I have frequently heard that rheumatoid arthritis has an emotional
component - i.e., unexpressed rage or grief.  Has anyone ever come
across this theory?  Additionally, are there risk factors, such as
adequacy of the diet, specific lifestyle that may precipitate the
onset of rheumatoid arthritis?  Finally, what are the usual outcomes
of this disease?

Hi purrsian,

What an interesting question! While some health providers may call it
quackery, there is mounting evidence that anger, rage, stress, and
indeed an entire range of emotions can affect our physical health.
Starting in the 70?s scientists began to intensely study the
relationship between mind and body, calling the science
?psychoneuroimmunology?.  In the late 80?s research in this field, now
unofficially known as ?neuroimmunomodulation? began to skyrocket,
providing ??neurosciences with the latest in immunology to provide the
scientific basis for understanding relationships between emotions and
disease once explored only in clinical settings?   ?Even more
important, it provides the scientific basis for understanding--at long
last--how emotions can in fact influence the onset, course, and
remission of disease.?
You can read all the scientific details and view some illustrations here:
http://www.nlm.nih.gov/hmd/emotions/frontiers.html




Emotional Aspects of Rheumatoid Arthritis (RA)
============================================================================

Emotions and mental well being seem to affect our health more than
most people know, or would care to admit. How else would you explain
the power a sugar pill (placebo) has in alleviating  pain, when the
recipient believes it is a powerful pain reliever? (This is known as a
placebo effect)
http://skepdic.com/placebo.html

?One interesting 1999 study found that people with RA reported
significant clinical improvement after writing about their pain,
stress, or other traumatic experiences. Writing for 20 minutes, just a
few days a week, resulted in improvement that lasted for months. A
2001 study found that spirituality (defined as "a belief in a power
outside oneself and one's own existence," as opposed to the practice
of any specific religion) is associated with better health, happiness
and well-being among RA patients. (Spiritual healing does not appear
to offer any advantages.)?
http://www.umm.edu/patiented/articles/what_lifestyle_changes_can_help_manage_rheumatoid_arthritis_000048_10.htm



Although the influence of stress or emotions on the progression of RA
is not fully known, having a history of major depression that persists
or reoccurs seems to increase the pain, disability, and fatigue.
Stress management alone cannot reduce pain, but it may be very helpful
in helping people deal with their condition. One interesting 1999
study found that people with RA reported significant clinical
improvement after writing about their pain, stress, or other traumatic
experiences. Writing for 20 minutes, just a few days a week, resulted
in improvement that lasted for months. A 2001 study found that
spirituality (defined as "a belief in a power outside oneself and
one's own existence," as opposed to the practice of any specific
religion) is associated with better health, happiness and well-being
among RA patients. (Spiritual healing does not appear to offer any
advantages.)

?On the other hand, one interesting study in England found that 10 out
of 17 people benefited from any diet recommended by their doctor.?
http://www.umm.edu/patiented/articles/what_lifestyle_changes_can_help_manage_rheumatoid_arthritis_000048_10.htm

This August, 2001 article, by Elaine Moore, discusses emotions and
auto-immune disease (This includes RA).  Ms. Moore is a medical
technologist (ASCP) who has written a book entitled  ?Living with
Graves? Disease?  She states ?Coincidentally, medical experts gathered
at the National Institute of Health in Bethesda this spring to
announce that yes, emotions and stress do affect our health. After 50
years, we?ve been told the important role love plays in healing. The
neurobiology of various emotions can now be measured. At last
scientists are acknowledging the studies of two decades ago and
agreeing that hormonal and immune system changes can be demonstrated
at the molecular level.
I wonder, though, if it will take another 50 years before mainstream
medicine acknowledges these reports. Recently, a patient told me that
her doctor said stress has no effect on disease. I?m sure such
skepticism will continue unless we as patients begin to educate our
doctors.?
 http://www.suite101.com/article.cfm/9630/72022


Because the actual cause of RA is not totally known, suspected causes
are viral and bacterial infections that trigger an auto-immune
response, family genetics, exposure to chemicals or toxins, hormones
and one?s emotional state. Women are seemingly more prone, possibly
due to hormones, exposure to household cleaners, chemicals in make up
and cosmetics, and  ? Also, a woman's vagina and cervix are potential
entryways for toxins and infectious agents that men don't have.?
http://www.ohiohealth.com/healthreference/reference/228367C1-61A8-45EF-A649741F1DFC372E.htm

According to this holistic  site, a study was done at Stanford
University, that showed  emotions can defeat genetics, and that by 
staying emotionally healthy on can avoid rheumatoid arthritis.
?Experts suggest that one reason women are afflicted with rheumatoid
arthritis as much as four times more frequently than men is probably
"because women are taught from the early childhood that it is wrong to
get angry."
http://www.holistic-online.com/Remedies/Arthritis/arth_RA_psychological-factors.htm


Risk Factors:
===================================

Even today, the causes of RA are not totally known. RA strikes women
three times more often than men, and usually between the ages of 35
and 50, making either a very quick appearance, or a lingering one.
?What causes RA is unknown, but various theories point to infections,
genetics and endocrine factors. This disease is not contagious. A
genetically susceptible person may develop abnormal or altered
antibodies when exposed to a virus or antigen (a substance which
induces the formation of antibodies). The body doesn't recognize these
altered antibodies as "self," and the person forms an antibody (known
as a rheumatoid factor) against them. This rheumatoid factor then
generates inflammation of the joint lining.?
http://www.healthcentral.com/bcp/main.asp?page=ency&id=120&ap=68&brand=8


Dr Andrew Weil says anger can be useful in recovering:
?We're now fairly sure that anger, either expressed violently or
turned inward, impacts your health negatively. An increasing body of
evidence shows that anger is a risk factor for coronary heart disease
and sudden death.? And ?Anger isn't always bad -- it can be useful.
I've seen it mobilize healing responses, for example. One patient
struggling with an autoimmune disease was able to overcome it through
a complete reworking of his lifestyle and the use of various mind-body
techniques. An important part of his recovery was becoming aware of --
and expressing -- his anger toward doctors and hospitals.?
http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=3015


Diet & Lifestyle for RA patients:

It won?t take you long in a bookstore or online to find plenty of fad
diets for RA. Most doctors and nutritionists will say, stick with a
normal healthy diet. Extra protein should be included in the diet, as
inflammation depletes some of our dietary protein. Some studies have
shown that oils such as borage, flaxseed, and fish oils may help
reduce inflammation. These oils contain compounds that appear to
reduce or block damaging inflammatory factors.



Dr. Eric Matteson, of the Mayo Clinic discusses how emotions and a
healthy diet factor in RA treatment, and recommends the following:
·Staying as physically active as possible
·Eating a healthy diet
·Managing stress
·Maintaining social support
?No scientific research has proved that specific foods or nutrients
can help people control their arthritis, although some studies have
shown that certain fish oils may help reduce inflammation in some
people with RA. Eating a balanced diet is good for overall health and
can help you control your weight, which can reduce pressure on your
joints.?
http://www.cnn.com/HEALTH/library/AR/00018.html

Some arthritis medicine may cause you to need extra nutrition. For
example, methotrexate can deplete your body of folic acid, and
glucocorticoids  can deplete potassium and increase sodium.
Here are diet recommendations from the ArthritisFoundation:
·  Eat a variety of foods, and avoid those that can interact with your medications.
·  Maintain a healthy weight.
·  Use fat and cholesterol in moderation.
·  Eat plenty of vegetables, fruits and whole-grain products.
·  Use sugar and salt in moderation.
·  Drink alcohol in moderation. 
·  Take in the daily requirements of vitamins and minerals, including calcium.

http://www.arthritis.org/resources/nutrition/guide.asp


The National Institutes of Health says this about the causes of RA:
?Rheumatoid arthritis is one of several autoimmune diseases, so-called
because a person's immune system attacks his or her own body tissues.
Scientists don't know exactly what causes this, but research over the
last few years has begun to unravel the factors involved.
Genetic (inherited) factors: Investigators have found that certain
genes that play a role in the immune system are associated with a
tendency to develop RA. At the same time, some people with RA do not
have these particular genes, and other people have these genes but
never develop the disease. This suggests that a person's genetic
makeup is an important part of the story but not the whole answer. It
is clear, however, that more than one gene is involved in determining
whether a person develops RA, and if so, how severe the disease will
become.
Environmental factors: Many scientists think that something must occur
to trigger the disease process in people whose genetic makeup makes
them susceptible to RA. An infectious agent such as a virus or
bacterium appears likely, but the exact agent is not yet known. This
does not mean that RA is contagious: a person cannot "catch" it from
someone else.
Other factors: Some scientists also think that a variety of hormonal
factors may be involved. These hormones, or possibly deficiencies or
changes in certain hormones, may promote the development of RA in a
genetically susceptible person who has been exposed to a triggering
agent from the environment.
Even though all the answers aren't known, one thing is certain: RA
develops as a result of the interaction of many factors. Much research
is going on now to understand these factors and how they work
together.?
http://healthlink.mcw.edu/article/952625523.html


Managing RA:
·Pain and stress management - relaxation techniques, hot and cold
packs, physical activity
·Exercise - such as exercising in warm water or tai chi
·Rest - helps to reduce joint swelling and manage fatigue
·Medication - including disease modifying anti-rheumatic drugs and
anti-inflammatory drugs
·Aids - such as walking aids, specialised cooking utensils and more
·Good communication with the health care team
·Support from others - join a self help group
·Surgery - to correct a badly damaged joint.
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rheumatoid_arthritis?OpenDocument


Living with RA
There are numerous links to RA resources on this page:
http://www.enbrel.com/conditions/enbrel-ra.jsp



?You may need to change the way you do certain activities so that you
are not overusing your joints. Try to find different ways to relieve
your joint pain.?
·Joint pain and stiffness may improve with heat therapy, which includes: 
oTaking warm showers or baths after long periods of sitting or sleeping.
oSoaking hand joints in warm wax baths.
oSleeping under a warm electric blanket.
·Use assistive devices to reduce strain on your joints, such as
special kitchen tools or door knobs.
·Use splints, canes, or walkers to reduce pain and improve function
http://my.webmd.com/hw/rheumatoid_arthritis/aa19583.asp

New Medications: 
DMARDS (Disease-modifying antirheumatic drugs)
DMARDs slow the advancement of RA.
?DMARDs can slow the progression of RA. In some cases, they may even
inhibit the progression of the disease. Although much remains unknown
about how many of these drugs work, DMARDs appear to inhibit
inflammation of the joints, which in turn may slow the destruction of
joints and cartilage.?

BRMs (Biologic response modifiers) 
BRMs block the effects of tumor-necrosis factor, a protein that attacks joints.
?ENBREL is indicated for reducing signs and symptoms, inhibiting the
progression of structural damage, and improving physical function in
patients with moderately to severely active rheumatoid arthritis.
ENBREL can be used in combination with methotrexate in patients who do
not respond adequately to methotrexate alone.?
http://www.enbrel.com/conditions/enbrel-ra-treatment.jsp


?Tai Chi is easy and inexpensive to learn. It can also help to:
·Promote correct body posture
·Integrate body, mind and spirit 
·Improve Qi (a life energy which governs all functions of the body).?
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Tai_Chi_can_help_manage_arthritis

Outcome of RA:

The sad news is, there is no cure for RA.
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rheumatoid_arthritis?OpenDocument



People with RA may expect to have a shorter life expectancy. ?On
average, the life expectancy of those with RA is shortened by about 4
years for women and 8 years for men. However, many factors may affect
this decrease in life expectancy, including?:
·The severity of the disease
·The number of organs involved
·Associated medical conditions such as heart or kidney disease

http://www.ohiohealth.com/healthreference/reference/07B9175C-63BC-4B04-BD5D2F3121A42229.htm?category=questions

RA shortens life expectancy:
?The researchers concluded that the risk of mortality for people with
rheumatoid arthritis is approximately 38% greater than for the general
population.  The risk was even greater for women, with a 55% increased
risk compared to women of the general population.  As an example, a 50
year old woman with rheumatoid arthritis can expect to live four fewer
years (30 more years instead of 34 more years) than a woman without
rheumatoid arthritis.  However, a 50 year old man with rheumatoid
arthritis can expect to live 26 more years while a 50 year old man
without rheumatoid arthritis can expect to live 27 more years.?
http://arthritis.about.com/library/weekly/aa030300a.htm


What?s on the Horizon for RA?
?Generally, medications are selected based on the severity of the
disease - mild, moderate or severe - which means the level of
inflammation, the level of erosions or bone deformities that may
already exist, and the systemic manifestations, such as fatigue and
fever. We try to fine tune the type of medication to the severity of
inflammation, while keeping in mind that the "personality" of the
inflammation can change over time, requiring a different medication
regimen.? And ?We have come a long way in the past 30 years. We now
have specific targets that we focus our therapies on. Our therapies
are amazingly effective and safe. The world has changed for people
with RA. However, these three new biologics are just the beginning. We
have many more coming down the road over the next few years that will
be even more effective, as well as less expensive, and which we will
be able to use in combination with each other for even better
results.?

http://rheumatology.hss.edu/pat/eduPrograms/livingRA/newImportant.asp


Additional Information on RA:
Web MD
http://webcenter.health.webmd.netscape.com/content/article/78/95599.htm

Hospital for Special Surgery
How to Help your Doctor Help You
http://rheumatology.hss.edu/pat/eduPrograms/livingRA/speakingPain.asp

Treatment of RA
http://healthlink.mcw.edu/article/952626319.html

Mastering Fatigue in RA
http://rheumatology.hss.edu/pat/eduPrograms/livingRA/fatigue_n_RA.asp

An interesting history of emotions and disease:? Can someone actually
die from loneliness? Is it really possible to become sick with fear??
http://science-education.nih.gov/nihHTML/OSE/snapshots/multimedia/ritn/emotions/emotions1.html

Anger and Disease
http://serendip.brynmawr.edu/bb/neuro/neuro01/web1/Gu.html

I hope this has answered your RA questions satisfactorily. If any part
of my answer is unclear, please request an Answer Clarification,
before rating. This will enable me to assist you further, if possible.

Regards,
crabcakes

Search Terms
Emotions + autoimmune disease
Emotional health rheumatoid arthritis
Rheumatoid arthritis lifestyles
Rheumatoid arthritis

Crabcakes,
If there were a 6-star rating, I would give you one.

My sister-in-law, who is 40 years old was just recently diagnosed with
RA, in addition to having also been diagnosed with thyroid failure. 
Without going into details, I've observed various character traits
that have tended to make me draw conclusions - only based on my
subjective, little voice.
I've printed out all of the links and will revisit the ones that have
references and additional recommended links.
Thanks for your hard work.
Maryanne

Thank you purrsian, for the kind comments, the stars, and the generous
tip! Seems you are very observant!
Regards,
crabcakes

Any observations on why people with one auto immune disease acquire
other auto immune diseases down the road? Time to look into ancient
chinese and indian ayuvedic healing techniques to reverse the pattern

Thinkcap, I would tend to agree with you about the transference of one
autoimmune for the other.  My husband's sister has rheumatoid
arthritis, psoriasis and recently her thyroid has stopped functioning
(which is another autoimmune disorder).  My husband has psoriasis, but
no rheumatoid arthritis (yet) and their father has fibromyalgia, which
I understand to have a basis in autoimmune functioning.  Their mother
has psoriasis.  I've never asked if their parents might be related, as
in cousins.  But, it could also be that autoimmune disorders are most
common in their "community."  I've also looked into the possibility of
either one or a combination of the following:  poor diet (high in
refined carbohydrates, large amounts of sugar, heavy animal and animal
fat diet, alcohol, caffeine, cigarettes), poorly controlled emotions
(repressed anxiety, rage), and life style, sleeping and eating habits.
 I also read one book on Leaky Gut Syndrome, which is the current
theory (resurrected from the thirties) as being a primary trigger for
a whole host of dysfunctions.

My husband has SAID that he's done accupunture and Chinese medicine -
and he wasn't satisfied with the results.  It may be that that course
of treatment requires a lengthy period of time to be effective.  The
thing is that he is quite impatient, like most Westerners ;o)).  Right
now he's trying to quit smoking and was proud to announce that he went
five hours without a cigaratte.  I failed to appreciate how meaningful
that was to him, but I know that breaking that type of bad habit is
often quite difficult.  If he does manage to quit smoking, I will
certainly be very proud of him.  His sister quit smoking when she was
diagnosed with the tyroid dysfunction (she claims that the cigarettes
gave her the "energy" she needed when her thyroid had been failing). 
Now that she has rheumatoic arthritis (diagnosed immediately after the
first diagnosis of a failed thyroid), she is beginning to "clean up" a
lifetime of bad habits.

It's sad that that frequently is the case.  My cousin, who had been
diagnosed with diabetes immediately set upon a daily workout regimin
which he had been hoping would reverse out a lifetime of bad eating
habits.  Then late last year he was diagnosed with cirrosis, and now
requires a new liver.  Too little, too late.  I've always thought
about my health, but it surprises me to this day just how many more
people don't.

Hello purrsian,
Thank you for validating my observation. Yes, there are many factors
in triggering RA and I was afflicted with RA 2 yrs ago. It took me a
lot of pain and knowledge to reverse this crippling disease. Now I'm
pain free and almost at the end of the tunnel. There is a method to
end this lunacy. I can refer you to other sources for useful
information. Yes, your reading on LGS(leaky gut syndrome) is the
correct answer to get rid of this disease. Here's a link from a former
RA patient who has taken great efforts to write this book. This book
was the main factor in my recovery too.
http://homepages.paradise.net.nz/rwgully/theories/mcferran01.htm

Happy reading! I'll be happy to answer any questions you have after
reading the book.

It is my belief that environmental factors may be at least partially
responsible for some instances of multiple autoimmune illnesses.

My late brother and I were exposed to large amounts of DDT in the
early 1950s. My sister was born after DDT was removed from the
American market.

Both my brother and I were afflicted later in life with numerous
autoimmune diseases, while my sister is the picture of health.

My brother's autoimmune neurological impairment (which ended in his
death) began soon after he was exposed to a pesticide that was being
sprayed in his neighborhood in Louisiana for the control of fire ants.

I experienced my first symptoms of Crohn's disease (which later became
life-threatening, necessitating the removal of my colon) shortly after
using flea-control products on my cat (and in my bedroom, whose carpet
was all ajump with the little critters).

One of my worst sieges of rheumatoid arthritis (severe enough to
require several weeks of hospitalization) occurred a few days after I
hung "No-Pest Strips" in my apartment to get rid of an influx of fruit
flies.

This is anecdotal evidence, of course, and it doesn't prove anything,
but it has influenced my thinking on the matter of autoimmune illness.
And, needless to say, I avoid pesticides whenever possible. I'd much
rather battle bugs than have to fend off deadly assaults from my own
immune system.