Dietary rules for rheumatoid arthritis - healthy and prohibited foods

General description of the disease

This is a disease that is associated with simultaneous or sequential inflammation of a group of joints. It is classified as a chronic disease. Polyarthritis also entails the destruction of the synoval membrane, which envelops the joint. This is accompanied by deformation and pain.

Causes of polyarthritis

There can be a huge number of reasons for the occurrence of polyarthritis. From infections to heredity. Let's look at the most common ones.

• hepatitis viruses (especially B);
• piggy;
• rubella;
• Epstein-Barr virus (a herpes virus associated with fever, swollen lymph nodes in the neck, sore throat, and sometimes swelling of the spleen);
• HIV (attacks the immune system and may increase the risk of developing polyarthritis);
• parvovirus infection;
• Wilson's disease (a rare inherited disease that prevents the liver from filtering excess copper from the body, resulting in copper buildup in the liver, eyes, brain and other organs);
• amyloidosis (a rare accumulation of a protein produced in the bone marrow that affects the heart, spleen, kidneys, liver, digestive and nervous systems);
• gout (high levels of uric acid in the blood);
• Lyme disease;
• tuberculosis;
• vasculitis (a disease in which the immune system attacks blood vessels);
• a thyroid disorder such as hypothyroidism or hyperthyroidism;
• oncological diseases;
• ENT diseases, for example, such as chronic tonsillitis[4].

Symptoms of polyarthritis

Symptoms of the disease may develop slowly and not be felt for months. Or it may appear spontaneously and unexpectedly for the patient. As a rule, polyarthritis makes itself felt through pain in the joints, stiffness during movement, and swelling of the joints. Other symptoms often develop, for example, severe weakness, sweating, fever - within 38 degrees, lack of appetite, sudden weight loss, redness of the affected area, rash.

Types of polyarthritis

There are many types of arthritis. It is worth noting that there is monoarthritis, localized in one specific joint, as well as polyarthritis, which became the topic of this article, and is characterized by inflammatory foci simultaneously in several parts of the body. There are many types of polyarthritis, we will look at the most common of them.

• Juvenile idiopathic arthritis is a type of disease that is common in children. It can develop from early childhood until late adolescence. Characteristic features include painful swelling in small and large joints from the ankles and wrists to the hips and knees. Doctors are not always able to determine what caused the development of this type of arthritis. However, with correct and timely treatment, the patient’s condition improves significantly.
• Lupus is an autoimmune disease caused by a person's own immune system attacking various organs and cells in the body. The result is damage and dysfunction of these cells and organs. In addition to directly affecting a person's joints, this type of arthritis can also affect the skin, connective tissues, nervous system, and kidneys. Most often it occurs in women aged 20 to 40 years. A characteristic feature is a red rash on the face, cheeks and nose.
• Psoriatic arthritis , as the name suggests, occurs in people suffering from psoriasis. However, in some cases, arthritis develops first, and then psoriasis. Characteristic symptoms include swollen fingers and toes, as well as the presence of a scaly red rash on the body[1].
• Fibromyalgia is a form of arthritis characterized by long-term and widespread pain in the ligaments, muscles and tendons. Fatigue and sleep disturbances are common symptoms of fibromyalgia. Typically, this form of arthritis is called a syndrome because it involves a collection of symptoms and signs that occur together without a known cause. Although classified under arthritis, fibromyalgia is not actually a form of arthritis in the classical sense due to the lack of inflammation or damage to joints, muscles, or other tissues.
• Infectious arthritis (septic) - provoked by bacteria, less often viruses or fungi. The infection can spread from nearby infected tissue through the bloodstream and eventually infect the joint[2].
• Allergic is a form of polyarthritis that develops as a result of an allergen entering the body (usually in the form of a vaccine). Has symptoms that are similar to an allergic reaction.
• Metabolic - appears due to a violation of metabolic processes, and as a result, salt crystals begin to be deposited on the joints. It can have acute and chronic forms.

Complications of polyarthritis

If polyarthritis is not promptly controlled and treated, it can negatively affect the functioning of other organs and systems of the body.

• Lungs : A scar in the lungs can cause complications such as shortness of breath and chronic cough.
• Skin : Rash or scars developing under the skin.
• Heart : The lining around the heart can become inflamed, causing chest pain. The risk of heart attack or stroke also increases.
• Eyes : With polyarthritis, the thin membrane covering the whites of the eyes or the entire eyeball may become inflamed. Sometimes this leads to loss of vision.

Prevention of polyarthritis

There are more than 100 types of arthritis, and, unfortunately, the disease is not always preventable. But there are a number of healthy habits that you can develop to significantly reduce your risk of developing this disease.

1. 1 Eat fatty fish (salmon, mackerel, sardines, trout) regularly. It contains polyunsaturated fatty acids, which help reduce inflammation in the body. Research shows that women who regularly eat fish are less likely to develop rheumatoid arthritis.
2. 2 Control your weight. Excess weight puts more stress on your joints, especially your knees. People who are overweight are almost four times more likely to develop knee osteoarthritis.
3. 3 Play sports. Moderate physical activity not only helps you lose weight, but also strengthens the muscles around your joints. This stabilizes them and protects them from additional wear. Swimming, walking, aerobics, and stretching are excellent types of exercise for preventing polyarthritis.
4. 4 Avoid injury. Joints wear out over time; this is a natural process in the body. But additional injuries cause faster wear and tear and make joints more vulnerable. When playing sports, use high-quality shoes, uniforms, and special equipment, if provided.
5. 5 Get regular check-ups with your doctor. Do not delay your visit if you have signs of illness. Remember that it progresses quite quickly, so it is important to keep your health under control[6].

Risk factors

Risk factors for polyarthritis are of two types: those that a person can influence and those that are irreversible. The first category includes the following:

• Lifestyle : Smoking, drinking alcohol and caffeine can make a person more vulnerable to factors that trigger the development of polyarthritis.
• Childhood experiences , for example, if a child grows up in an environment with smoking parents or in unfavorable conditions, this can also make him vulnerable later in life.

Factors that cannot be influenced:

• Age : People become more likely to develop polyarthritis as they age.
• Gender : the frequency of diagnosis of cases of polyarthritis in women is higher than in men.
• Heredity : Specific genes can make a person more likely to develop polyarthritis[1].

Treatment of polyarthritis in official medicine

Polyarthritis is a disease that is difficult to diagnose due to the fact that it can be caused by a large number of factors and have a number of other symptoms in addition to joint pain. Here are a number of alarming signs, if you notice them you should definitely consult a doctor:

• Joint pain that makes daily activities difficult.
• Redness in the joint area, as well as an increase in body temperature in a certain part of the body. For example, if you notice that your knee is reddish and warmer than the rest of your body, you should definitely consult a doctor.
• Swelling in the joints, stiffness.

The doctor will do a variety of tests, including blood tests that may look for evidence of viral infections, or for a marker called rheumatoid factor (RF). RF is a protein that can attack healthy tissue in the body[1].

There are a number of criteria that help determine which type of treatment is advisable to choose.

• number of affected joints;
• the presence of inflammation in the joints;
• main symptoms other than joint pain.

Medical treatment may include drugs that will prevent further damage to the joints and help keep them active. Analgesics and anti-inflammatory steroid drugs are also often prescribed, which have a quick effect and relieve pain. Here are the groups of drugs that are prescribed for polyarthritis:

1. 1 Non-steroidal anti-inflammatory drugs - reduce inflammation, help cope with moderate pain, but have a number of side effects and negatively affect the gastric mucosa. Therefore, along with them, protective drugs are also prescribed that will prevent damage to the stomach.
2. 2 Corticosteroids – reduce inflammation. Because many of the diseases that cause polyarthritis are associated with autoimmune diseases, corticosteroids also suppress the immune response that accompanies autoimmune diseases.
3. 3 Disease-modifying antirheumatic drugs are a broad group of drugs that are designed not only to relieve inflammation and reduce pain, but also to slow down and modify the progression of the disease, softening the lesions that it can provoke[5].

It is also suggested that the symptoms of polyarthritis can be minimized by making lifestyle changes. If the patient is also overweight, losing weight will help reduce pressure on the joints, and thereby reduce pain. It is also important to switch to a healthy diet and enrich your diet with healthy foods, a list of which is given in the corresponding section of the article.

Moderate physical activity, such as swimming, will also be beneficial. It does not greatly deplete the body, but at the same time helps to use all major muscle groups at the same time[4].

Symptoms of polyarthritis

Main manifestations of PA:

• swelling of the joints;
• pain and stiffness of movement;
• skin redness;
• the tissues over the joints are hotter than the surrounding tissues;
• in the acute period, increased body temperature, fever.

Inflammation of joints of different origins is characterized by its own localization of the lesion. Most often, small joints (hands, fingers and toes) become inflamed; later, larger joints are involved in the process.

Types of polyarthritis

Depending on the duration of the course, acute and chronic PA are distinguished.

Depending on the causes, the disease is divided into:

• rheumatoid
  ー caused by the appearance of antibodies to one’s own joint tissues, often accompanied by damage to the heart, kidneys, blood vessels and nervous system (characterized by symmetrical inflammation of the small joints of the arms and legs);
• reactive polyarthritis
  ー develops as a result of a bacterial or viral infection, caused by increased reactivity of the immune system (symptoms typically appear 2-4 weeks after an infectious disease, the lower extremities are more often affected);
• crystalline
  ー caused by the deposition of calcium salts, uric acid, affects the joints of the fingers, knees, ankles;
• psoriatic
  ー is accompanied by characteristic skin lesions (the joints are not symmetrically inflamed, the course is chronically recurrent);
• infectious specific
  ー caused by the penetration of microorganisms into the joint (syphilitic, gonorrheal, tuberculosis, brucellosis).

Gluten-free diet

Abstaining from foods containing a special grain protein - gluten, is recommended for people with cyalkia (individual gluten intolerance). The development of this pathology against the background of autoimmune arthritis was noted.

However, a study by nutritionists and arthrologists conducted between two groups of 66 patients suffering from rheumatoid joint inflammation proved a direct link between the effect of gluten on the symptoms of arthritis. It is worth noting that these patients did not have any signs of cyalkia. According to this study, patients on a gluten-free diet showed increased activity of antibodies that reduce inflammation.

A gluten-free diet for exacerbation of rheumatoid arthritis allows you to include the following foods in your diet:

• boiled eggs, omelettes;
• boiled lean meat and fish;
• baked goods made from soy and bean flour;
• rice and buckwheat porridge;
• rice cakes;
• vegetable soups and salads;
• low-fat kefir and cottage cheese;
• baked apples;
• fruits;
• rosehip drink.

In addition to grain products, you need to exclude products containing yeast, malt sugar, pasta, sauces, mayonnaise, and processed foods. When buying tea, instant coffee, kefir and other food products, you must carefully study the composition for gluten content.

Reviews and results

Reviews from most patients with rheumatoid polyarthritis indicate that diet is the most important component of the treatment process and can reduce the clinical manifestations of the disease and accelerate the attenuation of the acute process.

• “... I recently went to the hospital about joint pain. After the examination, a diagnosis was made: rheumatoid seronegative arthritis, early stage, activity II, non-erosive (X-ray stage I), ACCP (+), FC I. They prescribed many medications and dietary Table No. 10. I had to completely change my approach to nutrition and introduce many restrictions. Fortunately, I can cook myself, so my food’s taste hasn’t suffered much. The only drawback is the limitation of salt, but I try to use garden greens, which conceals the lack of salt. In general, I started to feel better”;
• “... I have been suffering from rheumatoid arthritis for more than 12 years. Every time during an exacerbation I go on a strict diet. I think that the diet helps me a lot, in addition, I practice traditional methods of treatment.”

Vegetarian diet

A plant-based diet is also effective in reducing symptoms of arthritis flare-ups. This effect is achieved by avoiding animal fats and proteins, and switching to foods rich in complex carbohydrates and fiber.

It is worth noting that raw plant foods are a source of many vitamins, including groups B, C and P, necessary for the production of the anti-inflammatory hormone cortisol.

Sometimes the menu includes eggs and lean fish rich in Omega-3 acid, calcium and vitamin D. This helps strengthen joints and prevent their destruction.

A plant-based diet is effective for those who need to lose weight to relieve pressure on their joints.

Vegetarian raw and mono diets can reduce inflammation in rheumatoid arthritis, but it is not recommended to adhere to them constantly. It is better to resort to such nutrition on fasting days.

Diets during remission

During periods of remission, strict restrictions can be lifted. However, you should eat prohibited foods no more than several times a week in limited portions.

The following products can be added to the menu during remission of rheumatoid arthritis:

• bread made from rye flour;
• beef, veal and pork in small portions;
• offal;
• coffee, tea, freshly squeezed juices, compotes;
• pasta;
• nuts;
• boiled potatoes.

What do doctors recommend?

Therapeutic diet No. 10 or the Dong diet involves reducing calories (the patient should consume no more than 1800 kcal per day) and completely eliminating red meat. Fast (simple) carbohydrates are removed from the diet as much as possible, the amount of protein is also reduced (but not less than 90 g per day), because in a certain percentage of patients it causes an exacerbation of the condition, the amount of fats, especially animals, is reduced (in total no more than 70 g per day) .

In fact, the Dong diet suggests that for 10 days the patient will eat rice and stewed vegetables with a small addition of chicken or turkey. Not everyone is able to withstand such a meager menu, but to relieve the pain syndrome you will have to make every effort and not break down. In the future, the diet is expanded to include fish meat, rabbit meat, and eggs.

On a note. For rheumatoid arthritis, meals are split - 6 times a day, or more often. The main thing is not to go overboard in calories. If the patient is overweight, such a diet will help get rid of several kilograms without much effort - it is no coincidence that doctors recommend it to obese patients.

The effect of drug therapy for RA on the body

Traditional treatment of rheumatoid arthritis of both types (seropositive and seronegative), in addition to basic drugs that have a delayed effect (at the choice of a rheumatologist, gold drugs, cytostatics, antimalarials, sulfonamides, D-penicillamine), includes painkillers and hormonal drugs, which have many side effects. Proper nutrition is aimed at minimizing the harm caused by medications. On the other hand, the task of a nutritionist when selecting a menu is to ensure that the patient receives the maximum of nutrients and to exclude foods that cause an exacerbation of the pathology (more on this below).

Groups of auxiliary drugs and their effect on the body of a patient with rheumatoid arthritis:

• non-steroidal anti-inflammatory drugs (NSAIDs);
• corticosteroids.

On the left is a stomach ulcer due to long-term use of NSAIDs, on the right is bone loss (osteoporosis) due to long-term hormonal therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Medicines in this group have a negative effect on the mucous membrane of the stomach and intestines, provoking an exacerbation of the patient’s existing gastritis, stomach or duodenal ulcers, or causing their appearance with long-term use. The diet of a patient with RA should include foods (meals) that would protect the gastrointestinal tract from such aggressive effects.

Corticosteroids

Hormonal drugs have a destructive effect on most organs and systems of the human body, especially with long-term use. However, if the patient’s arthritis activity is off the charts, such remedies cannot be avoided. In such a situation, proper and balanced nutrition comes first, helping in a number of cases (increased blood sugar levels, increased blood pressure, irritation of the gastric mucosa up to the appearance of ulcers, increased blood viscosity and increased risk of blood clots, decreased bone density) to minimize the negative impact of treatment.

On a note. Banana is a fruit that can replace most antacids (neutralize the effect of gastric juice). In addition, it contains a lot of potassium and carotene, which is good for the heart, which often suffers from rheumatoid arthritis, as well as other vitamins, macro- and microelements. A couple of bananas a day can, in a fairly short time, regulate blood pressure and sugar levels, improve mood and have a beneficial effect on the stomach. However, if the prothrombin index is high, eating them is not recommended.

Authorized Products

The diet for rheumatoid polyarthritis includes the inclusion of vegetarian soups with the addition of cereals and vegetables. For second courses, dietary poultry (turkey, chicken) and rabbit meat, lean varieties of red meat boiled or baked in the oven are used.

Both sea and river fish are allowed, mostly lean ones. Eating porridge is permitted both as a side dish and as an independent dish. Fats are introduced into the diet in the form of unsalted butter and various vegetable oils (linseed, olive, sunflower). Dried white bread and crackers are allowed. Chicken eggs can be used in the form of a steamed protein omelet. The diet should include low-fat fermented milk products, cottage cheese and dishes made from it, skim milk, unsalted/mild varieties of cheese.

The volume and range of vegetables/fruits should be increased. They can be consumed raw (vinaigrette/salads), seasoned with vegetable oil, or boiled/stewed. As a dessert, you can use marshmallows, marshmallows, jam, marmalade. Drinks include freshly prepared vegetable/fruit juices, weak green tea, compotes, fruit drinks, decoctions of bran, rose hips, chicory, slightly mineralized non-carbonated alkaline waters.

Table of permitted products

General information about polyarthritis

Inflammation of the joints can develop as a result of infection of joint tissue, trauma, or autoimmune damage. The acute form of the disease responds well to treatment, but as the process becomes chronic, irreversible degenerative changes in the cartilage tissue develop. PA is treated by therapists, orthopedic traumatologists, and rheumatologists, depending on the cause of the disease.