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Arthritis Rheumatoid

 

Rheumatoid Arthritis Introduction

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. :rheumatoid-arthritis.jpg 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.

Rheumatoid Arthritis Statistics

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 Symptoms

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:

  • 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.

Rheumatoid Arthritis Treatment

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.

Supplements helpful for Rheumatoid Arthritis

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).

References

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

3. Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. Jan2000;71(1 Suppl):349S-51S.

4. Lau CS, et al. Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in patients with mild rheumatoid arthritis–a double-blind placebo controlled study. Br J Rheumatol. Nov1993;32(11):982-9.

5. Kremer JM et al. “Effects of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis,” Lancet 1985 (1):184-7.

6. Kremer JM et al. “Fish-oil supplementation in active rheumatoid arthritis: a double-blinded, controlled cross-over study,” Ann Intern Med 1987 (106): 497-502.

7. Sperling RI et al. “Effects of dietary supplementation with marine fish oil on leukocyte lipid mediator generation and function in rheumatoid arthritis,” Arthritis Rheum 1987 (30): 988-97.

8. James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000 Jan;71(1 Suppl):343S-8S.

9. Mantzioris E et al. “Dietary substitution with alpha-linolenic acid-rich vegetable oil increases eicosapentaenoic acid concentrations in tissues”, Am J Clin Nutr 1994 (59): 1304-9l

10. Zurier RB, et al. Gamma-Linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum. Nov1996;39(11):1808-17.

11. Leventhal LJ, et al. Treatment of rheumatoid arthritis with black currant seed oil. Br J Rheumatol. Sep1994;33(9):847-52.

12. Brzeski M et al. “Evening primrose oil in patients with rheumatoid arthritis and side effects of non-steroidal anti-inflammatory drugs,” Br J Rheumatol 1991 (30):371-2.

13. Jantti J et al, “Evening primrose oil in rheumatoid arthritis: changes in serum lipids and fatty acids,” Ann Rheum Dis 1989 (48): 124-7.

14. Comstock GW et al, “Serum concentrations of alpha tocopherol, beta carotene and retinol preceeding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus,” Ann Rheum Dis 1997 (36):323-5.

15. Jikimoto T, Nishikubo Y, Koshiba M, et al. Thioredoxin as a biomarker for oxidative stress in patients with rheumatoid arthritis. Mol Immunol. 2002 Feb;38(10):765-72.

16. Sakai A, Hirano T, Okazaki R, et al. Large-dose ascorbic acid administration suppresses the development of arthritis in adjuvant-infected rats. Arch Orthop Trauma Surg. 1999;119(3-4):121-6.

17. Edmonds SE, et al. Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis. Results of a prospective placebo controlled double blind trial. Ann Rheum Dis. Nov1997;56(11):649-55.

18. Wittenborg A, et al. Effectiveness of vitamin E in comparison with diclofenac sodium in treatment of patients with chronic polyarthritis. Z Rheumatol. Aug1998;57(4):215-21.

19. Kose K, et al. Plasma selenium levels in rheumatoid arthritis. Biol Trace Elem Res. 1996;53(1-3):51-6.

20. Tarp U, et al. Low selenium level in severe rheumatoid arthritis. Scand J Rheumatol. 1985;14(2):97-101.

21. Tarp U et al., “Selenium treatment in rheumatoid arthritis,” Scandinavian Journal of Rheumatology 1985 (14): 365-8.

22. Heinle K, Adam A, Gradl M, et al. [Selenium concentration in erythrocytes of patients with rheumatoid arthritis. Clinical and laboratory chemistry infection markers during administration of selenium]. Med Klin (Munich). 1997 Sep 15;92 Suppl 3:29-31.

23. Honkanen VE, et al. Plasma zinc and copper concentrations in rheumatoid arthritis: influence of dietary factors and disease activity. Am J Clin Nutr. 1991;54:1082-1086.

24. Shen ZQ. Inhibitory effects of copper-aspirin complex on platelet aggregation. Chung Kuo Yao Li Hsueh Pao. Jul 1997;18(4):358-62.

25. Sorenson JR, Hangarter W. Treatment of rheumatoid and degenerative diseases with copper complexes: A review with emphasis on copper-salicylate. Inflammation. 1977;2(3):217-238.

26. Murray MT and Pizzorno JE, eds. Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 1998: 782

27. Ammon HP, et al. Pharmacology of Curcuma longa. Planta Med. Feb1991;57(1):1-7.

28. Satoskar RR et al., “Evaluation of anti-inflammatory property of curcumin (diferuloy methane) in patients with postoperative inflammation,” Int J Clin Pharmacol Ther Toxicol 1986 (24): 651-4.

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.

30. Life Extension eds., Disease Prevention and Treatment, 4th ed. Florida: Life Extension Media, 2003.

31. Stoppard M. Family Health Guide, New York: DK Publishing, 2002.

32. Balch JF, and Balch PA. Prescription for Nutritional Healing, 3rd ed. New York: Penguin Putnam Avery, 2000.