Rheumatoid Arthritis

Rheumatoid arthritis (RA) occurs when your body's immune system attacks and destroys the tissues that make up your joints. The joints become swollen stiff and painful. In later stages the joints can become deformed. Other areas of your body can also be affected including your lungs heart blood vessels and eyes. About 1 percent of the U.S. population suffers from RA. Typically it strikes between the ages of 30 and 60 but it can occur at any age.

Signs and Symptoms

• Stiffness swelling and pain in and around certain joints especially after not moving for a while (for example when waking)
• Affected joints typically include hands fingers wrists ankles feet elbows and knees.
• Generally if a joint on the right side of your body is affected the same joint on the left side is also affected.
• Feeling tired and run-down with swollen lymph glands a low fever little or no appetite and weight loss
• Appearance of small bumps under the skin near the affected joints

What Causes It?

Medical researchers do not know why RA develops. Genes may play some as yet unknown role. It also is possible that a change in the body such as an infection or hormonal shift can trigger its development.

What to Expect at Your Provider's Office

Your health care provider will assess the swelling and pain in each joint and will likely ask you to demonstrate how well you can use that joint. During the physical examination your provider will take your temperature and check your lymph nodes and spleen for swelling. Your provider may order X-rays and blood and urine tests. In some cases a small amount of fluid may be taken from the affected joint for examination. These tests help rule out other causes of your symptoms and confirm a diagnosis of RA.

Treatment Options

Treatment Plan

Treatment is aimed at relieving symptoms and preserving joint function. Rest helps to generally reduce the inflammation response in the body. Exercise helps to maintain joint motion and strength. Heat and cold also are used to reduce symptoms. There are various drugs available for RA. Some newly developed experimental drugs attack the cells in your immune system that destroy joint tissue. In severe cases of joint destruction or deformation surgery may be necessary.

Drug Therapies

Prescription

• Nonsteroidal anti-inflammatory drugs (NSAIDS)—for example naproxen reduce inflammation and pain; side effects include gastrointestinal irritation bleeding and ulceration
• Cyclo-oxgenase-2 (COX-2) inhibitors—such as celecoxib reduce pain and inflammation with fewer gastrointestinal side effects but various other possible side effects
• Disease-modifying anti-rheumatoid drugs (DMARDs)—include gold salts antimalarial drugs and sulfasalazine; DMARDs that suppress the immune system include methotrexate or azathioprine; DMARDs have serious side effects
• Corticosteroids—decrease inflammation and control pain; given orally or intravenously; possibly serious side effects

Over the Counter

• Nonsteroidal anti-inflammatory drugs—such as aspirin and ibuprofen reduce pain and inflammation; side effects include gastrointestinal irritation bleeding and ulceration

Complementary and Alternative Therapies

The goal of therapy is to decrease inflammation and preserve joint function. Treatment is long term.

Nutrition

• The most common allergic foods are wheat corn and dairy. An elimination diet may identify whether these foods constitute a problem: avoid allergenic foods completely for two weeks then reintroduce the foods one at a time every three days and note if your RA symptoms get worse. Citrus chocolate alcohol red meat spices and carbonated drinks may also aggravate RA.
• A vegetarian diet high in antioxidants and flavonoids (green tea blueberry elderberry) and low in saturated fats
• A small percentage of people respond dramatically to a diet free of nightshades. These include peppers eggplant tomatoes and white potatoes. A month-long trial is recommended.
• One clinical study demonstrated that selenium combined with vitamin E reduces RA symptoms. Dose is 50 to 75 mcg per day of selenium and 400 to 800 IU of vitamin E.
• Zinc (45 mg per day) and manganese (45 mg per day)
• Omega-3 fatty acids keep white blood cells from producing substances that cause swelling. Dose is 1 000 to 1 500 IU per day.
• Bromelain: anti-inflammatory when taken between meals. Dose is 2 000 to 2 500 mg twice a day.
• Quercetin: stabilizes mast cells found in increased numbers in the synovial membranes of affected joints. Dose is 250 to 500 mg three times per day on an empty stomach.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots.

• Devil's claw (Harpagophytum procumbens): analgesic anti-inflammatory
• Ginseng (Panax ginseng): adaptogen (tonic for long-term stress) specific for chronic disease and the effects of suppressive medications
• Ginger (Zingiber officinale): antispasmodic digestive stimulant
• Valerian (Valariana officinalis): relaxant reduces spasms
• Blue flag (Iris versicolor): stimulates liver to process effects of inflammation
• Wild yam (Dioscorea villosa): specific for RA helps reduce spasms
• Horsetail (Equisitum arvense): diuretic stabilizes connective tissue

Devil's claw and three to five of the above herbs can be mixed as either tincture 30 to 60 drops three times per day or 1 cup tea three times per day.

Homeopathy

Some of the most common remedies used for rheumatoid arthritis are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Rhus toxicodendron for arthritis that feels worse in the morning in damp cold weather or before a storm
• Bryonia alba for arthritis that feels better with pressure feels worse with any movement or cold weather
• Ruta graveolens for arthritic pains that feel worse after exertion feel better after resting especially with a history of strains or sprains
• Calcarea carbonica for arthritis that is associated with weakness

Acupuncture

May decrease pain and joint inflammation and slow progress of RA

Massage

May be helpful in relieving symptoms and increasing mobility

Following Up

Make regular visits to your health care provider to monitor the progress of the disease and side effects of drugs you may be taking.

Supporting Research

American College of Rheumatology Clinical Guidelines Committee. Guidelines for rheumatoid arthritis management. Arthritis Rheum. 1996;39:713–722.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:121 135 150–151 138 226–227.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:810.

Kelley WN Harris ED Sledge CB eds. Textbook of Rheumatology. 5th ed. Philadelphia Pa: WB Saunders Company; 1997: chap 55.

Mazzetti I Grigolo B Borzai RM Meliconi R Facchini A. Serum copper/zinc superoxide dismutase levels in patients with rheumatoid arthritis. J Clin Lab Res. 1996;26(4):245–249.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:73–75 85–86 226 329–330.

Mulherrin DM Thurnham DI Situnayake RD. Glutathione reductase activity riboflavin status and disease activity in rheumatoid arthritis. Ann Rheum Dis. 1996;55:837–840.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998:492–501.

Tierney Jr LM McPhee SJ Papadakis MA eds. Current Medical Diagnosis & Treatment 1999. Stamford Conn: Appleton & Lange; 1999.

Weisman MH Weinblatt ME eds. Treatment of the Rheumatic Diseases: Companion to the Textbook of Rheumatology. Philadelphia Pa: WB Saunders Company; 1995: chap 3.

Wylie G et al. A comparative study of Tenidap a cytokine-modulating anti-rheumatic drug and diclofenac in rheumatoid arthritis: a 24 week analysis of a 1-year clinical trial. Br J Rheumatol. 1995;34:554–563.

Zurier RB Rossetti RG Jacobson EW et al. Gamma-linolenic acid treatment of rheumatoid arthritis. A randomized placebo-controlled trial. Arthritis Rheum. 1996;39:1808–1817.

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