Rheumatoid arthritis (RA) - diagnosis and treatment
In some ways the body is not very clever. The immune system can only react in one way, that is with inflammation. Nearly always this inflammation is helpful. But sometimes it is unhelpful; indeed, positively destructive. This is the case with Rheumatoid Arthritis (RA). RA is a "useless" inflammation of joints - see Inflammation
Rheumatoid arthritis could be a classic example of a lectin disease - see Lectins Lectins are natural toxins within plants to try to make them poisonous - this prevents animals from eating them. Because humans have got such a good digestive and detox system they can eat a wide range of plants. However if this fails then lectins can become a clinical problem. They are found in the highest amounts in wheat, potato, tomato and pulses. Another possibility is that RA is another example of molecular mimicry (see Ankylosing spondylitis). With RA there is a cross-reaction between proteus mirabilis (a common cause of urinary infections) and the joints. This explains why RA is more common in women because urinary infections are more common in women. This would be a good reason to try high dose probiotics to try to change the gut flora since proteus mirabilis is not a normal part of the gut flora.
- The joints show signs of inflammation: heat, pain, swelling, redness and loss of function.
- Hands and wrists commonly affected, then feet, knees and ankles, but can be any joint.
- It is the proximal metacarpal joints and the metacarpo-phalangeal joints (DIPs and MCPs) often affected - the former result in fusiform swellling, the latter in lateral dislocation of the joints.
- Both sides often equally affected - this is a symmetrical arthritis.
- Often there is joint and muscle stiffness which is worse in the morning and improves as the day progresses. Patients will tell me they have to "warm up" in the mornings, sometimes need a hot bath to get going but by the end of the day are moving better.
- Often patients do not feel well.
- Blood tests usually show signs of inflammation (ESR, plasma viscosity, C reactive protein) are raised.
- Blood tests are positive for rheumatoid factors.
- Associated with a tissue type HLA D4 and HLA DR4.
- Later on there are characteristic X ray changes.
- Later on there are characteristic joint changes.
So my treatment for rheumatoid arthritis would be to start with Arthritis and the general approach to maintaining and restoring good health.
I would also use bolt on extras as per the Inflammation.
All my RA patients must do a Stone Age Diet to reduce the major allergens - In fact, more often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds. But I have a low threshold for starting enzyme potentiated desensitisation (EPD) because of delayed reactions, multiple reactions and the possibility of bacterial allergy being a problem.
Physiotherapy is very important to keep joints mobile and keep muscles as strong as possible. Muscle wasting is a real problem in RA. Because exercise is painful many sufferers do no exercise, but 12 minutes a week is possible for all and highly beneficial See Exercise.
These are largely preventable with good nutrition:
- RA patients tend to get anaemic. See Anaemia
- RA patients are at increased risk of Osteoporosis.
- Increased risk of infection - this probably reflects the fact that the immune system is not functioning properly. See Infections - who gets them and why
RA patients can get complications involving the heart, lungs, arteries, eyes etc., which is why specialist treatment should always be sought.
Update Oct 2001
I have just found a website which looks at treating inflammatory arthritis with antibiotics. This makes sense if the cause is molecular mimicry. See ROAD BACK FOUNDATION.
Update August 2003
There is a very informative website about all forms of arthritis, some available treatments, advice for self-help etc. Have a look at THE ARTHRITIS AND GLUCOSAMINE INFORMATION CENTRE.
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