Gale Encyclopedia of Alternative Medicine --Rheumatoid arthritis

October 14, 2002

Gale Encyclopedia of Alternative Medicine

Rheumatoid arthritis

Author/s: Kathleen

Definition

Rheumatoid arthritis (RA) is a chronic disease causing inflammation and

deformity of the joints. Other systemic problems throughout the body may

also develop, including inflammation of blood vessels (vasculitis), the

development of bumps (rheumatoid nodules) in various parts of the body, lung

disease, blood disorders, and weakening of the bones (osteoporosis).

Description

The skeletal system of the body is made up of different types of strong,

fibrous tissue called connective tissue. Bone, cartilage, ligaments, and

tendons are all forms of connective tissue that have different compositions

and characteristics.

The joints are structures that hold two or more bones together. Synovial

joints allow for movement between the bones being joined, the articulating

bones. The simplest synovial joint involves two bones, separated by a slight

gap called the joint cavity. The ends of each articular bone are covered by

a layer of cartilage. Both articular bones and the joint cavity are

surrounded by a tough tissue called the articular capsule. The articular

capsule has two components: the fibrous membrane on the outside and the

synovial membrane, or synovium, on the inside. The fibrous membrane may

include tough bands of tissue called ligaments, which are responsible for

providing support to the joints. The synovial membrane has special cells and

many tiny blood vessels called capillaries. This membrane produces a supply

of synovial fluid that fills the joint cavity, lubricates it, and helps the

articular bones move smoothly about the joint.

In rheumatoid arthritis the synovial membrane becomes severely inflamed.

Usually thin and delicate, the synovium becomes thick and stiff, with

numerous infoldings on its surface. The membrane is invaded by white blood

cells, which produce a variety of destructive chemicals. The cartilage along

the articular surfaces of the bones may be attacked and destroyed, and the

bone, articular capsule, and ligaments may begin to erode. These processes

severely interfere with movement in the joint.

RA exists all over the world and affects men and women of all races. In the

United States alone, about two million people suffer from the disease. Women

are three times more likely than men to have RA. About 80% of people with RA

are diagnosed between the ages of 35 and 50. RA appears to run in families,

although certain factors in the environment may also influence the

development of the disease.

Causes & symptoms

The underlying event that promotes RA in a person is unknown. Given the

known genetic factors involved in RA, some researchers have suggested that

an outside event occurs and triggers the disease cycle in a person with a

particular genetic makeup.

Many researchers are examining the possibility that exposure to an organism

(a bacteria or virus) may be the first event in the development of RA. The

body's normal response is to produce cells that can attack and kill the

organism, protecting the body from the foreign invader. In an autoimmune

disease like RA, this immune cycle spins out of control. The body produces

misdirected immune antibodies, which accidentally identify parts of the

person's body as foreign. These immune cells then produce a variety of

chemicals that injure and destroy parts of the body.

RA can begin very gradually or it can strike without warning. The first

symptoms are pain, swelling, and stiffness in the joints. The most commonly

involved joints include hands, feet, wrists, elbows, and ankles. The joints

are typically affected in a symmetrical fashion. This means that if the

right wrist is involved, the left wrist is also involved. Patients

frequently experience painful joint stiffness when they first get up in the

morning, lasting perhaps an hour. Over time, the joints become deformed. The

joints may be difficult to straighten, and affected fingers and toes may be

permanently bent. The hands and feet may also curve outward in an abnormal

way.

Many patients also notice increased fatigue, loss of appetite, weight loss,

and sometimes fever. Rheumatoid nodules are bumps that appear under the skin

around the joints and on the top of the arms and legs. These nodules can

also occur in the tissue covering the outside of the lungs and lining the

chest cavity (pleura), and in the tissue covering the brain and spinal cord

(meninges). Lung involvement may cause shortness of breath and is seen more

in men. Vasculitis, an inflammation of the blood vessels, may interfere with

blood circulation. This can result in irritated pits (ulcers) in the skin,

gangrene, and interference with nerve functioning that causes numbness and

tingling.

Diagnosis

There are no tests available that can absolutely diagnose RA. Instead, a

number of tests exist that can suggest the diagnosis of RA. Blood tests

include a special test of red blood cells, the erythrocyte sedimentation

rate, which is positive in nearly 100% of patients with RA. However, this

test is also positive in a variety of other diseases. Tests for anemia are

usually positive in patients with RA, but can also be positive in many other

unrelated diseases. Rheumatoid factor is an autoantibody found in about 66%

of patients with RA. However, it is also found in about 5% of all healthy

people and in 10-20% of healthy people over the age of 65. Rheumatoid factor

is also positive in a large number of other autoimmune diseases and other

infectious diseases.

A long, thin needle can be inserted into a synovial joint to withdraw a

sample of the synovial fluid for examination. In RA, this fluid has certain

characteristics that indicate active inflammation. The fluid will be cloudy,

relatively thinner than usual, with increased protein and decreased or

normal glucose. It will also contain a higher than normal number of white

blood cells. While these findings suggest inflammatory arthritis, they are

not specific to RA.

Treatment

There is no cure available for RA. However, treatment is available to combat

the inflammation in order to prevent destruction of the joints and other

complications of the disease. Efforts are also made to provide relief from

the symptoms and to maintain maximum flexibility and mobility of the joints.

A variety of alternative therapies have been recommended for patients with

RA. Meditation, hypnosis, guided imagery, relaxation, and reflexology

techniques have been used effectively to control pain. Acupressure and

acupuncture have also been used for pain; work on the pressure points should

be done daily in combination with other therapies. Bodywork can be soothing

and is thought to improve and restore chemical balance within the body. A

massage with rosemary and chamomile, or soaking in a warm bath with these

essential oils, can provide extra relief. Stiff joints may also be loosened

up with a warm sesame oil massage, followed by a hot shower to further heat

the oil and allow entry into the pores. Movement therapies like yoga, t'ai

chi, and qigong also help to loosen up the joints.

A multitude of nutritional supplements can be useful for RA. Fish oils, the

enzymes bromelain and pancreatin, and the antioxidants (vitamins A, C, and

E, selenium, and zinc) are the primary supplements to consider.

Many herbs also are useful in the treatment of RA. Anti-inflammatory herbs

may be helpful, including turmeric (Curcuma longa), ginger (Zingiber

officinale), feverfew (Chrysanthemum parthenium), devil's claw

(Harpagophytum procumbens), Chinese thoroughwax (Bupleuri falcatum), and

licorice (Glycyrrhiza glabra). Lobelia (Lobelia inflata) and cramp bark

(Vibernum opulus) can be applied topically to the affected joints.

Homeopathic practitioners recommend Rhus toxicondendron and bryonia (Bryonia

alba) for acute prescriptions, but constitutional treatment, generally used

for chronic problems like RA, is more often recommended. Yoga has been used

for RA patients to promote relaxation, relieve stress, and improve

flexibility. Nutritionists suggest that a vegetarian diet low in animal

products and sugar may help to decrease both inflammation and pain from RA.

Beneficial foods for patients with RA include cold water fish (mackerel,

herring, salmon, and sardines) and flavonoid-rich berries (cherries,

blueberries, hawthorn berries, blackberries, etc.). The enzyme bromelain,

found in pineapple juice has also been found to have significant

anti-inflammatory effects.

RA, considered an autoimmune disorder, is often connected with food

allergies or intolerances. An elimination/challenge diet can help to

decrease symptoms of RA as well as identify the foods that should be

eliminated to prevent flare-ups and recurrences.

Hydrotherapy can help to greatly reduce pain and inflammation. Moist heat is

more effective than dry heat, and cold packs are useful during acute

flare-ups. Various yoga exercises done once a day can also assist in

maintaining joint flexibility.

Allopathic treatment

Nonsteroidal anti-inflammatory agents and aspirin are used to decrease

inflammation and to treat pain. While these medications can be helpful, they

do not interrupt the progress of the disease. Low-dose steroid medications

can be helpful at both managing symptoms and slowing the progress of RA, as

well as other drugs called disease-modifying antirheumatic drugs. These

include gold compounds, D-penicillamine, antimalarial drugs, and

sulfasalazine. Methotrexate, azathioprine, and cyclophosphamide are all

drugs that suppress the immune system and can decrease inflammation. All of

the drugs listed have significant toxic side effects, which require

healthcare professionals to carefully compare the risks associated with

these medications versus the benefits.

Total bed rest is sometimes prescribed during the very active, painful

phases of RA. Splints may be used to support and rest painful joints. Later,

after inflammation has somewhat subsided, physical therapists may provide a

careful exercise regimen in an attempt to maintain the maximum degree of

flexibility and mobility. Joint replacement surgery, particularly for the

knee and the hip joints, is sometimes recommended when these joints have

been severely damaged. Another surgery used to stop pain in a stiff joint,

such as the ankle, is the fusion of the affected bones together

(arthrodesis, or artificial anklylosis).

Prognosis

About 15% of all RA patients will have symptoms for a short period of time

and will ultimately get better, leaving them with no long-term problems. A

number of factors are considered to suggest the likelihood of a worse

prognosis. These include:

* race and gender (female and Caucasian)

* more than 20 joints involved

* extremely high erythrocyte sedimentation rate

* extremely high levels of rheumatoid factor

* consistent, lasting inflammation

* evidence of erosion of bone, joint, or cartilage on x rays

* poverty

* older age at diagnosis

* rheumatoid nodules

* other coexisting diseases

* certain genetic characteristics, diagnosable through testing

Patients with RA have a shorter life span, averaging a decrease of three to

seven years of life. Patients sometimes die when very severe disease,

infection, and gastrointestinal bleeding occur. Complications due to the

side effects of some of the more potent drugs used to treat RA are also

factors in these deaths.

Prevention

There is no known way to prevent the development of RA. The most that can be

hoped for is to prevent or slow its progress.

Key Terms

Articular bones

Two or more bones connected to each other via a joint.

Joint

Structures holding two or more bones together.

Synovial joint

A type of joint that allows articular bones to move.

Synovial membrane

The membrane that lines the inside of the articular capsule of a joint and

produces a lubricating fluid called synovial fluid.

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