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Rheumatoid Arthritis (RA): Which Treatment Option is Best?

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Over the past several months I have received comments that I think need to be addressed in a much longer format than a comment response.  The comments are related to treatment options for rheumatoid arthritis and which treatment is best.

We are fortunate enough to have many options available to us today to manage our rheumatoid arthritis (RA).   Traditional medicine offers everything from NSAIDs (Non Steroidal Anti-Inflammatory Drug) like Advil and  DMARD s(Disease Modifying Antirheumatic Drugs) such as Plaquenil, Arava, Methotrexate, Gold, and Cyclosporine to biologics like Remicade, Enbrel and Humira. There is a growing trend toward alternative medicine as a  solution to  deal with this disease.  Each option has its benefits, risks and side effects.

NSAIDs are a class of drug that are used primarily to treat inflammation and mild to moderate pain.  These medications vary in potency and  include the brand names Advil, Motrin, Naproxen, Anaprox and Celebrex.  Between 10% to 50% of patients are unable to tolerate NSAIDs because of their side effects. These side effects include upset stomach, stomach pain, and diarrhea.  About 15% of people on long term NSAID treatment develop ulcers of the stomach and/or the duodenum.

DMARDs cover a variety of different of drugs.  Anti-malarial drugs such as Plaquenil (Hydroxycloroquine) are considered a DMARD and were initially used to treat malaria. It was discovered to help  arthritis when patients noticed an improvement in their arthritis symptoms while taking plaquenil for malaria.  Plaquenil effects the immune system but doctors do not know how it works for rheumatoid arthritis. Arava (leflunomide) interferes with genes in developing immune cells. When taking Arava, liver monitoring for toxicity is required.  You should not take this drug if you are planning to get pregnant or are currently pregnant because of birth defects. The most common side effects for patients taking Arava are rash, nausea, hair loss, liver enzyme elevation and anemia. Methotrexate is a chemotherapy drug that initially was used to treat acute leukemia.  Methotrexate (MTX) has become the gold standard for treatment of rheumatoid arthritis (RA).  Methotrexate interferes with the growth of cells in the bone marrow.  The most common side effects from methotrexate include stomach upset, hair loss, diarrhea, and  mouth sores.  Folic acid is given while taking this medication to reduce the side effects.  Liver function monitoring is necessary to watch for toxicity. Methotrexate should also not be taken if you are pregnant or planning to get pregnant. Injectable Gold has been shown to improve symptoms of rheumatoid arthritis however toxicity is common and constant monitoring in necessary.  Side effects include rash, diarrhea, conjunctivitis and marrow suppression. Cyclosporine is a medication that is used primarily for the prevention of rejection of transplanted organs.  It is effective for the treatment of rheumatoid arthritis because it stops an overactive immune system from attacking the joints. Side effects can be severe and include hypertension, kidney problems, headache, nausea and diarrhea.

Biologic response modifiers (biologics) are the latest treatment option for rheumatoid arthritis pain and inflammation.  They work by blocking the tumor necrosis factors(TNF) components of the immune system.  People with RA have too much TNF in their bodies and it overwhelms the immune systems response to inflammation. Biologics such as Enbrel, Remicade and Humira are genetically engineered proteins that binds to and deactivates the TNF molecules before they can do damage.  The risks in taking this class of drug include serious infection including sepsis and tuberculosis, nervous system diseases such as multiple scholosis, allergic reactions, lymphoma and congestive heart failure.  Because these drugs are fairly new their long term side effects are not known.

There has been much debate on the effectiveness of complimentary and alternative treatments options for rheumatoid arthritis.  These treatments include GLA (Gamma Linolenic Acid), DHA (Docosahexaenoic Acid, Tai Chi, herbal supplements and acupuncture. There are many more complimentary and alternative treatment options that will be discussed in future posts.

GLA (Gamma-linolenic Acid) is an essential fatty acid found primarily in plant oils. It is found in borage  oil and black currant seed. In preliminary testing it has shown to reduce morning stiffness and swelling however studies have been small to date and additional research would provide more information. DHA (Docosahexaenoic Acid) is an omega 3 fatty acid found in cold water fish. Several studies have shown that DHA reduces inflammation but not the progression of the disease. The movements of Tai Chi improve strength, flexibility and balance. There is no indication that Tai Chi effects the progression of rheumatoid arthritis. Acupuncture in thought to stimulate the release of chemicals called endorphins that block pain. Acupuncture is very effective in treating chronic pain like that in rheumatoid arthritis. The list of supplements as an alternative solution to conventional medicine for the treatment of rheumatoid arthritis include vitamin E, MSM, copper, manganese, vitamin C, selenium, zinc, bromelain, ginger, turmeric and boswellia.  These alternatives have proven to help in inflammation and in some cases joint damage.

The benefits of using conventional medicine for the treatment of rheumatoid arthritis are that knowledgeable doctors using this method are readily available and the medications work for many people. These medications have significantly improved the lives of many with rheumatoid arthritis. The downside to this treatment option is the side effects can vary from mild to severe and some long term effects are not even known.

The benefits to choosing an alternative medical solution for the treatment of rheumatoid arthritis is that the side effects to these treatment are few and are less damaging to the body.  The disadvantage to complimentary and alternative treatments are that finding a qualified medical professional that can help guide you through all the options available can be a challenge and there is debate on whether or not they can help with joint damage.

Ultimately the choice for a treatment option is a personal one.  What matters is what works for you. Everyone has their own body chemistry.  What works for one person may not work for another. The advantage that we have today is that we have options, many options, and if something is not working for us we can try in another direction until we find our own solution. It is not up to me or anyone else to decide what is best for you and your body.  Trust yourself to figure out what is best for you.

Power of Pomegranates for Rheumatoid Arthritis (RA)

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One of my favorite healthy snacks this time of year is the pomegranate.  The kids and I just love to pick at the little gems and eat the sweet, crunchy seeds just as nature made them.

Pomegranates are native to the mediterranean region and are a good source of vitamins A, C, E , folic acid and potassium. The name “pomegranate” in Latin is translated as seeded apple.  The polyphenols in pomegranate juice are antioxidants that can prevent and repair oxidative damage caused by free radicals.

In a recent study funded in part by the National Center for Complimentary and Alternative Medicine researchers from Case Western Reserve University studied the effect that the dietary supplement made from pomegranate extract called POMx had on an animal model of rheumatoid arthritis (RA) in mice.  The mice were treated before and after the arthritis was induced.  The mice that were treated with the POMx before the induced arthritis had significantly reduced incidence and severity of disease than the untreated mice.  In mice that were treated to exhibit arthritis symptoms before receiving the POMx, the effected joints showed less inflammation and less destruction of cartilage and bone that those that did not receive the POMx.Future studies will test the disease modifying effects of POMx on mice that have been treated to mimic the symptoms of RA.

Pomegranates are available in the market in the northern hemisphere from September to February.  In the southern hemisphere you can find them from March to May but the juice is available year round.

Oriental Orange Chicken Salad

oriental chicken salad-smI haven’t added a recipe in a quite a while so today I thought I would share one of my favorite salads.  This is a nice light summertime dish that won’t weigh you down on the hottest of days. We enjoy it  for either lunch or dinner and the kids really love it. On the rheumatoid arthritis front this salad has garlic, ginger, vitamin C, folic acid, omega 3’s and  beta carotene.  All of which are good for fighting inflammation.

Marinade:

1 Tablespoon Minced Ginger

1 Tablespoon Minced Garlic ( about 2-3 cloves depending on the size of the cloves)

1 Tablespoon Soy Sauce ( a good quality soy sauce like Tamari is best )

1 Cup Orange Juice

1 Tablespoon Orange Zest

Put all the above ingredients in a zip close bag ( gallon size is probably best)

Chicken:

Prepare 2 full skinless boneless chicken breast by trimming away any excess fat. Place chicken between 2 pieces of plastic wrap and take out any anger and aggression you have about having  rheumatoid arthritis out on your chicken.  I use a metal mallet so that I don’t have to use a lot of muscle to pound the chicken out.  Pound the chicken to about 1/2 inch thickness. Add chicken to the marinade and zip up plastic bag making sure to squeeze out any excess air and place in refrigerator while preparing the salad.

Salad:

You can use whatever salad greens that make you happy.  When I made this recipe today for lunch.  I used the lettuce and spinach from the garden.  If you don’t feel like cutting up salad greens getting the prepackaged stuff will work just as well.

2 Large Carrot peeled and julienned  ( My son gave me an oxo julienne peeler that makes the process easy with very little effort ) or you can buy prepackaged stuff

2 Cup shredded Red Cabbage

2 Oranges Supremed (How to supreme and orange) or if it is easier for you or your hands are bothering you use a jar of mandarin oranges

1/2 Cup Toasted Slivered Almonds ( just place slivered almonds in a non stick fry pan and heat for about 5 minutes stirring occasionally to make sure that the almonds  release some of  their oils and get crunchy)

Wash and dry all the vegetables. ( My kids like to use the salad spinner so they do that for me ) Tear lettuce into bite sized pieces unless of course you have purchased the ready made stuff.

Take the marinading chicken out of the refrigerator and grill until fully cooked. Cooking times will vary based on the grill size and the amount of btu’s that it puts out.  It usually only takes me about 15 minutes flipping the chicken halfway though the cooking process. When the chicken is fully cooked place on a cutting board to rest while you prepare the dressing.

Dressing:

1 Tablespoon Dijon Mustard

1 Tablespoon Soy Sauce ( a good quality soy sauce like Tamari is preferable )

1 Tablespoon Sesame Oil

1 Tablespoon Rice Wine Vinegar

1/4 Cup Orange Juice

2 Tablespoon Honey

2 Teaspoon Grated Ginger

Whisk all ingredient together in a mixing bowl. ( You can also just throw everything together in the blender and mix )

Place the lettuce, cabbage and carrot in a large salad bowl or serving platter and toss until well mixed.  Place oranges randomly about the bowl or plate.  Slice grilled chicken and place warm chicken on top of lettuce mixure. Top with slivered almonds and drizzle with dressing. Serves 4 – 6

Enjoy!

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