Professional Refresher
Rheumatoid Arthritis
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an inflammatory form of arthritis that leads to joint pain and
damage. RA is a symmetrical arthritis, occurring on both sides of the body. Deformity
often results. Severe cases of RA lead to an inability to perform numerous activities of
daily living (ADLs). RA is two to three times more common in females and usually
strikes in middle age. White blood cells move into the synovium (joint lining), and this
appears to play a role in the inflammatory process. This inflammation leads to protein
release, which cause the synovium to thicken after a prolonged period. The cartilage,
bone, tendons, and ligaments near the joint also are damaged by the proteins. This may
also affect the skin, eyes, lungs, heart, and nerves.
Causes of rheumatoid arthritis
RA is most likely caused by a combination of genetics and lifestyle choices, particularly
smoking, or by a virus or bacteria. Some research shows involvement of the endocrine
system.
Signs and symptoms
The following are signs and symptoms of RA:
▪ Joint pain, swelling, and deformity
▪ Fatigue
▪ Fever
▪ Weight loss
▪ Usually starting in the small joints of the hands, feet, wrists, and ankles
▪ Weakness
▪ Carpal tunnel syndrome
▪ In children younger than age 16, a rash made up of flat patches
Treatment
Many different medications are available for people with RA, including steroids,
salicylates, immunosuppressive drugs, aspirin, and nonsteroidal anti-inflammatory drugs
(NSAIDs). Sometimes surgery for arthroplasty (joint replacement), synovectomy
(removal of the joint lining), or apheresis of antibodies or lymphocytes is recommended.
Plaquenil®, originally used to treat malaria, is proven useful in the treatment of patients
with RA.
Exercise
Regular resistance and aerobic exercise is good for patients with RA. Swimming, water
aerobics, and walking are recommended. Patients in acute flare should avoid exercise.
Nutritional intervention
The following nutritional interventions are used with RA patients:
▪ Weight loss, if necessary, will help to relieve some of the pain
▪ Shopping for, preparing, and eating food is sometimes problematic, depending on the
severity of the disease
▪ Tempromandibular joint (TMJ) involvement may necessitate changes to the diet
consistency, as will dysphagia secondary to esophageal or pharyngeal dryness
▪ RA often leads to an increased metabolic rate; patients in active disease will require
more calories
▪ RA patients require the same amount of protein as the rest of the population, and more
if they are in an inflammatory phase of the disease
▪ Low-fat diets lead to lower serum levels of vitamin A and vitamin E, which stimulates
lipid peroxidation and eicosanoid production; this appears to aggravate RA
▪ Anorexia is common
▪ Changes to the GI mucosa may lead to digestion and absorption issues
▪ It is sometimes useful to keep a dietary record to ascertain any association between food
intake and disease flares
▪ Omega-3 fatty acids seem to decrease inflammatory responses, but interact with some
medications
▪ Some studies show that omega-6 oils from evening primrose, black currant, and borage
help to alleviate symptoms associated with RA
▪ Vitamin E decreases inflammation, with some studies showing that supplementation is
warranted
▪ Patients with RA are most often deficient in calcium, folic acid, zinc, and selenium
▪ Vitamin D appears to act as a selective immunosuppressant; further research will
determine whether this is possibly useful for the RA population
References
Dorfman L. Medical nutrition therapy for rheumatic disorders. In Mahan LK, EscottStump S. Krause’s food, nutrition, and diet therapy. 11th ed. Philadelphia, PA: WB
Saunders; 2004:1121-1126.
WebMD. Arthritis: rheumatoid arthritis basics. Available at:
http://www.webmd.com/content/article/133/118609. Accessed February 18, 2008.
Mayo Clinic. Rheumatoid arthritis. Available at:
http://www.mayoclinic.com/health/rheumatoid-arthritis/DS00020/DSECTION=1.
Accessed February 18, 2008.
Review Date 3/08
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