Rheumatoid Arthritis

 

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disease of the joints. It’s an autoimmune condition, in which your immune system mistakes the linings of your joints as “foreign,” and attacks and damages them, resulting in inflammation and pain.

This disease most often affects the distal joints symmetrically, for example, the hands, wrists, and knees.

About 1 percent of the American population lives with rheumatoid arthritis. According to a 2017 report in the journal Rheumatoid International, the prevalence of Rheumatoid Arthritis (RA) in the United States increased between 2004 and 2014, affecting about 1.3 million adults in 2014.

Two to three times as many women as men develop Rheumatoid Arthritis (RA), and 70 percent of people with Rheumatoid Arthritis (RA) are women, according to the Arthritis Foundation

Rheumatoid Arthritis vs. Osteoarthritis

There are several different kinds of arthritis (“arth” is Latin for “joint” and “itis” is Latin for “disease” or “inflammation”), including Rheumatoid Arthritis (RA), Osteoarthritis, Gout, and Lupus.

Osteoarthritis is the most common type of arthritis, affecting more than 30 million Americans, according to the Centers for Disease Control and Prevention (CDC).

Rheumatoid Arthritis (RA)  and osteoarthritis affect the body differently.

In Rheumatoid Arthritis (RA), the joint lining becomes inflamed and eventually erodes the joint.

But in osteoarthritis, the cartilage that covers the ends of the bones in a joint is damaged by multiple different causes, and it is considered more of a mechanical (wear and tear) disease.

Signs and Symptoms of Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a complex disease that is not well understood by medical practitioners or researchers. Early signs of disease, such as joint swelling, joint pain, and joint stiffness, typically begin in a gradual and subtle way, with symptoms slowly developing over a period of weeks to months and getting worse over time. Rheumatoid Arthritis (RA) usually begins in the small bones of the hands and wrists.

Rheumatoid Arthritis (RA) is a progressive disease. When left untreated, inflammation can start to develop in other parts of the body, causing various potentially serious complications that can affect other organs, such as the heart, lungs, and nerves, and could cause significant long-term disability. If you’re experiencing Rheumatoid Arthritis (RA) symptoms, it’s crucial to get diagnosed as soon as possible so that you can receive prompt treatment.

How Is Rheumatoid Arthritis Diagnosed?

While no single test can definitively diagnose Rheumatoid Arthritis (RA), doctors consider several factors when evaluating a person for rheumatoid arthritis.

The diagnostic process typically begins when a doctor gets your medical history and conducts a physical exam. After symptoms are discussed and evaluated, blood tests for rheumatoid factor and other antibodies are ordered. Imaging tests such as X-ray, ultrasound, and magnetic resonance imagery (MRI) scans may be used to help a doctor determine if your joints have been damaged, or to detect joint inflammation, erosion, and fluid buildup. Risk factors for rheumatoid arthritis include a personal history of smoking and a family history of Rheumatoid Arthritis (RA).

The Development of Rheumatoid Arthritis

Within the body, joints are the points where bones come together and allow for movement. Most of these joints — those called synovial joints — allow movement between the bones and provide shock absorption.

The synovial joints are enclosed within protective capsules, which are lined with a type of thin tissue called synovium. This tissue produces a clear substance called synovial fluid that provides lubrication and nutrients for joint tissue, bones, and cartilage — an elastic tissue that covers the ends of bones.

Rheumatoid Arthritis (RA) develops when white blood cells, which normally protect the body from foreign invaders such as bacteria and viruses, enter the synovium. Inflammation ensues — the synovium thickens, causing swelling, redness, warmth, and pain in the synovial joint. These are the cardinal signs of inflammation.

Over time, the inflamed synovium can damage the cartilage and bone within the joint, as well as weaken supportive muscles, ligaments, and tendons.

What Causes Rheumatoid Arthritis?

A Look at Rheumatoid Arthritis (RA) Risk Factors – Researchers don’t know exactly what causes the immune system to invade the synovium, though it’s believed that genes and environmental factors play a role in the development of Rheumatoid Arthritis (RA).

Research suggests that people with certain genetics, the human leukocyte antigen (HLA) genes, have an up to the fivefold increased risk of developing Rheumatoid Arthritis (RA). The HLA gene complex controls immune responses by producing proteins that help the immune system recognize proteins from foreign invaders.

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Other genes connected to Rheumatoid Arthritis (RA) include some involved with the immune system and inflammation, such as STAT4, TRAF1, C5, and PTPN22.

But not everyone with these identified gene variants develops Rheumatoid Arthritis (RA), and people without them can still develop it. So it’s likely that environmental factors often trigger the disease, particularly in people with a genetic makeup that makes them more susceptible to it.

These factors include:

• Viruses and bacteria (though certain infections may reduce RA risk, at least temporarily)

• Female hormones

• Exposure to certain kinds of dust and fibers

• Obesity

• Severely stressful events (2, 3, 4, 7, 8)

Equally important are smoking and a family history of Rheumatoid Arthritis (RA) in increasing a person’s risk of developing the condition.

Treatment for Rheumatoid Arthritis

There is no known cure for Rheumatoid Arthritis (RA). To treat the condition, doctors aim to stop the progression of the disease by reducing symptoms, controlling inflammation, minimizing joint and organ damage, and improving physical function.

Proven treatments include medication and physical therapy. Early, aggressive measures can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible.

This strategy is essential to preventing disability, and it usually amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time.

Rheumatoid Arthritis Complications and Comorbidities

It is well established that rheumatic diseases such as Rheumatoid Arthritis (RA) increase the risks for developing a variety of health conditions.

The most common Rheumatoid Arthritis (RA) comorbidity is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis.

It is important for people with Rheumatoid Arthritis (RA) to work with their doctors to assess their heart disease risk factors, such as high blood pressure, diabetes, and smoking, and reduce them.

Osteoporosis, or low bone density, as well as mental health conditions like anxiety and depression, are also common in people with Rheumatoid Arthritis (RA).

Rheumatoid Arthritis Diet

While there is a lot of interest in the role of diet and nutrition in symptom management for rheumatoid arthritis, there is no comprehensive research on the topic.

Nor is there a dietary magic formula to fight Rheumatoid Arthritis (RA) symptoms, but some evidence suggests that eating certain foods may help reduce inflammation and improve symptoms for some people.

Certain foods, such as fatty meats and processed sugar, have been shown to worsen inflammation and related symptoms.

Rheumatoid Arthritis and Diet

1. Healthy Eating – A balanced, nutritious diet consisting of the recommended amounts of all the food groups helps promote wellness and makes it easier to maintain a healthy weight.

2. Daily movement – Even when you don’t have time to exercise, try to make movement part of your everyday routine.  Use the stairs instead of taking the elevator. Park in a spot that makes you walk a bit to enter a building. Take the long way to a meeting in your office.

3. Topical products – These creams, gels, or stick-on patches can ease the pain in a joint or muscle. Some contain the medicine that you can get in a pill, and others use ingredients that irritate your nerves to distract from the pain.

4. Supplements – Studies show that curcumin/turmeric and omega-3 supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.

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5. Balancing activity with rest – Rest is important when Rheumatoid Arthritis (RA) is active, and joints feel painful, swollen, or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day protects joints and preserves energy.

6. Hot and cold treatments – Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain and swollen joints. It can numb painful areas and reduce inflammation.

7. Stress Reduction and Complementary Therapies – There are different ways to relax and stop focusing on pain. They include meditation, deep breathing, and thinking about images in your mind that make you feel happy. Massage can help reduce pain, relax sore muscles and ease stress or anxiety. Acupuncture involves inserting fine needles into the body along special points to relieve pain. If you don’t like needles, acupressure uses firm pressure instead.

8. Positive Attitude and Support System – Cultivate a network of friends, family members, and co-workers who can help provide emotional support. Take time to do things that you enjoy to lift your mood.

Rheumatoid Arthritis Pain Management

Rheumatoid Arthritis (RA) is a progressive disease; pain and other symptoms may change over time. People living with Rheumatoid Arthritis (RA) are continually seeking new ways to address pain, increase comfort, and improve the quality of their lives.

In addition to medication, there are many options for pain relief for people living with Rheumatoid Arthritis (RA), such as fish oil supplements, hot and cold treatments, exercise and movement, and mind-body modalities such as mindfulness-based stress reduction (MBSR), acceptance and commitment therapy (ACT), and biofeedback.

Sleep Better With Rheumatoid Arthritis

Rheumatoid arthritis, an autoimmune disease in which the immune system mistakes the body’s own cells for foreign invaders, can cause joint pain so intense that it prevents people from sleeping.

A lack of quality sleep can lead to other problems; research suggests that poor sleep can worsen pain and increase functional disability in people with Rheumatoid Arthritis (RA).

Other conditions associated with Rheumatoid Arthritis (RA), such as depression and anxiety, can complicate sleep issues, too. Luckily there are proven strategies and solutions for sleep problems in people with Rheumatoid Arthritis (RA).

Infections and Rheumatoid Arthritis Development

Studies have shown a link between gum disease and rheumatoid arthritis. It’s not fully understood how the two issues are related, but certain oral bacteria may be directly behind some cases of Rheumatoid Arthritis (RA), or inflammation in the mouth might somehow fuel inflammation in the joints.

In a 2016 study in the journal Science Translational Medicine, researchers found that the common gum disease bacterium Aggregatibacter actinomycetemcomitans may release toxins that induce the production of certain proteins suspected of activating the immune system and causing Rheumatoid Arthritis (RA). But the team found that more than half the study participants with Rheumatoid Arthritis (RA) had no evidence of an A. actinomycetemcomitans infection, suggesting other bacteria in the gut or elsewhere may have similar effects on the body.

It has long been thought that Epstein-Barr virus, which causes the infection mononucleosis, is linked to Rheumatoid Arthritis (RA). Researchers have proposed numerous hypotheses for how the virus could cause Rheumatoid Arthritis (RA), most notably “molecular mimicry,” in which proteins from the virus resemble proteins produced by certain cells in the body, such as synovial cells. Immune system antibodies see the virus’s proteins as foreign and attack them, as well as those that look like them.

But a literature review published in September 2015 in the journal Arthritis Research & Therapy found that prior infection with the Epstein-Barr virus does not occur more frequently in people with Rheumatoid Arthritis (RA)than those without Rheumatoid Arthritis (RA), calling into question this virus-Rheumatoid Arthritis (RA) link. More research is needed to settle this issue.

In summary, there are multiple studies looking at oral bacteria and the microbiome to see how these bacteria affect Rheumatoid Arthritis (RA) risk.

Are You at Risk for Rheumatoid Arthritis?

The exact cause of Rheumatoid Arthritis (RA) remains a mystery, but researchers have uncovered clues about who’s at risk for this chronic joint disease and why.

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The Different Types of Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is classified as either Seropositive Rheumatoid Arthritis (RA) or Seronegative Rheumatoid Arthritis (RA).

People with Seropositive Rheumatoid Arthritis (RA) have anti-cyclic citrullinated peptides (anti-CCPs), also called anti-citrullinated protein antibodies (ACPAs), found in their blood test results or a Rheumatoid Factor (RF). These antibodies attack the synovial joints and produce symptoms of Rheumatoid Arthritis (RA).

About 60 to 80 percent of people diagnosed with Rheumatoid Arthritis (RA) have ACPAs and, for many people, the antibodies precede the symptoms of Rheumatoid Arthritis (RA) by 5 to 10 years, according to the Arthritis Foundation.

What’s the Role of Rheumatoid Factor?

The presence of a protein called rheumatoid factor (RF) in the blood is also indicative of seropositive Rheumatoid Arthritis (RA).

People with seronegative Rheumatoid Arthritis (RA) have the disease without the presence of antibodies or RF in their blood. Though it would seem that seronegative Rheumatoid Arthritis (RA) produces milder symptoms because of a lack of damaging antibodies, this isn’t always the case.

What Is Juvenile Rheumatoid Arthritis?

Juvenile Rheumatoid Arthritis, now known as Juvenile Idiopathic Arthritis (JIA), is the most common type of arthritis affecting children. Idiopathic means that the cause of the disease is unknown. In the United States, Juvenile Idiopathic Arthritis (JIA) affects between 1 in 1,000 and 1 in 2,500 children (30,000 to 75,000 children), according to 2015 census data estimates. Juvenile Idiopathic Arthritis (JIA) important distinction in that it’s diagnosed before age 16.

About 10 percent of Juvenile Idiopathic Arthritis (JIA) cases are systemic or affecting the whole body. Other types of Juvenile Idiopathic Arthritis (JIA) affect a few joints or more than five joints at a time.

Unlike Rheumatoid Arthritis (RA)Juvenile Idiopathic Arthritis (JIA) can’t be diagnosed with a blood test, so doctors instead focus on reviewing symptoms and medical history and ruling out other potential diseases that can look like Juvenile Idiopathic Arthritis (JIA), such as infections, cancer, Lyme disease, bone disorders, and lupus.

Symptoms of Juvenile Idiopathic Arthritis (JIA) can include:

• Joint swelling

• Fever

• Stiffness after waking

• Reduced activity levels, fine motor control, and use of arms and legs

• Limping

Home Remedies and Alternative Treatments for Rheumatoid Arthritis

The effectiveness of many alternative treatments for Rheumatoid Arthritis (RA) is still unclear, though most are safe to try.

Rheumatoid arthritis (RA) can be effectively managed through conventional treatments:

1. Medication,

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2. Physical Therapy, and, if necessary,

3. Surgery.

But some lifestyle changes and home remedies may help your recovery while undergoing treatment. Alternative and complementary therapies that fall outside of conventional Western medicine may provide additional relief.

Lifestyle Changes and Home Remedies for Rheumatoid Arthritis (RA)

Lifestyle changes and home treatments help decrease RA symptoms and improve functioning.

If you have Rheumatoid Arthritis (RA), it’s important to remain active. In fact, exercise is considered an essential aspect of Rheumatoid Arthritis (RA) treatment and typically consists of flexibility, range-of-motion training, aerobics, and strength training.

A physical therapist can design an exercise program for you to maintain at home, with exercises that will help keep your joints as flexible as possible, and also keep your muscles strong — further relieving pressure on your joints.

Though exercise is important for Rheumatoid Arthritis (RA) recovery, you should balance your physical activity with rest, since fatigue is a common symptom of Rheumatoid Arthritis (RA). Rest can help reduce joint inflammation and the associated symptoms of pain, stiffness, and swelling.

Dealing With Rheumatoid Arthritis Flare-Ups

If you’re experiencing an occasional flare-up of pain and inflammation, you can try using:

• Heat treatments, such as packs or warm baths, to soothe stiff joints and tired muscles; or cold treatments for acute pain

• Over-the-counter topical ointments

• Specialized braces or splints that support the joints and allow them to rest

• Self-help devices, such as zipper pullers and long-handled shoehorns, to ease the stress on your joints during daily activities

It’s also important to maintain a healthy emotional state. Though there’s no evidence that stress itself can cause rheumatoid arthritis, it may affect the severity of your Rheumatoid Arthritis (RA) symptoms. For instance, going through major depression while having Rheumatoid Arthritis (RA) can increase your pain, disability, and fatigue, according to the consumer health information company. A.D.A.M.

Relaxation techniques, visualization exercises, group counseling, and therapy (such as cognitive behavioral therapy) can help you deal with the inevitable stresses of living with Rheumatoid Arthritis (RA).

Complimentary or Alternative Therapies for Easing Rheumatoid Arthritis Symptoms

Some complementary or alternative therapies may play a role in Rheumatoid Arthritis (RA) treatment.

These therapies include, among others:

• Ayurveda

• Homeopathy

• Magnet therapy

• Hydrotherapy (or balneotherapy)

• Cryotherapy

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But studies looking into these therapies for Rheumatoid Arthritis (RA) have found no benefits or are inconclusive, sometimes due to small numbers of participants or poor study designs.

You should always check with your medical provider before trying any complementary or alternative therapies.

Other such therapies include acupuncture, tai chi, and yoga, which may be more promising.

Acupuncture for Rheumatoid Arthritis Symptom Relief

Acupuncture has long been used to treat pain. And while numerous studies have investigated the needle-based technique for pain treatment, few have focused specifically on rheumatoid arthritis.

Overall, reviews of the effectiveness of acupuncture for Rheumatoid Arthritis (RA) have yielded conflicting results.

A review published in the Cochrane Database of Systematic Reviews, which focused on acupuncture studies for Rheumatoid Arthritis (RA), concluded that the treatment has no effect on pain or on the number of swollen or tender joints, among other things. More recently, a review published in the British Medical Journal also failed to find a clear benefit to using acupuncture for Rheumatoid Arthritis (RA).

In a review published in September 2012 in the journal Rheumatology, which investigated complementary and alternative therapies for Rheumatoid Arthritis (RA), researchers found that studies showed no benefit of acupuncture over “sham acupuncture” for pain relief. But one study found that people with RA who received acupuncture felt better about the state of the disease.

Research published in the Cochrane Review did find that acupuncture may relieve the pain of osteoarthritis, a condition that people with RA are susceptible to developing.

Tai Chi and Yoga for Lessening RA Symptoms

Tai chi hasn’t yet been thoroughly investigated for Rheumatoid Arthritis (RA). Studies appear to suggest it may improve mood (especially during practice), quality of life, and physical function, but may not be effective for joint pain, tenderness, and swelling, according to the National Center for Complementary and Integrative Health (NCCIH).

With that said, tai chi, which is a form of low-impact exercise, appears to be safe to try for Rheumatoid Arthritis (RA).

Though tai chi may not reduce the inflammation-related symptoms of Rheumatoid Arthritis (RA), a review published in November 2016 in the journal Canadian Family Physician found that the practice may confer some benefits for depression and anxiety, lung disease, fibromyalgia, and lower back pain — all issues that people with Rheumatoid Arthritis (RA) may also experience.

Some individual studies have found that yoga may help people living with rheumatoid arthritis by improving physical function, increasing grip strength, and reducing inflammation — specifically decreasing the number of tenders and swollen joints.

A small (just 26 participants) study published in November 2013 in the Clinical Journal of Pain found that a type of yoga called Iyengar yoga offered multiple benefits after two months of practice, including reduced pain, disability, and fatigue, along with improved health, mood, and quality of life.

A randomized-control trial published in July 2015 in the Journal of Rheumatology found that yoga can help sedentary people with Rheumatoid Arthritis (RA) by increasing physical activity, and improving physical and psychological health.

But systematic reviews of these and other studies have found mixed evidence for yoga.

If you do decide to try yoga for Rheumatoid Arthritis (RA), avoid Bikram yoga and other high-intensity forms of yoga.

Can Supplements Help Improve Rheumatoid Arthritis Symptoms?

It is important to discuss supplements with your doctor before starting them. Numerous dietary supplements have been proposed for Rheumatoid Arthritis (RA) treatment, and research suggests that some of them appear promising.

Fish oil, for instance, contains high levels of Omega-3 fatty acids, and studies have suggested that this substance may help relieve tender joints and morning stiffness, reducing the need for anti-inflammatory drugs. But fish oil should be used with caution because it can interact with blood pressure medication, and some products also contain high levels of mercury.

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Plant oils, such as black currant seed, evening primrose, and borage seed, may also be beneficial as they contain omega-6 fatty acids — specifically gamma-linolenic acid, or GLA.

An article published in the Cochrane Review found that these oils, in addition to omega-3 fatty acids, probably improve pain, may improve function, and likely do not increase unwanted side effects in people with Rheumatoid Arthritis (RA).

In a report published in June 2015 in the journal Annals of the Rheumatic Diseases, researchers found that combining the herbal remedy Triperygium wilfordii Hook F (thunder god vine) with methotrexate — a common Rheumatoid Arthritis (RA) medication — works better than the methotrexate (Trexall) alone.

But this herbal remedy can cause severe side effects that may not be worth the intended benefits, according to the NCCIH.

Research has shown that curcumin — a major active component of turmeric — also has anti-inflammatory properties that may make it helpful for Rheumatoid Arthritis (RA) and numerous other conditions. A review published in August 2016 in the Journal of Medicinal Food found that there’s scientific evidence that curcumin could help with Rheumatoid Arthritis (RA), but it’s difficult to draw definitive conclusions due to the quality and size of the studies reviewed.

Because curcumin is rapidly removed from the body, several formulations exist on the market to increase its “bioavailability” — how much of the substance circulates in the body.

Curcumin is generally safe, but, as always, talk to your doctor before taking it.

Other supplements under investigation include:

• Pomegranate extract

• Boswellia

• Ginger

• Green tea

• Valerian

 

References:

Arthritis Foundation

Journal Rheumatoid International

Journal Science Translational Medicine

Arthritis Research & Therapy

Cochrane Database Of Systematic Reviews

British Medical Journal 

Journal Of Rheumatology

National Center For Complementary And Integrative Health (NCCIH)

Journal Canadian Family Physician

Clinical Journal Of Pain

Iyengar Yoga

Journal Annals Of The Rheumatic Diseases

Journal Of Medicinal Food

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