Rheumatoid arthritis (RA) is an autoimmune disease in the general family of lupus. For reasons that are not understood, in rheumatoid arthritis the immune system goes awry and begins attacking innocent tissues, especially cartilage in the joints. Various joints become red, hot, and swollen under the onslaught. The pattern of inflammation is usually symmetrical, occurring on both sides of the body. Other symptoms include inflammation of the eyes, nodules or lumps under the skin, and a general feeling of malaise.

Rheumatoid arthritis is more common in women than in men and typically begins between the ages of 35 and 60. The diagnosis is made by matching the pattern of symptoms with certain characteristic laboratory results.

Medical treatment consists mainly of two categories of drugs: anti-inflammatory drugs in the ibuprofen family (nonsteroidal anti-inflammatory drugs, or NSAIDs) and drugs that may be able to put rheumatoid arthritis into full or partial remission, the so-called disease-modifying antirheumatic drugs (DMARDs).

Anti-inflammatory drugs relieve symptoms of rheumatoid arthritis but do not change the overall progression of the disease, whereas the DMARDs seem to affect the disease itself. A good analogy might be the various options available to "treat" a house "suffering" from a severe termite infestation. You could remove heavy furniture, tiptoe about instead of holding public dances, and put large beams under the joists. However, none of these methods would do anything to stop the gradual destruction of your house. These methods are like NSAIDs and other supportive techniques in that they treat only the symptoms.

A more definitive approach would be to hire an exterminator and kill the termites. In medical terms, this would be described as a disease-modifying treatment. Because medical treatments for chronic diseases are seldom as completely effective as this example, a closer analogy might be spraying a chemical that slows the spread of termites but does not stop them.

In rheumatoid arthritis, the drugs believed to alter the course of the disease (to slow it down or stop it) include antimalarials (hydroxychloroquine and chloroquine), sulfasalazine, TNF inhibitors (etanercept, infliximab, and adalimumab), interleukin-1 receptor antagonists, leflunomide methotrexate, gold compounds, D-penicillamine, and cytotoxic agents (azathioprine, cyclophosphamide, and cyclosporine). They are unrelated to one another but work somewhat similarly in practice.

Unfortunately, most of the drugs in this category can cause severe side effects. Because of this toxicity, for years a so-called pyramid approach was taken with people with rheumatoid arthritis. Physicians started with NSAIDs to help with the pain and inflammation, and progressed to successively stronger and more toxic medications only when the basic treatments failed. Natural treatments such as those described here might also be useful in early stages.

However, over the last few years, research has found that severe joint damage occurs very early in rheumatoid arthritis. This evidence has caused many authorities to suggest early, aggressive treatment with disease-modifying drugs to prevent joint damage. Nonetheless, this approach has not been universally adopted, and some physicians still prescribe NSAIDs for early stages of rheumatoid arthritis. The treatments described here may be reasonable alternative options.

Rheumatoid arthritis is a difficult disease, and no alternative approach solves it easily. Even if you choose to use alternative methods, you should maintain regular visits to a rheumatologist to watch for serious complications. Finally, keep in mind that medical treatment may be able to slow the progression of rheumatoid arthritis. It is not likely that any of the alternative options have the same power.

Fish Oil

Fish oil is the only natural treatment for rheumatoid arthritis with significant documentation. According to the results of at least 13 double-blind, placebo-controlledstudies involving a total of over 500 participants, supplementation with omega-3 fatty acids can significantly reduce the symptoms of rheumatoid arthritis.1,2In addition, at least one small study suggests that it may help rheumatoid arthritis patients lower their dose of nonsteroidal anti-inflammatory medication (eg, ibuprofen).84

However, unlike some of the standard treatments, fish oil has not been shown to slow the progression of rheumatoid arthritis. It has been suggested that omega-3 supplementation is more effective when omega-6 intake (particularly arachidonic acid) is kept low, as occurs with a vegetarian diet.67The benefits of fish oil may also be enhanced by simultaneous use of olive oil.74 A badly designed human study hints that a relative of fish oil, krill oil, might be helpful as well.79

For more information, including dosage and safety issues, see the full Fish Oil article.

Flaxseed oilhas been offered as a more palatable substitute for fish oil, but it does not seem to work.8