Rheumatoid Arthritis

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune condition which preferentially affects the joints, causing pain, swelling, and stiffness. Although the joints (particularly in the hands and wrists) are most commonly affected, this disease can also cause anemia, damage the lungs, heart, eyes, and bones. It has a big impact on general wellness. Sufferers of rheumatoid arthritis frequently suffer from depression and experience great difficulty being productive in the workplace.

It is a relatively common condition, affecting up to 1% of the adult population. Women are more than twice as likely as men to be affected. Signs usually arise between the age of 40 and 50 for women. Men tend to develop the disease later. Due to its systemic effects, rheumatoid arthritis sufferers also have shorter lifespans and are at increased risk of many co-morbidities, including a doubled risk of cardiovascular disease, increased rates of alcoholism, hypertension, and obesity.

Common Symptoms

The most common symptoms of rheumatoid arthritis are manifested in the joints. These signs include:

Pain in multiple joints
Swelling in multiple joints
Stiffness in multiple joints
Loss of mobility of joint
Deformation and/or nodules around joints

There can also be a wide variety of systemic symptoms with this condition, including:

Depression
Weakness
Fatigue
Hair loss
Anemia
Dry eye
Carpal tunnel syndrome
Clumsiness
Numbness and/or muscle weakness
Weight loss

Diagnosis

A physical examination and history are the most important basis for a diagnosis of rheumatoid arthritis in most people, however the following diagnostics may also be recommended:

X-rays
MRI: This may be performed to evaluate other organ systems in the body
Ultrasound
Echocardiogram: This may be performed to evaluate the heart.
Blood tests:
- Erythrocyte sedimentation rate (ESR)
- C-Reactive Protein
- Rheumatoid Factor
- Anti-cyclic citrullinated peptide antibodies
- Infectious disease testing such as Lyme disease
Joint Taps:
- Sometimes taking a sample of joint fluid can help rule out other causes which resemble rheumatoid arthritis

Treatment Options

There is no known cure for rheumatoid arthritis, although spontaneous resolution has been reported. Most people will experience this as a progressive condition. Early, aggressive treatment seems to be more likely to result in remission.

Pharmaceuticals and Medical Procedures:

Disease-modifying Antirheumatic Drugs (DMARDs): These are now the main treatments for rheumatoid arthritis and work best when started early in the disease process. About 50% of people experience remission after starting these drugs. These drugs include
- Hydroxychloroquine: An anti-malarial drug which has been found to be effective in several autoimmune conditions, including rheumatoid arthritis. It is known to be effective against Lyme disease and is used in some cases of Lyme arthritis.
- Methotrexate: This is a chemotherapeutic which is the most commonly used drug in rheumatoid arthritis. It can have many side effects and requires close monitoring.
- TNF-alpha inhibitors: These drugs block the pro-inflammatory cytokine TNF-alpha
  - Etanercept
  - Certolizumab
  - Infliximab
  - Golimumab
  - Adalimumab
- Abatacept: This drug interferes with the function of T-cells, a type of white blood cell which plays a major role in the disease.
- Anakinra: This drug blocks the effects of the pro-inflammatory cytokine interleukin-1 (IL-1)
- Rituximab: This drug targets B cells which produce the antibodies directed against the body.
- Sulfasalazine
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): There are several over-the-counter medications which can be helpful in relieving pain and inflammation associated with rheumatoid arthritis. These include common medications such as ibuprofen and naproxen. Prescription NSAIDs may also be useful for cases for more severe pain and swelling.
Corticosteroids: These are powerful anti-inflammatories which can help relieve severe, acute pain and swelling. Because they tend to have a wide range of undesirable side effects, they are usually prescribed for shorter-term use and overlapped with other medications which may take longer to begin working.
Antimicrobials: For some cases, there may have been an infectious trigger for rheumatoid arthritis, such as Lyme disease. Antimicrobial therapy may be indicated.
Surgical Treatments:
- Synovectomy: This procedure involves removing part of the lining of the joint where the inflammation takes place. This is usually only done if drug therapies are unsuccessful.
- Arthrodesis (Joint Fusion): In some cases, surgically fusing joints may be the best option. This means the joint will have no further mobility, but it can provide great pain relief and may be the best option for severely damaged joints.
- Joint Replacement: Prosthetic joints may be an option for some people.

Non-pharmaceutical options:

There are many non-pharmaceutical therapies for rheumatoid arthritis which may be beneficial in some people.

Heat or Cold Therapy: Cold packs can help reduce swelling and inflammation of affected joints, while warm packs can help improve circulation and may improve joint mobility in stiffened joints.
Acupuncture: Acupuncture therapy is beneficial in a variety of inflammatory conditions. Some people may find pain relief through this option.
Aromatherapy: Although not directly affecting the body, aromatherapy can play a psychologic role by inducing a state of relaxation and reducing focus on pain and discomfort.
Magnet Therapy: Manipulation of magnetic fields around affected joints may provide some pain relief in people, although the mechanisms are not well-understood.
Hydrotherapy: Mineral baths or Epsom-salt baths seem to be helpful in the management of symptoms by decreasing stiffness of joints and improving blood flow.
Physical Therapy:
- Water Aerobics: Low impact exercise in a pool can help people stay physically fit while taking the burden off of joints.
- Strength Training: This will help keep your muscles strong and make injuries less likely to occur
- Range-of-Motion: These exercises can help decrease stiffness of joints and may reduce swelling.
- Massage Therapy: Deep stimulation of muscles can help lower pain and improve mood and relaxation.
Mind-Body Approaches:
- Meditation: Mindful meditation can help take focus off of pain and build a sense of well-being. Chronic pain can result in stress and depression; mindfulness meditation can be one of the most effective therapies against this.
- Biofeedback: This approach allows you to monitor your own biological responses and learn techniques to control them through mental techniques. This can help teach people how to modulate their own responses to pain and discomfort.
- Yoga: Yoga is not only good as a meditative technique itself, but can also provide flexibility and help maintain function of affected joints.
- Breathing Exercises: Deep breathing can be very useful in helping reduce the focus and perception of pain.
- Progressive Muscle Relaxation: Alternating tightening and relaxing of muscles combined with breathing exercises may relieve tension, pain, and promote overall relaxation.
Topical Treatments:
- Capsaicin: The component of peppers which gives them their heat is a known to activate the body’s natural opioid system. Topical application actually produces a burning sensation, but this is followed by pain relief. It should not be used in combination with heat therapy.
Dietary Modification: Following a diet which is as anti-inflammatory in nature can help reduce the symptoms of rheumatoid arthritis. Things to consider are
- Reduce animal proteins
- Reduce dairy intake
- Increase intake of fish, nuts, and flaxseed to increase omega-3s
- Decrease processed food/sugar intake
Apitherapy: Some people find controlled bee stings over the site of discomfort may provide relief. Do not use this therapy if you have a known or suspected allergy to bees. Some people may be unaware of their bee allergies. Seek medical attention if a strong reaction occurs.
Probiotics: Maintaining healthy gut bacteria can help reduce the body’s overall inflammation. Clinical studies have shows that supplementing with Lactobacillus casei 01 reduced the amount of pain and inflammation in people with rheumatoid arthritis.
Mold Binders: Products like cholestyramine and apple pectin can help remove toxic mold from the body. Mold toxins may increase inflammation in the body and worsen rheumatoid arthritis.
Stem Cells: This is may be a treatment on the horizon with great potential to help rheumatoid arthritis sufferers.
Supplements:
- Turmeric: The potent anti-inflammatory properties may be beneficial in some people with rheumatoid arthritis.
- Fish Oil: Omega-3 fatty acids are anti-inflammatory in nature and may be helpful in managing chronic inflammation associated with rheumatoid arthritis.
- Glucosamine and chondroitin: These are compounds which are naturally produced in healthy joints and provide lubrication to eh cartilage and joint capsule. They are found heavily in shellfish. It is a very safe supplement which may benefit some people.
- Eggshell membrane: This is a source of collagen which may be helpful in different types of arthritis.
- Thunder God Vine: This is a root which seems to have potent anti-inflammatory properties. In clinical trials, it performed well when compared against the medication sulfasalazine in rheumatoid arthritis sufferers.
- Feverfew: This is an anti-inflammatory herb which may be helpful.
- Ginger: Ginger also has anti-inflammatory properties which may help in rheumatoid arthritis.
- SAM-e: This may support collagen repair and is an anti-inflammatory compound.
- Indian frankincense (Boswellia): This is an anti-inflammatory herb commonly used in various types of arthritis.
- Borage seed oil: Borage seed oil is very high in omega-6 fatty acids. Clinical trials have shown people taking borage seed oil experienced reduced pain and inflammation.
- Cat’s Claw: Possesses anti-inflammatory and anti-oxidant properties.
- Evening primrose oil: Like borage seed oil, this is high in omega-6 fatty acids and appears to be moderately helpful in rheumatoid arthritis
- Methylsulfonylmethane (MSM): This is a potent anti-inflammatory and source of sulfur, which is important for maintenance of healthy joints.
- Rosehip Extract: This contains many anti-inflammatory polyphenols. A small trial of rheumatoid arthritis sufferers suggested this supplement improved their overall quality of life and improved physical function.
- Vitamin D: This essential vitamin is important for immune function and deficiencies have been linked to many autoimmune conditions, including rheumatoid arthritis.

Prevention

Like most auto-immune disorders, there is no known way to prevent the condition from initially arising. There are a number of risk factors which are generally out of the control of each person, including genetics, being a woman, and being over the age of 40. It is known to run in families.

There are few risk factors, however, which may be able to be mitigated. Smokers have a higher risk, particularly among those who are already genetically pre-dispositioned. If you have a family history of rheumatoid arthritis, you should consider quitting smoking (for this and many other reasons). There is also increased risk among people who have been exposed to asbestos or silica. This category includes miners, people who work in construction or demolition. There are higher rates of rheumatoid arthritis among emergency responders who went to ground zero following the 9/11 World Trade Center attack. This increased rate of rheumatoid arthritis is thought to be due to exposure to asbestos in the dust.

Obese people also may be at higher risk. Obesity is a pro-inflammatory condition which carries a number of negative health implications. Weight management through diet and exercise can help minimize the risk of developing this debilitating condition, particularly among those who are already more likely to develop the disease.

A healthy lifestyle is your best defense against developing this condition. Eat a diet rich in healthy fats and vitamins, minimize refined sugars, and maintain a healthy body weight through the addition of exercise. Consider taking a pro-biotic to reduce your body’s inflammatory state and help maintain proper immune system regulation. Get exposure to sunlight for 10-20 minutes a day to help maintain your vitamin D levels. Oral hygiene may also play a role in the development of the disease. Brushing your teeth twice daily and getting regular dental care, which is part of any healthy lifestyle, may be important as well.

If you have already been diagnosed with the disease, work with your healthcare professional to best control your condition. Many people are able to achieve remission, particularly in the early stages of the disease, which can help improve prognosis and reduce the chance of other complications which arise from chronic inflammation in the body. Take your medications and supplements as directed, and continue to live a healthy lifestyle.

Causes

There are numerous factors linked to the development of rheumatoid arthritis, but often the cause is unknown. Although there are genetic factors involved, not everyone who is at risk will develop the disease, and people will develop the disease who would not be considered at risk. The overall condition occurs due to immune dysregulation, resulting in the body attacking itself. In this regard, rheumatoid arthritis is similar to conditions such as lupus. What causes the body to begin attacking itself is usually a mystery.

Vitamin D deficiency appears to linked to people with rheumatoid arthritis, among other autoimmune conditions. It is difficult to ascertain whether or not this may be a cause or an effect of rheumatoid arthritis, but some studies are highly suggestive a link between low vitamin D levels and greatly increased risk of rheumatoid arthritis.

There is also evidence to suggest that periodontal disease (disease around the teeth) may be linked to rheumatoid arthritis. Some types of bacteria which live in the mouth modify proteins in the gums through a process called citrullination. Rheumatoid arthritis sufferers often produce antibodies against citrullinated proteins. It is possible that poor dental hygiene may increase the risk of rheumatoid arthritis.

Lyme disease is another well-known cause of erosive arthritis which closely resembles rheumatoid arthritis. It is possible that infection with the Lyme bacteria may also trigger autoimmune reactions. You should minimally be tested for this infection and consider taking antimicrobial therapy.

Toxic mold exposure should also be considered in rheumatoid arthritis. Studies in mice have shown that environmental molds can increase the expression of inflammatory cytokines in mouse models of rheumatoid arthritis. This may be an underappreciated factor in either the development of the worsening of the disease in some people.

As with any autoimmune disease, it is important to note that our Westernized lifestyles have also likely contributed to susceptibility to the disease. Autoimmune disorders appear more likely to occur in developed countries. There are multiple theories as to why this is the case, but one of the most popular is called the “hygiene hypothesis.” This states that our relatively high levels of hygiene and absence of intestinal parasites have deprived our immune systems of the normal exposures required to develop appropriately. Because our immune systems encounter much fewer truly threatening bacteria, it becomes more likely to misidentify normal proteins in the body as potential threats.