Rheumatoid arthritis (RA) is a long-term inflammatory condition that causes pain, swelling and stiffness in the joints. The hands, wrists and feet are commonly affected, but any joint can be affected.
RA is an autoimmune condition that occurs when the body’s immune system, which normally fights infection, starts attacking healthy joints. Sometimes symptoms can suddenly get worse, causing severe pain and making daily life difficult.
RA is associated with a number of complications and comorbidities (conditions that often occur alongside another condition) such as an increased risk of cardiovascular disease and osteoporosis (a condition that weakens the bones).
Rheumatoid arthritis is less common than osteoarthritis, there is no permanent cure and it can have a significant personal impact on people with the disease and their families. However, early treatment can help control the disease and help people continue to live active and fulfilling lives. Medical management with drug therapy aims to reduce pain and stiffness while supporting mobility.
What is the diet to manage rheumatoid arthritis?
People with RA often use dietary changes to try to improve their symptoms. The most common diets that people with RA try are those that may have anti-inflammatory benefits or increase antioxidant levels (see the section on antioxidants below). Other dietary strategies focus on cutting out foods or food groups that may be considered to be the cause of symptoms.
For people with RA, it is important to be aware of the dietary advice that has evidence of benefit and that has limited evidence, as well as being aware that some of the suggested alternative diets may affect nutrient intake.
Food elimination
People with RA often believe that certain foods or ingredients have adverse effects and that food allergies/intolerances can cause or worsen inflammation.
A number of reviews have evaluated the effectiveness of a range of interventions that restrict certain foods to treat RA and manage its side effects.
However, there is little research in this area and the results are mixed. It is uncertain whether any of these dietary strategies can improve pain, stiffness, and mobility. Some individuals or small groups may improve if they cut out certain foods, but many others do not. Furthermore, some of these diets can be difficult to adhere to, and people may lose weight when they do not need to or plan to.
There is no test that can determine whether a person with RA would benefit from dietary changes, although offending foods can be identified through an elimination programme under the supervision of a dietitian.
Fasting has been reported to reduce pain and inflammation in some people with RA. It is recognised that inflammation is reduced by fasting, but this effect is short-term and may also be a result of weight loss. Symptoms return when a normal diet is resumed and fasting can pose health risks, so is not recommended.
Authorities do not generally recommend cutting out important food groups as this may increase the risk of nutritional deficiencies.
Milk and dairy products
There is some suggestion that dairy products are associated with inflammation, but the evidence is conflicting and limited due to small trials.
Studies of milk and dairy products generally show neutral or even beneficial effects on levels of inflammatory markers and do not indicate adverse inflammatory effects.
It is difficult to establish specific dietary guidelines for people with RA because of individual differences. However, since dairy products can play an important role in a healthy, balanced diet, based on the available data, there is no evidence to support the exclusion of dairy products unless there is an intolerance or allergy. If you think you may have an adverse reaction to milk and dairy products, talk to your GP or a health professional involved in your care such as a specialist nurse.
The nightshade plant family
Aubergines, peppers, tomatoes, potatoes and goji berries are all members of the nightshade family. Some people believe that solanine, one of the alkaloids (naturally produced compounds in various plants), contributes to inflammation and pain in arthritis. However, the connection between arthritis and nightshades is largely considered anecdotal. There is a lack of any clinical human studies and so currently there is no scientific evidence that nightshade vegetables make arthritis symptoms worse. It is also worth noting that solanine is also found in blueberries, apples, cherries, okra and artichokes, none of which is in the nightshade family and not included in anecdotal reports of adverse effects.
The fruit and vegetables that contain solanine are rich in nutrients and antioxidants. However, if you think you may have an adverse reaction to vegetables like potatoes, tomatoes and peppers then talk to your GP or a health professional.
