Rheumatoid arthritis (RA) occurs when your body's immune system attacks and destroys the tissues that make up your joints. The joints become swollen, stiff, and painful. In later stages, the joints can become deformed. Other areas of your body can also be affected, including your lungs, heart, blood vessels, and eyes. About 1 percent of the U.S. population suffers from RA. Typically, it strikes between the ages of 30 and 60, but it can occur at any age.

• Stiffness, swelling, and pain in and around certain joints, especially after not moving for a while (for example, when waking)
• Affected joints typically include hands, fingers, wrists, ankles, feet, elbows, and knees.
• Generally, if a joint on the right side of your body is affected, the same joint on the left side is also affected
• Feeling tired and run-down with swollen lymph glands, a low fever, little or no appetite, and weight loss
• Appearance of small bumps under the skin near the affected joints

Medical researchers do not know why RA develops. Genes may play some as yet unknown role. It also is possible that a change in the body, such as an infection or hormonal shift, can trigger its development.

Your health care provider will assess the swelling and pain in each joint and will likely ask you to demonstrate how well you can use that joint. During the physical examination, your provider will take your temperature and check your lymph nodes and spleen for swelling. Your provider may order X rays and blood and urine tests. In some cases, a small amount of fluid may be taken from the affected joint for examination. These tests help rule out other causes of your symptoms and confirm a diagnosis of RA.

Treatment is aimed at relieving symptoms and preserving joint function. Rest helps to generally reduce the inflammation response in the body. Exercise helps to maintain joint motion and strength. Heat and cold also are used to reduce symptoms. There are various drugs available for RA. Some newly developed experimental drugs attack the cells in your immune system that destroy joint tissue. In severe cases of joint destruction or deformation, surgery may be necessary.

The following drugs are used to treat RA.

• Nonsteroidal anti-inflammatory drugs (NSAIDS)—for example, naproxen, reduce inflammation and pain; side effects include gastrointestinal irritation, bleeding, and ulceration 
• Cyclo-oxgenase-2 (COX-2) inhibitors—such as celecoxib, reduce pain and inflammation with fewer gastrointestinal side effects, but various other possible side effects 
• Disease-modifying anti-rheumatoid drugs (DMARDs)—include gold salts, antimalarial drugs, and sulfasalazine; DMARDs that suppress the immune system include methotrexate or azathioprine; DMARDs have serious side effects 
• Corticosteroids—decrease inflammation and control pain; given orally or intravenously; possibly serious side effects
• Combination therapy uses two or more DMARDs together.
• Experimental therapy uses newly developed drugs. Several of these attack cells in your immune system that destroy joint tissues.

The goal of therapy is to decrease inflammation and preserve joint function. Treatment is long term.

• The most common allergenic foods are wheat, corn, and dairy. An elimination diet may identify whether these foods constitute a problem: avoid allergenic foods completely for two weeks, then reintroduce the foods one at a time, every three days, and note if your RA symptoms get worse. Citrus, chocolate, alcohol, red meat, spices, and carbonated drinks may also aggravate RA.
• A vegetarian diet high in antioxidants and flavonoids (green tea [Camellia sinensis], blueberry, elderberry [Sambucus nigra]) and low in saturated fats
• A small percentage of people respond dramatically to a diet free of nightshades. These include peppers, eggplant, tomatoes, and white potatoes. A month-long trial is recommended.
• One clinical study demonstrated that selenium combined with vitamin E reduces RA symptoms. Dose is 50 to 75 mcg per day of selenium and 400 to 800 IU of vitamin E.
• Zinc (45 mg per day) and manganese (45 mg per day)
• Omega-3 fatty acids, such as alpha linolenic acid (ALA), keep white blood cells from producing substances that cause swelling
• Bromelain: anti-inflammatory when taken between meals. Dose is 2,000 to 2,500 mg twice a day.
• Quercetin: stabilizes mast cells, found in increased numbers in the synovial membranes of affected joints. Dose is 250 to 500 mg three times per day, on an empty stomach.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

• Devil's claw (Harpagophytum procumbens): analgesic, anti-inflammatory
• Ginseng (Panax ginseng): adaptogen (tonic for long-term stress), specific for chronic disease and the effects of suppressive medications
• Ginger (Zingiber officinale): antispasmodic, digestive stimulant
• Valerian (Valeriana officinalis): relaxant, reduces spasms
• Blue flag (Iris versicolor): stimulates liver to process effects of inflammation
• Wild yam (Dioscorea villosa): specific for RA, helps reduce spasms
• Horsetail (Equisetum arvense): diuretic, stabilizes connective tissue

Devil's claw and three to five of the above herbs can be mixed as either tincture 30 to 60 drops three times per day, or 1 cup tea three times per day.

Some of the most common remedies used for rheumatoid arthritis are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours until your symptoms get better.

• Rhus toxicodendron for arthritis that feels worse in the morning, in damp, cold weather, or before a storm
• Bryonia alba for arthritis that feels better with pressure, feels worse with any movement, or cold weather
• Ruta graveolens for arthritic pains that feel worse after exertion, feel better after resting, especially with a history of strains or sprains
• Calcarea carbonica for arthritis that is associated with weakness

There is extremely limited scientific evidence supporting the use of acupuncture for rheumatoid arthritis, however some practitioners will consider acupuncture to treat this joint condition. Acupuncturists treat people with rheumatoid arthritis based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. A qi deficiency is usually detected in the spleen and/or kidney meridians.

Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may be used to strengthen the entire energy system. Lifestyle, dietary, and herbal advice may also be provided by qualified acupuncturists to people with this condition. Local treatment to the painful areas and related sore points may be applied, either with a needle or moxibustion. In general, however, given the current lack of evidence, acupuncture should be used as a supportive treatment alongside conventional medical therapy.

Chiropractors do not treat red, swollen joints, and high velocity chiropractic manipulation is considered inappropriate in areas of the body affected by this condition. However, some chiropractors report that spinal manipulation may decrease pain and enhance joint mobility among people with rheumatoid arthritis.

Massage may be helpful in relieving symptoms and increasing joint mobility.

Make regular visits to your health care provider to monitor the progress of the disease and side effects of drugs you may be taking.

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