Review on etio-pathogenesis and diagnostic approach of Amavata.

: Amavata is a one of the difficult disease for clinicians due to it’s chronicity , incurability, complications, and morbidity. It is chronic disease as it needs repeated hospitalization so it put economic burden on family members and poor quality life. Madhavkara had described etiopathoganesis and clinical presentation of the disease briefly before thousands of years. Amavata is a multisystemic illness can be caused by vitiation of Vata and generation of Ama in the body which has articular as well as extra articular manifestations. Rheumatisim and Amavata have great similarities in the clinical presentation. Amavata can be clinically identical with any of the rheumatic disorder. Diagnosis of Amavata is not difficult in patient when it’s clinical presentation is classical but it may be confusing in a early stage. In Amavata most of the clincical features are nominal and categorical there is wide range of clinical signs and symptoms narrated in Madhavakara So the diagnosis often made by some degree of subjective interpretation of clinician. To make a valid, reliable, consistent diagnosis of Amavata some pathological investigations can be included in the diagnostic criteria of Amavata . This study gives insight into review of diagnostic criteria of Amavata .

Diagnosis of Amavata is not difficult in patient when it's clinical presentation is classical but it may be confusing in a early stage. In Amavata most of the clincical features are nominal and categorical there is wide range of clinical signs and symptoms narrated in Madhavakara So the diagnosis often made by some degree of subjective interpretation of clinician. To make a valid, reliable, consistent diagnosis of Amavata some pathological investigations can be included in the diagnostic criteria of Amavata. This study gives insight into review of diagnostic criteria of Amavata .

Introduction:
In this modern era life has become fast, competitive, mechanical and stressful that one could not follow the daily regimen and seasonal regimen which are explained by Ayurveda. This results in to vitiation of dosha and agnidusti. Mandagni and agnidushti which is impaired status of angi leads to develop various diseases (1) one of them is Amavata . In case of Amavata the clinical features are produced due to Ama, dosh prakopa, and rasadushti which are nominal and categorical so clinicians have to assess these sign symptoms with lots of subjectivity . As there are great similarities are seen in the clinical presentation of the Amavata and Rheumatisim, Amavata can be correlated with rheumatisim. So to make a consistent, valid, reliable diagnosis of Amavata some pathological investigations must be used which are routinely used for the diagnosis of rheumtic conditions. Here attempt has been made to review of the diagnostic criteria of Amavata .

Review of literature:
Description of Amavata as a complete diseases not found in brihattrayi, Amavata has explained by Madhavkara as separate disease in 16 th century AD. Madhavakara has narrated the brief etiopathogenesis and clinical presentation of Amavata . Amavata is a disease of madhyam marga and initially it is disease of rasavaha srotasa but later on it spreads in pranvaha and asthivaha srotasa. The basic root cause of the disease is the Ama. Ama is fermented or putrefide form of first dhatu( adya-rasa), which was not properly digested due to mandagni. (2) . Ama may form in the body by two ways acute formation and insidious formation, when Ama forms in a acute way the diseases like visuchika and alasaka may develops (3) ), but when Ama forms gradually diseases like Amavata can be develops.

Clinical features in association with Dosha:
If pitta becomes the predominant dosha, there could be daha (burning sensation), raga(redness). If vata is predominant pain will be very sever and If kafa is predominant stimit (feeling of being covered with wet clothes), guru (heaviness), kandu (itching sensation) are present (10). Individuals of age group 5-15 yrs are more susceptible to Rheumatic fever, girls are more affected, it is uncommon in age group less than 3yrs. It is common in 3 rd world countries, environmental factors, overcrowding, poor sanitation, poverty also increases the risk of Rheumatic fever. Incidences are more during fall, winter and early spring.
Rheumatoid Artheritis: (RA) is a chronic inflammatory multisystem disease involving articular and extra articular tissues. Cause is still uncertain. Genetic factor, environmental factor, autoimmune factors may responsible for RA. It is characterized by persistent symmetrical arthritis involving peripheral small joints, (14) . Morning stiffness is common PIP (Proximal inter phalangeal), MCP (metacarpophalangeal) joints are frequently affected. Joint deformities ,may develop after persistent inflammation (15) . The prevalence of 0.8% of the population(range 0.3% to 2.1 %) and sex ration of women vs men is 3:1 the onset is most frequent during 4 th and 5 th decades of life (16) .  (17) .  Amavata can be describe as the family of diseases like Rheumatic fever arthritis, Rheumatoid arthritis, seronegative arthritis (Ankylosing spondylitis). There is great clinical similarities are found with rheumatic fever arthritis, rheumatoid arthritis, seronegative arthritis. Common clinical feature is monoarticular or polyarticular, axial or peripheral joint or both joints may involve, they have extraarticular signs and symptoms also, they can produce cardiac abnormality in a different extent. Clincical features of Amavata can be categorize as clinical features due to Ama and agnimandya, clinical features due to doshaprakopa, articular and extra articular. Pathological investigations like RA, ASO, CRP, HLA-B27 are useful for the diagnosis of Amavata . Presence of RA factor in serum gives evidence for Amavat (Rheumatoid arthritis type), ASO titre gives evidence for infection of Group A beta hemolytics streptococi which produces rheumatic fever. In these disease joints and connective tissues www.ayurlog.com E-ISSN: 2320-7329 are affected hence CRP (C-Reactive Protein) will be increase. Human leukocyte antigin-B27 is measured in lymphocytes is useful supporting evidence in a difficult case. It is important to know that may normal people (2% to5% ) carry the gene.HLA-B27 is present in 90% if cases of Ankylosing sypodylitis. (20) Diagnosis