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Rheumatoid arthritis

What is it?

Rheumatoid (ROO-muh-toid) arthritis (arth-RI-tis) is also called "RA." Your body has a special system set up to help you attack and fight off illness. It is called your immune system. When you have RA, the system attacks your own body tissues. This causes pain, swelling, and stiffness of your joints. Later, joints may become a different shape (joint deformity) and you may lose movement. Joints are the places in your body where two bones meet. RA usually affects the joints of your hands, wrists, knees, ankles, and feet.

Causes:

No one knows for sure what causes RA. Scientists have found that it may be caused by an infection (in- FECK-shun) in some people. If someone in your family has RA, you may be more likely to have it.

Signs and Symptoms:

Signs and symptoms of RA may be different for everyone. You may have signs and symptoms for a time and then they will get better. This is called "remission." After a remission, the signs and symptoms may start up again. RA is a life-long disease. At first, you may feel very tired, lose your appetite, and feel weak and achy. You may feel this way for weeks or months before the following signs and symptoms are seen. They may be first seen and felt in your hands, wrists, knees, ankles, and feet.

  • Joint pain and inflammation (swelling).
  • Joint redness and warmth.
  • Joint stiffness, especially in the morning and after long periods of sitting. Stiffness will last over 1/2 hour.

With time, RA may damage your body tissue and cause bone to wear away. When this happens, you may have the following signs and symptoms:

  • Bone fractures.
  • Difficulty breathing.
  • Firm, round growths on or around your joints. You may lose movement in your joints, making it hard to do activities that you used to do.
  • Joint deformity. You may first see this in your hands ("swan neck deformity"). Your fingers may become bent or crooked and you will have trouble straightening them.
  • Loss of feeling, tingling, and burning in your feet.
  • Muscle wasting (decrease in size and strength).
  • Skin, hair, and nails may become thin and dry.

Wellness Recommendations:

Daily exercise, decreasing stress, and not smoking may help RA.

Medical Care:

Caregivers will ask you many questions and then examine you. X-rays, blood tests, and screening tests for osteoporosis may also be done. Ibuprofen and aspirin may be used to treat your symptoms but these medicines do not prevent RA from getting worse. A group of medicines called disease modifying antirheumatic drugs (DMARDs) changes RA and keeps it from worsening. Sometimes DMARDs are used soon after caregivers learn that you have RA. Prednisone is another medicine that may be used to treat RA. It is one of the oldest DMARDs. But it has side effects that include weight gain, high blood pressure, and others. Surgery may be needed to remove or replace joints.

HOW TO TREAT YOUR SYMPTOMS:

If you have aggressive rheumatoid arthritis that is causing joint destruction, these strategies can be used in addition to the DMARDs, not in place of them. Using these strategies in either mild or aggressive cases of rheumatoid arthritis may reduce the need for more aggressive interventions and the associated risks.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Ashwagandha (Withania somnifera) may be helpful for RA and has been studied in people.
  • Borage (Borago officinalis) oil is helpful for RA and has been studied in people.
  • Boswellia (Boswellia serrata) has been used for many years, but has not been studied in people who have RA.
  • Capsaicin creams (Capsicum frutescens) from the cayenne pepper, applied to the skin over the affected area, can help pain. Initial applications are irritating but after the first couple of weeks, the irritation goes away. The hands should be washed after application of the cream unless the hands are the treated areas, in which case, they should be washed 30 minutes after application.
  • Evening primrose (Oenothera biennis) oil may be helpful for RA and has been studied in people.
  • Ginger (Zingiber officinale) has been used for many years, but has not been studied in people who have RA.
  • Nettle (Urtica dioica) may be helpful for RA and has been studied in people.
  • Turmeric (Curcuma longa) has been used for many years, but has not been studied in people who have RA. You can also use turmeric liberally as a spice in your diet.
  • Yucca (Yucca spp) may be helpful for RA and has been studied in people.

Supplements:

  • Copper has been used, but has not been studied in people who have RA.
  • Chondroitin sulfate has been used, but has not been studied in people who have RA.
  • DMSO (dimethylsulfoxide) may be helpful, and has been studied in people who have RA.
  • D-Phenylalanine has been used, but has not been studied in people who have RA.
  • Fish oil (EPA and DHA) may be helpful for RA and has been studied in people.
  • GLA (gamma linolenic acid) is helpful for RA and has been studied in people.
  • Glucosamine sulfate has been used, but has not been studied in people who have RA.
  • MSM (methylsulfonylmethane) has been used, but has not been studied in people who have RA.
  • SAMe (S-Adenosylmethionine) has been used, but has not been studied in people who have RA.
  • Vitamin B3 (niacin, niacinamide) has been used, but has not been studied in people.
  • Vitamin B5 (pantothenic acid) may be helpful for RA and has been studied in people.
  • Vitamin E may be helpful for RA and has been studied in people.

Complementary Therapies:

  • Relaxation therapy helps RA.
  • Traditional Chinese medicine (TCM), which includes acupuncture and herbs, may help RA.
  • Massage therapy may help RA.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat rheumatoid arthritis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

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2. Berman BM, Singh BB, Lao L et al: A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology (Oxford) 1999; 38(4):346-354.

3. Bingham R, Bellew BA & Bellew JG: Yucca plant saponin in the management of arthritis. J Appl Nutr 1975; 45-51.

4. Bruusgaard A & Andersen RB: Chenodeoxycholic-acid treatment of rheumatoid arthritis. Lancet 1976; 1:700.

5. Edmonds SE, Winyard PG, Guo R et al: Putative analgesic activity of repeated oral doses of vitamin E in the treatment of rheumatoid arthritis: results of a prospective placebo controlled double blind trial. Ann Rheum Dis 1997; 56(11):649-655.

6. Field T, Hernandez-Reif M, Seligman S et al: Juvenile rheumatoid arthritis: benefits from massage therapy. J Pediatr Psychol 1997; 22(5):607-617.

7. Guan Z & Zhang J: Effects of acupuncture on immunoglobulins in patients with asthma and rheumatoid arthritis. J Tradit Chin Med 1995; 15(2):102-105.|

8. Haugen MA, Kjeldsen-Kragh J, Skakkebaek N et al: The influence of fast and vegetarian diet on parameters of nutritional status in patients with rheumatoid arthritis. Clin Rheumatol 1993; 12(1):62-69.

9. Jonas WB, Rapoza CP & Blair WF: The effect of niacinamide on osteoarthritis: a pilot study. Inflamm Res 1996; 45(7):330-334.

10. Leeb BF, Schweitzer H, Montag K et al: A meta analysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol 2000; 27(1):205-211.

11. Lundgren S & Stenstrom CH: Muscle relaxation training and quality of life in rheumatoid arthritis. A randomized controlled clinical trial. Scand J Rheumatol 1999; 28(1):47-53.

12. Marks R & de Palma F: Clinical efficacy of low power laser therapy in osteoarthritis. Physiother Res Int 1999; 4(2):141-157.

13. McAlindon TE, LaValley MP, Gulin JP et al: Glucosamine and chondroitin for treatment of osteoarthritis. A systematic quality assessment and meta-analysis. JAMA 2000; 283(11):1469-1475.

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15. McMeeken J, Stillman B, Story I et al: The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis. Physiother Res Int 1999; 4(1):55-67.

16. Newnham R: Essentiality of boron for healthy bones and joints. Environ Health Perspect 1994; 102(7):83-85.

17. Ovesen L: Vitamin therapy in the absence of obvious deficiency: what is the evidence? Drugs 1984; 27(2):148-170.

18. Ramm S & Hansen C: Stinging nettle leaf extract for arthritis and rheumatic arthritis. Therapiewoche 1996; 28:3-6.

19. Smyth JM, Stone AA, Hurewitz A et al: Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA 1999; 281(14):1304-1309.

20. Taylor MR: Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983; 8:28-38. (review).

21. Trock DH, Bollet AJ, Dyer RH Jr et al: A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. J Rheumatol 1993; 20(3):456-460.

22. van Baar ME, Assendelft WJ, Dekker J et al: Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum 1999; 42(7):1361-1369.

23. Volker D, Fitzgerald P, Major G et al: Efficacy of fish oil concentrate in the treatment of rheumatoid arthritis. J Rheumatol 2000; 27:2343-2346.

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25. Zurier RB, Rossetti RG, Jacobson EW et al: Gamma-linolenic acid treatment of rheumatoid arthritis: a randomized, placebo-controlled trial. Arthritis Rheum 1996; 39(11):1808-1817.


Last Updated: 7/4/2017
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