V, Shitre A, Bhirud P Ayurveda and modern perspective of atulyagotriya: An approach to prevent congenital anomalies. World J Pharm Med Res 2017;6:323-5. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
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