Rheumatic and Arthritic Conditions Including Rheumatoid Arthritis and Osteoarthritis

Compiled by John G. Connor, M.Ac., L.Ac. Edited by Barbara Connor, M.Ac., L.Ac.

TABLE OF CONTENTS
Painful ObstructionSyndrome
Research on How Acupuncture Benefits Osteoarthritis
Research on How Acupuncture Benefits Rheumatoid Arthritis
Acupuncture, Moxibustion and Herbs
Dietary Recommendations
Highly Recommended Foods
Foods to Avoid
Useful Herbs and Supplements for Osteoarthritis
Useful Herbs and Supplements for Rheumatoid Arthritis
Additional Nutritional Support
Exercise
References

PAINFUL OBSTRUCTION SYNDROME
According to Traditional Chinese Medicine, rheumatic and arthritic conditions are known as Painful Obstruction Syndrome.  Painful Obstruction Syndrome is defined as pain, soreness or numbness of muscles, tendons and joints due to the obstruction in the circulation of Qi and blood in the channels caused by invasion of exterior Wind, Cold, Heat or Dampness.

Persistent obstruction of the joints by pathogenic factors may lead to the retention of body fluids that turn into Phlegm, which further obstructs the joints and channels.  This leads to muscular atrophy and swelling and deformity of the bones in the joints, which is an extreme form of Phlegm.

The obstruction in the circulation of Qi, Blood and Body Fluids may in turn lead to Blood Stasis.  If there is Blood Stasis, one may experience pain and pronounced stiffness due to the stagnant Blood not nourishing and moistening the sinews.

Another important factor in chronic Painful Obstruction Syndrome is Kidney and Liver deficiency.  It is this deficiency that allows the retention of Phlegm and Stasis of Blood.  Liver-Blood nourishes the sinews, and when the Liver is deficient, the sinews and tendons are not nourished, which leads to aching and stiffness in the joints.  The Kidneys nourish the bones, and when they are deficient, the bones are deprived of nourishment, and this allows Phlegm to build up in the joints in the form of swellings.

RESEARCH ON HOW ACUPUNCTURE BENEFITS OSTEOARTHRITIS
• According to a study published in Ann Intern Med 2004 Dec 21;141(12):901-10 by Berman BM, Lao L, et al entitled “Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial” involving 570 patients with osteoarthritis of the knee it was concluded that acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

• The results of a study published in Rheumatology (Oxford) 1999 Apr; 38( 4): 346-54 by Berman et al entitled “A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee” concluded that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with osteoarthritis of the knee.

• The results of a study published in Danish in Acta Anaesthesiol Scand 1992 Aug; 36 (6): 519-25 entitled “Acupuncture treatment of severe knee osteoarthrosis. A long-term study” concluded that acupuncture on patients waiting for arthroplasty surgery can ease the discomfort while waiting for the operation and perhaps even serve as an alternative to surgery. Seven patients responded so well that at the time of publication they did not want an operation. Comparing the acupuncture treated group with the group receiving no acupuncture it was noted that there was a significant reduction in pain, analgesic consumption and in most objective measures. In the second part of the study it was shown that it was possible to maintain the improvements with once a month acupuncture treatments.

RESEARCH  ON  HOW  ACUPUNCTURE  BENEFITS  RHEUMATOID  ARTHRITIS
•  According to The Early Rheumatoid Arthritis Study, Albans City Hospital, UK; Exeter University, UK; reported in Renter’s Medical Health, June 15, 2001 acupuncture used by rheumatoid arthritis patients caused a significant reduction of both pain and the use of painkillers. Pain was reduced by a third in 73 percent of patients, and by at least 50 percent in more than half of those afflicted. Analgesic use also declined significantly, from an average of 17 tablets per week to just six.

ACUPUNCTURE, MOXIBUSTION AND HERBS
The combination of acupuncture, moxibustion and Chinese herbs is particularly useful in resolving Phlegm and Dampness, expelling Cold or Heat, subduing Wind, moving Qi and Blood, removing obstructions of the channels and nourishing the Liver and Kidneys.

DIETARY RECOMMENDATIONS
•  Specific Recommendations for Patients Suffering from Cold Painful Obstruction Syndrome:  Do not eat too much of the cold energy foods such as raw fruits and vegetables.  Avoid iced drinks.  Beneficial foods include warming ones such as meat (in moderation), ginger, eggs, garlic, and spices (in moderation).

•  Specific Recommendations for Patients Suffering from Damp Painful Obstruction Syndrome:  Avoid eating foods such as milk, cheese, butter, cream, ice-cream, peanuts, bananas and any greasy, fried foods.

•  Specific Recommendations for Patients Suffering from Wind Painful Obstruction Syndrome:  Avoid eating foods such as prawns, shrimps, crab, lobster, spinach, rhubarb and mushrooms.  Eat mild Blood-nourishing foods such as chicken, hen-soup, rice and carrots.

•  Specific Recommendations for Patients Suffering from Heat Painful Obstruction Syndrome:  Do not eat too much of the hot or warm energy foods such as game, lamb, beef, alcohol, garlic, ginger and spices.

HIGHLY  RECOMMENDED FOODS
Barley and wheat grass, omega-3 and GLA fatty acids, whole alfalfa or alfalfa tablets or tea,* oatmeal, brown rice, wheat, rye, oat bran, rice bran or ground flaxseed, sprouts, legumes, algae, asparagus, onions, carrots and most other vegetables and fruits except those mentioned below to avoid.  Fresh pineapple contains bromelain, which reduces inflammation.  Cherries, hawthorn berries, blueberries and other dark red-blue berries are a rich source of flavonoid molecules, which enhance collagen matrix integrity.   *Alfalfa contains all the minerals essential for bone formation & may be helpful for arthritis.

Consider an anti-inflammatory diet such as this one outlined by Andrew Weil:  Emphasize monosaturated fats (found in olive oil, canola oil, avocado and nuts) and omega-3 fatty acids (in fish, walnuts and flax) and eliminate polyunsaturated and trans fats (in many processed foods).  Plus consider taking a daily fish-oil supplement; try 2 grams per day of a product with both EPA and DHA.

A study done by Hanninen et al published in Toxicology, Nov. 30, 2000, Vol 155, (1-3,) 45-53, concluded that patients of rheumatoid diseases appear to benefit both subjectively and objectively from a vegan diet rich in various anti-oxidants, fiber and lactobacilli.

Recommended for deficient persons: Onions, garlic, black peppercorn, dill, fennel, coriander, marjoram, sage, saffron, thyme, rosemary, bay leaf, chives, horseradish, ginger root, grains, vegetables, oats, spelt, quinoa, rice, corn, mustard greens, parsley, parsnip, black beans.

FOODS TO AVOID
Avoid excess meat or protein from any source, alcohol, tobacco, coffee, refined sugar, too many sweets, excess salt, rhubarb, cranberry, plum, chard, beet greens, spinach, tomatoes, eggplant, bell pepper and potatoes, all nuts, oil-rich seeds, nut butters, etc., except almonds and omega-3/GLA-rich seeds, alfalfa seeds and sprouts.  Reduce the amount of fat in your diet.  Avoid milk and dairy products.  Avoid citrus fruits and paprika.  Do not take iron supplements, as iron is suspected of being involved in pain, swelling and joint destruction.  Consume iron in foods, instead.

USEFUL HERBS AND SUPPLEMENTS FOR OSTEOARTHRITIS
· Scutellaria – was tested along with another natural compound called catechin and the combination was found to be as effective as naproxen in controlling the signs and symptoms of osteoarthritis of the knee. (Levy et al 2009)
 
· Eleutherococcus senticoccus, Panax notoginseng and Rehmannia glutinosa – were found to be safe, tolerable and effective for symptomatic improvement of pain and physical function of knew osteoarthritis patients.  (Park et al 2009)

·   Curcumin and resveratrol combined may be a useful strategy in osteoarthritis therapy as compared with separate treatment with each individual compound. (Csaki et al 2009)

·   Eicosapentaenoic acid (EPA) was the most effective, followed by docosahexaenoic (DHA) and then alpha-linolenic (ALA) acid – These omega-3 (n-3) PUFAs cause a reduction in the mRNA levels for various proteins known to be important in the pathology of osteoarthritis. The relative efficacy of EPA suggests that this omega-3 PUFA may be especially useful for dietary supplementation in patients with osteoarthritis. (Zainal et al 2009)

· Vitamin D – Low dietary vitamin D intake increases the risk of progression of knee radiographic osteoarthritis. Particularly in subjects with low baseline bone mineral density, vitamin D status seems to influence the incidence and progression of knee radiographic osteoarthritis . Thus, improving the vitamin D status in the elderly could protect against the development and worsening of knee osteoarthritis, especially in those with low bone mineral density. (Bergink et al 2009) 

· Vitamin D – We observed a significant positive association between serum 25(OH)D and bone mineral density in individuals with primary knee osteoarthritis, independent of sex, age, BMI, knee pain, physical activity, and disease severity. Given the high prevalence of low 25(OH)D status in persons with knee osteoarthritis and the positive association between 25(OH)D and BMD, vitamin D supplementation may enhance bone mineral density in individuals with osteoarthritis. (Bischoff-Ferrari et al 2005)

· Cat’s Claw (Uncaria tomentosa) – was found to be an effective treatment for osteoarthritis. (Piscoya ete al 2001)

· Boswellia serrata extract – was shown to reduce pain rapidly, as early as after 1 week of treatment.  It reduces levels of the cartilage degrading enzyme MMP-3 in synovial fluid, and, most importantly it is safe for human consumption, even long term.  (Sengupta et al 2008)

 Glucosamine sulfate and chondroitin sulfate  — 
 ·   In a review published in 2003 it was concluded that in short-term clinical trials, glucosamine provided effective symptomatic relief for patients with osteoarthritis of the knee. In addition, glucosamine has shown promising results in modifying the progression of arthritis over a 3-year period.  Glucosamine may therefore prove to be a useful treatment option for osteoarthritis. (Matheson & Perry, 2003)

·    Clinical findings have revealed that glucosamine sulfate and chondroitin sulfate are effective and safer alternatives than NSAIDs to alleviate the symptoms of osteoarthritis.  Experimental evidence indicates that these compounds and their low molecular weight derivatives have a particular tropism for cartilage where they serve as substrates in the biosynthesis of component building blocks. (de los Reyes GC et al 2000)

·    According to a review by Reginster et al preliminary results obtained in patients with osteoarthritis of the hands suggests that chondroitin sulfate could be used for inhibiting the structural progression of osteoarthritis. (Reginster JY et al,2003)

·    A review by Volpi found that chondroitin sulfate produces a slow but gradual decrease of the clinical symptoms of osteoarthritis and these benefits last for a long period after the end of treatment.  Literature data shows that chondroitin sulfate could have an anti-inflammatory activity and a chondroprotective action by modifying the structure of cartilage. (Volpi, N, 2004)

·    A meta-analysis published in 2000 in JAMA concluded that trials of glucosamine and chondroitin preparations for osteoarthritis symptoms demonstrate moderate to large effects. (McAlindon TE et al,2000)

·    In published studies glucosamine used in a dosage of 1.5 grams daily is, after a period of 2 to 4 weeks, just as effective as low doses of NSAIDs in alleviating the pain of osteoarthritis.  Chondroitin sulphate has been less well investigated; but there are indications that it affects the symptoms of osteoarthritis, even though this effect only occurs after a longer period of time. (Bijlsma, JW, 2002)

·    Clinical trials of glucosamine and chondroitin sulfate showed substantial benefit in the treatment of osteoarthritis. (Deal CL and RW Moskowitz, 1999)

·    Chondroitin apparently works by attracting essential fluid into the joints, which thereby acts as a shock absorber.  It also attracts needed nutrients into cartilage. (Benedikt, 1997)

· Ginger – In a study involving 56 patients (28 with rheumatoid arthritis, 18 with osteoarthritis and 10 with muscular discomfort) who used powdered ginger against their afflictions.  Amongst the arthritis patients more than 75% experienced, to varying degrees, relief in pain and swelling.  All the patients with muscular discomfort experienced pain relief. It is suggested that at least one of the mechanisms by which ginger shows its ameliorative effects could be related to inhibition of prostaglandin and leukotriene biosynthesis, i.e., it works as a dual inhibitor of eicosanoid biosynthesis. (Srivastava & Mustafa, 1992)   

· Dandelion root may have potential use as an anti-inflammatory agent in osteoarthritis. (Tito et al, 1993 & Mascolo et al, 1987)

·    A poorly designed study found suggestive evidence that cat’s claw might reduce osteoarthritis symptoms. (Piscoya, 2001)

·    There is evidence that capsaicin cream may be helpful for relieving pain due to various types of arthritis

·    Niacinamide – is said to be particularly effective for degenerative arthritis of the knee.  1 gram three times daily (start with 500mg twice daily; taper once effective; take with 100 mg vitamin B complex).

· Omega-3 Fatty Acids, Pantothenic Acid, Vitamin E, Vitamin C, Boron, Selenium, Sulfur, Zinc, and Sea Cucumber may be beneficial.

USEFUL HERBS AND SUPPLEMENTS FOR RHEUMATOID ARTHRITIS
· Boswellia decreases leukotriene synthesis that is responsible for maintaining inflammation and edema. (Bruneton, 1995; Gupta et al, 1997)

· In clinical trials of boswellia, promising results were observed in patients with rheumatoid arthritis. (Ammon,  2002)

· Preliminary research suggests that boswellia may protect cartilage from damage (Reddy, 1989)

· Dandelion root may have potential use as an anti-inflammatory agent rheumatoid arthritis. (Tito et al, 1993; Mascolo et al, 1987)

· Fish oil – Thirteen double-blind, placebo-controlled studies involving a total of more than 500 individuals found that omega-3 fatty acids in fish oil can reduce the symptoms of rheumatoid arthritis. (James & Cleland 1997; Volker et al 2000)

· Gamma-Linolenic Acid (GLA) – In a double-blind study of 56 patients with rheumatoid arthritis, 16 of 21 patients treated with 2.8 g/day of GLA for 1 year significantly improved compared to those in the placebo group. (Zurier et al 1996)

· Ginger – In a study involving 56 patients (28 with rheumatoid arthritis, 18 with osteoarthritis and 10 with muscular discomfort) who used powdered ginger against their afflictions.  Amongst the arthritis patients more than 75% experienced, to varying degrees, relief in pain and swelling.  All the patients with muscular discomfort experienced pain relief. It is suggested that at least one of the mechanisms by which ginger shows its ameliorative effects could be related to inhibition of prostaglandin and leukotriene biosynthesis, i.e., it works as a dual inhibitor of eicosanoid biosynthesis. (Srivastava & Mustafa, 1992)

·  Devil’s claw – A 2 month, double-blind, placebo-controlled study of devil’s claw following 89 individuals with various rheumatoid disorders found a significant decrease in joint pain intensity and an improvement in mobility.  Another double-blind study of devil’s claw in 50 individuals with various types of arthritis showed that 10-day treatment provided significant pain relief.(ESCOP 1996-1997)

· There is evidence that capsaicin cream may be helpful for relieving pain due to various types of arthritis.

· A low fat diet may be beneficial, particularly if it is relatively high in polyunsaturates.

· Copper Salicylate has been found to be an effective anti-inflammatory agent.

· Pantothenic acid, Vitamin A, Vitamin C, Vitamin E, Vitamin K, Boron, Sulfur and Quercetin – may be beneficial.

Specific supplementation recommendations for Rheumatism (including Arthralgia, Arthritis, Fibrositis and Synovitis):
· Thiamine, Vitamin E and Magnesium – may be beneficial for fibrositis.

· Vitamin B₆ – may be beneficial for tenosynovitis.  (Tenosynovitis causes carpal tunnel syndrome in the majority of cases.)

· Selenium and Vitamin E – may be beneficial for muscle pain.

ADDITIONAL NUTRITIONAL SUPPORT
· Vitamin E – protects the joints from damage by free radicals.
· Vitamin C – destroys free radicals and is anti-inflammatory.
· Omega-3 and Omega-6 Fatty Acids – help to control arthritis pain & inflammation.  Note: Take a natural source of vitamin E supplement when consuming highly unsaturated oils such as Omega-3 and Omega-6 Fatty Acids.
· D-Glucuronic Acid – provides antioxidant protection of synovial tissues.
· Boron – for better calcium absorption.
· Bromelain – stimulates production of prostaglandins.
· Pantothenic Acid – vital for the production of steroids in the adrenal gland
· Sea cucumber – helps lubricate the joints.
· Silica – helps in rebuilding of connective tissue and bone.
· Superoxide dismutase – protects the fluid in the joints from destruction by free radicals.
· Calcium – prevents bone loss.
· Magnesium – needed to balance with calcium.
· Copper – a cofactor for lysyl oxidase that strengthens connective tissue.
· Zinc – needed for bone growth.
· Coenzyme Q₁₀ – increases tissue oxygenation to aid in repair of connective tissue.
· Manganese – needed for normal bone growth.  Do not take manganese and calcium at the same time, as they compete for absorption.
· Vitamin B₆ – reduces swelling in tissue.
· Vitamin B₁₂ and Folic Acid – needed for the production of myelin.
· PABA – good for swelling.
· Amino Acids – to supply protein needed for tissue repair.
· Bioflavonoids – boost the activity of vitamin C and benefit connective tissue.

For more information on other herbs and supplements which can help relieve pain we invite you to read our article entitled Pain Management.  And to find out more about the connection between inflammation and rheumatoid arthritis we invite you to read our article entitled Inflammation and Its Role in Disease.

EXERCISE
A proper amount of regular exercise is absolutely essential to preserve good health and mobility.  Regular exercise stimulates the circulation of Qi and Blood and keeps the sinews supple, which helps to prevent invasion of external pathogenic factors.

As far as prevention of painful joint conduction is concerned, both external and internal exercises are beneficial.  A combination of the two is ideal.  Tai Qi and Yoga are both excellent types of internal exercises.  Of the external exercises, the only ones that are not particularly beneficial are jogging, weight lifting, squash and aerobic exercises.