Diet is an important measure in the management of rheumatoid arthritis patients. Some of the diet and nutrition related concerns and factors affecting patients with this condition include:-
- Maintenance of a healthy body weight
- Incorporating fats in diet
- Incorporating antioxidants in diet
- Incorporating minerals and vitamins in diet
Maintenance of a healthy body weight
Obesity and weight gain is a problem that may affect the joints in several ways. Excessive body fat predisposes one to inflammation worsening rheumatoid arthritis. Excessive body weight leads to raised markers of inflammation such as C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Obesity and being overweight also raises the pressure over the weight bearing joints like knees, hips, ankles etc.
Weight loss to achieve a healthy body weight is desirable. Towards this end the energy intake must be less than energy expenditure. To reduce body weight intake portions may be reduced, high fat foods may be eliminated from diet and high fat foods may be substituted with lower-fat versions. Eating leaner meats, using low-fat cooking methods such as baking and grilling and eating plenty of fruits and vegetables are advised.
Becoming underweight after diagnosis of rheumatoid arthritis is another common feature. This is due to multiple reasons including:
- loss of appetite
- inability to feed oneself or prepare food as the disease progresses
- side effects of the medications
- side effects of depression associated with disability
In severe weight loss there is loss of muscle and fat tissues. With loss of muscles daily activities are further hampered. With unplanned and severe weight loss the patient soon becomes frail and ill. To prevent weight loss a healthy balanced meal that is taken in small portions is advised. Smaller portions of nutrient dense and energy rich foods are advised. These include fish, cheese, eggs, dairy products and meats. Energy and nutrient rich drinks such as milk and milk-based drinks and fruit juice is advised.
Incorporating fats in diet
There are several varieties of foods with beneficial fats that can help patients with rheumatoid arthritis. The fats consumed in diet are broken down into 4 different types of fatty acids – saturated, trans, monounsaturated and polyunsaturated. Of these saturated and trans fatty acids are considered harmful for the body while monounsaturated and polyunsaturated are desirable and beneficial.
Polyunsaturated fatty acids may be of two types - Omega-3 and Omega 6 fatty acids. Omega-3 fatty acids are found in oily fish such as tuna, salmon, sardines, anchovies, herring, mackerel etc. as well as in flaxseed, walnuts, canola oil etc. These help in reducing the production of markers of inflammation in the body.
Omega 3 fatty acids also relieve joint pain and stiffness in rheumatoid arthritis. These agents act similar to non-steroidal anti-inflammatory drugs (NSAIDs) and also prevent platelet aggregation.
Omega-6 fatty acids are found in seeds, nuts and vegetable oils such as sunflower, safflower, corn, sesame etc. Omega-6 fatty acids are not thought to be beneficial in rheumatoid arthritis.
Incorporating antioxidants in diet
Inflammation is a complex process that gives rise to free radicals. These free radicals are highly damaging. Antioxidants protect against free radical damage. In diet antioxidants are obtained from vitamin C, vitamin E and β-carotene. These agents are found in high amounts in fruit and vegetables including apples, oranges, spinach, tomatoes, blueberries, cherries, carrots, broccoli and other brightly coloured vegetables etc.
Incorporating minerals and vitamins in diet
- Calcium is essential for all patients of arthritis as it helps maintain healthy bones. Those with rheumatoid arthritis are prone to develop osteoporosis or brittle and fracture-prone bones. Calcium helps prevent that. Milk and dairy products are excellent sources of calcium.
- Vitamin D is also involved in maintaining the calcium balance in the body and bones. Vitamin D is also important for helping the body to absorb calcium. Vitamin D can be obtained from eggs, oily fish and exposure to sunlight.
- Iron - anemia is a common feature of persons with rheumatoid arthritis. This is caused both by medications used in the condition as well as inflammatory flare ups. Iron is essential to prevent and treat anemia. Iron is obtained in diet from red meats, poultry and fish and from green leafy vegetables, legumes and seeds.
- Folic acid – this is a vital nutrient for patients who are taking methotrexate. Folate helps in making the new cells in the body. Methotrexate may lead to folate deficiency that must be replaced with supplements. Foods with folate include green leafy vegetables, pulses, fortified cereals etc.
- Glucosamine and chondroitin supplements are not useful in patients with rheumatoid arthritis and should not be used. These agents help in repair and maintenance of cartilage and are useful in patients with osteoarthritis rather than rheumatoid arthritis.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)