|Also Listed As:
Rheumatoid arthritis (RA) is a chronic disease characterized by inflamed
joints leading to swelling, pain, stiffness, and the possible loss of function.
It occurs when the body's immune system attacks tissues (groups of cells) that
make up joints. This destroys the joint's protective cartilage (the firm,
rubbery tissue that cushions bones at the joints). Healthy cartilage allows
bones to glide smoothly over one another. Normal cartilage also absorbs the
shock of physical movement. The cartilage in those with rheumatoid arthritis
breaks down and wears away. As a result, the bones rub together, causing the
pain, swelling, and stiffness associated with this condition. The inflammatory
process of rheumatoid arthritis is not confined to joints, but may damage other
organs in the body as well. In addition, rheumatoid arthritis can occur in
children, this is known as juvenile rheumatoid arthritis (JRA).
|Signs and Symptoms|
RA usually develops slowly over time, with the following
- Morning stiffness -- waking up with stiff joints (often the wrists and
base of the fingers; ankles, balls of the feet, elbows, and/or knees may also be
- Joint pain with warmth, swelling, tenderness, and stiffness of the
joint after inactivity
- Limited range of motion in the affected joints
- Low grade fever (when joints are acutely inflamed)
- Small, round, firm bumps (called nodules) under the skin; you can feel
these, but they are generally painless
Rheumatoid arthritis almost always follows a symmetrical pattern. This means
that the same joints on opposite sides of the body are affected (for example,
both the left and the right knees). This is important because it will help your
doctor distinguish rheumatoid from other types of arthritis.
Juvenile rheumatoid arthritis, also known as Still's disease, is usually
preceded by a high fever and shaking chills; a pink skin rash may also be
Medical researchers do not know exactly why RA develops. They speculate that
a combination of factors, including genetic susceptibility, an abnormal immune
response, and certain changes in the body such as an infection or hormonal
shift, can trigger its development.
Risk factors for RA include:
- Age -- although the disease can occur at any age, it generally starts
in young adulthood, with peak onset between ages 25 and 55. JRA affects 50,000
children in the United States.
- Female sex -- women are affected two and a half times more often than
men, and have a greater chance of having a severe case
- Family history -- having relatives with this type of arthritis
increases your risk of getting it yourself
- Cigarette smoking - it appears that heavy
smoking over a long period of time increases your risk of getting RA
- History of blood transfusions
- Coffee intake - controversial; one Finnish
study reported a direct association between coffee consumption and an increased
risk for RA, but the study did not account for other factors such as the way
coffee is prepared in Finland (typically without filters). Further investigation
in other countries is needed.
- Medication -- interferon-alpha, a drug used to treat hepatitis,
autoimmune diseases, and other diseases has triggered RA in rare cases
Rheumatoid arthritis can be difficult to diagnose because it resembles many
other conditions, and symptoms develop so gradually they can go unnoticed. Even
after RA has been diagnosed, it is extremely important to determine how the
disease is progressing in order to treat it appropriately.
Your doctor is likely to use a combination of the following methods to
diagnose the disease and rule out the possibility of other causes of
- Medical history - assessing symptoms by
asking when they started and how they changed over time, including which joints
are currently involved and have been affected previously. You may be asked about
other medical conditions that could be contributing to current joint symptoms,
and whether any factors (such as a fall or injury) could have caused these
symptoms. The doctor will also determine whether you are taking might interact
with drugs that he or she is considering prescribing.
- Physical exam -- each of the affected joints is examined for redness
and swelling, the presence of fluid in the joint, and the strength and range of
motion of the joint.
- Blood tests -- are performed to look for general signs of
inflammation, to help eliminate the possibility of other types of arthritis such
as osteoarthritis or Lyme's disease, and to check for possible markers of RA
such as antibodies called rheumatoid factor that collect in the synovium (a
membrane that produces joint-protecting fluid).
- Joint aspiration -- fluid may be withdrawn from the joint for
evaluation using a needle and syringe. The synovial fluid, as it is called, is
evaluated for signs of inflammation and to eliminate other causes of your
Rheumatoid arthritis usually requires lifelong treatment, including various
physical therapy, education, and possibly
surgery. Treatment is aimed at relieving
symptoms and preserving joint function.
Regular visits to your healthcare provider will be necessary to monitor the
progress of the disease and side effects of drugs you may be taking. This might
also entail regular blood and urine tests.
Frequently, the disease can be controlled with a combination of treatments.
Treatment may vary depending on the severity of the symptoms. Surgery may be
needed, if medications fail.
For the past 10 years, studies have shown that early, aggressive treatment
for RA can delay the onset of joint destruction. In addition torest,
strengthening exercises, and anti-inflammatory agents, the current standard of
care is to start therapy with disease-modifying anti-rheumatic drugs (DMARDs)
- that is, drugs that actually alter the course of the
disease rather than just relieve symptoms. Studies show that certain
dietary supplements, particularly
omega-3 fatty acids, show promise in helping to relieve symptoms. Other
symptom-relieving measures might include bathing in sulfur baths or warm pools,
applying capsaicin to the skin for pain, and having electrical stimulation to
increase muscle strength.
Range of motion exercises and individualized exercise programs prescribed by
physical therapist can help to maintain
joint motion and strength and delay the loss of joint function.
Joint protection techniques, such as heat and cold treatments and splints or
orthotic (straightening) devices to support and align joints, may be very
The following drugs are used to treat RA.
- Disease-modifying anti-rheumatoid drugs
(DMARDs)—include gold compounds and methotrexate.
Methotrexate is used most often, sometimes with antimalarial drugs (such as
hydroxychloroquine) or sulfasalazine, and has been proven effective. DMARDs can
have serious side effects such as kidney, liver, lung, or retinal damage. Other
DMARDs include D-penicillamine, cyclosporine, and leflunomide.
- Aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs)—reduce pain and inflammation. These include
numerous over-the-counter and prescription medications such as ibuprofen,
naproxen sodium, diclofenac, diflunisal, etodolac, fenoprofen, indomethacin,
ketoprofen, nabumetone, oxaprozin, piroxicam, sulindac, salsalate, and tolmetin;
side effects of frequent use include gastrointestinal irritation, bleeding, and
- Cyclo-oxgenase-2 (COX-2) inhibitors—such as
celecoxib and rofecoxib, reduce pain and inflammation with fewer
gastrointestinal side effects than NSAIDs
- Corticosteroids—decrease inflammation and
control pain; given orally or intravenously. Some potentially possibly serious
side effects (such as diabetes, cataracts, osteoporosis, weight gain, and high
blood pressure) are associated with this class of drugs, if used over a long
time; therefore, use of corticosteroids for RA is usually limited to short
courses and as low a dose as possible.
- Immune suppressants—are used for serious
cases of RA when all other medications have failed. These include azathioprine
Some promising new drugs include:
- Tumor necrosis factor (TNF) modifiers—such as
etanercept, a new, and increasingly popular, medication, and infliximab. Both
are FDA-approved for moderate to severe cases of RA. These drugs block TNFs
(inflammatory proteins) and are given by intravenous injection. Etanercept
reduces pain and swelling with fewer severe side effects than DMARDs; infliximab
reduces symptoms of RA and in combination with methotrexate may halt progression
of joint damage. TNF modifiers are associated with side effects such as severe
|Surgery and Other Procedures|
Occasionally, surgery may be required to treat severely affected joints. The
most successful surgeries are those on the knees and hips. Removal of the
synovium (called synovectomy) is a common surgical procedure.
A later alternative is total joint replacement with a prosthesis (an
artificial joint). Surgeries can be expected to relieve pain, correct
deformities, and modestly improve joint function. In extreme cases, total knee
or hip replacement can mean the difference between being completely dependent on
others and having an independent life at home.
|Nutrition and Dietary Supplements|
In general, it is important to eat a nutritious diet full of whole foods
including protein, which is needed to heal. Foods rich in the B vitamins,
vitamin E, zinc, and selenium may be particularly important. Although there are
claims of several types of diets being effective for rheumatoid arthritis, no
one diet has been found to work for everyone.
There are reports of people with RA who experienced an improvement in their
symptoms when they switched from a typical Western diet (high in animal protein
and simple sugars) to a vegan diet with lots of uncooked berries, fruits,
vegetables, nuts, roots, seeds, and sprouts. Vegan diets contain no animal
products and obtain protein from vegetable sources.
Elimination/provocation diets (also called elimination/re-challenging diets),
designed to detect allergens by systematically taking certain foods out of the
diet and reintroducing them one at a time can be considered but should be
strictly supervised by a qualified physician and/or dietitian. If this process
is followed, you should keep careful track of your symptoms in a food diary to
see if the dietary changes impact your symptoms or not.
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare
Bromelain (Ananas comosus), found in pineapples, is a mixture of enzymes with
anti-inflammatory properties. Preliminary studies suggest that bromelain may
help reduce the pain associated with rheumatoid arthritis. In fact, studies of
people with osteoarthritis suggest that bromelain supplements may be as
effective as some commonly used nonsteroidal anti-inflammatory (NSAID)
medications (such as ibuprofen and diclofenac) for reducing pain associated with
this other type of arthritis. Bromelain is generally recommended for no longer
than 8 to 10 days in a row. Quercetin and bromelain are often taken
Animal studies suggest that oral copper supplements reduce the development
and progression of arthritis. Many people with RA apply copper solutions to
their skin or wear copper bracelets in hopes of relieving pain and inflammation.
Although reports of success with these methods are mixed, one early study did
show that the copper bracelets worked better than placebo bracelets. Sweat can
interfere with how well the topical copper solutions and bracelets work.
People with rheumatoid arthritis tend to have low levels of MnSOD (an
antioxidant that helps protect the joints from damage during inflammation).
Manganese supplementation is thought to increase MnSOD activity. Also, manganese
is often combined with glucosamine and/or chondroitin, two substances often used
to help treat the other major type of arthritis, osteoarthritis.
Omega-3 Fatty Acids
Extensive research indicates that omega-3 fatty acids reduce inflammation and
help prevent arthritis. Omega-3s are essential fatty acids, meaning that the
body requires them but must obtain them from food. Several articles reviewing
the research on omega-3 fatty acids conclude that omega-3 supplements reduce
tenderness in joints, decrease morning stiffness, and allow for a reduction in
the amount of medication needed for people with rheumatoid arthritis.
Further, an animal study suggests that treatment with omega-3 fatty acids may
reduce the risk of ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs).
More research is needed to determine whether this particular effect applies to
Good sources for omega-3 fatty acids include fish oils (from cold water oily
fish) and plant oils (for example, rapeseed [canola] oil, soybeans, soybean oil,
pumpkin seeds, pumpkin seed oil, flaxseeds, flaxseed oil, walnuts, and walnut
Another potential source of omega-3 fatty acids is the New Zealand green
lipped mussel (Perna canaliculus), used for centuries by the Maori people for
good health. In a trial involving 28 people with RA, nearly 70% of those who
received P. canaliculus extracts experienced the following:
- Decreased joint stiffness and pain
- Increased grip strength
- Enhanced walking pace
Note, however, that 10% of participants experienced a temporary worsening of
symptoms when first taking the supplement. In addition, it is better to use
lipid extracts of P. canaliculus rather than powder as there is less chance of
an allergic reaction. P. canaliculus should be avoided by people who are
allergic to seafood.
Omega-6 Fatty Acids
Some preliminary information indicates that gamma-linolenic acid (GLA), an
omega-6 fatty acid, from evening primrose oil (EPO), borage oil, or black
currant seed oil, may diminish joint pain, swelling, and morning stiffness. GLA
may also allow for lower amounts of pain medication. These studies have been
small in size, but nevertheless, you may want to talk to your doctor about
whether using GLA is safe for you. Pay attention, over 1 to 3 months of use, to
whether your symptoms get better or not. Note that some researchers theorize
that borage oil may not be safe to use with non-steroidal anti-inflammatory
drugs (such as ibuprofen). This theory needs to be tested.
At the same time that this particular omega-6 fatty acid (namely, GLA) may be
helpful, other omega-6 fatty acids (linoleic acid, found in vegetable oils and
arachidonic acid, found in meat) should be avoided because these promote
Quercetin is a flavonoid as well as an antioxidant found in many fruits,
fresh berries, and vegetables. Laboratory and animal studies suggest that
quercetin has anti-inflammatory properties. In test tubes, for example,
quercetin inhibits the type of inflammation that can occur in the joints of
those with arthritis. Bromelain can enhance the effects of quercetin.
Selenium is an essential mineral found in tiny amounts in the body. It is
also an antioxidant, and is found in fish, shellfish, Brewer's yeast, wheat
germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Low levels of
selenium in the blood may be associated with increased risk of RA. It is not
known whether supplementation with selenium alone is beneficial. Some experts
believe, however, that the combination of selenium and vitamin E can relieve
symptoms of RA.
Sulfur is a naturally occurring mineral found primarily near hot springs and
volcanic craters. It is available in two supplement forms -- dimethyl sulfoxide
(DMSO) and methylsulfonylmethane (MSM). Sulfur-containing mud baths (often
called balneotherapy) is one of the oldest forms of therapy to relieve pain for
people with arthritis, and this tradition is supported by scientific studies.
Soaks in the Dead Sea, with or without mud packs, may be particularly
beneficial. The benefits that you can experience from sulfur baths if you have
- Improved strength
- Less morning stiffness
- Decreased inflammation and swelling
- Diminished pain
You can purchase mud packs and Dead Sea salts over the counter. These are not
as effective as a spa treatment or the Dead Sea itself, but you may feel better.
More studies are needed to determine whether topical application of DMSO is
effective for reducing pain.
Vitamin B5 (Pantothenic Acid)
Although vitamin B5 has not been widely used for RA, some researchers report
that blood levels of vitamin B5 are lower in people with RA than those without
this condition. A study conducted in 1980 concluded that 2,000 mg/day of calcium
pantothenate (a form of vitamin B5) improved symptoms of RA including morning
stiffness and pain. Further studies are needed to confirm these findings, but
there may be some benefit to making sure that there is an adequate amount of
vitamin B5 in your diet. Vitamin B5 is found in a wide variety of foods, such as
fresh meat and vegetables and whole grains. Processed and frozen foods contain
lower amounts of this vitamin.
Vitamin B6 (Pyridoxine)
Low levels of vitamin B6 have been associated with rheumatoid arthritis. This
may be due to low dietary intake of vitamin B6. In addition, methotrexate and
penicillamine, drugs sometimes prescribed for RA, can reduce the levels of
vitamin B6 in people taking either of these medications.
Vitamin B Complex
Eating a balanced diet, including a complete vitamin B complex, is a good
practice. It is not known if taking extra vitamin B5 or B6 is of any use if you
Vitamin B9 (Folic Acid)
Methotrexate, commonly prescribed for RA, increases your body's need for
folic acid. Taking a folic acid supplement decreases the side effects from the
drug without reducing its effectiveness.
Vitamin D is needed to maintain healthy cartilage. Vitamin D has been shown
to prevent the breakdown of cartilage in people with osteoarthritis. It is
possible that adequate amounts of vitamin D may also be useful for those with
Vitamin D is found in cod liver oil, fatty fish, eggs, and fortified milk and
cereal. If you follow a vegan diet, don't get enough exposure to the sun, or are
obese or older, you may be prone to having low levels of vitamin D and may need
to take a supplement.
Additional nutrients that may prove beneficial as part of the treatment of RA
if more research is conducted include:
- Antioxidants in general, vitamins C and E in particular
- Vitamin B2 (Riboflavin)
The use of herbs is a time-honored approach to strengthening the body and
treating disease. Herbs, however, contain active substances that can trigger
side effects and interact with other herbs, supplements, or medications. For
these reasons, herbs should be taken with care and only under the supervision of
a practitioner knowledgeable in the field of herbal medicine.
The following have been used traditionally to treat rheumatoid
- Burdock (Arctium lappa and other Arcticum spp)
- Goldenrod (Solidago virgaurea)
- Horsetail (Equisetum arvense)
- Lavender (Lavendula augustifolia) -
- Pau d'Arco (Tabebuia avellanedae)
- Stinging nettle (Urtica dioica)
- Turmeric (Curcuma longa)
- Wild yam (Dioscorea villosa)
A qualified herbal specialist may recommend a single herb or a combination of
substances. It is important, if you are considering taking herbs for RA, that
you work closely with a knowledgeable practitioner and follow their instructions
Other herbs that may be considered by an herbalist that do have some
scientific backing include:
Black cohosh (Cimicifuga racemosa)
Preliminary studies suggest that black cohosh may help reduce inflammation
associated with the two main types of arthritis, osteoarthritis and rheumatoid
arthritis. In a review of scientific studies, researchers concluded that a
combination of black cohosh, willow bark (Salix spp.), sarsaparilla (Smilax
spp.), guaiacum (Guaiacum officinale) resin, and poplar bark (Populus
tremuloides) may help relieve symptoms of osteoarthritis. Whether this same
combination would be helpful for RA requires research
Capsaicin (Capsicum frutescens)
Capsaicin is the main component in hot chili peppers (also known as cayenne).
Applied to the surface of the skin, it is believed to deplete stores of a
substance that contributes to inflammation and pain in arthritis. Pain reduction
generally begins 3 to 7 days after initially applying the capsaicin cream to the
skin, but may be most pronounced after about 4 weeks of use. Wash hands well
with vinegar after use and avoid touching the eyes.
Cat's claw (Uncaria tomentosa)
In a study of 40 people with RA who were taking the drugs sulfazaline or
hydroxychloroquine, treatment with an extract from cat's claw for 24 weeks
resulted in reduced joint pain and swelling.
Devil's claw (Harpagophytum procumbens)
Devil's claw has been evaluated for helping to treat the other main type of
arthritis, osteoarthritis, and may prove to be beneficial for RA, if studied
properly. For people with osteoarthritis, devil's claw appears to decrease pain,
improve joint function, and reduce the amount of medications used.
Feverfew (Tanacetum parthenium)
Although many laboratory tests demonstrate anti-inflammatory properties of
feverfew and many professional herbalists recommend feverfew for the treatment
of arthritis, a study conducted in 1989 concluded that feverfew was no more
effective than placebo in improving symptoms of rheumatoid arthritis. Some
experts argue that this study was poorly designed, particularly because some
patients continued, throughout the study, to use non-steroidal anti-inflammatory
drugs (NSAIDs), which can interfere with feverfew and reduce its effectiveness.
(NSAIDs, such as ibuprofen, are commonly prescribed or recommended for
arthritis.) Until further studies are conducted, it appears that the safety and
effectiveness of feverfew for people with rheumatoid arthritis has yet to be
Ginger (Zingiber officinale)
Ginger extract has long been used in traditional medical practices (such as
Ayurvedic and Chinese) to decrease inflammation. There have been case reports of
the benefit of ginger for RA in the medical literature. In one case, a man with
RA consumed fresh ginger lightly cooked in meat and vegetable dishes every day
and after 3 months was completely free of pain and swelling. More research is
needed before it can be said that ginger relieves the symptoms of RA.
Willow bark (Salix spp.)
This herb has been used traditionally for arthritis because it can decrease
pain and reduce inflammation. In fact, it was from salicylic acid, one of the
ingredients in willow bark, that aspirin was originally synthesized.
There is little to know scientific evidence supporting the use of acupuncture
for rheumatoid arthritis, however, some practitioners will consider acupuncture
to treat this joint condition. Acupuncturists treat people with rheumatoid
arthritis based on an individualized assessment of the excesses and deficiencies
of qi located in various meridians. A qi deficiency is usually detected in the
spleen and/or kidney meridians.
Moxibustion (a technique in which the herb mugwort (Artemesia vulgaris) is
burned over specific acupuncture points) may be used to strengthen the entire
energy system. Lifestyle, dietary, and herbal advice may also be provided by
qualified acupuncturists to people with RA. Local treatment to the painful areas
and related sore points may be applied, either with a needle or moxibustion. In
general, however, given the current lack of evidence, acupuncture should be used
as a supportive treatment alongside conventional medical
Chiropractors do not treat red, swollen joints, and high velocity
chiropractic manipulation is considered inappropriate in areas of the body
affected by this condition. However, some chiropractors report that spinal
manipulation may decrease pain and enhance joint mobility when used in between
flare ups for people with rheumatoid arthritis.
|Massage and Physical Therapy|
It is important to maintain a balance between rest (which will reduce
inflammation) and exercise (which will relieve stiffness and weakness). Studies
have suggested that even as little as 3 hours of physical therapy over 6 weeks
will help you if you have RA, and that these benefits are sustained.
The goal of exercise is the following:
- To maintain a wide range of motion
- To increase strength, endurance, and mobility
- Improve general health
- Promote well-being
While traditional guidelines have restricted RA patients to only gentle
exercise, recent research suggests that more intense exercise may not only be
safe, but may actually produce greater muscle strength and overall functioning.
Signs from your body are the best guides for how long or hard you should
- If you feel sharp pains while exercising, stop immediately.
- If lesser aches and pains continue for more than 2 hours afterwards,
then try a lighter exercise program for a while.
- Using large joints instead of small ones for ordinary tasks can help
relieve pressure. For example, use your hip to close doors or the palm of your
hand to push buttons.
Balneotherapy (Hydrotherapy or spa therapy)
Balneotherapy is one of the oldest forms of therapy for pain relief for
people with arthritis. The term "balneo" comes from the Latin word for bath
(balneum) and refers to bathing in thermal or mineral waters. Sulfur-containing
mud baths, for example, have been shown to relieve symptoms of arthritis. The
goals of balneotherapy for arthritis include:
- Improving range of joint motion
- Increasing muscle strength
- Eliminating muscle spasm
- Enhancing functional mobility
- Easing pain
Exercising and swimming in a heated pool may also be beneficial.
A variety of mechanical devices, called orthoses, are available for people
with RA to help support and protect joints. Made from lightweight metal leather,
elastic, foam, and plastic, orthoses allow some movement within the affected
joint and do not restrict nearby joints. For example, splints or braces help
align joints and properly distribute weight. Shock-absorbing soles in shoes can
help in daily activities and during exercise. These mechanical aids are used
most frequently to treat arthritic hands, wrists, knees, ankles, and feet.
Orthoses should be custom-fitted by a physical or occupational therapist.
Another potentially helpful aid is compression gloves. Two studies on the
overnight use of compression gloves (close-fitting nylon-spandex gloves)
concluded that the gloves reduced pain and stiffness in people with RA in the
Other possibilities for symptom relief include:
- Transcutaneous nerve stimulation (TENS) -- small studies show that at
70Hz, TENS, a technique used by many physical therapists, may provide short-term
pain relief for people with RA.
- Magnetic devices -- devices employing static magnetic fields may help
- Heat and cold applications -- some people find these applications
comforting; may reduce pain
Recent trials evaluating the use of homeopathy in the treatment of rheumatoid
arthritis found that the remedies were no more effective than placebo in
reducing symptoms. These studies contradict an older trial that showed
beneficial effects with homeopathic treatment. Despite the lack of definitive
evidence, professional homeopaths might recommend one of the following
treatments for RA based on their knowledge and clinical experience, as well as
successful trials for homeopathy to treat another type of arthritis, namely
osteoarthritis. Before prescribing a remedy, homeopaths take into account an
individual's constitutional type. In homeopathic terms, a person's constitution
is his or her physical, emotional, and intellectual makeup. An experienced
homeopath assesses all of these factors when determining the most appropriate
remedy for a particular individual.
Potential remedies include:
- A topical homeopathic gel containing comfrey (Symphytum officinale),
poison ivy (Rhus toxicodendron), and marsh-tea (Ledum palustre)
- A combination homeopathic preparation containing R. toxicodendron,
Arnica Montana (arnica), Solanum dulcamara (climbing nightshade), Sanguinarra
Canadensis (bloodroot), and Sulphur
- A liquid homeopathic preparation containing R. toxicodendron,
Causticum (potassium hydrate), and Lac vaccinum (cow's milk).
Chronic pain and disability can make daily functioning difficult. A holistic
approach to your care may positively affect both your lifestyle and how you feel
overall. Many people report that relaxation techniques, such as guided imagery
and meditation, are an important part of general care and help to alleviate pain
and other symptoms of RA.
This ancient Indian practice is well known for its physical, psychological,
emotional, and spiritual benefits and is often recommended in the West to
relieve musculoskeletal symptoms. In one small study, men and women with RA had
improved grip strength in their hands after practicing yoga for only 15 days.
Women in this study showed greater improvements than men. Certain yoga "asanas"
(postures) strengthen the quadriceps and emphasize stretching. People with
arthritis should begin asanas slowly and they should be performed only after a
warm up. Yoga is best performed under the careful guidance of a reputable
A recent trial comparing Ayurvedic herbal remedies with placebo found that
participants who consumed the Ayurvedic herbs experienced significant
improvement (with only mild side effects) compared to those in the placebo
group. An Ayurvedic combination containing the following herbs significantly
reduced pain and disability in people with RA:
- Winter cherry (Withania somnifera)
- Boswellia (Boswellia serrata)
- Turmeric (Curcuma longa)
Potential side effects from these herbs include nausea, dermatitis, and
|Traditional Chinese Medicine|
This gentle exercise program practiced in China for centuries has been shown
to produce a number of benefits, including the following:
- Improved fitness
- Increased muscular strength
- Enhanced flexibility
- Reduced percentage of body fat
- Diminished risk of falls in the elderly
In a trial of people ranging in age from 49 to 81 with another type of
arthritis, namely osteoarthritis, of the knee or hip, those who practiced tai
chi twice a week for 3 months showed significant improvement compared to those
in the control group in the following areas:
- Overall sense of quality of life
- Diminished feelings of stress/tension
- Increased satisfaction with general health
- Decreased fatigue
- Easier self management of arthritis symptoms
These benefits are likely to apply to individuals with RA as
Borage seed oil, and possibly other sources of gamma-linolenic acid (GLA),
should not be used during pregnancy because they may be harmful to the fetus and
induce early labor. Pregnant or breastfeeding women should also not take
|Warnings and Precautions|
Omega-6 fatty acid supplements should not be used if you have a seizure
disorder because there have been reports of these inducing seizures.
Stinging nettle may enhance the effect of NSAIDs. Although the combination of
stinging nettle and NSAIDs may be beneficial for the treatment of arthritic
conditions, a knowledgeable healthcare provider should be consulted before
adding this herb to an existing medication regimen.
|Prognosis and Complications|
RA is associated with the following joint-related
- Deformities -- these can result from cartilage destruction, bone
erosions, and tendon inflammation and tears; such deformities can interfere
considerably with even ordinary, daily tasks.
- RA involving the neck called the cervical spine) -- can be
life-threatening if these neck joints become unstable
RA is also associated with several complications that do not involve the
joints. These include:
- Rheumatoid nodules -- painless, hard, round or oval masses that appear
under the skin, usually on pressure points, such as the elbow or Achilles
tendon. Occasionally, they appear in the eye where they sometimes cause
inflammation. If they occur in the lungs, inflammation of the lining of the lung
(called pleuritis) may occur, causing shortness of breath.
- Anemia and other blood abnormalities - anemia
may occur due to failure of the bone marrow to produce enough new red cells to
make up for the lost ones. Iron supplements will not usually help this condition
because iron utilization in the body becomes impaired.
- Rheumatoid vasculitis (inflammation of the blood vessels) -- a
serious, sometimes life-threatening, complication. It can lead to open sores
(ulcers) on the skin that may become infected, bleeding stomach ulcers, and
neuropathies (nerve problems causing pain, numbness or tingling). Vasculitis may
also affect the brain, and heart causing strokes, heart attacks, or heart
- Other Heart complications - also caused by
inflammation Including inflammation of the outer lining of the heart (called
pericarditis) and possibly the heart muscle (called myocarditis). Both of these
conditions can lead to congestive heart failure characterized by shortness of
breath and fluid accumulation in the lung.
- Lung complications -- can be caused by the growth of fibrous tissue in
the lungs or by inflammation of the lining of the lung (pleuritis). Pulmonary
nodules, as described earlier, can also develop.
- Eye complications -- include inflammation of various parts of the eye.
The course of the disease varies between individuals. People with a certain
antibody in the blood (rheumatoid factor) and/or nodules (small swellings) under
the skin seem to have more severe disease. People who develop RA at younger ages
also tend to have faster disease progression.
Remission is most likely to occur in the first year and then likelihood
decreases over time. Ten to 15 years after the initial diagnosis, about 20% of
people will have had remission and most people will still be able to look after
Although complications may shorten the life expectancy of people with RA,
treatment is constantly improving and the occurrence of severe disability and
life-threatening complications appears to be
Al-Harbi MM, Islam MW, Al-Shabanah OA, Al-Gharably NM. Effect of acute
administration of fish oil (omega-3 marine triglyceride) on gastric ulceration
and secretion induced by various ulcerogenic and necrotizing agents in rats.
Food Chem Toxicol. 1995;33(7):555-558.
Ang-Lee M, Moss J, Yuan C. Herbal medicines and perioperative care.
Asseth J, Haugen M, et al. Rheumatoid arthritis and metal
compounds—perspectives on the role of oxygen radical
detoxification. Analyst. 1998;123:3-6.
Belch JJ, Hill A. Evening primrose oil and borage oil in rheumatologic
conditions. Am J Clin Nutr. 2000;71(1 Suppl):352S-356S.
Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for
rheumatologic conditions. Rheum Dis Clin N Amer. 2000;26(1):103-115.
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:121, 135, 150-151, 138, 226-227.
Chopra A. Ayurvedic Medicine and arthritis. Rheum Dis Clin North Am.
Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic
effectiveness of Herba Urticae dioica in acute arthritis: A pilot study.
Danao-Camara TC, Shintani TT. The dietary treatment of inflammatory
arthritis: case reports and review of the literature. Hawaii Med J.
Dash M, Telles S. Improvement in hand grip strength in normal volunteers and
rheumatoid arthritis patients following yoga training. Indian J Physiol
David J, Townsend R, Sathanathan R, Kriss S, Dore CJ. The effect of
acupuncture on patients with rheumatoid arthritis: a randomized,
placebo-controlled cross-over study. Rheumatology. 1999;38:864-869.
Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical
capsaicin: a double-blind trial. Clin Ther. 1991;13(3):383-395.
Elkayam O, Ophir J, Brener S, Paran D, Wigler I, Efron D, Even-Paz Z, Politi
Y, Yaron M. Immediate and delayed effects of treatment at the Dead Sea in
patients with psoriatic arthritis. Rheumatol Int. 2000;19(3):77-82.
el-Ghazaly M, Khayyal MT, Okpanyi SN, Arens-Corell M. Study of the
anti-inflammatory activity of Populus tremula, Solidago virgaurea and Fraxinus
excelsior. Arzneimittelforschung. 1992;42(3):333-336.
Ernst E. Complementary and alternative medicine in rheumatology.
Baillieres Clin Rheumatol. 2000;14(4):731-749.
Ernst E, Chrubasik S. Phyto-anti-inflammatories. A
systematic review of randomized, placebo-controlled, double-blind trials.
Rheum Dis Clin North Am. 2000;26(1):13-27.
Friso S, Jacques PF, Wilson PW, Rosenberg IH, Selhub J. Low circulating
vitamin B(6) is associated with elevation of the inflammation marker C-reactive
protein independently of plasma homocysteine levels. Circulation.
Garfinkel M, Schumacher HR, Jr. Yoga. Rheum Dis Clin North Am.
Garfinkel MS, Schumacher HR, Husain A, Levy, M, Reshetar RA. Evaluation of a
yoga based regimen for treatment of osteoarthritis of the hands. J
Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal
Medicines. Montvale, NJ: Medical Economics Co; 1998:810.
Guardia T, Rotelli AE, Juarez AO, Pelzer LE. Anti-inflammatory properties of
plant flavonoids. Effects of rutin, quercetin, and hesperidin on adjuvant
arthritis in rat. Farmaco. 2001;56(9):683-687.
Hafstrom I, Ringertz B, Spangberg A, et al. A vegan diet free of gluten
improves the signs and symptoms of rheumatoid arthritis: the effects on
arthritis correlate with a reduction in antibodies to food antigens.
Rheumatology (Oxford). 2001;40(10):1175-1179.
Halpern GM. Anti-inflammatory effects of a stabilized lipid extract of Perna
canaliculus (Lyprinol). Allerg Immunol (Paris). 2000;32(7):272-278.
Hanninen, Kaartinen K, Rauma AL, et al. Antioxidants in vegan diet and
rheumatic disorders. Toxicology. 2000;155(1-3):45-53.
Hines Burnham, et al, eds. Drug Facts and Comparisons. St. Louis, MO:
Facts and Comparisons; 2000:18.
Hutchinson D, Shepstone L, Moots R, Lear JT, Lynch MP. Heavy cigarette
smoking is strongly associated with rheumatoid arthritis (RA), particularly in
patients without a family history of RA. Ann Rheum Dis.
Kast RE. Borage oil reduction of rheumatoid arthritis activity may be
mediated by increased cAMP that suppresses tumor necrosis factor-alpha. Int
Kirsteins AE, Dietz F, Hwang SM. Evaluating the safety and potential use of a
weight-bearing exercise, Tai-Chi Chuan, for rheumatoid arthritis patients. Am
J Phys Med Rehabil. 1991;70(3):136-141.
Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the
knee with oral enzymes. A randomized, double-blind study versus diclofenec.
Clin Drug Invest. 2000;19(1):15-23.
Klein-Galczinsky C. [Pharmacological and clinical effectiveness of a fixed
phytogenic combination of trembling poplar (Populus tremula), true goldenrod
(Solidago virgaurea) and ash (Fraxinus excelsior) in mild to moderate rheumatic
complaints.] [in German]. Wien Med Wochenschr.
Kneckt P. Serum selenium, serum alpha-tocopherol, and the risk of rheumatoid
arthritis. Epidemiology. 2000;11(4):402-405.
Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin
Nutr. 2000;(suppl 1):349S-351S.
Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with
black currant seed oil. Br J Rheumatol. 1994;33(9):847-852.
Lineker SC, Bell MJ, Wilkins AL, Badley EM. Improvements following short term
home based physical therapy are maintained at one year in people with moderate
to severe rheumatoid arthritis. J Rheumatol. 2001;28(1):165-168.
Little C, Parsons T. Herbal therapy for treating rheumatoid arthritis.
Cochrane Database Syst Rev. 2001;(1):CD002948.
Man SC, Baragar FD. Preliminary clinical study of acupuncture in rheumatoid
arthritis. J Rheumatol. 1974;1:126.
Martin RH. The role of nutrition and diet in rheumatoid arthritis. Proc
Nutr Soc. 1998;57(2):231-234.
Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther.
Mazzetti I, Grigolo B, Borzai RM, Meliconi R, Facchini A. Serum copper/zinc
superoxide dismutase levels in patients with rheumatoid arthritis. J Clin Lab
McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very
low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern
Complement Med. 2002;8(1):71-75.
McKnight PT, Kwoh CK. Randomized, controlled trial of compression gloves in
rheumatoid arthritis. Arthritis Care Res. 1992;5(4):223-227.
Milanino R, Marrella M, Crivellente F, Benoni G, Cuzzolin L. Nutritional
supplementation with copper in the rat. Effects on adjuvant arthritis
development and on some in vivo- and ex vivo-markers of blood neutrophils.
Inflamm Res. 2000;49(5):214-223.
Mulherrin DM, Thurnham DI, Situnayake RD. Glutathione reductase activity,
riboflavin status, and disease activity in rheumatoid arthritis. Ann Rheum
Mur E, Hartig F, Eibl G, Schirmer M. Randomized double blind trial of an
extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the
treatment of rheumatoid arthritis. J Rheumatol. 2002;29(4):678-681.
Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a
double-blind, placebo controlled study. Ann Rheum Dis.
Pasquier C, Mach PS, Raichvarg D, Sarfati G, Amor B, Delbarre F.
Manganese-containing superoxide-dismutase deficiency in polymorphonuclear
leukocytes of adults with rheumatoid arthritis. Inflammation.
Randall C, Meethan K, Randall H, Dobbs F. Nettle sting of Urtica dioica for
joint pain - an exploratory study of this complementary
therapy. Complement Ther Med. 1999;7(3):126-131.
Riehemann K, Behnke B, Schulze-Osthoff K. Plant extracts from stinging nettle
(Urtica dioica), an antirheumatic remedy, inhibit the proinflammatory
transcription factor NF-kappaB. FEBS Lett 1999;442(1):89-94.
Rosenstein ED. Topical agents in the treatment of rheumatic disorders.
Rheum Dis Clin N Am. 1999;25(4):899-918.
Rothman D, DeLuca P, Zurier RB. Botanical lipids: effects on inflammation,
immune responses, and rheumatoid arthritis. Semin Arthritis Rheum.
Segal NA, Toda Y, Huston J, et al. Two configurations of static magnetic
fields for treating rheumatoid arthritis of the knee: a double-blind clinical
trial. Arch Phys Med Rehabil. 2001;82(10):1453-1460.
Simopoulos AP. Essential fatty acids in health and chronic disease. Am J
Clin Nutr. 1999;70(3 suppl):560S-569S.
Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and
musculoskeletal disorders. Medical Hypotheses. 1992;39:343-348.
Struthers GR, Scott DL, Scott DG. The use of 'alternative treatments' by
patients with rheumatoid arthritis. Rheumatol Int. 1983;3(4):151-152.
Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman S, Horowitz
J. Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea
area. Ann Rheum Dis. 1990;49(2):99-102.
Sukenik S, Neumann L, Flusser D, Kleiner-Baumgarten A, Buskila D.
Balneotherapy for rheumatoid arthritis at the Dead Sea. Isr J Med Sci.
von Kruedener S, Schneider W, Elstner EF. A combination of Populus tremula,
Solidago virgaurea and Fraxinus excelsior as an anti-inflammatory and
antirheumatic drug. A short review. Arzneimittelforschung.
West Sk, Oosthuizen JM. Melatonin levels are decreased in rheumatoid
arthritis. J Basic Clin Physiol Pharmacol. 1992;3(1):33-40.
Willer B, Stucki G, Hoppeler H, Bruhlmann P, Krahenbuhl S. Effects of
creatine supplementation on muscle weakness in patients with rheumatoid
arthritis. Rheumatology. 2000;39(3):293-298.
Zurier RB, Rossetti RG, Jacobson EW, et al. Gamma-linolenic acid treatment of
rheumatoid arthritis: a randomized, placebo-controlled trial. Arthritis
|Review Date: December 2002|
|Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Gary Guebert, DC, DACBR, (Chiropractic section October 2001)
Login Chiropractic College, Maryland Heights, MO; Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and
Senior Medical Editor A.D.A.M., Inc.; Joseph Trainor, DC, (Chiropractic section
October 2001) Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD,
LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center,
New York, NY; David Winston, Herbalist, Herbalist and Alchemist, Inc.,
Washington, NJ; Leonard Wisneski, MD, FACP, George Washington University,
Rockville, MD; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001)
President and Chairman, Hawaii State Consortium for Integrative Medicine,
Copyright © 2004 A.D.A.M., Inc
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