A Functional Medicine Approach to Rheumatic Disease in the Geriatric Population

The population of seniors is growing, with the number of elderly Americans increasing by 36% between 2009 and 2019. With this growing population of older adults comes an increase in the incidence of rheumatic diseases. Rheumatic disease encompasses arthritis and other conditions affecting the joints, muscles, tendons, ligaments, and bones. The most common rheumatic condition and most common source of chronic joint pain among older adults is osteoarthritis.

Older adults have unique challenges, such as multiple chronic conditions, polypharmacy, cognitive impairment, and frailty, and they often lack social support. For this reason, rheumatic disease in the geriatric population requires a comprehensive, patient-centered approach. Functional Medicine provides a whole-person, patient-centered approach that can address the unique needs of the geriatric population to heal rheumatic disease and promote well-being.

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What is Rheumatic Disease?

Rheumatic diseases are a group of conditions that affect the joints, muscles, bones, and other connective tissues in the body.  

Rheumatic diseases, such as osteoarthritis, rheumatoid arthritis, and gout, are characterized by pain, stiffness, inflammation, and swelling in the affected areas. They can also affect other organs and systems in the body.

Rheumatic diseases can significantly impact the health and well-being of elderly individuals. As we age, our joints, muscles, and bones can become weaker and more susceptible to damage, increasing the risk of developing these conditions. These conditions can limit how the body functions, making it difficult to carry out daily tasks and impacting the quality of life.

These conditions are often treated with medications, physical therapy, and lifestyle changes. However, a multidisciplinary approach, including integrative therapies, is beneficial.

Most Common Rheumatic Diseases Found in Geriatric Populations

The most common rheumatic diseases in geriatric populations include osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, gout, and osteoporosis.

Osteoarthritis is a rheumatic disease involving the joints. It is more common in women than men after the age of 50. Osteoarthritis is characterized by joint pain, swelling, crepitus (a grinding sound heard when joints move), inflammation, and limited movement. Osteoarthritis mainly affects the hands, knees, hips, and spine.

Rheumatoid arthritis is a chronic, inflammatory, autoimmune joint disease. It typically presents between the 4th and 5th decade of life. However, it is becoming more prevalent in adults over 60 and is termed ‘Elderly-Onset Rheumatoid arthritis’ in this population. Rheumatoid arthritis is often debilitating and is characterized by inflammation of the synovial membrane in the joints, along with cartilage and bone destruction.

Polymyalgia rheumatica is an inflammatory disease common in adults over 50 that causes muscle pain and stiffness. It presents as severe and sudden pain and stiffness in the neck, shoulders, upper arms, and hips. This rheumatic disease can be associated with giant cell arteritis, diverticular disease, and vascular damage.

Giant cell arteritis is inflammation of the lining of the arteries that occurs in the elderly, more commonly in women. This condition most often affects arteries in the head, particularly the temples, which is why it is sometimes referred to as temporal arteritis. It is characterized by headaches, jaw pain, scalp tenderness, and impaired vision, which can lead to blindness if left untreated.

Gout is a common rheumatic disease characterized by sudden and severe bouts of pain, swelling, and redness in one or more joints. It occurs most often in the big toe. A buildup of urate crystals in the joint causes the inflammation and pain associated with this condition. High levels of uric acid in the body increase the risk of gout. Factors that can increase the body’s uric acid levels include certain medications and foods such as red meat, shellfish, beer, and fructose.

Osteoporosis is a condition characterized by loss of bone mass, causing them to become weak and increasing the risk of fracture. Older women are at the highest risk of developing this condition.

Systemic Lupus Erythematosus is an autoimmune rheumatic disease in which the body’s immune system attacks its own tissues, including joints, lungs, kidneys, skin, brain, and blood vessels. It occurs more often in women. Weight loss, weakness, and fatigue are often the first symptoms. However, other symptoms, such as arthritis and a malar rash across the cheeks, are also associated with lupus.

Signs and Symptoms of Rheumatic Diseases

Common signs and symptoms of rheumatic diseases include:

• Joint pain
• Muscle pain
• Stiffness
• Limited range of motion
• Swelling
• Inflammation and redness
• Headache
• Scalp tenderness
• Jaw pain
• Vision problems
• Fever
• Fatigue
• Loss of appetite
• Unexplained weight loss
• Loss of height over time
• Stooped Posture
• Brittle bones that fracture easily

Possible Causes of Rheumatic Disease The Geriatric Population

While the exact causes of these diseases are not fully understood, there are a few uncontrollable risk factors that may increase your risk of developing rheumatic diseases.

Age

Many types of rheumatic diseases are more common in older adults, such as osteoarthritis and polymyalgia rheumatica.

Gender

Some rheumatic diseases, such as rheumatoid arthritis and lupus, are more common in women than men.

Genetics

Certain genes, called HLA (human leukocyte antigen) class II genotypes, have been linked to an increased risk of developing rheumatic diseases.

It's important to note that while these risk factors may increase a person's chances of developing rheumatic disease, they do not guarantee that the person will develop the condition. As you will learn in the remainder of this article, there are also several risk factors you can control to prevent these conditions. There are natural therapies and lifestyle-driven treatments to improve your pain, function, and quality of life if you develop them.

Risk Factors for Rheumatic Disease in The Geriatric Population

The risk factors for rheumatic diseases that you can control include:

Weight

Being overweight or obese puts more weight on the joints and increases the risk of developing certain rheumatic diseases, such as osteoarthritis.

Infection

Certain microorganisms, such as bacteria and viruses, can increase the risk of developing certain rheumatic conditions, such as polymyalgia rheumatica and giant cell arteritis.

Injuries

Joint stress, whether from an injury or repetitive stress, can damage the joint and increase the risk of developing conditions such as osteoarthritis.

Smoking

Smoking increases the risk of developing rheumatoid arthritis and osteoporosis.

Physical Activity

Living a sedentary lifestyle has an association with rheumatic diseases. Physical inactivity is associated with increased inflammation, which may explain why sedentary lifestyles increase the risk for these conditions.

Diet

A Western diet composed of poor-quality foods such as unhealthy fats and refined carbohydrates is associated with an increased risk for rheumatic diseases, such as rheumatoid arthritis. This style of eating increases inflammation, insulin resistance, and obesity, which may explain this association.

Vitamin D

Vitamin D deficiency is associated with various rheumatic diseases.

Sleep

Sleep disorders are associated with an increased risk for various rheumatic diseases.

Dysbiosis

An imbalance in the health of the microorganisms in the gastrointestinal tract, gut dysbiosis, is associated with certain rheumatic diseases, such as rheumatoid arthritis, Sjögren's syndrome, and systemic lupus erythematosus.

Functional Medicine Labs to Test for Root Cause of Rheumatic Disease

In addition to imaging tests or procedures required to identify a root cause, your Functional Medicine practitioner may order various functional laboratory tests to determine a root cause for your rheumatic disease.

Comprehensive Stool Analysis

A comprehensive stool analysis offers an in-depth look at the health of the gut microbiome to assess for dysbiosis as a root cause of rheumatic disease. The GI-MAP + Zonulin test by Diagnostic Solutions and the GI Effects® Comprehensive Profile from Genova Diagnostics measures for markers of digestive function to provide a complete assessment of the microbiome.

Rheumatoid Factor (RF)

RF is an antibody that can be measured with a blood test and is associated with certain rheumatic conditions, including rheumatoid arthritis and lupus.

Antinuclear Antibodies (ANA)

ANA are autoantibodies that mistakenly attack the body's own cells and can be measured in a blood test to screen for autoimmune diseases, such as Hashimoto's thyroiditis, as well as certain autoimmune rheumatic conditions, such as lupus.  

C-Reactive Protein (CRP)

CRP is a protein produced in the liver associated with inflammation when levels are elevated. Because rheumatic conditions are associated with increased inflammation, this marker can be a helpful way to test for the presence of inflammatory rheumatic disorders. It's also a valuable marker to indicate the effectiveness of treatment.

Erythrocyte Sedimentation Rate (ESR)

ESR is a blood test that measures the rate at which red blood cells settle to the bottom of a test tube. Inflammation causes red blood cells to cluster together and sink to the bottom of the tube more quickly. This marker and CRP are often used to identify the presence of inflammatory rheumatic diseases and monitor how effective treatment is.

Uric Acid

Uric acid is a marker that can be tested in the blood and is helpful in the diagnosis of gout.

Vitamin D3

Vitamin D3 deficiency is associated with various rheumatic conditions, making it an essential addition to the laboratory workup in identifying a root cause.

Blood Workup

Comprehensive blood testing, such as a CMP and a CBC with differential, can provide helpful indicators as to the overall health of the body and whether an infection is present. If an infection is identified, further blood testing can be performed to identify the specific microorganism.

Sleep

If sleep disturbances are present, a urine test, such as the ZRT Laboratory Sleep Balance Profile, may help identify a root cause since sleep issues are associated with rheumatic diseases. Your practitioner may also suggest going to a lab for an in-depth sleep study.

Conventional Treatment for Rheumatic Disease

Conventional treatment for rheumatic diseases often involves the use of pain medications, non-steroidal anti-inflammatory drugs (NSAIDs), or glucocorticoid steroid medications such as prednisone. Disease-modifying antirheumatic drugs (DMARDs) are medications often used to treat autoimmune rheumatic conditions, such as rheumatoid arthritis.

Functional Medicine Treatment of Rheumatic Diseases

Functional medicine treatment of rheumatic diseases in the geriatric population focuses on non-pharmacologic, lifestyle-based therapies to support overall health and promote well-being.

Lifestyle factors that should be considered include smoking cessation, sleep optimization, and avoiding repetitive stress injuries.

Exercise is another lifestyle practice that significantly benefits older adults with rheumatic diseases. Exercise can improve endurance, strength, and aerobic capacity in older adults with rheumatic disease, improving function and allowing older adults to be more independent. Exercise also helps maintain a healthy weight, keeping the excess weight from stressing the joints and increasing the risk for these conditions. Resistance training, in particular, is known to help prevent bone loss and even build new bone.

Best Diet for Rheumatic Diseases

The best diet for rheumatic diseases is an anti-inflammatory eating style, such as the Mediterranean Diet. The Mediterranean Diet mainly comprises vegetables, fruits, whole grains, legumes, fish, extra-virgin olive oil, herbs, and spices, a moderate intake of red wine, poultry, dairy, and eggs, and low consumption of refined sugar and red meat.

Rheumatoid arthritis patients that consumed a Mediterranean Diet for two years had reduced levels of inflammatory activity, improvements in physical function, and better vitality than those in the control group. A Mediterranean Diet is also known to support a healthy gut microbiome, making it an excellent dietary choice for people with dysbiosis included as a root cause of rheumatic disease.

Supplements for Joint Pain and Joint Health

There are many supplements that functional medicine practitioners use to support healthy inflammation, joint, and connective tissue health in patients with rheumatic diseases. In addition to the supplements noted below, green tea, borage oil, and rosemary have been shown to reduce pain and inflammation in patients with rheumatoid arthritis.

Omega-3 Fatty Acids for Rheumatic Disease

Evidence indicates that omega-3 fatty acids are protective against rheumatic conditions. This is due to their anti-inflammatory properties. A prospective cohort study of women showed an omega-3 intake of more than 0.21 g/day was associated with a 35% decreased risk of rheumatoid arthritis. A high-dose regimen of omega-3 fatty acids of 3 to 5 grams per day was shown to be helpful in rheumatoid arthritis patients.

Curcumin for Rheumatic Disease

Curcumin is a compound found in turmeric that has been shown to alleviate symptoms in people with joint arthritis. Curcumin reduces inflammation and modulates the gut microbiota, both beneficial for those with rheumatic disease.

Probiotics for Rheumatic Disease

Probiotics have been shown to support a healthy gut microbiome and are an essential consideration for those suffering from rheumatic diseases, with dysbiosis contributing to the root cause. Some studies have shown probiotic supplements to help reduce inflammatory markers and improve symptoms in people who have rheumatoid arthritis.

Vitamin D for Rheumatic Disease

Vitamin D deficiency is associated with rheumatic diseases, indicating the importance of achieving optimal Vitamin D status in the functional medicine treatment of these conditions.

Boswellia Serrata for Rheumatic Disease

Boswellia Serrata extract is an herb known for its anti-inflammatory properties. A double-blind, placebo-controlled human trial showed Boswellia reduced pain and stiffness, improving physical function in patients with osteoarthritis. It also reduced levels of CRP in the blood, indicating a reduction in inflammation.

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Complementary and Alternative Medicine for Rheumatic Diseases

Tai chi is a Chinese practice that combines slow, gentle movements with deep breathing and meditation with a relaxing effect. Tai chi may be a safe and effective movement therapy for older adults with rheumatic diseases as it has been associated with improvements in rheumatoid arthritis disease activity.

Meditation is an effective stress-management strategy with many benefits for overall health. It’s also been shown to reduce pain, making it another safe option for older adults with rheumatic disease.

Hatha yoga has been shown to benefit older adults with osteoarthritis by improving symptoms and function.

Acupuncture therapy is a Traditional Chinese Medicine treatment using tiny needles at various points on the body to promote balance in the body. Acupuncture is an effective and safe way to relieve pain in older adults with osteoarthritis.

Massage therapy offers a safe and gentle approach to relief for older adults with rheumatic diseases. This study revealed the positive effects for older adults with osteoarthritis by improving their ability to perform their activities of daily living after receiving a massage.

Summary

Rheumatic diseases can significantly affect older adults, reducing mobility, function, and quality of life.

A functional medicine approach to rheumatic disease in the geriatric population provides a patient-centered way to identify the underlying cause of their condition and address their unique needs. It offers non-pharmacologic and lifestyle-driven options for pain relief and well-being for those suffering from rheumatic diseases.

Talk to your functional medicine practitioner about ways to support your joint and connective tissue health as you age!