Rheumatoid arthritis natural treatment, herbs vitamins supplements diet, alternative therapy by Ray Sahelian, M.D.
Feb 2 2014

Rheumatoid arthritis is an autoimmune disease in which joints, usually those of the hands and feet, are symmetrically inflamed, resulting in swelling, pain, and often the eventual destruction of the joint's interior. It is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one per cent of adults and is more common in women and the elderly. Rheumatoid arthritis may be accompanied by fatigue, weight loss, anxiety, and depression. In this condition, the immune system attacks the tissue that lines and cushions joints (certain immune cells, perhaps mast cells, attack the carbohydrate molecules, known as glycosaminoglycans, in the joints). Eventually, the cartilage, bone, and ligaments of the joint erode, causing scars to form within the joint. The joints deteriorate at a highly variable rate.

Rheumatoid arthritis diet
A regular, healthy diet is generally appropriate. Some people have flare-ups after eating certain foods. A diet rich in cold water fish has beneficial effects on inflammation. Eating a relatively large amount of red meat every day appears to increase the risk of inflammatory arthritis. Research has linked smoking and drinking a lot of coffee to rheumatoid arthritis, while suggesting that eating lots of fish and vegetables may protect people from the condition. Alcohol intake in small to moderate amounts could be beneficial by reducing the inflammatory response.

Swedish researchers found that of the 32,000-plus women they followed for nearly eight years, those who ate fish at least once a week were less likely to develop RA than other women were. Aug. 12, 2013, Annals of Rheumatic Diseases, online.

The production of antibodies to certain foods is increased in the gut of many patients with rheumatoid arthritis. Hypersensitivity to certain foods leads to a flare-up in the joints. Systemic and intestinal immune responses are abnormal in many patients. Most often these antibodies are to components of milk, eggs, and pork. It may be worthwhile to avoid these foods or other foods suspected of causing flare ups. Gut, August 2006.

There is evidence that rheumatoid arthritis is less severe in the southern Mediterranean countries, such as Italy and Greece, where oil-rich fish, fruit, vegetables and olive oil are consumed in greater amounts than in many other countries. Lower intakes of fruit and vegetables and dietary vitamin C are associated with an increased risk of developing inflammatory polyarthritis. Proc Nutr Soc. 2004.

Obesity increases the risk. Perhaps weight loss can reduce symptoms.

Sleep and insomnia
People with RA who don't sleep well have a higher likelihood of greater functional disability due to pain and fatigue symptoms associated with poor sleep quality

Natural remedy, therapy for rheumatoid arthritis
I will update this page as more studies become available regarding the natural approach to rheumatoid arthritis. In the meantime, I have come across some studies regarding natural supplements that I wish to share with you. Discuss with your doctor to see whether these herbs and supplements are appropriate for you, and whether there could be potential problems when combined with rheumatoid arthritis medications. At this time I am not aware of a
natural rheumatoid arthritis cure. See the section on food and rheumatoid arthritis discussed below.

Fish oils are certainly one of the first supplements to try for rheumatoid arthritis since they reduce inflammation. Cod liver oil is another option, there have been some studies regarding the use of cod liver oil and rheumatoid arthritis treatment.
   The beneficial properties of fish oil are related to its fatty acid composition rich in omega-3 polyunsaturated fatty acids. A number of epidemiological and clinical studies have demonstrated the benefits of fish oil supplementation in rheumatic diseases, in particular in rheumatoid arthritis. The anti-inflammatory effects of fish oil are due to the production of alternative eicosanoids, to the reduction of proinflammatory cytokines, and to the inhibition of the activation of T lymphocytes. Fish oil supplementation may be a good addition to the traditional pharmacological treatment of rheumatoid arthritis.
   Arch Med Res. 2012. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Department of Internal Medicine, Division of Rheumatology, Korea University College of Medicine, Seoul, Korea. We undertook this study to assess the effects of omega-3 polyunsaturated fatty acids (PUFAs) (administered at ≥2.7 g/day) for a minimum duration of 3 months on clinical outcomes in patients with rheumatoid arthritis (RA). This meta-analysis suggests that the use of omega-3 PUFAs at dosages greater than 2.7 g/day for greater than 3 months reduces NSAID consumption by RA patients.

Folic acid for patients on methotrexate.
Vitamin D - Int J Rheum Dis. October 2013. Serum vitamin D level and disease activity in patients with recent onset rheumatoid arthritis. The results of this analysis indicated that patients with more active RA have a lower serum vitamin D level.
Andrographis paniculata has been evaluated as a treatment for RA.
Curcumin has antioxidant and antiinflammatory properties. Curcumin is derived from turmeric.
Cat’s claw a small study showed a reduction in pain in rheumatoid arthritis patients given Cat's claw extract.
Ginger herb may be helpful in rheumatoid arthritis and since ginger has a number of health benefits, it is a good idea to consume ginger daily or to take ginger supplements.

Green tea extract may offer some help. It would not hurt to drink a cup of green tea a day. Some people may consider taking a g
reen tea extract supplement a few times a week.
Guggul has anti-inflammatory activity and may be helpful in some patients.
Pomegranate consumption. Isr Med Assoc J. 2011. Consumption of pomegranate decreases serum oxidative stress and reduces disease activity in patients with active rheumatoid arthritis: a pilot study.
Rose hips have shown benefits.
Lyprinol, a green mussel extract, has been found to be helpful.
Stop smoking
Gluten free diet may be tried
Chicken collagen may be helpful for rheumatoid arthritis.
Resveratrol - Z Naturforsch C. 2013. The influence of resveratrol on the synovial expression of matrix metalloproteinases and receptor activator of NF-kappaB ligand in rheumatoid arthritis fibroblast-like synoviocytes.

Rheumatoid arthritis exercise
For people with extensive damage in large joints from rheumatoid arthritis, high-intensity, weight-bearing exercise accelerates the progression of joint damage. Mild to moderate exercise programs to improve muscle strength and aerobic capacity are beneficial for people with rheumatoid arthritis. Progressive resistance training can help patients who experience muscle wasting. Generalized muscle wasting in rheumatoid arthritis is common although often masked by a concomitant increase in fat mass. Progressive resistance training is an effective treatment for this metabolic complication.
Regular sunshine exposure is of benefit.

Yoga improves hand grip strength in normal persons and in patients with rheumatoid arthritis, though the magnitude of improvement varies with factors such as gender and age.
Tai Chi is helpful

Curcumin
Curcumin and quercetin are antioxidant molecules with anti-proliferative, anti-inflammatory and immunosuppressive activities. The objective of this study was to investigate the inhibitory activity of these agents using four assays of inflammatory aspects of arthritis. Both curcumin and quercetin inhibited neutrophil activation, synoviocyte proliferation and angiogenesis. Curcumin strongly inhibited collagenase and stromelysin expression at micromolar concentrations whereas quercetin had no effect in this assay. These studies suggest that curcumin and to a lesser extent quercetin may offer therapeutic potential for the treatment of crystal-induced arthritis or rheumatoid arthritis. Inflamm Res. 2006. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver BC, Canada.

Fish oils and omega-3 fatty acids
Effects of n-3 fatty acids on serum interleukin-6, tumour necrosis factor-alpha and soluble tumour necrosis factor receptor p55 in active rheumatoid arthritis.
We investigated the effects of a low n-6 fatty acid (FA) diet supplemented with fish oil on serum pro-inflammatory cytokine concentrations and clinical variables in patients with active rheumatoid arthritis. Sixty patients were randomly assigned to receive a diet low in n-6 FAs and n-3 FAs supplement (fish oil group), a diet low in n-6 FAs and placebo (placebo group), or no special diet or intervention (control group). At week 18 the fish oil group had significant reductions in linoleic acid, C-reactive protein (CRP) and soluble tumour necrosis factor receptor p55 (sTNF-R p55), and significant elevations in eicosapentaenoic acid and docosahexaenoic acid compared with baseline. There were no significant differences in the clinical variables between the three groups. At week 24 there were significant reductions in interleukin-6 and TNF-alpha in the fish oil and placebo groups. Supplementation with n-3 FA and a low n-6 FA intake decreased serum sTNF-R p55 and CRP levels in patients with Rheumatoid arthritis. J Int Med Res. 2004.

Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis.
We undertook this study to assess the effects of omega-3 polyunsaturated fatty acids (PUFAs) (administered at ≥2.7 g/day) for a minimum duration of 3 months on clinical outcomes in patients with rheumatoid arthritis (RA). Our meta-analysis suggests that the use of omega-3 PUFAs at dosages >2.7 g/day for >3 months reduces NSAID consumption by RA patients. Arch Med Res. 2012.

Folic acid
Folate, homocysteine, and methylcobalamin status in patients with rheumatoid arthritis treated with methotrexate, and the effect of low dose folic acid supplement.
To investigate the effect of methotrexate (MTX) treatment of rheumatoid arthritis on folate metabolism, and to determine the effect of low dose folic acid on toxicity, efficacy, and folate status. A 52-week prospective study of 81 patients with rheumatoid arthritis  treated with MTX and self-administered low dose folic acid; 38 rheumatoid arthritis patients were included prior to MTX therapy, 33 rheumatoid arthritis patients continued established MTX therapy, and 10 rheumatoid arthritis patients were excluded. Drug efficacy and side effects were monitored with biochemical and clinical indicators. MTX treatment resulted in decreased concentrations of red blood cell (RBC) folate and a rise in plasma homocysteine. Intracellular concentrations of MTX were inversely correlated to RBC folate levels after treatment for a longer period (mean 41 months). Supplement with low dose folic acid prevented or diminished the influence of MTX on folate status and had a protective effect on MTX induced liver toxicity without changing the efficacy of MTX. MTX interferes with folate and homocysteine metabolism. Our results indicate low dose folic acid supplementation has a beneficial effect on MTX toxicity in rheumatoid arthritis patients. J Rheumatol. 2004.

Cat's claw herb
Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa (Cat's Claw) for the treatment of rheumatoid arthritis.
Forty patients undergoing sulfasalazine or hydroxychloroquine treatment were enrolled in a randomized 52 week, 2 phase study. During the first phase (24 weeks, double blind, placebo controlled), Rheumatoid arthritis patients were treated with UT extract or placebo. In the second phase (28 weeks) all patients received the plant extract. Twenty-four weeks of treatment with the UT extract resulted in a reduction of the number of painful joints compared to placebo (by 53% vs 24%). Rheumatoid arthritis patients receiving the UT extract only during the second phase experienced a reduction in the number of painful and swollen joints compared to the values after 24 weeks of placebo. Only minor side effects were observed. This small preliminary study demonstrates relative safety and modest benefit to the tender joint count of a highly purified extract from the pentacyclic chemotype of cats claw in patients with active Rheumatoid arthritis taking sulfasalazine or hydroxychloroquine. J Rheumatology. 2002.

Citrus, zinc may cut rheumatoid arthritis risk: study
Zinc and an antioxidant found in citrus fruit may lower the risk for rheumatoid arthritis a new study suggests, but the researchers say the findings are preliminary and there are still no well-defined risk factors for the disease. The researchers looked at nearly 30,000 women from the Iowa Women's Health Study. All had answered a food questionnaire in 1986 that assessed how much and how often they ate certain foods as well as their vitamin and supplement intake. Years later, there were 158 cases of rheumatoid arthritis among the women. The diets of those women were compared with those of study participants who remained free of the illness. The doctors found that women getting less than 40 micrograms of beta-cryptoxanthin, which is found in citrus fruits like oranges and grapefruit, were at a slightly higher risk of developing rheumatoid arthritis than women who consumed more than that amount. When they looked at the amount of zinc in each woman's diet, they found that those who took zinc supplements had a lower risk of rheumatoid arthritis. But getting an equivalent amount of zinc from food was not associated with decreased risk. Their results are published in the February issue of the American Journal of Epidemiology. American Journal of Epidemiology 2003;157:345-354.

Rose hip herbal remedy in patients with rheumatoid arthritis - a randomised controlled trial
In a double-blind placebo-controlled trial, patients with rheumatoid arthritis (RA) according to ARA/ACR criteria were randomised to treatment with capsulated rose-hip powder 5g daily or matching placebo for 6 months at two outpatient clinics in Berlin and Copenhagen. Primary outcome variable was Health Assessment Questionnaire (HAQ) at 6 months, secondary outcome included DAS-28, physician's global evaluation of disease activity, RAQoL, SF-12 and concomitant pain medication. In a total of 89 patients (90% female, mean age 56) HAQ-DI in the rose-hip group improved, whereas in the placebo group it worsened. In the HAQ Patient Pain Scale no significant differences were observed between both groups. In the HAQ Patient Global Scale a trend was seen favouring rose-hip. The Physicians Global Scale demonstrated more improvement in the rose-hip compared to the placebo group. The results indicate that patients with RA may benefit from additional treatment with rose hip powder.Phytomedicine. 2010. Willich SN, Rossnagel K, Roll S, Wagner A, Mune O, Erlendson J, Kharazmi A, S÷rensen H, Winther K.Institute for Social Medicine, Epidemiology and Health Economics, CharitÚ University Medical Centre, Berlin, Germany.

MSM
Email - I am a 38 year old woman who has been dealing with Rheumatoid Arthritis since my child bearing years. I started seeing an rheumatoid arthritis doctor about 7 years ago and had been using a Naproxen prescription since then for pain, inflammation, morning and night stiffness. Not wanting to continue taking Naproxen for recent concerns about its safety. I started taking MSM advised by my mother who recently was diagnosed with Rheumatoid Arthritis. I have been taking 3 grams of MSM in the morning and night for the past 3 months with no need for addition pain medications. I am truley amazed at the results I've had. If anyone has had chronic pain from arthritis like I have had it is worth trying MSM.

Supplements that are not effective rheumatoid arthritis treatments
Taking vitamin E supplements does not reduce a woman's risk of rheumatoid arthritis. Arthritis Care and Research, November 15, 2008.

Role of alcohol
In a study that followed 2,900 adults with rheumatoid arthritis, Swiss researchers found that light-to-moderate drinkers showed slower progression in their joint damage compared with non-drinkers. Heavy drinkers, on the other hand, showed the greatest progression. Dr. Axel Finckh, of University Hospital of Geneva, one of the researchers says the findings are in line with past research linking moderate drinking to a lower risk of developing RA. There is also animal research suggesting that alcohol may inhibit arthritis, possibly by reducing inflammation. Heavy drinking, on the other hand, seems to promote inflammation. The study by Dr. Axel Finckh, of University Hospital of Geneva, was published in Arthritis & Rheumatism, 2010.

Causes
Rheumatoid arthritis can also produce a variety of symptoms throughout the body. The exact cause of rheumatoid arthritis isn't known, but many different factors, including genetic predisposition, may influence the autoimmune reaction. Usually, rheumatoid arthritis first appears between 25 and 50 years of age, but it may occur at any age. In some people, the disease resolves spontaneously, and treatment relieves symptoms in three out of four people; however, at least 1 out of 10 people eventually becomes disabled. is different than rheumatoid arthritis.
Half of the risk is attributable to genetic factors. Smoking is the main environmental risk. Air pollution and smog exposure is starting to be recognized as a factor.

Traditional treatment of rheumatoid arthritis
This ranges from simple, conservative measures such as rest and adequate nutrition to drugs and surgery. Treatment starts with the least aggressive measures, moving to more aggressive ones if needed. A basic principle of rheumatoid arthritis treatment is to rest the affected joints, because using them aggravates the inflammation. Regular rest periods often help relieve pain, and sometimes a short period of total bed rest helps relieve a severe flare-up in its most active, painful stage. Splints can be used to immobilize and rest one or several joints, but some systematic movement of the joints is needed to prevent stiffening.  RA increases the risk of developing potentially fatal blood clots in the legs and lungs.

Rheumatoid Arthritis Treatment - Drugs - Medication
The main categories of drugs used to treat rheumatoid arthritis are non-steroidal anti-inflammatory drugs (NSAIDs), slow-acting drugs, corticosteroids, and immunosuppressive drugs. Generally, the stronger the drug, the more severe its potential side effects, so that closer monitoring is needed. Treating rheumatoid arthritis with "biologic" immunosuppressive drugs, such as TNF-blockers, neither increases nor decreases the risk of heart attack or stroke compared with use of methotrexate, the most commonly prescribed drug for rheumatoid arthritis. As of 2013, information indicates that the standard and older use of medications is as good as the costlier and newer ones.
   Although jewelry may be the first thing that springs to mind when someone says "gold", injecting a liquid form of the metal can help people with rheumatoid arthritis. In fact, gold therapy has been around for a while, and now new research shows it can be effective when combined with another treatment. In the study, reported in the journal Arthritis & Rheumatism, gold therapy reduced the severity of arthritis in patients who had a poor response with methotrexate, the standard drug used to treat the disease.
   Even if an initial course of methotrexate for the treatment of rheumatoid arthritis gives disappointing results, persistence may pay off. A second course may be more successful. Many patients continue to have active disease in spite of intensive therapy with disease-modifying antirheumatic drugs (DMARDs).
   Two biotech drugs used to treat rheumatoid arthritis -- Abbott Laboratories Inc.'s Humira and Johnson & Johnson's Remicade -- may raise the risk of cancer and infections.

Disease-modifying antirheumatic drugs (DMARDs) reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumor necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents.

Danger of rheumatoid arthritis medications
The use of certain rheumatoid arthritis medications can harm the immune system. Invasive fungal infections can occur in patients taking tumor necrosis factor-alpha blockers (TNF blockers), certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). The FDA has received reports of patients developing pulmonary and disseminated histoplasmosis, coccidioidomycosis, blastomycosis and other opportunistic infections while taking TNF blockers.

TNF-blockers used to treat rheumatoid arthritis may lead to psoriasis. Annals of the Rheumatic Diseases, February 2009.

Post-marketing surveillance reports indicate that TNF-blockers such as infliximab, etanercept, adalimumab, certolizumab, and golimumab increase the risk of haematological and other cancers and psoriasis in children, adolescents, and adults.

Some patients who take the anti-rheumatic drug Arava (leflunomide) develop peripheral neuropathy, a nerve problem that involves numbness, tingling or pain in the hands or feet.

Newer drugs like Enbrel and Remicade may lead to the development of an inflammatory disorder of blood vessels, usually affecting the skin. The rheumatoid arthritis drugs, called TNF blockers, have been linked to a condition called leukocytoclastic vasculitis, or LCV.

Cimzia, Enbrel, Humira, Remicade, and Simponi all inhibit a natural protein called tumor necrosis factor alpha (TNFa). TNFa plays a major role in arthritis. It also plays a major role in protecting the body from infections and cancer and therefore their use may increase the risk for some forms of cancer.

Steroid use
Patients who are treated with low-dose of the steroid prednisone have an increased risk of coming down with pneumonia. Most other drugs used to treat arthritis don't have this drawback. Prednisone, a steroid, tends suppresses the immune system and at high enough doses this could increase the chances of infection. Even though prednisone is commonly used to treat arthritis patients, there have been no studies looking at it's effect on the risk of pneumonia -- which is one of the major causes of death in patients with rheumatoid arthritis. The most common treatments for rheumatoid arthritis are methotrexate, prednisone, Remicade, hydroxychloroquine and Enbrel. There appears to be no significantly increased risk associated with so-called TNF-blockers -- Remicade, Enbrel or Humira -- or with methotrexate, hydroxychloroquine or sulfasalazine. Prednisone use is common in rheumatoid arthritis and is therefore a potentially important health risk. Arthritis & Rheumatism, February 2006.

Rheumatoid arthritis symptom
Common symptoms include fatigue, weight loss and anemia. Affects about 2 million Americans, three times more women than men. Symptoms of rheumatoid arthritis are different than symptoms of osteoarthritis. Osteoarthritis and rheumatoid arthritis.
     Rheumatoid arthritis sets a body at war with itself, as white blood cells attack healthy tissue in the joints. The cost of that war may be greater than previously thought: people with rheumatoid arthritis are twice as likely to die of heart disease.

Pregnancy
Women who give birth have a lower risk of developing this joint condition than women who remain childless -- though the potential protective effect seems to fade over the years. Arthritis & Rheumatism, 2010.

Rheumatoid arthritis Research studies
Increased blood levels of C-reactive protein (CRP), a marker for inflammation, are seen long before symptoms of rheumatoid arthritis appear.

Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome.
University of Manchester Medical School, Oxford Road, Manchester UK. Best Pract Res Clin Rheumatol. 2002.
There is some evidence that Rheumatoid arthritis may have been brought from North America to Europe during the 18th century. Its arrival in rural parts of the developing world is still more recent. The incidence and prevalence of Rheumatoid arthritisvappear to have fallen in Europe, North America and Japan in the last 50 years. During this time the peak age of onset has risen. Risk factors for the development of Rheumatoid arthritis include genetic factors, an adverse pregnancy outcome, smoking, obesity and recent infections. The oral contraceptive pill and some dietary constituents may be protective. Older age and female gender are risk factors both for the development of Rheumatoid arthritis and for a worse outcome. This risk factor profile offers some opportunities for primary and secondary prevention. However, treatment is the greatest determinant of Rheumatoid arthritis outcome.

Influence of co-administrated sinomenine on pharmacokinetic fate of paeoniflorin in unrestrained conscious rats.
J Ethnopharmacol. 2005.
Paeonia lactiflora root( Chinese Peony ) and Sinomenium acutum Rehder and Wilson stem are two herbs widely used in Chinese medicine to treat rheumatoid arthritis.

Emails
I have been diagnosed with rheumatoid arthritis multiple joint failure. While I was in the USA, I was taking prescription medicine namely Arava. I was only getting relief from it with many side effects. I decided to go to Vietnam. I have been living here since 2 years ago. Since I first came, I started taking natural traditional herbal medicine made up of roots, barks, leaves, insects, snake skin, etc. This medicine helped me get my feet back on the ground. However, I always had the need to continue taking pharmaceuticals every other day, like Vioxx and later Mobic. Since I began taking turmeric as a juice mixed with other fruits, I have no longer the need to take Mobic. That was a month ago.
   I appreciate you sharing this with us, please keep us updated on your progress.

I was going to buy a cream for rheumatoid arthritis that contains pregnenolone along with glucosamine and emu oil. Does the pregnenolone really help with rheumatoid arthritis.
   I have not seen studies with pregnenolone in cream form for rheumatoid arthritis, so I can't say.

I combined maca herb with pregnenolone but my rheumatoid arthritis got worse.

My wife is now on methotrexate because of RA. When I was sorting my old books, I found your book on pregnenolone that refers to its use for RA. I visited your website but it does not talk pregnenolone for RA. She now wants to try it. Would you give us any advice on the use?
    There are quite a number of other supplements to try before resorting to hormones. If nothing else works it may be worthwhile to try a low dose of 5 mg of pregnenolone, but I have not seen any recent studies regarding the benefits and risks of this hormone as a treatment for RA. Also, it is not clear how it would interact with medications used for this condition.

My wife has just been diagnosed with severe rheumatoid arthritis. Can you tell me what you know about injectable peptides from Belguim as a treatment for RA. She cannot take the allopathic perscription drugs because some of her past illnesses could be activated.
    I have not studied the topic of injectable medications from Europe and I am not familiar with Belguim.

I started taking LubriSyn to help with RA and it's been working wonderfully. About a month into it I started getting a chicken pox-like rash on my neck and shoulder. I brushed it off thinking it was dry winter skin until I lapsed in taking the hyaluronic acid. The rash started to go away and went out of my mind until I started taking it again. I'm 18 days into taking the LubriSyn hyaluronic acid and that rash sparked back up. I've never been allergic to a thing in my life, I'm one of those folks who can roll around in poison ivy and be just fine.