Ayurvedic management of psoriatic arthritis with Dactylitis - A Case Report.

This case report is the description of dactylitis associated with Psoriatic arthritis (PsA) of a thirty-eight years old male, government employee. He presented with complaints of pain, swelling, stiffness and restriction of movements in fingers of upper limb, especially distal interphalangeal joints (IJP) for 1 month. Skin manifestations like silvery flaky scales, itching over the scalp region and mild pinkish discoloration on mid dorsum of right foot were also present. Diagnosis was made with the aid of CASPAR criteria, history taking and clinical examination. Only temporary relief was obtained from non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) he had taken for 2 weeks as suggested by conventional treatment. In Ayurvedic parlance, PsA resembles conditions like Gambheera Vatrakta, due to involvement of skin and deeper tissues like bones and joints and dactylitis may be considered as Anguli sopha. Internal medications with properties alleviating three doshas (tridoshahara), skin diseases (kushtahara), vitiated rakta dhatu (raktahara), which detoxifies blood (raktaprasadana), anodyne (soolahara), anti-inflammatory (shothahara), rejuvenating (Rasayana) were used. The assessment was done before and after the treatment by using the Psoriasis Area and Severity Index (PASI) score and European Alliance of Associations for Rheumatology's 'The Psoriatic Arthritis Impact of Disease 12 (EULAR PsAID 12)' questionnaire score. It was observed that symptoms were almost completely resolved with Ayurvedic management and changes in biochemical parameters were also noted. Prescribed Ayurvedic medications was found to be a good alternative therapy in managing dactylitis associated with PsA.