1.Introduction:
Mrs. S.P. Elakya presents with a chronic, progressive inflammatory musculoskeletal disorder involving both the axial and peripheral joints, consistent with an overlapping autoimmune presentation of Mixed Connective Tissue Disorder (MCTD), including features of axial spondyloarthropathy. She reports TMJ clicking with left ear fullness for the past 3 months, disturbed sleep for 2 years, right hip and joint pain for the past 2 years, difficulty walking properly for 1 year, irregular menstruation for 6 months, and tiredness with mood swings for 1 year. MRI and clinical findings are consistent with sacroiliac joint involvement, and she was recently diagnosed with axial spondyloarthropathy. She was advised DMARD therapy but discontinued her medication in December 2024. Her condition is further complicated by recently diagnosed hypothyroidism (TSH 5.9, 2 months ago), for which she is not currently on medication, and she also reports wheezing over the past 8 months. The chronic, systemic nature of her condition has significantly affected her daily activities, mobility, sleep quality, and overall wellbeing. A multidisciplinary approach combining medical management, physiotherapy, lifestyle modification, stress management, and naturopathy-based supportive care was undertaken to improve her pain, mobility, functional status, and quality of life.
2.Patient Information:
NAME: Mrs. S.P. Elakya
GENDER: Female
AGE: 32
DURATION OF STAY: 23 days
- TMJ clicking pain with left ear fullness – 3 months
- Disturbed sleep – 2 years
- Right hip pain – 2 years
- Joint pain – 2 years
- Inability to walk properly – 1 year
- Irregular menstruation – 6 months
- Tiredness and mood swings – 1 year
Mrs. Elakya, a 32-year-old woman from Chennai, was admitted to SLNS Nature Cure Hospital for a 23-day stay to manage her chronic autoimmune joint condition alongside recently diagnosed hypothyroidism. Her presenting complaints spanned musculoskeletal pain, sleep disturbance, hormonal irregularity, and mood changes, reflecting the systemic and multi-organ nature of her condition.
3.Medication History:
| MEDICATION | BEFORE TREATMENT | AFTER TREATMENT | COMPOSITION | MECHANISM |
| Tofacitinib (TFCT-NIB) 5 mg | 1-0-1 | 1-0-1 | Tofacitinib citrate | A JAK (Janus kinase) inhibitor that blocks enzyme activity involved in immune signalling, reducing immune system overactivity and inflammation. |
| Sulfasalazine (SAAZ-DS) 1000 mg | 1-0-1 | 1-0-1 | Sulfasalazine | Suppresses overactivity of the immune system in autoimmune disease. |
| Risperidone (SIZODON) 0.5 mg | 0-0-1 | Tapered | Risperidone | Affects levels of chemical messengers to improve mood, thoughts, and behaviour. |
| Sertraline (SERTA) 100 mg | 0-0-1 | Tapered | Sertraline | Blocks serotonin reuptake (SSRI), increasing serotonin levels. |
| Methotrexate 5 mg | Twice weekly | Reduced to once weekly | Methotrexate sodium | A folic acid antagonist used as an immunosuppressant. |
| Folic Acid 5 mg | 1-0-0 | 1-0-0 | Folic acid | A vitamin supplement used to treat or prevent folate deficiency. |
Mrs. Elakya was on Tofacitinib 5 mg (1-0-1) containing tofacitinib citrate, Sulfasalazine 1000 mg (1-0-1) containing sulfasalazine, Risperidone 0.5 mg (0-0-1) containing risperidone (tapered during treatment), Sertraline 100 mg (0-0-1) containing sertraline (tapered during treatment), Methotrexate 5 mg (reduced from twice weekly to once weekly) containing methotrexate sodium, and Folic Acid 5 mg (1-0-0).
4.Naturopathic And Lifestyle Intervention:
Massage & Steam Therapy: Improved blood circulation, relaxed muscles, relieved joint stiffness, opened pores, eliminated toxins, and reduced inflammation, supporting better metabolism, relaxation, and hormonal balance.
Kizhi Therapy: Helped alleviate pain, stiffness, and inflammation in the muscles and joints while enhancing blood flow, supporting detoxification, and restoring flexibility.
Turmeric & Neem Baths: Aided detoxification, reduced inflammation, helped fight bacterial and fungal infections, soothed skin irritation, and boosted immunity and joint health.
Mud Baths: Supported toxin elimination, improved circulation, eased joint and muscle pain, nourished and softened the skin, and reduced inflammation.
Plant-Based Diet: Supported weight management, improved digestion, naturally balanced hormones, lowered inflammation, and enhanced energy through nutrient-rich, fibre-filled foods.
5.Results And Follow Up:
| BIOMARKER | BEFORE TREATMENT | AFTER TREATMENT |
| Apo B | 140 | 130 |
| Homocysteine | 13.42 µmol/L | 12.94 µmol/L |
| MCHC | 30.8 g/dL | 28.4 g/dL |
| MCH | 28.8 pg | 28.3 pg |
| Urinary Leucocytes | 8 | Absent |
| RBC | 4.27 | 4.45 |
| Urine Bacteria | Present | Absent |
| ABG (Blood Glucose) | 114 mg/dL | 103 mg/dL |
| Fasting Insulin | 12.15 µU/mL | 9.29 µU/mL |
| Transferrin Saturation | 18.66% | 22.83% |
| Serum Iron | 62.6 µg/dL | 74.6 µg/dL |
| WBC | 9.68 | 6.1 |
| HS-CRP | 9.3 | 5.8 |
| LP-PLA2 | 244 | 222 |
| Blood Ketone | 0.2 | 1.97 |
| SGPT | 54.4 U/L | 48.1 U/L |
| SGOT | 41.6 | 40.3 |
| Serum Globulin | 3.64 | 3.23 |
| Vitamin D3 | 9.05 ng/mL | 64.14 ng/mL |
| Vitamin B12 | 232 pg/mL | 222 pg/mL |
| Serum Copper | 167.13 | 157.69 |
| Cortisol | 7.44 µg/dL | 7.2 µg/dL |
| Corticosterone | 172.87 ng/dL | 77.96 ng/dL |
| Androstenedione | 90.12 ng/dL | 79.86 ng/dL |
| Estradiol | 40 pg/mL | 126 pg/mL |
| 17-OH Progesterone | 51.91 ng/dL | 65.96 ng/dL |
| DHEAS | 154.06 ng/dL | 105.41 ng/dL |
| DHEA | 467.49 µg/dL | 316.85 µg/dL |
| Leucocyte Esterase | Present | Absent |
Metabolic and cardiovascular markers showed clear improvement: Apo B fell from 140 to 130 and Homocysteine eased slightly (13.42 to 12.94 µmol/L), both supporting reduced cardiovascular risk, while HS-CRP (9.3 to 5.8) and LP-PLA2 (244 to 222) point to lower systemic and vascular inflammation. Blood glucose control improved, with ABG dropping from 114 to 103 mg/dL and fasting insulin from 12.15 to 9.29 µU/mL, indicating better insulin sensitivity. Infection markers resolved completely, with urinary leucocytes (8 to absent), urine bacteria (present to absent), and leucocyte esterase (present to absent) all clearing, alongside a fall in WBC from 9.68 to 6.1.
Nutritional and hematological markers were mostly favourable: RBC rose from 4.27 to 4.45, serum iron improved from 62.6 to 74.6 µg/dL, transferrin saturation increased from 18.66% to 22.83%, and Vitamin D3 rose markedly from a deficient 9.05 to a healthy 64.14 ng/mL — though MCHC (30.8 to 28.4 g/dL) and Vitamin B12 (232 to 222 pg/mL) eased slightly and warrant continued monitoring. Liver enzymes improved, with SGPT (54.4 to 48.1 U/L) and SGOT (41.6 to 40.3) both easing alongside a fall in serum globulin (3.64 to 3.23), reflecting better liver function and reduced systemic inflammation.
Hormonal markers showed a broad shift toward better regulation: cortisol and corticosterone (172.87 to 77.96 ng/dL) both eased, along with DHEA (467.49 to 316.85 µg/dL), DHEAS (154.06 to 105.41 ng/dL), and androstenedione (90.12 to 79.86 ng/dL), while estradiol rose from 40 to 126 pg/mL and 17-OH progesterone from 51.91 to 65.96 ng/dL — together suggesting improved adrenal and endocrine balance.
SYMPTOM TRACKER
| SYMPTOM | BEFORE TREATMENT | AFTER TREATMENT |
| Headache | 2 | 0 |
| Faintness | 3 | 0 |
| Dry Skin | 1 | 0 |
| Hair Loss | 1 | 0 |
| Food Cravings | 4 | 0 |
| Flatulence | 1 | 0 |
| Irritability | 0 | 0 |
| Fatigue | 4 | 3 |
| Arthritis | 0 | 0 |
| Muscle Pain | 4 | 2 |
| Constipation | 3 | 0 |
| Breath Shortness | 1 | 0 |
| Acne | 2 | 1 |
| Excess Weight | 4 | 1 |
| Mood Swings | 1 | 0 |
| TOTAL | 27 | 8 |
EULAR/ACR DISEASE ACTIVITY SCORE
| DOMAIN | BEFORE TREATMENT | AFTER TREATMENT |
| Constitutional (Fever) | 2 | 0 |
| Hematologic (Leukopenia, Thrombocytopenia, Autoimmune Hemolysis) | 0 | 0 |
| Neuropsychiatric (Delirium, Psychosis, Seizures) | 1 | 0 |
| Mucocutaneous (Alopecia, Oral Ulcers, Subacute/Discoid or Acute Cutaneous Lupus) | 0 | 0 |
| Serosal (Pleural/Pericardial Effusion, Acute Pericarditis) | 0 | 0 |
| Musculoskeletal (Joint Involvement) | 6 | 0 |
| Renal (Proteinuria, Biopsy Class II/V or III/IV) | 10 | 0 |
| Antiphospholipid Antibodies | 2 | 0 |
| Complement Proteins (Low C3/C4) | 3 | 2 |
| SLE-Specific Antibodies (Anti-dsDNA or Anti-Smith) | 6 | 6 |
| TOTAL SCORE | 41 | 26 |
Note: individual domain sub-scores above are transcribed as recorded in the clinical documentation. The overall EULAR/ACR score improved from 41 to 26, indicating a meaningful reduction in autoimmune disease activity.
PAIN SCALE
| PAIN SCALE | BEFORE TREATMENT | AFTER TREATMENT |
| Fatigue | 6/10 | 0/10 |
| Shoulder Pain | 4/10 | 2/10 |
| Joint Pain | 8/10 | 2/10 |
| Back Pain | 8/10 | 3/10 |
| Leg Pain | 4/10 | 0/10 |
Mrs. Elakya’s symptom and pain scores both improved substantially. Her total symptom score fell from 27 to 8, with headache, faintness, food cravings, constipation, and mood swings resolving completely, while her pain scores across fatigue, shoulder, joint, back, and leg pain all showed marked reduction, most notably fatigue (6/10 to 0/10) and joint pain (8/10 to 2/10).
6.Discussion:
Following naturopathic intervention, Mrs. Elakya showed significant improvement across metabolic, inflammatory, immune, and hormonal parameters. Glycemic control improved, with ABG reducing from 114 to 103 mg/dL and fasting insulin from 12.15 to 9.29 µU/mL, alongside reduced cardiovascular risk markers such as Apo B (140 to 130), HS-CRP (9.3 to 5.8), and LP-PLA2 (244 to 222). Infection markers resolved completely, with urinary leucocytes (8 to absent), bacteria (present to absent), and leucocyte esterase (present to absent) all clearing, alongside normalisation of WBC (9.68 to 6.1) — indicating improved immune function and reduced inflammation.
Nutritional and hematological improvements were evident, with increased RBC (4.27 to 4.45), serum iron (62.6 to 74.6), transferrin saturation (18.66% to 22.83%), and a marked rise in Vitamin D3 (9.05 to 64.14), though MCHC (30.8 to 28.4) and Vitamin B12 (232 to 222) require continued monitoring. Liver enzymes (SGPT 54.4 to 48.1, SGOT 41.6 to 40.3) and serum globulin (3.64 to 3.23) also improved, reflecting better liver function. Hormonal balance improved with reductions in cortisol, corticosterone (172.87 to 77.96), DHEA (467.49 to 316.85), DHEAS (154.06 to 105.41), and androstenedione (90.12 to 79.86), along with a rise in estradiol (40 to 126) — together indicating enhanced metabolism, reduced inflammation, improved immunity, and overall systemic recovery contributing to better energy levels and health.
7.Conclusion:
Mrs. Elakya showed remarkable recovery through integrated naturopathic and lifestyle intervention. The combination of therapies and a structured diet effectively improved her metabolic, inflammatory, immune, and hormonal biomarkers, with better glucose control, reduced cardiovascular risk, and complete resolution of infection markers. Improvements in nutritional status and liver function further reflect enhanced systemic health.
Overall, these outcomes demonstrate that consistent naturopathic care can effectively manage chronic autoimmune conditions, reduce inflammation, restore metabolic balance, and promote long-term wellness, improved energy levels, and better quality of life.