Rheumatoid Arthritis

Rheumatoid arthritis (RA) is likely caused by a pathological immune response in individuals who are genetically predisposed to an environmental challenge, probably a viral or bacterial infection.1 However, no organism has been definitively linked to cause RA. Recent evidence points to the gut microbiome as playing important roles in health and susceptibility to autoimmune conditions. The neural, endocrine, and immune systems all share communication molecules that interact extensively. Molecules from the hypothalamic-pituitary-adrenal axis (e.g. cortisol and corticotropin-releasing factor) and from the sympathetic-adrenal-medullary system (e.g. epinephrine, norepinephrine) are linked to disease activity in RA.2

Definite RA is confirmed by the presence of synovitis in at least one joint, the absence of a better alternative diagnosis, and a score of 6 or greater (out of a possible 10) from four domains: number and site of involved joints (scored 0–5); rheumatoid factor or anticyclic citrullinated peptide (0–3); elevated sedimentation rate or C-reactive protein (0–1); and duration greater than 6 weeks (0–1).3

Joint pain can inhibit activity and lead to muscle disuse and atrophy. In turn, muscle atrophy can lead to decreased stability of joints. Light weight training can maintain or even increase muscle strength around joints and can lead to increased joint stability. Stretching muscles can help decrease flexion contractures. Aerobic exercise improves mood, decreases fatigue, and helps control weight gain. Water exercise can be helpful because it is less stressful on joints; however, weight training and walking work better to decrease bone loss (osteoporosis).

Fasting clearly decreases symptoms in RA; however, symptoms rapidly recur with the resumption of food intake.4 A few people with RA appear to have a food intolerance that exacerbates their disease. Many more people believe that certain foods exacerbate symptoms, but this effect has not been observed in blind trials of food exposure. The offending foods are usually dairy products, wheat, citrus, or nuts. An elimination diet for 2 weeks with the reintroduction of the suspected food can be done with or without the supervision of a physician or a nutritionist.

Increased intake of omega-3 fatty acids from cold-water fish, such as salmon, and from nuts, such as walnuts, as well as from flaxseed or hempseed, can provide modest improvement in the control of RA. Cooked vegetables and olive oil have been found to be independently protective against the development of RA. Ginger and Turmeric are two botanicals that have shown some promise in reducing systemic inflammation including in the context of RA.

Beyond lifestyle modifications, there are other treatment modalities that we offer at RMRM which have proven helpful and may apply to your specific circumstance.

  1. I.B. McInnes, G. Schett: The pathogenesis of rheumatoid arthritis. N Engl J Med.365:2205-2219 2011
  2. R. Straub, M. Cutolo: Involvement of the hypothalamic-pituitary-adrenal/gonadal axis and the peripheral nervous system in rheumatoid arthritis. Arthritis Rheum. 44:493-507 2001
  3. D. Aletaha, T. Neogi, A.J. Silman, et al.: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 62:2569-2581 2010
  4. C.J. Henderson, R.S. Panush: Diets, nutritional supplements, and nutritional therapies in rheumatic diseases. Rheum Dis Clin North Am. 25:937-968 1999
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