Although most experts are not yet ready to endorse major changes in diet, they are cautiously acknowledging that certain foods may affect painful joint inflammation, the hallmark of this chronic and sometimes crippling disease.
Does diet have any effect on rheumatoid arthritis? Not long ago, the leading rheumatology textbooks confidently dismissed the notion - if they considered it at all. However, thanks to medical scientists who have been researching the subject over the past decade, the textbooks are being revised.
Rheumatoid arthritis (RA) is an autoimmune disorder - a disease in which the immune system attacks the body's own tissues. The main target of this inflammatory assault is the synovium (the membrane lining the fibrous capsule that encloses a joint). The disease is unpredictable in that the frequency of episodes, the number of joints affected, and the severity of symptoms vary considerably from person to person.
Most people with RA have painfully tender joints - their fingers, wrists, knees, or feet may be stiff in the morning or after long periods of inactivity. Some patients find that they tire easily and feel vaguely ill.
Drug therapies for RA include high doses of aspirin or other nonsteroidal anti-inflammatory drugs, which reduce the inflammation and ease joint pain. Patients whose symptoms fail to respond sufficiently to these medications may be switched to more powerful agents. But these drugs have side effects, which makes the notion of using diet to reduce RA's discomforts more appealing.
There are two valid ideas about how a person's diet might trigger or worsen symptoms. One scenario is that specific foods may provoke an allergic response that causes or worsens symptoms. A second possibility is that dietary factors act indirectly by influencing the immune system and altering the inflammatory response. Scientists are still exploring both of these prospects.
Research on the connection between diet and RA was inspired in part by the observation that patients who temporarily stopped eating felt better. Some studies have shown that after fasting for a few days, people with RA have substantially less pain, stiffness, and swelling, and require less medication.
Some scientists maintain that this happens because fasting changes levels of polyunsaturated fatty acids in cell membranes. These fatty acids influence the behavior of cells and may be metabolized into substances involved in inflammation.
Other researchers hold that short-term fasting helps people with RA because possible allergy-provoking chemicals from digested foods are not getting into the bloodstream.
Other scientists have suggested particular foods are the culprits and not food in general. Affected people are variously said to have "allergic arthritis" or a food insensitivity or intolerance.
Many people with RA are convinced that eating certain foods aggravates their symptoms, but this connection evaporates when investigated under controlled conditions.
Research on how dietary fats affect inflammation is expected to have far greater impact on most people with RA than investigations that focus on food allergies. Studies indicate that omega-3 polyunsaturated fatty acids (found primarily in cold-water fish such as trout and salmon), in doses of 2.5 to 3.0 grams per day, can bring about a modest reduction in symptoms for some people with RA. Such research suggests that this may be due to the capacity of omega-3 fatty acids to dampen the body's inflammatory and immune responses. In addition, oral administration of collagen from articular cartilage has been helpful to some patients.
Arthritis specialists generally agree that the link between food and arthritis is not yet strong enough to support making dramatic dietary changes. Most people with RA would do well to stick with the advice from the American College of Rheumatology: "Until more data is available, patients should continue to follow balanced and healthy diets."
Ask your physician for additional advice and guidance.
Can you recommend a nutritionist that specializes in diet and arthritis?
Should an allergist be consulted?
How long should a food be avoided to see if that food increases the symptoms?
Are there any experimental studies or research on diet in the area?
Can you provide a list of foods that are most likely to affect arthritis?
