Around 1.3 million Americans live with rheumatoid arthritis. This inflammatory condition not only affects the joints, causing pain, swelling and reduced mobility, but can also involve organs such as the heart and lungs. As inflammation occurs throughout the body, many people with this form of arthritis develop problems such as tiredness, anemia, flu-like symptoms and loss of appetite.

Rheumatoid arthritis is an autoimmune condition, which occurs when the immune system starts to attack the body’s own tissues. The exact cause of the condition is unknown, but possessing certain genes is thought to make you more susceptible and smoking, stress, hormones and previous infections all appear to be triggers. While the condition can be very disabling, once diagnosed through a combination of a physical exam, blood tests and an x-ray of your affected joints, commencing treatment can help to slow progression of the disease and allow you to resume a more normal life.

The aims of treatment for someone with rheumatoid arthritis are to reduce the pain and inflammation experienced, minimize joint damage and to improve your functional ability and feelings of well-being. Lifestyle measures and medications are the main forms of treatment available, though in more extreme cases of joint damage, surgery is also an option. Here we look at what you can do to help yourself beyond taking prescribed therapies to improve your symptoms and stay in good health.

An explosion of scientific interest has occurred in a glucoside extract from the white peony root for its ability to treat autoimmune diseases by bringing a dysfunctional, over-excited immune system back into balance. In China, peony glucosides are an approved drug for treatment of rheumatoid arthritis, the most common autoimmune arthritis.^1,7

In laboratory experiments, animals with rheumatoid arthritis develop increased numbers of inflammatory cells.

These cells then produce high levels of inflammatory cytokines resulting in destructive inflammation of the delicate tissues lining the joints. The end result is destruction of the joint.

Supplementation with peony glucosides appears to reduce the population of inflammation-provoking cells while increasing the inflammation-suppressing ones.⁴ The result is that inflammatory cytokine levels fall while the over-active immune response in the joints begins to reverse; animal studies show that this biochemical reversal of inflammation is accompanied by reversal in joint damage and pain.^2,3,5,6,7,8

Treatment with peony glucosides produces a significant reduction in both arthritis severity and joint damage.^4,6,9,10 Studies in animals with experimentally-induced arthritis, for example, demonstrate a reduction in clinical manifestations of arthritis after treatment with peony glucosides.^9,10 Arthritis scores, numerical summaries of joint swelling, range of movement, and other parameters are lower in supplemented animals than in controls.^4,10 Finally, autopsy results of these experimental animals reveal significant reductions in visible joint damage of the kind that produces pain and immobility in human sufferers.⁶

As an added benefit in preventing the further destruction caused by arthritis, peony glucosides reduce the excessive new blood vessel growth (angiogenesis) that contributes to excessive tissue growth within the joint.¹¹ When excess tissue builds up inside a joint, victims experience decreased range of motion, stiffness, and often pain with movement, as they try to force the joint to overcome the obstruction created by bulky tissue.

Human studies with peony glucosides have focused on its use in conjunction with mainstream therapies. One early study found that adding peony glucosides to a standard drug, methotrexate, originally used for chemotherapy, resulted in a faster onset of action, and lowered serum measures of inflammation significantly more than with the drug alone.¹²

Additional studies demonstrated that more people (97.5%) experienced at least some relief when treated with both peony glucosides and a standard immunomodulatory drug, leflunomide, compared with those treated with the drug alone ( 85%).¹³

Levels of inflammation fell faster when peony glucosides were included in medication regimens, and the onset of protective action was faster.^12-14 Peony glucosides also reduce the liver toxicity of the commonly-used combination of methotrexate and leflunomide with improvements in clinical disease scores.¹⁵

"Reprinted with permission of Life Extension®"

While it is important not to exert yourself too much when you experience a flare up of rheumatoid arthritis, when the disease is less of a problem, taking regular exercise is important. Rest provides relief from pain, inflammation and fatigue and while the amount of rest needed is very individual, it is generally considered that taking a little and often approach to this is more beneficial than spending long periods of time in bed. When able to do so, exercise serves a number of useful purposes. Firstly it not only helps to build bigger arms and leg muscles, but these are stronger, helping to maintain mobility and flexibility of your joints.

Exercise also provides the additional benefits that it aids sleep which can often be disturbed in rheumatoid arthritis, helps with pain relief, aids weight loss if carrying excess weight and can promote a brighter outlook due to its potential to boost your mood. Daily stretching exercises are recommended, as are resistance exercises that can be done with or without weights.

Aerobic exercise such as walking, swimming and cycling are also good forms of activity as they are low impact so reduce the strain placed on the joints; these have the additional advantage that they help to improve the fitness of your heart and lungs. Avoid those forms of activity that place too much impact on your joints such as jogging on hard surfaces and lifting heavy weights; receive advice on what weight it is safe for you to lift.

Although you may read that you should avoid particular foods if you have rheumatoid arthritis, there is not sufficient evidence to encourage such dietary restrictions and you may risk nutritional deficiencies if you do so; if you genuinely think particular foods are triggering flare ups, ask to see a dietician. Instead, follow a balanced diet including all food groups – carbohydrates, protein, dairy foods, fruit and vegetables.

The only area to be cautious of is including oils rich in omega-6 fatty acids, as these are known to worsen inflammation. This means you are best avoiding sunflower, corn and soya oil and instead opting for canola or olive oil. Omega-3 fatty acids are known to have anti-inflammatory properties, so aim to include oily fish such as salmon or mackerel once or twice a week; if you don’t like these fish or prefer not to eat them, supplements containing omega-3 are available.

If you suffer from poor appetite, the best approach is to eat small regular meals and snacks, choosing those that are energy dense; now isn’t the time to opt for those low in fat and sugar, as you need the extra calories to maintain your weight. Although snacks such as cake, cookies and chips are okay occasionally, choose more nutritious options such as a small sandwich, cheese and crackers, a pot of full fat yogurt or a milky drink made with whole milk. If anemia is a problem, up your intake of iron rich foods such as red meat, fortified breakfast cereals, pulses and green leafy vegetables, as well as avoiding tea and coffee near mealtimes; including vitamin C rich foods and drinks though can aid iron absorption at meals.

While these steps are no substitute for the medications you have been prescribed, when used in conjunction you are likely to see greater benefits.

References:

1. Wang YN, Zhang Y, Wang Y, et al. The beneficial effect of Total Glucosides of Paeony on psoriatic arthritis links to circulating Tregs and Th1 cell function. Phytother Res. 2013 Apr 23.

2. Chang Y, Wei W, Zhang L, Xu HM. Effects and mechanisms of total glucosides of paeony on synoviocytes activities in rat collagen-induced arthritis. J Ethnopharmacol. 2009 Jan 12;121(1):43-8

3. Chang Y, Zhang L, Wang C, Jia XY, Wei W. Paeoniflorin inhibits function of synoviocytes pretreated by rIL-1alpha and regulates EP4 receptor expression. J Ethnopharmacol. 2011 Oct 11;137(3):1275-82.

4. Wu H, Wei W, Song L, Zhang L, Chen Y, Hu X. Paeoniflorin induced immune tolerance of mesenteric lymph node lymphocytes via enhancing beta 2-adrenergic receptor desensitization in rats with adjuvant arthritis. Int Immunopharmacol. 2007 May;7(5):662-73.

5. Chen JY, Wu HX, Chen Y, et al. Paeoniflorin inhibits proliferation of fibroblast-like synoviocytes through suppressing G-protein-coupled receptor kinase 2. Planta medica. May 2012;78(7):665-71.

6. Zhang W, Dai SM. Mechanisms involved in the therapeutic effects of Paeonia lactiflora Pallas in rheumatoid arthritis. International immunopharmacology. Sep 2012;14(1):27-31

7. hu L, Wei W, Zheng YQ. Effect and mechanism of action of total glucosides of paeony on synoviocytes from rats with collagen-induced arthritis. Yao Xue Xue Bao. 2006 Feb;41(2):166-70.

8. Lin J, Xiao L, Ouyang G, et al. Total glucosides of paeony inhibits Th1/Th17 cells via decreasing dendritic cells activation in rheumatoid arthritis. Cell Immunol. 2012 Dec;280(2):156-63

9. Xu HM, Wei W, Jia XY, Chang Y, Zhang L. Effects and mechanisms of total glucosides of paeony on adjuvant arthritis in rats.J Ethnopharmacol. 2007 Feb 12;109(3):442-8.

10. Wang QT, Zhang LL, Wu HX, Wei W. The expression change of beta-arrestins in fibroblast-like synoviocytes from rats with collagen-induced arthritis and the effect of total glucosides of paeony.J Ethnopharmacol. 2011 Jan 27;133(2):511-6.

11. Deng H, Yan C, Xiao T, Yuan D, Xu J. Total glucosides of Paeonia lactiflora Pall inhibit vascular endothelial growth factor-induced angiogenesis. J Ethnopharmacol. 2010 Feb 17;127(3):781-5.

12. Du JH, Dong BD. Comparative study on clinical efficacy of using methotrexate singly or combined with total glucosides of Paeony in treating rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Jun;25(6):540-2.

13. Zhao YX, Liu Y. Clinical observation on effects of leflunomid and total glucosides of paeony on rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2006 Apr;26(4):355-7.

14. Wang Y, Xing HY. Clinical observation on effect of total glucosides of paeony combined with methotrexate on rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007 Sep;27(9):839-40.

15. Chen Z, Li XP, Li ZJ, Xu L, Li XM. Reduced hepatotoxicity by total glucosides of paeony in combination treatment with leflunomide and methotrexate for patients with active rheumatoid arthritis. Int Immunopharmacol. 2013 Mar;15(3):474-7.