Rheumatoid Arthritis and Nutrition

The term Arthritis generally describes inflammation of the joints. The suffix -itis in medicine indicates inflammation. There are more than a hundred different forms of arthritis (rheumatoid, urinary, microbial, osteoarthritis, etc.) and are mainly characterized by pain and limited movement. These symptoms can be mild, e.g. morning joint stiffness, or completely restrict mobility.


Rheumatoid arthritis is an autoimmune disease in which the body attacks its joints and gradually destroys them. The joints in this case are affected symmetrically and in the long run are deformed.



Symptoms

• Pain in the joints with swelling (swelling) and redness

• Stiffness of the joints especially in the morning and after rest or immobility

• Loss of appetite

• Fever


Rheumatoid arthritis can affect other organs, such as the heart, eyes, skin, or respiratory system.


Risk factors

  • Age: Rheumatoid arthritis can occur at any age, but is more common in 35-55 year olds

  • Gender: it is more common in women

  • Smoking: is associated with both an increased risk of disease and the severity of symptoms

  • Metabolic diseases such as diabetes and metabolic syndrome

  • Deficiencies in micronutrients: vitamins (D3, K2, C), minerals (magnesium, zinc, chromium), omega 3 fats, amino acids (lysine, proline, glycine, glutamine), probiotics and antioxidants

  • Obesity

Diet

The Mediterranean diet has been shown to lower blood pressure, improve glucose metabolism, lipid and lipoprotein particle profiles, and may reduce inflammation and oxidative stress. In patients with rheumatoid arthritis (RA), the Mediterranean diet reduces pain, morning stiffness, the number of swollen joints and also improves HAQ, Disease Activity Score 28 (DAS28). Three systematic reviews reported that the Mediterranean diet reduced pain in patients with RA. In addition, the Mediterranean diet is recommended for cardiovascular diseases and osteoporosis (these are common comorbidities of RA).



Fish oil

Fish oil is rich in Ω-3 polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have been associated with decreased expression of TNF-α and interleukin-1β. These properties are similar to synthetic drugs used in RA patients such as non-steroidal anti-inflammatory drugs (NSAIDs) and TNF inhibitors. In addition, EPA and DHA can reduce inflammation.


A meta-analysis showed that the inclusion of omega-3 PUFA in doses> 2.7 g / day in the diet for> 3 months reduces NSAID consumption in patients with RA. In addition, moderate benefit for swelling and joint pain, duration of morning stiffness, pain assessment, and reduction of NSAID use.


It is important to know that high-dose Ω-3 PUFA is not recommended in patients who may be susceptible to increased bleeding (eg, warfarin patients), as it may increase blood clotting times.


Virgin olive oil

Virgin olive oil contains numerous compounds that exert powerful anti-inflammatory and antioxidant effects. The main active ingredients of olive oil include oleic acid, linolenic acid, alpha-linolenic acid and phenolic ingredients. Oleic acid is metabolized to eicosatrienic acid (omega-9 fatty acids) with similar anti-inflammatory properties as omega-3 fatty acid fish oils.


The groups of RA patients who received omega-3 fatty acids and olive oil showed a more early and marked improvement than those who did not.


According to another scientific article:

"Evidence for polyunsaturated fatty acids suggests that they produce clinical improvement and inhibitory effects against the inflammatory response. As for the Mediterranean diet, evidence shows that it reduces both pain and disease activity. In the case of olive oil, although there are not enough studies, some effects are observed such as reduction of inflammatory markers and inhibition of oxidative stress. Finally, limited and contradictory data were found on the effectiveness of antioxidants. "


Vitamin D

Vitamin D supplements could have an effect on the treatment of RA. Brohult et al. studied the effects of high doses of calciferol in patients with RA in a double-blind clinical trial. After 1 year, oral calcipherol treatment (high dose) showed a positive effect on disease activity in patients with RA


In addition, in a 3-month open trial, vitamin D supplementation with DMARDs was associated with a reduction in patient pain. No vitamin D-related side effects have been reported



Probiotics

Probiotics are living microorganisms that, when administered in sufficient quantities, offer health benefits to the host.

Current evidence suggests that probiotics may play a therapeutic role in chronic inflammatory diseases such as RA.


Obesity

Overweight and obesity were associated with higher inflammatory activity characterized by a higher number of sensitive and swollen joints. A positive correlation was found between the swollen "amount" of the joint and the body fat mass indicators evaluated. Evaluating / improving body composition should be an important part of the care routine of RA patients.


Excercise

Exercise is recommended for patients with RA. However, physical activity should have a low impact on the joints in order to avoid pain and musculoskeletal injuries.


Summary:

  • Mediterranean diet

  • Fish oil

  • Virgin olive oil

  • Probiotics

  • Vitamin D

  • Healthy Body Weight

  • Exercise


References:

  • Fernández-Llanio Comella N, Fernández Matilla M, Castellano Cuesta JA. Have complementary therapies demonstrated effectiveness in rheumatoid arthritis? Reumatol Clin. 2016 May-Jun;12(3):151-7. English, Spanish. doi: 10.1016/j.reuma.2015.10.011. Epub 2015 Dec 18. PMID: 26711840.

  • https://www.reumatologiaclinica.org/es-have-complementary-therapies-demonstrated-effectiveness-articulo-S1699258X15001862

  • González Cernadas L, Rodríguez-Romero B, Carballo-Costa L. Importancia de los aspectos nutricionales en el proceso inflamatorio de pacientes con artritis reumatoide; una revisión [Importance of nutritional treatment in the inflammatory process of rheumatoid arthritis patients; a review]. Nutr Hosp. 2014 Feb 1;29(2):237-45. Spanish. doi: 10.3305/nh.2014.29.2.7067. PMID: 24528339.

  • Alvarez-Nemegyei J, Pacheco-Pantoja E, González-Salazar M, López-Villanueva RF, May-Kim S, Martínez-Vargas L, Quintal-Gutiérrez D. Association between Overweight/Obesity and Clinical Activity in Rheumatoid Arthritis. Reumatol Clin (Engl Ed). 2020 Nov-Dec;16(6):462-467. English, Spanish. doi: 10.1016/j.reuma.2018.11.005. Epub 2018 Dec 21. PMID: 30583870.

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