Rheumatoid Arthritis and Metabolic Syndrome

Rheumatoid arthritis (RA) is a progressive and severely disabling disease that affects both wrists, fingers, hip, knees, and ankles. 1.3 million U.S. adults have RA.  While no definite cause of RA has been found, RA is associated with body-wide inflammation, similar to metabolic syndrome (MetS).

Epidemiological studies have shown that MetS can be present in as much as 40 % of people with RA.

Heart Attacks are Common in Rheumatoid Arthritis

People with RA die of heart disease two times more than the rest of the population. The longer the person has RA, the higher the risk of dying from a heart attack. Even if a person with RA may not have the usual risk factors for heart disease like diabetes, smoking, and hypertension, just by having RA, the increase, the risk of dying of a heart attack or brain stroke is much higher.

Rheumatoid Arthritis, Metabolic Syndrome, and Cardiovascular Disease are Inflammatory Diseases

The inflammation in RA is not limited to the joints but also affects the eyes, causing dryness, anemia, nerve damage, pulmonary fibrosis, pericarditis, splenic enlargement, osteoporosis,  muscle wasting, and joint deformities.

What Caused the Inflammation?

Since the common denominator in RA, MetS, and CVD is inflammation. The primary cause of the inflammation is the excess visceral fat. Visceral fats produce pro-inflammatory cytokines.

How can visceral fat get excessive? It comes from insulin resistance (IR) and hyperinsulinemia (HI). Both IR and HI results from the frequent eating of carbohydrates, including sugar. Once the storage depot of glucose (glycogen) in the skeletal muscles and liver are all filled up, the excess glucose is turned to fat. The fat inserts itself into the different solid organs in the abdomen like the liver (fatty liver), pancreas (fatty pancreas), and around the intestines initiating a chain reaction that leads to more diseases.

Some of the pro-inflammatory cytokines (signaling proteins) involved are:

• TNF α (alpha) that activates more cytokines
• Interleukin-1 (IL-1),
• Macrophage inhibitory factor (MIF),
• C-reactive proteins (CRP),
• Interleukin-6 (IL-6),
• Toll-like receptors (TLRs) activate the specialized white blood cells called the T and B-cells that further the inflammation by the production of reactive oxygen/nitrogen species, cytokines, chemokines, and more damage.
• Matrix metallopeptidases (MMPs)

Pro-inflammatory cytokines can produce injury throughout the whole body, including the inner lining of the blood vessels (endothelium). Once the blood vessels are damaged, blood flow is limited and contributes to multi-organ dysfunction

Medications for Rheumatoid Arthritis have Serious Adverse Effects

Rituximab is used in combination with methotrexate. However, a significant increase in total cholesterol and LDL was observed within 2 weeks of treatment. It can also lower the different blood cells that can potentially lead to anemia, infections, and bleeding. All of which can lead to death, which is what we are trying to prevent.

Disease-modifying antirheumatic drugs (DMARDs) like methotrexate is associated with an increase in homocysteine, a risk factor for cardiovascular disease. Liver damage and severe infections can happen because DMARDs suppresses the immune system.

Steroids are associated with arterial stiffness and atherosclerosis that can lead to strokes, gastrointestinal bleeding, high blood sugar, and osteoporosis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are widely used. However, NSAIDs have been associated with a higher risk of myocardial infarctions. NSAIDs also cause severe gastrointestinal bleeding.

Sadly having RA is very difficult to treat because the available medications that have to be taken for several weeks are not months are fraught with dangerous side effects.

Is there something else that can be done?

Curcumin Can Alleviate the Symptoms of  Arthritis

A meta-analysis published in the Journal of Medicinal Food that measured pain intensity using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the pain visual analog score (PVAS) among arthritis patients that used curcumin showed an improvement in both WOMAC and PVAS scores.

Curcumin should be used with pepper and some oil to maximize the absorption in the intestines. Lyfe Botanicals sells curcumin and other supplements that “exceed the industry’s highest quality standards.” This page discusses the many benefits of turmeric curcumin.

Intermittent fasting and Exercises also reduce the inflammation of Rheumatoid arthritis and metabolic syndrome.

Non-diseased right-hand x-ray shows defined wrist bones.

Intermittent Fasting Melts the Source of Inflammation!

During fasting, the body turns to visceral fat as a source of energy thru the process of gluconeogenesis.  The longer the fast, the more fat is mobilized, causing less inflammation resulting in fewer pains. As a bonus, intermittent fasting also lowers the risks of heart attacks and strokes.

Exercise Makes Intermittent Fasting More Effective

Exercise uses the stored glycogen in the muscles. In the absence of excess carbohydrate intake, the visceral fat is mobilized and is converted to glucose to replace the spent glycogen in the muscles.

Exercise will not only metabolize fat, but it also has many other benefits and can prolong life.  The exercising muscles also produce myokines and exerkines that exert positive systemic effects. If you would like to know how the body adapts to exercise, it is in How to Get Physically Active.

Exercise also increases the mobility of the joints and lessens the mechanical load on the knees and hips. All beneficial to RA patients to perform more physical activities and exercise possible.

Word to the Wise

As a precaution, talk to your physicians before starting an intermittent fasting and exercise program. Some medications for diabetes and hypertension may need to be decreased in dose.

Other Diseases Associated with Metabolic Syndrome that Benefits from Intermittent Fasting and Exercise

As mentioned above, here are the different disease conditions associated with Metabolic Syndrome. Top Causes of Mortality, lungs, gout, and eye, coagulation, periodontal disease, erectile dysfunction, atrial fibrillation, cancer, ear problems, tinnitus, and vertigo,  male genitourinary and female reproductive system, heartburn, and osteoarthritis.

Thanks for reading. Feel free to ask questions, comment, share, like, and subscribe.

Further Reading

• The Magical Endothelium
• Gluconeogenesis: The Sugar Factory Inside
• How to Fast
• The Kaizen Way of Fasting

Arthritides Associated with Metabolic Syndrome

• Diseases Associated with Metabolic Syndrome Part 16.2 Osteoarthritis
• Diseases Associated with Metabolic Syndrome. Part 3 Gout
• Psoriasis and Metabolic Syndrome

References:

1. Full et al. Targeting inflammation as a therapeutic strategy in accelerated atherosclerosis in rheumatoid arthritis. Cardiovasc Ther. 2011 Aug;29(4):231-42.
2. Da Cunha VR et al. Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity. Scand J Rheumatol. 2012 May;41(3):186-91. doi: 10.3109/03009742.2011.626443. Epub 2012 Mar 15.
3. Dao HH et al.Increased frequency of metabolic syndrome among Vietnamese women with early rheumatoid arthritis: a cross-sectional study. Arthritis Res Ther. 2010;12(6): R218.
4. Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016 Aug;19(8):717-29. doi: 10.1089/jmf.2016.3705.

Image Credits:

RA hand By James Heilman, MD – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11110471

RA joint and atherosclerotic artery from Targeting inflammation as a therapeutic strategy in accelerated atherosclerosis in rheumatoid arthritis. Cardiovasc Ther. 2011 Aug;29(4):231-42.

Normal X-ray of right wrists By Mikael Häggström – Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=55338792

X-ray of RA wrists By Mikael Häggström – Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=55338793

Skeletal muscles and myokines from Svenia Schnyder and Christoph Handschi. Skeletal muscle as an endocrine organ: PGC-1α, myokines, and exercise. Bone. 2015 Nov; 80: 115–125.