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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

bulletStiffness, swelling, and pain in and around certain joints, especially after not moving for a while (for example, when waking)
bulletAffected joints typically include hands, fingers, wrists, ankles, feet, elbows, and knees.
bulletGenerally, if a joint on the right side of your body is affected, the same joint on the left side is also affected.
bulletFeeling tired and run-down with swollen lymph glands, a low fever, little or no appetite, and weight loss
bulletAppearance 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

 

bulletNonsteroidal anti-inflammatory drugs (NSAIDS)—for example, naproxen, reduce inflammation and pain; side effects include gastrointestinal irritation, bleeding, and ulceration
bulletCyclo-oxgenase-2 (COX-2) inhibitors—such as celecoxib, reduce pain and inflammation with fewer gastrointestinal side effects, but various other possible side effects
bulletDisease-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
bulletCorticosteroids—decrease inflammation and control pain; given orally or intravenously; possibly serious side effects

 

Over the Counter

 

bulletNonsteroidal 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

 

bulletThe 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.
bulletA vegetarian diet high in antioxidants and flavonoids (green tea, blueberry, elderberry) and low in saturated fats
bulletA 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.
bulletOne 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.
bulletZinc (45 mg per day) and manganese (45 mg per day)
bulletOmega-3 fatty acids keep white blood cells from producing substances that cause swelling. Dose is 1,000 to 1,500 IU per day.
bulletBromelain: anti-inflammatory when taken between meals. Dose is 2,000 to 2,500 mg twice a day.
bulletQuercetin: 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.

 

bulletDevil's claw (Harpagophytum procumbens): analgesic, anti-inflammatory
bulletGinseng (Panax ginseng): adaptogen (tonic for long-term stress), specific for chronic disease and the effects of suppressive medications
bulletGinger (Zingiber officinale): antispasmodic, digestive stimulant
bulletValerian (Valariana officinalis): relaxant, reduces spasms
bulletBlue flag (Iris versicolor): stimulates liver to process effects of inflammation
bulletWild yam (Dioscorea villosa): specific for RA, helps reduce spasms
bulletHorsetail (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.

 

bulletRhus toxicodendron for arthritis that feels worse in the morning, in damp, cold weather, or before a storm
bulletBryonia alba for arthritis that feels better with pressure, feels worse with any movement, or cold weather
bulletRuta graveolens for arthritic pains that feel worse after exertion, feel better after resting, especially with a history of strains or sprains
bulletCalcarea 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.