JOURNAL 13: Rheumatoid Arthritis
This is the first blog in a series on autoimmune and inflammatory diseases. The goal is to look at symptoms, highlight causes and discuss common approaches to treatment as well as how naturopathic care can support patients to alleviate symptoms and improve their quality of life.
Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis. It is an autoimmune disease, which means the body has lost the ability to recognise its own cells as ‘self’. With RA, immune cells produce autoantibodies that attack the synovium in the joints. The inflammation that results from this thickens the synovium, which goes on to destroy the cartilage and the bone within the joint.
Whatever the trigger is, both the innate and adaptive immune systems respond quickly and brutally, resulting in inflammation, cartilage degradation, bone resorption and pain.
Key symptoms
The most common symptoms of RA are painful, swollen and deformed joints. It can affect any joint in the body with a synovial membrane, but it typically affects the hands and feet. However, I am seeing patients with significant shoulder and hip pain at the moment, with little involvement with hands and feet, so every person will present differently.
Autoimmune and inflammatory processes in RA can also impact on organs including the skin, heart, lungs and eyes. It is important to report any unusual and new symptoms including skin rashes, dry mouth, mouth ulcers and vision changes including dry eyes and change of colour to sclera (white of the eye). The latter is particularly important if you are taking medications such as hydroxychloroquine and methotrexate.
Causes
There is definitely a genetic component to the development of RA, with approximately 60 per cent of cases thought to be genetically driven. Genetic susceptibility can be assessed through DNA testing of HLA-DQ genes through your doctor, specialist or a practitioner qualified in nutrigenomics and naturopathy such as myself. However, it is important to understand that having the genetic predisposition does not always equal disease development. Environmental triggers including diet, lifestyle, psychological, hormonal and immune factors are equally important to consider.
Important note: all autoimmune diseases have a common driver – a loss of the gut-immune interface; therefore, restoring this is a key component of treatment.
Risk factors
A family history is the number one risk factor due to the likely genetic component, but there are other contributing factors including hormones. For example, women are affected significantly more than men, and onset often occurs at times of significant hormonal change such as post-birth and menopause. Furthermore, symptoms can disappear during pregnancy (this is common for all autoimmune diseases), likely due to the body’s protective mechanisms against for the foetus – the immune response is quietened. Fascinating stuff hey?!
Other risk factors include smoking, vitamin D deficiency, dysbiosis (imbalance in gut bacteria), infection (including glandular fever or Epstein-Barr virus) and exposure to silica dust.
Like all other autoimmune diseases, the further you live from the equator, the higher your risk of developing RA.
Diagnosis
Stiffness, swelling, deformation of joints and pain are the most significant physical symptoms. There can also be skin changes.
Most patients will test positive to rheumatoid factor (RF) and have other abnormalities in immune cells and high inflammatory markers.
Conventional medical treatment
Treatment for RA typically includes strong medications to suppress the immune system and inflammatory processes that can have significant side effects for many patients. The most commonly used are:
Methotrexate – This is a chemotherapeutic drug and immune suppressant that also impacts on cell division (hence its use in cancer). One of its key actions is to reduce folate metabolism, thereby affecting a detoxification process called methylation, that is essential for your health and wellbeing. Folic acid is often co-prescribed for this reason but can often create more inflammation in those with genetic variants including MTHFR.
Hydroxychloroquine – This is an anti-malarial drug that has gained a lot of notoriety lately due to its potential role in the treatment of COVID. Its mechanism of action in RA is not well understood but it is believed to exert an action on the immune system, thereby reducing inflammation.
Humira – This is given as an injection and works by binding to and neutralising TNF-alpha, an inflammatory molecule, and suppressing the immune system.
All immune suppressants carry a greater risk of developing serious infections and even cancer, so working with a naturopath who can safely co-prescribe is essential.
Naturopathic treatment
Where possible, seeing a naturopath who specialises in autoimmune and inflammatory diseases before medication is prescribed is the best thing you can do. Even if you are taking medication, there is a lot we can do to support you and your immune system, reduce side effects and give you a much better quality of life.
Naturopathic treatment focuses on diet and lifestyle interventions, alongside nutrients and herbs that are scientifically proven to exert an anti-inflammatory action and modulate (or balance) the immune system, as opposed to suppressing it. As I say to my patients, we want to stop your immune and inflammatory cells from yelling and throwing things at each other in an attempt to put out the perceived ‘fire’ and get them talking calmly and gently instead.
Next steps
If you or someone you love has RA and needs support to better manage your condition, we would love to work with you. Our practitioners are qualified and experienced professionals, and we can recommend one of our team who specialises in autoimmune and inflammatory diseases. Book a free Discovery Call today to find out how we can help you. Alternatively, if you are ready to take action, make a booking today!
Written by Denise Berry BHSc
Naturopath
