Rheumatoid arthritis is common throughout the world and knows no ethnic boundaries. About 0.5–1% of the world's population suffers from it, and among older people in developed countries, the proportion of people with RA is 5%. Despite the constant efforts of scientists, there is no therapy that would cure this disease, and those that are available to doctors can only somewhat slow down the degenerative process in the body and do not always relieve the patient from pain.
Now it seems the situation is changing.
How to read this text
If you like long texts and want to know what RA is and why it still cannot be cured, just read on. If you love it briefly and clearly, you know everything about RA or, God forbid, you suffer from it, go straight to the good news, they are waiting for you here.
But first, let's remember what kind of disease it is and why helping a patient with RA is so difficult.
Autoimmune disease
Rheumatoid arthritis is a systemic inflammation of connective tissue—tendons, ligaments, cartilage, and fluid in the joint cavity (called “synovial”)—predominantly affecting small joints. It is autoimmune in nature. This means that the immune system, designed to produce antibodies to pathogens entering the body, fails and begins to produce them to the cells of its own tissues, which gradually destroys them.
The most common manifestations of RA
- Fatigue, weakness. – Morning stiffness. The longer it lasts, the more active the disease. – Swelling of the joints. – Flu-like symptoms, the main one being high fever. – Pain when sitting for long periods of time. - Muscle pain. – Loss of appetite, weight loss, depression. – Disruption of the salivary and lacrimal glands, causing insufficient production of tears and saliva.
Fatigue and weakness in RA, especially in combination with pain, significantly reduce the patient’s performance and quality of life in general, and in many cases lead to disability.
Why is rheumatoid arthritis not yet curable?
Rheumatoid arthritis.
Photo: https://newhospital.ru/ In order to prevent or cure a disease, it is necessary to understand its origin. As with most autoimmune diseases, the exact causes of rheumatoid arthritis are still unknown and there is only speculation.
It is believed that the triggering factor can be infection, stress, intoxication, mutagenic (causing gene mutations) medications, as well as hormonal changes in the body, as evidenced by the fact that women suffer from RA 3–5 times more often than men.
A new theory of the trigger of the autoimmune process was proposed by scientists from University College London. They published an interesting study that established a correlation between damage to the intestinal mucosa and joint inflammation and the severity of rheumatoid arthritis.
At first glance, this is unexpected, but at the same time it is not surprising if you know that in recent decades scientists have been carefully studying how communities of intestinal microorganisms (they are called “microbiota”) influence a variety of diseases, and especially autoimmune ones.
An imbalance of beneficial and harmful bacteria in the intestine leads to damage to its walls and the “leakage” of molecules that normally should not be there.
Researchers discovered such disorders in people with RA, and then conducted an experiment on a mouse model of rheumatoid arthritis. When, with the help of medications, they healed the damage to the intestinal walls of the mice, their arthritis went away on its own!
“We have shown that in arthritis there is deep damage to the intestinal mucosa, which can no longer function as a protective barrier. This means that the intestinal mucosa could be an important therapeutic target for the development of new therapies for rheumatoid arthritis,” says co-author Claudia Marie.
Since mice with arthritis have already been cured in this way, let's hope that the matter will reach people.
Diet for chronic joint arthritis
Arthritis is a chronic disease, and therefore it is advisable to combine chondroprotectors for joints with a healthy diet rich in vitamins A, B, C, E, macro- and microelements throughout life. Daily consumption of a varied and nutritious menu prevents joints from starving, helps maintain immunity, and protects cartilage cells from oxidation and bombardment by free radicals. This is why it is so important to include foods rich in:
- Belkom. Lean meat, poultry, fish, game, eggs, seafood and dairy products, as well as wheat germ are excellent sources of proteins and, in particular, essential amino acids. They are needed to maintain the elasticity of cartilage, as well as a healthy amount of muscle mass. Not consuming enough protein? The muscles will not be able to perform a shock-absorbing function, and the entire load will fall on the joints.
- Carotenoids and other antioxidants. In addition to red and orange fruits, such as carrots, peaches, citruses, apricots and plums, it is important to eat all kinds of berries - raspberries, rowan berries, viburnum, lingonberries, blueberries, strawberries, cranberries, currants. They help reduce oxidative stress, a cellular aggression that increases symptoms of inflammation.
- Zinc, selenium, sulfur, magnesium and other minerals. Don't forget about broccoli, apples, onions, nuts, whole grain bread, legumes, spinach, mushrooms, pumpkin.
And you shouldn’t buy these products from the “harmful” list:
- products made from 1st grade flour, incl. white bread and pastry;
- sausages and semi-finished products;
- fast food and salty snacks;
- alcohol;
- sweets (except dark chocolate and dried fruits);
- pickles, canned food, sauces and marinades.
Be careful with fried, fatty, spicy and salty foods - for chronic joint arthritis, it is better to cook them steamed or in foil.
Why are the drugs that doctors use to treat RA today bad?
The main treatment for rheumatoid arthritis is the so-called disease-modifying antirheumatic drugs, which reduce the activity of the immune system and fight inflammation. These are methotrexate, leflunomide, penicillamine and others. They all have very unpleasant side effects.
Biological agents are also used, such as Adalimumab (Humira), tocilizumab (Actemra), and others. They are much more expensive than basic antirheumatic drugs, and therefore are used only in cases where the basic ones did not work.
To relieve pain, the doctor may prescribe drugs from a large group of non-steroidal anti-inflammatory drugs (meloxicam, celecoskib, nimesulide), as well as glucocorticosteroids. Both are not always effective in pain relief and also produce negative side effects.
By the way, RA patients should be especially careful about COVID-19. The current epidemiological situation is doubly bad for a person with rheumatoid arthritis.
The first danger is the coronavirus itself, which should never be infected by anyone taking immunosuppressive drugs, because in this case, most likely, the immune system will not cope well with the infection. The second danger is vaccination, which can result in an exacerbation of RA. In some cases, with long-term remission and a stable condition, the doctor may stop taking the drug for several weeks so that the patient is vaccinated and develops antibodies, which will not happen in the presence of a drug that suppresses antibody immunity. In any case, patients must strictly follow the rules of social distancing, personal hygiene, try to avoid public events, especially indoors, and wear a mask in public places. The issue of vaccination must be discussed with the attending physician, who is attentive to the peculiarities of the course of RA in a particular patient, and a balanced decision must be made.
How to cure chronic arthritis
Managing chronic arthritis is a lifelong task that involves daily exercise, following a diet (luckily not a strict one!), taking preventative medications, using orthoses, and attending physical therapy. Maintaining such a regimen allows patients to do without heavy drug treatment and control the disease with minimal effort
Physiotherapy for chronic arthritis
Physiotherapeutic techniques are aimed at eliminating pain and other inflammatory symptoms in the joint due to chronic diseases, including arthritis. These techniques should be divided into two groups:
- procedures that are allowed during the period of acute chronic arthritis (for example, drug electrophoresis, cryotherapy);
- procedures that are carried out strictly in a state of remission (therapeutic massage, therapeutic exercises, amplipulse and others).
A general list of techniques that can alleviate the condition of a patient with chronic arthritis of the joints includes:
- phonophoresis;
- laser therapy;
- magnetic therapy;
- ultrasound therapy;
- shock wave therapy;
- electromyostimulation;
- acupuncture;
- thermotherapy;
- electrophoresis;
- paraffin applications;
- ozokerite;
- ozone therapy;
- mud therapy and balneology;
- hirudotherapy.
To treat chronic arthritis, it is necessary to support the joint and relieve stress on it - for this, the doctor may prescribe special orthopedic insoles for shoes, walking canes, and joint fixators.
Massage for chronic arthritis
Massage for chronic arthritis is carried out exclusively in a state of remission! The attending physician must confirm the absence of inflammation in the joint. For home rehabilitation, the following types of massage movements are allowed:
- stroking (along the muscles and circular);
- rubbing and pulling;
- palpation (deep massage) and pinching;
- grasp the skin and muscles with the palm and moderately pull.
Under no circumstances should you experience pain when performing these movements! Only slight tension is allowed, which is replaced by pleasant warmth and relaxation around the joint.
Please note that massage for chronic joint arthritis should be given at least 10-15 minutes a day. It is advisable to combine it with baths (before the massage), application of medicinal ointments, creams or gels (during the massage), as well as therapeutic exercises (after the massage). In this case, the massage is carried out not only at the location of the joint, but also in the surrounding areas. For example, if the knee joint is affected, the thigh and ankle are also massaged.
Exercise therapy for chronic arthritis
During remission of a chronic disease - arthritis - patients are recommended to moderate physical activity, which allows them to preserve muscle mass, reduce the load on the joint by strengthening muscles and tendons, and also maintain joint mobility.
An individual list of exercises for each sore joint is determined by the instructor. But, in the absence of contraindications, “general” warm-ups for the whole body are useful, which can be started right in the morning:
- Body rotations. The left hand is on the belt, the right hand is placed behind the back at shoulder level. Turn your body back without jerking. Repeat on the other side.
- “The sprout reaches for the sun.” Stretch your arms up and stretch, standing up on your toes.
- "Penguin". Place your arms straight behind your back at shoulder level or slightly higher. Bring them together, moving your shoulder blades, and then move them forward, as if flapping your wings.
- Body tilts. They can be performed in different ways - for example, with your arms raised up or holding one hand on your belt and the other above your head. Side bends are especially useful.
- "Cat". Get on all fours, alternately arching your back and bending it down.
- On all fours, raise your left leg and right arm parallel to the floor and hold for a few seconds. Change sides.
If you have a gymnastic stick, add the following exercises:
- Grasp the stick by the ends with an overhand grip, holding it in front of you. Pull the bar to your chest and return to the starting position. Repeat with an underhand grip.
- Place the stick behind your head and begin to “saw” the back of the neck, fully straightening one or the other arm.
- Place the stick behind your back and “swing” it left and right.
- Sit down, place the stick vertically in front of you and begin to move your hands along it from top to bottom and back.
So what have scientists discovered?
Study leader Dr. Ritu Chakravarti.
Photo: The University of Toledo/Daniel Miller As sometimes happens in scientific practice, it happened by mistake.
A team of scientists at the Toledo College of Medicine, led by Associate Professor Ritu Chakravarty, has been studying the 14-3-3 zeta protein and its role in immune pathologies for many years. Researchers have suggested that this protein may be a trigger for the onset of rheumatoid arthritis.
In a mouse model, they tried to prevent the development of RA by removing this protein using gene editing technology.
To their surprise, the opposite happened. Not only did the mice get sick, but it happened very quickly, and the disease itself was more severe than usual.
Then scientists developed a vaccine using 14-3-3 zeta protein grown in bacterial cell culture. By injecting the vaccine into mice with rheumatoid arthritis, they saw a rapid and very strong response from the animals' immune system, resulting in long-term protection from RA.
As Chakravarty said, this is one of those rare cases in medical science when scientists do not get the desired result, but it turns out not only not to be a failure, but on the contrary - a great success.
“The happy surprise was that the rheumatoid arthritis completely disappeared in the mice that we gave the vaccine,” she says.
The vaccine has demonstrated another positive effect. The mice had significantly improved bone health.
The potential of this therapy is enormous. Researchers are already looking for partners among pharmaceutical companies to conduct preclinical studies of the drug's safety in humans.
It's entirely possible that in 5 to 10 years, rheumatoid arthritis patients will be cured of it, but if you read this and thought you'd have to wait too long, we're happy to give you some more good news.