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Date posted: October 17, 2011

  Result of the use of the Homeopathic combinations and short term low dose prednisolone for the treatment of patient with gonartrosis and on potential mechanisms of action Homeopathic Medicines

N. Djumaeva1,2*, L.Djumaeva2
 1Scientific Research Institute of Virology, Muradow Street,7a,100193 Tashkent, Uzbekistan;
2 Medical Centre of Alternative Medicine,  Kary Nyasow street,5,Tashkent, 100000, Uzbekistan.
Corresponding author: Djumaeva Naylya: 56/21,Center-2, Tashkent,100000,Uzbekistan, +99897 465-53- 04(mob),+99871 23736 93(office), dr.djumaeva@gmail.com

Abstract.
Gonarthrosis or osteoarthritis of the knee joint (OA) is a degenerative and dystrophic process developing in the hyaline cartilage of the knee joint and resulting in damage to the cartilage and replacement of the defect by bone tissue that leads to the joint deformation. It is a common disease of joints leading to disability of approximately 10 % of the population who are over 55 years old.(1) Treatment generally involves a combination of exercises, lifestyle change and analgesics. If pain becomes debilitating, joint replacement surgery may be used to improve the quality of life.(2)Unlike the traditional medicine, homeopathy assists in pain relief or slowing  down the degenerative process, but cannot cure the disease completely.(3) We present a case of patient with OA who was treating successfully with the use of homoeopathic medicines in KUF – series and short term  low dose of prednisolone. To date, after 12 months, there has been no clinically evident exacerbation  of the disease.

Case reports
In October 2010, a 63-year old Caucasian female patient presented with constant pain in the right knee joint, at night in particular. It impeded the patient’s sleep, caused difficulties in walking, mainly in the morning or after long sitting; stiffness, pain and cracking in the affected knee joint in movements, restriction of bending and unbending the joint. The patient limped when walked and had to use a walking cane .

At the age of 16 years the patient sustained an injury (rupture) of the meniscus of the right knee joint After that the patient suffered inflammation of the right knee joint which constantly was treated by a course of paracetamol, NSAIDs, kenalog (topical steroid) into the knee joint, physiotherapy procedures on the knee joint. All these gave merely a temporary pain relief. In 1999 the surgical treatment of the joint was offered for the first time; however, the patient refused from the surgery. Since that time she had been using a walking cane.

The examination revealed the signs of the knee deformation, extensive contraction of the joint.  Also a painful area in the interior part of the joint, in particular in the area of the hip condyles, tibia and joint space was revealed. The patello-condilar symptom was positive. OA symptoms were evaluated by WOMAC scores, mobility by recording her walking performance (treadmill). Before treatment the patient had 8/10 pain in the right knee joint which limited her mobility using 4WF. The range of movement in knee flexion was 80 degrees and knee extension up to 92 degrees. On XR, there were degenerative changes consistent with osteoarthritis.  The patient’s body temperature was normal.

The patient was examined by the electroacupuncture diagnosis by Voll with the use of “medicine testing” technique to evaluate the functional status of the knee and other joints and select the homoeopathic medicines to our patient. (4)

When examining our patient, such  organ preparations as the interlumbar joints, subtalar, talocalcaneonavicular  joints and ankle, cervical intervertebral disks,  meniscus,  knee joint cartilage,  connective tissue  and the following homoeopathic medicines: Russ Toxicodendron, Pirogenium, Phytolaca, Belladona, Lachesis were tested on the meridian of Joints Degeneration (Voll). Organ preparations represent the complexes consisting of different potencies of the same homoeopathic remedy; they are the so-called KUF-series which are produced by various firms such as: WALA-Heilmittel GMBH, Staufen-Pharma GMBH&CO.KG,etc.(5)The homeopathic medicines (ampules) consisted of the following homeopathic  potencies: 6 x, 6cH, 12cH, 30cH, 100cH ,200cH  and a very careful assessment was made  for their selection on the basis of in-depth  interviewing of the patient. At the same time, the daily dose of prednisolone (tab) equal to 7.5 mg was tested on the Joint Degeneration (Voll) and Triple meridians.(6) Then the ampules of the tested homoeopathic medicines and organ preparations were opened and transferred into the homoeopathic globules by the saturation method in accordance with the rules of the Homoeopathic Pharmacopoeia. After that, the single and daily doses of homoeopathic globules were tested by the “medicine testing” technique and prescribed to the patient together with the selected dose of prednisolone. The latter was administered according to the standard protocol of corticosteroid therapy with a decrease in the dose and the subsequent therapy cessation.

As the practice has shown, in the course of the therapy, the doses of the homeopathic globules were to be decreased gradually. So, while in the beginning of the treatment course, the patient was receiving seven globules of the medicines three times a day, in the subsequent period, the dose has decreased to two globules of the medicines twice a day. The homoeopathic globules and prednisolone were withdrawn simultaneously. The tested therapy course dose of prednisolone constituted of 122.5 mg  and lasted for 29 days. By the end of the treatment pain decreased to 2/10 in right knee joint which allowed her to mobilize independently. The range of movement in knee flexion increased to 110  degrees and knee extension up to 120 degrees. The  WOMAC score decreased from 130 points before treatment to 57 points after treatment  and  walking distance in the treadmill test was prolonged from 68 m at the start to 177 m after the treatment. The patient practically stopped using her walking cane, taking it only for a long distance walk. At present the patient is being followed-up.

Discussion.
Homoeopathy successfully treats various conditions associated with joint pathology  using both one-component and complex preparations. (7) In our case we have similarly applied therapy by complex homoeopathic medicines, too. However, the medicines were preliminary individually selected on the basis of interviewing of our patient and the “medicine testing” technique and then the tested medicines were transferred from the liquid medicinal forms into homoeopathic globules.

In our earlier published papers, we have demonstrated the possibility of therapy of some diseases with homoeopathic preparations in KUF-series, assuming that the positive effects of complex homoeopathic medicines might be associated with their influence on the intracellular bound water (8).

Intracellular water is known to present in cells in two conditions: bound and free (9). According to K.Trincher,  the  specific reactions of the cells  to external exposure have various forms of nonspecific reacting because all, or nearly all, intracellular water is bound and has a certain structure, and the course of biochemical processes in a cell is linked with a change in structurally organized or bound water. (10) G. Ling believes that an ion – water – protein complex is an elementary structural unit of a cell where protein plays a key role. Molecules of protein have a linear form with geometrically correct alternation of peptide bonds (with oxygen as the negative dipole and nitrogen as the positive one) and are an ideal matrix thanks to which intracellular water is structured. The dipole charges of all its peptide bonds, co-operating with dipole water molecules, orient them in space and limit their mobility. The first layer of the water molecules, oriented and bound by protein, is in turn a matrix for the following water layer, etc. As a result, the multilayered water “fur coat” is formed around the protein.(11) E Andronikoshivili had studied the properties  of the water inside the cancer cells on the base of NMR spectroscopy and found  that  the time of spin-lattice relaxation in cancer  cells  is changed ; the amount of water bound to DNA is also increased, the thermodynamic characteristics of the system DNA + bound water are changed. The time of protons’ relaxation is also changed in water solution of healthy tissues of patient with cancer.(12)  Accordingly, restoration of the bound intracellular water structure carried out with homoeopathic medicines, in our opinion, can lead to restoration of normal biophysical and biochemical processes in the body cells. This seems to be the mechanism of regulating action of homoeopathic medicines.

The most widespread hypothesis to explain the mechanism of action of homeopathic dilutions refers to ‘memory of water’ effects and   structure of liquid water. R. Roy concludes  that during the process of homeopathic “successions,    water molecules clusters of different shapes and sizes are formed in the water, and they have a very firm structure.(13) We believe that when such artificially created water clusters in the form of various homeopathic preparations are introduced  to a human body, the protein molecules recognize the necessary clusters of the water, which they need for restoration of the normal structure of the bound intracellular water  damaged by a pathological process, and draw them. Using complex homeopathic medicines, in our opinion, results in the condition, when a considerably greater variety of water clusters is introduced into the patient’s body, which in turn provides a wider range of choice for the body cells during the certain periods of their functioning, that reduces therapy duration.

In our opinion, the mechanism of changes in the health condition of the volunteers, who took part in the research conducted by Hahnemann, can be described as follows: administering various homoeopathic medicines into healthy volunteers’ body, he artificially created (modeled) changes in the structure of the normal bound intracellular water, which in turn led to the development of various symptoms of disease in volunteers. It should be stressed that these were disease symptoms rather than a true pathological processes. In homoeopathy, people sensitive to one medicine are known to have a lot of similarities among them –habits, taste preferences, predisposition to certain illnesses, heredity profile. This is a group of so-called constitutional homoeopathy. Apparently, this phenomenon can be explained in the following way: if ab extra, it is a set of symptoms intrinsic to a homoeopathic medicine (the so-called pathogenesis of a homoeopathic medicine), ab intra it is a set of identical clusters of the bound intracellular water in various people. Therefore, it is suggested to be this way that homoeopathic medicine  also creates patterns of various conditions in healthy humans because, having been introduced into the body, they change the structure of the normal  bound intracellular water and thus form a “virtual” illness. In other words, there are symptoms but there is no true illness. Hence, it appears that   there is a certain relation between symptoms of disease and the altered structure of the bound intracellular water of the human body.

The following metaphor can illustrate all of the above mentioned  about the  intracellular  water.  For millions  of years in winter the nature has been tatting fancifully a lace of a fantastic show when snowflakes are flying turning slowly to fall to the ground.  All of them are fantastically beautiful, with their various shapes and sizes. They seem to say :“Look at us -  we all are what you, yourselves, consist of. We are similarly different and wonderfully beautiful like you!” Don’t you think,  that snowflakes consisting of clusters of water with different sizes  and forms   can serve  as  an model of intracellular bound water clusters which compose the  cells of all the living substances  on the planet Earth?

Now some words about the prednisolone therapy we used. In the early forties of the past century, Hench was the first one to find out a positive effect of corticosteroids on the course of rheumatoid arthritis. (14) The initial hope that steroids might dramatically alter the long term course of the disorder gave way to recognition of the serious adverse effects that accompany high dose treatment. The research were conducted to study the effects of smaller doses of steroids. The data from randomized controlled trials  of less than 2 weeks’ duration of oral low dose prednisolone (15mg daily) consistently show improvement in measures of pain and tenderness compared to placebo and nonsteroidal anti-inflammatory controls.(15) Several  controlled studies showed that glucocorticoids in dosages between 7.5 mg/day and 10 mg/day reduced the progression of joint damage, but other studies using 7.5 mg/day did not confirm an effect on radiographic progression (16-19). In one two-year randomized trial, it was shown that  prednisolone at 7.5 mg/day added to the initial DMARD retarded the progression of radiographic damage after 2 years in patients with early RA, provided a high remission rate, and was well tolerated.(20) However, we did not find any information regarding usage of the low doses of steroid s(orally) in treatment of patients with  ОА. The case we described suggests successful using  a short term low dose prednisolone for OA patient.

In conclusion, osteoarthritis can be successfully treated with the combined use of homoeopathic medicines in KUF-series which include organ preparations and homoeopathic  medicines  and a short term low dose of prednisolone. The administered therapy resulted in stabilization of the pathologic process, improvement of the patient’s condition and her quality of life.

Competing interests
The authors declare that they have no competing interests.

Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor–in Chief of this journal.   

References
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2. Jordan K M, Arden N K, DohertyM, Bannwarth B, Bijlsma JWJ,  Dieppe P et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report or a Task Force of the Standing Committee for International  Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-1155.

3. Long L, Ernst E. Homeopathic remedies for the treatment of osteoarthritis: A systematic review. Br Homeopath J. 2001; 90:37-43

4. Voll R.The phenomenon of “medicament testing” in the electro-acupuncture according to Voll. Amer J Acupucture  1980;11: 106-116.

5. Voll R. Leitfaden zur Anwendung von KUF-Reihen bei der EAF-Testung und Therapie. Goppingen: Staufen-Pharma, GmbH.1988; 42.

6. The Method of Determining   the Daily   Dosages of Pharmacologic  Medicines. Patent of Uzbekistan, 2006. № IDP 03033.

7. Gibson G, Gibson SLM, MacNeill AD, Buchanan WW. The place for non-pharmaceutical therapy in chronic rheumatoid arthritis: A critical study of homœopathy Brit Hom J. 1980, 69(3): 121-133.

8. Djumaeva N, Djumaeva L, Akhundjanova G. Successful treatment of Takayasu Arteritis in the practice of integrative medicine – case report”.  JSHO 2011;10:5-7.

9. John T H, Bruce M K. Netter’s Atlas of Human Physiology. Teterboro,N.J: Icon Learning Systems, 2002.

10. Trincher K.S, Dudoladov A.G. Spin-lattice interaction of water and protein membranes in cell metabolism .J Theor Boilogy, Russia,1972;3:557-576.

11. Ling G N.Revolution in the Physiology of the Living Cell .Krieger Publishing Company, Malabar, Florida, 1992.

12. Andronikoshiwili E.I. Malignization and change in some physical-chemical characteristics of bio-macromolecules and supra-molecular structures. J  Biophys , Russia, 1987; 32: 782-799.

13. Bell I, HooverM P ,Roy R, Tiller W A.The structure of liquid water; Novel insights from materials research; Potential relevance to homeopathy. Materials Research Innovations 2005; 4: 577-608.

14. Hench PS, Kendall EC, Slocumb CH, Polley HF.Effects of cortisone acetate and pituitary ACTH on rheumatoid arthritis, rheumatic fever and certain other conditions: A study in clinical  physiology. Arch Intern Med 1950; 85:546-666.

15. Gotzsche PC, Johansen HK. Meta-analysis of short-term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis. BMJ 1998; 316:811—818.

16. Kirwan JR and the Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med 1995; 333: 1426.

17.  Van Everdingen AA, Jacobs JW, Siewertsz van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med 2002; 136: 112.

18. Paulus HE, DiPrimeo D, Sanda M, Lynch JM, Schwartz BA, Sharp JT, et al, for the Long-Term Etodolac Study Investigators. Progression of radiographic joint erosion during low dose corticosteroid treatment of rheumatoid arthritis. J Rheumatol 2000; 27: 16327.

19. Hansen M, Podenphant J, Florescu A, Stoltenberg M, Borch A, Kluger E, et al. A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis: clinical benefits and skeletal side effects. Ann Rheum Dis 1999; 58: 7138.

20. Svensson B, Boonen A, Albertsson K, van der Heijde D, Keller C, Hafström I. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum. 2005 Nov;52(11):3360-70. 

Comments

2 Responses so far.

  1. Dear Author i, No need of steroids(immuno-suppressants)in treating OA cases may be of any degree.
    Correct homoeopathic med has the capacity of curing/treating such cases.

    • Naylya Djumaeva says:

      Dear Dr.S.S.Vithal,
      In this case we have descibed the usage of low doses of steroids, whose effects are differ from the high doses of theirs.This question now is in very great concern.

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