Natural or Traditional Treatment Path for Rheumatoid Arthritis?

Which Way Should You Go?

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You have just been diagnosed with rheumatoid arthritis. You have heard about various medications used to treat the disease, but you are guarded because of the potential side effects. You are aware that early treatment offers the best chance for bringing rheumatoid arthritis under control. What should you take? What treatment will work best for you?

Consider the goals of treatment as you decide on the best course.

The goals of rheumatoid arthritis treatment include:

With your doctor's input, you are faced with a choice of two treatment paths—traditional (also known as conventional) or natural. This choice is not solely for the newly-diagnosed. People with rheumatoid arthritis who are unsatisfied with their current treatment regimen may want to reconsider their treatment path as well. To help you decide, here is what you need to know.

The Traditional Approach

Most doctors and rheumatologists will treat early symptoms with medications used to relieve pain, reduce inflammation, and slow progression of joint damage. Typically, an analgesic medication, a nonsteroidal anti-inflammatory drug (NSAID), and a disease-modifying anti-rheumatic drug (DMARD) or biologic drug are prescribed.

This is almost certainly the treatment course that will be suggested if the onset of symptoms is severe. An oral corticosteroid, such as prednisone, may also be prescribed to bring inflammation quickly under control. That said, this sets you on a treatment path that is typically longterm because rheumatoid arthritis is a chronic, inflammatory, autoimmune disease.

Corticosteroid injections can be given directly into an inflamed joint (i.e., intra-articular injections) or they can be delivered to the whole body through intravenous or intramuscular injections. Steroid injections may provide significant symptom relief and be an effective interim step while waiting for slower-acting DMARDs to work.

In 2012, the American College of Rheumatology (ACR) provided recommendations for the treatment of rheumatoid arthritis. The guidelines, which focus on the use of DMARDs and biologic drugs, were updated in 2015.

Surgery may become necessary as rheumatoid arthritis progresses and joint damage worsens.  The need for surgery is typically seen in advanced cases, as well as severe cases of rheumatoid arthritis. When medications, injections, and conservative treatments inadequately control symptoms, the disease may greatly interfere with function and quality of life, making surgery necessary and the last resort.

The Natural Approach

Doctors who specialize in natural treatments are called naturopaths.

Naturopathic medicine attempts to help the body heal itself with natural treatment modalities or natural supplements. Andrew Weil,MD, on his website, states that steroids and immunosuppressive drugs used to treat rheumatoid arthritis are toxic when used longterm. Dr. Weil suggests that "lifestyle modification can moderate autoimmunity" and "other strategies can help control the symptoms of rheumatoid arthritis."

Dr. Weil recommends that people with rheumatoid arthritis:

  • Follow a low protein, high carbohydrate diet, while minimizing foods of animal sources.
  • Avoid milk and milk products.
  • Avoid polyunsaturated oils, margarine, shortening, and items made with partially hydrogenated oils.
  • Increase consumption of omega-3 fatty acids. Eat more cold water fish, walnuts, freshly ground flaxseeds. Consider a fish oil supplement.
  • Get regular aerobic exercise; swimming is optimal.
  • Practice relaxation techniques.
  • Try hypnotherapy, guided imagery, meditation, and yoga.
  • Reduce caffeine and tobacco consumption.
  • Consider an elimination diet. Over a two month period, eliminate these categories of food one at a time: all sugar except fruit; all citrus fruit; wheat, corn, and soy. Add back in at the end to see which may affect your symptoms.
  • To manage symptoms use aspirin or over-the-counter NSAIDs.
  • Feverfew, ginger, and turmeric have anti-inflammatory effects.
  • Experiment with traditional Chinese medicine or Ayurvedic medicine.
  • Consider fasting, but only with doctor's supervision.

There are other supplements that are recognized as having anti-inflammatory properties besides those highlighted by Dr. Weil.  Here is a compilation of the 13 Best-Known Anti-Inflammatory Supplements.

The Dilemma

Regarding treatment options, safety and effectiveness are equally important. Ideally, we should not have to sacrifice one for the other. For any FDA-approved medications, you can be sure there were clinical trials conducted which evaluated safety and effectiveness. Supplements do not require clinical trials or FDA approval to be marketed. Most evidence supporting natural treatments is anecdotal or from trials with limitations. That is not to say there are no beneficial effects of natural treatments.  It may be that both traditional and natural treatments can be used together. Perhaps the mistake is in thinking that it is an exclusive choice. Ask your doctor these questions?

  • Is it possible that taking an anti-inflammatory supplement could reduce the need for prescription anti-inflammatory drugs and thereby reduce the risk of side effects? 
  • Since the natural treatments are not viewed as disease modifiers, is it wise to include one of the DMARDs as part of the treatment regimen?
  • What is the best combination of natural and traditional treatment that will achieve the best outcome in terms of safety and effectiveness?

The Bottom Line

If all treatments were equally effective for people with rheumatoid arthritis, the decision of which path to follow wouldn't be so complicated. There is an element of trial and error involved to find the most effective treatment or combination of treatments for you. But, you do have to start somewhere.

That said, there is another factor which must be considered. Researchers have emphasized the need to treat early rheumatoid arthritis—with "early rheumatoid arthritis" defined as less than three months of symptoms and disease activity. Treatment should be started immediately after symptoms are evaluated and a diagnosis is made by a doctor. The desired window of opportunity for treatment, in order to prevent permanent joint damage, is now recognized as "the earlier the better".

Sources:

Cush, Weinblatt, and Kavanaugh. Chapter 6 - Diagnosis of Early Rheumatoid Arthritis. Rheumatoid Arthritis: Early Diagnosis and Treatment. Third edition. Professional Communications, Inc.  

Maroon JC et al. Natural Anti-inflammatory Agents for Pain Relief. Surgical Neurology International. December 13, 2010. 

Weil, Andrew MD. Rheumatoid Arthritis: Natural Remedies? DrWeil.com. Updated 6/20/2005.

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