AUSTRALIAN NATUROPATHIC NETWORK
 Serving the community since 1998

Rheumatoid arthritis (R.A.) is a systemic inflammatory disease, which affects the entire body, but especially the joints.

The joints usually involved are the hands, wrists, feet, ankles and knees. Between one and three percent of the population is affected - with women outnumbering men by about three to one [1]. The average age of onset is 24 years, although RA can begin at any time [1].

• Joint swelling is usually caused by inflammatory exudate (leukocytes, plasma and plasma proteins in the synovial membranes), hyperplasia of the inflamed tissue and the formation of new bone.
• Excessive cytokines in the joint fluid and damage to the synovial membrane leads to destruction of the joint cartilage, tendons and ligaments and erosion of the bones of the joints themselves.
• The hands are most commonly affected.
• Like lupus, autoimmune cells may also attack other organs, most commonly the skin – causing skin nodules – the lungs and their lining, the heart and blood vessels and the eyes.^a

• Onset is usually gradual but occasionally abrupt.
• Fatigue, low grade fever, joint weakness, joint stiffness and vague joint pains may precede the appearance of painful, swollen joints by several weeks.
• The condition is invariably bi-lateral [1]
• Stiffness usually worsens early on arising, easing after an hour and is thought to be related to synovitis.
• Initially, the joints affected are the metacarpophalangeal joints, proximal interphalangeal joints and wrists [2].
• On palpation, the joint feels warm and the synovial membrane feels boggy.
• The skin covering the joint has a ruddy, cyanotic hue and may look thin and shiny [2].

Other symptoms include:

• Loss of mobility, even with mild synovitis
• Loss of range of motion can become permanent.

• Afternoon fatigue and difficulty in sleeping.
• Ulcers
• Inflammation of the blood vessels
• Inflammation of the pericardium
• Inflammation of the nerves and eyes.
• Alternating remissions and flare-ups [2]

Classically, R.A. is a psychosomatic disorder. Increase in stress commonly manifests prior to R.A.

Personality features include:

• Static anxiety
• Rationalisation
• Dependency
• Infantile aggression
• Reduced ability to express emotions openly [2]
• David Hoffman [4] feels that there is a relationship between a person’s friction in her joints and between other people and states – what he believes to be a truism - that a person prone to behavioural friction is prone to R.A.

The septic foci theory of C.W. Buckley explains most arthropathies [2]. Briefly, this states that different foci of infection can gather throughout the body. The principle such focus is the bowel, followed by teeth, gums, sinuses, throat, ulcers and other similar pockets (foci) of infection. Khoury has stated that the bowel remains the principle septic focus. Additionally, it should be considered that perhaps lymphatic/adipose toxic accumulate (cellulite) may be an eventual (vast) site of septic material. (Author’s theory).

Hoffman makes a similar observation to Buckley, but relates RA to septic sites adjacent to the actual lesion. He says: "one of the causes of rheumatism and arthritis is the accumulation of toxins or waste products in the affected tissue" [2].

Simon (Modern Herbalism) Mills states that R.A. is mainly an autoimmune disease, where the body’s immune system is basically attacking itself.

Certainly, an assault on the digestive system may predispose one to R.A., as poor digestion leads to toxic build-up in the bowel, which – as noted - produces the major septic focus. As we have seen, such assaults arise from:

• Poor food selection
• Predisposition to food allergies and repeatedly eating such foods
• Unhealthy eating habits – such as rushing meals, not chewing food sufficiently and eating in an excitable state.
• Not only that, but you also must consider the ubiquitous cavalcade of refined foods, preservatives used in their preparation and pesticides applied to their growth (including antibiotic and hormone additives to poultry and farm animals).
• Throw in an excess of fat and refined carbohydrate, add a deficiency of – or at least a depressing lack of variety in – fibre sources and you finish up with a gut which has borne its share of abuse.

According to Raymond Khoury, the liver also plays a major part in many factors affecting R.A.. Apart from its role in fat digestion through bile production, and its processing of micelles and LDL’s, a healthy liver is needed to rid the body of toxins. An accumulation of unconjugated "foreign" chemicals will lead to an exhausted immune system (by constant challenge). This in turn changes the body’s reaction to invading pathogens, allows rampant overdevelopment of the septic foci and perhaps– it seems to me – provide one avenue for the formation of unwanted immune complexes. Hence an unhealthy liver can lead to R.A.

Theories abound but the big feature is that RA is multifactorial.

Leaky gut syndrome and genetic inheritance may also feature [2]. An autoimmune attack on circulating immune complexes (from gut micelles, through a permeable gut lining or "leaky gut") produces anti-antibody antibodies. These can recognise components of joint tissues as targets and begin to fixate and lyse them. This is the main theory of Murray [1] although he can’t explain why the body does this.

Turning to the chapter on Glycoproteins in Harper’s Biochemistry sheds some light on the aetiology of this occurrence. In this chapter, it clearly sets out a pathway for GP complexes to enhance cell to cell recognition. So, if you recognise the corollary (ie the lack of correct Glycoprotein formation strips the "recognition" ability of neutrophils and so cause our own cells to come under "friendly fire"), then: IT IS EASY TO SEE WHY THE UNWELCOME AUTO-IMMUNE NEUTROPHIL REACTION CAN OCCUR.

In other words, correct cell "coding" by the glycogen tendrils must occur before proper recognition of "friendly" protein – by the killer cells - can occur.

Consider this for a moment, with what we know about Streptococcus sanguinis (ubiquitous in periodontal disease). S. sanguinis has a collagen coat rather than a polysaccharide one. This fools the cell recognition system into thinking that it is "one of us". When you take the two observations, it is not hard to see that – given even a slight faltering of the quality of the saccharide component of our endogenous proteins + enzyme exhaustion an over-challenged and exhausted immune response //à glycoproteins (via a faulty enzyme cascade) – the Strep. can "get in". Not only that, but – if the S. sanguinis survives long enough, antibody complexes are formed against it that can also attack collagen "by mistake" [2,3]. This also fits in nicely with C.W. Buckley’s "Septic Foci" theory and also Hoffman’s conclusions – as the septic focus is on this occasion the mouth and the infective agent is disguised.

The good old "free radicle" theory still has its adherents – in fact it’s as popular as ever. Henry Osiecki, in his tapes on his new "Dr Vera’s" range of supplements, states that Nitric Oxide is the ultimate free radicle. When its over-production is triggered, it becomes more destructive by far than the exogenous lipid peroxides (found in peroxidated fats and hydrocarbons) which are ingested by innocent taxpayers on a daily basis.

This effect puts a major strain on the workload of the peroxide-snuffing enzymes (glutathione peroxidase and 6 hydroxy dismutase – selenium dependent enzymes).

Incidentally, this places a strain, in turn, on delta 9 desaturase (of which we hardly ever hear) impairing our ability to make endogenous omega-3FA’s. Thus, this places a bigger burden in turn, on our need to source these from the diet – an increasingly harder task, as the food quality of society deteriorates daily. It also drives cyclo-oxygenase into producing inflammatory prostaglandins.

Interestingly, Harper’s states that humans can’t produce omega-3 fatty acids. If that is so, how do they account for the high concentration of omega-3’ UFA’s in human mother’s milk? Bland stated – in his lecture series of the eighties – that "humans CAN produce omega-3 fatty acids, but only in minute amounts, due to the lack of activating cofactors. That is why we need to supplement with them.

Perhaps the enzyme has been rendered all but inactive in modern man by the severe undernutrition (decline in trace elements) which are needed to activate the said enzymes. (Also, if Dr Ralph Heineke is correct about "the ubiquitous proxeronine", then maybe our vital enzymes are being deactivated by a simple lack of fresh fruit and vegetables //à proxeronine, also.

(Proxeronine, originally found abundantly in pineapples, has since declined in that fruit due to over-cultivation. That led to Dr Heineke’s search for proxeronine in other fruits of that family, which is – according to him – how he came to find it in great abundance in wild-crafted Noni. Noni is a member of the Pineapple family).

Finally, some "rogue antibodies" form against fragments of circulating IgE antibodies and become "RA factors".

Finally, impaired androgen formation – notably DHEA (Dihydro ethyl androsterone) is common in RA sufferers. (Presumably, this is in response to excessive inflammation causing an exaggerated production of DHEA and finally, a deficiency of production as supply becomes exhausted through constant challenge/demand)

{Author’s opinion}

Interestingly, Dr Neil Solomon claims - in his limited treatise on the plant, Morinda citrifolia (Noni) – that some of the alkaloids in Noni have a direct involvement in DHEA synthesis.

• Heal and seal the gut
• Normalise gut microflora
• Support phagocytic activity
• Test for food allergy
• Eliminate food allergy
• Institute acceptable diet
• Supplement deficient nutrients
• Reduce inflammation – in gut and joints
• Make lymphatic circulation efficient
• Eliminate calcification of soft tissue
• Ensure normal calcium intake
• Ensure adequate protein variety and intake
• Ensure other trace elements and vitamins are balanced and adequately supplied
• Use specific supplements as needed.

1. Food Allergy:

Reduce intake of…

• dairy products(cow-sourced) to an absolute minimum and the following if testing +ve to RAST or Cytotoxic assays:
• Beef
• wheat, corn, rye or rice products or other relevant grains
• tomatoes, potatoes or other relevant nightshades.

1. Food sensitivity:

Reduce intake of

• Excessive quantities of orange juices, grapefruit, quantities of other acidic foods or juices
• strawberries and other similarly sensitising foods, if patient susceptible to them.

c) Proven allergens:

Avoid completely and re-introduce on a programmed basis, by negotiation with client.

PREFERRED FOODS: (preferable organic foods)

• Increase fish and seafood meals (fatty fish are especially beneficial – due to high omega-3 content). Garlic and chilli prawns are good at least once a week.
• Lamb, pork, poultry (organic chicken!), game meats and birds are acceptable in moderation and variety.
• Increase remaining vegetables and/or
• Take vegetable juice daily (a good recipe is 80% carrot, 10% celery, 10% beet

Or 80% carrot, 10% spinach, 10% celery. Must be taken 20 mins before meals or 2 hours after meals.

Replace wheat with other grains, potatoes with other white vegetables (sweet pot., swede, parsnip and turnip).

• Eat fruit 3-4 times daily
• Ensure adequate fats – mainly omega-3 or –6 and/or plenty of olive oil in salad dressing. Take cod liver oil regularly.
• Drink mainly water as a thirst quencher (other drinks may acidify or salinate joints – or both)..
• Take apple cider vinegar (5 mls in water once or twice daily).
• Apple juice, lemon juice and grapefruit juice are helpful in moderation. [1]
• Curries featuring turmeric are desirable. (Metagenics newsletter… Turmeric and its effect on cyclo-oxygenase – A.A. à PG1’S AND// à PG 2II’s).).
• Eat ginger daily. (Enhances Circulation and reduces inflammation).)
• Eat garlic daily – raw as well as cooked (in order to maximise its potential to assist in the healing process). (Garlic’s antibiotic and selenium and sulphurated amino acid content are widely documented and assist liver and bowel detox).
• A daily salad with added parsley, ALFALFA, extra virgin olive oil in salad dressing, celery and carrots is desirable. (Medicago sativa is the herb specific for alkalising the blood). (Use the oils and the ACV as a salad dressing).
• Salad dressing could include warming herbs and spices, such as ginger, cinnamon, turmeric, cumin,
• Moderate to hot curries are good, within our food selection parameters and client’s consent, so as to enhance peripheral circulation).

Water to be used as the main thirst quencher. Warming herbal teas, such as ginger, are good – as well as combinations such as Vata tea.

Most alcoholic beverages are allowable in moderation, except those brewed from suspected allergenic grains or vegies – such as vodka and beer. Best to stick to wine, to be safe.

Warning: RA sufferers are prone to uric acid crystals forming in the inflamed areas: do not take alcohol to excess.

Ensure adequate, regular exercise – by negotiation with client. The goal is to ensure adequate circulation flow and oxygen exchange at the periphery.

• Glycoprotein complexes (a) – Replete Dose: 500mg-1g tds
• Calc Orotate 400mg tds to qid pc ex aq
• Mag Orotate 400mg tds-qid pc ex aq (Enhance osteophyte and Calcium crystalline resorption and healthy bone formation)
• Calc Ascorbate – 2g qid pc ex aq
• Bioflavonoid complex with each dose of above (Inflavonoid C)
• Multigenics – ½ tab tds
• Metazinc - 1 tds pc ex aq
• HEME – 1 tds pc
• Chondroitin sulphate/glucosamine complex powder – ½ tspnfl tds or Bovine trachea cartilage, Shark cartilage. (Chondrosamine – Nutralife)
• Sod Selenite solution – 50mcg tds
• Glycoprotein complex [2] – Replete or Ambrotose

Other supplements:

• Oralmat drops – 3 drops s/l tds
• Noni.

Introduce any of the above supplements selected by degrees and by negotiotiation with client.

Naturally, the client will not want or need ALL of them – the above merely represents the full catastrophe of helpful agents.

• Calcium and Magnesium salts of Orotic acid. B13 is linked to RNA and DNA synthesis [2]. Calcium and Magnesium are deposited in large quantities in the bone [1]. Osteoblasts contain specific receptors for the entry of the orotate salts of calcium and magnesium [2]. Given that these (calcium and magnesium salts of orotic acid) are powerful chelate entities and hence absorbed straight across the gut cell membranes (by passive diffusion), the calcium and magnesium are absorbed straight into the bone tissue, virtually unhindered and instantly, because they bypass the normal absorption process.

Stretching the imagination for a second, it can be seen that excess quantities of orotates will be generated (surplus to immediate bone metabolic requirements). This acid is a powerful chelating agent and will therefore circulate and lock up any mineral deposits found to be collecting in soft tissue. The orotates will then combine with existing calcium deposits, and virtually re-cycle it back into the bone. (Author).

• Calcium ascorbate. Calcium is needed by deficient bone tissue. This is also a chelate, although weaker than the Orotates. Ascorbic acid is also needed in great quantities to aid collagen formation.

• Bioflavonoid complex is also an essential co-factor in collagen and elastin formation.

• Various trace elements are also required for other secondary supportive metabolic processes. eg Chromium is essential for normal CHO metabolism and blood glucose levels need to be normal for optimum energy availability – per the Krebs cycle – for tissue regeneration. By deduction, it is odds-on that Chromium is also involved in glucosamine production.

• Iron is not usually represented adequately in multi-formulations by law, so an iron supplement is invariably needed. RA often features blood loss (through the gut) and also from bleeds around the joints.

• Chondroitin sulphate is essential for GAG formation and is often overlooked. The reason is that the GAGs are usually produced plentifully by the body but – alas – in our RA sufferer they are not (for reasons of possible food allergy, malabsorption and poor diet selection). While it is true that chondroitin is produced from glucosamines, it has been shown that supplementing with both can improve arthropathies over giving either alone. (My own preference is to simply induce normal, healthy metabolism to begin with, using diet, low-dose supplements and "our beautiful herbs" – a phrase immortalised by Raymond Khoury).

• Oralmat is a potentised source of essential phyto-oestrogens (of the isoflavone and lignans families), beta 1-3 glucans, beta sitosterol, squalene and CoQ10. All of these nutrients are documented as being helpful in preventing inflammation. The Daidzen, Genistein et al are now accepted protectors of oestrogenic receptor sites (in males and females) from attack from exogenous oestrogenic irritants (xeno-oestrogens). It is this process which is now known to excite premature (and immature) cell proliferation, which is now accepted as a major component in modern auto-immune disease, of which RA is an example [2].

• Sod Selenite solution. Selenium is a must in the control of free radicle formation, as it powers enzymes specific to this task – namely glutathione peroxidase and 6-hydroxy dismutase. Free radicle formation is a major feature in RA [1].

• Glycoprotein complex. The cell to cell communication is the task of the glycoproteins. That means that normal production of these massive units must occur constantly, if the immune system is to be viable. Eventual breakdown of the normal production has been found to be THE MAJOR FACTOR in the onset of auto immune disease. The production of these is under attack from increasing nutritional depletion of our (increasingly) refined western diet – which is also providing us with an ever-increasing supply of free radicles, to fuel the fire.

They also make NK activity more specific, nullify the RA factor, improve T and B lymphocyte activity, enhance all immune Cluster Determinants, enhance NK recognition of MHC 1 molecules on antigens of pathogens and of course, control the entire HLA process of human biology [2].

Not to be sneezed at as a required nutrient, although our (flagging) enzyme cascades should be able to make them – given the correct dietary saccharide substrate.

• Noni is also said – by Dr Solomons, as well as Dr Russell Cooper and Dr Scott Gerson - to upregulate the action of biologically active protein components eg enzymes, neuropeptides, hormones etc.. Dr Bill McEnally says, in another publication, that the glycoprotein complex (known as "Ambrotose") specifically activates cell to cell recognition. Dr Darryl See has also alluded to this. Michael Murray deals with this question in Chapter 53 of Harper’s Biochemistry, his conclusions supporting this view]. As mentioned earlier, Herper’s states that ALL proteins are glycoproteins. (This is the profound biochemical-immune discovery in the 20’th century, in my view).

Complete Systems questions;

X-ray of joints;

Bone scan;

Full blood test (incl. RA factor);

• Hair analysis (mineral deficiencies);
• Live blood analysis. Factors – such as rouloux, T-cell activity, RBC health); clot retraction and many others spot early disease trends and allow for timely preventative action.
• Full Holistic Questionnaire; (Full personal and medical Hx (as above), Family history, lifestyle, eating habits, all other symptoms, healing time, sport, interests, family life, relationship issues and other related and non-related matters);
• RAST test for food allergies;
• Observation;
• Spiritual and mood and personality assessment and counselling.

ORTHODOX TREATMENT:

Rest;

Management Drugs:

• Steroids

• nandrolone
• prednisone, prednisolone, hydrocortisone.

• NSAID’s;

• Diclofenac (Voltaren)
• Naproxen (Naprosen)
• Ibuprofen (Brufen)
• Probenecid (benemid)
• Indomethacin (Indocid)
• Phenylbutazone (Butazolidin)
• Piroxicam (feldene)

• Complement fixator suppressants:

• Gold injections; (Sod Aurothiomalate –" Myocrisin")
• D-Penicillamine
• Chloroquine (Nivaquine)

• Immunosuppressants

• Azathioprine (Imuran)
• Cyclosporin (Not common in Oz retail pharmacy)
• Methotrexate

All of the above have side effects. The deeper they work systemically, the greater the severity of the side effect (see MIMS)

• Advice on how to learn to accept and live with it;

(This may have the greatest side effect of all – loss of hope).

1. Murray and Pizzorno, Encyclopedia of Natural Medicine (Revised 2’nd Ed’n), 1998, US.
2. a See, Dr Darryl, Breakthrough discoveries in Immune System Responses; Visua.Com, 1998
3. Porth, C, Pathophysiology, 5’th Ed’n., Lippincott, 1998
4. Khoury, Raymond, Class notes, Herbal Medicine II (Musculoskeletat system) Naturecare college, 1998
5. Hoffman, David, The New Holistic Herbal, Longmead, 1991.
6. Ruiter M. Wentholt HMM. The occurrence of a pleuropneumonia-like organism in fuso-spillary infections of the human genital mucosa. J Invest Dermatol 1952;18:313-25
7. Williams M.H., Pathogenic mycoplasma in rheumatoid arthritis? Association of Scientific Publishers 1972;251-62
8. Murray, R., Granner,D., Mayes, P.A., Rodwell, V.W., Harper’s Biochemistry, 24’th Ed’n.,1996
9. Buist, R.A., Bland, G., International Symposium on Human Physiological Nutrition, Regent, Regent Hotel, Sydney, 1986.
10. Adlercreutz, Herman, Phytooestrogens and inflammatory disorders, University of Helsinki, 1991.
11. Heuther, S. and McCance,K., Understanding Pathophysiology, Mosby, St Louis, 1996.