Vitamin C in Rheumatoid Arthritis (SQ-134)
Vitamin C as a well-known micronutrient that plays a particularly important role in improving immunity, wound healing and iron absorption. This powerful antioxidant also helps in keeping your bones, heart, skin and eyes healthy.
Your body is incapable of making its own vitamin C. You must get it from diet and supplements. Vitamin C deficiency can cause fatigue, increased susceptibility to infections and slower wound healing.
Can vitamin C also help in rheumatoid arthritis (RA), an autoimmune disorder that involves joint damage and causes pain and joint deformity?
Vitamin C has several important functions which may help prevent or slow down the progression of rheumatoid arthritis. Studies also show that vitamin C may help reduce pain and inflammation in RA and protect against cartilage and joint damage.
In this article, let us look at the role of vitamin C in rheumatoid arthritis as well as in general bone health.
What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic disorder that causes joint inflammation, pain and deformity. It is an autoimmune disease where the cells of your immune system start attacking its own healthy joint tissues.
While it mainly attacks the lining of the joints, in severe cases RA can also affect other organs such as eyes, lungs, heart, and blood vessels. This can give rise to other health conditions such as rheumatoid nodules, heart disease, lung disease, and eye disorders. The bent or mishappened joints can even cause pressure on your nerves, leading to nerve pain.
Symptoms and Causes of Rheumatoid Arthritis
Symptoms of rheumatoid arthritis include pain, swelling and stiffness in affected joints, especially after a period of inactivity. The stiffness is generally worst in the morning.
It is difficult to catch on the symptoms in the early stages, but as the disease progresses, the inflammation gradually causes the bone to erode and move the joint away from its normal position – leading to chronic pain, deformity and loss of joint function.
One of the other main symptoms is that rheumatoid arthritis usually affects joints in both sides of the body. This important characteristic differentiates it from osteoarthritis, another form of arthritis that is caused by wear and tear of joints as you age.
One may experience flare-up episodes, where pain and swelling in your joints may get worse. Sometimes, pain and swelling resolve on its own, in what is known as periods of remission. This usually happens in early RA.
Other symptoms of rheumatoid arthritis include fatigue, low-grade fever, loss of appetite and dry mouth.
Rheumatoid arthritis is more likely to affect women. And a family history of RA increases your risk of getting the disease. Obesity and cigarette smoking are two other important factors that can increase the risk of developing the disease or making it worse.
Medication, diet, physical therapy and right exercises can prevent or slow the disease progression. In some cases, surgery can be used to repair the damaged tissue.
“Rheumatoid arthritis is an autoimmune disorder that causes joint pain and inflammation. Medication, exercise and diet can play a role in slowing down the disease.”
Can Vitamin C help in rheumatoid arthritis?
Let us look at how vitamin C works inside our body, especially towards your bone health.
1. Acts as co-factor in collagen synthesis
Collagen is the major structural protein in the connective tissues such as skin, arteries, cartilage, ligaments, tendons and bones. It is also present in the teeth and cornea of your eye. Collagen holds your internal tissues and organs together and provides them structure and strength. You cannot make this important protein without the help of Vitamin C.
Vitamin C works as an essential cofactor for the two enzymes needed for collagen synthesis. It builds, maintains and repair collagen fibres. In this capacity, vitamin C plays an especially important role in strengthening your bones.
The bone tissue is composed of minerals that are deposited around a protein matrix which is predominantly made of collagen. Having plentiful and healthy collagen means you have a strong ground for bone mineralization, leading to strong bones. This bone matrix also contains proteins other than collagen and vitamin C helps in the synthesis of these proteins too.
Studies show that vitamin C also plays an essential role in the healing of musculoskeletal tissues, such as bone. 
“Vitamin C is required for synthesis of collagen, a strong fibrous protein in bone and other connective tissues. It improves mineral density in the bone, and aids in the growth, repair and healing of bones, ligaments and cartilage.”
2. Works as an antioxidant and anti-inflammatory
It is seen that patients with rheumatoid arthritis have high oxidative damage. RA is an autoimmune and inflammatory disease, where the immune system attacks the synovium — a thin membrane that lines the inner surface of capsules surrounding your joints.
This abnormal immune response triggers inflammation within the joint, causing the synovium to become thick and inflamed. Inflammatory chemicals that are released in the process damage the affected ligaments, tendons, cartilage and bone. The joint starts losing its alignment and may appear bent or crooked.
Controlling inflammation and oxidative damage can go a long way in protecting joint tissues from damage. Vitamin C is a powerful antioxidant, and it can reduce the production of chemicals that cause inflammation and oxidative stress, the main feature of rheumatoid arthritis.
A 2019 study highlighted the importance of antioxidants in RA. It concluded that antioxidant micronutrients, such as zinc, vitamin C, magnesium, and selenium may reduce inflammation and improve the function of antioxidants enzymes in RA patients. 
Osteoarthritis is another form of arthritis, where vitamin C may help. OA is a chronic disease caused by the breakdown of cartilage – a flexible tissue around the end of the bones in our joints.
Cartilage cushions the bones and reduces friction between the moving joints, leading to smooth movements. Wear and tear over time damages cartilage and can result in osteoarthritis, causing painful and stiff joints. Age, heredity, joint injuries, infections and being overweight are the main causes of OA.
While rheumatoid arthritis is known as inflammatory arthritis, osteoarthritis is generally classified as a non-inflammatory condition. However, this line of thought is changing.
Inflammation may or may not cause osteoarthritis, but degeneration of cartilage may activate immune responses over time and trigger inflammation, causing symptoms like redness and swelling as the disease progresses. This leads to further cartilage damage, leading to a vicious cycle of tissue break-down, inflammation and pain. Studies have found that inflammation is present in the very early stages of osteoarthritis and may play a big role in how the disease advances.
Studies show that vitamin C may reduce the risk of cartilage loss and progression of osteoarthritis, due to its antioxidant properties.    A 2019 study found that vitamin C may prove helpful in reducing symptoms in people with knee osteoarthritis. 
“Vitamin C is an antioxidant and controls inflammation, a hallmark of rheumatoid arthritis. It may also help in reducing symptoms in osteoarthritis, where resulting inflammation contributes to disease progression and painful symptoms.”
Vitamin C may also reduce the risk of osteoporosis and fractures
Studies show vitamin C supplements may reduce the risk of fractures in elderly, especially postmenopausal women.
As women reach menopause, their oestrogen levels drop, and bone health takes a hit. Oestrogen works in several other ways to protect your bone health. For example, it stimulates the activity of cells that produce bone. Oestrogen maintains the balance between bone formation and bone loss and helps regulate bone turnover.
Loss of oestrogen leads to reduced bone density over the years and impacts the natural bone repair process. This increases the risk of osteoporosis, where bones become weak and susceptible to fractures.
Vitamin C help maintain the bone mineral density and can reduce the risk of hip fractures in older adults.   
A new research published in the journal Nutrients also found that vitamin C may benefit your bone health. The study highlights the role of vitamin C in bone growth and in increasing mineral density. 
“Preliminary research strongly suggest that Vitamin C is useful for bone health and may reduce the risk of osteoporosis and fractures in the elderly, especially in the post-menopausal women. Menopause accompanies reduced oestrogen levels and oestrogen supports bone health in a number of ways, including maintaining bone density.”
Vitamin C and pain
One of the main symptoms of rheumatoid arthritis is the debilitating pain in joints. This is where vitamin C can help.
Vitamin C deficiency disease - scurvy - presents many symptoms including tiredness, weakness, and pain in joints and muscles. In severe cases, it can also cause bleeding into the joints and muscles, leading to excessive joint pain, painful swelling and tenderness. Studies have also linked low levels of vitamin C with spinal pain and pain associated with arthritis and rheumatoid arthritis. 
Outright deficiency is rare but is common in people with cancer, severe infections and surgical trauma. People with Crohn's disease and ulcerative colitis, and those on a restricted diet can also become vitamin C deficient.
Quality Vitamin C supplements will help with debilitating pain, arising due to vitamin C deficiency. Studies show that vitamin C can reduce pain and improve quality of life in a number of health conditions including cancer, post-surgery, chronic regional pain syndrome and neuralgia.
How does vitamin C work as an analgesic?
Many theories are proposed.
Vitamin C is an antioxidant and also shows anti-inflammatory properties, and thus helps to decrease inflammation markers in the body. In addition, vitamin C helps in the production of brain hormones such as serotonin and norepinephrine, and both these hormones are involved in pain control mechanisms.
A 2017 study published in the Journal of Translational Medicine provided some new insights into how vitamin C may relieve pain. 
Researchers speculated that vitamin C works like opioids in reducing pain. Vitamin C increases the synthesis of endomorphins, chemicals that work as natural pain killers and are also known for their anti-inflammatory properties.
Researchers also noted that vitamin C may be required in the synthesis of calcitonin, which has been used to treat osteoporosis for decades. Calcitonin reduces bone pain and pain associated with Paget’s disease and complex regional pain syndrome. It is believed that calcitonin may enhance the release of endorphins, feel-good chemicals that play an important role in relieving pain.
“Studies show that vitamin C can reduce pain. This could be due to its anti-inflammatory properties or its role in producing neurotransmitters that play a key role in pain control. Recent studies suggest that vitamin C may increase the synthesis of endomorphins, neurochemicals that naturally reduce pain and inflammation.”
Other health benefits of vitamin C
Vitamin C is known for its antioxidant and anti-inflammatory powers. In addition, it plays a crucial role in building, maintaining and repairing collagen – a protein that provides structure to all your connective tissues. It also stimulates the production of white blood cells. All these properties are the reasons why vitamin C offers such amazing benefits to your health:
- Boosts immunity
- Helps in iron absorption and keeps anaemia at bay
- Keeps your heart, skin, bones, and eyes healthy
- Speeds wound healing
- Involved in healing and repair of damaged tissues
- Helps in folic acid synthesis
- Involved in the synthesis of neurotransmitters
Since you can’t make your own vitamin C, it is important that you include vitamin C-rich foods in your diet. Most fresh fruits and vegetables provide healthy amounts of vitamin C. However, cooking destroys most of the vitamin present in the food. In addition, smoking, infections, stress, and certain health conditions can deplete the vitamin from the body, leading to low vitamin C levels in the blood. Consult your doctor to find out if you need vitamin C supplements to support your health.
If you have any form of arthritis, get in touch with your doctor to determine if quality liposomal vitamin C supplements can help you in reducing inflammation and painful symptoms.
- DePhillipo et al. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. Orthop J Sports Med. 2018
- Arablou et al. Association between dietary intake of some antioxidant micronutrients with some inflammatory and antioxidant markers in active Rheumatoid Arthritis patients. International Journal for Vitamin and Nutrition Research. 2019.
- McAlidon et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996
- Li et al. Associations between dietary antioxidants intake and radiographic knee osteoarthritis. Clin Rheumatol. 2016
- Chang et al. Ascorbic acid provides protection for human chondrocytes against oxidative stress. Mol Med Rep. 2015
- Ripani et al. Vitamin C May Help to Reduce the Knee’s Arthritic Symptoms. Outcomes Assessment of Nutriceutical Therapy. Med Arch. 2019
- Morton et al. Vitamin C supplement use and bone mineral density in postmenopausal women. J Bone Miner Res. 2001
- Sahni et al. Protective effect of total and supplemental vitamin C intake on the risk of hip fracture - A 17-year follow-up from the Framingham Osteoporosis Study. Osteoporos Int. 2009.
- Kim et al. Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int. 2015
- Brzezińska et al. Role of Vitamin C in Osteoporosis Development and Treatment—A Literature Review. Nutrients. 2020
- Dionee et al. Serum vitamin C and spinal pain: a nationwide study. Pain. 2016
- Anitra C. Carr and Cate McCall. The role of vitamin C in the treatment of pain: new insights. Journal of Translational Medicine. 2017.