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Rheumatoid Arthritis

By Pamela Williams, MPH, R.D.

Photo: iStockphoto

Every morning, many of us jump out of bed and never think about how we are going to cross the floor or button a shirt. We just do it. However, there is an estimated 1.3 million rheumatoid arthritis (RA) sufferers in the United States who are challenged to take on what we do with ease.

What is RA?

Our joints are usually made up of two bones that meet and are held together with tendons, cartilage and muscle. Within the joint area is a special tissue called synovium. This tissue produces a lubricant called synovial fluid and it helps to keep our joints moving.

In this disease, certain white blood cells from the immune system attack us. These cells induce swelling in the joint. The swelling causes the synovium to become thick and it damages and/or destroys the cartilage and bones. This is why sufferers experience warmth and redness in the area, weakness and pain. Fingers and wrists are commonly affected. Other symptoms include anemia, neck pain, dry eyes, and in rare cases, inflamed blood vessels, lining of the lungs and/or the sac that holds the heart.

What causes RA?

Researchers are not too clear on the exact causes but there may be several areas to consider.¹

Genes. Researchers have identified several genes that are associated with RA. However, there are some people who have one or more of these genes but they never get the disease. On the other hand, there are other people who do not have these genes and they get the disease. More research needs to be done to help determine the role genes play in RA.

Environment. Researchers believe there are factors within our environment that increases our risk of the disease but they are not clear on the culprit. They suspect that a virus and/or bacteria infection might play a role. The exact agent has yet to be identified.

Other Causes. More women are diagnosed with RA than men and researchers suspect that hormones might play a role. For example, RA may flare up after pregnancy or during breastfeeding. In addition to hormones, other substances involved in swelling, may also play a role.

RA Diagnosis and Treatment

Diagnosis of RA is somewhat difficult because there is no one test that doctors routinely use and symptoms can differ from person to person. However, if there is suspect of RA, check with the doctor to help diagnose the problem. Most likely, he or she will perform a medical examination that will include blood tests. These tests may look for an antibody called rheumatoid factor, and/or check the white blood cell count. Other tests may check for anemia and/or measure the C-reactive protein – this helps to determine the disease process in the body.

Once diagnosis has been established, one or more treatments may be recommended.

Medication is one way to help prevent early damage, minimize or eliminate pain and prevent or reduce inflammation. For example, analgesics help relieve pain, corticosteroids and nonsteroidal drugs help reduce inflammation, and disease-modifying antirheumatic drugs help to slow the disease process. Other drugs help to block certain white blood cells that cause inflammation while others block body compounds that play a role in producing these white blood cells. Doctors can help make the choice on whether or not to use medications such as these.¹

Lifestyle changes may also help ease symptoms and progression of the disease. If overweight, losing weight can help reduce the stress on the joints. It can also reduce body fat, which also reduces the production of inflammatory compounds. Moderate exercise helps with weight and overall health maintenance. Reducing stress has also been shown to reduce the symptoms associated with RA.

Changes in the diet may help reduce symptoms and progression of the disease. Recently, researchers reviewed 15 studies involving 837 subjects and various diets. They reported that these studies might have some bias but subjects reported reduced symptoms in one vegetarian study and one Mediterranean study.²

Another article in Arthritis Today reported that in a test tube study, researchers found a higher count of antibodies in RA subjects who consumed cow’s milk, pork, codfish, cereal, hen’s eggs and pork than in non-RA subjects. Researchers suggest the best way to determine whether or not a food increases antibody production is to go back to basics. Consume a plant-based diet that includes whole foods for a month and gradually add other foods to determine which one causes the symptoms.³

Several foods have been studied and show promise of symptom reduction.

• Omega-3 fatty acids have been studied for their role in helping to produce compounds in the body that reduce inflammation. Consuming about 3 grams of omega-3 fatty acids for more than 12 weeks showed a reduction in inflammation. Eating fatty fish such as tuna or salmon are rich in omega-3 fatty acids. Other foods such as flaxseed and walnuts contain a different form of omega-3 fatty acids called alpha linolenic acid that may also be helpful.

• Some omega-6 fatty acids may play a role in increasing inflammation. Increasing the omega-3 fatty acid intake and reducing the omega-6 fatty acid intake could help reduce inflammation. Reducing vegetable oil consumption, baked goods and poultry can help lower omega-6 intake.^{4, 5}

• Gamma linolenic acid (GLA), another type of oil, may also help reduce inflammation. Evening primrose, borage and black currant oils contain GLA. The research shows benefits from GLA but the results are preliminary.

• Sweet Bing cherries provides several plant chemicals that may help reduce inflammation in some people. In one study, 18 healthy adults ate cherries for 28 days. Researchers reported that C-reactive protein and nitric oxide, two marker compounds for inflammation activity, were significantly reduced^.6

• Nightshade vegetables – potatoes, tomatoes, eggplant and peppers contain a compound called solanine. This compound is thought to increase inflammation and some people report that alleviating these foods from the diet reduces pain. However, research to support this is lacking.

• Herbal supplements are also used to find relief from symptoms but the research is lacking to support many of the herbs used. Some herbs are promising and early research shows that there may be some benefit. Turmeric contains curcumin and may protect joints from inflammation and damage. Boswelia contains a resin that prevented inflammation activity in animal research. Human studies are still needed to confirm this action. Ginger contains anti-inflammatory compounds and may be shown to be beneficial.⁷

This article is only an introduction to the information available on this subject. There are other options beyond the scope of this article that could be considered for treatment. Several organizations provide additional information for RA sufferers. If more information is needed, please stop by and visit the following web sites:

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Web site: www.niams.nih.gov
Toll-free in the U.S.: 1-877-22-NIAMS

Arthritis Foundation
Web site: www.arthritis.org

The John Hopkins Arthritis Center
http://www.hopkins-arthritis.org

1. Handout on Health: Rheumatoid Arthritis. 2009. http://www.niams.nih.gov/Health_info/Rheumatic_Disease/default.asp Accessed 3/18/2010.

2. Hagen KB, Byfuglien MG, Falzon L, et al. Dietary interventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006400.

3. Mann DL. Rheumatoid Arthritis Diet: RA and Food Allergies. Arthritis Today. http://www.arthritistoday.org/conditions/rheumatoid-arthritis/healthy-living/ra-food-allergies-2.php Accessed 4/3/10

4. Calder PC. n–3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases1,2,3. 2006. Am J Clin Nutr. Vol. 83, No. 6, S1505-1519S.

5. Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000;(suppl 1):349S-351S.

6. Kelley DS, Rasooly R, Jacob RA, et al. Consumption of Bing sweet cherries lowers circulation concentrations of inflammation markers in healthy men and women. J Nutr. 2008;136:981-986.

7. Rheumatoid Arthritis and CAM. NCCAM, National Institutes of Health, U.S. Department of Health and Human Services. 2009.
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Pamela A. Williams, MPH, R.D., is a dietitian and writes from Cypress, CA. All rights reserved © 2010 AnswersForMe.org. Click here for content usage information.