Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects the entire body, including the synovial membranes of the joints. The joints typically involved are the hands, feet, wrists, ankles and knees. Somewhere between 1% and 3% of the population are affected; female patients outnumber males almost 3:1. The usual age of onset is 20-40 years, although rheumatoid arthritis may begin at any age.
Standard medical treatment of RA involves the use of physical therapy along with drugs. Physical therapy includes exercise, heat, cold, massage and the use of special physical therapy equipment such as diathermy, lasers and paraffin baths.
The first drug generally employed is aspirin. It is often quite effective in relieving both the pain and inflammation. It is also relatively inexpensive. However, since the therapeutic dose required is relatively high, toxicity often occurs. Tinnitus (ringing in the ears) and gastric irritation are early manifestations of toxicity. Other NSAID (nonsteroidal anti-inflammatory drugs) are often used as well, especially when aspirin is ineffective or is intolerable. While more expensive, none of these drugs have demonstrated superior efficacy to aspirin. In addition, these drugs are also associated with side effects including gastrointestinal upset, headaches and dizziness.
If conservative therapy does not offer benefit, more aggressive and potentially more toxic treatments are available. Gold salt injection aids about 60% of patients but severe side effects occur in nearly one third of them. Other powerful drugs are used, including d-penicillamine and hydroxychloroquine, but benefit often does not substantiate toxicity. Corticosteroids are also used during acute worsenings of the disease but long-term use of them for RA is not advised due to the side effects. Joint surgery and joint replacement are reserved for the most severe cases.
There is abundant evidence that rheumatoid arthritis is an "autoimmune" reaction, where antibodies develop against components of joint tissues. Yet what triggers this autoimmune reaction remains largely unknown. Speculation and investigation is centered around genetic susceptibility, lifestyle factors, nutritional factors, food allergies and microorganisms.
An interesting association between rheumatoid arthritis and abnormal bowel function exists that may provide a unified theory as to the cause of RA. What is currently known is that individuals with RA have increased intestinal permeability to dietary and bacterial antigens as well as alterations in bacterial flora. This altered permeability and bacterial flora could result in the absorption of antigens that are very similar to antigens in joint tissues. Antibodies formed to bind these antigens would "cross-react" with the antigens in the joint tissues. Increasing evidence appears to support this concept.
Signs & Symptoms
The onset of rhematoid arthritis is usually gradual, but occasionally it is quite abrupt. The appearance of primary symptoms may precede the appearance of secondary symptoms by several weeks.
Fatigue Low-grade fever Weakness Joint stiffness Vague joint pain
Painful, warm, tender, swollen joints
Ruddy, purplish-blue color of skin over the affected joint(s)
Several joints are usually involved in the onset, typically in a symmetrical fashion (i.e. both hands, both wrists, both ankles, etc.).
In about 1/3 of the cases of RA, initial involvement is confined to one or a few joints.
There are a variety of abnormal laboratory findings in RA, including elevated erythrocyte sedimentation rate (characteristic of inflammatory conditions), anemia, serum protein abnormalities, and antibodies to altered immunoglobulins. X-ray findings usually show soft tissue swelling, erosion of cartilage and joint space narrowing.
Structure & Function:
Immune System Support &
Betaine HCL 400 mg. with meals Copper 1 mg./day DHEA* DLPA* Fish oils 1.8 grams/day Glucosamine sulfate* Manganese 15 mg./day Pantothenic acid* Quercetin 250 mg. between meals, t.i.d. Selenium 200 mcg./day Vitamin C 1-3 grams/day in divided doses Vitamin E 400 I.U./day Zinc 45 mg./day
* Please refer to the respective topic for specific nutrient amounts.
Many individuals with RA are deficient in stomach acid and other digestive factors. Supplementation with betaine HCL with meals will aid in protein digestion and possibly reduce food sensitivities through improved digestion.
The proteolytic enzyme of the pineapple, bromelain, has been demonstrated to be an effective anti-inflammatory agent in both clinical studies and experimental models. Its major effect is to reduce swelling. For best results, bromelain should be taken between meals.
Copper aspirinate (salicylate) is a form of aspirin that yields better results in reducing pain and inflammation than standard aspirin preparations. These copper containing substances may be indicated in patients with RA requiring aspirin.
The wearing of copper bracelets has been an old folk remedy which appears to have some scientific support as a double-blind study performed in Australia. Presumably, copper is absorbed through the skin and chelated to another compound which is able to exert anti-inflammatory action. Copper is a component, along with zinc, in copper-zinc SOD (one type of superoxide dismutase). Deficiency may result in significant susecptibility to free-radical damage as a result of decreased SOD levels. However, an excess intake of copper may be detrimental due to copper's ability to combine with peroxides and damage joint tissues.
DLPA is a mixture of the natural form of phenylalanine (the L- form) with its mirror image (the D- form). The D-form has been shown to be an effective pain reliever against the chronic pain of osteoarthritis, RA, low back pain and migraine headaches. Its mode of action appears to be inhibiting the breakdown of endorphins, thereby increasing the effect of these components of the body's own pain relieving system. Endorphins are morphine-like compounds acting as mild mood elevators and potent pain relievers.
Fish oils / EPA
In a double-blind study of patients with rheumatoid arthritis, it was shown that a diet rich in polyunsaturated fats and low in saturated fat supplemented daily with 1.8 grams of eicosapentaenoic acid (EPA) brought about significant improvement. Prostaglandins and leukotrienes formed from EPA are significantly less inflammatory than those prostaglandins and leukotrienes formed from arachidonic acid. Supplementing the diet with EPA appears warranted in the treatment of RA and other inflammatory conditions.
Manganese also functions in the antioxidant enzyme superoxide dismutase (manganese SOD), which is deficient in patients with RA. Manganese supplementation has been shown to increase SOD activity, indicating increased antioxidant activity. No trials have yet been done with manganese and RA, but supplementation appears to be indicated.
The bioflavonoid quercetin has demonstrated several effects in experimental studies indicating it may be beneficial to individuals with RA. Specifically, quercetin inhibits the release of histamine and the production of the potent inflammatory compounds, the leukotrienes. For best results, quercetin should be taken with bromelain between meals. Bromelain is believed to enhance the absorption of quercetin, as it does medications.
Serum selenium levels are low in patients with RA. This may be a significant factor, as selenium plays a valuable role as an antioxidant and serves as the mineral cofactor in the free-radical scavenging enzyme glutathione peroxidase.
Selenium is also important in reducing the production of inflammatory prostaglandins and leukotrienes. Free radicals, oxidants, prostaglandins and leukotrienes cause much of the damage to tissues seen in RA. A deficiency of selenium would result in even more significant damage. Clinical studies have not yet clearly demonstrated that selenium supplementation alone improves the signs and symptoms of RA; however, one clinical study indicated that selenium, combined with vitamin E had a positive effect.
Supplementation appears to be appropriate due to increased demand for selenium in RA and selenium's synergistic effect with other antioxidant mechanisms.
This antioxidant enzyme protects cells and tissues from free-radical damage. The injectable form of this enzyme (available in Europe) has been shown to be effective in the treatment of RA and osteoarthritis; however, it is not clear if any orally administered SOD can escape digestion in the intestinal tract and exert a therapeutic effect. In one study, oral SOD was not shown to affect tissue SOD levels.
Vitamin C functions as an important antioxidant. Supplementation with Vitamin C increases SOD activity, decreases histamine levels and provides anti-inflammatory action.
Vitamin E is an important antioxidant, working synergistically with glutathione peroxidase and other antioxidant enzymes (catalase, superoxide dismutase). Vitamin E also has slight anti-inflammatory action due to its effect on prostaglandin and leukotriene synthesis. Vitamin E combined with selenium supplementation has been shown to improve RA.
Zinc is also an antioxidant and functions in the antioxidant enzyme superoxide dismutase (copper-zinc SOD). Zinc levels are typically reduced in patients with RA and several studies have been done using zinc sulfate in the treatment of RA, with some of the studies demonstrating a slight therapeutic effect. For these reasons, zinc supplementation appears to be indicated for individuals suffering from RA.
Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Arthritis medications may rob your body of important nutrients, including:
Vitamin C NSAID drug therapy (including aspirin) can cause urinary excretion of vitamin C. This important vitamin is essential for maintaining connective tissue and synthesizing collagen, a protein and primary constituent of connective tissue. It also plays a role in the body's healing process by enhancing the immune system and aiding in the prevention of infections. Low levels of vitamin C are common in sufferers of rheumatoid arthritis (RA).
Calcium Corticosteroids can reduce dietary calcium, vital for nerve, muscle, and bone functioning. Reduced levels can increase the risk of osteoporosis. Low levels of calcium might cause aching joints, muscle cramps, extremity numbness, and is a common deficiency in R-A sufferers.
Vitamin E This antioxidant is essential in protecting the body's cellular membranes and aiding in the body's healing process.
Zinc Low serum levels of zinc are common in people taking corticosteroid medication and in those suffering from RA. This key mineral in the body is a constituent in the enzyme synthesis of collagen.
Arthritis medications may also affect the levels of Vitamin D, Folic Acid, & Selenium.
Mahan, K. & Escott-Stump, S: Krause's Food, Nutrition and Diet Therapy. Saunders, 1996.
Drugs are the primary allopathic therapy to control the pain and inflammation associated with osteoarthritis and, more especially, rheumatoid Arthritis.
Most of the drugs diminish the production of prostaglandins, produced by the inflammatory process. [Vitamin E is a natural prostaglandin inhibitor.]
Today, the first line of attack comprises NSAIDs (Nonsteroidal anti-inflammatory drugs) including salicylates. More exotic drugs may also be resorted to in desperation: antimalarial agents, gold salts, penicillamine, steroids and immunosuppressive agents.
Side effects frequently include nutritional status.
Aspirin, for example, increases urinary excretion of vitamin C. Decreased vitamin status with respect to vitamin C as well as folate have been noted. There may also be extensive bleeding both with salicylates and other NSAIDs. An associated condition is anemia.
Methotrexate and Sulfasalazine (both used as NSAIDs) are associated with the greatest losses of folate and these drugs should be accompanied with daily supplements of folate.
Corticosteroids are the most potent drugs but are mostly reserved for the worst cases as the side-effects are so severe. Nutritionally, they can produce a negative nitrogen balance, so that protein is lost and muscle tissues waste away. There is also reduced calcium absorption, so that bones become soft and weak.
Penicillamine (like gold salts) may both cause proteinuria but with penicillamine there may also be depletion of minerals: zinc, copper and iron.
Diet has been strongly implicated with many forms of arthritis for many years, both in regards to cause and cure. Various practitioners have recommended all sorts of specific diets for arthritis. In general, since rheumatoid arthritis is not found in societies that eat a more primitive diet and is found at a relatively high rate in societies consuming the so-called "Western" diet, a general healthful diet rich in whole foods, vegetables, fiber and low in sugar, meat, refined carbohydrates and saturated fat appears to be indicated in the prevention and possibly the treatment of RA. In addition, there appears to be strong, scientific support for the roles that food allergies and dietary fats play in the inflammatory process.
Elimination of allergenic foods has been shown to offer significant benefit to some individuals with RA. An Elimination Diet or Hypoallergenic Diet followed by systematic reintroduction of possible allergenic foods is often an effective method of isolating offending foods. Virtually any food can result in aggravating RA, but the most common offending foods are wheat, corn, milk and other dairy products (see Allergy Free Cooking), beef and foods from the Nightshade Family (tomatoes, potatoes, eggplants, peppers and tobacco).
Fatty acids are important mediators of inflammation through their ability to form prostaglandins, thromboxanes and leukotrienes. Manipulation of dietary oil intake can significantly increase or decrease inflammation, depending on the type of oil being increased. Arachidonic acid is a fatty acid derived almost entirely from animal sources (meat, dairy products, etc.). It contributes greatly to the inflammatory process through its conversion to inflmmatory prostaglandins and leukotrienes. The Vegetarian Diet is often beneficial in the treatment of inflammatory conditions, presumably as a result of decreasing the availability of arachidonic acid for conversion to the products.
Another important way of decreasing the inflammatory response is the consumption of cold-water fish such as mackerel, herring, sardines and salmon. They are rich sources of eicosapentaenoic acid (EPA) which competes with arachidonic acid for prostaglandin and leukotriene production. The net effect of consumption of these fish is a significantly reduced inflammatory/allergic response.
In a double-blind study of patients with RA, it was shown a diet rich in polyunsaturated fats and low in saturated fats supplemented daily with 1.8 grams of eicosapentaenoic acid brought about significant improvement. Supplementation may not be necessary if a serving of one of these cold-water fish was consumed at least once daily.
In another study, individuals with arthritis who supplemented their diets with cod liver oil showed major clinical improvement. Cod liver oil may be a less expensive way of administering EPA.
Patients with RA have benefitted from fasting, however it is not advised that an individual begin such a regimen without direct medical supervision. Fasting presumably decreases the absorption of allergenic food components.
1.* Rhus Toxicodendron - 30C to 10M use chronically.
2.* Rhododendron - 6X to 15C.
3.* Elaterium - 15C especially gouty arthritis and arthritic nodules.
4. Arbutus andrachne - 3X to 15C better on larger joints.
5.* Bryonia alba tinct. - 12X to 15C especially with swelling, knees, feet.
6.**Apocynum androsaemifolium - 200X to 30C use when all joints hurt, swelling in feet, hot feet.
1. Icthyolum - 15C
2. Rhododendron - 30C
3. Rhus Toxicodendron - 30C
Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.
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Calc. Fluor. enlarged joints; Calc. Phos. stiff, numb joints, worse at night and in bad weather; Mag. Phos. sharp pain, relieved by warmth; Nat. Mur. joint pains, worse at night and in bad weather; Nat. Phos. principal remedy: sour perspiration, acidosis; Silicea shoulder pains, worse at night and from warm covering;
Blueberries (Bilberry), cherries and hawthorn berries
White Willow Bark
German Commission E recommends a number of essential oils:
Pine essence (external)
Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.
Many herbs possess significant anti-inflammatory action and would be appropriate in the treatment of rhematoid arthritis. Some of the more effective herbs in the treatment of RA are discussed herein:
Blueberries, Cherries and Hawthorn Berries
These berries are rich sources of flavonoid molecules, particularly proanthocyanidins, the flavonoids giving them their deep red/blue color. These flavonoids exhibit membrane and collagen stabilizing, antioxidant, anti-inflammatory actions as well as many other actions very beneficial in the treatment of RA. These berries or extracts of them should be consumed.
Curcumin, the yellow pigment of Curcuma longa, and crude extracts of Curcuma longa have demonstrated significant anti-inflammatory activity in a variety of experimental models. Its effects in these models were comparable to cortisone and the drug phenylbutazone. It appears curcumin "sensitizes" or primes cortisol receptor sites, thereby potentiating cortisol action. Curcumin is more effective in acute inflammation, having little effect in chronic inflammation.
Devil's claw has been advocated in the treatment of a variety of diseases, including rheumatoid arthritis. Several pharmacological studies in animals and clinical trials in human beings have reported that devil's claw possesses an anti-inflammatory and analgesic effect comparable to the potent drug phenylbutazone. Other studies have indicated Devil's claw has little anti-inflammatory activity. In addition to relieving joint pain in the positive clinical trials, serum cholesterol and uric acid were reduced.
As feverfew has a long folk history in the treatment of fever, arthritis, and migraine, it would be only natural to assume that feverfew acts in a similar fashion as aspirin. Researchers have actually shown extracts of feverfew to have greater activity in inhibiting inflammation and fever than aspirin in experimental studies. They have specifically shown feverfew extracts to inhibit the synthesis of many pro-inflammatory compounds at their initial stage of synthesis. In addition, feverfew also decreases the secretion of inflammatory response. These experimental studies provide insight to the exact healing effect of feverfew in the treatment of arthritis.
Common ginger exerts a greater effect on inhibiting the production of inflammatory compounds than the potent prescription drug indomethacin. Ginger has also been shown to possess pain-relieving and antioxidant activity. Including liberal amounts of ginger in the diet appears to offer some benefit to individuals with RA based on experimental evidence.
Licorice has a long history of folk use in the treatment of many inflammatory conditions including RA. Much of its activity relates to its ability to increase the action of the adrenal hormone cortisol along with its direct effect on many key areas of inflammation.
Mistletoe is uniquely recommended by the German Commission E for use in degenrative joint inflammation.
White Willow Bark
The barks of trees in the willow and poplar families have been used since antiquity in the treatment of pain throughout the world. Their activity in relieving pain and inflammation is due to the high content of natural salicylates or aspirin-like molecules. The common white willow has a long folk history in the treatment of arthritis and also has a very high content of salicylates.
Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
Aromatherapy - Essential Oils
Coriander Essence, Cypress Essence, Ginger Essence, Juniper Essence, Lavender Essence, Marjoram Essence, Pine Essence.
Related Health Conditions
Acromegaly Aging Anemia Anorexia Bursitis Diabetes mellitus Fatigue Fever Gout Infection Injury Ochronosis Osteoarthritis Pain Rheumatoid arthritis
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