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Rheumatoid arthritis (RA) is an autoimmune disease that causes a chronic inflammation in the synovial membranes of multiple joints in the body. It attacks the lining of the joints and often produces severe pain and inflammation, joint disfigurement, and loss of joint movement and function.(1) Extra-articular involvement including rheumatoid nodules, vasculitis, eye inflammation, neurologic dysfunction, cardiopulmonary disease, lymphadenopathy, and splenomegaly are manifestations of the disease. Although the usual disease course is chronic, some patients will spontaneously enter a remission.(2)
The chronic inflammation causes proliferation of the synovial tissue, creating a characteristic of RA known as pannus. It is this process that invades cartilage and eventually the bone surface leading to destruction of the joint. The factors that initiate the inflammatory process are unknown; however, there are several possible causes, including genetics,(3) stress,(4) poor nutrition,(5) and bacterial infection.(6)
Heavy metals such as mercury, cadmium, and lead have been associated with rheumatoid arthritis. One study reported that these toxic metals may interfere with collagen synthesis.(7) Chelation therapy may be helpful for rheumatoid arthritis patients who are found to have an accumulation of heavy metals.
Stress affects the immune system and is linked to disease onset and exacerbation in patients with rheumatoid arthritis. It has also been reported that stressful events often precede the onset of disease flare-ups.(4) In one study, stress management programs produced statistically significant improvements on measures of helplessness, self-efficacy, coping, pain, and health status. These beneficial effects were still detectable at the 15-month follow-up evaluation. This indicates that stress management interventions are capable of producing important clinical benefits for individuals with rheumatoid arthritis.(8)
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