Does

Vitamin C help benefit Rheumatoid Arthritis?

Introduction

Rheumatoid arthritis is the most common auto-inflammatory disease

globally known. It is also the leading form of inflammatory arthritis and yet making
an accurate diagnosis is often difficult. After reading the previous two statements,
one could only imagine why there is no real definitive answer in detecting
recognition of this disease to a future patient. Why is it that we have no knowledge
of a source that directly stimulates this disease? While our future holds promising
for that one miracle drug, all we can do now is educate ourselves on ways to
neutralize and decrease rheumatic symptoms.

After further researching this study I came to a conclusion asking myself

would vitamin C help prevent rheumatoid arthritis? This particular study interest
me seeing my close uncle suffer from R/A. Antioxidants such as vitamin C help to
control inflammation. My issue is normal inflammation and rheumatic
inflammations are both very different. Other questions to be asked surrounding this
topic may consist of how is inflammation caused and controlled? Which joints are
affected from rheumatoid arthritis? Are there stages to this disease? How would
vitamin C help benefit a suffering patient? Are there tests that can be done to prove
you are a carrier? Last but not least, have there been conducted studies showing
improvement via vitamin C supplementation?

What Is Rheumatoid Arthritis? What is the difference

between normal and Rheumatic inflammation?

Rheumatoid arthritis is an autoimmune disease where the humans natural

occurring antibodies and immune cells attack healthy and functioning bodily tissue.
In an unaffected individual inflammation occurs at the site of injury or infection.
Inflammation comes in forms of warmth, pain, redness, and swelling. Normally, the
amount of inflammation is proportional to the severity of the injury or infection.
Working in conjunction with one another lymphocytes, neutrophils, and
macrophages otherwise known as white blood cells exert themselves to accomplish
controlled inflammation. The white blood cells communicate amongst one another
via chemical messengers called cytokines. Once infection or injury has ceased, white
blood cells retreat and inflammation dissipates.

When a patient suffers from rheumatoid arthritis the stimulus of

inflammation is unknown. There are theories that I will later mention but have yet
to be proven as beneficial evidence. When an antigen (foreign invader) is present in
the body T-cells programmed in the thymus latch on to read its DNA protein capsid.
Once completely read an all out immune response is activated. T and B-cells
representing immunity regulators become overexcited resulting in a continuous
immune response. In rheumatoid arthritis the body never recognizes the lack of a
present antigen and constantly attacks itself. This natural phenomenon can be
visualized as friendly fire in a war zone.

Which joints are affected?

Only joints containing synovial fluid are affected by rheumatoid arthritis.

These joints are known as synovial joints. Once continuous inflammatory responses
are initiated the capsule surrounding the joints begins to swell. An increase in
synovial fluid is sent to this joint which starts to limit its range of motion and
increase stiffness. Some examples of synovial joints are the intercarpals located in
the hand close to the wrist and elbow joint. The three most commons suffering
breakdown in physical activities are shoulders, knees and hips. In the case of
rheumatoid arthritis joints in the hands, wrist, and feet are generally the first to see
emerging symptoms. I will further discuss in detail the breakdown of synovial joints
while explaining the stages of rheumatoid arthritis.

Stages of Rheumatoid Arthritis.

RA can be broken down and synthesized into five different stages. These

stages differentiate depending on the amount of uncontrolled inflammation present.

During stage 1 people generally have no symptoms of any arthritis. The joints
appear normal as if the disease never existed. Patients generally start to see
symptoms at stage 2 when their affected joint or joints begin to swell. It is around
this time when synovitis begins to occur. Synovitis is when the synovium becomes
inflamed. This process is initiated by lymphocytes migrating to the synovial lining.

Still in stage 2 pro-inflammatory responses are continuously sent to the joint

through chemical messengers called cytokines. Tumor necrosis factor (TNF) and

interleukin-1 (IL-1) are the main cytokines associated with inflammation. Cytokines
can actually trick the body by increasing the number of blood vessels being sent to
the synovium. While more blood is being sent to the joint it simply becomes
inflamed.

In stage 3 the synovium (synovial membrane) becomes extremely thick due

to the abundance of white blood cells through the help of cytokines. Transitioning
from stage 3 to stage 4 is when RA takes a serious turn for the worse. Stage 4 is
generally when the inflamed synovium starts to grow over the existing cartilage.
This is called a pannus. A pannus produces collagenases, which are enzymes that
destroy collagen. Collagen is the main protein making up avascular connective tissue
cartilage. Collagenases even initiate bone erosion when the synovitis and bone are
at a cohesive bond.

By stage 5, surrounding bone and cartilage are nearly destroyed. The pannus

continuously produces collagenases, which furthers the breakdown of the joint.

Even worse, the cartilage may very well disintegrate through actions by the pannus.
When this happens swelling will generally disappear because the pannus will have
nothing else to feed on. To make matters worse, tendons and ligaments have been
stretched from all of the swelling. This fact leads to even more instability of an
already corrupted joint.

How does Vitamin C help monitor inflammation?

Reactive oxygen species are chemically reactive molecules containing

oxygen. They form as a natural byproduct of human metabolism. Their roles include

cell signaling and maintaining proper homeostasis. Free radicals are molecules,
atoms, or ions that contain an odd number of unpaired valence electrons throughout
its shell. These may be excessively reactive with other substances in the body and
cause metabolic imbalances in nutrients and hormones.

Operating amidst one another the dynamic duo proceeds to damage the

mitochondria of the cell. In most cases the cell begins a programmed cell death
called apoptosis. When a cell dies a new one replicates soon after. When free
radicals cause serious harm to a cell the point of apoptosis might be unreachable.
Damaged cells act as an open wound. They are susceptible to disease and will
eventually become infected. When these actions continue extensively the body will
fall into a state of oxidative stress. Oxidative stress occurs when free radicals in the
body abundantly exceed our antioxidant levels. This creates homeostatic imbalance
causing everything in our body to work harder to maintain homeostasis.

Vitamin C comes into play by safely inhibiting the oxidation process free

radicals use to corrupt and kill off beneficial cells. Vitamin C also known as L-
ascorbic acid does not allow the free radical chain reaction to progress. While
vitamin C is extremely important its downfall is it can only stop or neutralize a chain
reaction before it starts. On the other hand, an equal to higher valued antioxidant
vitamin E can actually disrupt and break a free radical chain reaction.

If these antioxidants didnt proceed to halt free radical chain reactions

cytokines such as TNF and IL-1 would continue to send pro-inflammatory responses
to the affected joints. While vitamins C and E may not stop antibodies from engulfing

one another they may contribute to inhibiting chain reaction oxidations free radicals
endure through their course of destruction of human cells.

What tests can be done?

To determine whether a patient has rheumatoid arthritis is difficult during

early stages. Many types of arthritic diseases exist and determining your particular
stage and case is complicated. Testing for rheumatoid factor is 80-90% accurate in
diagnosing RA. Rheumatoid factor is a specific antibody found in nearly all RA
patients. The malfunction to this test is this particular antibody can also be found in
patients not having rheumatoid arthritis.

Another test is measuring a potential patients ESR. ESR represents

(Erythrocyte Sedimentation Rate). A physician first extracts a sample of blood from

the surrounding affected joint. After extraction the fresh blood is transferred into a
test tube standing upright. When inflammation is present proteins in the blood
simply force erythrocytes to the bottom of the test tube causing them to settle much
faster than normal. An ESR test is not very effective in diagnosing a patient with the
specific RA disease. Although, it does effectively show when an increased rate of
inflammation is present.

Similar to an ESR test comes a CRP test. CRP stands for C-reactive protein.

Produced by the liver, these proteins are also measured in abundance when
inflammation is present. Last but not least is a biopsy. A biopsy is a small incision
surgical procedure where a piece of the synovium is removed. With the tissue of the

synovium at hand doctors can then look under a microscope to verify whether
antibodies are attacking one another resulting in RA.

Breakdown of my 2 studies.

While conducting research for my topic, I came across two studies that

supported my central thesis. Doctor Nina Mikirova at the riordan clinic in Wichita
Kansas conducted the first. She selected 11 females aged 45-69 all diagnosed with
RA. Their pain levels were measured from a 1-7 scale through strict verbal
confirmation. Their C-reactive protein measurements were also recorded. Based on
these measurements the women either received 7.5, 15, or 25 grams of intravenous
vitamin C solution.

A mean of 9.44.6 mg/L CRP measurement was the initial reading recorded.

The study was conducted over a 100-day period with IV solution given every 33
days. When the study was concluded the womens mean CRPs had decreased to a
6.44.6mg/L. Remember that vitamin C doesnt break a free radicals chain reaction.
It simply stops the reaction form initiation. Vitamin C is not going to stop RAs path
of destruction. However, limiting the extra-unwanted inflammation to the affected
joint or joints will decrease pain and stretching of tendons surrounding the joint.

Doctor Symmons in Norfolk England conducted study number 2. 23,654

individuals were initially seen at the beginning of the experiment. Although this
experiment was to oversee a broad range of medical complications, RA in
association with vitamin C was one of the studies conducted. Of the 23,654 patients
74 were RA positive. Of these 74, 36 of them consumed less than 50mg vitamin C

daily. Nearly all of these 36 patients symptoms worsened to a stage 4 or 5 RA. This
goes to show how vital antioxidants such as vitamins C and E play important roles in
autoimmune diseases such as RA.

Conclusion/ Application

Throughout this study I have learned extensive information pertaining to

rheumatoid arthritis and the role antioxidants play in our body. Vitamin C helps to
decrease inflammation, the immune deficiency scurvy, and promote connective
tissue strength. The science and breakdown of this molecule show how it
neutralizes and progresses to stabilize chemically reactive free radicals. As future
dietitians we need to educate our youth about antioxidants and their benefits
pertaining to healthful well-being. Antioxidant consumption along with proper
exercise may even cure some diseases all together. The future is in our hands. Lets
see what we can achieve.