Rheumatoid Arthritis Alternatives

January 22, 2010 Written by JP    [Font too small?]

When I was growing up I had a friend who became a doctor. I remember going to his home one day and asking for his advice about a medical dilemma with which I was grappling. In my 20’s I struggled with depression. It had become severe enough for my doctor to suggest that I begin using a prescription antidepressant. But I had reservations. I was concerned about the impressive list of reported side effects and a whole host of adverse reactions that might occur during the course of long term use. It literally felt like a lose-lose situation. If I was lucky, I might experience an improvement in mood. However, I was almost assured of one or more unintended consequences of treatment such as constipation, dry mouth, insomnia, nausea, restlessness and sexual dysfunction. The feelings that I experienced during that decision making process are shared by many people. And it’s not exclusive to those with depression. Anyone who is prescribed a powerful medication for a chronic condition may very well share similar thoughts.

If you have rheumatoid arthritis (RA) you’ll almost certainly be asked to take a combination of drugs that are intended to improve mobility, lessen joint damage and reduce pain. However the real possibility of side effects often influences the decision about the right course of treatment. Anti-inflammatory medications can promote abnormal bleeding (bruising and ulcers) and can occasionally cause kidney and liver damage. Antirheumatic drugs, immunosuppressants and steroids have been associated with a greater risk for bone loss, cataracts, infections and weight gain. Perhaps this is why some research shows that up to 90% of patients with RA incorporate some form of alternative or complementary medicine into their treatment programs. (1,2)

A recent review in the December edition of the journal Phytotherapy Research attempts to summarize the current state of herbal medicine in the management of RA. In this research, scientists from Victoria University in Melbourne, Australia conclude that two natural remedies show the greatest promise as “mediators of inflammation” in those with rheumatism. Oils containing a rare fatty acid known as GLA (gamma linolenic acid) have the largest amount of evidence to support their use. Blackcurrant, borage and evening primrose oil, the best sources of GLA, were deemed promising when given at a dosage of 1,400 mg of GLA/day. Lower amounts of 500 mg or less were found to be ineffective. The second noteworthy herbal medicine is one that I’ve previously highlighted on this site: Thunder God Vine (Tripterygium wilfordii). (3)

After reading the meta-analysis, I couldn’t shake this thought from my head: Two remedies?! That’s it? Do you mean to tell me that RA patients only have these two options from which to choose? I had a hard time accepting that. It’s a good thing too because it led me to investigate the issue further. The result of my curiosity yielded five additional alternatives that may be worth considering.

  • Probiotics May Tame the Flame – A new study in the journal BMC Complementary and Alternative Medicine examined the effects of a specific probiotic strain (Bacillus coagulans GBI-30, 6086) in a group of 45 men and women with RA. Half of the study participants were given a capsule of the probiotic and the remainder received a placebo. All of the participants were instructed to continue using their standard medication during the 60 day trial period. Those receiving the GBI-30 bacteria reported significant improvements in their Pain Scale, Patient Global and Pain Assessment scores and “self-assessed disability”. Before and after blood tests also revealed a decline in C-reactive protein concentrations, a measure of inflammation. Strides were also made in the patients’ “ability to walk 2 miles” and with regard to participation in daily activities. No adverse reactions were associated with the addition of GBI-30. These current findings are supported by recent studies conducted in Korea using other healthy bacteria including Lactobacillus casei. (4,5,6)
  • Aquatic Exercise for RA Muscle Preservation – A newly published systematic review in the Journal of Epidemiology determined that aquatic exercise yields “small but statistically significant effects on pain relief and related outcome measures of locomotor diseases (eg, arthritis, rheumatoid diseases, and back pain)”. Reducing inflammation and pain is certainly of critical importance in the successful management of RA. But it’s also very important for those with rheumatoid arthritis to actively work to prevent the loss of muscle mass and strength that often accompanies this disease. Specific underwater exercises such as “water treadmill walking” and underwater bicycle riding can help those with rheumatism to increase their aerobic capacity, burn extra calories and help maintain lean body function and mass. (7,8,9)
  • Fish Oil for Pain, Prevention and Protection – Adding 1 gram of fish oil to a conventional treatment protocol results in significant reductions in key inflammatory markers associated with RA. This is according to a new trial published in the December edition of the journal Clinical Biochemistry. 83 women with RA were asked to take a fish oil soft gel or a similar looking placebo for 3 months. Blood tests were used to assess any serum changes due to this complementary treatment. The results indicate that fish oil “could decrease the inflammatory response by lowering serum TNFalpha levels and sRANKL/osteoprotegerin ratio”. A November 2009 experiment also revealed that EPA (eicosapentaenoic acid), one of the two major omega-3 fatty acids in fish oil, may affect gene expression that protects against “arthritis-induced muscle wasting”. Finally, a large population study from Sweden recently determined that “intake of oily fish was associated with a modestly decreased risk of developing rheumatoid arthritis”. (10,11,12)
  • Freeze the RA Away – Cryotherapy is a type of physical therapy that employs the use of cold chambers, cold packs or cold air sprays that lower “skin and tissue temperature and subsequently decrease neuronal activity and tissue blood flow”. These physiological effects often result in analgesia (pain relief). But questions remain about its safety and tolerability. Several new studies attempt to clarify the promise and risks involved with this unconventional treatment. A three month trial published in the journal Inflammatory Research discovered that 2-3 minutes of “whole body cryotherapy at -140 to -160 degrees C” daily for 4 weeks resulted in “beneficial clinical effects” due to a reduction in histamine levels in RA patients. It’s interesting to note that histamine degradation, production and release were not affected by conventional physiotherapy. A comparison group of patients with osteoarthritis was also unresponsive to cryotherapy. Other cryotherapy studies have documented improvements in RA severity, as measured by reductions in inflammation (TNF-alpha and IL-1), Disease Activity Score and Visual Analog Scale indexes. However some research has found that a considerable percentage of patients discontinue treatment due to side effects (up to 21.7%). (13,14,15,16)
Fish Oil (DHA + EPA) Inhibit Inflammation via Multiple Pathways
Source: American Journal of Clinical Nutrition, Vol. 83, No. 6, S1505-1519S (link)
  • Rose Hips to the Rescue – A standardized extract of rosehip (Rosa canina) was recently evaluated in a double-blind placebo controlled study involving 89 patients with RA. 5 grams of encapsulated rosehip powder or a “matching placebo” was provided to study participants recruited from “two outpatient clinics in Berlin and Copenhagen”. Most of the volunteers were middle-aged women who had suffered from rheumatism for an average of 11.3 years. Several indicators of RA symptom severity improved in the women treated with rosehips vs. placebo. Specifically, benefits were noted when analyzing before and after Health Assessment Questionnaires (HAQ) and an index known as DAS-28 – a “physician’s global evaluation of disease activity”. While the results suggest some positive activity, no reduction in pain medication use was found in either the experimental or placebo groups. Still, there may be reason for optimism with regard to rosehips and arthritis in general. A recent meta-analysis concluded that rosehip powder can effectively reduce pain in osteoarthritic patients. In addition, a one-year survey of patients with chronic low back pain and osteoarthritic knee pain revealed that those with “greater degrees of pain and disability” may respond in a more pronounced way to this form of phytotherapy. Overall, most of the scientists involved in the rosehip research urge for additional studies on this seemingly promising supplement. (17,18,19)

If I had rheumatoid arthritis, I’d certainly explore every available natural therapy that I could find. Today’s column isn’t a comprehensive review of all of the alternative and complementary options for RA. I simply wanted to point out some of the most recent findings that may be worth considering and that you may not have already heard or read about. Please remember that much of this research utilizes a holistic approach in concert with standard care. An integrative program may very well be the best way to go for many patients. It sometimes allows for greater efficacy and a lower overall toxicity profile. However, it’s vital to consult with well informed health professionals prior to applying a “kitchen sink” approach to RA treatment. One important reason is that certain supplements may interact with medications. The best way to avoid this issue and other common pitfalls is to work with an integrative health team. If you do so, please make sure that they’re aware of the research presented here today.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


Tags: , ,
Posted in Alternative Therapies, Bone and Joint Health, Nutritional Supplements

27 Comments & Updates to “Rheumatoid Arthritis Alternatives”

  1. Paul F. Says:


    Our Silver Sneakers’ instructor is enthusiastic about your blog and is advertising its benefits among the participants!

    As your blog readership grows, more people may decide to follow your guidance and become their own advocates with their doctors, helping them in their slow but sure transition to incorporate complementary medicine in their practice, reducing the proliferation of bad side effects of symptom curing medicines.

    It made us feel really good!

    Keep up with your great job!

  2. JP Says:

    Thank you for letting me know, Paul! 🙂

    You made my night!

    Be well!


  3. liverock Says:

    Fish oil is the best at counteracting TNF(a)inflammation, as the study stated, but I would have thought that a dosage higher than 1 gram would be more effective.

    Improving the adrenal gland hormones, which normally provide corticosteroids that fight bodily inflammation, and are usually exhausted in RA would also help. Vitamin C and pantothenic acid(B5) are usually used to help exhausted adrenals.

  4. JP Says:


    I think you’re probably right on about the dosage of fish oil. I’m not certain why they chose that specific dose. I suspect they were trying to use the lowest amount possible since they were combining it with conventional meds. A conservative approach.

    I did a brief search of studies utilizing pantothenic acid (as calcium pantothenate) and RA and found studies dating back to the early 1950’s! Very interesting! 🙂

    re: Vitamin C

    Vitamin C deficiency appears to be present in RA patients of all ages:



    Thanks for pointing out the potential of B5 + C in RA. 🙂

    Be well!


  5. Iggy Dalrymple Says:

    re Cryotherapy…reminds me of various “Polar Bear” clubs, where members swim in the icy cold ocean. Mighty Joe Rollino, who just died at age 104, was an avid Polar Bear.

  6. JP Says:

    That’s so true, Iggy! Thanks for posting that! Who knows how long he would have gone on if not for the accident that took his life …

    “Joe Rollino, was 104, just 2 months shy of turning 105, when he was fatally injured by a minivan in Brooklyn on January 11, 2010. He was on his daily early morning walk to pick up coffee, a tabloid, and a lottery ticket. Until the end he was strong, healthy, and a picture of health!”

    I’m off to take a cold shower now! 🙂

    Be well!


  7. Nina K. Says:

    Morning JP 🙂

    great informative article, thanks. i have two family members which suffer from RA. the medications they have to take are a choice between pest and cholera :-(! i will let them know the infos you provide here. i hope this will help them a little.

    wish you and mrs. healthyfellow a wonderful weekend 🙂

    Nina K.

  8. Oct Says:

    I am printing this article out for my mom (she does have rheumatoid arthritis). Thanks JP … What great research!


  9. JP Says:

    Thank you, Nina! I hope the information will indeed be useful for your family.

    I’ll keep on the lookout for more RA-related research in the future and post whatever I find. There must be better solutions out there!

    I wish the same for you and yours! We had lots of rain this past week but it’s cleared up just in time for the weekend. 🙂

    Be well!


  10. JP Says:

    Thank you, Oct! 🙂

    I sure hope it helps your mom out. Please let me know if she has any questions about the info. in the column.

    Be well!


  11. pikko Says:

    Thank for your post. Very usefull.

    Come to see inspiring stories, motivating storys, and warm stories for your heart.

  12. Lisa Says:

    Great information. For individuals to learn what works and doesn’t work for their own RA– I’d suggest: http://www.symptomjournal.com as a place to keep track of the supplements, treatments, etc. and how it impacts your RA. There are customized questions for jouraling about your rheumatoid arthritis symptoms.

  13. Andrea Says:

    Thanks for pointing out the benefits of aquatic exercise for people with rheumatoid arthritis. I have heard that water is the great equalizer and can help people with stiff or sore joints move more freely. Exercise programs like aquafit are great for people with RA because you can work at your own pace and have fun doing it.

  14. JP Says:

    Thank you, Andrea. 🙂

    Be well!


  15. Robert Physical Says:

    I found the information about rose hips to be really hopeful. Wild roses are plentiful where I come from, and there are tons of recipes incorporating rose hips. It’s a win-win-win situation for me! They’re plentiful, tasty, cheap, and natural, without any severe side effects.

  16. JP Says:

    Updated: 09/16/15:


    Rheumatology (Oxford). 2015 Sep 13.

    Lower omega-3 fatty acids are associated with the presence of anti-cyclic citrullinated peptide autoantibodies in a population at risk for future rheumatoid arthritis: a nested case-control study.

    OBJECTIVE: The aim of this study was to investigate omega-3 fatty acid (FA) supplement use and omega-3 FAs in erythrocyte membranes [omega-3 FA % in erythrocyte membranes (RBC)] and their association with anti-CCP autoantibodies in a population without RA, but who are at genetic risk for RA.

    METHODS: The multicentre Studies of the Etiology of RA (SERA) cohort includes RA-free subjects who are first-degree relatives of RA probands or are enriched with the HLA-DR4 allele. In a nested case-control study, 30 SERA cases were identified who were anti-CCP2 antibody positive. We further identified 47 autoantibody negative controls, frequency matched to cases on age at study visit, sex, race and study site. Anti-CCP2 status, self-reported omega-3 FA supplement use and omega-3 FA % in RBCs were obtained from a single visit.

    RESULTS: Anti-CCP2 positive cases were less likely than controls to report omega-3 FA supplement use (odds ratio: 0.14; 95% CI 0.03, 0.68). In addition, the likelihood of anti-CCP2 positivity was inversely associated with total omega-3 FA % in RBCs (odds ratio: 0.47; 95% CI 0.24, 0.92, for a s.d. increase).

    CONCLUSION: The inverse association between anti-CCP2 positivity and self-reported omega-3 FA supplement use and omega-3 FA % in RBCs suggests that omega-3 FAs may protect against the development of RA-related autoimmunity in pre-clinical RA.

    Be well!


  17. JP Says:

    Updated 12/26/15:


    Arthritis Res Ther. 2015 Dec 24;17(1):380.

    The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis.

    BACKGROUND: Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.

    METHOD: In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).

    RESULTS: FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10-3). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10-2). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (-7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10-2); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10-3) and arterial stiffness (baPWV; P = 2.22 × 10-2) after adjustment for improvement in total cholesterol level.

    CONCLUSION: Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

    Be well!


  18. JP Says:

    Updated 1/14/16:


    Clin Rheumatol. 2016 Jan 13.

    Evaluation of the effects of different supplementation on oxidative status in patients with rheumatoid arthritis.

    Rheumatoid arthritis is a chronic inflammatory disease. Reactive oxygen species have been considered as aggravating factors for autoimmune diseases. Fatty acids had been linked in reduction of various diseases by augment of their antioxidant potential and antiinflammatory mechanisms. The aim of this study was to assess the oxidative status in patients with rheumatoid arthritis who used concentrated fish oil only or concentrated fish oil in combination with evening primrose oil in a period of 3 months. Subjects were divided into three groups. The group I consists of patients who had been taking only their regular rheumatologic therapy; group II, patients who had been taking concentrated fish oil; and group III, patients who had been taking concentrated fish oil and evening primrose oil. Peripheral blood samples were used for all the assays. We assessed the following oxidative stress markers: index of lipid peroxidation (thiobarbituric acid-reactive substances (TBARS)), hydrogen peroxide (H2O2), superoxide anion radical (O2 -), nitric oxide (NO), superoxide dismutase activity (SOD), catalase activity (CAT), and glutathione levels (GSH) in erythrocytes. There were no statistically significant changes for any of the oxidative stress parameters in group I. In group II, levels of TBARS, NO2 -, and GSH were increased, while levels of H2O2 decreased. Increased values of TBARS, NO2 -, and SOD were found in group III. Our findings indicate that intakes of fish oil and evening primrose oil may be of importance in mitigation of inflammation, disease activity, and oxidative stress biomarkers, through increased activities of antioxidant enzymes.

    Be well!


  19. JP Says:

    Updated 10/10/16:


    J Am Coll Nutr. 2016 Oct 6:1-7.

    The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial.

    OBJECTIVE: Previous studies have shown that the bioflavonoid quercetin has anti-inflammatory and anti-nociceptive effects. We investigated the effect of quercetin supplementation on inflammation, disease severity, and clinical symptoms in women with rheumatoid arthritis (RA).

    METHODS: The present study was a randomized, double-blind, placebo-controlled clinical trial in which 50 women with RA were allocated into a quercetin (500 mg/day) or placebo group for 8 weeks. Plasma levels of high-sensitivity tumor necrosis factor-α (hs-TNFα), erythrocyte sedimentation rate (ESR), clinical symptoms including early morning stiffness (EMS), morning and after-activity pain, and tender (TSC) and swollen joint counts (SJC) were determined. Disease activity and functional disability were assessed by Disease Activity Score 28 (DAS-28), physician global assessment (PGA), and a health assessment questionnaire (HAQ) at the beginning and end of the study.

    RESULTS: Quercetin supplementation for 8 weeks significantly reduced EMS, morning pain, and after-activity pain (p < 0.05). DAS-28 and HAQ scores decreased in the quercetin group compared to placebo and the number of patients with active disease significantly decreased in the quercetin group. Plasma hs-TNFα level was significantly reduced in the quercetin group compared to placebo (p < 0.05). There were no significant differences in TJC and SJC between groups but TJC significantly decreased in the quercetin group after the intervention. Supplementation had an effect on ESR but it was not significant (p > 0.05).

    CONCLUSIONS: Five hundred milligrams per day quercetin supplementation for 8 weeks resulted in significant improvements in clinical symptoms, disease activity, hs-TNFα, and HAQ in women with RA.

    Be well!


  20. JP Says:

    Updated 11/09/16:


    J Phys Ther Sci. 2016 Oct;28(10):2820-2829.

    Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis.

    This study aimed to evaluate the effects of green tea and supervised exercise training interventions on improvement of disease activity and bone metabolism markers in rheumatoid arthritis patients. [Subjects and Methods] One-hundred and twenty subjects who had a mean age of (60.7 ± 2.53 years) and had been diagnosed with rheumatoid arthritis at least ten years previously were randomly included in this study. Patients were treated with infliximab, green tea, or a supervised exercise program for six months. Disease activity markers as well as antioxidant activity of green tea extracts were estimated before supplementation using in vitro assays. [Results] Rheumatoid arthritis patients treated with green tea for 6 months alone or in combination with infliximab or an exercise program showed significant improvement in disease activity parameters, including C-reactive protein, and erythrocyte sedimentation rate, swollen and tender joints counts, and modified Stanford Health Assessment Questionnaire score, along with an increase in serum levels of bone resorption markers, i.e., deoxypyridinoline, amino-terminal telopeptide of type 1 collagen, and bone alkaline phosphatase, at 6 months of after initial treatment. The European League Against Rheumatism and American College of Rheumatology scores revealed more clinical improvement in the disease activity of rheumatoid arthritis patients treated with green tea along with exercise compared with rheumatoid arthritis patients treated with infliximab or exercise combinations. This may have been due to the higher potential antioxidant activity of green tea (89.6% to 96.5%). [Conclusion] Both exercise and green tea interventions appeared to be beneficial as nondrug modulates for rheumatoid arthritis disorders.

    Be well!


  21. JP Says:

    Updated 02/03/17:


    Ann Rheum Dis. 2017 Jan 30.

    Long-term dietary quality and risk of developing rheumatoid arthritis in women.

    OBJECTIVES: To evaluate the association between long-term dietary quality, measured by the 2010 Alternative Healthy Eating Index, and risk of rheumatoid arthritis (RA) in women.

    METHODS: We prospectively followed 76 597 women in the Nurses’ Health Study aged 30-55 years and 93 392 women in the Nurses’ Health Study II aged 25-42 years at baseline and free from RA or other connective tissue diseases. The lifestyle, environmental exposure and anthropometric information were collected at baseline and updated biennially. Cumulative follow-up rates were more than 90% for both cohorts. The primary outcome was RA alone with two subtypes of the disease: seropositive and seronegative RA.

    RESULTS: During 3 678 104 person-years, 1007 RA cases were confirmed. In the multivariable-adjusted model, long-term adherence to healthy eating patterns was marginally associated with reduced RA risk. To assess potential effect modification by age at diagnosis, we stratified by age. Among women aged ≤55 years, better quality diet was associated with lower RA risk (HRQ4 vs Q1: 0.67; 95% CI 0.51 to 0.88; p trend: 0.002), but no significant association was found for women aged >55 years (p interaction: 0.005). When stratifying by serostatus, the inverse association among those aged ≤55 years was strongest for seropositive RA (HRQ4 vs Q1: 0.60; 95% CI 0.42 to 0.86; p trend: 0.003).

    CONCLUSIONS: A healthier diet was associated with a reduced risk of RA occurring at 55 years of age or younger, particularly seropositive RA.

    Be well!


  22. JP Says:

    Updated 03/14/17:


    Clin Nutr. 2017 Feb 21.

    Monounsaturated fatty acids might be key factors in the Mediterranean diet that suppress rheumatoid arthritis disease activity: The TOMORROW study.

    BACKGROUND & AIMS: The Mediterranean diet is reportedly effective in suppressing disease activity in rheumatoid arthritis (RA), but the key elements responsible for this effect remain unknown. The presented study therefore aimed to identify such elements.

    METHODS: This study included 208 consecutive patients with RA (RA group) and 205 age- and sex-matched healthy volunteers (controls) from the prospective “TOMORROW” cohort study that has been ongoing since 2010 were included in this study. Food and nutrient intake was assessed using the brief self-administered diet history questionnaire (BDHQ), Mediterranean diet scores were calculated based on intake by controls and disease activity was determined from disease activity scores in 28 joints and erythrocyte sedimentation rates (DAS28-ESR).

    RESULTS: Intake of monounsaturated fatty acids (MUFA) was significantly lower in the RA, than in the control group (P = 0.003) and the ratio of consumed monounsaturated to saturated fatty acid (MUFA/SFA) significantly differed within the RA group after being sub-classified according to DAS28-ESR. Moreover, DAS28-ESR significantly correlated with MUFA/SFA intake after age adjustment (R = -0.228, P < 0.01). Logistic regression analysis selected high MUFA intake as an independent predictor of remission in the RA group with borderline boundary significance (odds ratio, 1.97; 95% CI, 0.98-3.98; P = 0.057). Changes in DAS28-ESR between 2010 and 2011 significantly correlated with MUFA/SFA intake after age adjustment (R = 0.180, P = 0.01). CONCLUSIONS: Daily MUFA intake, a component of the Mediterranean diet score, might suppress disease activity in RA patients. Be well! JP

  23. JP Says:

    Updated 06/18/17:


    Iran J Allergy Asthma Immunol. 2017 Apr;16(2):99-106.

    Silymarin (Livergol®) Decreases Disease Activity Score in Patients with Rheumatoid Arthritis: A Non-randomized Single-arm Clinical Trial.

    Rheumatoid arthritis (RA) is a chronic autoimmune disease, which can lead to joint destruction and disability. Pannus formation due to chronic synovitis is the hallmark of RA. Oxidative stress as a consequence of immune cell activation and disease-modifying anti-rheumatic drugs can prevent inflammation and tissue destruction. Silymarin, an antioxidant extract from Silybum marianum, has been traditionally used for the treatment of liver diseases for decades. In the present non-randomized single-arm clinical trial (NRSACT) study we evaluated the effects of silymarin tablet (Livergol®) on inflammatory markers in stable RA patients. Disease activity score (DAS-28) was measured before and after adding silymarin to standard drug regimen used for controlling inflammation in RA patients. Silymarin significantly reduced the DAS28 related symptoms in 44 RA patients after 90 days (3.02±0.98 versus 2.3±0.74, p<0.001). The exact mechanism of therapeutic effects of silymarin in RA patients is not clear but it could be as the results of its anti-inflammatory and anti-oxidative properties. Conducting the study on larger number of patients and also measuring cytokines levels including TNF-α and IL-1β may clarify the underlying mechanisms of the anti-inflammatory effects of silymarin in RA patients.

    Be well!


  24. JP Says:

    Updated 06/24/17:


    Arthritis Care Res (Hoboken). 2017 Jun 21.

    The relationship between fish consumption and disease activity in rheumatoid arthritis.

    OBJECTIVE: To assess whether more frequent fish consumption is associated with lower RA disease activity scores among participants in an RA cohort.

    METHODS: We conducted a cross-sectional analysis using baseline data from participants in the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in RA (ESCAPE-RA) cohort study. Frequency of fish consumption was assessed by a baseline food frequency questionnaire assessing usual diet in the past year. Multivariable, total energy-adjusted linear regression models provided effect estimates and 95% confidence intervals (CI) for frequency of fish consumption (never to <1/month, 1/month to <1/week, 1/week, and ≥2/week) on baseline DAS28-CRP. We also estimated the difference in DAS28-CRP associated with increasing fish consumption by one serving per week.

    RESULTS: Among 176 participants, median DAS28-CRP was 3.5 (interquartile range 2.9-4.3). In an adjusted linear regression model, subjects consuming fish ≥2 times/week had a significantly lower DAS28-CRP compared with subjects who ate fish never to <1/month (difference -0.49 [95% CI -0.97, -0.02]). For each additional serving of fish per week, DAS28-CRP was significantly reduced by 0.18 (95% CI -0.35, -0.004).

    CONCLUSIONS: Our findings suggest that higher intake of fish may be associated with lower disease activity in RA patients.

    Be well!


  25. JP Says:

    Updated 09/01/17:


    J Med Food. 2017 Aug 29.

    A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study.

    Rheumatoid arthritis (RA) is an autoimmune, chronic systemic inflammatory disorder. The long-term use of currently available drugs for the treatment of RA has many potential side effects. Natural phytonutrients may serve as alternative strategies for the safe and effective treatment of RA, and curcuminoids have been used in Ayurvedic medicine for the treatment of inflammatory conditions for centuries. In this study, a novel, highly bioavailable form of curcumin in a completely natural turmeric matrix was evaluated for its ability to improve the clinical symptoms of RA. A randomized, double-blind, placebo-controlled, three-arm, parallel-group study was conducted to evaluate the comparative efficacy of two different doses of curcumin with that of a placebo in active RA patients. Twelve patients in each group received placebo, 250 or 500 mg of the curcumin product twice daily for 90 days. The responses of the patients were assessed using the American College of Rheumatology (ACR) response, visual analog scale (VAS), C-reactive protein (CRP), Disease Activity Score 28 (DAS28), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) values. RA patients who received the curcumin product at both low and high doses reported statistically significant changes in their clinical symptoms at the end of the study. These observations were confirmed by significant changes in ESR, CPR, and RF values in patients receiving the study product compared to baseline and placebo. The results indicate that this novel curcumin in a turmeric matrix acts as an analgesic and anti-inflammatory agent for the management of RA at a dose as low as 250 mg twice daily as evidenced by significant improvement in the ESR, CRP, VAS, RF, DAS28, and ACR responses compared to placebo. Both doses of the study product were well tolerated and without side effects.

    Be well!


  26. JP Says:

    Updated 1/24/18:


    Nutrients 2017, 9(4), 325

    Clinical Benefits of n-3 PUFA and ɤ-Linolenic Acid in Patients with Rheumatoid Arthritis

    Background: Marine n-3 polyunsaturated fatty acids (PUFA) and ɤ-linolenic acid (GLA) are well-known anti-inflammatory agents that may help in the treatment of inflammatory disorders. Their effects were examined in patients with rheumatoid arthritis;

    Methods: Sixty patients with active rheumatoid arthritis were involved in a prospective, randomized trial of a 12 week supplementation with fish oil (group I), fish oil with primrose evening oil (group II), or with no supplementation (group III). Clinical and laboratory evaluations were done at the beginning and at the end of the study;

    Results: The Disease Activity Score 28 (DAS 28 score), number of tender joints and visual analogue scale (VAS) score decreased notably after supplementation in groups I and II (p < 0.001). In plasma phospholipids the n-6/n-3 fatty acids ratio declined from 15.47 ± 5.51 to 10.62 ± 5.07 (p = 0.005), and from 18.15 ± 5.04 to 13.50 ± 4.81 (p = 0.005) in groups I and II respectively. The combination of n-3 PUFA and GLA (group II) increased ɤ-linolenic acid (0.00 ± 0.00 to 0.13 ± 0.11, p < 0.001), which was undetectable in all groups before the treatments; Conclusion: Daily supplementation with n-3 fatty acids alone or in combination with GLA exerted significant clinical benefits and certain changes in disease activity. Be well! JP

  27. JP Says:

    Updated 10/18/18:


    J Altern Complement Med. 2018 Oct 16.

    Effectiveness of Acupuncture on Pain, Functional Disability, and Quality of Life in Rheumatoid Arthritis of the Hand: Results of a Double-Blind Randomized Clinical Trial.

    BACKGROUND: Rheumatoid arthritis (RA) is characterized by pain, functional disability, poor quality of life (QoL), high socioeconomic impact, and annual costs of over $56 billion in the United States. Acupuncture (AC) is widely in use; however, studies show severe methodological shortcomings, did not consider the functional diagnosis for the allocation of acupoints and their results showed no differences between verum and control groups.

    OBJECTIVE: The authors aimed to objectively assess the safety and efficacy of AC treatments for RA.

    METHODS: 105 RA patients with a functional diagnosis of a “Pivot syndrome” or “Turning Point syndrome” were randomly assigned to (1) verum-AC (verum acupoints), (2) control-AC (sham acupoints-points outside of the conduits/meridians and of the extra-conduits), or (3) waiting list (each group n = 35). AC groups experienced the exact same number, depth, and stimulation of needles. Assessments took place before and 5 min after AC with follow-ups over 4 weeks.

    RESULTS: (1) Verum-AC significantly improved self-reported pain (Z = -5.099, p < 0.001) and pressure algometry (Z = -5.086, p < 0.001); hand grip strength (Z = -5.086, p < 0.001) and arm strength (Z = -5.086, p < 0.001); health status improved significantly (p < 0.001, Z = -4.895); QoL improved significantly in 7/8 survey domains; and number of swollen joints (Z = -2.862, p = 0.004) and tender joints (Z = -3.986, p < 0.001) significantly decreased. (2) Control-AC showed no significant changes, except in self-reported pain improvement. (3) Waiting list group showed an overall worsening. CONCLUSION: This is the first double-blind controlled study on AC in RA of the hand that objectively and specifically assesses positive effects supporting its integration in rheumatology. Acupoint allocation according to Chinese Medicine functional diagnoses is extremely relevant to assess AC effectiveness in a patient group primarily defined by a "western" medicine diagnosis. Based on clear allocation criteria for acupoints, the authors minimized the possible bias of unspecific and suggestive effects on the control group, showed the specific effects of the points chosen, improved efficacy, and identified an evidence base for AC. Be well! JP

Leave a Comment