Rheumatoid Arthritis Naturopathic Approaches by Chris Habib, ND Mahaya Forest Hill Clinic Director www.mahayaforesthill.com Introduction Rheumatoid arthritis (RA) is a chronic health condition that causes pain and stiffness in multiple joints, typically in the hands and feet. It impacts the lining of the joints, which, depending on the severity of the condition, causes pain, swelling, and deformity. [1] RA can also cause symptoms such as fever, loss of mobility or function, and redness; also, nodules can sometimes appear. RA is an autoimmune disease, which means that the body s immune system is targeting normal tissue. Over time, damage can occur to the joints, cartilage, bones, and ligaments. However, the degree of symptoms does not necessarily correlate to the amount of damage that has been done. People with RA can have flare-ups and remissions, with long periods of time with many symptoms or very few symptoms. There is no specific known cause for RA. [2] Several infectious organisms have been suspected as potential causes, including bacteria and viruses. It is possible that for some people with RA, the correlation with exposure to certain infections is strong, but it is not always the case. RA also has a genetic component to it, and certain genes have been identified that can increase the risk of RA. When inflammation occurs in RA, the immune cells called lymphocytes are activated and certain chemicals are present. These include messengers called cytokines, interleukins, and tumor necrosis factor. These messengers are often studied and measured to see if certain treatments can help to decrease their levels (and thus in theory decrease disease activity). RA is considered a whole-body condition. Even though the joints are primarily affected, various areas of the body can also be damaged. The skin of people with RA can develop vasculitis, which means vessels are inflamed, and in some people the skin
can turn purple. The lungs can be impacted by fibrosis or scarring, and it is also a consequence of some RA treatments. The cardiovascular system tends to be more at risk for atherosclerosis or calcification of the vessels, and the risk of heart attack and stroke increases. [3] Other areas of the body are also at risk, including the eyes, the liver, kidneys, and the nervous system. The reason so many areas are at risk is because the autoimmune process happens all over the body, not just in the joints. This article will examine the most common diagnostic and therapeutic approaches for RA. Getting Diagnosed Given the wide range of symptoms that can present, getting a diagnosis can sometimes be challenging. There is no specific test that unequivocally tells you that you have RA. The symptoms are varied in each individual and can look like other conditions. The first step in obtaining a diagnosis of RA is by obtaining a thorough medical history. A key piece of information here is how the symptoms have changed over time, as this can help rule out similar conditions. The most common description includes pain, stiffness, and problems with joint function. The next step is always a comprehensive physical exam. In this case, you want to make sure to have your doctor check your range of motion, which is how far you can move your joints. The doctor should be checking where it hurts and how much it hurts. All of the areas where there is the risk of damage from RA should be checked. This means your doctor could be checking your lungs, your abdomen, and your eyes. There are a number of lab tests that can be particularly helpful in obtaining or confirming a diagnosis of RA. [4] There s one lab test called Rheumatoid Factor (RF). RF is an antibody that is found in the blood of many people who have RA; however, not everyone will have it, and conversely, many people who have it will never develop RA. So this means that the RF test is not the only thing that should be tested or relied upon, but it helps to provide additional information. RF can also be helpful in identifying the severity of RA the higher the RF levels, usually the worse the severity of RA. Another common lab test is called Anti-CCP antibodies. Similarly, this is found in most people with RA and can be found even before RA develops. Finally, there are a number of other lab tests that can be utilized; some measure inflammation and others look at blood counts. Sometimes, imaging is used to identify damage to the joints. The bottom line is that to obtain an accurate diagnosis, all of the information must be taken together including the medical history, the physical exam findings, and the lab results.
Conventional Treatments Treating the root cause would involve providing a treatment that helps decrease the activity of the immune system, since the underlying issue is really the autoimmunity; there are a number of drugs that do this successfully. Some of them work by reducing inflammation and structural damage to the joints by disrupting the steps involved in the development of the inflammatory process. Some block some of the chemical messengers we mentioned earlier, including tumour necrosis factor, cytokines, or interleukins. [2] Each of these drugs is a little different, and not every drug works the same way in every person with RA. Actually, there may be a trial-and-error approach until the best drug or most effective cocktail is found. The drugs that target the immune system are only one option. Often, medications that help with pain are used. They don t treat the cause, but since there is no cure for RA, making sure the symptoms are tolerable is a worthy goal. These medications include things like Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs). The challenge is that all drugs can have side effects; depending on the person, the side effects can be severe. Drugs for RA can cause stomach problems, cardiovascular problems, and issues with the liver and kidneys. This is perhaps where lifestyle approaches and naturopathic approaches can be of additional benefit. We will discuss these in the next section. Other conventional RA treatments include joint replacement surgery and specific lifestyle measures. Joint replacement surgery may be indicated if medications are not effective, or if the surgery will have many benefits compared to risks. Oftentimes, it is the larger joints that get replaced, such as the knees. Some of the lifestyle habits that can be incorporated include resting and stretching, joint care, and diet modification. Exercise is one of the most important lifestyle habits, because it can strengthen the muscles and enhance flexibility. [4] Both aerobic exercise and resistance training should be recommended. Exercise is a fantastic prevention tactic and so should be recommended as soon as possible. It should take into account physical limitations and pain management, and should be tolerable. Diet modification should incorporate the removal of any inflammatory foods, including any trigger foods or foods that a person is sensitive to. The addition of anti-inflammatory foods like fish, which contain omega 3 fatty acids, may be a good idea.
Naturopathic Approaches The naturopathic approaches to RA can be incorporated at any stage in the condition. If it is very early, naturopathic approaches alone may be able to reverse symptom progression and eliminate pain. The magnitude of success depends on the starting point, the patient s individual symptoms, and how many changes they are willing to make. The lifestyle changes mentioned above should all be incorporated and reinforced. If interested in using nutritional supplements, fish oil is an excellent anti-inflammatory and can reduce joint pain and stiffness. [5] To address the root cause, supplements that help modulate the immune system should be considered. These include vitamin D and probiotics. Probiotics are healthy bacteria, and the chemicals that they metabolize and excrete help to regulate the activity of the immune system. Every product is different and every strain is different. Many products available today utilize multistrain preparations, meaning that several different bacterial cultures are included in the same capsule. The dose of the probiotic can make a big difference; this is best determined by your naturopathic doctor once they have all of the required information about your case. Probiotics should be kept in the fridge and had with food to optimize their effects. Herbal supplements can be extremely beneficial. Naturopathic doctors utilize several highly anti-inflammatory and immunomodulatory herbs. These include things like curcumin, Boswellia, and Salix. Oftentimes, the herbs are combined with some of the nutritional options to make it easy to comply with treatment. Herbs can also be provided on their own in tincture form or in tablet form. Acupuncture is another great option for RA. It can be performed from a traditional Chinese medicine perspective, or from a Western perspective. Both have value, and both can have significant positive clinical effects. A comprehensive treatment approach that allows for collaboration and provides the patient with choice is ideal. For this reason, we suggest utilizing all of the health-care practitioners at your disposal so that you can get a clear diagnosis and multiple different treatment options. As always, please consult your naturopathic doctor for more information. References 1. Mayo Clinic. Rheumatoid arthritis http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/definition/con-20014868 Accessed 2016 02 04. 2. MedicineNet.com. Rheumatoid arthritis http://www.medicinenet.com/rheumatoid_arthritis/page2.htm Accessed 2016 02 04. 3. Aviña-Zubieta, J.A., et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: A meta-analysis of observational studies. Arthritis Care & Research Vol. 59, No. 12 (2008): 1690 1697.
4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis http://www.niams.nih.gov/health_info/rheumatic_ disease Accessed 2016 02 05. 5. Kremer, J.M., et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis and Rheumatism Vol. 38, No. 8 (1995): 1107 1114.