What is rheumatoid arthritis and what causes this ailment

By rheumatoid arthritis there is an inflammation of the joints. The core process of the inflammation is an attack by the immune system at the joints and especially the inner lining of the joints, the synovial membrane. The damages done to the synovial membrane make the membrane overreact and it grows much more than what is necessary to repair the damages.

The synovium thickens greatly and grows into adjacent structures. The over-active synovium also makes enzymes that erode cartilage structures and bones. Thereby the joints gradually swell, gets disconfigured, gets out of alignment and gets dysfunctional.

In 2003, reports indicated that over 2.1 million americans are affected with rheumatoid arthritis, a disease that not only affects the joint sytem, but also the nervous system, the eyes, the heart and the lymphatic system. While rheumatoid arthritis usually affects the mid-aged population, occurance in the 20's and 30's is also common.

Rheumatoi arthritis often occur together with other autoimmune rheumatic diseases and there are many cases of rheumatism that cannot easily be classified as Rheumatoid arthritis or another rheumatic disease because the charactiristics are blended.

A variant of rheumatoid arthritis also often occur together with the skin disease psoriasis.


Symptoms of rheumatoid arthritis

An important early symptom by rheumatoid arthritis is stiffness, especially in the morning and after a period of rest. The stiffness often alleviates when one have been in motion some time. Other early symptoms are fatigue, loss of weight, influenza-like feelings in the body and fever. These early symptoms can last a long time, sometimes several years before other symptoms occur in any degree.

Other important symptoms of rheumatoid arthritis that usually come after some time are: Swelling of joints, pain in joints and reduction of range of movement. Later there may be permanent abnormal joint angles, misconfiguration of greater parts, and total joint immobility. Only when some of these other symptoms are recognized and been there in at least six moths, can the diagnosis rheumatoid arthrites be certified.

These other symptoms are most usual and use to come first in the hands and fingers, especially in the inner finger joints, but all joints in the body can be attacked with visible inflammation. The attacked joints are often warmer than normal, as if there is localized fever. The inflammation in the joints use to be symmetrically placed in joints at both sides of the body.

Fluid can gather in a join and the area nearby and make a big cyste, especuially by the knees where the cyste is ofrten localized at the backside of the knee, Baker's cyste.

About 20% of the patients get lumps under the skin, rheumatic noduli, that can remain small but also grow. These are caused by inflammation in small blood vessels. The noduli can be painful.

There can also also inflammatory symptoms from other organs, like the heart, the eyes, the lymph system or nervous system.

The disease is found in any grade of seriousness, from just annoyng to totally delibitating and life-threatening.


Rheumatoid arthritis by children

By children rheumatoid arthritis often begins with high fever, shivering and with pain and swelling in many joints. There is also often a rash in the skin. The inflammation often also attcks other organs like the heart and the lungs.


Complications of rheumatoid arthritis

Rheumatoid arthritis can make the joints deformed, not only swallen and thickened, and thus getting the limbs out of normal alignment.

The disease can erode cartilages and bones and this will add to the deformation of the jointes and to the misalignment of the limbs. Sometimes the disease makes the bones generally brittle due to decalcification, so-called osteoporosis.

The inflammation by rheumatoid arthritis is not only confined to the joints, but reach to some extend many organs. Sometimes the inflammation of other organs makes painful or serious complication, like anemia, destruction of blood vessels, heart sack inflammation and sometimes heart failure, complications in the eyes, inflammation in the lungs, and central nervous affection with cognitive problems.

Sometimes a type of insoluble protein called amylid is depsited in many body tissues as the result of rheumatoid arthritis. Amyloid consists of fragments of immune system proteins. The material deposited causes functional impairments in the affected organs, and the symptoms will therefor vary very much. Amyloidosis is a very serious complication.


Diagnosis of rheumatoid arthritis

The disease is diagnosed by a blood test and x-ray of the swollen joints. By the blood tests one looks for antibodies against constituents of the joints.

One of the antobodies tested for is rheumatoid factor. This antibody is actually an antibody against a part of another antibody, the Fc portion of IgG. The diagnosis can be difficult because the disease can long have symptomes and clinical signs shared by many other diseases.

There also often occur conditions that are bledings of rheumatoid arthritis and other rheumatic diseases or that cannot be classified according to strict diagnostic criteria.


The causes and mechanisms of rheumatoid arthritis

The causes of the disease are not fully known. There is an auto-immune reaction against the bodie's own tissue, and especially against the connective tissue in the joints and the epitelial tissue inside the joints - the synovial membrane. There also seem to be some heriditary factor predisposing for the disease, and there may be a virus infection present.

Studies have shown that also toxic metals such as mercury, cadmium, and lead could be contributing factors for the onset. It has been reported that these toxic metals deplete collagen supplies in the body, weakening the joints and making them susceptible to RA.

People suffering from the skin disease psoriasis often also get a sort of rheumatoid arthritis. Both diseases seem to be caused by some primary attack from the immune system upon tissue components, and then the repairing actions of the tissue is over-reacting and causes excessive proliferation of cells and thickening.

The synovial membrane react to the causing factors by thickening and sometimes growing to immense dimmensions, and sometimes also by growing into surrounding structures which then are destroyed. Thus the cartilage of the joint and also the ends of bones and muscles can be eroded away. Connective tissue from the walls of the joints also will proliferate and blend itself into the thickened synovial tissue.


Farmacological treatment for rheumatoid arthritis

There are many types of treatment used against the disease. No treatment is able to cure the disease, but with a clever combination of therapy modules, the disease often can be well controlled. By this disease there is no standard way of treatment. Each case have to be treated individually. These treatment modes are in use:

ORTOPAEDIC DEVICES: Use of splints, crouches or braces may be iecessary to help stand and move properly and no keep affected joints from being over-loaded.

PAIN MEDICATION: You can use pain relievers such as acetaminophen (e.g., Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil) to reduce the pain caused by many rheumatic conditions. NSAIDs have the added benefit of decreasing the inflammation associated with arthritis. A common side effect of NSAIDs is stomach irritation, which can often be reduced by changing the dosage or medication. Newer NSAIDs have been introduced to reduce gastrointestinal side effects and offer additional options for treatment.

ANTI-INFLAMATORY MEDICATION: Doctors use anti-inflammatory medication admistered orally or by injection, both of non-steroid and steroid type. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil) are often the first approach or used on a permanent basis. Steroidal drugs, such as prednisolone, are used by serious affection or in a shorter period to beat down the effects of the disease.

Pharmacological anti-inflammatory drugs against rheumatoid arthritis decrease the action of the immune system. Thereby they also tend to decrease the restistance agsinst infections. Therefore it is necessary to use these drugs cautiously.

NEW IMMUN SYSTEM MODULATING AGENTS - New agents that modulate the behaviour of the immune system, mostly reduceing some immunological actions, has come to use against rheumatoid arthritis. The differnce between these drugs and more traditional drugs are the modulation of only specific processes in the immune system. Among these are blockers of tumor necrosis factor and the signal substance interleukin-1. These drugs are useful where other means do not help very well.

MYOCRISIN: Mycocrisin is an organic gold compund, sodium aurothiomalate. A solution of the compound is used as injections intramuscularly weekly for some months and therefter monthly injections. The compund alleviates the inflammation in the joints. The compund is an old drug against rheumatoid arhritis that has gained new popularity. The working principle of this drug is not well known, but it seem to work as a cytostaticum to some extend. Therefore it can hurt organs like the kidneys and the liver if it is not used with caution.

CYTOSTATICA: Cystostatica is sometimes used in severe cases. The cytostatica hinders the prliferation of immune cells that attack the joints and the proliferation of cynovial cells that thickens the synovium. A cytostaticum often used is methotrexate.

IMMUNOSUPPRESSIVE DRUGS: For severely active RH immunosuppressive drugs, that is drugs that significantly suppress the whole action of the immune system, are sometimes used. Such a drug is cyclosporine. Cyclosporine is often combined with the cytostaticum methotrexate.


Surgery and radiation therapy for rheumatoid arthritis

SURGERY: Surgery is performed sometimes to remove sick synovial tissue and to reconstruct the joints. When the inflamed synovium has been removed, new and usually health synovium grows back again from the rims. By extensive destruction of a joim, the bone ends and artificial joint mechanisms are sometimes set in.

RADIATION THERAPY: Radoation therapy in low doses have ocationally been used agsinst RH some time. One mode used is injectio of radioactive agents in the joit, another mode is distant irradiation with x-rays. The results of such therapy are uncertain.


Natural means to treat rheumatoid arthritis

PHYSICAL THERAPY: Massage, thermotherapy and other physical therapies to increase the joint mobility.

EXERCISES: Gymnastic exercises and sport activities adjusted to the condition should be done. Exercise cathegories reccomended are: Stretching exercizes to increase mobility, exercises that loads the muscles to increase strength and aerobic exercises to increase general condition and well-being. Swimming in warm swimming pool has a directly theraputic effect, strengthens muscles, improves condition and improves mobility.

SLIMMING: It is important to reduce or cure over-weight in order to increase mobility and decrease the load on the joints.

REST: Enough rest is important so that affected joints are not over-loaded.

BALANCE BETWEEN REST AND EXERCISE: It is important to find the right combination of excercise and rest.

ANTI-INFLAMMATORY NUTRIENTS: Anti-inflammatory nutrients, for example certain essential fatty acids like omega-3 poly-unsaturated acids and mono-unsaturated fatty acids should be a part of the daily diet. To get these nutrient you should eat fat fish, use flax oil and olive oil. Much raw or carefully cooked vegatables are useful.

REDUCING INFLAMMATORY TRIGGERS IN THE DIET: Reducing the amount of nutrients in the diet that trigger inflammation, for example omega-6 poly-unsaturated fatty acids will be useful. You will however need some of these acids. If you eat very much bread and cereals, it may be useful to reduce this amount, but not stop eating cereals. You should reduce the amount of oils like soy oil, sunflower oil, corn oil and the like.

TOTALLY AVOIDING SOME TYPES OF NUTRIENTS: You should totally avoid certain nutrients that are very potent triggers of inflammation, for example trans-fat found in margarine, snacks, cookies and other pre-maid food. Also make your food from natural ingredients. Do not trust fast food or any ready made food, since these often are full of inflammatory triggers.

FASTING AND VEGATARIAN CURES: Some sufferers get dramatically better by having a short period of fasting and thereafter having a vegetarian diet with much raw food for some time. However such a strict regime is not good as a permanent diet.

HERBAL SUPPLEMENTS: You can find herbal supplements on the market to help for rheumatoid arthritis. Such supplements are more general in action than pharmacological products, and may also help against other rheumatic diseases. Supplemets for these purpose often contain the herbs boswellia serrata and turmeric.



The working principles of natural drugs against rheumatism

Natural drugs against rheumatism can either be topical to be smeared at the affected areas or oral. Oral drugs will be distributed to the whole body, and since rheumatism to some extend affects the whole body, this will be useful.

Topical remedies will affect rheumatism by stimulating the nerves in the skin over the affected area, and by penetrating into the tissues to work there. They have the advantage that one can obtain a great concentration of effective components in the affected areas without letting these components affect body areas where they are not needed. Often it is useful to combine oral and topical products.

Most rheumatic condition has inflammation as a main component. Therefore these products contain herbs or substances to reduce inflammation.

Among the best-known herbs with anti-inflammatory herbs are: Camomile (Matricaria recutita), Turmenic (Curcuma longa), Ginger (Zingiber officinale), Licorize (Glycyrrhiza glabra), (white willow) Salix alba, Cats Claw (Uncaria tomentosa) and Boswelia species.

Also many essetial fatty acids have an ability to reduce inflammation. Most omega-3 fatty acids have this ability. Gamma-linoleic acid, which is an omega-6 acid has good inflammatory reduction abilities by rheumatoid arthritis. Most other omega-6-acids, however, tend to increase inflammation.

By rheumatic conditions, tissue are distroyed. Herbal remdies against such conditions therefore contain substances use to rebuild tissue, for example the structural components of tendons and cartilage. Chondriotin sulphate and methylsulfonyl methane are substances used to build and rebuild connective tissue and cartlage tissue. Methylsulfonyl methane is used in a lot of structures, and is especially important for the elasticity of connective tissue. protein components or amino acids can also be furnished by natural drugs to treat rheumatism.

In orther to help repair of tissue injured by the disease process, such drugs also typically contain ingredients that work as tools in tissue repair, or ingredients that stimulate tissue repair. Tissue repair involves sytesis of proteins and other structural components. In such systesis enzymes coupled with vitamins and minerals work as molecular mashines. Therefore these herbal products will contain certain vitamins and minerals.

To increase tissue repair, also substances that stimulate such repair is furnished. The body regulates and stimulates the development, growth and repair of tissues by means of local hormones, for example prostaglandins. Herbal medicines against rheunatism will therefore often contain substances with such hormonal effects or substances that the body converts to such hormones. Gamma-linoleic acid is also used in this way.

By rheumatic condition the tissues of the body, and especially tissues of the joints will be filled with a lot of vaste products and unnecessary components produced by the disease. These components must be cleaned out. Vitamins and minerals furnished by the natural drugs are also used by the body as tools for this cleaning process.

By rheumatic conditions, the production of the lubricating components of synovial fluids may be impaired. Therefore natural drugs to combat rheumatic conditions often also contain ingredients that the joint use to produce synovial fluid and components that stimulate the production of synovial fluid. Hyaluronic acid is an important lubricating component of synovial fluid. Vitamins and minerals are also intended to be used as tools in the production of these lubricating components.

Rheumatic conditions are often painful. The pain hinders a person to move, and the lack of movement makes the joints and muscles stiff, something that worsen the rheumatic condition. By reducing inflammation, the pain will also be reduced. Drugs against reumatic conditions will however also often contain ingredients directly targeted against the pain.

Etherical oils to be applied topically will often give a good effect against rheumatic pain. Ointments to help for rheumatism will therefore often contain such oils or herbs containing these oils.