Rheumatoid Arthritis

Western Overview

Rheumatoid Arthritis (RA) is a chronic autoimmune disease primarily attacking the joints and affiliated soft tissue, causing non-infectious inflammation.  RA first symmetrically attacks small, distal joints in the body, such as those in the fingers, toes and wrists.  It is a chronic, progressive disease and patients will often experience alternating periods of symptomatic flare up and relief.  It is often seen in young adults, affecting females more than males (a 3.5:1 ratio) and has a gradual onset.

Early symptoms include fatigue, weight loss, poor appetite and low grade fever, as well as numbness, tingling and stabbing pain affecting the hands and feet.  Eventually RA may invade the heart, lung, and blood vessels, potentially leading to pericarditis, myocarditis, pleurisy, interstitial pneumonia, kidney amyloidosis, generalized vasculitis, peripheral nerve injury and disorders of the eye.  Western treatments for RA include oxybenzoic acid, gold preparation, immuno-depressants, and possibly surgery.

 

Traditional Chinese Medical Perspective

In Chinese diagnosis, Rheumatoid Arthritis belongs to Bi (Painful Obstruction) Syndrome.  Bi Syndromes are further classified by the specific symptoms experienced by the patent into one of several patterns, each of which has distinct treatments.

Factors contributing to disease onset:

  • Coldness, dampness, other external injuries
  • Fatigue, mental over-stimulation, and nutritional impairment
  • Disturbance of work and rest cycles
  • Congenital deficiency

Disease progression:
Bi Syndromes most often are a combination of deficient root and excess branch factors, such as Liver and Kidney deficiency with dampness obstruction and blood stagnation.  The affected regions are bones, joints, tendons, and muscles.
1)    The basic pathology is constitutional deficiency, including either or both qi-blood deficiency and liver-kidney deficiency.  This deficiency may either be genetic or onset later in life after overwork depletes the body’s reserves.
2)    Eventually the deficiency becomes complicated by exterior pathogens (such as excessive exposure to wind, cold or dampness) lodging themselves in the small spaces of the joints and obstructing Qi flow in the channels, causing pain.
3)    If the blockage becomes chronic, the wind-cold-dampness may invade organs, injuring the Liver, Spleen and Kidney, thereby resulting in generalized Qi and Blood, Yin and Yang deficiencies.
4)    Chronic blockage affects circulation (of Qi, Blood and Body Fluids).  Poor circulation creates stasis, which is marked by swollen, rigid and deformed joints.
For some patients the early stage causes tend to be more excess.  It is only after battling with the excess pathogens for some time before later stage deficiencies present.

Clinical Manifestations

1. Joints

Early stage:
Multiple joints which are red and swollen, presenting symmetrically.  They are hot to the touch and the pain feels “burning.”  This is accompanied by stiffness, especially in the morning, and is often seen in small joints.
Middle-late stage:
The early stage becomes chronic and lingering and is marked by limited range of joing movement, translocation of the joint’s articular surface, and even deformed joints.

2. General symptoms

  • Skin lesions
  • Eye disorders
  • Lung disorders
  • Vasculitis
  • Nervous system problems
  • Amyloidosis
  • Bone and muscle disturbances

Treatment Principle

Herbs: Augment Qi, nourish Yin, enrich and invigorate blood, tonify the liver and kidney

Other Methods: use herbal wash, soaking, application, acupuncture, and Tui-Na to strengthen the righteous Qi, promote qi and blood circulation, eliminate dampness and blood stasis, control the inflammation, moderate pain, prevent joints deformation.

Differentiation of Bi Syndrome Patterns

Active Stage

1) Intermingling of Cold and Heat:

Swollen joints with severe pain, possibly with feverish sensation of the joints, limited joint movement (made worse by cold weather), strong dislike of cold weather and temperatures, fever, headache, pale complexion.

2) Damp-Heat Accumulation

Major pain and swelling in the lower extremities with obvious rigidity in the morning.  A feeling of heaviness in the limbs, limited movement, and general aching of the body  with complaints of “heaviness.”  Often the patient will feel thirsty without wanting to drink, experiencing a bitter taste and sticky-greasy sensation in the mouth.  There may be macula on the skin, more severe swelling or an extreme feeling of heat.

Chronic/Remission Stage:

1) Interlocking of Phlegm and Blood Stasis

Swollen, painful and deformed joints becoming progressively worse with activity.  Limited range of motion and stabbing pain in the muscles with fixed quality.  Skin elasticity declines, and the skin will often appear a dusky purple color and slightly hard when palpated.  The facial complexion becomes dusky, sometimes the eye lids will appear swollen.  Subcutaneous nodules, or stubborn numbness in the limbs are possible.

2) Liver-Kidney, Qi-Blood Deficiency

Emaciation, deformed joints, muscle atrophy, irritating pain in rigid joints with limited range of motion.  Numb limbs, tense tendons, muscular twitching and cramping is often accompanied with weakness and soreness in the lower back and knees, dizziness, palpitations, shortness of breath and pale nails.  Some patients may experience more extreme feelings of heat or cold, stubborn pain, emotional irritation or edema.