Rheumatoid arthritis: Symptoms and Diet changes

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that affects about 1% of the world’s population. The pathogenesis of the disease remains unclear. Genetic factors account for 50-60% of the risk and the rest may be related to infectious diseases, smoking, intestinal bacteria and diet [1].

The disease can cause joint pain and damage to the whole body. The joint is where two or more bones join. The ends of the bones are covered with cartilage that allows the ends of the bones to move on top of each other with very little friction. The joints are surrounded by articular membrane, which produces fluid that nourishes the cartilage and lubricates the joints. Rheumatoid arthritis occurs when the immune system does not work properly and infects the joint membrane causing inflammation. As a result of inflammation, the joint membrane becomes hyperplastic and the cartilage can corrode [2].

The disease mainly affects the fingers, knees and ankles while the damage usually occurs on both sides of the body. Thus, if one joint is affected in one of the arms or legs, the same joint will probably be affected in the other arm or leg. This is a way for doctors to differentiate between rheumatoid arthritis and other forms of arthritis, such as degenerative arthritis (osteoarthritis).

Symptoms

It is important to know the symptoms because treatments work best when the disease is diagnosed early. Rheumatoid arthritis often begins with precursor symptoms such as discomfort, easy fatigue, anorexia, muscle weakness, generalized pain and stiffness that are not clearly located in the joints. Gradually, the pathological findings of the disease are found mainly in the joints and elsewhere.

Symptoms include:

• Joint pain.
• Swelling (swelling) of joints.
• Sensitivity to the pressure of the affected joints.
• Morning stiffness, ie difficulty in joint movements as the patient gets out of bed in the morning. It can last for 30 minutes or more.
• Loss of joint function and deformities.
• They may also include: low-grade fever, loss of strength, weight loss, generalized muscle aches, and rheumatic nodules on the skin.

The symptoms are not the same for all patients and can range from mild to severe. 10-15% of patients have a severe picture and lymphadenopathy. It can affect the eyes (keratitis, conjunctivitis), the lungs (eg pleurisy), the blood (eg anemia), the kidneys, the heart and the bones (generalized osteoporosis). The course of the disease is characterized by relapses and outbreaks while more rest is needed during outbreaks and adequate sleep.

Patients fear that if they exercise, their condition will worsen, but gentle exercise improves the range of motion of a joint. Exercise also strengthens muscles and relieves the pressure exerted by the joints. Gentle yoga can help you regain strength and flexibility.

The role of nutrition

One of the most frequently asked questions by patients with rheumatoid arthritis is whether there is a special diet to relieve their symptoms. The link between diet and rheumatoid arthritis is complex because the foods that cause reactions are individualized and are therefore difficult to detect.

However, it seems that proper change in your menu can significantly reduce joint pain, swelling and other painful symptoms. A vegetarian diet that includes good fats, such as e.g. omega-3s can be a beneficial principle. On the other hand, some foods play a stimulating role in triggering the inflammatory process that is the basis of rheumatoid arthritis.

Fruit and vegetables

Fruits, vegetables and legumes can be extremely useful. A recent review showed that a vegetarian diet can relieve the symptoms that accompany rheumatoid arthritis [1].

One explanation for the benefits of a vegetarian diet is that it can prevent certain microorganisms or their toxins from entering the bloodstream – this is a way to trigger inflammation. Bowel health plays an important role in inflammatory reactions. Fiber alters the synthesis of intestinal bacteria and increases bacterial diversity, which is often lacking in patients with rheumatoid arthritis. A balanced microbiome prevents intestinal damage and inflammation [3].

Another explanation for the benefits of a vegetarian diet is its vitamins and antioxidants. Vitamins A, C and E, as well as selenium can help reduce inflammation. Berries, strawberries, spinach and artichokes are some of the foods rich in antioxidants. Flavonoids (eg tea, broccoli, grapes) can also help.

Berries are rich in quercetin and rutin, two plant compounds that are generally thought to benefit health. In a test tube study, quercetin and curcumin were found to inhibit certain inflammatory processes associated with arthritis [4]. A study of 1,005 women’s diets found that taking cross-linked vegetables such as broccoli was associated with reduced levels of inflammatory markers [5].

Fish and fish oils

The American Heart Association recommends eating fish twice a week because of its omega-3 fats. In the case of arthritis, more fish may be better as omega-3 fats are known to fight inflammation. A study of 727 postmenopausal women published in the Journal of Nutrition in 2004 found that those who consumed the highest omega-3s had lower levels of two inflammatory proteins, C-reactive protein (CRP) and interleukin-6. Good sources of omega-3 fats are salmon, tuna, sardines, herring, anchovies and scallops.

Fish is also a good source of vitamin D. Some studies have found that rheumatoid arthritis may be associated with low levels of vitamin D.

Taking 600-1,000 mg of fish oil supplements helps reduce swelling and joint pain during morning stiffness. A post-analysis of 17 studies found that taking omega-3 fat supplements reduced the intensity of joint pain, morning stiffness, the number of painful joints and the use of analgesics in patients with rheumatoid arthritis [6].

Olive oil

Two to three tablespoons daily can help fight inflammation. Olive oil contains oleocanthal, which has properties similar to non-steroidal anti-inflammatory drugs (NSAIDs). Olive oil inhibits the activity of enzymes, which have pharmacological action similar to ibuprofen [7]. Inhibition of these enzymes reduces the body’s inflammatory processes and sensitivity to pain. The best source is extra virgin olive oil.

A study that analyzed the diets of 333 participants with and without rheumatoid arthritis found that olive oil consumption was associated with a lower risk of disease.

Walnuts

Several studies confirm the role of nuts and nuts in general in an anti-inflammatory diet. A 2011 study published in the American Journal of Clinical Nutrition found that for a period of 15 years, men and women who consumed the most nuts had a 51% lower risk of dying from inflammatory disease than those who consumed the least amount.

A meta-analysis of 13 studies showed that nut consumption was associated with reduced inflammatory markers [9]. Walnuts are high in alpha-linolenic acid, an omega-3 fatty acid.

What to avoid

What you don’t eat is just as important as what you eat. Be sure to avoid processed carbs and trans fats.

A growing body of data suggests that rheumatoid arthritis may be linked to the gastrointestinal tract, at least in some people. Antigenic load and susceptibility to certain foods can contribute to both the onset and severity of the disease [10]. There is evidence that arthritic symptoms are associated with bowel disease, including celiac disease.

One study found an improvement in patients who followed a diet in which antigenic proteins were eliminated. Participants were given proteins broken down into their amino acids. This diet was equally effective with 15 mg / day of prednisolone orally for a period of 2 weeks [10]. However, the symptoms returned after she stopped. Similar benefits were not observed in patients on a peptide diet containing protein fragments of 3 to 6 amino acids. These findings suggest that certain foods may trigger symptoms because some people are sensitive to proteins that do not break down properly, such as e.g. gluten.

However, the removal from the diet of suspicious foods is individualized. As with food allergies, a food that bothers someone does not mean that it causes problems for others. Animal foods, including dairy and eggs, are particularly problematic for some patients with rheumatoid arthritis.

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References

1. Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review.
2. Synovial fibroblasts: key players in rheumatoid arthritis. Rheumatology.
3. Review article: dietary fibre–microbiota interactions.
4. The antioxidants curcumin and quercetin inhibit inflammatory processes associated with arthritis.
5. Cruciferous vegetable intake is inversely correlated with circulating levels of proinflammatory markers in women.
6. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.
7. Oleocanthal, a Phenolic Derived from Virgin Olive Oil: A Review of the Beneficial Effects on Inflammatory Disease.
8. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables?
9. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review.
10. Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone.
11. Treatment of rheumatoid arthritis with a peptide diet: a randomized, controlled trial.