Rheumatoid Arthritis Diet – Food & Nutrition Guidelines

The main function of body’s immune system is to protect the body against foreign invaders such as bacteria and viruses. But when your own immune system attacks your own body mistakenly, it leads to the onset of autoimmune diseases. Rheumatoid arthritis is one such clinical disorder in which body’s immune system mistakenly attacks the joints. This further causes pain, inflammation and stiffness of the joints. The tissue that lines the inside of the joints is called the synovium. This synovium produces a lubricating fluid called the synovial fluid. Synovial fluid acts as a lubricant and helps the joints to move smoothly. Rheumatoid arthritis causes inflammation and thickening of synovium. Such a thickening causes swelling and pain in the joints. If such condition is ignored, it may further damage the cartilage. In a joint, the ends of the bones are covered with an elastic tissue. This elastic tissue is called cartilage. Furthermore, if this is not treated properly it may lead to loss of cartilage. Therefore, an early diagnosis and proper treatment is required to prevent an irreversible loss. Approximately 1% of the total population in the developed countries are affected by rheumatoid arthritis. Rheumatoid arthritis commonly affects joints of-

1. Wrists
2. Knees
3. Elbows
4. Hands
5. Feet
6. Ankles

Symptoms of Rheumatoid Arthritis

Presence of four or more symptoms confirms the presence of rheumatoid arthritis.

1. Joint pain
2. Stiffness of joints
3. Morning stiffness in and around the joints that may last for an hour
4. Warm and swollen joints
5. Fever
6. Fatigue
7. Weight loss
8. Presence of rheumatoid nodules

Causes of Rheumatoid Arthritis

• Genes: Individuals with a family history of rheumatoid arthritis are a greater risk.
• Environment: Environmental factors and infections can trigger rheumatic arthritis in individuals who are genetically predisposed to it.
• Hormones: Hormones play an important role in the onset and severity of rheumatic arthritis. For example, an improvement in the symptoms of rheumatoid arthritis is seen during pregnancy, but post-delivery the severity of rheumatoid arthritis may increase and the condition may deteriorate.

Risk Factors of Rheumatoid Arthritis:

• Smoking: Research has shown a positive association between cigarette smoking and development of rheumatoid arthritis in men. In addition to this, it was observed that smoking was linked to the production of rheumatoid factor. This rheumatoid factor precedes the development of rheumatoid arthritis.
• Gender: Rheumatoid arthritis is more likely to develop in females as compared to males.
• Family History: The risk of developing rheumatoid arthritis increases in individuals who have first-degree relatives (especially females) affected with rheumatoid arthritis. In addition to this, mothers with rheumatoid arthritis predispose a greater risk of developing rheumatoid arthritis on their offspring (sons and daughters) more than fathers develop.
• Age: Though rheumatoid arthritis can occur at any age, it is more likely to affect individuals between 40 to 60 years.

Complications of Rheumatoid Arthritis

Risk of Cardiovascular Diseases: Research has shown that individuals with rheumatoid arthritis are at a greater risk of developing coronary heart disease as compared to individuals without rheumatoid arthritis. Such patients are less likely to have symptoms of angina and have a higher risk of sudden death. Another study showed that individuals with rheumatoid arthritis had increased markers of inflammation, which further increases the risk for cardiovascular death. ⁽¹⁾

Risk of Lung Disease: There are a variety of pulmonary diseases, which may be seen in patients with rheumatoid arthritis, these include:

• Interstitial lung disease
• Pleural thickening and pleural effusions
• Vasculitis
• Pulmonary hypertension

Among all the lung diseases, interstitial lung disease is the most common manifestation of rheumatoid arthritis. Two autoantibodies are present in patients with rheumatoid arthritis. These autoantibodies are linked to the development of interstitial lung disease and airway disease. Thickening of pleura and pleural effusion is more common in males with rheumatoid arthritis who are more than 35 years of age. Females or subjects with severe rheumatoid arthritis are at an increased risk of developing airway disease. These patients may have symptoms such as dysphagia (inability to swallow food) and throat pain. Therefore, a soft diet maybe recommended to these patients. ⁽²⁾

Osteoporosis: Research has observed that individuals with rheumatoid arthritis have a lower bone mineral density as compared to individuals without rheumatoid arthritis. In addition to this, individuals with severe or long-standing rheumatoid arthritis have greater bone loss as compared to healthy individuals. ⁽³⁾

Tests & Diagnosis

Physical exam: Your doctor or health care provider may first ask you about your family history of rheumatoid arthritis as well as the presence and severity of symptoms. Your each joint may be examined and the doctor may look for swelling, pain, redness, tenderness, stiffness, reduced flexibility and presence of rheumatoid nodules.

Blood tests: Blood tests look for antibodies that are linked to rheumatoid arthritis and level of inflammation. High levels of markers of inflammation such as C-reactive protein and erythrocyte sedimentation rate may indicate inflammatory process in the body. The presence of antibodies such as rheumatoid factor and anti-CCP may confirm the presence of rheumatoid arthritis.

Imaging tests: Various imaging tests such as x-rays, MRI scan or ultrasound may help to track joint damage, narrowing of joint space and loss of bone. If the imaging tests are normal and show no abnormality, it may mean that rheumatoid arthritis is at its initial stage and has not yet severely affected the joints. Thus, early detection and proper treatment is very important.

Nutrition in Rheumatoid Arthritis

Increase Your Intake of Vitamin D

A research published in 2012 has shown that a decreased intake of vitamin D is associated with increased susceptibility of developing rheumatoid arthritis. Furthermore, it was also observed that patients with rheumatoid arthritis were deficient in vitamin D. Therefore, vitamin D supplementation or foods rich in vitamin D should be consumed by individuals with rheumatoid arthritis for prevention of osteoporosis and pain relief. Thus, increased intake of vitamin D is inversely associated with rheumatoid arthritis. ⁽⁴⁾

Foods Rich in Vitamin D Include:

1. Mushroom
2. Foods fortified with vitamin D
3. Sunshine – 30 minutes a day

Increase Your Intake of Zinc

A research published in 2012 has shown that reactive oxygen species play a vital role in the development of rheumatoid arthritis. One such reactive oxygen species is ‘superoxide radical’. To eliminate superoxide radical from the body and to protect the body, a zinc-containing enzyme is required named ‘superoxide dismutase’. Zinc is required for proper functioning of superoxide dismutase in the body. ⁽⁵⁾

Foods rich in zinc include:

1. Nuts and oilseeds
2. Lentils
3. Beans
4. Spinach

Add Omega-3 Fatty Acid to Your Diet

Consuming omega-3 fatty acid has shown to reduce morning stiffness. It also reduces tenderness of joints in individuals with rheumatoid arthritis. Omega-3 fatty acid has shown to reduce the mediators of inflammation that are thought to contribute to inflammatory events that commonly occur in rheumatoid arthritis. Therefore, individuals can either consume a diet rich in omega-3 fatty acid or consume omega-3 supplements daily. However, these supplements should not replace the drugs that are prescribed for the treatment of rheumatoid arthritis. ^{(6, 7)}

Foods rich in omega-3 fatty acid include:

1. Flaxseeds
2. Walnuts

Follow a Mediterranean Diet Pattern

In recent years, research has observed various health benefits of following a Mediterranean diet pattern and such diet pattern has found to have many beneficial effects in individuals with rheumatoid arthritis.

A Mediterranean diet pattern includes loads of plant foods such as whole grains cereals, pulses, legumes, nuts and oilseeds, fruits, vegetables, and fatty fish. The type of oil used for cooking is olive oil, which is rich in monounsaturated fatty acid (healthy fat).

In addition to this, herbs and spices are used abundantly, which not only improves the palatability of food, but also has many health-promoting properties. Eggs, poultry, milk, and milk products should be restricted.

A recent research has observed that Mediterranean diet has protective effect on the development and severity of rheumatoid arthritis. Such diet has anti-inflammatory properties that help to reduce the inflammation. A decrease in the inflammation has in turn shown to improve the condition of individuals with rheumatoid arthritis. ^{(8, 9)}

Antioxidant Rich Diet

Individuals with rheumatoid arthritis are constantly under a state oxidative stress. Oxidative stress is a state of imbalance in which there is increase in the free radicals and decrease in the detoxification of these free radicals by antioxidants. An increase in the free radicals causes damage and destruction of joints in individuals with rheumatoid arthritis. Therefore, to reduce oxidative stress, it is very important to include rich sources of antioxidants in the diet. Antioxidants protect the joints by scavenging free radicals and keeps oxidative stress at bay. ⁽¹⁰⁾

Rich sources of antioxidants include:

1. Whole grain cereals
2. Pulses, legumes, beans
3. Fresh whole fruits
4. Nuts and oilseeds
5. Green tea

Increase Your Intake of Vitamin B6

A research published in the year 2005 has shown that low levels of vitamin B6 in the blood is associated with increased disease activity and severity, increase in the joint pain and synovial burden in individuals with rheumatoid arthritis. In other words, vitamin B6 deficiency is associated with increase in the inflammation. In order to reduce inflammation and symptoms of rheumatoid arthritis, it is important to increase the intake of vitamin B6. ⁽¹¹⁾

Foods rich in vitamin B6 include:

1. Potato
2. Sweet potato
3. Banana
4. Wheat bran
5. Chickpeas
6. Pistachios
7. Sunflower seeds

Limit Your Consumption of Coffee

Research has shown a positive association between intake of coffee and rheumatoid arthritis. Individuals who drank more than 4 cups of decaffeinated coffee per day were at an increased risk of developing rheumatoid arthritis. On the other hand, individuals who drank more than 3 cups of tea per day were at a reduced risk of developing rheumatoid arthritis. ^{(12, 13)}

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