Detoxification’s Vital Role in Autoimmune Health
Rheumatoid arthritis (RA) is an inflammatory autoimmune condition in which the immune system confuses tissues in the body as foreign, impacting the health of the synovial lining in joints. It is characterized by persistent symmetric arthritis of multiple joints, most commonly the hands and feet. As the immune system mounts a response in the joints, the inflammation may result in warm, swollen and uncomfortable joints. Eventually, the cartilage, tendons, ligaments and bone can be affected, impacting joint function, form and range of motion. As the condition is systemic, some individuals may also have low-grade fevers, fatigue, prolonged morning stiffness, decreased red blood cell production (anemia), and inflammation affecting various other parts of the body.
It is estimated that 1 percent of the population (1 in 100) has RA,1 and the incidence is increasing. Women are approximately three times as likely to have RA compared to men. A recent study conducted between 1995 and 2007 revealed that the incidence increased, specifically in women, during this time period. The data indicates that the prevalence is now up to 1.5 million Americans, up from the previous estimate of 1.3 million. The study authors stated, “The reasons for this recent increase are unknown, but environmental factors may play a role.”2
Determining whether a person has RA can be difficult, as it often has a slow onset and there is no single test that identifies the condition. Determination is often based on a combination of clinical symptoms, blood tests and imaging. Rheumatoid factor (RF) test is a blood test commonly performed to help identify this condition and measures a specific antibody. It is positive in 80 percent of patients with RA, but is also found in other rheumatic conditions. Furthermore, 20 percent of people over 65 years old have an elevated rheumatoid factor. Another test, the anti-cyclic citrullinated peptide antibody (anti-CCP), increases sensitivity when used in combination with rheumatoid factor, and is more specific than rheumatoid factor. Imaging studies such as X-rays are often normal early in the disease process, but later may show changes in the affected joints. Determining the presence of RA is crucial, as 20 to 30 percent of individuals with RA become unable to work within three years of identification of having RA if not taken care of appropriately.3
Environmental and Lifestyle Factors
The cause of RA is unknown. However, researchers have uncovered various environmental and lifestyle factors associated with increased risk of developing the condition. These include hormone imbalances, smoking, environmental toxin exposures, diet and digestive health. Other interesting associations include coffee consumption or having a first-degree relative with specific mental or metabolic issues.4 Genetics play a significant role in the susceptibility to RA and is estimated to account for 50 percent of the risk of developing the disease.5 This statistic is based on twin studies, which show that identical twins both experience the disease in 15.4 percent of cases, compared to only 3.6 percent of dizygotic (fraternal) twins.6 Most researchers are in agreement that the cause is likely a combination of genetic susceptibility and environmental triggers. Although there are numerous factors associated with increased risk, this article will focus primarily on exposure to environmental chemicals, in addition to a few other factors.
Hormones
Sex hormones play a role in the development of RA, which is consistent with the fact that the incidence is disproportionately higher in women. Furthermore, the disease often regresses during pregnancy, returns post-partum and increases around menopause. Research suggests that decreased levels of estrogen, progesterone, dehydroepiandrosterone (DHEA) and testosterone are associated with increased risk of RA.7 Androgen hormones, including DHEA and testosterone, are important immune modulators, and researchers suggest that low levels of these hormones allow for dysregulation of the immune response. Low levels of these hormones have been demonstrated in blood, synovial fluid and saliva in both men and women with RA.8 Studies have shown that low DHEA in subjects with RA correlated to increased levels of the pro-inflammatory cytokines, which are cellular signaling molecules, including interleukin (IL)-6 and IL-12.9 Additionally, estrogen and progesterone are hormones that promote an immune response known as T-helper 2 (Th-2), whereas a deficiency promotes Th-1 response, which is the type of immune response seen in RA.10
Gastrointestinal Health
Diet and related intestinal health may also play a role in the development of RA.
Celiac disease is a digestive condition in which the body mounts an immune response to the intestinal lining upon exposure to the protein gluten, found in wheat and other grains. The antibodies associated with celiac disease are seen in patients with RA at a higher frequency than in the general healthy population.11
In one study, anti-gliadin antibodies, which are antibodies to a portion of the gluten protein, were measured in subjects with RA and healthy controls. The study found anti-gliadin antibodies in 37 percent of the subjects with RA compared to 12 percent of the control subjects.12 Similarly, a study of children and adolescents with juvenile RA showed that 42.8 percent had antibodies associated with celiac disease.13 Another study evaluated subjects with RA for the reactivity of the rectal mucosal lining to gluten and cow’s milk protein. The study showed a strong mucosal reactivity to cow’s milk in 11 percent, a moderate reactivity to cow’s milk in 22 percent, and a moderate reactivity to gluten in 33 percent of subjects.14
Environmental Toxins
Research has found a link between exposure to environmental toxins and the development of RA. In a large study, postmenopausal women were evaluated for RA or SLE and workplace or residential insecticide use. The study found that compared to women that had never used insecticides, personal use of insecticides was associated with increased risk of both autoimmune conditions. For those who used insecticides 6 times a year or more and those that used insecticides for 20 years or longer, there was approximately double the risk of developing RA. Furthermore, there was an 85 percent increased risk with long-term insecticide application by others, and nearly 3 times the risk in women with a farming history exposed to frequent insecticide application by others.15
Another study evaluated the association between persistent organic pollutants and arthritis risk. This study found that RA was more strongly associated with polychlorinated biphenyls (PCBs) exposure than osteoarthritis. In women, the risk of RA increased significantly with increased exposure to PCBs, with as much as 8 times the likelihood of developing RA with the highest exposure to dioxin-like PCBs, over 5-times the risk with exposure to the highest amounts of nondioxin-like PCBs, and over 3-times the risk with the highest exposure to organochlorine pesticides.16
Researchers have also found that exposure to asbestos-contaminated vermiculite from mining in individuals age 65 or older was associated with greater than 3 times the risk of developing RA compared to individuals not exposed to asbestos. Exposure to asbestos from other sources such as occurs in the military was also associated with increased risk.17 In another study, researchers evaluated the association between reported deaths from RA and specific occupations. The study found that individuals involved in farming occupations, farming-related exposures (including animals and pesticides), mining machine operators, and timber cutting and logging were at increased risk of death from systemic autoimmune diseases, particularly RA.18
Detoxification
Some risk factors for RA, such as gender and genetics, cannot be affected. Thus, it is important to address risk factors such as exposure to environmental toxins. Detoxification of the body reduces the total body burden of many unwanted chemicals, which data strongly supports increases the risk of developing RA. Detoxification can also support healthy intestinal function, which also plays a role in RA.
Detoxification should be undertaken regularly. It’s important to realize that when detoxifying the body, one should consider the importance of balance in the phase I and II enzyme systems. If a detoxification method results in an imbalance in these systems, it’s likely to induce an inflammatory imbalance leading to symptoms in people attempting detoxification.
Conclusion
RA can significantly impact quality of life. Data indicates that this condition is increasing in prevalence, particularly in women. Addressing risk factors such as exposure to environmental pollutants can ease the body burden of the chemicals and promote optimal health.
References
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14. Liden M, Kristjansson G, Valtysdottir S, et al. Self-reported food intolerance and mucosal reactivity after rectal food protein challenge in patients with rheumatoid arthritis. Scand J Rheumatol. 2010 Aug;39(4):292-8.
15. Parks CG, Walitt BT, Pettinger M, et al. Insecticide use and risk of rheumatoid arthritis and systemic lupus erythematosus in the Women’s Health Initiative Observational Study. Arthritis Care Res (Hoboken). 2011 Feb;63(2):184-94.
16. Lee DH, Steffes M, Jacobs DR. Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women. Environ Health Perspect. 2007 Jun;115(6):883-8.
17. Noonan CW, Pfau JC, Larson TC, et al. Nested case-control study of autoimmune disease in an asbestos-exposed population. Environ Health Perspect. 2006 Aug;114(8):1243-7.
18. Gold LS, Ward MH, Dosemeci M, et al. Systemic autoimmune disease mortality and occupational exposures. Arthritis Rheum. 2007 Oct;56(10):3189-201.