Arthritis:(Rheumatoid Arthritis)

A chronic syndrome characterized by nonspecific, usually symmetric
inflammation of the peripheral joints, potentially resulting in progressive
destruction of articular and periarticular structures; generalized manifestations
may also be present.


Rheumatoid arthritis (RA) is a chronic inflammatory condition that involves
not only the joints but other connective tissue as well. The majority of
the more than five million cases seen in the U.S. have appeared in persons
between the ages of 20 and 70 years. Three times as many women as men are
affected. Some individuals are more susceptible than others: a familial
pattern is commonly observed, and RA is often associated with a special
tissue-typing gene.


A disorder of the body’s immune system is suspected. An important laboratory
findings is the presence of rheumatoid factor (RF), a special antibody active
against the normal antibodies present in the bloodstream. Why RF develops
is unknown, but current theories center point toward an exaggerated immune
response to long-term stimulation by infectious agents or `foreign substances’.
Rheumatoid factor itself is not directly responsible for the inflammatory
process; it acts solely as a marker for the disease.


The joint destruction that occurs with severe RA results from inflammation
of the synovia, the thin, smooth membrane or capsule lining the joints.
As part of the immune response to the unknown stimulus, white blood cells
and antibodies infiltrate the synovial membranes causing them to proliferate
and fold over on themselves. Persistent or recurrent inflammation causes
permanent damage to the joint cartilage, bones, ligaments and tendons. The
widespread inflammatory process also involves other tissue such as blood
vessels, skin, nerves, muscles, heart, and lungs. The result is painful
joints, loss of mobility, and generalized soreness and depression.


The various signs and symptoms of RA include:

  • Joint pain, aching and stiffness come on gradually.

  • This is followed in a few weeks by joint swelling, redness and warmth.

  • The hands, wrists, shoulders, elbows, feet, ankles and knees are usually
    involved on both sides of the body, but inflammation of a single joint may
    be the initial presentation.

  • Symptoms tend to be worst in the morning, diminishing with activities
    of the day

  • Small firm lumps beneath the skin (rheumatoid nodules) appear in some
    patients, especially around the elbow.

  • There is often distressing fatigue in the early afternoon; and difficulty
    in sleeping.

  • RA can affect other organs. Vasculitis, inflammation of the blood vessels,
    may cause skin rashes, ulcers and gangrene. Other manifestations include
    scarring of the lungs, inflammation of the membranes surrounding the heart
    and lungs (pericarditis, pleurisy), nerve damage, dry eyes and mouth (Sjögrens
    syndrome) and enlargement of the spleen and lymph nodes.


In about 5-10 % of patients, the arthritis is mild or limited to one or
two episodes. Another 25 % will have an erratic pattern of prolonged remissions
and periods of relapse. In the majority, however, the clinical course is
progressive with intermittent flare-ups. Most patients continue to function
despite some pain and discomfort, about ten percent of RA patients will
progress to severe permanent joint deformities, limitation of movement and
disability.


Actions indicated for the processes behind this disease:

Immune support is essential for any fundamental change in this problem.
However, no specific connection can be made between, say, Astragalus
and R.A.. It must be a whole immune support program.


Anti-Rheumatics as with O.A., they will help but their selection
must be based upon some rationale that relates them to the unique individual
involved.


Anti-Inflammatories are very important as much of the symptom picture
is the direct result of the inflammatory process. The saponin containing
anti-inflammatories come into their own here. However the salicylate herbs
are still helpful. They probably complement each other well.


Alteratives play a pivotal role in any immune system work.


Anti-Spasmodic remedies will ease any associated muscular tension.


Circulatory Stimulants are not as crucial in R.A. as in O.A., but
still must be considered. This difference reflects the role of the blood
in both conditions.


Rubefacients are not as relevant as for O.A.


Analgesic will ease both the pain and the stress response to this
pain.


Diuretics will help as in O.A..


Nervines are especially relevant considering the acknowledged `psycho-somatic’
nature of this problem. The relaxants will also help as anti-spasmodics,
the tonics will help the person deal with the constant stress of the pain
and discomfort. Hypnotics will help them sleep in the face of pain. Tonics
and anti-depressants will support the work of coping with this extremely
tiring & debilitating condition.


Other actions such as bitters, hepatics or in fact anything else
may be appropriate.


System Support

Potential every system and organ of the body will need tonic support in
this auto-immune condition that effects connective tissue so badly. The
two primary foci for support are the musculo/skeletal and immune systems.
In addition, emphasis should be placed upon nervine tonics. If the digestive
system has problems, tone it as well as dealing with any symptoms.


Specific Remedies

There are no specific remedies for rheumatoid arthritis. This is only to
be expected when the multi-factorial nature of such immunological conditions
is taken into account. Of especial relevance are the alterative based anti-rheumatics,
the key being the `alterativeness’. This includes Menyanthes trifoliata,
Harpagophytum procumbens
, Smilax spp. and Arctium lappa. Guaiacum
officinale
and Dioscorea villosa are especially useful as
anti-inflammatories
. Tanacetum chrysanthemum can be very
helpful in some people. Beyond this it is largely a reflection of the diagnostic
skills of the practitioner combined with the patients observance of dietary,
life-style and dosage regime.


One possible prescription:

Menyanthes trifoliata 2 parts

Filipendula ulmaria ———- 11/2 parts

Dioscorea villosa ———- 11/2 parts

Guaiacum officinale ———- 1 part

Valeriana officinalis ———- 1 part

Cimicifuga racemosa ———- 1 part

Apium graveolens ———- 1 part

Angelica archangelica ———- 1 part

Achillea millefolium ———- 1 part

Hypericum perforatum ———- 1 part as tincture to 5ml. t.i.d.



for sleep and pain relief:


Valeriana officinalis

Piscidia erythrina

Passiflora incarnata equal parts as tincture to 5-15ml 1/2
before retiring.


The digestive system must be working well so treat any stomach irritation
as a priority. This combination does not take such problems into account.
As with O.A., if there is any epigastric tenderness due to the harshness
of the Menyanthes or Guaiacum, add Althaea. In this
combination we are combining anti-rheumatics that provide a range
of relevant actions:

  • alterative remedies: Menyanthes, Guaiacum & Cimicifuga

  • salicylate anti-inflammatories: Filipendula

  • saponin containing anti-inflammatory : Guaiacum

  • general anti-inflammatories: Angelica, Menyanthes,
    Guaiacum
    & Cimicifuga

  • nervine anti-spasmodics: Valeriana, Cimicifuga
    & Apium

  • nervine tonic & anti-depressive: Hypericum
    perforatum

  • diuretics: Apium & Achillea

  • `stomachics‘, in this case carminative and intestinal
    anti-inflammatory: Angelica, Valeriana and Apium

  • bitter tonics: Menyanthes & Achillea


Remember that this must all be done in the context of a general immune support
program. Please refer to that section.


Broader Context of Treatment

The general suggestions given above for O.A. are equally pertinent here.
In addition it is worth considering some variety of counseling. If, for
the patients’ reasons, it is not appropriate for them to embark upon depth
counseling, then aid in initiating some relevant stress management program
is essential.


Systemic Lupus Erythematosus

An inflammatory connective tissue disorder of unknown etiology occurring
predominantly in young women, but also in children.


Systemic lupus erythematosus (SLE or lupus) is about 1/10 as
common as rheumatoid arthritis. It has an even stronger predilection for
women, especially those in the child-bearing ages. It is characterized by
inflammation of blood vessels and potential involvement of several tissues
and organs, particularly the skin, joints, kidneys, lungs, heart, nervous
system, and blood cells. Some patients are acutely affected with a febrile
disease that is life threatening because of renal disease, nervous system
disease, or accompanying infections. Most have a more indolent disease that
produces moderate disability from nondeforming arthritis, skin eruptions,
and fatigue.


As in rheumatoid arthritis, the body seems to react against itself rather
than against an invading microorganism, that is it is an autoimmune conditions.
The characteristic laboratory finding is the presence of antibody to DNA
and other substances within the nuclei of individual cells. Anti-self antibodies
react with intact blood cells, nuclear components, and blood-vessel walls.
In addition to these anti-nuclear antibodies, there may be antibodies to
blood cells and various proteins present in the circulation. The complexes
that form in the patient’s blood precipitate in basement membranes of skin,
kidneys, and nervous system and thus cause inflammation. Although the antibodies
do not damage intact cells or their nuclei directly, they may set off inflammation
in response to reaction with small amounts of circulating antigens.


Common signs and symptoms include:

  • Joint pains, swelling and tenderness are the most common early findings,
    occurring in over nine out of ten patients. This is not usually deforming,
    but it can be severe and debilitating.

  • Skin rashes appear in the majority of patients. The classic manifestation
    is a pink, butterfly-shaped eruption over the nose and cheeks that is aggravated
    by sun exposure. A similar rash, bruising, hives, blisters or ulcers may
    be present in other areas.

  • Kidney disease (glomerulonephritis) affects about one-half of cases
    and accounts for a major part of the mortality associated with SLE.

  • Involvement of the heart and lungs can lead to pericarditis and pleurisy.
    Fluid collections at the bottom of the lungs and around the heart may be
    associated with chest pains and trouble breathing.

  • When the CNS are affected, a variety of neurologic events may ensue:
    headache, convulsions, confusion, mental deterioration, mood swings, nerve
    palsies, stroke, etc.

  • Other symptoms are fever, swollen lymph glands, fatigue, weight loss,
    diminished appetite and recurrent infections.


Individuals vary greatly in the number and severity of their symptoms. While
some have only mild symptoms which remit spontaneously, others run a progressive
downhill course with involvement of many organs. Flare-ups may be noted
during the later stages of pregnancy and after delivery. A pattern of remission
and relapse is most common, with nervous system involvement and kidney failure
tending to be the most debilitating consequences of the disease.


Treatment of this condition is problematic, not only because of its auto-immune
basis but also due to the characteristic pattern of flare up and remission.
The case study that follows, written by Meryl Baskervill (a graduate
of Therapeutic Herbalism), is a graphic example of the therapeutic possibilities
offered by Phytotherapy. As the symptom pictured changed, the prescription
was modified to address these changes. This flexibility allowed the practitioner
to identify the appropriate remedies and clarify some non-herbal issues
that arose.

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David L. Hoffmann BSc Hons MNIMH Written by David L. Hoffmann BSc Hons MNIMH

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