This is an outdated version published on 28-09-2026. Read the
most recent version.
Research Articles
Early Access
Preliminary efficacy of shallakyadi capsules (Ayurvedic intervention) on post-chikungunya chronic inflammatory rheumatism: Single-arm, open-label clinical trial
Department of Kayachikitsa, Institute of Teaching and Research in Ayurveda, Jamnagar 361 008, Gujarat, India
Department of Dravyaguna, Institute of Teaching and Research in Ayurveda, Jamnagar 361 008, Gujarat, India
Department of Kayachikitsa, Institute of Teaching and Research in Ayurveda, Jamnagar 361 008, Gujarat, India
Clinical Biochemistry Laboratory, Institute of Teaching and Research in Ayurveda, Jamnagar 361 008, Gujarat, India
Kriya Sharira, Institute of Teaching and Research in Ayurveda, Jamnagar 361 008, Gujarat, India
Abstract
Over 40 % of chikungunya (CHIK) patients develop arthritic manifestations resembling amavata disease as described in Ayurveda. Therefore, a clinical trial was planned to establish the efficacy and safety of the Ayurvedic medicine shallakyadi capsules on post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR). A single-centre, open-label, single-arm, clinical trial was conducted on the participants with pCHIK-CIR. A total of 90 participants were treated with shallakyadi capsule, in a dose of two capsules twice daily (each of 500 mg), orally before lunch and dinner for two months. The primary outcomes were disease activity score (DAS-28) and clinical disease activity index (CDAI), while secondary outcomes were health assessment questionnaire (HAQ) and changes in clinical symptoms. Mean changes were calculated using paired t-tests (for continuous data) and the Wilcoxon signed-rank test (ordinal data). A significant improvement was observed in the changes between before and after treatment for the primary and secondary outcomes, viz. DAS-28 (mean difference (MD) ± standard deviation (SD): 1.27 ± 0.74, p < 0.001), CDAI (MD ± SD: 8.85 ± 4.34, p < 0.001), HAQ (MD ± SD: 13.73 ± 5.71, p < 0.001). In contrast, changes in C-reactive protein (CRP) (MD ± SD: 1.17 ± 9.3, p = 0.25) and erythrocyte sedimentation rate (ESR) (MD ± SD: 2.1 ± 13.1, p = 0.14) were statistically insignificant. No adverse drug reactions were observed. Shallakyadi capsule improves disease activity, quality of life and symptomatic relief with no adverse effects in pCHIK-CIR cases during a two-month treatment regimen. The study demonstrates the feasibility and potential of Ayurvedic treatment for post-chikungunya arthritis, underscoring the need for larger, well-designed multicentre trials.
References
- 1. Wimalasiri-Yapa BM, Stassen L, Huang X, Hafner LM, Hu W, Devine GJ, et al. Chikungunya virus in Asia-Pacific: A systematic review. Emerg Microbes Infect. 2019;8(1):70–9. https://doi.org/10.1080/22221751.2018.1559708
- 2. LaBeaud A, Bashir F, King CH. Measuring the burden of arboviral diseases: The spectrum of morbidity and mortality from four prevalent infections. Popul Health Metr. 2011;9(1). https://doi.org/10.1186/1478-7954-9-1
- 3. Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, et al. Chikungunya fever: Epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res. 2013;99(3):345–70. https://doi.org/10.1016/j.antiviral.2013.06.009
- 4. Rodríguez-Morales AJ, Cardona-Ospina JA, Fernanda Urbano-Garzón S, Sebastian Hurtado-Zapata J. Prevalence of post-chikungunya infection chronic inflammatory arthritis: A systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2016;68(12):1849–58. https://doi.org/10.1002/acr.22900
- 5. Javelle E, Ribera A, Degasne I, Gaüzère B, Marimoutou C, Simon F. Specific management of post-chikungunya rheumatic disorders: A retrospective study of 159 cases in Reunion Island from 2006–2012. PLoS Negl Trop Dis. 2015;9(3):e0003603. https://doi.org/10.1371/journal.pntd.0003603
- 6. Bouquillard É, Combe B. A report of 21 cases of rheumatoid arthritis following chikungunya fever: A mean follow-up of two years. Joint Bone Spine. 2009;76(6):654–7. https://doi.org/10.1016/j.jbspin.2009.08.005
- 7. Amaral JK, Bingham CO 3rd, Schoen RT. Successful methotrexate treatment of chronic chikungunya arthritis. J Clin Rheumatol. 2020;26(3):119–24. https://doi.org/10.1097/RHU.0000000000000943
- 8. Chopra A, Anuradha V, Ghorpade R, Saluja M. Acute chikungunya and persistent musculoskeletal pain following the 2006 Indian epidemic: A 2-year prospective rural community study. Epidemiol Infect. 2012;140(5):842–50. https://doi.org/10.1017/S0950268811001300
- 9. Thiberville SD, Boisson V, Gaudart J, Simon F, Flahault A, de Lamballerie X. Chikungunya fever: A clinical and virological investigation of outpatients on Reunion Island, South-West Indian Ocean. PLoS Negl Trop Dis. 2013;7(1):e2004. https://doi.org/10.1371/journal.pntd.0002004
- 10. Schilte C, Staikowsky F, Couderc T, Madec Y, Carpentier F, Kassab S, et al. Chikungunya virus-associated long-term arthralgia: A 36-month prospective longitudinal study. PLoS Negl Trop Dis. 2013;7(3):e2137. https://doi.org/10.1371/journal.pntd.0002137
- 11. National guidelines for clinical management of chikungunya fever. New Delhi: Ministry of Health and Family Welfare, Government of India; 2023.
- 12. Pathak H, Mohan MC, Ravindran V. Chikungunya arthritis. Clin Med (Lond). 2019;19(5):381–5. https://doi.org/10.7861/clinmed.2019-0035
- 13. Wang W, Zhou H, Liu L. Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review. Eur J Med Chem. 2018;158:502–16. https://doi.org/10.1016/j.ejmech.2018.09.027
- 14. Min HK, Kim SH, Kim HR, Lee SH. Therapeutic utility and adverse effects of biologic disease-modifying anti-rheumatic drugs in inflammatory arthritis. Int J Mol Sci. 2022;23(22):13913. https://doi.org/10.3390/ijms232213913
- 15. Abdel Shaheed C, Ferreira GE, Dmitritchenko A, McLachlan AJ, Day RO, Saragiotto B, et al. The efficacy and safety of paracetamol for pain relief: An overview of systematic reviews. Med J Aust. 2021;214(7):324–31. https://doi.org/10.5694/mja2.50992
- 16. Jaiswal YS, Williams LL. A glimpse of Ayurveda-the forgotten history and principles of Indian traditional medicine. J Tradit Complement Med. 2016;7(1):50–3. https://doi.org/10.1016/j.jtcme.2016.02.002
- 17. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League against rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–81. https://doi.org/10.1002/art.27584
- 18. Fransen J, van Riel PL. The disease activity score and the EULAR response criteria. Clin Exp Rheumatol. 2005;23(5 Suppl 39).
- 19. Clinical disease activity index (CDAI) for rheumatoid arthritis: Determines severity of rheumatoid arthritis using only clinical data; 2024.
- 20. Chopra A, Saluja M. Validation and usefulness of Indian version (CRD Pune) health assessment questionnaire: Drug trials, community practice and COPCORD Bhigwan population study (1994–2012). Indian J Rheumatol. 2012;7(2)74–82. https://doi.org/10.1016/j.injr.2012.04.009
- 21. Shukla RK, Chandil A, Sharma V, Sharma S. Efficacy of Ayurvedic interventions in the management of post-viral arthritis: A case study. J Ayurveda Integr Med Sci. 2024;12:351–7. https://doi.org/10.21760/jaims.9.12.48
- 22. Jain J, Narayanan V, Chaturvedi S, Pai S, Sunil S. In vivo evaluation of Withania somnifera-based Indian traditional formulation (Amukkara Choornam) against chikungunya virus-induced morbidity and arthralgia. J Evid Based Integr Med. 2018;23:2156587218757661. https://doi.org/10.1177/2156587218757661
- 23. Gupta S, Mishra KP, Kumar B, Singh SB, Ganju L. Andrographolide attenuates complete Freund's adjuvant-induced arthritis via suppression of inflammatory mediators and pro-inflammatory cytokines. J Ethnopharmacol. 2020;261:113022. https://doi.org/10.1016/j.jep.2020.113022
- 24. Jain J, Pai S, Sunil S. Standardization of in vitro assays to evaluate the activity of polyherbal Siddha formulations against chikungunya virus infection. Virusdisease. 2018;29(1):32–9. https://doi.org/10.1007/s13337-018-0421-0
- 25. Watson H, Nogueira-Hayd RL, Rodrigues-Moreno M, Naveca F, Calusi G, Suchowiecki K, et al. Tender and swollen joint counts are poorly associated with disability in chikungunya arthritis compared to rheumatoid arthritis. Sci Rep. 2021;11(1):18578. https://doi.org/10.1038/s41598-021-98164-9
- 26. Online Charak Samhita. Chikitsa Sthana Chapter 3 (Jwara Chikitsa), verse 104: Management of Jwara (different types of fever); 2025.
- 27. Srikanta Murthy KR. Madhav Nidanam of Madhavakara. Ch 25, verses 1-12. Varanasi: Chaukhambha Orientalia; 2018. p. 95–6.
- 28. Sontakke S, Thawani V, Pimpalkhute S, Kabra P, Babhulkar S, Hingorani L. Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian J Pharmacol. 2007;39(1):27–9. https://doi.org/10.4103/0253-7613.30759
- 29. Majeed M, Majeed S, Narayanan NK, Nagabhushanam K. A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res. 2019;33(5):1457–68. https://doi.org/10.1002/ptr.6338
- 30. Srivastava S, Girandola RN. Screening of herbal extracts for rapid effect on activity-induced knee joint discomfort: A randomized and placebo-controlled pilot study. Int J Clin Trials. 2024;11(2):73–83.
- https://doi.org/10.18203/2349-3259.ijct20240400
- 31. Patel JR, Tripathi P, Sharma V, Chauhan NS, Dixit VK. Phyllanthus amarus: Ethnomedicinal uses, phytochemistry and pharmacology: A review. J Ethnopharmacol. 2011;138(2):286–313. https://doi.org/10.1016/j.jep.2011.09.040
- 32. Kumar V, Van Staden J. A review of Swertia chirayita (Gentianaceae) as a traditional medicinal plant. Front Pharmacol. 2016;6:308. https://doi.org/10.3389/fphar.2015.00308
- 33. Peterson CT, Denniston K, Chopra D. Therapeutic uses of triphala in Ayurvedic medicine. J Altern Complement Med. 2017;23(8):607–14. https://doi.org/10.1089/acm.2017.0083
Downloads
Download data is not yet available.