Rheumatoid Arthritis and Diet

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects more than 1.5 million people in the United States. Joints affected by RA and their severity can vary depending on the individual. Inflammation often occurs in a symmetrical pattern and can also impact organs of the body, such as the heart and lungs. Individuals may experience episodes of remission, as well as "flares", so quality of life and ability to perform certain tasks are often influenced by disease activity. The focus of treatment is preventing RA's progression, while controlling pain and inflammation, and this is often done with a combination of different medications, some of which can affect nutritional status.

Patients and clients with RA are at increased risk for comorbidities, such as cardiovascular disease and osteoporosis. Anemia of chronic disease has also been associated with RA, and individuals may suffer from malnutrition. Because chronic inflammation can elevate metabolic rate, higher energy and protein needs may be needed. Nutrition recommendations should be individualized based on the individual's overall health status, taking into account any additional factors that could impact appetite, food preparation, or feeding.

Currently, there are no evidence-based nutrition practice guidelines for RA. An eating pattern consistent with the Dietary Guidelines is recommended, in general, with a focus on nutrients that present an increased risk of deficiency. These include folate, vitamins B-6, B-12, C, D, and E and minerals calcium, magnesium, selenium, and zinc but will depend on the individual's medication regimen and dietary intake. Foods consistent with a Mediterranean dietary pattern, especially sources of omega-3 fatty acids, like fatty fish, have been encouraged due to their anti-inflammatory properties and role in heart health.

In addition to dietary changes, the use of herbal medicines and other "natural" remedies are commonly used by people with arthritis. Although some herbal remedies and supplements may help in managing symptoms, the American College of Rheumatology does not recommend using them solely to treat RA and offers caution regarding their use. In many cases, there is insufficient scientific evidence regarding their effectiveness and safety, as well as inconsistency with ingredients and amounts depending on the product and manufacturer. Plus, there is also a risk of interactions with prescription medications, so guidance regarding the safe and appropriate use of supplements is an important consideration.

Due to the variability of RA, nutrition interventions will need to be tailored not only to the individual but also to accommodate any changes in disease status. Registered dietitian nutritionists can assist patients and clients with RA by assessing their food preferences, use of dietary supplements, lifestyle and abilities to self-feed and prepare food. Encouraging dietary sources, and/or supplements, for select nutrients based on their medication regimen and elevated risk for co-morbidities is also recommended, as are referrals to other disciplines, such as occupational therapy, when appropriate.

References:

• Escott-Stump S. Rheumatoid Arthritis. In: Nutrition and Diagnosis Related Care, 9th Ed. Chicago, IL: Academy of Nutrition and Dietetics; 2022:881-888.
• Rheumatoid Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 2019. Accessed June 15, 2022.
• Academy of Nutrition and Dietetics. Nutrition Care Manual. Musculoskeletal Conditions, Rheumatoid Arthritis. Accessed June 15, 2022.
• American College of Rheumatology. Herbal Remedies, Supplements & Acupuncture for Arthritis. Updated December 2020. Accessed June 28, 2022.
• Peregrin T; 2019-2020 Ethics Committee. Guidance Regarding the Recommendation and Sale of Dietary Supplements. J Acad Nutr Diet. 2020;120(7):1216-1219. Doi:10.1016/j.jand.2020.05.009.