EVIDENCE-BASED SIDDHA HERBO-MINERAL/METALLIC FORMULATIONS FOR THE MANAGEMENT OF RHEUMATOID ARTHRITIS (UTHIRAVATHA SURONITHAM): A SYSTEMATIC REVIEW

A. Janarthanan*, R. Prakathi, K. Preyadarsheni, S. Uma Kalyani

Background: Rheumatoid Arthritis (RA), known as Uthiravatha Suronitham in Siddha medicine, is a chronic autoimmune inflammatory disorder affecting synovial joints. Despite advancements in modern medicine, RA management often faces challenges related to efficacy, side effects, and patient compliance, leading to a growing interest in traditional therapeutic approaches like Siddha medicine. Siddha formulations, particularly herbo-mineral/metallic preparations, are traditionally used for their anti-inflammatory, immunomodulatory, and analgesic properties in various chronic conditions. Objective: This systematic review aims to summarize and critically evaluate the available classical Siddha evidence and modern scientific studies on herbo-mineral/metallic formulations used for the management of Rheumatoid Arthritis (Uthiravatha Suronitham). Methods: A systematic literature search was conducted across databases including PubMed and Google Scholar. The search terms "Rheumatoid arthritis," "Herbo-mineral/metallic Siddha formulations," "Uthiravatha suronitham," were used with Boolean operators (AND, OR). Inclusion criteria comprised published journals exploring pre-clinical studies, clinical studies, and standardization studies of Siddha herbo-mineral/metallic drugs against rheumatoid arthritis. Exclusion criteria included narratives, letters, conference papers, dissertations, and articles in languages other than English. The study selection process followed PRISMA 2020 guidelines, involving identification, screening, eligibility, and inclusion phases. Data extraction focused on study characteristics, interventions, outcomes, and findings. Risk of bias was assessed using appropriate tools where applicable, and data were synthesized qualitatively. Results: A total of 68 records were identified (43 from database searching, 25 from other sources like classic literary texts and Materia medica). After screening, 57 records were assessed, and 11 were excluded. Sixteen full-text articles were included in the review, comprising 7 clinical studies, 3 preclinical studies, 5 standardization studies, and 1 literature evidence. Clinical studies demonstrated reductions in RA factors, CRP, DAS 28, HAQ-DI, VAS scores, pain, and swelling, alongside improvements in ROM with formulations like Amirdha Gandhi Kukkil Vallathy, Rasa chenduram, Thirikadugu choornam, Karpoora Chindhamani Mathirai, Seenthil chooranam, Serankottai Nei, Meghasaanthi Chooranam, Amirtharasa Mathirai, Suronitha vatha ennai, and Chandamarutha Chenduram. Preclinical animal studies showed reductions in arthritic swelling, score, joint swelling, and reversal of bone and tissue morphology, with evidence of down-regulation of pro-inflammatory cytokines (TNF-α, IL-1β) and extracellular matrix degradation. Standardized drugs for RA were identified, including Keel Vayu Nivarana Chooranam, Chanthirothaya Tablet, Amirdha Gandhi Kukkil Vallathy, Ratthi Naagara Rasa Mezhugu, and Sanda Marutha Chendooram, among others. Conclusion: The available evidence suggests that Siddha herbo-mineral/metallic formulations hold promising therapeutic potential for the management of Rheumatoid Arthritis (Uthiravatha Suronitham), exhibiting anti-inflammatory, immunomodulatory, and pain-relieving effects. While traditional wisdom and preliminary modern studies support their efficacy, there is a significant lacuna in robust, evidence-based data, particularly large-scale clinical trials. Further rigorous research is warranted to validate their safety, efficacy, and mechanisms of action, paving the way for their integration into broader healthcare.