Rheumatoid Arthritis (RA)

Published by NHC on January 5, 2021January 5, 2021

Rheumatoid Arthritis (RA)

Info
Description	An autoimmune condition affecting the joints causing pain, stiffness, inflammation and deformity
Signs & Symptoms	Joint pain and swelling Pain typically worse in morning Stiffness Inflammation Warmth felt at joints Tenderness Limited ROM Fatigue Rheumatoid nodules Joints commonly affected: Fingers (90% – early) Toes (90% early) Wrist (80% – early) Ankles (80%) Knees (80%) Shoulder (60%) Hip (50%) Elbow (50%) Cervical spine (40%) Sternoclavicular (30%) Jaw (30%)
Causes & Contributors	SIBO/dysbiosis/microbial infection Higher rates of Clostridium perfringens parovirus B19 Rubella Epstein-Barr Hepatitis B, Hepatitis C Cytomegalovirus Mycoplasma fermentans or mitogen Proteus mirabilis Cross reacts with XI collagen Periodontal bacterial infection Porphyromonas gingivalis Increased intestinal permeability (Leaky gut) Cigarette smoking Dietary allergies Lectins Genetics HLA DRB1/DR4 Vaccination may be a trigger in some people Imbalanced hormones
Pathophysiology/Aetiology	The synovium of the joints are transformed (through autoimmunity) into an invasive structure know as the pannus. The synovium thickens and there is oedema Hormonal component as observed in the following: Pregnancy can lead to remission History of child bearing can protect against RA HRT may reduce risk of women who carry the HLA-DRB1 gene RA is associated with antibodies to Proteus mirabilis, a common bacteria often involved in UTIs Changes in small intestine microflora may be implicated in disease
Commonly Affected	More common in women than men. Ratio 1:3 >65 years old Most common autoimmune disease in Australia
Complications	Progression of disease Erosion of cartilage and bone Deformity CVD increase
Treatment
Best Therapeutic Treatment	Autoimmune condition, consider the following: Past or present infections GI function (Permeability, Flora) Improve detoxification pathways Immune modulation Weed and Seed Remove Replace Repair Repopulate Reduce inflammation and pain Discuss natural anti-inflammatories VS NSAIDs Pathology Testing CDSA SIBO breath test Intestinal Permeability Diet Elimination Diet/Autoimmune diet Eat These: Fresh fruit and vegetables Seafood (especially fatty fish) Avoid These: Sugar Gluten Red meat Refined carbohydrates Processed foods Chemical, additives, preservatives Trans fats Processed meats Caffeine Alcohol Lectins Nightshades Nutritional Omega 3 Anti-inflammatory Probiotics Broad range L. Rhamnosus GG Vitamin D (if required) Immune modulation Herbal Example Herbal Formula (Antiviral, autoimmune and anti-inflammatory) Echinacea – 1:2 30ml Immune modulation St Johns Wort – 1:2 20ml Antiviral against enveloped viruses Bupleurum – 1:2 20ml Improves autoimmunity Cats claw – 1:2 25ml Immune enhancing, anti-inflammatory Ginger – 1:2 10ml Lifestyle Exercise (If possible) Walking outside Yoga Meditation helps with stress and pain Once a day Sunlight exposure To increase vitamin D Combined Products Anti-inflammatory (Combination tablet/capsule) Tumeric Boswellia Ginger Consider: Orthoplex Intestaclear Eliminate pathogenic microorganisms Orthoplex Immunobiotic Repair intestinal hyperpermeability
Herbal	Boswellia (Boswellia serrata) Anti-inflammatory Tumeric (Curcuma longa) Antioxidant, Anti-inflammatory Echinacea Immunomodulator Lacks evidence to show that it wont increase immune function, leading to possible worsening Devils claw (Harpagophytum procumbens) Anti-inflammatory, Antioxidant Bupleurum Improves autoimmunity Immunosuppresants Hemidesimus indicus Immunosuppressant Combines well with echinacea for the autoimmune aspect of RA Tylophora Immunosuppressant Phellodendron amurense Immunosuppressant Rehmannia glutinosa Immunosuppressant Little good quality evidence
Nutritional	Omega 3 Inhibit inflammatory pathways Glucosamine and chondroitin Prevent cartilage erosion Selenium deficiency common in RA has been suggested as being a cause of RF negative RA Vitamin A cartilage growth Regulate immune function deficiency common in RA Vitamin C Antioxidant, anti-inflammatory Collagen production, cartilage Immune function Vitamin D Immune regulation Zinc deficiency leaves joints susceptible to damage from oxidation Commonly deficient in RA, likely due to inflammation Immune function Probiotics
Dietary	Avoid food allergies (both IgE and IgG) Eat These: Fresh fruit and vegetables Seafood (especially fatty fish) Avoid These: Sugar Gluten Red meat Refined carbohydrates Processed foods Chemical, additives, preservatives Trans fats Processed meats Caffeine Alcohol *Give food swap ideas if necessary
Lifestyle	Exercise where possible Meditation helps with stress and pain Once a day
Pharmaceutical	NSAIDS Methotrexate Sulfasalazine Predisolone
Combination Products	Orthoplex Intestaclear Eliminate pathogenic microorganisms Orthoplex Immunobiotic Enterocare
More
Differential Diagnosis	Ankylosing spondylitis Enteric infections Psoriatic arthritis Reiter’s arthritis Whipple’s disease IBD
Diagnostic Criteria	Symptoms for more than 6 weeks Suffering 4 of the following 7: Morning stiffness Arthritis of three or more joint areas Arthritis of hand joints Symmetric arthirits Rheumatoid nodules Positive for RF Radiographic changes Markers Often Raised: + RF + Anti-CCP + ANA
Testing/Examinations	Clinical examination check for inflammation nodules redness, tenderness ROM Rheumatoid factor Positive in 80% of patients More likely to have joint erosion and deformity and worse prognosis Anti-CCP Positive in 60-70% of patients Predicts progression of RA More likely to have joint erosion and deformity and worse prognosis CRP and ESR Elevated indicates inflammation Antinuclear anitbodies (ANA) Typically elevated Antibodies to extractable nuclear antigens (ENA) to eliminate other MSK conditions IgG food intolerance test CMV, EBV, HIV Assess for viral cause Mycoplasma, Chlamydia, Borellia Iron Usually low in RA patients CDSA identifying pathogenic bacteria, parasites and GIT function given the link between the GIT and RA SIBO breath test
Additional Notes	RA seems to have declined after the 1960s, particularly in women. One theory suggests the increased use in OCPs from 1960-2000. Although new data suggests it is on the rise again.

References

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