Amavata as a disease entity is not mentioned in Brihat Tryi. Its first description was given by Madhavkars in Madhav Nidana. Ama and Vata are the main causative factors of the disease, though the vitiation of tridosa also occur along.

Epidemiology

RA occurs throughout the world and in all ethnic groups in all geographical conditions with a higher proportion of patients in western and urban communities. The overall prevalence of RA in Caucasian populations is about 1% with a female to male radio of 3:1. The disease starts most commonly between the third and fifth decades. The increased mortality is mainly due to infection, renal disease, respiratory disease and Rheumatoid arthritis itself.

Aetiology

Madhava Nidana has mentioned the specific aetiological factor for Amavata as follow:
1. Viruddha Ahara ( Unwholessome diet)
2. Viruddha Cesta ( Erroneaus habits)
3. Mandagni (Hypofunctioning of Agni)
4. Niscalata (Sedentary habits)
5. Any type of exertion immediately after taking snigdha ahara.

RA is a multifactorial disease involving genetic and environmental factors including infections. There is a significant association with HLA DR4 and HLA DR1. Disease is triggered by T-Lymphocyte activation in genetically predisposed individuals with defined HLA class II haplotypes. HLA DR1 is the major susceptibility haplotype in Indians.

The serum and joint fluid of the majority of patients with RA contain antibodies specific for the Fc fragment of IgG (Rheumatoid factor). Patients with sub acute Bacterid Endocarditis or with other form of chronic infection develop Rhematoid factors which disappear from the serum after successful treatment of the infection.

Clinical features

Main clinical features can be summarized as

1. Onset is usually insidious but may be acute or systemic
2. Symmetrical joint involment. The affected joints are painful to start with then became swollen, warm, tender with restriction of movement.
3. Rest pains and especially early morning stiffness are characteristic features.
4. Joint deformities commonly seen in hands include buttonhole type, swan neck, Z-deformity and ulnar deviation of fingers.
5. Rheumatoid nodules are found in approximately 20 percent of patients.
6. Late features of systemic involvement are  : 
   Pulmonary  : Fibrosing alveolitis, pleural effusion, pulmonary nodules, Bronchitis, Bronchiectasis.
   Cardiac : Pericarditis, Cardiac Conduction defects includes complete heart block and cardiac murmurs.
   GIT : Peplic Ulceration, haemorrhage and Perforation of bowel

Sadhy Asadhyata (prognosis)

According to Acharya Madhavakara and Bhava Mishra

• Ekadoshajanya Amavata is Sadhya
• Dvidoshaja Amavata is Yapya
• Sannipatika Amavata is Krichchhasadhya.

Treatment

Chikitsa Siddhanta of Amavata

• Langhana
• Ruksha Svedana with Baluka Pottali
• Tikta Katu and Agnivardhaka Dravya.
• Virechanam Snehapanam with Eranda Taila
• Vasti Chikitsa
• Anuvasana Vasti with Vrihatsaindhavadi Taila
• Kshara/Vaitarana Vasti

Aushadhi Yoga

A. Preparation used for external application

1. Swedan :- Sankar Sweda, Baluka Sweda
2. Oleation - Saindhavadi Taila

B. Preparation for internal use

1. Single Drugs :-Shunti, Rasna, Eranda Sneh, Nirgundi, Guduchi
2. Churna :- Hingwadi Churna, Shunti Churna, Panchakola Churna,Viashwanar Churna
3. Guggulu :- Yoga Raj,Singhanad, Vatari,
4. Kwath :- Shunthiyadi, Rasna Saptak, Dashamuldi
5. Vatak :- Ajamodadya vatak
6. Rasa Aushadhi :- Amavatari Rasa, Amavateshvaro Rasa, Vatagajendrasingh Rasa.
7. Ghrita Yoga :- Shunti Ghrita, Amrita Ghrita
8. Virechan :- Haritaki Churna,, Eranda Taila
9. Vasti :- Kashara Vasti, Vaitaran Vasti, Saindhavadi Vasti.

Pathya

Yava, Kulathi, Sanvan, Kodo, Raktashali, Vastuka, Shigru, Varsabhu (Punarnava), Karvellaka, Patolakam, Ardraka, Taptaneeram Lashunam Takrasanskritam, Jangala Mamsa.

Apathya

Dadhi, Matsya, Guda, Ksheera, Upodika, Mashapishtakam, Dushtaneeram Poorvavatam, Viruddhanyashana, Asatmyam, Vegarodham, Jagaran, Vishamashanam, Guru Abhishyandi Padartha.