Taking Aim at Arthritis
Remedies now target inflammation as well as the ache
En español | We all know what it’s like to wake up in the morning with an aching back or stiff knees. But for those with chronic inflammatory arthritis, a disease in which our immune system starts attacking healthy cells by mistake — manifesting in widespread pain and red, swollen, inflamed joints — the discomfort is very different. “The distinction has to do with the pervasiveness of the experience,” says Nortin Hadler, M.D., emeritus professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill. “Without medicine, people with rheumatoid arthritis or psoriatic arthritis are lucky to feel good ever during the day. It is remittent: There are good days, and there are bad days.”
Getting the disease under control with drugs, such as disease-modifying antirheumatic drugs (DMARDs) or biologics, can significantly reduce the pain. “But while medication these days is very effective, it’s not completely effective,” says Nancy Shadick, M.D., a rheumatologist at Boston’s Brigham and Women’s Hospital and an associate professor at Harvard Medical School. “You’re dealing with the intermittent flares or some ongoing pain or disability.”
For help where drugs leave off, and in an effort to deal with both problems of addiction and side effects that drugs for inflammatory pain can cause, doctors are increasingly turning to alternative and “non-drug therapies,” says Mark Bicket, M.D., an assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. Here are what a few experts recommend beyond the basics of a warm bath and gentle stretching.
Apply the pressure
If your muscles and joints aren’t feeling too tender, massage can offer sweet relief from the pain of inflammatory arthritis. The best hands-on approach: moderate pressure massage. “When you move the skin, you’re increasing the activity of the vagus nerve, a large nerve that connects the brain with other parts of the body, including the heart and lungs,” says Tiffany Field, a professor in the departments of pediatrics, psychology and psychiatry at the University of Miami Miller School of Medicine and director of the Touch Research Institute. “This slows down the production of cortisol, the body’s chief stress hormone. You’re also increasing the production of serotonin, a chemical in the brain that helps diminish pain.”
A fair amount of research backs up Field’s claim, including her own study published in the journal Complementary Therapy in Clinical Practice. During the study, participants afflicted with rheumatoid arthritis reported relief from pain and stiffness — as well as a stronger grip — after weekly moderate-pressure massages on their arms that were supplemented with daily self-massage at home. In another study, researchers found participants who received a moderate-pressure massage, this time to the knees, reported reduced pain and greater range of motion.
“It’s important to have a daily dose of some kind of pressure to the skin,” says Field, who suggests scheduling a once-a-week massage with a licensed massage therapist, as well as taking matters into your own hands by doing daily 10-minute self-massages at home between sessions.
Turn up the heat
Inflammatory pain relief may be as easy as knocking back a capsule. “There are nutritional supplements that have been proven beneficial for inflammatory conditions,” says Chrystina Jeter, M.D., assistant clinical professor of pain medicine at the University of California, Los Angeles (UCLA), Comprehensive Pain Center. “One that has been best studied is turmeric.”
The bright yellow Indian spice, commonly used as an ingredient in curries, has long been embraced by Indian and Chinese medicine for its healing properties. In fact, it’s not turmeric that eases inflammation, but curcumin, the active chemical in turmeric, which researchers believe blocks certain enzymes and a large group of proteins known as cytokines that lead to inflammation.
In a small 2012 study, a curcumin product called BCM-95 proved better at reducing joint pain and swelling in patients with rheumatoid arthritis than a standard anti-inflammatory drug.
What’s more, a small 2016 study found that curcumin may help to prevent bone erosion in people with rheumatoid arthritis. “It’s not a medication you would take like Advil,” Jeter says. “If you have an acute flare-up, it’s probably not going to be helpful. But when taken daily, as part of your normal regimen, curcumin can help smooth out your overall pain.” Adding a dash to your favorite Indian dish won’t do the trick; curcumin needs to be consumed as a supplement. Look for one formulated with pepper, which may help improve absorption.
Grill up some salmon
That orangey-pink fish is chockful of health benefits — now add pain reliever to the list. In a 2017 study published in Arthritis Care & Research, in which participants were asked to eat specific foods from a list, fatty fish got high marks when it came to improving rheumatoid arthritis symptoms. Tuna, sardines and mackerel are also rich in omega-3 fatty acids, which inhibit immune cells called leukocytes as well as cytokines, both of which are involved in the body’s inflammatory response.
To get the full, inflammation-fighting benefits, eat two to three servings of fish a week. If you don’t fancy seafood, consider a fish-oil supplement. “The data on fish oil is quite good,” says Shadick, who notes research showing that it reduced joint tenderness and stiffness.
Whip out the resistance bands
Working out may seem kind of counterintuitive when you’re dealing with achy knees or a sore elbow. But keeping muscles strong, while maintaining flexibility and range of motion, is crucial. Otherwise, underutilized limbs become weak, making it even more painful when you try to move around. In fact, a study published in the Journal of Aging Research concluded that exercise improves overall function in those with rheumatoid arthritis. That same study found that the best exercise program for those with rheumatoid arthritis should include both aerobic and resistance training.
“Muscle strength is especially important because you need muscles to absorb the impact that may occur when you’re walking around or doing other activities,” says Jonathan Samuels, M.D., an associate professor of medicine in the division of rheumatology and the codirector of the Joint Preservation & Arthritis Center at New York University (NYU) Langone Health. “Think of it as maintaining a shock absorber around the joints.” Strengthening exercises are also beneficial for keeping bones strong, since people with rheumatoid arthritis are more prone to getting osteoporosis.
Aerobic heart-pumpers are another important part of the keep-fit equation, since poor cardiovascular health is the main cause of death in rheumatoid arthritis patients. Physicians give high marks to peddling on a stationary bike (a great workout for your knees and your ticker) and pretty much anything water-related — in particular, swimming and water aerobics. The buoyancy of the water helps support body weight, which means these types of exercises don’t impact heavily on the joints. “Plus, many water aerobics classes are done in warm water, which feels wonderful,” Jeter notes.
Stamp out stress
Research shows that stress and pain like to feed off of one another. “Feeling a twinge of pain may make you feel anxious,” Jeter says. “And when you feel anxious, you focus more on the pain.” Biofeedback therapy can help you break the cycle by changing the way your body responds to pain. “Being aware of your body’s stress response, and learning to decrease it, is particularly important for inflammatory arthritis,” says Darcy Mandell, associate staff psychologist in the Chronic Pain Rehabilitation Program at the Cleveland Clinic.
How it works: A trained practitioner attaches sensors to your skin at specific locations to enable you to read measures of your heart rate, blood pressure, muscle activity and body temperature. Looking at a monitor, you can see how these functions change when you’re faced with a stressful situation (for example, your heart rate might go up, your muscles may tighten, and you may start taking faster breaths). Armed with this information, you can learn, through trial and error, which techniques — say, deep breathing or visualization — can best help you “control” the inner workings your body so that you can better cope with pain.
“When you practice these techniques and become good at them, you can actually calm yourself anywhere,” Jeter says. What’s more, research suggests that controlling anxiety can lead to pain relief. “Inability to regulate or decrease the stress response system can lead to activation of autoimmune chemicals that prompt flares,” Mandell says. “Biofeedback can change some of the biological mechanisms that affect how often patients have those flares.”
You can find a certified practitioner at the Biofeedback Certification International Alliance website. One way to measure your stress responses at home, Mandell says, is by using a stress thermometer (available for sale online), which uses your hand temperature. (The warmer your hands are — somewhere around 90 degrees — the more relaxed you are; the cooler your hands are — in the 60- to 79-degree range — the more stressed you are.)
Down an anti-opioid
Here’s an interesting twist: Some physicians are using a powerful medication (naltrexone) that’s normally used to treat opioid addiction, off-label (meaning for a condition it hasn't officially been approved for) and in very low doses, to treat a host of inflammatory pain conditions — fibromyalgia and rheumatoid arthritis among them.
How researchers suspect low-dose naltrexone (LDN) works: In certain chronic pain conditions, glial cells, the main cells in the nervous system, get overactivated and secrete a storm of cytokines, which triggers inflammation and increases pain sensitivity. “We think that low-dose naltrexone slowly [gets] into the central nervous system and calms down the glial cells so they stop secreting so many cytokines,” Jeter says. “Over time, pain improves because the central nervous system isn’t so revved up and irritated.”
Two reasons why the medication is attractive to physicians: There are few side effects, and the drug doesn’t seem to lead to dependency. “It’s being studied for use in a number of conditions,” says Jeter, who prescribes the drug in order to avoid adding an opioid to treat chronic pain.