Rheumatoid Arthritis

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Latest Edit: Iva Lloyd, ND 2017-05-05 (EDT)

Rheumatoid arthritis (RA) is an autoimmune condition that mainly affects the small joints. The onset of rheumatoid arthritis usually occurs between 30 and 50 years of age. It affects about 1% of the population and occurs twice as often in women as in men. RA is an inflammatory condition and overtime can result in the progressive destruction of the joints. The joints that are most commonly affected include the fingers and toes, wrists and ankles, shoulders, elbows and hips.[1]

Rheumatoid Arthritis
Causes Genetics, Dietary Factors, Infections, Stress
See Also Musculoskeletal Conditions, Arthritis, Hypochlorhydria, Anemia
Books Books on Muscle, Joint and Bone Conditions
Articles Articles on Musculoskeletal Conditions

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With rheumatoid arthritis the causes are variable and include lifestyle and environmental factors. A detailed assessment is required to determine which factors are contributing.

Lifestyle

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Check out this book Natural Treatments for Arthritis
Check out this book Healing Arthritis, Complementary Naturopathic, Orthopedic and Drug Treatments
Check out this book Alternative Medicine Definitive Guide to Arthritis: Reverse Underlying Causes of Arthritis With Clinically Proven Alternative Therapies


Check out this book The Anti-Inflammation Diet and Recipe Book: Protect Yourself and Your Family From Heart Disease, Arthritis, Diabetes, Allergies - and More

Social

  • Mental Emotional Health
  • Social stress is strongly correlated with inducing, exacerbating, and effecting the ultimate outcome in RA.
  • Anxiety and depression are commonly associated with RA. Those individuals with depression tend to RA that is worse and that progresses more rapidly.[4]
  • Psychiatric illness is a relatively common disorder in those with RA, with a frequency higher than that of other general medical conditions.[5]
  • Social stress and a lack of support can contribute to RA.[5]

Environmental

  • Low levels of Vitamin D are associated with increased occurrence and progression of RA.[6]
  • There is a strong association between periodontal disease and rheumatoid arthritis.[8]
  • There is a strong association between chronic urinary tract infections due to a protease infection and rheumatoid arthritis.[9]
  • Demographics
  • There is an increased incidence of rheumatoid arthritis in urban as opposed to rural areas.[10]

External

  • Trauma and Overuse
  • Trauma and overuse can increase the likelihood of RA in joints affected.

Medical Interventions

  • Prescription Medications
  • NSAIDs suppress the symptoms of rheumatoid arthritis, but worsen the intestinal hyper-permeability that can contribute to the disease process.[2]

Diagnostic Testing

Rheumatoid.jpg
  • Rheumatoid factor is detectable via blood test in two thirds of patients with rheumatoid arthritis.[11] It is absent in children with this disease.[12]
  • Blood tests indicated to diagnose rheumatoid arthritis include:[2] rheumatoid factor level, histocompatability antigen HLA-DRw4, CRP, ESR, ANA.
  • Other tests include:[11], [12] X-ray of the joints.

Related Symptoms and Conditions

Conditions associated with RA or that may predispose a person to the disease include:

  • Hypochlorhydria. Up to 50% of patients with rheumatoid arthritis do not produce quantities of hydrochloric acid sufficient for proper digestion.[2], [7]
  • Deficiency in pancreatic enzymes which can contribute to incomplete digestion.[2].
  • Urinary Tract Infection
  • Hormone imbalances, especially when in menopause
  • Increased intestinal permeability which allows antigens to pass through the gut wall, leading to the formation of antibody-antigen immune complexes. Some of these are deposited in joint tissue, where they are sought out and destroyed by white blood cells.[2], [11] Specifically, CD4+ T cells cause the release of tumour necrosis factor alpha, and interleukin-1 in the area to destroy the antibody complexes.[7] When this destruction occurs, surrounding tissue, in this case the synovium of the joint, is also damaged.[2]

People with rheumatoid arthritis are at increased risk of developing:[11]

Characteristics

Rheumatoid arthritis commonly affects the hands and feet, causing proliferation of the synovial membrane which results in an abnormal layer of fibrovascular tissue, known as a pannus. As this enlarges, it can decrease the joints ability to move and the affected joints usually become enlarged, warm and often deformed. The skin over the joints can become red or purple.[11]

Rheumatoid arthritis occurs as a result of the activity of inflammatory cells within the synovium of the joints. These cells secrete interleukins, tumor necrosis factor, leukotrienes, prostaglandins, and metalloproteinases (enzymes that break down cartilage). This process results in the uncontrolled growth of the synovium within the joint.[10]

Symptoms associated with RA include:

  • Symmetrical joint pain
  • Stiffness of the joints that is typically worse in the morning
  • Swollen joints
  • Calcification and deformity of the joints may develop
  • Fatigue and low grade fever are also commonly present.

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. This is done by supporting digestion, decreasing/avoiding allergies, decreasing gut permeability, and choosing foods and supplements that work on decreasing inflammation. As rheumatoid arthritis can be a rapidly progressing chronic disease with seriously debilitating outcomes, it is commonly co-managed with a rheumatologist, especially in severe cases.[7]

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Lifestyle

Lifestyle recommendations include:

  • Dietary recommendations. As dietary factors have been shown to contribute strongly to this disease, diet modification is a main avenue of treatment.
  • Short periods of gentle, low impact exercises on a daily basis is recommened. A warm swimming pool or an exercise bicycle are helpful at decreasing any excessive stress on the joints.

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

The naturopathic therapies used to treat osteoarthritis include:

  • Other foods such as Royal Jelly
Herbs can be used as tinctures, teas, capsules, oils, lotions, creams and salves, and as poultices and compresses for the treatment of rheumatoid arthritis.[16]

, Acupuncture treatment has three aspects; local points for affected joints, distal points for underlying causes, and back transporting points for deficiency and other factors.[17]

"Swollen joints can be pricked to produce light bleeding. Points such as si feng, LU 5, and PC 3 can be bled to relieve local joint pain and immobility."[17] The most tender points in the tendons and muscles can be needled either by deep tendon insertion into the tendon, or by needling of the tender points in the muscles while the patient moves the limb (if possible)."[17]
  • Hydrotherapy is helpful both in acute periods of pain and discomfort and in decreasing the progression of RA.
Article Arthritis: Manipulation and Physical Treatment Perspectives, Vital Link; 2006 Spring/Summer
  • Massage can improve the circulation and mobility of the joint and give relief to pain, especially when it is done using herbal oils such as Calendula, Hypericum, Cajaput, Juniper, Rosemary or Lavender.[16]

References

Co-Authored by:

Dr. Iva Lloyd, BScH, RPE, ND[1]
Dr. Raymond Trott, ND
  1. Pizzorno Joseph, Murray Michael, Joiner-Bey Herb The Clinician's Handbook of Natural Medicine Churchill Livingstone.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Murray Michael (1994) Arthritis: Your Natural Guide to Healing with Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods Prima. Cite error: Invalid <ref> tag; name "Murray" defined multiple times with different content
  3. Mikuls TR, Cerhan JR, Criswell LA, Merlino L, Mudano AS, Burma M, Folsom AR, Saag KG (2002) Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: results from the Iowa Women's Health Study. Arthritis Rheum;Jan;46(1):83-91. PMID: 11817612.
  4. Isik A, Koca SS, Ozturk A, Mermi O (2007) Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol.Jun;26(6):872-8. PMID: 16941197.
  5. 5.0 5.1 el-Miedany YM, el-Rasheed AH (2002) Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine.May;69(3):300-6. PMID: 12102277.
  6. 6.0 6.1 Laragione T, Shah A, Gulko PS (2012) The vitamin D receptor regulates rheumatoid arthritis synovial fibroblast invasion and morphology. Mol Med.Mar 27;18(1):194-200. PMID: 22064970.
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Prousky Jonathan (2008) Principles and Practices of Naturopathic Clinical Nutrition CCNM Press Inc. p 391
  8. Ranade SB, Doiphode S (2012)Is there a relationship between periodontitis and rheumatoid arthritis? J Indian Soc Periodontol.Jan;16(1):22-7. PMID: 22628958.
  9. Puntis D1, Malik S, Saravanan V, Rynne M, Heycock C, Hamilton J, Kelly CA. Urinary tract infections in patients with rheumatoid arthritis. Clin Rheumatol. 2013 Mar;32(3):355-60.
  10. 10.0 10.1 Kendall-Reed Penny, Reed Stephen (2002) Healing Arthritis, Complementary Naturopathic, Orthopedic and Drug Treatments CCNM Press Inc.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Hobbs Ron, Bucco Gloria, Barton Anna (1999) Natural Treatments for Arthritis Prima.
  12. 12.0 12.1 El-Hashemy Shehab, Skowron Jared, Sorenson Linda (2011) Textbook of Naturopathic Family Medicine & Integrative Primary Care: Standards & Guidelines CCNM Press. P 376.
  13. 13.0 13.1 13.2 Murray Michael (1996) Encyclopedia of Nutritional Supplements, The Essential Guide for Improving Your Health Naturally Prima Publishing
  14. Lu Henry (1986) Chinese System of Food Cures, prevention and remedies Sterling Publishing Co. New York.
  15. Boon Heather, Smith Michael 2004 The Complete Natural Medicine Guide to the 50 Most Common Medicinal Herbs, Robert Rose, Toronto
  16. 16.0 16.1 Hoffmann David (1992) Therapeutic herbalism: A correspondence course in phytotherapy. Cite error: Invalid <ref> tag; name "Herbalism" defined multiple times with different content
  17. 17.0 17.1 17.2 Ross Jeremy (1995) Acupuncture Point Combinations, the Key to Success Churchill Livingston.