6 min|Dr. Maya Kuczma
Autoimmune Disease 101: Treatment of Rheumatoid ArthritisAutoimmune Disease
Treatment of Rheumatoid Arthritis
Conventional treatment focuses on symptom management of RA. Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, diclofenac, and naproxen are typically the first-line therapy for treatment of RA. These drugs block COX enzymes, a key component in the production of prostaglandins, a family of chemicals that promote inflammation; if the production of prostaglandins is halted, inflammation is reduced. If NSAIDs are insufficient at controlling symptoms, corticosteroids, such as prednisone, may be utilized.
Depending on your symptoms and disease progression, your Doctor may recommend disease-modifying anti-rheumatic drugs (DMARDS), such as hydroxychloroquine, methotrexate, sulfasalazine, or biologics, such as adalimumab, etanercept, infliximab, rituximab. All of these drugs, from NSAIDs to biologics, have significant side effects, particularly with long-term use. Additionally, a treatment plan that solely utilizes medication does not identify the root cause(s) of the immune-mediated attack on your joints. Without identifying the triggers of the immune system, we cannot remove them.
If you are diagnosed with one autoimmune condition, such as RA, you are at an increased risk of developing a second autoimmune condition.(5) A naturopathic approach to RA aims to identify and treat the underlying cause of autoimmunity to both decrease the symptoms and progression of RA, as well as your risk of further autoimmunity. While we cannot change your genetics, we can alter many of the environmental factors that have been linked to autoimmunity.
The intestinal epithelial lining, also known as the gut lining, forms a barrier between you and your environment. A healthy gut lining allows for the absorption of nutrients into the bloodstream. If the barrier is compromised and becomes hyper permeable (also known as ‘leaky gut’), toxins, bacteria, and antigens can pass into the bloodstream, and may trigger autoimmunity.(6) Increased intestinal permeability can be triggered by many factors, including NSAIDS,(7) stress,(8) and toxins, such as alcohol.(9)
Permeability of the gut lining is greatly mediated by the gut microbiome, the ecosystem of microorganisms that live in your gut. Imbalances, or infections, within the gut microbiome, can lead to increased gut permeability.(10) Stool and breath tests (such as urea or lactulose breath tests) can be utilized to analyze the gut microbiome. A Naturopathic Doctor can help guide you through the elimination of factors that irritate the gut lining, while emphasizing vitamins, prebiotics, probiotics, and minerals that can help to restore the gut microbiome and gut lining integrity.
Certain foods may induce inflammation, a factor that contributes greatly to the development of autoimmune conditions.(11) Gluten, a component found in many grains including wheat, rye, and spelt, has been shown to increase intestinal permeability.(12) High sugar and refined carbohydrate intake has been shown to worsen autoimmunity, due to increased inflammation.(13,14) Studies have shown an increased risk of metabolic syndrome in RA patients; this may be due to the systemic inflammation underlying autoimmunity.(15)
RA patients are also at risk for ‘rheumatoid cachexia’, an increase in adipose (fat) tissue alongside a loss of muscle tissue, as a result of chronic inflammation in combination with a decrease in physical activity.(16) Naturopathic Doctors can help support you through adoption of a nutrition plan that aims to decrease exposure to inflammatory triggers and stabilize blood sugar. Specific steps can be taken to restore health of the gut lining, increase absorption of nutrients, and ensure adequate protein intake to maintain or increase muscle mass.
Stress has been linked to an increase in gut permeability, a known factor in the pathogenesis of autoimmunity.(8) Increases in perceived levels of stress has been associated with increased levels of inflammation in patients with RA.(17) Even a history of stressful experience can affect our health today; studies have linked childhood traumatic stress to an increased likelihood of autoimmune disease diagnosis into adulthood.(18) Additionally, while stress can be a precursor or exacerbating factor in the development of RA, the experience of living with RA is itself stressful. Many patients with RA report non-optimal sleep.(19) Elevated stress can affect sleep quality; in turn, sleep disturbances can lead to increased pain perception.(20)
A Naturopathic Doctor can help you to identify the role of stress in your life, and work with you to determine an effective plan to balance how your body and mind respond to stress. Your plan may include methods to support hormonal response to stress, steps to improve sleep quality, reframing of daily interactions and obligations, or referral to stress and/or trauma-focused tools, such as mindfulness based stress reduction (MBSR), biofeedback, or therapy.
Clinical studies indicate that certain infectious microbes, such as Porphyromonas gingivalis, Proteus mirablis, Epstein-Barr virus, and mycoplasma, contribute to the development of RA.(21) It is suspected that infections play a role in autoimmunity via the process of ‘molecular mimicry’ - certain microbes have elements that are similar in structure to our proteins; when our immune system attacks the microbes, it mistakenly also attacks our own tissue, triggering autoantibody production.(22) Identifying, and treating, these infections may aid in decreasing the autoantibody production at the root of autoimmune conditions. For example, control of periodontal disease reduced levels of inflammation (as measured by ESR level) and reported levels of pain in patients with RA.(23)
Vitamin D deficiency has been associated with the pathogenesis of autoimmune conditions, and may be linked to the severity of RA.(24) Supplementation with vitamin D led a significant improvement of RA disease severity.(25) Omega-3 fatty acids can decrease inflammation throughout the body.(26) Supplementation of omega-3 fatty acids led to a reduction of NSAID usage in patients with RA.(27)
Research has shown a reduction in ESR and pain in patients with inflammatory joint disease following treatment with proteolytic enzymes, such as bromelain and serrapeptase.(28) Naturopathic Doctors are well-versed in supplementation; your Doctor can recommend specific nutrients that may be helpful in modulating the dysregulated immune activity and chronic inflammation associated with RA.
Monitoring and Thriving
Your Doctor will likely ask you to complete blood work in order to monitor your progression. Blood levels of inflammatory markers and antibodies can be helpful in monitoring the success of our treatment plan. It is also important for us to monitor how you feel, including your level of pain and energy, as well as your ability to complete specific movements.
Pregnancy, menopause, stressful life events, toxic exposure, infections, and changes in diet can all affect symptoms and disease progression. As a result, your treatment plan may also need to change over time. A skilled practitioner recognizes that healing is not always a straight line; they can help guide you through the ups and downs we all experience over a lifetime, and support you along the way.
Do you have many of the symptoms of Rheumatoid Arthritis? Have you been diagnosed with Rheumatoid Arthritis and are not sure how to proceed with treatment? Or, are you receiving treatment for Rheumatoid Arthritis, and wondering if there’s more you could be doing to support you body?
At Integrative, we’re here to help. Take a step towards better health and vitality. Book your initial consultation today!