Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that causes joint inflammation and pain. RA commonly affects the hands, knees, ankles and usually the same joint on both sides of the body. In some people, RA can affect other parts of the body as well such as skin, eyes, lungs, heart and circulatory system.
Unlike the wear-and-tear damage (degeneration) of osteoarthritis, RA is an autoimmune disease. The immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. The immune system considers the body’s own cells, particularly those in the synovium, as foreign invaders, leading to chronic inflammation. Synovium is the tissue lining around a joint that produces fluid to help the joint move smoothly. The chronic inflammation results in red, warm, tender and painful swollen joints that can eventually cause bone erosion and joint deformity. In addition to the joints, RA can affect other organs in the body.
Rheumatoid factor (RF) is an antibody that is often present in the blood of individuals with rheumatoid arthritis. Its presence is one of the diagnostic markers for RA, but not everyone with RA has detectable levels of RF, and some people without RA may have elevated RF levels.
The exact cause of RA remains unclear, but researchers believe that a combination of genetic and environmental factors plays a role in its development. It is thought that individuals with specific genetic predispositions may be more susceptible to RA, and certain environmental triggers can activate these genes. These triggers may include viral or bacterial infections, physical or emotional stress, or other external factors (for e.g. being constantly in a cold or humid environment).
The reasons behind a higher prevalence of RA in women compared to men remain unclear, and the condition typically manifests during middle age (25-50 years old). The likelihood of developing RA is higher for individuals with a family history of the condition.
Early stage of RA
Often affect smaller joints (wrists , certain joints (particularly the 2nd and 4th finger) in the hand and feet ) first
Muscle aches or joint pain worsens during humid or rainy days
Affect other bigger joints like wrist, elbows, shoulders, hips, ankle and knee
Joint pain and deformity affecting daily activities
About 40% of people also experience symptoms that do not involve the joints.
The inflammation associated with RA can damage other parts of the body as well such as:
Eyes: Dry eyes, redness or sensitivity to light
Mouth: Dryness and chronic gum inflammation
Skin: Rheumatoid nodules near joints (formed due to the accumulation of inflammatory cells and fibrous tissue)
Lungs: Chronic inflammation and scarring can lead to progressive shortness of breath
How TCM views Rheumatoid arthritis
RA belongs to the category of “ 痹症，Bi Zheng” in Traditional Chinese medicine (TCM).
TCM believes that the pathogenesis of RA is related to external causes and internal causes.
External cause: Wind, cold, heat and dampness pathogen
Internal cause: Deficiency of qi, blood, spleen, liver and kidney
RA etiology in TCM perspective
Experiencing chronic over-exhaustion or having a weaker body constitution may make one more susceptible to the invasion of wind, cold, or dampness pathogens targeting the joints. Extended inflammation leads to the buildup of heat and dampness within the joints.
In the TCM framework, chronic inflammation has the potential to harm the liver, spleen, and kidneys over time. This persistent inflammatory state can lead to either blood stasis or heat dampness, eventually giving rise to symptoms like swollen and deformed joints, the formation of rheumatoid nodules, or discoloration of skin.
TCM approach to treating RA
TCM employs a holistic approach to health and often utilizes a combination of therapies to treat RA. RA are generally categorized into three stages based on factors such as the duration of the condition, the type of pathogen involved, and the individual’s body constitution. Herbal medication, acupuncture and dietary restrictions are common methods to treat and manage RA.
1.Initial stage (早期：Wind and cold dampness Type 风寒湿型)
Shorter duration 病程短
Generally weaker body constitution 多体虚
Morning stiffness and joint pain , especially during cold, humid or rainy environment or emotional triggers 晨僵，痛处受寒或气候潮湿或情绪波动时加重
No redness or warm joints 患处不发热发红
Aversion to cold or heat 恶寒发热
Floating and tight pulse 脉浮紧或沉弦带紧
Herbal prescription commonly used: 麻黄加白术汤加减 （麻黄， 桂枝，炒白芍，炙甘草，炒白术，姜黄，鸡血藤，忍冬藤等。)
Common acupuncture points used
2. Middle stage (中期： 久病化热伤阴型）
Pain in the hand and feet joints 四肢关节肿痛，僵硬
Morning stiffness worsens with inactivity 晨僵，屈伸不利
Other accompanying symptoms: Dry throat, heart palpitations, dizziness 咽干，心悸，眩晕
Tight, thin and fast pulse 脉弦细数
Herbal prescription commonly used: 桂枝芍药知母汤加减 （桂枝，白芍，炙甘草，知母，生石膏，白术，防风，生地，炮附子，石斛，姜黄，秦艽等。）
Common acupuncture points used
3. Late stage (晚期： 肝肾气血亏虚，痰瘀痹阻型)
Chronic pain: persistent and intense joint pain 慢性疼痛，关节刺痛或僵直
Limited mobility 关节活动不利
Joint deformities: swelling, stiffness and changes in joint structure maybe more pronounced 关节变形
Rheumatoid nodules can be seen 可见类风湿结节
Decreased quality of life. Daily activities, social interactions, and mental well-being may be compromised. 生活素质变差。
Herbal prescription commonly used: 独活寄生汤合虎潜丸加减 （独活 桑寄生 秦艽 防风 黄芪 当归 生地黄 熟地黄 黄柏 知母 白薇 炒白芍 石斛 姜黄 淫羊藿 桂枝等。）
Common acupuncture points used
Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on the body to stimulate energy flow and promote healing. Here are some potential ways acupuncture might help individuals with RA:
Pain Relief: Acupuncture may help alleviate pain associated with rheumatoid arthritis. The insertion of needles at specific acupuncture points is thought to stimulate the release of endorphins, the body’s natural painkillers, which may contribute to pain relief.
Inflammation Reduction: Some studies suggest that acupuncture may have anti-inflammatory effects. By modulating the immune system and reducing inflammation, acupuncture might contribute to the management of RA symptoms.
Improved Joint Function: Acupuncture may help improve joint function and mobility in individuals with RA. By promoting better circulation and reducing muscle tension, acupuncture might have positive effects on the range of motion in affected joints.
Reduce consumption of
Sugary Foods, Cold Drinks, and Beer
Excessive sugar consumption is associated with inflammation, and some people may experience allergic reactions or increased joint pain as a result.
Raw and Cold Foods
In TCM, foods that are considered “cold” and “damp” are thought to obstruct the flow of yang energy, potentially leading to discomfort or achy joints.
Peanuts, chocolate, millet, yogurt, glutinous or dairy products
These certain foods possible due to their amino acid content (tyrosine, phenylalanine or tryptophan), may contribute to production of inflammatory factors such as prostaglandins, leukotrienoic acid or IgE antibodies, potentially worsening joint inflammation or causing pain relapse
Too much sour food such as sour plum, vinegar or lemon.
Sour foods are generally considered to have a contracting and cooling nature and may worsen joint pain.
One is encouraged to consume more Chinese barley (reduce dampness), black beans, green beans, yellow beans, soy products, chestnut or sesame, Chinese yam, carrot, blueberry or turmeric powders (antioxidant properties).
Early diagnosis and treatment in the earlier stages of RA can help prevent or slow down the progression to late-stage complications. Regular medical monitoring and adjustments to treatment plans are crucial in managing the disease effectively. Individuals with late-stage RA may benefit from working closely with a rheumatologist， TCM physicians and other healthcare professionals to optimize their care and improve their quality of life.
Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.
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^Treatments are done by certain physicians only