Arthritis is a well-known condition that causes extreme, debilitating, life-altering pain. According to the Arthritis Foundation, arthritis impacts over 50 million Americans, making it the number one cause of disability in the country.1 That means 1 in every 5 adults, 300,000 children, and countless families deal with the ramifications of this painful condition every day. The Centers for Disease Control report that more than 43% of adults with arthritis have work or leisure related activity limitations due to pain.2 Arthritis is really an umbrella term for more than 100 different conditions.3 While all types exhibit the same general symptoms of pain and joint inflammation, each has a unique etiology, some better understood than others. The most common forms of arthritic conditions include osteoarthritis (OA) and inflammatory arthritis types including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and gout.

Osteoarthritis

The concept of the pathophysiology of OA is still evolving, from being viewed as a cartilage-limited to a multi-factorial disease that affects the whole joint.4 Traditionally considered “wear and tear damage” to the joint cartilage, OA is a degenerative joint disease caused by breakdown of the physiological pathways that affect the cartilage and other joint structures. The physiological events that occur in OA result in progressive joint degeneration including destruction of cartilage, joint space narrowing, cysts, spinal disc and facet joint changes, and changes to synovium, joint capsules, ligaments, muscles, meniscus, fat pads, and the layer of bone beneath the cartilage.5  Symptoms of osteoarthritis can include joint pain, loss of mobility, and deformation.6 Currently, only symptom modifying drugs are licensed by the FDA for use. These are largely pain reducing therapies that are limited in efficacy and can have life-threatening side effects as well as significant toxicity.5

Inflammatory Arthritis

Inflammatory arthritis is a category of arthritis, containing diseases characterized by inflammation of the joints and other tissues.6 Most conditions classified as inflammatory arthritis are also autoimmune conditions. In autoimmune diseases, the immune system, which is supposed to protect the body, begins attacking the body instead. Symptoms of inflammatory arthritis can include pain, swelling, warmth and tenderness in affected joints, as well as morning stiffness that lasts over an hour.7 Inflammatory forms of arthritis are systemic and impact the entire body. Because of this, inflammation related symptoms might appear, including skin rashes, development of lumps or nodes under the skin, eye inflammation, hair loss, dry mouth, and fever.6 The prevailing current theory supposes exposure of a genetically prone person to an environmental trigger as the most likely mechanism for initiation of inflammatory arthritis.7

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis.7 It affects more than 1.3 million Americans, about 75% of whom are women.8 RA is characterized by persistent synovitis (inflammation of the joint lining), systemic inflammation, and auto-antibodies (particularly to rheumatoid factor and citrullinated peptide).9  The small joints in the hands and feet are most commonly affected, and sometimes RA can even impact organs, such as the eyes, skin or lungs. Over time, persistent inflammation can break down the joint and lead to permanent joint deformity and damage.

Psoriatic Arthritis

Psoriatic arthritis is a type of autoimmune inflammatory arthritis that occurs in some patients with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.10 Psoriatic arthritis is most often seen in the larger joints. It is especially prominent in the joints of the lower extremities, as well as the distal joints of the fingers and toes, and also can affect the back and sacroiliac joints of the pelvis.

Gout

Gout is a form of non-autoimmune inflammatory arthritis that impacts over 8 million American adults and is the most common inflammatory joint disease in men.11 The incidence of gout has more than doubled over the recent 20 years, likely tied to dietary changes and the increased prevalence of obesity.12 Fortunately, it does not result in the system-wide inflammation seen in RA or psoriatic arthritis.3 In gout, the joint inflammation is the result of elevated levels of uric acid in the blood stream (hyperuricemia) leading to the deposition of uric acid crystals inside the joints. The chances of developing gout are increased with a rich diet (red meat and wine are common culprits leading to the increase of uric acid). The outcome is extremely painful joint inflammation. The most common site for gout is the large joint at the base of the big toe, but it can also affect other joints as well.

Naturopathic management and treatment

Although the various forms of arthritis cause pain in different ways, the basics of naturopathic management and treatment options are quite similar across all types.

Diet

Of the non-pharmacological treatment approaches, dietary interventions are among the most common. In recent years, the role of dietary antioxidants in arthritis management is increasingly being addressed by researchers in reported studies. Although the underlying cause of arthritis is largely unknown, a number of nutrient and non-nutrient components of food have been shown to affect the inflammatory process and, in particular, to influence clinical disease progression.13 Emerging research demonstrates a protective role of fruits and their polyphenols in pre-clinical, clinical and epidemiological studies of multiple forms of arthritis.14 Berries and berry extracts have shown protective qualities with regard to joint structures and overall inflammation levels.14,15 There is also some evidence on the role of specific fruit polyphenols, such as quercetin and citrus flavonoids in alleviating arthritis symptoms.14

Movement as medicine

Exercise is recommended as a first-line conservative intervention approach for arthritis, particularly osteoarthritis and strong evidence supports that aerobic and strengthening exercise programs are beneficial for improving pain and physical function in adults with mild to moderate OA.15 Arthritis can be a barrier to physical activity with studies reporting that 43.5% of adults with arthritis reporting arthritis associated activity limitations.16 However, movement may also be preventive in the development of arthritis. Research has found that when adjusted for age, the prevalence of arthritis among adults reporting no leisure time physical activity is significantly higher at 23.6% than the prevalence of arthritis among adults who report meeting basic physical activity recommendations at 18.1%.16

Acupuncture

The philosophy behind Traditional Chinese Medicine and acupuncture involves the belief that energetic forces circulate in the body on pathways known as “meridians.” When the free-flowing circulation of the energy in the meridian is blocked or hampered, disease and dysfunction occur. Acupuncture, which involves the stimulation of an individualized aggregate of acupoints found along the meridians, is a means by which energy circulation is restored and health and balance are restored. Acupuncture has been reported as an effective treatment for many chronic pain conditions, including arthritis.17 The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life in those with arthritis.17

Supplements and Herbs

There are a number of supplements and herbs that have been studied for their benefits on various factors involved with arthritis. Some focus on inflammation, others on supporting cartilage regeneration, and others on factors such as immune balancing. Among the most common supplements utilized for joint pain are glucosamine and chondroitin. This duo has been evaluated in several trials, both as separate supplements and in combination. Studies of glucosamine alone have found it to be equivalent or superior when compared directly to ibuprofen.18 Chondroitin has consistently been found to be superior to placebo.18 Trials examining the two together revealed moderate to large benefits that were relatively consistent for both pain and functional outcomes.19

Omega 3 fatty acids are well known for their inflammation modulating activity and studies using experimental models have shown benefit in a variety of inflammatory conditions.20 With regards specifically to arthritis, research has found omega-3 fatty acids to be superior to placebo in improving outcome measures and decreasing the long-term requirements for non-steroidal anti-inflammatory drugs.21 Omega 3 fatty acids have also been shown to have a therapeutic role in decreasing pain in arthritic patients, particularly those with rheumatoid arthritis.22 Other fatty acids like gamma linolenic acid (GLA) have also been studied. GLA-Rich oils have been shown to have anti-angiogenic, anti-inflammatory, and anti-oxidant activities.23 A meta-analysis of studies investigating the impact of GLA-rich oil found that taking GLA resulted in a near 33% decrease in pain intensity and a 15% improvement in disability.24

Herbal supplements have also shown benefit for those with arthritis. Studies of the impact of the herb Boswellia serrata on osteoarthritis, indicated that a 90-day treatment with 100 mg of enriched Boswellia serrata extract improved symptoms such as pain and physical function compared to placebo.25 Studies have also demonstrated that the herbal extract curcumin has both defensive and therapeutic effects on the occurrence and development of RA.26 A curcumin extract was evaluated for its impact on inflammation and synovial hyperplasia in rheumatoid arthritis in an experimental model. Researchers found that curcumin inhibited the RA induced infiltration of inflammatory cells into the synovium as well as synovial hyperplasia.26 Further, the study found that curcumin reduced the levels of pro-inflammatory markers in both the serum and synovium.26 Green tea and green tea polyphenols have also been investigated for their benefits in those with arthritis. Green tea impacts inflammation via multiple pathways. Consuming green tea polyphenols prevented both the onset and progression of arthritis.27

Of course, because naturopathic medical protocols always seek to find and remove the cause, there will be individual variances in treatment based not only on the specific condition and its cause but more importantly, on the individual patient as well. These might include therapies like hydrotherapy, homeopathy, orthopedic regenerative injection therapy with stem cells or platelet-rich plasma (PRP) in patients with OA, immune balancing therapies in cases of inflammatory arthritis like RA or psoriatic arthritis, or very specific dietary considerations in those who experience gouty arthritis.

Naturopathic doctors share patient success stories

Naturopathic medicine has a large and deep toolbox to draw upon to help those suffering with any form of arthritis. Click here to find an ND near you in the US and Canada.