Rheumatoid arthritis is an autoimmune disease in which joints, usually including those of the hands and feet, are symmetrically inflamed, resulting in swelling, pain, and often the eventual destruction of the joint's interior. Rheumatoid arthritis is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one per cent of adults. Rheumatoid arthritis may be accompanied by fatigue, weight loss, anxiety, and depression.

Rheumatoid arthritis can also produce a variety of symptoms throughout the body. The exact cause of rheumatoid arthritis isn't known, but many different factors, including genetic predisposition, may influence the autoimmune reaction. This disease develops in about 1 percent of the population, affecting women two to three times more often than men. Usually, rheumatoid arthritis first appears between 25 and 50 years of age, but it may occur at any age. In some people, the disease resolves spontaneously, and treatment relieves symptoms in three out of four people; however, at least 1 out of 10 people eventually becomes disabled.

In rheumatoid arthritis, the immune system attacks the tissue that lines and cushions joints (certain immune cells, perhaps mast cells, attack the carbohydrate molecules, known as glycosaminoglycans, in the joints). Eventually, the cartilage, bone, and ligaments of the joint erode, causing scars to form within the joint. The joints deteriorate at a highly variable rate.

Treatment of rheumatoid arthritis
Treatment for rheumatoid arthritis ranges from simple, conservative measures such as rest and adequate nutrition to drugs and surgery. Treatment starts with the least aggressive measures, moving to more aggressive ones if needed. A basic principle of treatment is to rest the affected joints, because using them aggravates the inflammation. Regular rest periods often help relieve pain, and sometimes a short period of total bed rest helps relieve a severe flare-up in its most active, painful stage. Splints can be used to immobilize and rest one or several joints, but some systematic movement of the joints is needed to prevent stiffening. A regular, healthy diet is generally appropriate. Some people have flare-ups after eating certain foods. A diet rich in fish minor beneficial effects on the inflammation.

Natural treatment for rheumatoid arthritis
Low fat diet with plenty of fish and fish oils
Gluten free diet may be tried
Cat’s claw a small study showed a reduction in pain in rheumatoid arthritis patients give Cat's claw extract.
Green tea extract. For more green tea extract information.
Folic acid (see below)
Stop smoking
Guggul
Peony root has been studied for its role in rheumatoid arthritis. Paeoniae alba Radix is a valuable herb in the treatment of rheumatoid arthritis in traditional Chinese medicine. Paeoniflorin is a bioactive glucoside from paeony root.

Clinical observation on effect of total glucosides of paeony combined with methotrexate on rheumatoid arthritis
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007. The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou.
To observe the effect of total glucosides of peony combined with methotrexate on rheumatoid arthritis. Two hundred and sixty patients were assigned to two groups, the treated group (180 cases) was orally administered with methotrexate plus peony herb, and the control group (80 cases) with methotrexate plus sulfasalazine (SSZ). The treatment lasted 24 weeks. Peony herb combined methotrexate treatment shows favorable effect on rheumatoid arthritis, showing a quicker initiation with less side-effect and higher compliance.

Treatment for rheumatoid arthritis
Rheumatoid arthritis causes pain, stiffness and swelling in the joints. There is no known cure, and most treatments focus on slowing joint damage and treating pain. In addition to pain medication, get plenty of rest, especially when you have severe symptoms. Get regular exercise -- more when symptoms have eased, and less when symptoms are severe. Protect joints, such as wrists and ankles, with splints. Reduce stress using relaxation techniques, exercising and joining a support group.

Drugs used for rheumatoid arthritis
The main categories of drugs used to treat rheumatoid arthritis are non-steroidal anti-inflammatory drugs (NSAIDs), slow-acting drugs, corticosteroids, and immunosuppressive drugs. Generally, the stronger the drug, the more severe its potential side effects, so that closer monitoring is needed.
   Prior to the availability of abatacept and rituximab, the routine of care for rheumatoid arthritis was to treat patients with methotrexate by itself; if patients had a good clinical response, methotrexate was continued. X-ray findings were followed on an annual basis, and as long as they had no progressive erosive disease, methotrexate was continued. However, if methotrexate had an insufficient clinical response, adding anti-TNF therapy to methotrexate was standard of care.

Which drug is best for rheumatoid arthritis?
It may not make a large difference which drug a patient uses to treat rheumatoid arthritis, although mixing different types of drugs in a cocktail approach may work better than using a single drug treatment. A group at the Agency for Healthcare Research and Quality, led by Dr. Katrina Donahue of the University of North Carolina, looked at 11 different drugs used to treat rheumatoid arthritis. Some drugs used to treat it reduce inflammation directly while others tone down immune system response - leaving patients vulnerable to infections and cancer. The therapies included corticosteroids, synthetic disease modifying anti-rheumatic drugs, or DMARDs, such as hydroxychloroquine, leflunomide, methotrexate and sulfasalazine. Biological DMARDs such as abatacept, made by Bristol-Myers Squibb Co. under the brand name Orencia; adalimumab, sold by Abbott Laboratories as Humira; anakinra or Kineret, made by Amgen Inc ; etanercept, sold by Amgen under the brand name Enbrel; infliximab, sold by Johnson & Johnson under the Remicade brand name; and rituximab, marketed by Genentech Inc and Biogen Idec Inc under the Rituxan and MabThera brand names. As of December 2007, it is not clear which treatment method is best and there are different viewpoints among rheumatologists.

Rheumatoid arthritis Research Update
Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa (Cat's Claw) for the treatment of rheumatoid arthritis.
Mur E. Innsbruck University Hospital, Austria. J Rheumatol. 2002 Apr;29(4):678-81.
To evaluate safety and clinical efficacy of a plant extract from the pentacyclic chemotype of Uncaria tomentosa (cat's claw) in patients with active rheumatoid arthritis (RA). Forty patients undergoing sulfasalazine or hydroxychloroquine treatment were enrolled in a randomized 52 week, 2 phase study. During the first phase (24 weeks, double blind, placebo controlled), patients were treated with UT extract or placebo. In the second phase (28 weeks) all patients received the plant extract. RESULTS: Twenty-four weeks of treatment with the UT extract resulted in a reduction of the number of painful joints compared to placebo (by 53% vs 24%). Patients receiving the UT extract only during the second phase experienced a reduction in the number of painfuland swollen joints and the Ritchie Index compared to the values after 24 weeks of placebo. Only minor side effects were observed. CONCLUSION: This small preliminary study demonstrates relative safety and modest benefit to the tender joint count of a highly purified extract from the pentacyclic chemotype of UT in patients with active RA taking sulfasalazine or hydroxychloroquine.

Mediterranean diet suppresses disease activity in rheumatoid arthritis
Switching from a typical western diet to a traditional Mediterranean (MD) diet reduces pain and inflammation associated with rheumatoid arthritis within 12 weeks, Swedish researchers report in the March issue of the Annals of Rheumatic Diseases. Dr. L. Hagfors, of Umeå University, and associates designed a diet plan characterized by a high consumption of fruit, vegetables, cereals and legumes. This diet also contains less red meat and more fish than usually consumed by westerners. The investigators slightly modified the diet by permitting patients to use canola oil in addition to olive oil and by substituting green or black tea for wine, both of which are high in polyphenols. Twenty-six patients were randomly assigned the new diet, while 25 patients served as controls. Disease duration was at least 2 years and disease activity score 28 (DAS28) ranged between 2.19 and 7.00 of a possible 10. After 3 weeks, results for the two groups did not differ. By the end of the 12-week study period, however, MD diet subjects showed significant improvements in three of four primary efficacy variables. DAS28 dropped on average by 0.56, Health Assessment Questionnaire had declined, and the vitality and mental health dimension of the SF-36 Health Survey had improved. Only the use of nonsteroidal antiinflammatory use was unaffected. Furthermore, the number of swollen and tender joints and pain scores significantly decreased, as did C reactive protein levels and thrombocyte counts. In contrast, the overall findings remained stable during the course of the trial among patients in the control group. "Even a minor effect that is persistent and accumulates over time might become important," Dr. Hagfors' team points out. The group intends to conduct a 1-year follow-up study. Ann Rheumatic Dis 2003;62:208-214.

Rheumatoid arthritis questions
Q. Does Tai Chi help reduce symptoms of rheumatoid arthritis?
   A. Tai Chi does not have a significant role to play in the treatment for rheumatoid arthritis.

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