Rheumatoid Arthritis

Description

Alternative Names

Lifestyle Changes

It is important to maintain a balance between rest (which will reduce inflammation) and exercise (which will relieve stiffness and weakness). Studies have suggested that even as little as three hours of physical therapy over six weeks will help people with RA, and that these benefits are sustained.

The goal of exercise is the following:

• To maintain a wide range of motion.
• To increase strength, endurance, and mobility.
• Improve general health.
• Promote well-being.

In general, some patients recommend the following approaches:

• Start with the easiest exercises, stretching and tensing of the joints without movement.
• Next attempt mild strength training. (One study found that people with RA who exercised with machines that use compressed air for gentle resistance experienced less pain and increased muscle tone.)
• Aerobic exercises may then be tried, for example, walking, dancing, or swimming, particularly in heated pools. Avoid heavy impact exercises such as running, downhill skiing, and jumping.
• T'ai chi, which uses graceful slow sweeping movements, is an excellent method for combining stretching and range-of-motion exercises with relaxation techniques. It is of particularly value for elderly RA patients who report significantly less pain after practicing this technique.

While traditional guidelines have restricted RA patients to only gentle exercise, recent research suggests that more intense exercise may not only be safe, but may actually produce greater muscle strength and overall functioning. Common sense is the best guide:

• If exercise is causing sharp pain, stop immediately.
• If lesser aches and pains continue for more than two hours afterwards, then a lighter exercise program should be tried for a while.
• Using large joints instead of small ones for ordinary tasks can help relieve pressure, for instance, closing a door with the hip or pushing buttons with the palm of the hand.

Diet

Fad diets for RA are common. Some claims include the following:

• Some people claim that foods from the nightshade family (tomatoes, potatoes, green peppers, and eggplant) can exacerbate arthritis.
• The Dong Diet eliminates all additives, preservatives, fruits, red meat, herbs, alcohol, and dairy.
• A few studies have reported that vegetarian diets may helpful for some patients. In one study, 40% of patients who were on a vegetarian diet and avoided foods containing gluten (found in wheat, barley, and rye) reported improved scores.
• In another study high total caloric intake correlated with worse symptoms.

Little scientific evidence of benefits for RA exists for any of these diets, and some may result in deficiencies of important nutrients. On the other hand, one interesting study in England found that 10 out of 17 people benefited from any diet recommended by their doctor.

Mediterranean Diet. Perhaps the best recommendation is for the Mediterranean Diet. A 2003 study reported that RA patients who followed it experienced reduced inflammatory activity, improved physical function and improved vitality compared to those on a standard Western diet. The Mediterranean diet is also rich in heart-healthy fiber and nutrients, omega-3 fatty acids, and antioxidants. The diet recommends the following:

• A relatively high fat intake (about 35% to 45% of daily calories), but mostly from monounsaturated and polyunsaturated oils. The Mediterranean diet is known specifically for its use of olive oil. One 1999 study found some evidence that high intake of olive oil and cooked vegetables reduced the risk of RA.
• Daily glass or two of wine.
• Protein source with this diet is primarily fish, which might be specifically helpful for RA patients. Fish (particularly--but not only--oily fish) have anti-inflammatory effects. It should be noted that protein is lost during the inflammatory process, and one study indicated that high amounts of protein might be protective. Either fish or soy should, in any case, be the primary sources of protein. (Although not included in the Mediterranean diet, soy may have specific benefits for RA.) Some evidence also suggests that fish oil supplements might be helpful.
• Carbohydrate choices emphasize fresh fruits, vegetables, nuts, legumes, beans, and whole grains.
• Foods seasoned with garlic, onions, and herbs.

Coffee and Tea. A 2002 study reported an association between RA and decaffeinated coffee but not regular coffee. Furthermore, drinking tea was associated with a lower risk.

Vitamins. Certain vitamin supplements may be beneficial. For example, certain drugs used for RA deplete folic acid, a critical vitamin B. Some patients take antioxidant supplements, such as vitamins C and E and selenium, although there is no strong evidence supporting their benefits. (Some studies have reported some possible benefits with vitamin E or other antioxidant combinations when used with standard medications.) Patients should check with their physicians about the need for supplements.

Miscellaneous Supportive Treatments

Various ointments, including Ben Gay and capsaicin (a cream that use the active ingredient in chilies) may help soothe painful joints.

Orthotic devices are specialized braces and splints that support and help align joints. Many such devices made from a variety of light materials are available and can be very beneficial when worn properly.

A number of specially designed appliances and devices are available to ease daily activities.

Managing Psychological and Emotional Conditions

Although the influence of stress or emotions on the progression of RA is not fully known, having a history of major depression that persists or reoccurs seems to increase the pain, disability, and fatigue. Stress management alone cannot reduce pain, but it may be very helpful in helping people deal with their condition. One interesting 1999 study found that people with RA reported significant clinical improvement after writing about their pain, stress, or other traumatic experiences. Writing for 20 minutes, just a few days a week, resulted in improvement that lasted for months. A 2001 study found that spirituality (defined as a belief in a power outside oneself and ones own existence, as opposed to the practice of any specific religion) is associated with better health, happiness and well-being among RA patients. (Spiritual healing does not appear to offer any advantages.)

Alternative and Integrative Medicine

People often turn to alternative therapies or nontraditional remedies to relieve the pain of rheumatoid arthritis. Some alternative procedures, such as acupuncture, therapeutic touch, massage, relaxation techniques, biofeedback, and hypnosis, are nearly always harmless as long as they are not used as substitutes for proven treatments. Some examples are the following:

• In one small 2001 British study, acupuncture reduced pain by a third in 73% of patients, and more than half reported at least a 50% improvement in pain. Patients reduced their use of pain medications from 17 to six tablets per week on average.
• Balneotherapy, also known as hydrotherapy or spa therapy, is an ancient form of therapy that involves mineral baths to soothe pain, and some patients have reported relief using such baths.

A number of herbal remedies have been used traditionally in treating RA, including boswellia, equisetum arvense (horsetail), devils claw, and many others. Herbal or other remedies can be of some concern, however, as the ingredients in over-the-counter herbal or natural remedies are not regulated or controlled.