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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:-
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:
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.
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.
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.