Rheumatoid Arthritis Information ~ Life Is Great

Saturday, June 17, 2006

Rheumatoid Arthritis Information

Natural Options for Rheumatoid Arthritis

Subscribe to a FREE Supplement Research Update newsletter. Twice a month we email a brief abstract of several studies on various supplements and natural medicine topics, including rheumatoid arthritis, and their practical interpretation by Ray Sahelian, M.D.

Rheumatoid arthritis is an autoimmune disease in which joints, usually those of the hands and feet, are symmetrically inflamed, resulting in swelling, pain, and often the eventual destruction of the joint's interior. Rheumatoid arthritis is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one per cent of adults. Rheumatoid arthritis may be accompanied by fatigue, weight loss, anxiety, and depression. In rheumatoid arthritis, the immune system attacks the tissue that lines and cushions joints (certain immune cells, perhaps mast cells, attack the carbohydrate
molecules, known as glycosaminoglycans, in the joints). Eventually, the cartilage, bone, and ligaments of the joint erode, causing scars to form within the joint. The joints deteriorate at a highly variable rate.

Rheumatoid Arthritis Diet
A regular, healthy diet is generally appropriate. Some people have flare-ups after eating certain foods. A diet rich in cold water fish has beneficial effects on inflammation. Eating a relatively large amount of red meat every day appears to increase the risk of inflammatory arthritis, such as rheumatoid arthritis. Research has linked smoking and drinking a lot of coffee to rheumatoid arthritis, while suggesting that eating lots of fish and vegetables may protect people from the condition.

Natural options for Rheumatoid Arthritis Treatment
I will update this page as more studies become available regarding the natural approach to rheumatoid arthritis. In the meantime, I have come across some studies regarding natural supplements that I wish to share with you. You may decide to discuss with your doctor to see whether these herbs and supplements are appropriate for you. At this time I am not aware of a
rheumatoid arthritis cure. Fish oils are certainly one of the first supplements to try for rheumatoid arthritis since they reduce inflammation. Cat’s claw a small study showed a reduction in pain in rheumatoid arthritis patients given Cat's claw extract.

Green tea extract
Curcumin has antioxidant and antiinflammatory properties. Curcumin is derived from turmeric.
Guggul has anti-inflammatory activity and may be helpful in rheumatoid arthritis
Lyprinol, a green mussel extract, has been found to be helpful for rheumatoid arthritis, (see study below). Folic acid (see below) for rheumatoid arthritis patients on methotrexate

Stop smoking
Go for a low fat diet with plenty of fish and fish oils

Gluten free diet may be tried
Yoga improves hand grip strength in normal persons and in patients with rheumatoid arthritis, though the magnitude of improvement varies with factors such as gender and age.

Tai Chi is helpful
Rheumatoid arthritis exercise -- For people with extensive damage in large joints from rheumatoid arthritis, high-intensity, weight-bearing exercise accelerates the progression of joint damage. However, intensive exercise appears to be safe for arthritis patients with little or no joint damage. Mild to moderate exercise programs to improve muscle strength and aerobic
capacity are beneficial for people with rheumatoid arthritis.

Causes of Rheumatoid Arthritis
Rheumatoid arthritis can also produce a variety of symptoms throughout the body. The exact cause of rheumatoid arthritis isn't known, but many different factors, including genetic predisposition, may influence the autoimmune reaction. Rheumatoid arthritis develops in about 1 percent of the population, affecting women two to three times more often than men. Usually,
rheumatoid arthritis first appears between 25 and 50 years of age, but it may occur at any age. In some people, the disease resolves spontaneously, and treatment relieves symptoms in three out of four people; however, at least 1 out of 10 people eventually becomes disabled. Is different than rheumatoid arthritis.

Traditional treatment of rheumatoid arthritis ranges from simple, conservative measures such as rest and adequate nutrition to drugs and surgery. Treatment starts with the least aggressive measures, moving to more aggressive ones if needed. A basic principle of rheumatoid arthritis
treatment is to rest the affected joints, because using them aggravates the inflammation. Regular rest periods often help relieve pain, and sometimes a short period of total bed rest helps relieve a severe flare-up in its most active, painful stage. Splints can be used to immobilize and rest one or several joints, but some systematic movement of the joints is needed to
prevent stiffening.

Rheumatoid Arthritis Treatment - Drugs - Rheumatoid Arthritis Medication
The main categories of drugs used to treat rheumatoid arthritis are non-steroidal anti-inflammatory drugs (NSAIDs), slow-acting drugs, corticosteroids, and immunosuppressive drugs. Generally, the stronger the drug, the more severe its potential side effects, so that closer monitoring is needed.

Although jewelry may be the first thing that springs to mind when someone says "gold", injecting a liquid form of the metal can help people with rheumatoid arthritis. In fact, gold therapy has been around for a while and now new research shows it can be effective when combined with another treatment. In the study, reported in the journal Arthritis & Rheumatism, gold therapy reduced the severity of arthritis in patients who had a poor response with methotrexate, the standard drug used to treat the disease. Even if an initial course of methotrexate for the treatment of rheumatoid arthritis gives disappointing results, persistence may pay off. A second course may be more successful. Many patients continue to have active
disease in spite of intensive therapy with disease-modifying antirheumatic drugs (DMARDs).

Steroid Use in Rheumatoid Arthritis
Patients with rheumatoid arthritis who are treated with low-dose of the steroid prednisone have an increased risk of coming down with pneumonia. Most other drugs used to treat arthritis don't have this drawback. Prednisone, a steroid, tends suppresses the immune system and at high enough doses this could increase the chances of infection. Even though prednisone
is commonly used to treat arthritis patients, there have been no studies looking at it's effect on the risk of pneumonia -- which is one of the major causes of death in patients with rheumatoid arthritis. The most common treatments for rheumatoid arthritis are methotrexate, prednisone, Remicade, hydroxychloroquine and Enbrel. There appears to be no significantly
increased risk associated with so-called TNF-blockers -- Remicade, Enbrel or Humira -- or with methotrexate, hydroxychloroquine or sulfasalazine.

Prednisone use is common in rheumatoid arthritis and is therefore a potentially important health risk. Arthritis & Rheumatism, February 2006.

Rheumatoid arthritis symptom
Rheumatoid arthritis early symptom. Common symptom for rheumatoid arthritis include fatigue, weight loss and anemia. Affects about 2 million Americans, three times more women than men. Symptoms of rheumatoid arthritis are different than symptoms of osteoarthritis. Osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis sets a body at war with itself, as white blood cells attack healthy tissue in the joints. The cost of that war may be greater than previously thought: people with rheumatoid arthritis are twice as likely to die of heart disease.

Rheumatoid Arthritis and Exercise
Progressive resistance training can help patients with rheumatoid arthritis who experience muscle wasting. Generalized muscle wasting in rheumatoid arthritis is common although often masked by a concomitant increase in fat mass. Progressive resistance training is an effective treatment for this metabolic complication of rheumatoid arthritis.

Types of Rheumatoid Arthritis
Juvenile rheumatoid arthritis

Rheumatoid arthritis Research Update
Newer drugs like Enbrel and Remicade have been a boon to many rheumatoid arthritis sufferers, but researchers now report that such drugs may lead to the development of an inflammatory disorder of blood vessels, usually affecting the skin. The rheumatoid arthritis drugs, called TNF blockers, have been linked to a condition called leukocytoclastic vasculitis, or LCV, according to an article in the Journal of Rheumatology. With LCV, bleeding of small blood vessels under the skin causes purplish raised areas to appear usually on the legs.

Treatment of rheumatoid arthritis with the potent TNF-alpha blocking drugs -- such as Enbrel and Remicade, for example -- is linked to an increase in dermatological conditions. The skin conditions included infections and eczema, both of which might logically be related to the way TNF blockers work, by interfering with the immune system. The investigators also
documented drug-related skin ulcers and malignant tumors, as well as a list of less common problems.

Systemic inflammation increases the risk of dying from cardiovascular disease in patients with rheumatoid arthritis, a new study shows, even afterfactoring in the effects of traditional cardiovascular risk factors and other illnesses. The rate of illness and death from cardiovascular disease is higher among rheumatoid arthritis patients, and there is increasing evidence that inflammation plays a key role in the development of atherosclerosis, also known as hardening of the arteries.

A Johnson & Johnson promotion for rheumatoid arthritis drug Remicade is misleading because it makes unsupported claims about the drug's effectiveness and omits important information about risks.

Efficacy and tolerability of a combination of Lyprinol and high concentrations of EPA and DHA in inflammatory rheumatoid disorders. Adv Ther. 2004 May-Jun;21(3):197-201. This 12-week drug-monitoring study was conducted to evaluate the efficacy of Sanhelios Mussel Lyprinol Lipid Complex on 50 adult men and women with inflammatory rheumatoid arthritis. A total of 34 patients required drug therapy before and during the study. By the end of the Lyprinol study, 21 (62%) patients were able to reduce their dosage and 13 were able to terminate drug therapy. At the end of the Lyprinol treatment period, 38% were regarded symptom free, and the number of patients with severe pain decreased significantly from 60% at baseline to 25% at the completion of the trial. A significant effect was observed for each investigated parameter.
The special combination of Lyprinol and omega-3 fatty acids was generally very well tolerated. This dietary supplement with Lyprinol may therefore be considered an effective and well-tolerated component of treatment regimens for inflammatory rheumatoid arthritis. Effects of n-3 fatty acids on serum interleukin-6, tumour necrosis factor-alpha and soluble tumour necrosis factor receptor p55 in active rheumatoid arthritis.

J Int Med Res. 2004 Sep-Oct;32(5):443-54. We investigated the effects of a low n-6 fatty acid (FA) diet supplementedwith fish oil on serum pro-inflammatory cytokine concentrations and clinical variables in patients with active rheumatoid arthritis (Rheumatoid arthritis). Sixty patients were randomly assigned to receive a diet low in n-6 FAs and n-3 FAs supplement (fish oil group), a diet low in n-6 FAs and placebo (placebo group), or no special diet or intervention (control group).

Serum cytokines and clinical and biochemical variables were evaluated at baseline and various timepoints. At week 18 the fish oil group had significant reductions in linoleic acid, C-reactive protein (CRP) and soluble tumour necrosis factor receptor p55 (sTNF-R p55), and significant
elevations in eicosapentaenoic acid and docosahexaenoic acid compared with baseline. There were no significant differences in the clinical variables between the three groups. At week 24 there were significant reductions in interleukin-6 and TNF-alpha in the fish oil and placebo groups.

Supplementation with n-3 FA and a low n-6 FA intake decreased serum sTNF-R p55 and CRP levels in patients with Rheumatoid arthritis. Folate, homocysteine, and methylcobalamin status in patients with rheumatoid arthritis treated with methotrexate, and the effect of low dose folic acid supplement.

J Rheumatol. 2004 Dec;31(12):2374-81.
To investigate the effect of methotrexate (MTX) treatment of rheumatoid arthritis on folate metabolism, and to determine the effect of low dose folic acid on toxicity, efficacy, and folate status. METHODS: A 52-week prospective study of 81 patients with rheumatoid arthritis treated with MTX and self-administered low dose folic acid; 38 rheumatoid arthritis patients
were included prior to MTX therapy, 33 rheumatoid arthritis patients continued established MTX therapy, and 10 rheumatoid arthritis patients were excluded. Drug efficacy and side effects were monitored with biochemical and clinical indicators. RESULTS: MTX treatment resulted in decreased concentrations of red blood cell (RBC) folate and a rise in plasma
homocysteine. Intracellular concentrations of MTX were inversely correlated to RBC folate levels after treatment for a longer period (mean 41 months).

Supplement with low dose folic acid prevented or diminished the influence of MTX on folate status and had a protective effect on MTX induced liver toxicity without changing the efficacy of MTX. CONCLUSION: MTX interferes with folate and homocysteine metabolism. Our results indicate low dose folic acid supplementation has a beneficial effect on MTX toxicity in rheumatoid arthritis patients.

Measuring levels of antibodies against cyclic citrullinated peptide (CCP) help predict future disease activity in patients with early rheumatoid arthritis, The anti-CCP antibody test is as sensitive as rheumatoid factor but a more specific diagnostic marker for recent onset rheumatoid arthritis.

Increased blood levels of C-reactive protein (CRP), a marker for inflammation, are seen long before symptoms of rheumatoid arthritis appear.

Recently developed drugs called TNF-blockers have brought relief to many people with inflammatory conditions such as rheumatoid arthritis or the intestinal disorder, Crohn's disease. However, the drugs do carry a risk. Federal health officials at the Centers for Disease Control and Prevention in Atlanta point out that patients taking TNF-alpha antagonists, such as
Remicade (infliximab), Enbrel (etanercept), and Humira (adalimumab) have an increased risk of tuberculosis.

Does diet have a role in the etiology of rheumatoid arthritis?
Proc Nutr Soc. 2004 Feb;63(1):137-43. Although dietary factors have been extensively studied in many chronic diseases, the role of diet in the epidemiology of rheumatoid arthritis has
received little attention. Fruit and vegetables and dietary antioxidants are thought to play a protective role in the pathogenesis of heart disease and some cancers, but few studies have investigated these dietary components in the etiology of rheumatoid arthritis. Fish oil supplementation has consistently been shown to have a beneficial effect on the symptoms of
established rheumatoid arthritis, but it is not known whether the fish oils can reduce the risk of developing the disease. There is evidence that rheumatoid arthritis is less severe in the southern Mediterranean countries, such as Italy and Greece, where oil-rich fish, fruit, vegetables and olive oil are consumed in greater amounts than in many other countries. Overall,
the evidence for a role of diet in the etiology of rheumatoid arthritis is limited to a small number of observational studies of very different designs

Recently, it was demonstrated that lower intakes of fruit and vegetables and dietary vitamin C are associated with an increased risk of developing inflammatory polyarthritis in a free-living population in Norfolk, UK. These findings provide further evidence for a role of diet in the development of inflammatory rheumatoid arthritis, although the mechanisms involved are

Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa (Cat's Claw) for the treatment of rheumatoid arthritis.
J Rheumatol. 2002 Apr;29(4):678-81.

OBJECTIVE: To evaluate safety and clinical efficacy of a plant extract from
the pentacyclic chemotype of Uncaria tomentosa (cat's claw) in patients with
active rheumatoid arthritis. Forty patients undergoing sulfasalazine or
hydroxychloroquine treatment were enrolled in a randomized 52 week, 2 phase
study. During the first phase (24 weeks, double blind, placebo controlled),
Rheumatoid arthritis patients were treated with UT extract or placebo. In
the second phase (28 weeks) all patients received the plant extract.
RESULTS: Twenty-four weeks of treatment with the UT extract resulted in a
reduction of the number of painful joints compared to placebo (by 53% vs
24%). Rheumatoid arthritis patients receiving the UT extract only during the
second phase experienced a reduction in the number of painful and swollen
joints compared to the values after 24 weeks of placebo. Only minor side
effects were observed. CONCLUSION: This small preliminary study demonstrates
relative safety and modest benefit to the tender joint count of a highly
purified extract from the pentacyclic chemotype of cats claw in patients
with active Rheumatoid arthritis taking sulfasalazine or hydroxychloroquine.

Tai chi for treating rheumatoid arthritis.
Cochrane Database Syst Rev. 2004;(3):CD004849.
Rheumatoid arthritis is a chronic, systemic inflammatory autoimmune disease
that results in the destruction of the musculoskeletal system. Tai Chi,
interchangeably known as Tai Chi Chuan, is an ancient Chinese
health-promoting martial art form that has been recognized in China as an
effective arthritis therapy for centuries. OBJECTIVES: To assess the
effectiveness and safety of Tai Chi as a treatment for people with
Rheumatoid arthritis. Studies reviewed. CONCLUSIONS: The results suggest Tai
Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai
Chi has statistically significant benefits on lower extremity range of
motion, in particular ankle range of motion, for people with Rheumatoid
Epidemiology of rheumatoid arthritis: determinants of onset, persistence and
University of Manchester Medical School, Oxford Road, Manchester UK.
Best Pract Res Clin Rheumatol. 2002 Dec;16(5):707-22.
Rheumatoid arthritis is the most common chronic inflammatory joint disease.
There is some evidence that Rheumatoid arthritis may have been brought from
North America to Europe during the 18th century. Its arrival in rural parts
of the developing world is still more recent. The incidence and prevalence
of Rheumatoid arthritisvappear to have fallen in Europe, North America and
Japan in the last 50 years. During this time the peak age of onset has risen
Risk factors for the development of Rheumatoid arthritis include genetic
factors, an adverse pregnancy outcome, smoking, obesity and recent
infections. The oral contraceptive pill and some dietary constituents may be
protective. Older age and female gender are risk factors both for the
development of Rheumatoid arthritis and for a worse outcome. This risk
factor profile offers some opportunities for primary and secondary
prevention. However, treatment is the greatest determinant of Rheumatoid
arthritis outcome.
Some patients with Rheumatoid arthritiswho take the anti-rheumatic drug
Arava (leflunomide) develop peripheral neuropathy, a nerve problem that
involves numbness, tingling or pain in the hands or feet.
Blocking the activity of a natural protein involved in inflammation may be a
new approach to treating rheumatoid arthritis. Japanese researchers have
shown that a synthetic antibody targeting the receptor for a hormone-like
protein called interleukin 6 (IL-6) significantly reduces disease activity
in patients with difficult-to-treat rheumatoid arthritis. IL-6 regulates the
immune response, inflammation, and bone metabolism, the team explains in the
medical journal Arthritis & Rheumatism. Overproduction of IL-6 is thought to
play a role in rheumatoid arthritis.
Folate supplementation and methotrexate treatment in rheumatoid arthritis: a
Rheumatology (Oxford). 2004 Jan 6
The folate antagonist methotrexate (MTX) has become established as the most
commonly used disease-modifying anti-rheumatic drug (DMARD) in the treatment
of rheumatoid arthritis but is commonly discontinued due to adverse effects.
Adverse effects are thought to be mediated via folate antagonism. In this
paper we summarize the current data on the use of folates as a supplement to
MTX use in rheumatoid arthritis for the prevention of adverse effects and as
a potential modulator of cardiovascular risk, and propose guidelines for
standard practice. METHODS: A Medline search was performed using the search
terms 'methotrexate', 'folic acid', 'folinic acid', 'folate' and
homocysteine'. Literature relevant to the use of folates as a supplement to
MTX in the treatment of rheumatoid arthritis was reviewed and other papers
referred to as references were explored. RESULTS: The use of supplemental
folates, including folic and folinic acid, in rheumatoid arthritis patients
treated with MTX has been shown to improve continuation rates by reducing
the incidence of liver function test abnormalities and gastrointestinal
intolerance. Folate supplements do not appear to significantly reduce the
effectiveness of MTX in the treatment of rheumatoid arthritis. Furthermore,
supplemental folic acid offsets the elevation in plasma homocysteine
associated with the use of MTX. This may in turn reduce the risk of
cardiovascular disease, which is over-represented amongst patients with
rheumatoid arthritis, and for which hyperhomocysteinaemia is now recognized
as an independent risk factor. CONCLUSIONS: We propose that folic acid
supplements be prescribed routinely to all patients receiving MTX for the
treatment of rheumatoid arthritis. We recommend a pragmatic dosing schedule
of 5 mg of oral folic acid given on the morning following the day of MTX
Influence of co-administrated sinomenine on pharmacokinetic fate of
paeoniflorin in unrestrained conscious rats.
J Ethnopharmacol. 2005 May 13;99(1):61-7.
Paeonia lactiflora Pall. (Ranunculaceae) root( Chinese Peony ) and
Sinomenium acutum Rehder and Wilson (Menispermaceae) stem are two herbs
widely used in Chinese medicine to treat rheumatoid arthritis.

Citrus, zinc may cut rheumatoid arthritis risk: study
Zinc and an antioxidant found in citrus fruit may lower the risk for
rheumatoid arthritis a new study suggests, but the researchers say the
findings are preliminary and there are still no well-defined risk factors
for the disease. The researchers looked at nearly 30,000 women from the Iowa
Women's Health Study. All had answered a food questionnaire in 1986 that
assessed how much and how often they ate certain foods as well as their
vitamin and supplement intake. Years later, there were 158 cases of
rheumatoid arthritis among the women. The diets of those women were compared
with those of study participants who remained free of the illness. The
doctors found that women getting less than 40 micrograms of
beta-cryptoxanthin, which is found in citrus fruits like oranges and
grapefruit, were at a slightly higher risk of developing rheumatoid
arthritis than women who consumed more than that amount. When they looked at
the amount of zinc in each woman's diet, they found that those who took zinc
supplements had a lower risk of rheumatoid arthritis. But getting an
equivalent amount of zinc from food was not associated with decreased risk.
Their results are published in the February issue of the American Journal of
Epidemiology. SOURCE: American Journal of Epidemiology 2003;157:345-354.
Rheumatoid Arthritis emails
Q. I am a 38 year old woman who has been dealing with Rhematoid Arthritis
since my child bearing years. I started seeing an rheumatoid arthritis
doctor about 7 years ago and had been using a Naproxen prescription since
then for pain, inflammation, morning and night stiffness. Not wanting to
continue taking Naproxen for recent concerns about its safety. I started
taking MSM advised by my mother who recently was diagnosed with RA. I have
been taking 3 grams of MSM in the morning and night for the past 3 months
with no need for addition pain medications. I am truley amazed at the
results I've had. If anyone has had cronic pain from arthritis like I have
had it is worth trying MSM.


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