Hello and thank you for coming to my blog. I am Dr. Warren and today we will be talking about Rheumatoid Arthritis (RA). Conventional drug therapy for RA is a combination of various pain killers and immune suppressing drugs. While these may be necessary for some patients, today I will share with you some of the other factors I look at with patients in my office. This is not a comprehensive list, but rather some of the things that have given me a “good bang for their buck” with my rheumatoid arthritis patients.
For starters let’s just look at official symptoms of rheumatoid arthritis.
- Morning stiffness >1 hour
- Idiopathic, non-traumatic arthritis of at least 3 joints for > 6 weeks
- Arthritis of the wrists/hands/knuckles/fingers
- Symmetric arthritis
- Rheumatoid nodules
- Positive RF factor/CCP Blood test
- Radiographic manifestations (Diagnosed via X-ray and/or MRI)
I would add to that list most of my patients have hand pain, and intermittent swelling when the arthritis pops up. Helping with the swelling can be overlooked in certain patients and is usually a fairly simple way to help. However, this only works if you are having pain associated with swelling.
Co-Infections: The Big Ways Patients with RA May be Helped
Rheumatoid Arthritis is an autoimmune disease where the immune system is attacking the joints. Chronic infections with a virus, bacteria, or parasite can keep feeding the inflammation and perpetuate a patient’s symptoms and joint destruction.
Let’s open up with the cytomegalovirus (CMV). The most famous kind of viral infections are a cold or flu that you suffer from acutely. A flu lasts a few days then is done. A cold last a week or so and then is done. However, some viruses can stick around in a chronic state for years causing health problems. This is especially true in patients with autoimmune diseases, as your immune system is already not functioning at 100%. A study published in 2012 found patients with CMV and RA to have more severe joint destruction than those with RA alone[i]. Therefore, if you are still struggling with symptoms for RA you should at least be tested for CMV! To get rid of CMV we use things like selenium, alpha-lipoic acid, L-glutamine, vitamin A, and vitamin D.
Next we will move onto various bugs that live in the intestines. If you have any kind of gut symptom along with your RA like bloating, constipation, diarrhea, or heartburn this section is likely for you!
Endolimax Nana is typically a non-pathogenic amoeba found in most people’s intestines. However, while it is harmless in many people, it can cause problems in patients with rheumatoid arthritis. We’ve actually known this for 30 years now. A study published in 1983 showed a case study of a man who had intestinal symptoms and unresolved joint pain from RA was found to be positive for Endolimax Nana and eradication of the infection cleared up both his intestinal symptoms and joint pain[ii]. What I loved most about that study is the patient went from testing positive for rheumatoid arthritis (positive rheumatoid factor) to negative after the study! The doctors were not even sure if the patient really had rheumatoid arthritis or if rather if it was an infectious arthritis mimicking RA.
This concept of infections and the various bugs in your gut playing a huge role in the expression of RA has been gaining more and more traction. In 2011 there was a review published in Nature Reviews Rheumatology investigates further this connection between the bugs that live in you and rheumatoid arthritis.
“It seems that interplay between predisposing genetic factors and environmental triggers is required for disease manifestation[Of RA]. New insights from DNA sequence-based analyses of gut microbial communities and a renewed interest in mucosal immunology suggest that the microbiome represents an important environmental factor that can influence autoimmune disease manifestation[iii].“
If that was Greek to you let me translate. The “microbiome” is the collection of bugs that live in your gut. These being healthy or unhealthy can play a huge role in your autoimmune disease like RA.
Small Intestine Bacterial Overgrowth – A Big Deal
When people come in and ask me about the gut, most of them are worried about a “bad bug”. They ask me if they have worms, or candida, or H. pylori, or some other bad bug. What most people do not consider is that oftentimes it isn’t a “bad bug” but rather your good bugs are in the wrong place and misbehaving that is causing the problem. For simplicity sake you are supposed to have your probiotics/good bugs in your large intestine. They should not be in your small intestine. When they grow more and more in the small intestine this is called “Small Intestine Bacterial Overgrowth” or SIBO.
To quote Dr. Alex Vasquez: “At least 40% of rheumatoid arthritis patients have bacterial overgrowth of the small bowel, and the severity of the bacterial overgrowth correlates positively with the severity of the musculoskeletal inflammation!”
The big part about this is the part I underlined. The severity of the bacterial overgrowth correlates with the musculoskeletal inflammation! That is huge! It is probably the single fact that has allowed me to help many previously unhelp-able patients suffering with RA. By clearing up the gut, many rheumatoid arthritis patients see significant improvement.
In Closing
Many patients with RA have significant pain impacting there day to day life. The common medications taken to control these symptoms often damage kidneys, liver, and can leave a person open to infections. If these drugs alone are not giving you back the quality of life you need, consider investigating some of the above natural strategies.
Until next time. Thank you for reading.
Dr. Warren
[i] Pierer M, Rothe K, Dagmar Q, Schulz A, et. al. Association of anticytomegalovirus seropositivity with more severe joint destruction and more frequent joint surgery in rheumatoid arthritis. Arthritis & Rheumatism. June 2012: 65(6) 1740-1749.
[ii] Burnsteine SL, Liakos S. Parasitic rheumatism presenting as rheumatoid arthritis. Journal of Rheumatology. June 1983: 10(3) 514-15.
[iii] Scher J, Abramson S. The Microbiome and rheumatoid arthritis. Nature Reviews Rheumatology. Oct 2011: 7; 569-578.
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