AYURVEDIC AND PANCHAKARMA-BASED MANAGEMENT OF SANDHIGATA VATA (KNEE OSTEOARTHRITIS): A REVIEW OF RANDOMIZED EVIDENCE
Background: Sandhigata Vata is the Ayurvedic counterpart of osteoarthritis (OA), and knee OA is a frequent reason for the use of Ayurvedic treatment. Objective: To review randomized and related evidence on Ayurvedic treatment, including Panchakarma-type procedures, in knee OA. Methods: Narrative review based on a PubMed search and classical texts. Findings: A multicentre randomized trial in Germany (n = 151) found that a multimodal Ayurvedic treatment produced a larger improvement in WOMAC index at 12 weeks than conventional care, with sustained effects at 6 and 12 months. A systematic review and meta-analysis found large effects for the compound Rumalaya and some evidence for Shunti-Guduchi, whereas for massage, steam therapy and enema no evidence of significant effects was shown against potential bias. A randomized trial of leech therapy (n = 51) showed greater short-term pain relief than topical diclofenac. An equivalence trial (n = 440) showed that two Ayurvedic formulations were equivalent to glucosamine and celecoxib, with asymptomatic SGPT elevation requiring further safety assessment. Conclusion: Randomized evidence supports the benefit of some Ayurvedic interventions in knee OA, but it concerns mainly multimodal care and oral formulations rather than classical Panchakarma. Trials of Basti-based regimens are in progress.