Sandhigata Vata (Knee Osteoarthritis) in an Ayurveda OPD: Observational Case Series with a Standardised Case-Record Form

Sandhigata Vata, described in the classics as a Vatavyadhi affecting the joints, is commonly correlated with osteoarthritis of the knee — one of the most frequent reasons older adults visit an Ayurveda OPD in India. Patients present with sandhi shoola (joint pain), shotha (swelling), prasarana-akunchana vedana (pain on flexion and extension) and vatapurna driti sparsha (crepitus-like feel on palpation), and are managed with a combination of internal medicines and external procedures such as Janu Basti.

This project is an observational case series, not a treatment trial. The student does not assign any intervention. Fifteen consecutive patients diagnosed with Sandhigata Vata of the knee by the OPD physician are documented with a standardised case-record form (CRF) that combines classical examination (Ashtavidha and Dashavidha Pariksha, Prakriti assessment) with validated modern outcome measures — WOMAC index, VAS for pain and goniometric knee range of motion — at baseline, week 2 and week 4, while patients receive whatever treatment their physician prescribes.

The report follows the CARE guidelines for case reporting, uses descriptive statistics and exploratory pre–post comparison, and is careful about what a case series can and cannot show: it describes a patient group and its course under routine care, generates hypotheses, and trains the student in consistent clinical documentation — but it cannot prove that any treatment works.

Abstract

An observational, prospective case series of fifteen consecutive patients with Sandhigata Vata of the knee attending the Kayachikitsa OPD of a teaching hospital. Using a standardised case-record form, the student will document demographics, Prakriti, classical examination findings, radiological grade where available, treatment prescribed by the treating physician, and outcomes (WOMAC, VAS, knee flexion range) at baseline, two weeks and four weeks. Data will be summarised descriptively; exploratory pre–post changes will be tested with the Wilcoxon signed-rank test and interpreted cautiously.

Introduction

The Charaka Samhita describes Sandhigata Vata in Chikitsasthana chapter 28 (Vatavyadhi Chikitsa) as a condition in which vitiated Vata lodged in the joints produces swelling that feels like an air-filled bag and pain on movement. Its presentation overlaps closely with knee osteoarthritis, which is common in Indian adults above fifty. Ayurveda teaching hospitals see many such patients, but case documentation is often inconsistent — different examiners record different features, and outcome measures vary.

Literature gap

Published Ayurveda studies on Sandhigata Vata are mostly small interventional trials with varied outcome tools. Few student-level studies document routine OPD patients systematically with a standard CRF and validated scales, and few describe the full spectrum of prescribed treatments in real practice.

Proposed work

• Develop and pilot a CRF combining classical and modern assessments.
• Enrol consecutive eligible patients after written informed consent.
• Record outcomes at three visits without influencing treatment.
• Report per CARE guidelines with a descriptive summary table.

Feasibility

• Operational: the OPD sees several knee-OA patients daily, so fifteen can be enrolled within four weeks.
• Technical: WOMAC and VAS are simple; a goniometer is available in the department.
• Economic: only printing and stationery costs.
• Ethical: Institutional Ethics Committee approval and written informed consent in the patient's language before enrolment.

Patients with Sandhigata Vata of the knee are among the most common in Ayurveda OPDs, yet the way they are documented varies from one physician and one student to another. Classical examination findings, disease severity and follow-up outcomes are often recorded in free text, without validated scales, making it impossible to describe the patient population, compare cases or generate sound hypotheses for future trials.

Undergraduate BAMS students rarely get structured training in prospective clinical documentation, consent and ethics processes. There is a need for a standardised case-record form that integrates classical Pariksha with validated outcome measures, and for a systematic observational case series that uses it to document the clinical profile and short-term course of such patients under routine care — without making claims about treatment effectiveness that a case series cannot support.

In scope

• Adults aged 40–70 with knee pain diagnosed as Sandhigata Vata by the OPD physician.
• Standardised documentation at three visits over four weeks.
• Descriptive and exploratory statistics.
• Adverse-event recording and reporting.

Out of scope

• Assigning, changing or comparing treatments (this is not a clinical trial).
• Control group or randomisation.
• Laboratory investigations beyond those ordered in routine care.
• Long-term follow-up beyond four weeks.

Study design: prospective, observational, single-centre case series.

Setting: Kayachikitsa OPD of an Ayurveda teaching hospital (fictional: Sri Sharada Ayurveda Hospital), under the supervision of a faculty guide.

Sample size justification: a case series is descriptive and does not test a hypothesis, so formal power calculation does not apply. Fifteen consecutive patients is feasible within the enrolment window and sufficient to describe a clinical profile and pilot the CRF; this is stated as a limitation.

Inclusion criteria: age 40–70 years, either sex; knee pain for ≥ 3 months; clinical diagnosis of Sandhigata Vata by the OPD physician with at least two of sandhi shoola, shotha, prasarana-akunchana vedana, vatapurna driti sparsha; willing to give written informed consent and attend follow-ups.

Exclusion criteria: inflammatory arthritis (rheumatoid, gout), knee trauma or surgery in the past six months, intra-articular injection in the past three months, uncontrolled diabetes or hypertension, pregnancy, inability to complete questionnaires.

Instruments: CRF with demographic data, Prakriti assessment proforma, Ashtavidha and Dashavidha Pariksha, local knee examination; WOMAC index (validated regional-language version where available); 10 cm VAS for pain; universal goniometer for active knee flexion; Kellgren–Lawrence grade if an X-ray exists in the record.

Procedure: screen OPD patients daily; explain the study and obtain consent; complete baseline CRF; record treatment exactly as prescribed; repeat outcome measures at week 2 and week 4 (± 3 days); record adherence and any adverse event.

Statistical analysis: SPSS/Excel; mean ± SD or median (IQR) for continuous data, frequency (%) for categorical data; exploratory change from baseline to week 4 by Wilcoxon signed-rank test, reported with the explicit caution that improvement cannot be attributed to any treatment.

Ethics: Institutional Ethics Committee approval before enrolment; written informed consent in Kannada/Hindi/English as preferred; confidentiality through study codes; compliance with the ICMR National Ethical Guidelines (2017); adverse events reported to the institutional pharmacovigilance cell under the national programme for ASU&H drugs.