Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a systemic autoimmune disease with inflammation of the joints and sometimes of other parts of the body.^[1] It needs medical treatment, and early treatment with disease-modifying drugs can avert or substantially slow joint damage in many people.^[2] For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Rheumatoid arthritis typically starts in the small joints of the hands and feet, is usually symmetric, and can spread to larger joints if untreated.^[1]

• Joint pain, swelling and warmth
• Morning stiffness lasting 30 minutes or longer
• Fatigue and feeling unwell
• Firm lumps (nodules) under the skin in some people
• Involvement outside the joints, such as the eyes, lungs, heart or blood vessels^[1]

Over time, inflammation destroys cartilage and bone, which is why early treatment matters.^[1]

Causes and risk factors

The exact cause is unknown. In many people it appears to come from an interaction between genes and environmental factors, including tobacco smoking.^[1] Having a family history raises the risk, and infections and hormonal changes have also been suggested as triggers, but these links are less certain.

How it is diagnosed and treated conventionally

There is no single laboratory test that diagnoses rheumatoid arthritis, so diagnosis relies on your symptoms, examination, blood tests such as rheumatoid factor and anti-CCP antibodies, and imaging.^{[1, 3]} Early diagnosis matters because treatment works best when started early.^[2]

Methotrexate is the usual first treatment. If that is not enough, biologic drugs such as TNF inhibitors, or Janus kinase inhibitors, are added, with the aim of remission or low disease activity within about six months.^[2] Physical therapy, counseling and patient education are also part of care.^[1] Many people now reach remission with modern treatment, but some still progress to disability.^{[1, 3]}

Why Rheumatoid Arthritis calls for a whole-person approach

Rheumatoid arthritis is driven by the immune system, but living with it also involves pain, fatigue and the effects of long-term medicines. Good management uses both medicines and non-drug approaches.^[1] Supportive care therefore focuses on how you feel and function, while your rheumatologist manages the disease itself.

Immune-driven joint inflammation

Chronic inflammation of the joint lining is the core of the disease and leads to loss of cartilage and bone erosion.^[1] This is controlled with prescription disease-modifying drugs. Nothing on this page replaces them.^[2]

Genes, smoking and other exposures

Genes and environmental factors such as tobacco interact in many cases of the disease.^[1] Stopping smoking is a medical decision to discuss with your physician.

Pain, fatigue and stiffness

Even with good drug treatment, many people remain troubled by symptoms. Many patients progress to disability and significant illness despite treatment, which is why non-drug measures are recommended alongside medicines.^[1]

Treatment side effects and overall health

Methotrexate and glucocorticoids are standard, and the safety profile of newer drugs such as Janus kinase inhibitors is still debated.^{[2, 3]} Your rheumatologist monitors these. Anything we add should not complicate that monitoring.

Acupuncture as supportive care in Rheumatoid Arthritis

What the research shows

The evidence for acupuncture in rheumatoid arthritis is limited, and it is mixed. Acupuncture has been studied mainly as an addition to usual drug treatment.

A 2005 Cochrane review found only two small, poor-quality trials (84 people in total). It found no effect of acupuncture on inflammation markers, pain or disease activity, apart from a possible short-term reduction of knee pain with electroacupuncture, and concluded the trials were too limited to recommend it.^[4] A 2012 review of practitioner-based therapies found that three trials comparing acupuncture with sham acupuncture showed no significant difference in pain, and concluded there was no good evidence of efficacy for any of the therapies reviewed.^[5]

More recent meta-analyses are more positive. A 2022 meta-analysis of 12 trials with 874 patients found that acupuncture-related techniques added to usual drugs reduced pain, joint counts, disease activity and inflammation markers more than drugs alone. The authors called for longer, higher-quality trials.^[6] A network meta-analysis of 32 trials with 2,115 patients found electroacupuncture plus drugs gave the best improvement in a disease activity score, while the techniques did not shorten morning stiffness compared with drugs alone.^[7]

Two sham-controlled trials are consistent with a possible benefit. In 132 patients with a traditional pattern of liver and kidney deficiency, shallow intradermal acupuncture improved disease activity and function more than sham, though not the inflammation marker CRP.^[8] A trial of 105 people with rheumatoid arthritis of the hand found that real acupuncture reduced pain and joint counts and improved grip strength, while sham acupuncture mainly reduced pain, and a waiting list group worsened overall.^[9] Both trials were small and need confirming. Acupuncture has not been shown to slow joint damage.

How acupuncture may work

In general pain research, acupuncture is proposed to strengthen the body's pain-inhibiting pathways and to lower local inflammatory chemicals.^[10] These are proposed explanations, not shown to explain any change in rheumatoid arthritis disease activity.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the hands, arms, legs and body, usually left in place for about 20 to 40 minutes, with a course of several visits and reassessment. Needles are not placed through broken or infected skin or directly into a hot, inflamed joint.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Also tell us if you take immune-suppressing medicines, since infection risk matters.

Ayurvedic medicine as supportive care in Rheumatoid Arthritis

The Ayurvedic view

Ayurveda describes a condition resembling rheumatoid arthritis as Amavata, in which ama, undigested metabolic residue, is said to combine with aggravated Vata in the joints, causing pain, swelling and stiffness. These are traditional categories, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine intended to improve digestion and calm Vata, such as warm, easily digested meals and regular sleep hours
• Gentle warm oil massage of non-inflamed areas
• Herbs such as guduchi (Tinospora cordifolia), ginger and turmeric, prescribed individually by a practitioner

Panchakarma procedures are not appropriate during pregnancy, acute illness, flares with fever, or frailty, and they would need your rheumatologist's agreement if you take immune-suppressing drugs. We make no claim that they help rheumatoid arthritis.

What the research shows

The research is limited to two trials. In a trial of 121 patients, two Ayurvedic preparations, one based on guduchi and ginger, were compared with hydroxychloroquine over 24 weeks. Improvement did not differ significantly between the groups, and only mild side effects were reported. The authors called it exploratory.^[12] A US pilot trial of 43 patients compared individualized Ayurvedic treatment, methotrexate and the two together for 36 weeks. No statistically significant differences were found, and the authors described the treatments as approximately equivalent within the limits of a pilot study. With so few patients, the trial cannot establish that they work equally well.^[13] These studies do not show that Ayurvedic medicine can replace disease-modifying drugs.

Herbal medicine as supportive care in Rheumatoid Arthritis

Herbs and formulas that have been studied

Turmeric (curcumin) has been studied in several small trials for this condition. Tripterygium wilfordii, known as thunder god vine, is a Chinese herb studied as a treatment for rheumatoid arthritis, but it carries significant risk. Ayurvedic herbs are discussed above. Herbs are prescribed individually by a qualified practitioner, and we do not use them as a substitute for disease-modifying drugs.

What the research shows

A 2023 meta-analysis of six studies with 539 patients found that curcumin supplementation was associated with lower ESR, disease activity score and swollen and tender joint counts than in controls. The authors called for larger randomized trials.^[14]

A systematic review of seven small trials of Tripterygium extract found it was about as effective as disease-modifying drugs on some measures but did not delay bone destruction, and it caused more adverse reactions. The authors noted many trials had methodological weaknesses.^[15] A larger safety meta-analysis found adverse reactions in about 23% of treated patients, most often affecting the reproductive system, stomach and gut, skin, blood and liver.^[16] For this reason, we do not recommend Tripterygium.

Safety and herb-drug interactions

Interactions matter more in rheumatoid arthritis because many patients take immune-suppressing drugs. Case reports describe St John's wort lowering blood levels of ciclosporin and tacrolimus, with organ rejection in some transplant patients, and Salvia miltiorrhiza (dan shen) increasing bleeding with warfarin.^[17] Herbal and dietary supplements are a recognized cause of liver injury,^[18] which is a concern when methotrexate is also being taken. Do not start any herb or supplement without telling your rheumatologist.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding or planning pregnancy, since several rheumatoid arthritis drugs and herbs matter in pregnancy.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often classes rheumatoid arthritis as a form of Bi syndrome, obstruction of the channels by wind, cold and damp, sometimes with Liver and Kidney deficiency. Researchers studying acupuncture look at inflammatory chemicals and pain pathways, which loosely parallel this picture.^[10]

Ayurveda's Amavata, with ama and aggravated Vata, describes a stiff, swollen, painful joint disease. Researchers have studied the in-vitro actions of Ayurvedic herbs on inflammation, but no study has shown that ama or a dosha corresponds to a specific biological process.^[20] Neither tradition's framework describes the autoimmune mechanism that modern rheumatology treats directly.

How this care fits with your medical care

Our care for rheumatoid arthritis is supportive only. Keep your rheumatologist and primary physician, continue every prescribed medicine on schedule, and do not stop or change disease-modifying drugs, biologics or steroids because of anything here.^[2] We do not diagnose or manage rheumatoid arthritis, and new or worsening joint swelling needs medical review.

Please bring your diagnosis, a full list of medicines and supplements, recent blood and imaging results, and the name of your rheumatologist, so we can work with your treating team.

When to seek urgent medical care

Some symptoms need prompt assessment, especially if you take immune-suppressing drugs.

• A single hot, red, very painful joint, especially with fever or chills
• Fever or signs of infection while taking immune-suppressing medicines
• New shortness of breath, chest pain or a persistent dry cough
• Eye pain, redness or sudden changes in vision
• Neck pain with new numbness, weakness, or loss of bladder or bowel control
• New skin sores or ulcers, or numbness and weakness in the hands or feet

If any of these occur, call 911 or go to the nearest emergency department.