Recalling the day on which she was diagnosed with rheumatoid arthritis (RA), author Mary Felstiner writes in her recent memoir, Out of Joint (University of Nebraska Press, 2005): “Hours before morning I wake feeling my wrists starched . . . and scorched. What is this?” That afternoon, the 28-year-old new mother learns this is RA, a chronic inflammatory condition in which the immune system attacks the tissues lining the joints. Her brain struggles to grasp her doctor’s words: “joints stiffen . . . inflamed membranes thicken . . . erode cartilage.”
In RA, joints in the hands and feet are typically affected, causing pain, swelling, redness, and heat. But the disease can also involve the shoulders, elbows, hips, and knees. Women with RA outnumber men by more than three to one, and it often strikes several decades earlier than osteoarthritis. I asked rheumatologist Dan Muller, MD, PhD, of the University of Wisconsin Medical School in Madison to explain what’s new in integrative treatment approaches for RA. One point he likes to emphasize with his patients is that there’s a lot you can do for yourself to treat this autoimmune disorder.
Although an “all-natural” approach to RA is possible, it’s more likely to work in the most mild cases. Medications clearly have a place in RA treatment both for comfort and to control flares. I’m encouraged to hear from Dr. Muller that the medications for RA have never been better; in fact, they have revolutionized treatment. These drugs can slow the disease process, leading to fewer joints affected by inflammation and less long-term damage to them.
In “mild” cases of RA, Dr. Muller might prescribe hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), or minocycline (Minocin). People with moderate or severe cases of the disease might need one of three drugs in a class known as TNF inhibitors—including etanercept (Enbrel), infliximab (Remicade), or adalimumab (Humira) in combination with methotrexate (Rheumatrex) or its alternative, leflunomide (Arava). The good news, says Dr. Muller, is that through combination therapy with these new medications, some 30 percent of people with RA can achieve a complete remission (previously, the chance for remission was only about 10 percent). The bad news is that this leaves 70 percent of people out of that category. Yet, a substantial number of those still greatly benefit from taking the drugs.
2. Diet and lifestyle.
I suggest following an anti-inflammatory diet. This eating plan emphasizes more fresh fruits and vegetables, whole grains, and foods rich in omega-3 fats such as salmon, walnuts, and ground flax. But it cuts back on animal protein (except fish), saturated and trans fats, plus foods made from refined flour and sugar. While eating this way has not been studied for RA, it closely resembles a Mediterranean-style diet, which some research suggests may have protective effects on the development and severity of RA. In addition, I think it’s worth experimenting with eliminating milk and other dairy products, wheat, or corn for at least two months to see how your symptoms respond, since food sensitivities may play a role in some cases of RA. I’d also advise using olive oil as your main fat and seasoning foods more with ginger and turmeric, three ingredients with natural anti-inflammatory compounds.
Contrary to previous research, consuming more than four cups of coffee a day does not appear to increase your chances of developing RA (Arthritis & Rheumatism, November 2003). However, this study reached the same conclusion as others had about tobacco: Smokers were more likely to develop RA than nonsmokers.
3. Mind-body approaches.
I like to recommend mind-body approaches such as meditation, guided imagery, or hypnotherapy for RA. Although these practices need to be better studied, one analysis of clinical trials noted they led to significant improvements in RA pain, disability, mental well-being, and coping skills. Another study found journaling improved health status in people with RA who wrote about a stressful experience for 20 minutes on three consecutive days. In a journal, you can keep a record of your emotions, experiences, and symptoms. And we’re awaiting results from one small study that ended last year and explored the usefulness of a mindfulness-based meditation program for RA symptoms. To purchase a guided imagery recording for people with RA, visit healthjourneys.com.
4. Physical activity.
Studies have found that physical activity can help keep muscles around the joints strong, restoring movement in them and possibly improving pain control. Regular exercise also helps patients with RA feel stronger physically and mentally. Dr. Muller advises doing some aerobic activity, stretching, and strength training using light weights and frequent repetitions. Water exercise is a good option for stiff joints, as is yoga or tai chi, which have the added benefit of a mind-body component.
There’s some evidence that fish oils, which are rich in omega-3 fats and have anti-inflammatory effects, help reduce joint tenderness, morning stiffness, and the use of over-the-counter pain relievers. Dr. Muller recommends a daily dose of 3 to 6 grams. In addition to the culinary use of ginger and turmeric, you can also supplement with 1 gram of powdered ginger or curcumin (an active component in turmeric), two or three times a day. I also suggest a daily antioxidant regimen, which includes vitamins C and E, mixed carotenoids, and selenium, or taking a good multivitamin; and get at least 1,000 IU of vitamin D every day, which may help regulate immunity.
6. Alternative therapies.
Dr. Muller says he’s excited about some promising evidence for low-level laser therapy. A review study suggests this treatment, which uses a light source and is given several times a week, can relieve pain and morning stiffness in the hands on a short-term basis.