Does Rheumatoid Arthritis Begin in the Intestine?

It's not widely known, but the results of numerous clinical trials over the last 30 years have pointed to an intriguing connection between rheumatoid arthritis and the intestines. As long ago as the 1940s, Charles de Coti-Marsh in his pioneering research into the causes and treatment of arthritis declared 'the disease begins in the bowel.' Nowadays there is increasing evidence that he was right.

Unfortunately, the connection between arthritis and diet has historically been downplayed, with nutrition never quite making the grade as an object of scientific study. More recently, however, the development of nutritional biochemistry. immunology and pharmacology, as well as ever increasing scientific data on free-radical disease, antioxidants, prostaglandins, and flavonoids have lifted the subject of nutrition out of the realm of anecdotal uncertainty into the province of credible science.

In Joints and Arthritic Disease (2002), Dr Gail Darlington references a number of research projects, for example a study by O'Farrelly which took small intestinal biopsies from 93 patients with rheumatic arthritis (RA) and compared them to those of a control group. The conclusion was that the gut may play a part in the immunopathogenesis of certain cases of RA.

The combination of the development of certain types of gut flora and an increased permeability of the intestine (allowing potentially harmful bacterial antigens into the blood stream) seems to be the key issue. Darlington notes that 'RA patients untreated by nonsteroidal anti-inflammatory drugs (NSAIDs) have normal gastrointestinal permeability, but patients on NSAIDs and perhaps also on disease modifying antirheumatic drugs show increased permeability. Such increased permeability may allow food or bacterial antigens to be absorbed in greater quantities than usual, overwhelming normal gut defences and, possibly producing symptoms of RA.'

What that means is that dietary manipulation could, in theory, reduce gastrointestinal permeability, with reduced absorption bacterial antigens - and perhaps treat one of the causes of rheumatoid arthritis. Despite these findings, and others like them, making dietary changes in order to treat arthritis is considered to be 'alternative', in other words unacceptable to the majority of the orthodox medical community.

Does rheumatoid arthritis begin in the intestine? Quite possibly - there is some evidence to support the theory. However, 'alternative' theories rarely attract commercial interests, which is of course the prime source of research funding. It therefore remains to be seen whether complementary and alternative therapies will ever achieve the status of 'proven' as required by Western science.

Elizabeth Hartland,
Nutritional Therapist,
The Arthritic Association