Rheumatoid arthritis

In this Article (Index)

• What is Rheumatoid arthritis?
• Overview of RA
• Symptoms and Signs of RA
• Causes and Risk factors
• Microbiome and RA
• Complications
• Treating Rheumatoid arthritis
• Lifestyle measures
• Medication
• Supportive Therapies
• Surgery
• Complmentary and Alternative Medicine

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease. This means that the body's immune system attacks the healthy lining of the joint capsule.

This thin yet tough lining becomes swollen, inflammed and the outcome is chronic pain and stiffness.

It constant immune attack will eventually damage the bone and the cartilage at the joints, causing disability.

It is an uncurable and chronic disease, meaning that it persists for a long time and can worsen.

The disease affects between 0.2 to 1% of the population.

It is important to diagnose RA at an early stage to start treatment to prevent joint damage and contain the disease.

Overview of RA

It can affect the joints on both sides of the body at the same time, impacting on the wrist, fingers, knees, feet, ankles, elbows. The mistaken immune response can also target other organs and put those who have RA at risk for other diseases subh as diabetes, osteoporosis or heart diseas.

It can affect people of any age but is more frequent among people 25 to 60 years old, and women.

There is no cure for osteoarthritis, and conventional medications can help stop its progression while complementary and alternative therapies can help relieve symptoms.

Diagnosis

The condition is diagnosed using several methods as there is no single test to detect RA. Your physician will do a general check-up, notice the swelling, redness of the joints, take x-rays, and run some blood tests looking for signs of inflammation (erythrocyte sedimentation rate or ESR), and markers of an overactive immune system, antibodies such as rheumatoid factor (RF), antinuclear antibodies (ANA), and anticyclic citrullinated peptide (anti-CCP) antibodies.

Signs and Symptoms of RA

The following are some of the symptoms of RA:

• Morning Stiffness. Stiff joints, especially in the hands (wrists, base of the fingers), feet, knees, ankles and elbows when you wake up in the morning. Joint stiffness after resting for a few minutes.
• Limited joint motion
• Joint pain.
• During a flare, a slight fever.
• Swelling, tenderness, inflammation. The area can be warm to the touch.
• Fatigue.
• Bumps, usually painless, appear under the skin. They are firm, small, and round. Located at the joints.

Causes and Risk factors

The immediate cause of rheumatoid arthritis is that the immune system attacks the healthy joint tissues.
A healthy immune system provokes inflammation to destroy invading microorganism and heal injuries, but in people suffering from RA, their immune system is overactive, and it targets healthy tissue, not only of the joints, but also other organs (skin, eyes, heart).

It is an autoimmune disease because the body's immune system can't distinguish between self and foreign tissue, attacking your own body by mistake.

As with most autoimmune diseases, there is a genetic predisposition and a trigger that launches it.

You may have an increased risk of RA if:

• You are a woman. Women are 2.5 more likely to have RA than men, and with more severe symptoms.
• Genetics: you have a family history of rheumatoid arthritis.
• You smoke.
• Being obese. Obesity increases the risk of having RA.

Microbiome and RA

Regarding the trigger, it is believed to be an environmental factor, a virus, an infection, stress, smoking.

Recent research suggests that the microbiome may have a role in autoimmune diseases like RA.

The micorogranisms that live in your digestive tract and skin, known as the microbiome, have a complex interaction with the body's immune system, modulating and regulating its response throughout the body. When the microbiome is thrown off balance, a disruption called dysbiosis, it can longer shape how the immune system functions leading to autoimmune disorders. Dysbiosis can be caused by stress, poor diet, an antibiotic treatment or some other factor.

Complications of RA

The disease affects the joints, so stifness, pain and swelling in the joints will affect the use of hands, feet, wrists.

There are periods when the symptoms worsen, known as flare-ups. Treatment will help decrease their number and space them further apart in time.

Fatigue, feeling tired and weight loss are also signs of RA affecting other parts of the body.

Some possible complications can be life threatening so it is critical that you monitor them with your caregiver:

• Carpal tunnel syndrome in the hands
• Increased risk of heart attack and stroke
• Joint deformities
• Your immune system attacks other parts of the body, causing inflammation in other organs:
  
  • Pleuritis: inflammation of the lungs
  • Myocarditis: inflammation of the heart muscle
  • Rheumatoid vasculitis: inflammation of the blood vessels
  • Eye inflammation
• Skin dryness, redness, rashes, thin skin that is easily bruised.
• Cervical spine problems that can be life threatening.
• Diabetes

Treating Osteoarthritis

Early diagnosis and treatment are critical. Visit your docotr if you have symptoms. After diagnosis, your doctor will define a treatment to reduce the symptoms, manage pain and also slow down the joint damage.

Although it is an uncurable disease, conventional medicine and some lifestyle changes can improve life quality and help manage the symptoms.

Conventional medication can slow down the disease and in some cases the symptoms may go away completely.

Complementary and Alternative therapies can also help in combination with regular medications.

RA usually requires lifelong treatment that is usually a combination of conventional, complementary and alternative medicine are used to manage RA. We list them below and will discuss them in the following sections:

• Lifestyle measures, weight loss, restful sleep, healthy food, stress management, and exercise.
• Medication.
• Supportive Therapies, physiotherapy, hot & cold packs, devices.
• Surgery, when the other treatments are not effective.
• Complmentary and Alternative Medicine, diet, supplements, herbs, nutraceuticals, acupunture.

Lifestyle Measures

• Exercise
• Weight Loss
• Diet and Nutrition
• Stress and Sleep

Exercise

Regardless of your age or fitness, regular physical activity will help you improve your general fitness and strenghten your muscles and they will support your joints better, it will enhance and maintain joint motion, relieve pain and, as a bounus it will also contribute towards losing weight and keeping it off. Weight loss reduces the pressure on the joints that bear the weight.

Exercise will improve your posture, coordination, flexibility, relieve stress, and boost your mood. It will also help prevent diabetes, heart disease and osteoporosis.

Type of Physical Activity

Aim at exercising 5 days a week or more, 30 minutes a day.

Include a combination of aerobic, strengthening and flexibility exercises.

Walking, swimming, biking, and exercise in a warm-water pool are good options.

If you are a sedentary or inactive person, start your physical activity program slowly, building up over the course of a few weeks.

You can keep your bones strong with weight-bearing exercises, such as walking or lifting weights.

Pay attention to your body's signals, don't overdo it. If you feel pain you should stop immediately. Perhaps you may want to rest during flare-ups.

Feeling slightly sore after exercising is normal.

Be sure to warm up and cool down correctly.

Weight Loss

Excess weight is carried by the joints in your feet, ankles, knees, hips! So losing weight will relieve the strain on these joints and slow down the wearing that damages your joints.

Before losing weight or engaging in an exercise program, check with your caregiver on how to do so in a safe, slow yet steady way.

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Medication

As mentioned further up, an early diagnosis and an aggressive treatment can halt the joints destruction by RA.

Therapy usually involves anti-inflammatory medicine and disease-modifying antirheumatic drugs (DMARDs) that not only relieve symptoms, they stop the progression of the disease.

• Non-steroidal anti-inflammatory drugs (NSAIDs). Theymrelieve pain and reduce inflammation and swelling. They do not stop the progression of RA. They work well but extended use can cause ulcers, bleeding and increase your risk of heart problems. Over-the-counter NSAIDs include: ibuprofen (Advil) and naproxen (Aleve).
  NSAIDs can also be applied as creams on the affected joints. These medicines have side effects so you should alway check with your healthcare provider before taking any.
• Corticosteroids. People with RA often take corticosteroids to reduce inflammation quickly, especially during a flare. However, taking steroids long term raises the risk of developing diabetes, osteoporosis, gaining wait, and retaining fluids.
• Disease-modifying antirheumatic drugs (DMARDs). They slow down and even halt the progression of the disease. Side effects can increase the risk of infections and cause liver damage.
• Immune suppressants. They suppress the overactive immune system in people with RA. Side effects include a higher risk of harmful infections (due to the lowered immune response).

Your doctor will prescribe the proper medicine to manage your RA.

Supportive Therapies

Complementing the other treatments, you can also try the following:

Hot and cold packs

Applying hot or cold packs to the joints can help ease the pain and RA symptoms.

Mechanical Aids

These help you get around with less pain such as special insoles or shock-absorbing shoes for exercising, joint protection, leg braces, a splint to support a joint and redistribute the weight, walking stick to support your weight. All mechanical aides should be custom-fitted by your doctor or occupational therapist.

Gloves may help some patients, whether compression gloves or regular ones. A study conducted in 2021 with, showed that both perform the same and that the patients "reported similar, but only small, improvements in hand pain", it also disclosed that the pain-reducing benefit comes from the warmth and comfort of the glove, not from the pressure exerted (16).

Surgery

Sometimes, when a joint has been damaged it may require replacement surgery, especially for knees and hips.

Complementary and alternative therapies

• Acupunture
• Hydrotherapy or spa therapy

There are several complementary or alternative therapies for RA.

Acupunture

A recent meta-analysis by Chow and Chu (2018) reported that: "acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying" (1).

Hydrotherapy, Balneotherapy or Spa Therapy

Balneotherapy is one of the oldest pain relief therapies for treating arthritis in general.

There is little evidence from clinical studies to support its use due to the lack of adequate randomized trials. A staistical analysis done by Verhagen et al. (2015) didn't find any data supporting hydrotherapy's benefits: "Overall evidence is insufficient to show that balneotherapy is more effective than no treatment" (3).

However, a review by Santos, Cantista and Vasconcelos (2016) reported studies that showed "important improvement on functional capacity ... improvement on morning stiffness ... number of active joints ... and activities of daily living ... improvement on handgrip strength" but, when it came to pain, the results were inconclusive about improvement (12).

Tai Chi and Yoga

Tai Chi is an ancient Chinese martial art with slow, precise, focused movements it is low impact and gentle. Clinical studies show it has benefits. Han (2019) reported that "Tai Chi does not exacerbate symptoms of rheumatoid arthritis...[and] has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion" (4).

Dietary Supplements

Diet and natural supplements are part of the complementary and alternative therapies.

Supplements

Supplements can be expensive and there is no strong evidence supporting their effectiveness as a treatment for RA or that they stop the damage it provokes in the joints.

These products have side effects for those taking blood thinners and it may interfere with some medications. Check with your doctor before taking any supplement, natural or botanical product.

• Omega-3 fatty acids
• Bromelian
• Ginger
• Capsaicin
• Cat's claw
• Gamma linolenic acid (GLA)
• Folic acid
• Viamin E
• Green Tea
• Turmeric
• Boswellia

Omega-3 fatty acids

A scientific review conducted in 2022 (6) reported that the "Omega-3 fatty acids... may attenuate and modulate the autoimmune inflammatory response. They have been shown to ameliorate or prevent experimental arthritis and may decrease disease activity in rheumatoid arthritis." Furthermore, omega-3 fatty acids reduce the risk of heart disease, a positive point considering that this risk is higher in people suffering from RA.

The most common types of omega-3 fatty acids are the plant-based ALA (alpha-linolenic acid), and the animal-based DHA (docosahexaenoic acid), and EPA (eicosapentaenoic acid). Fatty fish like salmon, anchovies or sardines and algal oil have DHA and EPA, walnuts, flax and chia seeds have ALA.

Bromelian

An enzyme obtained from pineapples has claims to alleviate RA symptoms, but further studies are required to evaluate its effects: "oral therapy ... produces certain analgesic and anti-inflammatory effects. However, the results are often inconsistent" (15), furthermore, it has side efects and if you are using blood thinners or have ulcers, avoid it.

Ginger

This oriental spice (Zingiber officinale) helps to reduce symptoms according to Aryaeian et al., (2019): "ginger reduces inflammatory factors hs-CRP and IL-1β gene expression in patients with active RA and it seems that ginger can improve the inflammation in the patients" (11).

Capsaicin

The capsicum genus is native to the Americas and best known for their fruits: the spicy chili pepper and bell pepper. One of the capsicum species, Capsicum frutescens produces a substance that gives the hot, painful kick to chili peppers, capsaicin. This substance has an effect on neurochemicals that transmit pain to the brain causing relief after. Its effect on RA has been reported as follows: "Significantly more relief of pain was reported by the capsaicin-treated patients than the placebo patients throughout the study; after four weeks of capsaicin treatment, RA... patients demonstrated mean reductions in pain of 57% ... According to the global evaluations, 80% of the capsaicin-treated patients experienced a reduction in pain after two weeks of treatment." However, the study reported that roughly half the patients felt a "Transient burning" at the site of application (13).

Cat's claw

Cat's claw (Uncaria tomentosa) is an Amazonian vine that is claimed to relieve RA pain. One study reported "modest benefit to the tender joint count of a highly purified extract ... in patients with active RA" who were also taking DMARDs (10).

Cat's claw can stimulate the immune system so it should not be taken without medical supervision.

Gamma linolenic acid (GLA)

This omega-6 oil was used by Native Americans to treat inflammation. It is found in orage oil, evening primrose oil, and black currant seed oil. A randomized clinical study by Reed et al. (1996) found that "Treatment with GLA for 6 months resulted in statistically significant and clinically relevant reductions in the signs and symptoms of disease activity in patients with RA," patients saw an even higher improvement after 12 months of treatment suggesting that "GLA might function as a DMARD" (2).

Those taking blood thinners or with a history of seizures shouldn't take GLA.

Folic Acid

Patients treating RA with the immunosupressing drug methotrexate may require supplementation with folic acid because it helps reduce some of this medicine's side efects. Folate or Folic Acid, also known as Vitamine B9 is found in asparagus, avocados, green leaf veggies (spinach), orange juice, cereal, pasta, and rice. Check with your caregiver before taking any vitamin or supplement.

Viamin E

A statistical study found that "Vitamin E supplements used on a regular basis can help individuals with RA reduce joint discomfort, edema, and stiffness, as well as enhance their overall quality of life" (8). But, it has side effects.

On the other hand, it doesn't prevent the onset of the disease: the (Women's Health Study) was a double blind randomized large scale trial involving almost 40,000 women, following them for 12 years. Among its findings, was that taking 600 IU daily of vitamin E supplements didn't provide a reduction in the risk of developing RA.

Herbal Nutriceuticals

These are plant-derived products that are available as teas, pills, extracts or tinctures. The fact that they are natural and botanical don't mean that they are harmless. They have adverse effects, and pregnant or nursing women, or those taking medications should consult with their physician before taking them.

Turmeric

Turmeric (Curcuma longa) has a long history in tradigtional medicine, it has bioactive curcuminoids that are antioxidants and anti-inflammatory.

A review of available trials stated that "the only human study showed that curcumin significantly improved morning stiffness, walking time and joint swelling... In conclusion, curcumin seems to be useful... on RA patients. (7).

Green Tea

Green tea (Camelia sinensis) has plenty of antioxidants and they have antioxidant activity. Menegazzi et al. (2020) (9) reported the protective anti-inflammatory properties of green tea against a wide range of diseases including covid-19: autoimmune diseases including rheumatoid arthritis.

Boswellia

Boswellia serrata is a tree that is found some parts of India where it is known as Salai guggal; its gum resin has been historically used in traditional Ayurvedic medicine for treating RA. Its component boswellic acid has anti-inflammatory properties. Clinical trials have had mixed results but one involving over 260 patients reported that it "is effective in the treatment of rheumatoid arthritis (RA).... The criteria for assessment were mainly joint swelling, pain... stiffness... side effects, and tolerance" (14).

Detailed Information on each type of Arthritis

We have written pages for each of the most common types of arthritis with in depth information on their symptoms, causes and treatment. Click below to learn all about them.