Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting multiple joints. The synovium, which is the lining of the joints, is the primary site of the inflammatory process, which if untreated leads to irreversible damage to the adjacent cartilage and bone causing pain and stiffness (ref)(ref).

According to Versus Arthritis charity, 430,000 people live with RA in the UK.  In the USA, 1.5 million people are estimated to have RA, and up to 14 million people worldwide (ref)(ref)(ref).

Signs and symptoms of RA

As the immune system mistakenly attacks the synovium (the tissue lining around a joint that produces a fluid to help the joint move smoothly), the synovium becomes inflamed, thicker and makes the joint area feel painful, tender, and swollen. The skin looks red and moving the joint becomes difficult (ref).

In the early stages of RA, joint tenderness, stiffness, and pain are more common rather than redness or swelling. Other early symptoms of RA include:

  • Morning stiffness that lasts for 30 minutes or longer
  • More than one joint is affected, with the same joints on both sides of the body being affected
  • Small joints (wrists, certain joints in the hands and feet) are typically affected first

Many people with RA get very tired or have a lack of energy, usually beyond what’s considered normal tiredness. This is known as fatigue and it’s the most common symptom across all autoimmune conditions. Some people with RA may have a low-grade fever. Dry mouth and eyes can also be present due to inflammation, as well as chest pain and shortness of breath.

RA symptoms may come and go. When they come with a lot of inflammation and pain, it’s called a flare. A flare can last for days or months (ref)(ref).

The difference between osteoarthritis and rheumatoid arthritis

The word arthritis simply means ‘inflammation of the joint’. However, the reasons for that inflammation differ. In osteoarthritis, the cause is ‘wear and tear’ of the cartilage in the joints, which means the condition is more common among the older population. RA is an auto-immune condition, which means the immune system, normally there to protect us, is attacking healthy joints causing inflammation, pain, and other symptoms (ref).  

  • Rheumatoid Artheritis
  • Autoimmune condition
  • Any age, but typically between 40-60
  • Only 1% of the UK population has RA
  • Joints affected symmetrically
  • Fatigue & flu-like symptoms on top of joint pain & stiffness
  • Stiffness worse in the morning and after inactivity
  • Osteoartheritis
  • ‘Wear and tear’
  • More common among the elderly
  • 1/3 of people over the age of 45 are affected
  • Individual joints affected
  • Pain and stiffness of joints
  • Symptoms often occur at the end of the day

Who is at risk from RA?

Women are two to three times more likely to develop RA compared to men. RA can affect adults of any age, although the most common age of onset is between 40 and 60.

Additionally, having one autoimmune condition makes a person more likely to develop another one(s). Approximately 24% of people with RA have at least one additional autoimmune condition, with lupus, psoriatic arthritis, and Sjögren’s syndrome being the most common (ref).

What causes RA?

Although the causes of many autoimmune diseases remain unknown, a person’s genes in combination with infections and other environmental exposures are likely to play a significant role in disease development.
It’s understood that three things are required for autoimmunity to develop.

  1. Genetic predisposition
  2. Environmental factors which are the triggering events (e.g. bacterial or viral infections, food intolerances, toxins such as silica or textile dust)
  3. Intestinal permeability (aka leaky gut)

In terms of environmental factors, viruses such as Epstein Barr, parvovirus B19, retroviruses, or bacteria such as H. pylori and Proteus mirabilis (responsible for UTIs) play a role in genetically susceptible people (ref)(ref).

Cigarette smoking, periodontal disease and respiratory infections also increase the risk of developing RA (ref)(ref)(ref).

Additionally, a high vitamin D intake has been associated with a lower risk of RA. In other words, people with low levels of vitamin D are more likely to develop RA and other autoimmune conditions such as MS or Type 1 Diabetes (ref).

Is RA treatable?

At the moment there is no cure for any autoimmune condition, including RA. Also, there isn’t a treatment that is effective for everyone. Conventional treatment of RA includes 2 main types of medication: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. If a DMARD medication is not effective on its own, biological treatment in a form of an injection can be prescribed. If someone cannot take DMARDS or biological treatments, or if they are not effective, a new type of medicine, called JAK inhibitors, can be suggested. Painkillers and corticosteroids can be also prescribed to relieve pain (ref).

An alternative approach, which can be done alongside medications, is finding and addressing the root cause (the trigger of RA) along with balancing the immune system and calming down the inflammation. By doing so, it’s possible to lessen the severity of the symptoms, or even resolve them.

My approach to RA

Even though rheumatoid arthritis isn’t curable, there is a lot you can do to improve the situation.  As a rheumatoid arthritis nutritionist, I can help you regain a better quality of life and take back control of your health. By changing the way you eat and live, by nourishing your body and brain, it’s possible to improve (and in some cases resolve) the symptoms (ref)(ref).

There are multiple variables that will need to be looked into and addressed, including:

  • Chronic stress
  • Sleep issues
  • Food intolerances and sensitivities, reactive foods
  • Nutritional deficiencies
  • “Leaky gut” and gut health
  • Viral, bacterial, yeast, and parasitic infections
  • Toxins, pollutants, heavy metals, moulds
  • Hormonal imbalances

What to do if you suspect RA

If you are experiencing any of the symptoms mentioned earlier it’s best to speak to your doctor. Because symptoms can come and go, and because there isn’t one test to diagnose RA, doctors (GPs) may not recognise the disorder in its early stages.

RA diagnosis is almost always made or confirmed by a consultant rheumatologist who is trained to identify synovitis, the swelling of joints. The rheumatologist will also take into account:

  • your symptoms & physical examination
  • medical & family history
  • X-Ray, ultrasound scan or MRI to check for inflammation and joint damage
  • blood test results with markers such as Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to check for inflammation. Auto-antibodies such as rheumatoid factor (RF)  and cyclic citrullinated peptide (CCP) can also be checked but they are not present in about 30% of people with RA (ref)(ref).

Where to start?

If you’d like to find out more or have any questions, please book a 30-min free inquiry call. I’ll help you make sense of your condition and honestly advise you about changes that need to be made for you to start reclaiming your health. As a nutritionist specialising in rheumatoid arthritis and an AIP (Autoimmune Protocol) coach, I can help you improve your diet and modify your lifestyle so that you have the best chance of living as comfortably as possible.

Client testimonials

Francesca client testimonial


“After some odd finger pains, unusual blood test results and some suggestions that my symptoms could be related to an auto immune condition [psoriatic arthritis], I sought advice from Anna Pinnock to see if dietary changes could help improve the situation without starting on a course of medication. Anna has been so supportive, knowledgeable and helpful throughout. I am still under medical investigations, but Anna has helped me optimise my nutrition during this period of uncertainty and I have never felt better! I have more energy, my skin is clear, I feel alive and much more mentally alert. I hadn’t realised how sluggish and lethargic I was before until these symptoms cleared.
Anna is guiding me through an elimination diet, where you essentially eliminate foods that are prone to causing inflammation for a given period and then you reintroduce them one by one. The advice Anna has given me has really supported the medical investigations and I have started to notice some links between certain foods and symptoms experienced. By avoiding these foods, Anna has helped me customise a diet plan which works really well for me. I can’t thank Anna enough. I feel so much healthier and I feel I am set up for life!