Rheumatoid arthritis
Rheumatoid arthritis (AR) is a chronic autoimmune disease that affects the joints, which appear swollen, painful, stiff and hot. The wrists and hands are most commonly affected (bilaterally). These symptoms of rheumatoid arthritis get worse with absolute rest.
The causes of rheumatoid arthritis are unclear and the disease is believed to depend on a combination of genetic and environmental factors.
The basic pathophysiological mechanism involves the immune system, which attacks the joints. This results in inflammation and thickening of the joint capsule, also involving the bone and underlying cartilage.
Diagnosis is made on the basis of signs and symptoms, by means of X-rays and laboratory tests.
Other diseases that may show similar symptoms are: systemic lupus erythematosus, psoriatic arthritis and fibromyalgia.
Treatment focuses on reducing pain and inflammation, and improving overall function. From a pharmacological point of view, anti-inflammatories and antirheumatics are commonly used (to try to slow down the progression of the disease). Surgery is used only for "repair" and replacement of severely damaged joints.
The incidence of rheumatoid arthritis is 0.5-1% in industrialized countries and it affects mainly women; the age of onset is that of middle-aged adulthood.
Diet and motor activity
As anticipated, rheumatoid arthritis is an idiopathic pathology that involves the activation of the immune system towards the joint tissues. This means that currently there is no definitive cure, even if many behaviors have been observed that can improve the symptoms and slow down the pathological progress; let's see which ones:
- Diet: to tell the truth, it is still uncertain whether certain specific dietary measures have a really positive effect; on the other hand, there is a real food strategy aimed at reducing joint inflammation.
- Regular exercise: recommended to maintain muscle strength and general physical function; however, exercise fatigue helps to decentralize attention to localized pain.
Despite the pain, it is strongly discouraged to interrupt the various occupational activities (of everyday life).
Nutrients and Supplements
Among the various therapies, in addition to conventional medical practices, there are several "alternative" systems. This is a rather generic term that includes a wide range of interventions, even quite different from one another. Of all, the most relevant scientifically is food supplementation.
Omega 3 and GLA
Gamma linolenic acid is able to reduce pain, swelling and joint stiffness; it is generally considered a safe product.
Medicinal herbs
The American College of Rheumatology does not recommend the use of medicinal herbs, due to the lack of a solid scientific basis to demonstrate its safety and efficacy as a replacement for conventional drugs. Moreover, we recall that certain medicinal herbs, even if classified as "natural", can be toxic or otherwise dangerous.
Based on preliminary positive results, they are still in the testing phase (therefore, they are not yet recommended for clinical use): boswellic acid, curcumin, devil's claw, Euonymus alatu and Tripterygium wilfordii .
WARNING! The National Center for Complementary and Integrative Health (NCCIH) has stated that Tripterygium wilfordii (also known as "thunder god vine") can cause serious side effects.
There is also conflicting evidence on the role of erythropoiesis-stimulating agents (those also used for the treatment of anemia, such as iron and folic acid) in people with rheumatoid arthritis.
Historically, in the treatment of this pathology have also been used (in a bankruptcy): apple diet, nutmeg, nettles, bee venom, rhubarb diet, fasting, honey, vitamins and insulin.
Foods for Arthritis
Based on the aforementioned, it is therefore possible to establish a range of foods that can be useful in the treatment of rheumatoid arthritis, or those rich in certain fatty acids (EPA, DHA, ALA, AGL).
Foods rich in useful fatty acids are divided into two groups: of animal origin and of vegetable origin. Those of animal origin contain EPA (eicosapentaenoico) and DHA (docosahexaenoic), while those of vegetable origin contain alpha and gamma linolenic acid (the first an omega 3 and the second an omega 6); only algae also contain EPA and DHA.
The foods richest in EPA and DHA are the fish that come from cold waters, krill oil and certain algae (which can be consumed as such or in the form of oil); among the fishes we remember all the blue ones like: tuna (plus the ventresca of the fillet), swordfish, bonito, mackerel, lanzardo, aguglia or costardella, horse mackerel, cicerello, papalina, herring, alaccia, sarda or sardine, anchovy or alice etc.
Cod is instead a fish that has an excellent percentage of EPA and DHA compared to other fatty acids but which, in an absolute sense, has a fairly low concentration of lipids.
On the contrary, salmon is quite fat, although the percentage of EPA and DHA is very abundant especially in wild fish; breeding ones have a different chemical profile.
As anticipated, the krill (of the arctic seas) is rich in EPA and DHA, but its consumption occurs mainly in the form of oil as a food supplement; on the contrary, taking inspiration from the eastern diet, algae consumption such as kombu is also spreading in the West. Also in this case, certain supplements based on oil or powder (in capsules) are available on the market.
Foods rich in alpha and gamma linolenic acid are oil seeds and their oils. For alpha linolenic acid, the main sources are: seeds and oil of kiwi, flax, hemp, rape, rape, walnut and soy.
For the linolenic gamma, on the other hand, the main sources are: blue algae (such as spirulina and klamath), seeds and oil of borage, evening primrose, blackcurrant and hemp.
Harmful foods
If it is true that some foods can promote the symptom reduction of rheumatoid arthritis, it is equally true that certain nutrients and an excess of body fat worsen the condition.
Obesity consists of an excess of body fat, which is mainly stored in adipose tissue; the latter is not made of amorphous matter, but rather of cells that interact with the rest of the body. Specifically, when they are too swollen and stressed for development, these cells secrete various molecules of an inflammatory nature that worsen the condition.
Chronic overweight, causing overweight, is an important risk factor for rheumatoid arthritis. Furthermore, the increased workload on painful joints can only aggravate the pain symptoms.
It is also scientifically demonstrated that alcohol abuse negatively affects the disease, favoring its onset and worsening.
Furthermore, while omega 3 and GLA counteract the inflammatory tendency, other molecules are able to increase it. For example, an excess of linoleic acid (an essential omega 6) and especially arachidonic acid, could be involved in the blood increase of inflammatory prostaglandins; the experimental data in support of this hypothesis are quite controversial and, more than to the quantity, they take into consideration the right relationship with the omega 3.
The negative impact of saturated fats is rather striking. These are debilitating both in terms of percentage and absolute. In practice, it is not important how many "beneficial" lipids are taken with food: an excess of saturated fats always has a negative effect on the metabolic parameters of inflammation.
Practical Tips
First of all we recall that, according to the statistics, those who follow a Mediterranean diet (rich in vegetables, whole grains and legumes) have a lower risk of onset and severity for rheumatoid arthritis.
According to what was specified in the previous chapter, increasing the shares of EPA, DHA, ALA and GLA with nutrition could reduce the severity of rheumatoid arthritis. Nevertheless, not everyone is able to accurately structure their diet; that's why below we will offer some useful guidelines for organizing a nutritional regime for rheumatoid arthritis.
We begin by pointing out that, before starting the intake of supplements, it is necessary to verify that the basic diet respects the principles of a healthy and correct diet.
As anticipated, the main sources of useful fatty acids for rheumatoid arthritis are: seeds and oils, blue or cold water fish, krill and oil, algae and oil. As for the portions, frequency of consumption, storage and cooking, below we will summarize the fundamental points:
- Consume bluefish 2-4 times a week; portions should be between 150 and 250g.
- Use delicate cooking methods, without applying very high temperatures (eg NO to frying, YES to steaming). This is because polyunsaturated fats do not resist high temperatures and deteriorate easily, losing all metabolic function.
- Consume the oil seeds rich in ALA and GLA every day, but in addition to other recipes; for example, adding a tablespoon of flaxseed to breakfast cereals.
- Select the oilseeds carefully, making sure they do not contain too much linoleic acid. This essential polyunsaturated fatty acid belonging to omega 6 could have a negative effect if consumed in excess compared to omega 3. NOT all oil seeds are the same! For example, prefer walnuts, flax seeds and hemp seeds.
- Strictly consume the oils rich in omega 3 and GLA (as a condiment) raw, making sure that they are obtained by cold pressing; it is important to keep them for a short time, in dark bottles and in the refrigerator.
- Insert the algae in the diet, even if it is "one time".
- Use food supplements based on krill or algae, establishing the dose with a specialist.
Moreover:
- Eliminate alcohol.
- In case of obesity, restore the normal weight (slimming diet).
- Consume fruit and vegetables daily (in all, at least 4-5 portions of 100-300g). These foods contain small amounts of essential polyunsaturated fatty acids and considerable portions of anti-inflammatory molecules such as: vitamin antioxidants (vitamin A, vitamin C and vitamin E), saline (zinc and selenium), phenolic antioxidants, chlorophyll, etc.
- Consume certain spices such as, for example, curcuma (which contains curcumin), curry, etc., which may be able to oppose systemic inflammation.
- Compensate for the negative impact of certain drugs by ensuring the achievement of potentially deficient vitamins and minerals. For example, with the use of corticosteroids it may be necessary to take food supplements that preserve bone mass (calcium and vitamin D).
Alternative therapies
Although there is not enough scientific evidence to support the efficacy of the so-called alternative therapies, many individuals have found a benefit in following certain healing principles other than traditional medical therapy.
Some practices that affect the mind and / or the body, as well as the nutritional supplement with food supplements, can help in reducing the symptoms of rheumatoid arthritis; some complete conventional treatments, but there is no scientific evidence to allow satisfactory conclusions to be drawn.
A systematic review of 2015 on CAM (Complementary and Alternative Medicine) found that the data available to date do not justify the use of complementary therapies in the management of rheumatoid arthritis, with the exception of fish oil. The studies that declare the opposite are called bias-type publications (unilateral and non-impartial) and are generally of low methodological quality.
Another older revision states that low-intensity laser therapy can be used to decrease the perception of pain and morning stiffness caused by rheumatoid arthritis as, regardless of efficacy, it does not have any noteworthy side effects.
There is also some evidence that Tai Chi (Chinese martial art) can improve joint movement in people with rheumatoid arthritis.
Acupuncture studies are inconclusive.
The "Colonna Prosorba" blood filtering device, aimed at removing IgG for the treatment of rheumatoid arthritis, was approved in 1999 by the "Food and Drug Administration"; however it was suspended at the end of the year 2006.
Bibliography:
- Rheumatoid arthritis and complementary health approaches - National Center for Complementary and Integrative Health - 1 July 2015.
- Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis - Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, Morin M, Shea B, Tugwell P (2005) - Cochrane Database Syst Rev. 4 (4): CD002049.
- Tai Chi in the treatment of rheumatoid arthritis - Han, Alice; Judd, Maria; Welch, Vivian; Wu, Taixiang; Tugwell, Peter; Pozzi, George A (2004) - Cochrane Database of Systematic Reviews (3).
- Medicinal herbs for the treatment of rheumatoid arthritis: a systematic review - Soeken, KL; Miller, SA; Ernst, E - Center for Reviews and Dissemination. National Institute for Health Research - March 23, 2013.
- Herbal remedies, supplements and acupuncture for arthritis - American College of Rheumatology - 3 May 2013.
- Erythropoiesis-stimulating agents for anemia in rheumatoid arthritis - Martí-Carvajal, Arturo J; Agreda-Pérez, Luis H; Solà, Ivan; Simancas-Racines, Daniel (2013) - Cochrane Database of Systematic Reviews 2013 - 20 October 2014.
