Osteoarthritis (OA), the most common joint disorder causing wear and tear of joints. It is a degenerative, non-inflammatory joint disease which is characterized by degeneration of articular cartilage and exposure of the underlying bone that further leads to inflammation of the synovial fluid and thickening of capsule, leading to pain, stiffness and deformity of the joint. It is mainly seen in elderly individuals in the weight-bearing joints like hip, knee, etc. Knee osteoarthritis is caused by mechanical stress to the knee joint which produces symptoms like joint pain, tenderness, swelling, stiffness, crepitus, erythema, restricted movements, etc.

                 In Ayurveda, Knee osteoarthritis can be compared with Janusandhigata vata. Acharya Charaka considered Sandhigata vata under Vatavyadhi as gatatva (localized) vata. When vitiated vatadosha lodges in janusandhi (marmasthana) it destructs janusandhi and manifests Janusandhigata vata. When it combines with vitiated kaphadosha, there will be Stambha and Gaurava.

                  Various treatment principles have been described in samhitas, among them Agnikarma is said to be superior because the patient treated with agnikarma has less chances of recurrence. Acharya Sushruta has explained that agnikarma can be done in condition of severe pain which occurs in twaka, mamsa, sira, snayu, sandhi, asthi. Agnikarma not just mitigates pain but also underlying inflammation. Acharya Dalhan has described that agnikarma is best treatment for vatakaphaja vyadhi. According to Bhavprakash samhita, agnikarma i.e. dahakriya is specifically mentioned in treatment of sandhigata vata. In Bhaishajya ratnavali, one another kind of agnikarma chikitsa is mentioned with the use of needles. It can be correlated with Viddha agnikarma. Viddha agnikarma is combined procedure of vyadhanakarma and agnikarma.

                    Viddha karma is one of the eight Shashtrakarma mentioned by Acharya Sushruta. where in a sterile procedure, hollow needles are pierced at specific points of the body for pain relief. Viddha Agnikarma blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. [9] These include opioids, which desensitize peripheral nociceptors and reduce pro-inflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal n-methyl-d-aspartate receptor subunit GluNI phosphorylation to inhibit pain.

                        In Sushruta samhita, bloodletting by means of leech (Jaluaka avacharan) has been advocated as most effective method in the management of all inflammatory conditions. During the process of jalauka avacharan, leeches secrete a complex mixture of different biologically and pharmacologically active substances like Hirudin, Calin, Bdellins, Hyaluronidase, Eglins, Factor Xa inhibitor, enzymes, etc. having anesthetic, anti-inflammatory, anti-coagulative, antibiotic, etc. properties which helps to provide significant relief in the management of symptoms of disease and to break the pathogenesis of disease.