Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory condition that affects the entire body but especially the synovial membranes of the joints. It is a classic example of an “autoimmune disease,” a condition in which the body’s immune system attacks the body’s own tissue. Although rheumatoid arthritis is a systemic disease, it affects primarily the joints. The joints typically affected by rheumatoid arthritis are the hands and feet, wrists, ankles, and knees. Involved joints will characteristically be quite warm, tender, and swollen. The skin over the joint will take on a ruddy purplish hue. As the disease progresses, joint deformities result in the hands and feet. Somewhere between 1% and 3% of the population is affected; female patients outnumber males almost 3:1; and the usual onset is 20 to 40 years, although rheumatoid arthritis may begin at any age. Symptoms may include: fatigue, low grade fever, weakness, joint stiffness, and vague joint pain may proceed the appearance of painful, swollen joints by several weeks. Severe joint pain with much inflammation that begins in small joints, may progressively affects all joints in the body. X-ray findings usually show soft tissue swelling, erosion of cartilage, and joint space narrowing and the presence of rheumatoid factor may be found in the serum. Systemic manifestations are common, including: inflammation of the blood vessels (vasculitis), muscle wasting, skin nodules, inflammation of the heart and lungs, enlargement of the spleen, anemia, and depressed white blood cell counts. The onset of rheumatoid arthritis is usually gradual, but occasionally it is quite abrupt. Several joints are usually involved in the onset, typically in a symmetrical fashion, i.e., both hands, wrists, or ankles. In about one-third

of persons with rheumatoid arthritis, initial involvement is confined to one or a few joints. Most persons with rheumatoid arthritis feel fatigued as a result of the anemia that usually accompanies the disease. Other common findings include carpal tunnel syndrome (tingling and pain in the fingers caused by pressure on the nerve as it enters the hand through the wrist), and Raynaud’s phenomenon (a condition where the blood flow through the fingers is severely reduced when they are exposed to cold). In some cases, soft nodules develop beneath the skin over bony surfaces. There is abundant evidence that rheumatoid arthritis is an “autoimmune” reaction, where antibodies develop against components of joint tissues. Yet what triggers this autoimmune reaction remains largely unknown. Speculation and investigation has centered around genetic susceptibility, abnormal bowel permeability, and microorganisms, as well as dietary factors. In short, rheumatoid arthritis is a classic example of a multifactorial disease where there is an interesting assortment of genetic and environmental factors which contribute to the disease process. A specific genetic marker (histocompatibility antigen HLA-DRw4) is found in 70% of patients with rheumatoid arthritis compared to 28% in the general population. This strongly implies that the likelihood of developing rheumatoid arthritis is influenced by genetic factors which govern immune response. Severe rheumatoid arthritis is also found at four times the average rate in children of parents with rheumatoid arthritis. As strong as these genetic associations are, environmental factors are necessary for the development of the disease. This is perhaps most evident in studies with identical twins. These studies show that it is quite rare for both twins to develop rheumatoid arthritis. An interesting association between rheumatoid arthritis and abnormal bowel function exists that may provide a unified theory as to the cause of rheumatoid arthritis. What is currently known is that individuals with rheumatoid arthritis have increased intestinal permeability. This means that their intestines are too “leaky.” Food sensitivities are thought to contribute greatly to the increased permeability of the gut in rheumatoid arthritis. The release of histamine and other allergic compounds after eating an allergic food greatly increases the “leakiness” of the gut. The result of a leaky gut is an increased absorption of large dietary and bacterial molecules. Normally these molecules are prevented from being absorbed because they are too large. In rheumatoid arthritis, however, they are absorbed into the body. The body’s response to these molecules is to form antibodies to bind them. Antibodies are released by our white blood cells to bind to foreign molecules such as those found on bacteria, viruses, and cancer cells, resulting in the formation of an immune complex.

In the case of rheumatoid arthritis, food and bacterial molecules are acting as antigens that are being bound by the antibodies. The resulting immune complex then triggers the immune system to release compounds to destroy it. These compounds work great when antibodies bind to bacteria and viruses, but when immune complexes are deposited in joint tissues these compounds actually destroy not only the immune complex, but also surrounding joint tissue. Another way in which the body may develop antibodies to its own tissue is by developing “cross-reacting” Antibodies. The increased gut permeability and altered bacterial flora result in the absorption of antigens that are very similar to antigens in joint tissues. Antibodies formed to these antigens would “cross-react” with the antigens in the joint tissues. Increasing evidence appears to support this concept as well. Clinically, physicians use the presence of immune complexes to monitor the patient as the serum and joint fluid of nearly all individuals with rheumatoid arthritis contain the “rheumatoid factor” (RF). The rheumatoid factor represents the formation of multiple immune complexes. Most of the rheumatoid factor is formed locally in the affected joints by white blood cells. The level of rheumatoid factor can be measured in the blood and usually correlates with the severity of arthritis symptoms. That is, when rheumatoid factor levels are high, severity is high, and when rheumatoid factor levels are low, severity is low.

Naturopathic Approach

A naturopathic approach to treating someone with RA would be very similar to the treatment for anyone with an autoimmune condition. I focus on the immune system, which since 60%-70% of the immune system resides in the gut, that is typically where I’ll start. Stool analysis looking for good bacteria, bad bacteria, yeast overgrowth, parasites may be ordered as there are specific organisms that have been linked to RA. Lyme disease would need to be ruled out. A food sensitivity panel may be ordered and these results along with the stool analysis results would directly dictate the treatment plan. Clinical nutrition and botanical medicine may be prescribed to help manage the inflammation and put health back into the joints to minimize destruction as the underlying cause is treated.