Study Finds Eating Fresh Fish May Ease Rheumatoid Arthritis Symptoms

Could relief for rheumatoid arthritis (RA) symptoms be as close as the nearest seafood restaurant? Possibly, say researchers from Harvard.
Study Finds Eating Fresh Fish May Ease Rheumatoid Arthritis Symptoms

Sara Tedeschi, MD, a rheumatologist at Brigham and Women’s Hospital in Boston and the study’s lead author, says researchers assessed 76 patients with moderate RA who were part of a larger heart disease study. A questionnaire looked at their diets over the past year and asked how frequently they ate fish.

As with fish oil supplements, the benefits of eating fresh fish are thought to stem from the anti-inflammatory effects of omega-3 fatty acids.
“We found people with RA who ate fish at least twice a week reported less joint swelling and tenderness than those who rarely or never consumed fish,” Dr. Tedeschi says.


Milk and beef may be a trigger for developing rheumatoid arthritis

A new study has found that a strain of bacteria that is often in milk and beef may be a trigger for developing rheumatoid arthritis.

WHERE: University of Central Florida, USA.

Study published in the Frontiers in Cellular and Infection Microbiology in January 2018

 Saleh Naser, University of Central Florida (UCF) infectious disease specialist, Dr. Shazia Bég, rheumatologist at UCF's physician practice, and Robert Sharp, a biomedical sciences doctoral candidate at the medical school.

WHAT: Researchers have found a connection between rheumatoid arthritis and Mycobacterium avium subspecies paratuberculosis, (MAP), a bacteria found in about half the cows in the United States. MAP may be a trigger for those who are genetically at risk for developing rheumatoid arthritis (RA). 
“We don’t know the cause of rheumatoid arthritis, so we’re excited that we have found this association,” Bég said. “But there is still a long way to go." 
 “Understanding the role of MAP in rheumatoid arthritis means the disease could be treated more effectively,” Dr. Naser said. “Ultimately, we may be able to administer a combined treatment to target both inflammation and bacterial infection.”

  • If  MAP is found in such a large percentage of cows, and therefore their products, how do we know if we are being exposed to MAP through consuming milk or meat from infected cattle
  • Also how do we know if we are genetically at risk for developing RA?
  • Many people with one autoimmune disease go on to develop other autoimmune diseases so in my way of thinking this is another reason to avoid cow's milk (which I already do) and now also beef. 
  • Do you think eating organic grass fed beef removes the risk of MAP?
  • Should we all be eating a Vegan diet or is that just too extreme?

Read the full article at the University of Central Florida site


Study Finds Bacteria in Milk Linked to Rheumatoid Arthritis


Around one-third of patients with juvenile arthritis fail to respond to first-line treatments

help for juvenile  arthritis

When treating the symptoms of juvenile idiopathic arthritis, also called juvenile idiopathic arthritis (JIA), disease-modifying anti-rheumatic drugs (DMARDs) and anti-tumor necrosis factor (TNF) are often used. These include methotrexate (MTX), Enbrel and Humira.

Around one-third of patients with juvenile idiopathic arthritis fail to respond to MTX or TNF therapy. Even fewer achieve the American College of Rheumatology Pediatric 70% criteria for response.

In this new research, printed in The Journal of Rheumatology in January 2018, the researchers evaluated whether measuring blood levels of the protein S100A12 could be a suitable predictor for treatment outcomes in JIA patients.
Because change in serum S100-protein myeloid-related protein complex 8/14 (MRP8/14) is associated with therapeutic response, we tested granulocyte-specific S100-protein S100A12 as a potential biomarker for treatment response.
S100A12 serum concentration was determined by ELISA in 163 patients treated with MTX or anti-TNF at baseline and follow up. Treatment response achievement of inactive disease, and improvement in Juvenile Arthritis Disease Activity Score were recorded. ELISA is enzyme-linked immunosorbent assay - a test that uses antibodies and color change to identify a substance. 

Researchers found that when compared to non-responders, patients who responded to the administrated therapies had significantly higher baseline levels of blood S100A12.

People who will respond to MTX or anti-TNF treatment can be identified by pre-treatment S100A12 serum concentration levels.

drugs for juvenile arthritis


S100A12 Is Associated with Response to Therapy in Juvenile Idiopathic Arthritis

Faekah GoharJanneke AninkHalima MoncrieffeLisette W.A. Van Suijlekom-Smit
Femke H.M. PrinceMarion A.J. van RossumKoert M. DolmanEsther P.A.H. Hoppenreijs
Rebecca ten CateSimona UrsuLucy R. WedderburnGerd HorneffMichael Frosch
Dirk Foell and Dirk Holzinger


Rheumatoid arthritis linked to cardiac problems and infections

Rheumatoid arthritis research results

This large-scale population-based study shows that rheumatoid arthritis (RA) leads not only joint damage, but it increases the long-term risks of problems such as heart attacks and infections. 

Multibiomarker disease activity (MBDA) test scores were analysed in US patients with RA. There were over 34,000 patients records involved in the research. Their mean age was 69 years and 79% of them were women. Medicare fee-for-service claims data from 2010–2014, was used for this research. 

There were 452 serious infection (SIE) events, 132 myocardial infarction (MI) and 181 coronary heart disease (CHD) events. "For MI/CHD events, a threshold effect was present; higher disease activity by MBDA score was associated with increased MI (HR=1.52, 95% CI 0.92 to 2.49) and CHD rates (HR=1.54, 95% CI 1.01 to 2.34 comparing scores ≥30 vs <30)."

“Higher disease activity as measured by a panel of biomarkers was associated with higher rates of hospitalized infections, MI and CHD events. These findings add to the growing body of evidence that further strengthens the argument to strive for lower disease activity in RA,” in Annals of the Rheumatic Diseases.

Higher MBDA scores were associated with hospitalised infection, myocardial infarction and coronary heart disease events in the large, predominantly older, US RA population.

  1. Curtis JR, Xie F, Chen L, et al. Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based studyAnn Rheum Dis. 2017 Dec 21. pii: annrheumdis-2017-211727. doi: 10.1136/annrheumdis-2017-211727. 
Rheumatoid arthritis linked to cardiac problems and infections


Is Rheumatoid Arthritis Preventable?

Is Rheumatoid Arthritis Preventable?
Results of a newly published study suggest that personalized medicine approaches may result in health behavior that may reduce RA risk.                                                                                                       
We have gotten to the point where we’ve identified some modifiable behaviors that affect rheumatoid arthritis risk,” says Jeffrey A. Sparks, MD, MMSc, assistant professor of medicine in the Division of Rheumatology, Immunology and Allergy at Brigham and Women’s Hospital in Boston. “We have made a lot of progress in observational studies to identify risk factors for RA, and the next step is trying to target prevention strategies for those at risk.”

Randomized, Controlled Trial

Dr. Sparks, Elizabeth Karlson, MD, MPH, and other colleagues performed a randomized, controlled trial among 238 first-degree relatives of patients with RA.1

Motivated to Change Following Education

“What we found is that, overall, people are motivated to change those behaviors once they were educated about them using this novel, personalized RA risk calculator,” says Dr. Sparks. “Just the act of giving this RA risk calculator to first-degree relatives made them want to change those behaviors more than those that were receiving standard care in the comparison arm.”
“In practice, we know there are behaviors related to RA risk,” says Dr. Sparks. “We have shown that telling people about their risk for RA really does change behaviors—and for the better. Although this doesn’t directly address whether these interventions change a person’s risk, we know these are healthy behaviors from many aspects.” 

Read the full article by Kurt Ullman at The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. 


  1. Sparks JA, Iversen MD, Yu Z, et al. Disclosure of personalized rheumatoid arthritis risk using genetics, biomarkers, and lifestyle factors to motivate health behavior improvements: A randomized controlled trialArthritis Care Res. 2017 (in press).

Rheumatoid arthritis and Sjogren's syndrome

RA and SS

A percentage of people with rheumatoid arthritis go on to develop Sjögren's syndrome (SS) which is another autoimmune disorder.  When someone with an established autoimmune disease develops SS it is called Secondary Sjögren's syndrome. 

The basic symptoms are dry eyes and dry mouth but the list of symptoms is long and not everyone gets all of them.

In a 2013 study researchers found that RA patients with secondary Sjögren’s syndrome had distinct features that set them apart from those with RA alone:

  • higher RA disease activity. 
  • more severe arthritis, with a greater number of swollen, tender, and deformed joints. 
  • tended to be older and have a longer duration of RA. 
  • appeared to have stronger hereditary component to their disease.
  • a clearer history of autoimmune disease in their family. 
  • presence of certain antibodies, rheumatoid factor (RF) as well as other auto-antibodies (SSA and SSB). 
  • more likely to have blood abnormalities. 
  • more likely to have fever and rash.
  • were more likely to have Interstitial lung disease, a common lung complication.

Find out more about Sjogren's Syndrome at Sjogren's Syndrome Info


Diet for rheumatoid arthritis update

This is a very thorough study that was published frontiers in Nutrition on 8 November 2017: Managing Rheumatoid Arthritis with Dietary Interventions from the Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India. 
It seems that they have gathered together the growing body of research evidence showing that food and diet can improve the symptoms of Rheumatoid Arthritis.

"Patients suffering from rheumatoid arthritis should switch from omnivorous diets, drinking alcohol, and smoking to Mediterranean, vegan, elemental, or elimination diets, as advised by their doctor or dietician."said Dr. Bhawna Gupta one of the report authors.
Many reports have stated that the population of gut microbes gets altered in a person affected with RA, and other autoimmune diseases,  and several animal studies have already proved that any alteration in gut microbiota corresponds to initiation of RA.  Self-help by means of dietary interventions can help in management of various disorders including rheumatoid arthritis (RA), a debilitating autoimmune disease. 

Mediterranean Diet for rheumatoid arthritis
Mediterranean Diet

Dietary suggestions are appealing to patients as they are affordable, accessibile, and scientific evidences show they have substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression.

In the review they have included all the dietary interventions that clearly indicate clinically and statistically significant and beneficial long-term effects for relieving symptoms, delay in disease progression and associated damages in RA patients.

Here are the recomendations from the study. I have not included all the supporting studies which you can see in detail in the report but just the simple dietary suggestions. Please keep in mind you do not have to do them all but just pick one to try:

Seven Days Fasting Followed by Vegan Diet. A fasting of 7–10 days with partial nutrient intake of vegetable broth, herbal teas, parsley, garlic, and decoction of potatoes; juice extracts from carrots, beets, and celery; and a controlled daily energy intake followed by 1 year of a vegan diet as compared to omnivorous diet was studied in different trials. Together these studies observed remarkable decrease in swollen and tender joints, pain, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

vegetable fasting for rheumatoid arthritis
Carrot, celery and beetroot juice
Vegan Diet. A diet including intake of only fruits and vegetables, eliminating any animal product or by-products is vegan diet.

Mediterranean Diet is rich in oleic acid, omega-3 fatty acids, unrefined carbohydrates, and phytochemicals . MD involves high consumption of olive oil, cereals, fruits, vegetables, fish, and legumes; less red meat; and inclusion of moderate amount of red wine in diet. Studies have also shown that incorporation of olive oil in diet decreases the risk of developing RA.

Elemental Diet provides food in simplest form consisting of glucose, vitamins, trace elements, and essential amino acids, is hypoallergenic, contains all nutrients for daily requirements, and is thought to be less immunogenic. 

Elimination Diet Certain food and food components may worsen the disease conditions in RA . Thus, an elimination diet plan may as well be considered wherein we eliminate those food related antigens that may possibly aggravate the disease symptoms. 

Individual Food Items in Diet and Their Relevance to RA

In an average diet comprising of breakfast, lunch, and dinner, there are several food items which are rich source of some phytochemicals and their efficacy in eradication of diseases has been known and is included under traditional medicines on which 80% of the world population relies . Food items such as dietary fibers, cooking oil, polyphenols, bioactive compounds from several herbs and beverages like tea are among the cheapest sources of medication; however, their bioavailability has always been a matter of concern.
Diet for rhuematoid arthritis

Dietary Fibers and Whole Grains

Most of the staple food consumed all over the world are comprised of dietary fibers and whole grains. A definitive explanation for dietary fibers can be put as remnants of food not digested in small intestine, which then moves to large intestine and gets fermented by the microflora and induces several health promoting effects. Insoluble fibers such as cellulose and lignin are found in fruits, vegetables, and whole grains; and soluble fibers including pectin, guar gum, and mucilage.

Spices. Ginger, Turmeric and Cinnamon bark are recommended.

Spices Recommended for Rheumatoid arthritis
Ginger root and ginger powder
Cinnamon bark recommended for RA
Cinnamon bark

Essential Fatty Acids
Omega-3 or omega-6 fatty acids have shown their potential as immunosuppressants and anti-inflammatory agentsBorage seed oil provides high amount of omega-6 fatty acid or gamma-linolenic acid (GLA) and significantly reduce tender and swollen joints.
Gamma-linolenic acid and omega-3 fatty acid alpha-linolenic and stearidonic acid from black currant seed oil (BCSO) gives significant positive effects in pain relieving and reducing joint tenderness.
Fish oils provide high amount of omega-3 fatty acids, and their efficacy to treat RA has been checked in several controlled trials. RA patients were provided with fish oil with 3.6 g of omega-3 fatty acids per day. 


Synbiotics are composed of probiotics and prebiotics (the non-digestible food products beneficial for growth of helpful bacteria in large intestine and provides health promoting effects)
Bifidobacterium and Lactobacillus are the key strains widely used as probiotics in commercial, pharmaceutical, and nutraceutical products. 
Yoghurt for rheumatoid arthritis
Yoghurt with probiotics and berries


Green tea. Epigallocatechin-3-gallate (EGCG) has proved its therapeutic potential and is a main phytochemical present in green tea that is obtained from dried leaves of Camellia sinensis and C. assamica of Theacease family.  The protective effects of green tea have been well proved in neurodegenerative disease, inflammatory disease, cardiovascular disease, and several types of cancer.


Sallaki (Boswellia serrata) is widely recommended as an anti-inflammatory herb as prescribed in Ayurveda. it lowers inflammation.
Ashwagandha (Withania somnifera) is one of the plants being described in Ayurveda as a potent anti-inflammatory plant which reduced stiffness, disability to move knee and joints, and pain score.
These diets may  not cure the RA  but an effective incorporation of these food items in the daily food plan may help to:
  •  reduce their disease activity, 
  • delay disease progression, 
  • reduce joint damage, 
  • eventually mean a decreased dose of drugs administered for therapeutic treatment of patients.


Managing Rheumatoid Arthritis with Dietary Interventions
Shweta KhannaKumar Sagar Jaiswal and Bhawna Gupta

Disease Biology Laboratory, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India


Biotherapy and oral complications in Rheumatoid Arthritis

Biotherapy drugs can inhibit key factors that cause inflammation in Rheumatoid Arthritis (RA) and other autoimmune conditions. 
These drugs include Rituximab, one of the first biotherapies to be approved for RA, Infliximab, Etanercept and Abatacept.

Studies have shown that people being treated with biotherapies can have oral complications. These side effects obviously vary greatly depending on the dosage amount, the type of product and the way they are administered. If dentists are aware of these biotherapy agents and the possible side effects then they can be very helpful in arresting and preventing further damage and educating the patient.

The treatment of rheumatoid arthritis focuses on the suppression of immune system with the help of biotherapy agents. The oral complications caused by these agents include oral thrush, metallic taste, soreness and burning sensation of tongue, difficulty swallowing, cold sores on lips, xerostomia, ulcers, gingival bleeding, oral pain, white spots or patches, itching of lips and tongue, halitosis, burning of lips, pain in the jaw, and swelling in glands. Sharoot Malik and Sumaiya Kasbati, Dentistry iQ

Dentistry iQ
American Nurse Today 
NCBI US National Library of Medicine


Passive smoking and Rheumatoid Arthritis linked

rheumatoid arthritis and passive smoking study

Passive smoking in childhood has a rheumatoid arthritis link. 

This study was done with over 70,000 women at University Hospitals of South Paris. It discovered the alarming fact that the women who had been exposed to cigarettes smoke in their childhood had a significantly increased risk of getting Rheumatoid Arthritis in later life.
"Our study highlights the importance of avoiding any tobacco environment in children, especially in those with a family history of RA," said Professor Raphaele Seror.
The participants were asked if as a child they were in a smoky room and for how many hours a day. 

RA is the most common chronic inflammatory joint disease, affecting about 0.5-1% of the general population and causing progressive joint destruction, disability and reduced life expectancy. 

In recent years, many potential environmental factors have been associated with an increased risk of developing RA, but so far smoking is the only one that has been extensively studied. 

SOURCE: eular Press Releases for 16.06.17 pdf


The Rheumatoid Factor Test

The rheumatoid factor blood test (RF) helps diagnose Rheumatoid Arthritis (RA). It measures rheumatoid factor, a chemical in the blood of many, but not all, people with RA. By itself, it does NOT show whether you have rheumatoid arthritis or not.
The Rheumatoid Factor Test gives your doctor more information to consider when diagnosing your condition, it does not necessarily mean you have RA. It is used along with your physical exam, other tests, and your symptoms to help diagnose your condition.  

People with other autoimmune conditions, such as lupus and Sjogren's syndrome, can also have a positive Rheumatoid Factor. So can people with infections such as hepatitis and mononucleosis. 

False positives occur in 5% of healthy individuals and in up to 20% of people over 65 years of age. False positives also occur in inflammatory condition such as Sjögren's Syndrome, Lupus and Systemic Sclerosis.

Some healthy people can have rheumatoid factor in their blood too. Also some people with RA don’t have a positive RA result. That’s why this test will not,

The higher the level in rheumatoid disease the worse the joint destruction and the greater the chance of systemic involvement.

What Abnormal Results Mean

An abnormal result means the test is positive, which means higher levels of rheumatoid factor have been detected in your blood. The higher the level, the more likely one of these conditions is present. There are also other tests for these disorders that help make the diagnosis.
People with the following diseases may also have high levels of rheumatoid factor:
Other blood tests for rheumatoid arthritis:
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • anti-CCP (anit-cyclic citrullinated peptide) 

  1. Wilson D; Rheumatoid factors in patients with rheumatoid arthritis. Can Family Physician. 
  2. Longmore M, Wilkinson IB & Rajagopalan SR; Oxford Handbook of Clinical Medicine, 2004
  3. MedlinePlus 
  4. WebMD