2022 American College of Rheumatology Guidelines for Rheumatoid Arthritis

 2022 American College of Rheumatology (ACR) Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

The guideline addresses the use of exercise, rehabilitation, diet, and additional integrative interventions in conjunction with disease-modifying anti-rheumatic drugs (DMARDs) as part of an integrative management approach for people with rheumatoid arthritis. It is not about the pharmacologic management of rheumatoid arthritis. It is about integrative interventions for the management of RA to accompany DMARD treatments.

EXERCISE.

Consistent engagement in exercise was strongly recommended. Aerobic, Aquatic, Resistance and Mind-Body exercise were the types of exercise recommended.

REHABILITATION RECOMMENDATIONS:

Occupational therapy; physical therapy; splinting, orthoses, compression, bracing, and/or taping; Joint protection techniques; activity pacing, activity modification, energy conservation, and/or fatigue management; Assistive devices, adaptive equipment, and/or environmental adaptations; Vocational rehabilitation, work site evaluations and/or modifications.

DIET.

Mediterranean-style diet was recommended.

ADDITIONAL INTERVENTIONS:

Standardized self management program; Cognitive behavioral therapy and/or mind body approaches; Acupuncture; Massage therapy; Thermal modalities.

You can view the Guideline Summary in pdf here 

FURTHER READING AND PERSONAL STORIES

If you are looking for further reading on these topics you may be interested in the following personal stories about some of these suggested interventions:

Aquatic Exercise: Starting hydrotherapy

Talk Over RA – Julia McNally and Yoga For RA

How 3 Women Stay Active with Rheumatoid Arthritis – Women’s Health

Activity pacing: Learning to Pace Myself

What do you actually eat on the Mediterranean diet? Mediterranean diet breakfasts. List of breakfast suggestions and a recipe.

Mediterranean diet simplified includes What a Day on the Mediterranean Diet might look like for both summer and winter.

Wellness for a Life with Rheumatic Disease

Actress Tatum O'Neal Opens Up About Living With Rheumatoid Arthritis

Actress Tatum O’Neal opening up about her struggle with rheumatoid arthritis - and the toll its taken on her body in an Instagram post. O'Neal, 56, shared a photo of her back, covered with surgery scars and bruises, to demonstrate what it's like to live with rheumatoid arthritis (RA).

Watch Have you heard about Rheumatoid Arthritis? 

Tatum is no stranger to adversity. A child of Hollywood, she has had “such a difficult life in some respects, although such a great life in others,” she says. After receiving an Oscar for the role of Addie, which she played alongside her father, actor Ryan O’Neal, she went on to star in Bad News Bears, Little Darlings and International Velvet. A young fan, like I was then, would have assumed she lived a happy, glamorous life. But in her 2004 book, A Paper Life, Tatum revealed a childhood of neglect and emotional and physical abuse and a family immersed in drugs and plagued with addiction. She, too, has struggled with addiction.

She described how her RA seemed to come on slowly and then all at once. She was already in what she describes as a “low state,” dealing with pain from several neck and back disc surgeries in recent years and unhappy knees – one kept ballooning, refusing to heal after meniscal repair surgery. But this was different. “The pain changed in nature and location. It was scary,” she says. She had difficulty walking, and thought, “Wow, something is so bad.”

Then one night it hit her hard. Her right hand swelled and ached “unbelievably.” A rheumatologist diagnosed RA, and an MRI revealed damage in her ankles. “That was a sad day,” she says.

Tatum began taking a biologic drug, giving herself shots in her stomach once a week, and methotrexate. Not long after, she was hospitalized with pneumonia three times in four months. Doctors were puzzled. Finally, a pulmonologist realized her lungs were reacting badly to methotrexate. “It’s been a tough road,” says Tatum, “very, very scary for my children and for all of us.”

READ THE FULL ARTICLE AT Arthritis Foundation

3 Millennials On Growing Up With Rheumatoid Arthritis

Rheumatoid Arthritis: 3 Millennials On Growing Up With Chronic Pain

"Be mindful of judging people when you can’t see anything going on."

By Natasha Hinde HUFFPOST

During his worst flare-ups, Daniel Morley lies in bed wondering if he should just go thirsty. He desperately wants a glass of water, but his body is in so much pain, he can’t bear to move the five metres to the sink. His joints are on fire.

Rheumatoid arthritis (RA), which Morley was diagnosed with at the age of 19, is a long-term condition that causes swelling and stiffness in the joints – usually the hands, feet and wrists. The immune system mistakenly attacks cells lining the joints, causing intense pain that makes it hard for some sufferers to leave the house.

He first noticed something was wrong as a teenager when his knees swelled up and his ankles started causing him pain. During this time he took almost nine months off work. Morley was eventually referred to a specialist consultant, who drained fluid from his joints and gave him steroid injections.

Debbie Griffin, 32, from north Wales, was diagnosed at just two years old. She recalls realising something wasn’t quite right when she was five. “I was making friends in school and noticed I couldn’t do the things everyone else could do, like sports day,” she says.

Griffin experienced problems with her hips and knees during her early teens, to the point where she struggled to move even a few feet without being in pain. At 13 she had to have a knee replacement, followed by a hip replacement at 17.

“It impacts my life daily,” says the 32-year-old. Some days, she will wake up without any issues; other days she will be in so much pain she can’t leave the house. “Making sure I’m fit for work every day is a struggle,” says the service manager, who works for a national charity.

Louisa Flannery, from Leeds, was diagnosed with RA in the run-up to her GCSEs. Initially, she experienced a pain in her feet, and was told to wear insoles, but when it began to continue up her body to her knees, she was referred to a specialist. She was diagnosed at 15, after a year and a half.

As a teenager, Flannery found it hard being heard by the adults around her. She recalls having to miss PE lessons because of the pain. “I didn’t know what was wrong with me, so it was difficult to communicate with the teachers – I think they thought I was just using it as an excuse,” she says. “The invisible part of it is quite difficult. People forget because they can’t see anything’s wrong with you.”

Now studying for a Masters degree, Flannery, 25, struggles with constant pain in her ankles and shoulders, as well as her back and knees from time to time. “My hands are swollen and a bit disfigured,” she says, noting that it’s quite hard to write. ”I usually do computer work which is fine.”

READ FULL ARTICLE AT HUFFPOST

What are the common symptoms of arthritis and other rheumatic diseases?

The following are the most common symptoms of arthritis and other rheumatic diseases.

But each person may have slightly different symptoms.

Also different types of rheumatic disease have different symptoms.

• Joint pain

• Swelling in a joint or joints

• Joint stiffness that lasts for at least 1 hour in the early morningChronic pain or tenderness in a joint or joints

• Warmth and redness in the joint area

• Limited movement in the affected joint or joints

• Tiredness (fatigue)

The symptoms of arthritis and other rheumatic diseases may look like other health conditions. Always see your healthcare provider for a diagnosis.

SOURCE: PIEDMONT HEALTHCARE IMAGES: BrownMed and Everyday Health

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What is Psoriatic arthritis PsA ?

What is Psoriatic arthritis PsA ?

Psoriatic arthritis, also called PsA, is an autoimmune condition that causes inflammation in the joints but can also affect other parts of the body. It can lead to permanent joint damage and other ongoing problems. 

Psoriatic arthritis is a form of arthritis that affects a percentage of people who have psoriasis.  Psoriasis is a skin disease that causes a red, scaly rash, on different areas including the hands and feet, elbows, knees and ankles.

The symptoms of painful and swollen joints in psoriatic arthritis are similar to those of rheumatoid arthritis. However, according to The Mayo Clinic, psoriatic arthritis is more likely to also cause:

• Swollen fingers and toes. Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. You may also develop swelling and deformities in your hands and feet before having significant joint symptoms.
• Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
• Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacroiliitis).

Diagnosis of Psoriatic arthritis

It isn’t easy to diagnose psoriatic arthritis because many symptoms are similar to other conditions. Your doctor will use the Classification of Psoriatic Arthritis (CASPAR) in which having at least 3 points is an indicator of psoriatic arthritis:

• Skin psoriasis
  • You have it now = 2 points
  • You had it = 1 point
  • You have a family history = 1 point
• Nail lesions (pitting, pulling away from the nail bed) = 1 point
• Dactylitis (swollen, sausage-like fingers or toes ) = 1 point
• Negative rheumatoid factor : You don’t test positive for this blood protein that signals rheumatoid arthritis = 1 point
• Juxta-articular (near a joint) bone formation that shows up on X-ray and isn’t bone spurs = 1 point

Treatments

Medical treatments for psoriatic arthritis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Disease-modifying antirheumatic drugs (DMARDs).
• Immunosuppressants.
• UV light. 
• Biologics. 
• Enzyme inhibitor. 
• Steroids.
• Surgery. 

The Arthritis Foundation has many helpful tips:

• Regular use of lotions or creams containing aloe vera, jojoba or zinc may help lubricate affected skin. 
• Taking short, warm (not hot) baths using oatmeal, bath oil, Dead Sea or Epsom salts may also soothe skin. 
• Wash clothes with fragrance-free detergent and fabric softeners to reduce risk of skin reactions.
• Heat improves blood circulation helping to reduce joint stiffness and muscle spasms.
• relaxing and managing stress.
• Cold helps reduce swelling by constricting blood vessels.
Eating anti-inflammatory foods: A healthy, balanced diet rich in fresh fruits and vegetables and low in sugar, fat and salt.

Research results will give rise to new drugs for rheumatoid arthritis.

Find out about this study from Karolinska Institutet in Sweden published in the scientific journal PNAS reports and how it affects RA (Rheumatoid Arthritis)

Endogenous proteins that play a vital part in allergies and parasitic infection can prevent the immune system from wrongly attacking the body and causing inflamed joints, a new study reports. 

The researchers hope that the results will give rise to new drugs for rheumatoid arthritis.


SUMMARY:

• Researchers at Karolinska Institutet discovered that certain proteins can play an important part in preventing autoimmune attacks. 
• These proteins are called IL-4 and IL-13 
• The proteins, are secreted by immune cells in the presence of allergens or parasitic infections.
• They influence the behaviour of a specific immune cell called a neutrophil. 
• Neutrophils are the most abundant immune cells found in the actively inflamed joints of patients with rheumatoid arthritis. 
• Proteins, IL-4 and IL-13, prevent neutrophils from migrating into the inflamed joint. 
• Researchers used the CRISPR method to modify immune-cell genes to understand how they affect cell behaviour.

"I have high hopes that the experimental use of CRISPR will be hugely important to our understanding of how immune-cell behaviour is regulated, and that this can guide us in the development of new efficacious drugs."  says Dr Wermeling assistant professor at the Department of Medicine, Karolinska Institutet (Solna).

READ THE FULL ARTICLE

SEE THE STUDY REPORT

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Turmeric For Rheumatoid Arthritis: Does It Work?

Some research suggests that turmeric may help alleviate the inflammatory symptoms of rheumatoid arthritis. The spice affords several benefits such as anti-inflammatory functions provided by its main component curcumin.

What Is Turmeric?

It is a spice that contains anti-inflammatory properties. Otherwise known as Curcuma longa, the bright yellow or orange spice is also the main component in traditional medicine such as Ayurveda. The latter treats skin diseases, stomach problems, blood disorders, cough, mild infections and liver conditions.

According to a review article published in the US National Library of Medicine, turmeric is rich in curcumin that has an antioxidant effect, lowers blood sugar, is anti-inflammatory and affords anticancer benefits. Since rheumatoid arthritis is an autoimmune disease that mistakenly attacks healthy joint tissue, patients experience inflammation that leads to bone and joint damage. The anti-inflammatory properties of turmeric could alleviate its symptoms.

Curcumin

In a 2016 systematic review, researchers measured the effectiveness of turmeric and curcumin extracts on arthritis patients. Those who took 1,000 milligrams of curcumin daily for eight to 12 weeks reduced their pain sensations and inflammation which are common symptoms of osteoarthritis.

Researchers found that curcumin extracts are effective in treating these symptoms by recommending patients to take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac. They, however, noted that there is a need for further research to confirm their findings. Nevertheless, they recommended that arthritis patients may use curcumin as a dietary supplement while undergoing conventional therapy.

A subsequent study looked into the effects of curcumin on rats with rheumatoid arthritis. Researchers determined that the component reduced inflammation and redness among the lab rats by blocking an intercellular signaling process called mTOR pathway.

Read full article by Leian Naduma at Medical Daily

Vagus nerve stimulation may reduce the symptoms of rheumatoid arthritis

Electrostimulation of the vagus nerve may be key to reducing the symptoms of rheumatoid arthritis, according to findings that scientists presented at the Annual European Congress of Rheumatology in Madrid, Spain.

This research gives hope that there may be a new way to help treat this autoimmune condition.

The vagus nerve, which is a very long nerve that runs between the brain and the neck, chest, and abdomen, is a complex structure.

Previous research has found an inflammatory reflex in the vagus nerve that reduces the production of cytokines, including certain molecules that are a component of autoimmune conditions. These molecules are called tumor necrosis factor (TNF).

The immune systems of healthy people block TNF, but in those with certain autoimmune conditions, excess TNF makes its way into the bloodstream and causes inflammation and a higher rate of symptoms associated with the conditions.

TNF is a target in many rheumatoid arthritis (RA) drugs, such as infliximab(Remicade) or etanercept (Enbrel). Many people call these drugs TNF-blockers.

The researchers thought that if they could boost this naturally occurring reflex in the vagus nerve, it might have a similar result — or one that was even better, as drugs that aim for TNF also suppress the immune system and have other unwelcome side effects.

"This is a really exciting development," says Prof. Thomas Dörner, Chairperson of the Scientific Programme Committee at the Annual European Congress of Rheumatology, which this year takes place in Madrid, Spain.

"For many [people living with] RA, current treatments don't work, or aren't tolerated. These results open the door to a novel approach to treating not only RA but other chronic inflammatory diseases. This is certainly an area for further study," adds Prof. Dörner.

Small neurostimulator led to big findings

The researchers implanted a small neurostimulator, called a MicrioRegulator, into 14 people with RA. To qualify for the study, each person had tried at least two medications that worked in different ways but that hadn't helped reduce their symptoms.

The scientists then divided the participants into three groups: a placebo group, a group that had vagus stimulation once per day, and a group that had vagus stimulation four times per day.

The study, which took place over 12 weeks, revealed that those in the once-per-day group had a much better result, symptom-wise, than those in the other two groups — including those that had stimulation four times each day.

Both stimulation groups also had a distinct reduction of more than 30% in their cytokine levels during the course of the study.

What does the future hold?

Although surgically implanting small neurostimulators into every person with RA is probably not feasible, reasonable, or required, this study does shine a light on potential therapy that can help those who do not respond well to traditional medications for the condition.

The findings of this research will also pave the way for future studies.

"Our pilot study suggests this novel MicroRegulator device is well tolerated and reduces signs and symptoms of [RA]," says Dr. Mark Genovese, the James W. Raitt Endowed Professor of Medicine at Stanford University in California.

Read the full article by Monica Beyer at MEDICAL NEWS TODAY

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.

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.

READ FULL ARTICLE

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.

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

WHO:  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.”

MY QUESTIONS and OPINION:

• 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

ARTICLE:

Study Finds Bacteria in Milk Linked to Rheumatoid Arthritis