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Massage Today
December, 2009, Vol. 9, Issue 12

Rheumatoid Arthritis

By Elaine Stillerman, LMT

It was supposed to be a Sunday like any other Sunday: get up, go to the gym, do the shopping and chores, and enjoy the rest of the day with my son. Except on this June morning, I couldn't get out of bed.

I put one foot down and the pain shot down from my knee to my toes. It was the same with the other leg. And both arms: pain, stiffness, swelling, and fire from elbows to fingers. All the connective tissues and articulations were inflamed. I recently had some dental work and thought that I was having an allergic reaction to the inlay. But that wasn't it at all.

My doctor suspected acute onset rheumatoid arthritis (RA), which blood tests later confirmed. For someone who has been practicing yoga since my teen years (let's not count how long ago that is) and works out regularly, this felt so wrong. The doctor prescribed heavy doses of prednisone which put out the fire and helped ease the stiffness, but this nasty drug has awful side effects and cannot be used long term.

RA & the Immune System

Generally affecting people 20-50 years of age, the cause of rheumatoid arthritis is unknown although there are a number of viable theories. RA is considered to be, by Western standards, an autoimmune disease. In RA patients, the immune system seems to attack body cells that are mistaken to be invader cells. Elevated levels of white blood cells are present within the synovial membranes that line the body's joints. This results in swelling, pain, and limited mobility. Over time, joints can become deformed and rheumatoid nodules, or small lumps, may grow under the skin at pressure points.

In more serious cases, RA can also affect other body parts such as tear ducts, salivary glands, the lining of the heart, the lungs, and sometimes blood vessels. Women are two to three times more likely to get rheumatoid arthritis than men and the rates for women are increasing. After nearly four decades of steady decline, the tide has turned and the numbers are rising. From 1985 to 1994, 36.4 per 100,000 women suffered from this debilitating condition. In 1995 to 2004, that number rose to 54 per 100,000 women. The incidence for men, however, stayed the same. And no one can explain why.

At the turn of the 20th century, rheumatoid-like conditions (i.e. ankylosing spondylitis) were considered to be venereal diseases. A few short years later, urinary infections were deemed to be the cause. By the time steroids transformed treatment, these causes were largely debunked.

"Immunological crossreactivity" is currently the leading theory of RA. This view reinforces the autoimmune nature of the disease. Infectious agents are considered to be the major environmental factors involved in the inflammatory process. The production of tumor necrosis factor (TNF), a pro-inflammatory cytokine, seems to have a major part in the inflammatory response. But the actual triggering mechanism is still unknown.

Other possible causes include hormonal factors which may explain the heightened risk factors for women. Reduced childbearing and breastfeeding (which seem to be contradictory) are associated with elevated prolactin levels.

In addition, there may be a genetic component to RA, abnormal bowel permeability, environmental and lifestyle factors, food allergies, and microorganisms all which lead to a multidimensional disease where any combination of factors may be culpable.

Treatment: Western vs. Eastern Thought

So how does Western medicine treat this painful, debilitating disease? Since the cause is unknown, standard medical therapy works by treating the symptoms - often times successfully. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are often well tolerated and inexpensive.

If these drugs are not effective, corticosteroids are prescribed, with prednisone the most frequently prescribed oral corticosteroid. This drug is very effective in the short term in reducing the inflammatory response, but long-term use generally causes more harmful side effects than benefits. Long-term use suppresses the natural production of the corticosteroids by the adrenal glands, and sudden withdrawal of the drugs may lead to collapse, coma and death. Other side effects, over a protracted period of time, may include: depression and other mental/emotional disturbances (this occurs in 57 percent of patients being treated with high doses of prednisone over a long period of time); high blood pressure; diabetes; peptic ulcers; acne; excessive facial hair in women; insomnia; muscle cramps and weakness; thinning and weakening of the skin; osteoporosis; and increased susceptibility to the formation of blood clots.

Disease-modifying anti-rheumatic drugs (DMARDs), such as hydroxychloroquine, gold therapy penicillamine, etc., are used to slow joint erosion, but their effectiveness is still unproven. One drug that has proven to be effective in delaying joint damage and reducing the inflammation is methotrexate, a drug commonly prescribed for breast cancer and severe psoriasis. This drug works by inhibiting the body's ability to use folic acid which is required for cell production (which is why it is used in instances of cancer.). In RA, the dosage is much lower than for cancer patients, but the side effects still may include gastrointestinal ulceration and bleeding; mouth and throat ulcers; hair loss; bone marrow suppression; liver, lung, and kidney damage; increased rate of infections; and higher risk for developing cancer.

Dietary considerations are strongly implicated in cases of RA. Some doctors posit that certain diets might even cause RA. It is interesting to note that the incidence of RA is practically non-existent in cultures and societies that eat a more "primitive" diet while it is found at a high rate in societies that eat a Western diet. A diet rich in whole foods, grains, vegetables and fiber and low in refined foods, sugar, and meat provides the best protection against developing RA. A vegetarian diet showed a substantial reduction in inflammation in many patients tested.

Another interesting factor in the development of RA is altered gastrointestinal gut flora. This is linked not only to RA, but other autoimmune diseases as well. Improper digestion is also suspect. Many patients with RA are deficient in digestive factors such as HCl and pancreatic enzymes resulting in incomplete digestion.

The Eastern interpretation of rheumatoid arthritis is quite different than the allopathic point of view. Arthritis is considered to be a "bi-syndrome" (pronounced "bee") which is a disorder resulting from blocked energy channels, the sluggishness of qi and blood circulation after wind, cold, dampness or heat. The symptoms of bi-syndrome are pain, numbness and heaviness of muscles, tendons and joints, joint swelling, hotness, and limited range of motion.

The wind-dampness-heat type of bi-syndrome is differentiated from the wind-cold-dampness type by its joint redness, swelling, hotness, and pain. An acupuncturist can determine the type of bi-syndrome it is and either disperse the wind and cold, dredge the meridians, and eliminate the dampness, or warm the meridians, disperse the wind and cold, and eliminate the dampness.

Chinese herbs may also be prescribed to support the related organs, nourish the blood and connective tissues, and eliminate the inflammation.

Massage & RA

Massage is never performed in cases of acute inflammatory RA, but can be very effective once the inflammation is controlled. A study by Field, Hernandez-Reif, Seligman, et al (1997) with children with mild to moderate juvenile RA showed that after the parents massaged their children 15 minutes a day for 30 days and a control group practiced relaxation therapy, the massaged group reported less stress and anxiety, less pain, and improved motor activities.

After including regular acupuncture, chiropractic care, dietary restrictions, herbal remedies, and stretching as part of my treatment along with proper medication, I am back on track. Perhaps not as agile and fluid as I once was (who is?), but I've got it under control. And I hope that this episode was my only one...one can hope.

Author note: I want to say a special "thank you" to Kellie White, senior editor, and Kelly Milford, editor, Elsevier Publishing, for their help in researching this article.

Resources

  1. Brennan P, Ollier B, Worthington J et al. "Are both genetic and reproductive associations with rheumatoid arthritis linked to prolactin?" Lancet 1996;348(9020):106-9.
  2. Field T, Hernandez-Reif M, Seligman S, et al. Juvenile rheumatoid arthritis: benefits from massage therapy. Journal of Pediatric Psychology 1997;22:607-7. IN: Field T. Massage Therapy Research. St. Louis: Churchill Livingstone, 2006.
  3. Goodman B. "Rheumatoid Arthritis Rate Rising in Women." Arthritis Today. http://www.arthritistoday.org/conditions/rheumatoid-arthritis/news.
  4. "Bi-Syndrome." Acupuncture.com. www.acupuncture.com/conditions/bisyndrome.htm.
  5. Mills S, Bone K. Principles and Practice of Phytotherapy. St. Louis: Churchill Livingstone, 1999.
  6. Pizzorno J, Murray M, Joiner-Bey H. The Clinician's Handbook of Natural Medicine, 2nd ed. St. Louis: Churchill Livingstone, 2007.
  7. Ulbricht C. Natural Standard Medical Conditions Reference. St. Louis: Mosby, 2008.

Click here for previous articles by Elaine Stillerman, LMT.

 

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