Rheumatoid Arthritis

• Spontaneous remission – These symptoms disappear, and are only found in people whose blood tests are negative for rheumatoid factor, which is a protein, an autoimmune mediator.
• Relapsing/remitting disease –These patients experience flare ups of symptoms, which have episodes of mild to no symptoms, and occurs early on in the course of the disease.
• Persistent and progressive disease – Disease gets progressively worse, flare ups and periods of remission are not as common as with relapsing/remitting disease. This is the most common cause.
• Rheumatoid arthritis can cause permanent damage to some tissues in the body, especially the joints.

• When suffering from RA, your immune system mistakenly attacks healthy cells and tissues, specifically the soft tissue between the joint capsule and joint cavity of the joints.
• The immune system then causes a destructive fibrous tissue in the affected joints, which erodes the cartilage and worsens joint function.
• RA damage is caused by components in the immune system by antibodiesand killer T-cells.
• Antibodies are proteins that recognize and bind to invading cells, like bacteria and viruses. Which then activate other components in the immune system and start an inflammatory response, and destroy cells. Once the antibodies attach to the cells in the joints, and cause an inflammatory response, this damage spills over into the cartilage cells that cushion joints.
• Killer T cells kill other cells directly, they destroy invading microbes, and in RA cause tissue damage by damaging joints and other affected organs.
• Arthritis is when collagen is exposed, and then deteriorates cartilage, and gets attacked by the immune cells and promotes more inflammatory joint destruction.
• Joints may become permanently weakened or deformed if the inflammation is severe, chronic and over a long period of having RA.

• When the immune system sends inflammatory Chemicals through the body, the results are widespread damage.
• Patients may experience, fatigue, discomfort and unexplained weight loss.
• RA may target these areas too, skin, lungs, eyes, blood, nervous system, heart and bones.

• Skin – Nodules and ulcers appear on the surface of the skin
• Lungs – Lung disease of some form, with a dry cough and shortness of breath, and could worsen after physical activity
• Eyes – Inflamed eyes are common, parts of the eyes that are affected cornea, conjunctiva and the white portion of the eye
• Blood – Anaemia and low iron levels cause fatigue, increased heart rate, dizziness and pale skin
• Nervous system – Degeneration of cervical vertebrae in the neck, compresses the spinal cord in the neck, which causes a lot of pain from the inflammation caused.
• Heart – People who suffer from RA have a higher risk of heart disease, this is due to an increase of circulating inflammatory molecules. This targets the lining inside the blood vessels.

• Bones – People who suffer from RA have higher risks of bone fractures. Due to the medications used to treat the disease.
• Dislipidemia – This is elevated lipids and triglycerides in the blood. People who have this problem as well as family history of RA, need to monitor their health closely. As this could compromise the cardiovascular health in RA patients.

• Is any inflammation present,
• Or is an autoimmune response occurring 

Number and site of joints involved

• Range point; 0-5
• Score calculation; Add 1 point per joint involved
• Definition; Any joint that is inflamed
• Test; Physical exam, patient report, or imaging of the joint

Abnormal blood test results

• Range point; 0-3
• Score calculation; 0=Normal 1=Abnormalities present at low level2=Abnormalities present at high levels
• Definition; High or low levels present/absence of RF/ACPA, high score is autoimmunity
• Test; Blood test done by a laboratory

Elevated acute phase response

• Range point; 0-1
• Score calculation; 0=Negative 1=Abnormal
• Definition; Abnormal means CRP/ESR high scores are inflammation
• Test; Blood test done by a laboratory

Symptom duration

• Range point; 0-1
• Score calculation; 0=Symptoms persist for less than 6 weeks 1=Symptoms persist for longer than 6 weeks
• Definition; Symptoms that are there for more than 6 weeks indicate RA
• Test; Monitored by doctor and patient reports

• To prevent and control joint damage
• Prevent loss of function
• Decrease pain levels
• Early diagnosis is important
• Conventional medicine is a mix of strong pharmaceuticals, which slow down the process, to provide relief of pain to people.
• Could cause side effects that may reduce the quality of life.
• These medications should be started as soon as diagnosis is confirmed.

• These medications decrease joint inflammation and slows down the damage caused to joints
• There are two types Conventional and Biologic:
  • Conventional – They are chemically made and slow down the immune system
  • Biologic – They are genetically engineered and target specific molecules in the immune system. These are considered as second-line drugs
• Glucocorticoids – Suppress both inflammation and activity in the immune system cells. Glucocorticoids today are prednisone. These drugs are affective but also have side effects:
  • Osteoporosis
  • Eye disease
  • Insomnia
  • Weight gain
  • Increased risk of infection
  • Can affect the quality of life
• When these drugs are injected into the joint, the benefits are only temporary.
• Chrono therapy – This is a new method of Prednisone to be administered. Prednisone is taken at bedtime, and gets released into the blood stream at about 2am, which helps to target the inflammation that peaks around midnight. This in turn reduces Morning stiffness, and slows down the levels of inflammation, compared to conventional Prednisone.

• Helps to reduce inflammation and pain, which contributes to swelling and pain in joints.
• These medications could have gastrointestinal side effects like pain and bleeding.
• Example of these are Aspirin which inhibit the blood to form blood clots.
• Statins – These drugs effectively lower cholesterol levels, and reduce heart attacks in people with Rheumatoid Arthritis. It is important to keep cholesterol levels healthy. The side effects of these drugs are that it breaks down muscle tissue, and depletes Coenzyme Q10, which you need for basic cell function.

• Stem cells can divided and reproduce, or differentiate into specialised cells.
• These cells can be treated in laboratories to develop into cartilage, bone, muscle cells, which get damaged due to inflammation from RA.
• This treatment is only used in the most severe cases.

• People with RA have a higher tendency to be allergic to some foods and be more sensitive.
• Reactions that start in the gut may flair up symptoms of RA sufferers.
• RA patients have shown that they make more intestinal antibodies against a variety of foods than healthy controls.
• Vegetarians, vegans and gluten-free diets have shown to relieve symptoms in RA patients.
• Avoiding foods with high IgG antibodies, can alleviate RA symptoms.
• Low-cost IgG blood testing can help pinpoint problematic foods.

• T-cells distinguish between “self” and “foreign” molecules.
• When these cells are exposed to those found in joint collagen, they react violently and cause a big inflammatory response and destroy the protein.
• By putting collagen into the digestive tract we can “learn” our T-cells to ignore collagen when they are found at the joints. This is called oral toleranceto collagen.
• By doing this the oral tolerance could be effective in easing the inflammatory rheumatic processes.

• Oestrogen is pro-inflammatory, while progesterone, androgens and glucocorticoids are anti-inflammatory.
• Testosterone and progesterone function is to promote the immune tolerance in males and females.
• Adequate levels of progesterone is needed to balance excess oestrogen in woman, and adequate amount of testosterone in men can change some underlying symptoms of RA.

• Fatty Acids
  • Polyunsaturated fatty acids are from marine sources, and are recommended for RA patients.
  • Reduces inflammation and strengthens cardiovascular health, and soothes overactive immune systems
  • Two main types Omega-6and Omega-3
  • It’s important to maintain the correct balance between the two.
  • If the Omega -6 is too high in the body then it becomes pro-inflammatory, which is the reason why RA patients should get enough Omega-3 fatty acids.
  • Omega-3 in fish oil form helps reduce inflammation, pain and symptom related to RA
  • These fatty acids are effective for controlling morning stiffness
  • Fish oil improves cholesterol and triglycerides and reduces the risk of cardiovascular risks.
  • Krill oil– It reduces arthritis scores and swelling
  • Gamma-linoleic acid– Omega-6 fatty acid found in plants. Symptoms of RA are reduced a lot by taking Omega-6, and less of the joints were painful and degree of swelling much less.
  • Blackcurrant seed oil – Improved the symptoms of RA
  • Borage seed oil – Plant seed rich in BLA, which helps with RA. Decreases levels of cholesterol, LDL, triglycerides and increased HDL levels
  • Evening primrose oil– Those that use this supplement have less morning stiffness and pain.

• Vitamins
  • Vitamin D – breaks down damaged immune cells, and supercharges protective cells
  • T-reg – a component in the immune system that balances the immunity. A low amount of these will cause the immune system to become overactive and cause RA for example. Vitamin D increases the protective T-reg cells balancing out an overactive immune system.
  • Vitamin B6 – There is a deficiency of Vit B6 in people with RA, which cause more severe symptoms.
  • Folate – In people with RA there is a deficiency due to the medication methotrexate, as it depletes folate in the body. Thus making Folate supplementation in RA patients beneficial.
• Plants and derived compounds
  • Andrographis – Has a powerful anti-inflammatory effect.
  • Curcumin – Antioxidant compound found in Turmeric. It reduces inflammatory state of cells, and stops production of pro-inflammatory proteins, and the activation of cells with inflammatory properties.
  • Curcumin helps to protect cartilage from inflammation and being damaged, promotes cartilage regeneration. Patients who take curcumin as well as methotrexate, decrease their risk of liver toxicity.
  • Quercetin - It is a flavonoid rich in fruits and vegetables like, apples, citrus fruits, parsley, sage and onions. It decreases inflammation and activates the pro-inflammatory cells.
  • Boswellia serrata extract –This tree contains a powerful anti-inflammatory compound that improves joint flexion, reduces swelling and protects joints from cartilage being broken down from inflammation that’s caused from RA.
  • Pomegranate – Has strong antioxidant properties, which helps improve the tender joints when supplementation is consumed.
  • Green tea – It has health promoting properties, as well as anti-inflammatory and antioxidant effects help optimize lipid functions. It helps to reduce inflammation in the joints in people with RA.
  • Ginger – anti-inflammatory and antioxidant properties, which reduces inflammation, and blocking the production of pro-inflammatory proteins.
  • Nigella sativa seeds – People with RA taking this seed oil, has shown that they experience an improvement in their symptoms.
  • Beta-sitosterol and beta-sistosterol glucoside– Helps to protect the immune system and suppress excess inflammation. It has been proven that the inflammatory tendency of blood is also decreased.

• SAMe – Helps improve symptoms of osteoarthritis, liver disease and depression. Helps with the production of cartilage, which can be destroyed by chronic inflammation of RA.
• Glucosamine – Has anti-inflammatory properties. Suppresses the production of pro-inflammatory cells, thus reducing RA symptoms.
• Chondroitin sulphate – Is a component of cartilage. When taken as a supplement it helps fight inflammation and rebuilding of cartilage. It is also healthy for the heart.

• This is an important component of maintaining muscle mass and supporting a healthy heart, as well as preventing joint damage. It is important for exercise especially for people with RA.
• Aerobic exercise– like swimming, walking and bike riding improves the overall health and quality of life in patients with RA and it also helps to reduce the pain. It also helps to improve cardiovascular health. High intensity exercise does not increase pain but improves inflammation and joint damage.
• Strength training– Like weight lifting – applies resistance to various muscle groups and improves muscle strength. Strength training reduces pain and improves function in patients with RA.