Find out if you are at risk of developing RA and what you can do about it
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic auto-immune disease where our body attacks its own joints, causing pain, inflammation and damage. The most common joints affected are the small ones in the hands and feet, but it can also affect other joints as well. The eyes, lungs and heart can also be affected by RA. It is a disease that affects 1% of the world population.
Am I at risk?
Although we don’t fully understand this disease, and why it happens. There are a few risk factors that we observe.
Genetics are responsible for most of the risk of developing RA. Smokers are at a high risk of developing this disease, especially if they have a genetic predisposition.
High body mass index (BMI) can increase the risk of RA as well. In women, for every 5kg/m2 of BMI increase, the risk increases by 13%. For those with an already high BMI (>30kg/m2), there is a 26% to 47% increased risk of developing RA.
How do I calculate BMI?
To calculate your BMI, divide your current weight in kilograms by your height square meters. For example, if you are 60kg and your height is 1.60m your BMI is 60/(1.60*1.60) = 23kg/m2
Those who drink a lot of sugar-sweetened sodas seem to have a higher risk of developing RA. However, breastfeeding seems to protect against RA.
Problems beyond the joints
Having RA puts you at risk of developing other health conditions. This is because of the disease itself or as side effects of the medications. Here’s a list of the co-morbidities associated with RA:
- Cardiovascular Disease
The inflammation in the body caused by the RA increases the risk of cardiovascular disease in 50 to 70%!
Support from a dietitian is crucial to help correct any nutritional deficiencies and prevent or manage these conditions and improve the disease symptoms. Dietary changes complement the medication prescribed by your doctor.
Here are some of the strategies that your dietitian will work with you on:
Help you keep a healthy weight
The most important aspect of diet management in RA is body weight. Excessive body fat can increase systemic inflammation, leading to more symptoms and prolong suffering. It can also reduce the effectiveness of the medication. Excessive body fat will also put you at risk of cardiovascular disease and diabetes.
On the opposite spectrum, if you are losing weight unintentionally, this can be caused by the disease. Unfortunately, in this case, you are most likely losing muscle mass instead of fat and putting your health at risk.
In both cases, the dietitian will help you to keep a healthy weight, support your lean mass through a balanced diet.
Help you choose the right type of fats
To reduce the risk of cardiovascular disease, keeping your blood cholesterol levels low is crucial. The type of fat that you use for cooking and the foods that you eat can influence blood cholesterol, joint inflammation and pain. Read more on cholesterol here.
During your consult, your dietitian may advise you to favour fish over meat and have more fatty fish. Also, fish oil may help to reduce RA symptoms. Discuss with your dietitian and doctor about it.
Help you assess your vitamins and minerals needs
People with RA are at risk of having anaemia and osteoporosis. Diet plays an important role to prevent and manage these conditions.
To avoid anaemia the dietitian will help to identify if you are missing specific nutrients such as iron, vitamin B12 or even folic acid. Together, you will work on strategies to incorporate these nutrients into your diet.
Calcium and vitamin D are essential to maintain bone structure. During the consultation, the dietitian will check whether you are eating enough of these nutrients and how you can increase them, if necessary.
Avoid foods with added sugar
Sweetened beverages and desserts are known as possible triggers of RA. If these foods are part of your routine, you might benefit from reducing or even eliminating them from your diet. You will be able to work with the dietitian on strategies to reduce sugar and replace them with healthier foods.
Keep your intestinal bacteria healthy
The gut microbiome plays an important role in our immune system. People with RA have altered gut microbiome. These changes seem to increase the risk of RA and influence the severity of the disease. The dietitian will help you with a diet that promotes a healthy gut, by helping you increase the amount of fibre and prebiotics that you eat. At this stage, the use of probiotics has not been shown to be effective.
The bottom line
A healthy diet together with medication may help alleviate your symptoms, but also help manage or prevent some other disease such as cardiovascular disease. Monitor your weight, check the type of fats that you are eating, look at foods that support your red blood cells, bone and gut health. The dietitian is your best partner to help guide you to implement the right strategies.
Adam O, Beringer C, Kless T, Lemmen C, Adam A, Wiseman M, Adam P, Klimmek R and Forth W. (2003) Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. Jan;23(1):27-36.
Chodara, A.M., Wattiaux, A., Bartels, C.M. (2017) Managing cardiovascular disease risk in rheumatoid arthritis: Clinical updates and three strategic approaches. Curr Rheumatol Rep;19(3):16.
George, M. D., & Baker, J. F. (2016). The Obesity Epidemic and Consequences for Rheumatoid Arthritis Care. Current rheumatology reports, 18(1), 6.
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 2007; 129: 210-223.
Weiss G and Schett G (2013) Anaemia in inflammatory rheumatic diseases. Nature Reviews Rheumatology (9): 205-215.
National Collaborating Centre for Chronic Conditions (NCC-CC). Rheumatoid arthritis: national clinical guideline for management and treatment in adults. London: Royal College of Physicians; February 2009.
PEN nutrition (updated 2020) Rheumatoid Arthritis Practice Guidance Toolkit. Available at pennutrition.com
Rudbane A, Rahmdel S, Abdollahzadeh SM, Zare M, Bazrafshan A & Mazloomi SM (2018) The efficacy of probiotic supplementation in rheumatoid arthritis: a meta-analysis of randomized, controlled trials. Inflammopharmacology 26(1):67-76.
Wasserman, AM. (2011). Diagnosis and management of rheumatoid arthritis. Am Fam Physician.84(11):1245-52.