Rheumatoid arthritis is a condition that affects nearly 1% of the world's population, with 1.3 million Americans affected. This article will discuss what rheumatoid arthritis is, including its symptoms and how it’s diagnosed. We’ll then discuss functional medicine testing of rheumatoid arthritis and the top supplements that have been shown to be beneficial for treatment.

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What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic, autoimmune condition of the joints. Autoimmune diseases occur when the immune system mistakes healthy tissues for a foreign invader, thus attacking the healthy tissues. In RA, the immune system attacks the joints. The majority (75%) of people who get RA are women. RA can begin at any age but most commonly starts between the age of 30-50. While there does seem to be a genetic predisposition to RA, there are also many environmental risk factors. Smoking, obesity, viral infections, hormonal factors, dietary factors, and chronic inflammatory gum disease periodontitis may increase the risk of RA. Additionally, gastrointestinal health may also influence RA.

There are four stages of RA. During the first stage, the lining of the joint, referred to as the synovium, becomes inflamed, leading to symptoms of pain, stiffness, and discomfort. During the second phase, the cartilage, or the cushion-type material at the end of bones, begins to be damaged. Inflammation is increasing, and joints are stiff; on a physical exam, your doctor will see a loss in the range of motion of the affected joints. Unstable joints characterize the third phase, as the inflammation continues to affect the cartilage, leading to bone erosions near the joints. Loss of motion, pain, and swelling are common symptoms in this phase. Stage four is referred to as “end-stage RA”; inflammation subsides, but the joint continues to deteriorate and may lose overall function. Lack of motion, pain, stiffness, and swelling will still occur, and joint replacement surgery may be considered.

Rheumatoid Arthritis Symptoms

RA symptoms will vary from person to person and will also depend on what stage of RA they are experiencing. Symptoms can include:

• Painful, tender, warm joints. The smaller joints of the hands, wrist, and feet are more commonly affected; however, large joints such as knees, shoulders, and hips can also be affected.
• Joint involvement is bilateral (right and left wrists, for example)
• Stiffness is worse in the morning, for about 30 minutes after waking.
• Weakness
• Weight loss
• Fatigue
• Fever
• Sleep difficulties

These symptoms may come in waves of flares and remission. Flares are described as periods of increased disease activity, and remission is when the joint pain and swelling disappear.

Additionally, RA can affect many other areas of the body besides the joints; 40% of those with RA will have symptoms outside the joints. Other areas involved include the eyes, heart, kidneys, lungs, nerve tissue, salivary glands, skin, blood vessels, and bone marrow.

How is Rheumatoid Arthritis Diagnosed?

No singular test diagnoses RA; rather, diagnosis is made after looking at many factors. On a physical exam, a doctor will assess joints for visible signs of inflammation, including swelling, redness, rash, and nodules. Orthopedic tests will also be performed to see what motions induce pain. A doctor may also perform a pulmonary exam, listening for signs of lung inflammation. Many laboratory tests can aid in diagnosing RA, including inflammatory factors and antibodies that remain elevated in RA. Imaging, such as X-rays, MRIs, CTs, and more, may also be ordered depending on where the patient is in the disease progression and other factors.

Functional Medicine Labs to Test That Can Help Individualize Treatment for Rheumatoid Arthritis

Laboratory results are an important factor in the treatment and diagnosis of RA. Below are a few of the most common functional medicine labs that can help individualize treatment plans for RA patients.  

Rheumatoid Arthritis Panel

The Rheumatoid Arthritis Panel by Access Medical Laboratories assesses anti-nuclear antibody (ANA), rheumatoid factor (RF), and anti-cyclic citrullinated protein (anti-CCP). ANA is a nonspecific test for autoimmunity, meaning if it’s positive, it means that there’s most likely an autoimmune process occurring, but further investigation is needed to figure out which specific autoimmune condition is occurring; for RA, RF, and anti-CCP are often checked next. RF is often elevated in people with RA, but this isn’t always true. In come cases, people can have elevated RF without RA, and some people with RA will have normal RF levels. Anti-CCP is often positive in people with RA in the early stages of the disease; however, like RF, some people with RA will have normal anti-CCP levels.

Inflammatory Markers

Since RA is a disease of inflammation, checking inflammatory markers can be helpful for diagnosis and assessing the state of the disease. C-reactive protein (CRP) is an inflammatory marker offered by many labs, including the CRP test by BioReference Laboratories. CRP levels should be <1.0 mg/dL. Erythrocyte sedimentation rate (ESR) is another inflammatory marker used in diagnosing and treating RA. ESR levels should be less than or equal to 15 mm/hr for males and less than or equal to 20 mm/hr for women. Newborns should have levels between 0-2 mm/hr, and children’s levels should be less than or equal to 10.

Some labs combine markers that are found in the above rheumatoid arthritis panel and the inflammation panel.

Comprehensive Stool Test

Many people may not realize that gastrointestinal (GI) health is linked to autoimmunity, but much evidence supports this connection. In fact, the GI tract hosts 70% of the immune system and thus can also influence inflammatory markers. The microbiome, a collection of various microbes living within the large intestine, plays a critical role in the modulation of immunity and inflammation. Because of this, studies have linked gut health with various diseases, including RA. A comprehensive stool analysis, such as GI Map by Diagnostic Solutions, will assess immune markers, inflammatory markers, and specific levels of gut microbes that can affect these systems.

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Top Herbs and Supplements Used in The Treatment of Rheumatoid Arthritis

Supplementation can help with many RA symptoms. Below are commonly used supplements that can be safely used to help treat the symptoms patients are experiencing with RA.

Quercetin for Rheumatoid Arthritis

Quercetin is a bioflavonoid found in apples, onions, garlic, and parsley. Quercetin has anti-inflammatory and antioxidant effects. It has been shown to have cholesterol and blood pressure-lowering effects and can induce widening and softening of the arteries. Quercetin may also be helpful for RA. A study published in the Journal of the American College of Nutrition assessed the effects of quercetin on RA. The study included 50 women, half receiving a quercetin supplement and the other half receiving a placebo. Blood work for inflammatory and immune markers and questionnaires that include symptom severity were given at the beginning of the study and after eight weeks. Results showed that quercetin supplementation significantly reduced one of the inflammatory markers and improved many symptoms, including early morning stiffness and pain after activity.

Dose: 500 mg/day

Duration: 8 weeks

Resveratrol for Rheumatoid Arthritis

Resveratrol is a polyphenol extracted from plants, including berries, grapes, and peanuts. Resveratrol has antioxidant, anti-inflammatory, antibacterial and antifungal properties. Resveratrol may be helpful in the treatment of RA. A study published in the Clinical Rheumatology journal had 100 participants with RA and split them into two groups: one group received conventional therapy, and the other group received conventional therapy and resveratrol. Blood markers and symptoms, including symptom surveys, were given at the beginning and end of the three-month study. Results showed significant reductions in the inflammatory blood markers in the resveratrol group. As indicated by both surveys, symptoms were also significantly improved in the resveratrol group.

Dose: 1 gram

Duration: 3 months

Green Tea and Exercise for Rheumatoid Arthritis

Green tea is a beverage and supplement from the plant Camellia sinensis. Leaves of this plant are either steamed, pan-fried, or dried to produce green tea. Green tea has been studied for uses in cancer, heart disease, cognitive functioning, digestive issues, and more. Green tea may also be beneficial in the treatment of RA. A study published in the Journal of Physical Therapy and Science aimed to evaluate the effect of green tea and exercise on RA. The study included 120 participants who had been diagnosed with RA for at least ten years. The participants were separated into six treatment groups: infliximab (a standard RA drug), green tea, exercise, infliximab and green tea, infliximab and exercise, and green tea and exercise. The study was six months long, and results showed that green tea and exercise, either alone or in combination with each other and infliximab, showed significant improvement in many biomarkers as well as symptoms and thus may be effective in treating RA.

Dose: 4-6 cups of green tea (60-120 mg of active compounds catechins) per day

Duration: 6 months

Probiotics for Rheumatoid Arthritis

Probiotics are supplements containing varying strains of bacteria that aid in a healthy gut microbiome. Probiotics have been shown to increase the number of microbes in the microbiome and the diversity of the microbiome. Probiotics can aid in treating RA as they can help lower inflammation and modulate the immune response.

Dose and duration will depend on the individual; comprehensive stool testing can help to tailor the specific recommendations.

Fatty Acids for Rheumatoid Arthritis

Borage oil contains a significant amount of gamma linoleic acid (GLA), a fatty acid that has antiinflammatory and immunomodulating properties.Numerous randomized, placebo control trials show that GLA is able to reduce inflammation and the use of nonsteroidal antiinflammatory drugs (NSAIDs) in rheumatoid arthritis patients. Fish oil contains two other fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Twelve randomized, placebo control, double blind trials showed fish oil can reduce symptoms of RA including morning stiffness, joint pain, number of tender joints, and time to fatigue while increasing grip strength. Additionally, an 18 month-long study was done to see if there was any benefit in combining GLA and EPA/DHA. While symptoms improved, there was no statistical significance, meaning no superiority, when combining GLA and EPA/DHA together for the treatment of RA.

Dose: > 2,700-3,000 mg (as EPA/DHA in a >1.5 EPA/DHA ratio); 4.5-7.2 g/day Borage seed oil

Duration: Minimum 3-4 months for EPA/DHA and up to 24 weeks for Borage seed oil

Tripterygium wilfordii Hook F. for Rheumatoid Arthritis

Tripterygium wilfordii Hook F is an herb used frequently in traditional Chinese medicine. Tripterygium wilfordii Hook F has been shown to have antiinflammatory and immunomodulatory actions and, according to research, has may be beneficial for including ankylosing spondylitis, systemic lupus erythematosus (SLE), nephrotic syndrome, Crohn’s disease, and solid tumors. Additionally, Tripterygium wilfordii Hook F. is beneficial for Rheumatoid Arthritis; in China it has been a part of their Clinical Guidelines for the treatment of RA since 2004. A systematic review and meta-analysis in Frontiers of Pharmacology assessed 14 randomized control trials and showed that Tripterygium wilfordii Hook F can positively impact RA by improving morning stiffness, swelling joint count, and grip strength.

Dose: 60-180 mg/day

Duration: Dependent upon clinical results

Boswellia for Rheumatoid Arthritis

Boswellia serrata, known as Boswellia or, more commonly, Frankincense, is an herb used since ancient times in Asia and Africa. Boswellia has anti-inflammatory properties and may be helpful in the treatment of arthritis. A meta-analysis was done on Boswellia in the treatment of another type of arthritis, osteoarthritis, and assessed seven studies with over 500 patients. Results showed Boswellia reduced pain and stiffness and improved joint function in those with osteoarthritis.

Dose: 100-1,000 mg

Duration: At least 4 weeks

Curcumin for Rheumatoid Arthritis

Curcumin is an active component of the traditional Indian spice turmeric. Curcumin has been studied for its anticancer, antioxidant, antimutagenic, and, most important for this article, antiinflammatory effects. A study explored the effectiveness of two different doses, 250 mg or 500 mg twice daily of curcumin for 90 days, on patients with rheumatoid arthritis. Results showed improvements in both symptoms and inflammatory markers in both groups. A meta-analysis done on eight studies showed that curcumin may be effective in the treatment of arthritis. Due to these positive findings, larger, more rigorous studies are suggested.

Dose: 500-1,000 mg/day

Duration: Dependent upon clinical results

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Summary

Rheumatoid arthritis is a common condition mostly affecting women that can lead to severe pain and reduced quality of life. Testing, including inflammatory markers, immune markers, and stool testing, can aid in formulating a treatment plan that focuses on reducing inflammation and modulating the immune response. Supplements, including quercetin, resveratrol, green tea, and probiotics, as well as exercise, can be helpful in the management and treatment of RA.