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Abstract

Amavata is a chronic systemic disorder described in Ayurveda, characterized by the involvement of Ama

(undigested toxic material) and Vata dosa, producing systemic and articular symptoms. It closely resembles

Rheumatoid Arthritis (RA) in modern medicine. Sandhi Vikruti (joint pathology) is the prime manifestation,

which can be objectively assessed by X-ray. Radiological evaluation provides structural correlation of

Ayurvedic descriptions of Sandhi-Vikara like sandhisankochoch, Sandhishotha (synovial

inflammation/swelling), stambha (stiffness), sandhi graha (ankylosis) and other structural changes.

Keywords- Amavata, Rheumatoid arthritis, X-ray, Sandhi vikruti.

P

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Year of Establishment – 2016

INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH

Corresponding author: Dr. Deepali Amale

Article Info: Published on : 15/10/2025

Impact Factor : 1.013

An Observational Single Case Study Of Sandhi Vikruti In Amavata By

Evaluating X-Ray With Special Reference To Rheumatoid Arthritis.

Dr. Deepali Jeetendra Amale

1

, Dr.B.D.Dharmadhikari

2

, Dr. Sneha Vijaysing Rathod

3

1

Professor, Guide & H.O.D. of Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and

Rugnalaya, Kanchanwadi, Chh. Sambhajinagar.

2

Associate Professor, Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and Rugnalaya,

Kanchanwadi, Chh. Sambhajinagar.

3

PG Scholar, Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and Rugnalaya,

Kanchanwadi, Chh. Sambhajinagar.

Cite this article as: - Dr.Deepali Amale (2025) An Observational Single Case Study Of Sandhi Vikruti In Amavata By Evaluating

X-Ray With Special Reference To Rheumatoid Arthritis.;Inter .J. Dignostics and Research 3 (1) 48-56,

DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 088

G

A

R

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49

Introduction :

Ayurveda is a science of life, having principle aim

to maintain the health and eradication of disease.

The Samhita grantha of ayurveda has explained

many diseases before thousands of years with their

signs and symptoms and proper line of treatment.

The term Amavata consists of two words Ama and

Vata. Ama is an important causative factor which is

associated with vitiated Vata dosha and producing

the disease Amavata. The Amavata as a special

disease entity was mentioned first by Madhavakar

[1]

.

Samprapti Of Amavata :

Nidana Sevana such as Viruddha Ahara, Viruddha

Chestha, Mandagni, Nischala, Snigdha Ahara

followed by immediate exercise originates from

Agni Mandya leading to Ama Utpatti (Apakva

Ahara-rasa → Ama formation). The combination of

Ama and Vata causes strotorodh which causes

Sanga in Rasavaha & Annavaha Srotas leading to

obstruction of normal nutrient flow and disturbance

of Vata Gati. Since Sandhi are the primary Sthana

of Vata. Sanchay in Sandhi, Vata carries ama to

Sandhi Sthana → sthanasamsraya, which further

produces Sandhi Vikruti like sandhisanchoch,

sandhi shotha (synovial inflammation/swelling),

stambha (stiffness), sandhi graha (ankylosis,

Sparsasahatva (tenderness) and produces

symptoms of Amavata. Ama and Vata vitiated

simultaneously and disease manifested mainly in

joints of Hasta, Pada, Sira, Trika, Gulpha, Janu and

Uru.

[2,3]

According to Madhavakar Pradhan Lakshanas

 Sarujam Sandhishotha: Hasta, Pada, Shiro,

Gulpha, Janu, Uru Sandhi’s are chiefly

involved in Amavata.

[4]

 Vrishchika danshavata Vedana,

Utsahahani, Bahumutrata, Kukshikathinya,

Kukshishoola, Nidra Viparyaya, Chhardi,

Bhrama, Murchha, Hritgraha, Vibandha,

Antrakujana, Anaha, Agnimandya, Praseka,

Gaurava, Vairasya, Daha, Trishna

Rheumatoid Arthritis

Amavata

Morning stiffness

Gatra sthabdata or

Sandhi sthabdata

Arthritis of 3 or more joints

Bahu sandhi shotha

Arthritis of hand joints

Hasta sandhi shotha

Symmetrical arthritis

Bahu sandhi shotha

(Ubhaya)

Pratyatma Lakshanas

In Amavata, Sandhi’s are the main site of

manifestation of clinical features, thus joint

associated symptoms are considered as Pratyatma

Lakshanas of disease Amavata.

These are as follows:

 Sandhi Shoola (joint pain)

 Sandhi shotha (joint swelling)

 Sthabdata (stiffness)

 Sparsasahatva (tenderness)

Upadrava Of Amavata:

[5]



Angavaikalya(deformity) is an Upadrava

considered by Harita. In Madhava Nidhana

the Amavata Upadrava are mentioned, they

are Trit, Chhardi, Bhrama, Murchha,

Hritgraha, Jadya, Antrakujana, Anaha etc.

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 All the Systems will involve or get

disturbed in the Amavata. It is not treated in

time it produces anatomical deformities like

Sandhi Vikruti and Hritgraha. So proper

management is must from the onset of

disease. The Upadrava depends upon the

type of kapha involved in samprapti. If

Ama combines with Shleshka kapha & gets

lodged in sandhi Sthana creates sandhi

vikruti and if Ama combines with

Avalambak kapha resides in Hridaya

develops Hritgraha.



Rheumatoid arthritis is a chronic,

progressive autoimmune arthropathy of

synovial joints that causes swelling,

stiffness and pain in the joints, joint

deformity and affects other organs like

lungs etc.

[6]

Amavata is very closely

resembles with the Rheumatoid arthritis on

the basis of its pathogenesis and clinical

manifestation, includes morning stiffness

(>45mins) and pain and swelling in joints,

painful movements, symmetrical arthritis

etc. As chronicity of diseases progress, it

involves some sites for deformity like

nodular formations at joints(elbow), and

some organs like lungs. Various deformity

also found like zig zag deformity, piano key

deformity, boutonniere deformity, swan

neck deformity, ulnar deviation etc.

[7]

Pathophysiology Of RA :

Genetic Susceptibility and Environmental Triggers

such as Smoking, infections, gut dysbiosis,

pollutants leading to Loss of Immune Tolerance.

Activation of Antigen-Presenting Cells (APCs) and

B-cell Activation (Autoantibody production (RF,

Anti-CCP) which Immune Complex Formation

which deposits in synovium causing Synovial

Inflammation (Synovitis) and Pannus Formation

(Hyperplastic invasive granulation tissue in

synovium). pannus release enzymes and cytokines

that causes Cartilage & Bone Destruction and

causes RA.

[7,8]

Clinical Features of RA-

[9]

 Joint pain, swelling, stiffness (esp. morning)

 Symmetrical polyarthritis

 Progressive deformities (ulnar deviation, swan-

neck, boutonnière)

 Extra-articular features (nodules, vasculitis,

systemic inflammation).

X-ray /radiography are a form of electromagnetic

radiation with a short wavelength and high energy,

capable of penetrating human tissues and creating

images of internal structures . It plays a crucial role

in the diagnosis, monitoring, and staging of

musculoskeletal disorders such as Rheumatoid

Arthritis (RA).

[10]

Radiography is the traditional gold standard for

assessment of joint damage. Radiography may be

used to examine multiple joints rapidly, and for

evaluating rheumatoid patients. Because of its

exquisite resolution and depiction of bony

structures, radiography is very good at detecting

erosions .

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The early radiographic findings

[11]

:

 Nonspecific periarticular soft tissue

swelling with a fusiform configuration and

periarticular osteopenia.

 Soft tissue swelling occurs from a

combination of joint effusion, edema,

synovial enlargement (pannus formation),

and/or tenosynovitis.

 Osteopenia typically becomes more

generalized as the disease progresses.

Initially, the small joints may widen as a

result of effusion; however, as cartilage

becomes eroded, the cartilage spaces

narrow.

Late Radiographic Findings

Subluxations from ligament, tendon, and joint

capsule laxity become more pronounced and may

lead to frank dislocations. Once RA progresses to

cartilage loss, the altered mechanics predispose to

pressure erosions at sites of bone-on-bone rather

than cartilage-on-cartilage interfaces.

Wrists, Feet and Ankles-As in the hands,

alterations in the wrists due to RA include soft

tissue swelling, erosions, joint space narrowing,

alignment abnormalities, and ankylosis.

The metatarsophalangeal (MTP) joints are among

the first to be affected by RA.

Large Appendicular Joints (knee, hip, elbow, and

shoulder) -uniform and severe cartilage space loss.

The Prevalence of Rain India affect more in female

as compared to male 3:1 ratio.

[12]

Aim :

To observe and evaluate sandhi vikruti in Amavata

through x-ray examination and to establish

radiological correlation with rheumatoid arthritis.

Objectives:

1. To observe and evaluate sandhi vikruti in

Amavata.

2. To study Amavata in detail.

3. To study Rheumatoid arthritis in detail.

4. To study X-ray findings related to

rheumatoid arthritis in detail.

Methodology:

Study Type :Observational Study.

Study Design:.

Diagnosed patient of Amavata vyadhi

⇓

Enrollment of patient in study and obtain written

informed consent.

⇓

Patient assessed for subjective and objective

criteria

⇓

Correlation of obtained data

⇓

Discussion

⇓

Conclusion

Study Design

Inclusion Criteria :

1. Diagnosed patient of Amavata.

2. Patient will be selected irrespective of their

sex, occupation, socioeconomic status.

Exclusion Criteria :

1. 1.Diagnosed patient having other joint

disorders like osteoarthritis, Gout, trauma

2. 2.Patient having Systemic diseases like

Uncontrolled Diabetes, Thyrotoxicosis,

Other .

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3. metabolic disorders and other severe

systemic diseases.

Subjective criteria:

1 . Sandhi shoola (Joint Pain)

Grade

Sandhi shoola (Joint Pain)

1

Mild bearable pain

2

Continuous Pain with No Difficulty in

Movement

3

Continuous Pain with Difficulty in

Movement

2. Sandhigraha (Joint stiffness)

Grade

Sandhigraha (Joint stiffness)

1

Stiffness last for half hour or hour only in

morning

2

Stiffness last for more than one hour

3

Stiffness last for all day and night

3. Sparshasahtva (tenderness/pain on touch)

Grade

Sparshasahtva

(tenderness/pain on touch)

1

Bearable pain on touch

2

Continuous pain on touch

3

Unbearable pain on touch

4. Sandhi shotha (joint swelling)

Grade

Sandhi shotha (joint swelling)

1

Mild swelling

2

Moderate swelling

3

Marked swelling

Objective Criteria :

X-Ray:

Grade

X-Ray Findings

1

Features periarticular osteopenia and

subchondral bone destruction but no

deformity.

2

Cartilage and bone destruction, joint

deformity, and osteopenia

3

Cartilage and bone destruction, joint

deformity, and osteopenia bony or fibrous

ankylosis (joint fusion)

Case Study :

A 30-year-old male brought by relative with Sandhi

shoola in bilateral wrist and finger joint with pain

last more than 1 hour and pain on touch since1 year

and also Generalised weakness, loss of appetite,

heaviness in body.

Patient details:

Name: Mrs.XYZ

Age/Sex: 30 yrs/ M

Occupation: Job

Chief complaints

 Sandhi shoola /Pain and Sandhi shotha

/swelling in bilateral wrist and fingers

joints since1 year.

 Sandhi graha / Morning stiffness lasting

more than 1 hour.

 Restricted movements of affected joints.

 Sparsasahatva / pain on touch of

affected joints.

History Of Present Illness:

Patient noticed gradual onset of pain and swelling

in small joints of hands, associated with stiffness,

aggregated in morning and relieved on mild

activity. Over months, deformities started to appear

in fingers.

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Past History: No history of major illness.

Family History: Mother with history of arthritis.

Clinical Examination:

General examination: Moderate built, pallor

absent, vitals – normal

Systemic examination:

 Symmetrical involvement of both wrists and

MTP joints.

 Swelling and tenderness present.

 Morning stiffness > 1 hour.

 Early deformity: ulnar deviation of fingers.

Ashtavidh Pariksha:

Ashtavidh Pariksha

Nadi: 80/min

Mala: Malavashtmbha

Mutra: 4 to 5 time in day, 1 to 2 times in night

Jivha: Sama

Shabda: Prakrut

Sparsha: Anushna

Drik: Prakrut

Akriti: Madhyam

Dashavidha Pariksha:

Dashavidha Pariksha

Prakruti: Vata Pradhana-Kapha Anubandhi.

Vikruti: Dosha - Vatapradhana Tridosha,

Dushya - Rasa, Meda, Ashti.

Satwa: Madhyama.

Sara: Rakta

Samhanana: Madhyama

Pramana: Madhyama

Saatmya: Sarva Rasa

Aharasakti: Madhyama

Vyayamshakti: Avara

Vaya: 30 years

Samprapti Ghatak :

Dosha

Vata (Vyana, Samana, Apana)

and kapha (Kledak, Bodhaka,

Sleshmak)

Dhatu

Rasa, Mamasa, Asthi, Majja

Updhatu

Snayu and Kandara

Srotasas

Annavaha, Rasavaha, Asthivah,

Majjavah

Udbhavasthana

Amashya (Ama), Pakwashaya

(Vata)

Adhisthana

whole body

Vyaktasthana

Sandhi

Avayava

Sandhi

Agni

Jataragni Mandya, Dhatwagni

Mandya

Observations :

Subjective Criteria :

Subjective Criteria

Observed Grade

Sandhi shoola

3

Sandhi graha

2

Sparsasahatva

3

Sandhi shotha

3

Objective Criteria :

X-Ray findings :

Objective Criteria

Observed Grade

X-Ray findings

3

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Observation in the present case showed grade 2and

3 changes of Amavata and grade 2 changes of RA.

Clinical picture of a given observed patient with

rheumatoid arthritis showing ulnar drift of the

fingers, resulting in restricted daily activities. b, c

Radiographs of the right hand displaying ulnar

deviation of the fingers, mild to moderate erosions

in the MCP joints, and partial carpal fusion in the

wrist.

Discussion :

 Amavata is a disease described in Ayurveda

with Ama and Vata as principal pathogenic

factors. In the present case showed grade

2and 3 changes of Amavata with the clinical

manifestation which primarily involves

Sandhi Vikriti (joint pathology), expressed

through Sandhishoola (pain), Sandhishotha

(swelling), Stambha (stiffness),

Sparsasahatva (tenderness), Akruti Vikriti

(deformity) and Gati Hani (restriction of

movement).

 X-ray in this case showed grade 2 changes

of RA.

 In contemporary medicine, these features

closely resemble the signs and symptoms of

Rheumatoid Arthritis (RA), a chronic,

systemic autoimmune disorder

characterized by symmetrical polyarthritis,

synovial inflammation, and progressive

joint destruction.

 The present case of observational study

attempted to document and analyses Sandhi

Vikruti objectively and subjectively in

patient of Amavata, correlating with

standard RA clinical parameters.

 Findings from the study reaffirm that

Sandhi shoola, Sandhi Stambha, and Sandhi

shotha were the most consistent and

predominant features, aligning with

Features periarticular osteopenia and

subchondral, Cartilage and bone

destruction, joint deformity, and osteopenia

bony or fibrous ankylosis (joint fusion)

bone destruction.

 Mapping these with Ayurvedic criteria

highlights a strong correlation: Stambha,

shotha with joint space narrowing; and

Akruti Vikrti with deformities and erosions.

This demonstrates that traditional clinical

observations of Sandhi Vikrti are not only

clinically evident but can also be objectively

validated with imaging.

 Thus, the study underscores the importance

of integrating X-ray evaluation into the

assessment of Amavata, bridging classical

Ayurvedic symptomatology with

contemporary diagnostic standards of RA.

Conclusion :

 Study of sandhi vikruti in Amavata is done

by evaluating x-ray with special reference to

Rheumatoid arthritis.

 The present case demonstrates clear

correlation between Ayurvedic description

of Sandhi vikruti and RA with x-ray

grading.

 Radiological findings such as joint space

narrowing, periarticular osteopenia, and

erosions correlate strongly with the

Ayurvedic descriptions of Sandhi Vikriti

(shotha, Stambha, Akrti Vikrti).

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 X-ray evaluation provides an objective tool

to validate subjective and clinical criteria of

Sandhi Vikruti, strengthening the clinical

diagnosis and staging of Amavata.

 Integration of Ayurvedic clinical parameters

with modern radiological assessment

establishes a comprehensive framework for

understanding disease progression and

enhances the evidence base of Ayurvedic

classification of disease.

 Such observations help in bridging

Ayurveda- Amavata and modern

Rheumatology, aiding in diagnosis,

treatment and prognosis.

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Declaration :

Conflict of Interest : None

ISSN: 2584-2757

DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 088

Dr.

Deepali Amale

Inter. J.Digno. and Research

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