Rheumatoid Arthritis

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Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic inflammatory condition of the joints believed to be caused by autoimmunity (wherein the immune system attacks the body itself). Dietary changes that may be helpful: Fat can trigger autoimmune reactions.1 People with RA may eat more fat, particularly animal fat.2 Extremely low-fat diets have been reported to help people with RA,3 and very low-fat, pure vegetarian diets have also proved helpful.4 5 In one trial, fourteen weeks of a gluten-free (no wheat, rye, or barley) pure vegetarian diet, gradually changed to a lactovegetarian diet (permitting dairy), led to significant improvement in symptoms and objective laboratory measures of disease.6 In the 1950s through the 1970s, Max Warmbrand, a naturopathic doctor, used a very low-fat diet for those with both rheumatoid arthritis and osteoarthritis. He recommended a diet free of meat, dairy, chemicals, sugar, eggs, and processed foods.7 Dr. Warmbrand claimed that his diet took at least six months to achieve noticeable results; a short-term (ten weeks) study with a similar approach failed.8 Solanine is a substance found in so-called nightshade plants: tomatoes, white potatoes, all peppers except black pepper, and eggplant. If not destroyed in the intestine, solanine can be toxic. A survey of people eliminating nightshade plants from their diets revealed that 28% had a marked positive response and another 44% had a positive response.9 Results often take six months, the elimination of tomatoes and peppers can be very difficult, and many people are simply not helped. Therefore, this diet is often reserved for severe cases of arthritis which do not respond to other natural treatments. Rheumatoid arthritis may be linked to food allergies and sensitivities.10 In many people, RA is made worse when they eat foods to which they are allergic or sensitive, and made better by avoiding these foods.11 12 13 14 English researchers suggest that one-third of people with RA can control the disease completely through allergy elimination.15 Finding and eliminating foods which trigger symptoms should be done with the help of a nutritionally oriented physician. Lifestyle changes that may be helpful: Although exercise may increase pain

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initially, gentle exercises help people with RA.16 17 Many doctors recommend swimming, stretching, or walking. Nutritional supplements that may be helpful: Rheumatoid arthritis causes inflamed joints, which in turn depletes the joints of vitamin E.18 A doubleblind report (using approximately 800 IU of vitamin E per day) found that vitamin E may relieve many symptoms of rheumatoid arthritis.19 Research suggests that people with RA may be partially deficient in pantothenic acid or vitamin B5.20 Those with RA have less morning stiffness, disability, and pain when they take 2,000 mg of pantothenic acid per day.21 Many nutritionally oriented doctors suggest vitamin B5 (sometimes in lower amounts such as 1,000 mg) to people with RA. Zinc metabolism is altered in RA. Some studies have found zinc helpful,22 although most have not.23 24 It has been suggested that zinc might help only those who are deficient.25 Although there is no universally accepted test for zinc deficiency, some doctors check white blood cell zinc RA levels. The relationship of copper to RA is complex. Copper acts as an antiinflammatory, because its needed to activate superoxide dismutase, an enzyme that protects joints from inflammation. People with RA tend toward copper deficiency.26 The Journal of the American Medical Association quoted one researcher as saying that while Regular aspirin had 6% the antiinflammatory activity of [cortisone]. . . copper [added to aspirin] had 130% the activity.27 Several copper compounds have been used successfully with RA,28 and a single-blind trial using copper bracelets reported surprisingly effective results.29 However, under certain circumstances, copper might actually increase inflammation in rheumatoid joints.30 Moreover, the most consistently effective form of copper, copper aspirinate (a combination of copper and aspirin), is not readily available. A reasonable amount of copper might be 1-3 mg per day. Many double-blind trials have shown that omega-3 fatty acids in fish oil, called EPA and DHA, help relieve symptoms of RA.31 32 33 34 35 36 The effect results from the anti-inflammatory activity of fish oil.37 Many doctors recommend 3 grams per day of EPA and DHA. This amount is commonly

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found in 10 grams of fish oil. Positive results can take three months to become evident. Evening primrose oil, or EPO, may help in RA because it partially converts to prostaglandin E1, which is known to have an anti-inflammatory effect. Double-blinded research has reported significant improvement in morning stiffness using 6 grams of EPO per day.38 Borage oil and black currant seed oil are thought to have similar benefits.39 40 However some trials have not found EPO helpful.41 Double-blind research has shown that fish oil and EPO can be successfully combined to help people with RA.42 Preliminary research suggests that boron supplementation at 3-9 mg per day may be beneficial, particularly in juvenile RA.43 However, more research on this is needed. The DL form of phenylalanine, or DLPA, has been used to treat chronic pain, including rheumatoid arthritis, with mixed effectiveness.44 Some doctors of natural medicine suggest that individuals with arthritis may benefit from cartilage; however, well-designed research is lacking, and many experts question the use of cartilage in this regard. Many individuals with rheumatoid arthritis have low levels of histidine; taking histidine supplements improves arthritis symptoms in some of these individuals. Are there any side effects or interactions? (Refer to the individual supplement for complete information.) Very large amounts of pantothenic acid (several grams per day) can cause diarrhea. Zinc intake in excess of 300 mg per day may impair immune function. People with Wilsons disease should never take copper. The level at which copper causes problems is unclear, but in combination with zinc, up to 3 mg per day is considered quite safe. Side effects from EPA and DHA in fish oil include nose bleeds (because of reduced blood clotting), gastrointestinal upset, and fishy burps. Amounts of boron found in supplements have not been linked with toxicity. However, one study found that 3 mg per day resulted in small increases of estrogen levels. This is a concern, since estrogen may increase the risk of several cancers. Until more is known, supplemental boron intake should be limited to 1 mg per day.

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The maximum amount of D-phenylalanine that is safe is unknown, but nerve damage has not been reported with 1,500 mg per day or less of Dphenylalanine. D-phenylalanine has occasionally caused mild side effects such as nausea, heartburn, or transient headaches in smaller amounts. There are no side effects reported with the use of histidine. Herbs that may be helpful: Boswellia, a traditional herbal remedy from the Indian system of Ayurvedic medicine, has been investigated for its effects on arthritis. A study using boswellia found a beneficial effect on pain, stiffness, and improved joint function.45 Boswellia is safe and showed no negative effects in the study. The herb has a unique anti-inflammatory action, much like the conventional non-steroidal anti-inflammatory drugs (NSAIDs) used by many for inflammatory conditions. But unlike NSAIDs, long-term use of boswellia does not lead to irritation or ulceration of the stomach. Many people take 400-800 mg of gum resin extract in capsules or tablets three times per day. Turmeric is a yellow spice that is often used to make brightly colored curry dishes. The active principle is curcumin, a potent anti-inflammatory, which protects the body against the ravages of free radicals.46 Many people take 400 mg of curcumin in capsules or tablets three times per day. Ginger has been used in Ayurvedic medicine as an anti-inflammatory. A cream made from small amounts of hot cayenne peppers, when rubbed onto arthritic joints, can help relieve pain.47 It does this by depleting the nerves of certain neurotransmitters. Although this may initially cause a burning feeling, it will lessen with each application and soon disappear for most people. A topically applied cream containing 0.025-0.075% of capsaicin (the active agent) is applied to the affected joints three to five times a day by many people. A tincture of cayenne can be used in the amount of 0.3-1 ml three times daily. Yucca, popular traditional remedy, is a desert plant that contains soap-like components known as saponins. Yucca tea (7 or 8 grams of the root boiled in a pint of water for fifteen minutes) is often drunk for symptom relief three to five times per day. Burdock root has been used historically both internally and externally to treat

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painful joints. Devils claw has anti-inflammatory and analgesic actions. However, it is important to note that recent studies do not support devils claw as a treatment for arthritis. The silicon content of horsetail is said to exert a connective tissue strengthening and anti-arthritic action. Sarsaparilla has anti-inflammatory properties, which may be helpful for rheumatoid arthritis. White willow has anti-inflammatory and pain-relieving effects. Although the analgesic actions of willow are typically slow-acting, they last longer than standard aspirin products. Are there any side effects or interactions? (Refer to the individual herb for complete information.) Boswellia is generally safe when used as directed; rare side effects can include diarrhea, skin rash, and nausea. Persons with symptoms from gallstones should avoid turmeric. There may be a short-lived burning sensation following initial application of cayenne cream. The hands should be washed after applying the cream, to avoid getting any in the eyes or mouth, where it can cause burning. Yucca tea can cause loose stools in some people; if it does, simply reduce the amount. Use of burdock root is generally safe; however, burdock root in large quantities may stimulate the uterus and should be used with caution during pregnancy. Since devils claw promotes stomach acid, anyone with gastric or duodenal ulcers should not use the herb. Horsetail is generally considered safe for non-pregnant adults. The only concern would be that the correct species of horsetail is used; Equisetum palustre is another species of horsetail that contains toxic alkaloids and is a well-known livestock poison. Sarsaparilla can cause nausea and kidney damage. Large doses for long periods of time are to be avoided. Since sarsaparilla can increase absorption and/or elimination of digitalis and bismuth, such combinations are contraindicated. Long-term use of white willow may possibly cause gastrointestinal irritation. As is the case with aspirin, willow should not be used to lower fevers in children. People who are allergic to aspirin should avoid white willow. Any inflammatory joint condition should be closely monitored by a nutritionally oriented physician.

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Checklist for Rheumatoid Arthritis

Nutritional Supplements Vitamin E Pantothenic acid (Vitamin B5) Zinc Copper Fish Oils (EPA/DHA) Evening Primrose Oil Boron DL-phenylalanine (DLPA) Cartilage Histidine Herbs Boswellia Turmeric Ginger Cayenne Yucca Burdock Devils claw Horsetail Sarsaparilla White willow Homeopathic Remedies Rhus toxicodendron 30c Bryonia 6c
References: 1. Anonymous. Effects of dietary fat on virus-induced autoimmune disease. Nutr Rev 1983;41:128-30 [review]. 2. Jacobson I, et al. Correlation of fatty acid composition of adipose tissue lipids and serum phosphatidylcholine and serum concentrations of micronutrients with disease duration in rheumatoid arthritis. Ann Rheum Dis 1990;49:901-5. 3. Lucas CP, Power L. Dietary fat aggravates active rheumatoid arthritis. Clin Res 1981;29:754A [abstr]. 4. Skoldstram L. Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 1987;15:219-21. 5. Nenonen M, Helve T, Hanninen O. Effects of uncooked vegan foodliving foodon rheumatoid arthritis, a three month controlled and randomised study. Am J Clin Nutr 1992;56:762 [abstr#48]. 6. KjeldsenKragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and oneyear

Ruta graveolens 6c Pulsatilla 30c

Arnica montana gel

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vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899902. 7. Warmbrand M. How thousands of my arthritis patients regained their health. New York: Arco Publishing, 1974. 8. Panush RS, Carter RL, Katz P, et al. Diet therapy for rheumatoid arthritis. Arthrit Rheum 1983;26:462-71. 9. Childers NF. A relationship of arthritis to the solanaceae (nightshades). J Internat Acad Pre Med Nov 1982:31-37. 10. Zeller M. Rheumatoid arthritisfood allergy as a factor. Ann Allerg 1949;7:200-205, 239. 11. Darlington LG, Ramsey NW, Mansfield JR. Placebocontrolled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet 1986;i:236-8. 12. Beri D et al. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis 1988;47:6972. 13. Panush RS. Possible role of food sensitivity in arthritis. Ann Allerg 1988;61(part 2):315. 14. Taylor MR. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983;8:28-38 [review]. 15. Darlington LG, Ramsey NW. Diets for rheumatoid arthritis. Lancet 1991;338:1209 [letter]. 16. Kay DR, Webel RB, Drisinger TE, et al. Aerobic exercise improves performance in arthritis patients. Clin Res 1985;33:919A [abstr]. 17. Harkcom TM, Lampman RM, Banwell BF, Castor CW. Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthrit Rheum 1985;28:32-8. 18. Fairburn K, Grootveld M, Ward RJ, et al. Alpha-tocopherol, lipids and lipoproteins in knee-joint synovial fluid and serum from patients with inflammatory joint disease. Clin Sci 1992;83:657-64. 19. Scherak O, Kolarz G. Vitamin E and rheumatoid arthritis. Arthrit Rheum 1991;34:12056 [letter]. 20. Barton-Wright EC, Elliott WA. The pantothenic acid metabolism of rheumatoid arthritis. Lancet 1963;ii:862-3. 21. General Practitioner Research Group. Calcium pantothenate in arthritic conditions. Practitioner 1980;224:208211. 22. Simkin PA. Oral zinc sulphate in rheumatoid arthritis. Lancet 1976;ii:539-42. 23. Peretz A, Neve J, Jeghers O, Pelen F. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Am J Clin Nutr 1993;57:690-4. 24. Job C, Menkes CJ, de Gery A, et al. Zinc sulphate in the treatment of rheumatoid arthritis. Arthrit Rheum 1980;23:1408. 25. Simkin PA. Treatment of rheumatoid arthritis with oral zinc sulfate. Agents Actions 1981;8 (suppl):587-96. 26. DiSilvestro RA, Marten J, Skehan M. Effects of copper supplementation on ceruloplasmin and copperzinc superoxide dismutase in freeliving rheumatoid arthritis patients. J Am Coll Nutr 1992;11:17780. 27. Medical News. Copper boosts activity of anti-inflammatory drugs. JAMA 1974;229:1268-9. 28. Sorenson JRJ. Copper complexesa unique class of antiarthritic drugs. Progress Med Chem 1978;15:21160 [review]. 29. Walker WR, Keats DM. An investigation of the therapeutic value of the copper braceletdermal assimilation of copper in arthritic/rheumatoid conditions. Agents Actions 1976;6:454-9. 30. Blake DR, Lunec J. Copper, iron, free radicals and arthritis. Brit J Rheumatol 1985;24:123-7 [editorial]. 31. Kremer JM, Jubiz W, Michalek A, et al. Fishoil fatty acid supplementation in active rheumatoid arthritis. Ann Int Med 1987;106(4):497503. 32. Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Arthrit Rheum 1990;33(6):81020. 33. Geusens P, Wouters C, Nijs J, et al. Longterm effect of omega3 fatty acid supplementation in active rheumatoid arthritis. Arthrit Rheum 1994;37:8249.

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34. van der Tempel H, Tulleken JE, Limburg PC, et al. Effects of fish oil supplementation in rheumatoid arthritis. Ann Rheum Dis 1990;49:7680. 35. Cleland LG, French JK, Betts WH, et al. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol 1988;151471-5. 36. Kremer JM, Lawrence DA, Petrillow GF, et al. Effects of highdose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthrit Rheum 1995;38:110714. 37. Lee TH, Hoover RL, Williams JD, et al. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med 1985;312(19):1217-24. 38. Brzeski M, Madhok R, Capell HA. Evening primrose oil in patients with rheumatoid arthritis and sideeffects of nonsteroidal antiinflammatory drugs. Brit J Rheumatol 1991;30:3702. 39. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med 1993;119:86773. 40. Leventahn LJ, Boyce EG, Zuerier RB. Treatment of Rheumatoid arthritis with blackcurrant seed oil. Brit J Rheumatol 1994;33:847-52. 41. Jantti J, Seppala E, Vapaatalo H, Isomaki H. Evening primrose oil and olive oil in treatment of rheumatoid arthritis. Clin Rheumatol 1989;8:238-44. 42. Belch JJF, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for nonsteroidal antiinflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis 1988;47:96104. 43. Newnham RE. Arthritis or skeletal fluorosis and boron. Int Clin Nutr Rev 1991;11:68-70 [letter]. 44. Balagot RC, Ehrenpreis S, Kubota K, et al. Analgesia in mice and humans by D-phenylalanine: Relation to inhibition of enkephalin degradation and enkephalin levels. Adv Pain Res Ther 1983;5:28993. 45. Singh GB, Singh S, Bani S. New phytotherapeutic agent for the treatment of arthritis and allied disorders with novel mode of action. 4th International Congress on Phytotherapy, Munich, Germany, Sep 10-13, 1992. 46. Kulkarni RR, Patki VP, et al. Treatment of osteoarthritis with a herbomineral formulation: A doubleblind, placebo-controlled, cross-over study. J Ethnopharm 1991; 33:91-5. 47. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991; 13:383-95.

Copyright 1998 Virtual Health, LLC

The information presented in HealthNotes Online is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-thecounter medication is also available. Consult your physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

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