Rheumatoid arthritis (RA) is a chronic inflammatory condition of the connective tissues throughout the body, but especially around the joints. The main sign of RA is often stiff, painful, and swollen joints. Areas of typical complaint include the hands, feet, wrists, ankles, and knees. Depending on the severity of the condition, these areas may eventually become deformed. The exact cause of rheumatoid arthritis remains, largely, unknown. It has been theorized that a number of genetic and environmental factors may contribute to the disease process, and may include; genetics, poor nutrition, lifestyle, chronic stress, abnormal bowel permeability, food allergies, and infection caused by various microorganisms. In rheumatoid arthritis, the joint lining, or synovial membrane, becomes inflamed and the joints become stiff and swollen. The synovial membrane secretes a slippery fluid that covers the cartilage-covered joints and reduces the friction between adjacent joints.
The chronic inflammation of rheumatoid arthritis eventually leads to destruction of the cartilage covering the ends of the joints and underlying bone. In many cases this damage causes joint deformity.
Rheumatoid arthritis is an autoimmune disease, in which the immune system produces antibodies (called rheumatoid factor) that attack the body’s own tissues. Because of this, Rheumatoid arthritis is also considered a connective tissue disorder. Collagen-rich connective tissues such as the eyes, lungs, heart, and blood vessels, may be adversely affected by RA and its accompanying inflammation.
According to The Arthritis Foundation (1):
- Rheumatoid arthritis affects approximately 2.1 million people in the United States.
- Onset usually occurs between the ages of 30 and 50, although RA may begin at any age
- Affects anyone, including children
- RA affects three times more women than men.
Rheumatoid arthritis usually develops slowly over the course of several weeks to several months. This type of arthritis may chronically recur in week- or month-long episodes. In some cases, after many years, the attacks gradually stop and the disease may “burn itself out,” though permanent disability may result.
General symptoms include:
- Fatigue from Rheumatoid symptoms
- Pale skin
- Shortness of breath on exertion
- Low-grade fever
- Loss of appetite
Specific symptoms may include:
- Painful, stiff, tender, and swollen joints, most often of the hands, but may also involve other joints of the feet, wrists, elbows, shoulders, hips, knees, and/or ankles.
- Joint pain and stiffness is typically worse in the morning and improves as the day goes on.
- Chronic disease can lead to disability and deformities, most typically affecting the middle joint of the fingers so that they become spindle-shaped.
Standard medical treatment of rheumatoid arthritis includes physical therapy for improvements in joint mobility and assistance in relieve pain. Physical activity is also critical for weight control. Lowering one’s weight is important to lessen the stress on joints, especially those found in the lower extremities. For persons suffering from severely damaged joints, joint replacement may be recommended. Common pain relievers, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), are also prescribed to relieve pain and inflammation.
For more severe cases, corticosteroid anti-inflammatory drugs, disease modifying antirheumatic drugs (DMARDS-including methotrexate, gold, sulfasalazine, or chloroquine), and COX-2-specific inhibitors (e.g., Vioxx and Celebrex) may be used to help prevent joint destruction. However, long-term use of these drugs may have potentially severe side effects. Merck & Co., Inc. recently announced that it is removing Vioxx from the market after clinical trials found that long-term use (more than 18 months) increased the risk of cardiovascular problems such as heart attack and stroke (2). The FDA has stated that it will closely monitor other COX-2 inhibitors for similar side effects.
Essential Fatty Acids (Fish Oil, Flaxseed Oil, and Evening Primrose) Numerous studies show that supplementation with omega-3 fatty acids, such as fish oil and flaxseed oil, may effectively reduce rheumatoid arthritis joint tenderness, stiffness, and inflammation (3-9). Evening primrose, black currant, and borage oils contain gamma-linolenic acid (GLA), an omega-6 fatty acid precursor to anti-inflammatory prostaglandins. Like omega-3 fatty acids, the supplementation with large doses of GLA’s have been shown to reduce the symptoms of rheumatoid arthritis (10-12). However, GLA supplementation may not be as beneficial as omega-3 oils in regards to its long- term use (13).
Antioxidants (Beta Carotene, Vitamin E, Vitamin C) Antioxidants help to protect against free-radical damage and inflammation. Rheumatoid arthritis patients are often deficient in such antioxidants, including beta-carotene, vitamin E, and vitamin C (14). Studies have found that antioxidant supplementation decreased inflammation and free radical damage in arthritis sufferers (15, 16). In addition to its antioxidant and anti-inflammatory capability, vitamin E has also been reported to diminish pain (17, 18).
Trace Minerals (Copper, Zinc, Selenium) Supplementation with trace minerals such as zinc, selenium and copper may increase antioxidant defense, and provide for a reduction in rheumatoid arthritis pain and inflammation. RA patients also have been found to exhibit extremely low levels of both selenium and zinc (19, 20). Studies have shown that zinc, selenium and copper supplementation may provide for some therapeutic benefit in these individuals (21-23). Differing studies have also found that copper aspirinate (salicylate), a copper compound that is a form of aspirin, may have better results in reducing pain and inflammation than standard aspirin preparations (24, 25).
Vitamin B5 (Pantothenic Acid) Rheumatoid arthritis patients have reduced levels of pantothenic acid. In a double-blind study, patients taking pantothenic acid had significant improvements in the duration of morning stiffness, degree of disability, and severity of pain (26).
Curcumin (Turmeric) Curcumin, the yellow pigment of Curcuma longa (turmeric), has been shown to possess both anti-inflammatory and antioxidant properties (27). Therefore, curcumin may provide benefit in the treatment of arthritis inflammation (28).
Olive Oil Olive oil is rich in oleic acid and has been shown to yield some anti-inflammatory properties. A 1999 study found that the consumption of olive oil may help protect against developing rheumatoid arthritis (29).
1. The Arthritis Foundation: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
2. The Arthritis Foundation: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
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29. Linos A, et al. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clin Nutr 1999 Dec;70 (6):1077-82.
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