Rheumatoid Arthritis is a painful and chronic autoimmune disease that causes persistent inflammation of the joints in the body. For a variety of reasons found in individuals that suffer from RA, the immune system begins to attack the thin tissue lining that covers the joints, known as the synovium. Because of the immune system’s attack, white blood cells travel to the synovium and cause the recruitment of cell chemical signals, called cytokines and initiate a painful inflammatory response.
Whether Rheumatoid Arthritis impact joints locally or all over the body, it is a painful condition that most often progresses into a debilitating, chronic disease.
How RA Feels
RA typically sets in after the age of 40, although it is not uncommon for teens and young adults like Maya to suffer from Juvenile Rheumatoid Arthritis (JRA or JIA); historically impacts women more often than men. Common symptoms of RA include pain, swelling, morning stiffness, and limited movement of the affected joints. The severity of pain and longevity of symptoms can vary, as RA is a chronic condition, which means there is no true “cure” and symptoms come and go frequently. Symptoms of RA are most often experienced at joint extremities such as the fingers and toes, but can affect larger joints such as the wrist, elbows, knee, ankle and hips.1
While the symptoms of Rheumatoid Arthritis appear to be strictly physical, RA has the potential to have a further reaching impact on the RA sufferer. Since RA is part of a collection of autoimmune inflammatory diseases, it shares symptoms with other inflammatory conditions such as Crohn’s disease, Ulcerative Colitis, Ankylosing Spondylitis, Psoriasis and Psoriatic Arthritis. Symptoms of these diseases expand to have an emotional and energetic effect whereby individuals with RA may experience anxiety or depression or become discouraged over the excruciating pain that seems to dictate their life.
How RA is Conventionally Treated
RA sufferers often visit with their primary care physician (PCP) when experiencing initial symptoms of arthritis, including joint pain, morning stiffness, redness, inflammation and fatigue. PCPs will often suggest a preliminary panel of labs to assess inflammatory markers associated with RA and refer individuals to a Rheumatologist for evaluation and treatment.
The conventional course of RA treatment involves the use of prescription drugs. Popular first line medications include non-steroidal anti-inflammatory drugs (NSAIDs), but often the disease progresses, requiring the use of more powerful anti-inflammatory agents such as disease modifying anti-rheumatic drugs (DMARDs). DMARDs can slow the progression of RA via various mechanisms and help prevent joint damage. DMARDs typically prescribed by rheumatologists include methotrexate (Trexall), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine) and leflunomide (Arava). Both DMARDs and NSAIDs have mild to moderate side effects, and NSAIDs are often not tolerated by individuals due to stomach irritation and kidney.2
Steroidal medications are often adjunct medications to DMARDS prescribed early on in the disease. Steroids may be used to temporarily to relieve extreme swelling and inflammation, but are not a permanent solution since they can cause significant liver damage.
Perhaps the most effective, yet potentially risky, anti-rheumatic drugs to date are the biologic DMARDs. Most common are the tumor Necrosis Factor-alpha (TNF-α) inhibitors. These are injectable medications that specifically target the initial inflammatory cascade occurring in and around the synovium of RA patients. TNF-α inhibitors have greatly improved the quality of life of countless RA suffers, however because they suppress the immune system, individuals are at risk for serious infections like tuberculosis (TB) and, in rare cases, may develop cancer. Examples include adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), certolizumab (Cimzia), and golimumab (Simponi). Additional drugs that target specific cells of the immune system to fight RA include rituxamab (Rituxan), tocilizumab (Actemra), abatacept (Orencia) an danakinra (Kineret).3
Rheumatoid Arthritis complicates daily life for individuals with this chronic disease. While traditional prescription drugs are effective in modulating the immune system to reduce inflammation and the symptoms and pain associated with RA, it is encouraging to know that there is an abundance of holistic treatments, dietary and lifestyle changes, and products and equipment that can help reduce and manage RA’s worst symptoms.
HOLISTIC HEALING FOR RA SUFFERERS
Rheumatoid Arthritis affects an estimated 1.5 million people nationwide, and 68% to 94% of RA patients use complementary and alternative medicine (CAM) therapies to treat their symptoms. As a malady of the immune system, RA can be treated through various holistic forms of healing. Rheumatoid arthritis natural treatments include the use of herbal supplements, Traditional Chinese Medicine, Ayurvedic medicine, yoga, and apitherapy.4
Herbal supplements are natural sources of medication that can be derived from flowers, plants, and tree bark. Whether taken as a tea, daily capsule, or tincture, herbal supplements deliver natural pain relief, but some may interfere with medication. RA sufferers should consult with their physician first along with a certified herbal practitioner prior to using any herbal supplements.
Because of their great potential to reduce pain and combat inflammation, feverfew and willow bark are two wonderful herbal supplements that can aid in treating RA.
- Feverfew5, also known as Tanacetum parthenium, has an anti-inflammatory effect that may ease joint inflammation associated with RA. Traditional treatment includes 1-2 supplements taken daily. As always, consult your physician before taking Feverfew or any other supplement.
- Willow bark6 is the bark from several varieties of willow trees, and actually acts as a natural aspirin. Willow bark contains salicin, the active ingredient that delivers pain-relieving properties. Willow bark is available dried for herbal teas and decoctions, in capsules, or as a tincture. Willow bark is considered a natural blood thinner and may be unsafe for individuals already taking anticoagulants. As always, consult your physician before taking any supplements.7
Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) follows the thousands’ of years old Chinese practice of striving for a balance to bring about good health. Where illness or sickness comes in, there is an imbalance in the Ying and Yang, the opposing yet complementary forces in the universe. TCM utilizes herbal medicines and mind-body practices such as acupuncture as its main source of treatment in bringing about a balance and harmony to the body.8 TCM practitioners create highly specialized formulas to treat RA with a combination of herbs that are unique to the individual’s condition.
Chinese Herbal Medicine
TCM relies on herbal medicines to treat a variety of ailments. This holistic approach utilizes medicinal effects already found in natural sources such as trees, plants, roots, flowers, and bark to reduce painful inflammation. In TCM, a doctor prepares a specific herbal medicine based on symptom severity, duration, and location. These herbal medicines are specially formulated dependent on each individual RA sufferer. Before taking any herbal supplements, consult your physician.
- According to TCM theory, arthritis is considered a disease of blood stagnation and many herbal treatments are focused on relieving energetic and blood blockages and increasing circulation. The popular, potent Chinese herb Tienchi Ginseng is often used to move and vitalize the blood for RA sufferers. Ginseng can be very heating to the body and should be balanced with additional herbs. Be sure to consult a certified TCM practitioner before taking herbal remedies.
- Another TCM approach for RA includes the use of anti-inflammatory herbs. Thunder God Vine is derived from the root of a plant that is indigenous to Asia and can help reduce rheumatoid arthritis symptoms. Due to the highly poisonous nature of the plant’s leaves and flowers, only the skinned root can be used for medicinal purposes. When taken under the care of a TCM professional, Thunder God Vine helps to reduce RA pain and inflammation due to its effect on the immune system.9
The ancient Chinese practice of acupuncture10 is the science and art of restoring the balance of natural energy to the body. Developed within Traditional Chinese Medicine, this form of therapy has proven useful in alleviating numerous conditions and disorders. Acupuncture uses very thin needles inserted into specific reflex points of the body to stimulate nerves, muscles, and connective tissues associate with a host of disorders. This stimulation sends a signal to the brain, which works to produce endorphins. Acupuncture can help ease RA symptoms by its’ ability to release endorphins,the body’s natural pain medicine, and quell aches and pains.
A trained Acupuncturist may focus on specific points where chi (energy) is blocked or may use a broader systemic approach to meridian (energy channel) support. Arthritis conditions in TCM theory are often known as bi-syndromes and associated with disturbances in heat, wind and cold. Some acupuncture points uses to relieve inflammation and joint pain include:
Spleen 4 Small Intestine 3
Galbladder 40 Triple Warmer 5
Kidney 3 Stomach 34
Gallbladder 30 Large Intestine 11
Small Intestine 10 Central Vessel 6
The 5,000 year old system of medicine from India called Ayurveda offers significant holistic therapeutic options for RA sufferers. Ayurveda focuses on restoring the balance of physical, mental and spiritual energies, bodily humors known as doshas, with nature to heal disease. According to rheumatologist and national thought leader Dan Furst, the use of Ayurvedic medicine to treat RA involves “a holistic, multifaceted system of treatment which includes complex herbal mineral combinations, dietary and lifestyle modification, oil therapies, and detoxification routines.”11
Ayurveda provides both dietary and lifestyle modifications to help reduce inflammation associated with the autoimmune disease of RA. Eliminating nightshade vegetables and fruit such as potatoes, tomatoes, peppers, eggplant, tomatillos, and goji berries is recommended, along with the reduction of spicy foods and the inclusion of cooling herbs such as fennel, mint, cilantro, and dill to the diet.12
Ayurveda also offers bodily detoxification therapies that use physical manipulation of the muscles and lymphatic system to remove inflammatory cells and toxins. Various massage oil therapies such as Abhyanga use heated herbal oils to draw out impurities from affected RA joints and muscles, thus reducing inflammation and promoting self-healing. This therapeutic practice Is followed by Svedana, the Ayurvedic practice of using a sweat box or warm shower in short intervals, to detoxify the system and relax muscles. This practice induces sweating from the neck down and is a useful form of heat therapy that can ease painful RA symptoms.13
Similar to TCM, certain Ayurvedic herbs and supplements have proven effective for reducing inflammation and detoxifiying RA affected joints and muscles.
- The tree resin Boswellia known by its more familiar name frankincense, is extracted from the gum of Boswellia trees and used to treat rheumatic arthritis. Due to its anti-inflammatory action, Boswellia makes a great form of treatment for RA sufferers. The inclusion of daily Boswellia dosages or topical application can reduce pain and inflammation over time. As always, consult with your physician before beginning any supplements.14
- Another powerful Ayurvedic supplement includes the use of a mineral pitch called guggulu. Often used with a combination of herbs in a collective formula, guggulu provides “strong detoxification and relieve from inflammatory toxins residing in the synovium,” according to Certified Ayurvedic Practitioner, Julie A. Cerrato, PhD, AP, CYT, CAT.
Painful RA inflammation can be reduced with the use of massage oils. There are many essential oils that can help reduce inflammation and pain due to RA. These oils include:
- Rosemary (ie. Rosmarinus Officinalis)
Rosemary essential oil is particularly powerful for relieving muscle stiffness, cramping, aches and pain associated with RA and by stimulating blood flow and tissue regeneration, may help eliminate toxins.
- Lemon (Citrus Limomum)
Lemon essential oil can be used to treat physical exhaustion, general fatigue, and depression that often accompanies RA.
- Lavender (Lavandula Angustifolia)
This essential oil provides a calming effect on the body and is used to treat insomnia, burns, colds, and muscle aches and pains.
- Eucalyptus (Eucalyptus Globulus)
This form ofEucalyptus essential oil is most commonly used because of its high eucalyptol content (70-85%) and anti-inflammatory compounds. It can be used as an expectorant, antibiotic, anti-fungal treatment, as well as providing relief from muscle pain.
- Peppermint (Mentha Piperita)
This invigorating essential oil is refreshing to the senses and nervous system. It can be used to treat headaches, cough and sinus congestion, muscle pains and motion sickness.
Each of the essential oils listed contain potent antioxidants that have powerful anti-inflammatory effects.The essential oils can be inhaled via a diffuser or tissue, applied topically to the skin using a carrier oil or lotion, or added to a warm bath. It is always recommended to dilute the essential oil in a carrier oil or lotion before applying directly to the skin as sensitivity may occur.15
The mind-body practices of Restorative Yoga, or gentle Hatha yogic postures called asanas, can help to reduce pain, inflammation, and relax the muscles. Yoga works by holding and releasing different positions to focus on mind-body integration. While originally used for meditation purposes, yoga has become an increasingly popular way to manage stress and acquire physical activity.
The connection between yoga and a reduction in RA symptoms has been documented through eleven different studies. According to some research, “evidence was strongest for reduction in disease symptoms (tender/swollen joints, pain) and disability, as well as improved self-efficacy and mental health.”16
Yoga provides a wonderful physical outlet for RA sufferers to focus on flexibility, stretching, balance, and posture. By following a gentle yoga routine regularly, individuals with Rheumatoid Arthritis may be able to better limit the length and severity of their RA symptoms. Poses to include in a yoga routine are designed to alleviate RA symptoms and strengthen supportive muscles.
Some asanas that are beneficial for RA sufferers include:
- Virabhaddrasana I (Warrior 1) – Try this position facing a wall with palms reaching and touching the wall for support. Be gentle and hold for only a few breaths.
- Virabhaddrasana II (Warrior ) – Try this position slowly, with lots of breath and hold for only a few seconds at a time.
- Utkatasana (chair pose) – Try this position parallel to a wall so arms can reach the wall for balance and support; hold for a few seconds at at time.
- Matsyendrasana (seated spinal twist) – Be sure to place a bolster or blanked under knees and/or hips if they are far off the ground to align the spine properly and take pressure off the knees.
- Bhujangasana (cobra pose) – Keep a gentle bend in the knees when lifting the chest.
- Balasana (child’s pose.17) – Use a blanked or bolster when leaning back into the pose to prevent knee strain.
In addition to performing these poses slowly and gently, restorative yogic poses may provide additional myofacial relief for RA sufferers and also alleviate stress experiences when living with the condition. As a more static form of yoga, restorative or Yin Yoga offers poses that use props to specifically position the body in a comfortable and supportive way to allow for muscle and mental relaxation. Often, the poses are held for a few minutes at a time to promote complete relaxation.
Apitherapy, the medicinal use of products made by honeybees such as honey, bee venom, pollen, royal jelly, propolis and beeswax18 is another holistic form of treatment for RA.
Apitherapy has been recognized as a powerful way to treat a wide spectrum of disorders and diseases for hundreds of years. For example, bee venom therapy for Rheumatoid Arthritis involves using targeted bee stings at localized sites of joint pain and inflammation to trigger the release of anti-inflammatory and pain-blocking agents present in the bee venom. According to Dr. Wong, MD of Grace Life Medical Center, at least 18 active components exist in bee venom and following a sting, the adrenal glands may be stimulated to release cortisol in the body.19 The release of several therapeutic components in the venom, including histamine and cortisol, help alleviate pain and inflammation associated with RA.20 However, Apitherapy does not only involve the use of venom. All aspects of hive products are involved in Apitherapy, from the medicinal use of honey to pollen to beeswax.
Preliminary research exists that examines the effects of apitherapy for RA patients. In a randomized trial of 100 RA patients, 50 of them treated with Apitherapy and 50 patients treated through traditional medication, the findings revealed that Apitherapy is indeed an effective and cost-friendly form of treatment with relatively low side effects. The results indicated that the 50 RA patients treated with Apitherapy experienced greater significant improvement in joint swelling, pain, and stiffness than the medically treated group. Additionally, the group treated with Apitherapy had a lower relapse rate (12% to 32%).21
HOLISTIC LIFESTYLE CHANGES
Holistic lifestyle changes are simple, yet effective, daily decisions that can reduce and help manage the painful side effects of RA. While RA is a chronic condition without a true cure, there are several holistic lifestyle changes RA sufferers can make.
Balance of Sleep/Exercise
A good balance of rest and exercise is vital for maintaining a healthy lifestyle and managing RA symptoms. A regular exercise routine will help increase blood flow, circulation, and improve overall health and mood. However, physical activity may be impossible during the height of RA pain and swelling. It is during times like this that rest becomes vital. A balance of resting when the RA symptoms are strongest and exercise for when they are more manageable will introduce a happy medium of physical activity and much-needed rest.22
Tai Chi is an ancient martial art form that has been heralded in China for its’ effective treatment of RA symptoms. Studies reveal that the regular practice of Tai Chi produces “statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA.”23 This low impact form of exercise helps to bring a sense of balance and strength while alleviating RA symptoms.
Meditation and other mind-body practices provide a cost-effective way to control RA pain from the comfort of home. To follow meditative techniques for pain, find a quiet, dark space in which to sit. Focus on deep, slow breaths while clearing the mind. Mindfulness meditation practices can help to reduce sensations of pain, stress, and anxiety and increase activity levels24
Healing Breath Techniques
Pranayama, the practice of controlled breathing, helps to relieve chronic pain associated with RA. This yogic style of breathing focuses on the deep inhalation and slow release of each breath, which increases oxygen inhalation and delivery throughout the body. This type of breathing can be an especially important pain relieving technique for RA.
Nadi shodhona, also known as alternate nostril breathing, is a powerful, calming pranayama that has been shown to have a physiological effect on the parasympathetic nervous system and to lower stress and blood pressure. Nadi shodhona involves right and left isolated nostril breathing to activate distinct parts of the nervous system and provide soothing relief. This pranayama, and others, have been utilized for treating various chronic pain disorders and may prove very beneficial for relieving RA symptoms.
HOLISTIC DIET & NUTRITION
Diet and nutrition play a large role in virtually every health condition. Rheumatoid Arthritis can be treated by specific dietary changes and a holistic approach to nutrition. An anti-inflammatory diet, specific supplements, supplements, and foods can all help to reduce inflammation and boost the immune system.
You can greatly reduce the severity of your RA symptoms by following an anti-inflammatory diet that is rich in Omega -3’s and low in Omega-6’s. Omega-3 fatty acids reduce inflammation in the system and are in short supply in most of our modern day diets. Omega-3 food sources include flax seeds, walnuts, fish, grass fed meat and eggs, Brussels sprouts, cauliflower, and fish oil.
Reducing or eliminate inflammatory nightshades such as peppers, eggplant, tomatoes and potatoes and foods with high levels of arginine such as chocolate, nuts, red meat, seafood and eggs.25
The addition of several foods to an anti-rheumatic diet have proven effective in reducing inflammation.
Cherries contain significant anti-inflammatory properties. Eating just 12 cherries a day can be very helpful in reducing inflammation. According to a 2003 study conducted by the U.S. Department of Agriculture, eating Bing cherries may help reduce inflammation associated with RA. The study showed that blood markers for inflammation were significantly reduced from consuming cherries.26
Ginger, Turmeric, Green Tea
Ginger, turmeric, and green tea are all delicious foods that contain natural anti-inflammatory properties. Curcumin, the main ingredient in turmeric, is what gives the spice its yellow color and is a powerful anti-inflammatory antioxidant. Recent studies conducted by the CCAM (National Center for Complementary and Alternative Medicines) have determined that ginger, turmeric, and green tea are all powerful anti-inflammatory agents that may be beneficial to those suffering with RA. These spices can be added to your favorite meals or taken as supplements. As always, consult your physician before taking any supplements.27
RA sufferers frequently find that their digestive systems are out of balance and overly acidic. This is caused by a traditional modern diet of heavily processed, sugar-rich foods. The solution to changing gut health includes the adoption of a more alkaline diet. This includes the consumption of alkalinizing foods like many fruits and vegetables. Raisins, carrots, spinach, bananas, lemons, and apricots are a few examples of strongly alkalinizing foods.28
Joint Lubricating Foods
Fish oil is a wonderful source of omega-3 fatty acids and can be obtained by eating fish or by taking supplements. A daily dose of fish oil can help to reduce inflammation in the body, and in turn, inflammation caused by RA.
An additional dietary change that will have an important impact on your allergy symptoms is to reduce your Omega-6 intake. This kind of fatty acid is found inmost processed foods and will wreak havoc on inflammation levels. The intake of Omega-6 fats can be significantly reduced by cutting out processed foods and vegetable oils.
The elimination of caffeine may play an active role in the reduction of RA symptoms. Painful RA inflammation can be caused by food allergens, and caffeine often is a culprit. Following an elimination diet is the only true way to determine what food source could be causing inflammation in the system. Removing caffeine as a potential allergen could mean significant reduction in the severity and duration of arthritis symptoms.29
PRODUCTS & EQUIPMENT
There are a host of supportive devices to improve and assist with daily activities. Wrist splints, zipper pullers, and shoehorns are all available to aid with activities that may prove painful. There are a also some specialized splints available30 that keep fingers and toes in pain-free positions. Additionally, there are many products available that assist with movements such as getting in and out of bed easier.
Rehabilitation may be helpful when treating painful RA symptoms. A physical or occupational therapist will be able to address pain, increase mobility, and ensure there is no loss of daily functioning due to RA.
A physical therapist will provide helpful exercises, education, and instruction as to which assistive devices are best. Seeing a physical therapist to treat RA includes working to maintain a certain level of physical function and mobility. A physical therapist can also provide relief for RA symptoms through techniques such as hot/cold applications and ultrasound.
An occupational therapist is committed to assisting RA sufferers with maintaining their independence and ability to properly work, take care of their personal hygiene, and participates in meaningful activities. Occupational therapists will often assess a home/work environment and provide helpful tips, information, and resources that will work to accommodate RA symptoms.31