A Whole Health Approach to Rheumatoid Arthritis

Waking up with stiff, swollen joints that make even simple tasks feel impossible is a daily reality for many living with Rheumatoid Arthritis (RA). As the number one reason people visit Whole Health Rheumatology, we understand that RA is more than just joint pain—it is a chronic autoimmune condition that requires a comprehensive solution.

For too many patients, treatment stops at a prescription pad. While medication is the cornerstone of RA management, the 2022 American College of Rheumatology (ACR) guidelines now formally recognize that exercise, rehabilitation, diet, and integrative interventions should be part of comprehensive care. At Whole Health Rheumatology, Dr. Olga Pinkston is putting this evidence into practice with an approach that addresses your whole health, not just your symptoms.

The "Whole Health" Difference

Healing happens when expertise meets compassion. As a Mayo Clinic-trained and board-certified rheumatologist, Dr. Pinkston has the expertise to handle complex cases of Rheumatoid Arthritis. However, she started this practice to provide the time and attention most patients have never been given, moving beyond rushed visits to a model of care that puts you first.

Our approach is built on the understanding that lifestyle factors can influence disease activity. We don't just treat the condition; we seek to understand your unique needs to craft a care plan that resonates with your lifestyle. This means looking at the "whole picture," including your sleep, stress levels, physical activity, nutrition, and gut health.

An Evidence-Based Path to Remission

The goal of modern RA treatment is remission—or at minimum, low disease activity. Both the ACR and the European Alliance of Associations for Rheumatology (EULAR) recommend a "treat-to-target" approach: starting disease-modifying medications as soon as diagnosis is made, monitoring disease activity closely (every 1-3 months), and adjusting treatment promptly if remission is not achieved.

Our comprehensive care for RA includes:

Disease-Modifying Medications: We use proven medications—including methotrexate, biologics (such as adalimumab, etanercept, and tocilizumab), and targeted synthetic DMARDs (such as tofacitinib and upadacitinib)—to control inflammation and prevent joint damage. These medications remain the foundation of RA treatment and should be started early to take advantage of the "window of opportunity" when treatment is most effective.

Exercise: The 2022 ACR guidelines make one strong recommendation: patients with RA should consistently engage in exercise. Research shows that exercise improves pain and physical function in RA. The type, intensity, frequency, and duration should be tailored to your individual needs and capabilities. Multiple forms of exercise are beneficial, including aerobic, aquatic, resistance, and mind-body approaches like yoga and tai chi.

Mediterranean-Style Diet: The ACR conditionally recommends adherence to a Mediterranean-style diet for RA patients. This dietary pattern emphasizes vegetables, fruits, whole grains, nuts, seeds, and olive oil while limiting added sugars, sodium, highly processed foods, and saturated fats. Evidence shows improvement in pain, though effects on disease activity measures are less consistent. The ACR supports a "food first" approach rather than relying on dietary supplements.

Rehabilitation Services: Physical and occupational therapy can help with joint protection techniques, activity pacing, energy conservation, and fatigue management. The ACR recommends early referral to these services so patients can learn to self-manage their disease.

Additional Integrative Interventions: The ACR conditionally recommends standardized self-management programs, cognitive behavioral therapy, mind-body approaches, acupuncture, massage therapy, and thermal modalities. While the evidence for these interventions is of low to very low certainty, they possess few harms and can help patients cope with the chronic disease aspects of RA.

Tobacco Cessation: Smoking is a known risk factor for RA development and may worsen disease outcomes. Patients who currently smoke should be supported in their cessation journey.

The Gut-Joint Axis: An Emerging Frontier

One of the most exciting areas of RA research involves the connection between gut health and joint inflammation—what scientists call the "gut-joint axis."

Patients with RA have significantly different gut microbiota compared to healthy individuals. Gut dysbiosis—an imbalance in the intestinal microbiome—may contribute to RA through several mechanisms: disrupting intestinal barrier integrity, skewing immune cell balance, inducing molecular mimicry (where bacterial proteins resemble joint proteins), and altering beneficial metabolites like short-chain fatty acids.

The gut microbiome may also influence how well RA medications work. Emerging research in "pharmacomicrobiomics" suggests that gut microbial signatures can help predict treatment responses, including methotrexate efficacy.

What does this mean for treatment? Microbiota-targeted interventions—including probiotics, prebiotics, dietary changes, and potentially fecal microbiota transplantation—are being actively studied as adjuvant therapies for RA. A meta-analysis of randomized controlled trials found that probiotic supplementation significantly improved disease activity scores (DAS28) and reduced inflammatory markers like C-reactive protein in RA patients. However, the current evidence remains insufficient to make definitive recommendations about specific probiotic strains or protocols.

At Whole Health Rheumatology, we stay current with this evolving science. While we don't yet have enough evidence to prescribe specific microbiome interventions, we do consider gut health as part of your comprehensive evaluation—particularly if you have digestive symptoms alongside your joint disease. The Mediterranean diet recommended by the ACR may itself support a healthier gut microbiome.

Lifestyle Interventions Work Best Alongside Medication

It's important to understand that lifestyle interventions do not replace disease-modifying medications—they augment them. An umbrella review of lifestyle medicine and integrative therapies found that exercise was beneficial for functional status in RA with moderate certainty of evidence. Diet interventions showed inconsistent improvements with low to very low certainty evidence. Some non-pharmacological therapies may modestly improve clinical outcomes, but they work best as part of a comprehensive treatment plan that includes appropriate medications.

Patients who optimize these key areas of health alongside their medical treatment often achieve better disease control. While remission isn't guaranteed, addressing multiple factors that influence inflammation gives your body its best chance for healing.

Take an Active Role in Your Health

Our commitment goes beyond managing your disease. We are focused on helping you aim for sustained remission, minimize future flares, and restore your quality of life.

If you are ready for a personalized, proactive approach to your Rheumatoid Arthritis, we invite you to schedule a new patient evaluation. This 60–75 minute visit gives us the time to review your history, talk through your symptoms without being rushed, and create a detailed action plan to help you move forward with confidence.