Osteoarthritis (Waja-ul-Mafasil) is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins, cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular fibrosis. Osteoarthritis is the commonest of all joint diseases and the knee is the commonest of the large joints affected by osteoarthritis. Indians have increased knee osteoarthritis as compared to western people. The reported prevalence of osteoarthritis in rural India is 5.8%. According to World Health Organization (WHO), Osteoarthritis is second commonest musculoskeletal problem in the world population (30%) after back pain (50%). Ninety percent of all people have radiographic features of osteoarthritis in weight bearing joints by age 40. The main presenting symptoms of osteoarthritis are pain and functional restriction..

The current treatment of osteoarthritis is aimed at minimising pain, optimizing function and reducing disability using a combination of non pharmacological, pharmacological and surgical therapies. Non pharmacological therapies include patient education and joint protection measures. Pharmacological management includes Non-steroidal anti-inflammatory drugs (NSAIDs) which are used to treat pain and inflammation in OA. Their use is limited by their gastric and renal toxicity, especially in the elderly. Intra-articular steroids are employed in patients with knee OA who have effusion. Repeated steroid injections may lead to more cartilage damage. Surgical management includes joint replacement in end stage joint disease. Other surgical therapies available are with varying grades of efficacies.

Thus, no curative therapy exists for osteoarthritis. In view of high prevalence, obnoxious side effects of pharmacological treatment and high cost of surgical interventions with less effectiveness of all treatment modalities, there is need for search of safe, economic and effective treatment in Unani system of Medicine for osteoarthritis, particularly of a knee joint. Various treatments are described in Unani Literature for Waja-ul-Mafasil. Hakim Muhammad Azam Khan mentioned Qai, Munzij wa Mus’hil-e-Balgham in management of Waja-ul-Mafasil. Further he mentioned Dalk with Roghan-e-Chobchini.

This open, pre and post clinical study was started after ethical clearance from IEC. Patients fulfilling inclusion criteria were enrolled in the study from OPD and IPD of NIUM Bengaluru after obtaining written informed consent. 30 patients completed the trial. Qai was induced on the 1^st day of treatment by Joshanda of Tukhm-e-Shibt and Aslussoos mixed with honey. From 2^nd day, Joshanda Munzij-e-Balgham (containing Aslussoos, Tukhm-e-Kasni, Maweez Munaqqa, Tukhm-e-Kharpaza, Tukhm-e- Khatmi, Suranjan Shireen, Boozidan, Anisoon, Badranjboya, Parsiyaoshan, Favvah) was administered till 15^th day of treatment. Joshanda Mus’hil-e-Balgham, containing Barg-e-Sana, Turbud, Zanjabeel, Barang Kabli, Maghz Khayar Shambar, was given on 13^th and 15^th day along with Joshanda Munzij-e-Balgham. From 16^th day onwards, Dalke Layyin Kaseer was started with Roghan-e-Chobchini till 30^th day. Patients were assessed at baseline, 15^th day and 30^th day using objective parameters KOOS and VAS. Safety parameters were assessed before and after the study. The Statistical software namely SPSS 18.0, and R environment ver.3.2.2 were used for the analysis of the data. Student t test (two tailed, dependent) has been used to find the significance of study parameters as well as safety parameters.

It was observed that VAS score was reduced significantly after treatment. VAS score in right knee was reduced from 6.86±1.48 to 3.45±1.40. Result was found statistically significant (p < 0.001). VAS score in left knee reduced from 6.79±1.50 at baseline to 3.17±1.10 after treatment. The mean difference was highly significant (p<0.001)

Assessment of symptoms, pain, ADL, sports/recreation and Quality of life was done by using KOOS which showed significant improvement. Symptoms improved significantly from 44.38±17.86 to 69.07±12.36 in the right knee and from 46.66±16.65 to 71.00±11.07 in the left knee after the treatment. Pain in the right knee improved from 37.83±18.09 to 66.83±13.56 and in the left knee it showed significant improvement from 38.79±19.25 to 67.76±14.20. ADL improved significantly from 41.00±17.06 to 64.31±16.20 in right knee and also improved significantly from 41.31±17.07 to 66.00±14.48 in left knee. Sports/recreation subscale score improved significantly from 32.24±16.93 to 63.28±11.28 in right knee and from 33.28±18.63 to 63.45±12.33 in the left knee, which was strongly significant statistically. Quality of life score improved significantly from 24.93±13.68 to 59.30±12.94. 

Properties of various ingredients of the test formulation strongly suggest the potential to treat the sign and symptoms of Waja-ur-Rukba and, therefore, validated their efficacy in this trial. The study involving Qai, Munzij wa Mus’hil-e-Balgham and Dalk with Roghan-e-Chobchini was found effective in treating Waja-ur-Rukba (knee osteoarthritis).