Rheumatoid Arthritis – Healing & Management from AN HOLISTIC PERSPECTIVE
Arthritis is a word taken from greek and literally means ‘Joint-Inflammation’. Rheumatoid arthritis (RA) is an autoimmune disease that causes pain and inflammation, affecting many joints, including those in the hands and feet. The inflammation causes the joints to become painful, hot, swollen and movement to be restricted. The inflammation caused by Rheumatoid Arthritis can result in damage to the joints particularly if left untreated. It is a difficult disease to live with, creating pain and deformity.
SIGNS AND SYMPTOMS
The most common symptoms of RA include:
• swelling, pain and heat in the joints, usually the smaller joints affecting the hands or feet
• stiffness in the joints, especially in the morning
• persistent fatigue (tiredness)
• sleeping difficulties because of the pain
• weak muscles
• Flu like symptoms such as feeling hot and sweaty
• the same joints on both sides of the body are usually affected.
The course and severity of rheumatoid arthritis varies from person to person and no two cases are the same. Symptoms may change from day to day and there may be times when the disease is active and ‘flared’ up and other times when its inactive.
PREVALENCE IN AUSTRALIA
Rheumatoid arthritis can occur at any age, but usually appears between the ages of 35 to 64. It is the second most common form of arthritis affecting nearly half a million Australians. An estimated 57 per cent of people with rheumatoid arthritis are women.
CAUSES OF RHEUMATOID ARTHRITIS - THE CONVENTIONAL MEDICINE VIEWPOINT
THE DISEASE PROCESS
The causes of Rheumatoid Arthritis are not yet fully understood from the conventional medicine perspective. There are many potential reasons for this condition which are currently being studied (impact of environmental toxicity, gastrointestinal microbial infection, genetics, inflammatory susceptibility, etc.).
What is known is that Rheumatoid Arthritis is an autoimmune disease. The normal role of the body’s immune system is to fight off and protect us from infections. However, when a person has an autoimmune disease, the immune system starts attacking the body’s healthy tissues instead of foreign matter like an infection.
Some people may be more at risk of developing rheumatoid arthritis due to heredity factors. Exactly what triggers the body’s immune system from this conventional perspective to attack the joints is unknown.
In the case of rheumatoid arthritis, the immune system targets the lining of the joints, called the synovial membrane, causing inflammation and joint damage. Synovial Fluid forms a thin film over the surfaces within the articular capsule of the joint.
The pathology of RA is characterised by the infiltration of several inflammatory cells into both the pannus and the joint fluid and causes subsequent tissue (and bone) destruction.
Chemokines, as well as other inflammatory mediators, play key roles in the pathogenesis of RA, and the coordinated production of chemokines and pro-inflammatory cytokines is important in the orchestration of the inflammatory responses observed in patients with RA. Imbalance between pro- and anti-inflammatory cytokine activities favours the induction of autoimmunity, chronic inflammation, and thereby joint damage.
The characteristic swelling happens when the joint produces too much lubricating (synovial) fluid in response to the inflammation.
Rheumatoid arthritis can also produce inflammation in other areas of the body, not just the joints. The lungs, the membranes of the lung (pleura), the membrane around the heart (pericardium), and whites of the eyes (sclera).
TREATMENT - MANAGEMENT OF RHEUMATOID ARTHRITIS
According the conventional medicine, there is no cure for any form of arthritis, so treatment is aimed at management of symptoms and minimising ‘flare ups.’ These strategies assist patients to lead a healthy and active life. This is achieved mainly by using anti-inflammatory drugs and immunosuppressants.
A rheumatologist may prescribe a number of different medications depending on symptoms and the severity of the condition to help reduce the inflammation and prevent structural damage to the joints.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation.
• The disease-modifying anti-rheumatic drugs (DMARDs) are a special group of medications used to treat inflammatory arthritis and work to decrease the abnormal function of the immune system that drives rheumatoid arthritis. They include Methotrexate, Sulphasalazine and Hydroxychloroquine.
Apart from pharmaceuticals, joint surgery, physical therapy, weight management and occupational therapy may be recommended.
There are many complications with being on these pharmaceutical medications long term. These include gastrointestinal toxify and liver damage among many, many more. In a study titled ‘Long-term methotrexate use in rheumatoid arthritis: 12-year follow-up of 460 patients treated in community practice’, only 58% were still using this medication 12 years later due to complications and tolerance issues. 17% were still taking the drug at 12 years, with the addition of concomitant DMARD’s to improve treatment effectiveness. They also concluded that risk of adverse effects appeared to persist over time. (Wluka, 2000)
THE HOLISTIC PERSPECTIVE ON RHEUMATOID ARTHRITIS
The key from a holistic perspective is in discovering what the true cause is for each patient.
Major causative factors and risk factors that can contribute to the incidence of RA include:
- Genetic predisposition
- Gender – RA strikes women in a 3:1 ratio to men
- Age – most commonly presents at 40 to 60 years, although RA occurs at all ages
- Smoking – increases or accelerates the risk in susceptible people
- Environmental toxicity – due to leaky gut (intestinal permeability), heavy metal toxicity
- Digestive issues – dysbiosis, leaky gut (intestinal permeability), impaired function
- Chronic or latent infections – recognised trigger and driver of auto-immunity
- Diet and poor eating habits causing - antigenic undigested food
THE DISEASE PROCESS – THE HOLISTIC VIEW
Rheumatoid Arthritis is seen as a disease of toxic accumulation and immune malfunction.
Present in the patient is a very high level of accumulated toxins (caused by any number of above factors) combined with high levels inflammation and acidity in the body.
These toxins move into channels of the body and begin to affect immunity – this is the basis for auto-immunity. (Heyman et al, 2000)
The inflammation and toxins also begin to lodge in the joints, causing the localised inflammatory response, swelling and pain recognised as RA.
This is where holistic (including Ayurvedic Medicine and Naturopathy) and conventional Medicine differ dramatically.
Depending on severity, holistic treatment can greatly reduce the debilitating symptoms and prevent RA from getting any worse, as well as reducing the need and dependency of pharmaceutical medication. If its medium level chronicity, these modalities can help reverse the disease process, leading to a state of remission. This is because the disease process is very well understood from this holistic perspective, and treatments can be applied to directly combat the root cause of disease.
Underlying all of these potentially important causes which are unique to RA, there is a need to set a foundation for sustainable wellness via diet, exercise, proper sleep, and stress reduction.
Holistically, the first step is strengthening and improving digestive function (healing intestinal permeability or addressing dysbiosis if present), eliminating toxins and re-balancing the immune response.
This can be achieved by correct diet and herbal supplementation initially. Then treatments such as massage, stress management and other physical therapies can be implemented for further healing and long-term management.
Some key steps to take to support healing:
· Eat the right food for you
· Move your body every day
· Maintain a positive mental attitude
· Choose specific targeted therapies to speed the process along
Incredible improvements can be made in terms of inflammation, pain, swelling and stiffness just by diligently following the correct diet.
There are several dietary approaches which may be useful for those who are suffering from the symptoms of RA (anti-inflammatory diet, elimination diet, controlled therapeutic fasts, Mediterranean diet etc.), and in working with a qualified health practitioner (Naturopath, Ayurvedic Consultant) they can find the ideal diet which suits your unique needs.
Generally, though, eliminating these following foods is favourable:
· A percentage of RA patients respond dramatically to a diet free of nightshades. These include capsicum, eggplant, tomato, and white potato. A month-long trial is recommended initially. Remission has also been reported from a salicylate-free diet
· Excessive animal protein (especially Red Meat), simple sugars, gluten, casein (dairy), and food additives/chemicals have been shown to alter the inflammatory potential of the entire system and to dysregulate immunity, leading to auto-immunity and a decrease ability to heal.
· Causes of acidity and inflammation include: eating excessively heating, fried, stimulating, pungent, sour or salty foods and drinks (including red meat, fermented foods, alcohol, coffee, chilli, acidic foods); not eating when hungry.
Generally, a diet designed for chronic disease healing is based on natural unprocessed foods, with adequate protein and essential fatty acids supplies, ample prebiotic compounds (foods which support the gut microbiome), protein for immune and hormonal health. Moderate portion sizes and eating to appetite also support complete digestion and prevent antigenic undigested food from stimulating inflammation and fuelling unfavourable bacterial growth/ digestive upset (i.e. this toxic build up).
A classic Ayurvedic remedy for Arthritis is taking Castor oil (1 tsp taken before bed with ginger tea or ½ tsp of dry ginger powder), and turmeric (1 tsp twice daily, with a pinch of black pepper). These are common household items and are effective when taken consistently and in the correct way.
Other holistic therapies include:
Exercise is shown to regulate and strengthen immune health. The goal is to achieve moderate exercise; building up to approximately 40 minutes, 4 or more times per week. Studies show that people that sit for more than 10 hours a day and do-little activity are prone to immune suppression, a feature of auto-immune onset and persistence. (Metagenics)
In a 7 year study of 30,112 women, there was a statistically significant 35% lower risk of RA among women in the highest category of leisure-time physical activity (median 40 – 60 minutes per day) and exercise (median 2 – 3 hours per week) compared to women in the lowest category (less than 20 minutes per day of walking/bicycling and less than 1 hour per week of exercise). (Giuseppe, 2015)
Exercise will help maintain muscle strength and joint flexibility, build up stamina and help in managing pain. Appropriate low-impact aerobic activities include exercising in warm water, cycling and walking. Activities like strength training and tai chi are also beneficial. A review of 9 studies concluded that yoga may be an important therapeutic tool for RA, improving “psychological and physiological” outcomes of arthritis. (Giuseppe, 2015)
Smile & Relax
Addressing stress is key to overcoming immune suppression. Stress hormones (cortisol, adrenalin and nor-adrenalin) disorder T-helper 1 mediated cell-mediated immunity (a key defect in auto-immunity), and favour T-helper 2 activity, as seen with humoral immunity.
Much of what we feel on an emotional plane is echoed in our physical wellbeing. How we cope with the stressors of life is a useful indicator of our likelihood to develop chronic disease. The ability to maintain optimism in the face of hardship related to a diagnosis of RA leads to improved perception of physical function. (Symmons, 2003)
Maintaining a positive attitude and smiling primes our body to better handle pain. Research shows that even a ‘fake’ smile and inauthentic optimism helps. (Soussignan, et al, 2002)
Meditation is also another wonderful tool to balance immunity, manage stress and alleviate pain.
In documenting benefits in the treatment of RA, it was suggested that Transcendental Meditation is warranted as it created substantial, sustained and sometimes dramatic improvements in this condition. It was found to fulfil the ideal of treating the patient, bringing benefits and contributing positively to the patient's general well-being and happiness. (Kirtane, 1980)
Another study found that participants who practiced the Transcendental Meditation technique for 5 months, had a decrease in pain response by 40–50%. The results suggest that the Transcendental Meditation technique longitudinally reduces the affective/ motivational dimension of the brain’s response to pain. (Orme-Johnson. 2006)
For the best possible results, an in-depth cleanse and rejuvenation process is essential. Called Panchakarma in Ayurveda, this deep cleanse address’ all of the major processes for a healthy modification of the human physiology.
It deeply removes toxins embedded in the physiology and deep tissues. This program effectively reduces the microbial load, restores the digestive tract flora and epithelial barrier (intestinal permeability), and supports the release of toxic compounds that serve to imbalance normal immune function. Both environmental (pollution, heavy metals, pesticides and recreational/some medical drugs) and endogenous (gut dysbiosis) toxicity directly induces immune activation and inflammation, affecting mitochondrial integrity and decreasing immune tolerance, all contributing to immune dysfunction and chronic disease.
By addressing the root cause, this program enables healing to occur in a much shorter period of time, greatly reducing the likelihood of a relapse.
For information on detox and panchakarma programs, visit ww.sukhavatibali.com
Author: Tegan Wallis
Tegan is an Naturopath, Ayurveda Health Consultant and Yoga Teacher at Griffith Consulting's sister company, Veda Wellness.
Tegan is one of Griffith Consulting's key program facilitators and specialises in workplace health & wellness.
For more information about Tegan or her services, please go to: www.vedawellness.com.au