Functional Medicine for Rheumatoid Arthritis

What is rheumatoid arthritis?

RA is the most common autoimmune type of arthritis. In RA, the immune system, which normally fights infection, attacks the body's own tissues. It inflames the lining of the joints. This causes pain, swelling and stiffness, and it can make the joint harder to use.^{1, 3}

Over time, the inflamed lining can thicken and damage the cartilage and bone in the joint. RA can also cause problems outside the joints, in areas such as the heart, lungs, blood, nerves, eyes and skin.¹

RA can start at any age, but the risk goes up as people get older. About two to three times as many women as men have it. Genes and things in the environment, such as cigarette smoke, seem to work together to start the disease, but the exact cause is not known. Long-term smoking raises the risk of RA, and continued smoking may make it more severe.¹

Common symptoms of rheumatoid arthritis

RA most often affects the wrists, hands and feet, but it can affect any joint. It usually affects both sides of the body in a matching pattern. It may start in a few joints and, without effective treatment, spread to more.^{1, 3, 4}

Symptoms can get worse during flares. A flare may be set off by stress, viral infections, doing too much, or suddenly stopping medicine, and sometimes there is no clear cause. Symptoms can include:^{1, 4}

• Joint pain, tenderness, swelling and warmth¹
• Joint stiffness that lasts more than 30 minutes, often in the morning or after resting for a long time¹
• Trouble with everyday tasks, such as making a fist, buttoning clothes or bending your knees¹
• Tiredness and low energy¹
• An occasional low-grade fever¹
• Loss of appetite¹
• Firm lumps under the skin, called rheumatoid nodules, often on the hands or elbows^{1, 4}
• Dry eyes and dry mouth^{1, 4}

How rheumatoid arthritis is diagnosed and treated

No single test confirms RA, and early symptoms can look like other joint problems. Doctors use your medical history, a physical exam, blood tests and imaging. Blood tests may check for rheumatoid factor and anti-CCP antibodies (proteins made by the immune system), along with markers of inflammation. Some people with RA have normal results. X-rays, ultrasound or MRI can show changes in the joints.^{2, 3, 4}

Joint damage can begin within the first one to two years of RA, and once it happens it usually cannot be undone. That is why early diagnosis and treatment matter.^{2, 3}

Treatment aims to relieve pain, reduce inflammation, prevent or slow joint and organ damage, and help you with daily activities. A disease-modifying antirheumatic drug (DMARD), such as methotrexate, is usually the first treatment. If that is not enough, a rheumatologist may add a biologic or another targeted medicine. Corticosteroids, physical and occupational therapy, and sometimes surgery may also be part of care.^{2, 3, 4}

Many RA medicines may raise the risk of infection, and RA can affect the heart and lungs, so regular visits and lab tests are important. Regular follow-up with your rheumatologist is key to keeping the disease under control and lowering the risk of joint damage.^{2, 3}

How our care fits alongside your rheumatologist

Avicenna Functional Medicine does not replace your rheumatologist or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as gut health, nutrition, environmental exposures, sleep, stress and immune regulation, alongside the care you already receive. Our aim is to understand the whole picture of your health and to support your overall wellbeing.^{1, 2, 3, 4}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. Supplements do not replace RA medicines, so check with your rheumatologist before starting any.³

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Tell your rheumatologist about any new or changing symptoms and any medication side effects. Because many RA medicines may raise the risk of infection, ask your rheumatologist which signs of infection they want to hear about right away.^{2, 3}

Telehealth visits with our team are not for emergencies. RA can sometimes inflame the lining around the heart or lungs. Call 911 right away if you have warning signs of a medical emergency, such as:^{1, 4, 5}

• Chest pain or pressure that lasts two minutes or more⁵
• Trouble breathing or shortness of breath⁵
• Sudden confusion, unusual behavior or trouble waking up⁵
• Fainting or passing out⁵
• Sudden dizziness, weakness or changes in vision⁵
• Being unable to speak⁵
• Severe belly pain, or sudden severe pain anywhere in the body⁵
• Coughing up or vomiting blood⁵
• Thoughts of suicide or of harming someone else (you can also call or text 988)^{5, 6}