Rheumatoid Arthritis (RA)

An Overview of RA

 Rheumatoid arthritis (RA) is an autoimmune disease that involves the immune system attacking the synovium, or lining, of the joints causing pain, swelling and inflammation. When the immune system attacks the synovium, joints can become tender, red and be difficult to move. A combination of genetic predisposition and environmental factors are the culprit of the development of RA. RA also effects women at a higher rate than men and is more common in older age. If left untreated, RA can cause significant destruction to joints, cartilage and even bone. Pain is most commonly felt in the wrists, hands, and feet but can also affect other joints, eyes, mouth, skin, lungs, blood vessels, blood and heart. Along with a physical examination and overview of medical history, physician may order blood work that includes specific inflammatory biomarkers. Elevated inflammatory biomarkers such as, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) are indicators of RA. In the treatment of RA, the goal is to reduce inflammation and pain to put symptoms in remission.

 Anti-Inflammatory Food Plan

The diet plays an important role in the management of RA and other inflammatory disorders. Incorporating anti-inflammatory and antioxidant rich foods, beverages, herbs and spices can benefit the immune system while also reducing oxidative stress within the body and limiting symptom expression. The following food pyramid was created to provide people with easy-to-use information to follow anti-inflammatory dietary recommendations.

The flags at the top of the pyramid represent extra supports for those with RA. The green flag represents supplementation with beneficial dietary supplements of vitamin D, omega-3s (fish oil), and antioxidants. The red flag indicates limiting or avoiding excess salt and added sugar.

Beneficial Dietary Supplements

• Vitamin D3

  Vitamin D is a fat-soluble vitamin that is important for many physiological processes. Vitamin D has immune-modulating properties and is related to the pathogenesis of different diseases/disorders including autoimmune disorders. Vitamin D deficiency is often common in people with RA, and is inversely related to disease activity. This means that the lower the vitamin D level, the more frequent or harsher the symptoms present and feel. Supplementing with vitamin D3 is beneficial in reducing pain related to rheumatic disorders as well as supporting bone health that is often diminished with long term use of corticosteroids commonly used for pain management.

• EPA/DHA Fish Oil

  Fish oil supplements contain omega-3 polyunsaturated fatty acids (PUFAs). Higher consumption of omega-3s have been associated with a lower risk of developing RA. Omega-3 fatty acids are considered anti-inflammatory and reduce overall inflammation in the body. Omega-6 fatty acids, which are commonly consumed in the standard American diet, are pro-inflammatory and increase overall inflammation in the body. While both omega-3s and omega-6s are necessary for strong immune function, it is important that they are balanced. Those experiencing symptoms of chronic inflammation would benefit from omega-3 supplementation with fish oil to increase the anti-inflammatory response and improve symptoms.

Self-Management with RA

There are many lifestyle modifications that you can implement to reduce symptoms of RA. Along with following an anti-inflammatory diet you can also improve symptoms over time by improving overall health through controllable lifestyle factors including:

1. Smoking – smoking and tobacco use increases the risk of developing RA and worsens symptoms. Smoking cessation would not only improve overall health but reduce overall inflammation and improve joint pain related to RA.

2. Alcohol Consumption – consuming alcohol in moderation may or may not improve RA pain. Alcohol is pro-inflammatory and will not improve overall inflammation. Consuming large amounts of alcohol daily/weekly can worsen RA pain. However, some people can consume alcohol in moderation, such as one 5oz. glass of red wine.

3. Body Mass Index (BMI) – maintaining a normal BMI of 18.5-24.9kg/m2 is effective in managing overall inflammation. Elevated BMI and obesity are associated with worsened RA pain and symptoms.

4. Physical Activity – it is true that movement is medicine! Moving your body helps prevent joint stiffness and supports joint mobility over time, while also supporting a healthy body weight.

Other Healthcare Professionals

It is important to have a team of healthcare professionals to help you manage RA and reduce symptoms of joint pain and stiffness. Along with a nutritionist and rheumatologist, working with an acupuncturist can be beneficial. Acupuncture can provide pain relief and help regulate the immune system.  Research has shown that complementary acupuncture therapy along with disease-modifying anti-rheumatic drugs (DMARDs) are highly effective in reducing joint pain and inflammatory biomarkers including CRP and ESR.

Conclusion

In conclusion, RA is a chronic autoimmune disease that can diminish a person’s quality of life when left untreated. Working to reduce inflammation in early stages of RA can prevent organ damage and debilitating joint pain. Adopting an anti-inflammatory dietary pattern along with beneficial supplementation of vitamin D3 and fish oil supplements can reduce overall inflammation in the body. Other self-care strategies of increasing daily movement, reducing stress and smoking cessation will also be beneficial to reduce pain associated with RA.

References

1. Image. Gizem Nikomedi. Unsplash License. https://unsplash.com/photos/the-word-war-spelled-out-of-pills-on-a-blue-background-oOW6Iju06T0

2. Rheumatoid Arthritis: Causes, Symptoms, Treatments and More. Arthritis Foundation. https://www.arthritis.org/diseases/rheumatoid-arthritis. Accessed December 1, 2024.

3. Chauhan K, Jandu JS, Brent LH, & Al-Dhahir MA. Rheumatoid Arthritis. StatPearls [Internet]. StatPearls Publishing. May 25, 2023. Accessed December 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK441999/

4. Rakel, D. Integrative Medicine. 5th ed. Elsevier; 2023.

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6. Athanassiou L, Kostoglou-Athanassiou I, Koutsilieris M, Shoenfeld Y. Vitamin D and Autoimmune Rheumatic Diseases. Biomolecules. 2023;13(4):709. Published 2023 Apr 21. doi:10.3390/biom13040709

7. Marchand NE, Choi MY, Oakes EG, et al. Over-the-counter fish oil supplementation and pro-resolving and pro-inflammatory lipid mediators in rheumatoid arthritis. Prostaglandins Leukot Essent Fatty Acids. 2023;190:102542. doi:10.1016/j.plefa.2023.102542

8. Zhang J, Fang XY, Leng R, et al. Metabolic Signature of Healthy Lifestyle and Risk of Rheumatoid Arthritis: Observational and Mendelian Randomization Study. Am J Clin Nutr. 2023;118(1):183-193. doi:10.1016/j.ajcnut.2023.04.034

9. Wan R, Fan Y, Zhao A, et al. Comparison of Efficacy of Acupuncture-Related Therapy in the Treatment of Rheumatoid Arthritis: A Network Meta-Analysis of Randomized Controlled Trials. Front Immunol. 2022;13:829409. Published 2022 Mar 7. doi:10.3389/fimmu.2022.829409