Rheumatoid arthritis (hereafter referred to simply as “arthritis”) is a chronic inflammatory disease.
It is a systemic pathology that affects the articular cartilages. The effects can be very serious, disabling and cause irreversible loss of functionality.
It mainly affects symmetrical joints but tendons, synovium, muscles, bags and other tissues are not excluded.
The pathological mechanism of arthritis is based on:
- Immune activation due to viruses or bacteria.
- Uncontrolled reaction and joint damage with chronic inflammation.
The disease impairs joint excursion and all related movements.
Arthritis affects 1-2% of the population. The onset is higher in women and in subjects aged 40-60 years. Early or late episodes are not uncommon.
Some hypothesize that behavioral and environmental risk factors play a determining role and not just a predisposing one.
The material published is intended to allow quick access to advice, suggestions and general remedies that doctors and textbooks usually dispense for the treatment of Rheumatoid Arthritis; these indications must in no way replace the opinion of the treating physician. or other healthcare specialists in the sector who are treating the patient.
What to do
- Arthritis is an autoimmune disease related to various factors:
- Familiarity.
- Infections (Human Herpes Virus 6 and Epstein-Barr Virus).
- Other autoimmune diseases.
- Other rheumatic diseases.
- Stress.
- Tobacco smoke.
- Alcohol abuse.
- Nutritional disadvantages.
- Poor oral hygiene and periodontitis from Porphyromonas gingivalis.
- Obesity: it is not certain that it is among the risk factors, but it is known that rheumatoid arthritis is more serious in obese people.
- Aware of a "possible family predisposition, it is necessary to adopt a series of preventive measures (see under Prevention).
- Recognize the symptoms: "arthritis manifests itself quite clearly even if sometimes the initial symptoms are neglected or confused with the" seasonal pains. "
- Joint swelling and deformation.
- Joint pain on palpation and in movements.
- Joint redness.
- Joint warmth sensation.
- Joint stiffness.
- Sometimes also:
- Fever.
- Weight loss.
- Anemia and hyperferritinemia.
- Muscle hypotrophy and tendon abnormalities.
- Inflammation of other tissues (eyes, skin, lymph nodes, etc.).
- It is important that the diagnosis is early: the reference figure, after having contacted the general practitioner, is that of the rheumatologist. He will perform and prescribe:
- Medical history and physical examination.
- Blood analysis for the search for typical markers of rheumatoid arthritis (inflammatory molecules, rheumatoid factor, anticyclic citrullinated peptide, etc.).
- Joint ultrasound, x-rays etc.
- Joint synovial sample collection and analysis.
- With a positive diagnosis, conservative therapy is initiated:
- Choice of suitable physical activities: unlike arthrosis, arthritis risks damaging the joints more significantly during movement. This requires a more careful selection of movements that do not cause pain.
- Help of devices for housework or travel.
- Physiotherapy and maintenance of the general physical condition: they prevent muscular hypotonia and stiffness, maintaining a satisfactory fitness (the use of a brace may be useful).
- Pharmacological therapy (anti-inflammatory, immunosuppressive, biological drugs, etc.).
- Medical treatments with heat, ultrasound and mud.
- Surgery (if needed).
- Surgical removal of any troublesome subcutaneous nodules.
- After the installation of a prosthesis it is necessary to maintain satisfactory muscle function (physical activity).
What NOT to do
- Neglecting prevention, especially knowingly to an important family trend:
- Obesity.
- Risk infection with Human Herpes Virus 6 and Epstein-Barr Virus.
- Lead a stressful lifestyle.
- Smoking and abusing alcohol.
- Having poor oral hygiene and increasing the risk of periodontitis with proliferation of Porphyromonas gingivalis.
- Adopt a diet lacking in vitamin D and anti-inflammatory and / or antioxidant molecules.
- Ignore the symptoms, do not seek medical attention or do not continue the diagnostic research.
- Choice of unsuitable, painful and worsening physical activities.
- When necessary, do not use devices for housework or travel.
- Do not practice physiotherapy and motor preservation.
- Do not follow the prescribed drug therapy.
- Do not adopt the recommended medical treatments.
- Do not resort to surgery (if necessary).
- Not maintaining satisfactory muscle function after implantation of a prosthesis.
What to eat
- There is no suitable diet for the treatment of "arthritis. On the other hand, some molecules may prove useful:
- In the treatment of any overweight that generates significant joint overload with increased pain.
- In the reduction of inflammation.
- In restoring the right levels of vitamin D.
- In the fight against anemia.
In summary:
- When the weight is excessive it becomes essential to practice a weight loss diet. This is a low calorie type. The basic principles are:
- Consume an adequate amount of calories, which is 70% of normal calories.
- Choose foods with a suitable metabolic impact (whole foods and foods without refined carbohydrates) by preventing spikes in blood sugar and insulin.
- Get a good amount of dietary fiber. It helps to keep blood sugar under control, modulates fat absorption and positively affects estrogen levels.
- Keep the fraction of simple carbohydrates no more than 10-16% of total calories (it is sufficient to eliminate all sweet foods by keeping 4-6 servings of fruit and vegetables as well as 1-3 servings of milk and yogurt).
- Keep the fat fraction no more than 25-30% of total calories, preferring the "good" ones (raw vegetable oils and medium-fat blue fish) over the "bad" ones (saturated, hydrogenated, bi-fractionated, etc.).
- In the event that arthritis inflames one or more joints it could be useful to increase the supply of nutrients with a strong anti-inflammatory function:
- Omega 3: they are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). They have an anti-inflammatory role.The first two are biologically very active and are mainly found in: sardine, mackerel, bonito, sardinella, herring, alletterato, tuna belly, garfish, seaweed, krill etc. The third is less active but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seed, grape seed, etc.
- Antioxidants:
- Vitamins: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in crustaceans and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.
- To increase the intake of vitamin D or calciferol: increase the consumption of fish, fish oil and egg yolk.
- Against anemia it is necessary to ensure the intake of iron (possibly in conjunction with vitamin C), vitamin B12 and folic acid.
- To ensure the intake of iron, especially heme and ferrous (2+), it is necessary to eat:
- Muscle tissue: both of terrestrial and aquatic animals: horse, bovine, swine, avian, fish, whole molluscs (including land snails), whole crustaceans, etc.
- Eggs: any, especially the yolk.
- Offal and fifth quarter: especially spleen and liver, but also marrow, diaphragm, heart, etc.
NB. Vitamin C or ascorbic acid is a thermolabile molecule and degrades with cooking. This means that to ensure its intake it becomes necessary to consume many raw foods. Furthermore, being involved in the absorption of the little available iron, it is important that it is taken with specific foods.
- To ensure the supply of vitamin B12 (cobalamin) it is necessary to eat:
- The same foods as a source of heme iron; in addition, certain bacteria are rich in vitamin B12.
- To ensure the supply of folic acid it is necessary to eat: liver, vegetables (eg tomatoes), sweet fruit (orange, apple, etc.) and legumes (eg beans).
NB. Folic acid is also a thermolabile molecule and degrades with cooking. This means that to ensure its intake it is advisable to eat specific foods in raw form.
- Remember that certain foods may contain anti-nutritional principles that reduce the absorption of iron (phytic acid and oxalic acid - relative phytates and oxalates). To reduce their content, it is necessary to practice:
- Soaking.
- Fermentation (yeasts or bacteria).
- Cooking.
NB. Since cooking inhibits the nutritional principles but limits the availability of thermolabile vitamins, it is advisable that raw and cooked foods are equally present in the diet. It is advisable to reserve the heat treatment especially for legumes and cereals, while most fruits and some vegetables could be eaten raw.
What NOT to Eat
- In case of obesity, it is advisable to reduce weight by decreasing the caloric intake by about 30% and leaving unchanged the nutritional distribution (balanced):
- It is advisable to eliminate junk foods and drinks, especially fast food and sweet or savory snacks.
- It is also necessary to reduce the frequency of consumption and the portions of: pasta, bread, pizza, potatoes, derivatives, fatty cheeses, fatty meats and fish, cured meats, sausages, sweets, etc.
- Elimination of alcohol is crucial: these drinks are related to an increase in the incidence of arthritis. They also promote overweight and impair pharmacological metabolism.
Natural Cures and Remedies
- Mud baths: they are useful in reducing joint pain but do not act on the triggering cause.
- Herbalist:
- Boswellic acid.
- Curcumin.
- Devil's claw.
- Euonymus alatu.
- Tripterygium wilfordii (can cause serious side effects).
Pharmacological treatment
They are anti-inflammatory, pain-relieving and specific for the preservation of cartilage.
- Opioids: have a very powerful pain relieving effect but are addictive.
- Hydrocodone: for example Vicodin; it is not for sale in Italy.
- NSAIDs or non-steroidal anti-inflammatory drugs to be taken orally and with systemic action. They reduce pain and facilitate joint mobility; fairly short courses of therapy are recommended due to potential side effects (stomach and liver compromises). They are most used:
- Acetylsalicylic acid: e.g. Aspirin, Vivin C.
- Ibuprofen: for example Brufen, Moment and Subitene.
- Naproxen: for example Aleve, Naprosyn, Prexan and Naprius.
- Diclofenac: for example Fastum Painkiller and Dicloreum.
- Celecoxib: for example Aleve, Naprosyn, Prexan and Naprius.
- Cortisones: systemic to be taken orally or locally by injection. Generally not recommended because they can cause thinning of the bones, bruising, weight gain, cataracts, diabetes, hypertension and swelling of the face. They are used ONLY if the inflammation reaches very high levels:
- Dexamethasone: for example Soldesam and Decadron.
- Antiarthritics and immunomodulators: they hinder the degeneration of the disease by acting on the immune system:
- Penicillamine: for example Sufortan.
- Hydroxychloroquine: for example Plaquenil.
- Chloroquine: for example Chloroquine and Cloroc FOS FN.
- Methotrexate: for example Reumaflex, Methotrexate HSP and Securact.
- Sulfasalazine: for example Salazopyrin.
- Leflunomide: for example Leflunomide medac, Arava, Leflunomide Teva, Leflunomide Winthrop and Repso.
- Azathioprine: for example Azathioprine, Immunoprin and Azafor.
- Biological drugs: are drugs that inhibit tumor necrosis factor alpha. They are used in active rheumatoid arthritis resistant to classic drugs if no benefits are recognized after 2 years of treatment:
- Adalimumab: for example Humira.
- Infliximab: e.g. Remicade.
Prevention
- Not smoking.
- Don't overdo it with alcohol.
- Stay in normal weight or lose weight in case of obesity.
- Adopt a diet sufficiently rich in vitamin D; it may also be useful to check the intake of omega 3 and antioxidants.
- Practice regular motor activity.
- Avoid infection with Human Herpes Virus 6 and Epstein-Barr Virus.
- Take care of oral hygiene and reduce the risk of periodontitis with proliferation of Porphyromonas gingivalis.
- Lead a less stressful lifestyle as possible.
Medical Treatments
- Application of heat: they are used to relieve the symptoms of arthritis. The methods are: heating pads, paraffin baths, exercises in a heated pool and compresses. Useful for reducing pain and increasing joint excursion before physiotherapy or physical exercise.
- Tecar therapy: it is a therapeutic method that uses an electric capacitor to treat joint muscle injuries. The mechanism of tecar therapy is based on the restoration of the electrical charge in the injured cells to make them regenerate more quickly.
- Ultrasound: this system uses high frequency acoustic waves. It is very useful as an anti-inflammatory, stimulant of edematous reabsorption and to dissolve the adhesions that form during healing. It produces heat and increases the permeability of cell membranes.
- Cortisone Infiltrations: Intra-articular injections may be necessary when common drug therapy has no effect. Given the side effects of cortisone, the tendency is to administer it as a last resort
- Surgery:
- Synovectomy: removal of the synovial membrane responsible for the destruction of cartilage.
- Osteotomy: remodeling of the bone deformed by arthritis.
- Installation of prostheses: it is essential when pain and anatomical alteration become disabling. In the past it tended to be used as late as possible; today the priority of functional maintenance is recognized. Especially in mature subjects or in old age, being bedridden significantly compromises the functional capacity and greatly lengthens recovery after surgery. The complexity, invasiveness and type of replacement are of various types. Today, the transplant patient is able to move the joint one day after the operation. It is not applicable in some joints.
- Physiotherapy and motor therapy: useful both before and after surgery. They optimize the maintenance of functionality and post-surgical functional recovery.
