Rheumatoid Arthritis – Symptoms, Causes & Treatment

Rheumatoid arthritis is a chronic autoimmune disease causing inflammatory arthritis. The immune system attacks the synovial membranes of the joints, causing pain, inflammation and deformity. It can occur at any age, but is more common between 30 and 50, and affects more three times more women than men. 

Auto immune diseases are becoming a lot more common in today’s society and the number one body system to address prior to anything else is the gut.  The attack on the body with foreign antigens or mistaken antigens must be reduced or eliminated to allow the body to recover from the overstimulated immune system and attack.  More commonly and compromised intestinal barrier and reactive foods are major driving cause of symptom and disease progression.  An Autoimmune Paleo (AIP) or similar diet that reduces common reactants along with targeted care is required.

Causes of Rheumatoid Arthritis

• Aetiology uncertain but a genetic link involving the major histocompatibility complex class II antigens has been identified.
• The autoimmune response is thought to be initiated and maintained by an excess of Th1 lymphocytes and a deficiency of Th2 lymphocytes. The Th1 cells stimulate excessive production of inflammatory mediators causing chronic inflammation and tissue damage.
• The most potent environmental factors appear to be viral and bacterial infections. The presence of chronic infection is thought to upregulate the immune response, which in turn causes chronic inflammation and oxidative damage of tissues.
• These infections can be precursors that affect the overall health of the patient and contribute to gut integrity issues causing intestinal permeability, low Secretory IgA, raised zonulin and a range of other inflammatory bowel markers.

Risk factors

• Genetic predisposition
• Female gender
• High lectin diet: foods very high in lectins, such as grains and legumes, can be harmful if eaten in excess or improperly prepared or cooked. Lectins are very resistant to digestive enzymes and may be transported through the gut wall (especially in leaky gut). Absorbed dietary lectins are presented to T cells and activate the immune system, and have been linked to autoimmune reactions.
• Food allergy / intolerances
• Bowel dysbiosis and intestinal permeability
• Psychological stress
• Bacterial or viral infection
• Hormonal changes
• Smoking: a significant risk factor for RA

Signs and symptoms of Rheumatoid Arthritis

• Usually affects joints on both sides of the body equally
• Most commonly affected joints are wrists, fingers, knees, feet and ankles
• Morning stiffness lasting more than an hour
• Pain, warmth and tenderness in joints
• Loss of range of motion and deformity over time
• Fatigue

Differential diagnosis

• Ankylosing spondylitis
• Osteoarthritis
• Gout
• Diffuse connective tissue disease e.g. SLE, scleroderma
• Viral polyarthritis
• Psoriatic arthritis
• Reiter‘s syndrome
• Malignancy
• Polymyalgia rheumatica

Investigations

• Rheumatoid factor test; blood test to determine presence of RF antibody. Not always positive in RA
• Intestinal Permeability
• Stool analysis – Complete Microbiome mapping  – gold standard stool test
• SIBO (small intestinal bacterial overgrowth)
• Comprehensive blood chemistry panel
• Methylation and genetic testing

TREATMENT STRATEGY

• Balance bowel microflora / reduce intestinal permeability
  • Balance methylation and associated biochemical pathways
  • Clear any detoxification pathways blocks in liver phases
  • Reduce pain and inflammation
  • Reduce oxidative damage to tissues
  • Support joint integrity and repair
  • Support proper immune response
  • Reduce antigen exposure
  • Support nervous and adrenal function (especially with corticosteroid therapy)
  • Enhance bowel and liver detoxification
  • Maintain weight and nutritional status

Diet plan guidelines for Rheumatoid Arthritis

The dietary recommendations for osteoarthritis are also suitable for rheumatoid arthritis; however, due to the autoimmune nature of RA, a more detailed and direct immune-modulating and antigen-lowering approach is required

• Reduce antigenic load: especially gluten and casein. Individuals with any auto-immune disease can often achieve remissions with a low-allergenic diet.  The Autoimmune Paleo diet (AIP) is an excellent diet to begin with.
• Minimise pro-inflammatory, acid-forming foods: sugar, refined carbohydrates, trans fats, excessive commercially produced red meat, saturated fats, omega-6 fatty acids, caffeine and alcohol
• Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil. Mediterranean and vegetarian diets are both associated with reduced inflammatory activity and increased function (Skoldstam, Hagfors & Johansson, 2002)
• Emphasise antioxidant-rich foods to promote tissue repair: berries, green tea, turmeric, fruits and vegetables
• Balance fatty acid intake: increased consumption of omega-3 fatty acids and decreased consumption of omega-6 fatty acids can improve symptoms and reduce NSAID use
• Extra-virgin olive oil: shown to be anti-inflammatory in arthritis due to the constituent oleocanthal, which possesses similar properties to ibuprofen
• Green juices and smoothies to increase alkalinity of tissues
• Increase probiotic and prebiotic foods: high fibre, fermented dairy and vegetables; to support immune health
• Reduce nightshade vegetables: alkaloids in nightshades may inhibit collagen repair or promote inflammatory degeneration in sensitive individuals
• Weight loss diet: essential in overweight or obese clients. Excess weight places an increased burden on joints and increased adipose tissue is associated with increased circulating inflammatory mediators.

Supplements that support Rheumatoid Arthritis

• Reduce pain and inflammation
  • Omega-3 EFAs: up to 8000mg/day
  • Curcumin – must be in a bioavailable form
  • Bromelain
  • Bioflavonoids (rutin, hesperidin, quercetin)
  • MSM
  • dl-Phenylalanine – inhibits breakdown of endorphins

Balance immune response

• Probiotics, especially L.plantarum
  • Zinc
  • Vitamin D –  depending on status
  • Mushroom extract (shitake, maitake, reishi, cordyceps)
  • Selenium

Promote collagen repair / antioxidants

• Vitamin C and bioflavonoids
  • Vitamin E

Support digestion

• Digestive enzymes, HCL, bromelain

Herbal Medicine treatment that support Rheumatoid Arthritis

• Anti-inflammatory – peony (numerous studies have shown the effect of peony in the treatment of RA; Zhang, 2012; Shang, 21010; Zhang, 2011), devil‘s claw, turmeric, ginger, boswellia, feverfew, bupleurum
• Anti-rheumatic – devil‘s claw, celery seed, black cohosh, wild yam, sarsparilla, baical skullcap
• Analgesic – California poppy, Jamaica dogwood, willow bark
• Adaptogen – withania, Siberian ginseng, Korean ginseng, rehmannia
• Immune modulator – echinacea, astragalus, hemidesmus, withania, rehmannia, reishi/shitake
• Promote tissue repair – horsetail, gotu kola, ginkgo, grape seed
• Support digestion – gentian, ginger
• Repair /Protect gut mucosa – slippery elm, goldenseal, calendula

Lifestyle considerations to improve Rheumatoid Arthritis

• Physical therapy: heat, massage, bodywork etc.
• Soak affected parts in ACV with warm water (1 part ACV to 4 parts warm water)
• Use topical liniments
• Avoid aspirin and other NSAIDs: increase intestinal permeability, inhibit cartilage repair and may promote sensitivities.
• Regular, low-impact exercise to maintain joint flexibility and function: swimming, yoga, tai chi

FUNCTIONAL MEDICINE TREATMENT OF RHEUMATOID ARTHRITIS

Rheumatoid Arthritis requires a multifaceted treatment approach that addresses the underlying factors driving the disease.  Just treating the symptoms will not put the disease in remission and stop the progression of the condition. 

Reducing and viral and antigen load is a must while optimizing digestion and gut function are two crucial strategies in the treatment of Rheumatoid Arthritis. 

A heighted immune system will not stop reacting and exacerbating RA symptoms until the multiple sources of reaction are removed and contained.  These sources include food intolerances, protein molecules passing through tight gap junctions in the intestinal wall to the blood stream, viral antigens, parasites, pathogenic gut bacteria and inflammatory mediators. 

A combined approach to eliminate these driving factors of the disease is required to allow the body to begin its healing process.  In addition, addressing methylation, blood chemistry imbalances and detoxification pathways is required in management of the condition.

At our Perth clinic of Advanced Functional Medicine have extensive experience with Rheumatoid Arthritis. 

If you or a family member are suffering from RA we would love to hear from you.  What lifestyle or diet changes helped your condition the most?  Have you investigated what is driving the disease for you, what were the outcomes?  Please leave a comment.

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