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SPECTRUM OF HOMEOPATHY
Jürgen Hansel
¦ BRYONIA ALBA
6
RHEUMATISM
The most common multi-system illness associated with autoim
mune reactions is chronic polyarthritis or rheumatoid arthritis,
which is primarily chronic. It affects around 1% of the popula
tion. Even though the synovia of peripheral joints are the main
areas affected by the associated chronic inflammation, we fre
quently find extra-articular manifestations. Typically there are
rheumatoid nodules on tendons, bursae or other connective
tissue structures. In rare cases the autoimmune process can
impact blood vessels, the eye or the pericardium.
Difficult prognosis:
From the point of view of homeopathic
treatment it is interesting to note the spontaneous course and
prognosis of the illness. In general we can say that the course of
rheumatoid arthritis is very variable and it is therefore difficult to
give patients an individual prognosis. Most patients experience a
persistent but fluctuating level of illness, which can also progress
in episodes with a varying level of joint deformation. Yet there
are certain parameters that influence the prognosis, such as the
number of affected joints, the radiological evidence of bone
erosion, the level of erythrocyte sedimentation rate (ESR) and
rheumatoid factor and the occurrence of rheumatoid nodules
or severe concomitant illness.
A WINDOW OF OPPORTUNITY
FOR HOMEOPATHY
Around 15% of patients with rheumatoid arthritis have a brief
illness with minimal inflammation and without subsequent
functional impairment – these patients in particular do not dis
play the markers typical of more severe forms of the disease
mentioned above. It is self-evident that successful homeopathic
treatment for rheumatoid arthritis as well as other autoimmune
illness tends to conventionally be explained by referring to this
small group with spontaneous remission.
This could also be true of the case discussed below, which
involves the initial stage of chronic polyarthritis with currently
minor clinical and humoral activity, according to the diagnosis
of the rheumatologist. At such an early stage we do not know
where things are heading. Rheumatologists maintain that the
symptom pattern at the start of the illness has no predictive
power for the development of functional impairment. For we
homeopaths, however, this means that we can more favourably
influence the course of the illness at an early stage compared
to cases in which the patients have already been treated with
cortisone and immunosuppressants.
In the last ten years the conventional medical approaches to
rheumatoid arthritis have dramatically shifted towards early and
aggressive intervention. The former president of the German
Society of Rheumatologists (Deutsche Gesellschaft für Rheuma
tologie), Prof Dr Elisabeth Märker-Hermann, maintained as early
as 2005 at the rheumatology congress: “The new treatment
approaches have been made easier thanks to the availability
of new immunosuppressive medication such as methotrexate,
leflunomide and cyclosporine as well as the TNF-alpha inhibitors.
It has been shown that these disease-modifying anti-rheumatic
drugs (DMARDs) must consistently be used as early as possible
in the window of opportunity to prevent or effectively delay
inflammation, joint destruction and severe functional distur
bances. A recent study demonstrated that the outcome after
five years was significantly worse after just three months' delay
in commencing DMARD treatment."
Due to this new strategy of rapidly deploying aggressive anti-
arthritic treatments, the homeopathic window of opportunity
to pre-empt the immunosuppressives, the TNF-alpha blockers
and other biotechnology treatments has shrunk further and we
need to use it quickly and effectively.
CASE: 60-year-old man with incipient rheumatoid arthritis
The patient comes from the rheumatologist with a suspected
diagnosis of seropositive chronic polyarthritis. The test results
show clear signs of inflammation with an ESR of 41 / 60 mm/h
(normal range for males is 0-22mm/hr) and a CRP of 23.0
mg/l (normal value < 3.0). The rheumatoid factor is 13.0 IU/l
(normal value < 8.9). X-rays of the hands and feet show no
signs of erosion.
Casetaking:
The complaints started gradually three months
earlier with pain and swelling in the left wrist and then the right
too. Later the middle joint of the right ring finger, the metatarsus
of the left foot and the left ankle were also affected. On the
metatarsus there is pressure-sensitive pain where the patient
broke the bone 30 years ago. The pain, which is associated
with stiffness, is worse in the morning and improves during the
day: “By midday I don’t need to limp anymore." The pain in the
wrists bothers him most. It goes from the outside to the inside
with a feeling of someone hammering him with an iron bar or
a wooden stick. The pain goes from the outside inwards and
he feels it most during twisting movements, such as opening or
turning a door handle, which is very painful for him.
He suffers greatly from the restriction caused by the rheumatic
complaints. He used to be very active in house and garden, liked
to chop wood and take long walks but now he feels condemned
to inactivity. He has always been an active person, involved in
various voluntary works in the church and local area, and works
in the caring professions. While he is professionally involved
with the feelings of other people, he is reluctant to discuss his
own feelings, remaining taciturn and matter-of-fact. He says he
does not tend to feel annoyance or aggression and describes
himself as yielding. His aim in life is to “live a holy life without
thinking the grass is greener on the other side.” Complaining
and moaning is not his style. He can put up well with difficul
ties – such as a heart attack several years ago, which he did not
make much of a fuss about.
Emotional hurts:
In the period before eruption of the illness,
there were nevertheless two events that strongly disconcerted
him. The first is that the institution where he has worked for
the last 30 years and which he has been leading for a long time