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Rheumatoid Arthritis

What Is Known About Rheumatoid Arthritis
Healthy Steps: Rheumatoid Arthritis—First Steps
Healthy Steps: Rheumatoid Arthritis—Full Program
Prevention
From Dr. Deborah's Desk

“Could I really be so sore from gardening yesterday? I seem to be more stiff each weekend.”

You know other people who have arthritis, but yours seems worse. Strangely, your complaints are symmetrical: the discomfort affects the same joint on both sides of your body, and bothers your larger joints (hip, shoulder), as well as the smaller joints of your hands.

What finally gets you to the doctor is a sense of weakness around the painful joints. It’s getting hard to reach up to comb your hair or you have to push with your hands to lift yourself out of a chair. The stiffness in the joints is impairing your strength as well as your range of motion. At that point you perhaps remember a couple episodes of fever with increased pain in your joints.

With x-rays that document some actual change in the joint structure and a blood test that is positive for rheumatoid factor, your doctor tells you don’t have old-age arthritis, but rather rheumatoid arthritis.

What Is Known about Rheumatoid Arthritis

Rheumatoid arthritis is a condition where, for unknown reasons, the immune system begins to attack the joints and sometimes other organs as if they were foreign substances. It is one of the more common autoimmune illnesses, affecting one out of every 100 Americans, women two to three times as often as men. Immune cells attack the joint components causing irritation and swelling which translate into heat and tenderness as well as pain and stiffness. Eventually the inflammation can wear down cartilage and even destroy bones and joint alignment. Rheumatoid arthritis at its worst is a destructive and deforming arthritis.

Not well understood but characteristic are bumps and nodules that form under the skin close to the involved joints, ranging in size from 1/4 inch to two or three inches. Nodules may form on internal organs as well and usually are found in people with disabling or progressive rheumatoid arthritis.

Your physician will suspect rheumatoid arthritis if your symptoms are symmetrical and accompanied by either fever or weakness. Diagnosis may be made on characteristic x-ray findings or a positive result on the rheumatoid factor blood test. The test is rarely positive in the absence of rheumatoid arthritis, so the combination of findings is important in making the diagnosis.

The medications used to treat rheumatoid arthritis range from topical pain relievers, with limited side effects, to anti-inflammatories, narcotics, steroids, and immune-suppressing medications, all of which have side effects and are usually prescribed in the minimum doses needed to achieve symptom relief. Therefore, even rheumatoid arthritis patients on conventional medication are often encouraged to do what they can to help their medications work better.

Patients are advised to balance exercise and rest: exercise to maintain strength and joint mobility, but rest during flare-ups to avoid aggravating the joint surfaces.

The recommendations I summarize below are those that have been found in either clinical practice or clinical trials to help control the inflammation and pain for RA patients.

Healthy Steps: Rheumatoid Arthritis—First Steps

For the greatest improvement with the fewest steps, do the following:

Healthy Steps: Rheumatoid Arthritis—Full Program

A comprehensive program for good health involves many areas in which action steps can be taken, gradually or all at once. Start by following my basic nutrition and healthy lifestyle guidelines, with the following special tips:

Savor Helpful Foods

Avoid Problematic Foods

  • Sugar of all kinds. Sweets increase inflammation. Stay away from cane sugar, brown sugar, honey, maple syrup, molasses, colas, pastries and candies as well as fructose from high-sugar fruits such as apples and pears, especially in the form of juice.
  • Starchy carbohydrates and grains, especially gluten. Wheat, rye, spelt, barley, beer, and other forms of gluten cause inflammation. See the Gluten-Free Eating Plan for full description. It is best to also avoid potatoes, carrots, and other high carbohydrate foods.
  • Legumes. Legumes also contain "lectins" which is one of the components in grains that might be causing inflammation.
  • Fried foods especially restaurant foods fried in GMO corn, soy, or canola oils. Damaged oils add to inflammation.
  • All refined carbohydrates and processed foods. This includes bread, cakes, cookies, and cereals.
  • Pasteurized dairy products of all types: milk, cheese, and ice cream. Raw dairy is associated with improvement in allergic and autoimmune conditions.
  • Foods you are allergic to. Allergic reaction is a major source of RA symptoms and avoiding these foods can reduce inflammatory symptoms. Besides gluten, other possible triggers include corn, dairy, eggs, onions, chocolate, coffee, tea, citrus, potatoes, soy, peanuts, yeast, pork chops, and oats. You may have an allergic reaction to more than one of these foods. Although blood testing for allergies may suggest culprits, the only definitive test is your personal reaction to foods. See the Allergy Elimination Diet for full description.

You may feel better quickly. When you resume individual foods make sure you choose raw dairy products instead of pasteurized, organic corn instead of GMO, and grass-fed beef instead of feedlot, antibiotic laden beef.

Supplements Can Help

Daily Life Choices

  • Don't smoke. Smoking reduces your body's natural ability to reduce inflammation.
  • Normalize weight. Excess weight adds to the strain on your joints.
  • Keep coffee drinking to a minimum. Over 4 cups daily is linked to RA.
  • Drink alcohol to prevent RA? A study published in the British Medical Journal found that drinking alcohol, even with certain high-risk indicators, reduced the risk of developing symptoms associated with RA. Though the mechanism is not understood, the study raises the question of other possible lifestyle changes that might affect disease expression.
  • Balance rest with activity.
    • Movement is extremely important for those with RA. Find gentle options such as swimming (look for warm pools, salt water if possible) and easy walking. Start slowly to warm up your joints and increase as tolerated.
    • Use pain as a signal to slow or stop. Avoid overdoing or high-impact exercise such as running or jogging, to avoid stress on inflamed joints.
    • Rest when necessary but avoid prolonged sitting. On long car trips, stop every 20 minutes to get out and walk or stretch for 5-10 minutes.
  • Avoid gripping and pinching. Certain actions should be avoided such as gripping or pinching things with your fingers or making tight fists.
  • Get the right equipment for the job. Find body-friendly chairs for desk jobs, proper kitchen tools for opening jars, sturdy shoes for walking. As a friend of ours with arthritis says, “Think like an Egyptian.” (They did not build the pyramids using blunt force but rather by finding the right tools.)

Caution: Unlike many other forms of arthritis, rheumatoid arthritis can be a destructive disease. It can damage components of the joint affected and lead to ongoing problems with or without pain. It is important to have a good working relationship with a physician or other health care practitioner who can help you monitor your joints to avoid joint damage. Your physician will have some conventional treatments to offer if there is evidence of progression involving your joints. Continuation of a healthy food and supplement program may minimize your need for conventional medical prescriptions.

Seeking Care

You may wish to speak to your doctor about an oral anti-amebic therapy that is based on the premise that parasitic animals known as amoebas cause RA. Anti-amebic therapy has produced 50% improvement in RA symptoms in 30 people who have not responded to any of the above nutritional or lifestyle therapies. You can find more information at The Arthritis Trust of America.

Another discussion you might wish to have with your doctor is about the prescription medication referred to as “low dose naltrexone”. A medication used in larger doses to reverse the effects of narcotics, naltrexone is being seriously studied at a number of medical centers for its efficacy in autoimmune and neurological diseases. You can read about it in great detail on the website www.lowdosenaltrexone.org and find medical references for your physician.

Homeopathic Treatment

Homeopathic treatment of rheumatoid arthritis requires individual consultation with a professional homeopath. With the correctly chosen remedy, the benefit can be quite significant.

Prevention

Conventional wisdom says that there is no preventing rheumatoid arthritis. The sole exception seems to be the British Medical Journal study cited above that showed patients with high-risk laboratory findings who drank the most alcohol were the least likely to progress to symptomatic RA. The application of this finding is uncertain, as few people know they have abnormal lab findings until they are symptomatic and there is no evidence that alcohol helps in this situation.

The most valuable prevention suggestions are for those folks who already have RA and don't want it to progress: prevent further pain and disability by keeping your overall levels of inflammation as low as possible.

Consider a consultation with me if the Full Program seems daunting to you. A little wise counsel can help you chart a step-by-step course that can have some long-term positive results.

From Dr. Deborah's Desk

I am always happy to see Jake's name on the schedule. We discovered that we both grew up in the same 1950's California small town. Then in the 1960's, when I went to UC Berkeley, he went to Vietnam. Somehow we are still kindred spirits.

Jake is decidedly youthful, so much so that he contracted an autoimmune juvenile arthritis known as Still's Disease when he was an adult. In addition to episodic and erratic heart palpitations, he has migratory aches and pains that are autoimmune-like RA-but happily much less deforming. We have worked primarily with homeopathic treatment that has kept his heart behaving much better, but we had another task to tackle a few years ago, when he sustained a tendon rupture after a steroid injection and his rheumatologist said, “No more!” Jake was desperate, and I was happy to get the subject around to diet while his motivation was so high.

A rancher himself, he eats good quality grass-fed meat, but had been lured into “healthy” oatmeal breakfasts and whole-grain bread sandwiches. His CRP (blood test for inflammation) was high, his stomach was expanding, and he hurt everywhere. He couldn't really believe it when I said he should go back to eggs and bacon for breakfast, and leave all the grains behind. Knowing there would be no more steroid injections, he was willing to start the omega 3 fish oil supplement I recommended. He traded his budget multi-vitamins for a food-based substitute from my office.

I don't see him as often now-the diet and its positive changes have stuck. He spent the winter working (outside!) in Alaska, and keeps his adult sons busy trying to keep up with him. He is living proof of the benefits of an anti-inflammatory diet change.

This information is provided for educational purposes only, and any individual diagnosis or treatment should be determined by you and your doctor. See Additional Information.

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