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


What is polyarthritis?


  • It is any type of arthritis which involves 5 or more joints simultaneously
  •  It is usually associated with autoimmune conditions such as rheumatoid arthritis, amyloidosis, psoriatic arthritis, and lupus erythematosus.
  • It may be experienced at any age
  • It is found in both men and women
  • It can also be caused by infection with an alphavirus such as chikungunya virus and Ross River virus. This condition is termed alphavirus polyarthritis syndrome.
Polyarthritis for medical professionals:

MEDICAL ARTICLE: Inflammatory Polyarthritis in the Older Adult

Preventing rheumatoid arthritis

Some people have recently asked if rheumatoid arthritis can be prevented. Until the cause is understood it may be difficult to stop it.  Some factors do increase your risk of getting it and they include your gender, genetics and age but none of these factors can be controlled. Environmental factors are also thought to be a factor in the development of RA and I suppose they can be controlled to some degree.
Genetics certainly is a complex area and the genetics of rheumatoid arthritis are complex. "The genetic component of RA is widely investigated: the strongest gene association is considered to be the one with the human leukocyte antigen (HLA) region, particularly the HLA-DRB1 genes accounting for about two-thirds of the genetics of RA." Arthritis research & therapy

There is one thing that has been shown to increase the risk of rheumatoid arthritis, that can be controlled, and that is smoking.  Recently, it has been reported that smoking is involved in the development of many autoimmune diseases such as RA,  Lupus, Systemic sclerosis, Multiple sclerosis and Crohn's disease.

RESOURCES: Rheumatoid arthritis and smoking: putting the pieces together
Zsuzsanna Baka, Edit Buzás and György Nagy


Refined Sugars and Rheumatoid Arthritis

Excessive consumption of refined sugars, including white sugar, brown sugar and corn syrup, may increase the acidity of the body. Some natural health practitioners have recommended that refined sugar be avoided in cases of inflammatory disease such as rheumatoid arthritis. Substitution with natural sugar alternatives such as stevia, agave nectar, fruit juice concentrates and honey may help to reduce inflammatory processes. An overall reduction of any type of sugar can also be recommended to avoid rapid increases in blood sugar, which may interfere with inflammatory processes.

Many people feel that their pain is reduced if they cut out sugar altogether. Have you experimented with this? I found it difficult to do at first but well worth the reduction in pain especially in my fingers, wrists and ankles. I recommend the following program which gives you online support...

                                                  The 21-Day Sugar Detox


Risk of getting Rheumatoid Arthritis involves gene regulators

The kind of DNA once known as “junk” may influence people’s risk of getting rheumatoid arthritis, according to a study that offers the latest look at the complex system of switches that turn disease genes on.

Using genetic information from more than 300 people with rheumatoid arthritis and another 300 without, the researchers found 10 areas that appeared to influence risk, according to the research published yesterday in the journal Nature Biotechnology. 

Read full story at Bloomberg