by K. Molnar-Kimber, Ph.D.
Many websites report that there are no known causes of rheumatoid arthritis. While there is no single cause of rheumatoid arthritis in each one of the 2.1 million RA patients in the US, something triggered the change from healthy to painful joints.
Let’s examine the current theories of the causes of rheumatoid arthritis.
Sometimes rheumatoid arthritis begins with an injury, an infection or another reason.
Many people have injuries to their bones and joints. Most people heal their bones or joints and do not succumb to rheumatoid arthritis. Only 1% of people in the US have rheumatoid arthritis.
Some countries or regions have even lower rates of rheumatoid arthritis.
Why do most people heal their injuries and some, like you and me, get rheumatoid arthritis?
There are several genes that occur more often in rheumatoid arthritis patients than others.
For example, your human lymphocyte antigen (HLA) gene cluster defines how your immune system will attack bacteria, viruses, molds, parasites and other foreign objects that get into your body.
The first HLA allele or type that occurs more often in rheumatoid arthritis patients than the general population was DR4.
In fact, some doctors currently test whether you have the HLA-DR4 allele as part of their diagnosis.
Another HLA allele, HLA-DR1, is often found in rheumatoid arthritis patients that have anti-CCP antibodies.
However, many people with HLA-DR4 or HLA-DR1 do not get rheumatoid arthritis.
Thus, your genes, HLA-DR4 or HLA-DR1 may increase the chances that you get rheumatoid arthritis, but they are not one of the causes of rheumatoid arthritis.
Scientists check the prevalence of rheumatoid arthritis in many sets of identical twins to measure the influence of genes on the onset (beginning) and progression of rheumatoid arthritis.
Based on 3 large studies of identical twins, the chance of both twins developing rheumatoid arthritis was only 12.3% to 21%. That is, both twins had rheumatoid arthritis in about 1 out of 5 cases.
These studies mean that only 1 out of 5 genetically identical individuals to you would be expected to get RA.
Although your genes may make you more susceptible to getting rheumatoid arthritis, your genes are not one of the causes of rheumatoid arthritis.
Thus, environmental factors have a major role in triggering and aggravating your rheumatoid arthritis.
Here are some of the potential causes of RA.
Dr. Leirisalo-Repo concluded that an “infection initiating the process of rheumatoid arthritis is observed in about 20% of patients studied in the early phase of arthritis.” (Curr Opin Rheumatol. 2005 Jul;17(4):433-9)
Many scientists have proposed that infection in susceptible people can be one of the initial causes of rheumatoid arthritis.
Many scientists and physicians have searched for that one infectious agent which causes rheumatoid arthritis.
Let’s pretend that you get infected. Your immune system sees the infectious intruder and responds with macrophages, NK cells, antibodies and killer T cells so it can clear the infection.
Unfortunately, part of your joint tissue such as synovium may look very much like a part of the intruder to your immune system.
In fact, your immune system may have trouble telling your joint tissues apart from the intruder.
Even when your immune system has cleared or rid your body of the intruder, your immune system may be confused. Your immune system may attack that part of your joints that looks similar or is cross-reactive to the intruder. This is called molecular mimicry because part of the molecules of your joints and the intruder look similar to your immune system.
This crossreactivity or molecular mimicry between your joint tissue and a part of the intruder probably triggers your initial immune response to your body's tissues or your autoimmune response.
Your autoimmune response against your own joint tissues is a major hallmark of rheumatoid arthritis.
Thus, an infection in a susceptible person, like you, can be one of the major causes of rheumatoid arthritis.
The following infectious agents are being studied for their role in initiating or aggravating arthritis-like symptoms, including rheumatoid arthritis.
The Hepatitis C virus, Epstein Bar Virus, Human Herpes Virus Type 6, Cytomegalovirus, Herpes Simplex Virus, and Parvovirus B-19 are being studied for their role in development of rheumatoid arthritis or other forms of arthritis.
Several bacteria including subclinical Proteus urinary tract infections, the common disease causing bacteria found in gingivitis, Porphyromonas gingivalis, as well as Mycoplasma arthritidis, Mycoplasma fermentans, Mycoplasma pneumoniae, Ureaplasma urealiticum, and Chlamidia trachomatis are also found to be associated with rheumatoid arthritis in some patients.
At least one researcher found each of these infectious agents (or antibodies reactive with them) in the joint fluid of some rheumatoid arthritis patients at higher levels than in osteoarthritis patients.
However, the incidence of these different infectious agents varies between studies, most likely due to measuring techniques and the patient population.
These studies suggest that infectious agents can be one of the causes of rheumatoid arthritis.
In other cases, joint fluid is infected with Staphylococcus, Streptococcus, or Haemophilus, and the arthritis is then called infectious arthritis.
Interestingly, skeletal evidence suggests that rheumatoid arthritis only became common in the European continent after Christopher Columbus returned from the Americas. This pattern is consistent with Christopher Columbus bringing an infectious agent to Europe from America.
Although infections can be one of the major causes of rheumatoid arthritis, vibrant health thwarts infections from taking hold in individuals.
These observations suggest that other factors which affect your overall health also contribute to inducing rheumatoid arthritis.
As early as 1993, some rheumatologists acknowledged that “There are now sufficient good scientific studies, from the UK and abroad, to suggest that, at least in some patients with RA, dietary therapy may influence at least the symptoms and possibly the progression of the disease.”
Recent scientific data shows that 3 of every 4 rheumatoid arthritis patients who eat foods that they are allergic to, experience significantly more stiffness, pain, tender and swollen joint counts, higher Ritchie's articular index, sedimentation rate, C-Reactive Protein levels as well as higher TNF-alpha and IL-1 alpha levels.
Surprisingly, 1 out of 5 rheumatoid patients whose test results did not detect a food allergy still had worse pain when they ate certain foods.
In addition, several physicians of nutritional medicine or integrative medicine write that food allergies are one of the causes of rheumatoid arthritis.
Several studies indicate an increased risk of rheumatoid arthritis in people with certain diets or levels of vitamins, minerals and other essential nutrients.
The following studies support that one of the causes of rheumatoid arthritis may be low levels of essential nutrients.
In a study of over 57,000 patients, people who ate more fruits and cruciferous vegetables (broccoli, cabbage, cauliflower, brussel sprouts), certain antioxidant micronutrients, particularly beta-cryptoxanthin, and who took supplemental zinc had lower rates of rheumatoid arthritis.
Vitamin B levels, such as vitamin B6 are often low in rheumatoid arthritis patients and often correlate with higher homocysteine levels, a marker of inflammation.
Vitamin B12 levels were also significantly low in 24% of rheumatoid arthritis patients.
Low levels of vitamin D and low vitamin E status are risk factors or increase your chances of getting rheumatoid arthritis.
Copper levels are significantly higher in rheumatoid arthritis patients than controls.
Selenium levels in both blood and the joints are significantly lower in rheumatoid arthritis patients than those of healthy subjects and osteoarthritis patients.
Thus, low essential nutrients make you more susceptible to RA. Low stomach acid which is associated with poorer protein digestion and mineral uptake is often found in rheumatoid arthritis patients.
Taken together, these data indicate that your diet and nutrient levels influence your risk of getting rheumatoid arthritis.
In other words, diet with insufficient vegetables and healthy oils or inadequate digestion of your food is likely one of the causes of rheumatoid arthritis.
In the last 50 years, our world has become more laden with many man-made chemicals including pesticides, organic solvents as chloroform and xylene, dioxins, volatile organic compounds such as formaldehyde, and polychlorinated biphenyls.
In addition, we are more exposed to heavy metals including cadmium, and toxic element mercury, than in previous centuries.
For example, the toxic element mercury gets into the body as a preservative of vaccines, from eating mercury laden fish and potentially from decaying silver amalgam dental fillings.
Most of these toxic substances increase our risk for cancer. Some, like the toxic metal mercury, altered the immune response to the infectious agent Mycoplasma in rodents and increased the incidence and severity of autoimmunity.
Toxic element mercury causes many effects which are found in at least some rheumatoid arthritis patients: adrenal dysfunction, allergy, poor coordination, depression, discouragement, dizziness, fatigue, immune dysfunction, irritability, joint pain, kidney damage, numbness, pain in limbs, tingling, and more.
Rheumatoid arthritis patients have less ability to rid their bodies of toxins due to
low glutathione activity.
In addition, formaldehyde can be used to induce arthritic symptoms in rodents.
Anecdotal reports suggest a role of toxins at least in aggravating arthritis.
Further studies are needed to determine whether accumulation of toxic chemicals in our bodies are one of the causes of rheumatoid arthritis.
In the meantime, your health will likely benefit from avoiding as many toxins as possible.
Dr. F. Batmanghelidj who studied many chronic and acute signals of dehydration in a stress filled environment in Iran has proposed that dehydration is one of the major causes of rheumatoid arthritis.
However, at present there is no clinical evidence whether or not dehydration is one of the causes of rheumatoid arthritis or affects its progress.
His proposal suggests that even mild dehydration can trigger joint pain in some humans. Furthermore, chronic dehydration would lead to damage to the cartilage, inflammation and angiogenesis, which is consistent with being one of the causes of rheumatoid arthritis.
I include it here as “food for thought”. Because of the theory’s simplicity, it probably will not receive funding to be adequately tested in a clinical setting.
However, you may want to monitor your water intake in case that his theory of dehydration may be one of your causes of rheumatoid arthritis.
To study the causes of rheumatoid arthritis and its progression, scientists compare the joint tissues of healthy people with those of rheumatoid arthritis patients.
They also use various methods (including injection with the infectious agent, Mycoplasma or chemicals like formaldehyde) to induce an arthritis-like symptom in susceptible strain (types) of mice. They then compare the immune response to the intruder in healthy animals vs those that succumb to arthritis to find out potential causes of rheumatoid arthritis.
They are finding correlations between many different markers of inflammation, angiogenesis, and rheumatoid arthritis.
Inflammation is one of the body’s ways to heal itself.
Angiogenesis is the body’s method to bring more blood vessels to an area. These blood vessels then bring more fluids, nutrients, water, white blood cells to fight infection and enhance healing, as well as remove waste.
This research helps to further understand the causes of rheumatoid arthritis, the disease process and to identify proteins that occur in rheumatoid arthritis damaged tissue that does not occur in normal tissue.
They then develop inhibitors of the proteins or enzymes that are in too high a concentration in rheumatoid arthritis for use as treatment.
The inhibitors can really help stem the progress of the rheumatoid arthritis in many patients…for a while. However, the inhibitors do not fix the causes of rheumatoid arthritis.
For example, these inhibitors do not replace the missing essential nutrients, do not help your body kill the infectious intruder, do not find out or eliminate the food sensitivities, do not dissolve the toxic deposits, do not reprogram your autonomic nervous system, do not give more water to your joints, nor relieve your stress.
If you've had RA for many years, like me, the initial cause of RA may now be an academic question. However,
One possible approach is to keep a health journal which records your activities, what you ate, the weather, how much water you drink, and minerals you consume.
It's well known that RA patients who play a major role in their healthcare have less pain.
By comparing how I feel with my activities, eating habits, water consumption, surroundings and exercise, I've identified 36 triggers for RA flares so far. And ways to calm each type of RA flare. I'm writing special reports to share the information.
In the meantime, I'd like to help you identify your triggers for RA flares and help you tame them, too.
If you'd like to have a phone consultation, please fill in the easy contact form and we'll arrange a convenient time.
Please note: the information on this website is a sharing of information and knowledge from the research and experience of Dr. Molnar-Kimber and her community. It is not intended to replace your one on one relationship with a qualified health care professional. It also is not intended to be medical advice. However, it is often observed that patients who take a major interest in their disease and learn as much as they can about their disease and potential treatments often improve faster than those who don’t. Dr. Molnar-Kimber encourages you to make your own health care decisions based upon your own research and discussions with your qualified health care professional.
How many events or substances can cause RA or RA flares?
Here in the 2012 Medical Hypothesis paper (volume 78, pg 123-129), we've listed over 36 different events or substances that have been reported to initiate RA in some patients.
Since one or more of these events or substances may trigger RA or an RA flare in a person, I asked how many potential combinations are there?
Thanks to my brother-in-law, Charles Kimber, the mathematics education teacher, we know that there are a lot of combinations of these 36 events or substances. In fact, there's 2 to the 36th power which is more than 68 billion combinations!
So wonder why it's so hard to pinpoint "the cause" of RA!
However, you can check to see if any of the 36 known causes affect your RA.
Because it's easier to give your body what it needs to heal if you know what's wrong.
For example, if you car needs oil, giving it more gas won't help. It needs oil to lubricate its gears and cylinders.
Do different types of causes of RA or RA flares affect the response to therapy?
I think so. That 's how I picked the therapies to help my body heal.
The Medical Hypothesis paper shown above formally proposes this hypothesis.