Joint pain or arthralgia is caused by inflammation or degeneration of tissues in one or more joints. When associated with stiffness, swelling and painful joint movement it is called arthritis. Joint pain can be a manifestation of acute febrile illnesses, trauma, excessive mechanical stress, a variety of medical conditions elsewhere in the body or a more serious form of disabling arthritis which may be infective, non-infective or degenerative. The common non-infective joint diseases with joint pain as a major symptom are rheumatoid arthritis, osteoarthritis, gout, and non-specific inflammatory arthritis such as psoriatic arthritis.

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints. Although the cause of rheumatoid arthritis is unknown, auto-immunity plays a pivotal role in its chronicity and progression. The onset of rheumatoid arthritis in a majority of patients is insidious. Morning stiffness is its characteristic feature and before the involvement of the joints the patient may complain of tiredness, fatigue, general malaise, low grade fever, etc. Generally the small joints of fingers or toes are initially involved, then it spreads to the wrists, elbow, shoulders, ankles and knee. The temporo-mandibular joint and sterno-clavicular joint may also be affected. As the disease progresses, the pain and swelling of the joints increases. Swelling of the proximal inter-phalangeal joint and muscular atrophy gives rise to spindled shape of the fingers.

Suggestive clinical features with consistent radiological changes, high erythrocyte sedimentation rate and a positive rheumatoid factor test usually help in diagnosing the disease.

Osteoarthritis is a degenerative arthritis resulting from excessive mechanical stress on a diseased or degenerated joint. It generally involves big weight-bearing joints such as the knee, hip, spine but in women it may involve the terminal joints of the fingers. The patients are frequently obese. Pain in joints initially is intermittent and appears after using the joints and is relieved by rest. With the progression of the disease, movement in the affected joints becomes increasingly limited. Crepitus are felt or heard in the affected joints. Bony outgrowth may appear on the joint margins.

Gouty arthritis is a form of arthritis which is caused by accumulation of uric acid crystals inside the joint which evokes an acute inflammatory response. It is one of the most painful joint diseases. Gouty arthritis usually strikes a single joint, most commonly the big toe, however, it can also affect the ankles, knees, wrists, fingers and elbows. Elderly males are more likely to develop gouty arthritis than women.

Psoriatic arthritis is a prototype of a group of chronic non-specific arthritis secondary to a primary immuno-inflammatory disease elsewhere like skin psoriasis. The exact causes are not yet known, but several genetic associations have been identified. Psoriatic arthritis can develop at any stage. However, on average it tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 50, but it can also affect children. Men and women are equally affected by this condition and the arthritis symptoms may occur before any skin involvement.

Of the many drugs and preparations for arthritis documented in Ayurveda, Ajamoda powder is a simple and effective remedy. It is used internally as well as on the affected joints of the patient in the form of poultice.

Ajamoda (Apium leptophyllum) (Pers.) F.V.M. ex Benth.

Ajamoda consists of dried, aromatic fruits of Apium leptophyllum, an annual herb cultivated in the central and southern states of India. It is collected by thrashing plants on a mat and dried in shade or in drying sheds. Ajamoda is a well-known drug for rheumatism and gout. Ajamoda is one of the chief ingredients in many formulations useful in rheumatoid arthritis. Poultice of crushed fruits can also be applied to painful joints along with oral use.

English name	Slender celery, Wild celery
Latin name	Apium leptophyllum (Pers.) F.V.M. ex Benth
Family	Apiaceae/Umbelliferae
Parts used	Fruit

Main chemical constituents

Essential oil and fixed oil.

Quality standards

As per the Ayurvedic Pharmacopoeia of India, quality standards determining the identity, purity and strength of Ajamoda fruits are based on the following:

Foreign matter	Not more than 5%
Total ash	Not more than 14%
Acid-insoluble ash	Not more than 14%
Alcohol-soluble extractive	Not less than 14%
Water-soluble extractive	Not less than 3%
Volatile oil	Not less than 2% v/w

Method of preparation

• (1) Clean the dried fruits of Ajamoda by removing the stalks, dust and other foreign matters.
• (2) Grind in a pulverizer or in a mortar and pestle to make a fine powder.
• (3) Filter through a fine sieve of mesh size 85.
• (4) Store in an air-tight container and consume within one year.

Dosage form

Aromatic, slightly bitter yellowish-brown powder giving a sensation of warmth to the tongue.

Therapeutic properties

Seeds have antiseptic, diuretic, anti-inflammatory, analgesic, anthelmintic, and anti-spasmodic properties.

Dose and mode of administration

• (1) The dose of the formulation for adults is 1 to 3 grams and for children 125 to 500 mg, two or three times a day, with warm water.
• (2) For local application as poultice, make a paste of the powdered seeds in warm water and apply on the affected joint.

Indications and uses

• (1) For relief from joint pain in arthritis such as osteoarthritis, rheumatoid arthritis, gouty arthritis, and non-specific arthritis.
• (2) It is useful in dyspepsia and colic with or without joint pain, when taken with salt and warm water.
• (3) Local application of the paste or poultice of Ajamoda seeds is recommended in painful joint condition.

Precautions and safety aspects

• (1) Ajamoda powder should not be used during pregnancy and nursing mothers are advised to take it under medical supervision.
• (2) The diuretic action of Ajamoda works by irritating the kidneys and therefore should be used with caution in cases of renal disorder.
• (3) Where joints are without swelling or inflammation but pain is dominantly present, massage with warm sesame oil can also be done following fomentation with Ajamoda seed powder.
• (4) Persons having arthritis should avoid eating sour and cold items.
• (5) Excessive use of the affected joints should be avoided.
• (6) If pain does not subside within two to three days or joints develop effusion of fluid, medical advice should be sought.

References

• (1) India, Ministry of Health and Family Welfare. The Ayurvedic Pharmacopoeia of India. Part 1 Vol. I. New Delhi: Department of Indian Systems of Medicine and Homeopathy, 2001. p. 2.
• (2) Sharma PC, Yelne MB and Dennis TJ. Database on Medicinal Plants Used in Ayurveda. Vol. 3. New Delhi: Central Council for Research in Ayurveda & Siddha, 2001. p. 475.

Further reading

• (1) Sri Brahmasankara Shastri. ed. Yogaratnakara. Varanasi: Chaukhambha Sanskrit Sansthan, 2005.
• (2) Mishra Pd. Sri Brahma Shankara. eds. Bhavaprakasha. Part I. Varanasi: Chaukhambha Sanskrit Sansthan, 2000.
• (3) Nadkarni KM. Indian materia medica. Vol. I. Mumbai: Popular Prakashan, 2005.
• (4) Sharma PV. Classical uses of medicinal plants. Varanas: Chaukhambha Visvabharati, 2004.

Source: Traditional Herbal Remedies for Primary Health Care - WHO