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 Herbal Medicine: Arthritis - (Rheumatoid Arthritis) 
 
A chronic syndrome characterized by nonspecific, usually symmetric inflammation of the peripheral joints, potentially resulting in progressive destruction of articular and periarticular structures; generalized manifestations may also be present.

Rheumatoid arthritis (RA) is a chronic inflammatory condition that involves not only the joints but other connective tissue as well. The majority of the more than five million cases seen in the U.S. have appeared in persons between the ages of 20 and 70 years. Three times as many women as men are affected. Some individuals are more susceptible than others: a familial pattern is commonly observed, and RA is often associated with a special tissue-typing gene.

A disorder of the body's immune system is suspected. An important laboratory findings is the presence of rheumatoid factor (RF), a special antibody active against the normal antibodies present in the bloodstream. Why RF develops is unknown, but current theories center point toward an exaggerated immune response to long-term stimulation by infectious agents or `foreign substances'. Rheumatoid factor itself is not directly responsible for the inflammatory process; it acts solely as a marker for the disease.

The joint destruction that occurs with severe RA results from inflammation of the synovia, the thin, smooth membrane or capsule lining the joints. As part of the immune response to the unknown stimulus, white blood cells and antibodies infiltrate the synovial membranes causing them to proliferate and fold over on themselves. Persistent or recurrent inflammation causes permanent damage to the joint cartilage, bones, ligaments and tendons. The widespread inflammatory process also involves other tissue such as blood vessels, skin, nerves, muscles, heart, and lungs. The result is painful joints, loss of mobility, and generalized soreness and depression.

The various signs and symptoms of RA include:
  • Joint pain, aching and stiffness come on gradually.
  • This is followed in a few weeks by joint swelling, redness and warmth.
  • The hands, wrists, shoulders, elbows, feet, ankles and knees are usually involved on both sides of the body, but inflammation of a single joint may be the initial presentation.
  • Symptoms tend to be worst in the morning, diminishing with activities of the day
  • Small firm lumps beneath the skin (rheumatoid nodules) appear in some patients, especially around the elbow.
  • There is often distressing fatigue in the early afternoon; and difficulty in sleeping.
  • RA can affect other organs. Vasculitis, inflammation of the blood vessels, may cause skin rashes, ulcers and gangrene. Other manifestations include scarring of the lungs, inflammation of the membranes surrounding the heart and lungs (pericarditis, pleurisy), nerve damage, dry eyes and mouth (Sjögrens syndrome) and enlargement of the spleen and lymph nodes.

In about 5-10 % of patients, the arthritis is mild or limited to one or two episodes. Another 25 % will have an erratic pattern of prolonged remissions and periods of relapse. In the majority, however, the clinical course is progressive with intermittent flare-ups. Most patients continue to function despite some pain and discomfort, about ten percent of RA patients will progress to severe permanent joint deformities, limitation of movement and disability.

Actions indicated for the processes behind this disease:
Immune support
is essential for any fundamental change in this problem. However, no specific connection can be made between, say, Astragalus and R.A.. It must be a whole immune support program.

Anti-Rheumatics as with O.A., they will help but their selection must be based upon some rationale that relates them to the unique individual involved.

Anti-Inflammatories are very important as much of the symptom picture is the direct result of the inflammatory process. The saponin containing anti-inflammatories come into their own here. However the salicylate herbs are still helpful. They probably complement each other well.

Alteratives play a pivotal role in any immune system work.

Anti-Spasmodic remedies will ease any associated muscular tension.

Circulatory Stimulants are not as crucial in R.A. as in O.A., but still must be considered. This difference reflects the role of the blood in both conditions.

Rubefacients are not as relevant as for O.A.

Analgesic will ease both the pain and the stress response to this pain.

Diuretics will help as in O.A..

Nervines are especially relevant considering the acknowledged `psycho-somatic' nature of this problem. The relaxants will also help as anti-spasmodics, the tonics will help the person deal with the constant stress of the pain and discomfort. Hypnotics will help them sleep in the face of pain. Tonics and anti-depressants will support the work of coping with this extremely tiring & debilitating condition.

Other actions such as bitters, hepatics or in fact anything else may be appropriate.

System Support
Potential every system and organ of the body will need tonic support in this auto-immune condition that effects connective tissue so badly. The two primary foci for support are the musculo/skeletal and immune systems. In addition, emphasis should be placed upon nervine tonics. If the digestive system has problems, tone it as well as dealing with any symptoms.

Specific Remedies
There are no specific remedies for rheumatoid arthritis. This is only to be expected when the multi-factorial nature of such immunological conditions is taken into account. Of especial relevance are the alterative based anti-rheumatics, the key being the `alterativeness'. This includes Menyanthes trifoliata, Harpagophytum procumbens, Smilax spp. and Arctium lappa. Guaiacum officinale and Dioscorea villosa are especially useful as anti-inflammatories. Tanacetum chrysanthemum can be very helpful in some people. Beyond this it is largely a reflection of the diagnostic skills of the practitioner combined with the patients observance of dietary, life-style and dosage regime.

One possible prescription:
Menyanthes trifoliata 2 parts
Filipendula ulmaria ---------- 11/2 parts
Dioscorea villosa ---------- 11/2 parts
Guaiacum officinale ---------- 1 part
Valeriana officinalis ---------- 1 part
Cimicifuga racemosa ---------- 1 part
Apium graveolens ---------- 1 part
Angelica archangelica ---------- 1 part
Achillea millefolium ---------- 1 part
Hypericum perforatum ---------- 1 part as tincture to 5ml. t.i.d.

for sleep and pain relief:

Valeriana officinalis
Piscidia erythrina
Passiflora incarnata equal
parts as tincture to 5-15ml 1/2 before retiring.

The digestive system must be working well so treat any stomach irritation as a priority. This combination does not take such problems into account. As with O.A., if there is any epigastric tenderness due to the harshness of the Menyanthes or Guaiacum, add Althaea. In this combination we are combining anti-rheumatics that provide a range of relevant actions:
  • alterative remedies: Menyanthes, Guaiacum & Cimicifuga
  • salicylate anti-inflammatories: Filipendula
  • saponin containing anti-inflammatory : Guaiacum
  • general anti-inflammatories: Angelica, Menyanthes, Guaiacum & Cimicifuga
  • nervine anti-spasmodics: Valeriana, Cimicifuga & Apium
  • nervine tonic & anti-depressive: Hypericum perforatum
  • diuretics: Apium & Achillea
  • `stomachics', in this case carminative and intestinal anti-inflammatory: Angelica, Valeriana and Apium
  • bitter tonics: Menyanthes & Achillea

Remember that this must all be done in the context of a general immune support program. Please refer to that section.

Broader Context of Treatment
The general suggestions given above for O.A. are equally pertinent here. In addition it is worth considering some variety of counseling. If, for the patients' reasons, it is not appropriate for them to embark upon depth counseling, then aid in initiating some relevant stress management program is essential.

Systemic Lupus Erythematosus
An inflammatory connective tissue disorder of unknown etiology occurring predominantly in young women, but also in children.

Systemic lupus erythematosus (SLE or lupus) is about 1/10 as common as rheumatoid arthritis. It has an even stronger predilection for women, especially those in the child-bearing ages. It is characterized by inflammation of blood vessels and potential involvement of several tissues and organs, particularly the skin, joints, kidneys, lungs, heart, nervous system, and blood cells. Some patients are acutely affected with a febrile disease that is life threatening because of renal disease, nervous system disease, or accompanying infections. Most have a more indolent disease that produces moderate disability from nondeforming arthritis, skin eruptions, and fatigue.

As in rheumatoid arthritis, the body seems to react against itself rather than against an invading microorganism, that is it is an autoimmune conditions. The characteristic laboratory finding is the presence of antibody to DNA and other substances within the nuclei of individual cells. Anti-self antibodies react with intact blood cells, nuclear components, and blood-vessel walls. In addition to these anti-nuclear antibodies, there may be antibodies to blood cells and various proteins present in the circulation. The complexes that form in the patient's blood precipitate in basement membranes of skin, kidneys, and nervous system and thus cause inflammation. Although the antibodies do not damage intact cells or their nuclei directly, they may set off inflammation in response to reaction with small amounts of circulating antigens.

Common signs and symptoms include:
  • Joint pains, swelling and tenderness are the most common early findings, occurring in over nine out of ten patients. This is not usually deforming, but it can be severe and debilitating.
  • Skin rashes appear in the majority of patients. The classic manifestation is a pink, butterfly-shaped eruption over the nose and cheeks that is aggravated by sun exposure. A similar rash, bruising, hives, blisters or ulcers may be present in other areas.
  • Kidney disease (glomerulonephritis) affects about one-half of cases and accounts for a major part of the mortality associated with SLE.
  • Involvement of the heart and lungs can lead to pericarditis and pleurisy. Fluid collections at the bottom of the lungs and around the heart may be associated with chest pains and trouble breathing.
  • When the CNS are affected, a variety of neurologic events may ensue: headache, convulsions, confusion, mental deterioration, mood swings, nerve palsies, stroke, etc.
  • Other symptoms are fever, swollen lymph glands, fatigue, weight loss, diminished appetite and recurrent infections.

Individuals vary greatly in the number and severity of their symptoms. While some have only mild symptoms which remit spontaneously, others run a progressive downhill course with involvement of many organs. Flare-ups may be noted during the later stages of pregnancy and after delivery. A pattern of remission and relapse is most common, with nervous system involvement and kidney failure tending to be the most debilitating consequences of the disease.

Treatment of this condition is problematic, not only because of its auto-immune basis but also due to the characteristic pattern of flare up and remission. The case study that follows, written by Meryl Baskervill (a graduate of Therapeutic Herbalism), is a graphic example of the therapeutic possibilities offered by Phytotherapy. As the symptom pictured changed, the prescription was modified to address these changes. This flexibility allowed the practitioner to identify the appropriate remedies and clarify some non-herbal issues that arose.
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 About The Author
David Hoffmann BSc (Hons), MNIMHWhilst working in conservation and lecturing in ecology and the eco-crisis for the University of Wales, David Hoffman became convinced that to heal the world, to embrace planetary wholeness and responsibility for it......more
 
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