JOINT STATEMENT
The pain of rheumatoid arthritis.
Rheumatoid arthritis is a frustrating, agonizing pain condition affecting various joints throughout the body. It's an autoimmune process, meaning the body’s own immune system has begun to attack its own tissue. With the resulting discomfort, quality of life can decrease. Today, advancements are being made to lessen this aggressive process and substantially help aching joints.
Rheumatoid arthritis (RA) is considered an inflammatory process diagnosed based on several criteria from the American College of Rheumatology. These factors include morning stiffness for 30-60 minutes, swelling in multiple joints including the wrists, hands or fingers, and abnormal blood tests (high rheumatoid factor). Firm lumps in the skin called rheumatoid nodules can also be present, along with joint changes detected on an x-ray. Unfortunately, the reason the body would start attacking its own joint fluid is still unknown. Multiple types of medication can be used to control the body’s immune response against the joints. Without some type of treatment, many joints progressively get worse and can even show signs of deformity.
Diet may be one of the most critical tools available to combat RA. Food should always be considered a drug. It's something we take every day that will either work in our favor or against us. Food triggers must be considered. Gluten intolerance (celiac disease) is often seen with RA [1]. Gluten is found in wheat, barley and rye grains. Avoiding gluten can have significant benefits for the joints if the patient is intolerant. Another common food trigger is dairy. Not everyone digests milk well, which may trigger immune system overactivity in the gastrointestinal tract [2]. Dairy is a pro-inflammatory food that can increase joint pain for some. Some patients can't tolerate dairy at all, while others do fine with cultured products like yogurt, kefir or cottage cheese. To find out if these foods are a problem, consider doing an elimination diet to better explore which foods are causing problems and should be avoided.
Overall, the dietary approach to combating this autoimmune disease is to be anti-inflammatory. The omega-6 fatty acids, found in soybean oil, vegetable oils and partially hydrogenated oils, promote inflammation and should be minimized. Omega-3 intake should be increased; walnuts, cold water fish like salmon and tuna, in addition to ground flaxseed. A mainly plant-based diet will help avoid the "bad" fats as well as refined sugars that can promote worsening of pain and inflammation.
There are several nutrients that may help RA symptoms. Vitamin D is associated with decreased risk of rheumatoid arthritis [3]. It is also needed for the body to absorb calcium and is associated with decreased cancer risk. Turmeric is a supplement derived from the spice curry, and is known to be a natural anti-inflammatory. Turmeric does have limited research to suggest consideration with the inflammation of RA, starting at 500 mg 1-2 times a day [4]. The hormone DHEA has been linked to improvements in inflammation. This hormone has been found to be low in many female RA patients [5]. DHEA can be taken as an over-the-counter supplement at doses of 10-50 mg daily. Clinically, many women with RA need higher doses (25-50 mg daily) initially until symptoms improve. Men with RA have been found to be low in testosterone, and can improve with therapy [6,7]. Ginger is another anti-inflammatory herb that could help with pain. Glucosamine at doses of 1,500-2,000 mg daily can help protect joint tissue from further destruction.
A few other points should be considered for those suffering from resistant cases of RA. Two antibiotics have been used to improve the outcome of RA, metronidazole and minocycline. These are not conventional, but have been basically passed on through discussions by physicians and are available by prescription. The theory with this treatment is that the joint inflammation may be caused by an unknown type of infection. Given the amount of positive responses to this treatment, further studys need to be done to solidify its status as a legitimate method. These are not without side effects. Patients should find a doctor well-versed in this treatment before attempting it.
Heavy metal burden due to lead, mercury or other toxins has also been suspected as a causative agent in chronic joint inflammation. Sources of heavy metals are prevalent in industrialized society and may significantly aggravate the inflammatory process.
RA may lead to significant loss of motion, function and increasing pain. Through a combination of therapies, patients can maximize their success with current symptoms and keep themselves as healthy as possible for the future.
References:
1. Hull, R. Rheumatoid arthritis and celiac disease. Lancet, 1.330.1989.
2. Hunter, J.O. Dietary studies. Gibson, P.R., Jewell, D.P. (1985). Topics in gastroenterology, Oxford (UK): Blackwell Science: pp 305-313.
3. Merlino, LA., Curtis, J., Mikuls, TR., Cerhan, JR., Criswell, LA., Saag, KG. (2004). Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 50:72–7.
4. Park, C. (2007). Curcumin induces apoptosis and inhibits prostaglandin E(2) production in synovial fibroblasts of patients with rheumatoid arthritis. Int J Mol Med, 20(3):365-72.
5. Imrichv R., Rovensky J., Malis F., et al. Low levels of dehydroepiandrosterone sulphate in plasma and reduced sympathoadrenal response to hypoglycemia in premenopausal females with rheumatoid arthritis. Ann Rheum Dis.
6. Tengstrand B., Carlstrom K., Hafstrom I. Bioavailable testosterone in men with rheumatoid arthritis—high frequency of hypogonadism. Rheumatology, 41.285-289.2002.
7. Cutolo, M., Balleari, E., Giusti, M., et al. (1991). Androgen replacement therapy in male patients with rheumatoid arthritis. J Rheumatol 34,(1):1-5.1991.
Other Trusted Sources:
MedicineNet
Arthritis Foundation
