RAY D. STRAND, M.D.

Specialist in Nutritional Medicine

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Rheumatoid Arthritis
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Arthritis is a degenerative process of the joints. Though it is not a disease that will typically shorten one's life, it will certainly cause significant pain if left untreated. Rheumatoid arthritis can be severely disabling as well.

There has been great interest among researchers for the past 20 years involving the role of oxidative stress in the development of arthritis. Most studies have not separated rheumatoid arthritis and osteoarthritis (degenerative arthritis) when looking at free radical reactions and these diseases. Information provided here is consistent with a comprehensive review article written by Dr. Henrotin in 1992 regarding oxidative stress and how it is involved in inflammatory joint disease. Several recent studies have further established oxidative stress as being the plausible cause of these diseases, thus supporting my recommended treatment.

When researchers study joint fluid extracted from an inflamed joint, they note a significant increase in the number of excessive free radicals. In contrast, fluid from a normal joint, has no free radicals present. Studies have shown a significant increased risk of developing rheumatoid arthritis in those individuals who have low levels of vitamin E, beta-carotene, and selenium. Research has further indicated low levels of vitamin D and vitamin C in patients suffering severe joint disease and in those whose disease progresses much more rapidly than the norm.

Many different factors may be contributors of increased oxidative stress within the inflamed joints. One such factor is a significant inflammatory response within the joint space, especially in those with rheumatoid arthritis. This is an autoimmune disease wherein one's own immune system is essentially attacking the joints. It is this inflammatory immune response that creates all the destructive oxidative stress within the joint. Neutrophils (a type of white cell) are a predominate cell in this inflammatory response and has been shown to release a significant amount of free radicals within the joint space. This causes a marked rise in oxidative stress.

The destruction of the joint in rheumatoid arthritis is also due to the release of certain enzymes within the joint space. These enzymes are under the control of certain cytokines called IL-1 and TNF-a (interleukin 1 beta and tumor necrosis factor alpha). The levels of IL-1 and TNF-a in the joints of rheumatoid arthritis patients are very high. They too create tremendous amounts of oxidative stress. Certain cells from the cartilage of an inflamed joint (called chondrocytes) have also been found to actively generate free radicals. These different sources of increased free radical production cause heightened oxidative stress within the inflamed joint. This overloads the antioxidant defense system of the joint space. The synovial fluid (joint fluid), which is usually very thick becomes thin and all components of the cartilage become damaged as the process of joint destruction begins taking place.

I was taught in medical school that autoimmune diseases were the result of an overactive immune system since the body was essentially attacking itself. Consistent with my training, almost all of the medical therapies that physicians offer patients with an autoimmune disease are based on this premise. This is why most of these patients are placed on chemotherapeutic medications, which primarily suppress the immune system. Medications like Methotrexate, Plaquinil, and Immuran are just a few of the potent medications that are used. Corticosteroids like Prednisone are also used not only because of its strong anti-inflammatory qualities but also because they suppress the immune system. Even though these therapies may help to slow down the damage caused by this autoimmune process, they have serious side effects and can cause significant harm to the patient.

Since specializing in Nutritional Medicine, I have seen amazing results in my patients with autoimmune diseases who are using an aggressive nutritional supplementation program. My only explanation for such unbelievable results in my patients is the fact that they are not dealing with an overactive immune system, but rather a confused immune system.

The immune system is intended to be our reliable protector. It is always checking for self (one's own body) while it is looking for non-self (any foreign substance or abnormal cell). When the immune system finds a virus, bacteria, or foreign body it destroys and eliminates it from the body. However, in autoimmune diseases the immune system actually attacks itself rather than a foreign substance. If it attacks the joint space, a person is diagnosed as having rheumatoid arthritis. If it attacks the bowels, it manifests as Crohn's disease or ulcerative colitis. When the connective tissue is attacked, a person might end up with scleraderma or lupus. If the myelin sheath around the nerve is the target, multiple sclerosis (MS) ensues.

In the case of autoimmune diseases, I believe one's immune system is not able to distinguish self from non-self. Being confused, the body is essentially destroying itself. In addition to treating my patients who are usually already taking traditional medicine with attempts to suppress and shut down the immune system, I administer potent nutritional supplements. In doing so, I am not only building up their NATURAL antioxidant defense systems, but also I am building up their own NATURAL immune system. I find this helps my patients on both sides of the disease.

I believe their immune system becomes less confused and begins to recognize "self" again. This means the immune system more readily identifies outside invaders--not attacking "self" as much. In addition, my patients' antioxidant defense system is also built up to balance out the tremendous number of free radicals being produced. This brings the root cause of the damage--oxidative stress--back under control. Therefore, it is absolutely critical that I place my patients on the most potent antioxidant combination available.

Am I promoting alternative medicine? Absolutely not. I never take my patients off of their medications until they've experienced significant improvement. Nutritional supplementation is always used in tandem with their present medical regimen. They not only tolerate their medications better, but I believe the nutritional supplements actually enhance the pharmaceutical effect of the drugs.

My goal is to have patients improve so much that their rheumatologist or primary care physician is able to decrease or eliminate some or all of their medications. I can't emphasize this enough. No one should stop taking the medications that have been prescribed to him or her by the specialist. Almost all physicians desire to get their patients off of these potent and potentially dangerous medications. However, this decision must involve the personal physician.

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