A.N. Gogate, M.D.
Hon. Asst. Physician, J.J. Hospital, Bombay, India.

Painful lesions in articular and periarticular structures are frequently encountered in clinical practice. Collectively grouped under the heading of Rheumatic, Rheumatoid and allied conditions and lately as collagen diseases, their clinical picture, severity and course differ widely. However, obscure aetiology, frequent recurrences, incapacitation and permanent crippling are seen as their common features.

The exact localisation of the lesion, its nature and its causation are primary steps in the management of these conditions. Where a specific aetiology like gonococcal or tuberculous can be worked out, the matter is relatively simple in as much as the requisite specific treatment can be administered with excellent results provided the case is seen in its early stages before irreversible damage has been done.

It is, however, the vague and obscure cases where specific aetiology cannot be worked out that the clinician finds himself in unhappy situation. The management of such cases is then on general symptomatic and palliative lines. Obvious or suspected nutritional, endocrine and vitamin deficiencies are corrected with the idea of building up of general resistance. one of the factors often blamed is focal sepsis and a thorough search is made for septic foci and if found, the same are eradicated with variable and sometimes very disappointing results. Physical and prosthetic measures, analgesics and anti-inflammatory drugs like salicylates iodides, gold and more recently ACTH and cortisone are advised. These measures though they cause remissions do not show lasting results in most cases.

In indigenous medicine some of the remedies used to the same purpose are Balsamodendron mukul (Guggul), ashes or bhasma of pure minerals like gold, silver, tin etc., or natural substances like Shilajeet which is rich in iron and Shankha bhasma which is rich in calcium. Their action is predominantly building up of general body resistance, restoration of the normal physiological functions of vital organs especially the bone marrow (Reticulo-endothelial system), liver and the kidneys and the excretion of toxic metabolic products like uric acid. Rumalaya and Septilin tried in this series are combinations of these drugs, the former having predominantly anti-inflammatory action and the latter is mainly anti-infective especially in the upper respiratory tract infections like tonsilitis, sinusitis etc. which are common sites of focal sepsis.

The combination was tried in 30 different cases in most of which the diagnosis was confirmed radiologically. The dosage used was 1-2 tablets each of Rumalaya and Septilin four times daily. The results of this study are put up herewith in the form of a table. The cases included in this series consist of 10 acute and 20 chronic conditions. The overall response was complete relief in 16 cases, partial relief in 11 cases and complete failure in 3 cases. The criteria of response were relief from pain, restoration of mobility, reduction in joint swelling, supplemented in suitable cases by improvement in laboratory findings like sedimentation rate, leucocyte count etc.

There were 10 acute cases in this series comprising 2 traumatic conditions, 2 non-specific polyarthritis, 1 thrombophlebitis, 1 Bell’s palsy, 3 fibromyositis and 1 acute rheumatic fever. There was complete relief in all the cases which on an average started within 2-3 days of treatment and was maximum by 8-10 days of treatment. This response is comparable with that of salicylates tried under similar circumstances. Some of the observations made in the treatment of these conditions are worth a mention.

Case No. 5 was a patient treated at the hospital for coronary thrombosis. He developed, as a complication, thrombo-phlebitis in the right arm which failed to respond to the standard local and internal remedies. with these drugs there was rapid relief from pain and this was noticeable about 4 days from starting treatment and complete by 4 weeks. Case No. 10 of acute rheumatic fever did not respond to usual salicylate treatment given in full doses. There was rapid relief in about 10 days with the administration of these drugs. Cases Nos. 7-8-9 of common ‘catches’ showed excellent and quick response to these drugs.

The combination was tried in 20 chronic conditions consisting of 7 cases of Rheumatoid arthritis, 7 cases of osteo-arthritis, 2 of sacro-Iliac arthritis and 4 miscellaneous conditions as shown in the table. Septic foci were noticed in a large number of these patients and most of them had shown either temporary or negligible improvement with the standard treatment including eradication of septic foci like extraction of teeth etc. With the use of Rumalaya and Septilin the following observations were made :

Out of the 7 rheumatoid arthritis cases 2 were seen early and showed complete improvement. Four cases of longer standing showed partial improvement while the remaining one case was advanced with deformities, contractures etc. and failed to respond to therapy.

In osteo-arthritis, out of the 7 cases 5 showed partial recovery by way of relief from pain, the remaining 2 being complete failure. It is possible that this medication acts by improving the secondary infection and spasm in osteo-arthritis without having any effect on the degenerative condition per se.

Both cases of sacro-Iliac arthritis showed partial improvement. In the remaining 4 miscellaneous cases the response was either partial or complete as shown in the table.

On an average, improvement was noticeable in about 3 weeks of treatment and was maximal by about 6-8 weeks in chronic conditions. There were no recurrences or relapses during variable periods of upto 6 months, up to which time it was possible to follow the patients in this preparatory study.

Thirty cases of acute and chronic rheumatic and allied disorders were treated with Rumalaya and Septilin. The overall response was satisfactory, there being only 3 cases of complete failures. In acute cases relief was rapid in about 10 days whereas in chronic conditions a long trial of about 6 weeks seemed necessary. The preparations lack any action in advanced cases with contractures, deformities etc., as also in degenerative conditions. Toxic effects were not noted in a single case. These preparations should prove a useful, safe and promising tool in the treatment of these conditions. However, longer follow ups are necessary before authentic conclusions about their long term utility can be made.

I have to thank the Superintendent, J.J. Hospital, for permission to report these cases and my chief Dr. J.G. Parekh, M.R.C.P., for his valuable guidance in the preparation of this report. I also thank the Himalaya Drug Co., for liberal supplies of Rumalaya and Septilin used in this clinical trial.